The South West of England Regional Peer Audit:

Developing quality across services

Frank Burbach1 & Martin Hember2

1Somerset Partnership NHS Foundation Trust2Avon & Wiltshire Partnership NHS Trust

IEPA conference, Amsterdam, November 2010

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AWP

A – S. GlosB – BristolC – N. SomersetD – B&NESE – WiltshireF – Swindon

F

South West Region

14 – 35 year old population:1.18 million

14 PCT Areas15 EI Teams

Introduction

Share with you the process and outcomes of 2 stage audit and review process

Focus on Peer Review Value for Teams and Services Value for those commissioning services Next steps

Stage 1 : Audit of EI Services

• The questionnaire was based on the National EI audit of October 2007.

• EI lead clinicians agreed the basic methodology for this audit at a Regional meeting and the questionnaire was finalised by Regional Lead Clinicians.

Stage 1 : Audit of South West EI Services

April 09: Questionnaires sent to each EI Team (n=15).

May – July 09: Data quality analysed and follow-up questions developed.

August 09: Teams asked to provide clarification of initial data.

September 09: Final results reported to the Regional EI Network.

Durham Fidelity Criteria

Have the capacity to intervene over a period of 3 years with first episode psychosis (FEP) cases.

Be accessible to the full age ranges from 14 to 35 years (acknowledging that services to under-18s may be provided from a separate CAMHS EI team).

Have systems in place to cover out-of-hours and weekends.

Durham Fidelity Criteria (continued)

Offer active monitoring of individuals who are considered at high risk of psychosis or with suspected FEP for a minimum of 6 months

Have caseloads of no more than 15 FEP cases per case manager

Have a strategy for early detection and engagement of high risk and suspected FEP cases

Durham Fidelity Criteria (continued)

Monitor DUP & other key outcomes incl. engagement rates, relapse rates, hospital readmission, suicide and para-suicide, education and employment functioning.

Have a caseload of between 91% and 100% of its target

Employ a multidisciplinary staff mix

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Compliance Demonstrated 15 15 14 12 5 3 8 10 5 11 10 12 12 12 15 3

Compliance Not Demonstrated 0 0 0 1 8 2 7 3 5 0 4 3 3 2 0 11

Further Information Required 0 0 1 2 2 10 0 2 5 4 1 0 0 1 0 1

Fidelity to the various criteria based upon responses provided to the survey

Questions Arising from Survey

How are teams counting ‘watching brief, assessment and active cases?

How can caseloads of less than 15 be reported considering size of caseload / number of care coordinators?

How did teams define an “Early Detection and Health Promotion Strategy”?

Questions Arising from Survey

How could we explain the large variation in employment outcomes?

Is the way in which data is collected influencing the reported outcomes?

How were teams defining ‘multidisciplinary’ and are they ‘stand alone’ services?

How robust are arrangements for 14 – 18 year olds?

Stage 2: Peer Review

Commissioned Oct 2009

Commissioner led Review

Completion February 2010

Final Peer Review Report March 2010

FIVE STEP PROCESS

STEP 1 – Lead commissioners work together to pull the process together locally

STEP 2 – Working group established within each area to plan and prepare for the reviews

STEP 3 – Site visits to review local intelligence and hold discussions with key stakeholders

STEP 4 – Rapid feedback reports presented to host teams as a basis for agreeing issues, learning and recommendations

STEP 5 – Final Reports submitted to host sites within 4 weeks of the site visit for local dissemination and action

Review Teams Established

South Gloucestershire/North Somerset Bristol Teaching/Bath & North East

Somerset Swindon/Wiltshire Somerset/Gloucestershire Devon/Bournemouth & Poole Teaching Torbay Care Trust/Dorset Cornwall & Isles of Scilly/Plymouth

Key Principles

Focus on local systems: Primary Care Trust & EI Team boundaries.

Led by service commissioners. Partnership approach

People who use services Carers MH Charities and Housing Early Team Staff

Build on partnerships to develop local improvement plan

Outcomes

Reports produced what is working well examples of innovative practice Service strengths and gaps key recommendations

Team and Trust action plans Closer working with Commissioners

(particularly in 8 PCT areas)

Commissioner’s View

“ By listening to and acknowledging examples of best practice and innovations in their own service and the ‘visiting service’, clinicians, managers and commissioners were able to identify elements of service that were essential to retain and those that required development……..The engagement and contribution of people who use EI services and their family carers was a key success feature in the SW EI peer review”.

Ian Pearson, Commission Manager, Devon

Outcomes 2

March 2010: South West EI Network Event overview of peer audit results best practice case studies workshops (developing common metrics,

commissioning, early detection & health promotion)

Sept. 2010: SW Commissioners meeting feedback to the commissioning process. Agreed that standardised SW data collection

would enable development of quality outcome standards

Outcomes 2

October 2010 South West EI Leads meeting agreed parameters for common data collection

& discussed how this relates to health quality outcomes

December 2010 meeting EI leads & commissioners common data collection to be agreed.

Data - baseline, annual, discharge

DUP (medication; EIS) Pathways into care Engagement

(rates;quality) Use of M H A (1st contact)

Relapse rates (admissions; CR&HTT; MHA)

Employment, Education or Training

Housing stability Substance misuse

Discharge destinations (recovery rates)

Self harm Suicide rates Offending rates Physical health Quality of life Satisfaction

1. Audit

Establish baseline data

1. Peer Review

Local Action Plans

1. Feedback

Network ConferenceLeads MeetingCommissioners Meeting

4. Regional Planning

Develop common Data Gathering and metrics

5. Review Data Collection

Inform Service Development

Service Improvement Cycle

What is the added value of the Peer Audit?

Commissioners’ involvement highlighted anomalies in the setting of targets (the number of new cases per year), previously assumed to be standard across the region

Bringing together commissioners, Teams, service users and carers enabled focus on quality and sensible service planning.

What is the added value of the Peer Audit?

Face to face meetings enabled more thorough exploration and greater honesty about variation in team practices, e.g. age range (esp.14-18; transition arrangements) multidisciplinary skill mix assessment processes health promotion procedures & early detection

strategies data collection

EI Team View “The Peer Review was a very positive

process; a catalyst. It was the first time in 6 years that we had been able to meet the Commissioners!

The Commissioner who was involved in the whole process has since continued to work closely with the EI team. We have now agreed an action plan which may lead to the development of an early detection service and an extension of the criteria for EI.”

Angela Hawke, team manager, East Cornwall

Conclusion

If the survey (mainly quantitative data) and Peer Audit (qualitative data) had been part of a research project then there would have been more rigour and the results would have been more reliable.

However, this process has bought together Clinicians, Commissioners and Managers and is likely to have a greater effect on future service delivery.

Finally

“The product of the EI review process was an improvement plan based on local and regional best practice, designed primarily by clinicians and owned by a range of interested parties, including host organisations, senior managers and NHS commissioners.”

Ian Pearson, Commissioning Manager, Devon

Acknowledgements

SW Early Intervention Teams SW Primary Care Trusts David Shires and Jo Smith (Former National

Programme Leads) Kate Schneider RDC Programme Director,

Mental Health & Well-Being Jo Gajtkowska, RDC

Thank you for listening

http://www.swdc.org.uk/mental-health/early-intervention-services/