South EIP 2019-20 NCAP Results& Recovery Planning - November 2020

South EIP 2019-20 National Clinical Audit
of Psychosis (NCAP)
Results & Recovery Planning
Meeting with NHS England South East Deputy Director
6th November 2020 | MS Teams

1 Background & Context
2 2019-20 NCAP Findings vs EIP Matrix Results
3 Possible Reasons for Results
Suggested Focus
4 Regional Support for Recovery
5 Future Ways of Working

South EIP Programme
13 Sustainability & Transformation Partnerships (STPs)
40 Clinical Commissioning Groups (CCGs)
15 Mental Health Providers
33 Early Intervention in Psychosis (EIP) Teams
~5,000 Patients with first episode psychosis or schizophrenia accessing EIP
610 EIP Practitioners Including 26 EIP Peer & Carer Peer Workers

NHS England (South West)
Mental Health Programme
Managed by Gayle Bridgman
Lines of accountability
Governance
Monthly Meeting
Quarterly Meetings & Briefings
Monthly Meetings & Training
ICS + STP + Commissioners + Providers + Clinical Networks + Health Education England + Academic Health Science Networks
NHS England (South East)
Mental Health, Learning
Disabilities & Autism Cell
Managed by Oral Arrindell
South West EIP Network
Clinical Chair: James
O’Donoghue
South East EIP Network
Clinical Chair: Nik Nikolik
Lines of engagement
South EIP Programme Board
Clinical Lead: Professor Belinda Lennox
Senior Programme Managers: Sarah Amani
South EIP Peer & Carer
Peer Support Worker Group
Co-Chair: Dawn Hyde

Refer to NHS Mental Health Implementation Plan 2019/20 – 2023/24 for full details.
Adult Mental Health (SMI)
Community Care 2019/20 2020/21 2021/22 2022/23 2023/24
Total 650 2,180 3,720 7,570 10,880
National indicative cumulative workforce profile (additional to Stepping Forward):
NHS Long Term Plan

Priority 2019/20 2020/21 2021/22 2022/23 2023/24
Early Intervention
in Psychosis (EIP)
Achieve 56% EIP Access
Standard
50% of teams to reach
Level 3 (Performing Well)
NICE concordance
[FYFVMH commitment]
Achieve 60% EIP Access
Standard
60% of EIP teams to reach
Level 3 NICE concordance
[FYFVMH commitment]
Maintain 60% EIP Access
Standard
70% of EIP teams reach
[LTP commitment]
Standard
[LTP commitment]
Standard
[LTP commitment]
SMI physical
health checks
A total of 280,000 people
receiving physical health
checks
[FYFVMH commitment]
checks
[FYFVMH commitment]
checks
[An additional 22,000
above FYFVMH ambition]
checks
checks
Individual
Placement and
Support (IPS)
16,000 total people
accessing IPS
[60% Increase in access as
per FYFVMH]
20,000 total people
accessing IPS [100%
increase in access as per
FYFVMH]
32,000 total people
accessing IPS
44,000 total people
accessing IPS
55,000 total people
accessing IPS
Integrated
primary and
community care
for adults and
older adults with
SMI access
Stabilise and bolster core
community mental health
teams
[Testing new model within
select number of STPs/ICSs]
Stabilise and bolster core
teams
[Testing new model within
select number of
STPs/ICSs]
At least 126,000 adults
and older adults with SMI
(including care for people
with eating disorders,
mental health
rehabilitation needs and a
‘personality disorder’
diagnosis) receiving care
from integrated primary
and community mental
health services
mental health rehabilitation
needs and a ‘personality
disorder’ diagnosis)
receiving care from
integrated primary and
services
mental health rehabilitation
needs and a ‘personality
disorder’ diagnosis)
receiving care from
integrated primary and
services

Covid -19 Specific Context
“Services should conduct proactive reviews for all patients on
community Mental Health teams’ caseloads and increase
therapeutic activity and supportive interventions to prevent relapse
or escalation of mental health needs for people with SMI in the
community.
In 2020/21, the year-on-year baseline funding uplift for
community-based services for people with SMI, including EIP
services and Physical Health Checks for People with SMI, is £162
million. The cumulative baseline uplift since 2018/19 is now £251
million. This is a significant component of CCG baseline funding
increases and we encourage services to invest this as soon as
possible to increase staffing to required levels.
Source: NHS England – Implementing Phase 3 of the NHS Response to Covid-19 https://www.england.nhs.uk/wp-
content/uploads/2020/08/implementing-phase-3-of-the-nhs-response-to-covid-19.pdf Page 15
”

