www.england.nhs.uk

NHSEnglandIAPTProgramme

AnupdateontheFiveYearForwardViewcommitmentsforIAPT

IAPTConnect2017

UrsulaJames– NationalIAPTProgrammeManager

www.england.nhs.uk 2

One Year On…

Alonewecandosolittle

Togetherwecandosomuch

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 5

Quality Premium 17/18 and 18/19

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%

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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?

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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?

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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

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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

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www.england.nhs.uk

• Startearly!Engagement,relationshipsanddevelopmentofpathwaysdoestaketime

• Developagoodimplementationplanwhichisco-produced,hasbothphysicalandmentalhealthinputalongwithserviceusercollaboration

• Thinkaboutfutureproofingtheinvestmentwhilstdevelopingtheimplementationplan,howlocalevaluationevidencessavings

• Whendevelopingpathways,carefullyconsiderlocalnuance– wherelendsitselftointegratedworking?WhatdotheRightCarepacksshow?

• Mappingexercise topreventduplicatecommissioning- whatiscommissionedfromthephysicalcareenvelope

Learning from EI’s- Commissioners

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www.england.nhs.uk

• Ensurethereisclarityrethedistinctionsbetween IAPTLTC,LiaisonPsychiatryandhealthpsychology,andthatthepathwaysbetweenallthreeareclear

• Linkinwithexistingworkstreamsinphysicalhealth

• CanyoumakethisworkacrosstheSTP/vanguard

• Useapatientfocusgroup

• UseGPchampions

• ConsiderwhattheGPprioritiesareintermsofconditions

Learning from EI’s- Commissioners (2)

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www.england.nhs.uk

• Startearly- Engagement,relationshipsanddevelopmentofpathwaysdoestaketime

• Makelinkstopdownandbottomup

• Castyournetwidely

• Don’tunderestimate theimportantofpublicityandmarketing- startthisearlytoo

• Howshouldyoubrandyourservice toappealtothetargetaudience

Learning from EI’s- Providers

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www.england.nhs.uk

• Doyouneedtousealternative language

• DoyouneedtotrainPHCstaff

• Canyoudualtrainpractitioners

• Beclearonthedesign- NOTsignposting- needintegrationandco-location

• Needtothinkabouthowto“sell”thistophysicalhealthcolleaguestodemonstratethebenefits

• Designingthepathwaysothattheservice cancatchpeoplewhentheyarefirstdiagnosedratherthanfurtherdownthepathway

Learning from EI’s- Providers (2)

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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

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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

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Ensuring Rollout

www.england.nhs.uk

Thankyou

NHSEnglandIAPTProgramme