NHS | Presentation to [XXXX Company] | [Type Date]1 1. Context for the introduction of access & waiting time standards

MH 5YP: rebalancing the system An effective ‘in balance’ mental health system would: Ensure rapid detection of mental ill health and access to evidence- based treatment in community settings. Provide responsive and compassionate care to individuals at risk of or in crisis. Provide safe, high quality inpatient care where community alternatives are not appropriate Enable discharge from inpatient care through provision of personalised packages of home-based support

The system is currently not in balance

There is a year gap in the life expectancy of individuals with serious mental illness compared with the rest of the population Health promotion activity, physical health assessments and interventions need to be integrated at every level if the year mortality gap is to be closed.

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

The 15/16 Access & Waiting Time Standards 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. 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. Achieving better access to mental health services by 2020 set the expectation that, by 2020, all acute trusts will have in place liaison mental health services for all ages appropriate to the size, acuity and specialty of the hospital.

The Financial Package The new standards for 15/16 will be 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 standard (criteria for distribution in development); and £30m to support delivery of the liaison psychiatry standard (criteria for distribution in development). In addition: 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.

Eating Disorders 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.

The new guidance 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 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.

NHS | Presentation to [XXXX Company] | [Type Date]10 2. Early intervention in psychosis

What is the standard? 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) or in adults CG178 (2014).CG155 (2013) 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.

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.CG155 (2013) CG178 (2014)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.

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 order for the dataset to change by 1 st January We hope to use national clinical audit and / or accreditation to assess the quality of service provision in 15/16.

Draft EIP Referral to Treatment (RTT) pathway 15

Referral to clock start 16

Assessment 17

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 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). CG155 (2013)CG178 (2014)

19 National Resources to Support Implementation 1. Bringing together the required expertise National expert reference group, NCCMH ‘hosting’, highly collaborative. Regional implementation steering groups. 2. Developing the required dataset – waiting times and quality of care Different approaches for 15/16 and 16/17 and beyond. Potential use of audit. Laying the groundwork for other A&W standards 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 supportSponsoring development of peer networks & accreditations schemes, national events, learning networks etc. 6. Workforce developmentJoint work with HEE

Regional preparedness work (£200k per region) 20 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 of ‘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

Midlands and East EIP preparedness Building on work over the past decade in the West, Midlands, East Midlands and East of England NIHR East of England Early Intervention Fellows Drawing on research from EoE DH systematic review of incidence in England Psymaptic web tool Supporting existing clinical EI networks in each sub-region New collaborations with AHSNs in Midlands & East – clinicians, managers, academics, commissioners, patients from across the region NHS | Presentation to [XXXX Company] | [Type Date]21

Challenges 22 We need to prepare this implementation support package quickly but we also want to do it well Needs to be shared understanding regarding not only on the benefits of EIP services but also ‘what good looks like’ and the complete package of interventions / staffing / skillmix required to deliver these benefits. Investing ‘upstream’ always more challenging against a background of significant financial pressures Delivery of the EIP standard will require significant workforce development – capacity and access to accredited training programmes A paucity of granular baseline data

Opportunities 23 We have a real opportunity to improve the quality of care that people receive and improve outcomes Can set a precedent for future access & waiting time standards – clinically informed waiting time standards for evidence based care Doing this quickly and doing this well will demand collaboration and joint working – great energy and enthusiasm to be harnessed Opportunities to review levers and incentives to try to ensure that they better ‘line up’ to incentivise timely access to effective care Could deliver a ‘step change’ in the quality of the data that we have available to evaluate the value of care delivered

Contact Details NHS | Presentation to [XXXX Company] | [Type Date]24 Simon Clark Team Manager: Enfield Early Intervention Service Barnet, Enfield & Haringey Mental Health NHS Trust Project Manager: Mental Health Access and Waiting Times Standard London Office for CCGs