The National Expectations for Improving Access to ... · PDF file The National Expectations for Improving Access to Psychological Therapies West Midlands Strategic Clinical Network

www.england.nhs.uk

The National Expectations

for Improving Access to

Psychological Therapies West Midlands

Strategic Clinical Network

June 2015

Caroline Coxon

Intensive Support Manager - IAPT Mental Health Unit

NHS England ([email protected])

1

www.england.nhs.uk 2

NHS Mandate – 2015/16

3.9 ………..extending and ensuring more open access to the Improving Access to Psychological Therapies (IAPT) programme, in particular for children and young people, and for those out of work, and to continue planning for country wide service transformation of children and young people’s IAPT. NHS England will work with stakeholders to ensure implementation is at all times in line with the best available evidence. NHS England will maintain the commitments that at least 15% of adults with relevant disorders will have timely access to IAPT services, with a recovery rate of 50%. In addition, NHS England will ensure that by March 2016, 75% of people referred to the IAPT programme begin treatment within 6 weeks of referral, and 95% begin treatment within 18 weeks of referral.

www.england.nhs.uk

www.england.nhs.uk

Adult IAPT What Next?

• Address Variation (Equity) – Access & Recovery

• Improve Choice – Provider & Treatment

• Introduce Waiting Time Standard

• Integrate provision with physical health care

pathways

• Improve access within mental health care

pathways

• Introduce an outcomes based currency and tariff

• Improve employment support

www.england.nhs.uk

Expectation is:

Access Rate of

15% - 18%

is achieved

5

www.england.nhs.uk

Achieving and Sustaining Access

Rates? • Are your referral rates sufficient to deliver 3.75% access rates

each quarter?

• What are your attrition rates?

• Nationally - 35% of patients referred do not enter treatment.

• There is good evidence that long waiting lists suppress referrals.

• Do you have a clear longer term strategy for IAPT / primary care psychological therapies?

• With immediate priorities and a marketing plan including:

• Simplified access and self referral routes

• Truly primary care which is not medically led

• Links with physical health

• Early intervention

• A Step 2 service including the specialisation of PWPs

• Maximising older people access and BME Access

Expectation is:

Recovery Rates

50% and over

is achieved

7

‘Recovery’ and ‘Reliable Improvement’

• The Key Performance Indicator (KPI) is 50% for

Recovery.

• Commissioners and the Providers need to understand

through sound audits or root cause analysis why the

recovery rate is not being reached so that the cause

can be addressed.

• Reliable Improvement is equally as important and is

being Nationally measured and monitored

• Commissioners and Providers need to understand

how their performance varies from the national

average on both.

Recommendations

9

– Monitor both Recovery and Reliable Improvement

together at all times.

– Make the link between presenting condition /

diagnosis, the range of NICE guidance for that

condition and the therapy offered

– Understand outcomes by:

• Step, Team, Modality and Therapist

– Therapist monitoring

– Offer choice of therapy by commissioning the full

range of NICE recommended modalities so that it

meets the needs of your population

Expectation is:

Waiting Standards

will be achieved by end of

March 2016

10

Waiting Standards / Targets

11

• 75% of patients to have received their first treatment

within 6 weeks from date of receipt of referral

• 95% of patients to have received their first treatment

within 18 weeks from date of receipt of referral

Measurement of the standard

• Guidance was published on 20 February 2015 to support

measurement of the new waiting time standard.

• The new national indicators will measure waiting times

from referral date to the start of a course of treatment –

i.e. for those people who have two or more treatment

sessions.

• Local areas will also be required to capture and monitor

waits from referral to first treatment appointment for all

people who enter the service and this should include

people who receive a single treatment session.

• Patient-initiated delays will not be taken into

consideration when calculating the IAPT indicator.

Tolerances have been built into the IAPT standard to

allow for such delays.

