1. Mark Fleming National ICP Co-ordinator Integrated Care Pathways Ali El-Ghorr Programme Manager

2. Overview of presentation  Policy context  Integrated Care Pathways  Standards for ICPs  Application in Primary Care  Discussion

3. John Loudon - Brin Jardine-Jill Gillies-Sean Doherty - Mark Fleming-Rosie Cameron Ali El Ghorr - Selina Clinch-Alastair Cook-Linda McKechnie-Joyce Mouriki Sam Atkinson - Trevor Johnstone - Elaine McKay - Susan McGaff - Gary Morrison NHS Quality Improvement Scotland Mental Health ICP Team

4. Conclusions  NHS Scotland is taking a national approach to ICP development and implementation in mental health  Focus on service user and meeting their needs  Top-down policy combined with bottom-up local ICP development  Supportive and facilitative approach  ICPs being used as a tool for service redesign and continuous quality improvement

5. Kerr report (2005) “Need to improve access, quality and efficiency of NHS services” Policy Context Delivering for Health (2005) Delivering for Mental Health (Dec 2006): 14 key commitments, and 3 national targets for each NHS Board in Scotland

6. Commitment 6 in Delivering for Mental Health (2006): "NHS QIS will develop the standards for ICPs for schizophrenia, bipolar disorder, depression, dementia and personality disorder by the end of 2007. NHS board areas will develop and implement ICPs and these will be accredited from 2008 onwards."

7. Integrated Care Pathway A tool to compare planned care with care actually given

8. Our Integrated Care Pathways  Much more than a document of care given  Encompass how care is organised, co-ordinated and governed  Embody a system of continuous quality improvement

9. Mental Health Services NHS: Primary Care, Secondary Care, CMHT, others Local Authority: Social Work & others Voluntary Sector Independent Sector Others

10. Myth busting: What ICPs Myth busting: What ICPs are not  national  intended to stifle individualised care  additional paperwork  wholly dependant on IT systems (not all variance is bad)

11.  Impossible to give evidence of current quality of services  Lots of information currently being recorded  Lots of duplication  Lots of effort spent looking for information  ICP offers opportunity to rationalise recording of information, bringing it all together into one document  Opportunity to use resources more effectively Why implement ICPs?

12. Benefits to service users ICPs will :  help improve assessment and care planning  ensure care is delivered in accordance with evidence and best practice  improve recording of care delivered and outcome achieved “…the right care and treatment at the right time…”

13. Benefits to services ICPs will generate information for identifying areas for development:  training needs identified to close skill gaps  need for service redesign  focused use of existing resources “…expectations for local management…”

14. National Standards  Key standards for ICPs for the main diagnoses: - schizophrenia - bipolar disorder - dementia - depression - borderline personality disorder

15. ICP Standards -Process standards (how ICPs are developed) generic condition specific - Care standards (content of ICPs) -Service improvement standards (how ICPs are implemented)

16. Main Process Standards  Stakeholder involvement  Process mapping  Leaders and project managers identified  Recording and sharing of information  Referral systems developed

17. Care Standards  Service user at the centre of care planning  Comprehensive assessment  Risk management  A service user rated measure of needs (eg Avon)  Use evidence based interventions  Measure outcome

18.  Support implementation of ICPs  Describe systems for reporting and acting on variances  Drive service redesign and continuous quality improvement Service Improvement Standards

19. Delivering together NHS Education Scotland NHS QIS National ICP Co-ordinators ICP Toolkit Govern ment Social Work Improvement Support TeamService users and carers National Regional Local Voluntary sector Workforces

20. Implementing ICPs Will help NHS boards achieve their HEAT targets:  Stop increase in antidepressant prescribing  Reduce suicide rates  Reduce hospital re-admissions

21. What does this mean to Primary Care?

22. Primary Care Involvement -4 GPs on our ICP development groups -GPs & RCGP involved in consultation process -GPs & others to be involved in local ICP development -CHPs to be involved in local ICP development

23. What do Primary Care need to do? -Consider sharing anonymous information about diagnosis with NHS board -Liaise with mental health services about referral protocols and care plans -Consider how best to be involved in depression & dementia ICP care

24. Possible incentives -ICP links to Quality Outcomes Framework: Mental health register Physical health checks Dementia review Depression screening Depression assessment using validated tool -ICPs linked to HEAT target for reducing antidepressant prescribing

25. Other incentives Delivering for Mental Health Commitment 3: “We will work with GPs to ensure that new patients presenting with depression will have a formal assessment using a standardised tool and a matched therapy appropriate to the level of need.”

26. Benefits to Primary Care -More and better quality information from mental health services -Co-ordinated care package -Holistic care based on service user needs -Better outcomes for individuals and families

27. Standalone Depression ICP Standard For people who do not have complex needs:  Objective measure of depression (eg PHQ9)  Assessment of need leading to appropriate interventions (eg self-help, lifestyle advice)  Depression-focused brief psychological therapies offered  Treatment algorithm with threshold for: antidepressant prescribing psychological therapies other evidence-based interventions

28. Application Mark Fleming National ICP Co-ordinator

43. Conclusions  NHS Scotland is taking a national approach to ICP development and implementation in mental health  Focus on service user and meeting their needs  Top-down policy combined with bottom-up local ICP development  Supportive and facilitative approach  ICPs being used as a tool for service redesign and continuous quality improvement