Preparing to implement the new access and waiting time standard for early intervention in psychosis

Transcription

1 Preparing to implement the new access and waiting time standard for early intervention in psychosis Lancashire Care HS Trust Conference, September 2015 Dr Alison Brabban ational Clinical Advisor for IAPT SMI

2 What is the standard? The new access and waiting time standard requires that, by 1 April 2016, more than 50% of people experiencing a first episode of psychosis will be treated with a ICE approved care package within two weeks of referral. The standard is two-pronged and both conditions must be met for the standard to be deemed to have been achieved, i.e. A maximum wait of two weeks from referral to treatment; and Treatment delivered in accordance with ICE guidelines for psychosis and schizophrenia - either in children and young people CG155 (2013) or in adults CG178 (2014). Most initial episodes of psychosis occur between early adolescence and age 25 but the standard applies to people of all ages in line with ICE guidance.

3 EIP: why set a standard? In 2011, o Health Without Mental Health, highlighted the effectiveness of EIP services. When delivered in accordance with ICE standards they help people to recover from a first episode of psychosis and gain a good quality of life.

4 The Financial Package The new standards for 15/16 are supported by: 40m recurrent funding to support delivery of the early intervention in psychosis standard; In addition: ICE (the ational Collaborating Centre for Mental Health, CCMH) has worked with group on EIP experts to been develop EIP Access Standard Commissioning Guidance will be published in next 2 weeks. Funding has been made available to support regional EIP preparedness programmes ( 200k per region). 5m has also been allocated by HEE to support training linked to implementation of the standard (to ensure staff have appropriate competencies).

5 Working Towards Implementation 1. The ational Collaborating Centre for Mental Health established a reference group of EIP experts to (to be published this month): Design the RTT pathway; Specify the interventions that would need to be captured; Specify the outcomes dataset. 2. HSCIC and provider information experts have agreed the associated changes required to the MHLDDS and the timeframe for delivery Regional EIP Preparedness Programmes were tasked with undertaking workforce surveys that would provide granular data regarding skill-mix and competencies. 4. RCPsych (CCQI) have developed a national clinical audit of EIP services to understand the current level of ICE concordance (currently being piloted). 5. RCPsych (CCQI) are working to establish an accreditation scheme for EIP services. 6. Working with HEE to ensure appropriate education and training is available.

6 How will we measure the standard? Both elements of the standard will be measured the wait from referral to treatment and whether the treatment accessed is ICE concordant. We have been working with the HSCIC to specify: 1. What the clock starts and clock stops should be to measure the two-week referral to treatment standard the waiting time 2. What the ICE concordant intervention codes should be the quality of care We are also working to specify what the EIP outcomes dataset should be. The changes to provider information systems and the MHLDDS will take effect from 1 st January We will be using national clinical audit and accreditation to assess the quality of service provision in 15/16.

7 The February guidance Clarifies the requirements of each of the new 15/16 mental health access and waiting time standards and associated expectations of CCG commissioners in line with the planning guidance. Includes in Appendix the draft approach to measuring the EIP RTT standard. Referrer suspects first episode psychosis (FEP) Urgent / emergency referral made flagged as suspected FEP Central triage point? Clock starts when Y central triage point receives referral Onward referral to EIP service Clock starts when EIP service receives referral Patient invited for EIP DA? Y EIP commences DA Y EIP completed FEP? Y Clock stops when: 1. Accepted on to EIP caseload 2. EIP care coordinator allocated 3. ICE concordant package of care commenced. Active monitoring / watch and wait Active monitoring / watch and wait Clock stops when: 1. Accepted on to EIP caseload 2. EIP care coordinator allocated 3. Specialist ARMS commenced. ARMS? Y Commence ICE concordant package of care Onward referral to appropriate service or discharge

8 Referral to clock start 1. Referrer suspects first episode psychosis (FEP) 2. Urgent / emergency referral made flagged as suspected FEP Central triage point? Y 3a. Clock starts when central triage point receives referral Onward referral to EIP service Referrals from anywhere in the system will count (not just external) 3b. Clock starts when EIP service receives referral Patient invited for EIP 8

9 Assessment 1. Patient invited for EIP 2a. DA or cancella tion? EIP commences 2b. DA or cancell ation? EIP completed Y Y 3a. Active monitoring / watch and wait 3b. Active monitoring / watch and wait DAs and cancellations will not stop the clock 9

10 Assessment to clock stop 1. EIP completed FEP? Y 2a. Clock stops when: 1. Accepted on to EIP caseload 2. EIP care coordinator allocated 3. ICE concordant package of care commenced. The clock does not stop until treatment begins (and the of ICE concordance does not stop there). ICE guidelines should be followed for people assessed as having an at risk mental state (ARMS) 2b. Clock stops when: 1. Accepted on to EIP caseload 2. EIP care coordinator allocated 3. Specialist ARMS commenced. 3. Y ARMS? Onward referral to appropriate service or discharge Commence ICE concordant package of care 10

11 ICE Quality Standards for Psychosis 1. Referral to EIP and start treatment within 2 weeks 2. Offer CBT for Psychosis 3. Offer Family Interventions 4. Offer Clozapine (if not responded to other meds) 5. Provide Supported Employment Programmes 6. Assessment of Physical Health 7. Promoting Healthy Lifestyles (exercise, smoking cessation, diet) 8. Offer carer focused education and support 11

12 Who Should be Offered CBTp and Family Interventions? ICE (2014) Those at-risk of developing psychosis (should not be offered antipsychotic medication). Those with a first episode of psychosis (if person wants to try therapy alone, go ahead, but advise that more effective if combined with medication review after a month). Anyone with a diagnosis of schizophrenia or psychosis irrespective of phase (i.e. acute, in remission). 12

13 ICE Economic Analysis The ICE economic analysis showed that CBT and Family Intervention are likely to be overall cost saving interventions for people with psychosis because the intervention costs are offset by savings in future hospitalisations and a reduction in the rates of relapse. 13

14 How well are psychological therapies being implemented?

15 Why such a low level of availability? Lack of staff with appropriate competences Lack of available training Lack of available clinical supervision Lack of ring-fenced time (specific therapy posts) & competing demands. Priorities and team culture (Lancashire Care and SLaM Trusts are IAPT SMI Demo Sites as they have worked systematically to overcome these barriers and demonstrate outcomes)

16 Key Messages from Regional Audit Access Standard is for all ages (14 60); most EIP services currently provide a service for year olds. Access Standard is focused on first episode cases but encourages services to take those at risk of developing psychosis (ARMS cases). Many services do not provide a service for this group and are not commissioned to do so. o service currently has the capacity to deliver ICEconcordant services to more than 50% of new first episode cases by

17 Key Messages from Regional Audit Significant shortage in staff with adequate CBTp skills (not only in EIP). More than 25% services in orthern Region had no psychologists employed in EIP. eed investment in training in Family Interventions. Clear guidance is required about the competences & training staff require to deliver ICE concordant care (e.g. CBTp, physical health interventions etc) 17

18 Regional preparedness Clinical Leads orth: Paul French (W) Guy Dodgson (E & Cumbria) Moggie McGowan (Yorks) Iain MacMillan (Medical Lead) Alison Brabban (Psychological Therapies Lead) M&E Peter Jones London Philippa Garety South Belinda Lennox

19 19 ] alison.brabban@nhs.net