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Our Directors are keen that we extend the work we have started in Mental Health because of the beneficial impact Patient Flow Planningand our Percept project structure can have on strategies which aim to :  

 

• Improve Access to Psychological Therapies (pdf)
• Re-base In-Patient Bed Provision
• Balance Community Mental Health Services
• Help implement the UK Dementia Strategy

Mental Health as a NHS Priority

According to the Mind Organisation "One-in-four of us will be affected by mental illness at some point in our lives. Each year 250,000 people are admitted to psychiatric hospitals and 4,000 people take their own lives."

This is neither insignificant nor inexpensive.

Data from the Sainsbury Centre for Mental Health tells us that the Social & Economic Cost of Mental Health Problems in:

Scotland were £8.6 Billion for 2004/2005. This equates to about 9% of the Scottish GDP and is actually £0.9 Billion more than the total spend on the Scottish NHS!

Northern Ireland the equivalent cost for 2002/2003 was £2.9 Billion.

England the equivalent cost for 2002/2003 is reported at a massive £77 Billion! This compares with £67.2 Billion spent on health and social services that year.The National Audit Office in their 2007 report estimates the costs to the economy of Dementia alone to be 14.3 billion pounds of which 3.3 billion pounds are direct costs to the NHS and social care.

With costs like these we might expect the UK Government to have Mental Health as a top priority. Indeed, the paper Mental Health in the Mainstream by the Institute for Public Policy Research reminds us that in 1997 the Government set out its top three priorities for the NHS as cancer, coronary heart disease and mental health.

The UK Dementia Strategy 2009, the report commissioned by the Alzheimers Society (Dementia UK 2007) and the National Audit Office report in 2007 each highlight the scale of the challenges facing NHS and Social service organisations with respect to Dementia. In the next 30 years , the cost of Dementia to the UK economy could treble to £50Billion per year.

Focused_On are able to offer their Dementia-Executive(pdf) model which is a high level System Dynamics simulation model designed to be used by world-class commissioners and strategic leaders in service provider organisations - private, public and voluntary. The Dementia-Executive(pdf)has been designed to help local Health Services re-think the way they are organised and re-visit their strategic investment decisions.  

Wouldn't it be NICE?

On 19th June 2006, the Chief Executives of four leading mental health charities (Mind, Rethink, the Mental Health Foundation and the Sainsbury Centre for Mental Health) issued a joint statement calling for far greater access to CBT (Cognitive Behaviour Therapy) for people with the more common mental health problems.

"NICE guidance has approved CBT for depression, some forms of anxiety and for schizophrenia on seven occasions yet it is still scarce and subject to waiting times that would be unacceptable for any other form of specialist treatment on the NHS."

What's the Government doing about it?

Improving Access to Psychological Therapies (IAPT) may prove to be one of the most important strategies of the National Health Service for people who suffer some of the more common mental health problems such as anxiety and depression.

Success could provide quicker and more sustained improvements in health and well being, substantially improving people's chances of staying in / returning to work or enjoying greater community participation.

How to deliver IAPT ?

In accordance with the Government's strategy for Improving Access to Psychological Therapies, PCT's (Primary Care Trusts) have widely adopted the Stepped Care approach which is based on the simple idea that Patients should start with the least intensive treatment that is most likely to work. For many people, this might be no more than reassurance and self-help.

When adapted to reflect local requirements, the Stepped Care approach can enable local mental health services to determine the correct therapeutic interventions for each step, the professional input required, and the ideal mix of skills. The Stepped Care approach should also assist PCT's in managing their resources more effectively.

But what does it mean?

Our Client has explained that : "At South Tyneside NHS Primary Care Trust we recognised that if our Stepped Care Plan was to deliver greater care to those Patients suffering Mental Health problems, then we needed to re-design how we deliver our Services. In fact, we have had to find new ways of designing our new processes - in a modern NHS we must be confident that our proposed changes are the most likely to achieve better Patient Flow, deliver greater Patient Care, be supported by our Staff, and provide better value-for-money."

