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SEL MH – Delivery Plan - PPT Presentation

July 2017 4 th July 2017 Draft in progress Delivery Plan Contents Page Title 3 Introduction 4 Milestone tracker 7 Children amp Young People 19 Perinatal 32 IAPT 44 EIP ID: 756929

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Slide1

SEL MH – Delivery PlanJuly 2017

4

th

July 2017Slide2

Draft in progress |

Delivery

Plan Contents

Page

Title

3

Introduction

4

Milestone

tracker

7

Children & Young People

19

Perinatal

32

IAPT

44

EIP

54

CRHTT

59

OAPS

66

SMI

78

Liaison Psychiatry

Core

24

90

Secure care

95

Suicide

Prevention

105

Older people and dementia

111

Finance

113

Digital

121

Appendix

1

123

New models of Care

funding awarded for a CAMHS Tier 4 service. Separate attachments

bid and business

caseSlide3

Introduction

Our Healthier South East London (OHSEL) was first established in 2013, by local health commissioners, to promote and develop more integrated, out-of-hospital and preventative care. Because of this, we have well-established transformation programmes with integrated patient, public and clinical involvement.

Since 2015, and the creation of STPs, OHSEL now includes managers and clinicians from NHS trusts, local council representatives and other stakeholders, all working together to ensure a sustainable future for NHS services in the area.Mental Health is a key priority to ensure those with mental health needs are cared for and treated in the same way as those that require physical health care. Key focus areas include delivering services that address people's mental and physical health needs in an integrated way, ensuring issues are detected soon enough to avoid people going into crisis and ensuring multiple organisations and professions work together across boundaries to provide more holistic health care for the patient. In SEL we aspire to high quality mental health services and are committed to meeting national and regional standards, including what is set out in the Mental Health Five Year Forward View. This delivery plan builds on progress made to date in the STP and provides a forward view of planned activity from 2017/18 to 2020/21, in order to meet the objectives set by NHS England. Slide4

SEL milestone trackerSlide5

Workstream

Activity

/ initiative

Final Target

Final Target

Deadline

2017/18

2018/19

2019/202020/21Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4CYPImproved access rate for CYPTBC*Mar-2124%26%28%30%30.50%31%31.50%32%32.50%33%33.50%34%34.25%34.50%34.75%35%% of patients receiving first definitive for eating disorder within four weeks from a routine referral95%Mar-2185.0%88.1%92.9%95.2%95.2%95.2%95.2%97.6%% of patients receiving first definitive for eating disorder within one week of an urgent referral 95%Mar-2172.7%83.3%91.7%91.7%90.9%91.7%91.7%91.7%Number of new CYP under 18 receiving treatment in NHS funded community services in the reporting period30%Mar-185.9%7.3%Reduction in inappropriate OAPs for inpatient CAMHS (Tier 4)Add baselineTBCTotal Number of bed days for CYP under 18 in CAHMS tier 4 wardsAdd baselineMar-21Spec CommDelivery against regional CAMHS implementation plans in line with the approval by NHSE of the CAMHS T4 service review outcomes50%+Mar-18SuicideReduction in age standardised suicide rate10%Mar-218.80%8.50%8.20%7.90%PerinatalIncrease access to evidence-based specialist perinatal mental health care (whole number)TBC*Mar-18487660832832IAPTIAPT access to treatment19%Mar-194.03%4.04%4.09%4.22%4.55%4.59%4.63%4.75%IAPT recovery rate50%Mar-2150.1%50.1%50.1%50.1%50.1%50.1%50.1%50.1%IAPT waiting time, 6 weeks75%Mar-2180.3%80.3%80.2%80.1%80.0%80.0%79.9%79.9%IAPT waiting time, 18 weeks95%Mar-2195.0%95.0%95.0%95.0%95.0%95.0%95.0%95.0%

5

RegionSELRDAnne Rainsberry

4. Mental Health Regional Milestone Tracker

Delivery milestones by workstream (I)

*please use your STP proportion of the national targetNote: Populated data taken from aggregated operating plans

Specialised commissioning providing

Specialised commissioning providing

Specialised commissioning providing

2019/20 and 2020/21 figures not available yet

2019/20 and 2020/21 figures not available yet

2019/20 and 2020/21 figures not available yetSlide6

WorkstreamTBC

Activity

/ initiative

Final Target

Final Target

Deadline

2017/18

2018/19

2019/202020/21Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4EIP% of people experiencing a first episode in psychosis treated with a NICE approved care package within two weeks of referral50%50.4%50.4%50.4%50.4%55.1%55.1%55.1%55.1%Liaison% of acute hospitals meeting core 24 service standard for all adults50%Mar-21(See U&EC tracker)OAPsReduce the number of OAPs for non-specialist acute care: localities plans in place to eliminate appropriate OAPs by 2020/21.LSLMar-2113%10%7.5%5%3%2%1%0%BBG15%15%15%15%15%15%15%8%4%0%SMIProportion of people with SMI who have received complete list of physical checksTBC30%60%60%60%DementiaProportion of people with dementia with a recorded diagnosis67%Mar-1867.8%67.8%67.8%67.8%67.6%67.6%67.6%67.6%FinanceIncrease baseline spend on mental health to deliver the Mental Health Investment StandardN/A2.92%2.80%DataEnsuring that all providers in regional footprint submit data to NHS DigitalN/AYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYes6RegionSELRDAnne Rainsberry4. Mental Health Regional Milestone TrackerDelivery milestones by workstream (II)*please use your STP proportion of the national targetNote: Populated data taken from aggregated operating plans2019/20 and 2020/21 figures not available yetSlide7

Children and Young People’s mental health

By 2020/21 at least

70,000 additional Children and Young people each year will receive evidence-based treatment representing an increase in access to NHS-funded community services to meet the needs of at least 35% of those with diagnosable mental health conditionsSlide8

Draft in progress |

Children and Young People - Delivery Plan Contents

Page

Title

9

National Expectations

10

Supporting Narrative

13Measures, Metrics and Baselines14Local Milestones15Risks and Issues16Enablers, Assumptions and Dependencies17Impact on activity, finance and quality18Gaps in PlansSlide9

Draft in progress |

Children and Young People : National Expectations

NHS England: Mental Health Delivery Plan 2017-18, May 2017

At least 30% of CYP with a diagnosable MH condition receive treatment from an NHS-funded community MH service.Commission 24/7 urgent and emergency mental health service for CYP and ensure submission of data for the baseline audit in 2017.

All services working within the

CYP IAPT programme

.

Community eating disorder teams

for CYP to meet access and waiting time standards: All localities expected to baseline current performance against the new standard and start measurement against it. Reduce the number of out of area placements for CYP and use of in-patient beds overall. Mobilisation and implementation of the recommendations from the Tier 4 CAMHS review. Monitor outcomes and progress in the new Crisis Care service models for CYP, in line with the wider Crisis Care pathway. Slide10

CYP – SEL Supporting Narrative

Each SEL CCG have published their ‘CAMHS Local Transformation Plan Refresh’ which have been signed off by their Health and Wellbeing Boards

Each plan reflects a commitment to transform access and experience of local mental health and wellbeing servicesEach CCG has established governance arrangements with partners and working in partnership to deliver and looking at opportunities for collaborative working (where we have shared providers working together) across 3 boroughs feeding into 6 SEL working The next slide reflects the work of a decade of collaborative commissioning across South London, which has resulted in a 7 borough Collaborative Commissioning Plan (including Croydon) which reflects the commitment to work across borough boundaries, responding to the local needs of our populationSlide11

In March 2017, partners including Lambeth, Southwark, Lewisham, Bexley, Bromley, Greenwich and Croydon CCGs, NHSE Specialised Commissioning and the two main mental health trust providers

SLaM

and Oxleas submitted a South London Collaborative Commissioning Plan.The 7 Borough Plan aims to:Demonstrate clear work aims across South London, highlighting pathways concerned and supporting collaboration across key partners involved have a joint commitment to deliver on this.Development of a local integrated pathway for CYP requiring beds that includes plans to support crisis, admission prevention and support appropriate and safe discharge.Embed ‘Transforming Care’ elements such as ‘At Risk Registers’ and facilitation of Community Treatment Reviews (CTRs) to take place pre and post admission and following discharge.Initiate plans to ensure join up with Health and Justice Commissioners to develop local integrated pathways (including transition to and from secure settings) and liaison and diversion (L&D) provision.

Anticipated high level outcomes of the plan include:Preventing admissions to paediatric wards and mental health inpatient units.Reducing the length of stay in paediatric wards and mental health inpatient units, through safe and appropriate discharge processes.Improving patient experience and individual outcomes.Governance Arrangements:The 7 Borough Collaborative Commissioning bi-monthly meetings are attended by:Lambeth, Southwark, Lewisham, Bexley, Bromley, Greenwich and Croydon CCGs, NHSE Specialised Commissioning and SLaM. CYP – SEL Supporting NarrativeSlide12

CCG

Lambeth, Southwark, Lewisham

Bexley, Bromley,

GreenwichNHS funded community funded MH serviceSLaM

are commissioned by four CCGs

(LSL & Croydon)

under a block contract with AMH to provide community CAMHS and some specialist Tier 4 outpatient provision across the four boroughs. All have a generic service alongside specific services for looked after children (LAC), forensic and children with disabilities.

Lambeth

commissions the Well Centre and Lewisham the YP Health & Wellbeing Service, to offer low level MH support.Community CAMHS is delivered by Oxleas NHS Foundation Trust are commissioned under a block contract with AMH to provide community health provision (including CAMHS) across BBG. All have a generic service alongside specific services for looked after children (LAC), forensic and children with disabilities.Bromley commissions Bromley Y, as a single point of access to mental health support and Bexley CCG commission the Community Health and Wellbeing Service with team of community outreach CAMHS professionals24/7 urgent and emergency serviceCrisis care services are available across the 3 hospital sites (GSTT, Kings and UHL) with access to a SpR supported by on call consultant psychiatrists 24/7. Lambeth and Southwark commission Red Thread (non-NHS provider) managing crisis presentations in hospital, where there’s an affiliation with gang crime.Psychiatric Liaison services are available in each Trust with access to a SpR supported by on call consultant psychiatrists 24/7. CAMHs specific practitioners available and on call from 08.00 through to 7pm (10pm in Bromley)Three Borough arrangements to extend CAMHs availability in each Trust currently under development CYP IAPTLSL and SLaM are part of the South London IAPT collaborative, Lambeth and Southwark (Wave 1) / Lewisham (Wave 3). Staff have completed training with more staff training this year. Lambeth and Lewisham are delivery partners for the Children’s Wellbeing Practitioner (CWP) programme, funded by HEEOxleas are part of Wave 2 CYP-IAPT programme, staff have completed trainings with more staff identified for current training programmeVol Sector providers are supporting all staff to complete CYP-IAPT training Community Eating DisorderNationally acclaimed community adolescent eating disorder service (CAEDs) provided by SLaM and delivered across 7 boroughs (including Croydon), creating consistency of provision across South London. CAMHS transformation resource has enabled an expansion of this, to include a schools training programme, self-referral access and an advice line for young people, parents and professionals.Out area placementsLSL /BBG are working with LA colleagues and Specialised Commissioning to prevent admission and promote discharge, specifically under the Transforming Care agenda. Tripartite funding arrangements are being reviewed across South London.Tier 4 CAMHSAll 6 areas commission SLaM to deliver T4 outpatient provision. T4 inpatient services through SLaM and private providers are commissioned directly through NHSE. Collaborative arrangements are in operation with SEL CCGs, Specialised Commissioning and providers, through the Collaborative Commissioning Plan.CYP – SEL Supporting NarrativeSummary overview of SEL CAMHSSlide13

CYP: Measures, metrics & baselines

Initiative

Measures/metrics available to support initiative

Is a baseline in use or available to support initiativeCurrent mechanisms in place for monitoring progress (e.g. routinely mentored at A&E DB level)NHS funded community funded MH service

CAMHS

a

ccess data reported electronically through MHSDS

Each CCG has

confirmed baseline access data for 16/17CAMHS providers submit quarterly minimum datasets - data covers the whole care pathway. Across the STP, there are monthly /quarterly contract monitoring meetings and reporting / governance structures across CCGs and LAs, such as Joint Commissioning Groups and Health and Wellbeing Boards, which oversee LTP KPIs & risks to delivery24/7 urgent and emergency serviceCrisis presentation data collected by borough crisis teamsBaseline data available for 16/17Crisis data is included in CAMHS minimum dataset and reviewed via contract monitoring meetings. A wider review of crisis provision across South London is being undertaken by SLaM during 2017CYP IAPTPaired ROMs collected and reportedBaseline data available for 16/17ROMs/SDQ data included in minimum dataset and reviewed via contract monitoring meetingsCommunity Adolescent Eating Disorder Service (CAEDS)Routine and Urgent waiting time data collected from 2016/17Each CCG has baseline access data according to 2016/17CAEDs waiting time data to be included in CAMHS minimum dataset. Performance to be managed via the Collaborative Commissioning Group.Out area placementsAdmission and OBD dataBaseline data included in Collaborative Commissioning planInpatient data (SLaM and private) included in CAMHS minimum dataset. Performance managed via the Collaborative Commissioning Group.Tier 4 CAMHSOutpatient, admission and OBD dataBaseline data included in Collaborative Commissioning planInpatient and Outpatient data included in CAMHS minimum dataset. Performance managed via the Collaborative Commissioning Group.Slide14

