Standard Operating Procedure: Early Intervention in Psychosis Access Times

Transcription

1 Corporate Standard Operating Procedure: Early Intervention in Psychosis Access Times Document Control Summary Status: New Version: V1.0 Date: Author/Owner: Rob Abell, Senior Performance Development Manager Approved by: Policy and Procedures Committee Date: 15/06/2015 Ratified: Policy and Procedures Committee Date: 15/06/2015 Related Trust Strategy or Aims: Implementation Date: Provide high quality services, built on best known practice and evaluated through service user and carer feedback and clear process and outcome measures. Deliver all regulatory performance, Quality standards and compliance indicators June 2015 Review Date: June 2018 Key Words: Associated Policy or Standard Operating Procedures Early intervention, psychosis, access times, target Compliance with the Access and Outcome Indicators in Monitor s Risk Assessment Framework Policy

2 Standard Operating Procedure: Early Intervention in Psychosis Access Times Contents 1. Introduction Rationale Measurement Scope Summary of responsibilities Non-compliance Trust Expectations Further Guidance and Appendices... 6 Appendix 1 Approach to measurement of the referral to treatment standard... 7 Version History Log Version Date Implemented Details of significant changes 1.0 Reference Documents Referred to Document NHS England Guidance to support the introduction of access and waiting time standards for mental health services in 2015/16 Document Date 12 February 2015 IT IS THE RESPONSIBILITY OF ALL USERS OF THIS SOP TO ENSURE THAT THE CORRECT VERSION IS BEING USED All staff should regularly check the intranet site for information relating to the issue of new or revised versions of this SOP. This SOP will normally be reviewed every 3 years unless changes to the legislation require otherwise. Page 2 of 8

3 1. Introduction This document details the process by which SSSFT staff must record information for the: Type of Indicator Required by Title Mandatory Indicator x Monitor and CQC Early intervention in Psychosis (EIP): People Commissioner Indicator x Host CCG experiencing a first episode of psychosis treated contracts with a NICE approved care package within two weeks of referral 2. Rationale In October 2014, NHS England and the Department of Health jointly published Improving access to mental health services by This document outlined a first set of mental health access and waiting time standards for introduction during 2015/16 and set out an ambition, subject to future resourcing decisions following the next Spending Review, to introduce access and waiting time standards across all mental health services between 2016 and These commitments were reaffirmed in the NHS Mandate and reflected in the joint planning guidance for 2015/16, Forward view into action 2015/16. 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. Most initial episodes of psychosis occur between early adolescence and age 25 but the standard applies to people of all ages in line with NICE guidance. In 2011, No Health Without Mental Health7 highlighted the effectiveness of early intervention services for people experiencing first episode psychosis. There is good evidence that these early intervention in psychosis (EIP) services, when delivered in accordance with NICE standards, help people to recover from a first episode of psychosis and to gain a good quality of life: 35% of people under their care are in employment, compared with 12% in traditional care; They reduce the likelihood of an individual receiving compulsory treatment from 44% to 23% during the first two months of psychosis; and They reduce a young person s suicide risk from up to 15% to 1%. NICE also found that these services reduce the likelihood that individuals with psychosis will relapse or be detained under the Mental Health Act, potentially saving the NHS 44 million each year through reduced hospital admissions. It is well established that failure to engage and intervene effectively in early psychosis and its prodrome (precursor stages) leads to poorer outcomes for individuals and their families and high levels of consequent expenditure in both NHS and other public services. The provision of evidence based care in the prodromal period can prevent the development of psychosis in a significant proportion of cases, preventing much illness, disability and distress to young people and their families. It is well known that currently far too few individuals experiencing or at high risk of first episode psychosis are receiving the right care at the right time and there can be very long delays in accessing some of the key effective interventions recommended by NICE, particularly the recommended psychological therapies - CBT for psychosis and family therapy but also physical healthcare interventions and employment support (e.g. individual placement and support schemes). These poor levels of access and long waits make very little sense in terms of either high quality care or effective use of NHS resources. Page 3 of 8

