nhs england iapt programme - iaptus | the leading patient ... · pdf file nhs england iapt...
TRANSCRIPT
www.england.nhs.uk
NHSEnglandIAPTProgramme
AnupdateontheFiveYearForwardViewcommitmentsforIAPT
IAPTConnect2017
UrsulaJames– NationalIAPTProgrammeManager
www.england.nhs.uk 3
2016 conference - What do the national IAPT team’s priorities look like for
services?• DesigninganddevelopingwithlocalareasnewintegratedIAPTservicemodels
andbusinesscasestosupporttheirspread– inbothprimaryandsecondarycare.
• Improvingtheequalityofaccessandoutcomesforalladults(olderpeopleandpeoplefromminorityethnicgroupsareunderrepresented inservices. Theproportionofolderpeopleinservices hasrisenfollowingfocusedlocalandnationalworktoimproveit,butstillneedswork)
• Improvingthequalityofservices– improvingandsustainingtherecoveryrate,addressingvariability,improvingtheoutcomesforpeopleusingservices intheperinatalperiod,improvingchoiceoftreatments inservices
• Improvingtheproductivityofservices – startingwithencouragingappropriateuseofdigitalservices.
• SupportingtheimplementationofactivityandoutcomesbasedpaymentinIAPT
• ImprovingthesustainabilityoftheIAPTworkforce
www.england.nhs.uk 4
2016 conference - What do the national IAPT team’s priorities look like for services?
• Improvingtheequalityofaccessandoutcomesforalladults(olderpeopleandpeoplefromminorityethnicgroupsareunderrepresented inservices.Theproportionofolderpeople inserviceshasrisenfollowingfocusedlocalandnationalworktoimproveit,butstillneedswork)
v QualityPremium2017-2019v WorkthroughClinicalNetworksv ActionPlanwithactionsforproviders,clinicalnetworksandcommissionersv Awarenesscampaignv WorkthroughAgeUKv Conferences
8th NovemberReadingSouthRegionClinicalNetworkshttps://www.eventbrite.co.uk/e/iapt-older-adults-conference-tickets-3741427610722nd NovemberMidlandsClinicalNetworks(notyetavailabletobook)
22/09/2017,19:30📖 @sophieshaesam #IAPTProgManager.#ClinicalNetworks improvingaccesstopsychologicaltherapiesforolderadults.ow.ly/xYrf30ff3hmpic.twitter.com/uCXGoaIa1H
www.england.nhs.uk 6
Older Adults ActionsAction ByWhomAskIAPTproviderstosupplyactivityandoutcomedataforOlderPeopletakeupofIAPTservices.ThisdatashouldbecomparedwithlocalpopulationdatatoseeiftheIAPTserviceismeetingtheneedsoftheolderlocalpopulation.
Thefollowingdatawouldbeusefultocollectbrokendownbyage:• Thenumbersofpeoplereferredfortreatment• Thenumbersofpeopleenteringtreatment• Thenumbersofpeoplecompletingtreatment• Thenumbersofpeoplereachingrecovery
MentalHealthCommissioners
ClinicalNetworks
IncentiviseIAPTservicestoengageolderpeopleintherapy. MentalHealthCommissioners
EnsurethatfundingisavailabletoensurethatIAPTservicesareabletoofferhomevisitstoprovidetreatment MentalHealthCommissioners
EnsurethatalltherapystaffcompletetheIAPTolderpeoples’trainingmodule.ThismoduleisembeddedwithincurrentIAPTaccreditedtrainingcourses.PeoplewhocompletedtheirIAPTPWP&HITtraining(includingfourmodalitytrainingpriortothe2011/12academicyearshouldreceivethetrainingascontinuousprofessionaldevelopment.ThistrainingprovidesIAPTtherapistswithknowledgeandtechniquesthatwillenhancetheirtreatmentofolderpeople.
