perinatal mental health data presentation to the perinatal erg
TRANSCRIPT
Perinatal Mental Health Data
Presentation to the Perinatal ERGZoë Page and Debbie Hibbert, NHS Benchmarking Network
16th July 2015
1
Bespoke Data Collection
• Data specification scoped with Perinatal Working Group to cover:-
Mother and Baby Units
Mother and Baby community teams
Any other perinatal mental health provision
• Data collection process with all 58 English MH Trusts; 2nd June – 29th June
• Data collection period covers either 2014/15 outturn or census data as at 31.3.15
• Primary level validation undertaken with participants due to time constraints e.g. a number
of duplicate patient records removed
Bespoke Data Collection - content
Mother and Baby Inpatient Beds
• Patient level data extract – all women discharged from MBU during 2014/15
• Service metrics – staffing, quality, activity, finance
Community Mother and Baby Teams
• Patient level data extract – all women seen by Mother and Baby CMHT during 2014/15
or sample
• Service metrics – staffing, quality, activity, finance
The bespoke data collection within
the national context
• 663,586 births 2013 in England (2014 data not published as yet)
• Data covers ~ 2% of births
• Average age of mothers nationally = 30*; bespoke data collection average age = 30.6 (MBUs) and 30.3 (CMBTs)
*ONS Statistical Bulletin – Births in England and Wales, 2013
Bespoke Data Collection - overview
56 submissions received (from 58 Trusts) to date
Inpatient and/or
community perinatal
service 49%
Bespoke Data Collection - overview
Inpatient and/or
community perinatal
service 49%
Narrative where no commissioned perinatal mental health
service exists
Examples include,
• Beds spot purchased when required
• Provision within generic MH services, MH crisis services and Health Visiting
services
• Limited consultant psychiatrist input (1 clinic 2 hours per month)
• Link midwives
• Patients managed within local adult MH acute units
• Managed within primary care
Bespoke Data Collection - overview
• Patient level data covers:-
Over 750 patient records from Mother and Baby Units
Over 11,500 patient records from Community Mother and Baby Teams
• 37% of Trusts reported having a perinatal liaison service
• 66% of Trusts have no other specialist perinatal mental health service
• Where perinatal mental health services are available, 76% are commissioned on a
recurring basis (only 6% of services commissioned on pilot basis)
• Where services have been commissioned, 16% have target volumes of service users
Initial findings –
Mother and Baby UnitsOrganisational level metrics
2015
Mother and baby units
Location of MBUs
• 115 MBU beds provided across the 15 units (as at 31st March 2015)
• MBUs are geographically spread –3 units in London area
• Number of beds in MBUs range from 4 to 13
• 4 Trusts only have beds
• 11 Trusts have beds and a community team
2015
Mother and baby units
Patient flow – Leeds and
York Partnership NHS
Foundation Trust (patient mapping for all MBUs in packs)
Used GP postcode to map distance travelled.
For patients travelling long distances, may be:
• Patient choice
• Capacity issues
• Geographical spread of MBUs
2015
• 729 admissions to MBUs reported in 2014/15
• 709 discharges from MBUs
• 70 % of MBUs have a lower age limit for services; lowest age accepted in MBUs is 16
• All MBUs will accept women in the antenatal period
• The upper age limit for babies accepted into the MBU is 12 months
• 19% of patients were admitted under a Mental Health Act section
Mother and baby units
Patient activity (2014/15)
Service models
2015
• 115 beds open on 31/3/2105
• Bed occupancy reported at:
65% / 62% (mean/median, excluding leave);
82% / 85% (mean/median, including leave)
• Delayed Transfers of Care –
very rare <1%
Mother and baby unitsBeds and Occupancy
2015
• Number of Serious Incidents
2014/15 (Mother and Baby
inpatient unit) per 100,000
occupied bed days mean =
79.5
• Number of Serious Incidents
2014/15 (Mother and Baby
inpatient unit) per 10 beds
mean = 1.9
Mother and baby units
Safety & quality (1)
2015
• Do you perform an annual audit of
compliance with NICE / SCIE
concordant care?
• Do you have internal quality control
systems (including dashboards) which
support you in measuring the quality of
care delivered?
Mother and baby units
Safety & quality (2)
Yes
No
Did not answer
Yes
Did not answer
g g g g g g g g g
g g g
g g g
g g g g g g g g g
g g g g g
g
2015
MBU discipline mix
• Predominantly Band 3 and
Band 5 nursing
Mother and baby unitsWorkforce metrics
Nursing AfC skill mix
Vacancy rate = 6% (mean/median)Staff turnover rate 9.6% mean (4.8% median)
Per 10 beds
Mean Median
All medical 1.8 1.7
Perinatal nursing
16 15.3
Clinical Psychology
3.5 1.1
Total workforce
30.9 30.9
2015
Total cost of service in 2014/15
(including corporate costs and
overheads) per admission
mean = £34,450
median = £32,934
Total cost of service in 2014/15
(including corporate costs and
overheads) per bed
mean = £207k
median = £193k
Mother and baby units
Finance metrics
Initial findings –
Mother and Baby UnitsPatient level metrics
30years old
White British
Any other White
Background
OtherKnown to MH services
New to MH services
31%
69%
Inpatient Typical Profile
NO substance misuse code (=82%)
NO history of prior maltreatment code (=90%)
2015
Diagnosis Groups – New or Known Patients
2015
Mother & baby units (patient level)
Patient demographics
Accommodation status of
patients on MBU
Employment status of patients
on MBU
Rented accommodation (private landlord
or housing association), 60%
Owner Occupier, 30%
Staying with family /friends
Shelteredaccommodation
Homeless / shelter /hostel / sofa surfing
2015
Length of time on MBU
88% stay < 3 months
NB:
12% stay less than 1 week, 12% stay more than 3 months
Mother & baby units (patient level)
2015
Mother & baby units (patient level)
2015
Mother & baby units (patient level)
Patient profile (2)
38% GP
32% Other
community mental
health teams
15% Maternity ward
Destination on Discharge
73% usual place of residence
10% inpatient bed
Source of referral
2015
Mother & baby units (patient level)
Patient profile (3)
• Patients on the MBU with previous admission to Trust I/P MH bed in last 12 months
• Patients on the MBU with readmission within 30 days
2015
• Age against length of stay – NO correlation
• Distance from home against length of stay – NO correlation
• Presence of a community Mother and Baby team and length of stay – NO
correlation
• Others?
