Chris Naylor discusses the extent to which opportunities for mental and physical health integration is being realised in the vanguard sites.
Please note: this video features lower quality audio than others produced by The King’s Fund.
This presentation was filmed at our conference on Sustainability and transformation plans: moving towards implementation on 24 May 2017.
As part of the Five Year Forward View, the 50 different parts of the country are trialling new models of care, they have been called the vanguard sites, and those new models of care are partly around the idea of trying to dissolve some of the barriers to multispecialty community providers in primary and acute care systems are in essence a similar idea. And they involve clustering together local GP practices, trying to wrap around those practices, a range of community health services including mental health services. And the ambition is that these models of care, particularly the MCPs and PACS are going to be expanded beyond the vanguards to cover at least 50% of the population of England by 2020. The STP process is being seen as the main vehicle for doing that, and we wanted to ask the question what is being done within those new models of care on mental health?
NHS England published a framework document which said that MCPs and PACS need to be thinking about these four different levels of need. And it’s encouraging to find that in the case study sites we went to, people with highly complex needs, there’s an emphasis on trying to develop integrated care teams that work on a locality basis or neighbourhood basis, and in most areas those integrated care teams are trying to get some kind of mental health expertise into their multidisciplinary team. In terms of people meeting the needs of people with long term conditions, there’s a big focus in the vanguards and other parts of the country, on scaled up models of primary care. Lots of work going on trying to integrate mental health into urgent and emergency care pathways, thinking about the role of liaison psychiatry and liaison mental health services in A&E. And there’s also work at the population level. So just to give you an example, so one of the MCPs is in West Cheshire, they’ve developed nine integrated care teams across different parts of their patch, and this illustrates the different ways they’re trying to get mental health expertise into their integrated care teams. So the people that they’re working with tend to have very complex needs, often they’re housebound, they might be older people with frailty as well, so the connection with the older people’s mental health team is something that they clearly focused on.
But not all of the people that they work with are older people, they work with other adults as well. So they’re trying to build a link with their primary care mental health services. So that’s particularly thinking about people with multiple long-term conditions who may have depression or anxiety on top of that. And then really importantly, the third element is about thinking more upstream and thinking more about prevention. So within these integrated care teams in West Cheshire you have wellbeing co-ordinators who are provided by the voluntary sector and who are there to think about things like social isolation. How do we make sure that we’re not offering a whole new medicalised response, that actually we’re thinking about how do we connect these people with things in their local community? We’re seeing there’s real value in incorporating mental health in integrated care teams. Lots of those teams are talking about needing to either increase their in-house mental health capacity over time, or develop arrangements for closer working with mental health teams, because they recognise that the level of need is just so huge.
There’s also some interesting messages I think about broadening the scope of mental health. So one thing we took from the teams we interviewed was that knowledge and skills around psychology and mental health can add real value, whatever the client group you’re working with. So it’s not just about people with diagnosable mental health conditions.
And finally a sort of lesson about focusing on prevention as well as care. So in some of the vanguard sites we’ve seen voluntary sector organisations being seen as a core part of the delivery system rather than as an external partner to sort of engage with but keep arm’s length. There’s quite a compelling case for integrating mental health support with the rest of the health system. If we get mental health right, we stand a better chance of getting the whole system right.