The Critical Role of EIP
EIP services have the lowest hospital admissions compared to any other community
secondary mental health team, averaging at 20% compared to 51% in generic community
mental health teams. EIP is fundamental to preventing crisis and hospital admissions and
therefore needs to be resourced adequately to support the rest of the system.
People with psychosis need expert, evidence-based services at all stages of their illness. This includes:
• Prevention and early detection
• Early intervention for first episode psychosis delivered in accordance with NICE guidelines
• Coordinated case management, rehabilitation and recovery for on-going needs
• Recovery to improve social inclusion, stable housing and employment
• Physical health care to reduce the 20-year premature mortality gap
• Rapid access to urgent and emergency care when in crisis
• Harm and suicide prevention
Source: NHS England – Implementing the Early Intervention in Psychosis Guidelines https://www.england.nhs.uk/mentalhealth/wp-
content/uploads/sites/29/2016/04/eip-guidance.pdf

2019-20 National Clinical
Audit of Psychosis (NCAP)
Findings
For the full range of information on the National
Clinical Audit of Psychosis (NCAP) and recording of
NICE interventions using SNOMED- CT please visit the
EIP Triangulation tool on the NHS Future Collaboration
Platform: https://future.nhs.uk/EIPtriangulationtool

EIP NCAP Results 2018-19
South of England
Region
Number of
EIP Services
Percent at Level 1
(Greatest Need for
Improvement)
Percent at Level
2 (Need
Improvement)
Percent at Level
3
(Performing Well)
Percent at Level
4
(Top Performing)
Percent at Level 3
and Above
(Goal = 25%)
England 151 16% 64% 13% 7% 21%
Regional NCAP Results 2018-19
London 27 0% 82% 7% 11% 19%
Midlands and East 42 29% 60% 12% 0% 12%
North 49 22% 47% 16% 14% 31%
South East 19 5% 68% 21% 5% 26%
South West 14 0% 93% 7% 0% 7%
Findings from NCAP Self-Assessment Sample Audit October 2018

South of England
Region
Number of
EIP Services
Percent at Level
1
(Greatest Need
for Improvement)
Percent at Level 2
(Need
Improvement)
Percent at Level 3
(Performing Well)
Percent at Level
4
(Top Performing)
Percent at Level 3
and Above
(Goal = 50%)
England 151 5% 69% 23% 3% 26%
Sub-Regional NCAP Results
Thames Valley 3 0% 100% 0% 0% 0%
Wessex 6 17% 83% 0% 0% 0%
Kent, Surrey &
Sussex
10 0% 80% 20% 20% 40%
South West 14 7% 57% 21% 14% 36%
Regional NCAP Results
South 33 3% 67% 15% 12% 27%
South East 19 5% 74% 11% 11% 22%
South West 14 7% 57% 21% 14% 36%
EIP NCAP Results 2019-20
Findings from NCAP Self-Assessment Sample Audit October 2019

South of England
Region
Number of
EIP Services
Percent at Level
1
(Greatest Need
for Improvement)
Percent at Level 2
(Need
Improvement)
Percent at Level 3
(Performing Well)
Percent at Level
4
(Top Performing)
Percent at Level 3
and Above
(Goal = 50%)
England 151 5% 69% 23% 3% 26%
Sub-Regional EIP Matrix Results
Thames Valley 3 0% 34% 66% 0% 66%
Wessex 6 0% 66% 17% 17% 34%
Kent, Surrey &
Sussex
9 0% 44% 34% 22% 56%
South West 12 0% 50% 33% 17% 50%
Regional EIP Matrix Results
South 30 0% 49% 36% 15% 51%
South East 18 0% 48% 39% 13% 52%
South West 12 0% 50% 33% 17% 50%
South EIP Matrix Results 2019-20
Findings from EIP Matrix Self-Assessment Full Caseload Audit October 2019

