www.hee.nhs.uk hetv partnership council thursday 9 july 2015 9.30am – 2.45pm the kassam stadium,...

www.hee.nhs.ukwww.thamesvalley.hee.nhs.uk

HETV Partnership CouncilThursday 9 July 2015

9.30am – 2.45pmThe Kassam Stadium, Oxford


A focus on the mental health workforce

Pauline BrownLocal Director

HETV


Working within our wider system

Tim WisemanHead of Partnerships

HETV


Social Care

Private/Voluntary/ Independent sector

Strategic Clinical Networks

Oxford AHSN

Clinical Commissioning

Groups

NHS providers in primary and

secondary care

Pharmacy, Dental, Optical and wider

primary care

Patients and carers

Education providers

Public Health

NHS England

Local authorities


A national priority: The mental health workforce

Professor Sue Bailey National Mental Health Advisor

Health Education England

www.hee.nhs.ukwww.hee.nhs.uk

Critical Levers

• Best education and training for whole health workforce

• Supporting mental health workforce to meet changing policy practice and new knowledge

• Collaboration with users and carers of services

Achieving parity of esteem for mental health and learning disability – taking a life course approach


• By 2030 depression will be the greatest disease burden in the world

• It’s the 1 in 4

• Treatment and interventions work

Why?


Mental health is as wide and deep as all the individual parts of the rest of medicine put together……

Challenges


• Effective mental health awareness training can improve all health outcomes

• It can improve the resilience of all staff and help deliver compassionate care across the lifespan

Good news !


The Five Year Forward View sets out the need for new models of care

New models of care – new access targets:

NHS England’s Mandate describes new access and waiting time standards


Chapter 4 of the HEE Mandate sets out the key deliverables across mental health and learning disability workforce, education and training.

The HEE Mandate from Government:


Awareness raising:

• All NHS staff to have an understanding of mental health conditions • Dementia awareness training at Tier 1 to all NHS staff• Drive improvements in physical health and awareness of the links with mental health • Long-term conditions and associated links with mental health problems• Mental health awareness and skills required in accident and emergency teams • Veterans health

New access and waiting standards:

• 75% of people referred to Improving Access to Psychological Therapies (IAPT) treated within 6 weeks of referral

• 50% of patients experiencing first episode of psychosis to be treated within 2 weeks of referral • Significant increase in liaison psychiatry within acute hospitals• Introduction of new standards relating to treatment of Eating Disorders in 2016/17• Dementia diagnosis rates

The HEE Mandate – key areas:


Medical training:

• Increase the numbers of Foundation doctors undertaking placements in psychiatry • Inclusion of compulsory work-based mental health training within GP training programme • Allow GPs to develop specialist interest in care of mental health patients • Long-term conditions and associated links with mental health problems• Mental health awareness and skills required in accident and emergency teams

Right people, right skills, right numbers:

• Address shortfall in capacity to deliver Cognitive Behavioural Therapy • Staff and therapists to deliver the Increasing Access to Psychological Therapy programmes• Liaison Psychiatry services • Early Intervention in Psychosis • Learning disabilities – a response to Winterbourne View



Partners:

• Increase partnerships with justice • Increase partnerships with drug and alcohol misuse partners

Patient:

• Maximise the opportunities for people to be involved in decisions about their care – reflecting the provisions in the Mental Capacity Act



The Mental Health and Learning Disability Programme of Work will include: o Awareness training for the whole health workforce o Perinatal health o Improving Access to Psychological Therapies (IAPT) programmeo CYP IAPT 1015/16o CYP IAPT 2016/20o Eating Disorderso Liaison Psychiatry o CAMHS Transformation projecto EIPo Learning disability programme of work o Liaison and Diversionary Services and other service partnerships between health and

justiceo Mental Capacity Act o Crisis Care Concordato Veterans’ healtho Dementia training

Mental Health and Learning Disability


South Region Psychosis Preparedness Programme

Belinda LennoxProgramme Lead – Early

Intervention Clinical NetworkOxford AHSN and NHS England

New Access and Waiting Time standard for EIP – challenges for training

Prof Belinda Lennox

Clinical LeadEIP Preparedness Programme

NHS South

[email protected] 18

NHS England Mental Health 5 Year Plan: rebalancing the system

An effective ‘in balance’ mental health system would:

• Ensure rapid detection of mental ill health and access to evidence- based treatment in community settings.

