NHS Benchmarking Network - iimhl

Mental Health Benchmarking

NHS Benchmarking Network Mental Health Benchmarking 2014

Report for Trust: T00 Comparison with all respondents, unweighted population

Mental Health Benchmarking Report 2014 NHS Benchmarking Network

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Mental Health Benchmarking Contents

Index Executive Summary Introduction Bed provision Adult Acute Admissions Length of Stay Emergency readmissions Bed Provision Older Adults Older adult LOS Older Adult Admissions Older adult readmissions Specialist beds Eating Disorders Low Secure Medium Secure High Dependency Rehab Longer Term Complex Care Clustering Use of the Mental Health Act Community Workforce Finance Quality Balance of care Conclusion Index of Charts


2 3 4 8 10 12 14 15 17 19 20 21 24 26 28 30 32 34 38 39 44 47 50 57 60 61

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Executive Summary This year's Mental Health Benchmarking Report analyses data from 1st April 2013 to 31st March 2014 across all Mental Health Trusts in England, all Local Health Boards in Wales, and a number of independent sector providers of inpatient care. Comparisons are available between organisations nationally and within local geographical peer groups using former SHA boundaries. Where relevant, data from 2011/12 and 2012/13 is included in key indicators to show the trends of the past few years. This report confirms the reduction in acute beds between 2011/12 and 2012/13 has continued and this year's figures for adult and older adult acute beds are lower than any previously reported. Length of stay has not changed significantly in adult services, while bed occupancy has continued to rise. This is an expected result of the increased pressure of operating a reduced bed base. A detailed analysis of the mental health workforce is provided and shows wide variation between different specialisms. The specialties with the highest staffing are PICU, secure services and mother and baby units. In the community, the highest staffed teams are Early Intervention and Crisis Resolution and Home Treatment. Cluster data illustrates higher acuity of patients within acute beds compared to previous years. This is consistent with bed closures resulting in higher thresholds for admission and thus the typical patient cohort being more acutely unwell than in previous years. A further impact of this may be an increased pressure on community services. Analysis of this area confirms an increased demand for community teams, shown by higher caseloads. Quality data looks at measures such as serious incidents, patient feedback, violence, use of seclusion and restraint. Rates have generally increased this year, although it is likely that this is, in part, due to more thorough reporting of incidents at the local level. The overall theme of this year's report is increased pressure on both community and bed-based services on a national scale. The Mental Health Toolkit which accompanies this report provides a great number of benchmarking comparisons that look in more detail at some of the points raised here. We would like to thank all of our members for their contributions to the 2014 benchmarking process.


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Introduction This report summarises the main findings from the 2014 benchmarking process that has taken place across NHS mental health services in England and Wales. This year we are delighted to report that participation levels are at record levels with all English NHS Trusts and Foundation Trusts who are providers of secondary mental health services taking part, along with all NHS providers of secondary mental health services within the NHS in Wales. For the first time we also have involvement from independent sector mental health providers. The high levels of involvement, and comprehensive submissions position for England and Wales, make the 2014 findings particularly compelling.

The benchmarking process has been member driven from inception and we would like to acknowledge the contribution made by the mental health reference group who have shaped the content of the project and definitions used to ensure like for like comparisons have been developed. We would also like to acknowledge the significant input of member organisations who took time to collect and validate data. All comparisons within the report use the financial year 2013/14 which creates a highly timely picture of the mental health sector across England and Wales. In addition to the 78 specific comparisons presented in the report, we would also like to reference the supporting mental health benchmarking toolkit which will be made available to all contributors. This is a bespoke software tool that allows around 5,000 individual comparisons to be viewed for each contributor. This guarantees a richness of content and understanding which can be used to fully profile local services and positions against peers. This version of the report looks at metrics benchmarked against a weighted population measure. Respondents also receive a report using a GP registered population. The interactive toolkit allows users to view a still wider range of metrics, with both weighted and registered population views.

Edward Colgan Chief Executive Somerset Partnership NHS Trust & Chair of NHSBN Mental Health Reference Group

Stephen Watkins Director NHS Benchmarking Network


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nowledge

Mental Health Reference Group Members The following people advised on the benchmarking process throughout and also shaped the content of this report.

