South Region Early Intervention in Psychosis Programme

South Region Early Intervention in Psychosis Programme

Progress Report

Document Ownership and Status

Document Owner / Sarah Amani
Document Status / Draft

Document Name and Version Control

Version / Date / Author / Changes Included
1.0 / 13.08.2015 / Sarah Amani / First draft
1.2 / 24.08.2015 / Sarah Amani & Sarah Roberts / Updated summary and discussion
1.3 & 1. 4 / 25.08.2015 / Sarah Amani / Revised following comments from Prof. Lennox

Document Review Distribution List

Name / Title, Organization
Prof Belinda Lennox / Senior Responsible Officer, South Region EIP Preparedness Programme
Sarah Roberts / Programme Manager, South Region EIP Preparedness Programme
Fiona Edwards / CEO, Surrey and Borders Partnership NHS Foundation Trust
Anthony Farnsworth / Senior Responsible Officer, South Region Mental Health Priority Programme

Document Approval

[Persons designated with final approval and sign off of this document]

Name / Title, Organization
Fiona Edwards / CEO, Surrey and Borders Partnership NHS Foundation Trust & Chair of EIP Preparedness Board
Prof Belinda Lennox / South Region EIP Preparedness Senior Responsible Officer
Purpose of Report / The purpose of this paper is to provide an update to NHS England (South) on the progress of the region in readying itself to meet the 14 day referral to treatment target of the new EIP access and waiting time standards
Program
Objectives /

1. Raise awareness of the requirements of the Access and Waiting Time (A&WT) standards.
2. Bring together local experts and establish quality improvement networks, ensuring effective linkage with existing networks of expertise.
3. Understand levels of demand in constituent CCGs and any inequities in access relative to the levels and patterns of psychosis incidence in the population.
4. Understand baseline performance against the A&WT standards in partner Trusts through analysis of locally collected data, in advance of the introduction of the standard.
5. Undertake a gap analysis of current EIP team structures, staffing mix and training and development needs for each partner Trust.
6. Support Trusts and CCGs in developing local preparedness action plans to meet the A&WT standards.
7. Allocate targeted funding to accelerate the implementation of preparedness action plans over 2015/16.
8. Support and facilitate local workforce development programs, working with Trusts and Health Education England.

Key Messages /

1. Many EIP teams in our region have been dismantled or reconfigured over the last few years and there is a lack fidelity to an EIP team model in many places.
2. There is a shortage of EIP staff in South region, and a lack of capacity to deliver NICE recommended interventions for first episode psychosis.
3. Funding allocated nationally for EIP has not made it through to EIP teams, in many places.
4. Most teams are able to assess >50% of referrals within 14 days of referral. Howeverno EIP teams are currently able to evidence delivery of NICE recommended treatment.

Contents

1. Introduction

2. EIP Preparedness Programme

Governance

3. Preliminary Findings

EIP Workforce

Service Development and Improvement Planning

4. Risks

5. Mitigation

1. Introduction

With a peak onset occurring between 15-25 years of age, psychotic disorders such as schizophrenia can derail a person’s social, academic, and vocational development and initiate a trajectory of accumulating disability. Over the past two decades national and international collaborative have mounted evidence showing superior outcomes when people with first episode psychosis are treated by a specialist Early Intervention in Psychosis Service. Studies conclude that EIP improves symptoms and restores adaptive functioning in a manner superior to standard care.

In recognition of its effectiveness and value, access and waiting time (A&WT) standards have been introduced to ensure that >50% of people experiencing first episode psychoses commence a NICE-concordant package of care within a maximum of two weeks.

2. EIP Preparedness Programme

The South Region Early Intervention in Psychosis (EIP) Preparedness Programme is a partnership between people who use EIP and their advocates, providers, commissioners and Health Education England (HEE). Together, we aim to hasten the readiness of the region in order to be able to provide NICE recommended treatment within 14 days of referral.

