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South EIP Programme Update 2019-20

The document outlines the South Early Intervention in Psychosis (EIP) Programme, detailing initiatives aimed at improving mental health services across the South of England. It highlights the findings from the National Clinical Audit of Psychosis (NCAP), with a focus on patient access, service performance, and the critical role of EIP in preventing hospitalizations. It also discusses funding increases and future strategies for recovery and support within the mental health framework, particularly in response to the COVID-19 pandemic.

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Efforts to Support Regional Recovery & Restoration South EIP Programme Meeting with NHS England (South East & South West) 23rd November 2020 and 12th February 2021 MS Teams #EpicMinds
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
Background & Context
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 Directed by Ursula James Lines of accountability Governance Monthly Meetings 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 Directed by Olivia Falgayrac- Jones South West EIP Network Clinical Chair: Sarah Amani South East EIP Network Clinical Chair: Sarah Amani Lines of engagement South EIP Programme Steering Group Clinical Lead: Professor Belinda Lennox Senior Programme Manager: Sarah Amani South EIP Peer & Carer Peer Support Worker Group Co-Chair: Dawn Hyde
Policy Context
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 Level 3 NICE concordance [LTP commitment] Maintain 60% EIP Access Standard 80% of EIP teams reach Level 3 NICE concordance [LTP commitment] Maintain 60% EIP Access Standard 95% of EIP teams reach Level 3 NICE concordance [LTP commitment] SMI physical health checks A total of 280,000 people receiving physical health checks [FYFVMH commitment] A total of 280,000 people receiving physical health checks [FYFVMH commitment] A total of 302,000 people receiving physical health checks [An additional 22,000 above FYFVMH ambition] A total of 346,000 people receiving physical health checks [An additional 66,000 above FYFVMH ambition] A total of 390,000 people receiving physical health checks [An additional 110,000 above FYFVMH ambition] 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 community mental health 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 At least 257,000 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 At least 370,000 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
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% ≥20% ≥24% 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 Top Performing Performing Well Needs Improvement Greatest Need for Improvement
Kent, Surrey & Sussex 4 3 2 1 Top Performing Performing Well Needs Improvement Greatest Need for 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 Service Users Per Care 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 Top Performing Performing Well Needs Improvement Greatest Need for 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 Service Users Per Care 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-
Regional Support
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.
Business Case Templates
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 60 190 160 Acute Psychosis in Primary Care and A&E 0 40 60 100 80 DIALOG+ 50 30 40 120 100 Physical Health 67 92 26 185 40 Health Equality 16 8 20 44 40 Total Training Requested & Delivered in 2020 643 430
Best Practice Briefings
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 • 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
Main Dashboard
Customisable
Outcomes Section
Recommendations Section
Admins View of Audits
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
“This is how all NHS England data should be presented - easy to understand and in service of us - not the other way round!” Mental Health Commissioner “What we have in EIP and actually in the NHS is a range of tools like Rio, Carenotes, SystemOne etc that collect data, but we are often missing tools that feedback to us swiftly to help us determine what that data means in terms of intelligence and what to do about it.” EIP Manager Feedback
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
Staff Wellbeing Support Please visit the NHS England EIP MS Teams files site for a full range of Staff Wellbeing Support resources
Discussion
• 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

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South EIP Programme Update 2019-20

