Norfolk Clinical Commissioning Groups and
Norfolk County Council Adult Social Care
The Commissioning Environment
Clive Rennie,
Head of Integrated Commissioning for Mental Health &
Learning Disabilities
1
Coverage

National MH Strategy

Current Funding Environment(s)
 CCG’s
 NCC

Organisational Arrangements
Commissioning
Intentions
2
National Picture – The Messages
 Feb
2011 “No Health without Mental Health”
 Health
and Social Care Act 2012
 Mandate
to NHS Commissioning Boards 2012
3
National Picture – The Messages
Mental Health – “Everyone’s business”
 Wider benefits to society of good Mental Health
 Interlinks with other Central Government
Departments
 Cross cutting strategies
 Community Responsibility
 Localism
 Reduce premature deaths

4
National Picture – The Messages
Increase Employment
 Increased access to MH services in Criminal Justice
settings
 Listen to the Patient experience
 Mental Health is of equal status to Physical Health
 Earlier intervention – IAPT
 Outcomes Focused
 Recovery Focused
 Payment by Results/ payment by Activity

5
Current Funding Environment
Clinical Commissioning Groups
2.3% extra funding in 2013/14
 CCG’s have a recurrent deficit position based on PCT
end position
 All CCG’s have to save 2% non-recurrent usage
 All CCG’s have to have a 1% surplus
 Activity, demographics and technology advances are
adding cost pressure of 2% and above per annum
 Continuing Health Care Restitution Costs – 15% growth
per annum

6
Current Funding Environment
Clinical Commissioning Groups
Increased funding passed across to Social Care from
CCG’s
 3% cost savings need to be made through Quality
Innovation Productivity and Prevention (QIPP) plans
 Equates to:
– £20Billion nationally
– £30M locally across the 4 CCG’s Norwich, West,
South, North
 No indication of the funding settlement for 2014/15
until December 2014

7
Current Funding Environment
Clinical Commissioning Groups
Increase
funding pass through to Social Care
Increased pressure on Acute i.e. A&E/ Beds/
Dementia
Community provision focus
What currency? Block/ Cost and Volume/ PbR Care
Clusters
8
Current Funding Environment
Norfolk County Council Adult Social Care
Comprehensive Spending Review 2011
 NCC savings 140M
 2011-2014 – 50.62M savings in Adult Social Care
 Comprehensive Spending Review 2014
 2014 – 2017 – 189M savings in NCC
 2014/15 – 73M savings

9
Current Funding Environment
Norfolk County Council Adult Social Care
2014 – 2017 – Adult Social Care share of the savings
56.6M (1% of the Adult Social Care budget)
 2014/15 – 21M
 2015/16 – 26.7M
 2016/17 – 8.2M
 Consultation - Norfolk Putting People First – starts
19th September

10
Integrated Commissioning
Organisational Arrangements

Integrated Commissioning Team for Mental Health
and Learning Disabilities

Legal agreement under Section 75 of the Health and
Social Care Act 2012 between:
Norfolk
Clinical Commissioning Groups
Norfolk County Council
NHS Anglia Commissioning Support Unit
11
Integrated Commissioning
Organisational Arrangements
Head of MH and LD Commissioning for 4 Norfolk
CCG’s and NCC
 Commissioning Lead for Adult Social Care
(Community Services)
 Head of Service, Mental Health
 Commissioning Lead - Adults with Learning
Disabilities
 Commissioning Lead - Dementia
 Commissioning Lead – Autism/ Aspergers
 Commissioning Lead - IAPT

12
Commissioning
Organisational Arrangements
Creation of the NHS England and Area Teams
 Linkage to the Department of Health
 Creation of Commissioning Support Services
(Hosted)
 Transfer of Public Health

13
Integrated Commissioning
Organisational Arrangements











Mental Health and Learning Disability Commissioning Board –
Norfolk CCG’s, Norfolk Adult Social Care, Public Health,
Healthwatch
CCG Board’s
Adult Social Care – Senior Management Team
NCC - Cabinet
NSFT – Contract and Performance Meeting
Contract meetings with other providers
Information and Performance Sub Group
IAPT Contract Sub Group
Clinical Quality and Patient Safety Reference meeting
Access and Assessment Service Reference Group
GP Leads clinical meeting
14
Organisational Arrangements –
Providers