June 17

July 17

Aug 17

Sept 17

Oct 17

Nov 17

Dec 17

Jan 18

Feb 18March 18Q1 18/19Q2 18/19Q3 18/19Q4 18/19Transforming careCrisis careIn-patient bedsCommunity alternativesHealth and justice programmeEngagement with young peopleWorkforce developmentCYP: Local milestonesPlease outline the delivery milestones for each of the workstreams – this is currently organised by workstream, but you may wish to organise each section by CCG or providerKEY: Milestone Brief description of planned activitySEL CTR Training, CAMHS commissioners represented on SEL TC BoardCrisis care reviewReview of admission and OBD dataImplementation of L&D work and trauma informed provision across the YOSImplementation of co-production practice across mental health and emotional wellbeing provisionBorough Transforming Care Boards and dynamic risk registers in placeDelivery of Mental Health First Aid across community servicesReview of impact of alternative to inpatient provision e.g. SDS, DBTSlide15

CYP: Risks / Issues

Risk /

Issue

DescriptionMitigationRAG Rating*CAMHS treatment and prevention challenges

Long waiting times for number of CAMHS services

Waiting time initiatives operating in

SLaM

Additional posts recruited through CT funding

3Lack of Tier 2 / low level provision around MH and emotional wellbeingCWP programme operating in Lambeth, Lewisham and BromleyNon-NHS provision being offered as part of early intervention offer (Bromley Y, YP Health and Wellbeing Services)5Challenges around recruitment which had effect of limiting capacity in servicesCommissioners and providers are reviewing capacity and capability across the workforceProviders are engaged in the CYP IAPT Collaborative4Delivery against ambitious CAMHS access targets (35%) by 2021 Risks will be mitigated by improving access to low level ‘evidence based’ mental health support and an improved understanding of CAMHS thresholds and eligibility criteria1Collecting access data through the MHSDS for non-mental health trusts.Risks will be mitigated by supporting providers when submitting data through N3 connections.2Sustainability of different initiativesCAMHS transformation resource is time limited (20/21) and budgets more widely are under considerable pressure Building capacity and capability within the system, through various approaches including CYP IAPT.Piloting new and innovative approaches, to demonstrate impact. CCGs to build on work with LAs and other partners to joint commission services, across SEL where possible12LA savings and budget pressuresLocal authorities are under huge pressure to identify savings across children’s servicesCommissioners are utilising joint commissioning functions across CCGs and LAs to promote and uphold efficient use of funding12Reduction in the number of CYP being placed in OOB MH inpatient unitsReduce the number of out of area placements for CYP and use of in-patient beds overall.Individual CCGs are working with LAs to develop processes to better manage complex cases (LD/SEN, forensic, LAC, transition) – boroughs are working together to share good practice and look for opportunities to co-commission / share resourcesTransforming carePreventing admissions into inpatient units, specifically for YP and adults with ASD / LDCTR training has been offered to commissioners across the STP footprint. LA / CCG colleagues are working together to develop comprehensive ‘dynamic risk registers’ for YP at risk of being admitted.*RAG Rating – based on OHSEL guidance included at appendix 1 Slide16

Enablers, dependencies and assumptions

Draft in progress |

Enabler

Title

Description

Action

RAG

Digital

Access Data Flow to MHSDSFor access data to be reported, NHS and non-NHS activity should be submitted through NHS digital Providers to work with commissioners to ensure relevant data is captured to support access targets.MHSDS data flow dial in training sessionsWorkforceCTR training for SELCCGs to ensure adequate arrangements are in place to response to the Transforming Care agenda To include development of dynamic risk registers and local Transforming Care Boards.To ensure measures are in place to deliver timely Care Treatment Reviews for CYP with ASD / LDTraining in Primary CareResponding to mental health training needs of GPsUndertaking a training needs auditCYP IAPTBuilding capacity and capability within the workforceAccessing training available and delivery of the Children’s Wellbeing Practitioner ProgrammeWorkforce expansionDelivering increased access to evidence based MH services will require significant expansion to the workforceSEL CCGs will be working together to deliver against CYP IAPT objectives, utilising opportunities to work collaboratively.DependencyCollaborative Commissioning GroupWell established SEL arrangements in place to support collaborative working with spec comm and MH trustsProactive agenda planningDevelopment of action and risk logsDigital, estates, workforce, communication and other assumptions and dependenciesImpact RAG KeyHighSignificantLowSlide17

Impact on activity, finance and quality - Community CAMHS only

Draft in progress |

CCG

CYP population (latest GLA estimates 15/16)

LA spend

CCG spend

Overall spend

LA spend as % of total

CCG spend as % of totalCAMHS Referrals Q3 16/17CAMHS caseloadQ3 16/17Lambeth67,400650,0003,000,0003,650,00018%82%3611082Southwark67,8001,446,2013,532,8454,979,04629%71%4291205Lewisham72,200940,0002,775,0003,715,00025%75%3561590Bromley74,300  **2,650,00 2,650,00 0%  100%165*829Bexley62,100443,2921,847,5092,290,80120%80%342***TBCGreenwich71,9001,083,6993,102,0003,354,06232%68%399***425* This only include Tier 3** LB Bromley invest significant resource in an Early Intervention Single Point of Access service delivered through a voluntary sector provider. 676 referrals in to the single point of access service Q3 2016/2017 *** Tier 2 and 3To note: The 6 CCGs spend does not currently include additional CAMHS transformation resource.Slide18

Heading

Recognised gaps in the delivery plan

Local response and next steps to address

timelineCAMHS Tier 4 review

Key elements of this work include: prevention of admission to MH inpatient units; reducing length of stray in paediatric wards and inpatient units; and improving patient experience and outcomes

Collaborative working within the 7 borough Collaborative Commissioning Plan enables: opportunity for sharing good practice; use of data to demonstrate impact, quality and consistency of information; offers challenge in terms of gaps / duplication; and looks for opportunities for joint commissioning

TBC

Baseline

and outcome dataNHSE are committed to delivery of a national assurance programme. CCGs / STPs are expected to report progress against key elements of the delivery plan. SEL CCGs are working collaboratively he collection and reporting of baseline data, trajectories and KPIs, identifying areas of good practice / gaps and duplication across the STP footprint CAMHS commissioners are working collaboratively with providers to ensure data is of a high standard in terms of quality and range of KPIs collected and reportedOngoing Co-productionKey principle in Future in Mind and the FYFVSEL commissioners committed to co-production and initial co-production exercises and engagement plans have taken place. However, co-production approaches will be extended On goingCYP: Gaps in plansSlide19

Perinatal Mental Health

By 2020/21, there will be increased access to specialist perinatal mental health support nationally; in the community or in-patient mother and baby units, allowing at least

30,000 women each year to receive evidence-based treatment closer to home when they need itSlide20

Draft in progress |

Perinatal - Delivery Plan Contents

Page

Title

21

National Expectations

22

Supporting Narrative

23Measures, Metrics and Baselines25Local Milestones26Delivery Plan Detail28Risks / Issues30Enablers, assumptions, dependencies31Impact on activity, finance, qualitySlide21

Draft in progress |

Perinatal: National Expectation

NHS England: Mental Health Delivery Plan 2017-18, May 2017

Increase access to evidence-based specialist perinatal mental health care: regional plans and trajectories in plan to meet national ambition of 2,000 additional women accessing care.Commission additional or expanded specialist perinatal mental health community services to deliver care to more women within the locality.Slide22

Perinatal in SEL STP

SEL has a varied current provision of specialist perinatal mental services.

Borough

Current specialist perinatal provision in relation to joint commission guidelinesExplanationLambeth3Lambeth, Southwark and Lewisham in collaboration with SLaM were successful in gaining funding to develop perinatal mental health services. A number of staff have been recruited including 5wte Specialist Nurse Practitioners, 1wte B6 Nurse operating a full caseload and 1wte Consultant Psychiatrist in Lambeth, Southwark and Lewisham. This has enabled a daily consultant emergency slot available. Patients who are relapsing or require urgent mental health review are now being seen either on the same day or next day. The model incorporates midwifery, obstetric and Health Visitor expertise to clinical meetings to support the delivery of evidence based treatment and riskManagement. All staff report an improvement in communication with

multiagencies

.

Lewisham

3

Southwark3Bromley3The Bromley specialist perinatal mental health service was launched in July 2016 and is provided by Oxleas Mental Health NHS Foundation Trust and Bromley & Lewisham Mind (Mindful Mums), working closely with other providers, including maternity teams at the Princess Royal University Hospital (PRUH), Children & Family Centres and Health Visitors. Bexley2In Bexley a small service is delivered by Darent Valley Hospital specialist midwifery team. Women also have access to a perinatal psychologist and a specialist obstetrician, however, additional investment is needed to upgrade this service to be fully compliant with guidance Greenwich1In Greenwich there is no compliant service, although locally women have had access to Best Beginnings and Time Team. The Provider MH trust employs a specialist Health Visitor for Parental Mental Health. Slide23

Initiative

KPI Definition

KPI Target

Current mechanisms in place for monitoring progress (e.g. routinely mentored at A&E DB level)Access & Waits standard - preconception advice: Number of weeks from referral to being seen by a specialist perinatal mental health service for women with a severe mental illness, or substance abuse who are planning a pregnancy and are referred for preconception advice. Also Women who have children have safeguarding protection plans. 50% within 6 weeks.TBC

Access & Waits standard - preconception advice:

Number of weeks from referral to being seen by a specialist perinatal mental health service for women with a severe mental illness, or substance abuse who are planning a pregnancy and are referred for preconception advice. Also Women who have children have safeguarding protection plans.

90% within 8 weeks.

TBC

Access & Waits standard - specialist perinatal mental health: OxleasNumber of weeks from referral to assessment for women with a known or suspected perinatal mental health problem who are referred to a specialist perinatal mental health service.50% within 2 weeks.TBCAccess & Waits standard - specialist perinatal mental health: Number of weeks from referral to assessment for women with a known or suspected perinatal mental health problem who are referred to a specialist perinatal mental health service.95% within 6 weeks.TBCPerinatal: Measures, metrics & baselines (1)The table on page 15 and 16 shows the Oxleas example of service measures and targets for women accessing PNMH services. Slide24

Initiative

KPI Definition

KPI Target

Current mechanisms in place for monitoring progress (e.g. routinely mentored at A&E DB level)Access & Waits standard - specialist perinatal mental health: Access & Waits standard: - access to Mother & baby unit. Hours from referral to access to mother & baby unit for women who require inpatient care for a perinatal mental health problem (from 32 weeks of pregnancy until 12 months after childbirth).90% within 24 hours.TBCAccess & Waits standard - Postpartum psychosis:

Number of hours from referral to assessment by secondary mental health services for women with suspected postpartum psychosis.

90% within 4 hours.

TBC

Access & Waits standard - referral to IAPT:

Number of weeks from referral to IAPT services to start of treatment for women with a perinatal mental health problem who are referred for psychological interventions.75% within 2 weeks.TBCAccess and Waits Standard: Number of women and their families referred into Mind family programme.75% within 2 weeks.TBCAccess and Waits Standard: Number of women and their families referred into Mind family programme.90% within 4 weeks.TBCPerinatal: Measures, metrics & baselines (2)Slide25

June 17

July 17

Aug 17

Sept 17

Oct 17

Nov 17

Dec 17

Jan 18

Feb 18March 18Q1 18/19Q2 18/19Q3 18/19Q4 18/19Lewisham, Lambeth & SouthwarkBexley GreenwichBromley Perinatal: Local milestonesPlease outline the delivery milestones for each of the workstreams – this is currently organised by workstream, but you may wish to organise each section by CCG or providerKEY: Milestone Brief description of planned activityWave 2 bid submittedRecruitment of MDT staffEvaluationService continuationService launchedNeeds analysis completeLearnings from SLaM serviceRecruitment of staffTrainingEvaluationBid decisionSlide26

Perinatal: Delivery plan detail

Initiative

Site/CCG

DescriptionTarget delivery DateRecruitmentSLAM/LSL

MDT staff in post. Proactively measure impact of increased staffing on service

April – October 2017

Evaluation

SLAM/LSL

Complete service evaluation, measuring impact of increased staffing on service.Nov 17 – Mar 18Service continuationSLAM/LSLContinue to monitor outcomes and develop the service based on feedback from stakeholders. We will streamline provision across South London through collaboration with our neighbouring SWL STP footprint.Apr 18 – Mar 19Gap and needs analysisGreenwich, Bexley/OxleasReview of services/pathway and develop joint Bromley, Bexley and Greenwich bidOutline of Bexley and Bromley existing provision, where patients go  and the cost and activity figures.Agreed transformation requiredApril – June 2017Learnings from SLaM serviceGreenwich, Bexley/OxleasSLaM to support The Provider and commissioners in development of new service including gap analysis, pathway design, performance metrics and recruitment plan.Nov – Dec 2017RecruitmentGreenwich, Bexley/OxleasRecruitment of core staffJan – March 2018Slide27

Perinatal: Delivery plan detail

Initiative

Site/CCG

DescriptionTarget delivery DateTrainingGreenwich, Bromley, Bexley/

Oxleas

Core staff in post, inducted into The Provider and trained (with input from

SLaM

colleagues as appropriate).

