Early Intervention in Psychosis Network 13 February 2020 - Yorkshire and the Humber

 
Early Intervention in Psychosis Network 13 February 2020 - Yorkshire and the Humber
Yorkshire and the Humber
                      Mental Health Network

    Early Intervention in Psychosis Network
                13 February 2020

•   Stephen McGowan, EIP Clinical Lead for Y&H CN and NHSE (North) (Chair)
•   Dr Steve Wright, Consultant Psychiatrist, TEWV (Co-Chair)
•   Sarah Boul, Quality Improvement Manager sarah.boul@nhs.net
•   Twitter: @YHSCN_MHDN #yhmentalhealth
•   February 2020

www.england.nhs.uk
Early Intervention in Psychosis Network 13 February 2020 - Yorkshire and the Humber
Yorkshire and the Humber
            Early Intervention in Psychosis Network

  Welcome and Housekeeping
           Sarah Boul, Quality Improvement Manager,
          Yorkshire and the Humber Clinical Networks

www.england.nhs.uk
Early Intervention in Psychosis Network 13 February 2020 - Yorkshire and the Humber
Housekeeping:

                      @YHSCN_MHDN
                      #yhmentalhealth

      The parking code to exit the car park is: 5549
Early Intervention in Psychosis Network 13 February 2020 - Yorkshire and the Humber
Slido:
At today’s meeting we are going to use Slido to
allow people to ask questions and take part in
polls.

• The WIFI code for the venue is:

• Then open: www.slido.com

• Enter code: #F485

              Now let’s give it a go!!
Early Intervention in Psychosis Network 13 February 2020 - Yorkshire and the Humber
Yorkshire and the Humber
            Early Intervention in Psychosis Network

  University of Hull 2020 CBTp program,
supervision workshops and masterclasses
     Gavin Lawton, Program Director CBT SMI, University of Hull

www.england.nhs.uk
Early Intervention in Psychosis Network 13 February 2020 - Yorkshire and the Humber
Post Graduate Diploma in
CBT
Early Intervention in Psychosis Network 13 February 2020 - Yorkshire and the Humber
Overall course aims:
• In increase access to CBT/ SMI training.
• To give people an opportunity to be taught CBT to diploma level.
• To maintain essential quality ingredients of IAPT high intensity training
  (reference to key evidence based protocols, evaluation of competence
  using recognised criteria)
• To progress to implementation of CBT with secondary care clients and cover
  presentations included SMI IAPT competencies.
• To establish the basics first and then specialise
Early Intervention in Psychosis Network 13 February 2020 - Yorkshire and the Humber
Course Overview
• For the PG Dip: Four taught modules, part – time over two years

• Module 1: Basic CBT theories and Skills (30 credits)
• Module 2: CBT for Common Disorders and Processes in SMI (30
  credits)
• Module 3: Psychosis and Bipolar Disorder (20 credits)
• Module 4: Complex Disorders including Personality Disorders (20
  credits)
• In addition, two supervision modules (each 10 credits). Clinical
  work and supervision to be undertaken in service.
• Six modules in total to complete the PG Diploma
• Also: the taught modules can be taken individually
Early Intervention in Psychosis Network 13 February 2020 - Yorkshire and the Humber
Plus…

• Portfolio of work, to be recorded on PebblePad.
• This covers clinical work from both supervised practice modules.
• The Portfolio will support the BABCP Accreditation process.
Early Intervention in Psychosis Network 13 February 2020 - Yorkshire and the Humber
The Course structure means that

• Trainees can leave at the end of year one with a Post Graduate Certificate in
  CBT.
• People with existing CBT Cert, CBT Dip or psychology qualification can join
  in year 2 (Top Up) and receive a Post Graduate Certificate.
• Or can join to do either the CBTp or CBT for complex cases as a stand-alone
  20 credit module.
Current Developments

• Tender for Post Graduate Diploma in CBT-SMHP ongoing for September
  2020 start.
• New National Curriculum for CBT-SMHP

• Year 1 3 x 20 credit modules
Foundations of CBT
CBT for Anxiety Disorders
CBT for depression

• Year 2
• 1 x generic complex disorder module (20 credits)
• A choice of 3 pathways totalling 40 credits (CBT Psychosis and Bipolar, CBT
  Personality Disorders, CBT Eating Disorders)
• ‘Top Up’ access would be to one of the 3 pathways and access would be
  from September 2021.

