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Mersey Care Mental Health – CQUIN Scheme v1 2013/14

MERSEYCARENHS TRUST Commissioning for Quality and Innovation (CQUIN) 2013/14 CQUIN Table 1: Summary of goals

Goal Number

Goal Name Description of Goal

Goal weighting (% of CQUIN scheme available)

Expected financial value of Goal (£)

Quality Domain (Safety, Effectiveness, Patient Experience or Innovation)

1 NHS Safety Thermometer

To reduce harm. The power of the NHS Safety Thermometer lies in allowing frontline teams to measure how safe their services are and to deliver improvement locally

0.125% TBC Safety, Effectiveness and Patient Experience

2 Advancing Quality Dementia


3 Advancing Quality Psychosis

0.1% TBC Safety, Effectiveness and Patient Experience, Innovation

4 Collaborative Working

Improving Collaborative Working between Primary and Secondary Mental Health Care.

1% TBC Safety, Effectiveness and Patient Experience, Innovation

5 Communication To improve the quality and timeliness of communications between the trust, primary care and patients


6 Transition from CAMHS to Adult Mental Health and Learning Disability services

Transition from CAMHS to Adult Mental Health and Learning Disability services


Totals: 2.5%


CQUIN Table 2: Summary of indicators Goal Number

Indicator Number

Indicator Name Indicator Weighting (% of CQUIN scheme available)

Expected financial value of Indicator (£)

1

1.1

National Safety Thermometer – Data Collection

0.0625%

1 1.2

National Safety Thermometer – Improvement Goal

0.0625%

2 2.1 AQ - Dementia 0.1% 3 3.1 AQ - Psychosis 0.1% 4 4.1 Collaborative Working 1% 5 5.1 Communications –

Transition from paper to electronic communication

0.3%

5 5.2 Communications – In Patient Communications

0.15%

5 5.3 Communications – Out Patient Communications

0.25%

5 5.4 Communications – OP Communications – Change in Medication / Treatment Plans

0.1%

6 6.1 Transition from CAMHS to Adult Mental Health and Learning Disability services

0.375%

Totals: 2.5%


NATIONAL CQUIN– NHS SAFETY THERMOMETER (NUMBER 1)

CQUIN TEMPLATES NHS SAFETY THERMOMETER – DATA COLLECTION Indicator number 1.1 Indicator name NHS Safety Thermometer – Data Collection Indicator weighting (% of CQUIN scheme available)

0.0625%

Description of indicator To collect data on the following three elements of the NHS Safety Thermometer: pressure ulcers, falls and urinary tract infection in patients with a catheter

Numerator Number of months per quarter for which a complete record of NHS Safety Thermometer survey data covering all appropriate patients in all appropriate settings for all relevant measures is submitted

Denominator Total number of relevant months in the quarter (usually three)

Rationale for inclusion National CQUIN scheme. Data source Provider submission to the Information Centre

which publishes the data at http://www.ic.nhs.uk/services/nhs-safety-thermometer

Frequency of data collection One day per month to agree locally which dates>

Organisation responsible for data collection

Provider

Frequency of reporting to commissioner Monthly Baseline period/date Not applicable Baseline value Not applicable Final indicator period/date (on which payment is based)

Not applicable. This CQUIN is based on quarterly achievement.

Final indicator value (payment threshold) Not applicable. This CQUIN is based on quarterly achievement.

Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner)

Commissioners will satisfy themselves of the appropriate completion and submission of the data collection for each provider by reference to the Information Centres publication of Safety Thermometer results for each provider. Further clarification on completeness of data submission (eg related to patient exclusion data) should be obtained from the relevant provider if necessary.

Final indicator reporting date NHS Safety Thermometer data for March 2014 will be available on 15 April 2014

Are there rules for any agreed in-year milestones that result in payment?

Each set of complete data for a single quarter will qualify the provider for 25% of the total value for this CQUIN

Are there any rules for partial achievement of the indicator at the final indicator period/date?

