What does parity of esteem mean?Who will deliver it?

Ms Joanna Powell, Domain Team Lead, Parity of Esteem Programme, NHS England

Dr Caroline DolleryMid Essex CCG GP leadClinical Director East of England Strategic Clinical Network

• How did we get here?• What is parity of esteem?• NHS England Parity of Esteem Programme

– MH CQUIN– Everyone counts – Planning guidance 2014/15 – 18/19

• Who will deliver it?• Discussion and questions

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Plan

A few of our drivers

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4

Health and

Social Care Act

2012

• The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement –

• (a) in the physical and mental health of the people of England, and• (b) in the prevention, diagnosis and treatment of physical and mental illness.

NHS Mandate

• By March 2015, we expect measurable progress towards achieving true parity of esteem, where everyone who needs it has timely access to evidence-based services• NHS England’s objective is to put mental health on a par with physical health, and close the health gap between people with mental health problems and the population as a whole• Every community to have plans to ensure no one in crisis will be turned away, based on the principles set in the MH Crisis Concordat

Putting People

First

• Parity Included in Priority 8 on the NHS England Balanced Score Care• Deliverable 11 against key deliverable: Put mental health on a par with physical health, and

close the gap between people with mental health problems and the population as a whole. Extend and ensure more open access to IAPT by March 2015, particularly for children and young people, and for those out of work

Parity of Esteem – valuing mental health equally with physical health

My family and I all have access to services which enable us to maintain both our mental and physical wellbeing.

If I become unwell I use services which assess and treat mental health disorders or conditions on a par with physical health illnesses.

“Person centred,

coordinated care”

The patient

What parity will mean to me

What Parity will mean to me

Nowhere in the 21st century NHS will a person’s mental health needs be neglected, or professionals lack confidence in dealing with a patient’s emotional or psychological needs.

Health professionals

“Person centred,

coordinated care”

What parity will mean to me

In our communities our attitude to a person with a mental illness will be exactly the same as a person with a physical illness. If we need to encourage our friends to seek help we will, and if we need help to improve our physical and mental wellbeing our friends and family are able to actively support us

The community

“Person centred,

coordinated care”

Whole Person Care – Royal College of Psychiatrists March 2013‘The overarching principle of the parity movement is equality – in access to care, in improving the quality of care, and in the way resources are allocated.… If we stay true to the principle of treating each person with dignity and respect in our health care system, then we should make no distinction between illnesses of the brain and illnesses of other body systems’ – US literature

Action focused report which ’refers simply to achieving ‘parity’ in order that mental health has equal status with physical health

http://www.rcpsych.ac.uk/usefulresources/publications/collegereports/op/op88.aspx

What is parity of esteem – other definitions

The House of Care The House supports National Voices ‘I’ statementsMy goals/outcomes e.g.

• All my needs as a person were assessed and taken into account

Communication e.g.• I always knew who was the

main person in charge of my care

Decision-making e.g.• I was as involved in discussions and decisions about

my care (including care planning) and treatment as I wanted to be

Transitions e.g.• When I went to a new service,

they knew who I was, and about my own views, preferences and circumstances

Emergencies e.g.• I had systems in place so

that I could get help at an early stage to avoid a crisis

The House of Care

Person centred, coordinated care at three levels:

National:What can national organisations and policy makers do to enable construction of the House of Care at the next two levels.

Local:How local health economies ensure that the House of Care involves a whole system approach, including ‘more than medicine’ offers

Personal:How the House of Care gives professionals on the front line a framework for what they need to do for patients and ask local commissioners to secure for them

• Facilitate NHS England to work to reduce the disparity which currently exists in health outcomes for those with mild, moderate or severe mental health illness

• Support integration and personalisation by promotion of whole person care which values everyone’s mental and physical health needs equally

Parity of Esteem Programme

NHS England Parity of Esteem Programme - Priorities

• Addressing and improving crisis Care • Data, Information and Intelligence • Development of capability and skills in commissioning – including

focus on cultural change / behaviour of commissioners change• Delivering improvements to clinical services (including IAPT and

increasing timely diagnosis and post diagnostic care for dementia) • Improving physical health for people with serious mental illnesses

and learning disabilitiesDiscrete improvement project – Business as usual –

Collaboration with system partners

Improving physical healthcare to reduce premature mortality in people with severe mental illness (SMI)

Indicator 1: 65 per cent of funding for demonstrating, through a national audit process, full implementation of appropriate processes for assessing, documenting and acting on cardio metabolic risk factors in patients with psychoses, including schizophrenia.

