[CBRT NHS Project Overview Statement]


CBRT NHS Training
Project Overview Statement
Executive Summary - Call to Action

Project Name: CBRT NHS Training Programme

Department: Training Department

Release Date: 15 August 2011

Project Timescale: 29th September 2011 to 31st March 2012

Author & Project Manager: Alison Bourne Director CBRT International Ltd

NHS contacts: (copy to Bruce Calderwood, Director, Mental Health Policy)

Graham Reid, DH Healthcare Innovation Policy Team

Susan Summers, Associate Director NHS NE

Rosalind Way, Head of NE HIEC.

Distribution to: SHA Directors of Commissioning, SHA Mental Health Leads
PCT Mental Health Trust and Foundation Trust Chief Executives
Directors of Adult Social Services, Directors of Adult Social Services,
Mental Health, PCT and SHA Directors of Finance

CBRT NHS Project Case

Project Overview
CBRT NHS is an all-inclusive Relaxation Support Technique which provides: a) service users with a health prevention and improvement service, b) a Patient centred, recovery focused and effective self-care initiative, c) best value to the NHS. CBRT NHS provides the framework for high quality care and support to a diverse population, based on an understanding of individual and community needs.
CBRT was selected by a DH panel to exhibit at the London based 2011 “Healthcare Innovation Expo” 1 during which the CBRT products and evidence based case studies attracted great interest from hundreds of healthcare professionals attending. Invented in 1997 (UK), CBRT has progressed through numerous and important R & D stages since inception. The CBRT Training Programme was acknowledged by the British Complementary Medicine Association2 in 2004.
The CBRT NHS Training Programme aims to support Primary Care Trusts in implementing National Institute for Clinical Excellence (NICE) guidelines for people suffering from depression and anxiety disorders. At present, only a quarter of the 6 million people in the UK with these conditions are in treatment, with debilitating effects on society. CBRT is a practical means of improving outcomes, including excluded groups in society, in contact with secondary mental health services.
CBRT Relaxation Support Sessions can be delivered to individuals and/or groups of up to 20 Patients at a time, by trained NHS Staff within 30 – 45 minutes. CBRT is a Mind-Body Relaxation technique 3 which combines correct breathing techniques 4, Mindfulness 5, a holistic care approach and positive thinking 6 all supported by NHS Evidence as being beneficial components to mental health, preventative health and wellbeing programmes. Patients are provided with a CBRT easel chart which contains seven coloured disks (see above) which they focus on whilst a) becoming aware of their natural breathing pattern and b) relaxing their body in seven stages.
CBRT is now ready to contribute to the quality, innovation and productivity challenge facing the NHS. NHS staff (suggested Bands 3 to 7) can become trained and proficient within two days to provide CBRT NHS Relaxation Support Sessions for individuals and/or up to 20 Patients. (CBRT is designed to be easy for use by all nursing staff across all bands, not solely by Psychological Wellbeing Practitioners or High Intensity Therapists. CBRT is ideal for use in GP settings, clinics, on the hospital ward and in community group settings.)
CBRT NHS Training supports the government strategies: No health without mental health: A cross-government mental health outcomes strategy for people of all ages 7; and Talking therapies: A four-year plan of action 8. 90% of SHA’s/ PCTs are already involved in The IAPT Programme 9. (By 31 March 2011,142 of 151 Primary Care Trusts in England were due to have a service from this programme in at least part of their area and just over 50 per cent of the adult population having access.)
Supported by leading academics, many healthcare, mental health and education specialists across the UK have been trained, using CBRT in their work, providing valuable feedback and case studies. The CBRT Research Team 10 led by CBRT Research Director, Professor Stephen Westland and Dr. Vien Cheung, (Leeds University) and Dr.Ute Leonards (Bristol University) is preparing to undertake collaborative CBRT/NHS research, working with Programme Manager for Industry, Nathalie Goulden of GM CLRN 11, initially in the field of dementia. The CBRT Apparatus is a form of healthcare technology and has a UK Patent, International Trademarks and Copyright. There is great interest internationally in its current model and future applications.