1. How could we better engage with our General Practitioners?
2. How could we prove that our service improvement ideas deserved the full support of their Practice Based Commissioning?
3. How could we design, develop, and deliver Patient care pathways that substantially improved Patient choice and provided quicker access to Psychological Therapies?
4. How could we optimise the availability of Staff and the development of their clinical skills for the benefit of our Patients?
5. To what extent should we engage skills best offered by the Voluntary Sector or via Service Level Agreements with Independent providers?
6. How could we test the impact on Service delivery if our talents and time were focused more on one Therapy, such as CBT, and less on another?
7. What-if our GP's changed their referral behaviour as access to psychological therapies improved?

With this challenge in mind, South Tyneside PCT have brought two powerful new planning tools into their organisation. These tools have enabled their desired Patient Journeys to be rationally mapped and have then applied metrics to a model to assess the degree to which existing and proposed staffing levels can meet their Patients' Needs. The tools have enabled commisioning to be agreed by the commissioners and the service providers so that both understand their commitments.

Stewart Ingram (Mental Health Service Delivery Manager) says "We have used our new PatientFlow Planning software to design and document when and where Therapy Services are going to be delivered as part of our Stepped Care Plan and this has helped us to secure clinical support at the outset. Our computerised process maps are really useful. In addition to storing data that quantify the number, duration, and frequency of Therapies, they are visually powerful and actually provide GP's and staff with electronic access to Patient assessment tools like PHQ9 and CORE."

" We quickly gained a more detailed and more rigorous understanding of which skills and resources were currently available and where the gaps in services were, but this in itself couldn't help us to plan how to optimise the skills and experience of our Staff alongside external Advisors and Counsellors."

	Covers the Recognition of the condition in Primary Care, going from initial assessment by the GP and specifying the proportion of patients proceeding to other forms of specialised therapy. Click the image for more details.
	Defines the availability of staff for different forms of brief intervention and the demands made on these staff by the patients in this step. Click the image for more details.
	Specifies the different types of complex intervention for non-psychotic conditions. Defines how frequently these may be executed and the staff who will perform the intervention . Click the image for more details.

We have, therefore, used our new Patient Flows to inform, design and calibrate a simulation FlowModel which means we can actually see the likely impact of our decisions on our process dynamics.

Better than ever, service Delivery and service Commissioning are working as a team, each being able to literally see how one can harmonise with the other.

Having decided what the care pathways should be, what staff and skills we have available and what the Patient needs are, we are now in a position to assess the extent to which we can meet these needs. This is done by using the gathered information in a simulation FlowModel. Click the image for more details.

As Terry Prior, Mental Health Commissioning Manager explains, "Now, we can quickly and easily measure the Queues & Wait Times likely to be experienced by Patients. We can sit down in front of our new IAPT FlowModel and test the expected benefits of some sharply focused recruitment or dedicated external Service Level Agreements. We can show our GP's where to invest in our Staff and how best to deploy their Counselling skills for the benefit of local Patients with mental health problems."

Or, as one enthusiastic GP put it "This is going to take away a lot of argument and guess-work. In future, we'll see robust, evidence-based commissioning."

A Way Forward?

The work done by South Tyneside evidences the extent to which service delivery can be improved with only marginal adjustments in the level of resource input. It also demonstrates the significant improvements which can be achieved with a well thought out approach to commissioning, delivering:-

(i)      Optimised use of in-house resources & skills + SLA's
(ii)    Delivery of prompt effective treatment
(iii)    Sustainable, better value-for-money processes
(iv)    Identification and use of more value-adding capacity
(v)    Optimised commissioning and local delivery plans

The result of this is of benefit to the whole Health Economy (GP's, the PCT's and Service Delivery units) . More importantly it also marshalls and directs staff who are able to provide help to the Patients. Improved access to psychological therapies can help mitigate some distressing and unnecessary conditions.

Terry Prior, Locality Commissioning Manager(Mental Health), explained this current work to an audience of renowned Academics & leading Healthcare Professionals at the University of Westminster. You can see a simple PDF version of his multi-media presentation with It's Good to Talk (PDF) .

 Terry and Steve Burnell have also presented, to this forum, their proven approach to whole service Commissioning for Mental Health. You can see their presentation at World Class Whole Service Commissioning(PDF)

Contact Us for a discussion on how this accumulated experience might be applied to your problems.

OPTIMISED RESOURCES : GREATER PATIENT CARE