National Standard for Early Intervention in Psychosis (EIP) Greatest Need for
Improvement
Needs
Improvement
Performing
Well
Top
Performing
Investment per Patient - £8,250 is recommended and based on 2014 NICE
interventions for psychosis and schizophrenia reference costs, £7,080 was the
national mean in 2018-19
<£7,080 ≤£7,080 ≥£8,250 -
Referral to Treatment - Percentage of service users referred with suspected first
episode psychosis that were allocated to, and engaged with, an EIP care coordinator
within 2 weeks of receipt of referral
<25% ≥25% ≥56% ≥60%
Care Coordinator to Service Users Ratio – the Opus Trial compared outcomes of 10
cases per care coordinator, to 25 per care coordinator. Care coordinators with ≤10
cases had better outcomes across multiple indicators including hospital admissions
>20 16-19 ≤15 -
CBT for Psychosis - Percentage of service users with First Episode Psychosis that
were offered and accepted CBTp
<12% ≥12% ≥24% ≥36%
Family Interventions – Percentage of service users with First Episode Psychosis and
their families that that were offered and accepted Family Interventions
<8% ≥8% ≥16% ≥20%
Clozapine - Clozapine is prescribed to patients for whom this treatment is indicated
(or valid reason is given for not prescribing clozapine)
Not Applicable
Employment and Education Support - Percentage of service users with First Episode
Psychosis that that were offered and accepted employment and education support
<10% ≥10% ≥20% ≥30%
Physical Health - Percentage of service users with First Episode Psychosis that had a
comprehensive physical health check in the last 12 months
<70% ≥70% ≥80% ≥90%
Carer Education Programmes - Percentage of carers who were offered and accepted
carer-focussed education and support programmes
<25% ≥25% ≥50% ≥75%
Outcome Measures- Percentage of people who have had Dialog, QPR and HoNOS
recorded 2 or more times since entering EIP treatment
<25% ≥25% ≥50% ≥75%

The overall score is calculated based on the number of domains rated as ‘Top performing’, ‘Performing Well’, ‘Needs Improvement’ and
‘Greatest Need for Improvement’. It does not include the sub-matrix domain service set up.
LEVEL 4 In order to be rated ‘Top Performing’ overall, a team will be rated:
o ‘Top performing’ in the effective treatment domain and the timely access domain
o ‘Performing Well’ or higher in the recording outcome measures domain
LEVEL3 In order to be rated ‘Performing Well’ overall, a team will be rated:
o ‘Performing Well’ or higher in the effective treatment domain and the timely access domain
o ‘Needs Improvement’ or higher in the recording outcome measures domain
o If a team is rated ‘Greatest Need for Improvement’ in any domain, they cannot be rated ‘Performing Well’ overall
LEVEL 2 In order to be rated ‘Needs Improvement’ overall, a team will be rated:
o ‘Needs improvement’ or higher in the effective treatment domain and the timely access domain
o Any score in the recording outcome measures domain
LEVEL 1 In order to be rated ‘Greatest Need for Improvement’ overall, a team will be rated:
o ‘Greatest need for improvement’ in the effective treatment domain or the timely access domain
NCAP Overall Rating

Thames Valley
4 3 2 1
Top Performing Performing Well Needs Improvement Greatest Need for
Improvement
Provider
Berkshire Healthcare NHS
Foundation Trust
Oxford Health NHS Foundation Trust
EIP Team Berkshire Buckinghamshire Oxfordshire
Cases Audited/Total Caseload (%) 100/164 (61%) 81/150 (54%) 100/242 (41%)
Investment Per Patient £8,112 £5,059 £4,185
Service Users Per Care Coordinator 12 19 19
CBT for Psychosis (CBTp) 58% 56% 57%
Family Interventions 35% 19% 20%
Supported Employment 41% 39% 45%
Physical Health 44% 38% 37%
Clozapine (if 2 antipsychotics proven
ineffective)
75% 88% 29%
Carer Education Programmes 44% 88% 53%
2 Paired Outcome Measures (HoNos,
Dialog and QPR)
72% 56% 69%
Overall NCAP rating 2 2 2

Wessex
Provider
Isle of Wight NHS
Trust
Solent NHS Trust Southern Health NHS Foundation Trust
EIP Team Isle of Wight Portsmouth East Hampshire North Hampshire West Hampshire Southampton
Cases Audited/Total Caseload
(%)
22/63 (35%) 48/83 (58%) 49/83 (59%) 40/63 (63%) 43/76 (57%) 66/90 (73%)
Investment Per Patient £6,425 £3,884 £3,576 £5,722 £7,585 £8,262
Service Users Per Care
Coordinator
18 23 13 10 11 8
CBT for Psychosis (CBTp) 36% 60% 49% 35% 53% 48%
Family Interventions 14% 23% 24% 15% 19% 27%
Supported Employment 0% 30% 0% 0% 0% 47%
Physical Health 27% 77% 69% 20% 53% 29%
Clozapine (if 2 antipsychotics
proven ineffective)
50% 0% 100% 67% 17% 13%
Carer Education Programmes 21% 65% 65% 61% 55% 70%
2 Paired Outcome Measures
(HoNOS, Dialog and QPR)
5% 77% 72% 80% 84% 50%
Overall NCAP rating 1 2 2 2 2 2
4 3 2 1
Improvement

