Mental health and social care commissioning

1
Mental health and social care commissioning

• Andrea Wright, Head of Social Care
• Maureen Begley, Commissioning Manager

2
How commissioning operates in mental health

• Head of service and commissioning manager lead on
  strategic commissioning
• NCC funds NSFT (S75 agreement) to provide a
  social work service for working age adults with
  mental health needs. NSFT staff lead on micro
  commissioning for individuals and have day to
  day responsibility for the management of the
  care budget
• NCC retains overall responsibility for the
  purchase of care budget (POC) and the management
  of services under block contracts/ Service Level
  Agreements
• Under the interim S75 agreement for 2013/14 we
  are looking at NSFT taking over more
  responsibility for budget management

3
How the NCC cash is spent

• 9.6m Purchase of care (gross)
• 6.42m in care homes
• 477k supported living
• 1.2m domiciliary care etc
• 1.5m day care etc
• Currently forecasting an overspend of 2.15m
• 4.8m Service agreements (gross with NHS and SP
  )
• 430k Information advice and advocacy
• 1.9m Short term/specialist care home places
• 1.85m Supported living and floating support

4
Purchase of care 2013/14
5
Mental health purchase of care trends - service
users and spend
6
Admissions to care homes continue to rise
7
Norfolk unit costs for care homes compared
8
What is affecting commissioning

• Increasing demand
• National drivers
• Local drivers including commissioning changes
  across health and social care

9
Increases /changes in demand

• General population growth
• More young people with complex needs
• Increasing needs of people already receiving
  service as they get older
• Increasing customer expectation e.g. to live in
  the community
• Section 117 and Ordinary Residence issues

10
National and local drivers

• Discussions on revisions to national social care
  eligibility criteria
• Impact of Francis Inquiry into Mid Staffs
  hospital expectation of culture change
  underpinned by CQC
• http//www.vodg.org.uk/members/vodg-publications.h
  tml
• Recovery as a focus
• Personalisation
• Peer support and experts by experience
• National and local Strategic objectives/
  performance indicators To increase the use of
  Personal Budgets, Carers assessments, numbers of
  mental health clients in stable accommodation and
  in employment

11
What we have been doing in commissioning

• De-commissioning preventive services and moving
  services off block contracts e.g. QUEST day
  opportunities
• Re-commissioning in key areas Information,
  Advice and Advocacy Carers Self directed
  support (support planning, employment support)
  IMCA/IMHA community mental health support
  services
• Re-negotiating block contracts under the open
  book process
• Improving the management of placements in
  residential care and supported living through the
  panel process
• AMHPs can now commission 7 day respite placements
  

12
Improved Advocacy

• Advocacy funding supported by contracts with
  clear outcomes
• Re-commissioned the mental health advocacy
  service to have a greater emphasis on self
  service and welfare rights
• Re-commissioning the IMCA/ IMHA service with
  higher targets
• Re-negotiated the Appropriate Adult service
  contract looking at increased demand for
  service to all 17 year olds and out of hours
  service

13
Norfolk wide commissioning initiatives at
present

• Market position statement 2011 being updated
  providers will be asked to feedback this autumn
• Work on cost of care between NCC and NIC. Desk
  top exercise to update information which will
  also draw on the findings of national
  benchmarking
• Continuing health care. Joint work (NHS/NCC) to
  develop new specification and bandings working
  with NIC to involve providers
• New contract for community services e.g. day
  care, which are not CQC registered co-produced
  with providers

14
More Choice

• Norfolk working to the themes in Think Local Act
  Personal
• All who want a personal budget will have one
  progress has been slower in mental health but is
  a key performance indicator
• Market will increasingly respond to provide
  services that meet individual needs
• Range of services are becoming available to meet
  changes in service demand

15
Supported Living/Residential Care

• All residents in residential care have been
  reviewed
• NSFT looking at dedicated teams to work with care
  homes/residents
• Continue to maximise use of short term supported
  living /care homes that focus on rehabilitation
• Planning with Housing Providers and Social
  Landlords and families.
• Planning with Residential Providers
  diversification
• Looking at innovation what will support moves
  out of care homes/ maintain people in the
  community

16
Market Management

• Capture and encourage innovation in response to
  personal budgets and supporting people in the
  community
• Will be looking at progression and outcomes
  evidence
• Use of Assistive Technology

17
Next Steps

• To work with providers around the shift from care
  homes and to increase the Supported Housing
  options available. In particular to revise
  supported living standards and create a clear
  accreditation scheme for providers around
  supported living.
• This work will be undertaken with the DAAT which
  is working on implementing the recommendations of
  the recent review of Tier 4 services around
  residential care and supported housing for people
  with dual diagnosis, and meeting the needs of
  people coming out of detox closer to home
• Further develop community services to prevent
  hospital admissions and care home placements,
  this will include development of personal
  assistant/ domiciliary care services which can
  meet the needs of people with mental health needs
• To tender supported living schemes provided by
  the third sector in central Norfolk in 2014