South East Coast Strategic Clinical Networks –
Mental Health, Dementia and
Neurological Conditions
Strategic Commissioning Guidance
2015-16
Author:MHDN SCN Team
Email: [email protected]
Web: www.secscn.nhs.uk
Page 1
South East Coast Strategic Clinical Networks –
Version
Date
Details/provenance/comments
Author
Sent to
0.1
01/09/2014
First draft for comment
C Masters
Keith Smith
Sally Allen
Steven Duckworth
0.2
02/09/2014
Update
K Smith
Cathryn Masters
Sally Allen
Steven Duckworth
0.3
05/09/14
Neurology, EoL, PPE and Rehab added
but needs further additions with links and
docs to make complete
S Allen
Cathryn Masters,
Steven Duckworth
and Keith Smith
0.4
05/09/2014
Updates, embedded documents and links
added
K Smith/C
Masters
Steven Duckworth
Sally Allen
0.5
1/10/14
Domains added in full and contact details
added. Includes comments from Deborah
Tomalin
Sally Allen
Cathryn Masters,
Steven Duckworth
and Keith Smith
0.6
2/10/14
Final document approved by Steven
Duckworth
S Duckworth
Jackie Huddleston
and Ali Parsons
Table of contents
Purpose and Summary ............................................................................................................... 4
MHDN Commissioning Guidance 2014/15 .................................................................................. 6
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South East Coast Strategic Clinical Networks –
Purpose and Summary:
Strategic Commissioning
Guidance 2014/15
Page 3
South East Coast Strategic Clinical Networks –
Purpose and Summary
The purpose of this paper is to provide commissioners of healthcare services across the South East Coast
(Kent & Medway, Surrey and Sussex) with some strategic commissioning guidance in relation to Mental
Health, Dementia and Neurology. This is intended to support the production of CCG 2015/16 commissioning
intentions and is based on the Mental Health Dementia Neurological Conditions South East Coast Strategic
Clinical Networks strategic work programme which was developed during 2014/15 to support both Clinical
Commissioning Groups (CCGs) and direct commissioning.
The MHDN SCN baseline reviews were produced in September 2013 and provided benchmarking detail
across SEC to identify the unwarranted variation and local priorities which underpinned the development of
the SCN work programme. They can be found on the SCN website - Baseline Reviews
The SEC MHDN SCN work programme priorities have been grouped under the NHS outcome domains in
order to demonstrate how the work of the SCN will support the delivery and achievement of the indicators.
The National Clinical Directors key work areas have also been identified and any other known related
national priorities.
Specific cases for change and guidance produced by the SCN have been inserted within this document or a
link to the SCNs website provided where the information is readily available for downloading.
Information is also provided on key strategic work programme areas which will result in specific guidance on
what good looks like either within 2015/16 or within the current 5 year lifespan of the SCNs to 2018.
All guidance produced by the MHDN SCN has drawn on the wide stakeholder membership including
clinicians, patients, carers, voluntary sector, commissioners, local authority and public health colleagues.
The documents have been widely circulated and commented on to gain the consensus agreement and
support from all members of relevant groups as the best possible advice that can be given.
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South East Coast Strategic Clinical Networks –
MHDN
Strategic Commissioning
Guidance 2014/15
Page 5
South East Coast Strategic Clinical Networks –
MHDN Commissioning Guidance 2014/15
MHDN SCN Work
Programme
MHDN SCN Project
National Priorities and relevant
Outcome Indicators
Audit of Psychiatric liaison
and crisis intervention
audit
Part of the urgent and emergency care review
MHDN SCN Commissioning Guidance
Domain 3
Development of
acute access to
mental health
specialist
NHS Crisis Care Concordat
NHS Outcomes Framework Domain 3 –
To reduce inappropriate mental attendances and
admissions to secondary care:
3a Emergency admissions for acute conditions that
should not usually require hospital admission
Details can be found on the SCN website at http://www.secscn.nhs.
Develop a case for change
using case study for
emergency crisis
intervention in emergency
care
To reduce inappropriate mental attendances and
admissions to secondary care (Outcome Domain 2
and 3) 3a Emergency admissions for acute conditions
that should not usually require hospital admission
Development of a case for change for early interventions across the patient
pathway as a ‘single point of access’, (all ages from 18 years upwards) will be
available end of October , early November 2014
National Mental Health GP
Leadership Programme
Policy Direction Closing the Gap. The national
leadership programme is referenced on page 10 no. 1.
