1. Commissioning for Mental Health By Dr Celia Grummitt Wiltshire Clinical Commissioning Group

2. Background  GP Provider  GP Mental Health Commissioning Lead  A few other CCG roles…….  Co Chair SW Armed Forces Network  Veteran  Involved even in PBC days

3. The exam question  The colloquium is intended to explore current service provision for veterans and serving personnel illustrating areas of good practice, the commissioning of services and the future challenges  Commissioning of services required for the local population, serving personnel and veterans.

5. The NHS before the reforms

6. NHS April 2013 onwards

7. And it Continues to Change  And there’s an election coming  And CCG s are going to start commissioning part of primary care  And Army rebasing

8. The Art of Commissioning  Nil new about the process of commissioning, its like anything else……  Where are we now, where are we going and how shall we get there?  And physical health and mental health differ only through PBR  How could innovative thinking improve things? What would make that future proof?  How much would it cost above what is currently funded?  What ROI would you expect?  Where would/could funds come from?  What do you want to buy to fill the gap and how will you afford it

10. What levers are there?  Military Covenant  Public opinion and politics, forever changing, national and local  Finance  Lead Commissioners  Good for saving resource but bad for localisation which helps meet the needs specific to an area

11. Contract management  Often included in commissioning which is technically incorrect but it is a sub function  Contracts are often managed on behalf of commissioners by another organisation eg the Commissioning Support Unit but more and more CCGs are taking the function back.  The “Old Way” was to help the Providers deliver, perhaps a little too much. Finding a balance is hard. Balance is needed to avoid disruption, a poorly performing provider might be better if helped and might be better than no provider. A commissioning cycle now costs a huge amount.  Procurement Law and the age of the Pilot!

12. Commissioning plans, intentions, approval and funding  And the long road through committees:  In Wiltshire  Localities ( about pop base 40 000),  the exec of the 3 sub groups ( covers about 140,000- 175,000)  Clinical Executive of the CCG  Governing Body of the CCG  the Joint Commissioning Board of the CCG ( services commissioned jointly with the Council  Oversight and Scrutiny Board  Health and Well being board

13. Know the funding streams Primary Care Partly paid for by Area Team, partly by CCG includes IAPT Provides to: Veterans, reservists and families Secondary Care Commissioned and paid for by CCG Provides to: Veterans, reservists and families Tertiary Care Commissioned and paid for by Area Team Provides to: Serving personnel, veterans, reservists and families 80% of mental health work is done in the surgery Psychiatry outpatients and inpatients Very small numbers

14. Working together

15. Wiltshire’s Future Health and Care Model Mental Health EMBED MENTAL HEALTH IN THE STRATEGY Managing Ill-health Establishing and sustaining wellness and independence

16. The future  “There is no money”  Veterans and reservists should use main stream, mental health services wherever possible, GP s, CMHTs etc  Veterans and reservists need the ability to talk to specially trained staff when needed, just like any other minority population which has its own cultural needs  Services are needed that reach and engage the marginalised who don’t access main stream mental health  The activity levels will grow before they go  Ensure these services are commissioned by the CCG and not forgotten