Early Intervention in Psychosis Network 13 February 2020 Stephen - - PowerPoint PPT Presentation

www.england.nhs.uk

• 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

Yorkshire and the Humber Mental Health Network

Early Intervention in Psychosis Network 13 February 2020

www.england.nhs.uk

Yorkshire and the Humber Early Intervention in Psychosis Network

Welcome and Housekeeping

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

@YHSCN_MHDN #yhmentalhealth

Housekeeping:

The parking code to exit the car park is: 5549

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!!

www.england.nhs.uk

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

Post Graduate Diploma in CBT

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

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

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.

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

www.england.nhs.uk

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

A Brief Strategic Overview

• f 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 2. Frimley Health and Care 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 13. Suffolk and North East Essex 14. North Cumbria

… 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.

21 Prevention Concordat for Better Mental 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

• pportunity to achieve good

mental health and wellbeing

• especially communities

facing the greatest barriers and those people who have to overcome the most disadvantages.

• This includes those living with and recovering from

mental illness

22 A Public Mental Health Approach

Mental health promotion Reducing premature mortality for those living with or recovering from mental illness Mental illness prevention and suicide prevention

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

24 Prevention Concordat for Better Mental Health – Local areas signed up

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

25

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

26

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

27

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

Maximising the use of resources in the community

19/02/2020

29

Society

Structural barriers Personal Contacts

The people that are in a person’s life, such as family, friends, neighbours, colleagues, support network

• r online communities

Local facilities and services

Services such as education and employment and spaces,

• ften provided by the state

and accessible to everyone including parks, libraries and communal areas

Health and Social Care Services

Services to help people maintain or achieve their best quality of life. This may include: GPs, pharmacy, social care, mental and physical health care.

Personal Interests

Activities and people who share common values and

• interests. This may include

sports clubs, faith groups, social clubs, online communities etc.

Society Society Society

Personalised care: social prescribing and community connections Social prescribing connects people to community groups and services, through the support of ‘link workers’ who:

• take referrals from local agencies
• can give people time
• co-produce a plan to meet the person’s

wellbeing needs, based on what is important to them Social prescribing is an umbrella term and is sometimes referred to as community connection, care navigation or other names. The core purpose 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.

Care planning and the Care Programme Approach

19/02/2020

30



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

Outcomes and quality measures



Outcomes for the person



Knowing, being a part of, and being responsive to the community



Effective working relationships with other services



Access



Building relationships with people and helping them take care of their own mental health



Assessments



Staffing

31



Families, carers, support network



Continuity of care



Joint working



Care planning



Physical health



Interventions



Reviews



Advocacy



Safety



Coproduced service planning, development and evaluation



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:

How is the proposed model 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

• ngoing 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

32

Prevention Concordat animation

33 Prevention Concordat for Better Mental Health - Commitment action plan

https://www.youtube.com/watch?v=LzryBSS2y90

www.england.nhs.uk

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

National AWT Performance

Org name People started Treatment within 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

Team Name People started Treatment within 2 weeks % Team Name People started Treatment 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 2019 Target Performance ENGLAND 25% Performing Well 22% Performing Well 18% GNFI ACCESS 56% 75.5% NICE CONCORDANT CARE PACKAGE 25% Performing Well 22% Performing Well CONTEXTUAL FACTORS Requires Improvement MEASURING OUTCOMES 25% Performing Well 22% Performing 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

NCAP Score

18/19 NCAP

Trajectory 19/20 Trajectory 20/21 Trajectory 23/24

Recovery Plan Access NICE Outcomes 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 & Easington Level 2 Level 3 Level 3 Level 3 N/A 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

NCAP Score

18/19 NCAP

Contextual Factors Trajectory 19/20 Trajectory 20/21 Trajectory 23/24

Recovery Plan Access NICE Outcomes 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: 79% NICE: Level 1 Outcomes: Level 1 NCAP rating: Level 1 Stand-alone MDT 3-Year service: 29m Caseloads: 19.6 Contextual Status Provision for Children Demand/Capacity: 240/120 Investment: £4,500pp ARMS Pathway Age range: 14-65 Data Quality & Snomed

Development Dashboard Example

Access: 84% NICE: Level 2 Outcomes: Level 1 NCAP rating: Level 2 Stand-alone MDT 3-Year service: 40m Caseloads: 17.6 Contextual Status Provision for Children Demand/Capacity: 225/150 Investment: £6,450pp ARMS Pathway Age range: 14-65 Data Quality & 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

www.england.nhs.uk

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

50 | 50 |

• The NHS Mental Health Implementation Plan 2019/20 – 2023/24 was published in July 2019 and sets
• ut 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.

The NHS Mental Health Implementation plan (Long-Term Plan)

www.england.nhs.uk

52 | 52 |

Adult Severe Mental Illness Community Care – national funding profile

Refer to NHS Mental Health Implementation Plan 2019/20 – 2023/24 for full details.

• 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 Illnesses (including care for people with eating disorders, mental health rehabilitation needs and a ‘personality disorder’ diagnosis) Early Intervention in Psychosis Central / Transformation Funding for each of these commitments is included in ‘Adult Mental Health (SMI) Community Care Total’ from 2021/22 onwards CCG baselines 12 18 52 Total 12 18 52 Individual Placement and Support Central / Transformation 13 30 23 CCG baselines Total 13 30 23 Physical health checks for people with Severe Mental Illnesses Central / Transformation CCG baselines 2 51 79 Total 2 51 79 New integrated community models for adults with SMI (including care for people with eating disorders, mental health rehabilitation needs and a ‘personality disorder’ diagnosis) Central / Transformation 31 52 CCG baselines 33 135 Total 65 187 Adult Severe Mental Illnesses (SMI) Community Care Central / Transformation 13 61 75 147 370 456 CCG baselines 14 103 265 279 326 519 Total 27 165 341 426 696 975

53 | 53 |

Community Care: Adult SMI

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

Adult Severe Mental Illness Community Care – LTP delivery requirements

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.

www.england.nhs.uk

• 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,
• ver 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

£52m

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 NHS Wakefield CCG £358,247

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

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)

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)
• Age group
• Inclusions/Exclusions
• Length of treatment
• Follow-up plans
• Audit/outcomes
• Care coordination
• Risk management
• Treatment elements
• CBT
• FI
• Vocational support
• Physical health
• Carers support
• Medical treatment
• 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/

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Yorkshire and the Humber Early Intervention in Psychosis Network

Time for a break?

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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

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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?

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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?

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Yorkshire and the Humber Early Intervention in Psychosis Network

Listening to the Network: Slido Session

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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!

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