Report to:
Board of Directors (Public)
Paper number:
3.2
Report for:
Information
Report type:
Strategy
Date:
31 March 2016
Report author:
Darren Summers, Director of Strategy and Business
Development
Report of:
Darren Summers, Director of Strategy and Business
Development
FoI status:
Report can be made public
Title:
Five Year Forward View for Mental Health – Mental Health
Taskforce Strategy
Executive summary
This report briefly summarises the key themes and recommendations of the Mental Health
Taskforce Strategy and outlines implications for the Trust.
Recommendation to the Board
The Board of Directors is requested to:

receive and accept this report, consider the implications of the Taskforce
Strategy and agree the next steps outlined in this report.
Trust strategic priorities supported by this paper
Excellence

Continually improve the quality and safety of service delivery, service user experience
and improving outcomes.

Delivering the highest level of quality and financial performance.
Innovation

Rapidly adopt best practice and maintain a culture of innovation in service
development.
Growth

Pursue organic and inorganic growth opportunities through strategic partnerships and
research and development.
Risk implications
There are no specific additional risks that need to be added to the risk register, but the report
does have far ranging implications, and whilst it presents a number of opportunities for the
Trust, there is a risk to long term business sustainability if these opportunities are not seized.
Legal and compliance implications
There are no immediate legal and compliance implications, but these may arise once the
national delivery plans are firmed up.
Finance implications
There are no immediate implications contained in this report, but it is likely there will be both
additional costs, and potential income streams, as we address the themes and
recommendations of the
Single Equalities impact assessment
There is a specific note of the lack of improvement in race inequalities since the end of the
Delivering Race Equality Programme in 2010.
Requirement of external assessor/regulator
None.
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The Five Year Forward View for Mental Health
The independent Mental Health Taskforce to the NHS published its report on February 15.
The report contains eight chapters, covering commissioning; 7 day a week quality care;
innovation and research; workforce; transparency and data; payment systems; regulation
and inspection; and leadership.
The report includes 58 recommendations. Recommendation 58 states that governance
arrangements to support the delivery of the strategy should be in place by summer 2016.
NHS England will be established as the lead ALB for delivery of the strategy, and a cross
ALB programme board set up to deliver at a senior operational level.
https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFVfinal.pdf
“The taskforce suggests, and the NHS accepts, investing over £1bn a year of additional
funding in NHS care by 2020/21 to reach one million more people – this investment is in
addition to the previously announced £280million annual) new funding for children, young
people and perinatal care.” (NHS England website.)
Themes
The report notes the advances made in mental health care following the development of the
Care Programme Approach and National Service Framework, as well as the shift in public
attitudes to mental health over the past five years. It notes that provision has been
inadequate in recent years and that outcomes have worsened, and that there is now a need
to “re-energise and improve mental health care across the NHS.”
Broad themes covered by the report include inequalities, in relation to mental health care
compared to physical health care, and within the mental health system; the cost of mental ill
health and the comparative investment; and the variation of mental health provision and
people’s experience of their care.
Priority actions are divided into three areas:

a 7 day NHS – right care, right time, right quality, which covers areas including crisis
services, acute liaison and secure step down;

an integrated mental and physical approach, including peri-natal services, physical
health needs of people with severe mental health problems, and psychological
therapies; and

promoting good mental health, including prevention (especially for children and young
people), employment and stigma.
There are a limited number of areas in which there are targets with figures attached, where it
is proposed investment should be focused. These are:

By 2020, new funding should increase access to evidence-based psychological
therapies to reach 25% of need, helping 600,000 more people access care. Combined
with investing to double the reach of Individual Placement and Support for people with
severe mental illness, this should support a total of 29,000 more people to find / stay in
work each year by 2020.

By 2020, at least 280,000 more people living with severe mental health problems
should have improved support for their physical health.

The £1.4bn (over five years – the £280million per year) committed for children and
young people’s (CYP) mental health should be invested to ensure that by 2020 at least
70,000 more children and young people have access to high quality care. The
Taskforce endorses the recommendations in the Future in Mind report in 2015.

New funding should be made available so by 2020/21 Crisis Resolution and Home
Treatment Teams (CRHTTs) can offer intensive home treatment as an alternative to
acute inpatient admission in each part of England.

New funding should ensure by 2020/21 no acute hospital is without all-age mental
health liaison services in emergency departments and inpatient wards, and at least
half of acute hospitals meet the ‘core 24’ service standard.

New funding should be invested to support at least 30,000 more women each year to
access evidence-based specialist mental health care in the perinatal period.

