IAPT What Now? What Next? Kevin Mullins Head of Mental Health 2 nd October 2015
Clinical Networks Business Planning Parameters for 2015/16
Business Planning Parameters for 2015/16 1. There should be a clinical network supported in each of the four mandated areas: a) Cancer b) Cardiovascular disease (incorporating cardiac, stroke, diabetes and renal disease) c) Children and maternity d) Mental health, dementia and neurological conditions 2. In each of the above four areas, Clinical Networks business plans should reflect the small set of national priority actions, as set out by the relevant Clinical Policy Teams and National Clinical Directors. They should also reflect local circumstances and need, drawing from 5 year strategic plans. SMART objectives should be developed for each 3. Clinical Network support teams may identify other clinical areas in which they will support Clinical Networks in their geography, according to local circumstances and need. These should be clearly identified in business plans, with SMART objectives set out for each. 4. Clinical Networks business plans should be aligned with business plans of their local Academic Health Science Networks to ensure that i) there is no duplication; and ii) they provide an aligned support offering to local commissioners and providers. 3
National Priority Actions MENTAL HEALTH, DEMENTIA AND NEUROLOGICAL CONDITIONS 1. Supporting the development and implementation of a new national plan for mental health to 2020 aligned to the vision in the Five Year Forward View. This will focus on evidence based interventions, implementation through service development/transformation& assurance through effective data capture and reporting in the following areas: o better prevention, o increased early access to effective treatments and crisis care, o integration of care to address mental and physical health co-morbidities, improve outcomes and reduce premature mortality o new commissioning& delivery models incorporating adoption/adaptation new technologies. 2. Supporting the maintenance or achievement of commitments set out in the NHS mandate or elsewhere in: o crisis care o dementia diagnosis and post diagnostic support o IAPT Access & Recovery o access& waiting time standards for: EIP; IAPT; Liaison Psychiatry; Eating Disorders 3. Facilitating transformation through local service improvement or development in order to: o Ensure timely access to NICE concordant perinatal mental health services (sitting across Children & Maternity Network) o Ensure effective transition from CAMHS to AMHS and on to Older People Mental Health services consistently for all patients as required o Transform and increase scope/capacity in CAMHS(sitting across Children& Maternity Network) 4. For neurological conditions enabling the establishment of a Collaborative of Interested Clinical Networks to progress priority work around developing the spread of Community-based service models through for example the development of a suite of commissioning tools to support CCGs
IAPT What Now?
October November December Q3 2014-2015 January February March Q4 2014-2015 April May June Referrals 113,287 103,277 89,218 313,349 112,683 111,609 123,474 355,277 103,897 99,893 114,126 Referral Rate 22.23% 20.27% 17.51% 20.50% 22.12% 21.90 24.23% 23.24% 25.69% 19.61% 22.40% Entering treatment 72,278 68,515 61,285 202,051 76,749 74,439 87,660 238,856 75,348 69,415 85,428 Annualised Access Rate 14.19% 13.45% 12.03% 13.22% 15.06% 14.61% 17.20% 15.63% 14.79% 13.62% 16.77% Completers 42,444 38,738 37,031 117,813 39,790 39,435 47,542 126,405 44,146 42,167 47,594 Ave Waiting (Days) 32.3 28.5 28.1 29.6 31.5 27.5 24.6 