Investment Proposals 2008
Working Age Mental Health (WAMH)
WAMH Recommended Initial Investments
Item / Provider / Purpose / Detail / Likely Spend 08/09 / Total Spend / To When / Status / Priority / Commissioner CommentEarly Intervention Service / HPFT / To allow the service capacity to reach the 450 caseload requirement of the DH / £886,000 / £1,049,000 pa
Ongoing / Already agreed / Essential to meet national targets
Community Development Workers / (Various Providers) / To support engagement with BME communities and to contribute to fulfilling the DH target of 10 CDWs within Hertfordshire / £331,000 / £331,000 pa
Ongoing / Already agreed / Essential to meet national targets
Includes the reconfiguration of roles within Watford Asian Community Centre and the Hertfordshire County Council Traveller Unit.
Counselling / TOTAL / £444,739 / Proposed by Strategic Commissioning Gp / To develop a range of counselling and therapy services so as to provide a comprehensive county wide service
To develop primary care counselling in South East and East Herts. / £250,000 / £522,733 pa / There are currently not sufficient services available and this will also be needed to enable further psychological therapies next year
Fear Fighter (computerised therapy) / £61,639 / £61,639 yr 1
£123,278 yr 2
£184,918 yr 3
=£369,835 / Half year cost only in 08/09. Figure increases as more of the population gain access. Costs based on 3 year incremental coverage package.
Beating the Blues (computerised therapy) / None / £90,000 p/a from 09/10 / Current licenses expire March 09
Voluntary Sector projects to develop counselling services / £133,100 / Agreed for 3 years £133,100 p/a / Specific proposal gone to PBC
MH Helpline / (To be decided) / To support out of hours use of on-line Computerised PsychologicalTherapy, / £50,000 / £50,000 pa Ongoing / Proposed by Strategic Commissioning Gp / Will help deliver better use of computerised approaches and link patients to mainstream services
Improving Access to Psychological Therapies / (JCT) / To support the implementation of programme across West Herts and East Herts, / £100,000 / £150,000 (2 years) / Proposed by Strategic Commissioning Gp / To provide funding for programme and project management and data collection for the expansion programme.
Innovation Fund / (Various Providers) / To support a range of pilots which will trial innovative services that might provide improved outcomes for service users andpromote recovery. / £500,000 / £500,000 in 08/09 £300,000 in 09/10 (approx) / Proposed by Strategic Commissioning Gp / Funding in second year will support projects which have achieved the agreed outcomes and have shown best value.
This fund will be used to allow third sector and other providers to explore possible new approaches.
A&E Liaison (HPFT) / Investment to replicate service currently operating at the Lister and the QEII in the West of the County. Extra funding will allow for 3.5 band 7 nurses and 1 band 8a team leader. / £146,602 / £146,602 pa / Agreed by Strategic Commissioning Gp / This proposal incorporates services for both Watford and Hemel Hempstead. The monies will initially provide service for one year there will be a requirement for ongoing funding but it is recommended that this is dependent on usage data and requirement for the Hemel Service.
Accelerated Discharge Programme (HPFT) / PCT allocation to fund medium secure facilities for patients discharged from high secure accommodation / £93,000 / Ongoing / Agreed / This is part of a national programme where the costs of new placements from high secure must be met
Mentally Disordered Offenders Pilot (Probation) / One third share of project management costs for Watford pilot of national development programme / £10,000 / £10,000 1 year only / Agreed by Strategic Commissioning Gp / The pilot will trial a screening / diversion approach at point of arrest.
Enhanced Primary Mental Health Care (HPFT) / Accelerated roll-out of EPMHto Hertsmere and Dacorum. One-off pump priming funding. / Hertsmere
£78,000
Dacorum
£72,000 / £150,000 in year one, £90,000 in year two / Agreed by Strategic Commissioning Gp / Reduced amount in year 2 for these sites due HPFT absorbing the costs of year 1 staffing.
See below for proposal regarding the remaining areas of Hertfordshire.
