AGENDA ITEM 10
CABINET
9 SEPTEMBER 2008
IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES (IAPT): REPORT OF THE HEAD OF ADULT SOCIAL SERVICES (COMMISSIONING)
1. / Purpose of Report1.1
2.
2.1 / To inform Cabinet of the proposed significant development of the Gateway Mental Health Service.
Decisions Required
Cabinet is asked to:(i)Consider the issues detailed in paragraph 6 of the Report.
(ii)Recommend to Council that the Adult Social Services Commissioning Unit progress the completion of a service level agreement with Bournemouth and Poole Teaching Primary Care Trust on the delivery of Improving Access to Psychological Therapies
3. / Background
3.1
3.2
3.3 / On the 10th October 2007, the Health Secretary - Alan Johnson, announced a substantial £170m expansion of Psychological Therapies to provide better support to people with mental health problems such as anxiety and depression in England. This follows two demonstration sites which showed impressive recovery rates and significant achievement in helping people off statutory sick pay and back to work / volunteering / education / training.
Over the next three years, the national investment in Improving Access to Psychological Therapies (IAPT) will mean:
- 900,000 more people treated for depression and anxiety.
- 450,000 of them likely to be completely cured.
- 25,000 fewer people with mental health problems on sick pay and benefits.
- All GP Practices having access to psychological therapies.
- Average waiting for psychological treatments down from the current 18 months to a few weeks.
4. / Local Developments:
4.1
4.2 / Of the 15 Primary Care Trust’s (PCT’s) in the South West region, the Strategic Health Authority has decided to invest in four PCT’s, one of which is the Bournemouth and Poole Teaching Primary Care Trust, as the first wave of this new Government programme. Bournemouth and Poole PCT Primary Executive Committee (PEC) have taken the decision to have two preferred providers, the Borough of Poole Gateway Service and Dorset HealthCare NHS Foundation Trust. Low intensity work (Steps 1 and 2) of IAPT will be delivered by the Poole Gateway Service, across both Poole and Bournemouth. The Gateway Team is based within Adult Social Services Commissioning Unit (ASSCU) and comprises of qualified social workers, nurses, psychology graduate workers and a Groupwork Coordinator. The high intensity work (Steps 3 and 4) has been awarded to Dorset HealthCare NHS Foundation Trust. Residents of Poole will therefore be early beneficiaries of this new national programme.
The PCT have taken this decision given the strong performance of Dorset HealthCare NHS Foundation Trust and the Borough of Poole’s Gateway Service. The Borough of Poole in fact, has been one of the few local authorities to proactively invest in the promotion of mental health and well-being. The Gateway Service has also recently received a national award for its groundbreaking work in addressing the needs of adults with anxieties and depression.
4.3 / The proposed investment by the Bournemouth and Poole PCT in the Poole Gateway Service is £640,000 per annum
4.4
4.5 / A service specification has been developed by the PCT, with the specific aims upon the Gateway Team being as follows: -
- To deliver low intensity psychological therapies to 6,000 people.
- To achieve 50% recovery rates for service users entering the service.
- 184 service users to return to work by March 2011.
- To ensure that there are sufficient trained low intensity therapists in the team to provide assessment within 3 days and interventions within 10 days.
- Single access point,
- Multi-disciplinary,
- Partnership with General Practitioner’s,
- Tightly defined access times to both assessment and interventions.
5. / Progress To Date:
5.1 / Given the timetable prescribed by the Department of Health (DoH), a number of steps have already been taken:
i)Report to Vacancy Clearance Committee on 17th June 2008 seeking approvals to appoint low intensity workers and admin staff. This request was supported by a letter from the PCT acknowledging their responsibility on any financial pickup and risk at the end of the initial Government funded period to March 2011.
ii)In response to the service specification produced by the PCT and received on 14 July 08, a business case jointly produced with Dorset HealthCare NHS Foundation Trust was submitted on 29 July 08, following consultation with Financial Services Unit and Legal and Democratic Services.
iii)Negotiations are continuing with the PCT Commissioners due to the total submitted bid being higher than the available funding. Additionally, more detailed commitments were requested and received from the PCT regarding financial risks that may occur in March 2011. Attached is Appendix A – a letter from the Bournemouth and Poole Teaching Primary Care Trust’s Director of Commissioning acknowledging their full responsibility. This removes any financial risk to the Borough of Poole should the IAPT Programme not be maintained or be significantly changed in March 2011, and this will be reinforced within a Service Level Agreement.
iv)Given the financial risks being acknowledged by the PCT, offers of employment have now been made to 7 staff to perform low intensity therapist roles, in order that they access the September training programme.
6. /
Issues for Consideration:
6.1 / This opportunity clearly represents a significant change in the current Gateway Service here in Poole, but also across the conurbation, with most evident change being an improvement in the wait times for treatment. However, there are several issues to be considered.6.1.1 / Advice received from Financial Services Unit, Legal and Democratic Services is that any gross service change in excess of £250k has to be approved by Full Council. Full Council does not meet again until 23 September 08. The value of this service level agreement represents a receipt from the PCT of the following amounts: £334k in 08/09, £640k in 09/10 and £783k in 10/11.
Issue: The service is required to commence under the prescription of the national programme by 01/09/08 but governance issues still need to be addressed within the Council.
6.1.2 / The delivery of the low intensity element of IAPT will represent a significant provider contract, and a growth within the direct provisioning of services by the local authority.
Issue: This may be viewed either as an exciting development or contrary to the strategic direction given previous outsourcing of Adult Social Services provision.
6.1.3 / The Gateway Service will also be delivering Psychological Therapies on behalf of Bournemouth residents. This is consistent with the broad strategic aim of conurbation wide initiatives.
Issue: There needs to be an awareness that the Borough of Poole will have responsibility for delivering a frontline service for Bournemouth residents.
6.1.4 / Within Adult Social Services Commissioning Unit’s core funding, a commitment already exists to the delivery of Primary Mental Health Services to the value of £376k. However, the service level agreement with the PCT will lead to some savings as this new service will fund elements of previous and current commitments made by the Borough of Poole.
Issue: There is an efficiency gainmade by the Council in delivering this service.
6.1.5 / Within the implementation timetable prescribed by the DoH, there are several operational issues that are still to be addressed in order to successfully deliver IAPT in Bournemouth and Poole.
To meet this specification, premises to provide assessment and treatment facilities have still to be procured. It is likely that the Borough of Poole may need to work with its partner provider – Dorset HealthCare Foundation Trust, to lease such premises.
Specific management information systems are also to be procured in order to meet the requirements of the local PCT specification and the national programme.
Issue: These operational matters have the potential to impede the successful implementation of IAPT on 1st September 2008.
JOHN DERMODY
HEAD OF ADULT SOCIAL SERVICES (COMMISSIONING)
29 AUGUST 2008
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