IAPT Performance Workshop

Transcription

1 IAPT Performance Workshop May 2015 Els Drewek Head of Intensive Support) England 1

2 This set of slides is provided in support of the interactive workshop on IAPT Performance and will cover the following areas: Referrals and Access Recovery and Reliable Improvement Waiting Standards All data provided is HSCIC published data either Q3 or January 2015 which was the first month of the new monthly HSCIC reports 2

3 Referrals and Access 3

4 Cheshire and Merseyside Access Rate 18% 16% Cheshire,W&W Merseyside 16% 14% 12% 10% 8% 6% 9% 10% 12% 12% 15% 10% 9% 14% 15% 12% 8% 11% 11% 4% 2% 0% Eastern Cheshire South Cheshire Vale Royal Warrington West Cheshire Wirral Halton Knowsley South Sefton Southport and Formby St Helens Liverpool Access Linear (National 25th percentile) Linear (National 75th percentile)

5 Cheshire and Merseyside Referral and Attrition Rates Chesire,W&W Merseyside 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Eastern Cheshire South Cheshire Vale Royal Warrington West Cheshire Wirral Halton Knowsley South Sefton Southport and Formby St Helens Liverpool Referrals closed without entering treatment as percentage of the prevalence (Attrition) Referrals that enter first treatment (the access KPI) Referrals required to achieve 15% access rate if the attrition rate remains the same Achieving 15% access rate with current attrition rates will require more than 35% of prevalence to be referred Source HSCIC January 2015 IAPT data.

6 Cheshire and Merseyside Older People referrals percentage in prevalence vs percentage of referrals to IAPT 18% Merseyside Chesire,W&W 16% 14% 12% 1% 5% 10% 8% 6% 12% 8% 6% 2% 4% 6% 3% 4% 5% 10% 8% 3% 4% 2% 4% 4% 8% 8% 6% 6% 6% 7% 4% 5% 0% Eastern Cheshire South Cheshire Vale Royal Warrington West Cheshire Wirral Halton Knowsley South Sefton Southport and Formby St Helens Liverpool Gap between the proportion of adults aged 65 or over who are referred to IAPT and who are estimated to have common mental health problems Proportion of referred adults patients who are aged 65 or over

7 Achieving and Sustaining Access Rates Summary Are referral rates sufficient to deliver 3.75% access rates each quarter taking into account known attrition rates? Nationally 35% of patients referred do not enter treatment. There is good evidence that long waiting lists suppress referrals. Is there a clear longer term strategy ( / HWBB / PHE) for primary care psychological therapies but with immediate priorities and a marketing plan that addresses: Simplified access and self referral routes Truly primary care led and not medically led Values the benefit Step 2 therapy can make to wellbeing of the population (mainly mild to moderate anxiety and depression) including specialisation of PWPs Links with physical health Early intervention Maximising older people access and BME Access

8 Cheshire and Merseyside Referral Indicators Source HSCIC January 2015 IAPT data. National Attrition rate 36%, National Self Referral Rate 44%

9 Self Referrals Cheshire and Merseyside 70% Self Referrals vs. Attrition 60% 50% England 40% 30% 20% 10% 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% Attrition Rate Source HSCIC January 2015 IAPT data.

10 Recovery and Reliable Improvement 10

11 Cheshire and Merseyside 80% Recovery and Reliable Improvement 70% 60% 50% 40% 30% 20% 10% 0% -10% Recovery Reliable Improvement Source HSCIC January 2015 IAPT data.

12 Cheshire and Merseyside 90% Completion Rates 80% 70% 60% 50% 40% 30% 20% 10% 0% Source HSCIC January 2015 IAPT data.

13 National Diagnosis Analysis Q2 Problem Descriptor Finished course of treatment Not at Caseness Recovered Recovery Rate (%) F10 - Mental and behavioural disorders due to use of alcohol F50 - Eating disorders F33 - Recurrent depressive disorder 4, , F43 - Reaction to severe stress, and adjustment disorders 3, , F99 - Mental disorder, not otherwise specified 4, , F31 - Bipolar affective disorder Other ICD10 code 1, Z63 - Oth probs related to prim sup grp, inc family circumstances F32 - Depressive episode 18,780 1,350 7, F40 - Phobic anxiety disorders 3, , F42 - Obsessive-compulsive disorder 2, F41 - Other anxiety disorders 36,025 3,170 16, F45 - Somatoform disorders Invalid Code No code provided 37,475 4,530 13, Ordered by recovery rate, with the lowest recovery rate first. Based on quarterly supplementary analysis and displayed at 3 digit ICD10 code level in line with v1.5 reporting Data source: Improving Access to Psychological Therapies (Adult IAPT) Dataset 13

