Working together to develop business cases that secure investment and resources for service development for better quality and outcomes.

1. Working Together to Develop Business
Cases to Improve Services for Better
Quality and Outcomes
16th January 2020
Sarah Amani
Senior Programme Manager
Commissioned by
South

2. 1 Background
2 Methods
3 Examples
Overview
4 Some Reflections
5 Q & A

3. Background

4. 1. Purpose Provide strategic and practical support to commissioners and providers so that they achieve
both elements of the early psychosis standards.
2. Objectives
1. Support commissioners and providers to develop business cases for securing funding to achieve NICE
concordance and meet population demand;
2. Improve the quality of EIP services to a rating of Level 3 (Good) or above with a particular focus on
improving physical health and employment prospects through Individual Placement Support (IPS);
3. Maintain quality improvement platforms so that teams have the space to share good practice and
strategies to overcome barriers to improvement;
4. Support workforce recruitment strategies e.g. using EPIC Minds, that use new roles and target new
sources of supply and innovations in the workforce;
5. Collaborate with national teams e.g. NHS England, Health Education England and NHS Improvement to
ensure the programme is fully aligned with national priorities, policy and strategy.
4. Deliverables
1. EIP Matrix online analytics and visualization tool to give teams real-time feedback
2. Best practice forums including face-to-face support, workshops and webinars to drive improvements*
3. Service Development and Improvement Plans with clinical expertise and change management input
4. EIP Business Plan and Service Specification templates to minimize burden on providers and commissioners
5. Annual report including achievements, good practice examples and case studies
*Organised with Quality Improvement Leads in Strategic Clinical Networks
About Time4Recovery
Commissioned by
South

5. Source: Implementing the Five Year Forward View for Mental Health. The Five Year Forward View for Mental Health
https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0ahUKEwjr3dTF6NzXAhUNYVAKHULIAbkQFgg3MAM&url=https%3A%2F%2Fwww.england.nhs.uk%2Fwp-
content%2Fuploads%2F2016%2F07%2Ffyfv-mh.pdf&usg=AOvVaw00koBiSoePYXtJWv4ITY6T Page 20
Policy Context

6. Additional funding for early intervention in psychosis estimates the costs
for an additional 10% of people to treated within two weeks as £70
million per annum when fully implemented including costs of workforce
development.
The profile builds up this steady state over four years from 2017/18, in
order to achieve a deliverable phasing of improvement and additional
capacity. This funding does not include the baseline monies provided from
2015/16, which are recurrent at £40 million per year over this period.
Source: Implementing the Five Year Forward View for Mental Health. The Five Year Forward View for Mental Health
https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0ahUKEwjr3dTF6NzXAhUNYVAKHULIAbkQFgg3MAM&url=https%3A%2F%2Fwww.england.nhs.uk%2Fwp-
content%2Fuploads%2F2016%2F07%2Ffyfv-mh.pdf&usg=AOvVaw00koBiSoePYXtJWv4ITY6T Page 25
”
“
Investment

7. Source: Implementing the Five Year Forward View for Mental Health. The Five Year Forward View for Mental Health
https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0ahUKEwjr3dTF6NzXAhUNYVAKHULIAbkQFgg3MAM&url=https%3A%2F%2Fww
w.england.nhs.uk%2Fwp-content%2Fuploads%2F2016%2F07%2Ffyfv-mh.pdf&usg=AOvVaw00koBiSoePYXtJWv4ITY6T Page 24
Other Investment Announcements

8. Why A Business Case?
Knoster Model for Managing Complex Change: https://practices.learningaccelerator.org/strategies/tool-knoster-model-for-managing-complex-change

9. NHS Finance
NHS Providers (2019) The end of parity of esteem? Patients face increasing risks as NHS funding announcements neglect mental health.
Accessed online at: https://nhsproviders.org/news-blogs/news/the-end-of-parity-of-esteem-patients-face-increasing-risks-as-nhs-funding-
announcements-neglect-mental-health

