Mental Health and Learning Disabilities
The following trusts provide mental health services in the NHS South Central region:
- Oxfordshire Health NHS Foundation Trust (which provides services in Oxfordshire and Buckinghamshire)
- Berkshire Healthcare NHS Foundation Trust
- Hampshire Partnership NHS Foundation Trust.
- Solent Healthcare
- NHS Isle of Wight
- Oxfordshire Learning Disability NHS Trust also provides a range of health care and social support services for people with a learning disability in Oxfordshire, Buckinghamshire, Swindon and Wiltshire.
Mental Health Statistics:
One in six adults will have a mental health problem at any one time.
17.6% of adults in England have at least one common mental disorder
0.4% of adults in England have a psychotic disorder, and 80% are receiving treatment
0.3% of adults in England have antisocial personality disorder
0.4% of adults in England have borderline personality disorder
10% of children in the UK have a diagnosable mental health condition
13–16% of older people in England have severe depression, and up to 50% of older people in residential care
One in 20 people over 65 in the UK has some form of dementia, rising to one in five people over 80
One third of all mental health service activity in England is concerned with the care and treatment of people over 65
The Impact and Burden of mental illness
Half of all lifetime mental health problems start by age 14.5
Mental ill health accounts for 13% of all lost years of healthy life globally, rising to 23% in high-income countries.
The financial costs of the adverse effects of mental illness on people’s quality of life are estimated at £41.8 billion per year in England.
Over a third (34%) of people with mental health problems rate their quality of life as poor, compared with three per cent of those without mental illness.
Recovery from mental ill health results in dramatic improvement in quality of life: among people who have recovered from mental illness, just 9% continue to report poor quality of life.
Onset of mental ill health is associated with significant deterioration in quality of life: 28% of people who experience onset of mental ill health report poor quality of life.
Times of economic slowdown are particularly challenging for mental health services, with numerous studies linking joblessness and other economic pressures with poorer mental health. We know that there are a number of areas where better care can cost less; it is with this context in mind that we have established a range of projects to deliver improved quality and productivity.
Reducing Out of Area Treatments (OAT’s)
The challenge of placements results from the need for PCTs to commission from multiple, often independent sector providers creating variation in costs and quality to meet additional demand. These arrangements lack consistent service specifications and performance monitoring arrangements and usually are much more expensive than services that are provided through normal contracting routes
A recent survey by the Royal College showed that out of area treatments are 65% more expensive than in-borough placements (£34,000 vs £21,000)
NHS SC is currently spending £20 million per annum on OAT’s.
The biggest spends are against, secure, learning disability and residential rehabilitation.
Mind/ Body
The links between physical and mental health are clear. There are shared risk factors for illness. Physical illnesses regularly present with both psychological and physical symptoms, and being physically ill, particularly with chronic illness has an impact on mental health. People with long-term conditions (LTC) are three times more likely to have a co-morbid depressive or anxiety disorder than those without long-term conditions. Those people with three or more LTCs are seven times more likely to have co-morbid mental health problems and, as a result, are more likely to use health care resources at all levels of the system. There are a number of examples both in the USA and the UK where providing psychological interventions has improved the outcome and health care utilisation of both the long-term condition and the co-morbid mental health problem, thereby improving outcomes and reducing use of health resources.
We are currently working to scope what current pilots and good practise we have across the patch, looking to scale up and roll out across the region. We will need support to develop the economic and financial case for this work. We will work with an expert reference group to agree KPIs to measure improvement. This work is being linked with the IAPT programme.
Mental health acute care pathway.
Nationally potential savings and efficiencies in the mental health acute care pathway are being investigated through:
- Early interventions at all stages of the pathway
- Developing the role of crisis resolution and home treatment services as alternatives to hospital admission
- Evidenced best practice interventions in the management of inpatient care episodes
- Addressing the most significant causes of delayed discharges from psychiatric hospital beds
- Reducing variation reflected in the Audit Commission’s benchmarking exercise
We are currently working to develop a mental health performance framework.
Implementing payment by results (PbR) in Mental Health
Work continues on developing currencies for use in the commissioning of mental health services for adults of working age and older people. The ultimate goal is the creation of a national tariff.
NHS SC has an established project structure working with PCT’s and providers to ensure successful implementation. The White Paper restated the timetable of 2012/13 for the care clusters to be used for payment for adult MH services.
Implementing the National Dementia strategy.
There are currently 700,000 people in the UK with dementia, of whom approximately 570,000 live in England. Dementia costs the UK economy £17 billion a year and, in the next 30 years, the number of people with dementia in the UK will double to 1.4 million, with costs trebling to over £50 billion per year.