Apr – October 2018EvaluationGreenwich, Bromley, Bexley/OxleasMDT staff in post. Complete service evaluation, measuring impact of increased staffing on service.Nov 2018 – March 2019Service continuationGreenwich, Bromley, Bexley/OxleasContinue to monitor outcomes and develop the service based on feedback from stakeholders. We will also seek to streamline provision across South London through collaboration with our neighbouring STP Footprint.April 2019 – March 2020Slide28

Perinatal Risks / Issues

Risk /

Issue

DescriptionMitigation

RAG Rating*

Issue

LSL/SLAM - Delay in recruitment of staff and London

region shortage of community mental health nurses

SLaM is a renowned employer of perinatal specialists and regularly attracts high calibre applicants.Existing SLaM staff in community and MBU team open to secondment opportunities. SPRs available for fixed term / part time roles.SLaM have been able to expedite recruitment and consider their recruitment strategy to be on track.12IssueLSL/SLAM – Initial challenges with increasingestate capacity and expansion of ICT to provide agile working.Team base has been identified. Staff have received mobile technology opportunities to optimise record keeping and communication as part of the Trust’s agile working strategy. tbcIssueLSL/SLAM - Waiting times. A significant reduction in waiting times to see a Consultant Psychiatrist. However, waiting times have been at 8 weeks to be seen by Psychologists. Staff recruited so far have reduced the waiting times. Those waiting have been triaged in relation to risk and crisis plan in place.tbcRiskBBG/Oxleas - staff recruitment and sustainability of the workforce across the system i.e. we may all be recruiting from the same pool of eligible staff.Training/up-skilling exiting staff may need to be consideredA successful BBG bid would also provide SEL with sufficient time to align the 2 services (i.e. the bid for BBG and the existing funding received for LSL) and to evaluate how this could be joined up across the STP footprint. 12*RAG Rating – based on OHSEL guidance included at appendix 1 Slide29

Perinatal Risks / Issues

Risk /

Issue

DescriptionMitigation

RAG Rating*

Risk

BG/

Oxleas

- Demand may outstrip the working estimates used in the bidTBC6riskPotential data collection issues where multiple providers are involved. Women and their families are not subject to handoffs that delay delivery and that women and their families feel confident that relevant information is shared in line with data sharing agreements in a seamless way so information is not repeated or duplicated etc.That Services are located within pathways and that women and that families can move easily within services even if different providers are involved e.g. from voluntary or maternity services, Local Authority and specialist perinatal services4RiskBBG/Oxleas - sustainability due to uncertainty about funding post 2020All 3 CCGs are seeking to find ways to invest additional funding in MH services to meet parity of esteem targets. This is against challenging financial QIPP programmesBromley CCG has committed £271k/annum funding towards developing PNMH servicesInvestment in this proposal also has the potential to reduce costs elsewhere in the system. Early intervention can prevent infant mental health issues arising, averting subsequent costs within the CAMH service. In addition, recognition and treatment of mothers at an earlier stage could avert preventable admissions to NHSE commissioned mother and baby units. 9riskBG/Oxleas - engaging vulnerable groupsensuring the service is non stigmatisingThe bid’s focus on promoting mental health and well-being aligns with BBG Health and Wellbeing strategies and this fits with the Mayor of London’s support for the Thrive London agenda, which addresses reducing stigma as a key component9*RAG Rating – based on OHSEL guidance included at appendix 1 Slide30

Enablers

Draft in progress |

Enabler

Title

Description

Action

RAG

Estates

Increasing estate capacityIdentifying venues for new teamsLink with STP estates disposal and retention strategyWorkforceRecruitment and retentionStaff recruitment and sustainability of the workforce across the system i.e. we may all be recruiting from the same pool of eligible staff.Consider how to align the two services (i.e. the bid for BBG and the existing funding received for LSL) across the STP footprint. DigitalMobile workingSLaM staff have received mobile technology opportunities to optimise record keeping and communication as part of the Trust’s agile working strategy. Review how this links to the STP Digital agile working approach. Oxleas already have a fairly mature agile working approach in place for community services.DigitalInformation sharingSharing data across providers and voluntary sectors to avoid duplication and repeating information Flag with STP digital group to link into SEL information governance group and Virtual Care RecordDigital, estates, workforce, communication and other assumptions and dependenciesImpact RAG KeyHighSignificantLowSlide31

The table below shows the investment required to deliver a PNMH across SEL and the impact on activity.

Perinatal: Impact on activity, finance and quality

CCG/Provider

yearFunding requiredActivity impactBromley/Oxleas17/18£283,391168 total numbers a yearLSL/SLAM16/17£70,00057 on top of existing activity17/18

£1,778,000

830

total

18/19

£1,778,000830 totalBexley/Greenwich17/18£2,560,201 345 whole year increase in women accessing PNMHSSlide32

Improving Access to Psychological Therapies (IAPT)

By 2020/21 there will be

increased access to psychological therapies so that at least 25% of people with common mental health conditions access services each year Slide33

Draft in progress |

IAPT - Delivery Plan Contents

Page

Title

34

National Expectations

35

Supporting Narrative

36Measures, Metrics and Baselines37Local Milestones38Delivery Plan Detail39Risks / Issues41Enablers, assumptions, dependencies42Impact on activity, finance, quality43Gaps in PlansSlide34

Draft in progress |

IAPT: National Expectations

Meet

IAPT access, recovery and waiting time standardsCommission additional psychological therapies for people with anxiety and depression with majority of the increase integrated with physical healthcare so that at least 16.8% of people with common MH conditions access psychological therapiesDevelop regional and STP workforce plans to ensure sufficient numbers of trainees to meet commitments

Increase

numbers of employment advisors

in IAPT through funding, monitoring and reporting on Employment Advisors in the IAPT project, coordinating with HEE local teamsSlide35

IAPT

supporting narrativeSEL CCGs have trajectories on track to achieve recovery wait, 6 and 18 week waiting time, though there are concerns around maintaining recovery rates. Feedback from our CCGs is that funding IAPT expansion, and into LTC pathways and physical health settings, presents a significant cost pressure and risk. Our CCGs welcome exploring innovative ways of delivering lower intensity programmes (STEP 2) e.g. Southwark’s Big White Wall or the Bromley phone/group modalities and other best practice examples and this is an areas we hope to explore across south east London learning from existing examples of best practice and linking with our Digital Programme team

Lambeth and Southwark CCGs, Kings Health Partners and Citizens’ Board and Healthwatch have organised a series of clinical meetings facilitated by SL Health Innovation Network to co-design and spread best practice on Long Term Conditions. Partners have come together to from five Local Care Networks (LCNs) across the two acute Trusts and mental health Trust across Lambeth and Southwark. A primary aim is for providers in LCNs to improve population health, in a geographical place, working collaboratively in integrated ways. A shared ‘Care Coordination’ incentive is in place for partners during 2016/17-2018/19, with LCNs coordinating the design and delivery of an approach to coordinated care for a selected cohort of people with three or more LTCs. This shared incentive is reflected in Acute, Mental Health and Community Trust CQUINs, with the intention of a similar ‘mirror’ incentive in general practice. Included in the cohort are people with uncontrolled risk factors including depression and serious mental health. The aim of this is to embed collaborative care planning and holistic management to include social, mental and physical health for our population, and improve the screening and identification of mental health issues into physical health consultations and clinical reviews. Slide36

IAPT: Measures, metrics & baselines

CCG

Access Baseline and trajectory

Recovery baseline and trajectoryCurrent mechanisms in place for monitoring progress (e.g. routinely mentored at A&E DB levelSouthwark

14%

Dec 2016

16.8% 2017/18

19% 2018/19 37.9% and improvement plan in place.Quality of service delivery is key to SLaM and is monitored through a standard data set. Patient satisfaction and feedbackClinical outcomesLength of contactAccessibility, including waiting timesClinical governance (complaints and incidents, and the learning from them)Activity levelsSafeguardingPerformance against these indicators is shared with clinical teams, the CAG Executive, the CCG and NHSE, along with patient feedback. Lambeth18% Dec 2016 17.3% 2017/18 19.2% 2018/19 48.8% but anticipate recovery target achieved by end of March 2017Lewisham53% January 2017Bexley15.13% achieved at 16/17 year end16.8% by end 2017/18 – some confidence that the Provider will hit this year’s target9.2% by 2018/19 – not confident they will hit next year’s target50.6% Bromley16 % Dec 201615.8% by 2017/1818.3% by 2018/1951.8% Jan 2017 Greenwich13.6% Dec 201616.8% by 2017/18 19.2% by 2018/1958.1% Jan 2017Slide37

June 17

July 17

Aug 17

Sept 17

Oct 17

Nov 17

Dec 17

Jan 18

Feb 18March 18Q1 18/19Q2 18/19Q3 18/19Q4 18/19Lewisham IAPT/Integrated Talking therapy Care Pathway All boroughs Greenwich /OxleasIAPT: Local milestonesPlease outline the delivery milestones for each of the workstreams – this is currently organised by workstream, but you may wish to organise each section by CCG or providerKEY: Milestone Brief description of planned activityImplementation of Pilot Integrated Talking therapy service Final agreement on service model Consider application for wave 2 STF bid Agree basic service price with IAPT providers Implement shadow Outcome payment tool process and reports Implement IAPT Outcome payment tool Working together to find efficiency savings to support IAPT achievementSlide38

IAPT: Delivery plan detail

Initiative

description

Target delivery DateDigital model of deliverySouthwark using Big White Wall as group support with psychologist supervision to deliver lower intensity interventionsOngoing

Workforce

Southwark exploring workforce funding announced with the provider

SLaM

and the local HEE team

TBCLambeth undertaking modelling exercise for additional workforce. ongoingLong term conditionsLewisham In the process of reconfiguring the model and incorporating in a psychological therapies pathways service and LTC. Ongoing BromleyBromley Health care is the new lead provider which includes a new specification for people with long term conditions in physical health settings. Go live date for this new contract was 3 April and will develop stretch targets to engage with LTC. Will be shadow running in 2017/18 and plan to move to outcome based tariff 2018/19. April 201717/18Slide39

IAPT: Risks / Issues

Risk /

Issue

DescriptionMitigationRAG Rating*Workforce gaps and impact of picking up LTCs

Concerns not about the quality of the service or provider but the ability to deliver the additional asks

with the current workforce

Lewisham will review

alternative ways of delivering lower intensity interventions – digital solutions add to risks

12Lambeth undertaking modelling exercise for additional workforce. 12Southwark exploring workforce funding announced with the provider SLaM and the local HEE team12Bexley to carry out LTC modelling12Bromley has modelling exercise as part of tender does factor in the growth and utilises other modalities such as phone/groups and on line.3FundingGreenwich did not bid for funding due to sustainability concerns . £120k has been reduced from the budget which Oxleas have managed with efficiency savings. However this may now prove tricky to manage the access targets. Greenwich CCG we will be holding Oxleas to account for meeting the NHS standard target’s year on year i.e. 16.8% in 2017-18 however they have not yet agreed that they can meet this target. We will be working with them over the next year and beyond to identify efficiency savings within the Oxleas MH envelope which can be redirected to any services that require additional funding.  With this in mind, we are holding a meeting on Monday 3rd July to discuss how we proceed. 16An additional statement from Oxleas:The CCG asked for a £120k reduction in funding from the 16/17 baseline, in the 17/18 contract. The trust agreed to continue to deliver the current 15% access (despite a significant cut in current funding) through service redesign, and on the basis of an agreement that increased funding is required to meet the new access target of 16.8%.  Todate, there has been no agreement on the additional funding required to meet this target and we are continuing to work together to address this issue.Bexley - Funding a significant risk as next year MIND in Bexley have indicated they will need an additional £40-50k of therapy time. No plans to bid for TF money as non recurrent. TBC12Southwark £317,000 Transformation bid unsuccessful which would have been used to provide breathing space to develop a plan for sustaining the service post funding. Spend in 16/17 was £3.2m, rising to £3.3m in 17/18Review bid for second wave funding along with Lewisham CCG12Lambeth - £317,000 Transformation bid unsuccessful. Need additional funding to achieve increased access target. 12*RAG Rating – based on OHSEL guidance included at appendix 1 Slide40

IAPT: Risks / Issues

Risk /

Issue

DescriptionMitigationRAG Rating*

Increased uptake

Difficulty encouraging uptake and increasing referrals to the service

Bexley - To increase numbers MIND have run initiatives to encourage GP referrals in from physical and mental health, but take

up poor from GPs.