Edward Colgan Tracy White Jayne Flynn Jennifer Illingworth Catherine Magee Ian Minto Toby Rickard Lee Cornell Chris Lanigan Gordon Folkard Sophie Donnellan Charlotte Hunt Mel Conway Nick Jenvey Sally Wilson Wendy Copeland Blair Jonathon Artingstall Emma Baker Kevin Daley Joanna Wood Lucy Macro Dr Mohit Venkataram Paul Sailes Michael McMillan Keren Corbett Dr Arokia Antonysamy Anne Forbes Rony Arafin Joanne Pinnington Alan Davies Shane Mills Esther Provins Mark Landau Adrian Clarke Neil Griffiths

Somerset Partnership NHS Foundation Trust Central and North West London NHS Foundation Trust Coventry and Warwickshire Partnership NHS Trust Northumberland, Tyne & Wear NHS Foundation Trust Berkshire Healthcare NHS Foundation Trust Manchester Mental Health & Social Care Trust Avon & Wiltshire Mental Health Partnership NHS Trust Somerset Partnership NHS Foundation Trust Tees Esk and Wear Valleys NHS Foundation Trust Avon & Wiltshire Mental Health Partnership NHS Trust Oxleas NHS Foundation Trust Oxford Health NHS Foundation Trust South Essex Partnership NHS Foundation Trust Dorset Healthcare NHS Foundation Trust Hertfordshire Partnership NHS FT Mersey Care NHS Trust Camden and Islington FT Dorset Healthcare NHS FT North Staffordshire Combined Healthcare NHS Trust South Staffordshire & Shropshire Healthcare NHS FT Hertfordshire Partnership NHS Foundation Trust East London NHS Foundation Trust Dorset Healthcare NHS FT Central and North West London NHS Foundation Trust Birmingham Children’s Hospital Lancashire Care NHS Foundation Trust Devon Partnership NHS Trust Devon Partnership NHS Trust 5 Boroughs Partnership NHS Foundation Trust Cardiff and Vale University Health Board Cardiff and Vale University Health Board Dorset Healthcare NHS Foundation Trust Hertforshire Partnership NHS Foundation Trust NHS Wales Cheshire and Wirral Partnership NHS Foundation Trust


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Terms of Reference The terms of reference for the project have been developed by the mental health benchmarking reference group. The terms of reference reflect the project’s overall objectives and are reviewed by the project reference group on an on-going basis.

This year, organisati Boards. In

The terms of reference for the Mental Health benchmarking project are; * To develop a specification for benchmarking mental health services * To support members in collecting consistent data * To process data and produce comparisons for member organisations * To validate data and ensure comparisons are robust * To produce detailed analysis reports for members * To support a desktop benchmarking toolkit and other reporting formats for members * To develop conclusions on the results of mental health benchmarking * To help identify and share good practice amongst member organisations * To support on-going improvements within the mental health sector * To facilitate networking and communications amongst member organisations

Participan

Wider objectives around contributing to continuous service improvement will be taken forward by the NHS Benchmarking Network through the knowledge exchange and networking services provided by the network. Mental health is an important aspect of the NHS Benchmarking Network’s wider work programme and will continue as an on-going area of project work in future years. The commitment to further enhance and develop the network’s mental health workstream in future years provides an excellent platform for future service provision to members and engagement with the wider member community. Members should also note that additional products are available to mental health providers that support additional analysis on other aspects of services offered by many mental health providers. Examples include CAMHS benchmarking which is now in its fifth cycle. New projects for 2014 also include projects on learning disabilities and pharmacy which contains elements of relevance to many Trusts. All of these products can be accessed from the NHS Benchmarking Network's website www.nhsbenchmarking.nhs.uk


2gether N 5 Borough Abertawe Aneurin B Avon and Barnet, En Berkshire Betsi Cadw Birmingha Black Cou Bradford D Cambridg Camden Cardiff & Central an Cheshire & Cornwall P Coventry Cumbria P Cwm Taf L Derbyshir Derbyshir Devon Par Dorset He Dudley & East Lond Greater M Hertfords Humber N Hywel Dd Isle of Wig Kent and M Lancashire Leeds and Leicesters Lincolnshi

