Section B Part 1 - Outcome Specifications

SECTION B PART 1 - OUTCOME SPECIFICATIONS

Mandatory headings 1 – 5. Mandatory but detail for local determination and agreement.

Optional heading 6. Optional to use, detail for local determination and agreement.

All subheadings for local determination and agreement.

Outcome Specification No.
Service / Mental Health Specialist Services
Commissioner Lead
Provider Lead
1. Population Needs
Local
Locally defined
2. Key Outcomes
No Health Without Mental Health sets out a clear and compelling vision, centred around six objectives:
(i) More people have better mental health
(ii) More people will recover
(iii) Better physical health
(iv) Positive experience of care and support
(v) Fewer people suffer avoidable harm
(vi) Fewer people experience stigma and discrimination
Each objective in the Implementation Framework (see Appendix) is relevant to secondary mental health services although some will be held jointly with primary health care and public health especially physical health care, early intervention, destigmatisation and suicide prevention.
2.1 Strategic Outcomes
Commissioner, providers and other stakeholders should work together to develop strategies for the below:
More people have better mental health:
·  Improve self-reported wellbeing through development of strategy to measure emotional wellbeing (e.g. in association with ONS initiative)
·  Implement use, data collection and dissemination of results of Patient Reported Outcome Measures (e.g. Warwick Edinburgh Scale or DIALOG) in users of secondary mental health services (target 40% of service users in year 1)
·  Implement strategy to develop use, data collection and dissemination of results of Health Of The Nation Outcome Scale (HoNOS)
·  Extend use of specific Outcome Measurement from IAPT to secondary care for common and severe mental health problems (establish pilot projects and develop data streams)
(ii) More people will recover
·  Increase proportion of service users of working age retaining employment & if not currently working returning to work and/or meaningful activity
·  Increase proportion of people with mental illness or disability in settled accommodation (e.g. measured using HoNOS scale)
·  Increase the proportion of people who use services who have control over their daily life (establish strategy to measure and improve)
(iii) Better physical health
·  Reduce excess under 75 mortality rate in adults with severe mental illness by implementing strategy with primary care and acute services to measure SMIs and improve outcomes.
(iv) Positive experience of care and support (prioritise and negotiate proportion improvement)
·  Improve patient experience by increasing patient satisfaction and increasing those that report feeling safe and secure and managing their own condition (using CQC Patient Survey, NHS Survey)
·  Improve carer quality of life by increasing carer satisfaction (using Carer Survey, NHS Survey)
(v) Fewer people suffer avoidable harm (establish local baseline)
·  Reduction in safety incidents involving severe harm or death (e.g. suicide and undetermined deaths measured over 3-5 year cycles) through strategy to ensure prompt (negotiable – eg within 45 days) critical incident review and feedback to staff involved with regular collation and consideration by clinical governance structures.
·  Provide right treatment at right time in line with the evidence base.
2.2 Specified Outcomes
Please note these outcomes are a list of examples (including the percentages) and are not proposed as mandatory. Local Commissioners will need to prioritise according to local need. Percentages or numbers need to be decided locally and where current measures do not exist, baseline data should be collected and increase or decrease negotiated within the timeframe of the contract. The percentages stated are “educated guesses” and will vary locally
Treating and caring for people in a safe environment; and protecting them from avoidable harm.
Optimise health and well-being by supporting individual goals
Collaboration with informed service users and carers
·  90% of all service users are effectively involved and engaged, and their views made explicit within individual care planning processes (including the use of Advanced Directives where appropriate)
·  Increase by 10% numbers of those receiving peer support enabling help in self-management
·  4% reduction in the discrimination experienced by people with mental health problems from surveys conducted by “Time to Change” in 2010 and 2011.
·  90% of identified carers are offered assessment using a Caregiver Strain Index
·  Improve overall, Carers reported quality of life (ASCOF) by 10%.
·  Improve by 10% patient experience of community mental health services (CQC Patient survey)
·  Improve by 10% the overall satisfaction of people who use services with their care and support (NHS Survey )
·  Increase by 10%, the proportion of people who use services who say that those services have made them feel safe and secure (NHS Survey)
