Mental Health Information: NHS Trust Forum26th April 2010, Birmingham Botanical Gardens

Welcome and IntroductionsGeneral Mental Health Information Update

Netta Hollings

Welcome

• General Election 2010 • House keeping

Agenda for Today

Summary and CloseNetta Hollings, Mental Health Programme Manager, The NHS Information Centre

15.20 – 15.30

Question and Answer Session15.10 – 15.20

Continuation of Key Changes to MHMDS and Response to ConsultationPaul Croft, Project Manager, Standards and Classifications, The NHS Information Centre

14.55 – 1510

Refreshment Break14.45 – 14.55

Key Changes to MHMDS and Response to ConsultationPaul Croft, Project Manager, Standards and Classifications, The NHS Information Centre

13.45 - 14.45

Carvery Lunch12.30 – 13.45

Question and Answer Session12.20 – 12.30

Introduction to Payment by Results for Mental HealthPeter Howitt, Head of Expanding the Scope of PbR, Department of Health

11.50 – 12.20

Question and Answer Session11.30 – 11.50

Update on the increasing use of MHMDS and related data quality issues includingJo Simpson, Senior Project Manager, The NHS Information CentreSteven Burrows, Senior Information Analyst, The NHS Information Centre

11.00 – 11.30

Welcome and Introductions

General Mental Health Information UpdateNetta Hollings, Mental Health Programme Manager, The NHS Information Centre

10.30 – 11.00

Registration and Coffee10.00 – 10.30

Summary and CloseNetta Hollings, Mental Health Programme Manager, The NHS Information Centre

15.20 – 15.30

Question and Answer Session15.10 – 15.20

Continuation of Key Changes to MHMDS and Response to ConsultationPaul Croft, Project Manager, Standards and Classifications, The NHS Information Centre

14.55 – 1510

Refreshment Break14.45 – 14.55

Key Changes to MHMDS and Response to ConsultationPaul Croft, Project Manager, Standards and Classifications, The NHS Information Centre

13.45 - 14.45

Carvery Lunch12.30 – 13.45

Question and Answer Session12.20 – 12.30

Introduction to Payment by Results for Mental HealthPeter Howitt, Head of Expanding the Scope of PbR, Department of Health

11.50 – 12.20

Question and Answer Session11.30 – 11.50

Update on the increasing use of MHMDS and related data quality issues includingJo Simpson, Senior Project Manager, The NHS Information CentreSteven Burrows, Senior Information Analyst, The NHS Information Centre

11.00 – 11.30

Welcome and Introductions

General Mental Health Information UpdateNetta Hollings, Mental Health Programme Manager, The NHS Information Centre

10.30 – 11.00

Registration and Coffee10.00 – 10.30

Updates

• PbR– ISN (DSCN) – for Classification and Currency– MHMDS changes – ISB – June; July ISN– Accurate clinical and activity information to support development of

MH tariffs …MHMDS version 4.00– Coverage, accurate team and staff info, diagnosis and HONOS

• Reducing the Burden– KP90 collection – Mental Health Act related info – comprehensive

and detailed– DRE Dashboard – team caseload– Community Activity – team caseload– Other elements of Performance Framework– CDS

Update continued

• More use of MHMDS– DH ACRA (PCT allocations)– Clinical Prioritisation – Bruce Keogh– QIPP – NHS Board dashboard– Supplied to SHAs, PCTs, Audit Commission routinely– DH Service Performance Indicators for MH Trusts

• Delayed Transfers of Care– Indicators for Quality Improvement– CQC Periodic Review– NI 149 and N1 150– WCC Datapacks– Clinical Indicators …– NHS Comparators …

Update continued

• Mental Health Informatics Board– Established – chaired by DH; members – DH (Mental

Health policy, CIO office and National Clinical Director), IC, CfH clinical leads, Chief Exec rep.