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Participants This year, 66 participants have taken part in the benchmarking cycle. This is an increase from 57 organisations last year and 42 in 2012. This includes English Mental Health Trusts and Welsh Local Health Boards. In addition, we have some new private sector members who have taken part for the first time. Participant organisations in the 2014 benchmarking study are as follows: 2gether NHS Foundation Trust 5 Boroughs Partnership NHS Foundation Trust Abertawe Bro Morgannwg UHB Aneurin Bevan UHB Avon and Wiltshire Mental Health Partnership NHS Trust Barnet, Enfield and Haringey Mental Health Trust Berkshire Healthcare NHS Foundation Trust Betsi Cadwaladr UHB Birmingham and Solihull NHS Foundation Trust Black Country Partnership NHS Foundation Trust Bradford District Care Trust Cambridgeshire and Peterborough NHS Foundation Trust Camden and Islington NHS Foundation Trust Cardiff & Vale UHB Central and North West London NHS Foundation Trust Cheshire & Wirral Partnership NHS Foundation Trust Cornwall Partnership NHS Foundation Trust Coventry & Warwickshire Partnership Trust Cumbria Partnership NHS Foundation Trust Cwm Taf LHB Derbyshire Community Health Services NHS Trust Derbyshire Healthcare NHS Foundation Trust Devon Partnership NHS Trust Dorset HealthCare University NHS Foundation Trust Dudley & Walsall Mental Health Partnership NHS Trust East London NHS Foundation Trust Greater Manchester West Mental Health NHS Foundation Trust Hertfordshire Partnership University NHS Foundation Trust Humber NHS Foundation Trust Hywel Dda UHB Isle of Wight NHS Kent and Medway Partnership Trust Lancashire Care NHS Foundation Trust Leeds and York NHS Partnership Trust Leicestershire Partnership NHS Trust Lincolnshire Partnership NHS Foundation Trust


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Manchester Mental Health & Social Care Trust Mersey Care NHS Trust Norfolk and Suffolk NHS Foundation Trust North East London NHS Foundation Trust North Essex Partnership NHS Foundation Trust North Staffordshire Combined Healthcare NHS Trust Northamptonshire Healthcare Foundation Trust Northumberland, Tyne & Wear NHS Foundation Trust Nottinghamshire Healthcare NHS Trust Oxford Health NHS Foundation Trust Oxleas NHS Foundation Trust Pennine Care NHS Foundation Trust Plymouth Community Healthcare (CIC) Priory Group Rotherham Doncaster and South Humber NHS Sheffield Health and Social Care NHS Foundation Trust Solent NHS Trust Somerset Partnership NHS Foundation Trust South Essex Partnership NHS Trust South London and Maudsley NHS Foundation Trust South Staffordshire & Shropshire Healthcare NHS Foundation Trust South West London & St George's Mental Health NHS Trust South West Yorkshire Partnership NHS Foundation Trust Southern Health NHS Foundation Trust St Andrews Healthcare Surrey and Border Partnsership NHS Foundation Trust Sussex Partnership NHS Foundation Trust Tees, Esk and Wear Valleys NHS Foundation Trust West London Mental Health Trust Worcestershire Health and Care NHS Trust

The level of participation in 2014 covers 100% of NHS provider organisations in England and Wales. We are also delighted that the 2014 project includes data contributions from specialist mental health providers in the independent and charitable sectors.


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Analysis overview The analysis in this report provides an overview of the metrics benchmarked this year, and commentary on key indicators common to many providers such as length of stay in both adult acute and specialist beds. The related mental health toolkit provides further, more detailed analysis of the full data set collected. Over comparisons are possible from this toolkit. The project covers all aspects of community mental health services. Where population based demographics are used, these use weighted populations. These weightings have been provided by NHS England and are consistent with the mental health element of CCG allocations.

They key domains covered by this project are activity, finance, workforce and quality and a selection of metrics from each area is included here. The report also contains detail on specialist services such as PICU and Eating Disorders, allowing providers to see at a glance how their services compare. While this report contains a short section on community services, further analysis of the different teams operating in the community is available in the mental health toolkit. Similarly, an overview of staffing positions is included in this report, including benchmarks of consultant psychiatrists and of qualified nurses. A full breakdown of ward and community skill mix can be reviewed in the toolkit. This allows organisations to see not only how they compare in terms of numbers of qualified or unqualified staff, but also their proportion in each level of seniority compared to peers. Mental Health service models are complex and different local solutions have emerged over time, meaning provision can vary on a local and regional level with no two Trusts or Health Boards offering an identical mix of core, specialist and community services. The diagram below shows the overall profile both of your individual organisation and the English and Welsh mental health systems as a whole. On average, organisations find that approximately 45% of their beds are specialist, 21% are for older peoples' services and 34% are general acute inpatient beds for working age adults, though this varies dramatically between organisations, with some providers having very few specialty beds. In Figure 1, the inner ring represents the reported split in your organisation, and the outer ring reflects the English and Welsh average.