IAPTServices
HEE
EnsurethatIAPTserviceundertakeoutreachactivitytoengageolderpeople.TheIAPTprogrammeisworkingwithAgeUKtopromoteIAPTservicestoolderpeople.MaterialshavebeendistributedtoallGPsandAgeUKcentresandsupporters.WeaskIAPTservicestodistributematerialstolibraries,luncheonclubs,bowlsclubsandotherplacesthatolderpeoplemightgettoseeinformationabouttheirIAPTserviceintheirownlocalities.
IAPTServices
ContactlocalAgeUKcentrestoseeifyoucanworkwiththemtoincreasereferralsfromolderpeople IAPTServices
EnsurethatlocalIAPTservicesareabletoprovidehomevisitsasmanyolderpeoplemayhavemobilityissuesthatmeanitisdifficultforthemtocometoyourpremisesfortreatment
IAPTServices
Continuetomonitortheequalityofaccess,outcomeandexperienceofolderpeople’suseofIAPTservices IAPTProgramme
ContinuetoworkwithAgeUKtopromoteIAPTservicestoolderpeople IAPTProgramme
www.england.nhs.uk
Ethnicgroup ReferralsReceived2014/15
ReferralsReceived2015/16
AsianorAsianBritish (Includesall) 4.77% 5.1%BlackorBlackBritish (Includesall) 2.91% 3.06%Mixed- AnyOtherMixedBackground 2.25% 2.39%OtherEthnicGroups- AnyOtherEthnicGroup
1.28% 1.39%Chinese 0.21% 0.22%White- AnyOtherWhiteBackground 4.31% 4.28%White- British 83.45% 82.83%White- Irish 0.82% 0.79%
7
Ethnicity – rates of referral
www.england.nhs.uk 8
Action ByWhomAskIAPTproviderstosupplyactivityandoutcomedataforBMEtakeupofIAPTservices.Thisdatashouldbecomparedwithlocalpopulation datatoseeiftheIAPTserviceismeetingtheneedsofthelocalpopulation.
Thefollowingdatawouldbeusefultocollectbrokendownbyethnicity:• Thenumbersofpeoplereferredfortreatment• Thenumbersofpeopleenteringtreatment• Thenumbersofpeoplecompletingtreatment• Thenumbersofpeoplereachingrecovery
MentalHealthCommissioners
ClinicalNetworks
MonitortheperformanceoftheirIAPTservicesinmeetingtheneedsoftheircommunities.IAPTservicesshouldbeheldtoaccountfortheirperformanceinensuringthatpeoplefromblackandminorityethniccommunitiesaregettingequitableaccess,outcomeandexperiencesfromIAPTservices.
MentalHealthCommissioners
ClinicalNetworks
LooktoincentiviseIAPTservicestoengagemorepeoplefromBMEcommunities MentalHealthCommissioners
Ensurehighlevelsofdatacompletionofethnicitydata.In2015/16,9.4%ofIAPTclientsdidnothavevalidethnicitydatarecorded. IAPTProviders
Ensurethatyouhaveuptodateandaccurateethnicitydatafortheareayouservetoactasabenchmark. IAPTProviders
EnsurethatyourIAPTserviceundertakeoutreachactivitytoengagepeoplefromBMEcommunities.Faithgroupsandethnicminoritycommunitygroupsareausefulstartingpoint.
IAPTProviders
TrytoensurethatyourIAPTworkforcereflectthedemographyofyourlocalpopulation,trytorecruitworkerswhowillhelpyourstaffgroupreflectthelocalcommunity
IAPTProviders
Donotassumethatanyclientwill wanttobeseenbysomeonefromtheirowncommunity.Thisisnotnecessarilythecase.Asktheclientwhattheyrequireandrespondtotheirneeds
IAPTProviders
Ifyouareusinginterpretersinyourservice,ensurethatyoutrainyourinterpreterstounderstandthelanguageandprocessesoftherapy.AlsoensurethatyoutrainyourIAPTtherapiststouseinterpreterseffectively.
