Mental health commissioning

Progress through partnership: involvement of people with lived experience of mental illness in CCG commissioning | Rethink Mental Health Illness

This report summarises responses from a Freedom of Information request to identify the extent to which a co-production approach has so far been used or intended to be used by CCGs in mental health commissioning. It indicates that 15% of CCGs who responded had used a co-production approach at least once in mental health commissioning.

The report includes examples of CCGs involving people in the design of services and makes recommendations to both NHS England and CCGs.

Full report available here

Stepping forward to 2020/21: the mental health workforce plan for England

Health Education England, July 2017

This plan sets out measures to expand the mental health workforce in England and fulfil ambitions to improve mental health services. By 2020 to 2021 local areas will need to create 21,000 new posts in priority growth areas to deliver the improvements in services and support set out in the Five year forward view for mental health.

Reality Check: More mental health staff for the NHS?

Health Secretary Jeremy Hunt has said there will be 21,000 more nurses, therapists and consultants working in mental health services in England by 2021 | BBC News

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But the Royal College of Nursing (RCN) has questioned whether there is enough money and how these posts are going to filled. BBC Reality Check looked at who’s likely to be right. We’re talking about England because the running of health services is devolved to the other nations.

The government has pledged to spend an extra £1bn already promised for mental health services in England on the new staff. This is not new money from the Treasury but comes from existing NHS budgets.

Experts from the Nuffield Trust, a think-tank specialising in health policy, say £1bn would be more than enough to fund 21,000 nurses. Although we don’t know how many of the new jobs will be for nurses and how many will be for consultants – and of course their salaries vary widely – it seems the plan is roughly affordable, albeit with money that has to be found from elsewhere in NHS budgets.

But that still leaves the question of whether staff can be recruited to fill the posts in such a short timeframe.

Read the full news story here

Children and teens let down by mental health inpatient services in England

Inpatient provision for children and young people with mental health problems. Emily Frith | Education Policy Institute | via OnMedica

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Image source: epi.org.uk

A report from the Education Policy Institute has found that 12% of  child mental health inpatient units failed to meet basic requirements for staff to patient ratios.

Nearly a quarter (24%) of units struggle to employ permanent staff – up from 17% since 2014/15. Temporary bank and agency staff make up 19% of child mental health inpatient pay costs.

Staff shortages affect the quality of patient care, so a sustained focus on recruitment of skilled staff to work in child and adolescent mental health services is needed, recommends the report.

The report also found:

  • inpatient mental health services for young people on average fail to meet 7% of minimum quality of care standards
  • The issue of bed shortages can mean that children with mental health problems are admitted to adult wards
  • Eating disorders were the most common reason for a young person being admitted to hospital in 2015/16
  • Young people are being left in hospital for longer than necessary due to a lack of community services with the trend getting worse – the number of delayed discharge days in December 2016 – February 2017 42% higher than in the same period the previous year

Full story at OnMedica

Download full report: Inpatient provision for children and young people with mental health problems.

Quality improvement in mental health

Quality improvement in mental health | The King’s Fund

This report explores the potential opportunities arising from the application of quality improvement approaches in the mental health sector and identifies relevant learning from organisations that have already adopted these approaches.

The authors were specifically interested in understanding how and why some mental health organisations have embraced quality improvement strategies and what has enabled them to do so. It explores what changes are needed from senior leaders to cultivate a quality improvement ethos within their organisation.    

Key findings

  • Embracing quality improvement requires a change in the traditional approach to leadership at all levels of an organisation, so that those closest to problems (staff and patients) can devise the best solutions and implement them.
  • Doing quality improvement at scale requires an appropriate organisational infrastructure, both to support frontline teams and to ensure that learning spreads and is taken up across the organisation.
  • Tools and approaches used in the acute hospital sector can be adapted for use in mental health care, including in community settings.
  • Success is most likely when there is fidelity to the chosen improvement method, and a sustained commitment over time.
  • The strong emphasis on co-production and service user involvement in mental health can be harnessed as a powerful asset in quality improvement work.

Download the full report: Quality improvement in mental health

Specialist mental health care in England

The state of care in mental health services 2014 to 2017| Care Quality Commission (CQC) 

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Image source: http://www.cqc.org.uk

This report describes how CQC inspectors found that the majority of services are caring and compassionate towards their patients. However, the report also identifies several areas of concern: difficulties around accessing services, physical environments not designed to keep people safe, care that is over-restrictive and institutional in nature, and poor recording and sharing of information that undermines the efforts of staff to work together to make sure that people get the right care at the right time.

Full report: The state of care in mental health services 2014 to 2017

Additional links: CQC press release | NHS Confederation

The State Of The NHS Provider Sector

NHS Providers has warned that the prime minister’s welcome commitment to tackling long-standing injustices faced by people with mental health problems is being undermined | NHS Providers

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Image source: NHS Providers

The report concludes that the impact of rapidly rising demand, workforce shortages and the failure of funding to get through to the frontline means core mental health services are being overwhelmed.

The findings are based – in part – on the largest regular survey of NHS trust chairs and chief executives, which drew responses from nearly two thirds of trusts that provide mental health services and more than half of all NHS trusts in England.

The report sets out how the provider sector is performing, the challenges trusts are facing, and the support they need as we face another five years of constrained funding and rapidly rising demand. Alongside the survey it presents other published data, together with extensive analysis and commentary.

The centrepiece of the report is mental health – a critical area of care for the NHS and other public services, as well as being a growing concern for wider society. The report acknowledges the strong and welcome commitment from the top of government to address long-standing inequalities in care for people with mental health needs. This is starting to enable better service provision in the targeted areas. However trust leaders say the position of core mental health services is deteriorating.