Crisis Concordat Task group AWP – Clinical Director/managing Director/Access and liaison services lead; RUH – A&E Consultant; Police; Commissioner (CCG/LA); AMPH Lead, SWAST clinical lead. Monthly Positive practice Service Background and need it addressed Resources Impact and challenges Sustainability Mental health liaison services in the acute trust – A&E and across wards – dementia and AOWA The core service has been established for at least 8 years in the RUH. It has been expanded over that time to include older adults and is now joint funded with Wiltshire CCG. In addition the Intensive team in provides overnight cover (for last two years) Enabled joint development of risk matrix for mental health clients. Provided training for general NHS funding (PCT/CCG) into the specialist mental health Consultant nurse, psychiatrist, psychiatric nurses, admin. Joint working with A&E consultants. Impact: Has enabled the earlier identification and treatment of people with mental health problems and supported diagnosis and care of clients with dementia (with or without as well as supporting discharge. Increased skills and understanding. Challenges: the consistent implementation of processes with aligned capacity to provide care within the A&E 4 hour target. Continued lack of clarity nationally about how much of this function should be supported through the acute tariff. Therefore growth of service to meet demand reliant upon mental health funding stream only. Needs national clarification. Future work around Parity of Esteem will require workforce initiatives to increase skill sets of staff. Recruitment of staff will affect sustainability. Reciprocal arrangement for
Dementia challenge fund monies supported programme of training into Care Home sector on dementia and dementia care. Improved discharge form community hospitals. Care Home Local Enhanced Service - GP Provision of GP support into “attached” care homes in order to support health, manage long-term conditions, prevent admission to hospital in a crisis and enable a good death Funding provided to GP practices by CCG on a fixed term basis currently Recurrent funding agreed for years from April 2015. Improved quality and continuity of care and interventions. Prevented people being admitted to A&E. Enabled people to die in the ‘home’ where they are residing. Funding agreed for three years from April 2015. Alcohol liaison team in the RUH Alcohol Liaison Service was set up at the Royal United Hospital (RUH) from April 2013. The aim of this integrated (3rd sector/specialist) service is to stem the rise in alcohol related hospital admissions by reducing bed days and frequency of attendance and admission of high impact as well as increasing detection of alcohol misuse across the Funded by BaNES CCG and Wiltshire Drug and Alcohol Team: 2 Alcohol Liaison Nurses 2 Recovery Workers 0.5 FTE Hepatology Nurse funded by RUH An additional community detoxification bed for the sole use by the RUH is being piloted Impact 4.4% drop in the Alcohol Specific Hospital Admissions from 765 in 12/13 to 731 in 13/14 63% reduction in client hospital spells 3 months post contact with the service compared to 3 months before contact Recurrent CCG funding is in place. Sustainability more dependent on widening the preventative initiatives available to us and thinking nationally about how to manage the market.
The team is respected for expertise by RUH staff. Primary Care Mental Health liaison service To upon the recognition that the majority of people who experience mental health difficulties will have their needs met within primary care and not within secondary specialist mental health services. PCLS Teams set up with a view to improve mental health for individuals and society as a whole and work collaboratively with others to aim to improving care in the six outcomes identified within DoH’s publication, No Health Without Mental Health” (2011). These are: •More people will have good mental health. •More people with mental health problems will recover. •More people with mental health problems will have good physical health. Psychiatrist Team leader Band 6 mental health professionals Impact: Improved access for professional advice and support for on a spectrum of mental health issues. Improved communication between mental health, sector and statutory services Inclusion of mental health professionals within primary care pathways, e.g. community ward rounds to enable timely interventions/ identify that potential mental health issue are considered at the same time as physical health issues (parity of esteem) Challenges: Review and redesign of wider mental health “access service” to streamline process to ensure that right interventions are delivered in a timely manner
•More people will have a positive experience of care and support. •Fewer people will suffer avoidable harm. •Fewer people will experience stigma and discrimination. Team work closely with other health, social care providers and third sector. Prescribing accountabilities Adaptation of the model from a primarily GP referral based system to an open access model. Delivering sustainable service delivery within an open access model Court Assessment and Referral Service (CARS) team Service in situ since 2007 but expanded considerably in 2014 in the context of Lord Bradley’s report. Function is to assess the mental health and learning disability needs of those coming into contact with the criminal justice system across Avon and Wiltshire, regardless of age, with a view to diverting those appropriate for diversion, out of the criminal justice system and liaising with the criminal justice system (assuming capacitated client consent) to inform that system of service users assessed Across the whole service, that includes B&NES: Team leader. Administration. 2 children and young people nurses band 6. 1 learning disability nurse band 6. 6 mental health nurses band 6 1 social worker band 6 7 mental health nurses band 5 1 OT band 5 1 social worker band 5 2 engagement workers band 4. Impact: Improved and timelier outcomes for people with mental health and learning disability needs involved in the criminal justice system regardless of age. Reduction in clients being remanded into custody for want of appropriate diversion. Reduction in need for mental health act transfers from prison. Criminal Justice system (we see Commissioned by specialist commissioning (NHS England). Funding also gratefully received from BaNES CCG NHS England contract due for review 2017.
