The Strategic Director for Community, Health and Social Care

ITEM NO.

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REPORT OF

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Joint Briefing of the Assistant Mayor for Health & Wellbeing and the Assistant Mayor for Adult Social Care onSeptember 11th2013

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TITLE:Integrated Mental Health Commissioning Strategy

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RECOMMENDATIONS:

(1)That the Assistant Mayors for Adult Social Care and Health & Wellbeing approve the Integrated Mental Health Commissioning Strategy on behalf of Salford City Council.

EXECUTIVE SUMMARY:

An Integrated Mental Health Commissioning Strategy has been developed to oversee the strategic development of the mental wellbeing agenda and mental health service provision in Salford. The commissioning strategy has a primary focus on adults – but will also address issues concerning the mental health of young people making the transition to adulthood and adult services.

Commissioning Intentions are grouped into 13 key areas

Public health
Primary care mental health
Functional mental illness
Organic mental illness
Transition for Young People
Development of rehabilitation and recovery services and management of out of area placements
Social care
Inclusive Communities: Living, working and learning
Mental and physical health
Voluntary sector
Service users
Carers
Commissioning systems and processes

Under each of these key areas, commissioning intentions are detailed along with the anticipated outcomes and rationale. Key actions for the current year are also highlighted

The Strategy has been to the Mental Health Development Board, Integrated Engagement Board and the Integrated Commissioning Board for comment and endorsement. The strategy has also been shared with mental health providers.

The Strategy has been approved by NHS Salford Clinical Commissioning Group, who currently commission around 85% of mental health service provision in Salford

Consequently, the Assistant Mayors for Adult Social Care and Health & Wellbeing are now being asked to approve the Strategy on behalf of Salford City Council

BACKGROUND DOCUMENTS: (Part 1)

Mental Health Commissioning Strategy
Commissioning Intentions

Commissioning Intentions 13/14

KEY DECISION:Yes

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DETAILS:

1)Introduction & Background

According to the most recent Salford Mental Wellbeing Needs Assessment (2010), around 36,500 adults (20% of people aged 16+) and 6,000 children (12% of people aged 0‐18) living in Salford might have some kind of mental wellbeing need.

Of these:

7,900 adults are likely to have extreme anxiety or depression
almost 7,700 claimed benefits in 2009 due to mental health reasons
over 6,500 were in contact with community mental health teams in

2008/09, of which around 3,500 were with outpatient psychiatrists

nearly 7,000 adults and children were treated as outpatients in 2008/09

for all mental and behavioural disorders or in psychiatry departments

over 3,500 were treated as inpatients in 2008/09 for mental and

behavioural disorders, 1,500 related to psychoactive substance use

around 650 people were treated as inpatients for self harm in 2008/09
60 people died from suicide or undetermined injury from 2006 to 2008
54% of people with dementia are registered with a GP (1281 of 2373 - Dementia Prevalence Data)
The most deprived populations are currently identified as having the

greatest need for services

NHS Salford and Salford City Council currently spend in the region of £53m directly on adult mental health service provision, 89% of which is commissioned by NHS Salford Clinical Commissioning Group.

Consequently, NHS Salford and Salford City Council requires a mental health integrated commissioning plan which will co-ordinate and oversee the strategic development of the mental wellbeing agenda and mental health service provision in Salford.

While there are well established integrated commissioning arrangements for mental health across NHS Salford CCG and Salford City Council , what was missing was an Integrated Mental Health Commissioning Strategy which will co-ordinate and oversee the strategic development of the mental wellbeing agenda and mental health service provision in Salford.

Echoing the National Mental Health Strategy, ‘No health without mental health’, the vision of the commissioning plan will be that:

“More people [in Salford] of all ages and backgrounds will have better wellbeing and good mental health. Fewer people will develop mental health problems, by starting well, developing well, working well, living well and ageing well.”

Consequently NHS Salford identified non-recurrent funding to appoint an external consultant to work alongside commissioners and key stakeholders to develop an integrated commissioning strategy. While the focus of this commissioning plan will primarily have a focus on working age adults, this will also encompass young people in transitionsas wellas older adults including dementia.

Mental Health Strategies (MHS) were commissioned to develop the draft strategy and worked in partnership with Commissioners to progress the strategy. MHS undertook interviews with key stakeholders including Clinical Leads in mental health and Older People, a range of providers, commissioners and service users. A steering group was established to oversee this work and regular meetings were held to monitor progress.

The draft strategy was submitted in December 2012, and work was subsequently undertaken to start to shape this meet requirements

The strategy comprises 5 sections:

1)Introduction: Providing an overview of mentalhealth and service provision in Salford

2)The Mental Health Commissioning Strategy: Outlining the purpose of the strategy and they key national and local policy drivers

3)Setting the Commissioning Strategy in Context: Detailing the range of needs assessment work and prevalence data that was analysed

4)Commissioning Intentions, Outcomes and Actions: Detailing the key areas which group the commissioning intentions in the strategy.