Also considering targeting outpatient clinics to encourage referrals9IssueSouthwark The recovery target has not been achieved in 2016/17 and remains a risk in 17/18 and beyond. A recovery plan is in place and has been submitted to NHS England. NHSI support offer taken up, and their IAT team assisting with data quality issues and assessing the strength of the service model in August 2017. 16IssueA key issue for Southwark is that the IAPT model provides higher level psychological services to more complex patients than found in a standard IAPT model. Whilst this has benefits, people in this cohort are less likely to meet the definition of recovery set in the national target. This aspect of the service model will be reviewed with support from the NHSI support team.12*RAG Rating – based on OHSEL guidance included at appendix 1 Slide41

Enablers

Draft in progress |

Enabler

Title

Description

Action

RAG

Digital & workforce

Low intensity interventions Southwark using Big White Wall as group support with psychologist supervision to deliver lower intensity interventionsReview best practice and SEL examples to spread learning and understand what could be delivered Pan SELWorkforceWorkforce and LTC modellingModelling around impact of LTCs and increasing uptake on the workforcePotential to share Lewisham and Bromley work undertakenEstatesIntegrated service provisionIdentify potential delivery sites with voluntary sector providers Potential to use additional accommodation for the delivery of some interventions Digital, estates, workforce, communication and other assumptions and dependenciesImpact RAG KeyHighSignificantLowSlide42

IAPT: Impact on activity, finance and quality

Draft in progress |

CCG

Access Baseline and trajectoryRecovery baseline and trajectory

Funding

Estimated gross savings from new service

Southwark

14%

Dec 2016 16.8% 2017/18 19% 2018/19 37.9% and improvement plan in place.£317,000 Transformation bid unsuccessful. Funding would have been used to provide breathing space to develop a plan.Spend in 16/17 was £3.2m, rising to £3.3m in 17/1817/18 - £170,48618/19 - £170,48619/20 - £71,366Pending wave 2 fundingLambeth18% Dec 2016 17.3% 2017/18 19.2% 2018/19 48.8% but anticipate recovery target achieved by end of March 2017£317,000 Transformation bid unsuccessfulNeed additional funding to achieve increased access target. Spend in 16/17 was £3.1m, remaining flat for 17/18. Unknown caseload17/18 - £170,48618/19 - £170,48619/20 - £71,366Pending wave 2 fundingLewisham53% January 2017Did not apply for funding but intend to bid in next waveTBCBexley14.8% Dec 201616.8% by 2017/18 - confident will hit this years target19.2% by 2018/19 – not confident they will hit next years target50.6% No plans to bid for TF money as non recurrent. Funding a significant risk as next year MIND in Bexley have indicated they will need an additional £40-50,000 of therapy timeTBCBromley16 % Dec 201615.8% by 2017/1818.3% by 2018/1951.8% Jan 2017 No funding issues anticipatedTBCGreenwich13.6% Dec 201616.8% by 2017/18 19.2% by 2018/1958.1% Jan 2017Currently spend £2,435m. Spend in 16/17 was £2.7m on a caseload of 6,091 patients: £440 per patientTBCThe table below gives a summary of the the cost to meet the IAPT targets, the impact on activity of achieving IAPT and funding issues Slide43

IAPT: Gaps in plans

Draft in progress |

Heading

Recognised gaps in the delivery plan

Local response and next steps to address

timeline

Transformation

funding

Addressing the funding gap through a submission for wave two Transformation fundingSTP support re-working the unsuccessful bids for Lambeth and Southwark along with a Lewisham submission. Calculating financial savings from service delivery to support sustainabilityTBCWorkforceSEL response to workforce gapsDiscuss with steering group and workforce enabler workstream to develop an STP approach to ensure sufficient numbers of trainees to meet commitments TBCDigitalDeveloping an SEL IAPT digital plan to free up workforce capacity through technology and provide increased access to IAPTDigital enabler workstream and steering group reviewTBCSlide44

Early Intervention in Psychosis

By 2020/21, at least

60% of people with first episode psychosis starting treatment with a NICE-recommended package of care with a specialist early intervention

within two weeks of referral Slide45

Draft in progress |

EIP - Delivery Plan Contents

Page

Title

46

National Expectations

47

SEL Narrative

49Local Milestones50Delivery Plan Detail51Risks / Issues52Impact on activity, finance, quality53Enablers/ Assumptions / DependenciesSlide46

Draft in progress |

EIP: National

Description

NHS England: Mental Health Delivery Plan 2017-18, May 2017Expand capacity so that more than 50% of people experiencing a first episode of psychosis start treatment within two weeks of referral with a NICE-recommended package of care.Slide47

SEL Overview

Bromley

and Bexley have low incidence of psychosis while the rest of the boroughs in the footprint have from average to very high level of First Episodes of Psychosis Southwark and Lambeth are two of the seven London Boroughs that have over 50 new cases of First Episodes of Psychosis that could be linked to higher levels of deprivation and ethnic composition of the population

In SLaM, current caseload is 953 whereas Oxleas is 284. significant investments have been made across all four Early Intervention services both in terms of staffing and training which have helped to achieve a positioning above national average on part II national standards on improving access to EIP services. In Oxleas, all relevant staff in the adult Early Intervention services had received the nationally delivered training in FI and Cognitive Behavioral Therapy for Psychosis (CBTp). However, a number of trained staff had now moved on from OXLEAS which had a direct impact on the ability of the services to deliver CBTp and FI.By 2020, the caseload could grow between +30% and + 77% for SLAM, and between +19% and +138% for OXLEASBased on practice staffing guidelines, both SLAM and OXLEAS seem already understaffed based on current volumes and should require a +49% and +35% increase respectively; the gap will continue to increase until 2020

It is predicted that meeting the 2 week wait the trajectory whilst currently OK, will become more challenging with the on-going impact of the age range extension. Meeting NICE interventions are not yet being met (

SLaM

) and this will impact further on capacity issues.

HLP review recommend a 50% increase in staffing at

SLaM based on current care coordinator caseloads. These are recommended nationally to be set at 15 cases per care coordinator, the 4 SLAM CCG teams’ CC caseloads range from 17-27. Findings were shared in June 2017 with the STP MH steering group and it was agreed to follow up with meetings between caseload teams and commissioners to review a realistic case load size and the duration of a patient on a caseloadEIP: supporting narrativeSlide48

SLAM progress to dateThe Early Intervention in Psychosis Access and Waiting Times standard Part II assesses provision of NICE concordant treatment and care. The self-assessment report arising from the national exercise in 2016/17 was presented to commissioners as planned, highlighting areas of good performance and areas for improvement. The report for 2016/17 is primarily for benchmarking purposes for all Trusts delivering EIP services. Areas of good practice included the waiting time standard, cognitive behavioural therapy for psychosis (

CBTp

) and vocational interventions. Ares of improvement included Family Intervention, Physical Health and carers support interventions. An action plan has been developed to focus on sustaining areas of good practice and addressing the areas of improvement.The Trust is participating in the London wide programme led by the Healthy London Partnership (NHS England) and the London Early Intervention in Psychosis (EIP) Clinical Reference Group. This is assessing London providers' capacity and demand against the requirements of part two of the standard. The Trust has now reported to the South East London Sustainability & Transformation Plan (STP) MH Board our concerns about delivery of part two of the standard; the rising caseloads and the projected 70% total caseload increase over three years.  Commissioners have been briefed previously on these risks based on existing CCG investment.National reporting of the EI standard will change in July, moving from the manual UNIFY return to an automatic submission as part of the Mental Health Services Data Set. A meeting has been held with Lewisham CCG as our co-ordinating commissioner to review our processes in advance of the change. As a result of the meeting, our data definitions have been refined.

EIP: supporting narrativeSlide49

June 17

July 17

Aug 17

Sept 17

Oct 17

Nov 17

Dec 17

Jan 18

Feb 18March 18Q1 18/19Q2 18/19Q3 18/19Q4 18/19Workforce capacitytrainingARMsCommissioningEIP: Local milestonesEI Teams workforce capacity detailed review and actionsSEL EIP training plan development and launchEI commissioning framework innovation At Risk of Mental State service implementation across SELSEL and EI teams review demand and capacity planning, agree on sustainable staffing planFeasible options for coping with increasing demand assessed and actions definedFirst batch of actions required to ensure sustainable staffing implemented – at least addressing current capacity gapAdditional actions implemented as requiredStrategy for providing appropriate training for current and new staff identifiedTraining for current staff developed and first edition delivered Training plan for new staff launchedOptions for ARMS operating model across SEL assessed and actions definedARMS implemented across SELStrategy for testing new commissioning framework identifiedLaunch of Proof of Concept initiative for new commissioning frameworkAssess results of the Proof of Concept and identify scalable elementsSlide50

EIP: Delivery plan detail

Initiative

Description

Target delivery Date

EI Teams workforce capacity detailed

review and actions

The initiative aims to ensure EI teams are provided with a sustainable level of workforce capacity as the volume of operations grows due to the implementation of the new NICE standards.

Commissioners will review in detail with EI teams the projections on the levels of demand, understand what could be a staffing plan ensuring a sustainable level of workforce capacity, discuss and define options for providing required level of resources (e.g. considering Length of Treatment and caseload size, agreeing on staffing plans with details of additional roles and WTE as patients volume grows).

August 2017 -March 2018SEL EIP training plan development and launchThe initiative will be looking at planning and providing required training for current staff (i.e. making sure workforce can be more flexible in delivering all services such as CBTp and Family Intervention), as well as for new staff (i.e. developing a pipeline of new qualified staff for EI teams as potential demand for additional workforce is likely to grow across London). Since institutional funding for such training could be scarce, STP and trusts should consider pooling budgets (also at London level) to maximise synergies. February 2018At Risk of Mental State (ARMS) servicesimplementation across SELEvidence highlights how ARMS services can be effective in further reducing the incidence of First Episodes of Psychosis among population cared, additional considerations can be also made about positive synergies in leveraging the service as primary triaging point; currently ARMS is not delivered in OXLEAS. The initiative will aim to identify and implement a potential operating model for implementing ARMS across SEL (e.g. hub-and-spoke model leveraging the ARMS already in place at SLAM).March 2018EI commissioning framework innovation It has been widely recognised that EI teams could be effective in containing the increase in healthcare spending, although current commissioning and monitoring systems have a limited effectiveness in capturing how such benefits are materialized across the portfolio of services – this isn’t facilitating the further development of such recovery oriented services. STP and Trusts should explore innovative Payment and Outcomes frameworks suggested by NHSE; this should be planned with a phased approach starting with a Proof of Concept or simulation of the new mechanisms. Q3 2018/19Slide51

EIP: Risks / Issues

*RAG Rating – based on OHSEL guidance included at appendix 1

Risk /

IssueDescriptionMitigation

RAG Rating*

issue

Scarce resources for funding additional workforce required to deliver ‘Part-II’ standards

Funding for EI has already been confirmed as limited

Identify with Trusts a minimum workforce baseline based on volumesAs well as a realistic length of time on a caseload and prioritise areas of immediate most pressing concerns. Discuss at MH STP level what are constraints and anticipated risks of providing a reduced level of funding in EI in order to make an informed decision and manage expectations6IssueFunding for EI has already been confirmed limitedConnect with other London STPs and Trusts to maximise efficiency in developing the training requiredConnect with HEE/NHSE/NHSI to identify potential budgets which can be used to deliver the training16Issue Scarce resources for funding ARMS services across SELFunding for EI has already been confirmed limitedIdentify most cost-effective way to deliver the operating model for ARMS services (e.g. leveraging on existing services at SLAMCheck if any budget for innovative services within NHS or other institutions can be leveraged to fund the service16Risk Necessary technological enablers not in place for EI commissioning framework innovationA key enabler for innovative commissioning framework is often the ability to deliver accurate real-time data on spending across the care system, this might not be readily available in SELReduce data complexity for implementing the Proof of Concept initial phaseIdentify a set of minimum IT data requirements to be prioritised to start the implementation of the Proof of Concept; link with the digital enabler to support progress in this area12Issue Greenwich Unable to locate NHSE monies for EIP developmentDespite a lot of investigation, we are unable to isolate how much this is and how to access it. Escalate to NHSE for further information18Slide52

EIP: Impact on activity, finance and quality

Draft in progress |

CCG

2 week baseline and trajectory

NICE

interventions

Finance

Commentary and next steps

SouthwarkSLaM meeting 14d target for all ages broadly for the last 9 months65.2% 16/17 Approx 20/quarter50% 2017/1853% by 2018/19Delivering the NICE treatment and care standards has not been met SLaM are developing a plan on how to meet these detailing timescales and staffing requirements.The CCG has increased the level of investment into this service by £39,000 in 17/18 Total budget of £379,000 SLaM have seen in increase in the first full year implementing the new standard in assessment activity (approx 30% increase in referrals) and FEP cases taken on (approx 25% more). Largely to age range extension, but also demographic causes in LSL. Over the next three years this is predicted to increase the caseloads of the 4 CCG SLaM EIP teams by 70%. 16/17 spend was £4.2m, increasing to £4.3m in 17/18 (2.2%)16/17 caseload was 282 patients, falling to 218 in 17/18 (£15k per patient)Lambeth70.6% Approx 28/quarter50% by 2017/18 53.6% by 2018/19 Lewisham75%. 16/17 was £1.885m Bexley75% Approx 6/quarter50% by 2017/18 66.7% by 2018/19 Block contractAlready as commission an all age serviceBromley51.9% Approx 17/quarter50% by 2017/18 53.3% by 2018/19 No dataConcerned target slipping and would like to drill down to make sure the right resources in place to deliver this standardGreenwich47.4% Approx 29/quarter51.7% by 2017/18 55.2% by 2018/19 16/17 spend was £900,000, for 69 patient caseload (£13k per patient)Advised that a data recording issue has been rectified and that the provider will hit target going forward. CCG need to see the final report to be assured.CCG overview of level of investment required to meet the target from a comSlide53

Enablers (1)

Draft in progress |

Enabler

TitleDescription

Action

RAG

Digital

Report for healthcare services consumption across all STP per patient

A report necessary to test most of innovative payment & outcomes mechanismsIdentify a set of minimum IT data requirements to be prioritised to start the implementation of the Proof of Concept; link with the digital enabler to support progress in this areaWorkforce Availability of workforceMeeting resources requirements even if funding is available.Review caseload size and duration on caseloadWays to resource the service pan SELDigital, estates, workforce, communication and other assumptions and dependenciesImpact RAG KeyHighSignificantLowSlide54

Crisis Resolution Home Treatment

By 2020/21 all areas will provide CRHTTs that are resourced to operate in line with recognised best practice – delivering a

24/7 community based crisis response and intensive home treatment as an alternative to acute inpatient admissionsSlide55

Draft in progress |

CRHTT

- Delivery Plan Contents

Page

Title

55

National Expectations

56

Supporting Narrative58Risks / IssuesSlide56

CRHTT

: Supporting Narrative

SEL overview

SEL has a 24/7 gate keeping (crisis advice and signposting service) function that direct to either the ED or the intensive home treatment as an alternative to hospital admission. Typically OOH the crisis lines will direct to ED for assessment by psych liaison staff where the patient seen as soon as team available as not all CRHTTs are available 24/7Lambeth is including an urgent

response by single point of access in new alliance contract for

2018

Suggested next steps

A review of the urgent

care pathways and response across SEL and how CRHTT and gatekeeping crisis lines relate to Core 24 liaison to provide 24/7 assessment.Slide57

CCG

Baseline

Funding

Commentary and next stepsSouthwark

HTT in place until 7pm.