• Provide responsive and compassionate care to individuals at risk of or in crisis.

• Provide safe, high quality inpatient care where community alternatives are not appropriate

• Enable discharge from inpatient care through provision of personalised packages of home-based support

The 15/16 Access & Waiting Time Standard for EIP

20

By 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.

How will the standard be measured?

• Both elements of the standard will be measured – the wait from referral to treatment and whether the treatment accessed is NICE concordant.

Aligning national levers and incentives:

• NICE quality standards for EIP • NCCMH commissioning

guidance, accreditation scheme, national audit (2015)

• Monitor and the NHS Trust Development Authority (TDA) prioritising EIP

• CQC inspections focussed on EIP

NICE Quality standards for EIPStatement Standard

Statement 1 Adults with first episode psychosis start treatment, with a NICE concordant package of care, in EIP services within 2 weeks of referral.

Statement 2 Adults with psychosis or schizophrenia are offered cognitive behavioural therapy for psychosis

Statement 3 Family members of adults with psychosis or schizophrenia are offered family intervention

Statement 4 Adults with psychosis or schizophrenia that have not responded adequately to treatment with at least 2 antipsychotic drugs are offered clozapine

Statement 5 Adults with psychosis or schizophrenia who wish to find or return to work are offered supported employment programmes

Statement 6 Adults with psychosis or schizophrenia have specific comprehensive physical health assessments

Statement 7 Adults with psychosis or schizophrenia are offered combined health eating and physical activity programmes, and help to stop smoking

Statement 8 Carers of adults with psychosis or schizophrenia are offered carer-focused education and support programmes

NHS | Presentation to [XXXX Company] | [Type Date]25

Current staff provision and training gap analysis for AHSN

and NHS England

Demographics

• Population 12.5 million• 25 EIP services• Employing 280 WTE staff• Current caseload 3982 FEP

EIP Readiness Data analysis 26

Total Caseload Vs. Predicted cases

27EIP Readiness Data analysis

Bucks

East Kent And Medway

Banes

Worthing

Isle Of Wight

Plymouth

Surrey

Portsmouth

Hampshire

West Surrey Ne Hampshire

Oxfordshire

Somerset

Cornwall

Torbay, Paignton And Brixham

Milton Keynes

West Dorset

Wiltshire

Sussex

Bristol

North Somerset

Berkshire

Gloucestershire

0 100 200 300 400 500 600 700

Predicted cases for 3 yearsCaseload

Who works in EIP teams?

28EIP Readiness Data analysis

Team ManagerConsultant Psychiatrist

Non Training Grade PsychiatristPsychologist Band 7-8Psychology Assistants

Cbt TherapistCommunity Psychiatric Nurse

Social WorkerSupport Time And Recovery Worker

Occupational TherapistCounsellors

Not Specified/OtherAdmin

Vocational AdvisorCarer Liaison

PharmacistResearch Assistant

0.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0

21.0

10.3

4.3

17.5

2.0

2.2

133.4

25.7

34.2

38.6

2.0

10.6

23.1

4.2

4.0

0.1

0.2

WTE Total

Skills gap survey in delivering NICE concordant care

• CBT skills• Family therapy interventions • Vocational skills• Physical health• Assessment tools


% without skills (total 280 WTE staff)

• CBT skills (76%)• Family therapy interventions (81%) • Vocational skills (76%)• Physical health (70%)• Assessment tools (48% - 70%)


Quality of CBTp important

• Generic CBT competencies are not associated with good clinical outcomes in psychosis(Durham et al, 2003);

• CBTp competencies are (Wykes et al, 2008 ; Steel et al, 2011)• IAPT-SMI: nationally agreed criteria for training and competencies in

CBTp and FI• Competency Frameworks for Psychosis, Bi-Polar Disorder and

Personality Disorder. www.ucl.ac.uk/CORE/

http://www.ucl.ac.uk/CORE/

IAPT for SMI Initiative• Part of the government’s four-year plan to increase access to talking therapies• Transforming mental health services to be better able to provide NICE

approved psychological therapies to people with bipolar disorder, personality disorders and psychosis

• Equity of provision regardless of age, gender & BME status

• 6 SMI demonstration sites, started in Nov 2012• 3 PD, 2 psychosis, 1 bipolar disorder• Data collection until Dec 2014, final report by April 2015

Part of the solution?

