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Health National Service Framework - Autumn 2002 Position Statement

Self-Assessment Framework

GUIDANCE FOR COMPLETION

Mental Health National Service Framework - Autumn 2002 Position Statement

Self-Assessment Framework

GUIDANCE FOR COMPLETION

(1) The framework should be discussed and a response agreed within the LIT.

(2) The framework has descriptive statements for each of the lines on the scoring sheets. Circle `green', `amber' or `red' as appropriate for the statement which most nearly matches the situation in your locality. Five questions in the framework also ask for the elements to be specified which contribute to your response. There is provision for this on the scoring sheets.

(3) If the situation varies within the LIT area as regards different progress in neighbouring PCT or LA areas, circle `amber' or `red' to reflect the poorest level of progress within the whole locality. Only circle `green', if this is the situation across the whole locality.

(4) Except where the statement explicitly states otherwise, the situation should be scored as at September 2002. This does not imply any change to deadlines for achievement of NHS plan or NSF targets - the self assessments aim simply to give a local and national picture of the current position.

(5) The shaded lines on the scoring sheets identify indicators which are substantially or wholly unchanged since last year.

(6) Please complete the framework as openly and honestly as possible. It is expected that all returns will contain a number of `red' assessments, and that few returns will contain a majority of `green' assessments.

(7) There are guidance notes for reference at the back of the framework.

Mental Health National Service Framework - Autumn 2002 Position Statement

Self-Assessment Framework : SCORING FOR LITs

For self-assessment please circle `R' Red, `A' Amber or `G' Green as applicable.

KEY SERVICES

LIT Name:

1. Assertive outreach

R

A

G

2. Crisis resolution

R

A

G

3. Early intervention in Psychosis

R

A

G

4. Secure places

R

A

G

5. Women's services

R

A

G

6. Carers' services

R

A

G

7. Black & minority ethnic people's services

R

A

G

Contact Name:

8. 'Gateway' workers

R

A

G

9. New graduate primary care workers

R

A

G

10. Primary-secondary interface

R

A

G

SMI registers _ Referral protocols _

Information exchange _ Primary care based services _

11. Acute inpatient services - Acute Care Forums

R

A

G

12. Acute inpatient services - Ward Organisation

R

A

G

Ward Forum _ Named Clinician _ Named Consultant _

13. Prison (MH) Services

R

A

G

CARE PLANNING

Telephone No:

14. Care programme approach - Access to Care Plans

R

A

G

15. Care programme approach - Information Sharing Protocols

R

A

G

16. Care programme approach - Comprehensive

R

A

G

17. Care programme approach - Carers' Plans

R

G

18. NHS Direct

R

A

G

E-Mail:

19. Transition Protocols

R

A

G

Children _ Older people _

LOCAL PLANNING

20. Planning process

R

A

G

Priorities _ Needs Assessment _ Measurable

Targets _ Timescales/Milestones _ Responsibility _

21. Commissioning - Planning

R

A

G

22. Commissioning - Health Act Flexibilities

R

A

G

23. Local strategic partnerships

R

A

G

SERVICE INTEGRATION

24. Provision - CMHTs

R

G

25. User Led Services

R

A

G

26. Voluntary sector

R

A

G

UNDERPINNING PROGRAMMES

27. Recruitment and retention

R

A

G

28. Workforce planning

R

A

G

29. Education and training

R

A

G

30. Representative workforce

R

A

G

31. Link to LIS

R

A

G

32. Integrated MHER

R

A

G

33. Local directory

R

G

34. Funding

R

A

G

OTHER PRIORITIES

35. Single sex accommodation

R

G

36. Mental Health Promotion

R

G

37. Specialist services

R

A

G

Sensory impairment _ Eating disorders _

Mother & baby _

38. Section 135/136 - Places of Safety

R

A

G

39. Mental Health Act 1983 - Board reports

R

A

G

40. Mental Health and Learning Disabilities

R

A

G

41. Dual diagnosis - LIT/DAT Interface

R

A

G

Thank you for completing this document. Please send it to your Strategic Health Authority Mental Health Lead.

