Mental Health Service Models for Young People

In 2015, the government committed five years of extra funding for children and young people’s mental health services (CYPMHS). All areas of England were required to submit plans outlining how they will improve their services by 2020.

This POSTnote describes some of the new models of CYPMHS and examines the challenges to their effective implementation.

Overview

  • The Office for National Statistics estimates that nearly one in four Children and Young People (CYP) show some evidence of mental ill health.
  • It is estimated that between £70-100 billion is lost each year in the UK due to poor
    mental health.
  • New models of CYP mental health services are currently being developed across the
    country to suit the unique needs of local areas. They include whole-system, schoolsbased, community-based and other models, and involve integrating services from across the statutory and voluntary sectors.
  • Issues with implementing new service models include data monitoring, recruiting
    and retaining staff and funding.

Full document available here

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NIHR Signal Early discharge ‘hospital-at-home’ gives similar outcomes to in-patient care

Gonçalves-Bradley DC, Iliffe S, Doll HA, et al. Early discharge hospital at home. Cochrane Database Syst Rev. 2017;6:CD000356.

Supported early discharge, where patients receive on-going hospital-level treatment in their own home, had no effect on mortality compared with standard in-patient care. Patients had shorter hospital stays, were more likely to be satisfied and less likely to end up in residential care.

This updated Cochrane review identified 32 international trials comparing early discharge hospital-at-home with hospital in-patient care. Most evidence related to people recovering from a stroke, where NICE already recommends supported discharge if this is appropriate. Other patient groups included those recovering from orthopaedic surgery and older people with various conditions. Trials were relatively small and the overall evidence quality was moderate to low.

The review aimed to see whether early discharge has an effect on NHS costs, but found insufficient evidence. Training, staffing and equipment costs need to be measured against patient outcomes in different therapy areas. Early supported discharge needs to be driven in areas where it can make the most difference and give the greatest benefit.

 

Effectiveness of UK provider financial incentives on quality of care: a systematic review

Rishi Mandavia, Nishchay Mehta, Anne Schilder and Elias Mossialos. Effectiveness of UK provider financial incentives on quality of care: a systematic review. Br J Gen Pract 9 October 2017; bjgp17X693149. DOI: https://doi.org/10.3399/bjgp17X693149

Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency.

Aim To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care.

Design and setting Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.

Method MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as ‘positive’, those that were ‘intermediate’ showed improvement in some measures, and those classified as ‘negative’ showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist.

Results Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points.

Conclusion The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives — if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK.

Prevention in action: how prevention and integration are being understood and prioritised locally in England

British Red Cross, 2017
red crossThis report states that local authorities in England must do more to provide services that prevent, reduce or delay the need for care and support. It has identified shortcomings in plans for integrating health and social care, and provides a national picture of local developments and areas of good practice.

 

Making the case for quality improvement: lessons for NHS boards and leaders

King’s Fund

This briefing makes the case for quality improvement to be at the heart of local plans for redesigning NHS services. It does this by drawing on existing literature and examples from within the NHS of where quality has been improved and describing how this was done

Collaboration in general practice

Collaboration in general practice: Surveys of GP practices and clinical commissioning groups | Nuffield Trust |  Royal College of General Practitioners

This report summarises the results of two surveys, sent to general practice staff and to CCG staff, aimed at finding out what had changed in the landscape of general practice since the previous surveys two years ago and to explore what GPs feel the future holds for them.

Key findings include:

  • The scaling up of general practice continues apace with 81% of general practice-based respondents reporting that they were part of a formal or informal collaboration, up from 73% in 2015.
  • However, the landscape is complex. Practices often belong to multiple collaborations that operate at different levels in the system, having been set up to fulfil different purposes.
  • The main priorities of all collaborations over the last year were: increasing access for patients, improving sustainability, and shifting services into the community. The priorities differed by size of collaboration. Both providers and commissioners reported that time and work pressures were the biggest challenge to collaborations achieving their aims.
  • When asked about developments in their local area, over half of GP staff and one-third of CCG staff surveyed felt practices and collaborations had not been at all influential in shaping the local sustainability and transformation partnership (STP). Only one-fifth of GPs thought STPs would deliver meaningful change in primary care. CCGs were more optimistic, with 61% reporting that meaningful change was probable.
  • When questioned about future models of care, around half of practice partners (53%) said they would be ‘unwilling’ or ‘very unwilling’ to give up their current GMS/PMS/APMS contract1 to join a new models contract (e.g. MCP or PACS contract2). The most common reason they gave was that they did not want to lose control of decision-making and leadership in their practice.

The report can be downloaded here