Acute Inpatient

Older Adults e.g. aged 65+ or appropriate frailty for organic illness Specialist Beds

Figure 1 Mental Health Benchmarking Report 2014 NHS Benchmarking Network

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Bed provision - Adult Acute beds The number of Adult Acute {BSPK_text_BMChart3} Thisbeds considers per Trust/LHB the impact is shown on demand here for permental 100,000 health registered services population from a variety of working of factors age adults. including Additional age, sex, reports ethnicity are available and mortality. which use A small a weighted numberpopulation of Trusts and measure Healthderived Boards from have the local populations whose Department of Health. mental Thishealth considers needs theare impact higheronthan demand the normal for mental rangehealth of need services in thefrom NHS,aand variety some ofhave local populations factors including age, whose sex,mental ethnicity health andneeds mortality. are lower. A smallThese number Trusts of Trusts and Health and Health BoardsBoards will find have it useful local to consider thewhose populations weighted mental population health needs analysis arealongside higher than the the registered normalpopulation range of need analysis in thetoNHS, gain and a complete some have picture local populations of their position whosewhen mental benchmarked health needsnationally are lower.and These against Trusts their andlocal Health peers. Boards will find it useful to consider the weighted population analysis alongside the registered population analysis to gain a complete Provision picture ofacross their position the NHSwhen ranges benchmarked from {BMChart3-Min} nationally beds and against per 100,000 their local population peers. to {BMChart3-Max} beds per 100,000 population, with a median position of {BMChart3-Median}. This compares to a median position of 22.6 beds Provision across per the 100,000 NHS ranges population fromin112013 bedsand pera100,000 median population of {BSPK_Median_BMChart3} to 39 beds per 100,000 beds population, per 100,000 population with a median in 2012. position of 19. This compares to a median position of 22.6 beds per 100,000 population in 2013 and a median of 23 beds per 100,000 population in 2012.

The char data. The number o

100%

Adult Acute beds per 100,000 population n/a

45

T00:

40

Mean:

21

35

Median:

19

30

Upper Q:

25

25

Lower Q:

17

SHA:

20

Trusts:

15 10 0

T24 T37 T46 T80 T30 T31 T18 T13 T12 T59 T56 T17 T61 T07 T67 T34 T28 T41 T14 T51 T32 T60 T72 T25 T70 T68 T75 T19 T33 T20 T48 T39 T10 T44 T77 T35 T03 T08 T11 T06 T50 T16 T21 T38 T65 T26 T42 T36 T52 T45 T47 T04 T01 T55 T29 T27 T05 T66 T71 T23 T53 T73

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Figure 2 The Royal College of Psychiatrists suggests a bed occupancy rate of 85% is optimal as it enables patients to be admitted in a timely fashion, reducing the risk of deterioration which may occur if a patient has to wait for a bed to become available. Similarly, this level allows flexibility for patients to take leave without the risk of losing a place in the same ward should that be needed. Bed occupancy for Adult Acute beds, shown in Figure 3, is consistently high with a median occupancy this year of 93%. {BMChart4-Median}. This compares toThis a median compares bedtooccupancy a median of bed 89% occupancy in 2013 and of 89% 91%inin2013 2012. and This 91% increase in 2012. in bed This increase in rates occupancy bed occupancy of around rates 4% should of around be seen 4% in should the context be seenofinthe thereduced context number of the reduced of bedsnumber reportedofinbeds reported figure 2. The in figure range2.isThe relatively range is low, relatively with a lower low, with quartile a lower of 88% quartile and an of {BMChart4-LQ} upper quartile of and 97% anindicating upper quartile that of {BMChart4-UQ} while the majority of indicating organisations that while are above the majority the RCPsyc of organisations recommended arethreshold, above the most RCPsyc arerecommended within a few threshold, most percentage points areofwithin their peers a few on percentage this measure. points These of their figures peers relate on this to bed measure. occupancy Theseexcluding figures relate leave,to bed occupancycomparisons although excluding leave, including although leavecomparisons are also reported including and leave are provided are alsoin reported the Mental and Health are provided toolkit.in the Mental Health toolkit.


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The chart shows actual bed occupancy and has not been adjusted for any long or short stay outliers in the data. The Mental Health toolkit can be used to adjust for the impact of long and short stay outliers on a number of metrics in adult acute care.

