1. Index Number:No. 10.3 Document:Northumberland CCG Mental Health Model of Care Description:Local strategic needs analysis, including the number of children living in homes where there is a parent/carer known to be receiving treatment for drug or alcohol misuse, known to be suffering from mental ill health and/or experiencing domestic abuse. This should also include details of any commissioned services in support of children and families living in these circumstances. The number and needs of looked after children and care leavers should also be included in respect of the provision of sufficient placements and choices for care leavers.

2. Northumberland CCG Mental Health Model of Care

3. Northumberland CCG’s Mental Health Model of Care Development Northumberland CCG spends almost £50 million per year on Mental Health services for the population of Northumberland In April 2013, the CCG began a process to develop a model of care for mental health to describe the services and outcomes we want to commission Aims of the model of care:  Describe the future care pathways that the CCG will be commissioning for mental health and the desired outcomes at each stage in the pathway  Ensure the spend on mental health is on services that have the capacity to deliver high quality services that meet all of the mental health needs of the people of Northumberland

4. Current Service Provision We currently commission a broad range of services for people of all ages suffering with mental health difficulties At present service users do not always systematically access the right service pathways to meet their needs Pathways are sometimes fragmented and incoherent The current arrangement of services does not always ensure service users receive evidence based, best practice interventions Pathways are not always designed around the patient and therefore do not deliver the outcomes needed

5. Stakeholder Feedback We need faster access to services Services need to communicate with each other better Services need to support people to build emotional resilience There needs to be a greater focus on early identification and intervention Transitions between children to adults services need to be smooth and effective We need more services for people with dementia Community mental health teams need to have better links to primary care We need a directory of services for people with mental health issues More training in mental health is needed for practice nurses We need better continuity of care for young people and their carers transitioning to adult services Better advice & support for family and friends coping with a relative with a mental health problem Services need to work with each other to meet all the needs of a person We need better integration of services between Physical and Mental Health We want faster response times; waiting lists are too long

6. Local 21.6% of the population of Northumberland is aged 0-19 The level of child poverty is better than the England average however, 18.4% of children aged under 16 are living in poverty Young people aged under 18 admitted to hospital as a result of mental health is lower than the England average The hospital admission rate for substance misuse (age 15- 24) and young people aged under 18 admitted to hospital as a result of self-harm is higher than the England average National Children with learning disabilities are six times more likely to have mental health problems than other children One in 100 children has autism, and that more than seven in ten children with autism have a co-morbid mental health problem Children with a long-lasting physical illness are twice as likely to suffer from emotional problems or disturbed behaviour Many looked after children have complex needs and high levels of mental health problems Children and young people in the criminal justice system are far more likely to experience mental health problems than their peers Children and Young People – Current Service Provision & Mental Health Profile Children and Young People’s Services Northumberland, Tyne and Wear NHS FT (NTW) Children and Young People’s Service (CYPS) provides a single service to all children and young people aged 0-18 years living in Northumberland who present with mental health difficulties. The service provides assessment, diagnosis and intervention on a range of mental health issues. NTW also provides intensive response and home- based treatment; an intensive Eating Disorder Service; a comprehensive transition support package to those young people need continuing support as adults and training, consultation, support and advice to front line staff working in targeted services for children. Northumbria Healthcare NHS FT provides a Primary Mental Health Workers Service which provides support to staff within Tier 1, in relation to early identification and intervention with children’s mental health needs. The service promotes the emotional health of children and young people in the community and provides support, advice and assessment to children, young people and their families.

7. Children and Young People – Priorities for Change We need to work with existing providers to ensure the successful delivery of service development plans to improve access, develop service user outcome measures and reallocate resource to increase capacity in Tier 1 and 2 We need to develop a new service model which incorporates the Northumberland Children and Young People’s Emotional Health and Wellbeing Strategy and the principles of the model of care We need to work with existing providers to ensure the successful delivery of service development plans to improve access, develop service user outcome measures and reallocate resource to increase capacity in Tier 1 and 2 We need to develop a new service model which incorporates the Northumberland Children and Young People’s Emotional Health and Wellbeing Strategy and the principles of the model of care