Mental Health adult of working age reablement team The Reablement service provides a pre and post crisis intervention – depending on where in the MH system service users are. It undertakes an initial assessment, develops a support plan and then implements the plan. The episode of support is normally completed within weeks and the case is closed once the service user’s needs have been met and any onward signposting – i.e. to community networks or another provider – has been completed. Funded via Sirona’s main service contract Impacts: The service helps to prevent people escalating into acute clinical need. It also helps people who are recovering from an acute episode to reintegrate into the community. Challenges: In some cases support is required beyond the time-limited service – i.e. for more than 6-8 weeks. However this can be managed through signposting. There are also occasions when a client is registered with a GP but resident in another local authority area and so pathways of care can be complicated. The service has recently been redesigned (effective July 1) and so far it seems to be achieving its expected outcomes within the agreed timescales. Performance in relation to the redesign specification will be kept under review.
Respite beds pilot (Wellbeing House) A respite house is being developed to offer short stays. The aim is to provide a therapeutic experience that will help people manage their mental health and keep them out of states of acute need. The respite pilot model will be developed in conjunction with the MH service teams to ensure there is a safe staffing model focused on supporting the individual pre or post crisis. The service will be jointly run with Curo and will include a peer support worker and support from peers. The Wellbeing House has opened in July 2015 after extensive refurbishment. Quality Innovation Productivity and Prevention (QIPP) investment funds. Impacts: The service will be one of the few of its kind in the country. Demand for it is expected to be high. Links to other services will be numerous. The scope for innovation is considerable. The therapeutic value of the service to the user should be substantial – which should result in reduced demand for other MH services. Challenges: The main challenge so far has been finding a suitable location for what is a sensitive service. However a Curo owned property was found in Bath and its previous supported living use may mitigate challenges in the The respite project is a pilot. Its continued funding is entirely dependent upon its performance during the pilot phase.
reception of the new service within its host community. In-patient peer support worker – acute mental health services This is a year’s pilot with a partnership arrangement between AWP and St Mungo’s Broadway To improve discharge processes by using the ‘Move On ‘ methodology To prevent delays and preparing people for change Funding via CCG Impact on length of stay A more coordinated approach to discharge planning better and supported approach This is a new way of working for both organisations and identifying pathways quickly One year’s pilot so request for recurring funding to be made if services appears to be cost effective. AMHP Service – LA Need to ensure collaboration between services in situations require a Mental Health Act assessment or related interventions. AMHP office with AWP services with LA and AWP computer access. Dedicated AMHPs and Lead plus Rota staffing. Impact: Enables close collaboration between AWP’s Intensive Service, MH Liaison Service, PCLS and Hillview Lodge Inpatient Unit. Challenges: The increased rates of Mental Health Act assessments and geographical barriers such as out-of-area AWP has agreed a move to a larger office space within HVL. These developments will help ensure sustainability.
