Brighton and Hove Wellbeing Service Data flow from non-NHS Providers Joanna Hillier – Clinical Lead

Context Brighton and Hove Wellbeing Service – operational since 2011. Collaboration between providers in the city to ensure that primary care mental health services are locally led May 2011- May 2017 service was adults only – IAPT, MIND Support services and primary care mental health practitioners (OT, Social work & CPN)

June 2017 New contract - Different requirements of IAPT and PCMHP service Additional adult advice and information open access service (MIND) Additional CYP service delivering 1500 completed treatments to 4-25 year olds with mild to moderate mental health difficulties YMCA Downslink group and other 3rd sector providers had established online and face to face counselling services but not part of NHS contracts New contract service specification not linked to MSHSD requirements

So how does it work? The Service is accountable to board made up of all collaborators – Here is the lead contractor Operational and Clinical Leads working within an integrated Governance structure applied across all partners

Primary Care Mental Health Workers CYP Wellbeing Service (4-25) CYP triage with CAMHS (4- 18) Primary Care Mental Health Workers (18+) Advice, information and employment support (18+) IAPT – step one and step 2 (18+) Administrators and Data Analysts work across service Systm1 and Power BI – Access to Carenotes

What do we know about IAPT? Psychology Sausage factory? We could all do that if we had all that investment Only offers CBT….. Fine if you fit into the IAPT box Data and target driven

What matters in IAPT Recovery (50%) PHQ9 and GAD 7 and disorder specific scales Access (16.8%) % of anxious and depressed population accessing service – rising to 20% in 2020 Waiting Times 6 week and 18 week plus local 4 week target And for Brighton and Hove – Reliable Improvement National target – 64% (B&H 70%) Significant measurement of change

What is used in IAPT Stepped model of care Evidence based practice Outcome measurement Demand and capacity modelling/monitoring and forecasting High Demand and high throughput IAPT add on’s – Long term conditions, SMI, perinatal period, employment workers

But what about the CYP service? The ultimate challenge

CYP Journey In June 2017 CYP triage and service opened. Tuped staff from other non-NHD organisations to YMCA Downslink Group No IT infrastructure No COIN connection Staff had very limited experience of using electronic patient records and high levels of suspicion Bespoke solutions needed to be found for specific pieces of CYP clinical work – LGBTQ counselling Admin solutions used in adult service were not transferable 75% staff turnover (honorary staff) No data to model on and CAMHS and schools services also redesigning

Mobilising Multiple treatment types – canine counselling, digital interventions, group programme, play therapy etc. Multiple bases Combined triage (CAMHS and CYP service) Problematic pathways 8 WTE – 26 staff Incidents and waiting lists Access to Open Exeter Portal already established (N3)

Staff engagement and Leadership New leadership team Partnership commit all of clinical lead time Focus on team needs Use the data in everything we do Move influencers into team Work with CCG on what they need Work through the data with the CCG

What made the difference? CCG provided extra investment for MHMDS to be prioritised Started with a data cleanse and audit Focus on what activity was being recorded already – booked appointment focus

SystmOne – unique challenges Relied on booked appointments giving activity data MHMDS turned this on its head Mandatory or not mandatory???? Building of new templates to collect data

Ongoing Ongoing Monthly review of all cases discharged with no activity recorded Continued communication with all clinical staff in CYP and understanding why it matters Refinement to templates and further engagement on what is mandatory Development of reports with outcome measurement

And the future A world without waiting Staff engagement – culture change & time IST and CCG engagement in challenges Quality of data flow CAMHS and schools Digital interventions and MHMDS CYP participation in data informing choice

Jo Hillier Clinical Lead joanna.hillier@nhs.net Anna Williams Operational Manager Anna.williams24@nhs.net Sarah Weston Head of Wellbeing and Therapeutic Services YMCA Downslink group sarah.weston@ymcadlg.org