Using Data to Evidence EIP Service Quality

Nick Gitsham and Michael Watson

Intensive Support Team – Mental Health

2nd March 2017

Overview

1. Measuring the EIP standards:

– Data sources

– NICE-concordant care

– SNOMED-CT

– Waiting times

– Local data

2. Changes to EIP reporting

2

Measuring the EIP Standards

EIP Standards

• By 1 April 2016, more than 50% of people experiencing a first episode of

psychosis will be treated with a NICE-approved care package within two

weeks of referral

1. Treatment delivered in accordance with NICE guidelines for psychosis

and schizophrenia – either in children and young people or in adults

2. A maximum wait of two weeks from referral to treatment

• Most initial episodes of psychosis occur between early adolescence and age

25 but the standard applies to people of all ages

4

Data sources

• Mental Health Services Dataset (MHSDS) is the repository:

http://content.digital.nhs.uk/mhsds

• All data is submitted by providers

• Mental Health Five Year Forward View Dashboard:

https://www.england.nhs.uk/mentalhealth/taskforce/imp/mh-dashboard/

5

NICE-Concordant Care

NICE-Concordant Care

• NICE clinical guideline 155 (2013)

Psychosis and schizophrenia in

children and young people

• NICE quality standard Bipolar

Disorder, Psychosis and

Schizophrenia in Children and Young

People

• NICE clinical guideline 178 (2014)

Psychosis and schizophrenia in

adults: treatment and management

• NICE quality standard Psychosis and

schizophrenia in adults

• It is planned to use Systematized

Nomenclature of Medicine Clinical

Terms (SNOMED-CT) to assess this

7

NICE-Recommended Treatments

Early intervention in psychosis services should aim to provide a full range of

pharmacological, psychological, social, occupational and educational interventions for

people with psychosis, consistent with this guideline.

For people with first episode psychosis offer:

• oral antipsychotic medication in conjunction with

• psychological interventions (family intervention and individual CBT)

8

SNOMED CT

• The most comprehensive and precise clinical healthcare terminology product in the

world

• Allows healthcare observations and interventions to be recorded consistently using a

logical structure that supports data analysis

� better decision making and improvements in care

• Being implemented across all NHS care settings

• Interventions and outcome tools should be recorded (by clinicians) in the MHSDS

using SNOMED CT codes

• Assessments, reviews, tests, therapies etc. can all be submitted as a Care Activity

using the Coded Procedure item

9

EIP SNOMED Overview

10

NICE Intervention SNOMED-CT description SNOMED-CT ID

CBT for psychosis CBT for psychosis 984091000000108

Family intervention Family intervention for psychosis 985451000000105

Antipsychotic medication Medication monitoring 395170001

Physical health interventions and monitoring Assessment of physical health 705139001

Diabetic care 385804009

Weighing patient 39857003

Weight management programme 990121000000104

Cardiovascular therapy 309513005

Combined healthy eating and physical education

programme

967251000000101

Referral to smoking cessation service 871661000000106

Supported employment programmes and

vocational rehabilitation

Educational rehabilitation 183339004

Vocational rehabilitation 70082004

Carer-focused education and support programmes Carer-focused education and support programme 985651000000108

Care Planning Provision of information about psychosis 985681000000102

Mental health care and treatment planning 861361000000109

Substance misuse Substance misuse assessment 777041000000105

Substance use therapy 385989002

SNOMED Status

• No reports using SNOMED codes have yet been produced nationally

• No precise definition of which codes would stop the clock, or how, has yet

been issued

But…

• Accurate treatment recording is still clinically important

• Used for clustering and, in the future, payments

• Several DQ items to monitor use:

– MHS-DQM23 shows valid SNOMED ‘procedure’ codes used

– MHS-DQM27 shows valid SNOMED ‘finding’ codes used

– MHS-DQM30 shows valid SNOMED ‘observation’ codes used

– But only shows the number of valid codes, not how many times the

codes ‘should’ have been used!

11

Systems used by providers submitting SNOMED codes to MHSDS

• ACS

• Care Notes

• EPEX

• Lorenzo

• Paris

• RiO

• Silverlink

12

System Suppliers

13

Provider System supplier

Bradford District Care Trust RiO

Community Links (northern) Ltd Paris

Humber NHS Foundation Trust Lorenzo

Navigo Silverlink

Nottinghamshire Healthcare NHS Trust RiO

Rotherham Doncaster And South Humber NHS Foundation Trust Silverlink

Sheffield Health & Social Care NHS Foundation Trust Local solution

South West Yorkshire Partnership NHS Foundation Trust RiO

Tees, Esk And Wear Valleys NHS Foundation Trust Paris

SNOMED Usage

14

SNOMED Usage

15

SNOMED Issues

So…

• Is your system compliant with SNOMED?

