1. Norfolk Clinical Commissioning Groups and Norfolk County Council Adult Social Care The Commissioning Environment Clive Rennie, Head of Integrated Commissioning for Mental Health & Learning Disabilities 1

2. Coverage   National MH Strategy   Current Funding Environment(s)   CCG’s   NCC   Organisational Arrangements   Commissioning Intentions 2

3. National Picture – The Messages   Feb 2011 “No Health without Mental Health”   Health and Social Care Act 2012   Mandate to NHS Commissioning Boards 2012 3

4. National Picture – The Messages   Mental Health – “Everyone’s business”   Wider benefits to society of good Mental Health   Interlinks with other Central Government Departments   Cross cutting strategies   Community Responsibility   Localism   Reduce premature deaths 4

5. National Picture – The Messages   Increase Employment   Increased access to MH services in Criminal Justice settings   Listen to the Patient experience   Mental Health is of equal status to Physical Health   Earlier intervention – IAPT   Outcomes Focused   Recovery Focused   Payment by Results/ payment by Activity 5

6. Current Funding Environment Clinical Commissioning Groups   2.3% extra funding in 2013/14   CCG’s have a recurrent deficit position based on PCT end position   All CCG’s have to save 2% non-recurrent usage   All CCG’s have to have a 1% surplus   Activity, demographics and technology advances are adding cost pressure of 2% and above per annum   Continuing Health Care Restitution Costs – 15% growth per annum 6

7. Current Funding Environment Clinical Commissioning Groups   Increased funding passed across to Social Care from CCG’s   3% cost savings need to be made through Quality Innovation Productivity and Prevention (QIPP) plans   Equates to: – –£20Billion nationally – –£30M locally across the 4 CCG’s Norwich, West, South, North   No indication of the funding settlement for 2014/15 until December 2014 7

8. Current Funding Environment Clinical Commissioning Groups   Increase funding pass through to Social Care   Increased pressure on Acute i.e. A&E/ Beds/ Dementia   Community provision focus   What currency? Block/ Cost and Volume/ PbR Care Clusters 8

9. Current Funding Environment Norfolk County Council Adult Social Care   Comprehensive Spending Review 2011   NCC savings 140M   2011-2014 – 50.62M savings in Adult Social Care   Comprehensive Spending Review 2014   2014 – 2017 – 189M savings in NCC   2014/15 – 73M savings 9

10. Current Funding Environment Norfolk County Council Adult Social Care   2014 – 2017 – Adult Social Care share of the savings 56.6M (1% of the Adult Social Care budget)   2014/15 – 21M   2015/16 – 26.7M   2016/17 – 8.2M   Consultation - Norfolk Putting People First – starts 19 th September 10

11. Integrated Commissioning Organisational Arrangements   Integrated Commissioning Team for Mental Health and Learning Disabilities   Legal agreement under Section 75 of the Health and Social Care Act 2012 between:   Norfolk Clinical Commissioning Groups   Norfolk County Council   NHS Anglia Commissioning Support Unit 11

12. Integrated Commissioning Organisational Arrangements   Head of MH and LD Commissioning for 4 Norfolk CCG’s and NCC   Commissioning Lead for Adult Social Care (Community Services)   Head of Service, Mental Health   Commissioning Lead - Adults with Learning Disabilities   Commissioning Lead - Dementia   Commissioning Lead – Autism/ Aspergers   Commissioning Lead - IAPT 12

13. Commissioning Organisational Arrangements   Creation of the NHS England and Area Teams   Linkage to the Department of Health   Creation of Commissioning Support Services (Hosted)   Transfer of Public Health 13

14. Integrated Commissioning Organisational Arrangements   Mental Health and Learning Disability Commissioning Board – Norfolk CCG’s, Norfolk Adult Social Care, Public Health, Healthwatch   CCG Board’s   Adult Social Care – Senior Management Team   NCC - Cabinet   NSFT – Contract and Performance Meeting   Contract meetings with other providers   Information and Performance Sub Group   IAPT Contract Sub Group   Clinical Quality and Patient Safety Reference meeting   Access and Assessment Service Reference Group   GP Leads clinical meeting 14

