Bringing patients closer to home helps them to maintain a better connection with their families and friends, and improve how they interact with local services. This programme aims to reduce length of stay and the number of patients who are out-of-area in a number of specialised mental health services. It delegates responsibility for the budget for in-patient services to local provider partnerships so they can ensure funding is spent as effectively as possible. Any expenditure gains are retained by the partnerships to invest in improving patient pathways, including in the community. Pilots in this programme:
- use a multi-disciplinary team approach, with providers taking ownership of their patient population
- develop a wide range of therapeutic interventions across a whole pathway
- include a focus on recovery through accommodation, community activities, social networks and employment advice
- work proactively with the criminal justice system, local authorities and secondary care providers
- expand both liaison support and community follow-up provision
- develop local capacity and capability to manage all types of patients.
The total budget of the programme across two waves is approximately £650 million. All selected sites focus on admission avoidance, shorter lengths of stay and repatriating patients from out of area placements. The six sites in the first wave of the programme went live in April 2017. The wave two sites have been launching from October 2017 and, as at 1 November 2018, 7 of the 11 wave two sites were live, giving a total of 14.
A full independent evaluation of the programme is underway and will report in late February 2019. Feedback from sites has been very promising, with over 257 patients brought back into care in their home area in 2017/18. In the same period, length-of-stay and median distance from home both reduced, particularly in child and adolescent mental health services (CAMHS). As a result, a total of £10.7 million was released for reinvestment by provider partnerships in local mental health services in 2017/18.
Next steps: Establishing Steady State Commissioning
Given the success of the New Care Model programme, NHS England has directed that the pilot approach is to be developed into business as usual, to be expanded across the country and to other specialised mental health services. The change programme to achieve this is called Establishing Steady State Commissioning (ESSC). The overall aim of ESSC is to improve outcomes for people using tertiary mental health services, through local management of the whole patient pathway, with incentives for less restrictive and more community-based care. This is to be achieved by
- Supporting provider-led partnerships to manage budgets, quality and pathways, transitioning the majority of specialised mental health services for the majority of the country by April 2020,
- Maintaining a strategic commissioning role in NHS England with oversight of key areas,
- Organising NHS England nationally to add value and enable straightforward, efficient commissioning.
The ESSC programme is governed by an Oversight Group, co-chaired by Claire Murdoch, NHS England’s National Mental Health Director, and John Stewart, Acting Director of Specialised Commissioning at NHS England. It has six component workstreams: function, quality, workforce, expansion, infrastructure and transforming care. Each is led by an experienced NHS England senior responsible officer, committed to co-designing the future model with stakeholders.
Read the following blogs and case study to find out how New Care Models pilot sites are helping to transform specialised mental health services:
- South West Regional Secure Service: Bringing specialist mental health services closer to home.
- South London Partnership, Child and Adolescent Mental Health (CAMHS) programme: Transforming child and adolescent mental health services.
- South London Mental Health and Community Partnership: Transforming services for forensic patients.
- South West Regional Secure Service: Award-winning partnership transforming specialist mental health services.