Background and Aims

Psychosis is relatively common, disabling disorder affecting thousands of people every year.  It has a hugely detrimental impact on people’s lives and significantly increases the risk of people completing acts of self-harm and attempting or completing suicide.  In addition to this, there is a wider societal economic impact with an estimated cost to the UK economy of £11.8 billion per year. Early intervention is critical to improving immediate and long-term personal, clinical and economic outcomes.  

The first access and quality standards for psychosis were introduced in April 2016 to ensure that anyone experiencing first episode psychosis would receive a specialist assessment by an Early Intervention in Psychosis (EIP) team within 14 days of referral and have access to NICE concordant evidence-based care. Most EIP teams across the South of England were not funded, staffed, or skilled to be able to deliver this standard. As a result, over 4000 people with psychosis were not receiving evidence-based treatments, with worse long-term outcomes. The delivery of NICE concordant care and timely access had not been measured before.

Solution

The Thames Valley Early Intervention in Psychosis (EIP) Clinical Network was invited to lead the South Region’s ‘Preparedness Programme’ on behalf of NHS England (South). The objective was to ensure that the 16 trusts in the region would be able to meet the incoming national EIP standards.

The network established a strong governance structure, engaging all the region’s CEOs, Medical and Nursing Directors with the understanding that any improvement programme must be owned and driven by the providers themselves. With clear and strong national and local mandates established, the programme collaborated to build an effective and intuitive online auditing and data analytics tool called the EIP Matrix. 

“The way that South of England EIP services collaborate to implement research evidence into practice and measure outcomes has been identified by NHS England as an exemplar approach to be adopted by other mental health priority areas.”
Ann Tweedale, NHS England Senior Programme Manager

The EIP Matrix pulls together data for key measures and uses colour coded charts to show the extent to which nationally and locally set standards are being achieved. The EIP Matrix has been used by the region’s NHS England managers, commissioners and providers since it was first developed with their input in 2015. The intuitive design of the online tool ensures maximum engagement, allowing users to quickly obtain information relating to current: 

  • investment per patient
  • performance against key targets 
  • compliance with NICE quality standards 
  • workforce capacity and whether this is sufficient to meet demand
  • outcomes being achieved. 

Users can also compare to previous achievement and other service providers. The latter enables EIP teams to learn from each other and share best practice.

Outcomes and Benefits

The programme’s annual reports provide an update with both achievements and areas that need improvement:

Achievements

  • More People Seen Quicker: The South of England EIP teams continue to see people within the 14-day referral to treatment window. Of all the referrals received by mental health providers for suspected psychosis, 85% were seen by EIP within 14 days of referral.
  • More People Receiving Cognitive Behavioural Therapy for Psychosis (CBTp): There has been an increase in people receiving CBTp (one of the recommended treatments defined by NICE), from 12% in 2016 to 21% in 2017, 30% in 2018 and 36% in 2019.
  • Better Physical Health Monitoring: 68% of people with first episode psychosis are reported to have had a comprehensive physical health check in the last 12 months compared to 41% in 2016. 

Areas for Improvement

  • Access to EIP: There continues to be a large variation in teams' caseloads with some EIP teams only seeing <30% of who they should be seeing according to psychosis incidence data. 
  • Investment: There continues to be a three-fold variation between the best and worst funded EIP teams in the South of England. Only two out of the 33 EIP services in the South of England are funded at the £8,250 per patient recommended to deliver NICE interventions to a full caseload.
  • Physical Health: Whilst physical health monitoring has improved, it is important to note that the 68% achievement in 2019 is lower than the 90% physical health standard.

The programme’s work was a finalist in the BMJ Awards and the NHS Healthcare Transformation Awards.  

Additional Information

You can find out more about the South EIP Programme by accessing the Time 4 Recovery website.

The programme has also worked with people who access EIP and their families and carers to develop resources and these are available on the Epic Minds website.

The Peer Review programme, which is one of the largest ever undertaken, has been published in the International Journal of Healthcare Quality Assurance.

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Content last updated: 20/01/2021

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