Not applicable


Milestones

Date/period milestone relates to

Rules for achievement of milestones (including evidence to be supplied to commissioner)

Date milestone to be reported

Milestone weighting (% of CQUIN scheme available)

Quarter 1 A complete survey for each month in the quarter is submitted to the Information Centre

Data for June 2013 will be available on 10 July 2013

25%


Data for September 2013 will be available on 9 Oct 2013

25%


Data for December 2013 will be available on 8 Jan 2014

25%


Data for March 2014 will be available on 15 April 2014

25%


NHS SAFETY THERMOMETER –IMPROVEMENT GOAL

Indicator number 1.2

Indicator name NHS Safety Thermometer – Improvement

Indicator weighting (% of CQUIN scheme available)

0.0625%

Description of indicator 0.36% Reduction in the prevalence of All Falls.

Numerator Total number of falls identified on day of survey

Denominator Total patients surveyed on day

Rationale for inclusion National CQUIN scheme

Data source Provider submission to the Information Centre which publishes the data at http://www.ic.nhs.uk/services/nhs-safety-thermometer

Frequency of data collection One day per month


MCT

Frequency of reporting to commissioner Monthly

Baseline period/date Median of six consecutive monthly data points up to 31 March 2013 set by individual organisations following the available guidance on data quality

Baseline value Total baseline of 6 consecutive months of prevalence data is 5.37%.

Final indicator period/date (on which payment is based)

Payment is split into two 6-monthly periods with 50% of the total annual available payment being available in each 6-month period

Final indicator value (payment threshold) 5.01%


Achievement of 95% or greater of the agreed improvement goal for the first 6-month period (shown through special cause7) followed by maintenance of that goal for the second 6-month period will trigger full payment of the CQUIN.

A sliding scale of payment for partial achievement of the improvement goal – across all areas of harm (PU, Falls and UTI) should also operate so that improvement from


Milestones

baseline performance (shown through special cause) that does not fully meet the target is still rewarded to some extent:

achievement of 80-95% of target = 40% payment




Achievement of <20% of target = 0% payment.

Final indicator reporting date NHS Safety Thermometer data for March 2014 will be available on 15 April 2014


The CQUIN goal will have been met if all of the following parameters are met:

there is evidence of special cause variation of the median value from the agreed baseline;

the reset median value is stably maintained for six consecutive months or improved further;

the difference in the median values from the baseline to the re-set value is equivalent to the agreed improvement goal.

Performance against the improvement CQUIN goal will need to be reviewed separately for each 6-month period.


No





April 2013 to September 2013

The CQUIN goal for the first six months will have been met if all of the following parameters are met: there is evidence of special cause variation of the median value from

Data for September 2013 will be available on 9 Oct 2013

50%


Performance against the improvement goal should be reviewed separately for each 6-month period. For the purposes of payment, the improvement goal can be assumed to be sustained for six months following the re-set of the median. Commissioners must monitor ongoing performance, and if performance is not sustained, payment must be recovered. If the full improvement goal is not met, but there is improvement from baseline that resets the median value, using the above rules, a sliding scale of payment should be used to reward improvement according to the size of the improvement, as shown above. Again, each 6-month period should be considered separately. If the full goal is achieved for the first six months but performance deteriorates for the next six months, provided it does not deteriorate to the original baseline, a proportionate payment can be made for the second six months using the above rules. More details are available at http://harmfreecare.org/measurement/nhs-safety-thermometer/

the agreed baseline within the specified period; the difference in the median value from the baseline to the re-set value is equivalent to the agreed improvement goal; the reset median value is achieved within the first six months.

October 2013 to March 2014

The CQUIN goal for the second six months will have been met if all of the following parameters are met: there is evidence of special cause variation of the median value from the agreed baseline either within the first or second six months; the difference in the median value from the baseline to the re-set value is equivalent to the agreed improvement goal; the reset median value is achieved within the first six months and is stably maintained for the next six months, or the reset median value is achieved within the second six months

Data for March 2014 will be available on 15 April 2014

50%


REGIONAL CQUIN – AQ - DEMENTIA (NUMBER 2)

AQ - DEMENTIA Indicator number 2.1 Indicator name Dementia Indicator weighting (% of CQUIN scheme available)

0.1%

Description of indicator The Composite Quality Score (CQS) and Appropriate Care Score (ACS) aggregate delivery of several underlying clinical interventions into two overall measures of quality. An example of how CQS and ACS are calculated can be found in section 6. The underlying clinical process measures for Dementia in 13/14 are: (1) Assessment of Functional Capacity before discharge; (2) Assessment of cognitive ability within 14 days; (3) Assessment of physical health within 7 days; (4) Patient focused care plan on discharge; (5) Assessment of depression within 14 days; (6) Assessment of pain within 7 days; (7) Assessment of nutrition within 5 days.