  • 1.
    Efforts to SupportRegional Recovery & Restoration South EIP Programme Meeting with NHS England (South East & South West) 23rd November 2020 and 12th February 2021 MS Teams #EpicMinds
  • 2.
    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
  • 3.
  • 4.
    South EIP Programme 13Sustainability & 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
  • 5.
    NHS England (SouthWest) Mental Health Programme Directed by Ursula James Lines of accountability Governance Monthly Meetings 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 Directed by Olivia Falgayrac- Jones South West EIP Network Clinical Chair: Sarah Amani South East EIP Network Clinical Chair: Sarah Amani Lines of engagement South EIP Programme Steering Group Clinical Lead: Professor Belinda Lennox Senior Programme Manager: Sarah Amani South EIP Peer & Carer Peer Support Worker Group Co-Chair: Dawn Hyde
  • 6.
  • 7.
    Refer to NHSMental 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
  • 8.
    Priority 2019/20 2020/212021/22 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 Level 3 NICE concordance [LTP commitment] Maintain 60% EIP Access Standard 80% of EIP teams reach Level 3 NICE concordance [LTP commitment] Maintain 60% EIP Access Standard 95% of EIP teams reach Level 3 NICE concordance [LTP commitment] SMI physical health checks A total of 280,000 people receiving physical health checks [FYFVMH commitment] A total of 280,000 people receiving physical health checks [FYFVMH commitment] A total of 302,000 people receiving physical health checks [An additional 22,000 above FYFVMH ambition] A total of 346,000 people receiving physical health checks [An additional 66,000 above FYFVMH ambition] A total of 390,000 people receiving physical health checks [An additional 110,000 above FYFVMH ambition] 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 community mental health 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 At least 257,000 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 At least 370,000 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
  • 9.
    Covid -19 SpecificContext “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 ”
  • 10.
    The Critical Roleof 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
  • 11.
    2019-20 National ClinicalAudit 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
  • 12.
    EIP NCAP Results2018-19 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
  • 13.
    South of England Region Numberof 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
  • 14.
    South of England Region Numberof 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
  • 15.
    National Standard forEarly 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% ≥20% ≥24% 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%
  • 16.
    The overall scoreis 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
  • 17.
    Thames Valley 4 32 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
  • 18.
    Wessex Provider Isle of WightNHS 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 Top Performing Performing Well Needs Improvement Greatest Need for Improvement
  • 19.
    Kent, Surrey &Sussex 4 3 2 1 Top Performing Performing Well Needs Improvement Greatest Need for 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 Service Users Per Care 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
  • 20.
    South West 4 32 1 Top Performing Performing Well Needs Improvement Greatest Need for 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 Service Users Per Care 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
  • 21.
    Part 1 ofStandards 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-
  • 22.
  • 24.
    Tsiachristas A, ThomasT, 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
  • 26.
    Service Design Service designis 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
  • 27.
    Family or SelfReferral 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
  • 30.
    Example EIP WinterPlan – 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
  • 31.
    Physical Health forSMI- Point of Care Project
  • 32.
    # Element Agreed Action/sWho 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.
  • 33.
  • 34.
    Regional Training Training NeedNumbers 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 60 190 160 Acute Psychosis in Primary Care and A&E 0 40 60 100 80 DIALOG+ 50 30 40 120 100 Physical Health 67 92 26 185 40 Health Equality 16 8 20 44 40 Total Training Requested & Delivered in 2020 643 430
  • 35.
  • 36.
    Peer Reviews “Following carefulconsideration 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
  • 37.
    Data Set SummaryLimitations 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 • Self reported audit (same as NCAP) so element of human error is inevitable EIP Reporting
  • 38.
    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
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.
  • 44.
    Data collected viaEIP 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
  • 45.
    Data collected viaEIP Matrix online data visualisation and analytics tool and checked with providers before publication Tracking Progress – EIP Matrix Five Year Dashboard
  • 46.
    “This is howall NHS England data should be presented - easy to understand and in service of us - not the other way round!” Mental Health Commissioner “What we have in EIP and actually in the NHS is a range of tools like Rio, Carenotes, SystemOne etc that collect data, but we are often missing tools that feedback to us swiftly to help us determine what that data means in terms of intelligence and what to do about it.” EIP Manager Feedback
  • 47.
    Annual reports providean 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
  • 48.
    Staff Wellbeing Support Please visit theNHS England EIP MS Teams files site for a full range of Staff Wellbeing Support resources
  • 49.
  • 50.
    • People AccessingEIP • 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
  • 51.
    www.england.nhs.uk For more informationabout 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

Editor's Notes

  • #8 Supported by ring fenced investment fund By year 5 funding reaches nearly a billion pounds By 2023/24: All STPs/ICSs will have received transformation funding to develop and begin delivering new models of integrated primary and community care for adults and older adults with severe mental illnesses,
  • #9 By 2023/24: All STPs/ICSs will have received funding to develop and begin delivering new models of integrated primary and community care for adults and older adults with severe mental illnesses, incorporating care for people with eating disorders, mental health rehabilitation needs and complex mental health difficulties associated with a diagnosis of a ‘personality disorder’, among other groups. These new models of care will span both core community provision and also dedicated services, where the evidence supports them, and they will be built around Primary Care Networks. By the end of 2023/24 every STP/ICS will have at least one new model in place, with care provided to at least 370,000 adults and older adults per year nationally, giving them greater choice and control over their care, and supporting them to live well in their communities.