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  • SOUTH REGION EARLY INTERVENTION IN PSYCHOSIS PROGRAMME ANNUAL REPORT 2016-17

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  • 2 of 35 | South Region Early Intervention In Psychosis Programme | Annual Report 2016 - 2017

    Version Date Authors Changes Included

    1.0 05.12.2016 Sarah Amani First draft

    1.2 - 1.3 12.12.2016 Sarah Amani • Updated foreword and chairs message • Sought consent from Dr David Shiers and

    Rt Hon Norman Lamb to include their story in background

    1.4 - 1.8 16.12.2016 Prof Belinda Lennox, Will Pank, Alison Griffiths, Dr Frank Burbach & Dr Stuart Clark

    • Revised tables, graphs and narrative with references to latest research findings on impact of extending age range, disengagement rates from EIP, comparative admission, accommodation and employment rates

    1.9 21.12.2016 Sarah Amani • Reviewed draft report as part of South EIP Programme Board meeting

    2.0 13.01.2017 Sarah Amani • Amended NHS England statement of EIP funding allocation from 2017/18 building to £70 m by 2020/21 in Background section

    • Added role of Oxford AHSN in executive summary • Clarified source of EIP budget information in

    executive summary and Findings section • Added rationale for asking for numbers receiving

    >2 sessions CBTp

    2.1 - 2-2 03.02.2017 Sarah Amani • Added proportion of caseload >35 years old • Amended 2Gether, The Zone, Somerset & Kent

    EIP annual budgets • Amended Sussex reported caseload from 435 to 579, and Sussex investment per patient, caseload vs prevalence and regional caseload as a result

    • Added narrative on difference between national and regional finance data

    • Revised Berkshire EIP prevalence data following conversation with PHE

    • Revised Recommendations section

    Chair Forum

    Fiona Edwards South EIP Programme Board

    Prof. Belinda Lennox South EIP Clinical & Technical Group

    David Radbourne NHS England (South) Mental Health Priority Board

    Document and Version Control

    Document Review Distribution List

    Name Title, Organization

    Fiona Edwards CEO, Surrey and Borders Partnership NHS Foundation Trust & Chair of EIP Programme Board

    Prof Belinda Lennox South Region EIP Preparedness Senior Responsible Officer

    Document Approval [Persons designated to approve and sign off of this document]

  • 3 of 35 | South Region Early Intervention In Psychosis Programme | Annual Report 2016 - 2017

    Foreword THE FUTURE OF EARLY INTERVENTION IN PSYCHOSIS

    IN THE SOUTH OF ENGLAND IS IN FOCUS.

    Clinical lead’s message

    Looking back on the past year, one thing is clear : a better future for people with first episode psychosis is coming into focus.

    The South Region Early Intervention in Psychosis (EIP) Programme is in full swing with clinicians gaining stride in using their newly acquired skills to deliver NICE interventions, new roles, third sector and community partners working more closely together and leaders and decision-makers helping address system-level questions. All of this to ensure individuals and families with first episode psychosis get high quality mental health services they need, when and where they need them most.

    We are pleased to share our 2016-17 annual report. It is both a look back at our collective achievements and a look forward at the future that lies ahead. In it, you will read how our work is supporting EIP teams in strengthening skills to enhance service outcomes, how we continue to share knowledge through best practice forums, facilitate training and events and how we are fuelling innovative ideas to propel the region forward. It’s an exciting time both in early intervention in psychosis and in the evolution of the programme.

    We look forward to working with you in achieving better outcomes for individuals and families with experience of early psychosis.

    “ It’s an exciting time both in early intervention in psychosis and in the evolution of the programme.”

    Prof Belinda Lennox

    South Eip Clinical Lead and Senior Responsible Officer

    Chair’s message

    This has been a year of renewed focus for the South Region EIP Programme with the launch of NHS England’s ‘Implementing the Five Year Forward View for Mental Health’.

    This plan is a direct response to the changing needs across mental health and an acknowledgement of the clear benefit of modernizing mental healthcare towards more focus on prevention and early intervention.

    The ‘Implementing the Five Year Forward View for Mental Health’ plan reinforces our commitment to our mission and vision while outlining new strategic directions: strengthening skills and knowledge across service areas, providing consistent, evidence-informed approaches at the clinical and system level and delivering innovative solutions for better outcomes.

