Geraldine Strathdee, Oxleas NHS Foundation Trust,and Jen Hyatt, Big White Wall, present in a breakout session on using technology to support people with mental health issues at home.

1. Delivering the Five Year Forward View for Mental
Health
Whole systems approach to Mental Health Informatics,
Information, Intelligence and Improvement Science (4Is)
#5YFV #MentalHealth
Dr Geraldine Strathdee @DrG_NHS
& Dr James Wollard
January 2015 v1

2. The 4 ‘Is’ is route map to better mental health services in England
Information &
data
What are the national
policies and priorities that
direct our work
What are the quality
standards we need to
implement for evidence
based best clinical
How do we agree what data
to gather to assess baseline
& to ensure we are making
progress
Informatics
How do we gather the data
in a low burden way to free
up time to care and improve
data quality
How do we achieve
integrated care through
interoperability's &
increased functionalities
Intelligence
How do interpret the data &
turn it into intelligence for
choice and improvement
support for the public,
patients and clinical teams
Where do we find and share
‘What Good Looks Like’ to
tackle the big problem of
variation in standards and
17 year science to front line
gap
Improvement
Implementation How do we
create a Learning
Organization Model of
leadership & improvement

3. NHS England’s The Five Year Forward View – Mental Health
• INVESTING IN MENTAL HEALTH NEEDS TO HAPPEN TO BENEFIT ALL OF US:
– Mental illness is the single largest cause of disability in the UK and each year about one in four people suffer from a
mental health problem. The cost to the economy is estimated to be around £100 billion annually – roughly the cost of
the entire NHS. Physical and mental health are closely linked – people with severe and prolonged mental illness die on
average 15 to 20 years earlier than other people – one of the greatest health inequalities in England. However only
around a quarter of those with mental health conditions are in treatment, and only 13 per cent of the NHS budget
goes on such treatments when mental illness accounts for almost a quarter of the total burden of disease. Over the
next five years the NHS must drive towards an equal response to mental and physical health, and towards the two
being treated together.
• WE ARE ALREADY ON OUR WAY, BUT IT IS ONLY A START:
– We have already made a start, through the Improving Access to Psychological Therapies Programme – double the
number of people got such treatment last year compared with four years ago. Next year, for the first time, there will
be waiting standards for mental health. Investment in new beds for young people with the most intensive needs to
prevent them being admitted miles away from where they live, or into adult wards, is already under way, along with
more money for better case management and early intervention. This, however, is only a start.
• BEGINNING WITH TIMELY ACCESS TO THE RIGHT CARE:
– We have a much wider ambition to achieve genuine parity of esteem between physical and mental health by 2020.
Provided new funding can be made available, by then we want the new waiting time standards to have improved so
that 95 rather than 75 per cent of people referred for psychological therapies start treatment within six weeks and
those experiencing a first episode of psychosis do so within a fortnight.
• CRITICAL STANDARDISATION OF CARE
– We also want to expand access standards to cover a comprehensive range of mental health services, including
children’s services, eating disorders, and those with bipolar conditions. We need new commissioning approaches to
help ensure that happens, and extra staff to coordinate such care. Getting there will require further investment.
January 2015 v1

4. The “I’ statements in 2014 for people who use mental health
services – what they experience now and what they want
‘I cannot find good
information on how to
build my resilience for
whatever life throws at
me
I look on NHS choices
and i can’t see what
services I can access
locally or on line
I am not sure if its safe
to speak to peers on
line in digital support
I have to tell my story
over and over again in
every settings.
I am not sure my
clinicians know what
each other has
recommended
I don’t get any text
reminders for
appointment or for my
blood tests like I do
from the dentist & my
physio
I don’t know what
treatments will help
me or how to judge
them
One of my
psychiatrists uses an
app to help me to do
mindfulness exercises
as part of my therapy
and its really helpful
I use crisis service often
because i can’t seem to
get them all to work
together to share my
crisis care plan
I can’t have my treatment at
home although it is a struggle
for me to get out because my
CPN’s trust will not let her use
video-calls or skype
I wish I could have my physical
health monitored at home, so I
don’t have to travel to be told
my blood pressure is normal
and to carry on with the same
treatment
My mother has dementia and she
is not safe as she wanders at night
and we dont have technology to
keep her safe at home