Mental Health National Service Framework - Autumn 2002 Position Statement

Self-Assessment Framework

RED

AMBER

GREEN

KEY SERVICES

1. Assertive Outreach

There is no service available which meets the Policy Implementation Guide definition of 'assertive outreach'.

There is some level of assertive outreach provided which meets the Policy Implementation Guide criteria

- but is provided only at a level which is

in-sufficient to meet local needs.

There is an assertive outreach service available which meets fully the Policy Implementation Guide definition, and which is provided at a level which is sufficient to meet local needs.

2. Crisis Resolution

Community-based services which provide assessment and intervention at times of crisis are not available 24 hours a day, 7 days a week as defined by the Policy Implementation Guide.

Community-based services which provide assessment and intervention at times of crisis are available 24 hours a day, 7 days a week, as defined by the Policy Implementation Guide but at a level which is insufficient to meet local needs.

Community-based services which provide assessment and intervention at times of crisis are available 24 hours a day, 7 days a week which fully meet the definition within the Policy Implementation Guide and at a level which is sufficient to meet local needs.

3. Early Intervention in Psychosis

There is no service available which meets the Policy Implementation Guide definition of 'early intervention in psychosis'.

There is some level of early intervention in psychosis which meets the Policy Implementation Guide criteria

- but is provided only at a level which is in-sufficient to meet local needs.

There is a service available which meets the Policy Implementation Guide definition of 'early intervention in psychosis' and which is provided at a level which is sufficient to meet local needs.

4. Secure Places

There are significant deficiencies in the availability of medium and low secure beds for local residents.

There are some deficiencies in the availability of medium and low secure beds for local residents.

There are no deficiencies in the availability of medium and low secure beds for local residents.

5. Women's Services

There are no women-only community day services for the local residents.

There are some women-only community day services for local residents.

There are sufficient women-only community day services for local residents.

6. Carers' Services

There are no plans or plans are in-sufficient to ensure the delivery of this target by April 2004.

Plans are being developed for the recruitment of staff to ensure that there are increased breaks available for carers and carer networks are strengthened sufficient to achieve `Green' status by April 2004.

There is already a sufficient number of staff in post to meet local needs and ensure that breaks are available for carers and that carer support networks are fully developed.

7. Black and Minority Ethnic People's Services

There is no evidence that collection of data in accordance with the guidelines (EL(94)77) is being reported to the boards of local services and hence integrated into governance arrangements.

There is evidence that data is being collected in accordance with the guidelines (EL(94)77) but no reports/action plans arising from its usage and hence no integration with governance arrangements.

Data is collected and integrated into governance arrangements at board level. Reports and action plans produced include specific targets and user and carer monitoring of the plans.

Please refer to guidance notes for further details

RED

AMBER

GREEN

8. `Gateway' workers

No or inadequate plans have been developed to incorporate `Gateway' community mental health workers into mental health services by 2004.

Plans are being developed to ensure that `Gateway' community mental health workers are in place by 2004.

A `Gateway' community mental health worker is now, or will be in place by March 03, to make explicit links with at least one PCT.

9. New graduate primary care workers

There are no local plans concerning access to appropriate training, education and supervision within primary care, and no consultation has been undertaken on where they will be based.

Only preliminary plans are in place to secure appropriate education, training and supervision or further work needs doing locally to agree on where they will be based.

Access to appropriate education, training and supervision can now, or will be provided by March 03, to support new graduate workers. Local agreement has been secured concerning their location.

10. Primary-secondary interface

Sparse coverage - only one or two of the following systems in place (please specify)

· SMI registers

· Referral agreements (protocols) reviewed to ensure they are operating effectively

· Protocols on exchange of information

· Systems for delivering specialised services on the primary care site (out-posted clinics, primary care liaison teams, etc).

Moderate coverage - three of the following systems in place (please specify)

· SMI registers

· Referral agreements (protocols) reviewed to ensure they are operating effectively

· Protocols on exchange of information

· Systems for delivering specialised services on the primary care site (out-posted clinics, primary care liaison teams, etc).

Good coverage - all four of the following systems in place

· SMI registers

· Referral agreements (protocols) reviewed to ensure they are operating effectively

· Protocols on exchange of information

· Systems for delivering specialised services on the primary care site (out-posted clinics, primary care liaison teams, etc).