Governance

The EIP Preparedness Program operates under the following governance structure:

3. Preliminary Findings

Providers of EIP teams were tasked with convening workshops, in collaboration with their commissioners, in order to complete the EIP Service Self-Assessment tool (EIP Matrix) which assesses the teams against the new EIP standards. The deadline for completing the tool is 1st September 2016 and therefore the full range of findings was not available at the time of writing this draft report.

Staffing and competencies available in the South region EIP teams were compared to what is recommended in the NCCMH commissioning guide workforce calculator. The staffing required to meet the EIP standards in the South of England are as follows:

South Region Early Intervention in Psychosis Preparedness Programme Report Page 1 of 15

EIP Workforce

Area / Population / Incidence rate / Manager / Admin
CG Workforce Calculator / Jan-15 / Variance / CG Workforce Calculator / Jan-15 / Variance
Cornwall / 327091 / 16.00 / 1.10 / 1.00 / 0.10 / 2.10 / 3.00 / 0.90
Isle of Scilly / 1351 / 15.70
Plymouth / 169787 / 21.90 / 0.80 / 0.00 / 0.80 / 1.50 / 0.00 / 1.50
Torbay / 78436 / 17.40 / 0.30 / 0.00 / 0.30 / 0.60 / 0.00 / 0.60
Devon (did not supply data) / 454799 / 16.70 / 1.60 / 3.10
Somerset / 323722 / 16.20 / 1.10 / 0.40 / 0.70 / 2.10 / 0.60 / 0.50
Noth Somerset / 123281 / 16.30 / 0.40 / 1.00 / 0.60 / 0.80 / 0.00 / 0.80
City of Bristol / 293781 / 28.50 / 1.70 / 0.00 / 1.70 / 3.40 / 0.00 / 3.40
South Gloucestershire / 168428 / 17.90 / 0.60 / 0.00 / 2.00 / 1.60 / 0.00 / 4.40
Gloucestershire / 378878 / 18.10 / 1.40 / 2.80
Swindon / 138920 / 19.60 / 0.60 / 1.00 / 0.60 / 1.10 / 0.90 / 2.20
Wiltshire / 294525 / 16.90 / 1.00 / 2.00
Bath and North East Somerset / 114622 / 19.80 / 0.50 / 0.00 / 0.50 / 0.90 / 0.00 / 0.90
Buckinghamshire / 319083 / 19.10 / 1.20 / 0.50 / 0.70 / 2.50 / 1.60 / 0.90
Oxfordshire / 427816 / 21.00 / 1.80 / 0.50 / 1.30 / 3.70 / 1.00 / 2.70
Reading / 107750 / 29.30 / 0.60 / 0.00 / 2.60 / 1.30 / 0.00 / 5.30
West Berkshire / 99105 / 16.90 / 0.30 / 0.70
Slough / 93821 / 32.70 / 0.60 / 1.30
Windsor and Maidenhead / 91823 / 19.00 / 0.40 / 0.70
Wokingham / 99221 / 18.00 / 0.40 / 0.70
Bracknell Forrest / 75596 / 19.10 / 0.30 / 0.60
Hampshire / 828011 / 17.30 / 2.90 / 2.00 / 1.90 / 5.90 / 2.40 / 5.40
Southampton / 164758 / 28.40 / 1.00 / 1.90
