This programme forms part of the wider partnering and work of the Association of Adult Directors of Social Services and the National Mental Health Development Unit on how to take and apply the learning from best outcomes for people realised through integrated Local Authority and NHS/clinical commissioning for mental health and well-being.
The programme is set in the context of the changes signalled in the NHS White Paper and elsewhere to the future commissioning arrangements for social care and mental health services. As well as the need for need for significantly increased quality and productivity outcomes from mental health and well-being commissioning activity in an economic downturn, and is aimed at adding to the momentum of the shift in mental health policy and multi agency commissioning towards:
· Aligned clinical and political leadershipaccountability to local communities
· Whole population engagement, needs assessment and risk stratification
· Seeking to promote and enhance public mental health and population well-being
· Co-production, and a changed relationship, with people who are current and potential users of services & carers
· Early (or earlier) intervention to impact on long term outcomes for people, including health; personal, social and economic well-being
· Personalisation from secondary care mental health services (without undermining their importance), to community and Primary Care focussed delivery, and beyond into education, healthy lifestyles, employment, leisure, community safety, housing and regeneration.
The programme is built around five major themes covering
1. Economic context (including employment)
2. Quality of life (including housing)
3. Personalisation and Safeguarding
4. Value and efficiency (adding value for people (social value) and financially)
5. Commissioning infrastructure, competency and capacity (How it works, and could work better)
This is to reflect that commissioning for mental health and well-being can only be done effectively by local Council and NHS commissioners (PCTs and GPs) acting jointly with partners. And then not solely by the adult social care or mental health commissioning elements of Councils and the NHS, but whole organisations covering the breadth of their responsibilities: From health promotion, reducing health inequalities, regeneration and economic well-being; through housing, leisure and culture; on into organisations' responsibilities as employers, or funders of employment; right through primary and social care to secondary mental health services; Then further on into specialist commissioning, secure placements and prison health care - bringing the circle back round to promoting community safety and public mental health. Utilising the tools and thinking behind QIPP in the NHS and equivalent efficiency and public value programmes in Local government, as well as place-based commissioning approaches – to help assure productivity in delivery, and outline the ‘core offer' from partners to the public.
This is particularly the case around Personalisation, housing and employment - and how these feature in the Local Government elements of the ‘core offer'. With the strategic re-balancing between Councils and the NHS contained in the NHS White Paper and linked policy and consultation documents on Public Health and Social Care.
The main aims and objectives of the programme are to bring together NHS and Local Government products and evidence on effective commissioning for mental health and well-being into an accessible development resource. This involves addressing key current, and potential future, issues for joint commissioners, including:
- The impact of payment systems and currencies: person-based resource allocation, Payment hu78by Results (or outcomes), care clusters and the Commissioning for Quality and Innovation payment framework (CQUIN).
- Procurement and pace of change issues around maximising the benefits of NHS Standard Contracts alongside the need to free-up resources to support choice and control through personalised or ‘any-willing provider' services to increase innovation, market diversity and options for users of services.
- What are the characteristics of good integrated / aligned commissioning? i.e. what adds most value to the outcomes realised, in areas like market-shaping and capacity development in the Third sector and elsewhere.
- The potential use of the developing social inclusion outcome measures** to support performance management through local Partnerships, Public service Boards or other accountability arrangements for multi-agency commissioning. **http://www.socialinclusion.org.uk/home/index.php?subid=50#whatsnew62
- Highlighting quality and productivity (QIPP) best practice examples*** which demonstrate the benefits of integrated or joint commissioning across ‘whole' Councils and all areas of NHS commissioning (clinical, specialist and universal).
For example: to help stimulate ‘up-stream' investment by the NHS or Councils, in helping to support and expand community resources, by articulating the vision and case that: Better support for people to access employment, leisure, education or training , leads to improved outcomes for individuals, and can contribute to reducing demand on mental health and social care services****
*** NHS Evidence: http://www.library.nhs.uk/qualityandproductivity/SearchResults.aspx?catID=15068
****Sainsbury Centre brief: http://www.scmh.org.uk/pdfs/briefing41_Commissioning_what_works.pdf