The first Access and Waiting Time standard for Mental Health services was introduced in April 2016. 50% of those with a first episode of psychosis should be assessed and treated within an Early Intervention in Psychosis service within 14 days of referral. Most EIP teams across the South of England were not funded, staffed, or skilled to be able to deliver this standard. We recruited clinical leads from each of the 32 EIP teams (16 Trusts) across the South of England. We have met monthly over webex since April 2015 as a community of EIP clinicians. We designed the EIP Matrix - a web based data collection tool to collect data on the activity, staffing, performance, outcomes and funding of our services
What We Did
The first Access and Waiting Time standard for Mental Health services was introduced in April 2016. 50% of those with a first episode of psychosis should be assessed and treated within an Early Intervention in Psychosis service within 14 days of referral.
Most EIP teams across the South of England were not funded, staffed, or skilled to be able to deliver this standard. As a result over 4000 young people with psychosis were not receiving evidence-based treatments, with worse long term outcomes. The delivery of NICE concordant care and timely access has not been measured before.
We recruited clinical leads from each of the 32 EIP teams (16 Trusts) across the South of England. We have met monthly over webex since April 2015 as a community of EIP clinicians.
We designed the EIP Matrix – a web based data collection tool to collect data on the activity, staffing, performance, outcomes and funding of our services. We undertook this baseline assessment August 2015. The tool was filled in by clinical leads for their own services.
The EIP Matrix is openly available to all our 16 Trusts and 50 CCGs and is used in many areas in an ongoing way, for planning and monitoring EIP service delivery. It is therefore sustainable. It is also being adapted to support other programmes, such as perinatal mental health.
Wider Active Support
We shared the data from our baseline assessment with each of our 50 CCGs and 16 mental health providers. We have also supported them to develop of Service Development and Improvement Plans (SDIPs) for each EIP service.
We presented our data to NHS England South, and Health Education England and were given a budget of £1 million to support workforce development and training for EIP teams. We allocated this funding, according to the gaps identified from our data.
Our team includes several Experts by Experience, carers, Carer Participation Leads and a Patient Participation and Involvement Lead. All our activities are designed and co-created with service user and carer involvement with reimbursement for people’s time and contribution to the programme.
Our South West EIP Network has recently completed a Peer Review pilot project where people with lived experience of psychosis and carers helped to design a training workshop and participated in the peer review visits. We are soon to move on to collating the qualitative data and key themes from the visits, and this will again involve people access the EIP services.
Looking Back/Challenges Faced
The main challenge is funding. The funding for EIP is not ring-fenced and the funding that EIP services receive is not the same that NHS England has allocated nationally. We have been transparent with our findings and shared data widely, e.g. NHS England, Chief Executive Forum, National Clinical Director for Mental Health, Rt Hon Norman Lamb – who raised the issue in parliament.
The other key challenge in delivery of the programme is in recruiting and retaining staff with several factors making the South of England particularly vulnerable to staffing shortages. For example, our proximity to London makes it difficult to recruit staff as they might be more attracted to London jobs which offer London Weighting as part of the contract.
We have shared different strategies used by Trusts to recruit and retain staff, including:
1) Golden hellos or short term extra funding to attract new staff, 2) Offer of CBT and other psychological training package as part of recruitment, 3) sharing of posts across multiple organisations – underpinned by Sustainability & Transformation Plan footprints.
Each of our regions i.e. South West, South Central (Thames Valley), Wessex and South East now has a clinical lead with full access to the EIP Matrix which will continue to give EIP teams real time graphed information on their:
– Investment per patient
– NICE Concordance
– Performance and Outcomes
This will ensure that the teams have resources to have meaningful dialogue with commissioners regards adequate resourcing to meet current and future demand.
Evaluation (Peer or Academic)
The BMJ has reviewed our programme and shortlisted it as mental health team/network of the year. We are in discussions with Oxford University and partners about an economic analysis of the programme’s work.
EIP teams in the South of England continue to demonstrate a real drive to improve outcomes and share expertise for adoption of good practice at pace. Even though none of the EIP Services in the South of England have reached the estimated required investment of £8,250 per patient, EIP teams continue to deliver superior outcomes when compared to standard mental healthcare. Most notably, almost half (42%) of people accessing EIP are in employment and/ or education, whilst 72% are in settled accommodation.
We share our experience and learning in various ways including quarterly face to face networking forums which take place in the South West, South Central, Thames Valley, Wessex and South East.
We also have a Twitter account (@time4recovery which currently has 19,000 followers who are engaged and regularly comment on our communications.
We send out a monthly e-newsletter to share progress and developments and we have a website (www.time4recovery.com) which is regularly up dated.
We also worked with people who have accessed EIP to develop an animation video titled ‘What is Psychosis’ that has been viewed on Youtube 19,000 times in the last 7 months.
Is there any other information you would like to add?
We have recently published a follow up report for 2016, having produced our baseline report in 2015. We are happy to share our findings if this would be helpful.