Kent, Surrey & Sussex
4 3 2 1
Improvement
Provider Sussex Partnership NHS Foundation Trust
Kent and Medway NHS and Social
Care Partnership Trust
Surrey and Borders Partnership
NHS Foundation Trust
EIP Team Bognor
Brighton and
Hove
Hailsham Hastings Horsham Worthing East Kent West Kent East Surrey
NE Hampshire &
West Surrey
Cases Audited/Total
Caseload (%)
31/67 (46%) 49/121 (34%) 27/61 (44%) 33/57 (58%) 38/65 (58%) 31/58 (53%) 100/220 (45%) 100/291 (34%) 67/149 (45%) 76/183 (42%)
Investment Per Patient £7,646 £7,704 £7,059 £9,105 £8,434 £7,646 £7,031 £6,885 £5,278 £7,670
Coordinator
18 18 13 14 19 12 12 12 18 14
CBT for Psychosis (CBTp) 48% 47% 67% 61% 55% 58% 57% 34% 40% 67%
Family Interventions 0% 12% 70% 27% 13% 26% 18% 21% 21% 26%
Supported Employment 33% 50% 61% 73% 71% 24% 10% 31% 41% 49%
Physical Health 74% 88% 74% 85% 68% 65% 86% 72% 66% 78%
Clozapine (if 2
antipsychotics proven
ineffective)
0% 14% 50% 80% 63% 43% 25% 83% 33% 100%
Carer Education
Programmes
68% 66% 92% 87% 64% 54% 27% 37% 82% 93%
2 Paired Outcome
Measures (HoNOS, Dialog
and QPR)
39% 12% 67% 85% 29% 45% 22% 46% 52% 74%
Overall NCAP rating 2 2 4 4 2 2 2 3 2 3

South West
4 3 2 1
Improvement
Provider
Gloucestershire
Health and
Care NHS
Foundation
Trust
Avon and Wiltshire NHS Foundation Trust
Cornwall
Partnership
NHS
Foundation
Trust
Devon Partnership Trust
Dorset
Healthcare
University NHS
Foundation
Trust
Livewell CIC
Somerset
Partnership
Trust
EIP Team Gloucestershire BANES
North
Somerset
South
Gloucersters
hire
Swindon Wiltshire Bristol Kernow
Exeter and
East Devon
North and Mid
Devon
Torbay, South
& West Devon
Dorset Insight Somerset
Cases Audited/Total
Caseload (%)
48/162 (30%) 55/86 (64%) 39/56 (70%) 50/84 (60%) 36/65 (55%)
76/103
(74%)
99/165
(60%)
100/211 (47%) 26/115 (23%) 36/114 (32%) 26/123 (21%) 62/148 (42%) 72/131(55%)69/133(42%)
Investment Per Patient £9,471 £7,257 £6,719 £7,080 £7,161 £7,140 £6,489 £7,201 £5,894 £5,894 £5,894 £4,338 £5,243 £5,849
Coordinator
9 11 19 14 18 9 16 19 15 18 14 14 16 13
CBT for Psychosis (CBTp) 42% 80% 36% 80% 61% 67% 48% 45% 46% 42% 58% 32% 29% 45%
Family Interventions 7% 36% 26% 46% 64% 25% 21% 43% 15% 28% 15% 13% 38% 57%
Supported Employment 17% 41% 0% 68% 71% 49% 26% 52% 39% 32% 7% 6% 42% 51%
Physical Health 71% 38% 46% 70% 89% 79% 18% 69% 12% 6% 4% 58% 85% 80%
Clozapine (if 2
antipsychotics proven
ineffective)
36% 73% 50% 100% 0% 29% 38% 31% 100% 38% 33% 55% 50% 15%
Carer Education
Programmes
58% 42% 76% 85% 96% 93% 40% 20% 20% 53% 37% 13% 92% 80%
2 Paired Outcome
Measures (HoNOS,
Dialog and QPR)
19% 16% 15% 84% 94% 58% 0% 47% 8% 42% 35% 31% 55% 54%
Overall NCAP rating 2 2 2 3 4 3 2 2 2 2 2 1 3 4