15. Organisational Arrangements – Providers   Mental Health – Providers   Norfolk and Suffolk Foundation Trust - Main Contract   Norfolk and Suffolk Foundation Trust – IAPT   Norfolk County Council Children’s Services – FST   Individual Placements – PICU/ LSU/ Residential – Justin Gardner Unit, Alpha, Huntercombe Manor, Cherry Tree, Orchard House, Newmarket House, S3, Rhodes Farm, Ketts Park, Elsenham House,   Gender Dysphoria – Charing Cross Hospital, St Peters, Imperial 15

16. Organisational Arrangements - providers   Eating Disorders – Norfolk Eating Disorder Association, Cambridge and Peterborough MH FT   Autism/ Aspergers – Aspergers Service Norfolk   Adult ADHD - NSFT   Veterans Health – Julian Support   Frequently Attending Patients (CQUIN) - NSFT   Joint Funding – Julian Support, MIND Norwich/ West Norfolk, Equal Lives   Single Funding – Rethink, City Reach, Timberhill GP Led Walk-in Centre, Eating Matters, SOS Bus 16

17. Organisational Arrangements – Budgets/ Expenditure approximations   Mental Health Main contracts 100M   IAPT 10M   Forensic 21M   CAMHS 2M   Independent Placements 10M   Third Sector 1M   Eating Disorders 1.1M   Gender Dysphoria 50K   Deaf Peoples Services 177K 17

18. Draft Commissioning Intentions 2014/15   To undertake the financial instruction (deflator)as outlined in Operating Framework for the NHS for all Mental Health and Learning Disability contracts with Health funding streams   To review all Health funded third sector contracts in line with the principles established by Norfolk CCG’s   To undertake the necessary actions to reduce the spending commitments on services in line with the budget reductions set by NCC Cabinet   To reduce the current numbers of clients in Residential provision and to minimise the use of permanent Residential placements 18

19. Draft Commissioning Intentions 2014/15   To simulate the market via the Market Position statement to reduce the Residential care and Nursing Home provision   To increase the Supported Housing options available. To revise supported living standards and create a clear accreditation scheme for providers around supported living   To increase the number of Mental Health clients supported in the community via Supported Housing, independent accommodation with community support and to tender supported living schemes provided by the third sector in central Norfolk in 2014 19

20. Draft Commissioning Intentions 2014/15   To increase the use of Personal Budgets, Carers assessments, numbers of mental health clients in stable accommodation and in employment   To work with the DAAT to implement the recommendations of the recent review of Tier 4 services around residential care and supported housing for people with dual diagnosis. Focussing on detox piloting 20

21. Other Draft Commissioning Intentions 2014/15   Dementia diagnosis trajectory to meet national calculator uplift between 2% - 5% per annum – requirement for additional resource to meet the early/ timely diagnosis of patients.   To ensure the pathway for patients assessed and referred under the FAIR scheme (Dementia CQUIN into the Acute Trusts 2012/13/14) is opened to direct referrals from Acute Trusts to Memory Services and to ensure that the current low level waiting times are not compromised by this change of pathway.   To implement the Dementia Direct Enhanced Service agreement for GP’s to ensure that accurate recording of all patients with Dementia is on the Quality and Outcome Framework 21

22. Draft Commissioning Intentions 2014/15   The system of activity and currency is changing in 2014/15 for the main Mental Health FT contracts to shadow Payment By Results as opposed to the current Block contract arrangements. This change will need to translate into the 2014/15 main contract   The restructuring of Mental Health services under the Radical Redesign process and the Payment By Results Care Clusters requires new clinical specifications to be agreed and costed.   Specific work is being undertaken for the design and modelling of the Psychiatric Liaison Service at QEH 22

23. Draft Commissioning Intentions 2014/15   The Improving Access to Psychological Therapies service across all the CCG’s in Norfolk will be re-commissioned in 2015. To undertake options appraisal leading to the tendering and procurement process in 2014/15   Specific work is being undertaken for the design and modelling of the Psychiatric Liaison Service at QEH   To ensure that the self-assessment of Autism commissioning and provision is undertaken and to plan the implementation of the outcomes of any deficits within the Norfolk system that are identified 23

24. Draft Commissioning Intentions 2014/15   To appraise the options as regards the potential establishment of a new Section 75 arrangement for Social Care provision in Mental Health   To agree the Section 75 arrangement between NCC and the Norfolk CCG’s for Learning Disability Services   To have staffed 136 suites in place throughout Norfolk. This is in line with recent CQC and HMIC report recommendations   To adopt, in Norfolk, the pilot and standards set in the North Essex agreement for the conveyancing of Mental Health patients by EEAST. 24