To reduce suicides by 10% by 2020 all areas should have multi-agency suicide
prevention plans in place by 2017 that are reviewed annually.
The taskforce also calls for the practice of sending people out of area for acute inpatient care
due to local acute bed pressures to be eliminated entirely by no later than 2020/21. It states
that clinical standards, including maximum waiting times for NICE-recommended care,
should be developed and rolled out as soon as funding allows.
Implications for the Trust
Whilst NHS England appears committed to substantially increasing investment in mental
health, it is not certain how the additional £1billion will be counted, nor whether this
aspiration will be blown off course by financial pressures in other parts of the NHS. It would
be reasonable to assume that, in line with the parity of esteem agenda, there will more focus
from national bodies to ensure that local commissioners and providers scale up mental
health provision in line with the areas of focus in the report, and improve mental health care.
The resources made available will be critical. If real additional funds are directed to mental
health, capacity can be increased with a corresponding improvement in quality across the
system. If, however, there is an expectation to deliver new targets within existing resources,
we could see an expansion of short term interventions to a wider segment of the population
(e.g. IAPT) and a focus on crisis and safety net type services, with a shift of focus away from
longer term care and recovery type services.
This will present opportunities for the Trust, as well as some challenges. Evidencing the
effectiveness and value of existing and innovative services and models will be vital, as will
the ability to influence the local system.
The underlying principles and broad direction laid out in the report and the Trust’s new
clinical strategy are similar. The emphasis on improved physical healthcare, for example,
fits well with the planned development of the IPU for psychosis.
The report also outlines an approach to commissioning which is in line with the 5 year
forward view, with an emphasis on integrated, population-based commissioning that
incorporates specialised commissioning.
4
The themes and recommendations that have direct implications for the Trust largely fall into
our ‘innovation, excellence and growth’ ambitions, as per the table below.
Innovation
24/7 crisis services
Excellence
Growth
X
24/7 crisis services for children and young people
X
X
Increased access to peri-natal care
X
All age acute liaison
X
Early intervention in psychosis access
X
Expand secure step down and specialist housing
X
X
X
Expansion of IAPT
X
Life chances fund for alcohol and drug
interventions
X
Race equality
X
Reduction in suicide rate
X
Reduce MHA detentions
X
Reduce out of area placements
X
Investigation of all deaths in inpatient services
X
Smoke free inpatient wards by 2018
X
X
System wide quality improvement
X
X
UK to become world leader in MH research
X
Increased access to digital services
X
X
Encourage and develop navigators
X
X
New model of inpatient care for 16 – 25 year olds
X
X
Increased peer support
X
NHS staff and well being
X
5 year plan to improve data
X
CQC to strengthen approach to regulation
X
Consideration of regulation of psychological
therapies
X
Learning from suicides
X
Introduction of new payment system
N/A
5
North Central London Sustainability and Transformation Plan
Whilst governance arrangements may not be established until the summer, the STP will
have to include our approach to deliver the recommendations of the report. Release of
transformation funding could be dependent on this.
The STP needs to demonstrate how NCL will close three gaps:

The finance and efficiency gap;

the health and wellbeing gap; and

the care and quality gap.
In North Central London mental health is one of the four priority strands of the STP. The
recommendations from the Taskforce report will be weaved into the six planned mental
health work streams of the STP.
There are currently twenty separate sub-streams that sit under the work streams listed
above. Between now and final STP submission in June these be will be refined and
prioritised, based on realistic benefit realisation and deliverability, as well as engagement
with stakeholders.
The latest iteration of the sub-streams covers the main areas of service development
signalled in the taskforce report, such as peri-natal services, crisis services and liaison.
There will need to be more specific plans around IAPT and step down housing. The more
qualitative recommendations are covered by the workforce, enabler and quality improvement
work streams, but there will need to be greater consideration of, and emphasis on, some
areas and recommendations, including race equality, reduction in Mental Health Act
detentions and investigations into inpatient deaths.
Next steps
6
This paper does not contain a full list of the recommendations contained in the Taskforce
report. Instead of working through all of these, relevant working groups and committees
should review the report and its implications for the Trust. We will need to be aware of
national governance arrangements as they are introduced and the detail of the national
delivery plan when in place. We should assume that the numerical targets will be translated
into local expectations and monitored closely.

The Clinical Strategy Working Group considers any impact on the clinical strategy, and
its implementation plan;

The Clinical Quality Review Group considers impact on the quality strategy;

The Research Committee considers implications and opportunities in research;

The Workforce Committee considers impact on the workforce and organisational
development strategies;

The Resources Committee considers impact on finance and implications on
sustainability;

The Service Development Forum is re-constituted as a task and finish Business
Growth Working Group, initially to consider strategic priorities and opportunities for
growth;

Changes to payment systems are kept under review at the MH PbR Technical
Meeting.
It is not proposed that a specific The Five Year Forward View for Mental Health or
implementation group or strategy is created. Instead, our existing strategies and plans can
be reviewed in the light of the Taskforce report, and any actions included in these plans.
These can be extracted for reporting purposes.
Given the potential implications of the Five Year Forward View for Mental Health, and the
rapid changes to the environment in which the Trust operates, such as the requirements for
system wide Sustainability and Transformation Plans, and new approaches to Foundation
Trust oversight from NHS England and NHS Improvement, the assumptions and plans made
in the 2014 – 19 Five Year Strategic Plan should be reviewed at the Strategic Development
Committee and Board later in the year.
7