Enhanced Primary Mental Health Care (HPFT) / Accelerated roll-out of remainder of programme to provide county wide service (One-off pump priming funding). Continuing 4 Pathfinder funded posts across 4 sites / SE & E Herts
£126,000
4 Existing IAPT Sites
£158,000 / £284,000 in year one, £387,000 in year two / Pending negotiation / A proposal has been received to enable accelerated rollout of remaining areas of Hertfordshire but commissioners recommend agreement only if a significant acceleration can be demonstrated and achieved
Eating Disorders (HPFT) / Service Expansion due to increased number of referrals and rise in the number of inpatient activity / £200,000 / £400,000 to 2010. / Pending negotiation / A higher amount may be needed ongoing but recommendation is for 2 year initial funding recommended to test viability and impact
Mental Health Act Implementation (HPFT / ACS) / To support the implementation of the new Mental Health Act including training cost. / £100,000 / £100,000 1 year only / Pending Further Detail / Level of funding to be finalised once full proposal drawn up.
Improving access to therapies on MH acute wards (HPFT) / Funding to support the development of STAR wards within Hertfordshire Acute care to facilitate access to psychological therapies and meaningful activities for inpatients. / £250,000 / £500,000 pa for 2 years initially. / Pending Further Detail / Pressures on acute services are recognised to be high and further resourcing is required. The nature and extent of this resourcing should be trialled for initial 2 years ahead of ongoing investment
WAMH Further Investment Options
Item / Provider / Purpose / Detail / Likely Spend 08/09 / Total Spend / To When / Status / Priority / Commissioner CommentMental Health Promotion (Various) / Implementation of MH promotion strategy / £60,000 / £100,000 pa for 2 years / Agreed dependent on timing and content / Although this investment needs to take place, the timing of it should be finalised dependent on the content and against competing priorities
Crisis Services (HPFT) / Service improvement through expansion of Out of Hour Services / Not yet known / Not yet known / To include in long term investment planning / Likely need has been likely for long term planning,
Employment Support Services (Various) / To pilot the expansion of Way2Work across the County in line with Department Work and Pensions employment programme / £200,000 / £450,000 for 2 years / To include in long term investment planning / Way to Work is currently running through Mind in Mind Herts and utilising STaR workers within HPFT. Additional funding would enable the expansion of this programme to other parts of the County.
Rather than provide this suggested one-off funding commissionersrecommend this is addressed through long term investment and the innovation fund
Race Equality / Cultural Competence (Various) / To support ancillary cost of Delivering Race Equality Agenda and cultural competence training / £10,000 / £10,000 pa Ongoing / Not Agreed / Although it is essential that this work takes place, it is commissioners current view that providers mainstream resourcing is already in place for this
Older People’s Mental Health (OPMH)
OPMH Recommended Initial Investments
Item / Provider / Purpose / Detail / Likely Spend 08/09 / Total Spend / To When / Status / Priority / Commissioner CommentAcute Mental Health Nurse Liaison (HPFT) / 4 wte Posts for the Lister, QE2, Watford and Hemel Hempstead.
to prevent delayed discharged,and support acute nursing in caring for dementia. / £115,932 / £154,576 per annum / Proposed by Strategic Commissioning Gp / Posts in place to facilitate Older People with Mental Health issues on acute wards and liaise with A&E. Fixed 2 year posts will be reviewed annually.
Red Cross Pilot (Vol Orgs) / Pilot Project for British Red Cross in Hertsmereto facilitate and support Older People post discharge from acute setting for 6 weeks. / £28,805 / £80,000 / Agreed by Strategic Commissioning Gp / In line with Age Concern’s similar developments
Linking with Hertsmere team for training and additional referrals from HPFT too. If successful, would look to roll out across the county with various providers.
Shared Care (To be decided) / To exploredevelopment of a primary care led service and Dementia Shared Care Protocol. 1 band 3 support worker for each team, fixed term for 12 months. Strategic Liaison Nurse (Band 8) / £115,000 / £142,600 for 2nd Year.
£280,000 per annum full year effect. / Agreed by Strategic Commissioning Gp / Initially Fixed term for 2 years.