Adult Acute bed occupancy T00:

n/a

Mean:

92%

Median:

93%

Upper Q:

97%

Lower Q:

88%

SHA: Trusts:

T28 T72 T18 T19 T61 T53 T25 T21 T44 T29 T07 T51 T32 T04 T30 T46 T27 T45 T17 T50 T23 T48 T26 T71 T12 T16 T80 T52 T39 T77 T42 T20 T31 T36 T67 T08 T01 T68 T47 T65 T55 T06 T33 T73 T03 T13 T56 T14 T41 T24 T37 T11 T35 T10 T34 T66 T59 T60 T75 T38

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Figure 3


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Adult Acute Admissions The number of admissions to acute adult beds is shown per {BSPK_Admissionsintro_BMChart5}. 100,000 registered population. This Thisfigure figureshould should be considered be considered along side along factors side factors such assuch totalas number total number of bedsof provided beds provided by eachby Trust/LHB, each Trust/LHB, length of length stay of stay of patients patients and theand needs theof needs the local of the population local population served by served the Trust/LHB. by the Trust/LHB. The median position is 229 {BMChart5-Median} admissions per 100,000 admissions registered {BSPK_Admissionsintro_BMChart5} population of working age adults. of working This can agebe adults. Thistocan compared a median be compared figure of to 236 a median admissions figureper of {BSPK_Admissions_BMChart5} 100,000 population in 2013, and admissions a medianper figure 100,000 of 234 population in admissions per2013, 100,000 and population a median figure in 2012. of {BSPK_2012_admissions_BMChart5} Thus, although the number of beds isadmissions reducing (Figure per 100,000 2), population number of admissions in 2012. Thus, intoalthough those beds thehas number not changed of beds significantly is reducing (Figure over the 2),last number 3 years. of admissions into those beds has not changed significantly over the last 3 years.

14,000 12,000 10,000

Adult Acute admissions per 100,000 population 600 500 400 300

T00:

n/a

Mean:

240

Median:

229

Upper Q:

288

Lower Q:

171

SHA: Trusts:

200

0

T60 T61 T37 T24 T72 T80 T31 T75 T68 T67 T66 T12 T51 T17 T46 T30 T77 T25 T42 T18 T34 T33 T28 T19 T56 T52 T59 T21 T13 T70 T06 T65 T03 T32 T08 T11 T26 T07 T36 T16 T35 T38 T29 T47 T41 T48 T44 T20 T50 T39 T45 T01 T14 T71 T27 T55 T05 T73 T04 T23 T53 T10

100

Figure 4

Data on occupied bed days for adult acute beds is shown in Figure 5. This data excludes patient leave and the range is influenced by both the number of beds available and the average length of stay of patients in those beds. A measure of bed days is used to allow comparisons between organisations with varying sizes of catchment area. In 2013 the mean position reported was 8098 {BSPK_BSPK_mean_BMChart6} occupied bed days per 100,000 occupied registered bed days population. {BSPK_Admissionsintro_BMChart5}. Notable change has been observed this Notable year, change with a 2014 has been meanobserved position this of 7,183 year, bed withdays a 2014 permean 100,000 position of {BMChart6-Mean} population. The median bed position days per has100,000 dropped population. to 6,765 bed The days median in 2014, position from has 7087 dropped in 2013. to This {BMChart6is likely to Median} be due tobed thedays inclusion in 2014, of new fromcontributors {BSPK_median_BMChart6} for the first timeinwhich 2013.has Thisskewed is likelythe to be distribution due to the ofinclusion the data. of new contributors for the first time which has skewed the distribution of the data. The reduction in occupied bed days in the last year is largely consistent with the reduced number of beds The reduction available, despite in occupied the growth bedindays bed in occupancy. the last year is largely consistent with the reduced number of beds available, despite the growth in bed occupancy.


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14,000

Adult Acute occupied bed days (excluding leave) per 100,000 population

T00:

n/a

Mean:

7,183

Median:

6,765

10,000

Upper Q:

8,616

8,000

Lower Q:

5,729

12,000

SHA:

6,000

Trusts:

4,000

0


2,000

Figure 5


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Length of stay and delayed transfers Average length of stay is a key performance measure used by mental health providers. It can be a measure of efficiency but is also used to assess whether appropriate patients are being admitted into beds. A number of factors influence length of stay and explain the variation between providers. These can include the capacity and range of community services available to which patients can be discharged, the acuity of the caseload, the number of patients subjected to delayed transfers of care and the length of these delays, and the number of beds available. In mental health services, Trusts and LHBs with fewer beds will often report longer average lengths of stay due to the acuity of patients who are admitted. Thresholds for admission can be higher when resources are limited.

