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.
Including mental health there are 12 national QIPP workstreams which sub-divide into 3 areas:
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Commissioning and care pathways
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Providers efficiencies
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System Enablers
At present mental health is not specifically included in the 12 national workstreams. However, the SHA's, NHS Confederation, Royal Colleges, ADASS and NMHDU are currently undertaking national collaborative work on three mental health QIPP initiatives intended to support regional initiatives, and these are also being validated with a view to formal inclusion within the national QIPP programme. The three detailed areas of work are:
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Reducing Out of Area treatment costs (including medium & low secure) and improving outcomes secured.
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Acute care pathway. Reducing the variation of mental health bed day usage bringing all areas into the upper quartile of national performance by improving adherence to evidence based interventions reducing admissions, length of stay and delayed discharges.
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Physical health & Wellbeing-reducing inappropriate health costs arising from medically unexplained symptoms/co-morbid physical long term conditions, through pathway redesign.
A central resource of best practice examples covering quality and productivity has been created and developed by NHS Evidence: The aim of the collection is to provoke thoughts, ideas and discussions about changes that can be made locally. The examples of improvements range from one-off studies in single organisations to robustly tested large scale changes that have been replicated in multiple organisations and have had results published in academic journals.'
The mental health section of the evidence is accessible from the following link: Click here
Medium Secure Services and QIPP
The Programme has previously been actively engaged in the field of Secure Services Commissioning - a National Stocktake of the arrangements for High Secure Services was commissioned by the DH Policy Lead for Secure Services and delivered in March of this year. Following on from the successful completion of this work further discussion has taken place as to how the Programme could support plans to transform Medium Secure Services through a Commissioning/QIPP Programme. Following detailed discussions it has been agreed that from 1 October responsibility for the delivery of this Medium Secure Programme will take place within the National Mental Health Commissioning Programme as part of the existing Partnership with the NHS Confederation Quality and productivity challenge
Commissioning for Outcomes
Outcome measurement is an important tool in monitoring effectiveness of services and understanding of the impact of services have on the lives of people who use them. The NMHDU commissioning programme is working with a range of partners to support this process. The links below highlight some of the current initiative that support work in this area.
Mental Health Outcomes Compendium
The Outcomes Compendium was developed as part of the NIMHE Outcomes Project to provide information on available clinical outcome measurement tools, their properties and their use in mental health services. It aims to help clinicians and their teams determine which of the widely available instruments best meet the needs of their service users. It is not intended to be an exhaustive or "recommended" list. The intention is that this will provide a helpful starting point in outcome measurement for many teams and services as they try to understand and improve what they do.
Click to download: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093316North
North West Commissioning for Outcomes Network
The North West Mental Health Improvement Programme (MHIP) and the National Mental Health Development Unit (NMHDU) have been working with commissioners to form the North West Commissioning for Outcomes Project. The project was established to provide commissioners with tools to commission for clear outcomes, and enable their providers to clearly articulate the outcomes for service users that result from their service interventions.
The project commenced in Autumn 2009 and enlisted commissioners from across the North West who were interested in developing their commissioning expertise in this area. The project draws heavily upon the Social Inclusion Outcomes Framework (SIOF) that was published in March 2009 and attempts to apply this in commissioning practice and service delivery.
The project intends to deliver achievable outcomes over the next few months to March 2011. That is, we will have learned about the process of agreeing and gathering robust and meaningful evidence on achieving outcomes and we will have learned about how effective services are in delivering the agreed outcomes. Each commissioner has agreed to work to develop SIOF areas with NHS and third sector providers that could be embedded in future contracts and linked to local or regional Commissioning for Quality and Innovation (CQUIN) payments.
Click to download North West Social Inclusion Outcomes framework
The project will introduce the National Social Inclusion Outcomes Framework into the Contracting and Performance phase of the commissioning cycle. The project will provide a useful opportunity for Mental Health Commissioning Teams to introduce specific outcomes into pathways and service settings that contribute to enabling service users to achieve recovery and aspects of a positive and socially inclusive lifestyle.