27.9 29.5 26.3 29.9 Less than 6wks Wait to Treatment Less than 18wks Wait to Treatment Number of referrals moving to recovery 75.4 75.9 76.9 77.5 77.1 78.0 79.9 80.3 79.8 94.3 94.5 94.5 95.3 95.6 95.9 96.2 96.1 96.4 47,036 16,306 16,388 19,467 52,046 18,220 17,480 19,625 Recovery Rate 44.2 44.7 43.9 44.3 45.1 46.2 45.2 45.5 45.4 45.5 45.3 Reliable Improvement 60.4 61.7 61.7 61.5 61.6 61.6 61.7 61.4 No of working days 23 20 21 64 21 20 22 63 20 19 22 Access Daily Average 3,145.52 3,425.75 2,918.33 3,157.47 3,654.71 3,721.95 3,984.55 3,791.37 3,767.40 3653.42 3883.09
IAPT - Access Rate, Annualised Comparing Regions 60% IAPT Recovery Rate Comparing Regions 20% 18% 50% 16% Percentage % 14% 12% 10% 8% 6% 4% 2% 0% Percentage % 40% 30% 20% 10% 0% Q2 14-15 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 LONDON MIDLANDS AND EAST OF ENGLAND NORTH OF ENGLAND SOUTH OF ENGLAND ENGLAND LONDON MIDLANDS AND EAST OF ENGLAND NORTH OF ENGLAND SOUTH OF ENGLAND ENGLAND
People completed treatment in 6 weeks People entered treatment in 18 weeks 100.0% 100.0% 90.0% 98.0% 80.0% 70.0% 96.0% Percentage % 60.0% 50.0% 40.0% Percentage % 94.0% 92.0% 90.0% 30.0% 20.0% 88.0% 10.0% 86.0% 0.0% Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 84.0% Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 LONDON MIDLANDS AND EAST OF ENGLAND NORTH OF ENGLAND SOUTH OF ENGLAND ENGLAND LONDON MIDLANDS AND EAST OF ENGLAND NORTH OF ENGLAND SOUTH OF ENGLAND ENGLAND
NHS LAMBETH CCG NHS RICHMOND CCG NHS ISLINGTON CCG NHS NEWHAM CCG NHS SOUTHWARK CCG NHS TOWER HAMLETS CCG NHS LEWISHAM CCG NHS HAMMERSMITH AND FULHAM CCG NHS WEST LONDON (K&C& QPP) CCG NHS HILLINGDON CCG NHS CAMDEN CCG NHS BRENT CCG NHS BEXLEY CCG NHS CITY AND HACKNEY CCG NHS WANDSWORTH CCG NHS CENTRAL LONDON (WESTMINSTER) CCG NHS HOUNSLOW CCG NHS KINGSTON CCG NHS EALING CCG NHS HARINGEY CCG NHS WALTHAM FOREST CCG NHS SUTTON CCG NHS BARKING AND DAGENHAM CCG NHS GREENWICH CCG NHS BROMLEY CCG NHS BARNET CCG NHS MERTON CCG NHS HAVERING CCG NHS REDBRIDGE CCG NHS ENFIELD CCG NHS HARROW CCG NHS CROYDON CCG 5.00% 4.50% 4.00% 3.50% 3.00% 2.50% 2.00% 1.50% 1.00% 0.50% 0.00% IAPT Access Rate, Rolling Quarter ending Jun 2015 Access Rate Standard LONDON ENGLAND Percentage %
NHS GREENWICH CCG NHS BARKING AND DAGENHAM CCG NHS ENFIELD CCG NHS HARINGEY CCG NHS NEWHAM CCG NHS TOWER HAMLETS CCG NHS WALTHAM FOREST CCG NHS HAMMERSMITH AND FULHAM CCG NHS LAMBETH CCG NHS EALING CCG NHS RICHMOND CCG NHS ISLINGTON CCG NHS HARROW CCG NHS LEWISHAM CCG NHS HAVERING CCG NHS CROYDON CCG NHS HILLINGDON CCG NHS HOUNSLOW CCG NHS WANDSWORTH CCG NHS CITY AND HACKNEY CCG NHS KINGSTON CCG NHS MERTON CCG NHS BARNET CCG NHS SUTTON CCG NHS BEXLEY CCG NHS SOUTHWARK CCG NHS WEST LONDON (K&C& QPP) CCG NHS CAMDEN CCG NHS CENTRAL LONDON (WESTMINSTER) CCG NHS BRENT CCG NHS REDBRIDGE CCG NHS BROMLEY CCG 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% IAPT Recovery Rate, Month Ending Jun 2015 Recovery Rate Standard LONDON ENGLAND Percentage %
1,200 1,000 800 600 400 200 Incomplete Pathway, People Waiting for Treatment Month Ending Jun 2015 Patients waiting for treatment 0 Number Waiting NHS CAMDEN CCG NHS ISLINGTON CCG NHS CITY AND HACKNEY CCG NHS LEWISHAM CCG NHS BARNET CCG NHS SOUTHWARK CCG NHS LAMBETH CCG NHS BROMLEY CCG NHS HAMMERSMITH AND FULHAM CCG NHS HOUNSLOW CCG NHS BRENT CCG NHS ENFIELD CCG NHS WEST LONDON (K&C& QPP) CCG NHS HILLINGDON CCG NHS TOWER HAMLETS CCG NHS CENTRAL LONDON (WESTMINSTER) CCG NHS WANDSWORTH CCG NHS HARINGEY CCG NHS HARROW CCG NHS CROYDON CCG NHS MERTON CCG NHS EALING CCG NHS NEWHAM CCG NHS SUTTON CCG NHS RICHMOND CCG NHS BEXLEY CCG NHS WALTHAM FOREST CCG NHS GREENWICH CCG NHS KINGSTON CCG NHS REDBRIDGE CCG NHS HAVERING CCG NHS BARKING AND DAGENHAM CCG
