The Operating Framework reinforces a number of priorities for improving provision of mental health and learning disability services, and on system levers. the Confederation has produced a short summary of key points from the Operating Framework which are relevant to commissioners and providers across the NHS, and can be found here. The below is a companion note to that short summary, pulling out additional points that are specific to Mental Health Network members.
The Operating Framework reinforces a number of priorities for improving provision of mental health and learning disability services – namely improving CAMHS services (in particular making headway on reducing waiting times), early identification of mental health problems (especially dementia), extending the provision of psychological therapies for mild to moderate depression, plus learning from the Michael review into learning disability services. It also highlights the need to give priority to veterans who are experiencing mental health problems as a result of their military service. On same sex accommodation, providers of mental health and learning disability inpatient services should have plans in place to ensure that men and women do not share sleeping areas and that women-only day areas are provided. Beyond the priorities in the Operating Framework, there are existing commitments which also need to be delivered:
• Deliver 7,500 new cases of psychosis served by early intervention teams per year.
• All patients who need them to have access to crisis services, with delivery of 100,000 new crisis resolution home treatment episodes each year.
• All patients who need it to have access to a comprehensive child and adolescent mental health service, including 24-hour cover and appropriate services for 16- and 17-year-olds and appropriate services for children and young people with learning disabilities.
In terms of system levers, the Operating Framework also states the new currency for adult mental health services will be made available for local use in 2010/11, and there will be an increase in the proportion of income that can be earned under CQUIN. A revised mental health standard contract for 2010/11 will also be published. For mental health trusts, the NHS performance framework will include a small set of additional indicators about the organisation’s ‘health’ and the Department will ask the CQC to use these indicators in its assessment of mental health providers. There is also a clear expectation all remaining acute and mental health NHS trust boards will need to come forward by the end of this financial year with a clear trajectory to reach NHS Foundation Trust status by the end of 2013/14 at the latest.
The following paragraphs relating specifically to mental health and learning disability services are taken directly from the NHS Operating Framework for 2010/11.
Priorities
2.27 In developing high quality child and adolescent mental health services (CAMHS), PCTs should have regard to the full Government response to the CAMHS Review. In particular, they should consider the best practice on reducing waiting times in CAMHS, published in August 2009, and the use of outcome measures to identify effective practice.
2.50 Keeping up momentum on diabetic retinopathy screening will continue to make a significant contribution to the prevention of avoidable blindness. The early identification of mental health issues as set out in the New Horizons strategy reduces demand on secondary health services as well as achieving better health tcomes, including higher employment rates and lower suicide rates. Offering evidence-based psychological therapies for people with mild to moderate depression or anxiety is another area that could deliver local priority improvements.
2.51 Improved outcomes and efficiencies in services for older people has been shown to result from:
• the early and accurate diagnosis of dementia;
• joint health and social care investment to reduce emergency bed days; and
• the Prevention Package for Older People, which has shown that a falls service can generate substantial savings for the NHS and social care.
2.54 PCTs should ensure that all providers have published a declaration before the end of March 2010 that they have virtually eliminated mixed sex accommodation, and all providers of NHS care should have robust plans in place for continued delivery of this commitment. After March 2010, PCTs are to report to SHAs, on an exception basis, those organisations that have failed to provide same sex accommodation and have had funds withheld as a result. Providers of mental health and learning disability inpatient services should have plans in place to ensure that: men and women do not share sleeping areas; and women-only day areas are provided.
2.55 The ongoing deployment of UK armed forces means it is now more important than ever that PCTs work closely with military services to ensure that the needs of this community are appropriately met. In particular it will be important to:
• ensure that commissioning plans provide for a smooth transition into NHS care for the increasing numbers of returning personnel who have been injured in the course of duty;
• ensure that their dependants are not disadvantaged by their circumstances (eg if they move location); and
• provide priority treatment, including appropriate mental health treatment, for veterans with conditions related to their service, subject to the clinical needs of others.
• Achieving these goals is a reputational issue for the NHS as a whole.
2.58 Other issues that PCTs and their providers will want to be mindful of include: learning from the independent inquiry by Sir Jonathan Michael into services for people with a learning disability.
System Levers
3.34 As the first step in introducing Payment by Results to mental health services, a new currency for adult mental health services will be made available for local use in 2010/11. This is in preparation for 2011/12 when all health economies should be using the currencies in some form and establishing local prices. We are also developing a currency for community services, establishing local prices, we will aim to have currencies for specific community services by 2011/12.
3.35 Also under our drive for high quality care, CQUIN continues for 2010/11 and subsequent years, but it will have a more significant impact on provider income than in 2009/10. In 2010/11, the income quantum that can be earned under agreed CQUIN schemes will treble to 1.5 per cent of contract income. All CQUIN schemes will be required to include a patient experience element, including a national goal linked to outcomes from the national inpatient survey (I wonder if this means using the MH inpatient survey – the issues with doing that are obvious…). SHAs will be responsible for assuring that schemes adhere to the CQUIN framework guidance for 2010/11. From 2011/12 we shall give PCTs the power to withhold a significant proportion of contract payment, rising to 10 per cent over time, if providers fail to meet agreed patient satisfaction goals on a service by service basis.
3.62 A revised suite of standard national NHS contracts will be published for 2010/11. These will cover hospital services, community services, mental health services and ambulance services. A separate national NHS contract for care homes will be published by July 2010. New contract models that move away from funding episodic hospital care and reward the provision of integrated care will be developed for 2011/12. The hospital contract will require providers and commissioners to agree elective schedules that support the 18-weeks waiting time commitment, guarantees patients’ rights under the NHS Constitution including choice, and ensure delivery of existing commitments and Vital Signs performance measures. Commissioners may specify thresholds and conversion rates for specific interventions, and may withhold payment if these are breached without good reason.
3.68 n the NHS foundation trust model combines clear accountability, strong financial management and robust governance with the freedom to innovate. We expect all remaining acute and mental health NHS trust boards to come forward by the end of this financial year with a clear trajectory to reach NHS foundation trust status by the end of 2013/14 at the latest.
Planning
4.9 In terms of the CQC’s periodic review, the Department will ask it to provide an assessment of each NHS organisation’s performance against the national priorities set out in this NHS Operating Framework and as measured by existing commitments and Vital Signs tiers 1 and 2. NHS providers will also be subject to ongoing registration, and the Department will work with the CQC to agree how performance against registration compliance can be incorporated into the overall assessment. For mental health trusts, the NHS performance framework will include a small set of additional indicators about the organisation’s ‘health’ and the Department will ask the CQC to use these indicators in its assessment of mental health providers.