MHDN Services Across South East Coast

1. MHDN Services Across South East Coast Steven Duckworth- SCN Manager Senate Presentation- 2nd July 2014

2. Mental Health • 2 Area Teams commissioning specialised services • 21 CCGS (13 Surrey and Sussex & 8 Kent and Medway) • 6 Joint Commissioning Units (with arrangements for Mental Health services) • 3 NHS Mental Health Providers • Multiple private providers • Numerous disease types and services

3. Population Health Profile (MH) • High youth unemployment in Brighton & Hove and Medway • High alcohol related admissions in East Sussex • High levels of depression across Sussex, but low take up of IAPT • High incidence of self harm across Sussex • Highest level in the country for child & adolescent mental health admissions in Medway

4. Issues (MH) • Mental health is anecdote rich, but data poor- a new intelligence system was launched last week • The system for access to services is fragmented- multiple services with differing criteria • Emergency care responses are poor and many people in crisis present to the ambulance service, A&E or the police • Mental health services are not considered as important as physical health services

5. Possible Solutions • Single point of access • Crisis Care Concordat • Parity of Esteem • Developing clinical commissioners confidence in mental health commissioning

6. Dementia • Dementia is predominately a disease of older people • Kent & Medway as an above average ageing profile and Surrey & Sussex has the highest ageing profile in England • The government is committed to having two thirds of people with dementia diagnosed by April 2015- it is unlikely that any SEC CCG will achieve this

7. Dementia • Despite much stigma and nihilism, some treatments and great care can be available to people with dementia • The SCN is working on describing new models of dementia diagnosis and post-diagnosis support. The Academic Health Science Network will continue to measure processes surrounding diagnosis and explore innovative approaches to dementia care

8. Neurological Conditions- SEC Background • Poorly co-ordinated and unplanned services • Traditionally low priority service areas • Historical lack of investment - Evidence and value for money questioned • Stigma and mis-conception about the conditions • Often hidden – lack of visibility – poor data • Partnership/integration between primary, secondary and community health providers and with social care and third sector is key • Big potential for improving outcomes and patient experience • Opportunities for savings and re-investment

9. Neurological Activity Across SEC • Epilepsy £24,187,749 • Neuropathy £15,250,710 • Parkinson’s & dementia in Parkinson’s £10,006,498 • Multiple sclerosis £6,595,640 • Acquired brain injury £4,066,764 • Hydrocephalus £3,788,337 • CNS infections £3,193,426 • Migraine £2,799,471 • Spinal cord injury £1,696,453 • Motor neurone disease £735,927 • Total of above is £90.7m. This equates to 52,220 admissions

10. Neurological Issues Across SEC • No tertiary centre for neuromuscular conditions - patients travel to London centres for care and Outreach is poor • Lack of access to community and in-patient based neuro-rehabilitation • Poorly co-ordinated pathways and out-reach, particularly with tertiary centres and for those with long-term conditions • Lack of GPwSI for neurological conditions and poor understanding generally in primary care of neurological conditions • Poor transition for those moving from paediatric services to adult services

11. Neurological Conditons- Moving Forward • Development of rapid acute access to neurological specialist • Potential to link with Hyper-acute stroke, e.g. development of neuro-vascular centres • Development of clear and navigable pathways for those with long term conditions, e.g. Parkinson's disease, Multiple Sclerosis, Motor Neurone Disease and Epilepsy