Preparing to implement the new access & waiting time standards - - PDF document

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Sarah Khan – Deputy Head of Mental Health (Policy & Strategy) Kevin Mullins – Head of Mental Health (Delivery) Kathryn Pugh - Programme Lead, C&YP Mental Health

Preparing to implement the new access & waiting time standards

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Welcome to the WebEx

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1. The new standards to be introduced from 15/16 2. Expectations of commissioners: i. Early intervention in psychosis ii. Liaison mental health services iii. Improving access to psychological therapies (IAPT) 3. Delivering Transformation in Child and Adolescent Mental Health Services (CAMHS) 4. Early thinking about distributing new funds

This presentation

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MH 5YP: rebalancing the system

 Right care  Right time  Right setting  Prevention  Early intervention  Effective care  Recovery

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The system is currently not in balance

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We are also missing opportunities to deliver better value care to individuals receiving treatment for a physical health condition

If we are to improve outcomes and quality of life for individuals with physical health needs, then:

• a. Promotion of positive mental health as

part of condition management

• b. Recognition of mental health needs
• c. Timely access to expert assessment and

evidence based mental health care Will need to be integrated at every level of the physical healthcare system. a + b + c = reduced demand from repeat attendances in primary care, UEC and outpatient clinics = reduced acute length of stay = better outcomes at lower cost for individuals with long term conditions

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From 1 April 2016:

• More than 50% of people

experiencing a first episode of psychosis will be treated with a NICE approved care package within two weeks of referral.

• 75% of people referred to the

Improving Access to Psychological Therapies programme will be treated within 6 weeks of referral, and 95% will be treated within 18 weeks of referral.

• £30m investment is to be targeted on

effective models of liaison psychiatry in a greater number of acute hospitals.

The 2015/16 planning framework

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The Financial Package

The new standards for 15/16 are supported by an £80m funding package:

• £40m recurrent funding to support delivery of the early intervention in

psychosis standard;

• £10m to support delivery of the IAPT; and
• £30m to support delivery of the liaison psychiatry standard.

In addition:

• NICE (the National Collaborating Centre for Mental Health, NCCMH) has

been commissioned to develop national resources to support implementation.

• Funding has been made available to support regional EIP preparedness

programmes (£200k per region).

• System resilience monies are being used in many areas to support

preparedness efforts across EIP and liaison psychiatry services.

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The Autumn Statement

The Autumn Statement 2014 outlined the provision of additional funding of £30million recurrently for 5 years to be invested in a central NHS England programme to improve access for children and young people to specialist evidence-based community CAMHS eating disorder

• services. Part of this programme funding will be used to develop an

access and waiting time standard.

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The Spring Budget

The Spring Budget 2015 included an announcement of £1.25bn new mental health funding over the next 5 years (£250m per year) to improve access to mental health services for children and young people and for mothers experiencing perinatal mental illness. This will include continuing and expanding the CYP IAPT programme of CAMHS transformation, plus resources to build capacity.

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Amount (15/16, £) Purpose Recurrent? Held where? 250m Improve access to CAMHS Yes TBC, but in 15/16 likely to be split between HEE and central programme. Moves to allocations by 19/20 40m Support EIP waiting time standard Yes CCG baseline 30m Eating disorders Yes Central programme, in allocations by 19/20. 30m Liaison psychiatry No Central programme 10m IAPT No Central programme

Finances

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The new standards to be introduced from 2015/16

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• 1. Clarify the requirements of each of the new

15/16 mental health access and waiting time standards and associated expectations of CCG commissioners in line with the planning guidance.

• 2. Outline the intention to implement access

and waiting time standards for eating disorders in community CAMHS from 2016.

• 3. Update stakeholders regarding the national

programme of support for implementation of the new access and waiting time standards.

• 4. Signpost stakeholders to helpful sources of

regional support for implementation of the early intervention in psychosis standard.

The February guidance

NHS | Presentation to [XXXX Company] | [Type Date] 14

• i. Early intervention in

psychosis

Sarah Khan Deputy Head of Mental Health (Policy & Strategy) NHS England

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Why set a standard?

In 2011, No Health Without Mental Health, highlighted the effectiveness of EIP services. When delivered in accordance with NICE standards they help people to recover from a first episode of psychosis and gain a good quality of life.

What are we aiming to do?

