Health and Social Care Delivery

Introduction

The Choosing Health (DoH 2004) new approach to public health backed by the public will deliver a sustained improvement to the health of the people of England. It will do so by responding to people’s concerns about their health with practical support on their own terms and by providing an environment needed to make real progress.

Recent years have seen significant changes to policy and services in the commissioning and delivery of mental health services. The National Service Framework for Mental Health (NSF) has delivered sustained development and improvement across England.

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Reflecting on the past decade, the transformation in the range and quality of services is there for all to see, in real services, new buildings and improved outcomes for patients. These developments have taken place across the health, social care and third sectors. They have been achieved by organizations working together in partnership and in many cases, integrating service delivery and commissioning.

Putting People First: is a shared vision and commitment to the mental health transformation of adult social care and under this programme, councils must transform their adult social care systems by March 2011. The programme is funded by a 525 million social care reform grant – available from 2008-2011. Much of the focus is on personalisation; giving more choice over services and control over decision making to individual service users. This policy allows personal budgets allocated to users on the basis of need, from which they will fund care services. The policy also is a strategic shift from reaction to prevention, promoting independence for the mental, older and disabled people. The policy set up information and advice services to be available to all users and care.

Government White Paper – Our Health, Our Care, Our Say

In April 2006, the Government published the White Paper “Our Health, Our Care, Our Say”. Its publication followed the largest public consultation in England concerning the future direction of healthcare. The White Paper recognised the ongoing challenges faced in this country as a consequence of increasing rates of obesity, diabetes, cardio-vascular disease, and the impact of mental illness, with estimates of around 15 million people now suffering from these types of long term conditions.

Around 5 million people were recorded to be suffering from work-related stress, with a ratio one to six adults considered to suffer mental health problems ‘at any one time’, One out of four patients consults their GPs concerning their mental health, and mental ill health is reported to the key reason for 865, 900 adults to be dependent on Incapacity Benefit in England (DOH, 2007b). Around 5 million people were recorded to be suffering from work-related stress, with a ratio one to six adults considered to suffer mental health problems ‘at any one time’, One out of four patients consults their GPs concerning their mental health, and mental ill health is reported to the key reason for 865, 900 adults to be dependent on Incapacity Benefit in England (DOH, 2007b).

The goals of Our Health, Our Care, Our Say: are expected to be achieved through, practice based commissioning, shifting resources into prevention, More care undertaken outside hospital and in the home, better joining up of services at the local level,encouraging innovation , allowing different providers to compete for services.

The nature of provision has also been altered with the advent of Foundation Trusts and the greater engagement of the independent and voluntary sector in the provision of services.

The environment in which commissioners and providers operate is now one that is more fluid and dynamic than ever before. It is an opportune time to consider what can be learned from the experience of integration and what role it will need to play in the future commissioning and delivery of mental health services.

Integration describes the coordinated commissioning and delivery of services and support to individuals in a way that enables them to maximise their independence, health and wellbeing. Coordination of this type is especially important for people with mental health problems who often require support from a variety of organisations or individual care workers. The delivery of integrated care is influenced by the practice of staff, the systems they work within, how users are engaged and the structure of organizations.

Putting People First

A shared vision and commitment to The National Service Framework for Mental Health was published in October 1999. It is a 10-year plan for the modernisation of mental health services, and sits alongside the NHS Plan.

The main provisions of the Mental Health Act 2007 came into effect on 3 November 2008. The direction of travel for health care services in broad terms and can be characterised by a renewed focus on primary care and prevention rather than just curative and reactive interventions.

Mental Health is recorded to be the second prime cause of death in men between ages 14 to 44 through suicide, and the prime cause of suicide among young men .The cost to society in human, social and economic terms is significant; poor mental health is the cause of increase in health-related benefit claiming production lost through time off due to sickness and the cost of treatment and sick pay recorded is reported to cost the economy between 30 billion and 40 billion per year.

The focus has been on transforming services through integrated working across health, social care and the third sector and represented the key guidance influencing those delivering mental health services at a local level, and has been the basis upon which their work is evaluated.

Transformational changes in the delivery of mental health brought together key areas of policy, increasingly addressing the mental well-being of communities as a whole and extending the progress made to date across all age groups, and to more marginal ones, such as offenders.

DOH (2007) further helped transformed mental health through broader NHS priorities helping shaping services, with themes such as health inequalities, the value of carers and dignity in care all contributing to an ever-improving service.

The Choosing Health (DoH 2004) policy has three core principles.

• Firstly ‘informed choice’ which enables people to make their own decisions and choices that impact on their health and to credible information to help them do so. People agree that there is need for special arrangements for those cases where one’s choice may cause harm to another for example exposure to second hand smoking.
• Secondly ‘personalisation of support to make healthy choices’: support has to be tailored around people’s lives and ensuring equal access to them.
• Thirdly ‘working together to make health everybody’s business’: real progress depends on effective partnerships across communities, including local government, the NHS, business, voluntary sector, faith organisations and many others.

The government will lead, coordinate ands promote these partnerships and expect others to engage constructively. Choosing Health (DoH 2004) also acknowledges the fact that the environment we live in, our social networks, socio economic circumstances and resources in our local neighborhoods can affect our health. According to the Choosing Health (DoH 2004) policy the consultation process established a set of priorities for action which included: reducing the numbers of people who smoke, reducing obesity, improving sexual health, improving mental health and reducing harm and encouraging sensible drinking. This set of priorities is lifestyle and behaviour which lead to preventable diseases Griffiths and Hunter suggest that improving health in communities and reducing preventable diseases lessens the burden on the NHS and freeing it up to provide better services for those with unavoidable ill health.

Choosing Health (DoH 2004) outlines a broad based social marketing strategy which focuses on engaging individuals, organisations and broader society to bring together messages that raise awareness of health risks with information about action that people can take to improve their health. Action has been linked to activities in the communities, schools, public places and workplaces and focus has been placed on the set of priorities.

Personalisation is a key strand in current and emerging health and social care policy. The message is being put out with personalisation is simple, cost effective and has transformed many and changes lives.

The NMHDU are working together to achieve shared goals. The NMHDU will continue to promote the needs of people with dual diagnosis, as an integral part of its work. In particular, the Improving Care Pathways programme lead will be scoping further opportunity to collaborate with other programme areas, including the national Alcohol Improvement Programme (AIP) and offender health programmes, to strengthen links across to mental health.

Since the publication of “High Quality Care for All” in June 2008, monitoring and incentivising better quality of care and better user outcomes has been a leading part of the Government’s agenda for the NHS.

Mental health has received high priority during the period of NSF implementation. The end of that period should not be seen as an ending of the work to improve either the range or quality of services. The challenge now is to utilise the power of integration to ensure that mental health is placed at the centre of local service development and delivery, coupled to an increasing focus on well being.

Local Implementing

Teams in mental health have successfully brought together commissioners, providers, the third sector and service users to shape priorities, drive delivery and monitor progress. They have demonstrated the benefits of engaging diverse stakeholders to achieve change, and are an example of the opportunities that integrated working can bring. Integrated working can offer the opportunity for health and social care to operate equally, breaking down traditional barriers and creating seamless services. In particular, it provides the chance for the role of social care to be enhanced and recognised as a key contributor to the planning and delivery of services ( ICN 2008).

The policies brought changes and good practice in delivering mental health and as a result ten GP practices are working together to integrate community mental health teams, based in a rural location, with a single point of access from GP practices. This project will integrate acute and social services and aim to remove boundaries so service users can more easily navigate their way through the system and avoid repetition of the history to numerous professionals.

Referenc

1. Department of Health (2004) Choosing Health: making health choices easier. Cmnd 6374. London: The Stationery Office.
2. Department of health (2007) Putting People First, a shared vision & commitment to the transformation of adult social care. London. The Stationery Office.
3. NIMHE ( 2003 ) Positive approaches to the integration of health & social care in mental health services,
4. National Mental Health Development Unit [NMHDU] (n.d) New Horizons-Working together for better mental health [Online] Available: at < http://www.nmhdu.org.uk/nmhdu/en/new-horizons/]
5. A guide ICN ( 2008) Bringing the NHS and Local Government Together, Integrated working:
6. NatPACT (2005)The Commissioning Friend for Mental Health Services
7. Bogg, D. (2008) The integration of mental health social work and NHS, learning Matters.
8. Glasby, J and Dickson,H. (2009) International rescue – Community Care
9. Integration and mental health (2009) Integrated care, London Stationery.
10. National Mental Health Development http://www.dh.gov.uk/en/Healthcare/IntegratedCare/DH_091112
11. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825 Putting People First: A shared vision and commitment to t
12. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicy and Guidance/DH_4009598
13. http://www.dh.gov.uk/en/ Publicationsandstatistics/Publications/PublicationsPolicy;

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