There is a crisis advice line that will send someone to carry out an assessment which

is likely

to be at A&E if out of hours.

No dataNeed to review compliance with national guidanceLambethHTT extended to 08:00 to 22:00 and includes gatekeeping 24/7 function however crisis assessment at home not available 24/7 Meeting twice daily visits in line with good practice standards for CRHRT.Spend in 16/17 was £4.2m (including adult UEC liaison) for 1,350 patients: £3,100 per patientOut of hours response needs to be explored and its relationship to HTT, psychiatric liaison and police to avoid directing people to A&E or Place of Safety for assessment. Issue with the quality/lack of information sharing  A single point of access for urgent response will be a component of the new alliance contract to go live April 2018LewishamCommission SLaM and voluntary organisations to provide an enhanced crisis offer with a 24/7 peer support crisis lines. The acute referral centre crisis line advice, bed management team are available 24/7 however CRHT is notNo dataAre considering 24/7 crisis assessment provisionBexleyCRHTT is not delivering 24/7 intensive home treatment. For patients known to Oxleas there is an urgent advice line and can be referred to HTT if needed. A generic crisis line for BBG is provided by SLaM. There is not 24/7 crisis assessment. Is being reviewed as part of a SDIP with provider.No data Business case submitted by Oxleas and is being considered. BromleySame as BexleyNo dataIs being reviewed as part of a SDIP with providerGreenwichSame as BexleySpend in 16/17 was £2.5m (including adult UEC liaison) covering 3,900 patients: £644 per patientSame as BexleyCRHTT : Supporting NarrativeCurrent overview of CHRTT across SELSlide58

CHRTT

: Risks / Issues

*RAG Rating – based on OHSEL guidance included at appendix 1

Risk /IssueDescription

Mitigation

RAG Rating*

Issue

Difficulty in funding in parallel

effective 24/7 Crisis Response and Home Treatment Teams as an alternative to acute admissions when funding Core 24. Review CRHTT plans with CCGs alongside Core 24 plans and wave 2 bids12Slide59

Out of Area placements (OAPS)Slide60

Draft in progress |

OAP - Delivery Plan Contents

Page

Title

61

National Expectations

62

Supporting

Narrative64Risks / Issues / gaps in plansSlide61

Draft in progress |

OAPs:

National

DescriptionNHS England: Mental Health Delivery Plan 2017-18, May 2017Out of area Placements will be eliminated for acute mental health care for adults by March 2017.

People will no longer have to travel out of area inappropriately for non-specialist acute inpatient mental health care by 2020/21.Slide62

OAPs

: Supporting Narrative

The LSL trajectories provided relate to a reduction in bed utilisation/occupancy rate within Mental Health Acute wards and is based on the current bed stock of 330 beds, there are several variables that can impact the delivery of the target that require mitigation actions that will be incorporated into the overall plan’.

There is an ambition for Rehab OAPs to be picked up in this work as there is likely to be some overlap between those in acute OAPs and those who end up in Rehab OAPs. Identifying those who require Rehab earlier - be it in-patient or in community settings, will improve patient flow in the acute bed system, in terms of revolving door acute admissions, DTOC and those more complex people who get stuck for long periods in OAPs.Section 117s aftercare costs individual CCGs approx. £3m a year as well as individual LAs approx. £3m. Work is underway through a finance working group to establish the cost of patientsWe know there

are low volume cohorts of patients that are difficult to place e.g. high functioning Asperger's, women in women only placements or forensic patients. This leads to spot purchasing.

We intend to establish

what all commissioners are spot purchasing for/what cohorts of patients they struggle to place there may be economies of scale in commissioning together for these groups.

OAPS

activity and spend has been difficult to gather but we have a finance group that is supporting progress in gathering this information.Slide63

CCG

Baseline

Funding

Commentary and next stepsSouthwark

446 adult acute admissions were reported as being OAPs

Currently spending about £300k

on patients receiving treatment out of borough e.g. in North London,

Oxleas

and further afield if on holiday from not having the correct processes in place to gain approval for treatment and repatriating.S117 costs the CCG about £3m a yearHave an issue with placing high performing Asperger's patients, women into women only places and forensic patients that won’t have rehab?Opportunities considered with Lambeth to commission together for section 117sLambeth36 patients were OAPs in 16/17, costing £676k: £18.7k per patientLonger term placements out of area approx. 200 with a budget £12m and some jointly funded with local authority. S117 cost about £3m a year of this £12mHousing issue often delays discharge – homeless and housing associations. LewishamData request for:Inpatient numbers by bed type(treatment) e.g. acute, rehab, crisis, ADHD, ASC, CHC, low secure, Section 117)duration of stay per patient cost per patientand Local Authority OAP spend (Section 117 aftercare) if possibleOverspend for residential placements for S117s that are jointly funded by LA and CCGs.Review residential placements across SEL looking at numbers/type/spend/ duration/ blockages to improve the pathway and make efficiencies. BexleyRisk share with Oxleas for any OAPs – no additional CCG resource to fund reductions through Trust opening additional beds locallyGreenwichGreenwich CCG have reported 8,724 OAP bed days in 16/17, equivalent to c.28 beds.Spend on OAPs was £1.3m, equating to around £147 per bed day, with an average LoS of 86 daysOAPs : Supporting NarrativeSEL summarySlide64

OAPs: Delivery plan detail

Initiative

description

Target delivery DateGreenwich/ Oxleas review of acute OAPSOxleas and Greenwich reviewing in numbers and reasons for acute OAPs

End of July 2017

Sharing of opportunities

SLaM

and

Oxleas to share opportunities to work across SEL to reduce out of borough OAPS and what may need to be delivered pan SEL due to small numbers.July 2017Rehab OAPSReview of overlaps between acute OAPs and rehab OAPs working with the south London community mental health partnershipJuly/AugustFindings Update on findings and opportunities SEL wide at August steering groupAugust 2017Slide65

OAP

: Risks /

Issues/ gaps in plans*RAG Rating – based on OHSEL guidance included at appendix 1

Risk /IssueDescription

Mitigation

RAG Rating*

issue

OAP plans are not yet well developed and the trajectory set in this plan is not yet one we can confidently meet.

Work has been agree with Greenwich/Oxleas and Southwark/Slam to establish a clearer view of the OAPs pathway to develop a plan for SEL.This is a priority for the STP MH steering group to address across SEL16Risk Oxleas and BBG have agreed to deliver a target of 8% reduction in acute OAPs by Q4 18/19, though this is considered a challenging target to meetSecuring resources to open additional local capacity within the trust (Cator ward). Work is underway on reviewing the acute and crisis pathway across the boroughs and a trajectory for a reduction in OAP will be included in this work. The trust and BBG expect to agree a trajectory by end of Q3, 17/18.  If it is agreed that the trust proceeds with opening the Cator ward, this additional capacity will be supported by a trust wide QI initiative, including CCG colleagues, that will seek to eliminate acute OAPs by the end of Q2 19/20.  For PICU, there is a commitment to developing plans within the next 6 months that will identify how new local capacity will be put in place for women and how additional local capacity will be developed for men. This work will need to take place across SEL. The business cases for these two areas will include a trajectory to eliminate out of area usage. Slide66

OAP

: Risks /

Issues/ gaps in plans*RAG Rating – based on OHSEL guidance included at appendix 1

Risk /IssueDescription

Mitigation

RAG Rating*

Issue

Lack of clarity on definition of OAPs still;

whether cross borough within LSLC,  across SEL or elsewhere. Southwark is focussing on having all our Individual Placements in SLaM, and has contacted other London Trusts (including Oxleas) to try to reduce the activity which happens that is not commissioner approved.  This is because we want to make sure that we can have a good discharge and access to local services. Southwark want to reduce the inappropriate OATs to zero, but there may be cases where they are appropriate but as a general rule we would want to have our patients treated locally within SLAM.   For residential placements (mostly funded jointly with the Council) there will always be a need for these as we do not have much local provision in Southwark, so  again, it would be about whether the placement is appropriate. 2Slide67

SMI and physical health checks

By 2020/21 there will be a

reduction in premature mortality of people with SMI with more people having their physical health needs met by increasing early detection and expanding access to evidence based physical care assessment and intervention each yearSlide68

Draft in progress |

SMI - Delivery Plan Contents

Page

Title

67

National Expectations

68

Supporting Narrative

71Measures, Metrics and Baselines72Local Milestones73Delivery Plan Detail74Risks / Issues74Enablers/ Assumptions / Dependencies75Impact on activity, finance, quality76Gaps in PlansSlide69

Draft in progress |

SMI: National Expectations

Deliver integrated physical and mental health provision to people with SMI in line with national ambition of

280,000 people with SMI receiving a full annual physical health check. Slide70

SMI - SEL

STP narrative

In SEL, there is a current life expectancy gap of around 18 years for men and 16 years for women between those who use mental health services and those that don’t. The difference is more marked in older mental health service users those aged 65. 6% of the population have been identified as being in contact with specialist mental health services.Individuals with SMI have a higher rate of physical co-morbidity associated with socio-demographic inequalities across many physical illnesses resulting in part from inadequate primary prevention and exclusion from many public health interventions. This risk of co-morbidity is heightened and associated particularly with smoking, other health behaviours such as diet and activity levels and psychotropic medication use.To meet the health needs of these individuals and expand access to evidence based physical health care, SEL plans to explore and address the provision of health checks as part of a cross sector targeted bundle of changes that supports reasonable adjustments across primary, secondary and tertiary disease prevention opportunities.

These include: preventative interventions (smoking cessation and health promotion programmes and targeted physical health support for those with co-existing substance misuse), enhanced primary care provision, workforce skills and systems in secondary mental health care to support physical health and in or out of hospital liaison services. Greenwich plans to deliver NICE-recommended screening and access to interventions for 30% of SMI population in 17/18. Awaiting funding and delivery model from NHSE According to the latest QOF figures, the recorded prevalence for SMI in SEL was 1.11% compared to 0.90% nationally with Lewisham recording the highest (1.27%) and Bexley the lowest (0.74%).Slide71

Current position in SEL based on QoF

The proportion of people with SMI who received a complete list of physical health checks used to be collected as part of the

QoF dataset, but it has not been collected as an indicator since 2014/15. Therefore the most recent data we have is set out in the table belowWith the exception of Lambeth CCG, all CCGs within SEL met the 30% target of patients with an SMI having a physical health check[Source: MH FYFV Dashboard]

SMI - SEL STP narrativeSlide72

Current position

of health checks for patients with SMI in

SEL

SMI - SEL STP narrativeSlide73

SMI: Measures, metrics & baselines

Initiative

Measures/metrics available to support initiative

Is a baseline in use or available to support initiativeCurrent mechanisms in place for monitoring progress (e.g. routinely mentored at A&E DB level)Providing physical health checks for people with an SMIRelevant QOF indicators, including QOF

exception rates for physical health checks for people with SMI

This has not been an explicit QOF measure since 2014/15.

Limited

mechanisms currently; may need to explore local method of capturing data, or of triangulating existing data sources to monitor progress.

