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Hertfordshire County Council

 

Overview of Service

The Integrated Health and Care Commissioning Team commission mental health services in Hertfordshire on behalf of HCC, Herts Valleys Clinical Commissioning Group and East and North Herts Clinical Commissioning Group. This includes the services provided by Hertfordshire Partnership NHS Foundation Trust (HPFT) such as community mental health services, and psychological therapies under the Improving Access to Psychological Therapies (IAPT) programme. Mental Health social care responsibilities are delegated to HPFT and so they hold the budgets for adult mental health residential and nursing care and social care in the community.

This Market Position Statement provides an overview of the impact of COVID-19 on the Mental Health services and highlights Hertfordshire County Council’s (HCC) anticipated market requirements in the next 9-12 months. For more information or any questions, please do get in contact with us at hertsjct@nhs.net

 

Impact of Covid-19

People with mental health issues have experienced particular stresses during the pandemic, and as evidenced by table 1.0, there is expected to be a significant increase in the demand for services to support people throughout and post COVID-19. The winter months bring further challenges to the market and we need to plan services together to meet the needs of our community. Due to the level of uncertainty at this time, it is unknown what the full impact of the COVID-19 pandemic on the mental health of people on Hertfordshire will be and the subsequent financial costs of this. We are engaged with the relevant parties to refine our estimates as better information becomes available.  


Table 1: Estimates of Impact on Adults living in Hertfordshire (based on Centrefor Mental Health Demand Modelling).

Table 1: Services we commission from the voluntary and community service sector

Population groupMost likely predicted new demand for servicesMental health condition

General population without pre-existing mental health conditions

23,081

Moderate severe anxiety

31,577

Moderate severe depression

People with pre-existing mental health conditions

17,774

Moderate severe anxiety

18,239

Moderate severe depression

Healthcare workers

5,225

Burnout

2,372

Post traumatic distress

7,717

High psychological distress

People recovering from severe COVID-19

139

Anxiety (38%-44%)

100

Depression (26-33%)

78

PTSD (22-24%)

Adult family members of those recovering from severe COVID-19

97

Anxiety (15-23%)

30

Depression

174

Post traumatic stress disorder

Bereaved people

93

Prolonged grief disorder

132

Post traumatic stress disorder

174

Depressive symptoms

People economically affected by COVID-19

318

Major depression

Total

107,319

 

 

Future Plans

Hertfordshire County Council (HCC) lead on the commissioning of mental health services across the council and the NHS in Hertfordshire. Jointly we work to deliver the Long-Term Plan priorities for mental health. Any questions, please do get in touch with us at hertsjct@nhs.net

The main priorities that could lead to opportunities for service development in the next 9-12 months reflect the priorities in the NHS Long Term Plan. They are focussed on new ways of working and commissioning care services based on outcomes, rather than traditional time and task model. This aligns to the Councils ‘Connected Lives’ practice model.

The main priorities are:

Connected Lives for people using mental health services

HPFT are working to align social care delivery to the HCC model of Connected Lives.  This model sets out standards, principles and approaches for staff delivering social care services on behalf of HCC, with an emphasis on prevention and enablement and achieving individual outcomes in line with the Care Act 2014.  This model is built on a foundation of values and ethics set out in the professional standards of social workers and occupational therapists and it applies to all areas of social care practice, not just formal assessments. This will be a key element of the HPFT social care pathway for adults of working age with functional mental disorders.
In order to ensure that staff understand and can deliver the model, the Trust has developed a range of training materials, supporting documentation (including information technology solutions) and will also be holding engagement sessions with teams as the programme develops.
A Connected Lives pilot project will commence in Watford ACMHS in September 2021, with a view to rolling out the model across Hertfordshire throughout the coming year.  


Developing a range of crisis alternative services

Such as crisis cafes and sanctuary spaces, to support people with a mental health crisis that does not involve a visit to A&E or a Section 136 suite. The existing crisis cafes in Watford and Bishops Stortford will continue to be embedded within 2021/22.  The intention is to develop/enhance the range of crisis alternative services into 2022/23 so additional services will need to fit geographically with these, reducing travel times for people further away from these existing cafes.   
 

Improving access to perinatal mental health services

Increasing the number of parents who receive support from both the statutory and voluntary sectors so that 8.6% of all new mothers can access support, around 1,300-1,500 each year. We will be looking for voluntary sector providers to support new mothers, working alongside statutory mental health services and to develop services to support the partners of women accessing perinatal mental health services, offering them assessment for their mental health and signposting to a range of community and statutory support, as required.  
 

