south region ccg mental health masterclass - eip preparedness programme
TRANSCRIPT
Early Intervention Network South Region Preparedness Programme @Time4Recovery #ei2015 12th February 2015
AHSN core purpose – health and wealth• Licensed by NHS England for 5 years to deliver four objectives: 1. Focus on the needs of patients and local populations: support and
work in partnership with commissioners and public health bodies to identify and address unmet health and social care needs, whilst promoting health equality and best practice.
2. Speed up adoption of innovation into practice to improve clinical outcomes and patient experience - support the identification and more rapid uptake and spread of research evidence and innovation at pace and scale to improve patient care and local population health.
3. Build a culture of partnership and collaboration: promote inclusivity, partnership and collaboration to consider and address local, regional and national priorities.
4. Create wealth through co-development, testing, evaluation and early adoption and spread of new products and services.
Our healthcare, academic and LEP partners11. South Central Ambulance Service FT 11
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Early Intervention Network: Our Mission
Improve health and social outcomes for young people with first episode
psychosis, including symptom reduction and engagement with education and
employment.
2008 2012 20132009 2010 2011
Started work at EIP + University of Surrey
Vision Unclear
Noted frequent Staff turnover
Poor pt satisfaction Poor staff morale Poor clinical outcomes
Manager left Staff posts cut Staff sickness rocketed
PIER Project awarded £10,000 (National Leadership Council)
Took up management of team Began developing a vision
Completed Transformational Leadership Programme
Reach Out Project awarded £12,500 Mary Seacole Award (DoH)
Youth Mental Health Network Project (YMHN) awarded £20, 000 for My Journey app (SHA)
Started Proactive Intervention to Enhance Recovery (PIER) project
YMHN awarded £35, 000 for YMH economic evaluation by LSE (NHS Confed)
After numerous rejected proposals My Journey App awarded £40,000 for evaluation of clinical, social & economic impact (Burdett Trust)
2014
Moyo Project www.moyoacademy.com & www.moyofoundation.org
The Future is Digital Scoping Project granted £60, 000
My Journey So Far…
www.england.nhs.uk
Components of an effective mental health system
An effective ‘in balance’ mental health system would: • Ensure rapid detection of mental ill health
and access to evidence- based treatment in community settings.
• Provide responsive and compassionate care to individuals at risk of or in crisis.
• Provide safe, high quality inpatient care where community alternatives are not viable
• Enable discharge from inpatient care through provision of personalised packages of home-based support
www.england.nhs.uk
The system is currently not in balance
www.england.nhs.uk
There is a 15-20 year gap in the life expectancy of individuals with serious mental illness compared with the rest of the population
Health promotion activity, physical health assessments and interventions need to be integrated at every level if the 15-20 year mortality gap is to be closed.
Why start with psychosis?
9Rethink Mental Illness. Lost Generation 5
FACTS AND STATS ABOUT EIP SERVICES
£44 MILLION EACH YEAR
FROM 44%
If everyone who was eligible received early intervention, it would save the NHS
EIP support reduces the probability of someone being ‘sectioned’
EIP support reduces the risk of a young person taking their own life
in the first two months of psychosis
FROM UP TO 15% TO 1%
TO 23%
Lost Generation Report, Rethink 2014
Key Strands of Work
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1. Bringing together the required expertise National expert reference group, NCCMH ‘hosting’ with Oxford as lead AHSN, highly collaborative. Regional implementation steering groups.
2. Developing the required dataset – waiting times and quality of care
Different approaches for 15/16 and 16/17 and beyond. Potential use of audit. Laying the groundwork for other A&W standards
3. Publication of commissioning guidance Service specifications, service model exemplars, staffing / skill mix calculators etc
4. Design of levers & incentives Planning guidance, payment system development, standard contract etc. Engagement with Monitor, TDA, CQC.
5. Implementation support Sponsoring development of peer networks & accreditations schemes, national events, learning networks etc.
6. Workforce development Joint work with HEE
The Financial Package
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1. 2014/15 saw a £40 million funding boost for mental health services, securing a kick-start delivery
of the 2020 vision;
2. Building capacity in some priority areas in order to prepare for the introduction of new access
standards in 2015;
3. The package released £7m to CAMHS Tier 4, £33m to EIP and crisis care in 14/15
• £1M for EIP for the South Region in 2014/5
• Plus Four x 200k EIP regional preparedness money in 2014/15
4. A further £80m will be freed in 2015/16 to enable introduction of the first access and waiting
times standards of their kind – lines in the sand – to be set on parity of esteem for mental health;
5. £40m to be targeted recurrently on EIP, £30m on liaison psychiatry and £10m on IAPT
Access & Waiting Time Standards
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By April 2016:
• More than 50% of people experiencing a first episode of psychosis will be treated with a NICE approved care package within two weeks of referral.
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Referral to clock start
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1. Referrer suspects
first episode psychosis
(FEP)
2. Urgent / emergency
referral made
flagged as suspected
FEP
Central triage point?