To ensure that:

• Anyone with an emerging psychosis and their families and key

supporters can have timely access to specialist early intervention services which provide interventions suited to age and phase of illness.

• Individuals experiencing first episode psychosis have consistent access

to a range of evidence-based biological, psychological and social interventions as recommended by the NICE guidelines for psychosis and schizophrenia in children and young people CG155 (2013) and in adults CG178 (2014) and the NICE guideline for psychosis with co-existing substance misuse.

• Care is provided equitably - taking into account higher rates of

psychosis in certain groups who may experience difficulties in accessing traditional services.

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• The new access and waiting time standard requires that, by 1 April 2016,

more than 50% of people experiencing a first episode of psychosis will be treated with a NICE approved care package within two weeks of referral.

• The standard is ‘two-pronged’ and both conditions must be met for the

standard to be deemed to have been achieved, i.e.  A maximum wait of two weeks from referral to treatment; and  Treatment delivered in accordance with NICE guidelines for psychosis and schizophrenia - either in children and young people CG155 (2013)

• r in adults CG178 (2014).
• Most initial episodes of psychosis occur between early adolescence and

age 25 but the standard applies to people of all ages in line with NICE guidance.

What is the standard

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Approach to implementation

• 1. Bringing together the

required expertise National expert reference group, NICE ‘hosting’, highly collaborative.

• 2. Developing the

required dataset Specifying the dataset, developing the MHSDS and commissioning national clinical audit.

• 3. Publication of

commissioning guidance Service specifications, service model exemplars, staffing / skill mix calculators etc

• 4. Design of levers &

incentives Planning guidance, payment system development, standard contract etc. Engagement with Monitor, TDA, CQC.

• 5. Implementation

support Regional preparedness programmes, national events etc.

• 6. Workforce

development Joint work with HEE

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How will we measure the standard?

Both elements of the standard will be measured – the wait from referral to treatment and whether the treatment accessed is NICE concordant. We have been working with the HSCIC to specify:

• 1. What the ‘clock starts’ and ‘clock stops’ should be to measure the two-week

referral to treatment standard – the waiting time

• 2. What the NICE concordant “intervention codes” should be – the quality of

care We are also working to specify what the EIP outcomes dataset should be. We had to specify the changes required to the dataset by the end of December in

• rder for the dataset to change from 1st January 2016.

We will be using national clinical audit and / or accreditation to assess the quality of service provision in 15/16.

Expectations of commissioners

• Planning guidance requirement that SDIPs are agreed setting out how

commissioners and providers will prepare for and implement the new standard in 15/16 and achieve it on an ongoing basis from 1 April 2016.

• Clear expectation that the additional £40m funding being made available

recurrently should be invested recurrently in EIP services.

• Local agreement on pricing so increases should take into account baseline

performance against both elements of the EIP standard: Referral to treatment waiting times; and Current levels of NICE concordance – access to the range of evidence-based biological, psychological and social interventions as recommended by NICE guidelines for psychosis and schizophrenia in children and young people CG155 (2013) and in adults CG178 (2014).

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Regional preparedness work

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• 1. Raising awareness – What are the requirements of the new standard? What are the

implications? What are the opportunities?

• 2. Bringing together the experts and establishing quality improvement networks
• 3. Understanding demand – incidence, incidence profiles etc
• 4. Understanding the baseline position + gap analysis – staffing, skill-mix, competency

to deliver full range of NICE concordant interventions (the 2 week wait is the easy part…)

• 5. Developing the workforce – capacity, skills & leadership – can the workforce

deliver the full range of NICE concordant interventions as this will be the definition

• f ‘treatment’?
• 6. Optimising RTT pathways – need to engage all of the potential referral sources,

many of which will be internal within secondary care

• 7. Preparing for the new data collection requirements – developments to provider

systems to prepare for MHLDDS upgrade + training for service and information leads

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Initial findings from the South Region

• Population 12.5 million
• 15 Mental Health Trusts
• 25 EIP services
• Caseload of c4000

And c70 psychological therapists And c5 consultant psychiatrists Based on caseload, a gap of c75 care coordinators

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NHS | Presentation to [XXXX Company] | [Type Date] 25

• ii. Liaison mental health

services

What do liaison mental health teams do?

