Psychological Therapies HEAT Access Target
Published: 07 March 2017
Psychological Therapies Waiting Times
- Service Improvement
- Driver Diagram
- Identifying current Delivery, Training and Supervision
- Developing Skills and Competencies
The HEAT target 'Deliver faster access to mental health services by delivering 18 weeks referral to treatment for Psychological therapies from December 2014' was approved by the Scottish Government in November 2010 for inclusion in HEAT from April 2011. The 2012/13 LDP guidance issued to NHS Boards can be viewed here.
Psychological therapies refer to a range of interventions, based on psychological concepts and theory, which are designed to help people understand and make changes to their thinking, behaviour and relationships in order to relieve distress and to improve functioning. The target applies specifically to psychological therapies for treatment of a mental illness or disorder.
What is counted under the target?
Psychological therapies as defined above are counted. These include psychological therapies listed in the Matrix and also those not listed but which clinicians decide are the most appropriate treatment to meet a patient’s needs. This will mean that at national and local level we have the information that will allow us to develop services to meet the need that exists.
The inclusion of therapies in the Matrix is dependent on the evidence base, particularly as currently defined in SIGN and NICE guidelines. The absence of evidence in literature does not mean that approach should not be used, or that it does not count towards the psychological therapies target - it may be that not enough relevant research has been carried out to develop an evidence base. Such treatments can still be recognised as being of benefit to patients. Irrespective of the evidence base, Boards should be providing services which meet local and individual need. What is delivered will to some extent be dependent on what services Boards already have and the expertise available locally.
While the aim is to record and understand all waits, where Boards still have data systems under development, it may be that there is no mechanism in place for capturing non-Matrix therapies. It is acceptable for Boards to concentrate on the reporting of Matrix therapies until such time as systems are fully developed.
- where the therapy is for treatment of a mental illness or disorder
- where the therapy is delivered to individuals or groups, in person, on the telephone or by videolink, in real time, by staff trained to recognised standards, operating under appropriate supervision, in dedicated/ focused sessions;
- where the therapy is delivered through family, health and/or care staff who are being trained or supported to deliver a particular intervention to a named patient/client;
- to all ages (including CAMH services);
- in community settings;
- in inpatient settings;
- in physical health settings where there is associated mental illness such as depression or anxiety, for example chronic pain and cancer;
- for substance misuse where there is associated mental illness;
- for learning disabilities where there is associated mental illness.
What Does the Target Mean to You?
Perspectives from a range of people about what the target means to them. You can view these here [37kb].
The waiting time is measured between the date referral received and the date psychological treatment commences as planned. A document (updated March 2014) highlighting the key measurement points can be accessed on the link below:
In November 2012 the Scottish Government issued the Summary Report on the Application of NHSScotland Waiting Times Guidance.
Guidance is being developed to support the collection of nationally consistent information in order to monitor progress towards delivery of the target. It covers two key areas:
- Application of Waiting Times Guidance - Guidance and Scenario HEAT Target [364kb] document (updated March 2014) for Psychological Therapies. This document will be updated with additional scenarios and guidance as required.
- Data Standards for recording Psychological Therapies - Tables grouping therapies by domain and intensity have been developed by ISD, NHS NES and key stakeholders. The tables are based on mappings from the 2011 Matrix and have been produced to support the local capture of information about therapies being delivered. The information could be used locally to examine waiting times by therapy, identify training needs and support service improvement work e.g. demand and capacity analysis. The tables been developed for use by those NHS Boards who choose to use them and will be updated over time. They can be accessed on the links below:
Therapies by Intensity - Adult and Older Adults [99kb]
Therapies by Intensity - Children and Young People [111kb]
The target is part of the HEAT performance management system and as such requires monthly data submissions to ISD. NHS Boards are making good progress in undertaking the relevant work required to capture the key information and collate for submission to ISD by 24th of the month. Progress against delivery of the target is being monitored through the existing 6-monthly review visits the MH Division have with NHS Boards.
A Psychological Therapies Implementation and Monitoring Group (PTIMG) has been established to manage issues arising from the implementation and governance of the target. The group has representation from a range of stakeholders. The terms of reference and membership can be viewed here [57kb].
Further information can be found under Support for Delivery.
