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									                                                                                       Appendix 2
Mental Health Strategy Action Plan.

1.       Cost Savings

     Objective               Key Rationale and Detail               Level of     Financial Implication
                                                                  Intervention       and Timescale
Develop clear             Understand pathways and              Forensic and     Intention to release
referral protocols         expenditure on current services.     Specialist       money for
and management            Ensure that people receive           Services         reinvestment in
for access to              referral only where general                           Primary and
specialist                 services are unable to meet                           Secondary care.
outpatient services        need and timely discharge and                         Current spend on
provided by                follow up is undertaken.                              outpatient specialist
SLAM.                     Requires TRP working group to                         services is £500,000
                           expand and develop protocols                          aprox per anum.
                           and principles, similar to
                           inpatient referrals. May involve                      Timescale: 2007/08
                           Practice Based Commissioning
                           Clusters.
                          Decision required about how
                           potential savings will be
                           managed and reinvested. It is
                           likely that this will be Primary
                           Care.
                          Cross-reference with eligibility
                           criteria work stream.
Improve cost              Over provision of PICU beds          Inpatient and    More effective use of
effectiveness of           following neighbouring borough       Emergency        investment.
PICU.                      reducing contract.                   Services         Financial detail TBC.
                          Work required to ensure that
                           there is appropriate service                          2007/08
                           provision for Lewisham
                           residents, provided in a cost
                           effectively.
Work to reduce            High admission rate to acute         Inpatient and    More effective use of
inpatient lengths of       inpatient wards.                     Emergency        investment.
stay and provide          Clinical Overview group has          Services         Financial detail TBC.
services within the        been established with the
community                  following objectives:
wherever possible.        Maintain an overview of
                           beds/placements across our
                           services, ensuring that people
                           are in the ‘right’ place with the
                           ‘right’ package of care to meet
                           their needs at any given point in
                           their care
                          Identify ways of reducing
                           ‘revolving door’ admissions
                          Develop plans to address
                           known pressures in the ‘system’
                          Examine the use of specialist
                           services
                          Learn form good practice
                           examples in other areas
Review contracts          Repatriate patients from the         Forensic and     Cost neutral or
for forensic service       private sector, to local provision   Specialist       savings where
with Oxleas and            where possible. This may             Services         duplication exists.
SLAM to ensure             involve increasing the number
that the                   of contracted beds.                                   Timescales: 2007/08
appropriate range         Develop a system, which allows                        , 2008/08, 2009/10
of services is cost        for and encourages move on as
effectively                early as clinically advisable.
contracted.               Work with Oxleas and SLAM to
                           develop clear specifications for



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                            services. Ensure that all
                            services are commissioned to
                            meet all requirements, without
                            duplication.


2.        Cost Neutral

     Objective                 Key Rationale and Detail             Level of         Financial Implication
                                                                  Intervention           and Timescale
Assess and if              Driven by activity-based             Primary Mental   Aim for cost savings/ more
appropriate,                contracts, as SLAM becomes a         Health Care      efficient use of current
change the                  Foundation Trust.                                     resources
balance of                 Develop greater links between
services provided           services. More communication                          Timescale: 2007/08
in primary care             and information sharing were
and CMHTs.                  identified as priorities at the
Strengthen links            Stakeholders Day.
and                        Depression Programme may be a
communication               model to adopt.
between primary            Will be influenced by the review
and community               of referral criteria.
care.
Foundation Trust-          Ensure that contract                 Cross Cutting    Aim cost neutral, but
Model Contract              documentation with SLAM is                            financial fluctuations likely
                            robust and does not result in                         to result.
                            significant risks from a
                            commissioner or provider                              Timescale: 2007/08
                            perspective.
                           Develop mechanisms to monitor
                            activity-based contract and
                            analyse data.
                           Use data analysis to influence
                            future patterns of investment,
                            service models and resource
                            allocation.
Review and                 Aim to ensure that the most          Cross Cutting    Review cost neutral or
Develop Care                effective and efficient service is                    savings. May lead to
Pathways and                provided within available                             recommendations in
Referral Criteria.          resources.                                            2007/08.
                           Will involve devising guiding
                            principles for services, reviewing
                            existing policies and including
                            into the Foundation Trust
                            Contract.
                           Cross reference with specialist
                            outpatient demand management
                            work stream.
Review all                 Ensure that all commissioned         Cross Cutting    Dependent on outcomes
commissioned                services fit strategically into                       of review. Aim- cost
services to ensure          Lewisham services and support a                       neutral or whole system
that they are fit for       whole system approach.                                saving
purpose.                   Ensure that all services provide
                            value for money i.e. effective and                    Timescale: Rolling
                            efficient.                                            programme 2007/08 –
                           Likely to require a rolling                           2011/12
                            programme of review for all
                            services.
Increase Social            Work with Partner agencies,          Population       Cost neutral where
inclusion of                optimise opportunities through       Based            possible.
people with                 LBL Community Services               Prevention
Mental Health               Directorate and explore joint                         Timescale: Wellbeing
Problems.                   funding streams to increase                           Strategy written and
                            Social Inclusion.                                     implemented in 2009/10
                           May include volunteering and                          – 2011/12
                            mentoring.