• The Tender also requires us to deliver CBT supervision training.
CBTp Masterclasses 2020
• Dr Lizzie Newton & Liz I’Anson, ‘Keeping Mood on Track – Cognitive
  Behavioural Group Psychoeducation and Individual Staying Well work with
  people with a diagnosis of Bipolar Disorder’. 30th March.
• Dr Charlie Heriot-Maitland, ‘ Compassion Focussed Therapy and Psychosis’.
  30th April.
• Dr Katherine Berry, ‘Attachment and Psychosis’. 18th May.
• Dr Pamela Jacobsen, ‘Mindfluness and Psychosis’ (date TBC).
• Dr Christopher Taylor, ‘Imagery Techniques and Psychosis’ (TBC)

https://shop.hull.ac.uk/conferences-and-events
Yorkshire and the Humber
            Early Intervention in Psychosis Network

  Integrated care systems, the new
community mental health framework
and the prevention concordat: where
              EIP fits in
Dr Steve Wright, Co-Chair, Consultant Psychiatrist, TEWV & Clinical
                  Advisor, Y&H Clinical Network

www.england.nhs.uk
A Brief Strategic Overview
   of Community Mental Health

Steve Wright
Yorkshire & Humber EIP Clinical Network
A Brief Strategic Overview of
       Community Mental Health
•   NHSE
•   44 STPs (3 in Yorkshire & Humber)
•   S is for Sustainability &
•   T is for Transformation
•   P is for………….
•   Plan
•   Programme
•   Partnership
From the top to the bottom of the LTP
• Integrated Care Systems (ICS)
Wave 1 completed, 2nd Wave from April
2020 then (final?) wave September 2020
• Integrated Care Partnerships (ICP)
• Place (~250k)
• Primary Care Networks (PCNs) (30-50k)
• Ward & Street Level Populations
The NHS Long Term Plan sets out that “by April 2021,
      Integrated Care Systems will cover the whole country”
Integrated care systems (ICSs) bring together local organisations to
redesign care and improve population health, building partnership with
local government and community partners, developing shared leadership
and action and managing collective resources

ICSs are a way of creating shared local responsibility to:
• Improve quality of care, access to care and health outcomes,
• Reduce inequalities and address the population health challenges in a
    system
• Address wider determinants of health and wellbeing and provide
    better, more independent lives for people with complex needs
• Create the capacity to implement system-wide changes
NHS England ICSs, 2019

1.    South Yorkshire and Bassetlaw        13. Suffolk and North East Essex
2.    Frimley Health and Care              14. North Cumbria
3.    Dorset
4.    Bedfordshire
5.    Nottinghamshire
6.    Lancashire and South Cumbria
7.    Berkshire West
8.    Buckinghamshire
9.    Greater Manchester (devolution deal)
10.   Surrey Heartlands (devolution deal)
11.   Gloucestershire
12.   West Yorkshire and Harrogate
… and are expected to implement new service models to
support more joined-up, proactive and person-centred care
0-25 services
•   Year- by- year milestones for delivery (realistic and achievable)
•   e.g. “19/20: review data and needs analysis, 20/21: develop commissioning plan,
    21/22, phased approach to implementing 18-25 offer, 23/24: comprehensive offer
    in place”
•   Whole pathway focus commitment to support both ends of the age spectrum
•   Needs analysis identifies local need
•   Join up across adult and CYP MH services “we will plan and deliver training to
    further develop competencies of IAPT and CMHT practitioners to support young
    adults”
•   Reflects the multi agency nature of the ask - support for CYP 0-25 requires
    partnership working across health, social care and education not just across
    CYPMH and AMH.
The “Prevention Concordat”
• Prevention involves reducing the incidence and prevalence of
  mental health problems and suicide.

•   Primary prevention aims to prevent the onset of mental health problems by
    addressing the wider determinants of illness and using ‘upstream’ approaches that
    target the majority of the population.

•   Secondary prevention involves the early identification of signs of mental health
    problems or suicide risk and early intervention to prevent their progression or the
    development of other health complications.

•   Tertiary prevention involves working with people with established mental health
    problems to promote recovery and prevent (or reduce the risk of) recurrence.

    Mental health promotion is part of primary prevention but
    also important for those experiencing and at risk of
    developing, mental health problems.

                              Prevention Concordat for Better Mental
      21
                                       Health Programme
A public mental health approach
•World Health Organization and SDG
methodology for public mental health
which has been adopted by Public Health
England

•Everyone, irrespective of
where they live, has the                                                    Mental health
                                                                             promotion
opportunity to achieve good
mental health and wellbeing
- especially communities
                                                                                           Reducing
facing the greatest barriers                               Mental illness                  premature
                                                           prevention and             mortality for those
and those people who have                                      suicide                   living with or
                                                             prevention
to overcome the most                                                                   recovering from
                                                                                        mental illness
disadvantages.
•This includes those living with and recovering from
mental illness

          22                          A Public Mental Health Approach
Sign up – Who is it aimed at?
 Partnerships: Sustainability and Transformation
 Partnership, Health and wellbeing Boards,
 Community Safety partnerships, Voluntary sector
 partnerships
 Organisations: Local authority, Clinical
 Commissioning Groups, NHS Hospital Trust,
 Voluntary organisation
 Communities: local community groups, faith
 groups, Big Locals
 National organisations: Professional
 membership bodies, charities, government agencies
Prevention Concordat for
Better Mental Health: Local
Adoption and Signatories
August 2019

