Back in February, the independent mental health taskforce published the Five year forward view, a report which made a series of recommendations for the improvement of mental health services over the next five years. Jacqui Dyer, vice chair of the taskforce, joined us at the iaptus user conference last month, where she explained the need for change, the recommendations made, and the impact they will have on IAPT.
Just a few weeks later, NHS England has published Implementing the five year forward view, a paper that sets out how the recommendations will be implemented across all mental health services over the next five years.
So what does this mean for IAPT?
- A gradual increase to access targets from 15 to 25% by 2020/21.
- Two thirds of these additional patients will have co-morbid physical and mental health conditions or persistent medically unexplained symptoms.
- The majority of new services will be integrated with physical healthcare.
- 3000 new mental health therapists to be co-located in primary and community care.
- A small number of areas will work to develop the evidence base for implementing integrated services in 2016/17 and 2017/18, which will be rolled out to all CCGs for 2018/19.
Increasing access
Access to psychological therapies will be increased from 15 to 25% of people (or 1.5 million) with common mental health conditions.
The access target will increase year on year, to achieve 25% by 2020/21.
Source: Implementing the Five Year Forward View, p.17
Integration with physical health
The expansion of access to 25% will be targeted, with two thirds of these people having co-morbid physical and mental health conditions or persistent medically unexplained symptoms. It is expected that support for these people will reduce demand in other areas such as A&E attendances, short stay admissions and prescribing costs, and should save up to £364m by 2020. In order to help meet these aims for co-morbidity and integration, the plan recommends that 3,000 new mental health therapists be co-located in primary care and community care.
Over the next two years, a small number of services will work to develop the evidence base for implementing these integrated services at scale. By 2019, this integration will be rolled out to all CCGs.
Workforce
Increasing access and treating those with co-morbid physical and mental health problems will also require changes in the IAPT workforce. This will include:
- current staff receiving top-up training in competencies for long-term conditions and medically unexplained symptoms
- targeted training given to those working with older people
- additional staff to increase overall capacity of services
The below table highlights the number of additional staff required:
.Source: Implementing the Five Year Forward View, p.17
Digital therapy
The report states that NHS England will be supporting this by “setting out a programme for digitally-enabled IAPT in autumn 2016”, to help improve the productivity of services. This will also give patients a wider choice over the type of treatment they receive.
Ongoing work to support this objective is already underway, with the National Information Board focussing on developing frameworks for the regulation of digitally enabled mental health services. The aim is that this will “support the evaluation and endorsement of digital tools to support evidence based mental health care, understanding and promoting the digital literacy and participation of those using mental health services, and setting standards for sharing electronic health records and data”.
NHS England are investing £500,000 to rapidly evaluate and scale the digital tools that are currently available. They will provide a list of evidence-based digital tools that will be available nationally and are expected to be promoted on the NHS Choices website by April 2017.
Funding
Funding has been put aside to support the above objectives. For the first two years, £108m will be held centrally and invested in training, integrating and expanding services. From 2018/19 funding is in CCG baselines to mainstream integrated services, building on the experience from the first two years.
.Source: Implementing the Five Year Forward View, p.18
The report is clear that the above objectives are to be achieved whilst services work continually to improve the quality of care provided. This includes ongoing work to:
- improve recovery rates
- address geographical variation
- improve choice
- address variation in outcomes for different population groups, including people from black and minority ethnic groups, people with a learning disability, older people, and women in the perinatal period.
We will soon share a recap of Jacqui Dyer’s talk at the user conference on the recommendations from the Five Year Forward View, the need for change and the expected results. Sign up to receive our newsletter and we’ll let you know when the video is available.
