To: CCG Accountable Officers Trust and Foundation Trust Chief Executive Officers Independent mental health providers Chief Executives System Resilience Group Chairs 8 December 2015 NHS England Publications Gateway Ref: 04456 HSCIC ISN: SCCI0011-3/7/2015 Dear colleague, Preparedness for delivery of Early Intervention in Psychosis access and waiting time standard We are preparing for the delivery from 1 April 2016 of the access and waiting time standard for Early Intervention in Psychosis (EIP). The standard requires that more than 50% of people experiencing first episode psychosis will commence treatment with a NICE-approved care package within two weeks of referral. There are two conditions relating to the standard and both must be met for it to be deemed achieved, namely: A maximum wait of two weeks from referral to treatment, and Treatment delivered in accordance with NICE guidelines and Quality Standards for psychosis and schizophrenia (in children and young people or in adults). There has been a significant regional and local activity in preparation for the introduction of these standards and we are now taking the opportunity nationally to establish whether the necessary funding, data and workforce requirements are in place to ensure successful delivery. Our intention is to establish a baseline assessment for each local health economy to ensure a consistent focus is brought to the delivery of these standards in the last quarter of 2015/16. 1. Preparing for implementation national investment and expectations NHS England s planning guidance and the tariff consultation notice required commissioners nationally to spend 40m more on Early Intervention in Psychosis services in 15/16 than in 14/15, to be funded from CCG baseline allocations. This is equivalent to an increase in funding for EI services of around 15%. Details of this investment were included in Monitor and NHS England s 2015/16 National Tariff Payment System a consultation notice (Excerpt at Annex A). Commissioners should therefore have included this in their plans for 2015/16. Commissioners are expected to ensure that the actual level of local investment takes into account current performance against the new standard both the length of time that people are waiting for EIP services and the adequacy of the care packages offered by
these services relative to the NICE guidelines and quality standard to determine the split between price and volume increases. The funding has been applied as guidance because different areas will have different requirements. As highlighted in the note NHS England investment in mental health 2015/16 1 that accompanied the tariff payment system consultation notice, the impact of applying the 40m solely through prices would be to reduce the indicative deflator for mental health services from 1.9% to around 1.5% for 2015/16. In addition, the joint planning guidance for 2015/16 makes clear the requirement that commissioners should agree robust implementation plans with providers as part of their 2015/16 contract development work. The guidance requires that service development and improvement plans (SDIPs) are agreed setting out how commissioners and providers will prepare and implement the new standard for EIP in 2015/16 and achieve it on an ongoing basis from 1 April 2016. 2. Mental Health Services Data Set data submission The HSCIC held a series of workshops in preparation for the submission of data into the Mental Health Services Data Set (MHSDS) which is required under a published Information Standards Notice (ISN). In order to comply with the ISN, providers must ensure that they are able to submit the MHSDS including the capture of all referrals and SNOMED codes for interventions and outcomes tools from the end of January 2016. Please note that failure to submit data to the MHSDS in line with ISN may be considered an information breach and as such commissioners are advised to consider applying the information breach penalty should providers not be taking not be taking all reasonable steps within their control to comply with the ISN. The HSCIC has contacted all providers for whom they hold contact details and have assessed the readiness of each organisation to submit the relevant data. The results of this readiness assessment are attached as Annex B. Where organisations have not been able to confirm readiness to submit data, this has been mainly due to system supplier issues. HSCIC are also able to offer some technical support where this is needed. If you require technical assistance or are experiencing issues with your system supplier, please email enquiries@hscic.gov.uk with MHSDS implementation in the subject line and describe your issues. Where issues have been identified at provider level, local health economies will need to develop rapid plans to support timely compliance. 1 https://www.england.nhs.uk/resources/pay-syst/con-notice/
3. Workforce preparedness The achievement of the new standard will be dependent on ensuring adequate EIP service capacity with the right staff, with the right skills and the requisite competencies to deliver the full range of interventions recommended by NICE. Work has been taking place nationally with Health Education England and locally with LETBs to prepare for this and we expect that plans will be in place locally for imminent recruitment where gaps have been identified to fill. Recognising the challenges, particularly ensuring sufficient numbers of EIP staff trained in CBT for psychosis and family interventions for psychosis, an additional investment of 5m has been identified for 2015/16 to support targeted investment in training places. The Health Education England (HEE) led procurement exercise to secure providers for family intervention therapy training is anticipated to be completed in time for training to commence mid- January 2016. Further information has been circulated separately to EIP provider leads and we would strongly encourage providers to take advantage of this centrally funded training. Regional workforce audits have revealed very significant gaps in appropriately trained psychological therapists within EIP services in the great majority of provider organisations. Actions we need you to take NHS England, Monitor and the TDA are taking a collective approach to providing support and guidance on both of these mandatory targets. In turn we would like you take a health economy approach in your response. Regional tripartite teams will be working to secure a rapid preparedness assessment for each local health economy. Please return a single joint response per provider to the relevant NHS England DCO by 18 December. The audit will in particular seek to establish for each provider: Preparing for implementation Baseline performance position against both elements of the standard Funding agreements and flow between CCGs and providers Delivery of the SDIP in 15/16 against plan Expected performance in April 2016 Forward trajectory for ensuring that anyone experiencing first episode psychosis is able to access the full range of interventions recommended by NICE as the norm MHSDS data submission Readiness to submit both referral to treatment waiting time data and relevant interventions and outcomes data using appropriate SNOMED codes Technical challenges remaining to be addressed HSCIC support requirements System supplier requirements Workforce Baseline assessment of workforce capacity, skills and competencies with accompanying gap analysis, recruitment and training plan Risks and mitigations to workforce issues
The baseline assessment templates is attached as an excel document (Annex C). We would be grateful if this return could be sent to your regional DCO team contact by 18 December 2015. Yours sincerely Paul Watson NHS England Dale Bywater Director of Delivery & Development NHS TDA Marianne Loynes Monitor Frances Shattock Monitor
Annex A Setting the waiting time standard and investment assumptions Taken from: NHS England investment in mental health 2015/16 A note to accompany the 2015/16 National Tariff Payment System a consultation notice To determine the waiting time standard, NHS England consulted with clinical experts to establish their best estimate of the size of team required to deliver NICE-concordant care to a population of 100,000 with 32 cases of first episode psychosis per year. Costing this leads to an estimated annual cost of approximately 8,250 for each patient in the full-time care of an early intervention team. It is assumed for this analysis that NICEconcordant care will meet the two-week waiting time standard. Based on work from the NHS Benchmarking Network, we have estimated the current spending on EIP as 276 million per year. Based on clinical advice, we assumed that half of an EIP service s caseload and that half of its spending is associated with new patients. Thus we estimate total spending on new patients in 2015/16 as 178 million (current spend of 138 million plus 40 million new spending). Based on the estimated annual cost, this is sufficient to treat more than half of the estimated 35,000 new annual-equivalent cases for an EIP service. (Note that only half of these are cases of first episode psychosis, with the remainder made up of at risk individuals receiving shorter treatment to prevent crisis.)