Transcript Document

Mental Health Information: NHS Trust Forum
26th April 2010, Birmingham Botanical Gardens
Welcome and Introductions
General Mental Health Information Update
Netta Hollings
Welcome
• General Election 2010
• House keeping
Agenda for Today
10.00 – 10.30
Registration and Coffee
10.30 – 11.00
Welcome and Introductions
General Mental Health Information Update
Netta Hollings, Mental Health Programme Manager, The NHS Information Centre
11.00 – 11.30
Update on the increasing use of MHMDS and related data quality issues including
Jo Simpson, Senior Project Manager, The NHS Information Centre
Steven Burrows, Senior Information Analyst, The NHS Information Centre
11.30 – 11.50
Question and Answer Session
11.50 – 12.20
Introduction to Payment by Results for Mental Health
Peter Howitt, Head of Expanding the Scope of PbR, Department of Health
12.20 – 12.30
Question and Answer Session
12.30 – 13.45
Carvery Lunch
13.45 - 14.45
Key Changes to MHMDS and Response to Consultation
Paul Croft, Project Manager, Standards and Classifications, The NHS Information Centre
14.45 – 14.55
Refreshment Break
14.55 – 1510
Continuation of Key Changes to MHMDS and Response to Consultation
Paul Croft, Project Manager, Standards and Classifications, The NHS Information Centre
15.10 – 15.20
Question and Answer Session
15.20 – 15.30
Summary and Close
Netta Hollings, Mental Health Programme Manager, The NHS Information Centre
Updates
• PbR
– ISN (DSCN) – for Classification and Currency
– MHMDS changes – ISB – June; July ISN
– Accurate clinical and activity information to support development of
MH tariffs …MHMDS version 4.00
– Coverage, accurate team and staff info, diagnosis and HONOS
• Reducing the Burden
– KP90 collection – Mental Health Act related info – comprehensive
and detailed
– DRE Dashboard – team caseload
– Community Activity – team caseload
– Other elements of Performance Framework
– CDS
Update continued
• More use of MHMDS
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DH ACRA (PCT allocations)
Clinical Prioritisation – Bruce Keogh
QIPP – NHS Board dashboard
Supplied to SHAs, PCTs, Audit Commission routinely
DH Service Performance Indicators for MH Trusts
• Delayed Transfers of Care
Indicators for Quality Improvement
CQC Periodic Review
NI 149 and N1 150
WCC Datapacks
Clinical Indicators …
NHS Comparators …
Update continued
• Mental Health Informatics Board
– Established – chaired by DH; members – DH (Mental
Health policy, CIO office and National Clinical Director),
IC, CfH clinical leads, Chief Exec rep.
– Then “task force” layer and Intelligence Network – will
be discussed at Pan Programme group in May
Update continued
• IAPT
– ISB this week (28th April)
• Mental Capacity Act
– DoLS publication – 23rd March
• Assembly investigation
– Verbal update
• Independent Sector
– Representatives today
– “Beginner’s Guide to MHMDS”
Update
• Advance warning
– Next annual bulletin
• Diagnosis
• Person based cost analysis
• More about patients on SCT
– Service mapping
• Some elements may return (but NB reducing the burden item
earlier)
• Use of ESR
– Mentally Disordered Offenders
– CAMHS
– Referral to Treatment data
– Dementia
– Autism / LD
Update on Uses of MHMDS and Related Data
Quality Issues
Jo Simpson
Steven Burrows
New uses of MHMDS
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Growing interest in activity data:
MHMDS extracts now regularly supplied to SHAs, PCTs, Audit
Commission, as well as CQC
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Growing interest in linking this to reference costs:
– Advisory Committee on Resource Allocation (ACRA)
– Clinical Prioritisation
– NHS Board – to support QIPP agenda
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Price proxies developed for units of activity from DH
Reference costs
Matching MHMDS and Reference Cost
Activity
• Community Mental Health Teams - Face to Face
• Mental Health Consultant Services (Community
Setting) - First Contact / Follow-up Contact Face
to Face
• Mental Health Consultant Services (Outpatient
Setting) - First Attendance / Follow-up Attendance
Face to Face
• Mental Health Inpatients
• Eating Disorder Services
• Mother & Baby Units
Other activity
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Mental Health Specialist Teams
Mental Health Day Care Facilities
Non Face to Face
Children’s Services
Drug & Alcohol Services
Maximum Secure Units
High Dependency Secure Provision
Autistic Spectrum Disorder Teams
Other activity
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Mental Health Specialist Teams
Mental Health Day Care Facilities
Non Face to Face
Children’s Services
Drug & Alcohol Services
Maximum Secure Units
High Dependency Secure Provision
Autistic Spectrum Disorder Teams
National Unit Costs
sum (Provider unit cost x Provider activity)
=
total activity
National MHMDS price proxies 08-09
Bed Days
Reference Cost code
MHIPMHIPA
MHIPMHIPE1
MHSUSCU3
MHSUSCU1
MHMDS
Adult MHD_Bed_Days_Mental_Health
Elderly MHD_Bed_Days_Mental_Health
Adult MHD_Bed_Days_Mental_Health_Medium_Secure
Adult MHD_Bed_Days_Mental_Health_Intensive
Average unit cost
£310.13
£289.22
£480.64
