thames valley strategic clinical network perinatal mental ... · new to mh services 31% 69%...
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Raising standards through sharing excellence
Thames Valley Strategic Clinical
Network – Perinatal Mental Health
Network
Wednesday 9th March 2016
Zoë Page, Project Manager
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Bespoke Data Collection • Commissioned by NHS England to assist Perinatal ERG/NHS England's work
programme on perinatal MH
• Data specification scoped with NHSE Perinatal Working Group to cover:-
Mother and Baby Units:-
Patient level data extract – all women discharged from MBU during 2014/15
Service metrics – staffing, quality, activity, finance
Mother and Baby community teams:-
Patient level data extract – all women seen by Mother and Baby CMHT during 2014/15 or sample
Service metrics – staffing, quality, activity, finance
Any other perinatal mental health provision
• Data collection process with all 58 English MH Trusts during June 2015
• Data collection period covers either 2014/15 outturn or census data as at 31.3.15
• Validated positions presented
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Bespoke Data Collection - overview 57 submissions received (from 58 Trusts)
• National position reported
• No Mother and Baby units in TV SCN area – nearest Winchester
• Only Oxford Health NHSFT have a community mother and baby team (IPPS)
Inpatient and/or
community
perinatal service
49%
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Raising standards through sharing excellence
Mother and baby units
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2015
• 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
Mother and baby units
Location of MBUs
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2015
Women from Thames Valley
requiring an MBU bed Distances travelled for a bed using GP practice as base
NB nearest MBU is Winchester (10 beds)
CCG No of patients
Admitted to MBU in: Average distance travelled (km)
NHS Aylesbury Vale CCG 1 South Staffordshire and Shropshire 182
NHS Bracknell and Ascot CCG 2 Royal Hampshire 71
NHS Chiltern CCG 1 Royal Hampshire 129
NHS Milton Keynes 2 1 – CNWL
1 - Hertfordshire 78
NHS Newbury and District CCG 1 Royal Hampshire 53
NHS Oxfordshire CCG 3 1 – CNWL
2 - Royal Hampshire 105
NHS Slough CCG 4 Royal Hampshire 95
NHS South Reading CCG 2 Royal Hampshire 69
NHS Wokingham CCG 4 Royal Hampshire 61
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2015
Map
Blue = Home GP
Red = MBU Admitted to
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2015
Map
Admission density is greater
in regions with a unit
Where specialist units do
not exist, women may also
be admitted to local general
services (adult acute /
PICU) – the scale of this
activity is unknown
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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
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30
years old
White British
Any other White
Backgro…
Other Known to MH services
New to MH services
31%
69%
Inpatient Typical Profile
NO substance misuse code (=82%) NO history of prior maltreatment code (=90%)
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2015
Mother & baby units
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
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Raising standards through sharing excellence
Community mother and baby teams
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2015
Of the 43% of Trusts having a Community Mother and Baby Team, the following
services are provided (as an example):-
Community mother and baby teams Service model
• 71% offer pre-conception counselling
• 90% offer care during first trimester (100% 2nd & 3rd trimester, and care and advice
following delivery)
• 14% provide advice and support OOHs
• 52% provide advice and support to women with LD
• 25% have a rapid response medicines advice line
• 76% offer NICE/SCIE fully concordant care – of these 52% perform an annual audit
of compliance with NICE/SCIE concordant care
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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
0
2
4
6
8
10
12
14
16
18
Average waiting times for routine appointment in 2014/15 (weeks)
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2015
Community mother and baby teams
Activity
• Measure of
intensity of input
• Report very wide
variation from 25 to
4 contacts per
service user
• Mean contacts per
service user = 13
• Median = 13
.0
5.0
10.0
15.0
20.0
25.0
30.0
Total contacts 2014/15 per patient on the caseload
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2015
Community mother and baby teams
Workforce
AfC skill mix
• Band 5 = 4.5%
• Band 6 = 29.6%
• Band 7 = 15%
• Consultant psychiatrists =
11.7%
Richer skill mix than MBUs
(consistent with skill mix in
CAMHS)
Total staff vacancy rate = 15%
Staff sickness/absence rate = 4%
Staff turnover = 16%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%Band 1
Band 2
Band 3
Band 4
Band 5
Band 6
Band 7
Band 8a
Band 8b
Band 8c
Band 8d
Band 9
ConsultantPsychiatrist
Other Medical
Community Staff Metrics Data
All Participants P044
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2015
Community mother and baby teams
Finance
• Unit cost per patient
on the caseload
mean = £2,454
• Median = £2,097
• Wide variation
apparent
• Cost per contact
(F2F + non-F2F) =
£208 mean
• median £207
£
£1,000
£2,000
£3,000
£4,000
£5,000
£6,000
£7,000
Total Costs of service in 2014/15 (including corporate costs and overheads) per patient on the caseload
£
£100
£200
£300
£400
£500
Total Costs of service in 2014/15 (including corporate costs and overheads) per Contact
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30
years old
Known to MH services
New to MH services
39%
61%
Community Typical Profile
White British
Any other White
Background
Other
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2015
Community mother and baby team
Accommodation status of
patients on community
caseload
Employment status of patients
on community caseload
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2015
Community mother and baby team
Length of time on
community team
caseload
85% stay < 1 year
NB: Over 400 patients had
0 -1 day LOS on caseload
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www.nhsbenchmarking.nhs.uk
21
@nhsbenchmarking