Two new financial incentives to improve mental health care for children and young people and for those with mental health needs attending A&E have been announced by NHS England and NHS Improvement.
As part of NHS England and NHS Improvement’s ‘Delivering the Forward View: NHS Operational Planning Guidance for 2017/18 and 2018/19’, which provides NHS trusts and commissioners with the tools they need to plan for the years ahead, two CQUINs (Commissioning for Quality and Innovation) aim to incentivise providers to work with partners to improve patient care by delivering services more efficiently and effectively.
The CQUINs are: ‘Improving services for people with mental health needs who present to A&E’ and ‘Transitions out of Children and Young People’s (CYP) Mental Health Services’.
People with mental ill health are three times more likely to present to A&E than the general population so the former CQUIN will allow mental health and acute trusts over the next two years to access funding aimed in year one at improving support for the top 0.25% or 150 to 200 people per A&E who use it most frequently through improved recognition and coding of mental health needs and proactive care planning.
Year two focus will be on reducing overall number of attendances at A&E by people with mental health needs as improved community-based mental health services come online.
On the CYP CQUIN trusts will be expected to ensure patients have a transition plan, know their dedicated key worker and were involved in planning with their parents or carers.
It will be available for the children and young people’s mental health service that may be sending the young person on and to the receiving service which could be adult trusts, voluntary or primary care services.
Thousands of young people transition each year and if the process is handled poorly this can result in repeat assessments and emergency admissions. A 2008 study showed transitions for young people at the age of 18 were poorly managed resulting in only 4% of young people receiving an ‘ideal transition’.
Separate audit data from Birmingham suggested 25-50 per cent of under 25s disengage from mental health services. A failure to help young people engage with adult services may lead to increased health, welfare and service costs later on. A well-planned transition will support the young person into adulthood.
Claire Murdoch, national director for mental health at NHS England, said: “This is an excellent way to marry up key NHS priorities by improving liaison mental health services and community-based mental health care to reduce avoidable pressures on A&E and acute services.
“When we drilled down into the numbers in North West London, we found that about three-quarters of frequent A&E attenders had a significant mental health problem. Through in-depth case management of the most intensive users, we calculated that we reduced attendances by about a thousand for 100 patients over a year. This group of people tend to have co-existing problems – think long term conditions, medically unexplained symptoms, dementia, complications from substance misuse – and may present in mental or physical health crisis, and are likely to benefit from a wide range of services outside of hospital.
“Joint working between acute trusts, mental health trusts, social care and primary care services to understand these people’s needs and plan for their care will be absolutely critical.”