Excess under 75 mortality rate in adults with SMI as a proxy measure for impact of initiativeAtlas of variationRightCare In Depth packPHE Fingertips SMI toolImproving physical healthcare to reduce premature mortality in people with SMI: Cardio Metabolic Assessment and treatment for Patients with Psychoses (CQUIN 3a)YesSLaM memorandum of understanding in 4 boroughs, in the process of developing RAG rating system for establishing which patients need to be targeted by secondary care for their physical health care Slide74

Intervention

June 17

July 17

Aug 17

Sept 17

Oct 17

Nov 17

Dec 17

Jan 18Feb 18March 18Q1 18/19Q2 18/19Q3 18/19Q4 18/19Local initiativesLondon initiativesSMI - Local milestonesPlease outline the delivery milestones for each of the workstreams – this is currently organised by work stream, but you may wish to organise each section by CCG or providerKEY: Milestone Brief description of planned activity On-going activityBaseline analysisLocal workforce analysisMapping of local pathwaysSoft launch HLP Stolen Years ProjectIntegrated workingSlide75

SMI: Delivery plan detail

Initiative

description

Target delivery DateBaseline analysisUnmet need analysis and health equity audits in current provision across sectors2018-19

Local workforce

Skills gap analysis and plan, commission training to support workforce requirements

2018-19

Care pathways

Map current service to scope possible development of care pathways to scale up screening and interventions including enhanced primary mental health care services and liaison services (Commissioners, Providers, Clinical leads, Local Authority, Public Health, Service users and other key stakeholders)OngoingHLP Stolen Years Project‘Soft launch’ of online resources in September/October 2017; work closely with stakeholders (6 CCGs, Public Health, LA) to address the SMI mortality gap through STP workshop building on completed resources and working with embedded workforceQ3 2017Stakeholder discussions Increase provision of tailored smoking cessation, health promotion programme and targeted physical health pathways for those with co-existing substance misuse; access to stop smoking services for people with mental illness has been prioritised in some areas following Public Health cutsOngoing Integrated workingJoined up STP-wide strategy to improving equality of access to targeted physical health care, and tailored interventions, at all levels (primary, secondary and tertiary); linking up SLaM with Oxleas to amplify efforts and provide some synergy2018-19Slide76

SMI: Risks / Issues

Risk /

Issue

DescriptionMitigation

RAG Rating*

LA savings and budget pressures

Local authorities are under huge pressure to identify savings

Possible joint working across the provider landscape in SEL footprint

12SMI physical health check data reportingNot been measured as part of QoF since 2014/15, and not due to be measured in the future either. It is a challenge how CCGs will report progress. NHSE are shortly to produce guidance to CCGs on how to implement and measure this indicator.6*RAG Rating – based on OHSEL guidance included at appendix 1 Impact RAG KeySMI: Enablers, dependencies and assumptionsAssumption /DependencyDescriptionMitigation / Action requiredImpact RAGWorkforce capacity and capabilityAbility to train staff to do the physical health checks for patients with SMITBCHighSignificantLowSlide77

SMI: Impact

on activity and finance

Draft in progress |

Reference: 1. Healthy London Partnership: Closing the mortality gap: opportunities in sustainability and transformation planning2. Midlands and Lancashire CSU: Making the case for integrating mental and physical health careSmoking prevalence is over twice as high (40.5%) in people with SMI than in the general population (18.4%). An estimated £40million can be saved from national medication costs by reducing smoking rates due to its interaction with certain medications. The estimated national economic cost of smoking among people with mental health problems was £2.34 billion in 2009/10. £719 million was spent on diseases caused by smoking. 85% of people using alcohol services and 75% of those using drug addiction services also have a mental health problem. The overall economic and social costs of alcohol misuse in England in 2006/07 were estimated at £17.7 - £25.1 billion

A Quality Watch report from 2015 found that in 2013-14, people with SMI had almost seven times more emergency in-patient admissions, and three times the rate of A&E attendances. Half of this activity was unrelated to mental health need and was instead driven by urgent physical health care needs.

Studies indicate that good quality primary care management of people living with SMI has the potential to reduce emergency hospital admission as well as reducing the length of stay in hospital, which may also be associated with reducing NHS expenditure (Jacobs 2015).Slide78

SMI: Gaps in plans

Draft in progress |

Heading

Recognised gaps in the delivery plan

Local response and next steps to address

Timeline

Baseline

and outcome data

NHSE are committed to delivery of a national assurance programme. CCGs / STPs are expected to report progress against key elements of the delivery plan. SEL CCGs are working collaboratively on the collection and reporting of baseline data, trajectories and KPIs, identifying areas of good practice / gaps and duplication across the STP footprint OngoingSlide79

Liaison Psychiatry Core

24

By 2020/21 all acute hospitals will have all-age mental health liaison teams in place, and at least 50% of these will meet the “Core 24” service standard as a minimumSlide80

Draft in progress |

Core 24 - Delivery Plan Contents

Page

Title

79

National Expectations

80

Supporting Narrative

81Measures, Metrics and Baselines82Local Milestones83Delivery Plan Detail85Risks / Issues86Impact on activity, finance, quality88Enablers, Assumptions / DependenciesSlide81

Draft in progress |

Core 24: Nationally prescribed offer

At least

25% of acute hospitals must meet the ‘core 24’ service standard for adults by March 2017

Assure that service development plans are in place to meet ambition of all acute hospitals with all-age liaison services by 2020/21 and 50% meeting Core 24 service standard for adults Slide82

Core 24 - Supporting Narrative

Three bids were submitted in January 2017 and received funding for Lewisham, Lambeth and Southwark in conjunction with South London and

Maudsley NHS Foundation Trust (SLaM), which provides Mental Health Liaison Team (MHLT). Reviews are planned at 6 and 12 months to understand the impact of the service and continued funding post the 12 months.QEW and PRUH are meeting demand currently but are not yet Core 24 compliant.Slide83

Measures, metrics & baselines

Initiative

Measures/metrics available to support initiative

Is a baseline in use or available to support initiativeCurrent mechanisms in place for monitoring progress (e.g. routinely mentored at A&E DB level)10% reduction in length of stay in in-patient wards in the acute trust

The average length of stay in an acute trust in the UK is 6.9 days, although this increases with age and complexity (expected with MH patients) at an average rate of £400.00 per day. Lewisham MHLT see approximately 850 inpatients per year across MHOA and general adult.

Therefore 900 x 6.9 = 6,210 bed days. A 10% reduction in bed days would see a released saving of 621 bed days x 400 = £248,400.00

SLaM work streams will have quarterly reporting arrangements: Oct 2017 Jan 2018 May 2018 Aug 2018 10% reduction in frequent attendance and readmission (in line with national frequent attender CQUINN). Lewisham MHLT sees approximately 2500 patients per year via the ED. Each presentation results in a cost of £150.00. 10% reduction in presentation will see 300 fewer presentations (skewed towards a small cohort) 250 x 150 = £37,500.00 SLaM work streams will have quarterly reporting arrangements: Oct 2017 Jan 2018 May 2018 Aug 2018 Slide84

Intervention

June 17

July 17

Aug 17

Sept 17

Oct 17

Nov 17

Dec 17

Jan 18Feb 18March 18Q1 18/19Q2 18/19Q3 18/19Q4 18/19Oxleas sitesSLAM sitesCore 24: Local milestonesPlease outline the delivery milestones for each of the workstreams – this is currently organised by work stream, but you may wish to organise each section by CCG or providerKEY: Milestone Brief description of planned activity On-going activityWave 2 biddingInitial service reviewDeep dive reviewImplement improvements and fixesOptions appraisal for achieving Core 24 Recruitment of postsPlanning and workstream development6 month service review and financial sustainabilitySustainability plan construction Slide85

Delivery plan detail – SLAM sites

Initiative

Description

Target delivery Date

Recruitment of posts

All posts to be advertised nationally and recruited to via

SLaM

MHLT provider Confirmation of money by March 2017 will result in probable 3 -4 month lag for full recruitment: by July 2017 Pre planning and work stream development Detailed project management documentation will be constructed outlining 1) current levels of KPIs and CORE 24 standards (as pre); 2) key milestones; 3) describing the KPIs in more detail and 4) ensuring e note system data collection plan and 5) engaging local teams This piece of work will be conducted at same time as recruitment to ensure that ne teams will have structure to work within: by July 2017 Implementation of work streams Implementation of the work streams around data collection and standards monitoring will occur. These work streams will have imposed quarterly reporting arrangements. Reporting arrangements Work stream reporting will occur at 3, 6, 9 and 12 month reporting stages for KPIs and CORE 24 standards These work streams will have imposed quarterly reporting arrangements: Oct 2017 Jan 2018 May 2018 Aug 2018 Sustainability plan construction This will form end point report but will be iteratively constructed as the year progresses as post extension and recurrent funding will be part of 2018/19 contract negotiations. This will form end point report but will be iteratively constructed as the year progresses as post extension and recurrent funding will be part of 2018/19 contract negotiations. Slide86

Delivery plan detail – Oxleas sites

Initiative

Description

Target delivery Date

Initial review

Greenwich MH Review completed, which includes recommendations for Crisis Care and MH Liaison:

short

term improvements and fixes

with providerfuture requirements for compliance with Core 24End June 2017Deep dive reviewAs a result of the Review, a Crisis Care and MH Liaison Task and Finish Group has been set up and will produce plans for:short term improvements and fixes to MH Liaison (including reducing frequent attenders to A&E)Gap analysis for Core 24. Work has already taken place on this to assess demand, resource levels, skill mix and performance.  The remaining work is to reconcile CCG and Oxleas resource and financial assumptions to agree ‘the gap’ to Core 24 complianceEnd July/August 2017Implement improvements and fixesShort term improvements and fixes to Mental Health Liaison service carried out. Improvements and performance evaluated to ensure the current service and investment is optimisedEnd November 2017Options for achieving Core 24Options appraisal carried out and plan produced for achieving Core 24. Options to include funding options to meet any resource gapBid submitted for Transformation FundingEnd March 2018April 2018Intentions for Crisis Care and Mental Health Liaison for QEH and the steps we will go through to determine when we will achieve Core 24Slide87

Risks / Issues

Risk /

Issue

DescriptionMitigation

RAG Rating*

Risk

Sustainability

beyond 17/18 is dependent on CCG funding. Transformation funding is to support achievement of Core 24 in 3/5 trusts for 17/18 only.

Bid developed in partnership with CCG and the service will be reviewed in September six months into service delivery. Lambeth:Planning post year 1 and working up efficiencies to sustain and pay for the service 2018/19Putting totality of adult MH spend into a single alliance contract for £65m commencing with a group of MH providers, liaison or other adult related targets. Negotiating from June – Dec. 7-10 year contractual arrangement and wish to include liaison service. Go live April 2018Lewisham:More work needed re how to sustain after 1st year funding and to look at activity within acute trust.12issuesFunding not received for QEW and PRU in wave 1Plans to implement Core 24 for the remaining 2 sites are underway and will be fully developed by March 2018 9IssueDifficulty in funding in parallel effective 24/7 Crisis Response and Home Treatment Teams as an alternative to acute admissions when funding Core 24. Review CRHTT plans with CCGs12Riskfailure to demonstrate savings in line with expected two 10% targets all evidence points to savings, however, initial year 2 risks will be eased by use of frequent attender CQUINN and risks transparently shared between partners including MHLT provider, acute trust and CCGs. 9riskinability to recruit Go wave 1 to reduce likelihood of higher competition following larger wave 2 investment in 2018 12*RAG Rating – based on OHSEL guidance included at appendix 1 Slide88

CCG

Access Baseline March 2017 and trajectory

Funding required as of January 2017

SouthwarkSuccessful bid and starting to recruit. Will extend service at Kings College Hospital (KCH) beyond the CORE 24 offer.

£ 2,196,099 existing

£ 495,140 additional bid

Lambeth

Funding achieved 2017/18 Recruitment to new posts (GSTT) may be a challenge

£1,963,654 existing£434,123 additional bidLewishamBid successful. Already had 24/7 service (UHL) and with the new funding are now Core 24. £1,043,202 existing £516,128 additional bidBexleyMeeting demand however not Core 24 compliant (QEW)£766,861.27 requiredGreenwichBromleyNot Core 24 compliant (PRUH)£996,747.4 requiredCore 24: Impact on activity, finance and qualityCurrent status and estimated funding as of January 2017Slide89

Confidential | Draft in progress | Not for wider circulation |

A&E attendances

NEL/NES

admissions

Readmissions

NEL

LoS

reduction

TotalA&E attendancesNEL/NES admissionsReadmissionsNEL LoS reduction A&E attendances (000s)Cost impact (£m)Admissions – FCEs (000s)Bed days (000s)Cost impact (£m)Readmissions – FCEs (000s)Bed days (000s)Cost impact (£m)Bed days (000s)Cost impact (£m)Total attendances (000s)Total FCE impact (000s)Total bed day impact (000s)Total cost impact (£m)LQS achievement0%11%90%20%--(1.7)(8.3)£2.7m(1.5)(6.3)£3.3m(23.5)£5.7m-(3.3)(38.1)£11.7mNational standards Facilities specification8%0%0%0%(8.1)£1.1m--------(8.1)--£1.1mEnhanced access: Community rapid response20%67%0%20%(20.2)£2.8m(10.5)(50.8)£16.7m---(23.5)£5.7m(20.2)(10.5)(74.3)£25.2mEnhanced access: Primary Care Extended Hours (8-8)20%0%0%0%(20.2)£2.8m--------(20.2)--£2.8mSpecialist advice: Access to specialist advice20%0%0%10%(20.2)£2.8m------(11.7)£2.8m(20.2)-(11.7)£5.7mSpecialist advice: Specialist response clinic8%0%0%20%(8.1)£1.1m------(23.5)£5.7m(8.1)-(23.5)£6.8mImproved 111 and LAS: LAS redirect8%0%0%0%(8.1)£1.1m--------(8.1)--£1.1mImproved 111 and LAS: 111 advice and triage8%0%0%0%(8.1)£1.1m--------(8.1)--£1.1mEnhanced ED front door8%0%0%0%(8.1)£1.1m--------(8.1)--£1.1mED interface with MH0%11%5%10%--(1.7)(8.3)£2.7m(0.1)(0.3)£0.2m(11.7)£2.8m-(1.8)(20.4)£5.8mDischarge planning and consistency0%0%0%20%--------(23.5)£5.7m--(23.5)£5.7mImplementation of LCNs0%11%5%0%--(1.7)(8.3)£2.7m(0.1)(0.3)£0.2m---(1.8)(8.7)£2.9mTotal100%100%100%100%(101.0)£14.1m(15.6)(75.8)£25.0m(1.7)(7.0)£3.7m(117.4)£28.4m(101.0)(17.3)(200.2)£71.1mCore 24: Impact on activity, finance and qualityExpected savings from improved mental health services with the EDSlide90

Enablers

Draft in progress |

Enabler

Title

Description

Action

RAG

Workforce

RecruitmentDifficulty in recruiting across SEL for both providers to deliver Core 24Review in conjunction with SLAM when developing the bid for BBGDigital, estates, workforce, communication and other assumptions and dependenciesImpact RAG KeyHighSignificantLowSlide91

Secure care

Developing early stage

regional plans for roll out of forensic community services and delivering community based alternatives to secure inpatient services such that people requiring services receive high quality care in the least restrictive setting.Slide92

Draft in progress |

Secure care

- Delivery Plan Contents

Page

Title

91

National Expectations

92

Supporting Narrative93Risks and EnablersSlide93

Draft in progress |

Secure

Care:

National DescriptionsNHS England: Mental Health Delivery Plan 2017-18, May 2017Developing early stage regional plans for roll out of

forensic community services

.

