Early Intervention in Psychosis Network 13 February 2020 Health/EIP... · •The Portfolio will...

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 [email protected]

• Twitter: @YHSCN_MHDN #yhmentalhealth

• February 2020

Yorkshire and the Humber

Mental Health Network

Early Intervention in Psychosis Network

13 February 2020

mailto:[email protected]

www.england.nhs.uk



Welcome and HousekeepingSarah 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!!

http://www.slido.com/

www.england.nhs.uk



University of Hull 2020 CBTp program,

supervision workshops and masterclassesGavin 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

https://shop.hull.ac.uk/conferences-and-events

www.england.nhs.uk



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

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 2. Frimley Health and Care3. Dorset4. Bedfordshire5. Nottinghamshire 6. Lancashire and South Cumbria 7. Berkshire West8. Buckinghamshire9. Greater Manchester (devolution deal)10. Surrey Heartlands (devolution deal)11. Gloucestershire12. West Yorkshire and Harrogate

13. Suffolk and North East Essex14. 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.

21Prevention 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 opportunity 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

28Principles 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

or online communities

Local facilities and services

Services such as education and employment and spaces, often 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.

Socie

ty

Socie

ty 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 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

32

Prevention Concordat animation

33Prevention Concordat for Better Mental Health - Commitment action plan

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

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 NamePeople started Treatment

within 2 weeks %Team Name

People started Treatment within 2 weeks %

Bradford & Airedale Redcar and ClevelandNorth Cumbria York & SelbyPSYPHER BarnsleyNAViGO Calderdale InsightGateshead EIP North Kirklees Insight North Tyneside EIP South Kirklees Insight Northumberland EIP Wakefield Sunderland EIP Harrogate, H&RNewcastle EIP North DurhamSouth Tyneside EIP HartlepoolDoncaster StocktonNorth Lincs Scarborough, W&RRotherham South DurhamSheffield MiddlesbroughAspire, Leeds

National Quality PerformanceQuality:

NICE quality standards and Contextual features

2019

Target Performance

ENGLAND

25% Performing

Well

22% Performing Well

18% GNFI

ACCESS56% 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 improvementNorth Cumbria Performing well York & Selby Greatest need for improvementPSYPHER Performing well Barnsley Top performingNAViGO Needs improvement Calderdale Insight Top performingGateshead EIP Needs improvement North Kirklees Insight Top performingNorth Tyneside EIP Needs improvement South Kirklees Insight Performing wellNorthumberland EIP Needs improvement Wakefield Top performingSunderland EIP Needs improvement Harrogate, H&R Greatest need for improvementNewcastle EIP Needs improvement North Durham Needs improvementSouth Tyneside EIP Top performing Hartlepool Needs improvementDoncaster Needs improvement Stockton Needs improvementNorth Lincs Needs improvement Scarborough, W&R Greatest need for improvementRotherham Needs improvement South Durham Needs improvementSheffield Needs improvement Middlesbrough Needs improvementAspire, 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 improvementNorth Cumbria Performing well York & Selby Greatest need for improvementPSYPHER Performing well Barnsley Top performingNAViGO Needs improvement Calderdale Insight Top performingGateshead EIP Needs improvement North Kirklees Insight Top performingNorth Tyneside EIP Needs improvement South Kirklees Insight Performing wellNorthumberland EIP Needs improvement Wakefield Top performingSunderland EIP Needs improvement Harrogate, H&R Greatest need for improvementNewcastle EIP Needs improvement North Durham Needs improvementSouth Tyneside EIP Top performing Hartlepool Needs improvementDoncaster Needs improvement Stockton Needs improvementNorth Lincs Needs improvement Scarborough, W&R Greatest need for improvementRotherham Needs improvement South Durham Needs improvementSheffield Needs improvement Middlesbrough Needs improvementAspire, Leeds Needs improvement

Assurance NETeam 18/19

NCAP Score

18/19 NCAP Trajectory

19/20

Trajectory

20/21

Trajectory

23/24Recovery 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&HTeam 18/19

NCAP Score

18/19 NCAP Contextual

Factors

Trajectory 19/20 Trajectory

20/21

Trajectory

23/24Recovery 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

ContextualStatusProvision for

ChildrenDemand/Capacity:

240/120Investment:

£4,500pp

ARMS Pathway

Age range:14-65

Data Quality & Snomed

Development DashboardExample

Access: 84%

NICE: Level 2

Outcomes: Level 1

NCAP rating:Level 2

Stand-alone MDT

3-Year service:40m

Caseloads: 17.6

ContextualStatus

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 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.

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

https://www.longtermplan.nhs.uk/publication/nhs-mental-health-implementation-plan-2019-20-2023-24/

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

0 0 0

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 0 0 0

Total 13 30 23

Physical health checks for

people with Severe Mental

Illnesses

Central /

Transformation

0 0 0


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

0 31 52


Total 0 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

https://www.longtermplan.nhs.uk/publication/nhs-mental-health-implementation-plan-2019-20-2023-24/

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




people with eating











people with eating








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


[An additional 22,000

above FYFVMH

ambition]

A total of 346,000

people receiving



above FYFVMH

ambition]

A total of 390,000

people receiving



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.

https://www.england.nhs.uk/publication/the-community-mental-health-framework-for-adults-and-older-adults/

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,

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

£52m

www.england.nhs.uk

Allocation of additional LTP

investment in EIP in 2020/21

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

www.england.nhs.uk

Allocation of additional LTP

investment in EIP in 2020/21NHS Airedale, Wharfedale and Craven CCG £147,395NHS Barnsley CCG £254,720NHS Bassetlaw CCG £111,931NHS Bradford Districts CCG £306,220NHS Calderdale CCG £192,480NHS Bradford City CCG £115,962NHS Doncaster CCG £306,799NHS East Riding of Yorkshire CCG £281,119NHS Greater Huddersfield CCG £207,296NHS Hambleton, Richmondshire and Whitby CCG £126,993NHS Harrogate and Rural District CCG £134,721NHS Hull CCG £281,781NHS North Kirklees CCG £168,642NHS North Lincolnshire CCG £161,357NHS Rotherham CCG £246,602NHS Scarborough and Ryedale CCG £116,214NHS Sheffield CCG £509,617NHS Vale of York CCG £282,120NHS 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 ClevelandNorth Cumbria York & SelbyPSYPHER BarnsleyNAViGO Calderdale InsightGateshead EIP North Kirklees Insight North Tyneside EIP South Kirklees Insight Northumberland EIP Wakefield Sunderland EIP Harrogate, H&RNewcastle EIP North DurhamSouth Tyneside EIP HartlepoolDoncaster StocktonNorth Lincs Scarborough, W&RRotherham South DurhamSheffield MiddlesbroughAspire, 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-2Aspire crew:

https://www.justgiving.com/crowdfunding/stephen-mcgowan-2

http://iris-initiative.org.uk/

http://iris-initiative.org.uk/

www.england.nhs.uk



Time for a break?

www.england.nhs.uk



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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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



Summary & CloseDr Steve Wright, Co-Chair, Consultant Psychiatrist, TEWV & Clinical Advisor,

Y&H Clinical Network

www.england.nhs.uk



Thank You for Attending!

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