The Policy Context
The policy context within which the Programme is operating continues to develop. Alongside the significant changes to commissioning policy set out in the NHS White Paper there are a number of other important policy drivers. The development of a new Mental Health Strategy builds upon the existing policy set out in "New Horizons". The focus on Quality and Productivity continues to shape the future of Mental Health Commissioning pn the economic downturn. An enhanced emphasis on Public Mental Health and Wellbeing means the central tole of Local Government as key partners in Mental Health is likely to grow still further.
The following present a brief overview of some of the policy areas within which the Programme will be operating over coming months:
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Outcomes:
The Government's White Paper, Equity and excellence: liberating the NHS, set out how the Secretary of State for Health will hold the NHS Commissioning Board to account for delivering better health outcomes through a national NHS Outcomes Framework. The framework was published for consultation in July and received over 700 responses. Responses are currently being collated and a final draft is expected to be published in December.
The consultation document outlined:
- the principles that should underpin the NHS Outcomes Framework;
- a proposed structure and approach that could be used to develop the framework;
- the potential outcome indicators (existing and future) that could be presented in the framework, including the proposed rationales for selection;
- how the proposed NHS Outcomes Framework can support equality across all groups and can help reduce health inequalities; and
- how the framework can support the necessary partnership working between public health and social care services needed to deliver the best possible outcomes for patients.
The proposed NHS Outcomes Framework is structured around five high level outcome domains:
EFFECTIVENESS
- Preventing people from dying prematurely
- Enhancing the quality of life for people with long-term conditions
- Helping people to recover from episodes of ill health or following injury
PATIENT EXPERIENCE: Ensuring people have a positive experience of care
SAFETY: Treating and caring for people in a safe environment and protecting them from avoidable harm
- Personalisation: Putting People First signalled "a social care transformation programme towards individual budgets, moving away from block commissioning" - this represented a very significant challenge to traditional models of MH commissioning which are not adequate to deliver the requirements of this policy initiative without significant transformation. The Coalition has underlined its commitment to personalisation with the SoS stating that 'nothing about without us' will be the starting point. Personal Health Budgets will be introduced with the evaluation now determing only what services will be included and how soon. MH commissioners will need to refocus to deliver on the four key principles of Prevention, Early Intervention and reablement, Personalisation and Information, advice and advocacy.
- The Quality and Productivity Challenge: QIPP is intended to be a process at national, regional and local level to support clinical teams and NHS organisations to improve the quality of care they deliver while making efficiency savings that can be reinvested in the service to deliver year on year quality improvements. Programme budgeting shows mental health accounts for around 11% of the NHS expenditure and affects 1 in 4 of the population having some form of common mental health problem with up to 1 in a 100 people living with a serious mental illness. Mental health has one of the most successful track records in redesign for improving quality and productivity across services, particularly adult mental health services; however there are areas where significant variation still exists across the country and where the connection and exacerbation of conditions between mental health and physical health can be improved.
- Practice Based Commissioning (PBC):
The White Paper Equity & Excellence; Liberating the NHS has signalled the Government's intention to devolve the majority of NHS commissioning resources and functions to consortia of GPs and their practice teams. NMHDU is working collaboratively with a range of partners including the Royal College of General Practitioners, Royal College of Psychiatrists, ADASS and the NHS Confederation to support this major transition and to identify key issues for delivering effective, outcomes-focused clinical commissioning.
The programme is specifically supporting projects on this change process in two SHA regions and at national level has been asked to develop a template for transition towards the new commissioning arrangements..
- 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: 2010/11 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 requirements 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 remains an imperative in health and particularly social care policy in the light of the new equality Act 2010. 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.