Isle of Wight / 82635 / 16.10 / 0.30 / 0.20 / 0.10 / 0.50 / 0.90 / 0.40
Portsmouth / 139844 / 26.70 / 0.80 / 0.00 / 0.80 / 1.50 / 0.00 / 1.50
Dorset (East and West) / 241451 / 15.80 / 0.80 / 1.50 / 0.20 / 1.60 / 1.10 / 2.40
Poole / 91828 / 18.10 / 0.30 / 0.70
Bournmouth / 122913 / 24.00 / 0.60 / 1.20
Surrey * / 719433 / 18.70 / 2.80 / 2.90 / 0.10 / 5.50 / 5.00 / 0.50
East Sussex / 315752 / 17.60 / 1.10 / 3.80 / 0.10 / 2.30 / 2.70 / 5.20
West Sussex / 495362 / 17.80 / 1.80 / 3.60
Brighton & Hove / 193332 / 24.90 / 1.00 / 2.00
Kent / 917880 / 18.40 / 3.50 / 8.00 / 3.80 / 6.90 / 5.00 / 3.40
Medway / 173506 / 21.10 / 0.70 / 1.50
Area / Population / Incidence rate / Medical time / Care coordinator
CG Workforce Calculator / Jan-15 / Variance / CG Workforce Calculator / Jan-15 / Variance
Cornwall / 327091 / 16.00 / 1.40 / 2.00 / 0.60 / 10.70 / 11.00 / 0.30
Isle of Scilly / 1351 / 15.70
Plymouth / 169787 / 21.90 / 1.00 / 0.00 / 1.00 / 7.60 / 3.20 / 4.40
Torbay / 78436 / 17.40 / 0.40 / 0.00 / 0.40 / 2.80 / 1.60 / 1.20
Devon (did not supply data) / 454799 / 16.70 / 2.00 / 15.50
Somerset / 323722 / 16.20 / 1.40 / 0.00 / 1.40 / 10.70 / 6.80 / 3.90
Noth Somerset / 123281 / 16.30 / 0.50 / 0.00 / 0.50 / 4.10 / 5.40 / 1.30
City of Bristol / 293781 / 28.50 / 2.20 / 1.00 / 1.20 / 17.10 / 10.80 / 6.30
South Gloucestershire / 168428 / 17.90 / 0.80 / 0.00 / 2.60 / 6.20 / 13.00 / 7.20
Gloucestershire / 378878 / 18.10 / 1.80 / 14.00
Swindon / 138920 / 19.60 / 0.70 / 0.00 / 2.00 / 5.60 / 8.50 / 7.30
Wiltshire / 294525 / 16.90 / 1.30 / 10.20
Bath and North East Somerset / 114622 / 19.80 / 0.60 / 0.00 / 0.60 / 4.60 / 5.00 / 0.40
Buckinghamshire / 319083 / 19.10 / 1.60 / 0.80 / 0.80 / 12.50 / 6.00 / 6.50
Oxfordshire / 427816 / 21.00 / 2.30 / 0.50 / 1.80 / 18.40 / 9.20 / 9.20
Reading / 107750 / 29.30 / 0.80 / 1.00 / 2.40 / 6.50 / 11.00 / 15.50
West Berkshire / 99105 / 16.90 / 0.40 / 3.40
Slough / 93821 / 32.70 / 0.80 / 6.30
Windsor and Maidenhead / 91823 / 19.00 / 0.50 / 3.60
Wokingham / 99221 / 18.00 / 0.50 / 3.70
Bracknell Forrest / 75596 / 19.10 / 0.40 / 3.00
Hampshire / 828011 / 17.30 / 3.70 / 2.35 / 2.55 / 29.30 / 18.60 / 20.30
Southampton / 164758 / 28.40 / 1.20 / 9.60
Isle of Wight / 82635 / 16.10 / 0.30 / 0.10 / 0.20 / 2.70 / 8.00 / 5.30
Portsmouth / 139844 / 26.70 / 1.00 / 0.00 / 1.00 / 7.60 / 2.00 / 5.60
