NHS | Presentation to [XXXX Company] | [Type Date]1

Practical strategies for physical health care

improvement: progress

Dr. Geraldine Strathdee, National Clinical Director for Mental

Health……..@DrG_NHS

Jan 27th

This talk

• The Jan 11th announcement on mental health • The 5YFV four programme implementation progress

• Transforming psychosis care: • How can you find the basic facts about your area

• What are the top tips

• What is the optimal implementation method

• What can we learn from other successful clinical areas

2

5 Year Forward view Lifespan

Building positive mental

health in individuals and

communities

through raising political & public awareness and reduced stigma

Prevention of mental ill

health

through addressing

the fundamental

causes

Improving access to Integrated

timely, effective services for the 16

mental health conditions

maximizing the potential of the

digital revolution

Transformation

of services to deliver value, better outcomes, quality & personalized Right

Care

Building a sustainable

future Of

Leaders, intelligence &

and improvement programmes

3

Being Born well Best early years

Living and working well

Growing older well Dying well

Lifespan resilience

Fundamental new insights on the outcomes &economics of mental health: 3 forms of evidence: patient narrative, scientific evidence, HM Treasury deep dives

• In England, we spend a lot of money on mental health, but we spent it on dealing with the consequences of NOT having provided prevention and early access to highly cost effective treatments

• So a lot of lives are lived in misery, children brought up in poverty, expensive institutions are full, and our communities are less wealthy and have less social capital than a different pattern of leadership & investment would enable

• There is a wealth of evidence from people, International scientific evidence, and Intelligence examples of ‘what good looks like’ to work out how to reverse this poor use of taxpayers money ………..

• There is a wealth of evidence on how to make quick wins that can transform outcomes and energize 4

The Prime Minister’s Jan 11 vision for mental health: ..focus on identifying and tackling the causes and we dramatically change the Life Chances of our citizens.....

PM’s view of the paradigm shift now from the Past dicotomy

• ‘Support, Welfare & government intervention versus free economic market creation of wealth

• “These previous approaches have one thing in common: they focus on the economics & miss tackling the social causes”

6

The Future: apply the science:

1. The first 1001 days & the neuroscience

2. Schools: Building ‘character & resilience’ not just academic success

3. Building social connections & experiences

4. ‘We know that so many of those in poverty have alcoholism & drug addiction & mental illness”

7

London and New York: international city leaders6 Guiding principles for population health

3. NHS E is introducing the world’s best Access standards for first episode Psychosis care: Using every proven implementation strategy to built in sustainability and continuous quality improvement and gathering and publishing PROMs, PREMs, CROMs

9

Right TimeRight Care NICE standards

✓ Information

✓ Physical health

✓ Medication

✓ Psychological therapies

✓ Rehabilitation & Recovery care plans for training/ employment

✓ Right carer and social network

✓ Crisis & relapse prevention

✓ Maximizing digital potential

Right OutcomesRight Team

✓ PROMs

✓ PREMs

✓ CROMs

✓ Employment

Right team - Compassionate, - Coaching, - Coproduction - Recovery focus - Multi disciplinary/ agency

Right implementation & Continuous Quality improvement

✓ Commissioning guidance

✓ Baseline national audit

✓ Workforce plans

✓ Data collection plans

✓ Accreditation networks

✓ 5 ALB & Regulation

✓ Big Data & innovation plans

Improving physical health care in mental health : what have we commissioning

High secure beds

Medium & low secure

beds

Mother & baby, eating disorder, other specialist units

Intensive rehabilitation closed unit

for complex dual diagnosis

Open rehabilitation units

Primary care

Self and social support to self manage

24/7 Assertive outreach/ community forensic team multi agency teams

Integrated perinatal mental health & maternity teamsEating disorder &other day treatment services

Rehabilitation /recovery team: multi agency teams

CMHT Community Mental health teams/ Enhanced primary care SMI with 3rd sector outreach

CQUIN for inpatients in all NHS & independent sector beds

National Audit of schizophrenia and My NHS transparent publication for all community mental health teams

Primary care & commissioning :

• QOF • Atlas of Variation • My NHS• Future

Primary care Psychosis physical checks variation The Atlas of Variation, 2015

Landmark Parity : Inclusion of mental health & psychosis into Atlas

• There are 480,000 people in England on GP QOF SMI

registers registered with a severe mental illness.

• The rate of exclusion from the registers and access to

essential physical health checks is 14.4%, ( range 4.9-

22.2%) the highest rate of exclusion from care of any

patient group in the NHS (4.4% is the average exclusion

rate, Atlas of Variation , 2015).

•  Even for those who access health checks, the quality

varies five fold, and many do not access the essential

elements of the necessary assessments and treatments.