• A number of additional measures will be captured in

national reports to guard against the introduction of

perverse incentives into local commissioning

arrangements

12

Improving Access to IAPT – Waiting Times

Improving Waiting times for Psychological Therapies (IAPT) Guidelines

and FAQs, http://www.england.nhs.uk/2015/02/13/mh-standards/

www.england.nhs.uk

Operationalising Access

Standards

The focus should be on entry to a course of treatment in order to

ensure the standard doesn’t introduce a perverse incentive into

local commissioning arrangements that would affect current case

mix or encouraging providers to:

Increase the proportion of patients offered a single session of

assessment and advice, rather than a course of therapy

Reduce the average number of sessions that are given to those

people who have a course of therapy

Introduce artificial treatment starts where patients have an early

appointment but are then put on an ‘internal’ waiting list.

www.england.nhs.uk

Cont….

There is a need to monitor contextual indicators with time series analysis to set the historical context and determine variance; enabling quality assurance of service provision. These include:

Average number of sessions

Numbers completing treatment as a percentage of those who entered treatment;

Case mix variance, both in terms of provisional diagnosis and also severity of symptoms;

Waits between first and second appointment to visualise long waits ‘hidden’ from nationally reported waits.

Additional reports commissioned from the HSCIC by NHS England to be available by Q4 2014/15. Further Reports will be commissioned for 2015/16 and will be available from October 2015.

www.england.nhs.uk

Good Practice in Waiting List Management

• Written pathways are in place with:

• agreed waiting standards for assessment, first treatment and all subsequent treatments in line with National IAPT RTT rules.

• Clearly defined clock starts and clock stops

• Senior Clinical sign off that (1) pathways are sound and (2) that decisions on what is first treatment are accurate (*)

• Admin Processes are defined in a clear written Access Policy

• (*) Accountability for accurate recording and reporting is understood with delegated accountability from the Trust Board

www.england.nhs.uk

• Focus on numbers of patients waiting

• Target waiting lists understood that will consistently deliver the waiting time standards calculated for the service.

• All waits are understood and visible i.e. daily/weekly PTLs are in place

• Tackle hidden waits as well as waits to first appointment

• Plans are in place to address backlogs (numbers waiting in excess of the target waiting list) in line with 6w and 18w standards by the end of Q4 2015-16.

Cont..

www.england.nhs.uk

What’s on the Horizon?

• Payment By Results (PBR)

• Rewards good outcomes rather than just activity

• Is fair (MONITOR criteria):

• To Patients;

• To Providers;

• To Commissioners;

• To Tax Payers

• Minimises perverse incentives and opportunities

for gaming

www.england.nhs.uk

• Is efficient and stable

• Incentivises innovation, efficiency and

improvement

• Enables Parity with Physical Health Services

Cont..

www.england.nhs.uk

Overview of Currency Model - Outcomes

10 Outcomes incentivised and a percentage of the price paid

for meeting targets. The expectation is that the exact split will

be for local determination

www.england.nhs.uk

Monitor / NHS England’s Objectives for

Commissioners

20

By April 2015 all contracts to be underpinned by an

understanding of need, evidence-based responses to need and

expected outcomes

By April 2016 all contracts to include clear incentives for the

delivery of outcomes, outcome and quality driven payment models

will have been introduced in a limited number of areas AND have

robust data on cost, activity, quality and outcomes

By April 2017 a wholesale shift to outcome-focused contracting

As a minimum IAPT within block contracts this year should

specify the volume(s) to be delivered with appropriate levers

in place that will ensure delivery

Providers are advised to use 2014-15 to understand costs,

and establish sound performance monitoring (activity and

outcome) and should can expect shadowing of new

currency in 2015-16

Monitor has indicated it will mandate implementation of

IAPT currency in 2017. Providers should expect all IAPT

contracts to have been extracted from blocks and

commissioned along the lines indicated here.

www.england.nhs.uk

• HSCIC website:

http://www.hscic.gov.uk/article/2021/Website-

Search?productid=18158&q=IAPT&sort=Most+recent

&size=10&page=1&area=both#top

• https://healthsector.webex.com/healthsector/ldr.php?

RCID=42a46923f8141a615402b60b6925c027

References: