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Update on progress against NHS England's commitments for Improving Mental Health Crisis Care

Sarah Khan Deputy Head of Mental Health & Adult MH Programme Lead MH Clinical Policy & Strategy Team NHS England gives an update on progress against NHS England’s commitments for Improving Mental Health Crisis Care at today’s conference. In her presentation Sarah discussed:

  • outline of NHS England’s national programme
  • developing pathway-based metrics
  • expanding liaison mental health services
  • developing commissioning guidance
  • ensuring alignment with the urgent and emergency care review
     

Sarah Khan’s full presentation is available for download at the end of this page.

In her presentation Sarah stated:

NHS England as a signatory to the Crisis Care Concordat, is committed to: 

  • Review data/metrics needed to assess and monitor the level of local need for crisis care; 
  • Developing a baseline assessment of current provision and gap analysis;
  • Commissioning support; Establish quality improvement collaborative;
  • Ensure that mental health crisis is part of the Urgent and Emergency Care Review
     

“There are a number of policy drivers, reviews and publications which all make the case for a clear imperative to improve crisis care services”

CQC thematic review:

  • Some excellent examples of innovation and practice;
  • Concordat means every single area now has multi-agency commitment and a plan of action.

However CQC found that…..

  • variation ‘unacceptable’ - only 14% of people felt they were provided with the right response when in crisis – a particularly stark finding;
  • More than 50% of areas unable to offer 24/7 support – MH crises mostly occur at between 11pm-7am - parity?
  • Crisis resolution  and home treatment teams not meeting core service expectations;
  • Only 36% of people with urgent mental health needs had a good experience in A&E  - ‘unacceptably low’;
  • Overstretched/insufficient community MH teams;
  • Bed occupancy around 95% (85% is the recommended maximum) – 1/5th people admitted over 20km away;
  • People waiting too long or turned away from health-based places of safety
     

“By 2020, our ambition is that all acute trusts will have in place liaison psychiatry services for all ages appropriate to the size, acuity and specialty of the hospital.  In  2015/16 we are investing £30m to enable a greater number of acute hospitals to establish effective models of liaison mental health.”

“From 2015/16, when the Care Quality Commission (CQC) rates acute services, it will include a specific focus on liaison mental health services”

“The Home Secretary announced in May, the Manifesto commitment - £15m in 2016/17 to be spent on reducing number of people held in police cells when detained under s.136. Use of police cells for s.136 has fallen by over 50% since 2011/12, and by a 1/3 last year – this is a success and we are on the right trajectory. Home Office Policing Bill is expected to come into effect on 1 April, which will further restrict use of police cells – potentially ruling out use for CYP.”

“NHS England / DH / CQC / Home Office have been conducting a  national desktop analysis using available evidence to identify target areas for investment of the £15m.  This will be followed up with selected priority target Crisis Care Concordat groups  to identify how the funding can be used locally”

“Flagship NHS England programme.  Our ambition is to embed crisis care into major review of UEC – making mental health core NHS business. Notable recent developments:  Winter planning: 5 mandatory mental health indictors included in this year’s SRG assurance and Strong mental health focus of UEC vanguards”

Horizon Scanning

Crisis Care

  • Crisis Care Concordat -  national partner commitments to be refreshed and agreement to be reached regarding future governance of the CCC. 
  • Section 135 & 136 and health based places of safety – anticipated legislative changes from 2017 to make use of police cells a never event for CYP and an exceptional event for adults
  • Introduction of access and waiting time standards for crisis care (level of ambition subject to available resources)
     

Acute Care  

  • Paul Burstow / NHS Providers commission on delayed transfers of care due to publish in November.  Expect a recommendation that the current indicator definitions are updated and increased focus on the key causes of delays.
  • Anticipate something in the Mandate regarding acute out of area placements – an ambition to reduce OATs.  Our aim will be to ensure that this is in the context of improving acute mental health pathways. 
  • Lord Crisp Commission on mental health acute care due to publish in January.  Expect a focus on CMHT and CRHTT capacity, availability of social care and housing and alternatives to admission (crisis houses / step-down care).  Unlikely that the ‘answer’ will be more acute beds.
     

Sarah Khan Biography:

Sarah is the Deputy Head of Mental Health & Adult MH Programme Lead in the Mental Health Clinical Policy & Strategy Team within the Medical Directorate at NHS England.  Previously, Sarah held senior roles at Central and North West London and Oxleas NHS Foundation Trusts leading strategy, planning, performance and information functions.

Future events of Interest:

Positive and Proactive Care Meeting the New National Guidance on Reducing Seclusion
Tuesday 20 October 2015 
Hallam Conference Centre, London

Smoking Cessation in Mental Health
Tuesday 20 October 2015 
Hallam Conference Centre, London

Identifying and Supporting Victims of Domestic Violence & Improving the effectiveness of MARACs
Monday 16 November 2015 
Hallam Conference Centre, London

Deprivation of Liberty Safeguards: Ensuring Compliance in Practice
Tuesday 17 November 2015 
Hallam Conference Centre, London

Information Sharing in Mental Health
Friday 27 November 2015 
Hallam Conference Centre, London


Download: Sarah Khan's full presentation

15 October 2015

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