8. Adult Current Service Provision and Mental Health Profile Adult Services Northumberland, Tyne and Wear NHS FT (NTW) and Mental Health Concern and Oakdale provide the IAPT Talking Therapies service across Northumberland. NTW also provides a range of inpatient and community services for adults including: Adult Assessment and Treatment Psychiatric Intensive Care Units Crisis Resolution and Home Treatment Community Mental Health Teams Early Intervention in Psychosis Assertive Outreach Local In Northumberland, demand on services is expected to increase with the growth of the 25-35 and 55-64 age groups up to 2020, both of whom are associated with higher age related mental health service use Northumberland has a higher than England prevalence rate for depression, but lower for other mental health conditions Northumberland has low rates of admissions for schizophrenia and significantly lower rates of admission for depression National Mental illness is the single largest cause of disability in the UK, contributing up to 22.8% of the total burden, compared to 15.9% for cancer and 16.2% for cardiovascular disease At least one in four people will experience a mental health problem at some point in their life and one in six adults has a mental health problem at any one time Almost half of all adults will experience at least one episode of depression during their lifetime About 1 in 100 people has a severe mental health problem

9. Adult Priorities for Change We need to ensure that across all age groups there is equity of access to IAPT and other counselling services and that they have adequate capacity to meet the increasing rates of depression and other common mental health problems We need to transform existing services to ensure they are delivered using an integrated approach with embedded partnership working to meet all of the needs of an individual We need to implement care pathways and packages to ensure that services deliver best practice interventions We need to ensure that across all age groups there is equity of access to IAPT and other counselling services and that they have adequate capacity to meet the increasing rates of depression and other common mental health problems We need to transform existing services to ensure they are delivered using an integrated approach with embedded partnership working to meet all of the needs of an individual We need to implement care pathways and packages to ensure that services deliver best practice interventions

10. Older Adult – Current Service Provision and Mental Health Profile Local Northumberland has an increasing over 65 population when compared to all ages. The over 65 age group is set to increase by 14,000 (17.8%) by 2020 compared to a decline of 6800 in under 65 The increasing percentage of the over 65 population is likely to increase the demand on social care, older people’s mental health and memory services For 65+ age bands there is a significant increase in the prevalence rates for all mental health issues covering both functional and organic – currently one third of national mental health service use is from the over 65 age group In 2012, was estimated that there was 5,748 people in Northumberland over 65 with depression, 1,821 with severe depression and 4,465 with Dementia By 2020 it is estimated there will be 6,955 people in Northumberland over 65 with depression, 2,208 with severe depression and 5,782 with Dementia Northumberland’s current prevalence rate for dementia is in the top 25% in England and the ratio of diagnosis and prevalence is 42% National The morbidity in older people is not just due to dementia, it also includes other functional illnesses such as depression and psychosis though these can, and frequently do, co-exist with dementia Depression affects: 50% of people with Parkinson’s disease; 25% following stroke; 20% with coronary heart disease; 4% with neurological disease; and 42% with chronic lung disease Older Adults Services Northumberland, Tyne and Wear NHS FT (NTW) provide a range of community and inpatient services for older people. This includes Community Mental Health Teams which provides specialist assessment, treatment and care for older people with mental health problems arising from functional or organic disorders. NTW also provides inpatient facilities delivering assessment and treatment by multi-disciplinary health and social care teams for older people with mental health problems arising from functional disorders such as depression.

11. Older Adults – Priorities for Change We need to ensure we have appropriate service provision for older adults with dementia and/or functional illnesses, to account for the expected increase in demand on these services We need to transform existing services to ensure they are delivered with an integrated approach that meets all of the needs of an individual We need to implement care pathways and packages to ensure that services deliver best practice interventions We need to ensure we have appropriate service provision for older adults with dementia and/or functional illnesses, to account for the expected increase in demand on these services We need to transform existing services to ensure they are delivered with an integrated approach that meets all of the needs of an individual We need to implement care pathways and packages to ensure that services deliver best practice interventions

12. Assessment and Formulation Treatment Discharge and Transition ACCESS Children & Young People Non Psychosis Cognitive Impairment Services can be accessed quickly and easily Services work as part of a whole system delivering integrated care pathways Services are focused on early identification and intervention Services are high quality, safe, effective and use evidence based best practice interventions delivered by highly skilled staff Services provide personalised care packages that meet an individual’s needs Service quality and effectiveness are measured by service user outcomes Services promote positive mental health and the prevention of mental ill health Communication between services is seamless Services demonstrate that they provide value for money Key Principles of Service Delivery Northumberland Mental Health Model of Care

