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APMH SERVICE DEVELOPMENT IN SOUTH CENTRAL. Dr Alain Gregoire Clinical Director for Mental Health South Central SHA. South Central PCTs with birthrates. Distribution of MBUs: existing units. PMHOTs. Who can make this happen?. South Central SHA. 2006. South Central SHA.

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apmh service development in south central

APMH SERVICE DEVELOPMENT INSOUTH CENTRAL

Dr Alain Gregoire

Clinical Director for Mental Health

South Central SHA

slide4

Who can make this happen?

South Central SHA

2006

slide5

South Central SHA

PERINATAL MENTAL HEALTH NETWORK

slide6

South Central SHA

PRIMARY CARE & MATERNITY

COMMISSIONERS

GENERAL & PERINATALMENTAL HEALTH

PATIENTS & FAMILIES

local evidence nice survey and phru report
Local Evidence: NICE Survey and PHRU Report
  • Very patchy services at all levels across SC
  • Current services inadequately resourced: PCT commissioning of: 1 PMHOT in S’ton/New Forest + PMHO sessions Hants + 6 MBU beds Winchester
  • Substandard care being delivered across most of South Central due to unavailability of services:
    • Mothers admitted without babies
    • Detection of high risk women not happening
    • No access to specialised services for high risk women
    • Care delivered by staff without required skills and expertise
    • Likely avoidable morbidity and mortality
phru specialised commissioning recommendations
PHRU Specialised Commissioning Recommendations
  • Improve access to local MBUs and closely linked PMHOTs.
  • Existing MBUs under-resourced.
  • Estimated bed need, assuming PMHOTs throughout, = 22.
  • Future of MBU at Heatherwood Hospital should be reviewed, as does not meet standards for a mother and baby unit.
  • Increase awareness amongst all clinicians of importance of mother and baby unit admission, and agreement on clear criteria.
  • Develop clear referral pathways
  • Improve collection of data by future providers of specialised perinatal services.
care and service standards
Care and Service Standards
  • S1: Primary care and Maternity Services standards
  • S2: Adult Mental Health Services standards
  • S3: Specialised Perinatal Outreach/Community Services standards

Derived from East Midlands Standards

  • S4: Specialised Perinatal Inpatient Services standards

Derived from Perinatal Quality Network Standards

s3 pmhots
S3. PMHOTs

Owned and shared

For quality, cost effectiveness & equity

Evidence based

Deviance unusual and auditable

Measurable (easily) data sets & documentation

Achievable

perinatal services estimated need
Perinatal Services: estimated need
  • *Assumes PMHOTs throughout and 85% occupancy
  • # Minor adjustment may be required for location of deliveries
mbus and pmhots
MBUsand PMHOTs

Managed Care Network

specialised commissioning
Specialised Commissioning

Clinical Advisory Group/Network: standards, pathways, needs, priorities

Head of Mental Health

Specialised Commissioning

Directors of Commissioning Group: PCT Directors of Commissioning

Specialised Commissioning Board: PCT CEOs

Commissioning of Services: 2009 round

next stage review
Next Stage Review…
  • CYP & Maternity Network & Mental Health Network both identified Perinatal Mental Health Services as a high priority for improvement
  • All networks, except cancer and neonatal, abolished
  • Clinical improvement programmes introduced as core work of SHA
mental health and learning disabilities programme
Mental Health and Learning Disabilities Programme

People with learning disabilities have the same rights to good health and quality of life as everyone else

Aims:

  • Reduce stigma
  • Increase the mental resilience of the population
  • Engage people in active self care
  • Join up the efforts of patients, carers, all services and agencies through care pathways
  • Deliver world class quality and efficiency of clinical care

HUGE!

No health without mental health

Specific clinical areas:

  • Dementia
  • Healthy mind – healthy body
  • Offenders
  • Personality disorders
  • Perinatal mental health
mental health and learning disabilities programme23
Mental Health and Learning Disabilities Programme

Establish care pathways which:

  • Are used by all(patients, carers, clinicians, managers, commissioners, strategists)
  • Are evidence based
  • Define clinical quality standards and outcomes
  • Map needs and population numbers at key points
  • Incorporate all components(eg. psychological, social, physical)and sources(eg. self, internet, primary, 3rd sector…)of care at every stage of the pathways
  • Facilitate personalisation and choice by defining ‘tracks’ within the pathways for need clusters (eg. Psychotic illness + substance misuse or + poor engagement or + PTSD…)

PCTs say YES!

clinical leaders network for apmh
Clinical Leaders Network for APMH
  • Clinical leaders from:
      • Primary care (health visiting and GP)
      • Maternity (midwives and obstetricians)
      • Mental health (specialist nurses and psychiatrists)
      • Public health
  • Non clinicians:
      • Commissioners (PCT and specialised)
      • Providers (MH and acute)
      • Research (in particular child development, infant MH, mother infant relations)
clinical leaders network for apmh25
Clinical Leaders Network for APMH

Aims:

  • Improved primary and secondary mental health care for women in pregnancy and postnatally
  • Increase equity of care
  • Develop leadership skills
    • National CLN programme: Future-engage-deliver
  • Support leadership activity
    • CLN; Action Learning Sets
    • buddies
  • Develop a new clinical network for sustainability