• Is the SNOMED assessment directly linked to the relevant appointment?

• Have staff been trained on how/which codes to use?

• Is the full list available e.g. RiO?

• Any other issues?

Reference resources and webinars available at:

https://digital.nhs.uk/snomed-ct

16

Waiting times

Clock starts and stops

Your data

Guidance documents

https://www.england.nhs.uk/mentalhealth/resources/access-waiting-time/

18

Waiting Times Principles

• Choice of the time of treatment by the person is important i.e. DNAs and

cancellations do not stop the clock

• Al patients should be offered a timely appointment

• Measurements and monitoring of the standards should always keep the

experience of the person at the centre

• Local areas are accountable for the information that they report and submit

• In addition to tracking compliance against clock stop standards, waiting times

for incomplete referral pathways will be monitored both nationally and locally

– Proportion of people waiting more than two weeks following referral

19

Referral to Treatment

• All patients should:

• Have been assessed by the EIP service

• And, where appropriate:

• Have been accepted onto the EIP service caseload

• Have been allocated an EIP care coordinator who has actively engaged

with the person to develop a plan of care and commence treatment in

line with NICE recommendations

20

Clock Starts

• Referral received for a person with suspected first episode psychosis (FEP),

or is recognised as such upon receipt.

– The primary reason for referral should be suspected FEP

– The clock start date is defined as the date referral received

• Where pathways start with an interface service, the clock start date is the

date the interface service receives the referral – not the date the referral is

passed onto the relevant clinical team.

• Where a primary reason for referral is not recorded as suspected FEP but

this is identified during triage/SPA, the clock start date is the date of initial

referral

• If this is not suspected during triage but at a subsequent assessment then

the date the clock starts is when suspicion is first raised.

– If a person is already in the system the clock starts when suspicion of

FEP is first raised

21

MHSDS

22

MHSDS

23

Clock Start Data

• MHS101 – Service or Team Referral

– Primary reason for referral = 01 (Suspected) First Episode Psychosis

– Referral request received date

• Only referrals where Primary reason for referral is 01 (Suspected) First

Episode Psychosis are included.

• People could have a co-existing problem and this might be recorded in Table

MHS103 as Other Reason for Referral

24

FEP Referrals Received – CCG

25

FEP Referrals Received – Provider

26

Clock Stops

• The patient is confirmed as having FEP or suspected FEP following

assessment

or

• The patient is confirmed as requiring ‘at risk’ mental state (ARMS) specialist

assessment

And

• NICE-approved package of care starts, this is when the person:

1. has been accepted on to the caseload of an EIP service, AND

2. has had an initial assessment, AND

3. has been allocated to and engaged with an EIP care coordinator

27

MHSDS

28

MHSDS

29

1. Accepted on to the caseload of an EIP

service

• MHS102 Service or Team Type Referred To

• Care Professional Team Local Identifier = links to MHS201 (Care Contact)

• Service or Team Type Referred to =

A14 Early Intervention Team for Psychosis

30

MHSDS

31

MHSDS

32

2. Initial assessment

• MHS201 Care Contact

• Care Professional Team Local Identifier = link to MHS102

• Consultation Medium Used =

– 01:Face to face communication

– 02:Telephone

– 03:Telemedicine web camera

– 04:Talk type for a person unable to speak

• Attended or did not attend code =

– 5 Attended on time or, if late, before the relevant professional was ready

to see the patient

– 6 Arrived late, after the relevant professional was ready to see the

patient, but was seen

33

FEP First Contacts – CCG

34

FEP First Contacts – Provider

35

Use of SNOMED for assessment

To indicate allocation of a care coordinator and commencement of ARMS

assessment – table MHS202

• Care Professional Team Local Identifier = link to MHS102

• Procedure Scheme in Use = 06 – SNOMED

• Coded Procedure =

802551000000107 – Mental health risk indicator assessment

36

MHSDS

37

MHSDS

38

3. Allocated to and engaged with an EIP care coordinator

• “The care coordinator actively attempts to form a therapeutic professional

relationship with the person and offers treatment to them”

• MHS006 Mental Health Care Coordinator

• Care Professional Service or Team Type Association (Mental Health) =

A14 Early Intervention Team for Psychosis

39

Care Coordinator Allocation – CCG

40

Care Coordinator Allocation – Provider

41

Summary

42

FEP Patients Treated – CCG

43

FEP Patients Treated – Provider

44

Key Points

• Only patients treated in the period are counted, not patients stopped for non-

treatment

• Only patients referred on or after 01/01/2016 are included in waiting times.

