SOUTH REGION EARLY INTERVENTION IN PSYCHOSIS PROGRAMME PROGRAMME REPORT

Transcription

1 SOUTH REGION EARLY INTERVENTION IN PSYCHOSIS PROGRAMME PROGRAMME REPORT

2 Document Ownership and Status Document Owner Sarah Amani Document Status FINAL Document Review Distribution List Forum Preparedness Clinical Group Preparedness Programme Board South Region Mental Health Priority Board (NHS England) Chair Prof. Belinda Lennox Fiona Edwards Julia Davison Document Approval [Persons designated to approve and sign off of this document] Name Fiona Edwards Prof Belinda Lennox Title, Organization CEO, Surrey and Borders Partnership NHS & Chair of EIP Preparedness Board South Region EIP Preparedness Senior Responsible Officer 2 of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

3 Table of Contents 1. Introduction Clinical Background Purpose of Document 4 2. EIP Preparedness Programme 5 3. Summary 5 4. EIP Audit Specification 6 5. Findings EIP Investment Status of Service Development and Improvement Planning (SDIP) EIP Structures Percentage of Caseload Allocated an EIP Care Coordinator within 14 Days of Referral NICE Concordance Workforce Performance and Outcomes Discussion Recommendations Appendix 1 - EIP Preparedness Programme Clinical Group Appendix 2 - Information Technology and Information Management Representatives Appendix 3 - EIP Preparedness Programme Board 19 3 of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

4 1. Introduction Waiting times and access standards can be used to measure and improve services as well as identifying an expected standard of care. In physical health, the NHS Constitution guarantees patients right not to wait more than 18 weeks for consultant-led treatment, but mental health treatment has historically been excluded. For the first time, in April 2015 NHS England committed to waiting time standards for mental healthcare, supported by 80 million of investment targeting first episode psychosis in 2015/16. The new access and waiting time standards require health systems to ensure >50% of people with suspected first episode psychosis receive a NICE recommended package of care within 14 days of referral. Early Intervention in Psychosis (EIP) Teams were originally set up as part of the National Service Framework for mental health in the late 90 s but despite mounting evidence of their effectiveness, have seen a significant decline in resources over the years. The new EIP access and waiting time standards mandate a reinstatement of EIP teams, with a statute to deliver the range of evidence based NICE recommended interventions Clinical Background The Independent Schizophrenia Commission ( ), established by the mental health charity Rethink Mental Illness, reported many deficiencies in the services for people with psychosis resulting in: Death years earlier than the general population. Only 1 in 10 who might benefit from cognitive behavioural therapy has access to it. Lack of employment opportunities; only 8% in employment. Inadequate support and recognition of the role of carers. Problems in the services for those with African- Caribbean or African backgrounds. A need to extend Early Intervention for Psychosis services. A need for improved prescribing Purpose of Document Developed in partnership with members of the South Region EIP Preparedness Clinical Group (Appendix 1), the purpose of this paper is to provide the reader with a single report that establishes local levels of psychosis incidence, current levels of performance against the new standard and the workforce skill mix and related training needs. The report intends to identify key areas of focus and also good practice, to help ensure equitable EIP services across the South Region. 1 Schizophrenia Commission, of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

5 2. EIP Preparedness Programme The EIP Preparedness Programme operated under the following governance structure: NHS England (South) Mental Health Priority Programme Board Chaired by Julia Davison EIP Preparedness Programme Board Chaired by Fiona Edwards Oxford AHSN Best Care Programme Board Chaired by Chandi Ratnatunga Youth Participation Lead Rojina Dorodvand EIP Preparedness Programme Clinical Group Chaired by Prof Belinda Lennox Carer Participation Lead Dawn Hyde South West IRIS EIP Lead Dr Frank Burbach EIP Preparedness Senior Programme Manager Sarah Amani South East IRIS EIP Lead Dr Stuart Clark 3. Summary EIP Preparedness Programme Manager Sarah Roberts Denotes line of accountability Reports provided for Information The findings in this report are based on data submitted by EIP teams in the South Region between August and September Whilst some of the results are encouraging and reflect the commitment and compassion of front line staff and managers, there are significant areas that cause concern and require urgent action. The data brings into stark focus the major investment needed to build the workforce capacity and skill set to deliver the full range of NICE recommended interventions within EIP teams. Of particular concern is the low provision of CBT for Psychosis, Family Interventions, and Individual Placement Support (IPS). Only 21% of the region s caseload has access to individual psychotherapy such as CBT for Psychosis. This is lower than the national findings of the National Audit for Schizophrenia (NAS2, 2014) which found a total of 29% of those accessing mental health services had access to CBT for psychosis. 2 Of the total 4,205 people accessing EIP services in the South Region, only 17% have been able to access Family Interventions and 41% have received support to attain or retain their employment or educational activities. The above findings are unsurprising given the wide variation in the funding and staffing of EIP teams across the region. Differing commissioning priorities, provider history and practices appear to have culminated in a variety in structures and capacity of EIP services across the South Region and ultimately a vast difference in performance outcomes. 2 Report of the second round of the National Audit of Schizophrenia (NAS2) of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

