1. New Standard NHS Community Contracts Part 2 April 2009
Christian Geisselmann
Consultant – Contracts & Commissioning
NHS South of Tyne and Wear - Substance Misuse Commissioning Teams

2. What is the Mental Health Contract?
What is it and who will use it?
Mandatory policy requirements
What you need to do
Provider reports/ reviews
Contract levers
What next?

3. MH sessions What is the MH contract?
The NHS Contract for Mental Health and Learning Disability Services, (the Contract), covers agreements between primary care trusts (PCTs), Local Authorities (where applicable) and providers of Mental Health and Learning Disability care (Providers)
The contracts will apply to the following providers of Mental Health and Learning Disability services
All NHS Trusts
NHS Foundation Trusts
Independent and Third Sector (including primary care providers where applicable)
PCT provider arms delivering specialist mental health and learning disability services
All NHS Trusts
NHS Foundation trusts (FTs) – All New FTs and existing FTs whose contracts expire by 31 March 2009 will adopt the contract. FTs whose contracts extend beyond March 2009 may choose to adopt the Contract or retain their existing contracts until the required period of notice to change has expired.
Independent (including primary care providers where applicable) and Third Sector
PCT provider arms delivering specialist mental health and learning disability services.
All New FTs and existing FTs whose contracts expire by 31 March 2009 will adopt the contract. FTs whose contracts extend beyond March 2009 may choose to adopt the Contract or retain their existing contracts until the required period of notice to change has expired.

4. MH sessions What is the MH contract?
Services covered:
Adults of working age
Older adults
Children and adolescents
Substance misuse
Learning disability
Forensic care

5. MH sessions What is the MH contract?
From April 2009 the Contract will be introduced on a one year basis to expire on 31 March 2010 with Providers of Mental Health and Learning Disability services
Where both the PCT and the Provider have a well developed contract in place and agree that their current contract arrangements would benefit from continuing until April 2010 then, subject to SHA approval, the parties can continue to contract under existing arrangements. PCTs will ensure that any extension to current contracting arrangements will not continue beyond April 2010.
As part of the approval the Parties will agree to vary their contract in accordance with the contract variation procedure to ensure that following policy requirements are introduced:

6. MH sessions What is the MH contract? Mandatory policy requirements
Data Quality improvement plans: each provider should agree an annual data quality improvement plan, as detailed in Clause 29, including timescales and performance management mechanisms
Healthcare associated infection improvement plan: each provider should agree a HCAI Plan demonstrating the lowest levels of HCAI appropriate to the care environment
Services quality and safety improvement plan: each provider should agree with their Commissioner a safety and quality improvement plan that is aimed to provide a structured process for the improvement of Service User quality and safety of care. The plan will be agreed within a month of the start of each contract year. The Services Quality and Safety Improvement Plan will form part of the Service Quality Reviews under clause 33.

7. MH sessions What is the MH contract? What you need to do: plans
HCAI reduction plan
Business continuity plan
Essential services continuity plan
Mixed sex accommodation plan
Services quality and safety improvement plan
Data quality improvement plan
Emergency response plan
Activity plan
Service specifications
Transfer and discharge protocols
Service Development plan

8. MH sessions What is the MH contract
MH sessions What is the MH contract? What you need to do: reports/ reviews
Service user, carer and staff experience surveys
Quality Assessment Framework
Annual review of service quality
Quality performance incentive scheme (non-mandatory for 2009/10)
Monthly performance reviews
Monthly service quality reviews
Monthly report of issues in national / local health economy impacting on contract
Action Plans / Improvement Plans

9. MH sessions What is the MH contract? Contract controls
Failure of achieve Targets: 10% monthly withholding
Contract query re performance: Exception report and liquidated damages
Failure to agree Remedial Action Plan: 20% withholding
Failure to meet service quality performance indicator: liquidated damages

10. MH sessions Legal Terms and Conditions
Contract controls work on the basis of “Remedy before Penalty”
Quality Improvement Plans are the key
Financial penalties and withholdings applied only after exhaustive process focussed on gaining solutions
Lack of action or failure to take action by either of the parties will generally trigger a withholding or penalty
-Clause 29 Information
-Clause 32 General Performance
-Clause 33 Clinical and Professional Service quality

11. What’s next?
Programme of development work to produce the 3 year contract mandated standard contract 2010/2011->
Active involvement of all stakeholder and the stakeholder reference groups
Continue to implement the contracts during 2009 and embed all the new systems with ALL provider

