South Region Early Intervention in Psychosis (EIP) Programme

South Region Early Intervention in Psychosis (EIP) Programme Supporting EIP Teams to Deliver the Best Possible Outcomes for People with First Episode Psychosis and their Families Sarah Amani Programme Manager Dawn Hyde Carers and Families Participation Lead www.england.nhs.uk @Time4Recovery

Content 1 Context 2 Our Mission 3 Methods 4 Outcomes 5 Next Steps @Time4Recovery

1 Context South West / South East Region boundaries and STPs 13 = 16 = 50 = = 32 @Time4Recovery

www.england.nhs.uk

Governance Meets 1 st Week of the Month South Region Mental Health Priority Programme Board Chaired by David Radbourne Director of Delivery & Assurance, NHS England - South Meets Every 3 Months South EIP Programme Board Chaired by Fiona Edwards CEO of Surrey & Borders Partnership NHS Foundation Trust Oxford AHSN Chief Executive Prof Gary Ford Meets Every 2 Months South EIP Programme Clinical & Technical Group Chaired by Prof Belinda Lennox Clinical Senior Lecturer, Researcher & Honorary Consultant Psychiatrist Managed by Sarah Amani Senior Programme Manager Meets Every Month South West EIP Clinical & Technical Group Chaired by Dr Frank Burbach South Central EIP Clinical & Technical Group Chaired by Dr Belinda Lennox Wessex EIP Clinical & Technical Group Chaired by Dr Paul Tabraham South East EIP Clinical & Technical Group Chaired by Collette Chamberlain Denotes line of accountability Information Provided for Information Providers + Commissioners + Strategic Clinical Networks + Health Education England+ Academic Health Science Networks

Our Mission 1. Involve people who have experience of first episode psychosis and their families to develop services that deliver improved outcomes, 2. Foster professional attitudes that engender hope and optimism that people with psychosis can achieve meaningful and fulfilled lives; 3. Combat stigma, discrimination and prejudice by raising awareness about psychosis and tackling factors that contribute to social exclusion; 4. Ensure that functional outcomes such as employment are as equally important as a reduction in symptoms; 5. Collaborate with partner agencies to achieve wider reaching positive influence and help more people with or at risk of developing psychosis. @Time4Recovery

EIP Matrix Step 1 Agree Person Relevant & Clinically Evidenced Indicators Step 2 Collect Data Using EIP Matrix Step 3 Verify Data With EIP Teams Scenario 1 Quality and Performance Less Than Satisfactory Step 4 Share EIP Matrix Summary Report Scenario 2 Quality, Performance and Outcomes Satisfactory Step 5 Support EIP & CCG to Revise EIP Service Development & Improvement Plan (SDIP) to Address Barriers to Improvement @Time4Recovery

DRAFT Findings from EIP Matrix 2017 Data submitted in September 2017 Please note that data is subject to change as some teams have submitted revised reports. www.england.nhs.uk

Draft Findings from EIP Matrix 2017 The highlights from the draft data analysis of the EIP Matrix 2017 are as follows: 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 an impressive increase of 69%. Better Physical Health Monitoring: 51% 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. There has also been an increase in the number of people offered referral to smoking cessation from 63% in 2016 to 83% in 2017. Areas for Improvement Access to EIP: There continues to be a large variation in teams caseloads with some EIP teams only seeing 25% of who they should be seeing according to psychosis incidence data. This is also evident in the huge disparity in the care coordinator patient ration which ranges from 32 patients per care coordinator in one of the least funded teams to 9 patients per care coordinator in one of the best funded teams. Investment: There continues to be a 4 fold variation between the most and least funded EIP teams in the South of England. Only one of the teams is 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 51% achievement in 2017 his is lower than the 90% physical health CQUIN standard. Draft Findings from EIP Matrix Self Assessment Audit 2017. Information is Subject to Change. @Time4Recovery

