The work of the

Mental Health Five Year Forward View Taskforce

Jacqui Dyer

Vice-Chair, Mental Health Taskforce

23 September 2015

The taskAsked by Simon Stevens to address: health and wellbeing gap; care and

quality gap; finance and efficiency gap;

• Create a new five-year all age “life course” NHS England-led ‘cross-system’

strategy for mental health to 2020, with a focus on reducing inequalities

• Setting priority outcomes (across the life course), supported by measurable

objectives

• While the Taskforce remit is NHS-funded activity the Terms of Reference

enable us to name critical cross-Government interdependencies

• Bringing together lived experience, professionals and system

• Co-production of approach – this strategy belongs to everyone

• Not reinventing the wheel - plenty of evidence

• 20,000+ respondents to Rethink Mental Illness and Mind

online survey

• Five main groups:

• People with lived experience

• Families and close friends

• Mental health professionals

• Health and social care professionals

• Public

• Analysis gives indication of priorities, the biggest levers for

change and types of support people feel need the most

improvement

People’s priorities for change

People want to be treated with hope, dignity and respect.

The quality of the NHS workforce is systematically raised, with key aspects

including:

• Mental health awareness in all NHS staff, including staff skilled in

psychological support across NHS settings;

• Mental health training for GPs (particularly alternatives to medication);

• The health and wellbeing of NHS-funded staff;

• Improvement in public attitudes;

• Improved attitudes in NHS-funded staff, particularly mental health

professionals;

• Improved care planning skills; and

• Continuity of care.

Attitudes and experience is a priority

People want mental health problems to be prevented and

for intervention to be as early as possible.

Several aspects of prevention and early intervention are coming through,

including:

• Increasing awareness of what mental health is;

• Access to support for pregnant women, children and young people; and

• Principles of prevention and early intervention applied across the system.

Prevention and empowerment is a priority

People want to quickly access effective care and

treatment, when they need it

Several aspects of access have come through, including:

• A focus on effective, high-quality treatment and greater choice of treatment;

• A wide range of talking therapies, including for complex needs and access

within community/primary care;

• Reduced variation across the country;

• Reduced waiting times; and

• Reduced inequalities.

Access is a priority

People want the NHS to treat them as a whole person,

wherever they are when they present for help and whatever

their needs.

There is a very strong emphasis on integration of care and treatment across the

system, including:

• Commissioners allocating physical and mental health resource;

• Mental health having greater priority across NHS settings;

• Mental health support for people with long term physical health conditions;

• Taking physical health needs of people with mental health problems seriously;

• Integrated physical and mental healthcare for people with specific mental

health needs e.g. eating disorders, psychosis.

Integrated care and support is a priority

• Huge amount of engagement with lived experience

• Set the headline themes and plotted 15 priority outcomes

• NHSE, DH and HMT co-commissioned economic work in preparation

for the Spending Review, focusing on establishing spend and cost

baseline for reform opportunities over 5 years. Joint working across

NHS England and with OGDs (DH, DWP, Justice, NOMS, Home Office,

Education, HM Treasury).

•Utilising current spend on MH services more effectively

• Integrated care models primary/secondary/specialised, including access & waiting time standards

•Wider economic impact of mental health / ill-health on the public

purse

What have we done so far?

• Following agreement of headline themes, there was intensive

content development for strategy

• Further engagement to find the solutions to achieve outcomes!

• Working with ALBs to shape activity for delivery of the strategy

nationally

• Describing what good looks like locally (without being

prescriptive)

• Extended engagement to identify the best means and ways to

improve!

Next steps for the Taskforce were

Respondents were asked to rank ten aspects of the NHS in the order they felt have the biggest role to play in bringing about priorities for change.

There is consensus that the most important aspect of change to enable improvement is “join up” of care and support.

This has been described as:

• Integration between mental health services e.g. community and inpatient

• Integration between primary and secondary care

• Integration between physical health (acute) and mental health support

• Integration across health and social care

This was true across respondents, who ranked integration 1st out of 10.

How people think change can be achieved

across the NHS

There were several other aspects of the NHS considered essential for bringing about change

across the groups, although the rankings varied.