14 HSCIC Data Quality and Provisional Diagnosis Validity by Data Item (Valid %): October 2013 to October 2014 Final >= < 40 NATIONAL Anxiety Disorder Specific Measures Appointment Type General Medical Practice Code Generalised Anxiety Disorder (GAD7) Score Number Organisation Code of Commissioner Patient Health Questionnaire (PHQ9) Score Provisional Diagnosis Therapy Types (1-4) Oct13 Nov13 Dec13 Jan14 Feb14 Mar14 Apr14 May14 Jun14 Jul14 Aug14 Sep14 Oct Few providers are giving a valid Anxiety disorder specific measure that is relevant to the diagnosis. In these cases GAD7 will be used instead of an ADSM. Provisional Diagnosis (now Problem Descriptor) recording has shown improvement and is now at 60% Recording of therapy type is still lower than in version 1, but has increased from 59% to 70% validity. This rise in validity is responsible for the variation between version 1 and version 1.5 entering treatment figures in the October Final activity data. New data quality measures have been introduced with version 1.5 of the dataset. Data source: Improving Access to Psychological Therapies (Adult IAPT) Dataset 14

15 Recovery and Reliable Improvement Summary For the KPI is the 50% Recovery. However, Recovery and Reliable Improvement are equally important as they measure different things and services need to understand how their performance varies from the national average on both. Commissioners and the providers need to understand through sound audits or root cause analysis why the recovery rate is not being reached so that the cause can be addressed. On reliable improvement, if a service is below average it equally needs to be understood through audits why high numbers of patients do not show reliable change/improvement. Recommendations Monitor both together at all times. Make the link between presenting condition/diagnosis during treatment, NICE guidance for that condition and therapy offered Understand outcomes by Step, by Team, by modality, by therapist Offer choice of therapy by commissioning the full range of NICE Recommended modalities so that it meets the needs of your population

16 Cheshire and Merseyside Commissioner Recovery Rate Reliable Improvement Completion Rate England 45.1% 61.7% 51.8% Eastern Cheshire 56.5% 63.3% 79.0% Halton 51.3% 68.8% 37.2% Knowsley 40.9% 60.9% 60.5% Liverpool 33.7% 60.0% 63.7% South Cheshire 66.7% 62.5% 53.3% South Sefton 41.5% 62.8% 67.2% Southport and Formby 42.9% 60.0% 68.2% St Helens 43.8% 57.9% 39.6% Vale Royal 53.3% 70.6% 65.4% Warrington 42.4% 50.0% 62.3% West Cheshire 50.0% 57.4% 66.7% Wirral 46.2% 61.4% 45.6% Source HSCIC January 2015 IAPT data.

17 Waiting Standards 17

18 Cheshire and Merseyside Average Waits to first treatment Chesire,W&W Merseyside Eastern Cheshire South Cheshire Vale Royal Warrington West Cheshire Wirral Halton Knowsley South Sefton Southport and Formby St Helens Liverpool Waiting list Backlog 1st quintile (<3.2 weeks) Waiting list Backlog 2nd quintile (3.2 weeks weeks) Waiting list Backlog 3rd quintile (4.84 weeks weeks) Waiting list Backlog 4th quintile (7.4 weeks weeks) Waiting list Backlog 5th quintile (>11.8 weeks) Linear (National 25th percentile) Linear (National 75th percentile) Source HSCIC January 2015 IAPT data.

19 Numbers Waiting and Clearance times From a operational management perspective, the numbers of patients that are waiting are as important, if not more important than the waiting times achieved. Clearance times in weeks suggests the scale of the backlog to be cleared, irrespective of the actual numbers and the size of the service. It is the number of weeks it would take to clear the waiting list if no new referrals arrived The service needs to understand the sustainable position, i.e. the number of patients that can sensibly be waiting to deliver a particular waiting standard Source HSCIC January 2015 IAPT data.