Unify collection does not exclude these but this should be minimal by now

• The clock is not affected by patients who cancel and DNA

• ARMS is only identified after a contact and if a SNOMED code is recorded

• It is planned to use SNOMED to assess NICE-compliance

• Currently very little SNOMED data

• SNOMED data is not reported except through data quality reports

45

Changes in EIP reporting

Unify2 and MHSDS

• Unify2 submissions extended to June 2017 (submitted in August 2017)

• MHSDS will be primary source for performance information from April 2017,

i.e. data submitted in June 2017 (preliminary) and July 2017 (refresh)

47

Publication month Unify2 data MHSDS data

April 2017February 2017 (Final) January 2017 (Final)

February 2017 (Provisional)

May 2017March 2017 (Final) February 2017 (Final)

March 2017 (Provisional)

June 2017April 2017 (Final) March 2017 (Final)

April 2017 (Provisional)

July 2017May 2017 (Final) April 2017 (Final)

May 2017 (Provisional)

August 2017June 2017 (Final) May 2017 (Final)

June 2017 (Provisional)

September 2017June 2017 (Final)

July 2017 (Provisional)

Unify2 and MHSDS EIP data

48

1 Figures rounded to nearest 5* Replaces values 0-4

Su

bm

itte

d r

eco

rds

in

MH

SD

S

Su

bm

itte

d E

IP r

eco

rds

in

MH

SD

S

Su

bm

itte

d r

eco

rds

to

Un

ify

EIP

op

en

re

ferr

als

(31

/12

/16

) -

MH

SD

S1

EIP

op

en

re

ferr

als

(31

/12

/16

) -

Un

ify

EIP

en

teri

ng

tre

atm

en

t

(01

/10

/16

-3

1/1

2/1

6)

-

MH

SD

S1

EIP

en

teri

ng

tre

atm

en

t

(01

/10

/16

-3

1/1

2/1

6)

-

Un

ify

BRADFORD DISTRICT CARE Yes Yes Yes 30 29 80 69

COMMUNITY LINKS (NORTHERN) LTD Yes Yes Yes 20 19 60 50

HUMBER NHS FOUNDATION TRUST Yes Yes Yes 5 6 30 35

NAVIGO Yes Yes Yes 5 4 10 12

NOTTINGHAMSHIRE HEALTHCARE Yes Yes Yes * 13 15 105

ROTHERHAM DONCASTER AND SOUTH HUMBER Yes Yes Yes 35 2 * 124

SHEFFIELD HEALTH & SOCIAL CARE Yes No Yes * 13 * 43

SOUTH WEST YORKSHIRE PARTNERSHIP Yes Yes Yes 25 21 75 79

TEES, ESK AND WEAR VALLEYS Yes Yes Yes 105 90 160 148

October – December Patients Treated

49

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sheffield Health& Social Care

NHS FoundationTrust

Rotherham,Doncaster andSouth Humber

NHS FT

NottinghamshireHealthcare NHS

Trust

CommunityLinks (northern)

Ltd

Tees, Esk AndWear Valleys

NHS FoundationTrust

South WestYorkshire

Partnership NHSFoundation Trust

Bradford DistrictCare Trust

Humber NHSFoundation Trust

Navigo

% Patients Treated Who Waited

Patients Waiting: 31/12/16

50

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Rotherham,Doncsater and

Humber NHS FT

Sheffield Health& Social Care

NHS FoundationTrust

NottinghamshireHealthcare NHS

Trust

Community Links(northern) Ltd

Bradford DistrictCare Trust

South WestYorkshire

Partnership NHSFoundation Trust

Tees, Esk AndWear Valleys

NHS FoundationTrust

Humber NHSFoundation Trust

Navigo

% Patients Not Yet Treated Who Have Been Waiting

Contact

Nick Gitsham Michael Watson

Intensive Support Manager Intensive Support Manager

M: 07730 376404 M: 07879 113249

E: nick.gitsham@nhs.net E: m.watson@nhs.net

Follow us on Twitter

@MH_ISTNetwork