Enhancing opportunities for peer support and people with lived experience

Hertfordshire has a strong history of involving people with lived experience and peer support to deliver mental health services, as volunteers and paid employees within organisations.  We are continually enhancing our peer support and lived experience workforce opportunities and we will be looking for voluntary sector organisations with established peer support and lived experience offers to work alongside statutory organisations to deliver mental health services across a range of programmes including community mental health transformation and crisis alternative services, and by participating in the mental health coproduction board in Adult Care Services.


Improving life for people with dementia

Hertfordshire has a strong system of partnerships across health, social care and voluntary sector to ensure people with dementia and their carers receive timely diagnosis and support services, and are able to continue enjoying an independent life wherever possible. We are piloting new models of assessment and pre-assessment support and will be tendering for community support services in coming years. This may also include training and education provision opportunities.


Improving physical health support for people with severe mental illness

People with severe mental illness (SMI) experience poorer physical health than the general population and die, on average, around 20 years earlier. The target is that 60% of adults with a severe mental illness receive support with their physical health each year, around 5,500 people. This will include a GP health check. We are also developing plans for those who may not engage with their GP or need support with improving their physical health once they have seen their GP. This may include voluntary sector proposals for ways to achieve this and so we may ask providers for e-proposals on how best to achieve this.


Winter preparedness plans for mental health services

Hertfordshire has ongoing programmes of winter pressures services procured from a range of statutory and non-statutory partner organisations, which support prevention of hospital admission, timely discharge, and ongoing support to help people stay well in the community. The planning typically takes place over spring and summer months for the following winter, although many of these services are year-round. The spend envelope for these services varies year to year, but is just over £1.4m in 2021-22.
 

Developing suicide prevention plans

NHS England have allocated local areas dedicated funding to develop local suicide prevention plans.  Hertfordshire and West Essex Integrated Care System received around £300,000 this year and we expect this level of funding to continue up to end 2023/24.  In partnership with Public Health, this year we identified, through a grants process, a range of small local organisations who were ready to carry out suicide prevention activities and provided them with a small amount of additional funding to mobilise these.  We expect to be able to offer the same opportunities to small local organisations over the next two years.  

This suicide prevention funding will be enhanced with a small pot of dedicated funding, around £64,000 from NHS England to be spent solely on suicide bereavement support for family, friends and professionals involved.  We are planning to work with small local organisations to develop this offer.  
 
Underlying all of these areas is an increased focus on inequalities and reaching parts of the community that traditionally have experienced poorer mental ill health, or poorer outcomes from services. We recognise that this may need different approaches to service delivery.  For further information or support please contact hertsjct@nhs.net

 

Completed Tenders

HPFT have gone out to tender contracting providers to join a framework for Enablement at Home Support services launched 1st Sept 2021. These services are community based for adults with mental health diagnoses to provide enabling type support with day to day living. Thirteen providers where successful.

The framework sets out price ceilings for the two support levels; standard and enhanced, as well as allowing Mental Health service users to access the 6 weeks of uncharged enablement at home that other social care services offer. This also benefits the service user, as there is a brokerage system to ensure the provider has the skills available to match the service users’ needs as well as offering value for money. Service users will be reviewed at their natural review date and offered the opportunity to move over to the framework provider. The CMHTs do have the flexibility to create bespoke packages that are outside of the price ceilings, where necessary, and to also commission off framework where there is justification for doing so. Service users will continue to be supported to set up personnel budgets.


Provider Review Program

The Provider review program (PRP) is a rolling two-year programme, HPFT are current completing the first set of reviews which are scheduled for completion in November 2022. Reviews have been ongoing, and as providers reset following the latest increase in Covid rates, capacity to engage in the process is increasing. This program involves the provider in a full financial review to establish if the costs of care are reasonable, too low or too high-the process allows for open conversations between commissioners and providers to ensure value for money. HPFT are reviewing the care of each service user with the provider at the same time to ensure, the providers business model is sound and that the care provision is at a level expected

Presently there are several provider reviews at various stages of completion. The Full Year Effect of savings achieved in the Financial Year 20/21 was £250,590.05, There are themes emerging suggesting residential services are under-funded whereas hourly rates for supported living services are higher than market rate.

