Introduction
Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups (CCGs) are statutory public service organisations. We work together to commission (buy) high quality health services and ensure value for money. Our vision is to improve the health of the whole population, reduce health inequalities and ensure NHS services are fit for the future.
Improving Access to Psychological Therapies (IAPT) is a programme to support people of all ages who are experiencing low mood, anxiety and depression, stress, excessive worry or difficulties controlling emotions. These therapies are sometimes known as ‘talking therapies’. Typical treatments include cognitive behavioural therapies, mindfulness, counselling, couples therapies, psychodynamic therapy, psychosexual therapy, and group-based support.
The current contracts for IAPT jointly commissioned between Bristol and South Gloucestershire are on the basis of an Any Qualified Provider (AQP) model of delivery. There are 16 separate contracts as part of the model. Services are commissioned for all ages. The contract for North Somerset is different, with a contract with one provider. Services are commissioned for adults only, with an additional 16-18 year old pathway to the adult services.
The current contract terms are overdue for recommissioning for Bristol and South Gloucestershire. North Somerset’s contract will come to an end in March 2019. We will take this opportunity to re-design and re-procure a new IAPT service for the people of Bristol, North Somerset and South Gloucestershire. This presents an opportunity to improve the service, both for the people who use the service and for our finances, without cutting the service or reducing the budget.
Feedback from people who use the service, providers and professionals suggests that changes could be made to offer more flexibility around treatments and shorter waiting times for the majority of people. The principles of a new IAPT service will include:
- a service that is available to everyone
- communicating well with people who use the service and within the service itself
- shorter waiting times for assessments and treatments
- a wide choice of appointments in a range of accessible locations,
- online provision
- individuals having a choice of therapist
- people who use the service having an active input into their choice of therapy
- a continuous process, allowing individuals to tell their story only once
- Access to useful information about the specific service
- people receiving a seamless service when they move within it.
This new service model will improve patient access and experience, recognising the interdependencies between IAPT and people’s wellbeing, housing, employment, financial issues, maternal mental health, social isolation, long-term health conditions and traumatic experiences, for example experience of sexual abuse. These are all age 16 and over services.
Our duty to involve patients and the public
Bristol, North Somerset and South Gloucestershire CCGs are committed to the people who use our services, and the people who support them, being involved at the heart of our work. We will continue to listen and act on patient and carer feedback to commission services that are informed by the experiences and aspirations of local people. This engagement process will:
- test out the proposed service model with a range of stakeholders and potential stakeholders across Bristol, North Somerset and South Gloucestershire, particularly amongst residents who are generally ‘harder to reach’.
- ensure that the views and experiences of specific groups are reflected in developing the service and its outcomes.
- ensure the procurement of a new IAPT service integrates the thinking and experience of people who have a direct experience of using the service in the last two years is reflected in the specification
- ensure people who use the service are involved in the assessment and decision making of bids and choice of providers for the new service.
Engagement to date
Our proposals are built on a large body of existing feedback. This includes:
Bristol CCG carried out engagement and consultation with people who use the service, local people and other stakeholders in 2016 to identify ways to improve the journey;
- easy to access single point of entry for all referrals
- strong and effective triage and assessment to include:
- walk-in community based option and information sessions, signposting where appropriate, a range of IAPT therapies at both low and high intensities
- review and discharge on completion of treatment
- informal follow-up to support relapse avoidance/peer support
- integrate system coordination and management within the service.
Healthwatch South Gloucestershire was commissioned in 2015 to inform South Gloucestershire’s mental health strategy 2016/2017. Healthwatch advised that there is increasing demand and a need to improve access and support for the IAPT programme, identifying:
- A lack of community-based support for people with sub-threshold mental health conditions
- Increasing demand for community mental health services
- People with autism face long delays before they can access diagnostic assessment
- People in South Gloucestershire with learning disabilities are less likely to receive day care services than the rest of England
- There is less support for longer-term mental health care
- People who use the service expressed concerns about engagement, access and the quality of care.
An evaluation of the South Gloucestershire Wellbeing College 2016/17.
An engagement activity with Bristol Aging Better was delivered in September 2017
An evaluation of the pilot of a model of care for IAPT services in South Gloucestershire September 2017
Bristol and South Gloucestershire CCGs for previous re-procurement activities 2016.
How will we engage with people who may use/have used IAPT services?