IAPTProviders
Continuetomonitortheequalityofaccess,outcomeandexperienceofpeoplefromblack,AsianandminorityethniccommunitiesuseofIAPTservices
IAPTProgramme
EnsurethattheGoodPracticeCaseStudies,onthebarrierstoBMEcommunitiesusingIAPTservicesandhowthesehavebeenovercometoimprovebothaccessandoutcomes,iswidelydisseminatedtoIAPTservicesandmentalhealthcommissionersthroughClinicalNetworks
IAPTProgramme
Ethnicity Actions
www.england.nhs.uk 9
2016 conference - What do the national IAPT team’s priorities look like for
services?• Improvingthequalityofservices– improvingandsustainingtherecoveryrate,
addressingvariability,improvingtheoutcomesforpeopleusingservices intheperinatalperiod,improvingchoiceoftreatments inservices
v PerinatalMappingExerciseQ416/17v RecoveryratemetforfirsttimeJanuary2017nationallyv Workingwithclinicalnetworkstoaddressvariation
www.england.nhs.uk 10
Improving quality and reducing variance
TheImprovingAccesstoPsychologicalTherapiesManual
Commissioned byNHSEngland
www.england.nhs.uk 11
2016 conference - What do the national IAPT team’s priorities look like for
services?• Improvingtheproductivityofservices– startingwithencouragingappropriateuseof
digitalservices.
v JamesWoollardtopresentonDigitalworkstreamsanduseofdigitalmethodsofdeliveringNICEapprovedevidencebasedtreatments
www.england.nhs.uk 12
2016 conference - What do the national IAPT team’s priorities look like for
services?• Supportingthe implementation ofactivityandoutcomesbasedpaymentinIAPT
v NationalTariff– activityandoutcomes-basedpaymentinIAPTfromApril2018
• PolicyobjectivesFYFVMH- Recommendedpaymentsystemthatwillincreasetransparencyinthepaymentsystemandsupportimprovementsbylinkingpaymenttoqualityandoutcomemeasures
• 2017/19NationalTariffLocalpricingrule8requires:
• theadoptionanoutcomes-basedpaymentapproach• useofthe10nationaloutcomemeasurescollected intheIAPTdataset
WorkjointlyledbyNHSEnglandandNHSImprovement
FAQsarebeingdeveloped
Allservicesmustbeclusteringpatientsnowtoestablishabaselineanddevelopalocaltariff
www.england.nhs.uk 13
2016 conference - What do the national IAPT team’s priorities look like for
services?• ImprovingthesustainabilityoftheIAPTworkforce
v RecruitmentofWorkforceWellbeing ProjectManager– RebeccaMinton
v Scopingtheworkdonesofar
v LiteratureReview
v WorkingwithHEE
v Wellbeing andsustainability section inIAPTManual(NCCMHEBTP)
www.england.nhs.uk 14
2016 conference - What do the national IAPT team’s priorities look like for
services?• DesigninganddevelopingwithlocalareasnewintegratedIAPTservicemodelsand
businesscasestosupporttheirspread– inbothprimaryandsecondarycare.
• FYFVCommitments:IntegratedIAPTservices
- Twothirdsofexpansion,by2020/21,tobe‘IntegratedIAPT’services– integratedwithphysicalhealthpathwaysforpeoplewithlongtermconditionsordistressingandpersistentmedicallyunexplainedsymptoms.
- In2016/17and2017/18:EarlyImplementerssupportedcentrally
www.england.nhs.uk
LTCs
• Peoplewithdepressionand/oranxietydisorderswhoalsohaveLTCsarealreadybeingseen inIAPTbuthavebeenunder-represented
• Treatingmentalhealthproblemsreducesphysicalhealthcarecostsbyaround20%andmainlypaysforitself(Layard&Clark,2014).Localexample:Hillingdon&COPD.
• BestoutcomesareachievedwithadaptedtreatmentsthattakeintoaccounttheLTCandareembedded initscarepathway(LTCPathfinderResults).
Lessons from the research literature and IAPT to date: why integrate?