6 4. EIP Audit Following nominations to a region wide board, an inaugural meeting with representatives from commissioners and providers from the South of England was held on 15th May 2015 (Appendix 3). One of the first decisions made by the board related to benchmarking the South of England EIP workforce, current demand and provision of services. It was decided that in the absence of any other EIP specific benchmarking tool that reflected the new standards, the programme would develop its own and encourage transparency in order to gather accurate data and share best practice. An online audit (the EIP Matrix: time4recovery.com/eip-matrix/) was developed in partnership with the Preparedness Clinical Group Specification The content of the EIP Matrix was generated by the nominated members of the EIP Preparedness Clinical Group (Appendix 1) who provided their expertise to develop the specification. The first section of the audit asked providers to list their EIP services, indicating the current caseload, age ranges and annual budget. The audit was further divided into three subsections covering: 5. Findings Between 3rd August and 1st September The level of completeness of the audit by providers was generally high; however as with all self-reporting audits there were some issues with accuracy. Where there were discrepancies, the programme team verified the data with the submitting clinical leads. Some areas where the data was questionable included smoking cessation and carers support, this was identified as an issue in a number of organisations and was a result of smokers and carers not being identified and recorded accurately. There was one organisation unable to provide the data due to technical difficulties with their Electronic Health Record (EHR) and the fact that this organisation s EIP services are currently provided within a generic Community Mental Health Team (CMHT), making information difficult to extract. All providers and constituent CCGs were given individual reports, analysed and graphed to support service improvement and development planning (page 17). 1. NICE Concordance 2. Performance and Outcomes 3. Staffing and Workforce Training The EIP Matrix calculates percentages, using denominators and agreed thresholds to produce colour coded bar charts which indicate levels of achievement against NICE standards. Following its seventh and final iteration, the EIP Matrix ( com/eip-matrix/ ) was tested by the Oxford AHSN informatics team to verify accuracy and reliability. Instructions to register to use the Matrix were sent to the clinical group with guidance following final board approval. Access to the EIP matrix was controlled via unique identifiers and passwords assigned to EIP Clinical Leads as part of the registration process. Data submissions were received between 3rd August and 1st September of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

7 5.1. EIP Investment In light of the differing commissioning priorities, resulting levels of investment, service development decisions, provider history and practice, there is a wide variation in the investment and structures of EIP teams across the South of England. This provides challenges in ensuring all EIP services in the South Region are able to meet the access and waiting time standards and highlights the need for focused activities specific to provider organisations. The range of responses in the level of investment in EIP per 100,000 of the population (from highest to lowest investment) is as follows: Health Economy Served By Reported Annual EIP Budget Population (100,000) EIP Cost Per 100,000 Cornwall Partnership NHS Foundation Trust Berkshire Healthcare NHS Foundation Trust Sussex Partnership NHS Foundation Trust 2Gether NHS (Gloucestershire) 1,246, , ,650, , ,098,357 1, ,179, The Zone (Plymouth) 379, , Isle of Wight NHS Trust 287, , Central and North West London Mental Health (Milton Keynes) Surrey and Borders Partnership NHS 359, , ,762,991 1,432 1, Oxford Health NHS 1,364, , Kent and Medway NHS and Social Care Partnership Trust Avon and Wiltshire Mental Health Partnership NHS Trust 2,323,208 1,969 1, ,123,926 1,900 1, Southern Health NHS 1,643,339 1,458 1, Dorset Healthcare University NHS 650, Somerset Partnership NHS Trust 406, Devon Partnership NHS Trust 651,012 1, Solent NHS Trust of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

