1 Perinatal Mental Health Data Presentation to the Perinatal ERG Zoë Page and Debbie Hibbert, NHS Benchmarking Network 16 th July 2015
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; 2 nd June – 29 th 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 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 Inpatient and/or • community perinatal Limited consultant psychiatrist input (1 clinic 2 hours per month) service 49% • 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 Units Organisational level metrics
Mother and baby units Location of MBUs • 115 MBU beds provided across the 15 units (as at 31 st 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
Mother and baby units Patient activity (2014/15) • 729 admissions to MBUs reported in 2014/15 • 709 discharges from MBUs Service models • 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 2015
Mother and baby units Beds and Occupancy • 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% 2015
Mother and baby units Safety & quality (1) • 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 2015
Mother and baby units Safety & quality (2) • Yes g g g g g g g g g Do you perform an annual audit of No g g g compliance with NICE / SCIE concordant care? Did not answer g g g • Do you have internal quality control Yes g g g g g g g g g systems (including dashboards) which g g g g g support you in measuring the quality of Did not answer g care delivered? 2015
Mother and baby units Workforce metrics Nursing AfC skill mix MBU discipline mix • Predominantly Band 3 and Band 5 nursing Per 10 Mean Median beds All medical 1.8 1.7 Perinatal 16 15.3 nursing Clinical 3.5 1.1 Psychology Total 30.9 30.9 workforce Vacancy rate = 6% (mean/median) Staff turnover rate 9.6% mean (4.8% median) 2015
Mother and baby units Finance metrics 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 2015
Initial findings – Mother and Baby Units Patient level metrics
Inpatient Typical Profile Known to NO substance 30 MH Other White misuse code (=82%) services British 31 % Any other NO history of prior 69% New to MH White years old maltreatment code services Background (=90%)
Diagnosis Groups – New or Known Patients 2015
Mother & baby units (patient level) Patient demographics Staying with family / friends Employment status of patients on MBU Sheltered accommodation Rented Owner Occupier, Homeless / shelter / accommodation 30% hostel / sofa surfing (private landlord or housing association), 60% Accommodation status of patients on MBU 2015
Mother & baby units (patient level) Length of time on MBU 88% stay < 3 months NB: 12% stay less than 1 week, 12% stay more than 3 months 2015
Mother & baby units (patient level) 2015
Mother & baby units (patient level) Patient profile (2) Source of referral 38% GP 32% Other community mental health teams Destination on Discharge 15% Maternity ward 73% usual place of residence 10% inpatient bed 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
Mother and baby units Correlations tested • 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? 2015
Initial findings – Community mother and baby teams (organisational level)
Community Mother & Baby Teams Service model – age limits 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 2015
Community Mother and Baby Teams Service model - services provided (1) Of the 42% of Trusts having a Community Mother and Baby Team, the following services are provided Service provided % of Trusts offering Service provided % of Trusts offering Pre-conception 70% CBT/talking therapies 90% counselling Perinatal care 100% Interventional 58% planning programmes Input from nursery 25% OOHs support & advice 15% nurses Medication advice 100% Therapeutic mother & 40% infant activities Relaxation & 89% Access to 55% anxiety group/therapeutic play management Pre-conception 80% Specialist advice to 50% care/advice to at women with LD risk women Specialist advice to 75% Specialist advice to 80% women with history women with history of of domestic abuse sexual abuse 2015
Community Mother and Baby Teams Service model - services provided (2) Of the 42% of Trusts having a Community Mother and Baby Team, the following other services are provided • 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
Community Mother and Baby Teams Access (1) • Average wait for routine appointment is 5 weeks (median is 4 weeks) • Some Trusts reporting high maximum waits at 16 weeks 2015
Community Mother and Baby Teams Access (2) • Mean = 54 women on the waiting list • Median = 52 women on the waiting list • Ranges from 103 to 10 2015
Community Mother and Baby Teams Access (3) • Mean DNA rate is 16% • Median is 15% 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
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