This will create capacity to redesign Memory Clinics to create a community (GP or specialist dementia nurse ) led memory service within primary care
Innovation Fund (Various) / To support time limited innovative projects linked to strategy and increase independence, / £100,000 / £100,000 / Agreed by Strategic Commissioning Gp / The fund would be run in conjunction with the proposal for working age mental health (see above for detail)
OPMHFurther Investment Options
Item / Provider / Purpose / Detail / Likely Spend 08/09 / Total Spend / To When / Status / Priority / Commissioner CommentPsychological Therapies (To be decided) / To pump prime the working age services as Older Peoples reconfiguration of services takes place / £50,000 / £100,000 / Pending Negotiation / Fixed Term only 18 months. JCT Working up proposals in conjunction with Older People Special Interest Group in St Albans and reviewing to see whether better done once shared care and working age services are established.
Acute Unit Inpatient Care Proposal (HPFT) / Increase staffing establishments to support new ways of working. / TBC – start date not determined / £555,940 per annum / Proposal to be revised / Staffing levels have not yet been increased to support the new ward configurations.
Proposal needs reviewing and aligning to the Dementia Intensive Outreach Service so as to get balance of inpatient / community investment right
Acute Units ~ Nutrition, Dysphagia & Communication (HPFT) / Address the lack of dietetic and speech and language therapy available to Older People. Particularly, Older people with Dementia. / TBC start date not determined / £200,000 / Proposal to be revised / This should be linked to the above proposal regarding inpatient establishments and developing intensive outreach community teams and should consider a wide range of possible therapeutic approaches .
Acute Unit Testing Out a Recovery Model Pilot (HPFT) / Identify an inpatient unit to pilot a ‘recovery’ model based approach with intensive therapy support both physical and psychological / TBC start date not determined / £165,000 / Proposal to be revised / This links closely to the work being undertaken by Age Concern in the Healthwise initiative (which is community based). It could also provide an inreach service so should be developed in conjunction with other / 3rd sector providers plus carers and associated community investment.
Carer Co-ordinator (HPFT) / 1.0wte post in Dacorum
Post Commenced from 1st April. Funding fixed for 2 years and post to be reviewed. If successful, roll out to all localities. / £20,853 / £20,853 / Agreed to use mainstream funding / Will provide in the community & HPFT in-patient units, services to Carers of older people experiencing mental health difficulties that require support & advice so as to better support their own health needs.
Strategy Implementation (JCT) / 1.0 wte Project Manager / Service Development Manager for Mental Health Services for Older People / £27,500 / £55,000 per annum / Agreed to use mainstream funding / Estimated start date 1st Sept to take forward and implement work programme set out in the strategy. Fixed term post for 2 years
Unfunded Activity (C&P) / Bassingbourn Branch Surgery Activity ( SLA with Cambridge and Peterborough MH Trust ) / £60,000 / £60,000 / Agreed to use mainstream funding / From 1st April fixed for 1 year so as to address a short term shortfall in funding in a small locality.
Substance Misuse (SM)
SM Recommended Initial Investments
Item / Provider / Purpose / Detail / Likely Spend 08/09 / Total Spend / To When / Status / Priority / Commissioner CommentReduction in Alcohol detox waiting times (HPFT / SLAM) / To eliminate current waiting list and then maintain reduced waiting times / £141,250 /
£185,625 / £247,500
to 2010 / Proposed by Joint Commissioning Gp / Currently (HPFT Figures) there are 55 Alcohol clients on the inpatient Detox waiting list, with waits of 4-6 months. this is set to rise by an average of 7.5 per month with the average waits extending to 12 months or more by the end of this financial year.
Hospital brief interventions (Turning Point) / Expand Watford General A&E brief interventions pilot to include the other units in the county. / £120,000 / £160,000
To 2010 / Proposed by Joint Commissioning Gp / This pilot has proved effective in gaining referral into mainstream treatment for dependent drinkers and to offer a brief intervention to hazardous and harmful drinkers. It would be expected that this post would provide training to A&E staff to deliver this intervention from 2009.
Brief Interventions (University) / County-wide training for delivery of Brief Interventions in doctors surgeries. 1 year program employing 2 trainers / £50,000 / £50,000 2009/10 / Proposed by Joint Commissioning Gp / Deliver a similar program of training to that provided by RoyalCollege for doctors and practice nurseswhich could then be incorporated into the rolling program currently delivered with the university.
