• Systems have failed to meet NHS England’s ambitions for early intervention in psychosis services 
  • Forward View for Mental Health said at least 25 per cent of EIP services would be meeting level three standards by 2018-19
  • But new data shows just 18 per cent met this requirement last year
  • East of England was the worst performing region with just 6.3 per cent of services given a level three rating

A key ambition for the treatment of seriously ill mental health patients has been missed, with some parts of the country falling short by a large margin.

Nationally, just 18 per cent of early intervention in psychosis services were judged to be meeting “level three” standards of care last year, as recommended by the National Institute for Health and Care Excellence.

This is despite NHS England setting a target in the Forward View for Mental Health to have 25 per cent of services meeting the level three standard by the end of 2018-19.

According to the data, published last week, the East of England was the worst performing region in 2018-19, with just 6.3 per cent of services meeting the level three standard. The North West was the best performing area, with 35 per cent of services graded at level three.

Region% of services meeting NICE level three% of services meeting NICE level two

East of England

6.3%

62.5%

South West England

7.1%

100.0%

Midlands

7.7%

76.9%

London

16.7%

90.0%

South East England

21.1%

94.7%

North East and Yorkshire

27.6%

89.7%

North West

35.0%

65.0%

HSJ has previously found many clinical commissioning groups have fallen below the benchmark spend of £8,250 per patient, set by NHS England, needed to deliver a NICE recommended care package.

Recent board papers for Norfolk and Suffolk Foundation Trust, in the East of England, said it is not commissioned to deliver EIP services to patients who have not yet experienced psychosis, but are deemed to be “at risk”. The trust did not respond to further requests for comment.

In a statement to HSJ, commissioning leaders in Cambridgeshire and Peterborough, also in the East of England, said they were working to meet the next target for level three care, which is 60 per cent by 2020-21.

NHSE has graded each EIP team across the country from one to four based on how well it is meeting eight care standards set out by NICE. Those graded level one are those requiring the most improvement while those at level four are the strongest performers. 

CCGs are responsible for commissioning EIP services locally, but providers will be responsible for certain elements of the rating.

In its Forward View for Mental Health, NHSE also set a target to have 100 per cent of EIP services meeting level two NICE standards in 2018-19, but just 83 per cent hit this target.

There was also a target for 60 per cent of patients referred to EIP services to be receiving care within two weeks by 2020-21. Data in the dashboard showed nationally this target was exceeded, with 78 per cent of patients seen within two weeks over quarter two of 2019-20.

NHSE’s regional team for the East of England declined to comment, referring HSJ to the national team. A spokesman said: “EIP services across the country are seeing an increasing number of people in good time, and in the last year alone thousands more people started treatment.

“Considerable progress has also been made on the quality of treatment since the standard was first introduced, and the NHS long-term plan will drive forward further improvements in care for people with psychosis.”

Key standards required by NICE for EIP service

  • Timely access, with treatment started within two weeks of referral
  • Take up of cognitive behavioural therapy
  • Take up of family intervention sessions
  • Prescribing (eg patients offered clozapine)
  • Take up of supported employment programmes
  • Physical health monitoring
  • Physical health interventions
  • Take up or referral to carer-focused education and support programmes