Transcript No Slide Title

The Offender PD Pathway –
QIPP in Action
Anne McDonald
Deputy Director
Mental Health and Disability Division
Introduction
• The scale
• The history
• The policy context
• The new mental health strategy
• Mental health and QIPP
• Some potential challenges
• Future developments
The Scale
• 1 in 4 people
• Cost to English economy £77 billion pa.
• More likely £105 billion pa.
• A million people on IB
• A third of GP consultations
• Largest proportion of disease burden
• Premature mortality
Policy Context
• Patients at the centre – shared decision-making, choice
and information
• Focus on outcomes – quality at the heart of the
healthcare
• Devolution – clarity about the “what” more than the “how”
• Strengthening public health
• Reform of adult social care
Policy Context
• Equity and Excellence White Paper - towards GP- led
commissioning and outcomes (12 July 2010) – Health
and Social Care Bill
• The Outcomes Frameworks
• Healthy lives, healthy people White Paper: Our strategy
for public health in England (30 November 2010)
• Quality Innovation Productivity & Prevention (QIPP)
agenda
Mental Health Strategy
A strategy to transform the mental
health and well-being of the nation
An ambition to mainstream mental
health and achieve ‘parity of esteem’
with physical health
The aim for mental health to be
‘everyone’s business’ – all of
Government, employers, education,
third sector
Mental Health Strategy Themes
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Services and public mental health
Outcomes and quality
A life-course approach
Early intervention
Patient choice and control
(personalisation)
• Reducing inequality and tackling
stigma
• Improving efficiency (QIPP) in the
context of a challenging financial
climate
Quality, Innovation, Productivity and
Prevention (QIPP)
Three mental health elements:
• The acute care pathway
Local variations
• Out of area treatments
Allocative efficiency
• Physical and mental health
Medically Unexplained Symptoms,
Co-morbidities
Potential Problems
• Stigma
• Training
• Service design
• Commissioning
Integrated
care pathway
(Dis)integrated care pathway
Implementation
• Embedded in reforms
• Coherent narrative
• The Joint Commissioning Panel
• RCPsych and RCGP
• The NHS Commissioning Board
• Position mental health
• Managed Networks
Context of the programme
Labour party manifesto (2001)
‘those with a dangerous severe
personality disorder – we will pass
new legislation and
create over 300 more high-security
prison and hospital places’
The vision
Reduce the risk of serious harm to others and
serious further offending
Improve psychological health and wellbeing, and
tackle health inequalities
Develop leadership in the fields of health,
criminal justice and social care, and create a
workforce with appropriate skills, attitudes and
confidence
Shared
responsibility
Managed
through the CJS
Evaluation:
public protection,
psychological health imp.
& economic benefit
An active pathway of
intervention
The principles
Whole systems
approach
Psychologically
informed
Community-tocommunity
The Pathway
An active pathway of
intervention
Early identification
Pathway planning
Treatment interventions
PIPEs
Community case
management
Workforce development
Outcomes
THE PATHWAY
 Reduced sexual or violent re-offending
 Psychological health improvement
 Better trained workforce
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STAGES OF THE PATHWAY
Cases screened and identified
Case formulation undertaken
Staff appropriately trained
Plan delivered and reviewed
Institutional misconduct/breaches of orders or
licence
Self-harm
Survival in the community
Personality Disorder &
QIPP
• Quality
- Improved outcomes and experience for patients, public and clinical
teams across agencies
- Improved workforce capability (Health, Social Care and Criminal
Justice)
• Innovation
- New models of intervention/treatment and training
- New service and system design
• Productivity
- Better value for money
- More effective health, criminal justice and social care interventions
• Prevention
- Reduction in hospital admissions, offences, victims and suicides.
- Intervention to reduce deteriorating psychological and social health
Offender PD Pathway
• Joint ownership in conceptualising need against
intervention .
• Designing and testing new models and processes as a
system.
• Delivering a pathway, not solely a service, intervention
over time.
• Generating evidence through research, evaluation and
practice development
• Re-configuring services, reinvesting resources and
supporting innovation.
• Measuring the outcomes at each stage of the pathway
and reducing unnecessary activities.
Supported through
Commissioning
• Initial funding provided to establish commissioning
structures
• Structures to be embedded within ‘Specialised
Commissioning’
• ‘Specialised Commissioning’ already commission the
‘health’ secure pathway
• Therefore well established relationships, systems and
processes to build on
NHS Commissioning
Board
• ‘Specialised Commissioning’ will be part of the NHS
Commissioning Board
• Therefore national consistent approach to pathways,
quality and standards delivered locally through the 4
geographical areas where relationships are in place
Conclusion
• Transition arrangements for NHS Commissioning Board
• Specialised Commissioning Groups developing a 'core' specification,
consistent quality standards and quality reporting mechanism for
2012/13 contracts
• PD pathways to be commissioned by specialised commissioners
working with NOMS partners
• Early development work around the interface between specialised
and local service commissioning
• Deliver consistent high quality commissioning for specialised mental
health services