The Policy Context
The policy context within which the Mental health commissioning programme is operating is continually evolving with shifts in emphasis emerging and impacting upon relative priorities. In order to ensure that the Commissioning Programme continues to add value it is important that, alongside responding to the feedback from SHAs and the Oversight Board, the emerging policy context is addressed. This particlularly relates to the implications for mental health of Liberating the NHS the NHS White Paper, which is currently under consultation, and the forming view on new mental health strategy. Including the priority on public health GP commissioning and the health improvement role of local government.
The following present a brief overview of some of the policy areas within which the Programme will be operating over coming months:
- Personalisation: As part of the wider Putting People First social care policy agenda it is likely that there will continue to be acceleration towards greater personalisation. One of the key aims of Putting People First is "a social care transformation programme towards individual budgets, moving away from block commissioning" - this represents a very significant challenge to traditional models of MH commissioning which will not be adequate to deliver the requirements of this policy initiative without significant transformation. MH commissioners will need to refocus to deliver on the four key principles of Prevention, Early Intervention and re-enablement, Personalisation and Information, advice and advocacy.
- The Quality and Productivity Challenge: The economic downturn is forecast to have a very significant impact on the future availability of resources to support health and social care. While predictions as to the scale of this impact vary there is no doubt that the consensus lies in reduced commissioning budgets for health and social care. The challenge for the NHS, in particular, has been clearly articulated by the NHS Chief Executive who describes the challenge of continuing to develop quality alongside greater productivity as the "day job" of "every NHS leader and every NHS Board". MH commissioners, along with all other commissioners, will require support to enable this challenge to be met while at the same time ensuring that MH disinvestment is not disproportionate.
- Practice Based Commissioning (PBC): PBC is one of the cornerstones of NHS System Reform. Clinically-led, locally-focussed commissioning is likely to remain a feature of health policy over coming years. The challenge for MH commissioners is to continue to bring about transformational change across whole health and social care systems while significant resources are increasingly deployed at the local level. The implications and indeed opportunities for joint commissioning are significant and learning lessons from emerging models will enable greater spread across the whole system.
- Payment by Results (PbR): A timetable for the anticipated roll out of PbR in MH has been published. MH provider organisations across the country are gearing up, in some cases as part of Foundation Trust preparation, to be in a position to take advantage of a currency-based funding environment. This represents significant challenge to MH commissioners who, as a general rule, have been less engaged to date in the development of MH PbR . MH commissioners will need to understand the risks and opportunities that a PbR system presents including in relation to increasing the plurality of provision, its potential impact on joint assessment and "cluster validation".
- Standard Contract: 2009/10 has been the first year of the new standard MH national contract. Lessons are currently being learned in order that from next year a revised contract will be in place to underpin the transactional relationship between MH commissioners and their providers. Some of the challenges already identified include; the impact of the contract on smaller non-NHS providers, the impact on commissioning arrangements that are joint with Local Authorities and how to use the provisions of the contract to incentivise transformational changes in service models.
- Quality Framework: As part of the wider implementation of the national contract specific opportunities are available to MH commissioners to incentivise change through the provision for CQUINs and the future requirement for Quality Accounts. There are emerging examples of the creative use of CQUINs between commissioners and providers to bring about change and learning the lessons of these examples will enable accelerated spread across the system.
- Equalities: Ensuring fair access and appropriate service provision across diverse communities will remain an imperative in health and social care policy. MH commissioners will need to develop increased awareness of and expertise in the use of metrics and outcome measures to ensure that the needs of BME communities are being appropriately identified through the Joint Strategic Needs Assessment and then met through wider commissioning process.