8 In addition to the data provided it is worth highlighting the challenges of providers working in rural areas. Cornwall Partnership NHS Foundation Trust and Kent and Medway NHS and Social Care Partnership Trust both cover a large geography with some highly rural areas bringing particular challenges of increased travel of clinicians, isolation of teams and also isolation of patients from central services. An increase in resource for the size of the population is likely needed in these areas. Health Economy Served By Reported Annual EIP Budget Total caseload EIP Cost Per Caseload at End of Q3 2Gether NHS 1,179, , Berkshire Healthcare NHS Foundation Trust Cornwall Partnership NHS Foundation Trust Sussex Partnership NHS Foundation Trust Surrey and Borders Partnership NHS 1,650, * 8, ,246, , ,098, , ,762, , Oxford Health NHS 1,364, , The Zone (Plymouth) 379, , Southern Health NHS 1,643, , Isle of Wight NHS Trust 287, , Central and North West London Mental Health (Milton Keynes) Kent and Medway NHS and Social Care Partnership Trust Avon and Wiltshire Mental Health Partnership NHS Trust 359, , ,323, , ,123, , Somerset Partnership NHS Trust 406, , Dorset Healthcare University NHS 650, , Devon Partnership NHS Trust 651, , Solent NHS Trust * In the absence of caseload data, we have resorted to using predicted caseload from the Psymaptic psychosis epidemiology tool accessible at 8 of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

9 EIP Investment per Person Accessing EIP Service 9, , , , , , , , , Gether NHS Berskshire Healthcare NHS Cornwall Partnership NHS Sussex Partnership NHS Surrey and Borders Partnership NHS Oxford Health NHS The Zone (Plymouth) Southern Health NHS Isle of Wight NHS Trust Central and North West London Mental... Kent and Medway NHS and Social Care... Avon and Wiltshire Mental Health... Somerset Partnership NHS Trust Dorset Healthcare University NHS Trust Devon Partnership NHS Trust Solent NHS Trust Current National Mean of 6,926 Required cost per patient in a fully compliant EIP team The above table and bar chart details the EIP cost per case across the 16 providers in the South Region. This ranges from 2, to 8, Solent does not currently have a budget for EIP as it is a very small service with 2 staff based within a CMHT. The estimated annual cost for treatment in a fully compliant early intervention team is 8, By these calculations only 2gether Trust meets this level of investment. The NHS Benchmarking Network report Mental Health Benchmarking Early Intervention in Psychosis Analysis finds the mean spend across the country for 2014/15 as 6,926 and the median as 6, /16 National Tariff Engagement Document (2015) Accessed at: 9 of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

10 5.2. Status of Service Development and Improvement Planning (SDIP) Individual provider reports from the EIP matrix were sent to each health economy in a bid to support systems to develop SDIPs that address achievement of the access and waiting time standards. Intelligence on adequacy of SDIPs was gathered through site visits to EIP services and local reporting from the EIP Preparedness Clinical Group. This information was cross referenced with Operations and Delivery Managers at NHS England. A summary of progress of commissioners and providers in committing resources (including time and funding) to develop SDIPs that specifically address the new EIP standards is as follows: RAG Rating KEY* On track. Successful delivery of the EIP Service Improvement and Development Plan (SDIP) highly likely. There are no major outstanding issues that appear to threaten delivery significantly at this stage Significant concerns. Successful delivery is possible, however constant attention is required. Commissioner/s and provider/s need to address risks as highlighted below. Critical concerns. Achievement of the standards unlikely. There is an overall lack of clarity on who is leading on EIP standards at executive level and allocation of the budget required. Organization Lead MH Commissioner has confirmed EIP uplift? Provider has ring fenced increased EIP budget EIP Service Development & Improvement Plan in place Comments 1 Gether NHS 2 Avon and Wiltshire Mental Health Partnership NHS Trust 3 Berkshire Healthcare NHS 4 Central and Northwest London Mental Health Trust (Milton Keynes) 5 Cornwall Partnership NHS 6 Dorset Healthcare University NHS Y U U EIP SDIP status unknown. Provider reports EIP funding has been increased amount unknown. No evidence of SDIP. Y N N Four of the six CCG area EIP services provided by AWP have received increased funding: Wiltshire 104,000, South Gloucestershire 140,000, Swindon 30,000, BANES 164,000, North Somerset have been promised 50,000 and Bristol have had no increase. Y Y Y EIP uplift of 1m confirmed by CCGs and ring fenced by provider. New standalone EIP service set up, SDIP is in place and evidenced. Y Y Y Funding allocated & ring-fenced for EIP. SDIP developed. Staff recruited. Y Y Y CCG engaged. EIP SDIP in development. New funding of 100K has been allocated. Team is currently recruiting staff. Y Y Y EIS SDIP agreed. New CCG investment of 168k allocated and varied into provider contract. * Based on self reports, observations and soft intelligence ** Please note that the below status is an indication of progress at the time of writing this report 10 of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

