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 other 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

on MBU

Rented accommodation (private landlord

or housing association), 60%

Owner Occupier, 30%

Staying with family /friends

Shelteredaccommodation

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

of 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

0

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

ConsultantPsychiatrist

Other Medical

Community Staff Metrics Data

All Participants P044

2015

Community mother and baby teams

Finance

• Unit cost per patient

on 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 overheads) per Contact

30

years old

Known to MH services

New to MH services

39%

61%

Community Typical Profile

White British

Any other White

Background

Other

2015

Community mother and baby team

Accommodation status of

patients on community

caseload

Employment 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

zoe.page@nhs.net

www.nhsbenchmarking.nhs.uk

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@nhsbenchmarking