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. They 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)
Of primary importance: commissioning mental health services in primary care | NHS Clinical Commissioners
This report highlights projects where CCGs and their partners are delivering better care for patients, working across the boundaries between physical and mental health, as well as health and social care, while at the same time reducing pressure on GPs and hospitals.
Developed by NHS Clinical Commissioner’s Mental Health Commissioners Network, the report aims to share learning and good practice from these projects to help support others looking to implement projects across primary care.
Case studies in the report include:
Community Living Well in West London which helps those with long-term mental health conditions and covers a full range of psychological therapies from guided self-help, through to sessions of short-term psychodynamic or CBT, carers therapy and a wellbeing service.
Work in Sheffield where IAPT workers are attached to each of the CCG’s individual 85 practices, and are incorporated as part of the practice multidisciplinary team.
The Well Centre, a primary care health centre in Lambeth for young people aged 13 to 20 offering support with all areas of health including mental wellbeing.
NICE has published a guideline on identifying and managing depression in children and young people aged between 5 and 18 years.
This guideline covers identifying and managing depression in children and young people aged between 5 and 18 years. Based on the stepped care model, it aims to improve recognition and assessment and promote effective treatments for mild, moderate and severe depression.
This tool has been developed to support an intelligence driven approach to understanding and meeting need| PHE
It provides commissioners, service providers, clinicians, services users and their families with the means to benchmark their area against similar populations and gain intelligence about what works. It collates and analyses a wide range of publically available data on: prevalence, protective factors, primary prevention (adversity and vulnerability) and finance. It provides commissioners, service providers, clinicians, services users and their families with the means to benchmark their area against similar populations and gain intelligence about what works.
Tool structure – indicators are presented in 5 domains:
Identification of need
Primary prevention: Adversity
Primary prevention: Vulnerability
Within this domains, indicators are grouped by geography (predominantly county and local authority but also Clinical Commissioning Group) and then ordered by topic (e.g.adversity associated with poverty, abuse and neglect, family difficulties and parental difficulties).
builds on the evidence in the commissioning report
can be adapted to local conditions
presents results showing the economic benefits of each intervention
show you how to use the ROI tool
The barriers and facilitator report identifies issues that can make the commissioning of mental health and wellbeing interventions easier or more difficult in a local area.
Local authorities, clinical commissioning groups, Health and Wellbeing Boards and their local partners (for example schools, employers, police) can use these set of resources to improve the provision of mental health services.
Little is known about the extent to which CCGs are involving people with experience of mental illness in the commissioning of mental health services | Rethink
CCGs told us that with enormous pressure on resources and very full remits, it was difficult to prioritise implementing new ways to involve experts-by-experience.
Information gathered by Rethink Mental Illness through a Freedom of Information (FOI) request, in which 196 out of 209 CCGs responded, uncovered that:
Only 15% of CCGs who responded told us they had used a co-production approach at least once in mental health commissioning
Only 1% of CCGs explicitly stated an ambition for co-production in mental health that was aligned to the vision in the Five Year Forward View for Mental Health – that co-production will be a standard approach to commissioning.
Only 14% of CCGs had plans to do more to involve people with experience of mental illness in their work.
Rethink Mental Illness’ research showed that there are some good examples of CCGs involving people with experience of mental illness in the design of services. CCGs told us that co-producing services has ensured focus on the day-to-day experience of people who use services.
This report recommends that bodies such as NHS England provide national leadership, advice and support for CCGs, and hold CCGs to account by establishing mechanisms to monitor progress. It also recommends that CCGs use tools such as the Rethink Mental Illness ‘Commissioners Co-production Grid’, and NSUN’s 4PIs to facilitate steps towards embedding co-production as the norm.