Yorkshire and the Humber Mental Health Network Early Intervention in Psychosis Network 29 June 2017 • Stephen McGowan, EIP Clinical Lead for Y&H CN and NHSE (North) (Chair) • Dr Steve Wright, Consultant Psychiatrist, TEWV (Co-Chair) • Rebecca Campbell, Quality Improvement Manager and Sarah Boul, Quality Improvement Lead • Rebecca.campbell6@nhs.net and sarah.boul@nhs.net • Twitter: @YHSCN_MHDN #yhmentalhealth • June 2017 www.england.nhs.uk
Yorkshire and the Humber Early Intervention in Psychosis Network Welcome! Rebecca Campbell, Quality Improvement Manager, Yorkshire and the Humber Clinical Networks www.england.nhs.uk
Housekeeping: @YHSCN_MHDN #yhmentalhealth HHonors
Y&H EIP Network Meetings so far….. • 3 rd March 2016, York – New Commissioning Guidance & Key Concerns • 7 th July 2016, Leeds – Prescribing for FEP & Implementing the EIP Access, CBTp Training and Waiting Time Standard Final Guidance • 17 th November 2016, Leeds – At Risk Mental State • 2 nd March 2017, Leeds – Children &Young People
Y&H EIP Network Meetings so far…..
Don’t Forget - Evaluation
Next Meeting • 2 November 2017, 13:30-16:30, Novotel, Leeds • Service User & Carers Involvement
Agenda: Moggie McGowan, Co-Chair, Clinical Advisor, 13:35 National & Regional Update Y&H IRIS, Y&H Clinical Network & NHS England – Themes from the Self-Assessment & Deep Dives North 14:00 Outcomes and Benefits – Local experiences of using a wider Simon Platt & Kate Quinn, SWYFT set of metrics including QPR and Dialog 14:20 EIP Matrix – EIP Service Self-Assessment & Action Planning Sarah Amani, Senior Programme Manager, EIP Tool Programme, South of England 14:50 Break Dr Steve Wright, Co-Chair, Consultant 15:10 Introduction to Group Discussions Psychiatrist, TEWV & Clinical Advisor, Y&H Clinical Network Group Discussion – Outcomes & Metrics Each table to discuss: - What are the best metrics for describing outcomes in 15:15 All EIP? - Ranking and how would you get the info? Summary Key Discussion Points – Top 10 Metrics; 16:15 Dr Steve Wright Actions & Next Steps 16:30 Close & Evaluation Moggie McGowan
Yorkshire and the Humber Early Intervention in Psychosis Network National & Regional Update Moggie McGowan, Co-Chair, Clinical Advisor (Y&H IRIS & NHS England North) www.england.nhs.uk
Update on EIP standard - National policy team Performance against the waiting time element of the standard • From the Unify2 data collection, the 50% standard continues to be met nationally. • From April 2017 data, all providers in the North region continue to meet the standard except for Pennine Care. Data quality • Data quality of the MHSDS is still of concern, however, we are seeing convergence of referral and performance data. • Had originally planned to move to MHSDS as the official source of reporting from Q1 2017/18 (this data is published in September 2017). • However, data coverage and completeness is still an issue. Unify2 collection will run for an additional 3 months with the last collection covering September 2017. Recording interventions and outcomes • Increased focus on reporting of interventions and outcome data to MHSDS through SNOMED codes. • Guidance being developed for EIP teams – out for consultation soon. • National work to increase use of SNOMED more widely in mental health. Assessing NICE-concordance • In 2016/17, all EIP teams have undertaken a self-assessment assessing the second strand of the standard (NICE concordance). • EIP teams provided with report on their performance along with benchmarking information. • Review process underway for CCQI self-assessment to ensure it is linked with National Audit of Psychosis, CQUIN etc. • Work underway to develop the MHSDS so it will be able to collect this information through SNOMED. 10
Update on EIP standard - National policy team Workforce issues • Continues to be major risk for EIP teams and CCGs. • Regional coordination and solutions needed. Looking forward • Expansion of services to full age range and ARMS: • Who is commissioned to provide care to +35s and under 18s. • Data from MHSDS provides greater transparency. • Further scrutiny on CCG baseline funding. • Role of STPs in supporting expansion, workforce and delivery. • Focus on care quality and outcomes as RTT data quality improves. Mental Health Dashboard • The dashboard is intended to help monitor progress against the delivery of the Five Year Forward View for Mental Health. • https://www.england.nhs.uk/mental- • health/taskforce/imp/mh-dashboard/ 11
Regional Update • Deep Dive feedback and Review • Agreed actions • Review of CCQI Audit • Workforce Calculator update • Data Quality • Training update • Incidence/Demand • Service User Involvement
Provider Provider Provider Provider Provider Provider Provider 1 2 3 4 5 6 7 AWT performance and MHSDS data flow Quality Self-Assessment: Good practice and areas that require improvement Summary of gap analysis (from refreshed workforce calculator) - workforce recruitment and skills Development and Investment plans, milestones and funding (in relation to 5YFVand NHS Improvement monitoring) Areas of best practice which could be shared across the region Are there any concerns to escalate/raise with the regional mental health operations group?
