Mid and South Essex STP: Developing a Costed Delivery Plan December 2019 DRAFT V2 FOR REVIEW
Mid and South Essex STP: Developing a Costed Delivery Plan Nigel Leonard – EPUT Executive Director of Strategy & Transformation Mark Tebbs – Director of Adult Mental Health Commissioning, MSE STP
Mid and South Essex STP: Costed Delivery Plan “This is the biggest transformation of mental health care in a generation”
Mental Health condition prevalence across the STP ▪ ~ 1 in 5 people in Mid & South Essex are estimated to have a MH condition , many of which are Last Modified 28/10/2019 19:01 GMT Standard Time undiagnosed, compared with an estimated ~1 in 4 people in England ▪ People living in areas of greater deprivation are more likely to live with an MH condition. For example: – Southend has highest recorded levels people with a MH condition overall, including people diagnosed with dementia, with similarly high rates of depression in Basildon & Brentwood – MH need estimated by the LTP national formula estimates that several GP practices in Southend have almost twice the level of MH need to national average, whilst all other CCGs have on average Printed 09/10/2019 20:34 GMT Standard Time 72-80% the level of need of England on average – East Basildon and Southend localities have highest levels of people diagnosed with psychosis – Alcohol dependency is lower overall than the national average but drug-related admissions vary, with levels in Southend well above national average ▪ The number of people diagnosed with depression in primary care vary widely across all CCGs and across GP practices. As few as 16 out of 100 people with depression are diagnosed in some cases. This means it is possible many people are not accessing the necessary MH support in primary care settings. 4
We defined clear parameters for success of the Costed Delivery Plan programme, developed in April-September 2019 Goals of the plan Prioritised guiding principles What this means for implementation Last Modified 28/10/2019 19:01 GMT Standard Time ▪ Development of the ▪ Focus on current STP MH strategy and the ▪ The Costed Delivery Plan provides a comprehensive picture of the activity and Costed Delivery Plan 4 strategic transformation priorities under cost implications of the current STP strategy has several development, e.g. : and the 4 core strategic transformation components : 1. Crisis services priorities under development – Develop a baseline of 2. Personality Disorder ▪ For each it includes implications on key current state and evidence base of enablers (e.g. workforce, estates, digital) 3. Dementia Services, and best practice ▪ It will also include a high-level 4. Integrated Primary & Community Care Printed 09/10/2019 20:34 GMT Standard Time – Describe what the implementation road-map including also Model (focused on PCNs) future for mental areas of Mental Health strategy that still ▪ Following an agreed : health services could need to be developed and integrated into the look like STP-wide Mental Health strategy and Delivery – 7-step Modelling approach – Generate a set of Plan going forward, such as the latest guidance – Needs-based segmentation (SMI, CMI, on LTP implementation, future developments modelling Dementia, mostly healthy) around CYP/CAMHS services et al. assumptions to cost ▪ In doing so, it provides a robust structure and the potential future – 5-service line focus for modelling, and state costing model to integrate additional services – 3-phase, 5-6 month process of data – Describe what it will as they are being developed, aligned with collection, analysis/modelling and financial and operational leaders across the take to deliver engagement STP (e.g. Data Sub-Group, Steering Group) 5 Source: Mid and South Essex STP; Costed Delivery Plan team analysis; approach developed with Data Sub-Group and Programme Steering Group
The population is growing but also ageing rapidly; people aged 2019 75-84 will increase by 28% over the next five years 2025 X Population increase Population, thousands X Population decrease Last Modified 28/10/2019 19:01 GMT Standard Time NHS Southend NHS Castle Point and NHS Basildon and CCG Age group Rochford CCG NHS Mid Essex CCG NHS Thurrock CCG Brentwood CCG STP total 274 260 +5% +2% +7% +7% +4% 84 82 65 60 0-17 47 44 40 41 34 36 +5% -3% -3% -1% -2% -3% 230 225 73 71 18-34 54 53 37 37 35 31 34 30 -2% 325 325 -3% -2% +5% +3% 0% 107 104 72 74 35-54 50 52 51 51 45 Printed 09/10/2019 20:34 GMT Standard Time 43 0% 293 276 +3% +5% +10% +7% +8% 101 96 55-74 62 58 49 48 45 41 36 32 +6% 98 +28% +32% +30% +22% +27% 76 75-84 35 27 19 19 16 15 15 12 10 7 +28% 37 +20% +22% +13% +13% +12% 32 13 85+ 11 8 7 7 6 5 6 3 3 +17% 1,251 +3% 1,199 +3% +6% +5% +4% 408 395 Total 267 281 192 178 184 174 186 184 +4% SOURCE: ONS data 6