Dorset (East and West) / 241451 / 15.80 / 1.00 / 0.20 / 2.00 / 7.80 / 14.20 / 3.00
Poole / 91828 / 18.10 / 0.40 / 3.40
Bournmouth / 122913 / 24.00 / 0.80 / 6.00
Surrey * / 719433 / 18.70 / 3.50 / 3.30 / 0.20 / 27.50 / 18.10 / 9.40
East Sussex / 315752 / 17.60 / 1.40 / 1.90 / 3.00 / 11.40 / 17.70 / 21.50
West Sussex / 495362 / 17.80 / 2.30 / 18.00
Brighton & Hove / 193332 / 24.90 / 1.20 / 9.80
Kent / 917880 / 18.40 / 4.40 / 0.00 / 5.30 / 34.60 / 33.00 / 9.10
Medway / 173506 / 21.10 / 0.90 / 7.50
Area / Population / Incidence rate / CBTP Therapist / Family worker
CG Workforce Calculator / Jan-15 / Variance / CG Workforce Calculator / Jan-15 / Variance
Cornwall / 327091 / 16.00 / 2.70 / 2.00 / 0.70 / 0.50 / 0.00 / 0.50
Isle of Scilly / 1351 / 15.70
Plymouth / 169787 / 21.90 / 1.90 / 0.00 / 1.90 / 0.40 / 0.00 / 0.40
Torbay / 78436 / 17.40 / 0.70 / 0.00 / 0.70 / 0.10 / 0.00 / 0.10
Devon (did not supply data) / 454799 / 16.70 / 3.90 / 0.80
Somerset / 323722 / 16.20 / 2.70 / 0.20 / 2.50 / 0.50 / 0.00 / 0.50
Noth Somerset / 123281 / 16.30 / 1.00 / 0.40 / 0.60 / 0.20 / 2.00 / 1.80
City of Bristol / 293781 / 28.50 / 4.30 / 1.00 / 3.30 / 0.90 / 0.00 / 0.90
South Gloucestershire / 168428 / 17.90 / 1.50 / 2.00 / 3.00 / 0.30 / 0.00 / 1.00
Gloucestershire / 378878 / 18.10 / 3.50 / 0.70
Swindon / 138920 / 19.60 / 1.40 / 0.20 / 3.70 / 0.30 / 0.00 / 0.80
Wiltshire / 294525 / 16.90 / 2.50 / 0.50
Bath and North East Somerset / 114622 / 19.80 / 1.20 / 0.00 / 1.20 / 0.20 / 0.00 / 0.20
Buckinghamshire / 319083 / 19.10 / 3.10 / 2.95 / 0.15 / 0.60 / 0.00 / 0.60
Oxfordshire / 427816 / 21.00 / 4.60 / 1.50 / 3.10 / 0.90 / 0.00 / 0.90
Reading / 107750 / 29.30 / 1.60 / 0.30 / 6.30 / 0.30 / 0.00 / 1.40
West Berkshire / 99105 / 16.90 / 0.90 / 0.20
Slough / 93821 / 32.70 / 1.60 / 0.30
Windsor and Maidenhead / 91823 / 19.00 / 0.90 / 0.20
Wokingham / 99221 / 18.00 / 0.90 / 0.20
Bracknell Forrest / 75596 / 19.10 / 0.70 / 0.20
Hampshire / 828011 / 17.30 / 7.30 / 2.00 / 7.70 / 1.50 / 1.00 / 1.00
Southampton / 164758 / 28.40 / 2.40 / 0.50
Isle of Wight / 82635 / 16.10 / 0.70 / 0.00 / 0.70 / 0.10 / 0.00 / 0.10
Portsmouth / 139844 / 26.70 / 1.90 / 2.00 / 0.10 / 0.40 / 0.00 / 0.40
Dorset (East and West) / 241451 / 15.80 / 1.90 / 0.00 / 4.20 / 0.40 / 0.00 / 0.90
Poole / 91828 / 18.10 / 0.80 / 0.20
Bournmouth / 122913 / 24.00 / 1.50 / 0.30
Surrey * / 719433 / 18.70 / 6.80 / 2.80 / 4.00 / 1.40 / 2.00 / 0.60