15
www.england.nhs.uk
MUS
• Medicallyunexplainedsymptomsarecommon.IndividualswithpersistentanddistressingMUScanbeseverelydisabledandarefrequentusersoftheNHS
• RCTshaveshownthatpsychologicaltherapiesareeffective. ThetherapiesaremainlybasedonCBTprinciplesandbuildonthecorecompetenciesoftheIAPTworkforcebutincludeadditionalprocedures
• Engagementintreatmentcanbeachallenge,manyofthekeyprincipleshavealreadybeentoucheduponinHItrainingofhealthanxietyandpanicdisorder:e.g.positiveevidence forpsychologicalmodulation,usingtherightterms(symptommanagement)
Lessons from the research literature and IAPT to date: why integrate?
16
www.england.nhs.uk
• Gettingoutcomedataoneveryone iscritical.IthelpedcoreIAPTgofrom38%recovery(2009)to51%now.
• LTC/MUSpilotsfellbelowthisstandard – importanttointegratedataintobusinessasusual(sessionbysession,dataviewineverysupervision, ITsystemsupport, digitalinput).
• IntegratedservicesneedtocollectsomeadditionaldataontheperceivedimpactoftheLTCandhealthcareutilization(e.g.CSRI)
• Importanttobeclearfromthebeginningaboutwhattocollect,when,why,andhowdatacompletenessismonitored.
Lessons from IAPT programme, including LTC/MUS: data is critical
17
www.england.nhs.uk 18
IAPT-LTC Definition
WhatdefinesanIntegratedIAPTservice?
Anintegratedservicewillexpandaccesstopsychological therapiesforpeoplewithlongtermhealthconditionsorMUSbyprovidingcaregenuinelyintegratedintophysicalhealthpathwaysworkingaspartofamultidisciplinary team,withtherapists, whohavetrainedinIAPTLTC/MUStopuptraining,providingevidencebasedtreatmentscollocatedwithphysicalhealthcolleagues.
WhatdefinesanIntegratedIAPTservice?
AnintegratedservicewillexpandaccesstopsychologicaltherapiesforpeoplewithlongtermhealthconditionsorMUSbyprovidingcaregenuinelyintegratedintophysicalhealthpathwaysworkingaspartofamultidisciplinaryteam,withtherapists,whohavetrainedinIAPTLTC/MUStopuptraining,providingevidencebasedtreatmentscollocatedwithphysicalhealthcolleagues.
Itisimportanttokeepthisdefinitioninmindwhensettingupyourintegratedservice.Itmaybethat,inthebeginning,alltheserequirementsarenotmet.However,youshouldbeaimingforaservicemodelwhichsatisfiesall3ofthecriteriaabove.
www.england.nhs.uk
Workingwith22areascovering30CCG’sinWave1(startedfromJanuary2017),withfurther15areascovering38CCG’sinWave2(startedfromApril2017)Componentsofexpansionprogramme:
IAPT EI Programme
Developingcurricula&trainingoffer
AllocatingfundsforEarly
Implementers
Guidancetosupportservice
design/implementation
Datacollection&analysis
Supportforearlyimplementers
HEEhavecommissionedLTCtrainingwithcoursesalready
started
FundingapprovedforWave1andWave2sites
IntegratedIAPTEvidenceBasedTreatmentPathwayDraftavailable
WorkPackagesagreed,supportavailabletoEIsitesandworkshopsarranged
Nationalworkshopscontinuing.Yammersiteisworkingwell.SitevisitsandimplementationcallswithnewWave2sites
completed.DeliverycallswithWave1sites
completed
www.england.nhs.uk
• ThereisenthusiasminprovidersandCCGstodevelopintegratedservices,andthereareexamplesofservices thatarealreadyprovidingpsychologicaltherapiesinthisway
• JointworkingacrossNHSEnglandnationalandregionalteams,HEE,andtheMHISThasstrengthenedtheprocessandresultsfromearlyimplementers
• ThefinancialcontextmeanssomeEIareashavehadconcernsaboutfinancialrisk– forinstancetakingonstaff– despiteastrongsavingscaseonintegratedpsychologicaltherapies
• Nationaldirectionistosupportareastomakethecasefortheprogramme– thepublicationoftheimplementationplanhelpedinmakingcleardirectionoftravel.
