Modernising Mental Health Services in Bristol. 23 rd February Care Forum- Vassall centre

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1 Modernising Mental Health Services in Bristol 23 rd February Care Forum- Vassall centre

2 Maya Bimson- Programme Director, Modernising mental health services in Bristol project. Mark Hayman- Associate Director of Procurement BNSSG

3 Agenda Opening address and welcome Presentation Where we are now Presentation The care pathways for the main MH project Questions The Talking Therapies pathway tendering and AQP Questions Maya Maya Maya Both Mark Mark Table top talking

4 Where we are Now

5 Aims/Value/Principles Co-production/lived experience evident throughout Inclusive not exclusive Locally focused Responsive to diverse needs Outcome focused Integration of health and social interventions Promoting recovery, resilience and wellbeing for individuals and communities

6 A thought for all potential bidders

7 You will need to show evidence of being a learning organisation. This means you will be able to evidence a history of a proactive approach to analysing the context within which your services operate and responding to changes in that context. It means you will be an organisation with a mature approach to complaints seeing them not as incidents to be dealt with by an energetic PR department but rather as special opportunities to learn something about the strengths and weaknesses of your organisation. It also means that you will be able to show evidence of an ability to develop a clear vision for how your organisation has delivered services in a variety of contexts and settings. It will also mean that you will be able to demonstrate how, through pro-active engagement with public, private and voluntary sector institutions, you will help to create the conditions for positive mental health to flourish in the city of Bristol.

8 Bristol s Emerging Model of Delivery Talking Therapies Early Intervention LTC Management Medication management Assessment & Diagnostics Signposting and care planning Case Management Meaningful daytime activity Integrated Community and Primary MH Care Drugs / alcohol joint working Assertive Engagement Crisis Home Treatment Crisis Houses Respite Care Residential & nursing care Continuing Care Acute Inpatient support Specialist consultancy supporting Primary Care

9 Emerging Model Narrative Multiple access points which can provide information, signposting and/or intervention A decreased and refocused in-patient/secondary care element enabling a greatly expanded community/primary care element Specialist care to advise and support primary care This model needs to be seen in a pan City context linked to and influencing wider determinants of positive mental health

10 Access: a Meta-Map Community Access Points Talking Therapies

11 Crisis Pathway The Police s136 A&E Hospital admission/place of safety Crisis Walk in Crisis Support Service including home treatment 111/999 Return to Primary Care for ongoing/follow up support Community Access Points, GP Practices, Out Of Hours GPs, Emergency Duty Team Social Interventions Substance misuse/alcohol pathway Crisis House/ Respite

12 Crisis Pathway Narrative Crisis will be more broadly defined to cover all types of mental distress, not just psychotic episodes Person in crisis to be able to access Crisis Service through a range of access points as well as 111. Community access points need to be trained and supported Some people will phone 111, so 111 staff will need to be trained and supported to handle mental health queries Some people in mental distress will not be able to cope with phone call so a walk in facility is required. Further work required to clarify where this would be based and likely cost/ risk issues etc. Social Interventions will be able to support some people in crisis (not all will need Crisis Service or other intensive interventions A&E/Psychiatric liaison will be a function of both UHB and NBT currently being re-commissioned across BNSSG (led by Jo Underwood) so out of scope for MMH Project but needs to link in closely the A&E environment needs to be more therapeutic.

13 Recovery Pathway Post Crisis 1 st point of contact with GP Primary Care Mental Health Service Including The Person & family The GP CPN/Practice nurse, psychiatry, psychology, STAR workers OT s & Physios Non time limited Fast track re-entry if required Recovery Action Plan To include: Social prescribing Relapse management Medication Spiritual & cultural support Carer and family support, Employment and training Peer support Symptom management Access to T4 Ongoing and regular reviews by the care team The Person & family At least annually or more frequent according to need. Linked to QoF Self directed Discharge Crisis Pathway Refining Plan