11 7 Devon Partnership NHS Trust 8 Isle of Wight NHS Trust 9 Kent and Medway NHS and Social Care Partnership Trust 10 Oxford Healthcare NHS N N N No EIP funding uplift for 2015/16. SDIP evidenced, significant work underway to reorganise and standardise EIP service across the county. N Y Y No EIP funding uplift. SDIP in place. Well-functioning team. Y N Y EIP uplift of 168,000 has been commited by East Kent CCGs but has yet to be received by EIP service. West Kent CCGs have yet to confirm any uplift. SDIP complete and evidenced. Y Y Y Funding of 550,000 allocated, funding ring fenced. Staff recruited. SDIP completed 11 Solent NHS Trust N N N No EIP budget and no evidence of SDIP. Lack of clarity on who is leading on this at executive level. 12 Somerset Partnership NHS Trust 13 Southern Health NHS 14 Surrey and Borders Partnership NHS 15 Sussex Partnership NHS N N Y No EIP Uplift. Provider and commissioners in discussions. SDIP complete. N N U No funding uplift for EIP. No evidence of SDIP. Variation in EIP service delivery across Hampshire. Y Y Y Commissioners have confirmed EIP budget uplift. SDIP in place. Staff recruitment and training underway. Y Y Y Commissioner has confirmed EIP uplift of 800,000. Staff recruitment on-going. SDIP evidenced. 16 The Zone (Plymouth) N Y N No EIP uplift. SDIP not evidenced EIP Structures The South Region EIP Preparedness Programme has a range of structures of EIP services. A NICE Concordant EIP service requires a standalone EIP team to deliver NICE treatments. Although this is the case in the majority of provider organisations, it is not the case in all. The rationale for mandating stand-alone EIP teams is the clear evidence that they are more clinically and cost effective 4 and better enable the implementation of NICE-concordant interventions 5. There are concerns with adaptations of the model 6, especially integration into CMHTs, in that they result in: Isolation of EIP workers Limitations in clinical supervision Lack of availability of competent therapists Abrupt or gradual increase in caseload numbers Deviation from the evidenced based model in rural and urban settings as a way of reducing short term costs has shown to have a negative impact on the experience and outcomes of people using services and carers; and produces higher longer-term costs 7. 4 Fowler D, Hodgekins J. Howells L, Millward M, Ivins A, Taylor G, Hackmann C, Hill K, Bishop N and Macmillan I. (2009). Can targeted early intervention improve functional recovery in psychosis? A historical control evaluation of the effectiveness of different models of early intervention service provision in Norfolk Early Intervention in Psychiatry 3: V. Bird, P. Premkumar, T. Kendall, C. Whittington, J. Mitchell and E. Kuipers Early intervention services, cognitive behavioural therapy and family intervention in early psychosis: systematic review. The British Journal of Psychiatry 197: Singh and Fisher (2007) One-year outcome of an early intervention in psychosis service: a naturalistic evaluation. Early Intervention in Psychiatry 1: Centre for Mental Health (2014) Investment in Recovery. Accessed online at: 11 of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

