Thames Valley Strategic Clinical Network Perinatal Mental Health - - PowerPoint PPT Presentation

Raising standards through sharing excellence

Thames Valley Strategic Clinical Network – Perinatal Mental Health Network

Wednesday 9th March 2016 Zoë Page, Project Manager

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

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%

Raising standards through sharing excellence

Mother and baby units

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

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

2015

Map

Blue = Home GP Red = MBU Admitted to

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

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

30

years old

White British Any

• ther

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%)

2015

Mother & baby units

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

Raising standards through sharing excellence

Community mother and baby teams

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
• f compliance with NICE/SCIE concordant care

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

2 4 6 8 10 12 14 16 18

Average waiting times for routine appointment in 2014/15 (weeks)

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

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 Consultant Psychiatrist Other Medical

Community Staff Metrics Data

All Participants P044

2015

Community mother and baby teams

Finance

• Unit cost per patient
• n 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

• verheads) per Contact

30

years old

Known to MH services New to MH services

39% 61%

Community Typical Profile

White British Any other White Backgroun d Other

2015

Community mother and baby team

Accommodation status of patients on community caseload Employment status of patients

• n community caseload

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

zoe.page@nhs.net www.nhsbenchmarking.nhs.uk @nhsbenchmarking