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090127 FAQs Denominator Definition for NI149 and NI 150

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									Frequently Asked Questions on the Denominator Definition for NI149 and NI
150 - January 2009


This document answers some Frequently Asked Questions (FAQs) concerning
the definition of the denominator for NI 149 and NI 150.


1. Who is included in the denominator for indicators NI 149 and NI 150?

The denominator includes those who are in contact with secondary mental health
services who are also on the Care Programme Approach (CPA). The CPA is the
framework that supports and co-ordinates effective mental health care for people with
severe mental health problems in secondary mental health services.


2. Why focus on those only on the CPA?

NI 149 and NI 150 are two of the eight indicators in the Public Service Agreement for
Socially Excluded Adults (PSA 16). The PSA aims to ensure that the most socially
excluded adults are offered the chance to get back on a path to a more successful
life, by increasing the proportion of at-risk individuals in settled accommodation and
in employment.

The PSA focuses on four client groups who are particularly vulnerable to multiple
forms of disadvantage, and who may be negotiating a difficult transition such as
leaving prison or long-term care. These two factors make them particularly at-risk of
falling into persistent exclusion, but also means that they are in contact with the
services that could and should make a difference.

Focusing on those who have severe mental health conditions who are on the CPA
reflects the principles of being at risk but also being in contact with services. Those
on the CPA are reviewed against their needs and outcomes at least once per year,
and the CPA provides a clear delivery mechanism (i.e. holistic needs assessment,
care planning and review, coordination of services via a lead professional) for
assisting those with mental health problems into a “job and a home” that isn‟t
available to those not on the CPA.


3. Hasn’t the CPA changed? Why are the indicators still focused only on those
   on the CPA?

Subsequent to the publication of the indicator definitions, the document „Refocusing
the Care Programme Approach‟ detailed the change from Enhanced and Standard
CPA to one level of CPA. This means the size of the population on the refocused
CPA is likely to approximate that on the old Enhanced CPA. Some Government
Offices and Local Authorities suggested examining a wider definition again given
these changes and a paper summarising the issue was put to the PSA 16 Delivery
Board on 22nd January. The Board decided to stick with the current definition of the
indicators.


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Although there were arguments on both sides there were considered to be more risks
in changing the definition. Most notably that changing the definition could introduce
delay into the Local Area Agreement process as it may have meant the definition
would need to go out to consultation again and would need Ministerial re-approval. In
addition, there were concerns that any change would be to the detriment of those
with the most severe issues as work could be focused on those considered easier to
work with.


4. What about those individuals in need who are not on the CPA? There are
   many of these who also need help to find a home and a job.

Focusing the indicator definitions on those who are on the CPA does not mean there
aren‟t those in need who are not captured by the indicator. Neither does it mean that
services should be designed to deliver to this group to the detriment of others. Local
Authorities and their partners will still want to design services which serve a wider
group of those with mental health conditions including those not in contact with
secondary mental health services.

Indeed many of the principles of support will be the same for those who have more
severe and enduring conditions and for those who have more moderate conditions
and there is likely to be synergies at a local level in designing services which cater for
the widest group. The Government has committed to publishing a Mental Health and
Employment Strategy which will encompass the full spectrum of mental health
conditions including those captured by NI 150.


5. What other measures are being considered?

The Social Exclusion Task Force and the Information Centre who collect the data are
in discussion about whether it is possible to provide analysis of the accommodation
and employment status of all of those in contact with secondary mental health
services for use by LAs and PCTs. It is hoped that this can provide context so that
LAs are able to ensure that any progress in delivery for those on the CPA reflects
progress for all of those in contact with secondary mental health services.


Further Resources

   PSA 16 Website:
    http://www.cabinetoffice.gov.uk/social_exclusion_task_force/psa.aspx
   Handbook of Definitions:
    http://www.communities.gov.uk/publications/localgovernment/finalnationalindicato
    rs
   CPA Guidance - „Refocusing the Care Programme Approach‟:
    http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicy
    AndGuidance/DH_083647




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