12 5.4. Percentage of Caseload Allocated an EIP Care Coordinator within 14 Days of Referral The Zone (Plymouth) Sussex Partnership NHS Surrey and Borders Partnership NHS Foundation Southern Health NHS Somerset Partnership NHS Trust Solent NHS Trust Oxford Health NHS Kent and Medway NHS and Social Care Partnership Isle of Wight NHS Trust Dorset Healthcare University NHS Devon Partnership NHS Trust Cornwall Partnership NHS Central and North North West London Mental Berkshire Healthcare NHS Avon and Wiltshire Mental Health Partnership NHS 2Gether NHS % of Caseload Allocated an EIP Care Coordinator within 14 days of Referral to EIP Services - Access and Waiting Time Standard from April 2016 Although 8 of the 15 Trusts appear to be able to allocate a care coordinator within 14 days of referral for >50% of referrals, the fact that almost half of providers are unable to meet the standard is a key concern. This metric likely reflects a number of possible problems in the delivery of a stand-alone EIP service, including insufficient staffing levels and access delays. Delays in the clinical pathway (usually between initial assessment at a single point of entry/ ward admission/ initial outpatient appointment to first appointment with the EIP team) are shown to account for the sub-optimal performance in many trusts 8. It is clear that funding is not the only factor that determines good performance. Other factors such as communication between EIP and it s referrers, IT infrastructure and data quality need to be optimised to achieve best possible outcomes. 8 Birchwood et al (2013) Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services. British Journal of Psychiatry; 2013 (1): of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

13 5.5. NICE Concordance % of people on the EIP caseload who smoke, who have a record of being offered smoking cessation support in the last year. 21 % of people on the EIP caseload with a record indicating they are smokers. % of people on the EIP caseload with evidence of receiving a physical health check, including: Pulse, BP, Lipids, Glucose, Weight, Waist Circumference. % of people on the EIP caseload who are receiving support to gain or retain their employment and/or education % of these people who are treated with clozapine. 2 % of people on the EIP caseload who remain symptomatic after treatment trial of two different anti-psychotics. 12 % of People On Caseload Who Have Beed Prescribed Medication 62 % of People On Caseload Receiving/Who Have Received Family Therapy % of People On Caseload Receiving/Who Have Received Group Psychotherapy % of People On Caseload Receiving/Who Have Received Individual Psychotherapy A NICE concordant EIP service is able to offer and deliver the following NICE recommended treatments to >50% of people within 14 days of referral: CBT for Psychosis (CBTp) Individual Placement Support (IPS) for education and employment Family Interventions Medicines management Comprehensive physical assessments Support with diet, physical activities and smoking cessation Carer-focused education and support programmes The above graph shows percentages of people with psychosis in receipt of each of the NICE recommended interventions. These results indicate that performance is not yet adequate on most of the indicators of NICE concordance. Only 21% of the caseload has received individual psychotherapy including CBT for psychosis. Whilst this low uptake might partially due to patient choice i.e. people declining this intervention, the low number of CBTp accredited therapists (18.4 WTE CBTp Therapists for the South of England) strongly suggests that the low percentage of those in receipt of CBTp is largely due to the lack of CBTp competence and capacity of the current workforce. 13 of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

14 5.6. Workforce Administrators Support Workers with IPS Training Family Intervention Therapists CBT Trained Clinicians 18.4 Care Coordinators Medical Time (CAMHS and Adult) Team Leaders % of WTE Dedicated to EIP The largest clinical group working in EIP are Care Coordinators who make up 55% of the total workforce. This is to be expected as successful treatment of individuals with first episode psychosis often requires a high degree of concerted effort to get engagement, and coordinated care which is effectively delivered using a case management model. Only 5% of the EIP workforce is qualified psychiatrists. Pharmacotherapy should be initiated by a qualified psychiatric doctor with Consultant level oversight to manage high risk cases. Without the necessary medical input, many people with psychosis are currently going without the necessary medical treatment to aid recovery and manage cardio-metabolic risk factors such as smoking, weight gain, hypertension, dyslipidaemia, and pre-diabetes. The numbers of staff in each workforce category fall far short of the staffing levels calculated to be required to deliver the new access and waiting time standards. For example, there are currently 228 care coordinators but approximately 252 are required; medical staff when approximately 50.4 are required, and 18.4 CBT trained clinicians when approximately are required. 8% 10% 8% 10% 4% 55% Team Leaders Medical Time (CAMHS and Adult) Care Coordinators CBT Trained Clinicians Family Intervention Therapists Support Workers with IPS Training Administrators 5% 14 of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