Alcohol Counselling (Various) / Reintroduce a countywide peripatetic service for specialist alcohol counselling. / £120,000 / £150,000 for 2009/10 / Proposed by Joint Commissioning Gp / To cover period till 2010 retender when would be integrated into generic service
Adult Learning Disabilities (ALD)
ALD Recommended Initial Investments
Item / Provider / Purpose / Detail / Likely Spend 08/09 / Total Spend / To When / Status / Priority / Commissioner CommentLD Nurses (ACS) / Community team and Epilepsy Nurses / £100,000 / £100,000 ongoing / Already Agreed / Funding to maintain existing epilepsy nurse post and to meet Agenda for Change cost pressures.
Secondary-Primary Care Liaison (HPFT) / Nursing Post for mainstream support of health needs / £50,000 / £50,000 ongoing / Already Agreed / To work strategically at the interfaces with primary and secondary care to ensure that mainstream services include learning disabilities
Transition Team (ACS) / Senior nurse practitioner nurse (band 6) to support transition work as part of new transition team. / £30,000 / £45,000 ongoing / Proposed by Strategic Commissioning Gp / To implement 2 of the 5 priorities of Valuing People Now (Personalisation and Better Health)– This year there are over 50 new young people in transition to adult services
Epilepsy Service (HPFT) / Specialist epilepsy support worker post and 0.4 pharmacist (as there is no pharmacy time to support this work in west Herts) to better meet epilepsy needs / £30,000 / £53,000 £30,000 (support worker post)for 2 years £23,000 pharmacist ongoing / Proposed by Strategic Commissioning Gp / Potentially Spend to save – to support people at home and prevent expensive admissions
Primary Care Liaison (HPFT) / Post (nurse band 6) to develop better working with primary care / £35,000 / £58,000 pa
2 years – / Proposed by Strategic Commissioning Gp / Will include training and sessional work and pump priming to implement the practice based commissioning project in one area alongside health promotion work in community teams
Continuing care reviews (PCT) / Staffing to conduct wholescale case reviews of people in continuing care and specialist treatment / 60k / Proposed by PCT / This is needed to prepare the ground for future integration of this funding and placements into integrated services and joint commissioning
User / Carer Involvement (Various) / Funding for organisations to establish systems for communicatingviews to inform service planning and implementation / £25,000 / £25,000 pa
2 years then review / Proposed by Strategic Commissioning Gp / At present there are not systems to collate users or carers views. although funding is provided to pay for people to be able to express views. This initial funding should enable reconfiguration of existing systems and funding.
Continuing care case management (JCT / ACS) / Staff to enable integration of continuing care and specialist treatment with mainstream services / £20k / To be determined / Proposed by Strategic Commissioning Gp / See also above re continuing care reviews
Health Facilitation (HPFT) / 3 posts full time plus one part time (1 day a week) post for person with learning disabilities for this work / £130,000 / £142,000
Ongoing / Proposed by Strategic Commissioning Gp / To implement the recommendations from recent policy / Hertfordshire audit and work to eradicate health inequalities and achieve equity across primary and secondary care, including training and reviewing the Health Action Planning system and implementing the required changes.
ALD Further Investment Options
Item / Provider / Purpose / Detail / Likely Spend 08/09 / Total Spend / To When / Status / Priority / Commissioner CommentTherapy Services (HPFT) / 4 Generic technicians (assistant therapists) to support mainstreaming work / £85,000 / £140,000pa
2 years then review / To include in long term investment planning / To implement 1 of the 5 priorities of Valuing People (Better Health) and work to eradicate health inequalitiesincludingdysphasia and communication work and access to mainstream physio, occupational therapy
Intensive support service (HPFT) / 4 nursing posts to augment the team to enable more people to be treated in their community settings / £150,000 / £200,000 pa
2 years then review / Develop business case on ‘invest to save’ basis / Potential Spend to save –to prevent expensive admissions. Supportsthe priorities of Valuing People Now and will support the work to reprovide for people with very high needs who are at present in NHS provision.
Community Support Unit (HPFT) / Additional staffing for CSU to enable the service to take more challenging clients / £116,000 / £116,000
for 2 years then review / Develop business case on ‘invest to save’ basis / Potential Spend to save - Will prevent having to spot purchase more expensive tertiary level services
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Item 6 - Appendix A Investment Planning.doc