Numerator ACS = Total number of patients receiving ‘perfect care’. CQS = Total number of achieved measures. Both CQS and ACS - The rules for achievement of a measure are as qualified by the AQ Data Dictionary.

Denominator ACS = Total number of clinically eligible patients presenting. CQS = Total number of presenting opportunities for the measures. Both CQS and ACS - The rules for eligibility for a measure are as qualified by the AQ Data Dictionary.

Rationale for inclusion Strategic alignment with the regional Advancing Quality programme, which is evidence and research based and known to yield improved outcomes.

Data source Data collection via the strategic AQ data collection systems (SUS / Clarity)

Frequency of data collection Monthly Organisation responsible for data collection

Trusts are responsible for data collection. Reporting will be delivered via the AQ programme.

Frequency of reporting to commissioner Monthly Baseline period/date ACS = April 2012 - September 2012

CQS = October 2011 – September 2012 Baseline value Cumulative ACS and CQS for the respective

baseline periods. Final indicator period/date (on which payment is based)

Cumulative ACS and cumulative CQS for April 2013 - March 2014.

Final indicator value (payment threshold) See section 5.1



The AQ programme will supply reports detailing the achievement against the final indicator value (payment threshold.) The calculation of the actual monies associated with each AQ indicator will not be performed by the AQ programme.

Final indicator reporting date Summer 2014 – exact date to be confirmed. Are there rules for any agreed in-year milestones that result in payment?

No


Yes

Rules for partial achievement at final indicator period/date

Final indicator value for the part achievement threshold

% of CQUIN scheme available for meeting final indicator value

Achievement of the cumulative ACS specified in section 5.1

50%

Achievement of the cumulative CQS specified in section 5.1

50%

REGIONAL CQUIN – AQ - DEMENTIA (NUMBER 3)


AQ - DEMENTIA Indicator number 3.1 Indicator name Early Intervention Psychosis Indicator weighting (% of CQUIN scheme available)

0.1%

Description of indicator The Composite Quality Score (CQS) and Appropriate Care Score (ACS) aggregate delivery of several underlying clinical interventions into two overall measures of quality. An example of how CQS and ACS are calculated can be found in section 6. The underlying clinical process measures for Early Intervention Psychosis in 13/14 are: (1) Risk assessment completed within 30 days; (2) Care Coordinator assigned within 1 day, and service user informed within 3 days; (3) Antipsychotic medication review within 6 weeks; (4) Duration of untreated psychosis assessment within 30 days

Numerator ACS = Total number of patients receiving ‘perfect care’. CQS = Total number of achieved measures. Both CQS and ACS - The rules for achievement of a measure are as qualified by the AQ Data Dictionary.

Denominator ACS = Total number of clinically eligible patients presenting. CQS = Total number of presenting opportunities for the measures. Both CQS and ACS - The rules for eligibility for a measure are as qualified by the AQ Data Dictionary.

Data source Data collection via the strategic AQ data collection systems (SUS / Clarity)

Frequency of data collection Monthly Organisation responsible for data collection

Trusts are responsible for data collection. Reporting will be delivered via the AQ programme.

Frequency of reporting to commissioner Monthly Baseline period/date ACS = April 2012 - September 2012

CQS = October 2011 – September 2012 Baseline value Cumulative ACS and CQS for the respective

baseline periods. Final indicator period/date (on which payment is based)

Cumulative ACS and cumulative CQS for April 2013 - March 2014.

Final indicator value (payment threshold) See section 5.1 Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner)

The AQ programme will supply reports detailing the achievement against the final indicator value (payment threshold.) The calculation of the actual monies associated with each AQ indicator will not be performed by the AQ programme.

