1
NHS Citizen Assembly Stocktake (March 2015) Mental health and parity of esteem
Version 1
2
Mental health and parity of esteem
Parity of Esteem Objective
1.
In line with the commitment in the Mandate, 2013 to 2015, NHS England is working towards putting mental health on a par with physical health, and of closing the gap between people with mental health problems and the population as a whole.
2.
NHS England has established a Parity of Esteem Programme comprising 5 work areas: data, information and intelligence;
development of capabilities and skills in commissioning;
improvements to clinical services;
improvements to crisis care; and
improvements to physical health for people with serious mental illness.
Actions Agreed at NHS Citizen Assembly Stocktake - September 2014
3.
The following actions were agreed at the NHS Citizens assembly: Parity of Esteem Dashboard - NHS England committed, as part of the business plan priorities for 2014/15, to producing a dashboard to track progress in achieving parity with physical health. This has been built and the expectation is that it will be handed over to Public Health England to run and develop further as part of the Mental Health Intelligence Network.
‘Roadmap’ to parity between now and 2020 - A new “all age”, Five Year Forward View for Mental Health will be developed.
Mental Health Intelligence Network (NHS England and Public Health England) – the Mental Health Intelligence Network was launched in May 2014. Public Health England are leading a work programme to:
develop Psychosis Care Pathway indicators;
develop the Common Mental Health Disorders Care Pathway indicators;
complete the development of the Children and Young People profiling tools; and
develop the dual diagnosis profiling tool.
This work will be taken forward in conjunction with the Strategic Clinical Networks, Public Health England Centres, and other relevant Stakeholder and Partners.
Mental Health and Parity of Esteem – Wider Work Programme Progress Update 4. Key priorities that are currently being delivered in support of the Mental Health and
Parity of Esteem Work Programme are:
3
Mental Health Access and Waiting Time Standards
5.
In 2015/16 mental health access and waiting time standards will be introduced. Improvements towards meeting the first standards will come into effect from 1 April 2015, for achievement by 1 April 2016, and are focussed on three areas: more than 50% of people experiencing a first episode of psychosis will be treated with a NICE approved care package within two weeks of referral. This standard will apply to people of all ages;
75% of people referred to the Improved Access to Psychological Therapies programme will be treated within 6 weeks of referral, and 95% will be treated within 18 weeks of referral. This standard will apply to adults;
£30m investment is to be targeted on effective models of liaison psychiatry in a greater number of acute hospitals.
6.
The new standards for 2015/16 will be supported by an £80m funding package:
£40 million recurrent funding to support delivery of the early intervention in psychosis standard;
£10 million to support delivery of the IAPT standard; and
£30 million to support delivery of the liaison psychiatry standard.
7.
In addition, an additional £30 million will be provided recurrently for 5 years to be invested in a central NHS England programme, to improve access for children and young people tospecialist evidence-based community CAMHS eating disorder services. Part of this programme funding will be used to develop an access and waiting time standard.
8.
The ambition is to introduce access and waiting time standards across all mental health services between 2016 and 2020, subject to future resourcing decisions following the next Spending Review.Children and Adolescent Mental Health Services (CAMHS)
9.
The Children and Adolescent Mental Health service (CAMHS) transformation programme (Children and Young People – Improving Access to Psychological Therapies - CYP IAPT) will embed collaborative, evidence-based and outcomes focused care. The participation of children and young people and now parents/carers is, and will continue to be, integral to the work of the programme at a national and local level.10.
In 2014, in addition to the work with young people, the programme commissioned YoungMinds to consult with parents/carers, and develop a resource toolkit that CAMHS partnerships could use to support the participation of parents/carers at a national and local level. The “Parents Say” toolkit will be available on the YoungMinds website from April 2015.11.
The outcomes from the work that was done with young people and parents/carers includes at a:4
national level, young people co-chair, and parents are members of, the programme’s national groups, and are involved in developing:
o CAMHS service specification linked to CAMHS values and standards ‘Delivering with, Delivering well’;
o guidance on complaints and consent forms;
o 10 top tips for recruitment;
o information passport, developed by young people and parents/carers, for them to use and complete in partnership with their Clinician, and keep so that they can control the sharing of information with others they are receiving treatment from now or in the future;
o video – young people’s views and recommendations for improving integration between services; and
o participation partners (GIFT) and young sessional workers developed and
maintained an online resource to disseminate best practice, information and blogs- www.myapt.org.uk.
local level:
o working with commissioners;
o recruitment of new staff in services;
o recruitment of new CAMHS partnerships to join CYP IAPT;
o service redesign;
o improving information and environment of the service;
o working to support regular use of regular feedback and outcomes measurement.
12.