What IAPT-SMI offersCBT for psychosis:

• Weekly or fortnightly individual 1 hour sessions• 6-9 months therapy• Therapists receive weekly-fortnightly group supervision• See clients locally at the team base

FI for psychosis:• Fortnightly 1 hour sessions with client and carer(s)• Up to ten sessions, over a period of 3-9 months• Therapy delivered by two trained therapists• Therapists receive weekly-fortnightly group supervision

A Matched-Care / Tiered Approach to Psychological Care

Psycho-social

interventions

Case managers/

ST&R

Tier 2

Tier 3

Formal CBT or FI,Discrete Problems

Staff with:

Formal CBT training or COPE Msc (under

supervision)

Complex / multiple

problems longer term CBT

or FI

Tier 1Specific PSI

Training

Supervision/ Consultation

Cognitive Therapists

Clinical Psychologists


A limited range of courses available across the region

Summary

• There are large gaps in EIP teams to deliver NICE concordant care for psychosis

• Professional training alone does not equip EIP staff with necessary skills

• There is a need for an EIP training package, with tiered competencies.

• Training will become mandated for service accreditation.



Our local workforce

Dr Sarah MarriotDivisional Medical Director

Central North West London NHS Foundation Trust


Refreshments

Please return to your seats by 11.30am


Workshop 1

Understanding local priorities


Workshop 1 – identifying local priorities: Against your CURRENT and your FUTURE

staff:

• Detail those specific priorities for workforce education and training which you feel any future collaborative programme should address

• Consider service-user changing needs, new models of care and wider multi-professionalism and integration across care sector boundaries Spend 30mins capturing areas of priority for feedback to the room


Lunch

Please return to your seats by 1pm


HETV perspectives of local workforce challenges

Dr Michael BannonPostgraduate Dean

Juliet AndersonAssistant Director – Workforce Strategy

HETV

West Midlands Mental Health Institute

Local Education and Training Council

Dr Teresa Hewitt-MoranDr Sharon Binyon

www.hee.nhs.ukwww.wm.hee.nhs.uk

Mental Health Institute LETC

1. Black Country Partnership Trust2. Coventry and Warwickshire

Partnership NHS Trust3. Worcester Health and Care NHS

Trust4. Birmingham Community

Healthcare Trust5. South Staffordshire and

Shropshire Healthcare NHS FT6. North Staffordshire Combined

Healthcare NHS Trust7. Birmingham and Solihull Mental

Health NHS FT8. Dudley and Walsall Mental

Health NHS Partnership Trust


MHI LETC Operating Model

www.wm.hee.nhs.uk

workforce innovation through collaboration, sharing best

practice and building sustainable relationships

Upskilling the workforce in psychological approaches

Raising the profile of Careers in psychiatry Medical

psychotherapy

Safer staffing tool- MH & LD inpatient

& community

Creating innovative solutions for the

learning disability workforce

Liaison & diversion workforce modelling

Substance misuse

workforce

Assistant practitioner programmes

Advanced practice roles

Dementia education for the entire

workforce across the patient pathway

Primary care workforce

training

Cross sector relevance

Specialist MH/LD service focus

Specialist MH/LD service focus/ national lead


Key Learning from West Midlands

Learning Disability Programme Example


Understanding the LD health and social care workforce needs outside of the NHS

• Worked with commissioners in 14 sub regional localities to produce key intelligence on the operating environment for LD providers in the region and changes to NHS LD service models that will influence demands for future workforce

• Commissioned Skills for Care to undertake “horizon scanning qualitative research” to understand potential future service changes and the effect on the workforce required

• Surveyed all identified PIV LD providers to understand and quantify how many of what type of worker they will require in future.