When th teams. A deteriora

This year, the mean length of stay is 32.4 {BMChart7-Mean} days, compared days, to 30.2 compared days into2013 30.2and days32indays 2013inand 2012. 32 Itdays must in be 2012. Itthat noted must thebedata noted in Figure that the 6, below, data in isFigure the reported 6, below,mean is thelength reported of stay mean excluding length of leave stayand excluding has notleave be and has not adjusted for be outliers adjusted (long-stay for outliers and short-stay (long-stay patients). and short-stay The mental patients). health Thebenchmarking mental healthtoolkit benchmarking includes toolkit includes alternative comparisons alternative in these comparisons areas. in these areas.

Delayed occupied many pat

It should also be noted that the participants in 2014 are slightly different to 2013 and include 9 organisations who are providing data for the first time this year. The fact that 2014 data includes all NHS statutory providers in England and Wales will provide an excellent and stable platform for measuring future changes in average length of stay. This will provide the ability to actively monitor the impact of new initiatives such as the introduction of admission avoidance schemes and short stay assessment facilities.

Delays ca or for an shown be organisat

In 2013 t figure ap below. has alsoTh i and {BM acute be last year.

12%

Mean length of stay (excluding leave and unadjusted for outliers)- Adult Acute

80 70 60 50 40

T00:

n/a 10%

Mean:

32.4

Median:

31.0

Upper Q:

38.2

Lower Q:

27.0

SHA:

30

Trusts:

20

0

T06 T68 T31 T04 T10 T14 T01 T41 T27 T39 T20 T13 T32 T50 T48 T30 T36 T46 T45 T42 T56 T18 T55 T35 T80 T44 T17 T08 T16 T12 T11 T28 T47 T51 T29 T21 T52 T03 T23 T19 T59 T53 T71 T65 T26 T37 T24 T61 T33 T67 T38 T72 T77 T60 T75 T66

10

Figure 6


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When there is pressure on beds and demand surpasses supply, delayed discharges can be frustrating for ward teams. Additionally patients and carers may express dissatisfaction and, in a worst case scenario, patients can deteriorate during this time. Delays can be caused by patients who are fit for discharge being forced to wait for a bed or place elsewhere or for an alternative package of care to be agreed and put in place to facilitate discharge. The data for 2014 is shown below. In a number of cases there has been little change compared to previous years, with some organisations consistently reporting either above average or below average delays.

Delayed transfers of care are calculated as the number of bed days lost due to delays as a percentage of all occupied bed days. This takes into account both a few patients with long delays and also a situation where many patients, perhaps the majority, have a short to medium delay at the end of their stay. In 2013 the median position for delayed transfers of care was 3.8%, a slight increase from 3.5% in 2012. This figure appears to have increased again this year, with a median of 3.9% {BMChart8-Median} shown in Figureshown 7 below. in Figure The range 7 below. has alsoThe increased range has slightly also this increased year with slightly organisations this year with reporting organisations betweenreporting 0.3% and between 10.8% of{BMChart8-Min} their adult and {BMChart8-Max} acute bed days lost to of delays. their This adultcompares acute bedtodays a range lost of to 0.7% delays. to This 10.8% compares last year. to a range of 0.7% to 10.8% last year.

Delayed transfers of care - Adult Acute T00:

12% 10% 8% 6%

n/a

Mean:

4.0%

Median:

3.9%

Upper Q:

5.7%

Lower Q:

2.0%

SHA: Trusts:

4%

0%

T28 T10 T68 T20 T17 T18 T32 T13 T67 T77 T30 T71 T16 T31 T25 T60 T80 T65 T34 T73 T07 T19 T21 T61 T72 T42 T44 T37 T75 T56 T08 T06 T41 T27 T66 T33 T26 T48 T23 T45 T38 T12 T50 T11 T24 T53 T59 T29 T14 T35 T03 T36 T46 T51 T52 T55 T04 T39

2%

Figure 7


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Adult Acute emergency readmissions within 30 days of discharge The number of patients who have an unplanned readmission within 30 days of discharge from inpatient care is a key performance measure across health care organisations for all types of hospital services. Readmissions can occur when a patient is discharged without an adequate care package or with an insufficient level of community support, or when discharge occurs too early. It is important to consider readmission rates along side length of stay to ensure that organisations who have successfully reduced length of stay have not seen a related rise in their readmission rates.