Strengths based assessments and intervention
·  90% service users offered choice of developing their own WRAP (Wellness, Recovery Action Plan
·  98% of service users in settled accommodation are recorded on assessment
·  98% of service users in employment are recorded on assessment
·  Increase by 10% the proportion of adults receiving secondary mental health services in paid employment using evidence based models.
·  Increase by 10% the proportion of adults receiving secondary mental health services occupied in Meaningful Activities such as hobbies, social activities with family and friends, exercise, sport and other leisure activities
·  Increase by 10% the proportion of adults receiving secondary mental health services in suitable accommodation
·  Reduce by 10% the length of stay in inpatient services due to accommodation issues
·  Increase by 20% the use of Personalisation includes prevention, early intervention, and self-directed support where people are in control of arranging and managing their own support services
·  100% or services users offered Patient Reported Outcome Measures (such as INSPIRE)
Timely, safe and effective interventions
·  98% of service users who are subject to CPA to have a CPA review within timescales reflecting in national guidance
·  Services in secondary care that are readily accessible and available for 24 hours a day, 7 days a week when in crisis
·  Ensure 70% of service users have a joint crisis plan (these differ from written care plans used as standard within the Care Programme Approach
·  Self-referral to enable people to get help without lengthy procedural delays especially important for people from BME
·  Decrease by 20% the use of antipsychotic medication specifically for borderline personality disorder or for the individual symptoms or behaviour associated with the disorder (although short-term use may be helpful during a crisis).
·  Decrease by 20% the use of poly-pharmacy (two or more drugs of same BNF category) and medication above BNF recommended levels.
·  Increase by 30% the use of Psychological Therapies for severe mental illness including psychosis, bipolar and Personality Disorders as an adjunct to medication.
·  Increase by 30% the use of Family Therapy for severe mental illness including psychosis and bipolar disorder as an adjunct to medication.
·  Increase by 30% the use of Social Prescribing for severe mental illness including psychosis and bipolar disorder as an adjunct to medication.
·  Increase by 30% the use of Dialectical Behavioural Therapy and/or Interpersonal Therapies for borderline personality disorders as an adjunct to medication
·  100% of inpatient units have environmental risk assessments in place (annual audit)
·  100% of inpatient units meet Infection control standards (annual audit)
·  ECT outcomes as per Technology Appraisal 59 (April 2003) “Guidance on the use of electroconvulsive therapy” NICE
·  90% of service users have up to date CPA
·  10% reduction in completion medicines reconciliation on admission within 24 hours (quality contract)
·  10% reduction in drug omissions in inpatient unit
·  100% of nurses medicines competency completed
·  95% of clinical staff complete rapid tranquiliser training
·  98% compliance with Insulin prescription standards
·  98% of Lithium prescribing meets NPSA guidance
Optimise physical health and Prevent people from dying prematurely
·  98% physical health screening offered on admission or as soon after as possible unless consent is not obtained
·  98% of service users to be registered with a GP and be assisted to access an annual health check
·  10% reduction in premature death in people with serious mental illness
·  95% of adult patients who smoke have received smoking cessation advice and been offered smoking cessation intervention
·  95% of inpatients being assessed for healthy weight resulting in 100% appropriate referral to weight management services and provision of lifestyle information
·  98% Inpatients and 90% community are screened for alcohol misuse, and AUDIT tool completed if concerns identified.
·  98% Inpatients and 90% community are screened for drug misuse, and referral to appropriate substance misuse services complete.
Provide least restrictive interventions in safe environments
·  Increase the numbers of people by 15% receiving home-based care or alternative to inpatient admission who are in Acute crisis
·  100% access to Inpatient, PICU and health-based place of safety provision available when needed.
·  CRHT function is involved and agrees with 95% of decisions to admit to acute inpatient or PICU provision
·  100% of service users offered access and information regarding advocacy services for those detained under the Mental Health Act 1983 (amended 2007).
·  No unsuitable environments for acute care, including mixed sex accommodation