4 The high level aims of the new standard are therefore to ensure that: Anyone with an emerging psychosis and their families and key supporters can have timely access to specialist early intervention services which provide interventions suited to age and phase of illness. Individuals experiencing first episode psychosis have consistent access to a range of evidencebased biological, psychological and social interventions as recommended by the NICE guidelines for psychosis and schizophrenia in children and young people CG155 (2013) and in adults CG178 (2014) and the NICE guideline for psychosis with co-existing substance misuse. Care is provided equitably - taking into account higher rates of psychosis in certain groups who may experience difficulties in accessing traditional services. 3. Measurement The indicator is measured by: Numerator The number of referrals following assessment who have been identified as experiencing a first episode of psychosis for whom definitive treatment commenced within 2 weeks of referral with a NICE approved care package (when a person has been accepted onto a caseload, an EIP care coordinator allocated and a NICE concordant care package commenced) Denominator The number of referrals following assessment who have been identified as experiencing a first episode of psychosis received in the period Indicator Numerator divided by the denominator expressed as a percentage Target By 1 st April 2016 More than 50% of people experiencing a first episode of psychosis are treated with a NICE approved care package within two weeks of referral By % of people experiencing a first episode of psychosis are treated with a NICE approved care package within two weeks of referral 4. Scope The standard is two-pronged and both conditions must be met for the standard to be deemed to have been achieved, i.e. 1. A maximum wait of two weeks from referral to treatment; and 2. Treatment delivered in accordance with NICE guidelines for psychosis and schizophrenia - either in children and young people CG155 (2013) or in adults CG178 (2014). Most initial episodes of psychosis occur between early adolescence and age 25 but the standard applies to people of all ages in line with NICE guidance. Further guidance on the approach to measurement of this access standard can be found in Appendix 1. Page 4 of 8

5 5. Summary of responsibilities Designation Responsibilities See patient within agreed timescales Ensure care packages put in place meet the appropriate NICE guidance Clinical Staff Record accurate, timely, complete and consistent information Entries should be made onto the clinical IT system at the time of an event taking place, but all entries must be made into the clinical system within the same shift that an event took place. Team Manager Monitor performance through reports to ensure specific contractual targets are met Validate reports and any figures showing as breaches/non-compliant, correct the record if necessary, including updating patient records on the clinical IT system and provide feedback All staff Every person who has contact with either: a) a service user (either face to face or telephone contact) or b) any individual (either face to face or telephone contact) The service users care must be recorded within the progress notes within the clinical system. Information Team Provide reports as required from the Data Warehouse Specification and publication of reports as specified in line with the definition in this document. Where performance falls below the KPI threshold the Information Team will provide the Executive Lead with the details of the shortfall. Compliance or otherwise will be included in the Finance and Performance Sub Committee and Trust Board papers submitted on a monthly basis. Executive Lead Request, where necessary, a narrative reason behind any noncompliance from the responsible teams Identify actions for the DMTs to address non-compliance Oversee the completion of actions to (which may involve developing action plans) to address under-performance Service Leads Provide narrative to the Executive Lead as required Provide evidence of service improvements established to address performance Performance On an ongoing basis, will review and monitor the performance trends of Development Team this indicator, informing the formal performance review process and providing remedial action with teams where appropriate. Directorate Performance against this KPI should be reviewed on a monthly basis at Management Teams Contract and Information Group 6. Non-compliance the relevant Directorate management team meetings. Ad hoc requests for information and data pertaining to this indicator will all be assessed and dealt with by the Contract and Information Group This indicator features in Monitor s Risk Assessment Framework, and as such is a national priority target which Foundation Trusts are expected to achieve. Failure to meet this target is a breach of our Monitor Licence This indicator is reported to Monitor on a quarterly basis and as such affects the overall governance risk rating of the Trust. The indicator is also reported to our commissioners and non-compliance can result in monetary penalties and so affect the funding available for patient care. Page 5 of 8

6 Note: This measure will start to be reported to Monitor from Quarter /16 and they will use the measure as a formal trigger in the Risk Assessment Framework from April 2016 (Quarter /17). 7. Trust Expectations To meet the statutory and commissioner requirements. To use the Trust s clinical system to record this activity in accordance with the data quality requirements. Distribution of information and data regarding this indicator will only be shared with external agencies through nominated contacts. The Contract and Information Group (chaired by the Director of Finance) will validate all requests for information and data regarding this indicator prior to their distribution. Teams are encouraged to agree local targets in excess of the contractual and statutory targets. The Information Team will provide information in support of local targets. This indicator applies to the following directorates: o Mental Health 8. Further Guidance and Appendices Appendix Guidance documents on the clinical processes for RiO The SQL code used to produce the information from the SSSFT data warehouse and reports See guidance on the RiO Quick Reference Guides and Manuals website or contact your RiO Super User for guidance Contact the Trust Information Team who will provide you with the latest version of the SQL code used to produce reports Page 6 of 8