There is significant range in the readmission rates from contributors, as Figure 8 shows, with figures from {BMChart9-Min} 0.6% to 15.9% being to {BMChart9-Max} reported. The median being reported. position isThe 8.8%, median whichposition is a marginal is {BMChart9-Median}, reduction on datawhich from is a marginal years previous reduction (a median on data offrom 9% inprevious 2013, and years 10%(ainmedian 2012). of This 9%isin a positive 2013, and finding 10% in for2012). TrustsThis andisHealth a positive finding for Boards withTrusts readmissions and Health reducing Boardsyear withon readmissions year. reducing year on year.

Readmission rate - Adult Acute T00:

16% 14% 12% 10%

n/a

Mean:

8.7%

Median:

8.8%

Upper Q:

11.0%

Lower Q:

6.4%

8%

SHA:

6%

Trusts:

4%

0%


2%

Figure 8


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Bed Provision - Older Adult beds The provision of Older Adult beds is a significant part of the business of specialist mental health providers and the second largest category of bed provision after Adult Acute services. Older Adult services treat patients aged 65 years or older. Some Trusts and Health Boards operate an "ageless service" where patients are allocated to beds based on a functional / organic split rather than by age. Where an age profile was unavailable, these organisations are excluded from the data below.

100%

In 2014, members reported a median position of 47 {BMChart10-Median} beds per 100,000 registered beds population aged 65+. This {BSPK_Admissionsintro_BMChart5} compares to a median of 60 beds in aged 201365+. and 62 Thisbeds compares in 2012toand a median confirms of the {BSPK_2013mean_BMChart10} on-going shift of care into beds in 2013based community and {BSPK_BSPK_2012_BMChart10} provision and the subsequent reduction beds in 2012 in number and confirms of inpatient the on-going beds. The shift reduction of care into of bed community numbers of based aroundprovision 20% in the andlast theyear subsequent also suggests reduction fundamental in number service of inpatient redesignbeds. has taken The reduction place in some of bed numbers health systems. of around 20% in the last year also suggests fundamental service redesign has taken place in some health systems.

Older Adult beds per 100,000 population T00:

140 120

n/a

Mean:

50

Median:

47

100

Upper Q:

65

80

Lower Q:

34

SHA:

60

Trusts:

40

0

T66 T05 T37 T75 T56 T20 T59 T39 T33 T67 T31 T32 T19 T10 T34 T06 T48 T61 T41 T12 T18 T03 T53 T42 T07 T80 T77 T21 T50 T16 T27 T52 T24 T11 T01 T36 T23 T17 T73 T04 T13 T25 T08 T29 T51 T26 T14 T44 T38 T65 T60 T45 T35

20

Figure 9

Once again, bed occupancy figures appear to have been influenced by the reduction in number of available beds. Figure 10 shows a median occupancy rate of 85.3% {BMChart11-Median} for older adult beds, for older an increase adult beds, from an83% increase in 2013 from82% and 83%inin2012. 2013As and the 82% number in 2012. of beds As thedecreases number of and beds beddecreases occupancyand rises, bedorganisations occupancy rises, move organisations towards the move towards optimal number the ofoptimal beds fornumber their local of beds population, for theirallowing local population, good access allowing to beds good when access needed to beds but without when neededprovision excess but without in this excess area.provision Organisations in thiswill area. beOrganisations able to interpret will what be able thistorepresents interpret what for them this represents individually for them and use this individually information andin use future this information service planning. in future service planning.


17

Older Adult bed occupancy T00:

n/a

Mean:

83.5%

Median:

85.3%

Upper Q:

90.4%

Lower Q:

77.9%

SHA: Trusts:

T13 T46 T19 T77 T36 T29 T28 T44 T71 T27 T80 T04 T51 T50 T26 T08 T21 T23 T05 T42 T16 T56 T53 T48 T20 T65 T39 T76 T14 T17 T68 T03 T35 T12 T31 T18 T61 T73 T30 T25 T75 T32 T60 T52 T11 T10 T66 T72 T06 T34 T41 T37 T24 T47 T07 T45 T38 T55 T67 T59 T33

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Figure 10


18

Older Adult - Length of stay and delayed transfers Figure 11 shows the mean length of stay for older adult beds, excluding leave. This figure has not been adjusted for outliers (long and short stay patients) but an analysis which excludes these patients is available in the Mental Health toolkit.

25% 20%

This year, the mean length of stay in older adult beds is 72 {BMChart14-Mean} days. In 2013 it was days. 67 In days 2013 and it in was 2012 67 days a 70 and day in 2012ofa stay length 70 day waslength reported. of stay was reported.

15%

There is still significant variation in ALOS amongst participants which should provide opportunities for discussion and sharing of good practice in this area.