Click to download:
http://www.socialinclusion.org.uk/home/index.php?subid=50#whatsnew62
Keep updated with progress and share learning from this implementation via this site or for further enquiries contact margaret.oates@nmhdu.org.uk
Wider Mental Health Outcomes Indicators
Since the publication of "High Quality Care for All" in June 2008, monitoring and incentivising better quality of care and better user outcomes has been a leading part of the Government's agenda for the NHS. There is now an established Quality Board for the NHS chaired by David Nicholson. A major part of its remit is reviewing the quality of NHS services in relation to health services in other countries. From 2010 -11 all NHS Providers of secondary services were required to publish Quality Accounts. Additionally, Commissioning for Quality and Innovation (CQUIN) was announced as a scheme to explicitly link a small fraction of the money committed by PCTs to pay for provider services, to achievement of satisfactory quality. PCT's in negotiation with the provider will agree a set of quality and outcome indicators for use in CQUIN from 2010/11. The main constraint is that the indicators should cover the three domains of safety, effectiveness and user experience. The Commissioning for Quality and Innovation framework can be downloaded from:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091443
There have been several other significant pieces of work over recent years that draw attention to what may be called quality indicators, metric or outcomes measures depending upon the context.
It is useful to draw on these separate sets of indicators but also important to recognise that they may have been;
• Drawn up for quite separate purposes
• Have different scope e.g. might restrict focus to a particular group of people
• Available to varying extent by organisation or geographical region
Care Quality Commission (CQC) MH Indicators
The CQC use existing commitments and national priorities to assess whether levels of service set through the 2008-2011 planning round are being maintained. The CQC ‘annual health check' assesses performance of PCT's and acute and specialist trusts. Ambulance trusts, mental health trusts and learning disability trusts. For mental health assessment based on indicators are divided into two sets:
Existing commitments:
• Commissioning of crisis resolution/home treatment services
• Commissioning of early intervention in psychosis services
• Commissioning a comprehensive child and adolescent mental health service (CAMHS).
National priorities, the indicators have been set to measure performance in key national priority areas. Full details can be found at:
http://www.cqc.org.uk/guidanceforprofessionals/healthcare/nhsstaff/annualhealthcheck2008/09/qualityofservices/exis/mentalhealthtrusts.cfm
Standard NHS Contract for Mental Health Services
The NHS standard contracts cover agreements between PCTs and providers for the delivery of NHS funded services. The contract applies to agreements for:
• NHS providers of mental health and learning diability services
• New foundation trusts and FTs whose existing contracts have expired
• New agreements between PCTs and independent sector providers
• New agreements between PCTs and third sector providers
The service quality schedule details a set of indicators, it is important to note that the purpose of these are to monitor the contract. These include national priorities -mandated items and suggested local determination indicators. The mental health and learning disability services contract was published initially in 2009 on a one year interim basis as a recommended contract. The new contact which will be mandated from 2010/11 is currently in draft, for more details see: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451
Improving Access to Psychological Therapies (IAPT)
The IAPT programme has agreed a set of outcomes measures to be routinely collected at therapy sessions. The IAPT data handbook provides guidance on the importance of routine outcome monitoring and outlines collection and reporting mechanisms. The data handbook includes the IAPT minimum data set and recommended disorder specific measures. All IAPT sites have agreed to collect the minimum data set. Patient level data is collected at provider level. The programme has made an application to the Information Standards Board to make the minimum data set a national standard in 2011. The IAPT data handbook can be downloaded from:
In order to support regional and national performance monitoring aggregated non-identifiable patient data is collected at PCT level on a quarterly basis. This includes information regarding:
• PCT coverage of the IAPT programme
• Delivery of training for therapists
• Extending access to NICE-compliant services
Delivering Race Equality (DRE) Dashboard
The DRE dashboard was developed to support measurement of progress in the DRE programme. It provides a detailed menu of indicators to support SHAs, PCTs and mental health trusts measurement..
The programme has agreed to adopt a phased approach to collecting information. Six headline priorities were identified and agreed by SHA Chief Execs and the NHS Management Board meeting. Metrics will be available mainly at a national level. These are:
(i) Access to early intervention
(ii) Access to crisis resolution/home treatment
(iii) Use of assertive outreach services
(iv) Access to psychological therapies
Data was collected from PCT's Quarter 4, 2008/09. The North East Health Observatory was commissioned to examine this data. They have produced a report that looks how far these services have been used in the care of ethnic minority groups, and the extent to which people with similar needs receive similar services.The report was published in June 2010 and can be downloaded from here