 

Upcoming Tenders

The service contract for the Midpoint Intensive Enablement medium stay supported living scheme in Stevenage is planned to come to market in 2022. HCC and HPFT are exploring options for developing an additional scheme on a similar model and scale to Midpoint, located more in the west side of the county. This would be a social care model of enablement accommodation-based support which focusses on helping people gain and regain skills for independent living over a 12-18 month period, often following a period of acute mental ill health.

 

Market Gaps

HPFT alongside commissioners and guidance from CQC are looking more closely at the availability of all accommodation for service users with a SMI within the county.  Organisations are concerned that there is a lack of residential care and nursing care environments for service users with co morbid physical health and a SMI.  HPFT will spend the next few months working with providers to establish if the market can be extended to support this group of service users within Hertfordshire rather than the present need to commission, in most cases, outside the county borders often leaving individuals often more than 50km from their family and friends.

 

Monitoring of mental health voluntary sector contracts

Voluntary sector mental health contracts

By responding quickly to the emerging needs of the population, delivering services differently as well as delivering flexible innovative services, the mental health voluntary sector organisations have played a significant role in ensuring that primary care and statutory mental health services have not become overwhelmed throughout the pandemic. The IHCCT are both reviewing current contracting arrangements alongside working in partnership with Adult Care Services to align future contracting arrangements with the voluntary sector via the VCSE Alliance and the development of a shared strategy for VCS, which will have oversight from the newly established Joint Strategic Commissioning Board.  This will ensure that our VCS organisations have the stability they need to continue to respond in a flexible way to meet the emerging needs of the population now and in the future.    Further detail is available in the Market Position Statement for VCS and carers.


Autism review

The purpose of the autism review was to give clarity to arrangements that are in place for people with autism and support their application, whilst highlighting gaps and proposing options for improvement.  Phase One focused on two areas, specifically the adult’s autism assessment pathway and post-diagnostic support available to adults with adult social care needs in Hertfordshire.

The review concluded in October 2020 and made some key recommendations which are now being implemented, the most significant being investment to reduce the backlog of the waiting list (there is currently a 3 year wait for autism assessment in Hertfordshire), and the launch of a new autism community support service.

 
Reducing the autism assessment waiting list backlog

Commissioners are currently concluding market engagement work to map autism assessment capacity and anticipate that a contract to reduce the waiting list backlog will be in place by the end of October 2021.


Hertfordshire Community Support Service – Autism Hertfordshire

Autism Bedfordshire have been awarded the contract for the provision of the Hertfordshire Autism Community Support Service after a robust procurement exercise.  Mobilisation has commenced with the new provider and we aim to launch the service in October 2021.  It is anticipated that over 700 people will be supported by the new community support service (to be known as Autism Hertfordshire locally) in year one.  The new community service will deliver pre and post diagnostic support through a combination of 1:1 work alongside a range of training and development opportunities and workshops on understanding autism and prevalent co-morbidities.


Phase Two of the Autism review

A proposal to commence phase two of the review has been approved by the Mental Health and Learning Disability Collaborative Board.  The second phase of the review will focus on specialist, mainstream and community provision for adults with forensic, behavioural, and mental health needs.  The review will aim to bring some clarity to arrangements around health and social care responsibility, mental health and crisis support and Section 117 responsibility to ensure that we can prevent hospital admission and step people down safely.  The scope of the review has also been widened to include other neurodiverse conditions i.e.ADHD


Carers

We will continue to fund support to carers through advice, breaks, peer support and other projects. All commissioned services are expected to identify & support carers and refer them to sources of further support.  People with mental health issues have experienced stresses during the pandemic, including reduced face to face peer support groups, and this has affected their carers. We are working closely with Adult Care Services as they refresh the Hertfordshire Carers strategy and with our mental health trust, HPFT to ensure carers needs are met, they are kept informed about services and to ensure that the models of support they wish to see are available for example on-line groups.  Further detail is available in the Market Position Statement for VCS and carers.

 

Contact information

For more information and support, or for providers who would like to informally discuss the service and opportunities available, please contact by email: hertsjct@nhs.net or by phone: 01438 845667.

Links

  • Provider Hub – Launched by HCPA and HCC during COVID-19, the provider hub supports adult care providers with a Coronavirus Support Line and email and regularly updated FAQs.

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