5)Monitoring and Evaluating the Strategy: Outlining the way inwhich the strategy will be performance managed and Governance arrangements

In addition a detailed action plan is attached as an appendix outlining the specific commissioning intentions and actions to be undertaken

2 Scope, Vision and Principles

2.1) Scope of the commissioning strategy

The commissioning strategyhas a primary focus on adults – but will also address issues concerning the mental health of young people making the transition to adulthood and adult services. In parallel to this, an Emotional Health and Wellbeing Strategy for Children and Young People (2013-2015) has been developed by the Children and Young People’s Emotional Health and Wellbeing Partnership, which reports to the Children and Young People’s Trust (CYPT).

2.2) Vision

Our vision is that all residents of Salford will have access to high quality, compassionateworld-class mental health services. In this context our aim is to commission services which achieve / provide:

Early intervention – meeting needs early and preventing the escalation of mental health problems (including transition planning from Children’s Services)
Addressing the stigma and discrimination that surrounds mental health
Rapid and convenient access at all times (and in all services, and relevant settings)
Fair access, based on people’s needs, not who they are, or where they live in Salford
Recovery – with service users returning to full health, moving through services, and being discharged where clinically appropriate
Recognition of the links between physical health and mental health, and the government pledge to achieve parity of esteem
Support to remain in your own home and to live independently for as long as possible
The lowest possible number of people placed out of area (outside of Salford)
The best possible outcomes for service users, their carers, and their families. “Outcomes” include fewer symptoms of ill-health, the ability to lead as normal a life as possible, and maintain contacts with family, friends and local communities

The lowest possible number of complaints and untoward incidents
Excellent value for money

2.3) Principles

Services which meet this vision should, we believe, be based on the following key principles:

A person-centred approach to assessment, treatment and care
A holistic approach to mental and physical health needs
Prevention and early intervention
Recovery focussed
Compassion and sensitivity
Asset based – building on existing services, resources and facilities strengths in Salford
Provide social value so that they are delivered in a way that provides maximum public benefit to the local community
Well-integrated links between health and social care, between mental health services and acute hospital services, and between statutory and non-statutory providers
Make use of opportunities to link with organisations and services beyond health and social care in the wider community
Use treatments and approaches for which there is good research evidence
Responsive to both unusual and common needs
Committed to user and carer involvement, with this involvement demonstrably influencing the way services are developing
Keen to share information, knowledge and skills with other services, and with the people and families who use them

2.4) Policy Drivers

Key national priorities / initiatives driving change at a national and local level include:

Personalisation and choice
Recovery and well-being
Supporting people with long term conditions
Less reliance on bed based services, and increasingly caring for more people at home or with shorter admissions
A focus on outcomes, with new models of contracting and payment via Payment by Results (PBR) and Personal budgets
The drive for more services to be delivered at primary care level
The need to link services with the voluntary / third sector, primary care and secondary care
Integration with other aspects of the health system to identify ‘invest to save initiatives’ (such as medically unexplained symptoms and acute liaison services)
Partnership working and collaboration, in particular with public health
Focus on primary care and the third sector as well as secondary care
The links between physical and mental health, alcohol/drug misuse and mental health and long term conditions / frail elderly and mental health
Supporting people with dementia and their families as outlinedin the national strategic drivers on Dementia (i.e. ‘Living Well with Dementia: A National Dementia Strategy’ and The Prime Minister’s challenge on dementia
The need to identify and engage with key groups that might be ‘hard to reach’ or under-represented, for example: BME Communities, LGBT Communities, offenders, military veterans, travellers communities, young people leaving care and young people on Education/Social Care/Health Plans. An example of which would be ensuring that Mental Health is a key component addressed within the Salford Armed Forces Community Covenant and that mental health services are responding to the needs of military veterans when required

Other key national and local drivers include:

Health & Social Care Act 2012
No Health Without Mental Health
Think Local Act Personal
Living Well with Dementia: A National Dementia Strategy
Keeping Children and Young People in Mind: the Government's Full Response to the Independent Review of CAMHS
Salford Mental Well-being Strategy 2011-
Salford Commissioning Strategy for Personalisation
Salford City Council, Adult Social Care Market Position Statement

3 Commissioning Intentions Outcomes and Actions

Commissioning intentions are grouped into the following key areas:

Public health
Primary care mental health
Functional mental illness
Organic mental illness
Transition for Young People
Development of rehabilitation and recovery services and management of out of area placements
Social care
Inclusive Communities: Living, working and learning
Mental and physical health
Voluntary sector
Service users
Carers
Commissioning systems and processes

Under each of these key areas, commissioning intentions are detailed along with the anticipated outcomes and rationale. Key actions for the current year are also highlighted and attached as a separate document.

Key Actions will be established each year against the stated commissioning intentions, by a Commissioning Strategy Group.