Deliver

community based alternatives to secure inpatient services

such that people requiring services receive high quality care in the least restrictive setting.£36 million of national funding to support the Secure Care objective held centrally from 2017/18, allocation to specific localities will be determined through a bidding process.75% of population with access to liaison and diversion.Support learning from suicides and preventing repeat events.6 NCM sites chosen going live in 2017 and supporting to delivery local services.Slide94

Secure Care:

Supporting Narrative

South London is a New Care Model Vanguard for adult forensic medium and low secure. The South London Mental Health Partnership has been established to implement all projects and initiatives that have been judged to add value when controlled by a three-way SLMHP programme. The Partnership successfully applied with NHS England (London) to become one of only six national trial sites for New Care Models for Specialised, Adult Tertiary Forensic Services.

The final bid was submitted to NHS England starting the NCM trial from 1st April 2017.The New Care Model will create for the first time a single South London adult forensic service that will repatriate (overtime) around 150 service users from external placements. The NCM will consist of both re-provided and new services as follows:A New Care Budget Service (“The Hub”): to manage patients and contracts across the Partnership and a wider provider network. The Hub will oversee the quality of care across all pathways (and providers to South London residents), will manage the phased repatriation of patients currently placed externally and will develop and manage a small residual group of remaining (specialist) out of area placements (estimated at 45 patients by 2020/21).Implementing a single point of access; for Women and for Men including a new Single Prison Assessment and Treatment Service New and re-provided capacity; implementing a series of capacity improvements including; A new single Women’s pathway and centre of excellence, repatriating external placements and consolidating our provision across the three Trusts A new (slow stream) assertive rehabilitation service for men A new (fast stream) acute care pathway for men New low and medium secure capacity for repatriated patients in line with pathways Shifting care; to lower intensity settings wherever clinically appropriate including supported housing and community forensic services Quality Improvement; implementing a programme of work to eliminate pathway inefficiencies and deliver model pathways (for men and women) with targets for length of stay (LOS). We will also work to mitigate any inequalities evident in the system. Increased specialisation; of care where this will enable us to deliver improved patient outcomes. This will deliver focused pathways for women, long-stay rehabilitation, and step-down supported housing.Slide95

Impact RAG Key

Secure care:

Risks and issues Risk/Issue

DescriptionMitigationRAG Rating*Financial

Information provided by NHSE in terms of detail in relation to existing contracts continues to be of concern. Expectations of how any efficiency savings may be shared also lack clarity.

Agreement has been reached to transfer to budget for the South London TCPs to the South London NCM projects

10

High

SignificantLowEnablers, dependencies and assumptions EnablerTitleDescriptionActionRAGWorkforceStaffingReleasing staff to support the projectHub administrator secondment post has been advertised. As other posts are part time this post is critical establishing the teamDigital, estates, workforce, communication and other assumptions and dependenciesImpact RAG KeyHighSignificantLowSlide96

Suicide prevention

By 2020/21, the number of people taking their own lives will be

reduced by 10% nationally compared to 2016/17 levels.Slide97

Draft in progress |

Suicide - Delivery Plan Contents

Page

Title

96

National Expectations

97

Supporting Narrative

99Measures, Metrics and Baselines100Delivery Plan Detail101Risks / Issues96Enablers/ Assumptions / Dependencies97Impact on activity, finance, quality98Gaps in PlansSlide98

Draft in progress |

Suicide: National Description

NHS England: Mental Health Delivery Plan 2017-18, May 2017

Develop plan to reduce suicides (10% by 2020/21) with local government and other partnersDelivery of local implementation support which includes action to deliver the requirement that all local areas have local multi-agency suicide prevention plans by the end of 2017Support learning from suicides and preventing repeat eventsContribute to the annual multi-agency suicide prevention plans review led by PHEParticipate in the Prevention Concordat programme which will support the objective that all local areas have a prevention plan in place Slide99

Suicide: Supporting Narrative

The

SEL age-standardised mortality rate from suicide and injury of undetermined intent per 100,000 population is 8.8 compared to 8.6 in London and 10.1 nationally. SEL shows variation in performance across the footprint with Greenwich and Lewisham (7.4) reporting lower rates than the national average whereas Southwark reports the highest (11.0) in 2013-15.

Majority (4 out of 6) of the boroughs are in the process of developing suicide prevention plans in line with the recommendations of the National Suicide Prevention Strategy. Oxleas have a suicide strategy in response to the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness and suicide prevention is part of the mortality review group. SEL London Public Health Teams are working together to develop a number of areas of focus for a SEL STP core suicide strategy/action plan. These are in line with the national strategy areas and build on local intelligence. This work reports through the Prevention workstreams into the Community-care care Clinical Leadership Group (CBC CLG) as well as the Mental Health Clinical Leadership Group (MH CLG). Currently, Southwark, Lewisham and Lambeth are working with the coroner around access to data.Slide100

Suicide- SEL Supporting Narrative

Local

areasCurrent strategy

Current action plansSouthwarkThe priority areas of action of Suicide Prevention Strategy 2017 (DRAFT) have been built around recommendations of National Suicide Prevention Strategy

Working with primar

y care, Southwark Wellbeing Hub, Solidary in a Crisis,

Southwark Suicide Prevention Steering Group – a multi agency group meets every 6 months

Lambeth

Joint Lambeth and Southwark ’s suicide prevention profile (2015) Work is focussed on prevention through Black Thrive, a partnership between statutory and community partners to continue to the work started by the Black Health and Wellbeing Commission (BHWC) to improve mental health and wellbeing for Lambeth’s black communitiesLewishamLewisham is currently developing a suicide prevention strategy that is due to be completed by the end of this year. This is being supported by a suicide prevention strategy group and has involved broad consultant with key partners through a suicide prevention stakeholder workshop held in May. A local suicide audit using PCMD data has also been completed this year to feed into the strategy development process.A multi-agency Suicide Prevention Strategy group has been convened and meets bi-monthly at present. Further consultation work has been planned with community stakeholders prior to completion of the strategy. Joint work with Greenwich, Lambeth, Southwark on engagement with the Coroner is ongoing. BexleyNone at present other than monitoring on a case by case basis through SI reviews.Monitoring through Oxleas and intention to carry out an audit in late 2017/18 or early 2018/19 to inform development of a strategyBromleyLatest suicide audit for 2016-17 completedThere is no suicide prevention plan but working on Mental Health strategy which will included suicide preventionGreenwichSuicide audit every yearGreenwich conducting a suicide audit, and is developing a multi-agency suicide prevention strategy. This strategy will be completed by the end of 2017 for publication in early 2018OxleasSuicide Prevention Strategy was published early in 2017Discusses ambition to work with partners and wider community and providing evidence-based careSLaMSuicide prevention gap analysis from NCISH report completed in 2015/2016 and Trust mortality audit completed this year, Priorities are carer engagement and public health screening . On-going work include carer/family engagement, ligature reduction, risk assessments, physical healthcare screening and crisis care/access to treatmentSummary overview of SEL suicide prevention strategySlide101

Suicide: Measures, metrics & baselines

Initiative

Measures/metrics available to support initiative

Is a baseline in use or available to support initiativeCurrent mechanisms in place for monitoring progress (e.g. routinely mentored at A&E DB level)Local suicide prevention strategiesHM Coroner’s and PCMD data

Each LA has done a suicide audit or discussed as part of JSNA

The latest available data on PHE fingertips is for 2013-15 which is age standardised for 100,000 population on a 3 year rolling averageSlide102

Suicide: Delivery plan detail

Initiative

description

Target delivery DateTailor approaches to improve mental health in specific groups Build on joint work as discussed across BAME groups, immigrant groups, young and middle aged men, healthcare workers, those in debt.OngoingReducing access to means

Build on any existing engagement with BTP, also saw concerns about number of river suicides. Also include medicines management issues

Ongoing

Supporting research, data collection and monitoring

Link to health intelligence work pooling info from PCMD as well as coroner work

OngoingMedia reporting Work Communications team for use of sensitivity and develop protocols in reporting of suicidesOngoingSlide103

Impact RAG Key

Suicide: Risks and

issues Risk/IssueDescription

MitigationRAG Rating*Data QualityNHSE are committed to delivery of a national assurance programme. CCGs / STPs are expected to report progress against key elements of the delivery plan. The collection and reporting of baseline data, trajectories and KPIs are integral to this.

Public Health teams in Southwark, Lambeth, Lewisham and Greenwich are working collaboratively with HM Coroner’s office to ensure regular access to data and is of a high standard in terms of range of demographic information collected and reported

4

LA savings and budget pressures

Local authorities are under huge pressure to identify savings across services

Commissioners are utilising joint commissioning functions across CCGs and LAs to promote and uphold efficient use of funding10HighSignificantLowEnablers, dependencies and assumptions EnablerTitleDescriptionActionRAGCommunicationMedia reporting Current and sensitive reporting of suicide in local areasDeveloping protocols and working with corporate communication teams in each LA/CCG/TrustDigital, estates, workforce, communication and other assumptions and dependenciesImpact RAG KeyHighSignificantLowSlide104

Suicide: Impact on activity, finance and quality

Draft in progress |

Suicide is much more common in adult years than adolescence. Between 2008 and 2010, there was an average of 579 suicides per year in London

.In 2011, London experienced 583 suicides (among people aged over 15) and the human costs of suicide in London amount to around £0.65bn each year. Each suicide represents a loss in terms of lost output.Department for Transport (DfT) research suggests that the lost output resulting from a suicide is worth around £0.58m on average. This means that the total cost of suicides in London in 2011 was around £0.34bn in terms of lost output alone.Analysis of three recent incidents suggests a loss of around 38,000 customer hours per incident. This means that the 55 fatal and non-fatal suicide attempts in 2011/12 resulted in around 2m lost customer hours. If these hours are valued using Department for Transport guidelines, then the total estimated annual cost of lost time due to transportation delays resulting from suicide attempts is around £16.5m. Southwark has worked with British Transport Police and Network Rail and responded to Freedom of Information queries.

London Mental Health: The invisible costs of mental ill health: Mayor of LondonSlide105

Suicide: Gaps in plans

Draft in progress |

Heading

Recognised gaps in the delivery planLocal response and next steps to address

Timeline

Local suicide

prevention plans

All

local areas to develop multi-agency strategies by end of 2017Not all local areas have the capacity and resources to develop themEnd of 2017Data collection NHSE are committed to delivery of a national assurance programme. CCGs / STPs are expected to report progress against key elements of the delivery plan. In SEL, there are 2 HM Coroners office covering the landscape. So far, data collation has occurred for Lambeth, Lewisham, Southwark and Greenwich. It’s a different HM Coroner for Bexley and Bromley and work needs to happen to linkOngoingSlide106

Older people and dementia

By 2020/21, maintain a dementia diagnosis rate of

at least two-thirds of the estimated number of people with dementia; increase number of people being diagnosed and starting treatment within 6 weeks from referral, with suggested improvement of at least 5% compared to 2015/16Slide107

Draft in progress |

Dementia - Delivery Plan Contents

Page

Title

106

National Expectations

107

Supporting NarrativeSlide108

Draft in progress |

Dementia:

National

DescriptionsNHS England: Mental Health Delivery Plan 2017-18, May 2017CCGs continue to work towards maintaining a dementia diagnosis rate of at least two-thirds of the estimated number of people with dementia.Increase the number of people being diagnosed with dementia, and starting treatment,

within six weeks from referral

; with a suggested improvement of at least 5% compared to 2015/16.