In addition, NHS England co-chaired the Children and Young people’s Mental HealthTaskforce, and there was substantial service user, parent and professional engagement – over 1700 people were involved in consultations about how to improve child and adolescent mental health services. The recommendations of the taskforce will be taken forward over the next 5 years. Participation by children, young people and parents in their own treatment and in service design was an underpinning principle expressed in Future in mind, the CAMHS Task Force report.
13.
The recent announcement in the budget of extra resources for CAMHS to build capacity, linked the use of resources to local Transformation Plans. The participation of children, young people and parents in local plans will be part of the assurance process. In addition, theengagement with children, young people and families will be built into national planning.
Dementia Programme
14.
NHS England has focused on working with GP practices to make sure that as many people as possible, who may have dementia, have their dementia recognised. Since September about 10,000 new people a month have been identified as having dementia. Once someone has a diagnosis of dementia it is more likely that they and their families will be able to be supported to “live well” with dementia.15.
The NHS Choices Website has increased the amount of information available to the public regarding dementia.5
16.
NHS England has been actively supporting the Dementia Friends campaign run by PublicHealth England. NHS England has also been working with a number of voluntary
organisations to look at ways of improving the lives of people living with memory loss and dementia.
17.
Over the next 6 months NHS England intends to: continue to work with a range of different services to ensure that people who might have dementia have their needs assessed without having to wait too long;
work with GPs and other staff who might visit people with dementia who live in their own homes to be offered a chance to say what care and support they want to receive, both immediately following their diagnosis and in the longer term;
continue to work with a number of voluntary sector organisations to continue to improve the care and support people with dementia expect to receive; and.
build up an understanding of what people with dementia need from health services and to identify the best ways of providing these services.
IAPT (Improved Access to Psychological Therapies)
Requirements
18.
The IAPT programme was established in October 2008 in order to support the NHS to commission primary care mental health services to deliver NICE approved and evidence based psychological therapies for the treatment of depression and anxiety disorders. The current NHS mandate confirms the ambition for a minimum of 15% of the adult population with depression and anxiety disorders to access treatment in local IAPT services in each CCG area and for at least 50% of those completing a course of treatment to recover.
19.
The NHS mandate for next year additionally asks that 75% of people gain access to treatment within 6 weeks of referral and 95% access treatment within 18 weeks.20.
In addition the NHS mandate set out a requirement for transformation of CAMHS (Child &Adolescent Mental Health Services) via the Children & Young People’s IAPT programme. By the end of March 2015 NHS England expects to roll out this programme to 60% of services covering the 0-19 population.
Performance
21.
IAPT services are open access services. Referrals for treatment can be made by your GP, or other agencies like Job Centre Plus, Adult Social Care departments, faith and community groups. Many IAPT services offer self – referral.
22.
Since October 2008, over 2.8million people have gained access to treatment with over 1.6million completing treatment, nearly 600,000 reaching recovery and many more achieve significant improvement in their symptoms.
23.
IAPT services provide fast access to treatment. At present, over 64% of people using IAPT services get access to treatment within 28 days of referral.6
24.
IAPT also provides employment support for those people with depression and anxiety whoneed support to keep their job or find new work. IAPT has supported over 93,000 people to move off of sick pay and benefits.
25.
The current recovery rate within IAPT services is just over 45%. This is less than the 50%recovery rate required to meet the NHS Mandate requirements.
Crisis Care Concordat
26.
As one of the signatories to the Crisis Care Concordat, NHS England is committed to working alongside other agencies to improve the system of care and support for people in crisis because of a mental health condition, and to improve prevention and early intervention to prevent crisis whenever possible.27.
NHS England’s Strategic Clinical Networks and Academic Health Science Networks have been raising the profile and importance of delivering good crisis care by meeting with partner agencies and working directly with CCG commissioners.28.
NHS England has aligned the work of the concordat with the ambitions of NHS England’s Urgent and Emergency Care Review.29.
A dedicated work programme for NHS 111 has been established to improve the outcome for people with mental health needs when accessing the service. As part of this work, a series of listening events with users of mental health services and healthcare professionals.30.
In 2014/15 an additional £30 million non-recurrent funding was allocated to CCGs for crisis care. This funding will support improvements in early intervention in psychosis and mental health crisis services.Forward Look – Mental Health and Parity of Esteem Work Programme over the next 6 Months
31.
The key priorities for the next six months are to:
continue the work to ensure the NHS is prepared for the introduction of access and waiting time standards, from 1 April 2016;
work with others to develop the plan to increase access to CAMHS, supported by the
£250 million announced as part of the new budget commitment;
maintain the focus on the number of people with depression and anxiety who have access to IAPT; and
continue to focus on diagnosing dementia and providing effective aftercare.
