Merton Mental Health Forum How the main mental health contract works? Emma Gennard 13 January 2016
Introduction The following presentation has been created at the request of the Merton Mental Health Forum to help provide a better understanding of how the main mental health contract works. The presentation is quite short, to avoid information overload. It will be presented by the Mental Health Commissioner who can elaborate and respond to questions and queries. A further update may be required depending on the level of information needed to ensure the group has the understanding they require. Merton Mental Health Forum 2 13 January 2016
Overview of Secondary Mental Health Services Contract • The main mental health contract is with South West London St Georges Trust. • The CCG uses their annual allocation to pay for a ‘block’ contract. • A block contract is a good way to ensure the provider knows their income and also for CCGs to ensure they only spend the amount of money they have got. • This is an agreed amount of money to cover all the services that are set out in the service specifications. • This includes CAMHS, Older People and Working Age Adults. • Commissioners have to manage the contract in line with the terms and conditions set out in the NHS Standard Contract. We cannot change these terms, this is so that everybody works in the same way and helps to ensure services are stable even when there are changes in the way that the CCG commissions or the provider, provides the services. • Contract schedules are the details of the contract these include quality, finance and information. • Everything is agreed in advance of the new contract year (1 April), this ensures everybody knows what is needed throughout the year. Performance Management – Month 2 3 18 January 2016
The Mental Health Budget The annual budget for Adult Mental Health services in Merton for 2015-16 is £18 million. What service? Who provides it? How much? (£)* (*rounded figures) Secondary Mental Health Services SWLstG Trust £15.4 Mil IAPT Addaction £1.5 Mil Inpatient Alcohol Detoxification Sussex Partnership Trust £320k Non-Contract Activity National Providers £283k MH Specialist Services South London and Maudsley £30k Cross Boundary Flow South London and Maudsley £252k Advocacy Imagine £33k Carers Support Carers Support Merton £50k Mental Health Enquiries Internal Budget £50k Psychiatric Liaison SWLStG Trust £82k (one off this year only) **Breakdown provided is indicative as some budget lines can change depending on activity throughout the year. Mental Health Forum 4 13 January 2016
How is the budget set and managed? • The starting point is based on the previous years budget (we can only spend what we have already got as the majority of funds is already an agreed financial amount in a contract). • This may be adjusted depending on the annual allocation from the government to the CCG. • We can only make new investments if the government give us more money in our allocation and or we have managed to reduce costs elsewhere either in mental health and or within the CCG. • Sometimes the government provides additional income for specific mental health schemes, these are usually specified in the national planning guidance. • We agree our contract payment mechanism (this is usually either a block (set amount), tariff (price for activity), cost and volume (price for activity affected by volume). • We then have to very closely monitor our contracts and ensure we are checking our budgets monthly to ensure we are not spending more money than we planned to in line with the agreed contracts. 5 18 January 2016
How is the contract managed • Merton CCG is the contract host. This means that Adam Doyle, Chief Officer at Merton is responsible for ensuring the contract works well in South West London. If there are any questions from NHS England, Adam is responsible for responding to this. • Individual service queries are raised with the individual CCGs relevant to that query. • SWL CCGs (Kingston,Merton,Richmond,Sutton & Wandsworth) pay the South CSU (Commissioning Support Unit) to manage the contract on their behalf. This means the process of ensuring the contract is used properly and fully and that we have everything in place when we should. • The CSU is responsible to Adam Doyle as the lead for the contract in SWL. • There are a number of meetings that are agreed in the contract which help the CSU and CCGs to monitor the contract and ensure everything is working well. • In addition CCGs may have their own meetings with the provider but anything that is set out in the contract must be addressed by the CSU. • A monthly contract monitoring meeting takes place chaired by the CSU and is attended by all commissioners in SWL and the Trust. • At this meeting we review and discuss performance against the agreed schedules in the contract and highlight any concerns or issues with the services of contract. 6 18 January 2016
How do we monitor the contract? • The CSU chairs a monthly contract performance and monitoring meeting where they look at agreed reports to check how the provider is doing. This meeting is also attended by all SWL commissioners. • The Trust send all the required reports to the CSU and they bring all this information together to start to help identify where there might be problems. • At this meeting the group looks at the monthly performance reports that have been agreed with Key Performance Indicators to demonstrate how well they are performing. • This helps us to keep an eye on how the service is performing and provides the opportunity to help identify issues and or improve services. • A monthly Clinical Quality Review Group also takes place and is chaired by the SWL Clinical Lead (Dr Phil Moore) and attended by the MH clinical lead and commissioners for each CCG and the Trust Medical Director. • This meeting is to review and discuss the agreed quality reports that are in the contract and to raise and discuss any clinical concerns. The aim of the meeting is also to ensure that any changes to services are clinically overseen by the CQRG as well as by individual CCGs. • There are also regular local meeting with the provider and individual CCGs where each CCG will raise and discuss particular areas of interest either due to problems, issues and or ideas for improvement. This is where stakeholder engagement can really influence and input into service changes. In Merton we hope that the Mental Health Forum partnership will start ensuring we have more feedback and steer about local services to help influence and shape services. • The CCGs will then use local discussions to inform more formal discussions about the contract. 7 18 January 2016
What reports do we get? • A monthly performance schedule that shows whether CCGs are Red, Amber or Green. • A monthly exception report that explains any dips and or problems in performance and tells us how they are going to improve this. • An activity report that is broken down into Mental Health Clusters. • A monthly quality report that is submitted to the CQRG for review • We can ask for other reports but the Trust will only provide information where we give a good reason. It is sometimes a bit of a challenge, but this is why local meetings are so helpful to build a clear understanding of what we need and why and explain what we are going to do with it. • Reporting requires a lot of organisation and resources, so the Trust is always very keen to avoid reports for reports sake which I think we can all understand. 8 18 January 2016
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