12. Service Specifications
Specifications will include the following:
Purpose
Scope
Service Delivery
Referral, Access & Acceptance Criteria
Discharge Criteria and Planning
Self Care and Patient Information
Continual Service Improvement Plans
Contract Details and Cost of Service
Activity Plans

13. Service Specifications
Quality Standards:
Service User Experience
Improving Service Users and carers Experience
Reducing Inequalities
Reducing Barriers
Improving Productivity
Access
Personalised Care Planning
Outcomes
Quality and Clinical / Integrated Governance
Harm Reduction and Healthcare
Workforce Development

14. Service Specifications
Activity Performance Indicators:
Treatments
Care Plans
Waiting Times
Harm Reduction
Vaccinations
TOPs
A new workbook will populate all of this data

15. What’s new in the MH and LD contract?
HCAI improvement plan (Clause 4)
Mixed Sex Accommodation (Clause 4)
Quality and safety Improvement plan (Clause 16)
Data Protection and FOI (Clause 27) more clearly set out especially in relation to protecting patient identifiable data
Variations (clause 38 and Schedule 6) clarified
Change of Control (clause 49) sets timescales for Commissioners to consent to change of control

16. What’s new in the MH and LD contract?
Staff (Clause 11)
Staff surveys to be carried out
Name badges to be carried and displayed as appropriate to the setting
Compliances with the Cabinet Office Code on Workforce Matters when employing staff to work on NHS funded contracts in that
TUPE shall apply to all staff transfers
transferring staff shall be offered membership of a pension scheme which is broadly comparable to the NHS Pension Scheme.
new staff should be offered fair and reasonable terms and conditions that are overall no less favourable than those of transferred employees

17. What’s new in the MH and LD contract?
Staff - cont..
for staff who are not eligible for membership of the NHS pensions scheme, staff to have access to good quality pensions arrangements that comply with the pensions provisions of the Cabinet Office Code.

18. Christian Geisselmann
Mental Health – Commissioning for Quality Improvement with effective Contract and Performance Monitoring
Christian Geisselmann

19. Overview Where are we now Work under-way for 09/10 contract
Next steps during 09/10
Key Messages

20. Contracts and Performance
Development of a Contract & Performance Management Policy which will form the base for taking contract and performance monitoring forward

21. Contracts and Performance Management Framework
The contract and performance management framework policy has been written for providers to improve understanding of NHS South of Tyne and Wear Substance Misuse Commissioning Teams approach to managing the service level contracts at an operational level

22. Contract and Performance Policy
The policy has 18 sections and 8 appendices
A brief overview of the process is as follows:

23. Contract and Performance Policy
Section 1 Includes NHS South of Tyne and Wear Approach to Contract Management
Section 2 Explains the Importance of the Contract Service Specification as the basis for Contract Management
Section 3 How will the Contract be Monitored?
Section 4 Type and Frequency of Contract Management for Providers

24. Contract and Performance Policy
Section 5 Contract Management Meetings
Section 6 Contract Management Visits
Section 7 Performance Monitoring Procedures
Section 8 Quality Assessment Framework (QAF)
Section 9 Service User Involvement in Contract Management
Section 10 Re-shaping the Market and Supporting Providers to Rise to the Challenge (“Our Commitment to you”)

25. Contract and Performance Policy
Section 11 Dealing with Poor Performance under the Contract
Section 12 Options Appraisal Meetings
Section 13 Extension of Contracts
Section 14 End of Contract Procedures and Options Appraisal Meetings
Section 15 Contract Management Outcomes and the Administration of Service Budgets

26. Contract and Performance Policy
Section 16 Data Protection and Contract Management
Section 17 Dispute Resolution & Complaints Procedure and Contract Management
Section 18 Review of Contract Management Procedures

27. Contract and Performance Policy
Appendix A Service Specification Summary Guide
Appendix B Request for variation to Contract Form
Appendix C Contract Management Agenda Template
Appendix D Improvement Plans
Appendix E Quality assessment Framework Self Assessment Summary

28. Contract and Performance Policy
Appendix F Contracts Team Provider Workbook Log Screen Shot
Appendix G Performance Notices
Appendix H Feedback Form

29. Work during 09/10
Further develop Quality and Performance Framework at service outcome level
Develop within each service specification high level metrics which addresses :-
Health gain (outcomes)
Patient experience
Patient Reported Outcome Measures (PROMS)
Further develop CQUIN thresholds and develop weighting

30. Key Messages Get Systems and Processes right – the rest will follow
Can only be done in partnership
Focus on small number of areas
CQUIN should be a win win.

31. Contracts Session Part 2
Any Questions???