Part 1 of Standards
EIP Care Coordinator Allocated <14 Days Following Referral
Part 2 of EIP Standards
NICE Concordance, Age Range & ARMS
NICE CONCORDANCE, AGE RANGE AND ARMS
WORKFORCE
• Extending the age range of EIP from the original 14-35 to 14-65 presents up to 50% increase in assessments and 35% increase
in caseloads1;
• Likewise, the At Risk Mental State (ARMS) group present an increase in demand by up to 34%2;
• Some EIP teams have not started providing a service for those over 35 years old or ARMS as they have not received extra
investment required to meet the extra demand that these groups present;
• Covid-19 has resulted in a further up to 31% increase in new cases of psychosis for EIP teams in the South of England
• Based on the above increase, the workforce needs to be increased significantly to deliver the standards in full by 2021;
• The majority of the workforce gap is in care coordination, psychological therapists and psychiatrists;
• The overall extent of workforce gap poses concerns in terms of managing demand and meeting NICE concordance
• EIP teams have been exploring the role of an EIP Associate Practitioners and also employed more Peer Support Workers
Challenges
1Jagger et al (2019) Early Intervention in Psychosis Treatment Components Utilization in Patients Aged Over 35 https://link.springer.com/article/10.1007%2Fs10597-019-00479-5
2Vidyah et al (2018) Implementing the access and waiting time standard for early intervention in psychosis in the United Kingdom: An evaluation of referrals and post-assessment outcomes over the first year
of operation https://www.pubfacts.com/detail/29582556/Implementing-the-access-and-waiting-time-standard-for-early-intervention-in-psychosis-in-the-United-

Tsiachristas A, Thomas T, Leal J and Lennox B (2016) Economic impact of early intervention in psychosis services: results from a longitudinal retrospective controlle
study in England http://bmjopen.bmj.com/content/6/10/e012611.full.pdf+html

Service Design
Service design is the activity of organizing and planning people,
infrastructure, communication and material components of a service in
order to improve its quality and the interaction between providers and users.
Lazier, Meghan (2016) "What is Service Design?“ Designlab https://trydesignlab.com/blog/what-is-service-design/
by Dr Kristin Lie Romm et al (2013-)Treatment in Psychosis Services (TIPS) Study, Oslo Early Intervention in Psychosis Service, Oslo University Hospital, Norway
http://cbdmh.org/lecture-series/the-tips-early-intervention-in-psychosis-study/
Supporting Teams to Streamline Processes

Family or Self Referral Primary Care Schools/Colleges/Uni Social Care Single Point Access CAMHS/CMHT CRHT/MH Ward Justice System
EIP Assessment
First Care Planning Meeting with Key Supporters
Assertive Outreach, Intensive Case
Management & Relapse Prevention
Social Interventions
Individual
Placement
Support
(IPS)
Social
Groups
F-F +
Online Peer
Support
Support with
accessing
housing &
benefits
advice
Medical Interventions
Interventions
for risks e.g.
Diabetes,
according to
NICE Guidelines
Pharmacology and
Medicines
Management
Comprehensive
Cardio-
Metabolic
Screening
Psychological Interventions
Family
Interventions
(FI)
CBT for
Psychosis
(CBTp)
High /Low
Intensity
Individual
and Group
Psycho -
Therapy
Midway Review with Carers and Key Supporters
Pre-Planned Discharge with:
Relapse Prevention Plan developed with receiving team including GP
Future mental health care options
Service user and carer views on experience and outcomes
Signpost to appropriate
Non-NHS service
Onward Referral to Most
Appropriate NHS Service
<2 Weeks
<3 Months
<18 Months
30 -36
Months
<6 Months
Allocate EIP Care Coordinator
Face to Face
and Online