5. I am psychological
resilient and use on line
tools to help have a
better quality of life
I use a series of on line
self assessment and
management tools as
part of my ‘mental health
‘reading
I can safely use an on line
peer support platform to
get support when a bit
shaky
I can access psychological
therapy for my conditions
on line
I can have my treatment
as a combination of on
line, face to face, groups,
by skype
I get text reminders to
remind me to go for
blood tests, see my
doctor for monitoring,
take my medication,
inspirational lines
I love to hold my own
records and get my blood
tests and track my own
improvement and self
monitoring
I feel more in control as I
am more knowledgeable
My doctors and
professionals all get the
test results so I feel safe
that treatment is not
interacting badly
I feel safe that when my
records are shared, the
very confidential issues
are well safeguarded
I can get most of my
treatment at home
I now get my blood tests
at home
I can monitor my blood
pressure and weights on
my iPhones the trust gave
me
The ambition for 2020:
“I’ statements for people who use mental health services in the future

6. The 4I’s behind meeting the #5YFV:
Intelligence
Information
Informatics
Improvement Science informed
change
January 2015 v1
In order to meet the vision of the five year forward view we need to engage in a whole
systems approach that makes the best use of the Informatics, Information, Intelligence
and Improvement Science available and being developed. These 4 “I’s” form a
reinforcing cycle that will drive the system towards better more effective care, for more
people, in more communities, in more personalised, technology enabled ways.

7. 4I’s sit at the centre of delivering effective policies that lead to
better commissioning and better, personalised care
January 2015 v1
Activity and Outcome Based
Tariff Models
Effective Patient
Choice
Access and Waiting
Time Standards to
Evidence-Base Care
Information,
Intelligence,
Informatics &
Improvement
Science

8. Quadri-lingual Leadership
At the heart of the strategy to meet the five year forward view for Mental
Health, we need four areas of co-ordinated leadership brought together in
effective forum:
– Policy and Healthcare Economics
– Patient/Person using services
– Technology and Data
– Clinical and Improvement Science Evidence
• Identifying and bring together the core leadership in these areas will be
critical
• Maintaining and developing the right skills and knowledge in emerging
leaders will also be critical to continuing progress through to 2020
January 2015 v1

9. Aims of a 4I strategy for Mental Health
January 2015 v1
• To implement the “No health without mental health”, Better Access & Crisis Concordat policies, and support
the implementation of the CYP taskforce recommendations & dementia
• To determine & develop the transparent metrics to inform Ministers, policy makers, the public, patients,
commissioners & clinicians of the levels of access, standards, outcomes & Value of the NHS, Las, & wider
system collaborative communities functioning
• To inform the development of an information, informatics, intelligence & improvement highway to support
the implementation of the 5YFV aims
• To steer the development of digital maturity in the mental health sector to
• a) ensure the commissioning of electronic care records systems that maximise the functionalities &
interdependencies of Electronic care record across primary & specialist sectors & social care sectors,
• b) enables modern integrated, safe, NICE/SCIE concordant effective treatment & care, & routine
outcome measurement, fed back to front line clinicians and teams to drive improvement &
transformations in care,c) improves data quality through reduced burden of data collection for clinicians
&, delivers a digital revolution in data access, decision support systems for patients & clinicians,
• To identify through our mental health networks, SCNs , AHSNs, CLARCs, ‘What Good looks like’ in
commissioning, provision & empowered patient self care & disseminate through improvement programmes &
to ensure sustainability through establishing an independent, robustly funded mental health intelligence
network collaborative ( like cancer IN)

