Thousands of people with psychosis are starting specialist community-based treatment in record time across the whole of southern England following a drive to improve care led by the Oxford AHSN for NHS England. Specialist multi-disciplinary teams are working together on a transparent data-based shared learning approach which is improving life chances by reducing variation, improving service quality and supporting individuals to effectively manage their wider needs relating to education, employment and housing. This has brought savings of £16 million. Spread across the whole of England this approach would benefit 8,000 people every year and save the NHS £63m.
Each participating Early Intervention in Psychosis (EIP) team uploads data onto the ‘EIP Matrix’. Instant reports are generated in a variety of graphical formats in line with Royal College of Psychiatrists’ Centre for Quality Improvement (CCQI) audit thresholds. The Matrix system delivers results much quicker than the CCQI reports which can take weeks or even months to reach frontline clinicians.
Psychosis is a relatively common, disabling disorder affecting thousands of young people every year. People with psychosis typically experience hallucinations and delusions. They can become frightened, withdrawn and isolated. The impact on young lives can be devastating – but complete recovery can be achieved through swift access to the right care.
Early intervention in psychosis (EIP) services are one of nine system ‘must do’s’ identified in the NHS Five Year Forward View. They are also included in the first national referral to treatment time targets for mental health introduced from April 2016.
Access to consistently high-quality specialist early intervention community services for young people when presenting with first instance psychosis leads to better outcomes and reduces demand for mental health services. However, most NHS mental health services have high variability and patchy record-keeping.
The Oxford AHSN Early Intervention in Psychosis Clinical Network led the development of a shared approach across southern England for NHS England, a mega-region of 15 million people from Kent to Cornwall. It includes 50 Clinical Commissioning Groups, 16 service providers, 13 Sustainability and Transformation Partnerships and five Academic Health Science Networks.
The South Region EIP Programme (Time4Recovery) brought together 500+ clinicians, commissioners, service users and carers to assess resources and clinical outcomes in every area, working towards rapid access to the best possible care from specialist multi-disciplinary teams. Other key partners include Strategic Clinical Networks, Health Education England, Public Health England and the NIHR CLAHRC Oxford.
The programme developed an innovative real-time data analytics and visualisation tool called the EIP Matrix to help benchmark services. It is aligned to NICE key performance indicators including duration of undiagnosed psychosis, interventions delivered, physical health and employment and education.
Quality champions were appointed to carry out regular data reviews around an evidence-based, validated dataset alongside shared learning events taking an open, collaborative ‘appreciative enquiry’ approach (see mural image). Peer reviews enabled teams to learn from each other’s strengths.
More patients are accessing specialist EIP services more quickly – currently over 4,300 across southern England (see map). This is leading to better quality care and reduced symptoms.
Annual savings across southern England are estimated at £16m based on a £4,000 saving per patient per year for those accessing EIP services compared to standard care (health economic analysis – Tsiachristas et al BMJ Open, 2016). That equates to an annual saving of £63m for the NHS.
There has been a significant increase in patients referred to smoking cessation services, from 21% in 2015 to 66% in 2016. Over the same period there has also been a 46% increase in individuals and families accessing family interventions (from a 17% baseline to 24.9%). Almost half (42%) of people accessing EIP are in employment and/or education, whilst 72% are in settled accommodation.
The new waiting time standard introduced in April 2016 set a national target for 50% of individuals to be moved onto an approved form of treatment within a fortnight of referral. The chart below shows that all regions in southern England were meeting the initial target and have gone on to significantly improve the access rate.
|% starting treatment in 2 weeks|
|Area (see below)||April 2016||May 2017||National target|
- South East: Sussex, Surrey and Kent
- South Central: Berkshire, Buckinghamshire, Oxfordshire, Gloucestershire, Bath/NE Somerset, Swindon and Wiltshire
- Wessex: Dorset, Hampshire and Isle of Wight
- South West: Bristol, N Somerset, S Gloucestershire, Somerset, Devon, Cornwall and Isles of Scilly
Initially, some providers and commissioners were worried about the high level of transparency. But this dissipated as they realised that concerns were met with offers of support.
Best practice case studies were captured along with a ‘What is psychosis?’ video which has been viewed over 54,000 in 18 months: https://www.youtube.com/watch?v=hGP_7cEP5cI
The EIP Matrix has been recognised by NHS England and featured at the Health and Care Innovation Expo events in 2016 and 2017.
Map showing EIP services across England
“The Early Intervention in Psychosis service has been the stepping stone that I needed. The team has helped me step up and leave my mental problems behind. They gave me support to apply to university. They gave me so much encouragement.”
The EIP Matrix is being extended to support EIP teams in other regions. It has also been adapted to benchmark existing and emerging perinatal mental health services to support mothers who may experience mental illness before or after giving birth.
The programme board and clinical groups are continuing to spread good practice through webinars and workshops. The programme intends to further strengthen data quality to support commissioning decisions and increase the proportion of patients seen by specialist early intervention teams within the 14-day target for first episode psychosis.
2014 – ongoing
Project contact for further information
Matt Williams, Network Manager, Early Intervention in Psychosis Clinical Network, Oxford AHSN
T: 07554 338150
E: [email protected]xfordahsn.org
Media contact for further information
Head of Communications, Oxford AHSN
T: 07966 174183
E: [email protected]