SWASFT – South West regional Mental Health Joint protocol The South West Regional Mental Health Joint Protocol has been created and agreed with the 5 police forces that cover the South West region to allow for an agreed understanding with our emergency colleagues across the South West. The Mental Health Clinical Guideline is also attached. Challenges Integrating knowledge of this police/ambulance service agreement into local practice. Review in 12 months.
Section 136 protocol facility and funding There was insufficient capacity for assessments under 136. The Avon Commissioners and all associated provider organisations agreed a shared protocol and the CCGs provided increased funding to operate a 4 bedded assessment suite based in Southmead. 135k for 0.67% occupied bed base Challenges The suite is receiving many clients who are assessed as having no mental health problems where there is no further follow up and a proportion of these clients are intoxicated. (Please see action plan). Positively the numbers of assessments in police cells has reduced. Recurrent funding.
Work force development in the RUH – mental health training. The RUH and AWP recognise the need to increase competence and confidence in managing people’s mental health problems which has resulted in the training of emergency department staff, their development of a risk matrix and bespoke training for healthcare assistants across the hospital. Training was provided by the liaison team and for the HCAs gives skills for health accreditation. Delivered within the funded liaison service envelope. Impact Increased awareness and skills in managing mental health problems. Part of an on-going drive for workforce development (See action plan).
Production by service users and community staff of the Hope Guide It was recognised that there was no single source of information on mental health services and points of contact. The service user and carer groups alongside community organisation have developed and distributed the Hope Guide which is updated quarterly. St Mungo’s Building Bridges Service, which is funded via Local Authority, supports the New Hope Group which produces the Hope Guide. The impact has been huge in terms of an increased awareness of what is available. Challenges The challenge is to keep it live and connected to other forms of information.
Oxford Health NHS Foundation Trust. CAMHS paediatric liaison service to the Royal United Hospital. All people up to the age of 18 who present at the Royal United Hospital following an act of deliberate self-harm and who are admitted to either the Paediatric ward or the Observation Ward are assessed the following day by a clinician from the CAMHS Team. A full assessment of their mental health needs and mental state is undertaken and follow up assessment / intervention offered as appropriate to their needs. Where a child / young person does not live in BANES a referral on is made to the most appropriate agency to support the young person. This is in compliance with the RUH protocol. Liaison rota in place. Senior Mental Health Practitioner available each day to carry out assessment on the ward. Consultant Child and Adolescent Psychiatrist is available to offer consultation and joint assessment if needed All young people admitted to the RUH following DSH including alcohol / illicit drug poisoning are given a comprehensive mental health assessment and offered appropriate follow up / intervention. are some times difficulties arranging follow up care when young people live outside the catchment area for Banes CAMH Services
Oxford Health NHS Foundation Trust CAMHS Out Of Hours Service. CAMHS have a 7 day a week 24 hours a day service. Out of hours a Senior Mental Health Practitioner and Consultant Child and Adolescent Psychiatrist are available to offer advice to professionals who have urgent concerns about a child or young person’s mental health. Where necessary mental health assessments can be carried out in a place of safety. Senior Mental Health Practitioners, Consultant Child and Adolescent Psychiatrist, Team Manager, Service Managers, Directors. Professionals have access to mental health advice 24 a day ensuring that young people’s mental health needs are appropriately addressed.
136 Diversion Work has recently begun in developing a similar agreement to that held in Wiltshire between the local police force and CAMHS. This is a formal agreement whereby OHFT CAMHS provide front line officers with direct contact to a Duty Clinician within CAMHS. This is available both in and out of hours whereby officers can contact the duty person for advice when a young person is picked up in a state of distress and presenting with apparent mental health issues. Senior Mental Health Practitioners, Consultant Child and Adolescent Psychiatrist, Team Manager, Service Managers, Police officers The impact of using the protocol in a neighbouring area has been to provide a supported service to the police force in the management of young people with mental health issues in an effective and appropriate way and has seen a significant reduction in the number of Section 136s in the county. It is anticipated that a similar working protocol being agreed in the Banes area will also support police officers and help to reduce the inappropriate use of S136 with those young people under the age of 18.