Identified outcomes are consistent with, and complement, the anticipated outcomes in the No health without mental health: implementation framework and, as well as being informed by local performance data collection, outcomes will also be measured from data collected via the following outcomes frameworks:

Adults Social Care Outcomes Framework
Public Heath Outcomes Framework
NHS Outcomes Framework

4) Monitoring Progress
A Mental Health Commissioning Strategy Group will be established which will report to the Integrated Commissioning Board for Health and Wellbeing and the Clinical Commissioning Group Programme Management Group. Terms of reference and membership will be clarified and agreed at the first meeting of the group but thisis expected to include:

Assistant Director Integrated Commissioning, SCC/ CCG
GP Clinical Lead for Mental Health, CCG
Integrated Commissioning Manager– Mental Health, SCC / CCG
Integrated Commissioning Manager– Older People, SCC / CCG
Mental Health Commissioning Manager, CCG
Consultant in Public Healthy, SCCl
Senior Commissioning Manager, (Children’s Services), SCCl
Mental Health Development Worker SCC / CCG

5) Approval of the Mental Health Commissioning Strategy
The Strategy has been taken to the following Boards for comment and endorsement:

Mental Health Development Board: The Mental Health Development Board was consulted as part of the developmentof the strategy on August 13th2012. Progress updates were given at the Development Board meetings on October 15th and December 10th. At the Development Board on March 25th, the entire meeting was given over to discussing the Commissioning Strategy in depth to facilitate a more detailed examination of the strategy and actions

Integrated Engagement Board: The Strategy was brought to the Integrated Engagement Board on February 21st2013. Citizen members of the Integrated Engagement Board also attended the Mental Health Development Board session in March where the strategy was discussed in detail. The Integrated Engagement Board discussed the Commissioning Strategy in depth at their meeting on April 25thand fed back their comments to Commissioner

Integrated Commissioning Board: The Strategy was brought to the Integrated Commissioning Board on March 22nd

NHS Salford Clinical Commissioning Group: The Strategy was taken to NHS Salford Clinical Commissioning Group Programme Management Group onMay 15th as a briefing and was subsequently approvedat the meeting on June 19th. The Clinical Commissioning Group commission 89% of mentalhealth service provision in Salford.

The Strategy has also been shared with Mental Health Providers at a recent provider forum and copies of the draft strategy were circulated.
While the strategy has a primary focus on adults, it does also address issues concerning the mental health of young people making the transition to adulthood and adult services and consequently this strategy will be linked intothe Children & Young People Trust Strategy and Action Plan.
Consequently, the Assistant Mayors for Adult Social Care and Health & Wellbeing are now being asked to approve the Strategy on behalf of Salford City Council

KEY COUNCIL POLICIES:

Health & Wellbeing
Community Engagement
Social Inclusion
Mental Wellbeing

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EQUALITY IMPACT ASSESSMENT AND IMPLICATIONS:-

An Equality Impact Assessment is in the process of being completed and will guide the setting and monitoring of commissioning objectives and actions during the lifetime of the strategy. A Commissioning Strategy Group will be established to oversee the implementation and progress of the strategy and at the first meeting will sign off the Equality Impact Assessment for submission to Equality Advocates.

The Equality Impact Assessment will be treated as a ’live’ document allowing the emergence of new data regarding specific groups to be acknowledged and addressed through objectives and actions.

The strategy has been taken to a variety of Boards including service users and carers for comment. One of the priorities identified in the strategy is the need to identify and engage with key groups that might be ‘hard to reach’ or under-represented, for example: BME Communities, LGBT Communities, offenders, military veterans, and travellers communities. Consequently, this will be something that the Commissioning Strategy Group considers and evaluates as progress is reported and Commissioning Intentions established.

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ASSESSMENT OF RISK: Low

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SOURCE OF FUNDING:N/A

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LEGAL IMPLICATIONS: Provided by Melinda Edwards, Solicitor Tel: 0161 219 6286

The proposed integrated mental health commissioning strategy has been developed to oversee the strategic development of the mental wellbeing agenda and mental health service provision in Salford. The report sets out how the City Council will work to improve mental health and wellbeing and reduce health inequalities in Salford in accordance with the requirements of national and local drivers identified in the report. Integration is a key part of the Health and Social Care Act 2012 reforms and various legal mechanisms exist to enable the collaborative commissioning arrangements set out in the report.

When exercising its functions the Council must have due regard for the matters set out in section 149 of the Equality Act 2010 failing which any policy or decision may be subject to legal challenge by way of judicial review proceedings.

When commissioning contracts for the procurement of goods, services and works the City Council must comply with the requirements of the public contract regulations and its Contractual Standing Orders.

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FINANCIAL IMPLICATIONS: Supplied by Dianne Blamire, Principal Group Accountant – Community, Health and Social Care

There are no financial implications in respect of this report.

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PROCUREMENT IMPLICATIONS: Mark Griffiths, Procurement Manager

If it is necessary to procure services from third party organisations in order to deliver the commissioning activities that the City Council requires to effectively implement the Adoption Support Grant in the medium term, this must be undertaken in accordance with Contractual Standing Orders.

Further procurement advice in respect of any specific requirement to commission services to meet the activities outlined in the report can be obtained from the Procurement Team.

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OTHER DIRECTORATES CONSULTED: Childrens Services, Public Health

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CONTACT OFFICER: Judd SkeltonTEL. NO.0161 212 5632

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WARD(S) TO WHICH REPORT RELATE(S): All wards

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