– Then “task force” layer and Intelligence Network – will be discussed at Pan Programme group in May

Update continued

• IAPT– ISB this week (28th April)

• Mental Capacity Act– DoLS publication – 23rd March

• Assembly investigation– Verbal update

• Independent Sector– Representatives today– “Beginner’s Guide to MHMDS”

Update

• Advance warning– Next annual bulletin

• Diagnosis• Person based cost analysis• More about patients on SCT

– Service mapping• Some elements may return (but NB reducing the burden item

earlier)• Use of ESR

– Mentally Disordered Offenders– CAMHS– Referral to Treatment data– Dementia– Autism / LD

Update on Uses of MHMDS and Related Data Quality Issues

Jo SimpsonSteven Burrows

New uses of MHMDS

• Growing interest in activity data: MHMDS extracts now regularly supplied to SHAs, PCTs, Audit Commission, as well as CQC

• Growing interest in linking this to reference costs:– Advisory Committee on Resource Allocation (ACRA)– Clinical Prioritisation – NHS Board – to support QIPP agenda

• Price proxies developed for units of activity from DHReference costs

Matching MHMDS and Reference Cost Activity• Community Mental Health Teams - Face to Face• Mental Health Consultant Services (Community

Setting) - First Contact / Follow-up Contact Face to Face

• Mental Health Consultant Services (Outpatient Setting) - First Attendance / Follow-up Attendance Face to Face

• Mental Health Inpatients• Eating Disorder Services• Mother & Baby Units

Other activity

• Mental Health Specialist Teams• Mental Health Day Care Facilities• Non Face to Face• Children’s Services• Drug & Alcohol Services• Maximum Secure Units• High Dependency Secure Provision• Autistic Spectrum Disorder Teams

Other activity

• Mental Health Specialist Teams• Mental Health Day Care Facilities• Non Face to Face• Children’s Services• Drug & Alcohol Services• Maximum Secure Units• High Dependency Secure Provision• Autistic Spectrum Disorder Teams

National Unit Costs

sum (Provider unit cost x Provider activity)=

total activity

National MHMDS price proxies 08-09

Bed DaysReference Cost code MHMDS Average unit cost

MHIPMHIPA Adult MHD_Bed_Days_Mental_Health £310.13MHIPMHIPE1 Elderly MHD_Bed_Days_Mental_Health £289.22MHSUSCU3 Adult MHD_Bed_Days_Mental_Health_Medium_Secure £480.64MHSUSCU1 Adult MHD_Bed_Days_Mental_Health_Intensive £644.65

Outpatient contactsReference Cost code MHMDS Average unit cost

MHCSOPA Adult total MHD_Out_Patient_Attendance_Consultant £166.71MHCSOPE Elderly total MHD_Out_Patient_Attendance_Consultant £178.55

Community contacts

Adult ElderlyCommunity Psychiatric Nurse £93.99 £135.19Clinical Psychologist £129.23 £185.88Occupational Therapist £90.07 £129.56Physiotherapist £90.07 £129.56Consultant Psychotherapist £121.40 £174.62

Average unit cost

Notes

• Age Bands include ages from 15 to 111• Total Bed Days removes wrongly recorded bed

days totals which significantly skew costs amongst Medium and Standard bed days

• When the total of bed days is greater than 365 days (apparent in c.1,100 records of the 1 million plus total) then the type of bed day is ranked in the order of highest to lowest, and where counts are equal in order of Intensive Medium Standard bed days

Sample total volume and costs in the 2008/9 MHMDS extract

Volume Costs (£'000s) Unit cost (£) % total costs

Inpatients 7,802,671 2,690,995 344.9 70.3%

Outpatients 1,527,911 261,889 171.4 6.8%

CPN 5,559,079 591,549 106.4 15.5%

Psychologist 734,776 102,077 138.9 2.7%

OT 1,250,342 129,791 103.8 3.4%

Physiotherapist 148,772 17,267 116.1 0.5%

Psychotherapist 266,430 33,936 127.4 0.9%

Total - 3,827,504 - 100.0%

Price proxy for Mental Health Activity: all English Providers

Mental Health Activity: all English Providers

Quarter Total Bed days CostQ1 2008/09 2,413,988 £794,225,826.98Q2 2008/09 2,184,808 £718,852,239.74Q3 2008/09 2,048,103 £673,194,170.77Q4 2008/09 1,844,056 £598,485,333.41Q1 2009/10 1,847,215 £603,852,336.71Q2 2009/10 1,876,857 £612,626,901.69