                 Prevention Concordat for Better Mental
                 Health – Local areas signed up           24
25
The Community Mental Health
Framework for Adults and Older Adults
 A radical change in the approach towards the delivery of community mental
 health care (NHS, social care, VCS, public health, communities):
    An integrated model of community based mental health care for adults
     (including those over 65), from less complex to complex mental health
     needs
    Primary care being enabled to provide a broader range of services in the
     community that integrate primary, community, social and acute care
     services, and bring together physical and mental health
        Organised at the local community level for a population of around 30,000 -
         50, 000 people (approximately 5 to 12 practices)
        Linked closely with wider community services (populations typically of
         150, 000 to 200, 000) that focus on more complex needs where services
         are provided by specialist multidisciplinary mental health teams
        Local needs, local geography and specialist services arrangements may
         contribute to variation in population size

                                                                                      19/02/2020
26
The new model

   Development of an integrated core community mental health
    network which brings together the extensive mental health support
    and treatment:
       1) currently provided in primary care for people with less complex and
        complex needs; and
       2) provided by current secondary care community mental health teams
   This model of care replaces the current models for delivery of care
    (where care is delivered separately from primary care or secondary
    care) through integrating mental health, physical health and social
    care
   Teams will be multidisciplinary, with strong links with crisis teams
    (which may be provided at a wider community level) and other
    services such as inpatient care, residential and liaison mental health
    services in emergency departments

                                                                                 19/02/2020
27
    A core community mental health
    network
   The central functions of a core community mental health network will be to
    effectively treat, care for and support people with the full range of mental health
    problems in a community setting. This will involve:
        Assessment and advice
        Assessment and brief interventions and other interventions
        Community support
        Care management
        Specific psychological, pharmacological and social interventions
   The specific make-up of each network or team may be subject to local
    determination, based on the particular needs of a geographic area or population
   Networks will have common pathways for specific needs or problems, agreed
    protocols for the delivery of care, shared protocols for the management of
    specific problems, and reduction in multiple points of access

                                                                                          19/02/2020
28
    Principles for a community mental
    health framework
   The organising principles of the community mental health framework are
    that they should:
        Organise care around their communities
        Dissolve barriers between primary and secondary care, and between health care,
         social care and VCS services
        Step up and step down care for people with increasing complexity and more specialist
         needs
        Know their communities, including to, as a result, understand and address inequalities
        Be proactive, flexible and responsive to needs
        Be outcomes centred, using co-produced patient focussed outcomes
        Understand and take a partnership approach to addressing the social determinants of
         serious mental ill health
        Make use of community assets and resources, including VCS, online resources and
         personal contacts

                                                                                            19/02/2020
29
 Maximising the use of resources in the
 community

Personalised care: social prescribing and
community connections
                                                                                                              Personal Contacts
                                                       Structural barriers                                      The people that are in a
Social prescribing connects people to community                                                               person’s life, such as family,

                                                                                                                                                            So
                                                                                     ty

                                                                                                                                                              cie
                                                                                                                   friends, neighbours,
groups and services, through the support of ‘link

                                                                                   cie

                                                                                                                                                                ty
                                                                                 So
                                                                                                              colleagues, support network
                                                                                                                 or online communities
workers’ who:
                                                                               Local facilities                                                  Health and
   •   take referrals from local agencies                                       and services                                                 Social Care Services
   •   can give people time                                                   Services such as education                                          Services to help people
                                                                             and employment and spaces,                                         maintain or achieve their
   •   co-produce a plan to meet the person’s                                 often provided by the state
                                                                              and accessible to everyone
                                                                                                                                               best quality of life. This may
                                                                                                                                                 include: GPs, pharmacy,
       wellbeing needs, based on what is                                     including parks, libraries and
                                                                                   communal areas
                                                                                                                                                  social care, mental and
                                                                                                                                                   physical health care.
       important to them                                                                                      Personal Interests
                                                                                                               Activities and people who
Social prescribing is an umbrella term and is                                                                 share common values and
                                                                                                              interests. This may include
sometimes referred to as community connection,

                                                                                       So

                                                                                                                                                                ty
                                                                                                               sports clubs, faith groups,

                                                                                         cie

                                                                                                                                                             cie
                                                                                            ty

                                                                                                                                                           So
                                                                                                                  social clubs, online
care navigation or other names. The core purpose                                                                   communities etc.

is the same – to ensure that a person can access
the range of resources that are available to them in
their communities to keep them well.