11. Acute Inpatient Services - Acute In-patient Forum

An Acute Care Forum is not currently established.

An Acute Care Forum has been established which is developing its terms of reference and remit/appropriate policies.

An Acute Care Forum has been established in line with guidance and with the involvement of all key stakeholders and is working to an agreed plan of action.

12. Acute Inpatient Services - Ward Organisation

None of the following are in place:

- Regular service user and ward staff forum on each ward

- Named clinical and professional leads responsible for ensuring regular multi-disciplinary input to the wards

- Named consultant psychiatrist lead for each ward

One or two of these in place, (please specify):

- Regular service user and ward staff forum on each ward

- Named clinical and professional leads responsible for ensuring regular multi-disciplinary input to the wards

- Named consultant psychiatrist lead for each ward

All of these in place:

- Regular service user and ward staff forum on each ward

- Named clinical and professional leads responsible for ensuring regular multi-disciplinary input to the wards

- Named consultant psychiatrist lead for each ward

13. Prison (MH) Services

There are no strategies or systems in place to identify local residents with mental health needs due for release from prison and link them to local services.

There are some strategies or systems in place to identify local residents with mental health needs due for release from prison and link them to local services but they are not operated consistently and effectively.

There are strategies or systems in place to identify local residents with mental health needs due for release from prison and link them to local services which are operated consistently and effectively.

CARE PLANNING

14. Care Programme Approach - Access to Care Plans

Care plans cannot be accessed 24 hours a day by staff providing direct care to users.

Care plans can be accessed 24 hours a day but are not held on a central database.

Care plans are held on a central database which is regularly updated and available 24 hours a day.

Please refer to guidance notes for further details

RED

AMBER

GREEN

15. Care Programme Approach - Information Sharing protocols

Information sharing protocols have not been discussed between local agencies.

Discussions have been initiated between local agencies but information sharing protocols have not yet been agreed.

There is an agreed information sharing protocol between local agencies.

16. Care Programme Approach - Comprehensive

The local enhanced CPA system does not enable recording of assessment and care plans for all of the following:

Employment or other occupation; housing; welfare benefits; crisis plans, including 24 hour access arrangements.

The local enhanced CPA system does enable recording of assessment and care plans for all of the following:

Employment or other occupation; housing; welfare benefits; crisis plans, including 24 hour access arrangements

However:

- There are significant deficiencies in services available to meet assessed needs

The local enhanced CPA system does enable recording of assessment and care plans for all of the following:

Employment or other occupation; housing; welfare benefits; crisis plans, including 24 hour access arrangements.

This information is always recorded and there are sufficient services available to meet assessed needs.

17. Care Programme Approach - Carers' Plans

All regular carers of people on enhanced CPA do not have their own written care plan which addresses their caring, physical and own mental health needs

NO AMBER OPTION

All regular carers of people on enhanced CPA have their own written care plan which addresses their caring, physical and own mental health needs.

18. NHS Direct

No protocols are in place between NHS Direct and local statutory crisis services.

Protocols stating referral routes to local crisis services are in place with NHS Direct but there is no referral agreement in place to enable direct referral by NHS Direct, where clinically indicated, to local crisis services.

Protocols are in place between local specialist mental health providers to enable fast access in a crisis.

By agreement with local services direct referrals by NHS Direct, where clinically indicated, will be accepted for assessment by local crisis services.

19. Transition Protocols

The arrangements for both of the following are inadequate or ineffective:

- transition of service users' care between child

and adolescent services and adult services

- transition of service users' care between adult

services and services for older people.

The arrangements for only one of the following are adequate and effective: (please specify)

- transition of service users' care between child

and adolescent services and adult services

- transition of service users' care between adult

services and services for older people.

The arrangements for both of the following are adequate and effective:

- transition of service users' care between child

and adolescent services and adult services

- transition of service users' care between adult

services and services for older people.

LOCAL PLANNING

20. Planning Process

The local planning process meets only two or fewer of the following standards: (please specify)

- there is clear agreement within the LIT as to
local priorities for action

- local action plans are based throughout on
local assessment of need

- most or all local targets can be readily
measured

- timescales and milestones have been agreed
for most or all local targets

- clear responsibility for implementation has
been agreed for most or all local targets.