·  75% of people with complex and long-term mental health needs who are supported by rehabilitation services to progress to successful community living within five years and around 10% to achieve independent living within this period
·  Reduce by 20% those readmitted to inpatient care within 7 days and 30 days
·  Reduce by 10% people admitted who are restrained
·  Reduce by 10% the hours of seclusion as a percentage of total patient hours during admission per year
·  Provide an annual audit of Mental Health Act Assessment and Mental Capacity Act Assessments with a focus on appropriateness.
Supporting individuals to maintain independence and maximise opportunity
Quality and accessibility of information
·  An annual audit of Information available for service users, family and carers using a variety of media including leaflet and web based
·  Decrease by 10% un-validated notes on RIO (or other information systems)
·  Decrease by 10% un-outcomes appointments notes on RIO (or other information systems
NB: Validated notes are those that are signed off by clinicians. Outcome within the information system report on the pathway used and may also be used linked to payment systems.
·  95% caseload with a care cluster allocated
·  95% caseload with completed cluster assessment
·  95% caseload with cluster reviews completed in time
·  95% diagnosis recorded
·  Health Of The Nation Outcome Scale (HoNOS) [collected as part of Payment-by-Results clustering] (target 90% initial score & 50% repeat score in year 1)
Staff skills and supervision
·  70% of staff are trained to be competent, using DANOS competencies in the assessment and clinical management of substance misuse
·  70% of staff are trained in Psychological awareness
·  20% of staff are trained in Psychological Therapies
·  Reduce the levels of staff sickness absence by 10%
·  95% of clinical and support staff receive evidence based supervision.
·  95% of clinical and support staff receive training in Safeguarding Adults and Children
·  95% of clinical staff receive training in clinical skills (risk assessment, care planning)
·  95% of clinical and support staff receive appraisals
Effective, recovery-oriented, risk assessment and management
·  Conduct biannual reflective practice sessions in all teams, focussed on risk (including positive risk taking)
·  Conduct biannual reflective practice sessions in all teams, focussed on recovery approaches
·  98% of risk assessments are up to date
·  70% of risk assessment and management is done in collaboration with service user and carer
·  90% of Critical Incident Reports completed within 45 days
·  90% of Complaints dealt with within agreed timescales
·  90% of Serious Incidents Reports dealt with within agreed timescales
Effective multi-agency partnerships
·  95% of working age service users are offered opportunities to access support around employment/education/accommodation
·  100% of teams has plans in place to support working relationships with CAMHS, OPMH, SMS, primary care, police, housing, third sector MH services, service user and carer support/ involvement groups
2.3 Process measures:
·  Improve rate of access to NHS mental health services(through MHMDS)
·  Decrease population rate of detained patients (MHMDS)
·  Improve ethnicity balance amongst detained patients (MHMDS)
·  Assess effectiveness of safety incidents reporting (MHMDS)
·  Assess appropriateness of numbers of absent without leave in detained patients (MHMDS)
·  Increase proportion of service users with severe problems offered NICE-compliant psychological interventions (phased plan to reach 100% over x years)
3. Scope
3.1 Population covered
(Please note that this could be delivered by a variety of Specialist Mental health Providers)
Intended users of the secondary care mental health specialist pathway will have multiple, complex needs including a number of the following:
·  A clinically diagnosable mental health problem
·  Severe problems can present as ‘common mental disorders’ (Clusters 4-7) and also psychoses, bipolar disorders (11, 12-17) & emotional difficulties (‘personality disorders’)(6-8).
·  History of violence or persistent offending
·  Significant risk of persistent self-harm or neglect
·  Poor response to previous treatment
·  Dual diagnosis of substance misuse and serious mental illness
·  Dual diagnosis of learning disability and serious mental illness
·  Dual diagnosis of developmental disorder and serious mental illness
·  Detained under Mental Health Act (1983) on at least one occasion in the past 2 yrs
·  Unstable accommodation or homelessness with a serious mental illness
·  Enduring Interpersonal Difficulties, in the context of existing mental health problems;
·  Unresolved Difficulties including those related to mood, anxiety, abuse and eating disorders;
·  Mental health problems exacerbated by personality disorder;
·  Complex Picture Of History Of Abuse, e.g. Sexual, in the context of existing mental health problems;
·  Chronic Post Traumatic States (Unresolved);
·  Recurring Patterns of Psychological Difficulty.