• http://www.rightcare.nhs.uk/index.php/atlas/nhs-atlas-of-variation-

in-healthcare-2015/

11

Primary care physical health : Its essential that the annual checks include the Right Care lifesaving assessments

NHS | Presentation to [XXXX Company] | [Type Date]12

Every LA & CCG commissioner & HWB Boards can find information on their -Local levels of need, access, high risk groups to prioritise, quality, outcomes & spend on primary care, specialist services, social care -The level of premature mortality -Rates of life saving assessment and treatment for primary care & MHT care

Mental health

intelligence Network Fingertips data by

LA & CCG

Publication of ‘easy to see’ levels of physical care by CCG & LA

MyNHS GP practices & MHT community services

2014 & 2015

Commissioners & clinical provider managers : find out your areas’ levels of premature mortality and standards benchmark for your primary care & specialist MHT services

Quality Watch: New study finds dramatic new findings It is very expensive to NOT provide physical health care for ppl with psychoses

• People with mental ill health use more emergency care than people without mental ill health.

• In 2013/14, they had 3.2 times more A&E attendances and 4.9 times more emergency inpatient admissions.

• Only a small part of the emergency care used by people with mental ill health was directly for mental health needs. In 2013/14, only one fifth of emergency inpatient activity for those with mental ill health was to directly support their mental health.

• • Deprivation is strongly associated with emergency care use. In 2013/14, the most deprived people with mental ill health visited A&E 1.8 times more than the least deprived and had 1.5 times more emergency inpatient admissions.

• People with mental ill health had 3.6 times more potentially preventable emergency admissions than those without mental ill health in 2013/14.

• For some common inpatient procedures, people with mental ill health were more likely to have an emergency rather than a planned admission, stay longer in hospital or be admitted overnight.

• • The high levels of emergency care use by people with mental ill health indicate that they are not having their care well managed and suggest that there are opportunities for planned care (inside and outside of the hospital) to do more. These people are well known to the healthcare system and are having many health encounters. All of these encounters represent opportunities to identify and support their physical health needs

14

http://www.qualitywatch.org.uk/blog/why-do-people-mental-ill-health-die-younger-%E2%80%93-and-what-can-we-do-about-it

Good practice support tools provided & …new QI website about to launch

Working closely with Royal Colleges & Health Education England & NHS Confed and NHS Providers to secure workforce undergraduate and post graduate training & in examinations in physical health & mental health

Encouraging medicines management to ensure the effects and side effects of psychotropic medications are routinely monitored and addressed.

Developing advice from successful best practice schemes about how to educate staff and patients to achieve smoke free inpatient settings and stop smoking.

15

Board to Floor commitment

Programme management

Clinical team Dashboard

Workforce skillmix & Training

Smoke FreeCommissioning

Evaluation

Smoke Free Trusts & Active Smoking Cessation Programmes

Primary care & specialist Masterclassses & Inter-professional Education & Training. Establishing communities of practice

Digitally mature I.T systems eg Bradford Tool & NTW Rio tool so every team can monitor progress continually

Expert project managers with a PID (project implementation document agreed with clinical commissioners )

Board-floor commitment & accountability: quarterly reports

Work with NICE & others for Rigorous Evaluation of Implemented Interventions

MH Intelligence network data for your CCG & CCG GP national leadership programme, assurance tools, CQUIN, time for stroke strategy

Practical Tips to fast track Implementation of better physical care

Employment of physical healthcare specialists in teams: GPs, practice nurses,

Board to Floor commitment

Programme management

Clinical team Dashboard

Workforce skillmix & Training

Smoke FreeCommissioning

Evaluation

Smoke Free Trusts & Active Smoking Cessation Programmes

Primary care & specialist Masterclassses & Inter-professional Education & Training. Establishing communities of practice

Digitally mature I.T systems eg Bradford Tool & NTW Rio tool so every team can monitor progress continually

Expert project managers with a PID (project implementation document agreed with clinical commissioners )

Board-floor commitment & accountability: quarterly reports

Work with NICE & others for Rigorous Evaluation of Implemented Interventions

MH Intelligence network data for your CCG & CCG GP national leadership programme, assurance tools, CQUIN, time for stroke strategy

Practical Tips to fast track Implementation of better physical care

Employment of physical healthcare specialists in teams: GPs, practice nurses,

England is becoming a world leader with our progress in MH Digital but there is a major priority to get the basics right

19

Electronic care recordsSafer, quicker, 21st century

✓ Interoperability• Primary, MHT, acute, community

social care, SU

✓Functionality• E prescribing, monitoring

reminders, GASS

• On line diagnostics order & see results

• Clinician decision support templates e.g.Bradford, lithium

• Skyp/ tele consultations

• Text reminders

• On line Outcomes tools PROM PREM. CROM

•✓Freeing time to care• Digital dictation

Efficient safe care Faster, safer, community care

✓SCR one click for medicines reconciliation

✓Directory of Services / Mobile app.

✓Capacity Management system to reduce junior doc & nurse time spent finding acute, PICU, CAMHS Tier4 beds/ OATS

✓Remote access tablets to access records from the community

-

Innovation, SU in control A care plan by any other name

✓Apps for fitness and literacy

✓Big Data to self manage & stop relapse

✓Self Management apps

✓ Psychosis avatars

✓ Interactive digital treatment sessions

✓On line city platforms & white label digital therapies

✓Sim City to show case what can be done

Continuous Quality improvement:• Clinical team digital dashboards • Touch screen in wards and teams every day