Example EIP Winter Plan – Essential & None Essential Activities
Task Brief overview Leads Risks
URGENT
Crisis Management Psychosis is a relapsing condition and early management
of crisis prevents escalation. This requires a duty system
to co-ordinate response and clinical staff to provide input.
All clinical staff. Service users become increasingly unwell,
posing a risk to themselves and others.
Relapses can deplete other emergency
services (CRHT and wards).
Referral Triage Triage needs to effectively identify those at high risk of
psychosis and organise assessment, using available
information and eliciting information through telephone
triage. Currently conducted through the duty system.
Triage needs to exclude potential ARMS or extended
assessments, as clinical capacity needs to be targeted at
those most likely to be psychotic.
Care Coordinators, psychologists. Missed cases of psychosis can result in the
deterioration of the mental state of the
service user, resulting in an emergency
response being necessary. Duration of
untreated psychosis predicts poor long term
outcome.
Urgent Assessments Face to face continue as far as is practically possible – 2
people especially where risk / complexity is indicated.
Online or telephone consultations can be conducted.
A cohort of 3 people should be involved in decision
making in relation to assessments – this could be
conducted face to face or MS Teams
All disciplines however at least one person
should be qualified. If a single person this
must be Care coordinator/ psychologist or
appropriately trained professional. MDT
should include a senior member of staff.
Missed cases of psychosis can result in the
deterioration of the mental state of the
service user, resulting in an emergency
response being necessary. Duration of
untreated psychosis predicts poor long term
outcome.
Support for service users who are
symptomatic or self-isolating
Service users who are symptomatic or self-isolating who
do not have family supports, need to have care needs
met, including medication, but also food and other
essential supplies. PPE equipment must be used.
Support workers, but all disciplines may
need to contribute. Promote awareness of
local supports available, e.g. food banks etc.
Mental and physical health of the service
user may deteriorate.
A full example EIP Winter Plan in availability in via MS Teams files

Physical Health for SMI- Point of Care Project

#
Element Agreed Action/s Who By
(Name of Person)
When By
(Month)
Risks and Support
Required
1. Demand, Capacity & Investment •
2. CBT for Psychosis (CBTp) •
3. Family Interventions •
4. Medication Management •
5. Individual Placement & Support (IPS) •
6. Physical Health •
7. Smoking Cessation •
8. Carer Education Programmes •
9. Workforce Recruitment & Retention •
10. Data Quality (including MHSDS, SNOMED-
CT and Paired Outcome Measures)
•
Service Development & Improvement Planning
On track. Successful delivery of a Level 3 (Performing Well) or above EIP Service is highly likely. There are no major outstanding issues that appear to threaten
delivery significantly at this stage. Periodic check in required to maintain status.
Some concerns. Recovery and successful delivery is possible, however constant attention is required. Commissioner/s and provider/s need to address risks as
highlighted below.
Significant concerns. Achievement of the NICE concordance unlikely. There is an overall lack of clarity on CCG allocation of the budget required and it is unclear who
is leading on EIP standards at senior level within the provider.

Regional Training
Training Need Numbers Requested Total Requested
for South Region
Total
Trained in
2020-21
South
West
South
Central
South
East
CAARMS 65 32 40 137 30
PANSS 80 50 60 190 120
DIALOG+ 50 30 40 120 60
Physical Health 67 92 26 185 40
Health Equality 16 8 20 44 40
Total Training Requested & Delivered in 2020 643 290

Peer Reviews
“Following careful consideration we have decided to use
‘Appreciative Enquiry’ as the methodology for our South
EIP Peer Review.
This maximises our chances of uncovering and
showcasing rich stories (qualitative descriptions) to
complement the detailed quantitative data collected via
recent national and regional audits.
We expect that this approach will uncover creative
examples of best practice which will inspire other Early
Intervention services and further drive up standards.”
Dr Frank Burbach
International Journal of Health Care Quality Assurance (2019) Appreciative enquiry peer review
improving quality of services https://www.emerald.com/insight/content/doi/10.1108/IJHCQA-01-
2018-0015/full/html

Data Set Summary Limitations
Mental Health Services Data
Set (MHSDS)
• Automatically collected from Electronic Health Records
(EHR)
• Published quarterly by NHS Digital in raw format
• Includes SNOMED-CT codes which identify NICE
interventions delivered
• Only a minority of Trusts have
enabled SNOMED-CT
• Therefore data quality is poor,
unable to use this dataset to
determine NICE concordance
National Clinical Audit of
Psychosis (NCAP)
• Case note audit of randomly picked ≤100 patients
• Conducted once a year in October
• Excludes patients on caseload for <6 months
• Results are published 12
months after audit completed
• Only gives snapshot for small
sample of patients
• Does not define what being in
receipt of an intervention means
EIP Matrix • Web-based data analytics tool with immediate feedback
• Audits whole caseload and graphs data for users
• Percentage who had ≥2 ‘doses’ of each intervention
• Also captures investment, workforce and outcomes data
• Can be/is used any time and multiple times a year
• Self reported audit (same as
NCAP) so element of human
error is inevitable
EIP Reporting

