Better outcomes, better value

24th June 2014

THE HEALTHY LIVERPOOL PROGRAMME – Joining Up Services

NHS Liverpool Clinical Commissioning Group

Liverpool CCG

498,000 Patients

18 Neighbourhoods

94 Practices

3 localities

1 Organisation

CONTEXT

• Poor health outcomes

• Growing demand

• Congested provider landscape

• Estates changes and opportunities

• Local authority cuts

CONTEXT

Vision

Provides a sustainability model of care

Improves & maximises

health outcomes

Delivers first class quality

care

Outcomes Characteristics Programmes Settings

Securing additional years

of life

Improving quality of life for people

with LTCs

Reducing Emergency Admissions

Improve experience of hospital care

Improve experience of outside hospital

Fully engaged citizens

Wider primary care at scale

Modern model of integration

High quality urgent and emergency care

Highly productive elective care

Concentration of specialist services in centres of excellence

Prevention

Neighbourhood Teams

Specialist Community

Services

Hospital Services

Mental Health

Healthy Ageing

Long Term Conditions

Children

Learning Disabilities

Cancer

Outcome Ambitions

Securing additional years of life for the

people of England with treatable mental and

physical health conditions

Improving the health related quality of life of the 15 million+ people with one or more long-

term conditions, including mental health

conditions

Reducing the amount of time people spend avoidably in hospital

through better and more integrated care in the community, outside of

hospital

Increasing the proportion of older

people living independently at

homefollowing discharge

from hospital

Increasing the number of

people having a positive

experience of hospital care

Increasing the number of people with mental and physical health conditions

having a positive experience of care outside

hospital, in general practice and the

community

Making significant progress towards

eliminating avoidable deaths in

ourhospitals caused by

problems in care

Outcome Ambitions

Strategic Outcome Ambitions by 2018/19

Reduce life years lost by 24.2%

Improve quality of life for people with long term conditions from the second worst in the country at 65.3% to 71%

Reduce avoidable emergency admissions by 15.3%

To improve hospital patient experience to average of top 10 CCGs

To improve out of hospital patient experience to average top 5 CCGs

Why Mental Health

• Premature Mortality – excess mortality for SMI SMR 425.8

• High prevalence of common mental health problems in LTC

• Prevalence three times higher for SMI for Diabetes and BMI 40+, twice as high for other LTC

• Lower proportions under control or on treatments e.g., anticoags

• 1 in 3 GP presentations for mental health issues

• Significant pressures on secondary care

• Integration of physical and mental health and focus on causes

New model for mental health

4.Hospital Based

3.Community based specialist service

2.GP & Neighbourhood

1. Prevention & Self Care

Skill

ed

an

d c

on

fid

en

t w

ork

forc

eSt

ron

g co

mm

issi

on

ing

par

tne

rsh

ip w

ith

LC

CC

ult

ure

of

colla

bo

rati

on

Shorter lengths of stay

New assessment

and care service Integrated care model that

focuses on recovery, personalised

care and independence.

Delivered from x4 new community

recovery

and wellbeing centres***

Primary care team

extended to include

mental health

practitioners,

psychological

therapists, benefits

advice workers

Community development initiatives

include advocacy, peer support,

counselling, bridgebuilding,

timebanking, community learning, all

accessible through a new directory

for mental health and well-being.