10. Clinical
Leads'
Evolving
Role
Commissioners →

11. Methods

12. South West / South East Region boundaries and STPs= 13
= 50
= 16
= 33
Population: ~ 15 million
Mapping Teams and Populations

13. South EIP Programme
Clinical Lead: Prof Belinda Lennox
Senior Programme Manager: Sarah Amani
NHS England (South West)
Mental Health Priority
Programme Board
Chaired by Mark Cooke
Denotes line of
accountability
Communicating Across Systems
Meets 1st Week of Month
Meets Every 3 Months
Monthly EIP Lead Webinars
Quarterly F2F Events
Providers + Commissioners + Strategic Clinical Networks + Health Education England+ Academic Health Science Networks
NHS England (South East)
Mental Health Priority
Programme Board
Chaired by David Radbourne
South West
EIP Network
Clinical Chair:
James
O’Donoghue
Wessex EIP
Network
Clinical Chair:
TBC
Thames Valley
EIP Network
Clinical Chair:
Dr Helena
Laughton
South East EIP
Network
Clinical Chair:
Nik Nikolik

14. Using Anthropology to Build Relationships
The Goal → Build Trust Collaboration

15. Video Link: https://www.youtube.com/watch?v=2fRxzBhbH4Y

16. ADVANCING EIP SERVICES – a data driven approach
Mike Denis(1)
, Katie. L. James(2)
,TonyThomas(3)
, Prof. Belinda Lennox(4)
, Sarah Amani(5)
1. Oxford Academic Health Science Network, 2. Oxford Academic Health Science Network, 3. Janssen Healthcare Innovation, 4. Clinical Network Lead, Consultant Psychiatrist 5.Clinical Network Manager
Resolution
Their task wasto co-design with the EI team a set of metricsto source,analyse and present data to meet
thischallenge.The team identified acrosstheAHSN region all patientswith psychosisbetween the agesof
16-35, split by those who were treated within an EIP service and those with no known interactions with
EIPservices.The two cohorts were compared for:rates of admission to mental health hospitals,length of
stay,A&Eattendance,and educational and employment status.
Results
Of the 4643 identified with psychosis, 947 interacted with an EIPservice. Both had similar numbers
of mental health unit admissions, however those under an EIPservice had used significantly lessbed
daysand had alower rate of A&Eattendances.
The estimated potential cost savingsfrom reduced use of health system resourcesamounted to
£7500 per person per year.
Patientsunder an EIPservice had higher ratesof people in employment or education, highlighting
the benefitsto the youngperson and wider society.
Abstract
Central to the Oxford Academic Health Science Network and the functioning of its programmes is
data; it allows an understanding of unwarranted variation so projects can implement interventions
and innovations to reduce inequalities in health services, outcomes and experience for the region’s
population. This project used to its advantage access to real world data collected via electronic
medical records to assess variation in outcomes.
The AHSN Informatics Hybrid Data Analytics Model
In order to deal with the increasingdemand for information,ahybrid dataanalyticsservice wascreated
to access, verify quality and analyse key data sets. Tailored to meet the diverse data needsof projects
across primary and secondary care, this model has the capacity to draw upon internal capabilities,
member NHSorganisationsand commercial partners.
FIGURE 1: The hybrid data analytics service
FIGURE 4:
A comparison of health system resources use
by patients seen by EI teams or by other teams
Oxford Academic Health Science Network
In-house
Using Research Data

17. Belinda Lennox
rk to investigate
s with psychosis.
o mental health
nd with previous
FIGURE 4:
A comparison of health system resources use
by patients seen by EI teams or by other teams
Real world evidence shows impact of Early Intervention teams
Tsiachristas et al (2016) Economic impact of early intervention in psychosis services: results from a longitudinal retrospective controlled study in England http://bmjopen.bmj.com/content/6/10/e012611.full.pdf+html
Using Economic Studies