14 Recovery Pathway Narrative This follows the physical health long term conditions model, with most people with ongoing mental health needs supported by GP and multidisciplinary 1 care Mental Health Service which is based at or near GP practice 1 care Mental Health Service to include Young People Primary Care Liaison workers who will help young people transition to adult services Everyone on this pathway will have a recovery action plan which will be co-developed by 1 care Mental Health Service and service user. The emphasis is on recovery and self management Recovery action plan will be reviewed and refined at least annually or more often according to need Service user can self discharge if condition stable and manageable but at any point they can re-engage with the GP and 1 care Mental Health Service Some people will have crisis episodes and will then go through the crisis pathway. After the crisis, they will once again be supported by the 1 care Mental Health Service and their recovery action plan may be reviewed and refined in the light of the crisis Further work being undertaken with BCC to map currently funded social interventions

15 Dementia Pathway Non time limited Fast track re-entry if required Post Diagnosis Post admission Post Crisis Primary Care Dementia Service (including diagnostics) Including The Person & family The GP, carers, Psychiatrists, CPN/Practice Nurse Social care staff Dementia Link workers OT s & Physios Personal Plan To include: Carer/family support Home care Physical healthcare Assistive Technology, Social prescribing Medication Spiritual & cultural support Housing, leisure & employment Peer support, End of Life Planning Ongoing and regular review by the Care team The The Person Person & family refined at least every 15 months or more often according to need. Linked to QoF Self Directed Discharge Crisis Pathway Hospital Admission End of Life Care Pathway Refining Plan

16 Dementia Pathway Narrative Stakeholder and clinical engagement strongly advocated a separate Dementia Pathway enabling it to be seen as an ongoing long term neurological condition This also follows physical health long term conditions model, with most people with dementia (regardless of age/type of dementia) supported by GP and multidisciplinary 1 care Dementia Care Service which is based at or near GP practice The 1 care Dementia Care Service will include the diagnostic element to enable assessment, diagnosis and advice to GPs Everyone on this pathway will have a personal plan which will be co-developed by 1 care Dementia Care Service and service user/ carer. The emphasis is on wellbeing and self management The personal plan will be reviewed and refined at least every 15 months or more often according to need Some people will have crisis episodes and will then go through the crisis pathway. After the crisis, they will once again be supported by the 1 care Dementia Care Service and their personal plan may be reviewed and refined in the light of the crisis. The Dementia Care Service will have key role in training and up skilling mainstream services, including nursing and residential homes, to deliver excellent dementia care Further work needs to be undertaken to identify the bedded facilities required and the management model for this pathway Further work being undertaken with BCC to map currently funded social interventions

17 Surround Support to Chaotic Lifestyles and Complex Needs Direct Fast Access where required facilitated by specialist Assertive Engagement Team and expanded Well Being Service The Person Specialist MH support for frontline chaotic lifestyles and complex needs support services

18 Surround Support to Chaotic Lifestyles and Complex Needs Narrative This service will have two main functions: Support, advice, training around mental health issues for agencies working with service users with chaotic lifestyles eg hostels, drug and alcohol services etc Direct fast access to Assertive Engagement Team who will support the service user where they are and enable them to access mental health interventions This will help ensure that the capacity within this service is maximised Assertive Engagement Service potentially to be jointly commissioned with Bristol City Council? The service will work in partnership with a wide range of agencies including for example housing and homelessness, substance misuse, prison discharge, to ensure that service users are not bounced between these agencies and mental health services.

19 Rehab Transition for Existing Patients Current Rehab inpatient beds Supported Step Down Nursing Care Residential Care Intensive Supported Tenancies Floating support Independent Tenancies Extra Care Housing

20 Rehab Transition Narrative Bristol, unlike most other health communities, still has a largely in-patient bedded model for rehab. Service users can spend 6 7 years in rehab bed by which they may be too institutionalised to cope with independent living. There are currently 40 rehab beds for Bristol (20 within Callington Road and 20 in two community bedded facilities). One community bedded rehab unit is due to close shortly. Current service users in rehab beds will be transitioned either into supported tenancies or where independent living is not possible, into nursing or residential care with the subsequent closure of all rehab beds (possibly as part of the 2012/13 QIPP). Need to ensure intensive recovery input for people in nursing or residential care and need to train/support nursing or residential care staff In the future rehab will be delivered in the community In the longer term it may be possible to develop extra care housing as an alternative to nursing and residential care