They provide services across the age range for people:

• In acute settings (inpatient or outpatient) who have, or are at risk of, mental ill

health;

• Presenting at A&E with urgent mental health care needs (particularly relating

to: self harm, dementia, mood disorders, alcohol abuse, psychosis relapse and co-occurring mental health and physical health conditions);

• Being treated in acute settings with co-morbid physical health conditions and

mental ill health;

• Being treated in acute hospital settings for physical conditions caused by

alcohol or substance misuse;

• Whose physical health care is causing mental health difficulties;
• In acute settings with medically unexplained symptoms (MUS).

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We want integrated physical & mental health care to become the norm

If we are to improve outcomes and quality of life for individuals with physical health needs, then:

• a. Promotion of positive mental health as

part of condition management

• b. Recognition of mental health needs
• c. Timely access to expert assessment and

evidence based mental health care Will need to be integrated at every level of the physical healthcare system. a + b + c = reduced demand from repeat attendances in primary care, UEC and outpatient clinics = reduced acute length of stay = better outcomes at lower cost for individuals with long term conditions

Another ‘no brainer’… They make sense in terms of our duty to deliver integrated, high quality compassionate care. Fully integrated liaison MH services could save an average hospital £4 for every £1 invested.

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What is the standard?

Achieving better access to mental health services by 2020 set the expectation that, by 2020, all acute trusts will have in place liaison psychiatry services for all ages appropriate to the size, acuity and specialty of the hospital. NHS England is supporting this aim by targeting £30m investment in 2015/16 to enable a greater number of acute hospitals to establish effective models of liaison psychiatry. It should be noted that, from 15/16, when the Care Quality Commission (CQC) rates acute services, it will include a specific focus on liaison mental health services and mental health care, as well as the quality of treatment and care for physical conditions. The planning guidance requires that commissioners agree service development and improvement plans (SDIPs) with acute providers, setting out how providers will work to ensure there are adequate and effective levels of liaison psychiatry services across acute settings.

How will we measure the standard?

• Commissioning a baseline and 12-month follow-up survey of liaison

mental health service staffing and skill-mix in each acute hospital and a supporting analysis of service adequacy relative to the size, acuity and specialty of each acute hospital.

• Working with the HSCIC to develop the MHLDDS so that, from April 16,

it will better support data capture and analysis of referral-to-response times, referral sources and discharge destinations.

• Exploring the potential for gaining additional data and insight through

the national clinical audit programme and we shall be seeking routinely to embed mental health in the ‘physical health’ audit programmes going forward.

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Approach to implementing the standard

• 1. Bringing together the

required expertise National expert reference group, NCCMH ‘hosting’, highly collaborative.

• 2. Developing the

required dataset MHLDDS and national clinical audit

• 3. Publication of

commissioning guidance Service specifications, service model exemplars, staffing / skill mix calculators etc

• 4. Design of levers &

incentives Planning guidance, payment system development, standard contract etc. Engagement with Monitor, TDA, CQC.

• 5. Implementation

support Sponsoring development of peer networks & accreditations schemes, national events etc.

• 6. Workforce

development Joint work with HEE 1242 1602 2603 2002 190 400 400 801

500 1000 1500 2000 2500 3000

Current Staffing Core Staffing Requirements Core 24 Staffing Requirements Enhanced Staffing Requirements Number of Whole Time Equivalent (WTE) staff

Current nurse and consultant numbers and those required to meet each grade of service for England's acute hospitals with A&E departments.

Nurses Consultants

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NHS | Presentation to [XXXX Company] | [Type Date] 33

• iii. IAPT for people

experiencing depression and anxiety disorders

Kevin Mullins Head of Mental Health (Delivery)

What is the standard?

The new waiting time standard requires that 75% of people with common mental health conditions referred to the Improved Access to Psychological Therapies programme will be treated within 6 weeks of referral, and 95% will be treated within 18 weeks of referral. The standard applies to adults. Services will continue to be required to maintain the access standard of ensuring that at least 15% of adults with relevant disorders will have timely access to IAPT services with a recovery rate of 50%.

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How will the standard be measured?

• The new national indicators will measure waiting times from referral date to

the start of a course of treatment – i.e. for those people who have two or more treatment sessions.

• Local areas will also be required to capture and monitor waits from referral to

first treatment appointment for all people who enter the service and this should include people who receive a single treatment session.

• Patient-initiated delays will not be taken into consideration when calculating

the IAPT indicator. Tolerances have been built into the IAPT standard to allow for such delays.