10. 10
Policy
• 5 Year Forward View
• No health without MH’
• Cross Govt Commission
• Better Access & Choice
• Crisis Concordat
• Care pathways & CFV
• PHE prevention agenda
• Workforce modernisation
• Generational ambition
• Tariff & economic
modelling
• Funding allocation
formula
Better, safer, modern care
• NICE /SCIE HTAS, PH &
care guidelines, quality
stds
• Generational
• Outcome measurement
• Research programme
• CPRD
• Prevalence project
• CFV design
• RCPsych/BPS Better
/MIND better
formulation
• ICD/ smowmed
introduction
Systems Programs
• SOS transparency prog.
• Jon Rouse T & F & PID
• MHSB sub group
• 13 agency programme
• HSCIC, MHMDS spec.
for ICD, bed+ team types,
effective interventions, Oats
+ coding alignment with A/E,
ambulance, CEM, MH
• NHS Choices
information
Fingertips pathways
• Prevention, Social care
Primary care
• Workforce data
• New NHSE+ CQC, CCQUI
• Website dev’t
NCD team work
• JSNAs
• Psychosis reports etc
• Atlas of variation
• Outcome metrics
• Quality metrics urgent
• Crisis concordat
metrics
• Crisis Concordat
assurance checklist
• CQUIN
Governance WGLL programmes
Digital maturity
optimization
• Electronic records
(interdependency &
functionality
• Digital data collection
• Empowered self
managing patients
• Use of NHS number,
ODS 5 digits, ICDs
• SPN notifications for
111 frequent attenders
• Clinician decision
systems
• Bradford SMI template
• Capacity man’t system
• 111 clinical pathways
Information sharing
Caldicott protocols crisis
Digital governance
• Digital Apps
accreditation
• Digital therapies
accreditin
• London platform
Current programs
• SCN manuals
• AHSN programmes
• CCG leaders programmes
Key products to commission
• Model JSNA + LGA/PHE
• Aligned coding for UEA
• Data demand & capacity
modelling
• Economic modelling
• Workforce modelling
• In vivo live for every
clinical team data set
• LCCG commissioner data
set
Leadership & improvement
programmes
1. What Good Looks Like
Repository
2. BBC & journals comms
• Timetable of products
• Slide share packs
3. MHIN funding
• Improvement offer 2
pager for 5 funders
• Establish blind trust
5. NCCCH access and waits
programme + MHIN ERGs
6. AHSN & Education
• JSNAs
• AHSN psychosis
pathway
• East London course
• Educational products
e.g. slide share
• Commissioning for value
• Newsletter to CCGs/
SCNs
What directs our work Getting & sharing good
data
How to agree & assure the
data indicators & analysis
Turning data into intelligence
and improvement programs
How do we develop
leaders with literacy to
drive sustainable
transformation &
improvement
Policy & clinical best
practice developments Digital developments
Governance &Innovation
An overview of the 4I programs in place or being developed to meet the #FYFV

11. Why we need a 4I’s strategy group to deliver it
• There are already multiple programs internally and externally to NHS England that are trying
to achieve the same ends, leading to partial and incomplete solutions being reached
• The number of existing and potential data streams is expanding and will continue to expand.
There needs to be an agreed, structured approach to organising and analysing those streams
of data – this is critical in closing the loop of: data – information – intelligence –
transformative change
• The increasing use and desire to use technology in self-care and care co-produced with
Healthcare serviced must be backed by co-ordinated, effective and safe policy – this cannot
be achieved if the relevant experts and stakeholders and not brought together in a sustained
and organised way.
• Specifically to Mental Health services: There is wide recognition that they are not meeting
the needs of the population, both in terms of the level of services available, but also in their
current models of delivery. However evidence for effective model of service and care exist
and need to be implemented in an intelligence driven way to bring about the changes desired
by all parties.
January 2015 v1

12. The Critical 5 W’s of data that will drive the 4I’s
• To accurate describe the pathways of care we need to collect data about 5
critical aspects of the processes involved at every stage:
– Who - Patient and HCP - NHS number and National Staff codes
– Why - Diagnosis Codes – ICD-10, SnoMed
– What - Intervention codes
– Where - ODS codes, standardised taxonomy of services across data streams
– What Happened - Outcome measurements
• Many of the W’s are already collected but need greater coordination across data sets.
– The NHS number provides a key part of this and hence the importance of it as a
“Primary Identifier”
– Intervention codes are the least developed area of data
– Use of Outcome measures needs to become embedded in clinical practice beyond IAPT
services.
– There is no current standardised taxonomy of services to define “where” care took place
January 2015 v1

13. “Global” Mental health Taxonomy
of service types and accurate
Directory of Service based on it
Tariff Models
Outcome or Acitivity
based models require
clear evidence of
where care took place
Enabling Choice through
choose and book – services
registered appropriately
Standardised information for patients
to make informed choice and access
services appropriate
Transparency and comparability
of services – drives service
improvement
Allowing standardised
collection of data and
aggregation of data across
sources
Where? – A standardised taxonomy and maintained Directory
of Service are a critical part of delivering other policy areas
Access and Waits – Clarity and
standardisation about what
these mean