A workshop 'Understanding the Role of Data in Relation to Waiting Times for Psychological Therapies' was held in Stirling on 2nd September 2011 to support NHS Boards to develop effective data capture systems to enable measurement and delivery of the target. Approx 65 delegates attended either in person or via webcasting. The programme and presentations from the day can be accessed below:
- Programme [1.6Mb]
- Psychological Therapies HEAT: Threat or Opportunity (Penny Curtis, Scottish Government Mental Health and Reshaping Care Division) [125kb]
- Measuring waiting times - understanding our destination and the key milestones along the way (Fiona Black, ISD Scotland) [1.6Mb]
- Measuring to improve management of demand and capacity - how important is it? (Ruth Glassborow, Scottish Government Quality and Efficiency Support Team) [1.8Mb]
- Measuring - the real life challenges - lessons to date from the NHS Lothian Early Implementer Site (Linda Irvine, Strategic Programme Manager Mental Health and Wellbeing, NHS Lothian) [53kb]
Support for Delivery
The Mental Health Collaborative previously developed a range of tools to support Boards to apply Demand, Capacity, Activity and Queue (DCAQ) techniques to mental health. Further information on these can be found on their website.
The Psychological Therapies HEAT Driver Diagram provides a summary of all the key actions needed to effectively manage demand, capacity, activity and queue and provides hyperlinks through to actual resources.
Following the end of the Mental Health Collaborative in March 2011, the Quality and Efficiency Support Team have retained some capacity to continue working with 2 NHS Boards (NHS Lothian and NHS Ayrshire and Arran) to demonstrate how improvement approaches can be used to deliver quicker access to psychological therapies within current resources, whilst delivering the same or better clinical outcomes. It will use these 'early implementer' sites to continue generate guidance, resources and tools that support the application of systems improvement methods to deliver improved access to Psychological Therapies. It will also use the learning from these early implementer sites to inform an assessment around what, if any, national improvement support is needed from April 2012 onwards. As part of this, the two sites are both collecting information on the costs and benefits of undertaking this work.
QuEST is setting up an email distribution list for those who are interested in receiving updates about the early implementer work including additional tools and resources as they are developed. If you want to be added to this list please email QuEST@scotland.gsi.gov.uk.
Improving outcomes in healthcare can rarely be achieved by simply working on one issue. For any given goal, there will be a range of issues that need to be tackled to deliver the desired improvement. A driver diagram is a method for identifying the key parts of a system that need to be improved to deliver the overall aim (Primary Drivers) and then, for each part of the system, identifying the specific changes that can be made to improve that aspect of the system. Effectively, they are cause and effect diagrams which show how actual changes at a service level feed into the delivery of a wider organisational aim.
A Driver Diagram has been developed to support implementation of the target and includes hyperlinks through to a range of resources which practically support implementation and includes links over to a range of practical resources to support delivery.
Please note that this document is a working draft and is being updated over time as more resources become available and changes are made based on feedback from NHS Boards.
If you would like further information please email Ruth.email@example.com.
In order to provide baseline data of existing recourses across NHSScotland delivering Psychological therapies, it is has been agreed that the current Psychology and CAMHS workforce database be expanded to pilot the capture of Psychological Therapies workforce data. The pilot will be held in NHS Tayside (adults and older people) and NHS Greater Glasgow and Clyde (CAMHS) in summer 2012. The purpose of the pilot is to test the collection and usefulness (locally and nationally) of information such as staff in post delivering Psychological Therapies by staff group, NHS Board, qualification/ training and supervision.
Please note: the excel file requires macros to be enabled for some of the drop-down list options to work. To enable macros; select tools from the top menu bar, select macro, within the macro list choose ‘security’, make sure Macro Security level 'medium' is selected, then try closing and re-opening excel. The drop down menu's should now work.
The Psychological Intervention Team has been set up by the Scottish Government Mental Health Division to develop workforce capacity to deliver the Psychological Therapies HEAT Access Target. The team is hosted within the Psychological Therapies work stream in NHS Education for Scotland (NES) and has been working closely with the Mental Health Division Psychological Therapy sub-groups to develop learning plans in the Scottish Governments key priority areas: information systems, referral criteria and care pathway; alcohol; trauma; forensic; and older adults.
Arising from this work the Psychological Intervention Team is working to complete the delivery of the 2011 / 12 training programme. By the end of February 2012, over 1000 staff had booked to attend over 40 different training events in the Scottish Government priority areas. Additional training for staff working with older adults has just been added to the Training Programme 2011 /12.
Further training is planned over the next few months, and the Winter Training Programme is available on the Psychological Intervention Team webpages.