Mental Health – Providers
 Norfolk
and Suffolk Foundation Trust - Main Contract
 Norfolk and Suffolk Foundation Trust – IAPT
 Norfolk County Council Children’s Services – FST
 Individual Placements – PICU/ LSU/ Residential – Justin
Gardner Unit, Alpha, Huntercombe Manor, Cherry Tree,
Orchard House, Newmarket House, S3, Rhodes Farm, Ketts
Park, Elsenham House,
 Gender Dysphoria – Charing Cross Hospital, St Peters,
Imperial
15
Organisational Arrangements
- providers
Eating Disorders – Norfolk Eating Disorder
Association, Cambridge and Peterborough MH FT
 Autism/ Aspergers – Aspergers Service Norfolk
 Adult ADHD - NSFT
 Veterans Health – Julian Support
 Frequently Attending Patients (CQUIN) - NSFT
 Joint Funding – Julian Support, MIND Norwich/ West
Norfolk, Equal Lives
 Single Funding – Rethink, City Reach, Timberhill GP
Led Walk-in Centre, Eating Matters, SOS Bus

16
Organisational Arrangements
– Budgets/ Expenditure approximations
Mental Health Main contracts 100M
 IAPT 10M
 Forensic 21M
 CAMHS 2M
 Independent Placements 10M
 Third Sector 1M
 Eating Disorders 1.1M
 Gender Dysphoria 50K
 Deaf Peoples Services 177K

17
Draft Commissioning Intentions 2014/15




To undertake the financial instruction (deflator)as outlined in
Operating Framework for the NHS for all Mental Health and
Learning Disability contracts with Health funding streams
To review all Health funded third sector contracts in line with
the principles established by Norfolk CCG’s
To undertake the necessary actions to reduce the spending
commitments on services in line with the budget reductions
set by NCC Cabinet
To reduce the current numbers of clients in Residential
provision and to minimise the use of permanent Residential
placements
18
Draft Commissioning Intentions 2014/15



To simulate the market via the Market Position statement to
reduce the Residential care and Nursing Home provision
To increase the Supported Housing options available. To
revise supported living standards and create a clear
accreditation scheme for providers around supported living
To increase the number of Mental Health clients supported in
the community via Supported Housing, independent
accommodation with community support and to tender
supported living schemes provided by the third sector in
central Norfolk in 2014
19
Draft Commissioning Intentions 2014/15


To increase the use of Personal Budgets, Carers assessments,
numbers of mental health clients in stable accommodation
and in employment
To work with the DAAT to implement the recommendations
of the recent review of Tier 4 services around residential care
and supported housing for people with dual diagnosis.
Focussing on detox piloting
20
Other Draft Commissioning Intentions 2014/15



Dementia diagnosis trajectory to meet national calculator
uplift between 2% - 5% per annum – requirement for
additional resource to meet the early/ timely diagnosis of
patients.
To ensure the pathway for patients assessed and referred
under the FAIR scheme (Dementia CQUIN into the Acute
Trusts 2012/13/14) is opened to direct referrals from Acute
Trusts to Memory Services and to ensure that the current low
level waiting times are not compromised by this change of
pathway.
To implement the Dementia Direct Enhanced Service
agreement for GP’s to ensure that accurate recording of all
patients with Dementia is on the Quality and Outcome
Framework
21
Draft Commissioning Intentions 2014/15



The system of activity and currency is changing in 2014/15 for
the main Mental Health FT contracts to shadow Payment By
Results as opposed to the current Block contract
arrangements. This change will need to translate into the
2014/15 main contract
The restructuring of Mental Health services under the Radical
Redesign process and the Payment By Results Care Clusters
requires new clinical specifications to be agreed and costed.
Specific work is being undertaken for the design and
modelling of the Psychiatric Liaison Service at QEH
22
Draft Commissioning Intentions 2014/15



The Improving Access to Psychological Therapies service
across all the CCG’s in Norfolk will be re-commissioned in
2015. To undertake options appraisal leading to the tendering
and procurement process in 2014/15
Specific work is being undertaken for the design and
modelling of the Psychiatric Liaison Service at QEH
To ensure that the self-assessment of Autism commissioning
and provision is undertaken and to plan the implementation
of the outcomes of any deficits within the Norfolk system that
are identified
23
Draft Commissioning Intentions 2014/15




To appraise the options as regards the potential
establishment of a new Section 75 arrangement for Social
Care provision in Mental Health
To agree the Section 75 arrangement between NCC and the
Norfolk CCG’s for Learning Disability Services
To have staffed 136 suites in place throughout Norfolk. This is
in line with recent CQC and HMIC report recommendations
To adopt, in Norfolk, the pilot and standards set in the North
Essex agreement for the conveyancing of Mental Health
patients by EEAST.
24