Final indicator reporting date Summer 2014 – exact date to be confirmed.



No


Yes

Rules for partial achievement at final indicator period/date

Final indicator value for the part achievement threshold

% of CQUIN scheme available for meeting final indicator value

Achievement of the cumulative ACS specified in section 5.1

50%

Achievement of the cumulative CQS specified in section 5.1

50%

LOCAL CQUIN – COLLABORATIVE WORKING (NUMBER 4)


COLLABORATIVE WORKING


Indicator name Improving Collaborative Working between Primary and Secondary Mental Health Care.

The Trust will implement a new way of working between Primary and Secondary mental health care which support the achievement of better outcomes in relation to the following:

Successful delivery of the CQUIN will be predicated on the achievement of process outcomes relating directly to the introduction of a new way of collaborative working with primary care. Its implementation will be formatively evaluated using an ‘action research’ type approach (the suggested method to aid reflection and transparency is the establishment of a community of practice.)

The CQUIN will also include an evaluation designed to assess whether there have been improvements to health and communication outcomes (as described in the numerator) as a result of the service changes.

Delivery will also be predicated on the Trust taking a visible and proactive approach to engaging with GPs across all three CCG areas.

Where the Trust is unable to engage with GP practices and has demonstrated effort in doing so this will be raised with respective CCGs who will assist in Trust in engaging with practices through other forums e.g. neighbourhood meetings


1%

Description of indicator A role is introduced within each community mental health team to undertake primary care mental health liaison at practice and neighbourhood level. 1. The role is developed, tested out,

evaluated and adjusted to optimise outcomes.


2. The workers participate fully in the

integrated and tailored care/virtual ward programmes.

3. The Trust will co-ordinate a reflective

‘community of practice ’for key stakeholders , the function of which will be to support the development of the role of the primary mental health liaison worker, champion the progress of changes to collaborative working, provide a forum for working together to identify barriers to progress and unlock solutions

4. The new model of collaborative

working is reviewed and evaluated against the agreed improvement outcomes, and recommendations (including proposed communication plan) are made for its further development in 2014/15

Numerator 1. Trust to develop a job description for

the primary mental health liaison workers role and submit to CCG leads for comment. (CCGs to comment/respond within 5 working days)

2. Quarterly Qualitative report to include the following:

• Update on recruitment to primary mental health liaison posts

• Summary of attendance/involvement in integrated and tailored care/ virtual ward meetings

• Summary of liaison with GP practices during the quarter to include practices visited, support provided around Annual Health Checks

3. Community of Practice meetings will be held quarterly through the year

4. GP information Packs that were set up in 2012/13 to be updated for each practice


5. Evaluation proposal to be developed and submitted to CCG leads for approval. The proposal should consider the following: -

• Details of Communications and relationship development between GPs and Mersey Care.

• The Quality and frequency of clinical discussions in relation to issues of concern.

• Identification and treatment of people with SMI who have physical health care needs.

• Identification and treatment of people with long term conditions who have co-morbid mental health problems.

• Responses to co-morbid physical and mental health needs.

• Sharing of information on physical health checks for people with SMI

• Transfer of care from secondary to primary care.

• Capacity and capability of primary care to respond to the mental health needs of their patients.

6. Evaluation to be undertaken and submitted, to include recommendations for 2014/15 and a communication plan.

Denominator 1. N/A

2. N/A

3. Community Practice Meetings

4. N/A


5. Production of evaluation proposal

6. Evaluation

Rationale for inclusion The majority of people who come into contact with NHS services as a result of mental ill-health do so in primary care.

1 in 3 presentations in primary care relate to mental ill health (<500,000 contacts), and the number, severity and complexity of presentations is increasing, without there having been any corresponding increase in resources.

Around 30% of people attending general practice have a mental health component to their illness (Jenkins et al 2002)

The introduction of a system for collaborative working will help primary and secondary care work more effectively together to anticipate and manage complex physical and mental health care needs.

