Access and waiting time standards for early intervention in psychosis

Summary

On Wednesday 7 September 2016 MPs will take part in a Westminster Hall debate on access and waiting time standards for early intervention in psychosis. The debate will be moved by Rt Hon Norman Lamb MP.

This debate pack includes a background briefing, recent press articles, Parliamentary material and links to further reading.

Associated briefing papers

Further background on mental health policy and NHS waiting time standards in England can be found in the following Library briefings: 

• Mental health policy in England, 6 April 2016
• NHS maximum waiting times and patient choice policies, 6 May 2016

Establishing standards

One of the standards is that at least 50% of people going through their first episode of psychosis will get recommended treatment within 2 weeks of being referred: the aim is to increase this percentage in future years. 

The Department of Health and NHS England said that their ambition is for access and waiting time standards to be implemented for all mental health services over the next five years: 

Access and waiting time standards for treatment in physical health will be complemented by access and waiting time standards for mental health. Starting in some key areas next year, for the next five years the vision is for all mental health services to guarantee people access to timely, evidence-based and effective treatment. In doing so the NHS will not only shorten the time that people go without treatment and support, but also improve outcomes.

The early intervention in psychosis access and waiting time standard (H3)

The access and waiting time standard for early intervention in psychosis (EIP) services requires that, from 1 April 2016, more than 50% of people experiencing first episode psychosis will be treated with a NICE-approved care package within two weeks of referral.

The standard is targeted at people aged 14-65.3 The standard is described as ‘two- pronged’ and both of the following conditions must be met for the standard to be deemed to have been achieved: 

• a maximum wait of two weeks from referral to start of treatment
• treatment delivered in accordance with NICE guidelines and quality standards for psychosis and schizophrenia

Funding

On 11 January 2016, following a speech on improving life chances by the Prime Minister, the Government announced investment to enhance mental health services across England, including an improved waiting time target for people experiencing psychosis:

About 75% of mental illness in adult life begins before the age of 18 and it is estimated that 17,000 people a year experience a first episode of psychosis. While care across the country is improving until now, there have been no national standards setting out a clear timeframe for care.

…the Prime Minister… set out a new waiting time target – to be in place in April 2016 – so that from next year at least half of those experiencing psychosis for the first time must be treated within 2 weeks, rising to at least 60% by 2020.

Mental Health Taskforce

In response to the recommendation of the Mental Health Taskforce, published in February 2016, NHS England confirmed that by 2020/21 the standard will be extended to reach at least 60% of people experiencing first episode psychosis.

£40 million recurrent funding has been allocated to support delivery of the early intervention in psychosis standard. NHS England’s report on implementing the Mental Health Taskforce recommendations, estimates the costs for an additional 10% of people to be treated within two weeks as £70 million per annum when fully implemented including costs of workforce development.

NHS England profile

The NHS England profile sets out increases towards this predicted funding level over four years, from 2017/18, in order to achieve “a deliverable phasing of improvement and additional capacity”. This proposed funding increase does not include the recurrent £40 million annual funding provided from 2015/16.

Further information on the standard, the evidence base for early intervention in psychosis, and expectations of commissioners and providers can be found in NHS England and NICE’s guidance, Implementing the Early Intervention in Psychosis Access and Waiting Time Standard. The guidance also provides information on clinical definitions and prevalence of psychosis.

Statistics

Since April 2016 NHS England has published statistics on Early Intervention in Psychosis Waiting Times, from December 2015 onwards.

The most recent dataset shows that in June 2016, 1,177 patients in England started treatment for Early Intervention in Psychosis, 863 (73.3%) of which began treatment within two weeks of referral. In the same month, 1,047 patients were waiting to begin treatment, 558 (53.3%) of which had been waiting for over two weeks.

The tables in the associated PDF below show equivalent figures for England back to December 2015 for patients starting treatment and for patients still waiting to begin treatment.

CCG monthly figures

Monthly figures by clinical commissioning group (CCG) are also available, with the figures for June 2016 the most recent. However, the very small numbers involved mean that figures for the percentage of patients waiting under/over two weeks to start treatment in each CCG should be treated with caution.

The notes to the datasets state that some providers who submitted data indicated that there may be data quality issues with their submissions.

Two main issues were raised:

1. Some providers were not able to include referrals made prior to 1st December 2015 due to the way that they had previously captured data.
2. Some providers were only able to include waiting times for referrals made to their dedicated EIP teams. These teams may only provide a services to a limited age range; often people aged 35 and under.

The notes state that both of these issues mean the numbers of patients who started treatment and incomplete pathways are likely to be under reported. This may also result in the percentage achievement against the standard being artificially inflated. These issues mean that individual months of data should be treated with a degree of caution at this stage.

FOI request into CCGs

On 10 August 2016 a BBC News article reported responses to Freedom of Information (FoI) requests made by the Liberal Democrats to CCGs in England.

The BBC report that of those CCGs that responded (170 out of the 209), 23% said they had applied the target to for 14- to 35-year-olds only. And more than three-quarters of those had no firm plans to extend it to 35- to 65-year-olds this year.

Furthermore, about 64% of CCGs that responded to the FoI request did not or could not say what they were spending on early intervention in psychosis.

Another 29% of CCGs said they were spending below the £8,250 per patient that NHS England estimates early intervention in psychosis should cost the NHS.

Further information

Content of the associated PDF

• Background: mental health waiting time standards
• Implementing the Early Intervention in Psychosis Access and Waiting Time Standard: Guidance
• Department of Health press release
• Press articles
• Parliamentary questions and debates

What is a Debate Pack?

Debate Packs are produced quickly after the announcement of parliamentary business. They are intended to provide a summary or overview of the issue being debated and identify relevant briefings and useful documents, including press and parliamentary material.

The House of Commons Library prepares a briefing in hard copy and/or online for most non-legislative debates in the Chamber and Westminster Hall other than half-hour debates. More detailed briefing are prepared for Members on request to the Library.