Mental Health
Mental Health issues affect 1 in 4 individuals at some stage in their lives. Co-morbidities and codependencies of services are the norm. The aim of the CCG in partnership with South Gloucestershire
Council is that we have the skill, capacity and capability within services to deliver recommended treatments
and interventions to meet the needs of individuals as determined by the national Health of the National
Outcome Scales (HONOS) Care Clusters for Mental Health.
Our responsibility is to ensure that community services, acute services and mental health services
commissioned by the CCG are able to meet the needs of that individual in the most appropriate location.



All people with mental ill health have an equal right to healthcare
All healthcare services should be accessible to people with mental ill health, with reasonable
adjustments being made where necessary to support them when they are unwell
All healthcare services should be “friendly” services to all vulnerable adults.
Clinical leads: Dr Peter Bagshaw
Priorities to be addressed:
1. Commission local specialist assessment and follow up services for people with attention deficithyperactivity disorder (ADHD).
2. Commission a local Autism diagnostic service to include specialist assessment and, in conjunction
with the local authority, to provide on-going therapy, support and practical assistance.
3. Increase the availability of talking therapies within secondary mental health services.
4. Suicide and self-harm prevention via a new SG suicide prevention partnership and strategy led in
partnership with Public Health.
5. Ensure safeguarding practices are improved within the mental health and learning difficulties
services.
6. Ensure through service redesign that mainstream services are accessible to vulnerable adults,
including those with mental health or learning difficulties.
7. Work together across health and social care to ensure adults with autism are benefiting from the
personalisation agenda and can access personal budgets. Social care target.
8. Services can make mental health and learning disabilities should also take into consideration the
additional impact of sensory loss.
9. Delivery of the South Gloucestershire Autism Strategy.
10. Compliance with the national Health of the Nation Outcomes Scale (HONOS) Mental Health
Cluster and associated tariff developments.
11. Public Health outcome scale
12. Delivery of No Health without Mental Health
13. Revised Green Light Toolkit (2013) for people with a learning difficulty experiencing mental health
issues
14. NHS Outcome Domains
Domain 1
Domain 2
Domain 3
Domain 4
Domain 5
Preventing people from dying prematurely
Enhancing quality of life for people with long term
conditions
Helping people to recover from episodes of ill health or
following injury
Ensuring that people have a positive experience of
care
Treating and caring for people in a safe environment
and protecting them from avoidable harm
Effectiveness
Patient
experience
Safety
Initiative: Increase commissioned capacity in the Attention Deficit Hyperactivity Disorder service
(provider AWP), with the aim to reduce waiting lists down to 18 weeks. The current waiting lists are
long, demand is predicted to increase.
Priorities it will address:
What patients will notice
1, 6,
 Reduced waiting list time for ADHD services
NHS Domain 2, 4, 5
 Patients transitioning from young people to adult
services will receive timely prescribing for
continuation of medication

How it will be measured:
 Waiting list length
 Patient satisfaction with the service
 Robust transition from CAMHS to adult
ADHD service.
Ensuring people will feel supported to manage
their condition
Financial implications (cost and any associated
QIPP):
This will be a cost pressure for 2014 of £20k
Initiative: Expand the autism diagnostic service as waiting lists are currently over 9 months.
Waiting list for post-diagnostic support is long.
Priorities it will address:
2, 3, 6, 7, 9
NHS Domain 2, 4
How it will be measured:
 Waiting list length for diagnostic and
post-diagnostic intervention.
 Patient satisfaction with the service
 Waiting list initiative funded through a
CQUIN 2014/15 (36 cases)
What patients will notice
 Reduced waiting list time for autism diagnosis
 Reduced waiting list time for post-diagnostic
support
 Improve provision of post-diagnostic support
options from existing commissioned services with
South Gloucestershire Council.
 Ensuring people will feel supported to manage
their condition.
Financial implications (cost and any associated
QIPP):
This will be a cost pressure: to reconcile the existing
waiting list and to provide sufficient capacity for
anticipated demand. The cost pressure for 2013/14 is
£60K above commissioned resource.
Initiative: Improve access to talking therapies for people using secondary mental health services.
Priorities it will address:
3, 6, 10
NHS Domain
2, 3, 4
How it will be measured:
 Delivery of agreed mental health cluster
treatments and interventions schedule.
 Delivery of agreed AWP tariff schedule.
What patients will notice
 Access to recommended talking therapies
 Ensuring people feel supported to manage their
condition
Financial implications (cost and any associated
QIPP):
Close local monitoring required to mitigate potential
financial risks.
Initiative: Joint South Gloucestershire Council – Public Health Directorate and Clinical
Commissioning Group – working group on Suicide and Self-Harm prevention
Priorities it will address:
4,6, 11, 12
NHS Domain
1, 5
How it will be measured:
 Robust self-harm pathways from
primary to acute services
 Suicide prevention action plan
 Improve satisfaction of liaison
psychiatry
 Reducing length of stay from acute
 Facilitating early discharge
What patients will notice
 Robust and effective response to presentations in
A&E
 Ensuring people feel supported to manage their
condition in Primary care
Financial implications (cost and any associated
QIPP):
Winter monies in place to increase psychiatric liaison
capacity in Southmead and Frenchay for 2013/14.
Initiative: Improve monitoring of patients on anti-psychotics drugs in the community, and ensure
they are treated as a high risk group due to the increase cardiovascular risk associated with these
drugs.
Priorities it will address:
What patients will notice
6, 10, 11, 12
 Appropriate clinical and lifestyle interventions and
NHS Domain 1, 2, 4, 5
monitoring from primary care, secondary care and
healthy living support when taking anti-psychotic
drugs
How it will be measured:
 Cardiovascular events in patients on
anti-psychotic drugs
 Improved patient safety for people
prescribed anti-psychotic medication.
 Improved patient satisfaction by
working to mitigate effects of antipsychotic medication.
Financial implications (cost and any associated
QIPP):
Proposed CQUIN for AWP to commence monitoring
schedule for patients prescribed anti-psychotic
medication.
Proposed LES for practice nurses to provide
monitoring for this high-risk group. QIPP value???
Initiative: Joint review of Whittucks Road Rehabilitation Service with AWP and BANES.
Priorities it will address:
3, 10
NHS Domain 2, 3, 4, 5
How it will be measured:
 Patients report improved experience of
service
 Patients enabled to move into stepdown provision (own home, supported
living etc)
 Patient outcomes will be reported and
monitored
 Staff are trained to support individuals
presenting with high levels of need.
 Equality of access for provision of
rehab for people with physical health
needs.
What patients will notice
 Improved rehabilitation opportunities
 New service user feedback opportunities
 Equality of opportunity to access the facility for
people with physical disabilities.
Financial implications (cost and any associated
QIPP):
Potential to expand on-site provision and reduce
onward placement costs for residents subject to
Section 117 aftercare.
Initiative: Comply with Royal College of Psychiatry Section 136 provision recommendations.
Priorities it will address:
4,6
NHS Domain 5
How it will be measured:


Monthly AWP monitoring report on
Section 136 provision.
Monthly police statistics on Section
136 detentions and place of
assessment.
What patients will notice
● Provision of Section 136 detention place of safety
in a fit for purpose (non-custodial) environment.
Reduced assessment waiting times.
Financial implications (cost and any associated
QIPP):
For 2014/15 £76k for 0.33 space. Recommended
contingency of £24k to cover cost per case (at risk)
provision. Cost per hour for section 136 suite has
been confirmed by AWP at £33 per hour.
Initiative: Section 12 Doctor provision. Scoping exercise led by SWCSU on Section 12 Doctor
provision across AWP commissioned area. Exploration to include potential for rota arrangements,
salaried provision etc.
Priorities it will address:
What patients will notice
NHS Domain 5
● timely access to Section 12 Doctor provision for
mental health act assessments.
How it will be measured:
 Scoping paper to go to Board for
decision.
Financial implications (cost and any associated
QIPP):
2012/13 spend was £137k for South Gloucestershire.
Potential QIPP if jointly commissioned service is
deemed feasible.
Initiative: Psychiatric inpatient services review at Callington Road and Oakwood Ward,
Southmead. Review of use of inpatient beds with Bristol (and possibly wider catchment) to see if
using them differently could offer improvements in the quality of the service provided to individual
patients.
Priorities it will address:
What patients will notice
NHS Domains 1, 3, 4, 5
● Positive experience of inpatient services
 Supported transition between inpatient and
step-down
How it will be measured:
 Friends and Family Scores
 Acute care forum feedback
 Monitoring of out of area
placements for acute and
psychiatric intensive care unit
(PICU)
 Reduction in re-admissions
Financial implications (cost and any associated
QIPP):
Currently unknown.
Initiative: Ensuring that the pathways between IAPT and secondary mental health services
are safe and robust. Ensuring that IAPT assessment and provision meet the mental health
need of the individual. Increase involvement in IAPT therapeutic groups.
Priorities it will address:
NHS Domain 1,3, 5
How it will be measured:
 Monthly contract performance
monitoring
 Any Qualified Provider monitoring
meetings
 Service User experience reporting
What patients will notice
 That they receive a cohesive and effective
response and service to their presenting
mental health need.
Financial implications (cost and any associated
QIPP):
Within contracted funds.
Initiative: Implementation of the Enhanced Quality Assurance Framework for all Mental Health
placements.
Priorities it will address:
5, 8, 10, 12
NHS Domain 1,2,3,4, 5
What patients will notice
 Effective provision, personalised to meet their
needs and support recovery
How it will be measured:
 Care Programme Approach
 Enhanced Quality Assurance
Framework monitoring
Financial implications (cost and any associated
QIPP):
-
Initiative: To support and contribute to the Joint Health and Wellbeing Mental Health Strategy.
Priorities it will address:
NHS Domain 1,2,3,4, 5
How it will be measured:
 Agreed strategy and action plans.
What patients will notice
 Effective services personalised to the
individual to support step down from
secondary services.
Financial implications (cost and any associated
QIPP):
-