Indicator 2: 35 per cent of funding for completion of a programme of local audit of communication with patients’ GPs, focusing on patients on the Care Programme Approach (CPA), demonstrating by Quarter 4 that, for 90 per cent of patients, an up-to-date care plan has been shared with the GP

Mental Health CQUIN

The CQUIN guidance for 2014/15 has recently been reissued on NHS England website

The following cardio metabolic parameters are assessed and actively managed;

• Smoking status• Lifestyle (incl. exercise, diet, alcohol and drugs)• Body Mass Index• Blood pressure• Glucose regulation (HbA1c or fasting glucose or random glucose

as appropriate)• Blood lipids

Mental Health CQUIN

Planning Guidance 2014/15 -18/19

Headlines• Outcomes drive everything we do• Significant financial challenge: no change is not an option• 2014/15 – transformation year in preparation for 2015/16 (Better Care Fund)

What’s new?• Support available to support commissioners• Operational (2 years) strategic (5 years) plans• Integration / collaborative working a key feature

– Monitor / NHS TDA (providers and commissioners)– Local authorities (Better Care funding)

• Unit of planning to support Health and Social Care planning

Six service characteristics

1. A completely new approach to ensuring that citizens are fully included in all aspects of service design and change and that patients are fully empowered in their own care

2. Wider primary care, provided at scale

3. A modern model of integrated care

4. Access to the highest quality urgent and emergency care

5. A step-change in the productivity of elective care

6. Specialised services concentrated in centres of excellence

High quality care for all, now and for future generations

• High Quality – ‘Driven by quality in all we do – our patients rightly expect the best possible service’

• For all – ‘…whether need is for mental or physical help and support. We must put the greatest effort in providing care for the most vulnerable and excluded in society’

• For now – ‘Need to get better at sharing good practice rapidly across the NHS’• For future generations – ‘Strategic plans developed in partnership working

between commissioners, providers and local government to deliver models of care that will be sustainable in the longer term’

Parity of esteem

Who will deliver it?

Dr Caroline Dollery

Mid Essex CCG GP lead

Clinical Director East of England Strategic Clinical Network

Physical health and mental health• People with SMI die prematurely of common physical health problems• People with physical health problems with co morbid anxiety and depression

die prematurely of physical health problems• The planned and immediate care presentation of physical symptoms

BECAUSE of common mental health problems drives costs up and quality down because of lack of screening, diagnosis and support

• Many people with SMI or depression never access health services, but present elsewhere in system: need for bio psychosocial approaches

HEALTH WATCH

NHS England

MONITOR

CQC

Clinical senate

Clinical commissioning groups

Commissioning support unit(s)

Health and Wellbeing Board

Primary careSpecialist services

System enablers

CCGs, social care and providers

AHSCNs

Strategic network

s

Levers: strategic• People with lived experience; personalisation; personal budgets• Health and Wellbeing Boards• Public Health and JSNAs• Strategic clinical networks; GP mental health lead networks

Levers: strategic• Commissioning strategies:

– assurance by NHS England and by Local Area Teams of CCGS; and of HWB integrated approaches: need consistent response across England

• Provider strategies: acute and mental health trusts• Specialised commissioning and links to whole pathway: CYP, criminal

justice• INTEGRATED APPROACHES• Better care fund

Levers: operational/contractual• National CQIN for SMI physical health care• Local commissioning : CQINS in primary and secondary care; Local

enhanced services • Leadership development networks via SCNS and AHSNS to develop an deliver

quality improvement in this area• Provider led quality improvement programmes• Use of new forms of contracting e.g. Alliance contracting across whole systems

Levers: integrated commissioning• Pioneer programmes• Frailty/long term conditions• Training and education of workforce across system• Examples: liaison work in A&E; primary care support; IAPT; employers;

CAB and other third sector organisations; schools, councils, community assets

Levers: integrated commissioning• Primary care hubs: comorbid conditions need to include parity of

ASSESSMENT• PARITY OF FUNDING: money following patients: acute trusts vs MH trusts

vs primary care• INFORMATION AND SYSTEMS CRITICAL, AND CURRENT BARRIER

National• Recognition of parity of esteem: steering group• Urgent care review and concordat• Mental health outcomes framework• Mental health intelligence network• Leadership development• Political support• Long term conditions and frailty models: house of care

What can you do?• REFLECT on what can be done in your circle of influence• USE your community support: put pressure on health and social care

commissioners to implement this agenda • USE people with lived experience to demonstrate need and deliver local

solutions• USE your public health consultants in local Authorities: to develop strategy

and help commissioners to build business case

What can you do?• LOBBY for better information and resources including shared data• LOBBY for parity of funding• MAKE SURE your Local Area Team has mental health as part of its

assurance of CCGS and of Better Care Funds: parity of assessment and outcomes

• MAKE SURE CCG Boards have built this into their 2 and 5 year plans

Questions?• What other steps can you take after today?• What can we do to help you?

• cdollery@nhs.net• Mobile 07900 715145

• Jo.powell2@nhs.net • 07876851756