Agenda Item No.
JOINT COMMISSIONING PARTNERSHIP BOARD
9
THURSDAY 15TH JULY 2010 AT 10AM
SUBJECT: IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES
Author:
Jonathan Fennelly-Barnwell, Service Development Manager,
Mental Health
Tel:
01438 843232
Lead Officer: Mark Lobban
1.
Purpose of report
1.1
As a supplement to the Quarterly Performance Report, to inform the
Joint Commissioning Partnership Board (JCPB) of progress in the
performance of Hertfordshire’s Improving Access to Psychological Therapy
(IAPT) services and to outline plans for movement towards project recovery.
1.2
To provide additional information as requested by JCPB on Step 4
psychology waiting times, outside of Enhanced Primary Mental Health
Services (EPMHS).
2.
Summary
2.1
Key performance indicators for Quarter 4 on waiting times for IAPT
have shown not only an undesirable maximum waiting time between
treatment and referral, but that there is considerable variation between IAPT
teams leading to geographical inequalities in access to treatment.
2.2
A number of measures have been put in place to address this
situation. Funding plans previously considered by JCPB have been reviewed
in line with commissioning priorities.
3.
Recommendations
3.1
JCPB are asked to note this report
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4.
Background
4.1
Waiting times to treatment
4.1.1 All EPMHS teams are now within the target of 3 days to initial contact.
Waiting times to treatment have improved in most areas of the county as a
result of the more efficient ways of working implemented over the past six
months. Although waiting times for step 2 and step 3 interventions are still
outside the targets of 10 and 28 days respectively, early indications show a
decrease in waiting times across the county.
Fig 1 and 2 Waiting Times for Quarter 4 2009-10 Compared against East of England
Averages.
Fig 1
East and North Waiting Time
70
58
60
50
46
44
41
50
49.83
42.89
42
40
Step 2
30
Step 3
20
10
0
March wait
April wait
May Wait
EoE Wait
Fig 2
West Waiting Time
100
88
90
80
70
68
58
60
56
57.57 60.28
50
50
42
Step 2
Step 3
40
30
20
10
0
March wait
April wait
May Wait
EoE Wait
2
4.1.2 Comparison of waits across teams (Figures 3 and 4) highlight areas
where significant improvements have been made, but also readily identify
teams remedial action is required.
Fig 3 and 4 Team comparisons of waiting times within Hertfordshire by locality.
Fig 3
Average Wait East and North October
2009 and May 2010
60
50
40
30
20
10
0
50.75
41.11
18.02
17.13 14.83
Stevenage
18.79 21.41
Hitchin
October
28.05
Welwyn
Ware
May
Fig 4
Average Wait West October 2009 and
May 2010
120
95.84
100
80
60
40.25
40
26.11
28.05
20
0
Watford
St Albans
October
Dacorum
Hertsmere
May
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4.1.3 Areas for particular attention include the Ware team – the newest
team, as the service rolled-out to cover the whole of South East Hertfordshire
at the end of 2009, referral rates have nearly doubled to just under 200 per
month, at a time when the majority of staff are still in training, for the first year
of which they are unable to take a caseload. There has been difficulty in
filling the psychologist post and Hertfordshire Partnership NHS Foundation
Trust (HPFT) are now looking to appoint a locum as an interim measure.
Additionally, 5 low intensity workers have now completed university training.
4.1.4 Whilst waiting times for the St Albans team remain well outside target,
the last six months have seen a reduction in waiting times of some 37%, and
figures in the competed Quarter 1 return are expected to demonstrate
continued reduction in waiting times. These and the figures for Ware will of
course be highlighted in the Quarter 1 return report to be reported to the
relevant Strategic Commissioning Group.
4.2
Waiting Times that have Exceeded Target (Breaches)
4.2.1 As at May 2010 Stevenage EPMHS team have the lowest percentage
of breaches of 28 days, a slight reduction since October 2009.
Fig 5
Stevenage
14.29
85.71
Breached May
Not Breached May
4.2.2 As expected for reasons given above, Ware has the highest
percentage of breaches
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Fig 6
Ware
33.02
66.98
Breached May
Not Breached May
4.2.3 The most significant reduction in breaches has been achieved at
Watford
Fig 7
16.56
Watford
Breached October 2009
83.44
Not Breached October 2009
Fig 8
Watford
31.74
68.26
Breached May
Not Breached May
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4.3
Challenges and recovery measures
4.3.1 The Board will be reassured that contracts are in place that ensure
100% population coverage of IAPT services in Hertfordshire and the
commissioners continue to work with the providers of these services to
improve the waiting times and outcomes achieved by these services.
4.3.2 Work will continue on increasing self-referral rates, and improving
access to the services, by reviewing public information about IAPT, improving
website and contact information, and ensuring that teams are accepting selfreferrals as per the service specification.
4.4
Waiting Times for Psychological Therapies in Community Mental
Health Teams (CMHTs)
4.4.1 In March 2008 an assessment was made of waiting times for
psychological therapies across the Community Mental Health Teams. This
exercise was repeated in May 2010 in order to assess the impact of IAPT on
secondary care. This is based on clinicians’ estimates and therefore the data
can be seen as average estimates only. Service users will wait a much
shorter time than reported if they are prioritised on grounds of risk.
Fig 9 Comparison of waiting times for non IAPT psychology services in Hertfordshire
2008 vs 2010
Fig 9
Secondary Care Psychological Waiting Times
35
30
Weeks
25
20
2008
15
2010
10
5
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CMHT
4.4.2 Fig 9 shows an average reduction in waiting times across county of
approximately 6%. It should also be noted that with the exception of the
discreet service in Bushey, there is no gap between assessment and
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treatment. However, waiting times at Cheshunt, Letchworth and St Albans
have become significantly longer with Cheshunt waiting times rising from 7
weeks to 18 weeks. In addition to these trends Hatfield and Welwyn CMHT
has a waiting time of 26 weeks which far exceeds the 18 week wait
requirement
5.
Financial Implications
5.1
As the Board have been previously advised, to mitigate the expected
further reduction to zero of the £1,100,000 central allocation for IAPT from the
Strategic Health Authority in 2011-2012, this further funding gap to be
managed as identified below.
5.2
These proposals have been reviewed in line with commissioning
priorities and expected progress made in areas of PCT activity in aligning
counselling services with IAPT.
Recommended Options
2011/12
Innovation fund
200,000
MH Employment Strategy
380,000
Realignment of Counselling
and IAPT services
Total
530,000
1,110,000
Potential Impacts
This will mean that we JCT is not in a position to fund innovation
projects at the current levels, and the process of funding prioritisation
will need to have a higher threshold for any monies that may be
available in future years.
This will mean that the Employment Strategy in 2010-11 is delivered on
a cost neutral basis, although funds have been secured to fund
employment workers for two years to work primarily with IAPT and
embed the employment strategy within mental health services locally.
This will mean that JCPB investment in primary care counselling as
growth money and short-term contracts will be reassigned to the
delivery of IAPT.
Background Papers
 Joint Commissioning Partnership Board - 23rd January 2010
 Strategic Commissioning Group (Working Age Mental Health) –
8th September 2009; 23rd February 2010; 25th May 2010
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