Two thirds of patients with serious mental health problems placed in rehab far from home and local support

Care Quality Commission | People in rehab for serious mental health problems more likely to face lengthy stays far from home and local support | 2018

The Care Quality Commission (CQC) sent information requests to 54 NHS and 87 independent healthcare providers that manage mental health rehabilitation inpatient services.  CQC, working in collaboration with NHS England and NHS Improvement, asked providers for information about the mental health rehabilitation inpatient services that they manage. This included information about the number of locations and wards providing mental rehabilitation services, and the average daily cost of a bed on those wards, the length of each patient’s stay, funding authority and the mental healthcare provider responsible for aftercare. university-2540603_1920They found nearly two thirds (63%) of placements in residential-based mental health rehabilitation services are ‘out of area’, which means they are in different areas to the clinical commissioning groups (CCGs) that arranged them.

CQC estimates that £535 million is spent on residential mental health rehabilitation annually, with ‘out of area’ placements accounting for around two thirds of this expenditure.  The review shows that people in residential mental health rehabilitation services provided by the independent sector are, on average:

  • More likely to be further from their homes than those staying in NHS services – 49km compared to 14km.
  • More likely to stay there for longer – 14.5 months on their current ward compared to 7.5 months on their current ward in a NHS service.
  • At a greater risk of having their aftercare compromised because the managers there are less likely to know which NHS trust would care for them following discharge – 99% of managers of NHS rehabilitation services were able to name the NHS trust that would provide their patients’ aftercare, in comparison to 53% for independent services.

CQC recommend that the Department of Health and Social Care, NHS England and NHS Improvement agree a plan to engage local health and care systems in a programme of work to reduce the number of patients placed in mental health rehabilitation wards that are out of area. (CQC)

Press release available here 

Briefing can be read on the CQC website 

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Reducing prescriptions for over-the counter medicines

NHS England is launching a public consultation on reducing prescribing of over-the-counter medicines for 33 minor, short-term health concerns.

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These prescriptions include items for a condition:

  • That is considered to be self-limiting and so does not need treatment as it will heal of its own accord;
  • Which lends itself to self-care, i.e. that the person suffering does not normally need to seek medical care but may decide to seek help with symptom relief from a local pharmacy and use an over the counter medicine.

Vitamins/minerals and probiotics have also been included in the consultation proposals as items of low clinical effectiveness which are of high cost to the NHS.

NHS England has partnered with NHS Clinical Commissioners to carry out the consultation after CCGs asked for a nationally co-ordinated approach to the development of commissioning guidance in this area to ensure consistency and address unwarranted variation.  The intention is to produce a consistent, national framework for CCGs to use. The consultation closes on the 14 March 2018.

View the full consultation document here

Strategic commissioning

CCGs in the UK should move towards strategic commissioning if the healthcare system is to embrace a move toward integrated local care, claims a new briefing from NHS Clinical Commissioners (NHSCC).

The publication brings out lessons based on evidence from the UK and health systems abroad. These are drawn from the perspectives of those implementing and developing policy around the new care models and from research of international models, primarily of high performing place-based systems of care that have developed in New Zealand, Sweden, Spain and the United States.

‘Making strategic commissioning work’ puts forward a number of recommendations aimed at easing the transition to strategic commissioning models.

  • The patient must be placed at the centre with a focus on quality – targets, payment incentives and prescriptive regulation have proved largely unsuccessful in driving system improvement and ensuring financial sustainability.
  • Clinical commissioning leadership and engagement must be retained – the evidence shows that success of population level planning is reliant on the engagement of clinicians in primary, secondary and community care, as well as the wider workforce.
  • National clarity on the ‘end state’ is essential – while local areas must lead the development of models for integrated health and care delivery, internationally, no system has been implemented without clear political consensus and a legislative framework to support it on an ongoing basis. In the UK, this could mean a national framework is needed – provided this is not too prescriptive to limit local development.

Full document: Making strategic commissioning work: Lessons from home and away

Guidance for CCGs on items not to be routinely prescribed

NHS England has published Items which should not routinely be prescribed in primary care: guidance for CCGs.

This guidance is addressed to CCGs to support them to fulfil their duties around appropriate use of prescribing resources supporting CCGs in their decision-making, to address unwarranted variation, and to provide clear national advice to make local prescribing practices more effective.

Additional link: NHS Clinical Commissioners press release

Budget 2017: Chancellor pledges extra £2.8bn for NHS

The chancellor has announced £2.8bn of extra revenue funding for the NHS to cope with pressures between now and the end of 2019-20 | via Health Service Journal

The funding will be split over three financial years, with £335m coming this year to help cope with winter pressures. An extra £1.6bn will be made available in 2018-19, followed by £900m in 2019-20.

NHS leaders had insisted an extra £8bn was needed over this period just to maintain day to day services, while the King’s Fund, Nuffield Trust and Health Foundation agreed £4bn was needed next year alone.

The Chancellor also said the government will provide money for an NHS staff pay rise, but only if unions agree to reform the Agenda for Change contract.

See also:

 

Commissioning children’s palliative care

Commissioning children’s palliative care in England: 2017 edition | Together for Short Lives 

This report summarises responses to a Freedom of Information request sent to every CCG and upper-tier local authority in England, asking how they plan care and support for children who need palliative care and their families, and which services they commission for them.

The report found that:

  • Children’s palliative care commissioning in England is patchy and inconsistent
  • The government’s end of life care choice commitment is not being fulfilled in almost half of local areas in England
  • Most CCGs have not implemented the new clinical guidance for children who need palliative care
  • Even though many seriously ill children need care 24 hours a day, seven days a week, commissioners are failing to plan and fund this support
  • Many local authorities are failing to commission short breaks for children who  need palliative care, despite being legally obliged to do so
  • There is a postcode lottery of bereavement care across England for parents whose child has died
  • CCGs and local authorities are failing to fund voluntary sector children’s palliative care organisations – including children’s hospices
  • Too many areas still do not commission age and developmentally appropriate services for young people with life-limiting and life-threatening conditions
  • Despite significant challenges across England, there are still some examples of commissioners reporting a broad range of children’s palliative care commissioning.

The report proposes a number of recommendations in response to these findings.

Full report:  Commissioning children’s palliative care in EnglandTogether for Short Lives’ report on children’s palliative care services commissioned by NHS clinical commissioning groups (CCGs) and local authorities in England.

CCG Improvement and assessment framework

CCG Improvement and Assessment Framework 2017/18 | NHS England 

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This updated framework describes the CCG annual performance assessment and the metrics that will inform that assessment for 2017/18; it replaces the Improvement and Assessment framework (IAF) for 2016/17.  The framework is accompanied by a technical annex which provides the detail of the construction and purpose of each of the indicators in the framework.

Full document at NHS England