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Implement               Implement action plan, ensuring       Population       Bid against external
Choosing Health          monitoring and assistance where       Based            funding stream to ensure
Strategy                 appropriate is provided by the        Prevention       cost neutral to current
                         Mental Health Partnership Board.                       resources.


Further develop         Lewisham AMH to review and            Individual       Cost Neutral or maximum
and promote              develop Crisis Card Scheme in         Prevention and   £50,000
Advance                  line with and work being              Care
Directives and           undertaken by SLAM legal
links to Crisis          department regarding the status
Planning                 of directives.
                        Pilot a service user led approach,
                         encouraging service users to
                         input proactively to their crisis
                         plan in one patch, with support
                         from Lewisham Mental Health
                         Foundation (LMHF).
Support and             Establish links with PBC groups       Primary Mental   Cost Neutral but will link to
Develop Practice         via visits/ presentations to inform   Health Care      Primary Care Strategy
Based                    of the current mental health
Commissioning in         context and aim to work
Mental Health            collaboratively regarding future
                         planning.
Improve provision    Implement recommendations from            Primary Mental   Standards are cost
of Psychological     Equity Audit:                             Health Care      neutral, however,
Therapies in            Improve data quality and                               development of resources
Primary Care.            information about services.                            will link to primary care
                        Introduce quality standards linked                     strategy.
                         to LES.
                        Improve efficiency of current                          Timescale: 2007/08
                         services (i.e. reduce DNA rate)
                        Ensure provision is equitable
                         across neighbourhoods
                        Increase provision with reference
                         to evidence
Undertake               Services currently managed by         Community        Review is Cost Neutral.
Management               SL&M and LBL. This in contrary        Services         Aim of re tendering is cost
review of Honour         to the norm, other services are                        neutral or to provide whole
Lee and Edward           contracted out.                                        system savings.
Street with a view      Examine the advantages of the                          Timescale: 2011/12
to re tendering.         current situation against potential
                         benefits of change in
                         management arrangement
Increase the take       Work to increase the take up of       Community        Cost Neutral
up of Direct             direct payments to promote            Services         Timescale: 2009/10 –
Payments                 choice.                                                2011/12
Section 31              Review and develop the Section        Cross Cutting    Cost Neutral
Agreement and            31 to ensure its fitness for                           Timescale: 2007/08
lead provision           purpose in the current
                         environment, including reference
                         to lead provision.
Develop Choice          Address gaps highlighted in the       Cross Cutting    Cost Neutral
available to             2005 Autumn Assessment                                 Timescale: 2008/09 –
service users            themed review and feedback                             2009/10
                         from Stakeholder Event.
                        To be developed alongside the
                         SLAM Trust work stream.
Develop Voluntary       Consider development of forum         Cross Cutting    Cost Neutral
Sector                   following consultation at Annual                       Timescale: 2008/09 –
involvement and          Stakeholder Event.                                     2009/10
engagement




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3.       Investment Required