Quarter Consulltant Psychiatrist contacts CostQ1 2008/09 395,411 £67,109,763.97Q2 2008/09 402,240 £68,396,510.72Q3 2008/09 391,143 £66,378,532.09Q4 2008/09 402,851 £68,378,561.57Q1 2009/10 393,062 £66,752,107.46Q2 2009/10 389,583 £66,201,664.17

Quarter Community contacts Cost Q1 2008/09 2,144,711 £231,064,827.12Q2 2008/09 2,063,127 £223,442,807.56Q3 2008/09 2,082,373 £225,912,142.15Q4 2008/09 2,083,648 £225,930,713.41Q1 2009/10 2,205,995 £238,678,942.82Q2 2009/10 2,173,637 £235,338,173.92

Related issues / areas for improvement

• Incorrect Start and End dates of Ward Stays– either overlapping – or not synchronised to Hospital Provider Spell,– or not present

• Derived bed days that are plainly invalid are excluded from cost calculations

Related issues / areas for improvement

• Incorrect Start and End dates of Ward Stays– either overlapping

Invalid Bed Days that can’t be used, eg > 366 in year or 92 in quarter

– or not synchronised to Hospital Provider Spell Admissions and discharges but not correctly related to Bed Days

– or not present No Bed Days

• Bed Days are most expensive unit of activity – potential impact on resourcing and payment.

Related issues / areas for improvement

• Coverage – all services and teams so that comprehensive records of contacts and appointments

• Improvements to recording of NHS day care facilities, acute home based care and stays in NHS residential homes – not considered reliable enough to include at present

Basic Data Quality Checks

Total Record Counts

Code Name 0708 0809 ChangeRGD LEEDS MENTAL HEALTH TEACHING NHS TRUST 20558 18918 -7.98RH5 SOMERSET PARTNERSHIP NHS AND SOCIAL CARE TRUST 13649 12957 -5.07RHA NOTTINGHAMSHIRE HEALTHCARE NHS TRUST 29795 43755 46.85RJ8 CORNWALL PARTNERSHIP NHS TRUST 4152 10466 152.07RKL WEST LONDON MENTAL HEALTH NHS TRUST 30358 31183 2.72

Any change in services?Can huge changes in data volumes be explained?

New uses of MHMDS

2. Growing range of indicators• DH Service Performance Indicators for MH Trusts• Indicators for Quality Improvement• CQC Periodic Review• NI 149 and N1 150• WCC Datapacks

Related DQ issues

• DH Service Performance Indicators for MH Trusts– HONOS, Diagnosis, Under 16s, AWOL

• Indicators for Quality Improvement– CPA

• CQC Periodic Review– Diagnosis, HONOS

• WCC Datapacks

New uses of MHMDS

3. Reducing the burden• KP90 collection, Mental Health Act related information –

comprehensive and detailed• DRE Dashboard – team caseload• Community Activity – team caseload• Other elements of Performance Framework

Present comparison, trust level figures about uses of the Mental Health Act

* subject to confidentiality risk assessment

Basic Data Quality Checks

Team Type (at the end of the reporting period)

0% 20% 40% 60% 80% 100%

2004-05

2005-06

2006-07

2007-08

2008-09

General adult psychiatry

Psychiatry of old age

Substance misuse

Crisis resolution

Early intervention

Assertive outreach

Other Teams

Missing or invalid data

Base Data: All records open at the end of the year that included a CPA review

Are your CLINTEAM and REV tables aligned?Are you using the same team identifier in both tables allowing the data to be linked?

New uses of MHMDS

4. Making published statistics more useful – wider range of analysis in MH Bulletin to include• Diagnosis• Person based cost analysis• More about patients on SCT