Summary of Post-Review themes • Shortages of CBTp practitioners in a number of teams and uncertainty about whether free training would continue to be available • Similar re IPS training • Meeting the physical health baseline is a challenge in many teams and most needed to improve take-up of interventions for weight gain and smoking • Bringing QPR and DIALOG into use is ongoing in most teams • At Risk Mental State (ARMS) interventions are in their infancy in most teams • Many teams have received investment to increase their workforces and appear to have reasonable capacity now. • Some haven’t • There are also real concerns about rising demand • At most meetings we managed to get providers and commissioners to agree to a joint review of referral rates after the summer so any requirement for further funding could be fed into contracting reviews • Poor appreciation of the 5YFV funding plans in most places and a great deal of interest in the IRIS illustration by CCG that had been presented elsewhere in the North Region
Next Steps Written feedback to CCGs/Providers Follow up by regional mental health operations group Return visits on invite (CL/CN/DCO) in the autumn Regional (North) summary of common themes to ensure a ‘do once and share’ approach to resolution/actions Funding illustrations circulated through commissioner’s network Y&H EIP Network to address the outcomes/themes.
EIP Announcement in 5 Year Forward View 17/18 18/19 19/20 20/21 11m 9m 10m 40m New 11m 20m 30m 70m Total Estimate of CCG Investment New EIP Populatio Investme New Populatio n of nt for Funding Year n of CCG* England* England in CCG 17/18 283193 58m 11m 53548 18/19 285029 58.5m 9m 43781 19/20 286855. 59m 10m 48620 20/21 288685 59.5m 40m 194393
www.england.nhs.uk
Review Team leaders were asked to rank order the current standards as either higher, medium or lower importance: MOST IMPORTANT CBT for Psychosis; Family Interventions; Assessment within 2 weeks; Physical health reviews; Care coordinator caseloads of 15; Stand-alone holistic multidisciplinary team; Crisis and relapse prevention planning; Personal recovery planning; Antipsychotic medication; Supported employment and education programmes. IMPORTANT Carer-focussed education and support programmes; Children have access to CYPMHS expertise; Monitoring take up of physical health interventions for weight management; Monitoring the no. of staff trained to deliver FI; Outcome measurement; Access to specialist drug and alcohol services; CBT for ARMS; Service users are offered/receive clozapine. LESS IMPORTANT Monitoring clinical supervision for CBT & FI; Monitoring the percentage of people who were not in work, education or training; Monitoring the no. of staff trained to deliver CBTp; 3- year treatment package; Detailing the types of supported employment programmes available; Counting the number of service users that disengaged; Monitoring take up of smoking cessation interventions.
Data Quality Jan_Mar_16/17 Unify Entering EIP Treatment (rounded) Jan-Mar_ 16/17 MHSDS Entering EIP Treatment 157 TEES, ESK AND WEAR VALLEYS NHS FOUNDATION TRUST 175 SOUTH WEST YORKSHIRE PARTNERSHIP NHS FOUNDATION 91 TRUST 90 51 SHEFFIELD HEALTH & SOCIAL CARE NHS FOUNDATION TRUST 15 ROTHERHAM DONCASTER AND SOUTH HUMBER NHS 115 FOUNDATION TRUST 45 88 PENNINE CARE NHS FOUNDATION TRUST 60 NORTHUMBERLAND, TYNE AND WEAR NHS FOUNDATION 107 TRUST 110 40 MERSEY CARE NHS TRUST 0 132 LANCASHIRE CARE NHS FOUNDATION TRUST 90 43 HUMBER NHS FOUNDATION TRUST 40 13 NAVIGO 10 GREATER MANCHESTER WEST MENTAL HEALTH NHS 101 FOUNDATION TRUST 105 25 CUMBRIA PARTNERSHIP NHS FOUNDATION TRUST 40 67 COMMUNITY LINKS (NORTHERN) LTD 80 CHESHIRE AND WIRRAL PARTNERSHIP NHS FOUNDATION 56 TRUST 160 92 BRADFORD DISTRICT CARE NHS FOUNDATION TRUST 100 71 5 BOROUGHS PARTNERSHIP NHS FOUNDATION TRUST 35 20
• Training update • Incidence/Demand • Service User Involvement
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