The Government has launched an update of the existing implementation plan for the National Dementia Strategy. The document presents the Department’s revised implementation plan for ‘Living Well with Dementia – A National Dementia Strategy’, which was published in February 2009. It updates the previous implementation plan for the Strategy, which was published in July 2009.
NHS South Central has a joint program with Department of Health South East to improve services and outcomes for people with dementia and their carers. The key priorities of the implementation plan are identified as;
- Early intervention diagnosis for all
- Improved quality of care for people with dementia in general hospitals
- Living well with dementia in care homes
- Reducing the use of Anti-psychotic drugs
- Improved community personal support services
Challenges and Changes
| Current Challenges | What does success look like in 2014 | What can be done? | Key Resource links |
| Diagnosis GapOnly one-third of patients ever receive a formal diagnosis, and those who do often receive it too late to take effective action. GPs feel ill-equipped to diagnose | All people with dementia should have a timely specialist assessment, an accurate diagnosis, treatment, and care and support as needed following diagnosis. Fewer people will require residential care as a result, releasing savings that can be channelled back into early support. |
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for people with dementia – National Audit Office
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| Improving Care in General Hospitals Up to 70% of acute hospital beds are currently occupied by older people37 and up to a half of these may be people with cognitive impairment, including those with dementia and delirium.38 The majority of these patients are not known to specialist mental health services, and are undiagnosed. People with dementia in general hospitals have worse outcomes in terms of length of stay, mortality and institutionalisation. | All people with dementia will have a timely specialist assessment, an accurate diagnosis, treatment, and care and support as needed following diagnosis. |
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| Improving Care in Care HomesTwo thirds of people in care homes have dementia; dependency is increasing; over half are poorly occupied; behavioural disturbances are highly prevalent and are often treated with antipsychotic drugs. The quality of care homes is variable; the Alzheimer’s Society often finds that activities, and interaction between residents and staff, are inadequate. | The quality of care improves. Homes have person-centred care planning and good staff training. They enable people with dementia to move around safely and provide purposeful activities based on individual preferences. Close relationships with families and close links with communities are nurtured. |
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| Reducing the use of Anti-Psychotic Drugs There are an estimated 180,000 people in the UK with dementia on antipsychotic drugs. In only about one third of these cases are the drugs having a beneficial effect and there are 1800 excess deaths per year as a result of their prescription. | Alternatives to Anti-psychotic drugs will be the norm rather than the exception with quality of life for patients being markedly improved. |
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| Improved community personal support services Most dementia sufferers live in their own homes. But short home care visits, based on tasks not outcomes, are often found to be inadequate for dementia sufferers | All people with dementia in the community would have access to flexible and reliable services, ranging from early intervention to specialist support, which respond to their needs and are tailored to their family circumstances. This should reduce admissions to hospital and care homes. |
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Learning Disability health improvement project
People with a learning disability have more health problems than the general population, across a wide range of physical and mental health conditions.
People with a learning disability have a right to as good health as possible, comparable to the general population. They need good health so that they can live the fullest life that they can in the way they choose. They should be able to make informed decisions and have more control over the different choices and options for their lives. They should also be supported to participate in all aspects of the community.
There are approximately 10,000 adults with a moderate to severe learning disability in the NHS south Central region.
Key national reports (Death by Indifference, Mencap 2007, Health Care For All DH 2008, and Six Lives PHSO 2009) following the deaths of people with learning disabilities in acute hospital care publicised the poor standard of health care and the inequality of health care experienced by people with learning disability.
Valuing People Now (Department of Health 2009) Valuing people now sets out the Government’s strategy for people with learning disabilities following consultation. It also responds to the main recommendations in Healthcare for All, the independent inquiry into access to healthcare for people with learning disabilities
http://www.valuingpeoplenow.dh.gov.uk/
The over all vision for the strategy is; that all people with a learning disability are people first with the right to lead their lives like any others, with the same opportunities and responsibilities, and to be treated with the same dignity and respect. They and their families and carers are entitled to the same aspirations and life chances as other citizens.
Our project incorporates
- Reducing health inequalities (incorporating primary care, acute care, mental health)
- Validating the Learning Disability Health Self Assessment process
- Ensuring safe services – Including Six Lives compliance
- Implementing the Valuing People Strategy
- Monitoring the campus closure programme
- Improving the number of Annual Health checks people with learning disability are receiving across our region. www.improvinghealthandlives.org.uk
Downloads
- Title : Learning Disabilities Acute Peer Review Report EasyRead V2.0
Size : 1 MB