High quality mental health services with an emphasis
on recovery should be commissioned in all areas
reflecting local need
The National GP Mental Health Leadership Programme will be launched in
October with every GP lead from each CCG across Kent, Surrey and Sussex.
The 7 day modular programme will strengthen existing knowledge and skills in
commissioning effective mental health services to improve patient outcomes
Valuing Mental Health and
parity of esteem 6
commissioning principles
Mental Health Strategy, No Health without Mental
Health,
Reducing premature death in people with serious
mental illness 1.5 Excess under 75 mortality rate in
adults with serious mental illness (PHOF 4.9* )
Valuing Mental Health: A change of perspective in Kent, Surrey and Sussex
report available to commissioners and all providers
For information and copies of documents related to this programme of work please contact
Cathryn Masters, Quality Improvement Lead, MHDN SCN [email protected]
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Effective Liaison Psychiatric Services resource pack for commissioners is
available and consists of:

a research evidence base

mental health admissions to Accident and Emergency settings across
the South East Coast, data-pack updated quarterly
South East Coast Strategic Clinical Networks –
Neurological Conditions
Development of
clear pathways for
those with long
term conditions Parkinson's
disease, Multiple
Sclerosis, Motor
Neurone Disease
and Epilepsy
NHS Outcomes
Framework
Domain 2
Development of
acute access
neurological
specialist care
NHS Outcomes
Framework
Domain 3
Baseline of current
activity and spend on
neurological LTC (May
2014)
Ensuring people feel
supported to manage their
condition:
2.1 Proportion of people
feeling supported to
manage their condition
Data Intelligence packs showing spend and admission by neurological LTC by CCG were issued in May 2014
and can be found on the SCN website at http://www.secscn.nhs.
Mapping of Neurological
services (November
2014)
Improving functional ability
in people with long-term
conditions:
2.2 Employment of people
with long-term conditions
(ASCOF 1E** , PHOF 1.8*)
Mapping is underway and will be complete by end of November 2014. Early findings suggest that unclear
and unplanned pathways for neurological patients lead to wide variation in access to services due to lack of
priority of neurological services and efficiencies can be achieved to improve patient experience and outcome.
Case for change for
alignment of LTC
pathways 'moving
investment around' (June
2015)
Baseline of emergency
admissions (May 2014)
Enhancing quality of life for
carers:
2.4 Health-related quality of
life for carers
The data indicates that all CCGs could focus on management of patients to prevent admission for common
infections, e.g. primary and community support for those with neurological LTC to reduce incidence of UTI
and chest infections.
Commissioners should commission services that meet NICE guidance for :
Neuropathy, Multiple sclerosis, Parkinson’s, Epilepsy (adults and children) and Migraine and against the
guidance due in 2015 for spinal injury assessment and motor neurone disease.
Commissioners should also consider improving access to neurological conditions specialist nurses given the
evidence of effectiveness in the RCN Report (20110) “ Specialist nurses Changing lives, saving money”. The
mapping and pathway work will indicate if these should be disease specific or specialist neurology nurses.
3a Emergency admissions
for acute conditions that
should not usually require
hospital admission
Data Intelligence packs showing spend and activity on emergency admissions for the most common
neurological conditions by CCG were issued in May 2-014 and can be found on the SCN website
http://www.secscn.nhs.
Agreed emergency
model of neurology acute
assessment (March
2015)
Improving recovery from
injuries and trauma
3.3 Survival from major
trauma
Guidelines which outline best practice for acute assessment were issued in 2011 by the RCP in their working
party report “Neurology services for the next decade” and commissioners can use this improve local services
for those with neurological conditions. The SCN is developing a model that can draw on this guidance and
apply it locally which will be available for commissioners by April 2015
Case for change to
support innovative
'networked' model of
acute assessment
(September 2015)
3a Emergency admissions
for acute conditions that
should not usually require
hospital admission
The SCN is building evidence and data to support a case for change for neurological services which will be
available to support commissioning intentions for 2016/17 and beyond.
The data indicates that all CCGs could focus on improved pathways and response for those who require
acute neurological assessment.
For information and copies of documents related to this programme of work please contact
Sally Allen Quality Improvement Lead, SCNs [email protected]
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South East Coast Strategic Clinical Networks –
Dementia
2.6 Enhancing
quality of life for
people with
dementia
Describe primary care
diagnostic model
2.6.i Estimated diagnosis rate for people with
dementia (PHOF 4.16).
