1 Vision for better co-ordinated care: how could mental health payment systems serve as a key enabler for integration and personalised care? Mental Health Payment Systems Development Stocktake Event - 19 March 2014

2 “Integration is a vitally important aspect of the experience of health and social care for millions of people. It has perhaps the greatest relevance for the most vulnerable and those with the most complex and long ‐ term needs.” NHS Future Forum (2012) Mental Health Payment Systems Development Stocktake Event

3 Integrated Care Integrated care is about commissioning services around the needs of patients, not the needs of the system. The Health and Social Care Act 2012 set out the Government’s commitment to drive integrated care. The Future Forum report in 2012 made recommendations for strengthening integrated care which the Government accepted in full. The Government launched the £3.8 billion Better Care Fund. Department of Health established 14 integration pioneer sites.

4 Vision for Integrated Care Patient-centred, clinically-led services that are flexible and easy to navigate to ensure patients have access to high quality health and social care services when they need them. The NHS, local government and other sectors working together to improve patient outcomes through better co- ordinated working. CCGs using their local knowledge to design services around the needs of their communities. Health and wellbeing boards bringing health and care commissioners together to advance the health and wellbeing of local communities. Mental Health Payment Systems Development Stocktake Event

5 Better Care Fund Overview Mental Health Payment Systems Development Stocktake Event

6 Integrated Care Overview Mental Health Payment Systems Development Stocktake Event Tackling the Barriers Integration Pioneers Information, governance and technology Pricing Competition and contracts Institutional Workforce and leadership Creation of £3.8bn pooled budgets from 2015/16 National conditions to ensure money is spent on integrated care Local and national support to deliver Performance related pay to focus on key outcomes 14 outstanding sites selected from over 100 applications Support provided from national partners to enable rapid progress Learning to be shared throughout the whole country Better Care Fund

7 Integrated Care in Mental Health Closing the Gap: Priorities for essential change in mental health (2014) set out our commitment to drive integration of mental and physical health care. People with enduring mental illness are intensive services users and traditionally cross organisational and sector boundaries. People with mental illness may find it more difficult to navigate the care journey or be able to take control of their care and exercise choice. Integrated mental health care can support the drive to reduce the gap in premature mortality by empowering people with mental illness to manage their mental health and live healthier and independent lives. Mental Health Payment Systems Development Stocktake Event

8 Integrated Care Pioneer Sites We established 14 integrated pioneer sites, most of which include a focus on mental health. The pioneer sites are championing innovative approaches to integrated care including providing better support at home and prevention through earlier treatment in the community. The pioneers are reducing patient admissions through integrated teams of nurses, social workers, occupational therapists and physiotherapists to prevent crises. Mental Health Payment Systems Development Stocktake Event

9 Integrated Care Pioneer Sites Greenwich Pioneer Redesigning local mental health care pathways to ensure they are delivered within a new integrated structure. Multi-agency teams offer health and social care interventions and support through one assessment route for children, adults and older adults with mental health needs and people with learning disabilities. Physical health community services are integrated with social services and some mental health services, for both adults and children. Cheshire Pioneer Co-locating and integrating mental health and community based teams for adult health and social care, structured around GP practices. Mental Health Payment Systems Development Stocktake Event

10 Payment systems enabling integration in mental health Payment systems for mental health must be flexible enough to support innovation and service redesign, using currencies that reflect clinical practice. The tariff arrangements for 2014/15 allow local variations and modifications to national currencies to encourage innovation such as developing integrated mental health and social care services. Commissioners and providers can work together to agree local arrangements that support new models of care that deliver better value and outcomes for patients. Mental Health Payment Systems Development Stocktake Event

11 Capitation Payments Capitation payments agree a fixed amount of funding per patient to cover some (partial capitation) or all (full capitation) of the medical needs of a specialised group of patients for a specified period of time. Capitation payments can support integration of health and social care, promoting prevention and co-ordination across settings. Capitation payments provide incentives to reduce overall costs of care (focus on prevention, reduced activity and improved efficiency). Mental Health Payment Systems Development Stocktake Event

12 Improving Tariff Data Improving the quality of mental health data is essential to developing mental health payment systems that reflect clinical practice and promote better patient outcomes. The quality of mental health data has lagged behind that of physical health. Mental health providers, commissioners and local authorities should work together to improve data quality across mental health and social care services. Developing better outcomes and integrated outcomes data can drive payment innovation and ensure the best services are funded. Mental Health Payment Systems Development Stocktake Event

13 Conclusion Effective payment systems for mental health will ensure commissioners and providers have the essential framework to innovate, design services around the patient and improve access and choice to achieve parity of esteem with physical health. Integrated mental health care, supported by innovative payment systems, will enable services to be designed around the needs of local populations and improve recovery and outcomes. Commissioners, providers and local authorities should continue to engage in the discussion with Monitor and NHS England as mental health payment systems are further developed for 2015/16 and beyond. But in the meantime, they can also seek to go further, faster. Mental Health Payment Systems Development Stocktake Event