20 Weeks to Clear Cheshire and Merseyside 20 Clearance Times Source HSCIC January 2015 IAPT data.

21 Cheshire and Merseyside Comparison between the national waiting standard (2 or more sessions measured at discharge ) and current waits achieved (all first treatments) Commissioner 6W All 18W All 6W KPI 18W KPI Clearance England 76.5% 96.8% 77.5% 95.3% 6.4 Eastern Cheshire 5.3% 63.2% 6.7% 70.0% 16.2 Halton 2.3% 69.8% 12.5% 62.5% 17.6 Knowsley 7.9% 76.3% 26.1% 87.0% 10.8 Liverpool 95.5% 100.0% 97.0% 99.0% 3.4 South Cheshire 73.3% 96.7% 75.0% 93.8% 5.3 South Sefton 92.2% 100.0% 97.7% 100.0% 7.3 Southport and Formby 95.5% 100.0% 100.0% 100.0% 4.8 St Helens 25.0% 68.8% 21.1% 78.9% 7.4 Vale Royal 88.5% 100.0% 82.4% 94.1% 3.5 Warrington 39.3% 100.0% 65.8% 100.0% 7.0 West Cheshire 43.2% 98.8% 72.2% 98.1% 11.5 Wirral 64.0% 99.2% 78.9% 98.2% 5.4 Source HSCIC January 2015 IAPT data.

22 Weeks to Clear Waiting List Cheshire and Merseyside clearance times vs waiting experience 20 Clearance Time vs. Waiting Time England % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 6W Performance (All Patients Treated in January) Source HSCIC January 2015 IAPT data.

23 What is First Treatment? FAQs from: Improving Access to Psychological Therapies (IAPT) Waiting Times Guidance and FAQ s February Question: What is meant by the terms assessment appointment and an assessment with treatment appointment? Answer: An assessment appointment is when the service makes initial contact with the patient (face-to-face, telephone or ) in order to assess the patient s condition and whether they are suitable for treatment. This is sometime carried out by a triage or single point of access service. An assessment with treatment appointment is when the initial contact is extended by the healthcare profession to include an IAPT compliant treatment. 13. Question: How is first treatment defined? Answer: The decision on what is treatment is a local decision that should to be clearly laid out in written, local pathways and have senior clinical sign off in the organisation. Such protocols should also clarify when an appointment should not be recorded as treatment. The final decision on whether a particular appointment is the start of treatment should not be a blanket decision but be made by the healthcare professional undertaking the appointment in the knowledge of those pathways. It is important to ensure the Appointment purpose field is completed on clinical systems as this is a mandatory field.

24 Long waits not visible in national reports The following slide gives an indication of hidden waits. It is the wait from first to second appointment. Nrs of patient who had a 2nd appointment during January 2015 who waited over 28 days and over 90 days since their 1 st appointment Scale of the problem: The above figures as a percentage of the number of patients discharged in the period who had two more appointments. (not adjusted for patient choice delays) It is acknowledged that this is not the full extent of hidden waits in the system.

25 Cheshire and Merseyside Commissioner st 2 nd st 2 nd Completed Treats 28+ Ratio 90+ Ratio England 22,830 3,783 39, % 9.5% Eastern Cheshire Halton Knowsley Liverpool South Cheshire South Sefton Southport and Formby St Helens Vale Royal Warrington West Cheshire Wirral 25 * % * 25 * % * % 13.0% % 15.0% % 31.3% 235 * % * 145 * % * 10 * % * 80 * % * 120 * % * % 22.2% % 36.8% Source HSCIC January 2015 IAPT data.

26 IAPT Waiting Standards Recommendations and providers have established written pathways from referral to discharge that contain waiting standards for assessment, first appointment and subsequent appointments, (including step-up) that are in line with the 6 wk and 18 wk standard and acceptable to patients and referring clinicians. There is a good understanding of the requirements for sustainable delivery and the run rate to deliver the 3.75% each quarter separate from any discussion on clearing backlogs. Providers establish PTL Management that weekly/daily visualise and manage all long waits and/or unequal waits by locality, therapy types or for particular therapists, whether this is for first treatment, for second treatment or subsequent treatments including step up. Delivery of the agreed waiting standards, and numbers of patients waiting at every point are monitored in contract meetings against expected numbers. Source HSCIC January 2015 IAPT data.

27 0-1 Weeks 1-2 Weeks 2-3 Weeks 3-4 Weeks 4-5 Weeks 5-6 Weeks 6-12 Weeks Weeks 18+ Weeks Dated Undated Example PTL Reports. The number of patients waiting on a particular date by weeks waited Develop by Site, by Therapy Type, dated and undated, 27

28 IAPT Intensive Support Team