3a. Clock starts when
central triage point
receives referral
3b. Clock starts when EIP service
receives referral
Onward referral to EIP service
Patient invited for
EIP assessment
Y
N
Referral to Treatment (RTT) - Clock Start
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Referral to Treatment (RTT) - AssessmentAssessment
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1. Patient invited for EIP
assessment
2a.DNA or cancella
tion?
3a. Active monitoring / watch and
wait
EIP assessment commences
2b. DNA or cancellation?
3b. Active monitoring / watch and
wait
EIP assessment completed
Y
N
Y
N
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Assessment to clock stop
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1. EIP
assessment completed
FEP?
2a. Clock stops when:1. Accepted on to EIP caseload2. EIP care coordinator allocated3. NICE concordant package of care commenced.
2b. Clock stops when:1. Accepted on to EIP caseload2. EIP care coordinator allocated3. Specialist ARMS assessment commenced.
3. ARMS?
Commence NICE
concordant package of
care
Onward referral to
appropriate service or discharge
Y
N
Y
N
Referral to Treatment (RTT) - Clock Stop
South Region Expert Reference Group
Inaugural Meeting 26th January 2015
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Regional Preparedness Work
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1. Raising awareness – What are the requirements of the new standard? What are the implications? What are the opportunities?
2. Bringing together the experts and establishing quality improvement networks 3. Understanding demand – incidence, incidence profiles etc 4. Understanding the baseline position + gap analysis 5. Optimising RTT pathways – need to engage all of the potential referral sources, many
of which will be internal within secondary care 6. Preparing for the new data collection requirements – training for service and
information leads 7. Developing the workforce – capacity, skills & leadership – can the workforce deliver
the full range of NICE concordant interventions as this will be the definition of ‘treatment’?
Purpose of Expert Reference Group (ERG)
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1. Increase the South regions capacity and capability to deliver the new access
and waiting time standards;
2. Reduce unwarranted variation in workforce competency and outcomes
across the region;
3. Share key messages, lessons learnt and drive for sustainability.
ERG Representation:
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1. Representatives of People with a Lived Experience 2. Subject Matter Experts on Equality, Youth Mental Health, Informatics, Research etc 3. CCG & Social Care Commissioners 4. South Region IRIS Leads 5. Strategic Clinical Networks 6. Provider Senior and Team Level Managers 7. Health Education England 8. NHS England (South) 9. Wessex, Oxford and South West AHSN 10.Programme Managers
Benchmarking Staff Capacity & Competency
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South Region Survey Deadline: 19th Jan 2015
Deliverables
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1. A report on current EIP staff provision and training gap analysis against the
new EIP access and waiting time standards;
2. A proposal detailing funding allocation, monitoring and reporting
arrangements;
3. Sign off of bi-Monthly progress reports on delivery which will feedback to
NHS England.
Big Data: What can the Unstructured & Structured Data Tell Us?
22~80% of clinical data on EPRs is uncoded/unstructured
Draft Analysis of Needs of People with Psychosis in Oxford AHSN Region (Using Structured Reported Data)Focus on Early InterventionDecember 2014
Identifying the Early Intervention Cohort
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Team Type = A14 in 2011-13 = 05 in 2010-11
All those having some interaction with the Early Intervention team in 2010-13 (3 yrs)
Psychosis
3 years
58,133
15,709(27%)
Other MH 42,424
Psychosis
3 years
1,344
986(73%)
167
Unknown
Other MH
191
Source: Oxford AHSN user data contained in HES and MHMDS datasets licensed from HSCIC, 2014
Comparison of Education, Employment Status
7%
19%
18%15%10%
4%
7%15%
36%
33%
48%41%
37%
11%18%23%
100%
Other mental health, 16-35
5,72210%
Psychosis, Other Age
Groups
7,068
4%
34%
Psychosis, Other teams, 16-35
2,7478%
Psychosis, Early
Intervention, 16-35
7857%
Latest across 2 years 2011-12 and 2012-13; Not all service users have Employment status recorded; 16-35 cohort identified by age in 2010-11
EmployedUnemployed and seeking workStudents in full-/part-time educationLong-term sick/disabled, on benefitsUnknown/Retired
Source: Oxford AHSN user data contained in HES and MHMDS datasets licensed from HSCIC, 2014
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+8%
Users without knownmental health issues,
16-35yr group
131,244123,567112,696
1,087 1,103 976
+6%
Users with psychosis, Other teams only,
16-35yr group
357 362 310
+7%
Early Intervention cohort, 16-35yr group
2012-132011-122010-11
1.41.41.4
+2%
2.92.82.7
+3%
1.92.12.0
2012-132011-122010-11
-2%
Total users Average per user
+100%
-35%
Source: Oxford AHSN user data contained in HES and MHMDS datasets licensed from HSCIC, 2014
16-35 years only
Early Intervention cohort has fewer A&E attendances
Examples from the South Region
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Patient Journey Mapping
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Describing digital maturity
Self-help & peer support
Self-management and remote triage
Remote care support
Face-to-face care
VCS Statutory Care
Against a traditional clinical perspective
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 General access to information Sign-posting to offline services
Health administration – reminders, appointments, prescriptions
Remote service support to assess and diagnose symptoms and conditions
Advanced remote service support to provide care support and treatment
Multichannel care services leveraging a digital core for optimal access and data sharing
Thriving Coping Managing Difficulties Struggling Complex needs
Along a trajectory of evolving digital capability
Along a care trajectory marking the transition between statutory and VCS and the shift from self-service to highly skilled face-to-face support
Crisis
Digitally Enhanced Pathways
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Engaging young people with familiar tools
92% of 14-25 year olds own a smartphone
Sensors, devices, networks, software, sensors
and data
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Engaging Using Multiple Channels
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Measuring Reach & Engagement
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Number of people reached during this
masterclass
Opportunity, Meet Preparation.