£644.65
MHMDS
Adult total MHD_Out_Patient_Attendance_Consultant
Elderly total MHD_Out_Patient_Attendance_Consultant
Average unit cost
£166.71
£178.55
Outpatient contacts
Reference Cost code
MHCSOPA
MHCSOPE
Community contacts
Community Psychiatric Nurse
Clinical Psychologist
Occupational Therapist
Physiotherapist
Consultant Psychotherapist
Adult
£93.99
£129.23
£90.07
£90.07
£121.40
Average unit cost
Elderly
£135.19
£185.88
£129.56
£129.56
£174.62
Notes
• Age Bands include ages from 15 to 111
• Total Bed Days removes wrongly recorded bed
days totals which significantly skew costs amongst
Medium and Standard bed days
• When the total of bed days is greater than 365 days
(apparent in c.1,100 records of the 1 million plus
total) then the type of bed day is ranked in the order
of highest to lowest, and where counts are equal in
order of Intensive  Medium  Standard bed days
Sample total volume and costs in the 2008/9
MHMDS extract
Volume
Costs (£'000s)
Unit cost (£)
% total costs
Inpatients
7,802,671
2,690,995
344.9
70.3%
Outpatients
1,527,911
261,889
171.4
6.8%
CPN
5,559,079
591,549
106.4
15.5%
734,776
102,077
138.9
2.7%
1,250,342
129,791
103.8
3.4%
Physiotherapist
148,772
17,267
116.1
0.5%
Psychotherapist
266,430
33,936
127.4
0.9%
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3,827,504
-
100.0%
Psychologist
OT
Total
Price proxy for Mental Health Activity: all English
Providers
Mental Health Activity: all English Providers
Quarter
Q1 2008/09
Q2 2008/09
Q3 2008/09
Q4 2008/09
Q1 2009/10
Q2 2009/10
Total Bed days
Quarter
Q1 2008/09
Q2 2008/09
Q3 2008/09
Q4 2008/09
Q1 2009/10
Q2 2009/10
Consulltant Psychiatrist contacts
Quarter
Q1 2008/09
Q2 2008/09
Q3 2008/09
Q4 2008/09
Q1 2009/10
Q2 2009/10
Community contacts
Cost
2,413,988
2,184,808
2,048,103
1,844,056
1,847,215
1,876,857
395,411
402,240
391,143
402,851
393,062
389,583
2,144,711
2,063,127
2,082,373
2,083,648
2,205,995
2,173,637
£794,225,826.98
£718,852,239.74
£673,194,170.77
£598,485,333.41
£603,852,336.71
£612,626,901.69
Cost
£67,109,763.97
£68,396,510.72
£66,378,532.09
£68,378,561.57
£66,752,107.46
£66,201,664.17
Cost
£231,064,827.12
£223,442,807.56
£225,912,142.15
£225,930,713.41
£238,678,942.82
£235,338,173.92
Related issues / areas for improvement
• Incorrect Start and End dates of Ward Stays
– either overlapping
– or not synchronised to Hospital Provider Spell,
– or not present
• Derived bed days that are plainly invalid are
excluded from cost calculations
Related issues / areas for improvement
• Incorrect Start and End dates of Ward Stays
– either overlapping
Invalid Bed Days that can’t be used, eg > 366 in year or 92 in
quarter
– or not synchronised to Hospital Provider Spell
Admissions and discharges but not correctly related to Bed Days
– or not present
No Bed Days
• Bed Days are most expensive unit of activity – potential
impact on resourcing and payment.
Related issues / areas for improvement
• Coverage – all services and teams so that
comprehensive records of contacts and
appointments
• Improvements to recording of NHS day care
facilities, acute home based care and stays in
NHS residential homes – not considered reliable
enough to include at present
Basic Data Quality Checks
Total Record Counts
Code
RGD
RH5
Name
LEEDS MENTAL HEALTH TEACHING NHS TRUST
SOMERSET PARTNERSHIP NHS AND SOCIAL CARE TRUST
0708
20558
13649
0809
Change
18918
-7.98
12957
-5.07
RHA
RJ8
NOTTINGHAMSHIRE HEALTHCARE NHS TRUST
CORNWALL PARTNERSHIP NHS TRUST
29795
4152
43755
10466
46.85
152.07
RKL
WEST LONDON MENTAL HEALTH NHS TRUST
30358
31183
2.72
Any change in services?
Can huge changes in data volumes be explained?
New uses of MHMDS
2. Growing range of indicators
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DH Service Performance Indicators for MH Trusts
Indicators for Quality Improvement
CQC Periodic Review
NI 149 and N1 150
WCC Datapacks
Related DQ issues
• DH Service Performance Indicators for MH Trusts
– HONOS, Diagnosis, Under 16s, AWOL
• Indicators for Quality Improvement
– CPA
• CQC Periodic Review
– Diagnosis, HONOS
• WCC Datapacks
New uses of MHMDS
3. Reducing the burden
• KP90 collection, Mental Health Act related information –
comprehensive and detailed
• DRE Dashboard – team caseload
• Community Activity – team caseload
• Other elements of Performance Framework
Present comparison, trust level figures
about uses of the Mental Health Act
* subject to confidentiality risk assessment
Basic Data Quality Checks
Team Type (at the end of the reporting period)
Base Data: All records open at the end of the year that included a CPA review
0%
2004-05
2005-06
2006-07
20%
40%
60%
80%
100%
General adult psychiatry
Psychiatry of old age
Substance misuse
Crisis resolution
Early intervention
2007-08
Assertive outreach
2008-09
Missing or invalid data
Other Teams
Are your CLINTEAM and REV tables aligned?
Are you using the same team identifier in both tables allowing the
data to be linked?
New uses of MHMDS
4. Making published statistics more useful – wider
range of analysis in MH Bulletin to include
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Diagnosis
Person based cost analysis
More about patients on SCT