                                                                                                                                                                     19/02/2020
30
Care planning and the Care Programme
Approach

   Core elements and purpose of the CPA are sound and remain important and relevant
       But it has often become an admin process, burdensome, meaningless to service users and not aligned
        with a personalised approach to care; there is significant variation in how MH Trusts apply the CPA

       It also creates a divide between those on CPA and not on CPA, in terms of what they can expect, and
        what a service is required to report on to national bodies

   Under the proposed model, every person who requires support, care and treatment in
    the community should have a care plan, based on good assessment
       The level of assessment, planning and coordination of care required will vary, depending on the
        complexity of a person’s needs

       Care plans will be co-produced, based on reviews and outcomes, and aligned to people’s rights under
        the Care Act

       The intensity of each element will vary, but everyone should have an expectation that they will receive
        this

   Assessments and care plans should be single across heath and social care, accessible
    across different settings and digitised where possible

                                                                                                          19/02/2020
31
    Outcomes and quality measures

   Quality measures will help support local areas set standards for what mental health
    care should be provided in the community and how care should be delivered within
    the framework
   Outcomes should be collected across the following areas:
        Outcomes for the person                             Families, carers, support network
                                                             Continuity of care
        Knowing, being a part of, and being responsive
         to the community                                    Joint working
        Effective working relationships with other          Care planning
         services                                            Physical health
        Access                                              Interventions
        Building relationships with people and helping      Reviews
         them take care of their own mental health
                                                             Advocacy
        Assessments                                         Safety
        Staffing                                            Coproduced service planning, development
                                                              and evaluation
How is the proposed model                                                               32
different from the current model of
care?
   A shift towards integrated delivery of care across mental health, physical health
    and social care based in local communities means care will be more
    responsive and less fragmented also enabling MH clinical expertise to reach in
    to primary care and provide additional expertise and support
   Ability to step care up and down based on need and complexity and unsure
    those no longer in need of more intensive support will still receive a level of
    ongoing care and support
   Increased delivery of evidence based interventions such as psychological
    therapies, trauma informed care, physical health care and employment support
    in the community
   Making more effective use of community assets and resources, including
    housing, debt advice, employment services
   Meeting the needs of people in integrated core community mental health
    networks enables more effective use of existing resources and less reliance on
    hospitals and crisis services
   More efficient links with specialist mental health services that may be delivered
    within the wider community

                                                                                        19/02/2020
Prevention Concordat animation

https://www.youtube.com/watch?v=LzryBSS2y90
Prevention Concordat for Better Mental Health - Commitment action plan
                                                                         33
Regional Assurance
               Update
                     Moggie McGowan

13th February 2020
www.england.nhs.uk
People with a first episode psychosis
 start treatment with a NICE-
 recommended package of care with a
 specialist early intervention in
 psychosis (EIP) service within two
 weeks of referral (5YFV)

www.england.nhs.uk
Within two weeks of referral:
60% by 2021

A NICE-recommended package of care:
60% by 2021

www.england.nhs.uk
National AWT Performance

                           People started
                           Treatment within
Org name                   2 weeks %
ENGLAND                         74.1%
LONDON                           71.8%
SOUTH WEST OF ENGLAND            74.5%
SOUTH EAST OF ENGLAND            63.3%
MIDLANDS                         68.1%
EAST OF ENGLAND                  78.3%
NORTH WEST                       72.6%
NORTH EAST AND YORKSHIRE         71.6%

                              OCTOBER 2019
Regional RTT Performance
                      People started Treatment                            People started Treatment
    Team Name                                           Team Name
                         within 2 weeks %                                    within 2 weeks %
Bradford & Airedale                              Redcar and Cleveland
North Cumbria                                    York & Selby
PSYPHER                                          Barnsley
NAViGO                                           Calderdale Insight
Gateshead EIP                                    North Kirklees Insight
North Tyneside EIP                               South Kirklees Insight
Northumberland EIP                               Wakefield
Sunderland EIP                                   Harrogate, H&R
Newcastle EIP                                    North Durham
South Tyneside EIP                               Hartlepool
Doncaster                                        Stockton
North Lincs                                      Scarborough, W&R
Rotherham                                        South Durham
Sheffield                                        Middlesbrough
Aspire, Leeds
National Quality Performance
Quality:
NICE quality standards and Contextual features
                                  Target            Performance
2019
                              25% Performing     22% Performing Well
ENGLAND                            Well               18% GNFI
                                   56%                 75.5%
ACCESS
NICE CONCORDANT CARE          25% Performing       22% Performing
PACKAGE                            Well                 Well
                                                      Requires
CONTEXTUAL FACTORS                                  Improvement
                              25% Performing       22% Performing
MEASURING OUTCOMES                 Well                 Well

                                                               2019
Regional Performance
    Team Name                  NCAP score             Team Name                   NCAP score

Bradford & Airedale        Needs improvement   Redcar and Cleveland     Needs improvement
North Cumbria              Performing well     York & Selby             Greatest need for improvement
PSYPHER                    Performing well     Barnsley                 Top performing
NAViGO                     Needs improvement   Calderdale Insight       Top performing
Gateshead EIP              Needs improvement   North Kirklees Insight   Top performing
North Tyneside EIP         Needs improvement   South Kirklees Insight   Performing well
Northumberland EIP         Needs improvement   Wakefield                Top performing
Sunderland EIP             Needs improvement   Harrogate, H&R           Greatest need for improvement
Newcastle EIP              Needs improvement   North Durham             Needs improvement
South Tyneside EIP         Top performing      Hartlepool               Needs improvement
Doncaster                  Needs improvement   Stockton                 Needs improvement
North Lincs                Needs improvement   Scarborough, W&R         Greatest need for improvement
Rotherham                  Needs improvement   South Durham             Needs improvement
Sheffield                  Needs improvement   Middlesbrough            Needs improvement
Aspire, Leeds              Needs improvement

