Classification: Official
Publications reference: PRN01524

To:

• Integrated care boards (ICBs):
  • chairs
  • chief executives
  • accountable officers
  • mental health leads
• NHS trust:
  • chief executives
  • medical directors

cc.

• Regional:
  • directors
  • medical directors
  • mental health leads

Dear colleagues,

Integrated care board (ICB) review of intensive and assertive community treatment for people with severe mental health problems

Thank you for your quick responses to the questions around Do Not Attend (DNA) policies and for your ongoing review of intensive and assertive community care which are critical to patient and public safety.

Working alongside local stakeholders and partners, reviews should be completed by 30 September 2024, with the outcome of the review communicated to your Regional NHS England Mental Health team. The reviews should be conducted in line with the national guidance around providing intensive support to people with a serious mental illness. To support transparency of findings we are asking all reviews to be presented and discussed at your public ICB board meetings alongside an action plan for how you will implement the national guidance.

ICB action plans should provide practical steps on how local areas will address any potential gaps in provision, highlighted as part of the review process. Action plans should include short-term actions with minimal resource implications such as ensuring that DNA is never used as a reason to discharge is embedded within practice and not just in policy, as well as reviewing policies and practice in relation to family involvement when someone is hard to engage. Action plans should also set out potential longer-term actions, which may have resource implications. Please include these potential resource gaps in your review process.  

NHS England will collate national trends and use it to inform future policy and understanding of resource requirements in this area, as well as communicate the outcomes to the Care Quality Commission (CQC)  and Department of Health and Social Care.

NHS England will also develop guidance on what good quality, safe care looks like for community mental health services and share best practice. This will include a review of patient safety and the fundamentals of good quality care e.g. care coordination, patient and family engagement, risk/safety management, treatment and effective discharge (including medication compliance and the application of the Mental Health Act including community treatment orders).

Outcomes of these reviews will also feed into wider digital actions for mental health, given that implementing digital and data tools can help with risk management for everyone within community services.

We are keen to hear feedback and reflections from ICBs and trusts, via regional mental health leads, on the process so far and the guidance shared. Thank you for your continued focus, support and effort in this important area it is hugely appreciated, and we are here to help if you have any questions.

Yours sincerely,

Claire Murdoch CBE, National Director for Mental Health, Learning Disabilities and Autism, NHS England 
Dr Adrian James, Medical Director for Mental Health and Neurodiversity, NHS England