Description of Primary care diagnostic model report issued
Description of
Primary Care Models of Dementia Diagnosis - Final July 2014.pdf
Dementia Coding initiative promoted to GP practices/CCGs (collaborative working with
Kent & Medway & Sussex & Surrey Area Teams)
NHS Outcomes
Framework Domain
2
links to other useful references
Dementia Prevalence Calculator, Primary Care Web Tool
https://www.primarycare.nhs.uk/ (registration required)
Dementia Partnership website with top ten dementia tools
Top Ten Dementia Commissioning Tools
Develop a case for change
for moving diagnostics.
2.6.i Estimated diagnosis rate for people with
dementia (PHOF 4.16).
Describe a model of post
diagnostic support
2.6.ii A measure of the effectiveness of postdiagnosis care in sustaining independence and
improving quality of life for people with
dementia (Due 2016/17)
Describe a networked
'admission avoidance' plan
which can be used by
commissioners (Sept
2016)
2.6.ii A measure of the effectiveness of postdiagnosis care in sustaining independence and
improving quality of life for people with
dementia (Due 2016/17)
Opportunity for commissioners to take an active role in shaping dementia services via
the Demetria Clinical Advisory Group and the project task and finish group
Commissioning forum has been launched to share best practice and support project
work
Working collaboratively with Academic Health Science Network to produce a guidance
and a plan on how to avoid admissions form care homesn
For information and copies of documents related to this programme of work please contact Keith
Smith, Quality Improvement Lead, MHDN SCN [email protected]
Page 8
South East Coast Strategic Clinical Networks –
End of Life Care
Improvement in
quality of life
experienced by
patients during
their end of life
care stage (to
prevent
inappropriate
emergency
admissions
NHS Outcomes
Framework Domain
4
Page 9
Encourage a whole
SEC wide adoption
and implementation of
EPaCCS (Electronic
Palliative care coordination system)
4.6 Bereaved carers’ views on the quality of care in
the last 3 months of life
Care Quality
Commissioning
thematic proposal on
quality of care
4.6 Bereaved carers’ views on the quality of care in
the last 3 months of life
Advanced Care Plans and End of Life services will be incorporated into the guidance to
commissioners on post diagnosis support for dementia (Dec 2014)
EPaCCS Lessons
Learned 2014.pdf
Commissioning base-line and follow-on commissioning guidance will be available along
with improved inspections approach June 2015
CQC Thematic
proposal 20140903 Inequalities in EOLC project briefing 2014.pdf
South East Coast Strategic Clinical Networks –
Rehabilitation
Maximise recovery
from ill health and
trauma and
maintain function
for those with LTC
through integrated,
so-ordinated
rehabilitation and
reablement
services
NHS Outcomes
Framework Domain
3
Page 10
Map current
rehabilitation services
(November 2014)
Helping older people to recover their
independence after illness or injury:
3.6 i Proportion of older people (65 and over)
who were still at home 91 days
after discharge from hospital into reablement /
rehabilitation service
(ASCOF 2B[1]*)
ii Proportion offered rehabilitation following
discharge from acute or
community hospital (ASCOF 2B[2]*)
Mapping of neurology services will include all rehabilitation services and the report will
be due end of November 2014
Review of
psychological support
model developed in
Sussex in 2012 (June
2015)
Improving outcomes from planned treatments:
3.1 Total health gain as assessed by patients
for elective procedures
v Psychological therapies
The training package in development for low level psychological support will ensure that
those with both physical and mental health conditions will have access to appropriate
psychological support through their rehabilitation and recovery, i.e. will promote the r
parity of esteem agenda and improve services for those with long term conditions. The
training package proposed is in draft format and can be shared by June 2015 once pilot
phase is completed.
Review specialised
rehabilitation services,
especially the
transition to local
services and whether
or not services meet
the needs of patients
(Dec 2015)
Improving recovery from injuries and trauma:
3.3 Survival from major trauma
The neuro-rehab task and finish group met in September 2014 and has agreed as part
of its work programme to review demand and access to level 1 and 2 rehab services and
will report by December 2015
South East Coast Strategic Clinical Networks –
Patient and Public Engagement
(PPE)
The active
engagement of
patients and the
public is key to the
work of the SCNs
and to successful
commissioning.
The SCN therefore
have an active
engagement
programme.
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The development of a
SCN PPE approach in
mental health,
dementia and
neurological
conditions.
The people bank for MHDN SCN, which commissioners can draw on for PPE, has been
developed with RAISE which has supports charitable and community organisations
which have access to people who are traditionally difficult to engage.