• Recruiting staff with particular skills, such as psychological therapies and lived experience

• Second most important lever for change for people with lived experience (17%) and

family and friends (16%)

• Third most important lever for change from both mental health professionals (16%) and other health and social care professionals (13%).

• Attitudes of mental health NHS staff was the second priority for other (non-mental health)

health and social care professionals (15%) and the third most important priority for people

with lived experience (15%) and their friends and family (15%).

• For mental health professionals, their second most important lever for change was NHS

commissioning expertise, which was a concern for 18% of respondents.

How people think change can be achieved

across the NHS

Respondents were asked to rank 14 types of mental health support in the order they feel needs the most improvement. This is the order in which types of support were ranked as Top 3.

Early intervention for mental illness (60%)

Talking therapies (37%)

Crisis support at home (27%)

Raising mental health awareness (27%)

Preventing mental health problems in wider population (25%)

Information and skills to manage own mental health (23%)

Alternatives to hospital admission e.g. Respite, crisis houses, home treatment (19%)

Access to inpatient beds (18%)

Wellbeing support in the community (17%)

The types of support people say need the most improvement

SO WHERE DO

WE WANT TO BE?

A chance in a generation to deliver change - achievable, urgent,

necessary• Our society becomes a place where there is no stigma in talking

about mental health problems and every person is confident in seeking help when they need it

• Our mental health care and support is the best in the world, and all people swiftly access effective, evidence-based treatment in respond to their need, whoever they are

• We move to the global forefront of mental health research

• Every employer in the country will promote good mental health

amongst their workforce

Clear strategic themes

Prevention• “I know how to achieve good mental health”

Access

• “I can get the right help when I need it, and my physical and mental health are valued equally”

Quality

• “I am treated with hope, dignity and respect”

Integration

System Transformation

• Reducing Inequalities: targeted approach for those with poorest access and outcomes e.g. BAME, CYP, older people; focus on CCG inequality spend

• Workforce: all NHS staff have suitable training, Health Education England embedding mental health across training, respect to the “navigator”/advocacy role

• Technology: Increased digital access to help – National Information Board and Public Health England / Greater London Authority London

• Pricing & Payment: Monitor introducing payment pilots in 16/7 to roll out in 17/8

• Data and Information: CCG Scorecard, Integration scorecard gives transparency

• Commissioning: capitation approach in Manchester, mental health vanguards, bring together specialised and local commissioning

• Individual empowerment: better information, peer support, owning care

System Transformation

• Research: support existing investments and increase proportion of spend, better understanding of biopsychosocial causes and treatments, ‘what works’ for mental health

• Population level engagement: build on success of Time to Change to tackle stigma, and Public Health England approaches to community wellbeing.

• Interdepartmental collaboration: e.g. joint unit with Department of Work & Pensions, work with Department for Education on Future in Mind, work with Ministry of Justice on clear policy for discharge from secure settings, and to reduce prison suicides

• Recovery: co-produced care plans, self-defined goals, focus on recovery pathways

• Safety: reduced suicide in inpatient settings and on discharge, and under crisis care

• Funding in Spending Review: in increased access, employment

support, secure pathway transformation, long term conditions

Mental Health Taskforce work to date

• Taskforce has met four times between April and July, 20k survey participants, engagement events especially with people from marginalised communities, 200+ written responses

• Established framework to co-produce measurable objectives & year-on-year ALB milestones

• Priority themes set (prevention/empowerment, access, quality integrated treatment/care,) for 5-year all-age ‘life course’ national strategy, working in partnership with ALBs focused on Five Year Forward View, with wider recommendations across Government.

MHTF works to date

• NHSE, DH and HMT co-commissioned economic analytical work in preparation for the Spending Review, focusing on establishing spend and cost baseline for reform opportunities over 5 years. Joint working across NHS England and with Other Government Departments (DH, DWP, Justice, NOMS, Home Office, Education, HM Treasury).

• Utilising current spend on MH services more effectively

• Integrated care models primary/secondary/specialised, including access & waiting time standards

• Wider economic impact of mental health / ill-health on the public purse

• Coordinating the content provided by Taskforce membership and experts

• Priority outcomes established

• On track for publication in autumn 2015