Thames Valley Strategic Clinical Network – Perinatal Mental Health Network Wednesday 9 th March 2016 Zoë Page, Project Manager Raising standards through sharing excellence
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%
Mother and baby units Raising standards through sharing excellence
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
Women from Thames Valley requiring an MBU bed Distances travelled for a bed using GP practice as base CCG No of Admitted to MBU in: Average distance patients travelled (km) 1 South Staffordshire and Shropshire 182 NHS Aylesbury Vale CCG Royal Hampshire 71 NHS Bracknell and Ascot CCG 2 1 Royal Hampshire 129 NHS Chiltern CCG 1 – CNWL NHS Milton Keynes 2 78 1 - Hertfordshire 1 Royal Hampshire 53 NHS Newbury and District CCG 1 – CNWL NHS Oxfordshire CCG 3 105 2 - Royal Hampshire 4 Royal Hampshire 95 NHS Slough CCG 2 Royal Hampshire 69 NHS South Reading CCG 4 Royal Hampshire 61 NHS Wokingham CCG NB nearest MBU is Winchester (10 beds) 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
Mother & baby units Length of time on MBU 88% stay < 3 months NB: 12% stay less than 1 week, 12% stay more than 3 months 2015
Inpatient Typical Profile Known to NO substance 30 MH Other White misuse code (=82%) services British 31 % Any NO history of prior other 69% New to MH years old White maltreatment code services Backgro … (=90%)
Mother & baby units 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
Community mother and baby teams Raising standards through sharing excellence
Community mother and baby teams Service model Of the 43% of Trusts having a Community Mother and Baby Team, the following services are provided (as an example):- • 71% offer pre-conception counselling • 90% offer care during first trimester (100% 2 nd & 3 rd 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 of compliance with NICE/SCIE concordant care 2015
Community mother and baby teams Average waiting times for routine appointment in 2014/15 Access (weeks) 18 • Average wait for 16 routine appointment is 5 14 weeks (median is 12 4 weeks) 10 • Some Trusts 8 reporting high maximum waits at 6 16 weeks 4 2 0 2015
Community mother and baby teams Activity Total contacts 2014/15 per patient on the caseload • Measure of 30.0 intensity of input 25.0 • Report very wide variation from 25 to 4 contacts per 20.0 service user • Mean contacts per 15.0 service user = 13 10.0 • Median = 13 5.0 .0 2015
Community mother and baby teams Workforce AfC skill mix Community Staff Metrics Data Band 1 30.0% • Band 5 = 4.5% Other Medical Band 2 25.0% • Band 6 = 29.6% Consultant 20.0% • Band 3 Band 7 = 15% Psychiatrist 15.0% • Consultant psychiatrists = 10.0% 11.7% Band 9 Band 4 5.0% 0.0% Richer skill mix than MBUs (consistent with skill mix in Band 8d Band 5 CAMHS) Band 8c Band 6 Total staff vacancy rate = 15% Band 8b Band 7 Staff sickness/absence rate = 4% Band 8a All Participants P044 Staff turnover = 16% 2015
Community mother and baby teams Finance Total Costs of service in 2014/15 (including corporate costs and overheads) per patient on the caseload £7,000 • Unit cost per patient £6,000 on the caseload £5,000 mean = £2,454 £4,000 • £3,000 Median = £2,097 £2,000 • £1,000 Wide variation apparent £ Total Costs of service in 2014/15 (including corporate costs and overheads) per Contact £500 • Cost per contact £400 (F2F + non-F2F) = £208 mean £300 £200 • median £207 £100 £ 2015
Community Typical Profile Other Known to 30 MH services 39 % Any other White 61% New to MH White years old British services Backgroun d
Community mother and baby team Employment status of patients on community caseload Accommodation status of patients on 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 2015
zoe.page@nhs.net www.nhsbenchmarking.nhs.uk @nhsbenchmarking
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