28% L3&4; 62% L2; 10% L1
Recovery Plans
    Team Name             NCAP score             Team Name                   NCAP score

Bradford & Airedale   Needs improvement   Redcar and Cleveland     Needs improvement
North Cumbria         Performing well     York & Selby             Greatest need for improvement
PSYPHER               Performing well     Barnsley                 Top performing
NAViGO                Needs improvement   Calderdale Insight       Top performing
Gateshead EIP         Needs improvement   North Kirklees Insight   Top performing
North Tyneside EIP    Needs improvement   South Kirklees Insight   Performing well
Northumberland EIP    Needs improvement   Wakefield                Top performing
Sunderland EIP        Needs improvement   Harrogate, H&R           Greatest need for improvement
Newcastle EIP         Needs improvement   North Durham             Needs improvement
South Tyneside EIP    Top performing      Hartlepool               Needs improvement
Doncaster             Needs improvement   Stockton                 Needs improvement
North Lincs           Needs improvement   Scarborough, W&R         Greatest need for improvement
Rotherham             Needs improvement   South Durham             Needs improvement
Sheffield             Needs improvement   Middlesbrough            Needs improvement
Aspire, Leeds         Needs improvement
Assurance NE
            Team      18/19                18/19 NCAP              Trajectory   Trajectory   Trajectory   Recovery Plan
                     NCAP Score   Access      NICE      Outcomes     19/20        20/21        23/24

Northumberland        Level 2                                       Level 2                               Submitted Y
                                                                                                          Responded Y

North Tyneside        Level 2                                       Level 2                               Submitted Y
                                                                                                          Responded Y

South Tyneside        Level 3                                       Level 3      Level 3      Level 3           N/A

Gateshead             Level 2                                       Level 3      Level 3      Level 3           N/A

Newcastle             Level 2                                       Level 3      Level 3      Level 3           N/A

Sunderland            Level 2                                       Level 2                               Submitted Y

North Cumbria         Level 3                                       Level 2                               Submitted Y

North Durham &        Level 2                                       Level 3      Level 3      Level 3           N/A
Easington
South Durham          Level 2                                       Level 3      Level 3      Level 3           N/A

Hartlepool            Level 2                                       Level 3      Level 3      Level 3           N/A

Stockton on Tees      Level 2                                       Level 3      Level 3      Level 3           N/A

Middlesbrough         Level 2                                       Level 3      Level 3      Level 3           N/A

Redcar & Cleveland    Level 2                                       Level 3      Level 3      Level 3           N/A
Assurance Y&H
            Team        18/19               18/19 NCAP              Contextual   Trajectory 19/20   Trajectory   Trajectory   Recovery Plan
                      NCAP Score   Access      NICE      Outcomes    Factors                          20/21        23/24

Sheffield              Level 2                                                       Level 2                                  Submitted Y
                                                                                                                              Responded Y
Doncaster              Level 2                                                       Level 3         Level 3      Level 3           N/A
Rotherham              Level 2                                                       Level 3         Level 3      Level 3           N/A
North Lincs            Level 2                                                       Level 3         Level 3      Level 3           N/A
[Bassetlaw]

NAViGO                 Level 2                                                       Level 3         Level 3      Level 3           N/A
Psypher                Level 3                                                      Level 3?         Level 3      Level 3           N/A
York and Selby         Level 1                                                       Level 2                                  Requested

Scarborough, W&R       Level 1                                                       Level 1                                  Requested

Harrogate, H&R         Level 1                                                       Level 1                                  Requested

Aspire Leeds           Level 2                                                       Level 3         Level 3      Level 3           N/A
Bradford & Airedale    Level 2                                                       Level 3         Level 3      Level 3           N/A
Halifax                Level 4                                                       Level 3         Level 3      Level 3           N/A
North Kirklees         Level 4                                                       Level 3         Level 3      Level 3           N/A
Huddersfield           Level 3                                                       Level 3         Level 3      Level 3           N/A
Wakefield              Level 4                                                       Level 3         Level 3      Level 3           N/A
Barnsley               Level 4                                                       Level 4         Level 3      Level 3           N/A
2019/20 NCAP

Target: 50% L3, 0% L1

Predicting: 70% L3; 7% L1
Development
                    Dashboards

  Access:             NICE:        Outcomes:      NCAP rating:
   79%               Level 1        Level 1         Level 1

