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					The Future of Low Secure
        Services
            Ged McCann
 Associate Director of Commissioning
             Chair of the
National Secure Commissioners Group
                      Context
• Medium Secure Services:
    • Number 64
    • 3000 patients
    • c. £500 M
• Low Secure Services
    • Number 135 approx
    • 5000 patients
    • c. £800 M
• 1% cost reduction = 13 M
                                                                     Secure Trend
                                                                                         Low/Medium/High Secure Split



450                                                                                                                                                                                                                  Total
                                                                                                                                                                                                                     Number
400                                                                                                                                                                                                                  of
350                                                                                                                                                                                                                  Patients
                                                                                                                                                                                                                     in LSU
300                                                                                                                                                                                                                  Total
                                                                                                                                                                                                                     Number
250                                                                                                                                                                                                                  of
200                                                                                                                                                                                                                  Patients
                                                                                                                                                                                                                     in MSU
150                                                                                                                                                                                                                  Total
                                                                                                                                                                                                                     Number
100                                                                                                                                                                                                                  of
                                                                                                                                                                                                                     Patients
50
                                                                                                                                                                                                                     in HSU
 0
                                 Nov-08




                                                                                                                                             Nov-09
                                                                                                         Jul-09
                                                   Jan-09




                                                                                                Jun-09




                                                                                                                                                               Jan-10




                                                                                                                                                                                                            Jun-10
      Aug-08

               Sep-08




                                          Dec-08



                                                            Feb-09



                                                                              Apr-09




                                                                                                                  Aug-09

                                                                                                                           Sep-09




                                                                                                                                                      Dec-09



                                                                                                                                                                        Feb-10
                                                                     Mar-09




                                                                                                                                                                                 Mar-10

                                                                                                                                                                                          Apr-10
                        Oct-08




                                                                                       May-09




                                                                                                                                    Oct-09




                                                                                                                                                                                                   May-10
               100
                         200
                                  300
                                          400
                                                     500
                                                           600




          0
Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

 Jul-09

Aug-09

Sep-09
                                                                 Diagnosis Split




Oct-09

Nov-09

Dec-09

Jan-10
                                                                                   Secure Trend




Feb-10

Mar-10

Apr-10

May-10

Jun-10
                                                Total MI




              Patients
                               Patients
                                                Patients




                               Total LD




              Total PD
                   QIPP
•   Quality
•   Innovation
•   Productivity
•   Prevention

• Aims: cost and quality targets
    QIPP Targets - Secure Care
•   Reduce Length of Stay
•   Reduce admissions
•   Reduce Costs
•   Improve Outcomes
•   Increase Patient Responsibility
Development Programme Aims

1. Development of Model Pathway
2. Patient Portfolio
3. Decision Making Tool – Risk Matrix
4. New Payment Model
5. Best Practise Update/Development
    Programme Management


• National QIPP Board - Kieran Murphy,
  NMHDU
• Secure QIPP Programme – Liz Allen
• £K Reserve
• National Secure Commissioners
  Group/Specialist Commissioning Group
  Delivery
                     1. Model Pathway
     Assessment and Engagement
     Information Gathering from all agencies
Management of immediate risks
Understanding the person
Explore needs and formulate joint actions for Recovery
               •HONOS Secure
•HCR20
•GAS, CAN, BPRS, PANSS
•Recovery Planning Tool

                                      Care and Recovery
                                      Joint care plan (Patient Portfolio)
                                 Psychosis treatment
                                 Drug/alcohol misuse related therapy
                                 Interpersonal violence
                                 Offence related therapy
                                 Personality issues related to risk
                                      •Repeated HONOS Secure and HCR20
                                 •Model of Human Occupation (MOHO) scores
                                 •Recovery Planning Tool scores
              1. Model Pathway
                   Rehabilitation and Discovery
                   Focus on functional skill development
              Increasing independence and social integration
              Structured use of S.17 leave, focus on skill development, social
              networking, and risk testing
              Management of Transitional steps – medium to low, low to community
              •Assessment of Motor and Process Skills (AMPS)
              •Recovery Plan/Star scores
              •Successful Transfer (Failure indicated by return within 9 months)



Key Themes:         - Outcome Based Approach/Standard Outcome Measures
                    - Timeframes
                    - LOS Targets
             2. Patient Portfolio
Moving in
    • Information – environment, security, orientation,
    • Education – care and treatment, therapy
    • Explanation – processes, timescales, care pathway
    • Engagement and Motivation – activities, choice and personalisation

Moving on
    • Treatment Goals and Outcomes
    • Risk and Mental Health – responsibilities
    • Tribunals, leave,
    • Resources
    • Relapse Factors, Coping Strategies, Planning

Moving out
    • Explanation about the different stages of moving out
    • Expected timeframes
    • Roles and responsibilities
    • Staying Out, Future Plan and Advanced Directives
  3. Risk Decision Making Tool
• Standardised Gate Keeping Process
• Risk Matrix
    •   Risk Assessment – escape, violence
    •   Mental Health Assessment
    •   Insight and Compliance
    •   Level of Dependence
• Pathway Trigger
        4. Payment System
• Underpinning payment system that
  rewards outcomes
• Speeds up pathway
• Encourages positive risk taking
• Pulls patients along pathway rather than
  pushes
• Cuts across NHS and IS, and whole
  pathway
   5. Best Practise Guidance
• New Low Secure Guidance linked to
  medium secure best practise
• Web Based range of resources
• DH Policy needs to reflect QIPP
  programme and New Commissioning
  Arrangements
              The Future
• Whole Pathway Partnerships
• Shared Health and CJS Outcomes
• Low Secure Services are a target for
  commissioners, a target for the Ministry of
  Justice, and a business target for FT’s and
  IS Boards…..
           …..We need to get them right
           Ged McCann
Associate Director of Commissioning
Secure and Specialist Mental Health
      Yorkshire and Humber


 Ged.mccann@barnsleypct.nhs.uk

				
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