14. Admission/Attendance
Referral
Assessment
Care
Planning
Investigations Treatments
Discharge
I can only receive information by
fax or over the phone and then
have to transcribe this into an
electronic record system
I have to write duplicate entries
in the medical records, often
still paper based, and the
mental health records system
I cannot use technology
based interventions and
monitoring routinely in
care planning
I have to rely on colleagues in
acute trusts to access pathology
results otherwise I have to call
the pathology lab and receive the
results manually over the phone
I have to rely on paper systems to
transfer results of investigations
between acute settings and
mental health outpatient and
community clinics
I cannot routinely contributed
to an integrated discharge
summary that is electronically
distributed.
I can only use technology in a
limited way to keep patients
up-to-date with follow-up
arrangements
There is no place for an
collaborative shared care plan
between the medical team, mental
health team and the patient/their
carers
Information about attendance
or admission is not
automatically sent to mental
health trusts systems
The current use of technology in Mental Health Care is far from what it could or needs
to be to meet the vision of the #5YFV
Liaison Services – example “I statements” for professionals now

15. Admission/Attendance
Referral
Assessment
Care Planning
Investigations Treatments
Discharge
I can receive referral electronically
that integrate into the electronic
records system reducing
duplication of work
I can write one entry in one
record system and it is shared
with other linked records
systems, or there is one record
systems across trusts
I can recommend
technology-enabled care
that integrates well with
other IT systems – e.g
Apps or remote sessions
using videocalling.
I have access to pathology
systems within the electronic
patient record for mental health
service. I can order investigations
online and remotely
Information about t physical
health investigations is shared
with primary care and
community services electronically
I can contribute to an
electronically integrated
discharge summary
Discharge plans (eg. appointment
times) are routine shared and updated
through an electronic system .
Notifications are sent about changes to
staff who will see the patient
Care plans are shared in real time
across systems and can be updated
and) accessed by all involved
(including patients.
My team are able to receive
timely alerts through an
integrated system that enable
us to respond quick and triage
our work more effectively
In to the future...
Liaison Services – “I statements” for professionals in 5 years

16. Wider Consensus Needed On Difficult Issues:
• Who own’s data generated by individuals – how do we agree policies that ensure
we can make the best use of this for the individual, communities and the whole
healthcare system
• How do we manage (both in terms of policy and technically) the balance between
confidentiality of data and the need to share information (such as care plans) to
ensure better care, particularly in urgent or emergency care and working with
other agencies. Not addressing these will lead to barriers in making progress.
Allowing local decision to be made on this will lead to a myriad of solutions that
will continue that post-code lottery of care
• Due to the sensitive nature of many narratives in mental health, potential
vulnerability for those suffering from mental health difficulties in negotiating these
issues, and the relevants laws, these issues required specialist consideration
beyond that which may agreed for other areas of healthcare
January 2015 v1

17. Appendices
Mapping the Complexity in the system
• The following slides illustrate the complexity of the systems we are
working with and the need for a consistent 4I’s strategy across the mental
health care system.
• That the systems we are trying to influence and change are complex only
underlines the need for a co-ordinated national mental health strategy
around informatics, information, intelligence and improvement science.
January 2015 v1

18. Local/FrontlinePublicSector
Industry/PrivateSector
National/International
NHS
England
Tim Kelsey
Beverly
BryantMonitor
PHE
Gregor
Henderson
CQC
Paul Lelliot
Benchm
arking
Club
NHS
Trusts
Private
Health
Care
Providers
CCIOs
RCPSYC
H
Simon
Wessley
CCGs
Informatics
Committee
Jonathon
Richardson
MHIN
James Seward
Transparenc
y – Emma
Doyle
CCG
Leadership
Program –
Data and
Tech Themes
Apps Library
Kite Marking
Technology –
Simon Dixon
DH
Kathy
Smethurst
Peter Burke
Charlotte
Lilliford
Wildman
HSCIC
Andy
Williams
EHI CCIO
NETWORK
EHI
Digital
Maturit
y Index
Technology
Strategy –
Paul Rice
TDA
Pathw
ays –
Jackie
Shears
NHS
Choice
s –
Nicola
Gill
AHSN
s
CSUs
NICE
The 4Is Organisational Map – there is
more to go on this!!
Electronic
Patient
Record
Providers
British
Computing
Society –
Specialist
Interest GroupDigital
Maturity
Model For
Mental
Health –
Jackqui
McBurnie
Patient
Information
/Technolog
y – Helen
Rowntree
Oxford
AHSN
– Sarah
Amani
Composite
indicators
– Karina G
Data
Catalogue
Paul Gavin
January 2015 v1
Health
Foundation –
Improvemen
t Expertise

