The Mental Health System Improvement Team Simon Bristow – System Improvement Advisor 1 |
Contents • Introduction to the Five Year Forward View for Mental Health (FYFV-MH) • Data and service development • CYPMH – Where are we now? • CYPMH next steps - The Long Term Plan – (LTP) • The System Improvement Team (SIT) • What does good CYPMH good look like? • Learning from systems Document title 2 |
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Mental Health Services Dataset The Mental Health Services Dataset (MHSDS) is a patient level, output based, secondary uses data set It delivers robust, comprehensive, nationally consistent and comparable person-based information for children, young people and adults who are in contact with Mental Health 5 5 | | Services.
Data Challenges • Detailed, complicated and new to MH • Infrastructure resource implications • Iterative processes to generating accurate and consistent data 6 6 | | Presentation title
Why is the data important? • Moral imperative to curiosity in how to support our patients to achieve better outcomes • There are significant unwarranted variations between service offer and outcomes • We have significant data gaps in mental health, primarily: • 1. Gaps in evidence base on what works for whom – RCTs for people with SMI often “represent a small atypical minority of the patient population, as up to 80– 90% of patients are excluded because of mental or physical comorbidity, suicidal or antisocial behaviour, or substance abuse” (1) • 2. Gaps in practice based evidence – There are some cohort studies on the real world effectiveness, but as a unified health system our potential to harness data to improve outcomes at individual patient and at population level is huge! 7 7 | | (1) Tiihonen J. Real-world effectiveness of antipsychotics. Acta Psychiatr Scand . 2016;134(5):371 – 373. doi:10.1111/acps.12641
Data in Improvement Science – Iterative reductions in variation, Informative? Imprecise? 8 8 | | Presentation title
Big, Beautiful Data There is significant utility for educators and students in the data reported through: Model Hospital – detailed inpatient, crisis and community activity data and dashboards accessible to anyone in the NHS https://improvement.nhs.uk/resources/model-hospital/ FutureNHS collaboration platform – dashboards and message boards on CYPMH, EIP, and crisis activity, interventions and outcomes https://future.nhs.uk/ 9 |
Big, Beautiful Data Detailed profiling tools, drilling down to CCG level are publicly available at https://fingertips.phe.org.uk/profile-group/mental-health Document title 10 |
Big, Beautiful Data • This includes detailed, real world health outcomes data at national, regional and CCG level 11 11 | | Presentation title
What good has this done in MH? 12 12 | | Presentation title
IAPT - 10 years of data We have a vast, richly detailed data set reporting on the reach, cost, and outcomes of IAPT services across the country, which can be compared by provider, CCG, STP and region. This enables detailed analysis of variance in commissioning provision and the development of evidence informed service development plans and impact measures 13 13 | |
CYPMH - The National Context Many of the issues and challenges highlighted below are common, to a greater or a lesser extent, to CYP systems across the country viz. Variation There is variation in the needs of children in different circumstances and at different stages of their development. There is variation in the availability and quality of services. And there is variation in the way different parts of the system are commissioned, funded and overseen. (CQC, 2017) Fragmentation The system as a whole is complex and fragmented. Mental health care is planned, funded, commissioned, provided and overseen by many different organisations, that do not always work together in a joined-up way. Poor collaboration and communication between agencies can lead to fragmented care, create inefficiencies in the system, and impede efforts to improve the quality of care. Poor data quality and availability Significant gaps in the availability of data mean it is difficult to get a clear picture of what services are available to children and young people across the country. Increased demand with long waits Evidence suggests that the demand for mental health care for children and young people is increasing. What is less clear is whether the capacity of services is also changing, as there is no reliable data to tell us how many children and young people 14 14 | | can be cared for across the mental health system.
Where are we now? – CYP access • The Government set the ambition that by 2020/21 at least 35% of CYP with a diagnosable MH condition receive treatment from an NHS-funded community service. • This equates to 70,000 more CYP per year will access services by 2020/21 (compared with 2015/16) • Estimated prevalence of diagnosable mental health problems in CYP aged 5-16 at 9.6% (2004 survey) • The percentage prevalence varies between CCGs according to age, sex and socio- economic classification (social class) 15 15 | | https://www.england.nhs.uk/publication/joint-technical-definitions-for-performance-and-activity-20171-8-201819/
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Who are the System Improvement Team? • We are a small, national team hosted within NHSE/I, offering improvement support to commissioners and providers of mental health care. • We use a collaborative consultancy approach to support organisations with working together to implement the transformational objectives of the 5YFV-MH and the Long Term Plan. • Inevitably, our work is often with systems who are struggling with achieving their desired position and are in need of support to improve, however we are not a performance management team. • Our core offer to commissioners and providers is providing a detailed diagnostic review of system challenges, formulating and agreeing system recommendations, and offering post-diagnostic implementation advice and support to achieve the desired state. 33 33 | | Presentation title
Skills and Experience • Our team members are from a variety of clinical and managerial backgrounds, hold a broad range of skills and experience in the delivery of mental health services, and hold subject matter expertise in particular areas, including: • Governance, leadership and culture • Clinical pathways • Operational management • Service improvement methodologies • Data quality and reporting • Value for money and productivity • Waiting list management and patient flow 34 34 | | Presentation title
How we work • We support improvements in patient care by helping systems and providers to deliver and evaluate evidence based treatment pathways • We take a holistic view, working across whole systems and pathways to support the delivery of national and local standards • We work with commissioners and providers to agree bespoke support offers based on a menu of possible support interventions • We use data and risk lists to identify areas of greatest opportunity • We use qualitative and quantitative approaches (e.g. appreciative enquiry, national benchmarking data and local intelligence) to build a well-informed view of improvement opportunities • We take care to select the right team for the assignment, matching skills and experience to the specific local context and needs • We give advice to national teams to help ensure that policy and guidance translates to operational delivery • We design and deliver workshops to inform and influence at scale 35 35 | | Presentation title
Our Support Offer Guidance on essential NATIONAL aspects necessary for operational delivery Developing capability in REGIONAL MH delivery oversight Insight, recommendations, LOCAL tools, coaching Providers Commissioners Improved patient care 36 36 | Presentation title |
Our Support Offer Full diagnostic Post diagnostic support Targeted diagnostic Workshops Tools and resources Advice, coaching & consultancy Support for national pilots 37 37 | | Presentation title
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