The local planning process meets three or four of the following standards: (please specify)

- there is clear agreement within the LIT as to
local priorities for action

- local action plans are based throughout on
local assessment of need

- most or all local targets can be readily
measured

- timescales and milestones have been agreed
for most or all local targets

- clear responsibility for implementation has
been agreed for most or all local targets.

The local planning process meets all of the following standards:

- there is clear agreement within the LIT as to

local priorities for action

- local action plans are based throughout on

local assessment of need

- most or all local targets can be readily

measured

- timescales and milestones have been agreed

for most or all local targets

- clear responsibility for implementation has

been agreed for most or all local targets.

21. Commissioning - Planning

Joint (Primary Care Trust and Local Authority) commissioning structures are not in place for mental health services. Commissioning activity does not reflect the LIP.

There is a joint commissioning structure in place but some commissioning activity exists which is not reflected in the LIP.

There is a joint commissioning structure in place and all commissioning activity is reflected in and drawn from the LIP as the comprehensive commissioning plan for mental health services.

Please refer to guidance notes for further details

RED

AMBER

GREEN

22. Commissioning - Health Act Flexibilities

No pooled budgets are in place across health, PCT and LA for the commissioning of the following:

a) New Services

b) Some current discrete services

c) All adult MH services

There are pooled budgets in place across health, (PCT) and LA for the commissioning of either of the following

a) New Services

b) Some current discrete services

There is a pooled budget covering the commissioning of

c) All adult MH services within at least one LA in the LIT area

23. Local Strategic Partnerships

LSP infrastructures in all or most LSP localities, (within the LIT planning area) have not yet focussed on the needs/circumstances of people with mental distress.

LSP infrastructures in all or most LSP localities, (within the LIT planning area) have focussed on the needs/circumstances of people with mental distress, but there has been no clear impact of this to date.

LSP infrastructures in all or most LSP localities, (within the LIT planning area) have focussed on the needs/circumstances of people with mental distress, and this has resulted in positive action being commissioned/proceeding likely to be of benefit to them.

SERVICE INTEGRATION

24. Provision - CMHTs

CMHTs (including specialist functional teams) are not fully integrated as regards management, policies and systems.

NO AMBER OPTION

Community mental health teams, (including all specialist functional teams) have fully integrated management, policies and systems.

25. User led services

There are no services within the LIT area run exclusively by service User(s) or led by Users within a host provider setting (with agreed funding streams).

The LIT (or member organisations of the LIT) are working to establish or increase the provision of User run or led services within the LIT area (with agreed funding streams).

User run or led services are provided at a level that the LIT deems to reflect an adequate mix within the overall provider arrangements.

26. Voluntary Sector

There is very little, or no, identification of, or engagement with, local mental health voluntary sector services in planning and management mechanisms.

There is some identification of, and engagement with, local mental health voluntary sector services in planning and management mechanisms, but there are no arrangements in place to ensure continuity of funding for key services.

Local mental health voluntary sector services are: known to statutory MH services (through mapping); involved in LIT planning and management mechanisms; and arrangements are in place to ensure continuity of funding for key services.

UNDERPINNING PROGRAMMES

27. Recruitment and Retention

There are significant problems with the recruitment and retention of key staff to provide services.

There are some problems with the recruitment and retention of key staff to provide services.

There are no significant problems with the recruitment and retention of key staff to provide services.

28. Workforce Planning

There is no agreed workforce strategy and action plan in place across all agencies.

There is an agreed workforce strategy and action plan in place across all agencies. However, it does not meet the minimum standards set out in the notes for guidance.

There is an agreed workforce strategy and action plan in place across all agencies which meets the minimum standards set out in the notes for guidance.

29. Education and Training

There are significant problems in providing education and training for the mental health workforce.

There are some problems in providing education and training for the mental health workforce.

There are no significant problems in providing education and training for the mental health workforce.

30. Representative Workforce

Local services have no systems and strategies in place to build a workforce that reflects the diversity of the local population, or to promote cultural competence in the workforce.

