Committed to improving the lives and outcomes of people with psychosis
Dr Geraldine Strathdee, National Clinical Director for Mental Health, who today addressed the National Psychosis Summit, details NHS England’s ambitions for the next five years:
I have been fortunate to work with people with psychosis, and am full of admiration for them and their families.
Admiration for how they live with this challenging condition in the face of the stigma more often than compassion. Yet they manage to be good neighbours, contributing citizens and good employees when they are given those life opportunities some of us take for granted
The leadership challenge for NHS England and its system partners is how to “industrialise” improvements in commissioning and care for people with psychosis to deliver the outcomes and value for which there is such a clear evidence base.
The transformational change in the care of those who have suffered a Stroke shows that it can be done, and we are keen to learn from this. We can use similar methodologies, adapted and co-produced with service users. Over the next five years, our ambition is for continuous, sustainable, and feasible improvement in the care of those who suffer from psychosis, with them and for them.
There are very clear standards of care, including NICE guidelines and robust peer accreditation schemes. There are examples of excellent practice, but there are major variations in quality.
The variations in care are in seven core standards:
- Timely access to reliable information, so the person understands their condition, the treatments and how to self-manage;
- Safe medicines and support for monitoring;
- Access to psychological therapies;
- Better physical care to reduce premature mortality,
- Employment support;
- Recovery interventions;
- Rapid response in crisis.
So what actions have we taken?
Through a range of commissioning levers and support for provider improvement, in 2014/15 we are tackling:
- Accessing physical care to reduce the 15 to 20 year prematurely mortality: Today’s National Psychosis Summit launches the NHS England physical health CQUIN. From this week, every inpatient unit in all mental health providers will start to embed systems to ensure that every patient has the physical assessments and treatments for the cardio-metabolic conditions that cause the premature deaths. This is the largest ever international improvement programme for people with psychosis, and we need all hands on deck, and to share the good practice to deliver this better care.
- Accessing psychological therapies for people with psychosis: Our Improving Access to Psychological Therapies (IAPT) programme development for people with psychosis continues, and is embedding improved assessment and outcome measurement into routine mental health practice. This year, we have a quality premium incentive to increase commissioning of psychological therapies. (ref Quality Premium).
- Access to employment support: We have the Clinical Commissioning Groups Outcome Indicator Sets (CCGOIS) lever to promote CCGs commissioning the highly effective evidence based intensive employment support programmes and treatment. (ref Centre for MH).
- Promoting better outcomes, better value, and least restrictive care: We need good information to improve care. In June, with PHE partners, we will see the launch of the Mental Health Intelligence Network which will provide data, CCG by CCG, on the level of psychosis in England, and the current commissioning and care standards against best practice.
- Personalised care planning and personalised budgets: Pilots are showcasing best practice for future roll out.
In the NHS England standard contract this year we have incentivised improved data quality, and we should see 100 per cent recording of rates of detention under the Mental Health Act. This will then enable us to work to identify the people who are detained more often, so that we can, as part of the development of NHSE care pathway and integrated care programmes, find ways to review care plans and enable more recovery orientated care that will promote resilience
We can’t promise instant improvement, but in working with partners across the system, with the CCGs, and our Strategic Clinical Networks and Academic Health Science Centres, today starts ‘England on the Move’ for the (transformational) improvement in the care of those who suffer from Psychosis.
- You can follow Geraldine Strathdee on Twitter: @DrG_NHS
Dr Geraldine Strathdee OBE
Dr Geraldine Strathdee, OBE, MRCPsych, is the National Clinical Director for Mental Health, NHS England, a consultant psychiatrist in Oxleas NHS FT, and Visiting Professor, Integrated mental health education programme at UCL Partners.
For over 20 years she has held senior roles in mental health policy, regulation and clinical management, at national and London regional levels, and advises internationally on mental health service design and quality improvement, while working as a practising clinician. She has been involved in transformational large scale service development programmes, moving services from hospital based, to 24/7 home care and primary care models, in roles which have included: the Trust Director of Clinical services in Oxleas NHS FT (2005-2007), Director of Service development at the Sainsbury Centre for Mental Health and Senior Lecturer, UMDS ( 1995-1998). She was the National Professional Adviser in mental health to the Healthcare Commission and the Care Quality Commission (2005-2012).
Her particular commitment is to the translation of policy and best practice evidence into front line routine clinical practice, empowering service users to reach their potential, and staff to maximise their time to care. She is passionate about the development of leadership competencies and using information to enable informed decision-making.
As London SHA Associate Medical Director (2009-2013), with responsibility for mental health, she led transformational change through the development of clinical networks for dementia and primary care mental health CCG leaders, developed ground breaking commissioning support care pathway profiling informatics tools, and high impact educational programmes. She was awarded the prestigious RCpsych Psychiatrist of the Year award in 2012.
Clinically, she has worked in a wide range of primary care, inpatient and community services, and latterly with people with complex and multiple needs, as a Consultant Psychiatrist for the Bromley Assertive Community Treatment team in Oxleas. She is committed to providing services which enable services users to live in their own homes, develop their own personalised care plans and self management expertise to achieve recovery, while at the same time working with community agencies to deliver coordinated, responsive, care pathways.
Service evaluation and research interests: Her teams have won awards for their use of technology in improving care, using patients as experts in staff training and leadership awards for new Ways of Working, the redesign of roles. Her research interests have included the fields of primary care mental health, evaluation of community services and dual diagnosis. Current research interests include the evaluation of competency based leadership programmes and clinical networks to drive transformational improvements, and high impact educational programmes.
One comment
Before any improvements can be made for the mentally ill, one has to understand the large numbers of agencies there are in this process. I will list a few to demonstrate how complex the issue is. DWP DLA Housing Benefit LA Appointees Deputy’s GP Psychiatrist Pharmacists Advocates Carers or Significant others ‘key Workers’ Residential Care Agencies. ‘Fit for work’ agency.
Firstly there has to be a list of entitlements to the patient, how are these to be delivered!
The Care Manager Co-Ordinator is crucial in this exercise. They will be highly skilled and trained individuals, they will know how the system works. They should be able to multi task. They will be in a category of their own. They should know who to contact within the CCG Boards and take concerns to the HWBB
The Carer is also important, they have years of experience in caring, and ‘fighting for care’.
As an Independent Mental Health Advocate and Advisor I am required to know everything about Mental Health Legislation, the Law, DWP Housing Benefit, and just about everything else there is to know, in order for me to represent my client.
Nothing will or can be achieved until it is recognised that somebody has to be responsible for the delivery of an Integrated System of Care in all of its entirety, this will require the services of an ‘elite’ individual namely the Care Manager Co-Ordinator.