21 Open Entry Public health and community wellbeing Open Entry Talking Therapies Pathway Reentry Universal MH Resource Experienced therapists providing person centred psycho-social assessments and providing navigation, signposting and low level interventions including employment retention. Universal Introductory Course(s) Entry/Re -entry Approved Agencies Providing eg Social Interventions Psycho- Education Groups see list CBT Level 2 IAPT Books on prescription Computer based CBT Entry/R e-entry Approved Agencies Providing eg Specialist Groups CBT Level 3 IAPT Individual therapy Couples/ relationship work Individual therapy counselling/ bereavement DBT/DIT Psycho-therapy Via GP Entry via GP Specialist Support/ Recovery Pathway PD/ED/M&B Specialist Psychology Psychiatry Specialist beds Residential & Nursing Care Resilience Achieved Resilience Achieved Resilience Achieved

22 Talking Therapies Renamed Talking Therapies to avoid any confusion with the homelessness mental health service It is broader than just IAPT similar to well regarded Swindon model Wide range of public health and community wellbeing programmes Everyone entering Talking Therapies can access face to face individual assessment provided by experienced therapists who will signpost and help them navigate the pathway. They will be based at or near GP practice. Everyone will also be encouraged to undertake a universal introductory course (eg Managing Anxiety & Depression) which will provide them with the tools to be able to effectively participate in CBT, psycho education groups etc. Some people will not need anything more than the introductory course. As well as the face to face individual assessment and introductory courses, people can be referred or book themselves on to interventions in 2 nd column. They can access as many of these and as often as they choose Only 5 10% of people will need the more specialist and 1:1 interventions in 3 rd column and even fewer will require the 2 care interventions in 4 th column Interventions in 2 nd and 3 rd columns will be procured through Any Qualified Provider route 1 st column to be procured from single provider

23 QUESTIONS

24 Thank You

25 Open Entry Public health and community wellbeing Open Entry Talking Therapies Pathway Reentry Universal MH Resource Experienced therapists providing person centred psycho-social assessments and providing navigation, signposting and low level interventions including employment retention. Universal Introductory Course(s) Entry/Re -entry Approved Agencies Providing eg Social Interventions Psycho- Education Groups see list CBT Level 2 IAPT Books on prescription Computer based CBT Entry/R e-entry Approved Agencies Providing eg Specialist Groups CBT Level 3 IAPT Individual therapy Couples/ relationship work Individual therapy counselling/ bereavement DBT/DIT Psycho-therapy Via GP Entry via GP Specialist Support/ Recovery Pathway PD/ED/M&B Specialist Psychology Psychiatry Specialist beds Residential & Nursing Care Resilience Achieved Resilience Achieved Resilience Achieved

26 Public health and community wellbeing Open Entry Open Entry The Talking Therapies Pathway Reentry Universal MH Resource Experienced therapists providing person centred psycho-social assessments and providing navigation, signposting and low level interventions including employment retention. Universal Introductory Course(s) Entry/Re -entry Approved Agencies Providing eg Social Interventions Psycho- Education Groups see list CBT Level 2 IAPT Books on prescription Computer based CBT Entry/R e-entry Approved Agencies Providing eg Specialist Groups CBT Level 3 IAPT Individual therapy Couples/ relationship work Individual therapy counselling/ bereavement DBT/DIT Psycho-therapy Via GP Entry via GP Specialist Support/ Recovery Pathway PD/ED/M&B Specialist Psychology Psychiatry Specialist beds Residential & Nursing Care Resilience Achieved Resilience Achieved Resilience Achieved

