Perinatal Mental Health Data Presentation to the Perinatal ERG
Transcript of Perinatal Mental Health Data Presentation to the Perinatal ERG
Perinatal Mental Health Data
Presentation to the Perinatal ERGZoë Page and Debbie Hibbert, NHS Benchmarking Network
16th July 2015
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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
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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
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