• A number of additional measures will be captured in national reports to guard

against the introduction of perverse incentives into local commissioning arrangements

• Technical indicator definitions can be found in the Forward view into action

2015/16 and frequently asked questions (FAQs) can be accessed via the Unify

• system. Further supporting guidance will be issued shortly.

Expectations of commissioners

• The planning guidance requires that commissioners should agree plans with

providers setting how they will prepare for and implement the new standards during 2015/16 and achieve these on an ongoing basis from 1 April 2016:  Commissioners will need to agree service development and improvement plans (SDIPs) as part of their 15/16 contract.  CCGs will also be required to submit plans setting out how they will meet the new waiting time standards. These will be monitored throughout the year and compliance will be assessed in the final quarter of 2015/16.

• The £10m implementation fund will be used to allocated in potentially:

1. Waiting list validation i.e. activity to confirm the accuracy of current waiting lists. 2. Additional / enhanced capacity i.e. in order to provide assessments / treatments. 3. Other infrastructure support to encourage improved practice & throughput

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Questions

NHS | Presentation to [XXXX Company] | [Type Date] 38

Delivering Transformation

• CAMHS
• Eating Disorders
• Perinatal

Kathryn Pugh kathryn.pugh1@nhs.net

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• New resources announced in the budget of £250M a year,

recurrent for 5 years

• This will be spent on building capacity and capability in

CAMHS to deliver evidence based, outcomes focussed care pathways in services that work in partnership with children, young people and families.

• Includes resource for rolling out the CYP IAPT programme

across the whole country (currently working with 68% of services covering 0-19yr population)

New resources for CAMHS

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• Plus £30M a year (recurrent for 5 years) for eating disorders which will be

used for specialist ED community teams. This will also release further general capacity into CAMHS for Crisis and self harm.

• The new service model will deliver:
• A more standardised level of provision for children, young people and

their families

• Better identification and swifter access to evidence based community

treatment

• Fewer transfers to adult services – reducing those who need to be

treated as adults

• Decrease in the use of inpatient beds
• Reduction in relapse
• To be delivered within the CYP IAPT programme framework - early

access to collaborative, effective evidence based and outcome focused treatment.

New resources to develop a service model for CAMHS Community Eating Disorder Services

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• NCCMH Expert Reference Group

 To agree a model of care/care pathways for community CAMHS ED services.  Performance measures  Access and waiting time standard to be in place 16/17  Training and workforce plans  Support for commissioners

• Develop appropriate training in the ED model
• ED Teams will be population-based so may span more than one CCG
• Funding likely to be through lead commissioners working in clusters with

providers

• Funding formula to give indicative budgets in development

Next steps for ED services

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• The new resources for CAMHS Capacity and Eating

Disorders will be contingent on the preparation of and agreement to publish robust, assured Transformation Plans to deliver the national ambition set out in Future in Mind.

• Lead CCGs would draw up the Plans, working closely

with Health and Wellbeing Board partners including local authorities. CAMHS Transformation Plans

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• Transparency - Local commissioning agencies: annual declaration of current

investment and needs of the local population with regards to the full range of provision for children and young people’s mental health and wellbeing. Providers: declaration of what services they already provide, including staff numbers, skills and roles, waiting times and access to information

• Service transformation - A requirement for all partners, commissioners or

providers, to sign up to a series of agreed principles covering: the range and choice of treatments and interventions available; collaborative practice with children, young people and families and involving schools; the use of evidence- based interventions; and regular feedback of outcome monitoring to children, young people and families and in supervision.

• Monitoring improvement - Development of a shared action plan and a

commitment to review, monitor and track improvements towards the aspirations set out in Future in Mind including children and young people having timely access to effective support when they need it.

CAMHS Transformation plans will include commitment to:

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• Funding will be contingent on development of robust published joint area

Transformation plans, assured by NHS England

• The components of transformation plans will include baseline information

plus action plans and locally agreed stretch targets around areas of particular concern

• Plans will need to demonstrate how resources will capacity to improve

access to services following evidence based best practice re outcome measures and readiness for CAMHS MDS - look at NHS England Model Specification for guidance.

• A letter will be issued shortly including timeframes, but do not wait for

guidance to start thinking locally how you will work together

What are we asking CCGs to think about?

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Questions

kevin.mullins@nhs.net sarah.khan@nhs.net kathryn.pugh1@nhs.net