East Sussex / 315752 / 17.60 / 2.80 / 1.60 / 8.10 / 0.60 / 0.00 / 2.00
West Sussex / 495362 / 17.80 / 4.50 / 0.90
Brighton & Hove / 193332 / 24.90 / 2.40 / 0.50
Kent / 917880 / 18.40 / 8.60 / 5.20 / 5.30 / 1.80 / 0.00 / 2.20
Medway / 173506 / 21.10 / 1.90 / 0.40
Area / Population / Incidence rate / Support/Peer worker / Total WTE
CG Workforce Calculator / Jan-15 / Variance / CG Workforce Calculator / Jan-15 / Variance
Cornwall / 327091 / 16.00 / 5.40 / 4.00 / 1.40 / 23.90 / 23.00 / 0.90
Isle of Scilly / 1351 / 15.70
Plymouth / 169787 / 21.90 / 3.80 / 0.00 / 3.80 / 17.00 / 3.20 / 13.8
Torbay / 78436 / 17.40 / 0.40 / 0.00 / 0.40 / 5.30 / 1.60 / 3.7
Devon (did not supply data) / 454799 / 16.70 / 7.80
Somerset / 323722 / 16.20 / 5.40 / 0.60 / 4.80 / 23.90 / 7.60 / 16.3
Noth Somerset / 123281 / 16.30 / 2.10 / 2.00 / 0.10 / 9.10 / 10.80 / 1.7
City of Bristol / 293781 / 28.50 / 8.60 / 3.00 / 5.60 / 38.20 / 16.20 / 22
South Gloucestershire / 168428 / 17.90 / 3.10 / 4.00 / 6.10 / 45.30 / 19.00 / 26.3
Gloucestershire / 378878 / 18.10 / 7.00
Swindon / 138920 / 19.60 / 2.80 / 3.00 / 4.90 / 35.10 / 13.60 / 21.5
Wiltshire / 294525 / 16.90 / 5.10
Bath and North East Somerset / 114622 / 19.80 / 2.30 / 3.00 / 0.70 / 10.30 / 8.00 / 2.3
Buckinghamshire / 319083 / 19.10 / 6.20 / 2.80 / 3.40 / 27.70 / 13.85 / 13.85
Oxfordshire / 427816 / 21.00 / 9.20 / 2.20 / 7.00 / 40.90 / 14.90 / 26
Reading / 107750 / 29.30 / 3.20 / 1.00 / 12.10 / 58.90 / 13.30 / 45.6
West Berkshire / 99105 / 16.90 / 1.70
Slough / 93821 / 32.70 / 3.10
Windsor and Maidenhead / 91823 / 19.00 / 1.80
Wokingham / 99221 / 18.00 / 1.80
Bracknell Forrest / 75596 / 19.10 / 1.50
Hampshire / 828011 / 17.30 / 14.70 / 5.30 / 14.20 / 86.70 / 33.65 / 53.05
Southampton / 164758 / 28.40 / 4.80
Isle of Wight / 82635 / 16.10 / 1.40 / 0.00 / 1.40 / 6.00 / 9.20 / 3.2
Portsmouth / 139844 / 26.70 / 3.80 / 0.00 / 3.80 / 17.00 / 4.00 / 13
Dorset (East and West) / 241451 / 15.80 / 3.90 / 0.00 / 8.60 / 38.30 / 14.00 / 24.3
Poole / 91828 / 18.10 / 1.70
Bournmouth / 122913 / 24.00 / 3.00
Surrey * / 719433 / 18.70 / 13.80 / 2.50 / 11.30 / 61.30 / 36.60 / 24.7
East Sussex / 315752 / 17.60 / 5.70 / 3.00 / 16.60 / 87.20 / 30.70 / 56.5
West Sussex / 495362 / 17.80 / 9.00
Brighton & Hove / 193332 / 24.90 / 4.90
Kent / 917880 / 18.40 / 17.30 / 2.00 / 19.00 / 77.10 / 53.20 / 40.5
Medway / 173506 / 21.10 / 3.70 / 16.60