Local services have some systems and strategies in place to build a workforce that reflects the diversity of the local population and to promote cultural competence in the workforce.

Local services have comprehensive systems and strategies in place to build a workforce that reflects the diversity of the local population and to promote cultural competence in the workforce.

Please refer to guidance notes for further details

RED

AMBER

GREEN

31. Link to LIS

There is no senior mental health representative on the local LIS group, and no or minimal reference to mental health issues within the current LIS.

There is a senior mental health representative on the local LIS group, but the current LIS contains no clear investment statements for mental health information.

There is a senior mental health representative on the local LIS group, and the current LIS contains clear investment statements for mental health information.

32. Integrated MHER

A mental health electronic record spanning health and social care is not in place. Plans to address this are absent or inadequate. Current systems are not capable of capturing the Mental Health Minimum Data Set.

A mental health electronic record spanning health and social care is not in place. There are however agreed and funded plans to address this issue, which will mean the capture of the Mental Health Minimum Data Set by April 2003.

A mental health electronic record spanning health and social care is in place, which is also fully capable of capturing the Mental Health Minimum Data Set.

33. Local Directory

A comprehensive directory of local services is not in place.

No AMBER OPTION

A comprehensive directory of local services is in place.

34. Funding

Funds have not been identified / allocated to meet the costs of implementing the NSF and NHS plan over the financial years 2002-3 to 2004-5.

Funds have been identified / allocated only partially or provisionally to meet the costs of implementing the NSF and NHS plan over the financial years 2002-3 to 2004-5.

There is a full local agreement to the identification / allocation of funds to meet the costs of implementing the NSF and NHS plan over the financial years 2002-3 to 2004-5.

OTHER PRIORITIES

35. "Safety Privacy and Dignity in mental health units"

Single Sex Accommodation

There remain some mixed sex accommodation, bathing and toilet facilities in in-patient/residential services, (including secure services).

NO AMBER OPTION

There are no in-patient/residential services with mixed-sex accommodation, bathing or toilet facilities. Women-only day and visiting areas are available as defined by assessed need.

36. Mental Health Promotion

As at September 2002, a mental health promotion strategy is not being implemented.

NO AMBER OPTION

As at September 2002, a mental health promotion strategy is being implemented.

37. Specialist Services

Local residents have access to only one or none of the following at a level which is sufficient for local needs: services for people with sensory impairment and mental illness, eating disorder services, mother and baby services (Please specify).

Local residents have access to two of the following at a level which is sufficient for local needs: services for people with sensory impairment and mental illness, eating disorder services, mother and baby services, (Please specify).

Local residents have access to all of the following at a level which is sufficient for local needs: services for people with sensory impairment and mental illness, eating disorder services, mother and baby services.

38. Mental Health Act 1983

Section 135/136/Places of Safety

There is no written policy which meets the needs of the MH Act regarding Section 135/136 and/or no routine arrangements within the LIT catchment area to monitor appropriateness and frequency of use of Section 136 powers and distribution of places of safety.

There is a written policy in place which complies with the needs of the MH Act and with established arrangements for regular monitoring at least annually within the LIT catchment area of appropriateness and frequency of use of the Section 136 powers and use of places of safety.

There is a written policy in place which meets the needs of the MH Act and is demonstrated by regular monitoring within the LIT catchment area to be working well in practice. The policy is sensitive to the needs of patients in terms of: geographic distribution; minimal reliance on use of police-based places of safety; and in terms of powers considered by ethnicity or gender.

Please refer to guidance notes for further details

RED

AMBER

GREEN

39. Mental Health Act 1983

Board reports and action plans

No report has been presented to Boards locally based on the self assessment of local arrangements and remedial action required to respond to the recommendations in the MHAC 9th Biennial Report.

A self assessment report regarding recommendations in the MHAC 9th Biennial Report has been received by respective local Boards but the related action plans are still under development or not yet agreed and resourced.

A self assessment report regarding recommendations in the MHAC 9th Biennial Report has been received by respective local Boards with realistic and fully resourced action plans agreed and in place at 30/9/02 and ongoing self-assessment and annual Board reporting arrangements established.

