DIMH 2018 keynotes

MANY MORE COMMITMENTS The speaker said: “There are a lot more commitments in the Five Year Forward View (for Mental Health), but those are the key spending commitments.” The Professor said he would now examine progress on a number of the key objectives. He began: “In Children and Young People, by the end of Year Two we had increased the number of children seen by half of our 70,000 target, i.e. we have seen an extra 35,000 children and young people.” He continued: “Although this wasn’t in the Five Year Forward View, with a current shortage of CAMHS Tier 4 beds, we also opened 81 new CAMHS beds, with at least another 50 set to be opened by the end of March this year.” The ‘really fantastic news’, however, was that the service had trained around 3,000 more people to undertake evidence-based psychological interventions across CAMHS to deliver on NICE guidance. Professor Kendall added: “Simultaneously, we have invested in new Eating Disorders services – and I have been to quite a few of the 70 new or extended community facilities for such service- users – for under 18s.” Consequently, he said, 75 per cent of children accessing such services were being seen within four weeks if their case was not urgent, and within a week where it was. He added: “That’s the first NHS waiting time introduced into mental health to date.”


Perinatal mental health was ‘another good news story’; by the end of April 2019, NHS England would be aiming for 100 per cent of England to have a specific specialist perinatal service, very significantly up from the current 15 per cent figure. “We’ve also identified the four sites for new eight-bedded Mother & Baby Units, and implementation has started at all four,” the Professor continued, explaining that these sites would be ‘in all the areas where it is currently really difficult to get access to such units’. (The locations are North West – Lancashire Care, July 2018; East Anglia – Norfolk and Suffolk NHS Foundation Trust, operational early 2019; South West – Devon Partnership Trust, early 2019, and South East Coast – Kent and Medway Partnership Trust, July 2018). In addition, in May this year £23 m would have been awarded to 35 perinatal mental health sites through the ‘Wave 2 Perinatal Community Services Development Fund’. Professor Kendall focused next on A&E Departments, where, by the end of the Five Year Forward View for Mental Health, the goal would be for every A&E department in England to have access to ‘24/7’ liaison services. However, he noted, only about half of them will have ‘Core 24’ provision – i.e. a consultant and nurse-led team based within A&E. A higher figure could not be achieved currently, he explained, due to difficulty in getting liaison psychiatrists to fulfil the role, although longer term NHS England was keen ‘to get to a full complement’.

IAPT Turning next to Improving Access to Psychological Therapies (IAPT), Professor Kendall said: “If someone has diabetes and is also depressed or anxious, the cost of their diabetes to the NHS is 50 per cent greater because they often don’t get to their appointments, or take their insulin promptly,


Kath Lazenby, an artist working with charity, Hospital Rooms, asks Professor Kendall a question.

and they may well then end up with more eye, kidney, and foot problems.” In fact, he noted, the costs of diabetes, cardiovascular disease, and chronic obstructive airway disease, were all increased ‘by about 50-70 per cent’ by the presence of a co-existing mental health problem. Secondly, the NHS England speaker said, of all those with a common mental disorder, 40 per cent will have a long-term condition. The ‘new wave’ of IAPT was thus ‘all focused on providing psychological treatment for people with chronic obstructive airway disease, cardiovascular disease, and diabetes etc’. “At one site – Peterborough and Cambridge,” he continued, “we have early results suggesting that people with chronic obstructive airway disease are about 60 per cent less likely to use an A&E. We are also gradually understanding that a lot of ambulance staff and paramedics aren’t able to recognise the difference between a panic attack in someone with COPD and an acute exacerbation of their chronic airway problem. It thus looks like this will be a major investment to save.” Professor Kendall noted that in the past year, over one million people had been referred with IAPT, with ‘over half’ recovering from their condition. He added that 37 ‘Early adopter’ sites were being supported by £80 m in funding to develop integrated IAPT and Physical Care services.

RECONFIGURING SECURE CARE The Professor’s next focus was ongoing work to reconfigure secure care, both Tier 4 CAMHS and Medium and Low Secure. He said: “The aim is to get service-users back to environments as close to their home town as possible, and also to liberate money for community developments.” NHS England was thus giving providers a budget for secure care to cover their locality; they could

use the money to develop a ‘community-based pathway’. The Professor added: “We are aware that specialist commissioning has stopped localities in England from developing local care pathways into the community, so there is a real shortage of forensic community care.” The Professor was involved in this type of work with colleagues. He said: “In Sheffield we have brought people back from ‘locked rehab’ – which is very similar to low secure care, and at half the price provided 24/7 community-based treatment teams, which has seen us reduce bed use by 99 per cent. This is eminently possible, and will save money and ensure much better care.” Another recent landmark, Professor Kendall noted, was that £18 m of the Winter Resilience budget had been released to specifically address ‘mental health-related system pressures’ – the first time that such funds had ever gone into mental health.

MENTAL HEALTH INVESTMENT STANDARD His next focus was the Mental Health Investment Standard (or ‘MHIS’), established at the start of the Five Year Forward View, which stipulates that for any rise in investment for CCGs to spend on physical wellbeing, the funds have to be matched by identical investment in mental health. He said: “On top of this, there are all the commitments in the Five Year Forward View for Mental Health. We are monitoring all the CCGs’ spend on mental health, and not all have reached their Investment Standard for the past two years. Last year they did, but not the year before. This year we are putting additional funding into Clinical Commissioning Groups to ensure they meet their Investment Standard again this year. The CCGs will be independently audited to show that they have met the MHIS, and will also have to have local mental health

The Mental Health Investment Standard

• MHIS – CCG investment in mental health rises at a faster rate than their overall programme funding.

• The MHIS is being met for 2017/18 both in plan and actuals at national and regional level. • The 2018/19 planning guidance set out ‘a universal ask’ for CCGs to meet the MHIS.

• CCGs’ auditors will be required to validate their 2018/19 year-end position on meeting the MHIS.

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