We know that being supported close to home, closer to family and friends and staff who know you, with a range of different community services and shorter lengths of stay improves the outcomes and experiences for people using specialised services. We also know that due to the way our current systems are set up, people who use specialised mental health, learning disability and autism services are too often cared for away from their home and community, and experience fragmented care in restrictive settings and may stay in hospital longer than they need to clinically.
The New Care Models (NCM) pilots address this fragmentation by empowering local systems to work together through Provider Collaboratives, with a view to reducing the number of people who are cared for out of area and creating the services their population need through local re-investment. This will enable providers to better address health inequalities and tailor services to local needs.
Where savings are generated by reducing admissions and length of stay, providers can invest these in local services and packages of care. This in turn minimises the need for out of area placements and improves experience and outcomes for people and their families.
Six NCM 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, seven wave two sites were live, giving a total of 13. Outcomes from the 13 NCM pilots to date are
- Over 500 people returned from out of area placement,
- Over 70% reduction of admission to Child and Adolescent Mental Health Service units,
- Over £30m savings for investment in new services.
By April 2020, NHS England and NHS Improvement aim to mainstream this approach for Child and Adolescent Mental Health, Secure and Adult Eating Disorder specialised mental health, learning disability and autism services and enable local service providers to join together under NHS-led Provider Collaboratives .They will be responsible for managing the budget and patient pathway for specialised care for their population.
NHS-led Provider Collaboratives will include providers from a range of backgrounds, including third sector providers such as in the housing sector, other NHS trusts and independent sector providers. Provider Collaboratives will work closely with Integrated Care Systems to support improved commissioning of services for people within the same population footprint. They will also work alongside service users, carers and families.
We want systems to plan for all specialised mental health, learning disability and autism services over the next five years, and for NHS-led Provider Collaboratives to become the vehicle for delivering our ambitions in these areas. Systems will align with service reviews in adult secure and CAMHS specialised services, fulfil the Long Term Plan inpatient ambitions for people with learning disabilities and autism, and roll out specialist community forensic care. This will prevent avoidable admissions and support recovery in the least restrictive setting, as close to home as possible.
The selection process for prospective Lead Providers and their Provider Collaboratives involves two stages:
- Phase one: Selection phase (May to July 2019),
- Phase two: Development and Approval phase (July to October 2019).
As part of phase one, following assessment, initial submissions will be placed on one of three tracks (Fast track, Development track, or Further development track). Regional NHS teams will be supporting Provider Collaboratives to develop their proposals further.
As part of phase two, provider teams will work together with support from NHS England and NHS Improvement to develop a detailed submission. Submissions will be assessed against approval phase evidence requirements and submitted in October.
The following services are part of this selection process:
- Adult Secure: Adult Low and Medium Secure Mental Illness, Personality Disorder, Learning Disability and Autism Services,
- CAMHS: General Adolescent, Psychiatric Intensive Care Units (PICU), Specialist Eating Disorders Units, Low Secure; Low Secure Learning Disability and Autism services Community Forensic CAMHS,
- Adult Eating Disorders.
The following services not included in this process are likely to be part of Phase Two, which will be subject to further provider selection processes from 2020:
- Adult Secure: Adult Low and Medium Secure Acquired Brain Injury, Secure Deaf and Women’s Enhanced Medium Secure. High Secure (commissioning for High Secure services being considered as part of the High Secure Commissioning Plan),
- CAMHS: Children’s (under 13s), Medium Secure and Deaf,
- Specialist Services: Obsessive Compulsive Disorder, Body Dysmorphic Disorder, Tier 4 Personality Disorder, non-secure Adult Deaf,
- Perinatal inpatient services.