18. • The EIP Matrix is a web-based data analytics tool which gives users immediate
graphed feedback on:
o Caseload versus prevalence
o Investment per patient
o NICE concordance
o Workforce
o Performance
o Outcomes
• It was developed with South of England clinicians and commissioners in 2015
• The EIP Matrix uses the same audit questions as the national Royal College of Psychiatry College for Clinical Quality
Improvement (CCQI)
• CCQI are commissioned nationally by NHS England to monitor achievement of the psychosis standards
• The CCQI audit is currently underway with a deadline of 31st November, teams will receive their CCQI reports in June
2020
• The EIP Matrix results are published faster to give teams timely feedback to support further improvements
EIP Matrix

19. 1. Agree KPIs
2. Submit data via EIP
Matrix 3. Receive summary
report
4. Verify or correct data
5. Copy and paste key
information into
business case template
6. Discuss with director/s
and commissioners as part
of regular SDIP meetings
7. Funds released/not
released for service
improvement
Process

20. Plan Versus Reality

21. Priority Action Lead Support Progress
RAG
Rating
1. Investment
Increase EIP investment in
line with overall CCG
budget uplift
CCG Commissioning
Manager
South EIP
Programme
NHS England Mental Health Investment
Standard and EIP Matrix Investment Per
Patient dashboard now being used to track
EIP funding. No EIP uplift in 2019-20.
2. NICE Concordance
Develop business case
including NICE
Concordance trajectory
and workforce plan
EIP Manager South EIP
Programme
South EIP programme has sent the team a
template business case to support CCGs and
Providers
3. Workforce
Identify funding
opportunities to pilot new
roles within EIP services EIP Manager
Health
Education
England
STP has called for bids for workforce
development. A bid has been submitted.
Awaiting results.
Service Development & Improvement Planning (SDIPs)

22. 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.
Reinforcing Improvement
You can find full reports at www.time4recovery.com

23. Business Case Examples

24. Sharing Resources
NHS England Priority Summary Example Business Case
Early Intervention in Psychosis (EIP) • Extend age range of service to 36-65
• Achieve NICE Concordance
• Evidence return on investment
At Risk Mental States (ARMS) • Develop service for early detection and
treatment for ultra high risk
• Reduce transition from ARMS to psychosis
Individual Placement and Support (IPS) • Extend existing or develop new IPS service
• Double number accessing IPS
• Improve employment outcomes
Workforce Expansion • Develop Associate Practitioner role
• Standardize training and supervision
• Create clear career trajectory for retention
• Reduce use of agency staff

25. 1. INTRODUCTION
2. PURPOSE
• NHS England Mandate
• Current Provision
• PSYCHOSIS PREVALENCE
• Projected Caseload
• At Risk Mental States
• Implications
3. ECONOMIC CASE
• Impact
• Outcomes
• Cost Savings
• Resourcing
4. OPTIONS FOR CONSIDERATION:
• Option 1: Do Nothing
• Option 2: Full NICE Concordance
• Option 3: Partial NICE Concordance
5. PREFERRED OPTION: OPTION 2
• Appendix 1: EIP Investment in NHS Long Term Plan
Example
Table of
Contents

26. 1 Foster curiosity about how finance decisions are made
2 Develop relationships with commissioners
3 Offer something of value e.g. expertise, time or other connections
Summary
4 Align goals, join forces and agree a plan
5 Commit to a process to monitor progress and assure stakeholders

28. • People Accessing EIP
• Relatives and Carers
• Researchers
• Practitioners and Managers from
- Avon & Wiltshire Partnership NHS Foundation Trust
- Berkshire Healthcare NHS Foundation Trust
- Cornwall Partnership NHS Foundation Trust
- Dorset University Hospitals NHS Trust
- Devon 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
• 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
• ANYONE WHO I MIGHT HAVE MISSED OUT (SORRY!)
THANK YOU!
Acknowledgements

29. Thank You
For more information about the South EIP Programme,
please visit
www.time4recovery.com
Commissioned by
South