7 Appendix 1 Approach to measurement of the referral to treatment standard Referrals to clock start Referrals for suspected first episode psychosis (FEP) will fall within two main categories: Internal: those originating from a team or ward that is within the same organisation e.g. from a crisis resolution home treatment team External: referrals from external sources including referrals from the individual, family, education, third sector agencies, GPs, justice system etc. This rule will apply equally to people already receiving secondary care e.g. if a person has been accepted by a Crisis Resolution/Home Treatment Team (CRHT) or admitted to an acute ward and is suspected of experiencing a first Episode of Psychosis (FEP), the CRHT or inpatient ward will have a duty to refer the person to the EIP service with the referral clearly flagged as suspected FEP. The RTT clock will start on the date that the secondary care provider first receives notice of a referral from any external or internal source which has a statement indicating that the referrer suspects a FEP. Where there are self-referral pathways agreed locally by commissioners and providers, the RTT clock will start upon receipt by the secondary mental health provider organisation of the enquiry from the person or carer regarding a concern of actual or developing FEP. The clock will start regardless of referral source, the age of the person being referred or co-morbidities such as learning disabilities or autism. Individuals who present with substance misuse should be assessed and provided treatment by EIP services collaborating with substance misuse specialist services in keeping with the NICE guidelines for Psychosis with co-existing substance misuse. The only suspected cases of FEP exempt from these arrangements will be referrals of individuals who are experiencing psychotic symptoms in the context of organic illness such as dementia. Many organisations operate a central triage point a single telephone number or referral point to which referrers send all referrals for mental health and social care assessment for triage. These are often referred to as a Single Point of Access (SPA), Central Point of Entry (CPE) or Assessment Centre. Receipt of a referral flagged as suspected FEP by a central triage point will start the RTT clock. If the central triage point identifies a referral that would appear to be for suspected FEP but is not flagged as such, the triage function should flag the referral as suspected FEP and start the clock upon the date of receipt and then urgently refer on to the EIP service. Where referrals are made directly to the EIP service (from any internal or external source), the RTT clock starts on the date the referral is received. Assessment Following receipt of referral by the EIP service, the person or/and their chosen accompanying support should be offered an appointment, where reasonably possible, at their convenient time and venue according to engagement and disengagement best practice guidelines. DNAs or patient cancellations do not stop or pause the RTT clock. Active monitoring / watch and wait should be initiated where the person with suspected FEP does not attend one or more of their assessment appointments and does not engage with the EIP service. An EIP team clinician should be allocated to coordinate efforts to engage the person and their support network to access psycho-education, support; and where appropriate carer support and family interventions. The EIP clinician should continue to try to engage the person suspected of having FEP and try to engage Page 7 of 8

8 their support network for a period of up to 6 months, whilst closely monitoring for any change in status. The EIP service should make an explicit record of all attempts of engagement and regular reviews. The discharge of someone who has been referred as suspected of having a FEP, who the team is unable to assess, must follow engagement and disengagement best practice guidelines. Assessment to clock stop Completion of the EIP assessment will result in one of two decisions: The person is experiencing first episode psychosis The person may have an at risk mental state (ARMS) i.e. he / she is not clearly experiencing frank psychotic symptoms, but there are indicators of deteriorating mental state and functioning The RTT clock stops at the start of first definitive treatment. The clock will stop for group: Experiencing first episode psychosis when the person has been accepted on to caseload, an EIP care coordinator allocated and a NICE concordant package of care commenced. All of these conditions must have been met. Possible at risk mental state (ARMS) - when the person has been accepted on to caseload, an EIP care coordinator allocated and a specialist ARMS assessment commenced by an appropriately qualified EIP clinician. All of these conditions must have been met. N.B. If the person enters an acute pathway (mental or physical health) before all of the conditions specified in the pathway steps above have been met, then the RTT clock does not stop. Research has established that the emergence of psychosis is often gradual with subtle symptoms preceding frank and florid psychotic symptoms. There is evidence to show that many people with prodromal symptoms may be inappropriately discharged due to lack of specialist assessment of ARMS. EIP services should undertake a specialist ARMS assessment of anyone who is assessed and deemed not to have the nature, severity or frequency of frank psychotic symptoms to warrant a diagnosis of first episode of psychosis. This specialist ARMS assessment will ensure that people with ARMS are identified, assessed and adequately treated if appropriate, and that any transition to first episode psychosis is detected quickly. All individuals identified as having ARMS should be offered a NICE concordant package of care. NICE recommend that this prodromal group should not be prescribed antipsychotic medication. Page 8 of 8