Costs to the health care system are significant: co morbid mental health problems exacerbate physical illness and raise total health care costs by at least 45% for each patient (Naylor et al, Kings Fund 2012)

Data source Quarterly data reporting

Frequency of data collection Quarterly


Provider Organisation

Frequency of reporting to commissioner Quarterly at CQP Meeting

Baseline period/date Quarter 1 2013/14

Baseline value N/A


Quarter 4 2013/14

Final indicator value (payment threshold) TBC


All reports submitted in line with quarterly reporting timescales

Final indicator reporting date As per agreed reporting timescales


See details of milestones below



Partial payment will be discussed and agreed at year end on review of trust performance during the year.

Milestones





Q1 • Role and Job Description to be developed by the Trust and then sent to all three CCGs for comment. (CCGs to comment/respond within five working days of receipt)

• Progress report to include details around

o Recruitment process o Key project and

stakeholders identified Timetable for community of practice meetings

• First Community of Practice

Meeting takes place, facilitated by the Trust, barriers to successful implementation are identified, discussed and solutions proposed.

As per agreed CQUIN reporting timescales

15%

Q2 • Second Community of Practice Meeting take place

• Progress report to include

details around

o Recruitment o Attendance of recruited

primary care liaison workers to the integrated care/tailored care/virtual ward teams

o Roll out of liaison meetings with practices with a recruited primary care liaison worker

o Identification of practices who do not engage


20%


• GP information Packs that

were set up in 2012/13 to be updated for each practice as ‘primary mental health liaison worker’ posts are recruited to.

Q3 • Third Community of Practice Meeting take place


o Recruitment o Introduction of recruited

primary care liaison workers to the integrated care/tailored care/virtual ward teams (on-going)

o Roll out of liaison meetings with practices with a recruited primary care liaison worker (on-going)

o For posts recruited during Q2 - Evidence provided that there is active and on-going liaison with GP Mental Health leads in each practice or Practice Managers where there is no identified mental health lead. Practices that do not respond will be identified in good time, and clinical commissioners will advise accordingly.

o For posts recruited during Q2 - Involvement in integrated care/tailored care/virtual ward teams

• GP information Packs that were set up in 2012/13 to be updated for each practice and circulated as ‘primary mental health liaison worker’ posts are recruited to (on-going).

• Evaluation proposal drafted

and jointly agreed with CCGs by 30th November 2013


30%


Q4 • Fourth Community of Practice

Meeting takes place, facilitated by the Trust, barriers to successful implementation identified, discussed and solutions proposed


o Recruitment o Introduction of recruited

primary care liaison workers to the integrated care/tailored care/virtual ward teams (ongoing)

o Roll out of liaison meetings with practices with a recruited primary care liaison worker (ongoing)

o For posts recruited during Q2 & Q3 - Evidence provided that there is active and ongoing liaison with GP Mental Health leads in each practice or Practice Managers where there is no identified mental health lead. Practices that do not respond will be identified in good time, and clinical commissioners will advise accordingly.

o For posts recruited during Q2 & Q3 - Involvement in integrated care/tailored care/virtual ward teams, ongoing

• Evaluation report with

recommendations and proposed communication plan for 2014/15 to be submitted by 28 February 2014.

• GP information Packs that were set up in 2012/13 to be updated for each practice and


35%


circulated where ‘primary mental health liaison worker’ posts are recruited to (on-going).

LOCAL CQUIN – COMMUNICATIONS (NUMBER 5)

IMPLEMENTATION PLAN TO SUPPORT TRANSITION FROM PAPER TO ELECTRONIC METHOD OF COMMUNICATION


Indicator name Trust to demonstrate the transition from paper to electronic transmissions between secondary and primary care.


0.3%

Description of indicator Submission of implementation plan to support the transition from paper to electronic transmissions of discharge letters, discharge notifications, out-patient letters, and transfer of care notifications and timely communication of changes to the level of care provided including medication changes.

Trust to develop an implementation plan and


have the plan agreed by Commissioners to support the integration and transition of electronic communication through the Merseyside Messaging Hub to primary care.

Numerator Submission of Implementation Plan to support the integration and transition from paper to electronic through the Merseyside Messaging Hub. Implementation Plan developed by MCT and agreed by Commissioners.