CBRT is ready to work with four regional SHAs and five Primary Care Trusts, Mental Health Trusts, Acute Trusts, Pathfinder Commissioning Groups and/or other NHS organisations across their region. CBRT wish to work with PCTs who are working towards the QIPP agenda, to provide their Patients with better services, new self-care initiatives, innovation, and cost savings.
As part of the CBRT NHS Launch Project, the first 20 PCTs to receive the initial Training Programme for 25 Practitioners will benefit from the £5000+ VAT discount already included in this cost price. The total price shown of £39,750 includes the training of 25 NHS Staff at cost price and 5 NHS Trainers per PCT, quickly enabling each PCT to provide Patients with a new specialised resource in the CBRT Relaxation Support Sessions service.
Each PCT will receive enough equipment for their CBRT NHS Trainers to train a further 100 NHS Staff for Phase 1 by 31st March 2012; in addition each PCT has the ability to train future staff in the technique at cost price.
Our intent is for each PCT to have completed Phase 1 by 31st March 2012, with each having 125 trained CBRT NHS Staff ready for the increased cost savings projections to be made in Phase 2.
HEADLINE FIGURES:
Upfront estimate of Costs and projected Savings Per PCT / Phase 1 / Phase 2
Timescales / 29th September 2011 to 31st March 2012 / 1st April 2012 to
31st March 2013
Initial CBRT NHS Training Programme
(Project cost* – see Page 21 of this document) / £39,881* / n/a
Additional factored in costs to 31.03.12:
e.g.125 x Grade 5- 7 Staff training cost 250 days@ £192 per day
5 x Grade 5- 7 Staff Train the Trainer training cost 2 days @ £192 per day
Total / £48,000
£960
£48,900 / n/a
n/a
n/a
Example cost* provided in this document (PS Example 4 page 5 of 19) of CBRT NHS Materials provision for Patients / n/a / £35,384
Total Cost / £88,650 / £35,384
Projected Phased saving per PCT / £228,000
Total projected saving - per PCT / £139,350 / £5.162M
Total projected saving - per SHA (5 PCTs) / £696,750 / £25.812M
The NHS Opportunity
1.  CBRT provides beneficial Relaxation Support for many Patient groups. (CBRT Case Studies 17 )
2.  CBRT will enable your team to become a leading edge, NHS innovation led, and one of the first PCT’s in England to provide the benefits of CBRT to your Patients.
3.  NHS staff from Bands 3 to 7 can become proficient within two days to provide CBRT Relaxation Support Sessions for individuals and/or up to 20 Patients. CBRT can be used with effect in many settings and situations.
4.  Patients may attend as many or as few Relaxation Support Sessions as they wish; we recommend patients attend a group of 6 sessions.
5.  Patients can quickly learn how to use the CBRT technique safely at home, providing ongoing treatment.
Per PCT / Below is the number of Patients who benefit with: / Below is the number of Patients who benefit with: / Below is the number of Patients who benefit with: / Below is the number of Patients who benefit with:
2 x 30 - 45 minutes CBRT sessions provided : Per staff member, per wk,
with 5 patients / 3 x 30 - 45 minutes CBRT sessions provided : Per staff member, per wk,
with 5 patients / 2 x 30 - 45 minutes CBRT sessions provided Per staff member, per wk,
with 10 patients / 3 x 30 - 45 minutes CBRT sessions provided Per staff member, per wk,
with 10 patients
Phase 1
A total of 25 CBRT trained staff (by end Nov. 2011) / 1,250 / 1,875 / 2,500 / 3,750
Phase 2
A total of 125 CBRT trained staff (by end March 2012) / 2,250 / 3,375 / 4,500 / 6,750
PCTs Potential Savings (PS*) Phase 1 - 29th September 2011 to 31st March 2012
Illustration of having 25 NHS CBRT Staff trained by end of November 2011.
Example 1 scenario
1.  25 Practice Nurses/ or Band 5 equivalent, complete their CBRT NHS Training Programme and case studies by the end of November 2011. These nurses are now trained to provide CBRT Relaxation Support Sessions in their clinics/ GP surgeries where patients would benefit their health through learning to relax, but who would normally go to see their GP e.g.: COPD, smoking cessation, bereavement, unemployment, insomnia, stress related conditions:
2.  5 of these will attend a two day “Train the Trainer” Training Programme in January 2012 and become CBRT Trainers for their PCT.
3.  The 5 NHS CBRT Trainers are provided with enough equipment to train a further 20 NHS staff each (e.g. each PCT has 125 staff trained in CBRT by the end of March 2012.)