Royal College of Psychiatry s College of Clinical Quality Improvement (CCQI) EIP Ratings 4 3 2 1 NICE Standard for Early Intervention in Psychosis (EIP) 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 CBT for Psychosis - Percentage of service users with First Episode Psychosis that received 2 or more sessions of CBTp Family Interventions Percentage of service users with First Episode Psychosis and their families that had 2 or more sessions of Family Interventions Requires Substantial Improvemen t Requires Improvement Good Outstanding <25% 25% 50% 60% <12% 12% 24% 36% <10% 10% 20% 30% Clozapine - Clozapine is prescribed to patients for whom this treatment is indicated (or valid reason is given for not prescribing clozapine) Individual Placement Support - Percentage of service users with First Episode Psychosis that had two or more appointments with an IPS Worker Physical Health - Percentage of service users with First Episode Psychosis that have had all of the below physical health checks in the past year: Body Mass Index (BMI) Blood pressure Glucose regulation (HbA1c or fasting glucose or random glucose as appropriate) Blood lipids Smoking Cessation - Percentage of those who smoke who were a referral to a smoking cessation service <10% 10% 20% 30% <70% 70% 80% 90% <25% 25% 50% 75%

National EIP Costs Per Service User 2015/16 The total cost per service user on EIP caseloads varies across trusts with a range of 2,500 to 17,850 per annum. The mean average cost per service user is 6,926, whilst the median is 6,808. 20,000 18,000 16,000 14,000 12,000 10,000 Early Intervention (incl Early Onset Psychosis) - Total costs including allocation of overheads and corporate costs 2013/14 per patient on caseload 8,000 6,000 4,000 2,000 0 Trusts Mean Lower Quartile Median Upper Quartile Source: NHS Benchmarking Network 2015

Greater Manchester Durham Cornwall Northumberland Derbyshire Hampshire East Surrey Lancashire Bath, Swindon Coventry South Yorkshire West Yorkshire Devon Cambridgeshire Somerset Coast, Humber Nottinghamshire Cheshire Norfolk Cumbria W,N&E Bristol, North Som Dorset Core Surrey Lincolnshire Hertfordshire Thames Valley North East LDN Herefordshire Frimley Health South West LDN Mid and South Essex North Central LDN Milton Keynes Staffordshire Suffolk Leicester Shropshire Black Country Kent & Medway South East LDN Gloucestershire North West LDN Northamptonshire Birmingham Percentage Difference Between Incidence and Referrals with an EIP Clock Stop Recorded in UNIFY by STP 2016/17 250% 200% 150% Difference National Figure 100% 50% 0% -50% Data Sources: NHS Digital s Mental Health Services Data Set (MHSDS): http://content.digital.nhs.uk/mhsds UNIFY: https://www.england.nhs.uk/statistics/statistical-work-areas/eip-waiting-times/ Public Health England s Epidemiology Fingertips Tool: https://fingertips.phe.org.uk/profile-group/mental-health/profile/severe-mental-illness/data#page/0

Performance & Outcomes Data submitted in September 2017 Data reviewed by South EIP Clinical & Technical Group on 18 th October. Please note that data is subject to change as some teams have submitted revised reports. www.england.nhs.uk

Training Training Requested Numbers Requested Total Requested for South Region South West South Central South East Total Trained in 2017-18 Family Interventions 67 21 20 110 108 Post Graduate CBTp* 17 5 8 32 30 Comprehensive Assessment of At Risk Mental States (CAARMS) ** 80 35 25 198 150 Positive & Negative Syndrom Scale (PANSS) Individual Placement Support (IPS) 70 34 36 140 140 41 19 16 76 46 Physical Health 67 92 26 185 40 Total Trained in 2017-18 514 *The post graduate CBTp course started in January and September 2017. Graduates are expected to qualify in January and September 2018 **To ensure sustainability, 15 staff across the 3 sub-regions have been trained as CAARMS trainers.