Assisted signposting for people who

don’t have access to the internet

Access to Recovery

Campus and similar

One gateway into both

psychological

therapies and wellness &

preventative services= no

‘wrong door’ for referrersPeople with long term

conditions

and other risk factors

have

access to a range of

psychological

treatments

Clinical liaison and collaborative

working across all steps

and all providers

One point of access to all local mental health services 24/7

Street triage & reduction in inappropriate

presentations & use of section 136

Fast response for

urgent needs

1 – 3 week

response

for routine

needs

Modern accommodation with single

en-suite rooms

Centre of excellence for acute mental health

care PICU and Section

136 suite at Clock View

Fewer people treated

out of area

Fewer admissions

Stro

ng

se

rvic

e u

ser

and

car

e p

arti

cip

atio

nSh

ift

fro

m p

ate

rnal

ism

to

co

-pro

du

ctio

nSu

stai

nab

le t

hir

d s

ect

or

con

trib

uti

on

Improved

access to

psychological

therapies for

people with

SMI

15% of people with anxiety &

depression have access to

psychological therapies & 50%

recovery

Working with complexity

Low income, debt,

isolation

Ill healthMental distress

Liverpool primary mental health care strategy for adults

• Psychological: all services will operate as a single system across steps and providers

• Practical: advice on prescription

• Social: peer support, education & employment support+++

• Physical: integration of mental and physical health care

Collaborative working CQUIN – secondary mental health care

• Liverpool-wide system of liaison and collaborative working between primary and secondary mental health care

• 5 CMHTs, 5 named liaison workers

• Linking systematically to practices & neighbourhoods

• Identification and treatment of the physical health care needs of people with SMI and LD

• Shared learning & capacity building

• Supported by a community of practice

• Y2 includes improvements to discharge planning & LD liaison, reduction in MH presentations at A & E

Collaborative working CQUIN - psychological therapies

• System of liaison and relationship development with primary care and secondary care

• Identification of people with LTCs who have co-morbid common mental health problems.

• Increased access to psychological therapies by people with LTCs

• Focus on diabetes year 1

• Test out collaborative care approaches to joint assessment and joint working eg COINCIDE model

• Primary care should feel that there is only one system of liaison

The pyramid of psychological need accompanying long term

conditions

LEVEL 1 General difficulties coping with illness and the perceived consequences of this for the person’s

lifestyle, relationships etc. Problems at a level common to many or most people receiving the diagnosis

LEVEL 3Psychological problems which are diagnosable / classifiable, but can be treated solely through psychological interventions,

eg mild and some moderate cases of depression, anxiety states, obsessive compulsive disorders.

LEVEL 2More severe difficulties with coping, causing significant anxiety or lowered

Mood, with impaired ability to care for self as a result

LEVEL 4More severe psychological problems that are

diagnosable and require biological treatments, medication, and specialist psychological interventions

LEVEL 5Severe & complex

mental illness/disorder requiring

specialist mental healthintervention(s)

Stepped model of care for psychological therapies

STEP 1

GP: ACTIVE MONITORINGDIRECTORY OF MENTAL HEALTH & WELLBEING SERVICESHEALTH TRAINERSASSERTIVE IDENTIFICATION OF PEOPLE WITH MULTIPLE RISK FACTORS: SMI, LTCs, BME, ADVICE ON PRESCRIPTIONMENTAL HEALTH & PSYCHOLOGICAL LIAISON

STEP 2

INTEGRATED GATEWAY PWP (PSYCHOLOGICAL WELLBEING PRACTITIONERS)ACTIVE LISTENING, ASSISTED SIGNPOSTING & DIRECT ACCESS TO ADDITIONAL (non-clinical) SUPPORTCLINICAL ASSESSMENT & LIAISIONTREATMENT: GUIDED SELF HELP; BRIEF INTERVENTIONS; CARE PLANNING COLLABORATIVE CARE

STEP 3HIT (HIGH INTENSITY THERAPIST)TREATMENT AT STEP 3

CBT, IPT, DIT, CCfD, CfC, EMDR etc.

STEP 4 SPECIALIST THERAPISTSTREATMENT AT STEP FOUR

ADDITIONAL SUPPORT

CLI

NIC

AL

LIA

ISO

N

AC

RO

SS S

TEP

S

Next Steps to a Better Model for Mental Health in Liverpool

Mental Health Transformation Board

Inter Agency Working

Better Use of Intelligence

Innovation

Commissioning for Outcomes