19. Awareness/Acknowledgement of
health related problem
Initial healthcare seeking activity
Effective Choice is Enabled
Public
Health/Preventative
Programs
Consultation and management in Primary
care
Referral for further assessment/care
by outpatient secondary care provider
Effective Choice is Enabled
Pre-consultation “wait” period
Specialist Consultation
Post consultation
Wait/communication period
Further
consultation/Investigations/
Interventions started
Individual generated data eg.
From Fitness Tracker
Web searches results from
Google etc
NHS Choices and its information
and Data
“Quantified Communities” – Mental
Health Intelligence Network (with
participatory model)
Analysed by Geography
Accesses Urgent or Emergency
Care Services (via 999/111)
Primary care record systems and
generated data sets
Episode of Secondary Care
Inpatient Treatment
Access and Waits
standards data -
monitoring
NHS Pathways systems
data
Outcome
Data
Data from self-management
tools/technology and
programs
Key
Green –
Information
flowing away
from the person
using services
Blue –
Information and
Intelligence
flowing back to
the person using
service
Secondary Record
Systems
Secondary Record
Systems
Initial 4I Flow Map – How Choice, A&W and Outcome link across the pathways

20. Awareness/Acknowledgement of
health related problem
Initial healthcare seeking activity
Public
Health/Preventative
Programs
Consultation and management in
Primary care
Referral for further assessment/care
by outpatient secondary care provider
Specialist Consultation
Accesses via Urgent or
Emergency Care Services (via
999/111)
Episode of Secondary Care
Inpatient Treatment
Continuation and modification of
care package
Discharge from Secondary Care
Outpatient Care Package agreed
and implemented
CPA Discharge from Secondary
inpatient care
Community
Discharges
Clinical Outcome
Measure (e.g Honos)
7 day follow up
Inpatient Measures
Admissions by bed type
Discharges
Length of Stay
Bed Occupancy Rate
Seclusion Rates
Medication Errors
Restraint
Death Rates
Medication Adherence
Rates of Detention of MHA
Outcomes of Detention
Community “In
treatment” measures
Goals Monitoring
Interventions Codes
Attendance rates/missed
appointments
Prescription Changes
Medication Adherence
Outcome/Recovery
Clinical Severity Measures
e.G PHQ9
Honos/Honos
Rates of EmploymentPrimary Care Data
Diagnosis rates in Primary Care by ICD-10 code
Use of psychotropic medications – prescription rates
Use of Legal Right to Choice
Access to Primary Care
MH assessment in secondary
care setting (e.g A&E, 136 suite)
Initial measures and data
Access and Waiting times
Clinical Severity ratings
ICD Diagnosis rates
Complexity Measures – Social deprivation, rates
of co-morbid conditions
Interventions codes
Prescription Rates
Outcome and Activity Measures along the pathway

21. Awareness/Acknowledgement of
health related problem
Initial healthcare seeking activity
Public Health/Preventative
Initial consultation with primary care professional
Referral for further assessment
?by secondary care provider
Pre-consultation “wait” period
Specialist Consultation
Post consultation
Wait/communication period
Further consultation/Investigations/
Interventions started
empowered
self-monitoring
And data gathering
“Portal” website/app facilitating
self triage – structured assessment tools
System that generate
Co-constructed referrals
Online tools
that inform consultation Apps, Websites, text message
Paper diaries
Preparing for consultation
Information
websites/apps/videos
Comms systems
around referral progress
Services
Videos on YouTube
, Twitter, Virutal Wards
Text message acknowledgements
And updates
Good Guiding Systems Principles
• Every interaction is an intervention – “design” this in.
• There should be no such things as “waiting time”
• Processes should be adaptable to overcome barriers
• Shared ownership of information where possible
Specific sites/Apps.
E.g. “Docready”
Ongoing self-monitoring
and data gathering
Co-Constructed
and recorded outcomes
NHS Choices and other curated
information sites
The Potential of Technology to
enhance person-centred care and
pathway effectiveness
Technology delivered
or enhanced
Therapy