We will do desktop research including complaints and patient experiences from current providers, Healthwatch reports, Wellbeing reports, previous engagement processes by Bristol and South Gloucestershire CCGs for previous re-procurement activities 2016. The engagement activities consisted of focus groups and an online survey supported by a Service User Reference Group. For this procurement activity, it is not proposed to repeat the processes but to use the information gained to inform the specification. However we need to understand the gaps in the information-gathering process and in particular to understand the specific needs of the North Somerset populations.
Equality Impact Assessment
An equality impact assessment will be undertaken to identify any potential negative implications of the implementation on particular groups, and any mitigation required. This will be undertaken by the commissioners with support from the Equality & Diversity Leads. The Equality Impact Assessment will inform our plans, enabling us to tailor engagement to suit different needs, ensuring that we provide opportunities for people from across the area to influence local health services.
Planned Engagement Activities
The Care Forum is working with Bristol, North Somerset and South Gloucestershire CCGs to run meetings for voluntary and community sector organisations with an involvement or interest in IAPT services to gather their feedback on proposals and to conduct focus groups and/or attend existing groups.
Bristol Independent Mental Health Network (BIMHN), as part of their contract with Bristol CCG, will undertake digital engagement activities across Bristol, North Somerset and South Gloucestershire; such as web-based, email, Twitter, Facebook and Instagram.
We will engage with Healthwatch, using their support to engage local populations across the region and to help recruit people for the procurement process.
We will engage with Health Overview and Scrutiny Committees through a written brief and engagement plan. We will meet with councillors if further conversations or interest is expressed.
Outcome of engagement activities
To understand people’s view about the IAPT services, ensuring that the views of people residing in North Somerset, South Gloucestershire and Bristol are heard and are reflected in developing the service specification for a new IAPT service. We would like feedback from participants regarding our proposed service model; what they think would work well and what they would like to change.
IAPT services are (nationally) very tightly measured on their ‘access’ and ‘recovery’ rates. However, ‘access’ and ‘recovery’ are not as openly defined as they would be in general usage. We need to meet national targets, but also provide an excellent service that is accessible, helps people recover and to sustain that recovery.
Accessing the service
- What would an ideal journey look like for people to access the IAPT service?
- What would help you get in to the IAPT service?
- What barriers might get in the way of you accessing the service?
- What would help increase access to IAPT from people who currently do not easily access the service(s) e.g. people from different BME communities.
- What do we need to have in place to achieve these ideas in practice?
Recovery and staying well
- How can the IAPT service be successful so that people stay well and don’t need to keep returning to the service?
- What can we learn that would help improve the IAPT service’s recovery and its sustainability?
- How can IAPT services meet the needs of the people who are referred, with more people staying engaged with the services once they make contact?
A holistic service
- If IAPT can see people holistically, understanding their mental health in relation to their physical health, employment situation, relationships and social networks, activity, housing, economic situation, substance use issues, etc., it is likely to be more effective than just treating the psychological problem(s). How can we ensure IAPT is well connected with and has clear pathways to and from a whole range of other existing services/interventions?
- Do you have experience and suggestions about how incorporating employment support into IAPT could look?
- We must ensure that IAPT supports the mental health needs of people with long-term health conditions. How could we do this in a way that joins up with other treatment?
- Social isolation has a strong impact on people’s mental health. What might the connection between the new IAPT service and social prescribing services look like?
- How could an IAPT service best connect in with other programmes that promote wellbeing, long term conditions, inclusion, employment, social connection?
Equalities
- The IAPT service must be open to people from all groups.
- What are the issues that might be important for us to recognise in relation to equality when designing the service (e.g. recognising people’s needs around their culture, language, sexuality, gender identity, age etc)?
- How can we ensure that we procure a service that integrates equality issues into it and has a high level of competency (including cultural competency) at its core?
Groups and one-to-one treatment
- How can we convince people of the positive benefits of group treatment and activities that help improve and promote their psychological health and wellbeing?
- What might be some of the cultural issues that group interventions need to take account of in order to be accessible and inclusive?
Technology
- How can we use technology to best effect to enhance this service?
- What do you think are the important things that online therapy needs to take account of?
Building on the experiences of people with recent experience of IAPT
- Was the service able to meet their needs?
- What one thing would have made it a better experience for them?
Timescale for Engagement Activities
The engagement process has been extended to 23rd February, 2018
For further information contact:
Louise Fowler louise.fowler3@nhs.net
Glenn Townsend glenntownsend@nhs.net