Reduce

unwarranted variation in diagnosis rates

and post-diagnostic support between geographies.Monthly reporting of diagnosis rate.Update dementia extract.Slide109

Dementia: Supporting Narrative

At March 2017, SEL dementia diagnosis rate is 71.8% compared to 67.6% nationally and 72.4% in London. The highest was reported in Lambeth (88.9%) and the lowest in Greenwich (66.4%). The over 65 population is projected to increase over next 10 years by 9% in Lambeth, 10% in Lewisham and 13% in Southwark.CCGs are continuing to develop local plans to address gaps in dementia diagnosis. The areas of focus in SEL are to:

Improve identification and provide timely, accurate diagnosis of dementia using a memory service for people of all ages and backgroundsEnsure people with dementia and their carers are able to navigate and understand the range of support available, by sustainably providing easily accessible, good quality, timely information about the illness, as well as the services available at diagnosis and throughout the course of their careImprove skills and knowledge of health and social care staff, voluntary sector, home care agencies, care homes and carers about the diagnosis, treatment, care, and interaction with, people who have dementiaImprove the co-ordination of care for people with dementia and their carers, particularly the links between dementia care and mental health, learning disabilities services and physical health careSlide110

Dementia:

Supporting narrative

Most CCGs are meeting the target of 66.7% is in SEL with with Lambeth reporting 88.9%Slide111

Dementia: Supporting Narrative

Local

areasCurrent service

Current action plansSouthwarkThe Southwark & Lambeth Memory Service (SLMS) is run by SLAM and offers appointments in a clinic setting or in the patient’s own home if they are housebound for a comprehensive memory assessment. Typically patients will also have an MRI scan before being given a diagnosis. If a patient is diagnosed with a form of dementia they will receive a care plan, may be prescribed anti-dementia medication (if appropriate) and will be introduced to the Dementia Advisor from the Alzheimer’s Society.

W

ork

with NHS partners, community groups and people living with dementia

and their carers, to develop a clear “dementia pathway” so the people can receive the appropriate level of treatment and support throughout their journey living with the condition.Referrals are accepted for people with suspected memory problems. They will undergo an assessment and may have an MRI or CT scan. If they are diagnosed with a form of dementia then they are case managed and supported with medication (if appropriate).The service will continue to work to reduce waiting times from GP referral to assessment, and then diagnosis. Thereafter multidisciplinary care plans can be put in place to support the person with dementia and their carer.LambethLewishamCCGs continues to support primary care, diagnostic services (Memory service) and post-diagnostic community services . Lewisham’s work related to awareness raising links to Dementia Action Alliance which is driving through the intention to achieve borough wide – Dementia friendly community status’ . Voluntary sector providers MindCare and Carers Lewisham offer post-diagnostic support to any Lewisham resident diagnosed with dementia and their carers. Additionally, MindCare provides Dementia training for professional and family carers on dementia. Additional investments have been made to the memory service to reduce waiting times. The Lewisham Dementia Action Alliance is raising awareness for dementia across the borough and residents are encouraged to seek advice from their GPs if they are concerned about their memory. A 12-month pilot to enhance the community provision of the dementia pathway including increased post-diagnostic support and care co-ordination is being implemented between August and September 2017. BexleyOxleas multi-disciplinary dementia service commissioned in Bexley and BromleyWorking towards understanding referral pattern from local GPs and explore routes into specialist services through development of GP ‘Choose and Book’ access and internal referral systemsDiscussing establishing Memory Clinics in some GP surgeriesRaising awareness through training health and social care professionalsExploring screening tools and early identification aids for GPs and physical health teamsExploring open access clinics in community and self referral to Memory ServiceThrough multi-agency partnership building dementia friendly communitiesBromleyBromley has  put in place an initial action plan to improve and increase the early diagnosis of dementia patients . This is being further supported by the recently commissioned Dementia Hub which provides advice and support in peoples, homes in the community to both patients with dementia and their carers.Dementia diagnosis development plans will feature highly in the MH Strategy Ensure consistent support and training provided to primary care to significantly increase the early diagnosis of dementia Include a stretch target that reflects the demographic of Bromley which has an ageing populationGreenwichThe enhancement of the Memory assessment service at the Memorial Hospital to support early referral diagnosis and treatment. Assess current delivery against specification and understand resources/skill mixPlan to achieve 67% diagnosis target, meet future demand growth and improve linkage with other servicesSummary of current service provision and action plansSlide112

Finance processSlide113

A finance working group has been established to be able to compare

areas of

MH spend across south east London CCGs  Purpose of the groupTo understand the disposition of spend  within mental health and variation between boroughsTo understand high and low spend areasUnderstand whether spend corresponds with move in service provision to community based services and preventionEstablish whether spend is going up or downInfluence the 2018/19 planning processEnable some principles to be agreed across SEL about how we spend strategically – what can do together and how might we want to change the focus of spend. Support the 5yfv work and help prioritise areas of work Process steps and actionsA discussion between SLAM and Oxleas to compare service lines and associated currency, understanding where there are differences and agree how to aggregate differences.

Oxleas to agree service lines with BBG commissioners and share with LSL commissionersGreenwich to do a starter for 10 using the agreed block heading and proposed sub headings by 29th June: CYPWorking adultsOlder adultsEstablish if we it is possible to have a Local Authority block – Rachael to action. Everyone to send Rachael their LA commissioner contact detailsSuggested sub headings: LD communityLD acute (this should this fit in acute in-patient beds)Primary care Community CrisisroutineCMHT EIP as a separate heading in CMHTIAPTPsych liaison MemoryForensicUsing the agreed headings map 16/17

and

17/18 spend.

Indicate if the spend is going up or down (this will be done when 2016/17 and 2017/18 is available)

Use caseload as the currency rather than referrals.  Discussion will be required as to the best consistently available currency. 

  Slide114

Digital planSlide115

Digital overview (1)

SLaM

, Oxleas & SWLSTG have formed the South London Partnership (SLP) to look for areas of synergy and collaboration. Part of this will be reviewing back office functions, whilst at the same time, SLaM will be recommending to NHSE that both Oxleas & SWLSTG are allowed to become GDE Fast Followers. There are a number of priorities for mental health digital that include:Patient data sharing initiative, enhancing the existing approach with further accessibility options

Patient portal, building upon earlier work to transform 20% to virtual clinics and on line workingPaperless patient workflow, which builds on existing electronic health record with further e-forms and e-observations to further improve patient safety, clinical quality and patient experience. Channel-shift with greater use of e-referrals along with patient e-mail to provide secure messaging to patients.Data sharing with our clinical partners with the development of our clinical portal and support for remote/mobile working at other care settings.Enhanced e-Prescribing which aims to bring everyone to a level of “closed loop” prescribing and ability to exchange medication chart informationDigitisation of communications across the organisation, which aims to link up messaging systems, electronic faxing and links in to structure messaging, digital dictation and Docman systems Optimising intelligence capability using business and qualily intelligence and management toolsSlide116

Digital overview (2)

Strategically

SLaM are creating a roadmap of for Mental Health Digital that includes the following priority areas of intervention: Data Sharing / InteroperabilityWorking across SEL on the Virtual Care Record a strategic programme to link the two main care record systems together making them available to users in any health and care settingAll providers are work with their main clinical system suppliers to ensure interoperability particularly with the emerging ‘

national architecture’On a Pan London platform to work with the Healthy London Partnership project – Health and Care Information Exchange (HCIE) – to provide the ability to share documents, etc.Proactive Clinical Support systemsEarly stage work with the clinical systems provider (Advance) to improve the pathways using algorithms an to develop the user experience of current systems.Working with Population Health Informatics providers to build a potential single platform for health, mental health and social care data to prioritise well-being and preventative interventions to avoid both deteriorating patients and improve early diagnosisSlide117

Digital overview (3)

Use

of TelepsychiatryBoth organisations are looking to broaden the use of remote consultations to improve patient choiceBeing delivered as part of the SLaM GDE programme, where appropriate and relevant to ensure best use of resource and increased accessibility to consultations and therapies

Working on a Skype based the solution, having already started pilots on the use of Skype for remote consultationGreater Use of Business IntelligenceUse of business intelligence is being expanded with increasing use of dashboards in clinical and non clinical teamsDashboards for both clinical and executive use are leveraging near 'real time' data to provide support for decision makingWithin SLaM they are building a pilot with Microsoft Azure Cloud and PowerBI that allows for the creation of the relevant dashboards/analytics and data visualisationWorking alongside

CCG’s to develop

Public

Health Informatics

to

Mental Health commissioningSlide118

June 17

July 17

Aug 17

Sept 17

Oct 17

Nov 17

Dec 17

Jan 18

Feb 18March 18Q1 18/19Q2 18/19Q3 18/19Q4 18/19Digitisation & Mobile WorkingCarenotes Patient Journey SystemCarenotes Mobile ApplicationHealthlocker PHR Personalised CareE-RS & e-correspondenceCloud infrastructure 7/7Virtual clinician 1/1Digitised paper 2/2User Training and DeploymentUser Training and DeploymentScope ProgrammeBusiness CaseRecruitmentProcess MappingPhase 1 DeliveryPhase 1Go-LiveDelivery of API’sDelivery of PathwaysScope ProgrammeWorking BriefsProcess MappingSupplier EngagementPhase 1DeliveryPhase 1Go-LiveBeta TestingBeta TestingBeta TestingScope & Business CaseSoW & RecruitmentProcess MappingSupplier EngagementPhase 1DeliveryPhase 1Go-LiveDigital Milestones (1)KEY: Milestone Brief description of planned activityPilots ReviewedProcurementProject Delivery (Oxleas)Full Review of DOS for existing Services (Oxleas)Look for opportunities to expand Telehealth (Oxleas)E-Forms Business Case (Oxleas)Project Delivery (Oxleas)Transition to BAU (Oxleas)Slide119

June 17

July 17

Aug 17

Sept 17

Oct 17

Nov 17

Dec 17

Jan 18

Feb 18March 18Q1 18/19Q2 18/19Q3 18/19Q4 18/19E-PrescribingCyberlabBI / QI Dashboards & Data Visualisation Cybersecurity ProgrammeWI-FIDigital Ward observations (e-OBS)KEY: Milestone Brief description of planned activityCareCert cons & reportPhase 1Phase 2CompletionImplementationBusiness CaseRecruitmentSupplier EngagementImplementDetection SupportProcurementPublish AnalyticsPartnership WorkingReq. & Business CaseSupplier EngagementRecruitmentSupplier EngagementStatement of WorkImplementDashboardsFood & FluidsDeliveryImplementationTransition to LiveDigital Milestones (2)Scoping and Business Case (Oxleas)Market Study (Oxleas)Business Case (Oxleas)Project Delivery (Oxleas)Upgrade and Replacement Programme (Oxleas)Slide120

Digital: Delivery plan detail (1)

Initiative

Description

Target delivery DateDigitisation & Mobile WorkingHelping staff adopt mobile working practices and use of cloud collaboration toolsJuly ‘17 – March ‘19

Carenotes

Patient Journey System

Acceleration of development of new pathways and innovations that can be shared across the wider mental health sector

Sept ‘17 – March ‘19

Carenotes Mobile ApplicationIntegrated mobile solution allowing community based clinicians to access patient data on tabletsJune ‘17 – March ‘19Healthlocker PHR User-led design and open source software hosted in Microsoft’s UK Azure cloud, can be used by any MH trust Sept ‘17 – Dec ’17 (1st Release)Personalised CareDigital access to records via PHR, view wearable tech and user reported data to record/view longitudinal data for monitoring and interventionE-RS & e-correspondenceTo support digital transfer of patients, development of integrated e-referrals and e-correspondence into clinical systemsJune ‘17 – March ‘19Slide121

Digital:

Delivery plan

detail (2)

InitiativeDescriptionTarget delivery DateE-PrescribingCo-ordinated electronic medication across the pathway leading to better patient management and clinical efficiencyTBA

Cyberlab

Develop a comprehensive pathology data set that runs alongside clinical systems

Sept ’17 – March ’19

BI / QI Dashboards & Data Visualisation

Develop dashboard & models to empower clinicians to reduce variation & drive up quality of careJune ‘ 17 - March ’18Cybersecurity ProgrammeEarly adopter of Care-cert programme & programme will accelerate thisJune ’17 – Dec ’17 (Certification)WI-FIIncrease wi-fi coverage to 100% coverageDec ‘17 – March ’19Digital Ward observations (e-OBS): Further development and implementation of open source digital observations for inpatient wardsJune ‘17 – March ‘18Health and Social Care Network (HSCN)Replacement of existing N3 connections with new HSCN to connect health and social care organisationsJune ‘17 – March ’19Slide122

AppendixSlide123

Appendix 1 – OHSEL guidance for classifying project level risks and issues

Calculating the risk rating

A risk is an event that may or may not occur

Each risk should be assigned a score for

Risk impact (1 Low – 5 High)

Risk likelihood (1 Low – 5 High)

The risk score is the product of the risk impact and risk likelihood

The score should be included on highlight reports with boxes colour-coded accordingly

Assessing the issue severityAn issue is an event that has in fact happenedRisks are classified by severity as shown belowPlease include the severity on highlight reports and colour-code accordinglyIssue SeveritySeverity descriptionHighA prioritised issue that requires immediate attention. Programme/project milestones, reputation, budget or quality are impacted.SignificantA significant issue that requires urgent resolution. Programme/project milestones, budget or quality are impacted. LowAn issue that has a limited impact on the programme but needs resolution to contain the impact on programme deliveryRisk ratingRisk scoreHigh15-25Significant10-14Moderate5-9Low1-4Slide124

New models of careSlide125

Supporting narrative

In SEL, we have the following New Models of Care that have been approved:

1) South London Partnership on forensic services (discussed in the Secure Care section)2) Developing work on CAMHS Tier 4 with NHSE (attached bid and business case separately 3) Lambeth Living Well Network for working age adults - Lambeth CCG and council are developing a whole system alliance contract (Living Well Network Alliance) to support improved outcomes and integrated care for adults with mental health problems (working age). This will encompass all of the adult related mental health service areas in this plan with the intention, subject to the on going procurement process, of commencement April 2018.4) Work on integration of mental health into Local Care Networks (link to

Community-based care work)