Stand-alone      3-Year service:   Caseloads:
   MDT                29m             19.6
                                                  Contextual
Provision for   Demand/Capacity:   Investment:      Status
  Children         240/120           £4,500pp
   ARMS            Age range:      Data Quality
  Pathway            14-65          & Snomed
Development Dashboard
                       Example
  Access:              NICE:        Outcomes:      NCAP rating:
   84%                Level 2        Level 1         Level 2

Stand-alone       3-Year service:   Caseloads:
   MDT                 40m             17.6
Provision for    Demand/Capacity:   Investment:    Contextual
  Children          225/150           £6,450pp       Status

   ARMS             Age range:      Data Quality
  Pathway             14-65          & Snomed
Next steps
• Confirmed development plans and recovery
  plans
• Regional reporting (quarterly)
• National assurance process (6-monthly)
• MHIS audit
• 2019/20 NCAP results (June?)
• Reviewed trajectories
• Regional support
• EIP & LTP
EIP: Five Year Forward into the Long
     Term Plan – Future Focus for EIP

                     Moggie McGowan

13th February 2020
www.england.nhs.uk
EIP 2014-2024
•   Achieving Better Access to MH Policy (2014)
•   New National Specification (2016)
•   Access & Waiting Time target (2015/16)
•   Investment standard (2015/16)
•   Workforce design tool (2016)
•   Annual clinical quality audit (CCQI/NCAP, 2016/17)
•   Audit of contextual factors (2016/17)
•   5YFV programme (2016-2021) – 60% target
•   Mental Health Implementation plan (Long-Term Plan)
    (2019/20-2023/24)
•   £40m new investment in 2015
•   £70m in 2016-2021
•   Additional £12m in 20/21
•   2021-2024: Share of £1bn LTP Community Mental Health
    Framework investment
www.england.nhs.uk
The NHS Mental Health Implementation
  plan (Long-Term Plan)
• The NHS Mental Health Implementation Plan 2019/20 – 2023/24 was published in July 2019 and sets
  out the detailed requirements for Mental Health,
• There is now a ringfenced local investment fund worth at least £2.3 billion a year by 2023/24 covering
  the Long Term Plan (LTP) ambitions for Mental Health
• LTP Headlines:
            - Integrated model for SMI community mental health care (inc. PD and ED)
            - New pathways for 0-25s
            - Trauma informed care
            - Psychological therapies for SMI
            - 95% of EIP services achieve level by 2023/24
• LTP states that all areas must invest to ensure EIP services are commissioned in line with NHS
  England guidance which includes:
1.   Provision for all age groups (under 18s and over 35 year olds) – areas should be aiming to
     deliver this now rather than planning for delivery in 2023/24
2.   Provision for people with an At Risk Mental State - areas should be aiming to deliver this now
     rather than planning for delivery in 2023/24
3.   Ensuring improvements are made in levels of NICE concordance (NCAP level 3)
4.   The referral to treatment element of the standard is met
This| is supported by significant new CCG baseline investment totalling £52 million nationally in 2020/21.
50
www.england.nhs.uk
Adult Severe Mental Illness Community Care – national funding
profile
• There is £52m worth of ringfenced Mental Health investment to be used for EIP in 2020/21. This investment is not
  predicated on savings.
• All areas are expected to use LTP investment for ARMs, over 35s and to improve NICE concordance. Intelligence from
  clinical network deep dives has shown that where investment has not grown in line with national uplift services can struggle
  to meet the quality standard.
• To access CCG and STP level indicative investment profiles for community SMI please ask your Regional MH Lead
  for access to the ‘Mental Health LTP analytical tool’ workspace on the Future NHS Collaboration Platform

  Five-year profile for the FYFVMH and LTP (£m in cash terms)           Baseline   Year 1    Year 2    Year 3     Year 4     Year 5
                                                                        2018/19    2019/20   2020/21   2021/22    2022/23    2023/24
  Adult Severe Mental    Early Intervention in         Central /        0          0         0
  Illnesses (including   Psychosis                     Transformation
  care for people with                                 CCG baselines    12         18        52
  eating disorders,                                    Total            12         18        52
  mental health          Individual Placement and      Central /        13         30        23
  rehabilitation needs   Support                       Transformation
  and a ‘personality                                   CCG baselines    0          0         0
  disorder’ diagnosis)                                 Total            13         30        23
                         Physical health checks for    Central /        0          0         0         Funding for each of these
                         people with Severe Mental Transformation                                      commitments is included in ‘Adult
                         Illnesses                     CCG baselines    2          51        79        Mental Health (SMI) Community
                                                       Total            2          51        79        Care Total’ from 2021/22 onwards
                         New integrated community Central /             0          31        52
                         models for adults with SMI Transformation
                         (including care for people    CCG baselines    0          33        135
                         with eating disorders, mental Total            0          65        187
                         health rehabilitation needs
                         and a ‘personality disorder’
                         diagnosis)

                         Adult Severe Mental         Central /          13         61        75        147        370        456
                         Illnesses (SMI) Community   Transformation
                         Care                        CCG baselines      14         103       265       279        326        519
                                                     Total              27         165       341       426        696        975