Prevalence and contacts will grow across settings of care over the next five years PRELIMINARY Estimated in Estimated in Last Modified 28/10/2019 19:01 GMT Standard Time Category Unit 2019 2025 Assumptions / rationale ▪ Assume prevalence grows in line with population Number of adults Number of 186 178 ▪ Despite high growth in the older population, prevalence with a MH condition patients, k +4% of dementia is still low and overall MH prevalence will remain at 19% (with rounding) 2.25 ▪ Assume growth in line with Primary Care Strategy – Primary care Contacts per 1.86 year, m 3.3% per year +22% Printed 09/10/2019 20:34 GMT Standard Time ▪ Assume demographic growth: CMI – 0.4%, SMI – 0.9%, 0.15 Input to primary & Contacts 0.13 +13% dementia – 2.8% community care ▪ Assume non-demographic growth 1% ▪ Assume demographic growth as above 0.47 Community based Contacts, m 0.41 +13% ▪ Assume non-demographic growth 1% MH support ▪ Assume demographic growth as above 38.8 Crisis Contacts, k 34.8 +12% ▪ Assume non-demographic growth 1% SOURCE: EPUT Activity Data March 2019, PC Strategy document 7
A similar pattern across localities: people in most deprived localities, for example in East Basildon and Southend, are most likely to suffer from depression or psychosis Last Modified 28/10/2019 19:01 GMT Standard Time Prevalence of depression , % Prevalence of psychosis , % ▪ Parts of 14 1.3 East Basildon Southend West 13 0.9 Southend Witham 13 0.8 11 1.4 and East Southend East Central West Basildon 11 0.8 Basildon Wickford 10 0.7 some of the Benfleet and Hadleigh 10 0.7 Grays 10 0.6 highest Corringham 10 0.6 levels of Southend East 10 1.1 deprivation in Printed 09/10/2019 20:34 GMT Standard Time Colne Valley 9 0.7 Chelmsford 2 9 0.8 the country South Ockendon 9 0.7 (top 1%) Rochford 9 0.7 Tilbury 8 0.7 Braintree 8 0.8 Canvey Island 8 0.7 Brentwood 8 0.7 Southend West Central 8 1.5 Chelmsford 1 8 0.7 Prosper 8 0.7 Maldon 7 0.8 Rayleigh 7 0.6 Billericay 7 0.7 Dengie 7 0.7 South Woodham 6 0.5 SOURCE: QOF 8
Patients under Mental Health Act detentions are also likely to be hospitalized longer than national benchmarks Last Modified 28/10/2019 19:01 GMT Standard Time Adult acute mean length of stay for Mental Health Act detentions EPUT 47 Median 41 -14% Printed 09/10/2019 20:34 GMT Standard Time 34 Top quartile -28% Best in region 21 -56% Note: all benchmarking done against providers submitting data to NHS Benchmarking report for 2017/18 1 Benchmarking is shown for whole of EPUT, not only the Mid and South Essex STP population SOURCE: NHS Inpatient and Community Mental Health Benchmarking report for MH72 2017/18 9
…while patients receive fewer community contacts than national average Older adult teams – community contacts per 100,000 registered population Total community contacts per 100,000 registered population Last Modified 28/10/2019 19:01 GMT Standard Time EPUT 16,158 EPUT 23,703 Median 29,447 82% Median 29,883 26% Printed 09/10/2019 20:34 GMT Standard Time Top quartile 41,499 157% Top quartile 37,667 59% 37,000 23,703 Best in region Best in region 129% 0% Note: all benchmarking done against providers submitting data to NHS Benchmarking report for 2017/18 1 Benchmarking is shown for whole of EPUT, not only the Mid and South Essex STP population SOURCE: NHS Inpatient and Community Mental Health Benchmarking report for MH72 2017/18 10
EPUT has proportionately fewer adult consultant psychiatrists and registered nurses as a proportion of inpatient beds Last Modified 28/10/2019 19:01 GMT Standard Time Adult acute registered nurses per 10 beds Adult acute Consultant Psychiatrists per 10 beds 5.5 0.4 EPUT EPUT 50% Median 7.7 40% Median 0.6 50% Printed 09/10/2019 20:34 GMT Standard Time Top quartile 8.8 60% Top quartile 0.7 75% Best in region 8.8 60% Best in region 0.7 -43% Note: all benchmarking done against providers submitting data to NHS Benchmarking report for 2017/18 1 Benchmarking is shown for whole of EPUT, not only the Mid and South Essex STP population SOURCE: NHS Inpatient and Community Mental Health Benchmarking report for MH72 2017/18 11
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