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My Journey App - The First International App for First Episode Psychosis Videos Viewable by Clicking Here
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Overview
1. The Cost of Schizophrenia 2. Background to ‘My Journey’ mobile app 3. An app a day keeps the doctor away? 4. Return on Investment
www.sabp.nhs.uk/eiip
Health Promotion
39http://www.psfk.com/2014/12/code-blue-panic-button-aims-to-help-teens-with-depression.html
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Who is Using MOMO • Surrey County Council • Derbyshire County Council • West Sussex County Council • South Eastern Trust (Northern Ireland) • Northumberland County Council • Reading Borough Council • London Borough of Bexley • Royal Borough of Greenwich • Birmingham City Council • Gloucestershire County Council • More local authorities on the way...
http://www.mindofmyown.org.uk
Sir Muir Gray42
“In the past we have given knowledge to clinicians who
have passed it on to patients, now our principles are that
we give knowledge to patients and give them the
opportunity to discuss it with clinicians.”
43http://www.computerworlduk.com/news/public-sector/3524196/oxford-nhs-trust-creates-mobile-electronic-health-records-with-advanced/
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Videos Viewable by Clicking Here
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Learning from Developing Countries
Community Health Worker/Ambassador Model for Community Dev.
Community Health Ambassadors should be members of the communities where they live, work, study, play… should be selected by their communities, should be answerable to the communities for their activities, should be supported by the health system but not necessarily a part of its organization,
and have shorter training than professional workers.
World Health Organization (2007)
“
”
Community Health Ambassadors (CHAs)
Six Characteristics of Effective Groups
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1.They share a sense of Purpose: There is purposefulness about their collaborations, discussions,
decisions and a sense of forward momentum;
2.They are United: They have learned to manage their differences well enough that they can unite to
accomplish their purpose;
3.They share Understanding: There is a widely shared understanding of whats going on, what the
challenges are and why what is being done has to be done;
4.People Participate: Lots of people and organisations in the system are active - not just in discussions
and meetings - but getting the work done;
5.They take Initiative: Rather than reacting to what ever happens in their environment, they are
proactive, and act upon their environment;
6.They Act: People do the work they must do to make the things happen that need to happen.
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Harnessing Digital Tools for Collaboration Across the Region
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An intelligent system that gets to know you
www.interact-intranet.com
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Collaboration: Anytime, anywhere
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• Secure log in using your existing email,
• Multi location configuration i.e we can set it so that different groups have different access rights &
content to other members dependent on their locations
• Meeting planning including ability to export confirmed attendees into an attendee list,
• Task allocation and tracking,
• Event scheduling and team based calendars including ability for people to book on to training
events/webinars;
• Expense claim submissions (e.g. for travel expenses),
• Document view, multi-user editing and version control,
• Mandatory document read settings with ability to send reminders if people haven’t Read
mandatory read documents;
• Analysis of users use of the platform so we can measure ROI and terminate use if not being used;
Challenges for Us
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• Divestment in mental health services put pressures on a system which was already failing to
reach all of those who need it;
• Access to existing services or lack of existing services
•Acceptability and stigma
•Visibility of services
•Capacity
• Variable team structures, leadership, management, training etc leads to unwarranted variation in
processes, methods and outcomes;
• Inappropriate and varying referral thresholds, practices and reporting leave the user often as the
last consideration.
What should you and I expect?
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1.Collaboration 2.Ideas 3.Action 4.Innovation 5.Sustainability
I also expect that we will: •Make mistakes •Tread on toes •Feel uncertain and a bit threatened
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https://www.eventbrite.com/e/early-intervention-network-achieving-better-access-to-mental-health-services-by-2020-tickets-15022846739?utm_campaign=order_confirm&utm_medium=email&ref=eemailordconf&utm_source=eb_email&utm_term=eventname Tickets:
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http://us2.campaign-archive2.com/home/?u=ab247a6ad6b0e2d93ab084c28&id=a09b7f2250 Monthly Newsletter:
In Summary
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•We have many of the required component parts;
•We have the mandate, top as well as bottom level support;
•Our stakeholders want/expect us to do this responsibly and to
the best of our abilities for sustainable, best value;
•We will not get this opportunity again.
Thank YouQ & A
More Information Available on Request
@Time4Recovery
#ei2015
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