Denominator N/A

Rationale for inclusion Timely care transfer requires clinicians and others to plan, inform and negotiate to ensure a smooth transition for individuals and their families

Data source Implementation Plan/Project Plan

Frequency of data collection Quarterly Updates provided to Commissioner/CCG


Mersey Care NHS Trust

Frequency of reporting to commissioner Quarterly Reporting

Baseline period/date Quarter One – 1st April 2013 – 30th June 2013

Baseline value N/A


31st March 2014



Completion of milestones contained within the trust implementation plan to generate payment.

Final indicator reporting date April/May 2014


Yes – See details of Quarterly Milestones


No

Milestones




Milestone weighting (% of CQUIN scheme


available) Quarter One

1.4.13 – 30.6.13

Submission of implementation plan to outline the trust intention to patch EPEX to an appropriate position to allow Merseyside Messaging Hub. Implementation plan to also include trust transition towards a suitable infrastructure to support the Cloud migration. Implementation plan to develop the interface to the Merseyside Messaging Hub.

Trust Submission between 1st August 13– 16th August 13

30% of allocated sum

Quarter Two

1.7.13 – 30.09.13

Submission of delivery plan based on implementation plan – showing evidence of milestone progression/ completion.

Trust Submission between 1st November 13 – 15th November 13

20% of the allocated sum

Quarter Three

1.10.13 – 31.12.13


Trust Submission between 1st February 14 – 15th February 14

20% of the allocated sum

Quarter Four

1.1.14 – 31.3.14


Trust Submission between 1st May 14 – 16th May 2014.

30% of the allocated sum.


IN-PATIENT DISCHARGE NOTIFICATIONS


Indicator name Inpatient Communication


0.15%

Description of indicator All discharge communication from In-patient episodes contains the agreed level of information and is sent to General Practice within a timely manner.

Numerator 1 95% of discharge notifications to contain the recommended CRG Minimum Dataset – including diagnosis/differential diagnosis and risk assessment. All discharge summaries/notifications are electronically constructed.

Numerator 2 95% of discharge notifications are sent to the patients General Practice within 24 hours of the patients discharge (excluding weekends and Bank Holidays). All discharge summaries/notifications are electronically constructed.

Denominator 1 Audit Sample


Rationale for inclusion Timely care transfer requires clinicians and others to plan, inform and negotiate to ensure a smooth transition for individuals and their families

Data source Trust clinical system and sample audit.

Frequency of data collection Quarterly data collection by provider.



Frequency of reporting to commissioner Quarterly Reporting to Commissioner/CCG

Baseline period/date None

Baseline value None


31st March 2014



Yes – See details of quarterly milestones for each indicator.




Numerator 1 - Milestones

Q1 – Planning and Implementation

Q2 – 60%

Q3 – 80%

Q4 – 95%

Numerator 2 – Milestones

Q1 – Planning and Implementation

Q2 – 60%

Q3 – 80%

Q4 – 95%


Partial achievement and payment to be discussed and agreed at year end on review of the trust performance.

Milestones Date/period milestone relates to




Quarter One

1.4.13 – 30.6.13

See details of Quarterly Milestones above.Audit Sample to include 10 patients per ward per quarter.



Quarter Two

1.7.13 – 30.09.13




Quarter Three

1.10.13 – 31.12.13




Quarter Four See details of Quarterly Milestones above.Audit Sample to include 10

Trust Submission between 1st May



1.1.14 – 31.3.14

patients per ward per quarter. 14 – 16th May 2014.


OUTPATIENT COMMUNICATION


Indicator name Outpatient Communication


0.25%

Description of indicator All clinic/outpatient correspondence/ letters sent to General Practice following the patient’s appointment, including discharge from service within 10 working days (excluding weekends and bank holidays). Correspondence to be electronically constructed and to contain the agreed Minimum Data including the following: -

• Demographic details, including full name, address, DOB

• NHS number

• Presenting Compliant /Reasons for referral (all new appointments and as appropriate for follow up appointments)

• Diagnosis/provisional diagnosis/differential diagnosis

• Care Plan/Management Plan detailing Care Co-ordinator details including contact details (if on CPA) and details of medication (with specific compliance and monitoring arrangements beyond routine clinical review if appropriate

• Risk Assessment and Management – details of whether the service user has any relevant infections including but not limited to MRSA.