40. The Mental Health of People with Learning Disabilities

There is no agreement between mental health and learning disability services about commissioning and provision roles, frequent disputes between the two services and no plans for integrated service development.

There is a degree of agreement between mental health and learning disability services about commissioning and provision roles and responsibilities. Some progress towards achieving NSF and Valuing People objectives for people with learning disabilities with mental health problems, but also some disputes between services.

There is clarity of agreement between mental health and learning disability services about commissioning and provision roles and responsibilities and people receive the standards of mental health services described in the NSF and Valuing People.

41. Dual Diagnosis - LIT/DAT Interface

No discussions have been initiated between the LIT and the corresponding DAT(s) on Dual Diagnosis.

The LIT and DAT(s) have jointly identified a lead commissioner and lead clinician for dual diagnosis.

A local Dual Diagnosis strategy and plan have been agreed between the LIT and the DAT(s).

Please refer to guidance notes for further details.

NOTES FOR GUIDANCE

The following notes are intended to help in clarifying the brief statements in the framework itself. Remaining uncertainties can be discussed either with your Strategic Health Authority mental health leads or with Mental Health Strategies (0161 727 9419) or [email protected]

1. Assertive Outreach

    The Mental Health Policy Implementation Guide (section 4) provides a detailed specification for this service. For a green rating, services should be provided in accordance with this specification. "Local needs" should be judged by reference to the size of the local target population.

2. Crisis Resolution

    The Mental Health Policy Implementation Guide (section 3) provides a detailed specification for this service. For a green rating, services should be provided in accordance with this specification. "Local needs" should be judged by reference to the size of the local target population.

3. Early Intervention in Psychosis

    The Mental Health Policy Implementation Guide (section 5) provides a detailed specification for this service. For a green rating, services should be provided in accordance with this specification. "Local needs" should be judged by reference to the size of the local target population.

4. Secure Places

    If provision is below 50% of the assessed level of need, the rating should be red; if from 50% to 99% at amber; only if 100% at green. Services do not need to be based within the geographical boundary of the LIT to count, provided there is access.

5. Women's Services - Women-only day services

    Mental health support services provided for women, in the community, in a women-only setting(s). The service may not be labelled "mental health services" by the organisations that provide them, but they will provide services and support that meet the mental health needs, i.e. these services may be provided by the statutory or voluntary sectors. Where provided by the voluntary sector, arrangements should be in place to ensure continuity of funding.

6. Carers' Services

    The NHS Plan says that by 2004, 700 more staff will be recruited to increase the breaks available for carers, and to strengthen carer support networks. It does not matter whether services are provided by the statutory or voluntary sector.

7. Black and Minority Ethnic People's Services

    This indicator is assessing the adequacy or appropriateness of both mainstream services and services targeted at particular ethnic groups. The extent to which specialist targeted services are necessary or viable will depend on the local population and local assessment of its needs. Effective planning and provision will require the collection of data, its reporting to the appropriate planning processes, (Boards, Governance Committees etc) and action plans arising that are monitored appropriately, including by user and carer representatives.

8. 'Gateway' Workers

    The NHS Plan says by 2004 500 community mental health staff will be employed to work with GPs and primary care teams, with NHS Direct, and in A & E to respond to people who need immediate help, who can call on crisis resolution teams if necessary. Plans are needed for recruitment, and to integrate existing staff and systems at the interface between primary and specialised services to improve access to services.

9. New Graduate Primary Care Workers

    The NHS Plan says by 2004 1000 new trained graduate primary care mental health workers will be employed to help GPs manage and treat common mental health problems in all age groups.

10. Primary-secondary interface

    On the scoring sheet, please tick those elements which are in place. The four elements listed have been identified as the core structural elements of a good working relationship between primary and secondary care. The reference to exchange of information relates to the target in the SaFF for 2001/02 which reads: "By March 2002, every health authority and local authority must have multi-agency protocols agreed and operational for the sharing of information relevant to reducing risk of serious harm to self or others." SMI is severe mental illness.

11. Acute Inpatient Services - Acute Care Forums

    This indicator reflects an early priority/recommendation within the Acute Care Guidance, launched in May 2002, as part of the Policy Implementation Guide.