IAPT Central Support Timeline Run Leadership and Training events accompanied by re-launch of the IAPT Enhanced Recovery High Impact Changes Nov-March 2015/6 Create greater granularity on recovery rates by step, modality and diagnostic coding in NHS England report/risk list and use with individual providers Dec 2015/6 Establish Buddy Arrangements for worst performing providers Start Oct 2015/6 Establish a consensus on factors that limit potential for recovery (e.g. deprivation) Oct 2015/6
IAPT Enhanced Recovery Top Factors (high impact changes) to enhance recovery 1 Assessment and Choice 1.1 - Being able to identify the main problem(s) that need treating (i.e. identify the relevant ICD-10 codes for provisional diagnosis as part of a personal centred assessment) 1.2 - A choice of treatments (CBT and non-cbt) are available so patients with depression are offered the range of therapies recommended by NICE (see NICE Depression Guidelines) 2 Optimised Performance Management Systems 2.1 - Delivering a sufficient dose of therapy at the right steps to maximise opportunity for reliable improvement and recovery. Avoiding excessive doses of therapy by having agreed sets of sessions (say 6), followed by review and extension as appropriate (i.e some response evident but patients hasn t recovered) 2.2 - Organisations and individual therapists are held to account for ensuring data recorded is reliable, complete and accessible. 2.3 - Clinical productivity is optimised by the data being available to the whole team and used to facilitate effective administrative processes as well as case management 3 Leadership and Staff Engagement 3.1 - Stable leader ship, good staff support and attention to wellbeing. 3.2 - Clinical supervision is regular (weekly), outcome focussed, supportive, and feeds into CPD plans for the therapist.. 4 Workforce 4.1 - A workforce that includes a core of staff with long experience in delivering IAPT modalities. 5 Commissioning 5.1 - The service is of sufficient size. 5.2 - Service is focused on treatment 5.3 - Avoiding perverse incentives in commissioning tariffs. 5.4 - Commissioning clear pathways and expected outcomes at step and diagnostic group level.
IAPT What Next?
Build on the success of IAPT by: The SR Proposal Increasing the scale of the depression and anxiety services to meet at least 25% of need. Extending the benefits of the IAPT approach to children (with a similar access target), and to adults with other mental health problems. Principles (supported by Consensus Statement): NICE-recommended therapies delivered by properly trained therapists. Therapists receive regular (weekly) case supervision and are managed as a team with an appropriate IT system that supports supervision as well as outcome monitoring. All patients have their outcomes recorded and service-level outcomes are published. Therapy is delivered in the most cost-efficient manner, utilising stepped-care when appropriate. Focused on: People with concurrent long-term physical conditions (diabetes, cardiovascular disease, COPD, cancer, medically unexplained symptoms, etc.) and People with employment issues (sickness benefit, out of work).
Operational Features Co-location - secondary care specialist clinics, and primary care plus job centres On-going demonstration of savings - roll-out step-wise with early adopters being required to collect information on physical healthcare costs as well as clinical plus similar monitoring of savings for employment Improved efficiency - substantially reduced cost per recovery through increased productivity and efficiency