• Specific actions for primary care including blood monitoring required for service users on Lithium or at risk of developing metabolic syndrome

Numerator 1 95% of Out-patient correspondence/letters to contain the recommended, Minimum Dataset – including the above information contained within the “description of indicator”.

Numerator 2 95% of Out-Patient correspondence/letters are sent to General Practice by fax or post within 10 working days of the patient’s


appointment.



Rationale for inclusion GPs require timely and relevant information about their patients so as keep them informed about on-going treatment and care plans.

Data source Sample audit

Frequency of data collection Quarterly Data Collection by Provider




Baseline period/date N/A

Baseline value N/A


31st March 2014






Numerator 1 - Milestones

Q1 – Planning and Implementation. Including Baseline Assessment. Targets below to be adjusted accordingly following results.

Q2 – 60%

Q3 – 80%

Q4 – 95%

Numerator 2 – Milestones

Q1 – Planning and Implementation Including Baseline Assessment. Targets below to be adjusted accordingly following results.Q2 – 60%

Q3 – 80%


Q4 – 95%


Partial achievement and payment to be discussed and agreed at year end on review of the trust performance.

Milestones





Quarter One

1.4.13 – 30.6.13

See details of Quarterly Milestones above. Audit Sample – 10 per consultant per quarter.



Quarter Two

1.7.13 – 30.09.13

See details of Quarterly Milestones above.Audit Sample – 10 per consultant per quarter.



Quarter Three

1.10.13 – 31.12.13

See details of Quarterly Milestones above.Audit Sample – 10 per consultant per quarter.



Quarter Four

1.1.14 – 31.3.14

See details of Quarterly Milestones above Audit Sample – 10 per consultant per quarter.




OUT-PATIENT COMMUNICATION – CHANGES IN MEDICATION/TREATMENT PLAN


Indicator name All changes to patient’s treatment plan/medication are communicated effectively to general practice within a timely manner.


0.1%

Description of indicator All patients seen in Out-Patients to have their change in medication or treatment plan communicated to General Practice within 24 hours (excluding weekends and Bank Holidays). Communication documentation is electronically constructed.

Numerator 95% of changes in medication/treatment plan are communicated to the patient’s general practice within 24 hours of the out-patient clinic (excluding weekends and Bank Holidays).

Denominator Total number of patients seen in out-patients with changes made to their treatment plan or medication.

Rationale for inclusion GPs require timely and relevant information about their patients so as keep them informed about on-going treatment and care plans.

Data source Trust clinical system.

Frequency of data collection Monthly collection by provider




Baseline period/date None

Baseline value None


31st March 2014







Details of Quarterly Milestones

Q1 – Planning and Implementation. Including Baseline Assessment. Targets below to be adjusted accordingly following results.

Q2 – 60%

Q3 – 80%

Q4 – 95%


Partial achievement and payment will be discussed and agreed at year end on review of the trust performance.

Milestones Date/period milestone relates to




Quarter One

1.4.13 – 30.6.13

See details of Quarterly Milestones above.



Quarter Two

1.7.13 – 30.09.13




Quarter Three

1.10.13 – 31.12.13




Quarter Four

1.1.14 – 31.3.14





LOCAL CQUIN – TRANSITION FROM CAMHS TO ADULT MENTAL HEALTH (NUMBER 6)

CQUIN TITLE: Transition from CAMHS to Adult Mental Health and Learning Disability services


Indicator name Transition from CAMHS to Adult Mental Health and Learning Disability services


0.375%

Description of indicator • For Alder Hey and Mersey Care to jointly develop and conduct an audit of the transitional mental health pathway and jointly undertake a survey of the needs of a sample of current young people aged 15 – 19 who are on Alder Hey CAMHS and MCT caseload.

• To work jointly to further develop the shared transition protocol which includes guidelines and checklist for transition planning arrangements, thresholds for transition, parallel and shared care, review and continuity of care, involvement of young people and carers, discharge planning with primary care, effective communication with all stakeholders.