Mother and baby units
Correlations tested
Initial findings –
Community mother and baby
teams (organisational level)
2015
Of the 42% of Trusts having a community mother and baby team:
• 65% have a lower age limit for services
mean = age 17 (median = age 16)
• 90% have an upper age limit for babies
Mean = 12 months (median = 12 months)
1 Trust will accept babies up to 36 months old
Community Mother & Baby Teams
Service model – age limits
2015
Of the 42% of Trusts having a Community Mother and Baby Team, the following
services are provided
Community Mother and Baby Teams
Service model - services provided (1)
Service provided % of Trusts offering Service provided % of Trusts offering
Pre-conception counselling
70% CBT/talking therapies 90%
Perinatal care planning
100% Interventionalprogrammes
58%
Input from nursery nurses
25% OOHs support & advice 15%
Medication advice 100% Therapeutic mother & infant activities
40%
Relaxation & anxiety management
89% Access to group/therapeutic play
55%
Pre-conceptioncare/advice to at risk women
80% Specialist advice to women with LD
50%
Specialist advice to women with history of domestic abuse
75% Specialist advice to women with history of sexual abuse
80%
2015
Of the 42% of Trusts having a Community Mother and Baby Team, the following other
services are provided
Community Mother and Baby Teams
Service model - services provided (2)
• 25% have a rapid response medicines advice line
• 80% offer NICE/SCIE fully concordant care – of these 50% perform an annual audit of compliance with NICE/SCIE concordant care
• 75% have internal quality control systems measuring the quality of care delivered
2015
• Average wait for
routine
appointment is 5
weeks (median is
4 weeks)
• Some Trusts
reporting high
maximum waits at
16 weeks
Community Mother and Baby Teams
Access (1)
2015
• Mean = 54
women on the
waiting list
• Median = 52
women on the
waiting list
• Ranges from 103
to 10
Community Mother and Baby Teams
Access (2)
2015
• Mean DNA rate
is 16%
• Median is 15%
Community Mother and Baby Teams
Access (3)
2015
Community Mother and Baby Teams
Activity (1)
• Mean number of patients on the caseload = 217
• Median = 176
• Raw numbers - not benchmarked by size of catchment area
• Unique patients on caseload over the year Mean = 572 women
• Median = 395
2015
Community Mother and Baby Teams
Activity (2)
• Total contacts mean = 2,893
• Median = 2,179
2015
Community Mother and Baby Teams
Activity (3)
• Measure of intensity of input
• Report very wide variation from 23 to 4 face to face contacts per service user
• Mean face to face contacts per service user = 10
• Median = 9
2015
Community Mother and Baby Teams
Activity (4)
• Mean = 7%
• Median is 4%
• Variation possibly explained by different service models in operation
2015
Community Mother and Baby Teams
Workforce metrics (1)
AfC skill mix • Band 5 = 4.4%• Band 6 = 28.5%• Band 7 = 15%• Consultant psychiatrists =
11.7%• Richer skill mix than MBUs
(consistent with skill mix in CAMHS)
Total staff vacancy rate = 3%Staff sickness/absence rate = 1%Staff turnover = 2%
2015
Community Mother and Baby Teams
Workforce metrics (2)
• Total medical staff per 1000 patients on caseload – mean = 3; median = 2
• Total Nursing staff per 1000 patients on the caseload - mean = 9; median = 6
• Total clinical psychologists per 1000 patients on the caseload - mean = 7; median = 7
• Total workforce per 1000 patients on the caseload - mean = 18; median = 15
2015
Community Mother and Baby Teams
Finance metrics
• Unit cost per patient on the caseload mean = £2,311
• Median = £1,981• Wide variation
apparent
• Cost per contact (F2F + non-F2F) = £203 mean; median £191
• Cost per F2F contact = £240 mean; £216 median
Community Mother and baby
Teams (patient level)
30years old
Known to MH services
New to MH services
39%
61%
Community Typical Profile
White British
Any other White
Background
Other
2015
Diagnosis Groups – New or Known Patients
2015
Mother & baby Community Team (patient level)
Accommodation status of
patients on community
caseload
Employment status of patients
on community caseload
2015
Mother & baby
community team(patient level)
2015
Mother & baby community team (patient level)
Length of time on community team caseload
85% stay < 1 year
NB: Over 400 patients had 0-1 day LOS on caseload
Conclusions
2015
Summary
High level comparisons
Metric MBU Community MBT
Scale of provision Number of beds available nationally = 115
Average number of patients on caseload = 270
Costs Cost per admission= £34,449
Cost per service user on caseload = £2,311
Workforce Total workforce per 10 beds = 30.9 wte
Per 100 patients on caseload = 4 wte
Activity Average length of stay = 48 days (including leave)
Average time on caseload = 63% patients < 6 months
Next steps & discussion points
48