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 ‘Intelligent Commissioning' in local councils and World Class Commissioning in the NHS to support joint or integrated mental health commissioning.
The programme is set in the context of the 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:
- Whole population engagement, needs assessment and risk stratification
- 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
- Focussing on the maintenance or recovery of a good quality of life
- Personalisation and personalised approaches for all commissioned services
- Using knowledge, evidence and information to assure quality, productivity and outcomes
- Seeking to promote and enhance public mental health and population well-being
- Ensuring that mental health is ‘everybody's business', including for Local Authorities' - education / housing / economic development / cohesion - functions, across the NHS, and for the NHS & Councils as employers
- Utilising a range of system / market management and procurement approaches to ensure service choice, diversity, quality, safety and effectiveness
Overall - supporting what local areas are already doing in moving the focus ‘up-stream' to shift the paradigm of commissioning 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 Councils and Primary Care Trusts acting jointly with partners. And then not solely by the adult social care or mental health commissioning elements of Councils and PCTs, but the 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 major 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 the Treasury-led Operational Efficiency Programme, Public Service Agreements, Comprehensive Area Assessment and Total Place 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 (including delivery on PSA 16) - and how these feature in the Local Government elements of the ‘core offer'. With the strategic re-balancing between Councils and the NHSand promoted through the work of the Future Vision Coalition*, away from concentration on the NHS-led secondary care sector towards a shared mental health and well-being agenda.
*http://www.newvisionformentalhealth.org.uk/A_future_vision_for_mental_health.pdf
The main aims and objectives of the programme are to bring together NHS and Local Government products and evidence on Intelligent and World Class Commissioning into an accessible development resource for mental health joint commissioning. This involves addressing key current issues for joint commissioners, including:
- The impact of payment systems and currencies: person-based resource allocation, Payment by 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 personalised or ‘any-willing provider' options to increase innovation, market diversity and choice 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.
- 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.
For example: to help stimulate ‘up-stream' investment by the NHS or Councils, linked to PSA 16, by articulating the vision and case that: Better support for people to access employment, education or training , leads to improved outcomes for individuals, and can reduce 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