• To jointly disseminate and implement the transition protocol.

• Jointly review and evaluate, to include recommendations for action 2014–15.

Numerator • Development and implementation of audit tool in collaboration with Alder Hey.

• Implementation of audits

• Submission of implementation plan


• Development of transition protocol

• Evidence that transition meetings have taken place

• Evaluation to include recommendations and proposals for 2014/15

Denominator A sample of young people aged 15 – 19 who are on MCT caseload for audit and survey only.

Exclusions - All service users whose primary presenting issue is ADHD

Rationale for inclusion Epidemiological research highlights that most adult mental health problems emerge in adolescence, and that mental health issues are the main health problem of this age group (Kessler et al, 2007). The new mental health strategy, ‘No Health without Mental Health’, suggests in the foreword that “by promoting good mental health and intervening early, particularly in the crucial childhood and teenage years we can help to prevent mental illness from developing and mitigate its effects when it does” (DH, 2011).

However, evidence suggests that young people are currently poorly served by mental health services (Singh et al, 2010 and Singh, 2009). There are problems with transition from CAMHS to AMHS services. The TRACK study (Singh, 2008) shows that transitions for young people at the age of 18 are poorly managed resulting in only 4% of young people receiving an ‘ideal transition’. Young people aged under 25s are underrepresented in adult services. Therefore services are failing to engage young people, at the time that their disorders may be most effectively treated.

Many commentators argue that the life stage of emerging adulthood lasts from 12-25 (McGorry et al, 2007). The current configuration of mental health services has a major transition of care in the middle of this stage. Having a transition at the age of 18, or 16 as is current practice in Liverpool and Sefton, 2 years earlier than national guidance, is service led and not user led, as it falls in the period where mental health


problems emerge.Young people value stable relationships, and this transition necessitates a change in worker (McDonagh, 2006). Moreover, recent research has highlighted how few people make the transition across to adult services, which have a different culture to CAMHS services and focus more on clear diagnostic categories (Singh, 2009; Singh et al, 2010).

Services often exclude young people who may go on to develop more severe problems. Moreover, even when adult services do accept a referral, the young person is particularly likely to disengage. Audit data from Birmingham suggests 25-50% of under 25s disengage from mental health services (Birchwood, Conference presentation, 2010) Data from Australia highlights how young people fail to engage with traditional adult services.

In addition there have been a number of local serious adverse incidents relating to issues with transitions within Liverpool and Sefton, fitting with the above concerns.

Data source Audit data & report, protocol, guidelines, implementation plan, evaluation report

Frequency of data collection Quarterly


Provider Organisation

Frequency of reporting to commissioner Quarterly at CQP Meeting

Baseline period/date Quarter 1 2013/14

Baseline value N/A


Quarter 4 2013/14



All reports submitted in line with quarterly reporting timescales

Final indicator reporting date As per agreed reporting timescales


See details of milestones below.



Partial payment will be discussed and agreed at year end on review of trust performance.

Milestones





Q1 • Recruit to joint posts across organisations to support CQUIN work

• Audit and survey tool developed in collaboration Alder Hey and Mersey Care. CCG’s to review and comment before end of Q1. (CCGs to send comments within 5 working days of receipt)


25%

Q2 • Implement audit and survey tools


25%

Q3 • To develop a shared transition protocol which includes guidelines and checklist for transition planning arrangements, parallel and shared care, review and continuity of care, involving young people and carers, discharge planning with primary care, effective communication with all stakeholders.

• For survey data to be collated as a report to explore need.

• To disseminate and commence implementation of the transition protocol. CCG’s to review and comment before end of Q3. (CCGs to send comments within 5


25%


working days of receipt)

• Q4 • Review and evaluate the

implementation of the protocol, to include recommendations to inform 2014 – 15 planning, and an assessment of issues which impact on future models of care for young people

• Repeat transitions audit in Q4 and compare findings from both audits

• Transition CQUIN review

meeting to take place with both organisations and commissioners and/or other key stakeholders to digest learning and findings to inform future planning


• 25%

merseycarenhs trust commissioning for …...mersey care mental health – cquin scheme v1 2013/14!...

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