1. Quality & Productivity (QIPP)
in Mental Health
Dr. Sabyasachi Bhaumik
Medical Director, Leicestershire Partnership NHS Trust
Honorary Senior Lecturer, University of Leicester

2. THE BACKGROUND
1. History of mental health services
a. Shift towards community based care.
b. Closure of beds
2. NSF (1999)
a. Social inclusion & community based care
b. New specialist teams – AOT, CRHT, PIER etc
c. Evidence based practice
d. Improving access – IAPT
3. New Horizons
a. Prevention & early intervention
b. Interagency working

3. Need for efficiency – why now?
 Economic downturn & its implications
 Projected efficiency savings - £15-20bn by
2013/14
 Implications of zero based budgets
 Mental health – 13.8% of health budget
 Direct and indirect costs of poor mental
health - £77 bn

4. Threats & opportunities
 Threats
 Decommissioning
 Tendering
 Competition from other sectors
 Drive towards value for money – efficiency
 Opportunities
 Autism Act
 National Dementia Strategy
 Long term conditions
 MUS
 GP commissioning
 PbR

5. QIPP as part of efficiency
 Drivers for efficiency
 CIPs
 Decommissioning
 PbR
 Tendering
 Vehicles for efficiency
 CQUIN
 Carepathways
 QIPP

6. What is QIPP?
 Quality
 Innovation
 Prevention
 Productivity
 Steered by DoH, National Mental Health Development Unit, Audit
Commission, NHS Confederation and Mental health Networks

7. QIPP framework
National
Indentifying levers & setting the agenda – CQUIN, PbR,
services for MUS etc
Providing support & advice for change
Developing partnerships
Co-ordinating programmes of change at scale
Local & Regional
Redesigning systems & pathways
Innovations
Sharing of audit data between commissioners and providers
Benchmarking and evidence building

8. The main principles underpinning QIPP in
mental health
 Care close to home.
 Fewer acute beds.
 Reduced variations in care.
 Standardization of Care pathways.
 Early Intervention.
 Productivity.

9. Three major areas for QIPPMH
1. Supporting improvements in the acute care
pathway
2. Out of area placements.
3. Physical / mental health interface – including how
mental health can support colleagues working in
the acute and primary care sector on areas like
tackling medically unexplained symptoms and
improving liaison services.

10. Examples of innovative practice
 Releasing time to care (Rampton Hospital)
 A series of steps designed by staff within the
ward
 Each step has an incentive for the staff
 Increase in staff morale
 Reduction in sickness from 14% to 1.1%
 More efficient ward means better patient care
and patient satisfaction

11. Examples of innovative practice
 Early discharge
 Underpinned by productive mental health
ward
 Staff initiated process review
 Achieved reduction in paper work
 Improvement in in-patient & community
coordination
 Reduction in readmission rate (400%
increase in successful early discharge)

12. Examples of innovative practice
 Intensive Home Intervention Team
(Edinburgh)
 Problems with high bed occupancy &
revolving door patients
 Resolved through creative IHIT combining
the functions of AOT and CRT
 60% reduction in bed occupancy
 94% user satisfaction

13. Further themes of innovative
practices
Adult mental health:
Bringing NSF teams together
AOT for revolving door patients
e-prescribing
generic prescribing
e-communication with GP’s
Admin support
MHSOP:
Long term care model
Dementia prescribing with primary care
Nurse led cognitive assessment team

14. Further themes of innovative
practices
CAMHS:
Joint working with Paediatricians
NWW
Mental health care workers with primary care
LD:
Care pathways and PbR
NWW
Tiered care model
Partnership with voluntary organisations, independent sector and
social care services
Out of area placements

15. Future
 Commissioning driven by quality of patient
experience
 PbR for mental health in place by 2013/14
 GP commissioning in place by 2013
 Partnerships in service provision
 Total place
 Transforming Community Services
QIPP is here to stay!!