Dual Diagnosis Support To provide a dedicated mental health nurse giving OOH advice and support to Police, Ambulance service and to 3rd sector organisations with focus on dual diagnosis and transitions. This is an ageless service which will include the Early Intervention service, Psychiatric Liaison and Intensive Services A, D Recruitment of Band 6 Nurse with substance misuse expertise to provide OOH advice and support to the Police, Ambulance and B&NES Street Homeless project (run by Julian House) also provide assistance with referrals on appropriate pathways to other services. Recruitment – January/February 2015 Training Implementation: February/March 2015 Full implementation and review of service: March 2015 onwards Update 15/05/2015: Unsuccessful in targeted resilience money bid. Continuing to try and get funding. Researching and investigating how to evidence that service will pay for itself. Update 30/09/2015: Band 6 Intensive team vacancy being converted into a police and homeless liaison post within contracted JE Increase number of contact with services related to substance misuse. Increased confidence in providers with providing advice and assisting with/ managing issues regarding dual diagnosis. Longer term reduction in the presentation of services users to ED/ 136 suites. Reduction in attendance times for ambulance and police services for service users with mental health problems Only people with mental health problems are detained in 136 suites
Ensure that, given the high prevalence of Borderline and other Personality Disorders within the homeless population, the Homeless Health Care Team are involved. Update 15/05/2015: First cohort have started STEPPs programme. All going ahead although not all materials have been delivered by training body. Update 30/09/15: Delivery of the programme continuing. All materials have now been delivered to deliver training. Update 29/04/2016: Programme continues to be delivered on a quarterly with all courses fully attended. community for service users. Increased confidence in across organisations in supporting people with personality disorder. Reduction of repeat presentation within primary care services. Improving level of resilience through increasing initiatives in the community A Implement the Wellbeing College in B&NES. January 2015-2017 Update 15/05/2015: All going ahead. 95 different learning opportunities on offer. Update 10/10/15: Continuation of an extra year to 2017 agreed in order to evaluate effectiveness. Project now linked to social prescribing initiative (local) and data integration project and funded by Innovate UK AM/BW Increased ability of the B&NES population to manage their long term conditions as well as their mental health at an earlier stage than is currently possible and before people need to use health services.
Mental health support in perinatal pathway B Improve the perinatal pathway Update 30/09/2015: Looking at developing the perinatal pathway to include mental health support. Still awaiting details of funding to support. Referrals to be accepted from midwives. Consideration to be given to how the pathway will look in a crisis situation and where would a crisis occur? To align with pathway developed in Wiltshire as shared services. Update 29/04/2016: Local perinatal pathway has been reviewed and provisional pathway has been developed which shares many similarities with Wiltshire, but takes into account local perinatal healthcare provision. Currently there is an AWP trust-wide review of perinatal mental health. AWP Improved services for receiving perinatal services and support. CAMHS A, B Improve services for children and young people experiencing mental health problems. Update 30/09/2015: There is national funding available for CAMHS transformation. A ring-fenced proportion of this is to be spent on eating disorders and the rest is available for spending on other areas. Funding will be provided for 5 years. Margaret Fairbairn Improved services in line with national expectations. Liaison and crisis services in B&NES able to provide appropriately timed
Working in collaboration with SWASFT as regular 1st point of contact for those in crisis. A, C, D SWASFT keen to involve partnership working in improving mental health care. We aim to develop: *direct referral pathways *Access to mental health advice (see street triage project) *Access to care and escalation plans (see single patient notes project) *Access to health based places of safety 2015-16 Update 15/05/2015: AWP have looked at documents that David had produced. Work is on-going. Mental health is included on annual mandatory training. Update 30/09/2015: AWP have received Trust agreement to have paramedics spend time with the mental health team if they would like to. David Partlow Improved of care. Lower the number of Emergency Department admissions. AMPH service B Review arrangements for out of hours AMHP provision and ensure this is effective and meets need As we have combined the OOH services with children’s safeguarding 2015/16 Update 30/09/2015: All 4 counties are looking at OOH AMPH provision. At the moment are 3 AMPH members of staff working until 1am. The team are prioritising their response as best as TL/AM/LH A more responsive out of hours emergency duty service so that coverage over 24 hours is equitable and efficient.