13. Access Services have a simple referral process to follow and are accessible to the whole community Referrals are clinically triaged; referrers and service users are actively engaged and receive clear communication, within agreed timescales Providers give service users choice and make reasonable adjustments to ease access Relapse management – known service users receive rapid, easy re-entry to services Referrers receive signposting and advice when referrals are deemed inappropriate Outcomes Service users enter the right pathway, easily and quickly (short waiting times – referral to assessment) Service users are engaged and attend appointments (reduced DNA rates) When a service user relapses, they receive rapid access back to services (waiting times) Referrers are supported to make appropriate referrals (referrer feedback) Assessment and Formulation Treatment Discharge and Transition ACCESS Access Phase of the Pathway Children & Young People Non Psychosis Cognitive Impairment

14. Assessment & Formulation Service users are put at the centre of a holistic assessment appropriate to their needs Where appropriate, service users are clustered and kept well informed throughout the process Personalised service user outcome focused care packages are formulated, in collaboration with service users and their carers and all service providers involved Carers are also offered a needs assessment Service users rapidly enter the treatment phase Outcomes Service users are effectively involved and engaged with the care planning process and their views are central to it (PREMS) Short waiting times (assessment to treatment) Service users receive a care plan which addresses all identified goals and needs (PROMS, PREMS, CROMS) Service users understand the assessment process, their diagnosis and treatment options (service user feedback) Carers needs are identified and they are supported to meet their needs (carer feedback) Assessment and Formulation Treatment Discharge and Transition ACCESS Assessment & Formulation Phase of the Pathway Children & Young People Non Psychosis Cognitive Impairment

15. TreatmentOutcomes Assessment and Formulation Treatment Discharge and Transition ACCESS Treatment Phase of the Pathway Children & Young People Non Psychosis Cognitive Impairment Service users receive a care package of outcome focused, safe, evidence-based interventions from highly skilled staff Service users are supported to self-manage their condition, where possible Where appropriate, involvement of families and carers is encouraged and supported through active engagement and information sharing Service users recover (PROMS, CROMS, recovery rates) Service users are actively involved in shared decision making and supported in self-management (PREMS) Lower relapse rates CROMS Patient safety (Incidents)

16. Discharge and Transition Discharge and transition planning is an explicit element of the care planning process with plans formulated collaboratively between service users, carers and providers Service users are supported to develop personalised relapse prevention plans, including urgent access to specialist care Communication about discharge and transition is clear and timely and all involved understand roles and responsibilities Transition of service users across pathways is safe and effective Outcomes Service users and carers are fully informed and involved throughout discharge planning (service user and carer feedback) Lower relapse rates Reduced delayed discharges Reduced average lengths of stay Young people are supported to transition to adult care pathways safely and effectively PROMS, CROMS, PREMS Assessment and Formulation Treatment Discharge and Transition ACCESS Discharge and Transition Phase of the Pathway Children & Young People Non Psychosis Cognitive Impairment

17. Implementation and What needs to Change We have a good foundation to implement the model of care based on the range of current service provision we have Successful delivery of the model will require significant cross organisational cultural change and the implementation of new ways of working The whole system approach to the delivery of mental health care services will require commitment to whole system working by all stakeholders involved Transformation of existing services to ensure they have the capacity and capability to deliver the desired care pathways Changes to how and where we allocate resources, taking account of the changing demographics and needs of the people of Northumberland Moving forward, using commissioning and contracting as a lever for driving up service quality, all service specifications with existing providers will be modernised to reflect the key service principles of the model of care. All providers, existing and new, will be required to demonstrate how their services will contribute to the delivery of the model of care and provide agreed performance and safety information including service user outcomes. The Integration Board will be used to ensure the model of care is strategically aligned, monitor the implementation and delivery of the model and will help to remove any barriers to success A phase of engagement with key stakeholders, including service users and carers, about the model will now begin A detailed work plan will be developed and governance arrangements put in place to ensure the successful implementation of the model across Northumberland

18. Implementation – Work Streams  Children and Young People’s Services (CYPS) Tender  Children and Young People’s Service Improvement  Transformation of Adult Community Mental Health Services  Implementation of Care Pathways and Packages (CPP)  Review Primary Mental Health and Psychological Services  Transformation of Older Adult Community Mental Health Services  Implementation of Care Pathways and Packages (CPP)  Dementia Pathway Development

19. Implementation Timeline Oct 13 – March 14 April 14 – Sept 14 Oct 14 – March 15 April 15 Onwards Children and Young People Adults Older Adults New Service Specification New Model live Existing Service Improvement Tender New Service Transformation of Community Services Review Primary MH and Psychological Services Dementia Pathway Development New Model live Potentially Tender New Service New Service live Implementation of Care Pathways and Packages New Service live

20. Questions?