    We continue to work in close alignment and partnership with Health Education England, NHS England and NHS Improvement to focus on quality improvement. As the programme has progressed in 2016, we have also enhanced our support to meet the changing needs of the 50 Clinical Commissioning Groups (CCG) and 16 providers spanning the South of England.

    In looking at what is to come, it is important to remember those who have helped pave the way. We would like to acknowledge Dr Geraldine Strathdee (National Clinical Director for Mental Health 2013-16) and Pat Haye, Director of Clinical Networks at NHS England (South) through whose vision, the programme is today an exemplar in implementing mental health policy at scale. We remain committed to providing strategic steer and support to help each health economy deliver optimum early intervention in psychosis services for their population

    “ We remain committed to providing strategic steer and support to help each health economy deliver optimum early intervention in psychosis services for their population.”

    Fiona Edwards Chair of South EIP Programme Board and Chief Executive of Surrey and Borders Partnership NHS Foundation Trust

    1 Report of the second round of the National Audit of Schizophrenia (NAS2) 2014

  • 4 of 35 | South Region Early Intervention In Psychosis Programme | Annual Report 2016 - 2017

    1. Introduction 5 1.1. Background 5 1.2. Executive Summary 6

    2. Objectives 7

    3. Method 8 3.1. Partnerships 8 3.2. EIP matrix 8

    4. Findings 9

    4.1. Access and Waiting Times 9 4.2. Number of People Accessing EIP 9 4.2.1. First Episode of Psychosis Caseload as Percentage of Predicted Prevalence 10 4.2.2. Proportion of Caseload Aged 36-65 Years Old 11 4.3. Investments 13 4.4. Nice Concordance 16 4.5. Workforce 18

    4.6. Outcomes 20

    5. Key Enablers 22

    5.1. Best Practice 22 5.2. Technology 23 5.3. Leadership 24 5.4. Peer Reviews 25

    6. Challenges 26

    6.1. Funding 26 6.2. Recruitment 27

    6.3. Training 27 6.4. Data Quality 28

    7. Discussion 29

    8. Recommendations 30 8.1. Appendix 1 - South Region EIP Programme Board 31 8.2. Appendix 2 - South Region EIP Clinical Group 32 8.3. Appendix 3 - South Region EIP Techinical Group 33 8.3. Appendix 4 - Nice Concordance For Each Health Economy 33

    9. Looking Forward 35

    Table of Contents

  • 5 of 35 | South Region Early Intervention In Psychosis Programme | Annual Report 2016 - 2017

    1. Introduction

    1.1. Background

    Psychosis is a common illness which can derail a person’s life trajectory leading to long term mental and physical disability. There is strong existing evidence that the early identification of psychosis and swift effective intervention leads to reduced morbidity, better long term outcomes and lower costs to the health service and wider economy. The Early Intervention in Psychosis (EIP) standard was introduced on 1st April 2016 to ensure:

    1. A maximum wait of two weeks from referral to treatment; and

    2. Treatment delivered in accordance with NICE guidelines for psychosis and schizophrenia.

    The story of how EIP was first implemented in the UK is one of both tragedy and triumph. In 1998, Dr David Shiers, a father who happened to be a GP watched as his 16-year-old daughter became increasingly unwell with early signs of psychosis. Her symptoms became worse as he battled to navigate a healthcare system designed to only intervene when an illness had taken permanent hold. David recollects that until then, he had not appreciated the poor state of mental health services in the UK. Unfortunately, David’s story was not unique as he would discover when other families and professionals steadily began to approach him with their own stories. It was both his personal and professional experience, with the support of other key figures notably, Antony Sheehan, Jo Smith, Max Birchwood, and Fiona Macmillan, who introduced the concept of early intervention in psychosis in the UK and established IRIS (Initiative to Reduce the Impact of Schizophrenia), which led to the World Health Organisation’s International Early Psychosis Declaration.

    Spurred in part by the above developments, in 1999 the Department of Health released the National Service Framework (NSF) for Mental Health which mandated every health economy to develop EIP teams for every 250,000 of the population. At its peak, the NSF policy saw 179 EIP teams across England. In 2010, health eco

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