15 5.7. Performance and Outcomes Percentage of EIP Caseload in Employment or Education The Zone (Plymouth) Sussex Partnership NHS Surrey and Borders Partnership NHS Foundation Southern Health NHS Somerset Partnership NHS Trust Solent NHS Trust Oxford Health NHS Kent and Medway NHS and Social Care Partnership Isle of Wight NHS Trust Dorset Healthcare University NHS Devon Partnership NHS Trust Cornwall Partnership NHS Central and North North West London Mental Berkshire Healthcare NHS Avon and Wiltshire Mental Health Partnership NHS 2Gether NHS % of EIP Caseload in employment or education (outcome indicator of a good service) Engagement in employment or education is a key functional outcome for EIP services and the best services have embedded staff members that are trained to provide IPS (Individual Placement Support). Some trusts, e.g. Cornwall, are highly successful with 68% of people who access their EIP service in education in employment. In a bid to understand the factors influencing for the success seen in Cornwall, the EIP Preparedness Team made a visit to the EIP service and its commissioners in December The Cornwall EIP service has a formal contract with Pentreath Limited. The charity s vocational workers are embedded within the EIP service so that they can provide timely and coordinated Individual Placement Support (IPS) to everyone referred to the service. As a result of the visit, the Cornwall EIP service has produced a video to share best practice with the rest of the South Region. The majority of trusts achieve over 30% employment or education, however, which indicates that with a bit more focus on this area, the >50% target is achievable. 15 of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

16 6. Discussion The key finding from this report is that only half of the South Region EIP providers and commissioners are able to meet the 14 day access and waiting time standard for >50% of all referrals. There is also low concordance to what NICE recommends as effective treatments for psychosis with only 21% of individuals with psychosis accessing EIP services able to access CBTp and 17% of families having received Family Interventions. Key factors emerging on analysis of the data are: Investment in EIP Team Structures & Pathway Design Workforce Training and Development, Technology to record and report accurately on the EIP access and waiting time standards These areas are issues across the South Region to differing degrees and are treated with different levels of urgency dependent on local leadership and competing demands. Vastly differing levels of investment will inevitably lead to a disparity in the service that can be provided. Only 3 trusts in the South region have invested in EIP to above the national mean spend of 6,926 with the majority of investment falling significantly below this national mean. NHS England has calculated that the provision of a NICE compliant service costs 8,250 for each patient which means that trusts such as Devon, Dorset and Somerset might need a 60% increase in funding to meet the access and waiting time standards for psychosis. Whilst these statistics might at least partially reflect a range of efficiencies and innovations in the delivery of EIP services, it is unrealistic to expect such poorly funded services to be able to achieve the expected outcomes. Services which are currently poorly resourced will be unable to meet even the relatively simple NICE standards such as a focus on smoking cessation. Only a minority of services, whatever their current levels of funding, are providing specialist Family Interventions and CBT for psychosis and this is the area in which the greatest new investment is required. For better funded services some of the existing staff could be trained to provide these specialist interventions but for services with low staffing levels the existing staff will need to spend all their existing time on care coordination and therefore employing new staff will be the only way of ensuring the new standards are met. Some teams plan to meet the provision of specialist intervention through internal referral to other services e.g. psychological departments. There is a likelihood that when interventions are outsourced they will not be offered in sufficient quantity, and with sufficient flexibility to engage this particularly challenging group. In such services specific arrangements will be required to promote successful engagement in therapies like CBTp, it is not sufficient to simply offer the intervention. Although some services have employed assistant practitioners, many services would benefit from expanding the non-professionally qualified workforce. We would recommend employing both peer support workers (people with lived experience of psychosis) and workers who can be trained to provide specialist employment support. These employment support workers should be integrated within the EIP teams to provide an evidence-based IPS service. Some of the other identified shortcomings- such as the relatively low level of medical time available in many services may reflect local service structures. Many services rely on accessing geographically deployed psychiatrists and the solution may simply involve the redeployment of existing staff. Another common issue is the unavailability of appropriately configured Electronic Health Records that can report on achievement of the standards and the NICE interventions delivered. 16 of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

17 7. Recommendations 1. Providers and Commissioners should take cognisance of the need to increase staffing levels, particularly staff able to deliver specialist family Interventions and CBT for psychosis. 2. Providers and Commissioners should work closely together on an ongoing basis to identify the main local service deficiencies and agree a service development and improvement plan with appropriate investment. 3. The existing workforce and newly appointed staff need to be provided with an ongoing programme of training. HEE investment in EIP training in is very much welcomed. Ongoing funding for training will be required if the improvement in services intended by the introduction of the access and waiting time standards is to be realised. 4. Accurate data gathering and reporting capabilities from Electronic Health Records need to be developed as some of the data in this report may have been overestimated and the deficiencies may actually be greater. 5. The exercise to gather information using the EIP Matrix, develop by the South Region EIP Preparedness Team, should be repeated post April This will give up to date information on workforce, NICE concordance and outcomes, as well as quantifying progress made towards achieving the access and waiting time standards. 17 of 21

18 8. Appendix 1 - EIP Preparedness Programme Clinical Group Prof. Belinda Lennox, Senior Responsible Officer, South Region EIP Preparedness Programme Rojina Dorodvand, Youth Participation Lead, South Region EIP Preparedness Programme Sarah Amani, Senior Programme Manager, South Region EIP Preparedness Programme Dawn Hyde, Carer Participation Lead, South Region EIP Preparedness Programme Sarah Roberts, Programme Manager, South Region EIP Preparedness Programme Jane Hainsworth, Programme Coordinator, South Region EIP Preparedness Programme Henrietta Mbeah-Bankas, Professional Advisor - EI Programme Mental Health Nurse, Health Education England Alison Griffiths, Programme Manager (Mental Health), Wessex AHSN Gabby Cooper, Team Manager, 2gether NHS Anthony Lacny, Consultant Nurse, Avon and Wiltshire Mental Health NHS Rachel Esposito, Service Manager, Avon and Wiltshire Mental Health NHS Alexandra Luke, Service Manager/ Consultant Psychiatrist, Berkshire Healthcare NHS Sasha King, Senior Occupational Therapist and Quality Champion, Central & North West London Mental Health Wayland Lousley, Mental Health Transformation Manager, Milton Keynes Clinical Commissioning Group Suzy Dion, Business Transformation Manager, Champion Central & North West London NHS Angela Hawke, Clinical Team Manager, Cornwall Partnership NHS Paul Bell Operations Manager, Community Mental Health, Cornwall Partnership NHS Tracy Read, Team Manager, Dorset Healthcare University NHS Brenda McCauley, Service Manager, Devon Partnership NHS Trust Su Tomkins, Team Manager, Isle of Wight NHS Trust Elaine Doyle, Clinical Team Lead and Consultant Psychiatrist, Isle of Wight NHS Trust Collette Chamberlain, Acting Service Manager, Kent and Medway NHS and Social Care Partnership Trust Matt McMillan, Nurse Team Leader, Kent and Medway NHS and Social Care Partnership Trust Vicky Green, Nurse Team Leader, Kent and Medway NHS and Social Care Partnership Trust Steve Bell, Service Manager, Oxford Health NHS Louise Johns, Consultant Academic Clinical Psychologist, Oxford Health NHS Helena Laughton, Chartered Counselling Psychologist/Deputy Team Manager Oxford Health NHS Jo Tedbury, Clinical Psychologist, Solent NHS Trust Helen Courtney, Psychologist, Solent NHS Trust Frank Burbach, Clinical Lead Somerset Partnership NHS Jeremy Rowlands, Consultant Psychiatrist Southern Health NHS Chris Woodfine, Service Improvement Project manager, Southern Health NHS Jo Lynch, General Manager, Surrey & Borders Partnership NHS Kate Sigov, Team Manager, Surrey & Borders Partnership NHS Peter Williams, Service Lead, Surrey & Borders Partnership NHS Rick Fraser, Consultant Psychiatrist, Sussex Partnership NHS Stuart Clark, Clinical Psychologist, Sussex Partnership NHS Gary Sargent, Team Manager, The Zone (Plymouth) 18 of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

19 8.1. Appendix 2 - Information Technology and Information Management Representatives Paul Williams, IT Manager, Plymouth CIC Emily Carter, Data Analyst, NHS England South Nigel Holland, Information Delivery Manager, Somerset Partnership NHS Dave West, Deputy Director of Performance and Information, Sussex Partnership NHS Sarah Powlesland, Performance Manager, Cornwall Partnership NHS Bill Johnston, IT Manager, Berkshire Healthcare NHS Paul Samain, IT Manager, Southern Health NHS Nigel Lowther, IT Manager, Kent & Medway NHS and Social Care Partnership Trust Judith Stone, Systems Trainer / Data Quality Officer, Central & North West London Mental Health Will Marchbank, Senior Information Analyst, Avon & Wiltshire Mental Health Partnership Trust Lindsey White, Business Partner, Business & Performance, Dorset Healthcare University NHS Dave Godley, Business Intelligence Developer, Devon Partnership NHS Trust Samantha Luboff, Senior Information Manager, Surrey and Borders Partnership NHS Charlotte Hunt, Information Manager, Oxford Health NHS 8.2. Appendix 3 - EIP Preparedness Programme Board Fiona Edwards, Chief Executive, Surrey & Borders Partnership NHS Prof. Belinda Lennox, Senior Responsible Officer,South Region EIP Preparedness Programme Sarah Amani, Senior Programme Manager, South Region EIP Preparedness Programme Justine Faulkner, Senior Programme Manager, NHS England South Sarah Roberts, Programme Manager, South Region EIP Preparedness Programme Emma Wilton, Education and Workforce Development Manager, Health Education England Thames Valley Marguerite Macfarlane, South East Strategic Clinical Network Jan Furniaux, Service Director, 2gether NHS Rosemary Neale, Service Director, 2gether NHS Kate Lavington, Head of Community Commissioning, South Gloucestershire CCG Andrew Keefe, Associate Director, South Gloucestershire CCG Aly Fielden, Mental Health & Learning Disability, Commissioning Manager Bristol CC Ian Mundy, West Berkshire Locality Director, Berkshire Healthcare NHS Nadia Barakat, Head of Mental Health Commissioning, East Berkshire CCG Cathy Phippard, Director for Mental Health, Central & North West London Mental Health Colin Quick, Associate Director of Functional Community Services, Cornwall Partnership NHS Ellen Wilkinson, Medical Director, Cornwall Partnership NHS Sam Wilson, Contracts Lead, Kernow CCG 19 of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016

20 Sandra Miles, Team Manager, Kernow CCG Mike Kelly, Head of Mental Health, Dorset Healthcare University NHS Tim Francis, Mental Health Commissioning Manager, NEW Devon CCG Jacquie Mowbray-Gould, Deputy Director of Operations, Devon Partnership NHS Trust Lin Walton, Mental Health Commissioner, West Locality New Devon CCG Alexis Bower, Medical Director, Isle of Wight NHS Trust Louise Chapman, Kent and Medway NHS and Social Care Partnership Andy Oldfield, Head of East Kent Mental Health Commissioning, NHS South Kent Coast Clinical Commissioning Group Roger Edmonds, Contracts Manager, Kent and Medway NHS and Social Care Partnership Trust Angus Gartshore, Director - Community Recovery Service Line, Kent & Medway NHS Partnership Trust Rob Bale, Clinical Director, Oxford Health NHS Matthew Hall, Operation Director, Solent NHS Trust Tim Archer, Associate Director- Joint Commissioning, Somerset CCG Andrew Dayani, Medical Director, Somerset Partnership NHS Katy Bartolomeo, Senior Commissioner (Mental Health & Substance Misuse), Southampton Integrated Commissioning Unit Jeremy Rowlands, Consultant Psychiatrist, Southern Health NHS Diane Woods, Head of Mental Health and Learning Disability Commissioning, NHS North East Hampshire and Farnham CCG Linda McQuaid, Director of Children & Young People s Services, Surrey & Borders Partnership NHS David McKenzie, Adult Mental Health Commissioning Lead, Horsham and Mid Sussex CCG Kay Mcdonald, Clinical Academic Director, Sussex Partnership NHS Lisa Gimingham, Deputy Locality Manager Citywide Services, Plymouth Community Healthcare Mike Jarman, Chief Executive, The Zone (Plymouth) Commissioned by NHS England (South) 20 of 20 South Region Early Intervention in Psychosis Preparedness Programme Report January 2016