and across 4 counties we need to, in consultation with the police and mental health providers, ensure that AMHPs can be available within locally agreed response times. Explore the potential for better integration of AMHP and EDT services with out of hours crisis provision of health and other partners. possible. The team find that their options are very limited OOH as there are very few services that are open or professionals that are available. There is a growing culture of working together. The team are also working with the police on individuals and identifying any mental health issues. Update 01/06/2016: Service level agreement for Emergency duty service has been agreed by all four Local Authorities. There are no changes to out of hours. Lack of resources out of hours continues to present a challenge.
Identify the frequent attenders at services with alcohol usage as part of their presenting features. (See Section 4, scheme 1) A, F To combine the information we have from the Blue data with other sources of information e.g. from community services to identify the size of client group for a revised pathway response. Q1 2015/16 Update 20/10/15: Cost of Blue clients in B&NES has been scoped. Of the total cost, 37% is attributed to mental health services. Also found that 14% of people with a mental health disorder are likely to be a dependent drinker. Currently exploring how a multiagency response to support and planning for Blue Light clients might operate locally. CS/AM More targeted and tailored responses to the needs of clients with co-existing mental health and alcohol issues.
Mental health support in Police Control room/ Control room triage C,D,E Other areas have seen benefits from having mental health staff available in control rooms. This allows access to patient medical records and mental health expertise to give those in crisis the best possible support. 3/6/15 - A meeting was held between CCG senior leaders, NHS England, senior leaders from AWP and Somerset Partnership, the PCC and Chief Constable whereby unanimous support was given to exploration of a control room triage scheme within the force area. 23/6/15 – Norfolk Police gave a presentation on control room triage to local Police/NHS/Fire/Ambulance partners, proposal to create a business plan to obtain funding to introduce locally. Information being sought on possible benefits to all partners to be incorporated into a force-wide business case, for presentation to each CCG in the next funding cycle. Avon and Somerset Police Increased support for police staff allowing for forces to respond in the most appropriate way. Improved quality of care received from the police when responding to crises with advice from mental health professionals.
Scheme Includes Action Timescales Led by Outcomes Investigate new provision/ pathway for intoxicated clients. A, Explore need; look at existing services (s136 suite and RUH) and community; SDAS/DHI/Julian House. Scope for pathway, services and facilities for rapid and intensive support to address around 200 individual impact alcohol clients, on top of work that is already happening for high impact patients. Specifically addressing 20-25 people that attend ED once a month on average. Explore the service provided by street marshals/ Pathway for Intoxicated/Mental health clients meeting set for 22/12/2014. Complete. Update 30/09/2015: There has been a lot of work taking place around ‘blue light’ clients. Looking at the possibility of providing blue light information and training to the police. Harm reduction work has also taken place and training can be provided. There is a ‘damp’ house provision with 4 beds to help clients who have relapsed. CS/AM ± 200 individual clients = £10m per annum cost. 20-25 Mental Health /Alcohol patients = £3.7m cost. Averaging 1 visit to ED per month. Improved pathway/facilities will look to reduce number of ED visits.
assessment and proposal paper Define next steps if approval gained. Consider whether this can be part of a wider assessment suite that could also work with children and young people. into having a s136 suite in B&NES and addressing issues with access for under 18s and under 16s. Instigate rapid response service in existing Specialist mental health services D, B Produce paper analysing opportunities within existing service configuration- paper in draft format at this time Currently we are near to completing the review of access service function which is likely to separate assessment and home treatment functions of January 2015 Update 15/05/2015: Paper has been completed and this is now being piloted with PCLS. This will be reviewed in June 2015 with the intention of including the intensive team as well. Update 30/09/2015: Rapid access is underway and is no longer a pilot. Improvements to be made to joint working JE The model is potentially linked to street triage investment bid Patient receives specialist service response at the point of presentation rather than needing further assessment (unless clinically indicated that further specialist assessment needed). Greater partnership will reduce multiple and improve experience.