The EIP Matrix
• The EIP Matrix is a web-based data analytics tool which gives users
immediate visual feedback on:
o EIP caseload versus psychosis prevalence
o Investment per patient
o NICE concordance
o Workforce
o Performance
o Outcomes
• The EIP Matrix was developed with South of England clinicians and commissioners in 2015
• It uses the same audit questions as the Royal College of Psychiatry College for Clinical Quality Improvement
(CCQI) National Clinical Audit of Psychosis (NCAP)
• CCQI are commissioned nationally by NHS England to monitor achievement of the psychosis standards
• The EIP Matrix results are published faster to give teams timely feedback to support further improvements
• EIP teams and their commissioners use the EIP Matrix in Service Development & Improvement Planning
(SDIP)

Annual reports provide an update with both achievements and areas that need
improvement:
Achievements
• More People Seen Quicker: The South of England EIP teams continue to see people within the 14-
day referral to treatment window. Of all the referrals received by mental health providers for
suspected psychosis, 85% were seen by EIP within 14 days of referral;
• More People Receiving CBTp: There has been an increase in people receiving CBT for Psychosis,
from 12% in 2016 to 21% in 2017, 30% in 2018 and 36% in 2019
• Better Physical Health Monitoring: 68% of of people with first episode psychosis are reported to
have had a comprehensive physical health check in the last 12 months compared to 41% in 2016.
Areas for Improvement
• Access to EIP: There continues to be a large variation in teams' caseloads with some EIP teams only
seeing <30% of who they should be seeing according to psychosis incidence data.
• Investment: There continues to be a 3-fold variation between the best and worst funded EIP teams
in the South of England. Only two of the EIP services are funded at the £8,250 per patient
recommended to deliver NICE interventions to a full caseload.
• Physical Health: Whilst physical health monitoring has improved, it is important to note that this
68% achievement in 2019 is lower than the 90% physical health CQUIN standard.
You can read our annual reports at www.time4recovery.com
Impact

Data collected via EIP Matrix online data visualisation and analytics tool and checked with providers before publication. Delivery of CBTp, Family Interventions and
Individual Placement Support is measured by attendance of >2 or more sessions
Five Year Dashboard

Data collected via EIP Matrix online data visualisation and analytics tool and checked with providers before publication
Tracking Progress – EIP Matrix Five Year Dashboard

Staff
Wellbeing
Support
Please visit the NHS England EIP MS Teams files site for a full range of Staff Wellbeing Support resources

• People Accessing EIP
• Relatives and Carers
• Practitioners, Operational Managers and IT Managers from
- Avon & Wiltshire Partnership NHS Foundation Trust
- Berkshire Healthcare NHS Foundation Trust
- Cornwall Partnership NHS Foundation Trust
- Devon NHS Trust
- Dorset University Hospitals NHS Trust
- Gloucestershire Health & Care NHS Foundation Trust
- Isle of Wight NHS Trust
- Kent & Medway NHS & Social Care Partnership Trust
- Livewell South West
- Oxford Health NHS Foundation Trust
- Solent NHS Trust
- Somerset Partnership NHS Trust
- Surrey & Borders Partnership NHS Foundation Trust
- Southern Health NHS Foundation Trust
- Sussex Partnership NHS Foundation Trust
• Commissioners
• Researchers
• Health Education England
• University of Oxford
• University of Southampton
• University of Sussex
• Exeter University
• University College London
• NHS England Policy and Delivery Team
• College for Clinical Quality Improvement (CCQI)
• NHS England Clinical Networks
• NHS Improvement Intensive Support Team
• Oxford Academic Health Science Network
• Wessex Academic Health Science Network
Acknowledgements

www.england.nhs.uk
For more information about the South EIP programme,
please visit
www.time4recovery.com
To access EPIC MINDS resources developed with
service users and carers, please visit
www.epicminds.co.uk
Commissioned by
Thank You

South EIP 2019-20 NCAP Results& Recovery Planning - November 2020

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