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

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%


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


• 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


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


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


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?


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


Finance metrics


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


2015


2015


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


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?


Correlations tested


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


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


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


Access (1)

2015

• Mean = 54

women on the

waiting list

• Median = 52

women on the

waiting list

• Ranges from 103

to 10


Access (2)

2015

• Mean DNA rate

is 16%

• Median is 15%


Access (3)

2015


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


Activity (2)

• Total contacts mean = 2,893

• Median = 2,179

2015


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


Activity (4)

• Mean = 7%

• Median is 4%

• Variation possibly explained by different service models in operation

2015


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


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


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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