Working in collaboration with SWASFT B, C, D SWASFT want to be engaged with work in relation to conveyance of PoS. Have committed to 30min response time for section 136 requests. In addition we need to discuss with SWASFT the numbers of private transport conveyances for patients detained under section of the Mental Health Act. Currently in operation as 2 response time. Update 15/05/2015: Partlow has been in contact with Liz Richards at AWP. Scoping exercise is being carried out to look at demand and develop a model. Update 30/09/2015: Agreement is currently in with private ambulances for conveyance. To be reviewed when contract is due for renewal. SWASFT This needs to be assessed in light of SWASFT ability to respond to all green 2 priorities in the face of capacity demands. Service User Charter B Document is being developed in partnership between New Hope/St Mungos, Healthwatch and Making it Real. Providing ‘I’ statements that Document is in draft form. Focus groups are being held between August and October 2015. New Hope/St Mungos, Healthwatch, Making It Real Supporting service users to gain an insight into their wellbeing.
December/January: Recruitment February onwards: Full implementation and review/evaluation Update 15/05/2015: Recurring funds received. Update 29/04/2016: Funding was fixed term and has now come to an end. Some aspects of this role have been developed and incorporated into the pilot project post with the RUH. Reduced admission to hospitals. Working in collaboration with SWASFT Plan to develop a facility to feedback into primary care and secondary mental health services with appropriate patient Update 15/05/2015: Looking at how to link in EPCR with other systems. Implementation date: Autumn 2015 David Partlow Often patients will present and not be conveyed, this may be an early indication of a degree of instability which could be managed earlier. The
contacts made by SWASFT. This will involve presentation on the SWASFT electronic clinical record due to be rolled out in B&NES in the summer of 2015. ability to feedback into services will allow for continuity and a higher level of care. Further develop shared patient notes to join up GP, Acute, ambulance and MH services A Special patient notes project in moving forward and mental health is part of that project. Again, this could link in the future to SWASFT work with the enhanced summary care record and their ability to access this via the SWASFT electronic record. 2015-16 Update 10/10/15: Next of work on special notes for people with mental health problems has begun with Katia Montella leading it in B&NES AM/CP/DP Ensure that all services have access to appropriate care plans for people who use services in an emergency or crisis situation
Already being used in some instances. Implement social prescribing project to prevent escalation of non-medical conditions The aim of this service is to redirect suitable patients away from the NHS and towards opportunities in the local community which can support their needs. People referred to the service may have mental health needs, long term conditions or other practical issues which affect their mental and physical wellbeing. This service will operate mainly The new commissioned service will start on 1 Jan 2015 and will aim to begin effective delivery by April 1st 2015. The commission initially is for 27 months to 31 March 2017 and any extension is dependent on good outcomes and continued CCG funding. Update 15/05/2015: Service has now been implemented on a two year pilot. Update 20/10/15: uptake by GPs very positive. It is already AM/BW Be responsive in addressing health, practical and social issues that may negatively impact on the health and wellbeing of people who frequently make use of local GP practices. Reduce the demand on costly health services and enable funds to be better targeted on people whose needs are purely clinical rather than practical or social. Improve the patient’s quality of life Encourage and enable people to better manage their conditions, take up of
experiences, discuss issues and developments. Current members include - Sirona Community Links -supporting networks in the community, to build resilience and help people live independently, with a strong social prescribing element. St Mungos Broadway - Peer Mentoring Service trains and supports peers to support people within the networks and the wider community. order to effectively support people and offer social interaction opportunities in the community. Update October 2015: The Your Care Your Way consultation process is currently underway, which will shape how future services are commissioned for the B&NES community. It is anticipated that a draft model will be determined by November 2015, with the model being operational by 2017. It is being proposed to extend existing contracts for 1 year to fall in line with the Your Care Your Way process.