     Objective                   Key Rationale and Detail                 Level of         Financial
                                                                        Intervention    Implication and
                                                                                          Timescale
Expand the Early         Key NSF target subject to RSU recovery        Community      £250,000 FYE
Intervention              plan.                                         Services
Service                  Local evidence is of positive impact of
                          service, which has strong links with BME
                          communities and is undertaking effective
                          preventative working.
Address                  Demographic analysis shows high BME           Population     Aprox. £30,000
inequalities              population and inequalities in access         Based          per BME CDW
experienced by            and service provision.                        Prevention     post
Black and Ethnic         Seek to provide more responsive,
Minority                  inclusive and appropriate service.
Communities.             Key NSF target to have 4 BME CDW by
                          Dec 06. Red on 2005 Self-assessment.
                         First step: Fund, recruit & develop role of
                          3 additional BME Community
                          Development Workers.

Produce and              Strategy required to ensure that: all         Primary        Will be determined
Implement Primary         elements of existing primary care             Mental         by production of
Care Mental               services are coordinated and working          Health Care    strategy.
Health Strategy           effectively; appropriate relationships                       Investment likely
                          exist between primary and community                          to be redirected
                          care: joint working occurs with PBC                          from changes to
                          groups and areas for future investment                       Tertiary Services.
                          are identified and evidence base
                          provided.
                         Strategy should refer to the
                          implementation of NICE guidance
                          (depression, anxiety etc) and the
                          stepped care model.

Maximise potential       Key NSF target. red on self assessment        Individual     Aprox. £30,000
of Primary Care           in 2005.                                      Prevention     post
Graduate Workers         Recruit 3 additional workers to meet          and Care
service.                  target of 7.
                         Develop range of services offered e.g.
                          additional CBT, health promotion.
                         Increase volume and appropriateness of
                          referrals.
                         Integrate fully within comprehensive
                          primary care service.
Develop support          Recruit 2 additional carer support worker     Individual     Some aspects
and information for       to meet NSF target of 5, for which a red      Prevention     cost neutral.
Carers.                   assessment was given in 2005.                 and Care       Workers Aprox.
                         Highlight resources available to carers                      £30,000 post
                          within the borough.
                         Undertake training/ discussion with
                          professionals regarding information
                          sharing and confidentiality.
Increase advocacy        Area of weakness highlighted in Self-         Individual     Some aspects
available to              Assessment and Community Services             Prevention     cost neutral.
service users.            Review.                                       and Care       Workers Aprox.
                         Further invest in current advocacy                           £30,000 post
                          service & develop range of advocacy
                          e.g. tailored for gender and culture.
                         Publicise all advocacy services available
                          e.g. ICAS
Develop and              Identified in the 2005 autumn                 Cross          TBC by Strategy
implement                 assessment as requiring further               Cutting        Recommendations



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Personality              development.                                          Timescale:
Disorders               Demographic Analysis indicated                        2008/09 –
Strategy.                significant prevalence of PD in local                 2009/10
                         population.
                        Need to ensure that CMHTs are
                         appropriately responsive/ inclusive and
                         specialist services available where
                         required.
                        Will involve consideration of future
                         commissioning of Henderson Hospital.

Develop and             Mental Health NSF and National Suicide      Cross     TBC by Strategy
Implement Suicide        Prevention Strategy for England specify     Cutting   Recommendations
Prevention               need for strategy.
Strategy                Local demographic analysis shows
                         Lewisham has similar population to
                         neighbouring borough’s but a higher
                         suicide rate.
                        Target to reduce suicide rate is included
                         in the LDP.

Develop                 Focus on information about illness,         Cross     To be determined.
information              medication, services available and          Cutting
provision for            inpatient ward rounds.
service users           Highlighted in Autumn Assessment,
                         Community Services Review and
                         Stakeholder Event.
Development of          Currently no local service provision,       Cross     To be determined.
local AMH strategy       some services available through SLaM        Cutting
for people with          specialist directorate at high cost.
ASD and                 Growing number of referrals received,
Aspergers                but not the core focus of mental health
Syndrome.                services.
                        Requires a council led response that
                         cross cuts care groups.
Commission              Includes: Eating Disorders,                 Cross     To be determined.
services in line         Schizophrenia, Anxiety, and Depression.     Cutting
with NICE
guidance




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