www.england.nhs.uk Next Steps

Annual Report 2017 Key Findings from 2015 and 2016 Each year the programme produces an annual report once teams have verified their self reported reports Key Findings from 2015-16 are as follows The regional caseload grew by 4% from 4,205 in Sept 2015 to 4,369 The percentage of people waiting no longer than 14 days from referral to treatment rose from 64% in 2015 to 83% in 2016 The region s EIP budget rose by 16% from 19m in 2015-16 to 22m in 2016-17 Of the 1,722 people reported to be smokers, 65.8% were referred for Smoking Cessation, an increase from 21% in 2015 South EIP Annual Reports: www.time4recovery.com

Peer Reviews 1. Peer Review Workshops 2. Peer Review Visits People who use services, carers, clinicians, managers and commissioners undertook training in Appreciative Enquiry (AE) Peer review workshops were necessary to ensure consistent approach A matrix approach of matching teams for reviews was employed i.e. A->B->C Peer reviews were undertaken in two s Questions focused on service user, carer and staff experience of EIP service A light touch inquisitive approach was employed to ensure teams do not feel like they are being inspected or interrogated 3. Peer Review Report Interviewing teams had a debrief after the visit The hosting team received a draft report on strengths, areas for improvement and a template for the hosting team plan for development (SMART goals) A review of the process and reports was held via the South West EIP Network forum face to face event on 23 rd March

A visual illustration captured during the EIP Peer Review Workshop on 17 th January 2017

Challenges 1. Funding for EIP, as described in the FYFV, is Not Ring-Fenced and requires providers and commissioners to work closely together and monitor progress via regular Service Development and Improvement Plan (SDIP) meetings. 2. The South of England s relative affluence, the related cost of living and proximity to London means that it is Hard to Recruit and Retain staff such as psychiatrists and nurses. 3. Most EIP teams are still having to Manually Audit Caseloads as not all Trusts have automated reporting from Electronic Health Records (EHRs), this takes clinicians away from clinical work and leads to an inescapable margin of error. @Time4Recovery

CCG Service Development & Improvement Plan (SDIP) Priority Action Lead Support Progress RAG Rating 1. Investment Increase EIP investment in line with overall CCG budget uplift CCG Commissioning Manager South EIP Programme NHS England Mental Health Investment Standard and EIP Matrix Investment Per Patient dashboard now being used to track EIP funding. No EIP uplift in 2017-18. 2. Workforce 3. Data Develop business case including NICE Concordance trajectory and workforce plan using previous years referrals and caseload changes Discrepancy between UNIFY & MHSDS report may skew performance once UNIFY is switched off. Clinicians are still having to manually audit caseload as EHR has not been configured to pull automated reports EIP Manager Trust Head of IT & Performance South EIP Programme NHSi South EIP programme has sent the team a template business case to support CCGs and Providers Training provided to EIP Clinicians and Admin on key entry points to ensure clock start & stop is reported accurately. Testing interim solution to capture NICE Interventions and SNOMED-CT for longer term reports.

CCG EIP Tracker Outstanding Good Requires Improvement Requires Significant Improvement EIP Standard Priority Sept 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 2018 Mar 2018 14 Days RTT 50% 83% CBT for Psychosis (CBTp) Target Actual Target Actual Target Actual Target Actual Target Actual Target Actual Target Actual 24% 16% Family Interventions 20% 24% Individual Placement Support (IPS) Physical Health Checks 20% 3% 90% 40% Smoking Cessation 50% 72% Clozapine (if 2 antipsychotics proven ineffective) Carer Focused Education Comments 34% 50% 89% Date Sign Off

EPIC MINDS Recruitment Campaign Most NHS Trusts and providers use WordPress for their websites with a section for information about EIP We have designed content aimed at people who need help and those considering a career in EIP Content includes stories from people who have had psychosis and people working within the service e.g. why they chose the profession, what it is like working within the team and why you might want to work in EIP too.

EPIC MINDS Recruitment Campaign @Time4Recovery

EPIC MINDS Recruitment Campaign @Time4Recovery

Kent and Medway NHS and Social Care Partnership Trust EIP Team at Recruitment Fair @Time4Recovery

Stakeholder Views @Time4Recovery

Q & A For more information please visit our website at www.time4recovery.com www.england.nhs.uk