 52 |Refer to NHS Mental Health Implementation Plan 2019/20 – 2023/24 for full details.
Adult Severe Mental Illness Community Care – LTP delivery
Community
requirements Care: Adult SMI
   Ambition             2019/20                  2020/21                  2021/22                   2022/23                    2023/24
                                                                  Fixed
Integrated      Stabilise and bolster     Stabilise and bolster  At least 126,000 adults    At least 257,000 adults    At least 370,000 adults
primary and     core community mental core community mental and older adults with           and older adults with      and older adults with
community       health teams              health teams           SMI (including care for    SMI (including care for    SMI (including care for
care for adults                                                  people with eating         people with eating         people with eating
                [Testing new model        [Testing new model
and older                                                        disorders, mental health   disorders, mental health   disorders, mental health
                within select number of within select number of
adults with SMI                                                  rehabilitation needs and   rehabilitation needs and   rehabilitation needs and
                STPs/ICSs]                STPs/ICSs]
access                                                           a ‘personality disorder’   a ‘personality disorder’   a ‘personality disorder’
                                                                 diagnosis) receiving       diagnosis) receiving       diagnosis) receiving
                                                                 care from integrated       care from integrated       care from integrated
                                                                 primary and community      primary and community      primary and community
                                                                 mental health services     mental health services     mental health services
SMI physical    A total of 280,000 people A total of 280,000     A total of 302,000         A total of 346,000         A total of 390,000
health checks receiving physical health people receiving         people receiving           people receiving           people receiving
                checks                    physical health checks physical health checks     physical health checks     physical health checks
                [FYFVMH commitment]     [FYFVMH commitment] [An additional 22,000           [An additional 66,000      [An additional 110,000
                                                              above FYFVMH                  above FYFVMH               above FYFVMH
                                                              ambition]                     ambition]                  ambition]
Individual      16,000 total people     20,000 total people   32,000 total people           44,000 total people        55,000 total people
Placement and accessing IPS             accessing IPS [100%   accessing IPS                 accessing IPS              accessing IPS
Support (IPS)                           increase in access as
                [60% Increase in access
                                        per FYFVMH]
                as per FYFVMH]
Early           Achieve 56% EIP         Achieve 60% EIP       Maintain 60% EIP              Maintain 60% EIP           Maintain 60% EIP
Intervention in Access Standard and     Access Standard and   Access Standard and           Access Standard and        Access Standard and
Psychosis       50% Level 3 NICE        60% Level 3 NICE      70% Level 3 NICE              80% Level 3 NICE           95% Level 3 NICE
(EIP)           concordance             concordance           concordance                   concordance                concordance
                [FYFVMH commitment]      [FYFVMH commitment]

 The new Community Mental Health Framework describes how the Long Term Plan’s vision for
 integrated primary and community care for adults with SMI can be realised.
53 |
£52m
• There is £52m worth of ringfenced Mental Health
  investment to be used for EIP in 2020/21.
• This investment is not predicated on savings.
• All areas are expected to use LTP investment for ARMs,
  over 35s, under 18s and to improve NICE concordance.
• Intelligence from clinical network deep dives has shown
  that where investment has not grown in line with national
  uplift, services struggle to meet the quality standard.
• To access CCG and STP level indicative investment
  profiles for community SMI please ask your Regional MH
  Lead for access to the MH LTP analytical tool on the
  Future NHS Collaboration Platform

www.england.nhs.uk
Allocation of additional LTP
investment in EIP in 2020/21

 NHS Darlington CCG                               £103,598
 NHS Durham Dales, Easington and Sedgefield CCG   £309,209
 NHS North Durham CCG                             £238,055
 NHS Hartlepool and Stockton-on-Tees CCG          £294,900
 NHS Northumberland CCG                           £326,028
 NHS South Tees CCG                               £303,963
 NHS South Tyneside CCG                           £167,902
 NHS Sunderland CCG                               £291,503
 NHS North Cumbria CCG                            £315,982

www.england.nhs.uk
Allocation of additional LTP
investment in EIP in 2020/21
NHS Airedale, Wharfedale and Craven CCG       £147,395
NHS Barnsley CCG                              £254,720
NHS Bassetlaw CCG                             £111,931
NHS Bradford Districts CCG                    £306,220
NHS Calderdale CCG                            £192,480
NHS Bradford City CCG                         £115,962
NHS Doncaster CCG                             £306,799
NHS East Riding of Yorkshire CCG              £281,119
NHS Greater Huddersfield CCG                  £207,296
NHS Hambleton, Richmondshire and Whitby CCG   £126,993
NHS Harrogate and Rural District CCG          £134,721
NHS Hull CCG                                  £281,781
NHS North Kirklees CCG                        £168,642
NHS North Lincolnshire CCG                    £161,357
NHS Rotherham CCG                             £246,602
NHS Scarborough and Ryedale CCG               £116,214
NHS Sheffield CCG                             £509,617
NHS Vale of York CCG                          £282,120
www.england.nhs.uk
NHS  Wakefield CCG                            £358,247
People with a first episode psychosis
 start treatment with a NICE-
 recommended package of care with a
 specialist early intervention in
 psychosis (EIP) service within two
 weeks of referral (5YFV)

