Mental Health - Commissioning and Parity of Esteem

Margi Butler

Head of Commissioning – Mental Heath, Learning Disability & Dementia

What you’ve asked me to cover:

• What is commissioning?• Investment in MH services in Warrington• The services that are commissioned• Where does MH fit in the bigger picture of overall

health?• MH Commissioning Priorities and how they are

decided• How are services changing?• How can local people be involved in shaping

commissioning?

Commissioning

Commissioning is akin to a relay race, with colleagues from different disciplines, Directorates and organisations, needing to deliver on their part of the process and hand on the baton at the appropriate stage. Multidisciplinary ‘task and finish groups’ may be brought together at different points of the work.

Mental Health Problems in Warrington

Fro m b o tt o m : 1 , 2 & 4 –esti m ated n o . p eo p le b ased o n 2 0 1 3 m id -year p o p u lati o n esti m ates (O N S). 3 , 5 , 6 , 7 actu al n u m b er at a p o in t in ti m e

Adults reporting low emotional wellbeing1 in 4 (39,000 people)

1 in 16(10,300 people)

1 in 260(790 people)

1 in 6(27,300 people)

1 in3,200(75

people)

1 in 18(9,150 people)

On GP register with diagnosis of

depression (aged 18+)

Subject to

Mental Health

Act

On CPA (Care Programme

Approach )

Had suicidal thoughts at some point in their lives

Attempted suicide at

some point in their life

Suicides 1 in 10,900

(average 18 suicides per year)

NHS Warrington CCG Budget 2015/16

ACUTE54%

PRIMARY CARE14%

MENTAL HEALTH11%

COMMUNITY HEALTH SERVICES11%

CONTINUING CARE6%

OTHER4% ACUTE

PRIMARY CARE

MENTAL HEALTH

COMMUNITY HEALTH SERVICES

CONTINUING CARE

OTHER

What do we commission?

Secondary Care

5 Boroughs Partnership

• Assessment service (this is the referral route into adult mental health services)• Home treatment service (adult MH)• Recovery service (adult MH)• Adult inpatients (33 beds)• Tier 3 Child and Adolescent Mental Health (CAMHS)• A&E Liaison & Ward Liaison (pilot) – both at WHHFT• Early Intervention in Psychosis• Learning Disabilities – inpatients (2 beds) and community services• Later Life and Memory Services (LLAMS)• Older Persons Acute Inpatients (14 beds)• Aspergers assessments• ADHD• Criminal Justice Liaison Service• Operation EMBLEM (Street Triage)

  

What do we commission (Cont.)

Cheshire & Wirral Partnership• Psychiatric Intensive Care• Adult Eating Disorders Service

Primary CareMental Health Matters

• Psychological Therapies (IAPT) [Plus Military Veteran IAPT, GMW]

Making Space

• Computerised CBT

St Josephs Family Centre

• Counselling & family support

Parity Of Esteem (where does MH fit in the overall picture)

• Mental illness is the single largest cause of disability in the UK and each year about 1 in 4 people suffer from a mental health problem.

• The cost to the economy is estimated to be around £100 billion annually – roughly the cost of the entire NHS

• Physical and mental health are closely linked – people with severe and prolonged mental illness die on average 15 to 20 years earlier than other people – one of the greatest health inequalities in England

• However only around 25% of those with mental health conditions are in treatment

• Only 13% of the NHS budget goes on such treatments when mental illness accounts for almost 25% of the total burden of disease

Parity of Esteem cont. • Mental illness has a similar effect on life expectancy to smoking and

a greater effect than obesity

• Largest proportion of the disease burden in the UK (22.8%), larger than cardiovascular disease (16.2%) or cancer (15.9%)

• People with psychosis die 14-20 years earlier of untreated illness

• Schizophrenia is associated with a 3 fold increased death rate from respiratory disease and a 2 fold increased risk of obesity, diabetes, hypertension and smoking

• 59% of triple amputees can be treated to get back into employment, 7% of people with SMI get paid work

DH

WCCG Strategic Commissioning Plan – 2014-19

Striving for:• Enhanced quality of life for people with mental illness

and/or with dementia • Improved experience of healthcare for people with

mental illness • Seamless integrated services for people with mental

health problems and substance misuse across all healthcare settings

• People with mental health problems and dementia identified and their physical health needs addressed.

• Reduced premature death in people with Serious Mental Illness

• Appropriate psychological support for Military Veterans

What we are aiming for:

• Improved patient pathway • Reduction in zero length of stay in the acute setting • Reduction in readmission rates • Reduction in delayed discharges • Reduction in use of out-of-area acute beds • Reduction in number of people out-of-area • Increase in shared care arrangements • Increase in detection rates of dementia • Improved access to services • Increased awareness of mental health in primary care • Improved management of mental health in primary care • Reduction in the inappropriate use of Section 136

How do we prioritise?

• Consultation with partners eg MH Strategy workshop

• Use of evidence eg liaison, street triage• Business cases outcomes vfm

Patient Engagement

Various routes:• Health Watch• Consultation events• Responding to complaints, compliments,

comments• Specialist user fora etc

What you’ve asked me to cover:

• What is commissioning?• Investment in MH services in Warrington• The services that are commissioned• Where does MH fit in the bigger picture of overall

health? • MH Commissioning Priorities and how they are

decided• How are services changing?• How can local people be involved in shaping

commissioning?

How to Contact The CCG

The Engagement & Experience Team

Warrington CCGArpley House110 Birchwood BoulevardBirchwoodWarringtonWA3 7QH

Email: patient.experience@warringtonccg.nhs.uk

Tel: 01925 843 774