PS Example 1
/ 1
Patient / 5
Patients / 10 Patients / 25 x Band 5 Nurses, or equivalent (@ £24 13 per hour) provide 12 x 45 mins* (*£18) CBRT sessions each,*pcm (5 Patients* each session)x 4 months to end of March = 3,600 Patients pcm = 39,600 GP patients appointments per annum total
GP @ c. £36 12 per 12 minutes appointment / £38 / £190 / £380 / Cost for the above example = £ (25 nurses x £18 cost x 12 sessions x 4 months = £1,752 nurse time cost. Each NHS CBRT nurse sees 240 Patients each in 4 months Dec – end March. 25 nurses provide 48 CBRT sessions each = 1200 sessions for 6000 Patients.
Patients use GP surgery CBRT kit and are not provided with their own.)
GP PS* 6000 x GP visits@ £36 = £216,000.
Cost saving per 45 min* CBRT session / £20 / £172 / £362 / Phase 1 ≥PS £216,000 per PCT
PCTs Potential Savings* (PS*) Phase 2 - 1st April 2012 to 31st March 2013
Illustration of having 125 NHS CBRT Staff trained by 31st March 2012.
Example 2 scenario -
1) 20 Psychiatric Community Nurses providing CBRT sessions in small groups:
PS Example 2 / 1
Patient / 5 Patients / 10 Patients / 20 x Psychiatric Nurses 14 provide 3 CBRT sessions each per week, for groups of 5 Patients each session, 300 patients per week total
Psychiatric Community Nurse (total service cost @ c.£59 per hour) / £59 / £295 / £590 / 60 sessions @ £59 x 46 weeks = 13,800 Patient places with special mental health support per annum.
13,800 individual sessions = £814,200 less
20 x Nurses @ £59 x 3 sessions per week x 46 weeks = £162,840
Cost saving per 1 hour / nil / £236 / £531 / ≥PS £651,360 per PCT, per annum
Example 3 – 60 Practice Nurses (or Band 5 equivalent) providing “drop in” CBRT Relaxation Support Sessions in GP surgeries and Clinics, where patients need to relax but do not necessarily need to see their GP e.g. COPD, smoking cessation, bereavement, unemployment, insomnia, stress related conditions.
PS Example 3
/ 1
Patient / 5 Patients / 10 Patients / 60 x Band 5 Nurses, or equivalent (@ £24 per hour) provide 12 x 45 mins* (*£18) CBRT sessions each *pcm (5 Patients* each session) x 11 months = 660 Patients each per annum; = 39,600 GP/nurse patients appointments per annum total = £1,425,600
GP @ c. £36 per 12 minutes appointment / £36 / £180 / £360 / Cost breakdown for the above example = (60 nurses £18 cost x 12 sessions x 11 months plus Patients use GP surgery CBRT kit and are not provided with their own.)
GP PS* £1,425,600 per annum – nurse time £142,560 = £1,283,040 per annum per PCT.
Cost saving per 45 min* CBRT session / £18 / £162 / £324 / ≥PS £1,283,040 per PCT, per annum
Example 4 - Patients provided with 6 x 45 min CBRT Sessions (over 3 weeks) + own CBRT kit, instead of immediately taking prescribed medication for depression related conditions:
PS Example 4
/ 1
Patient / 5 Patients / 1
Patients / 45 x Band 5 Nurses (@ £18* per hour) each provide:
i) 3 groups of 10 Patients with ii) 6 x 45 mins CBRT sessions iii) over 3 weeks (two sessions per week for 3 weeks)and iii) kit to use at home.= 30 patients x 6 sessions x 14 (annual cycle) = 420 Patient places per nurse per annum. 18,900 per PCT.
Medication for depression @ £170 15 per annum / £170 / £850 / £1700 / Potential annual medication cost saving example per nurse for above example = 420 patients @ £170 = £71,400
Cost saving based on: i) nurse (cost per Patient pro-rata) ii) size of group patients per session: iii) 6 sessions of CBRT, (£1.80 x 6) + iv) CBRT Kit & Observations Diary @£26.21 / £44.21
cost
saving
£136.59 / £221.05
cost
saving
£628.95 / £334.10
cost
saving
£1365.90 / Cost savings below are based on Band 5 Nursing staff providing 30 Patients (3 x 10) with six CBRT Relaxation Support Sessions (total 420 patients each per year, 18,900 Patients in total.) E.g. Nurses cost = 45 x 18 x 6 x 14= £68,040; Kits cost for 30 Patients = x 45 x £26.21 x 17 = £35,383.50. PS based on total patients 18,900 x £170 annual medication per patient = £3,213,000 minus Nurses time and kits cost (£103,423.50)
=£3,109,576 per PCT, per annum.
UPFRONT COSTS: Initial Cost of CBRT NHS Staff Relaxation Support Sessions Implementation includes enough kit for 125 staff:
CBRT Training Programme Upfront Cost
Per PCT / £39,275 + VAT
Per SHA with 5 participating PCTs = / £196,375 + VAT
Potential Savings of CBRT NHS Staff Relaxation Support Sessions Implementation:
Case Study 2 / Case Study 3 / Annual PCT/SHA Potential Savings
£651,360 / £1,401,900 / £3,109,576 / Per PCT = £5,162,836