Learning from process so far
20
www.england.nhs.uk
• Startearly!Engagement,relationshipsanddevelopmentofpathwaysdoestaketime
• Developagoodimplementationplanwhichisco-produced,hasbothphysicalandmentalhealthinputalongwithserviceusercollaboration
• Thinkaboutfutureproofingtheinvestmentwhilstdevelopingtheimplementationplan,howlocalevaluationevidencessavings
• Whendevelopingpathways,carefullyconsiderlocalnuance– wherelendsitselftointegratedworking?WhatdotheRightCarepacksshow?
• Mappingexercise topreventduplicatecommissioning- whatiscommissionedfromthephysicalcareenvelope
Learning from EI’s- Commissioners
21
www.england.nhs.uk
• Ensurethereisclarityrethedistinctionsbetween IAPTLTC,LiaisonPsychiatryandhealthpsychology,andthatthepathwaysbetweenallthreeareclear
• Linkinwithexistingworkstreamsinphysicalhealth
• CanyoumakethisworkacrosstheSTP/vanguard
• Useapatientfocusgroup
• UseGPchampions
• ConsiderwhattheGPprioritiesareintermsofconditions
Learning from EI’s- Commissioners (2)
22
www.england.nhs.uk
• Startearly- Engagement,relationshipsanddevelopmentofpathwaysdoestaketime
• Makelinkstopdownandbottomup
• Castyournetwidely
• Don’tunderestimate theimportantofpublicityandmarketing- startthisearlytoo
• Howshouldyoubrandyourservice toappealtothetargetaudience
Learning from EI’s- Providers
23
www.england.nhs.uk
• Doyouneedtousealternative language
• DoyouneedtotrainPHCstaff
• Canyoudualtrainpractitioners
• Beclearonthedesign- NOTsignposting- needintegrationandco-location
• Needtothinkabouthowto“sell”thistophysicalhealthcolleaguestodemonstratethebenefits
• Designingthepathwaysothattheservice cancatchpeoplewhentheyarefirstdiagnosedratherthanfurtherdownthepathway
Learning from EI’s- Providers (2)
24
www.england.nhs.uk
Headline figures for 16/17
25
133PWPtraineeswererecruitedaspart
oftheexpansion
23IntegratedIAPTservicesstarted
delivery inJanuary2017 172HItrainees
wererecruitedaspartoftheexpansion
121PWP’sstartedtheLTCCPDtraining
3202patientswereseeninan
Integratedservicein16/17
143HI’sstartedtheLTCCPDtraining
IAPT- LTC
www.england.nhs.uk
Plan for 17/18
26
IAPT-LTC
45,000patients
195HItrainees
176PWPtrainees
207HICPD
260PWPCPD
www.england.nhs.uk 27
NHS Operational Planning and Commissioning Guidance 2017-2019
• Ensurelocalworkforceplanningincludesthenumberoftherapistsneededandmechanismsareinplacetofundtrainees.
• From2018/19,commissionIAPTservicesintegratedwithphysicalhealthcareandsupportingpeoplewithphysicalandmentalhealthproblems.
www.england.nhs.uk 28
NHS Operational Planning and Commissioning Guidance 2017-2019
• Overallplanningofworkforceshouldincludeincreasingthenumbersoftherapistsco-locatedingeneralpracticeby3000by2020/21.
• HUGE thanks to Mayden for their help with baselining• WearecalculatingeachCCG’sshareoftheadditional4,500
therapistsandthe3,000MHtherapistsinprimarycare• Thisisbasedonsimplisticassumptionsusingprevalence• Wewillsharethesewithregionsandusethemastartingpointsfor
refinementbasedonlocalintelligence• Thiswillbeaniterativeprocess
Inwave1352additionalpractitionersstartedworkinginprimarycareasaresultoftheexpansion
www.england.nhs.uk
• CommissioningIAPT-LTCevents ineveryclinicalnetwork• Suiteofguidanceproduced
- FAQs- EvidenceBasedTreatmentPathway- Developingthebusinesscasedocument- “HowTo”guide- Localevaluationguide– evidencingsavings- Datahandbook
29
Ensuring Rollout