12. Acute Inpatient Services - Ward Organisation

    On the scoring sheet, please tick those elements which are in place. This indicator reflects an early priority/recommendation within the Acute Care Guidance launched in May 2002, as part of the Policy Implementation Guide.

13. Prison (MH) Services

    The indicator definition is self explanatory

14. Care Programme Approach - Access to Care Plans

    Effective and safe care is provided when staff have ready access to the care plans of clients. Out of hours, or for a re-referral, care plan details should be accessible by the member of staff who will need to engage with the client at the point of contact, (within a service setting) or prior to making a visit into the community.

15. Care Programme Approach - Information Sharing Protocols

    The indicator definition is self explanatory

16. Care Programme Approach - Comprehensive

    The indicator definition is self explanatory and is a slight refinement of the indicator for LIP 3

17. Care Programme Approach - Carers' Plans

    This was an NSF target for April 2002, hence there is no amber option. Either services have met this target, (green) or they have yet to meet it, (Red).

18. NHS Direct

    Local services must work with NHS Direct to facilitate access to local specialist mental health crisis provision, 24 hours a day, 7 days a week. In order to do this local services will have agreed protocols with NHS Direct on the direct referral of clinically indicated clients and adequate services are available to meet their needs within an acceptable time frame.

19. Transition Protocols

    On the scoring sheet, please tick those elements which are in place. The exact detail of "cut-off ages" and transitional systems does not matter. What does matter is local agreement as to their effectiveness, and implementation.

20. Planning Process

    On the scoring sheet, please tick those elements which are in place. This indicator should reflect the updated position as at September 2002. Agreements should have been reviewed within the last year.

21. Commissioning - Planning

    A thorough comprehensive LIP should be built around the agreed negotiated priorities and assessed service development programme of all the LIT constituent member organisations. Independent commissioning of services outside the joint agreements within the LIT should therefore be unnecessary. This indicator reflects the degree to which member organisations have committed themselves to the joint planning process recommended within the MH NSF.

22. Commissioning - Health Act Flexibilities

    Fully integrated service provision and choice for clients without over-burdensome inter service referral/assessment processes are likely to be achieved better where pooled budgets exist. This measure will identify the degree to which local organisations have utilised the Health Act Flexibilities to improve client access to a full range of services.

23. Local Strategic Partnerships

    Comprehensive guidance on this topic is given in "A new commitment to neighbourhood renewal - national strategy action plan".

    Local Strategic Partnerships represent a major opportunity for mental health services to become better integrated into their local communities. They offer the potential to engage the wider community in support of recovery-based service models, and to influence the public's response to mental health issues. Local Strategic Partnerships also emphasise citizenship - and mental health services need to stimulate work to address the specific disadvantage faced by citizens with the most severe mental health problems.

    For a green rating, there should be substantial evidence of benefits deriving from practical partnerships between mental health services and local non-specialist community, voluntary or private organisations (to promote, for example, social support, leisure or employment opportunities.)

24. Provision - CMHTs

    Interpretation of "fully integrated" will inevitably vary to some degree. Indicators of full integration include: joint bases; joint management; joint training; joint budgets; joint casenotes; joint information systems; joint operational policies; joint rosters. Most or all of these should be in place for a green rating. A green rating does not however require there to be a single employer. "Community mental health team" includes specialist functionalised and generic teams.

25. User Led Services

    Consideration needs to be given to the range and nature of services provided in the area and whether there is a sufficient mix of services either provided exclusively by users or user organisations OR sufficient user led services hosted by other providers, e.g. the NHS or PSS. This indicator recognises that some service users require choice in provision and may wish to include services run by their peers amongst the mix of services they access. An adequate mix will be one that the LIT assesses to meet the most significant demands of local users. Adequacy of provision also requires that where such services need funds to operate, the providers have enough confidence in funding streams to plan over longer than a one year horizon.

26. Voluntary Sector

    This is a similar indicator to that of User Led services above. The Voluntary sector offer a useful range of services to complement those provided by statutory services and hence increase the choice available to clients in meeting their assessed needs. Engagement in service planning processes is likely to ensure a complementary arrangement of services rather than ad hoc provision.