• Social care and commissioners Stakeholder event in April to further understand workforce requirements of the social care sector in partnership with Skills for Care and launch network


Raising Awareness of LD in Healthcare Settings

• Commissioned the development of a Learning Disabilities Health Toolkit and distributed copies to all NHS trusts in the region.

• Each ward/ department in acute & community teams has a copy

• Promoted awareness of LD and the health toolkit with region wide “Learning Disability Made Clear” campaign and series of workshops

• Conducted a direct mail marketing campaign to 1000 GP’s in the region.

• December 1st – launched website to host all components of toolkit – free to download


Competency Framework for the Specialist Healthcare Workforce • Established a Region Wide Expert Reference Group to work together to devise and agree

a generic interventions framework and corresponding ‘I Story’

• Developing a Region Wide Competency Framework for the whole specialist Learning Disabilities workforce that is aligned to interventions along the care pathway.

• Worked in partnership with Skills for Health to ensure competencies are mapped to the National Occupational Standards to inform education and training development

• All staff within specialist learning disability services currently moping competencies to framework to enable a training needs analysis to emerge

• Work planned 15/16; Mapping workforce requirements to support seamless transition from Children’s services to Adult Learning Disability services and address any related workforce/learning needs


Centre of Excellence for Learning Disability Education

• Identified key challenges with current commissioning arrangements through workshops with HEI partners

• Hosted region wide workshop to identify alternative models of education to meet future LD service models

• Commissioned a comprehensive research study into alternative models of undergraduate LD nurse training and assessed appetite for a dual LD award in the West Midlands.

• Agreed a region wide strategy to create a Centre for Learning Disabilities Excellence in the West Midlands to include flexible programmes to meet the needs of services across the spectrum of service user need, including part time and flexible programmes


Within first 6 months worked hard to establish an understanding that the MHI exists for the ‘common good’ of MH & LD workforce across the region- beyond individual trust interests

Maintaining board level membership

Good mix of members from HR, Nursing and Medical backgrounds

Integration of the post graduate school of psychiatry- whole workforce consideration

Ability to focus down on top ‘big hitters ‘ eg; ld, dementia and psychological skills for the whole workforce, safer staffing

Utilising expertise to inform national programmes (liaisn and diversion NHSE project)

What has worked well

www.wm.hee.nhs.uk

Identifying how members can influence core business – tangible impact

Quality review; identifying challenges and working with hei providers to find solutions to problems (RMN curriculum)

Workforce planning and education commissioning; improving plan quality and assuring data to inform decisions that impact upon individual trusts and HEIs (clinical psychology commissions)

Horizon scanning-Looking to the future impact of service commissioning changes upon the workforce and our ability to train (substance misuse)

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Lessons learned• We need to look upwards and outwards to ensure

that maximum benefit is realised from good practice in other LETBs- no need to reinvent wheels

• One size will not always fit all but pragmatic decisions about adoption and spread have enabled pace of change to accelerate

• Commissioner involvement needs to be enriched• Undergraduate medical school input is required• Focussed Communication strategies are require to

ensure LETC outputs land where they need to in acute and community trusts and primary care (Learning Disability/ Dementia)

• All member trusts host a programme of work- this strengthens commitment and ownership, and a sense of collaboration


Questions?


Workshop 2

Developing a collaborative model for

success


Workshop 2 – a model for success:

1. What model would work to enable a collaborative, partner-led approach to addressing priorities?

2. What workstreams should a model consider?

3. Which partners and networks should be involved – either directly, or through using existing activities?


Closing remarks

Comments and questions:[email protected]

mailto:[email protected]


HETV Autumn Conference

Tuesday 13 October 2015The Oxford Hotel

Oxford

Diary date:

www.hee.nhs.uk hetv partnership council thursday 9 july 2015 9.30am – 2.45pm the kassam stadium,...

Documents

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work of existing networks

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levers best education

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