This service is delivered collaboratively with Sirona and Bath Mind Creativity Works - provide “taster sessions” in creative, supported activities. Creativity Works works with the groups to see how they can develop on a sustainable, peer led and supported basis. Bath Mind - work collaboratively with St to develop peer mentors. They also facilitate MOSAIC, a community Update 29/04/2016: A local mental health alliance has been formed and development is underway around the mechanism to involve third sector and carer/service users as a part of this. Your Care Your Way has progressed with multiple work streams. There is mental health representation within these to ensure that parity of esteem is achieved.
Assess elements of preventative that can be delivered through Wellbeing College – 2 year A Independent evaluation taking into account both health and social outcomes – incorporating 5 ways to wellbeing, e.g. into more health based outcomes. College will also assess courses themselves for style, content and effectiveness, getting feedback from participants. Evaluation will inform a business plan for the format of any future Wellbeing College to be commissioned in 2016. Link with social prescribing and social options into The college is a 2 year pilot with an independent evaluation spanning approximately 12 months. The college monitoring will take place over full 2 year period. Update October 2015: The Wellbeing College contract is being extended for 1 year to allow developments to take place and more effectively evaluate the model. All WC providers/LA/PH/CCG. People to self-manage their long term conditions and through peer support, enable them to share experiences and solutions and support. To assess whether the educative, term intervention approach to self-management enables people to avoid accessing higher level services - GPs, acute, MH services in crisis To assess whether early intervention, through mainstreaming and appealing to the whole community, reduces the need for people to take up services subsequently. 2016)
Housing need for high risk offenders, sex offenders and IRIS clients. A To research, develop and consider partnership working within B&NES and also across authorities to address a need for housing high risk offenders, sex offenders and IRIS clients are considered too high risk for the current supported housing options but do not meet the criteria for the dangerous offender protocol scheme, Homesearch. This can result in individuals being homeless posing challenges with monitoring and Andy Busfield – Julian House To have appropriate supportive housing for high risk offenders allowing better monitoring and support resulting in reducing the risk, severity and escalation of offending and helping to create safer communities.
Wellbeing House A To provide term respite beds within a safe environment and provide therapeutic interventions throughout their stay to prevent crisis and help people to better manage environments and situations that may cause stress and lead to crisis. To be in operation by Summer 2015. 1 year Update 30/09/2015: Wellbeing is now open for referrals. Feedback on the house has been positive so far. Those in the house have received meaningful interventions. A holistic practitioner is working at the house and using a wellbeing options tool that uses the 5 Ways to Wellbeing. Also linking in with outside agencies, looking at what client’s would like to do and supporting their journey. Looking at how to maintain the service in the longer term. PW/Sirona To provide term respite to individuals, enabling them to be removed from stressful environments as a way of preventing people from reaching crisis.
A tariff (price) for specific healthcare activity is paid by the PCT to healthcare providers. This is determined nationally. Payment by results complements practice based commissioning as it enables a unit cost calculation to develop the indicative practice level budgets for practice based commissioning. For mental health, payment by results is not operational. A national target date for the introduction of payment by results for mental health is 2008. Foundation Trusts By 2008, all provider NHS Trusts to become Foundation Trusts. This affects the commissioning / provider relationship for the following reasons:- Foundation Trusts are able to borrow money and invest money without some of the current restrictions. Foundations Trusts require that the service level agreement with commissioner is a legally binding contract for a three year period. This differs from the current arrangement of a one year service level agreement which has no legal status. Foundation Trusts have greater flexibility to commission the voluntary and private sector directly to provide services on their behalf. The Local Authority through integrated services will need to have a robust governance structure in place with the Trust for service provision and with health commissioners to manage demand and cost. Provide for greater accountability at a local level through revised governance arrangements. Individualised Budgets Changes in the way in social care packages are costed and managed through providing an individualised budget from which services are commissioned. Power shifts from the Council to the individual to manage the social care market with the support of effective information, advice and brokerage systems. Individualised budgets can include streams of funding including supporting people, independent living fund, access to work in addition to social care budgets. Health Act Flexibilities (referred to as Section 75 partnership agreements)