27. Recruitment and Retention

    The significance of problems should be judged in terms of the impact on service provision. If services have dealt with staffing issues in creative ways, ensuring minimal service impact, they could be rated amber or even green.

28. Workforce Planning

    The determination of what is locally key must be for local decision. As a guide, a comprehensive plan should include: a detailed analysis of the structure of the current workforce; analysis of trends in recruitment and retention and plans to address any shortfalls; the future numbers, types and skill mix of staff required to deliver the NSF standards and NHS plan targets; training issues including skills, knowledge and leadership.

29. Education and Training

    Education and training should ensure that the skills, knowledge and values of the mental health workforce are appropriate to the delivery of the service models in the NSF and NHS plan. The significance of problems should be judged in terms of the extent to which training and education address:

_ issues arising from all NSF and NHS plan standards and commitments

    _ needs of all staff groups (including staff without a professional qualification)

    _ knowledge, skills and values.

30. Representative Workforce

    The extent to which targeted approaches are necessary or viable will depend on the local population and local assessment of its needs. At minimum, arrangements must exist for accessing specialist support when required.

31. Link to LIS

    For a green rating mental health must have at least equal status and attention within the LIS (Local Information Strategy) in terms both of detailed planning and of resources, and there must be a clear commitment within the LIS to the resources required to deliver the mental health information strategy.

32. Integrated MHER

    The Mental Health Information Strategy provides guidance on these issues. For a green rating, the local system must deliver the requirements of this strategy, and must be capable of capturing the Mental Health Minimum Data Set.

33. Local Directory

    The Mental Health Information Strategy provides guidance on the requirements for this directory. For a green rating, the local directory must be widely accessible to staff, service users and the general public, and deliver the requirements of this strategy.

34. Funding

    The costing template which LITs are completing this autumn will provide hard data on this issue. This indicator is seeking a more subjective perspective on the adequacy of funding and the confidence of the LIT that commissioners will make available the necessary funds to meet the NSF and NHS Plan priorities within the target time-scales. (targets requiring achievement by 2005).

35. "Safety, Privacy and Dignity" - Single Sex Accommodation

    This indicator does not require application of these standards to all small community based rehabilitation units or small longer term accommodation in the community (although the principle of maintaining the privacy and dignity of all residents remains of course important).

36. Mental Health Promotion

    "Making it Happen" offers comprehensive guidance on the development and implementation of local strategies for mental health promotion. For a green rating, local strategies should satisfy the following criteria:

    _ be based on an assessment of local needs to identify key settings and target groups

    _ demonstrate a clear rationale for selected interventions which are based on the evidence or which, through their implementation, can add to the evidence base

    _ include action to reduce discrimination against people with mental health problems

    _ show evidence of links to mainstream community development initiatives to promote social inclusion, such as neighbourhood renewal, education action zones etc.

    and there should be demonstrable progress on these issues.

37. Specialist Services

    On the scoring sheet, please tick those elements which are in place. This indicator measures adequacy of access to specialist services, irrespective of location. Services do not have to be located within the geographical boundaries of the LIT to make a green rating possible. If services are very geographically remote, this may however affect local views as to the "sufficiency" of access.

38. Section 135/136 - Places of Safety

    The Code of Practice to the Mental Health Act offers guidance on this issue. Although the LIT has no statutory accountability for this issue, its constituent agencies will need to be cooperating closely to ensure good practice. This indicator asks that the LIT be assured that member organisations are carrying out their necessary monitoring arrangements. There is no suggestion that LIT itself is responsible for monitoring these arrangements.

39. Mental Health Act 1983 - Board Reports

    This indicator is establishing to what extent there has been follow-up to the recommendations of the Mental Health Act Commission's 9th Biennial report. Again the LIT is asked to identify if it is assured that those member organisations with specific responsibilities are carrying these out effectively. There is no suggestion that the LIT itself is responsible for these issues.

40. The Mental Health of People with Learning Disabilities

    "Valuing people" offers important guidance in this field.

41. Dual Diagnosis

    `The Good Practice in Dual Diagnosis' guidance published as part of the Policy Implementation Guide in April 2002 offers background to this indicator.