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1 Perinatal Mental Health Data Presentation to the Perinatal ERG Zo Page and Debbie Hibbert, NHS Benchmarking Network 16 th July 2015 Bespoke Data Collection Data specification scoped with Perinatal Working Group to cover:- Mother

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SLIDE 1

Perinatal Mental Health Data Presentation to the Perinatal ERG

Zoë Page and Debbie Hibbert, NHS Benchmarking Network 16th July 2015

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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
  • f duplicate patient records removed
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SLIDE 3

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
  • r sample
  • Service metrics – staffing, quality, activity, finance
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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

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Bespoke Data Collection - overview

56 submissions received (from 58 Trusts) to date

Inpatient and/or community perinatal service 49%

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SLIDE 6

Bespoke Data Collection - overview

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
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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
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SLIDE 8

Initial findings – Mother and Baby Units

Organisational level metrics

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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
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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
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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

Mother and baby units

Patient activity (2014/15) Service models

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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 units

Beds and Occupancy

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2015

  • Number of Serious Incidents

2014/15 (Mother and Baby inpatient unit) per 100,000

  • ccupied bed days mean =

79.5

  • Number of Serious Incidents

2014/15 (Mother and Baby inpatient unit) per 10 beds mean = 1.9

Mother and baby units

Safety & quality (1)

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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?

Mother and baby units

Safety & quality (2)

Yes No Did not answer Yes Did not answer g g g g g g g g g g g g g g g g g g g g g g g g g g g g g g

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2015

MBU discipline mix

  • Predominantly Band 3 and

Band 5 nursing

Mother and baby units

Workforce 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

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2015

Total cost of service in 2014/15 (including corporate costs and

  • verheads) per admission

mean = £34,450 median = £32,934 Total cost of service in 2014/15 (including corporate costs and

  • verheads) per bed

mean = £207k median = £193k

Mother and baby units

Finance metrics

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Initial findings – Mother and Baby Units

Patient level metrics

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30

years old

White British Any other White Background 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

Diagnosis Groups – New or Known Patients

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2015

Mother & baby units (patient level)

Patient demographics

Accommodation status of patients on MBU Employment status of patients

  • n MBU

Rented accommodation (private landlord

  • r housing

association), 60% Owner Occupier, 30%

Staying with family / friends Sheltered accommodation Homeless / shelter / hostel / sofa surfing

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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 (patient level)

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2015

Mother & baby units (patient level)

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2015

Mother & baby units (patient level)

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

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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
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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?

Mother and baby units

Correlations tested

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Initial findings – Community mother and baby teams (organisational level)

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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

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2015

Of the 42% of Trusts having a Community Mother and Baby Team, the following services are provided

Community Mother and Baby Teams

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% Interventional programmes 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-conception care/advice to at risk women 80% Specialist advice to women with LD 50% Specialist advice to women with history

  • f domestic abuse

75% Specialist advice to women with history of sexual abuse 80%

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2015

Of the 42% of Trusts having a Community Mother and Baby Team, the following other services are provided

Community Mother and Baby Teams

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

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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 (1)

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2015

  • Mean = 54

women on the waiting list

  • Median = 52

women on the waiting list

  • Ranges from 103

to 10

Community Mother and Baby Teams

Access (2)

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2015

  • Mean DNA rate

is 16%

  • Median is 15%

Community Mother and Baby Teams

Access (3)

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2015

Community Mother and Baby Teams

Activity (1)

  • Mean number of

patients on the caseload = 217

  • Median = 176
  • Raw numbers - not

benchmarked by size

  • f catchment area
  • Unique patients on

caseload over the year Mean = 572 women

  • Median = 395
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2015

Community Mother and Baby Teams

Activity (2)

  • Total contacts

mean = 2,893

  • Median = 2,179
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2015

Community Mother and Baby Teams

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
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2015

Community Mother and Baby Teams

Activity (4)

  • Mean = 7%
  • Median is 4%
  • Variation

possibly explained by different service models in

  • peration
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2015

Community Mother and Baby Teams

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%

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2015

Community Mother and Baby Teams

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
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2015

Community Mother and Baby Teams

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

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Community Mother and baby Teams (patient level)

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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

Diagnosis Groups – New or Known Patients

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2015

Mother & baby Community Team (patient level)

Accommodation status of patients on community caseload Employment status of patients

  • n community caseload
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2015

Mother & baby community team

(patient level)

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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

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Conclusions

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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

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Next steps & discussion points debbie.hibbert@nhs.net zoe.page@nhs.net

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