www.england.nhs.uk
People between the ages of 14 and 65
 with, or at-risk of, a first episode
 psychosis start treatment with a NICE-
 recommended package of care with a
 specialist early intervention in
 psychosis (EIP) service within two
 weeks of referral (LTP)
www.england.nhs.uk
ARMS & 14-65 (2019)
    Team Name          14-65   ARMS          Team Name         14-65   ARMS

Bradford & Airedale                   Redcar and Cleveland
North Cumbria                         York & Selby
PSYPHER                               Barnsley
NAViGO                                Calderdale Insight
Gateshead EIP                         North Kirklees Insight
North Tyneside EIP                    South Kirklees Insight
Northumberland EIP                    Wakefield
Sunderland EIP                        Harrogate, H&R
Newcastle EIP                         North Durham
South Tyneside EIP                    Hartlepool
Doncaster                             Stockton
North Lincs                           Scarborough, W&R
Rotherham                             South Durham
Sheffield                             Middlesbrough
Aspire, Leeds
14-65
•   Working with children
•   14-16
•   16-18
•   Joint working with CYPMH
•   Protocols
•   Over 35s
•   Long DUPs
•   Different needs
•   Evidence base
ARMS
•   Client group (CAARMS)   • Treatment elements
•   Age group                     - CBT
•   Inclusions/Exclusions         - FI
•   Length of treatment           - Vocational support
•   Follow-up plans               - Physical health
•   Audit/outcomes                - Carers support
•   Care coordination       • Medical treatment
•   Risk management         • Trauma

             Regional Consensus?
NEWS
•   PsyMaptic update
•   Beth McGeever – covering for Amy
•   Updating EIP guidance in Q4
•   Voyage of Recovery
VOYAGE OF RECOVERY

SW Yorks crew: https://www.justgiving.com/crowdfunding/stephen-mcgowan-2
Aspire crew:
http://iris-initiative.org.uk/
Yorkshire and the Humber
            Early Intervention in Psychosis Network
                     Time for a break?

www.england.nhs.uk
Yorkshire and the Humber
             Early Intervention in Psychosis Network

Introduction to the Group Discussion
Dr Steve Wright, Co-Chair, Consultant Psychiatrist, TEWV & Clinical Advisor,
                           Y&H Clinical Network

 www.england.nhs.uk
The ARMS Pathway:
On Slido please put a thumbs up for against the questions the
you agree with

Please also use Slido to post your thoughts or questions on
what Moggie should feed back to the NHS England Team
developing the guidelines

On your tables please discuss what are the best “ingredients”
for an ARMS pathway. Please capture your thoughts on the A3
sheets of paper

  www.england.nhs.uk
The ARMS Pathway:
1. Which of the following should be routinely offered in an ARMS pathway:
• CBT
• DBT
• IPS
• Family interventions
• Trauma-focused therapy
• Social support
• Peer support
• Other interventions (specify)

2. Do you have confidence in your current assessment process in consistently
identifying cases of ARMS / FEP?

3. Do you feel that other teams and services (e.g: inpatient or Crisis) understand and
support the ARMS pathway?

   www.england.nhs.uk
The ARMS Pathway:
4. Do you have agreed funding from your commissioners for an ARMS pathway?

5. What approximately is the proportion of ARMS cases on caseload compared to
FEP?

6. What are your biggest concerns around the ARMS pathway?

7. Do you have examples of good practice in your ARMS pathway that you would be
willing to share? What would you like to share?

8. Any other feedback for the National EIP Team?

   www.england.nhs.uk
Yorkshire and the Humber
            Early Intervention in Psychosis Network

                Listening to the Network:
                      Slido Session

www.england.nhs.uk
Listening to the Network: Slido Session
1. How would you like to be contacted or communicated with by the network? For
   example, email, WhatsApp, Pando (the new NHS messaging thing) etc.

2. What sort of updates/information would you like to receive?

3. How often would you like to meet as a network?

4. Where would you like future network meetings to be held?

5. What topics would you like to focus on?

6. Would anyone like to volunteer to present?

7. If yes to presenting – what will you present on?

   www.england.nhs.uk
Yorkshire and the Humber
             Early Intervention in Psychosis Network

                      Summary & Close
Dr Steve Wright, Co-Chair, Consultant Psychiatrist, TEWV & Clinical Advisor,
                           Y&H Clinical Network

 www.england.nhs.uk
Yorkshire and the Humber
            Early Intervention in Psychosis Network

         Thank You for Attending!

    Don’t forget to fill out your evaluation form!

www.england.nhs.uk
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