Service Development and Improvement Planning

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 / Criteria Description*
Green / 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
Amber / Successful delivery appears probable however constant attention will be needed to ensure risks do not materialise into major issues threatening delivery of the SDIP
Red / Successful delivery of the SDIP currently appears unlikely. There is an overall lack of clarity on who is leading on EIP standards at executive level and allocation of the budget required. The organization and its commissioners require significant support from NHS England Performance and Operations Team.
Organization / Lead MH Commissioner has confirmed EIP uplift? / Provider has ring fenced increased EIP budget / EIP Service Development & Improvement Plan in development / Comments / RAG**
2Gether NHS Foundation Trust / Y / U / U / EIP SDIP status unknown. Provider reports EIP funding has been increased. Commissioner has yet to attend EIP programme board
Avon and Wiltshire Mental Health Partnership NHS Trust / Y / N / Y / EIP funding released to provider. Provider unsure of where money located. SDIP in development
Berkshire Healthcare NHS Foundation Trust / Y / N / Y / EIP uplift of £1m confirmed. SDIP in development. Service was previously dismantled. Recruiting EIP staff.
Central and Northwest London Mental Health Trust (Milton Keynes) / Y / Y / Y / Funding allocated & ring-fenced for EIP. SDIP in development. Commissioner keen for provider to start recruiting staff
Cornwall Partnership NHS Foundation Trust / U / U / U / No CCG engagement on programme board. EIP SDIP status unknown. EIP delivery team meeting with providers & commissioners on 20th July
Dorset Healthcare University NHS Foundation Trust / Y / Y / Y / Provider has confirmed £80K EIP funding agreed for 15/16. SDIP in development.
Devon Partnership NHS Trust / U / N / N / Provider unaware if EIP has received funding uplift, commissioners recently joined EIP programme board and have requested support in convening SDIP workshop on 4th September
Isle of Wight NHS Trust / Y / N / Y / SDIP in development. Query re: location of funding uplift.
Kent and Medway NHS and Social Care Partnership Trust / N / N / Y / 8 CCGs and provider have requested support with SDIP development. SDIP Workshop on 28th August
Oxford Healthcare NHS Foundation Trust / Y / Y / Y / Funding allocated, SDIP in development
Solent NHS Trust / U / Y / N / Commissioner and provider very well engaged. Commissioner reporting negative equity. SDIP workshop scheduled for 7th Sept
Somerset Partnership NHS Trust / N / N / Y / No EIP Uplift. Provider and commissioners in discussions and developing SDIP
Southern Health NHS Foundation Trust / N / N / Y / No funding uplift for EIP. SDIP workshop with commissioners scheduled for 7th Sept (organised by Wessex AHSN)
Surrey and Borders Partnership NHS Foundation Trust / Y / Y / Y / Commissioners have confirmed EIP budget uplift. SDIP development meeting held on 25th June. Recruiting EIP staff
Sussex Partnership NHS Foundation Trust / Y / Y / N / Commissioner has confirmed EIP uplift and plans to convene an EIP SDIP workshop
The Zone (Plymouth) / Y / N / N / Uplift confirmed. Commissioners have requested support in hosting SDIP workshop.

*Based on Self Reports & Soft Intelligence

**Please note that the above status will change as and when new updates are received by the programme

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4. Risks

We have identified the following as key risks to the region’s EIP programme:

1. Lack of ring-fencedEIP funding means that some EIP teams are unable to recruit and train EIP staff to have the competency and capacity to deliver NICE recommended care to >50% of referrals;
2. Delay in NCCMH Commissioning Guide until mid-Septemberresults in a lack of understanding from some commissioners and providers.
3. Lack of clarity on consequences for target breaches has left some areas showing an overall lack of urgency;
4. Electronic Health Records (EHRs) are not configured to collect, record and report data specific to the EIP standards;

5. Mitigation

The programme team is taking the following steps to mitigate against the above risks:

1. Support Commissioners and Providersto convene SDIP workshops and encouraging commissioners to ensure content clearly addresses the funding gap and how the provider is to meet the EIP standards;
2. Participate on theNational EIP Expert Reference Groupto support the publication of the commissioning guide in order to reduce the lack of clarity in terms of what is expected;
3. Engage with the TDA in order to determine theconsequences of breaching the targets;
4. Engage IT managers in developing the EIP Common Assessment on Electronic Health Records;

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