27 Tender Time table-1 Date Task 1 01/03/12 Formally advertise in S2H and OJEC tendering of services 2 Noon 20/03/12 3 Noon 02/04/12 Closing date to receive the expressions of Interest Deadline for receipt of Completed Pre- Qualification Questionnaire Submissions 4 13/04/12 Advise those selected and debrief unsuccessful bidders

28 Tender Time table-2 Date Task 5 17/04/12 Issue of Tender documents (includes full specification) 6 24/04/12 or 25/04/12 Meetings with individual bidders to clarify points in our specification or our procedures. 7 Noon on 23/05/12 Tender returns closing date 8 01/06/12 Notification of short-listed bidders

29 Tender Time table -3 Date Task 9 08/06/2012 Short-listed bidder attend presentations and clarification meetings 10 27/06/2012 Board decision day cooling off period 12 11/07/2012 Formal contract(s) award announced - subject to any challenge /08/2012 Contract signed 14 29/10/2012 Contract Start Date

30 Any Qualified Provider Accreditation

31 The Talking Therapies Pathway Entry/Re -entry Entry/R e-entry Approved Agencies Providing eg Approved Agencies Providing eg Social Interventions Specialist Groups CBT Level 3 IAPT These are the Any Qualified Provider Services (AQP) Psycho- Education Groups see list CBT Level 2 IAPT Books on prescription Computer based CBT Individual therapy Couples/ relationship work Individual therapy counseling/ bereavement DBT/DIT Psycho-therapy Via GP Resilience Achieved Resilience Achieved

32 Likely Step 2 Services-1 Depression: mild - moderate Panic Disorder: mild - moderate General Anxiety Disorder: mild - moderate OCD: moderate CBT: guide to self help, behavioural activation, exercise CBT: guide to self-help, pure self help CBT, guide self help, pure self help, psychoeductional groups CBT for people with LTCs, diabetes, chronic pain, CBT: guide to self help, pure self help, psychoeductional groups CBT for people with LTCs, diabetes, chronic pain, CBT: guide to self-help, pure self help

33 Likely Step 2 Services- cont Fibromyalgia Effective communications in relationships Moving on from separations and divorce Stress at work Assertiveness Bereavement Support Anger awareness Post Natal Depression

34 Step 3 Services CBT Panic disorder Depression: mild- moderate-severe General Anxiety Disorder: mild - moderate Depression: mild- moderate Social Phobia Behavioural couples therapy Behavioural activation Postnatal Depression Post Traumatic Stress Disorder (PTSD) Obsessive Compulsive Disorder (OCD) Anger management

35 Accreditation process/criteria Applications are accredited. The DH have developed an online accreditation package via Supply2health web site. DH are proposing 8 national accreditation centres ( 1 for each of the services). IAPT type services may be accredited in Sussex( TBC ).

36 Part 1 On Line Is about your organisation- partnership. Mainly Yes- No answers

37 Part 1 But you have to agree to: Pricing model /tariff Have a credit rating check (TBC) The standard NHS Contract Failure to agree to the above- means that your bid is halted.

38 Part 2 Your responses to certain questions. Your care pathways How, what and when Follow up care Innovation Staffing etc

39 Accreditation and Qualified Applicants are accredited They will join a national directory managed by the DH who will also carry out annual checks Once the contract has been signed off- you become qualified and then join the Choose and Book scheme

40 Supply 2 health All AQP Information can be found on the Supply2 Health website: Look for AQP

41 Draft AQP Timetable 04/04/12 Advert for expression of interest placed in supply2health 25/04/12 Expression of Interest closing date 26/04/12 Accreditation process Part A issued to potential bidders 21/05/12 Return of Part A 24/05/12 Part B issued to suitable providers

42 AQP timetable cont 25/06/12 Part B return by noon 26/06/12 Part B evaluated 09/07/12 Notify bidders of outcome/issue invite for clarification session 12/07/12 Inform the MH project Board of the accredited organisations.

43 AQP Timetable 26/07/12 Announcement of framework contract awards to preferred bidders 30/09/12 Framework Contract signed. 01/10/12 Accredited organisations can start taking referrals. 01/11/12 New service starts

44 Thank You

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