Mean length of stay (excluding leave and unadjusted for outliers) - Older Adults

180

T00:

10%

n/a

160

Mean:

72

140

Median:

66

120

Upper Q:

82

100

Lower Q:

58

SHA:

80

Trusts:

60 40 0

T48 T56 T71 T46 T41 T55 T14 T52 T10 T50 T30 T32 T36 T04 T39 T20 T03 T18 T80 T27 T01 T12 T11 T13 T47 T08 T29 T19 T76 T61 T42 T16 T35 T24 T68 T75 T37 T44 T21 T53 T31 T65 T51 T26 T06 T66 T17 T77 T33 T59 T60 T28 T38 T72 T67

20

Figure 11

Delayed transfers of care are particularly prevalent on older people's wards. This year a mean position of {BMChart15-Mean} 6.8% was reported. This was is reported. the percentage This is the of all percentage days spent ofon all adays ward spent which onwere a ward thewhich resultwere of a delayed the result of a delayedoftransfer transfer care andofcan care beand compared can be compared to a meanto position a meanofposition 7% last of year. 7%Delays last year. often Delays occur often when occur olderwhen older people people are discharged are discharged homehome and require and require a package a package of careoftocare be arranged, to be arranged, or when or when patients patients are transferred are transferred directly fromdirectly an inpatient from an bed inpatient to a nursing bed to oraresidential nursing orhome residential placement homeand placement a periodand of waiting a periodoccurs of waiting until occurs an appropriate until an appropriate bed is available. bed is available. The mental health toolkit allows additional analysis of the reasons for delays, whether due to internal or external factors.


19

Delayed transfers of care - Older Adult T00:

25% 20% 15%

n/a

Mean:

6.8%

Median:

5.9%

Upper Q:

10.0%

Lower Q:

2.8%

SHA:

10%

Trusts:

0%

T41 T03 T28 T68 T45 T72 T27 T25 T16 T10 T13 T31 T75 T38 T08 T71 T06 T18 T52 T65 T35 T76 T04 T21 T48 T73 T59 T23 T44 T50 T32 T46 T17 T05 T11 T77 T67 T42 T34 T61 T60 T36 T53 T47 T14 T37 T33 T24 T19 T51 T39 T55 T12 T80 T30 T20 T26 T56 T29

5%

Figure 12


20

Older Adult Admissions The rate of older adult admissions per {BSPK_Admissionsintro_BMChart5} 100,000 registered population isisshown shownininfigure figure12. 12.This Thisyear, year,the the median reported figure is 227 {BMChart12-Median} admissions per 100,000 admissions population, per 100,000 compared population, to 243 compared in 2013 andto258 the {BSPK_admissions2013a_BMChart12} previous year. This is linked to the sizeable in 2013 reduction and {BSPK_admissions2012a_BMChart12} in available older adult beds demonstrated the previous earlier, year. and Thisincreased the is linked to system the sizeable pressures reduction suggested in available by the average older adult lengths bedsofdemonstrated stay reported earlier, in 2014.and the increased system pressures suggested by the average lengths of stay reported in 2014.

Older Adult admissions per 100,000 population 600 500 400 300

T00:

n/a

Mean:

236

Median:

227

Upper Q:

285

Lower Q:

165

SHA: Trusts:

200

0

T68 T66 T67 T37 T46 T75 T30 T70 T60 T72 T31 T20 T32 T71 T12 T06 T59 T34 T39 T33 T27 T42 T21 T19 T61 T56 T36 T16 T11 T10 T13 T17 T07 T80 T77 T35 T03 T51 T53 T18 T14 T01 T50 T76 T44 T04 T24 T73 T65 T25 T48 T23 T08 T55 T29 T52 T41 T26 T47 T05 T28 T38 T45

100

Figure 13 Older adult bed days have a median position of 15,398 {BMChart13-Median} per 100,000 registered {BSPK_Admissionsintro_BMChart5} population for ages 65 and for ages this over 65 and year, over compared this year,tocompared 18,141 in to 2013. {BSPK_bedday_BMChart13} This figure can be considered in 2013. along This with figure the can number be considered of older along admissions adult with the number in figure of older 13 andadult length admissions of stay shown in figure in figure 13 and11length . This of data stay confirms shown in reduced figure 11 levels . This of data confirms reduced provision of inpatient levels care of for provision older people of inpatient in 2014 care although for older admitted people in patients 2014 although are staying admitted longer.patients This are staying longer. position can beThis compared position with canthe be level compared of community with the based level ofcare community for olderbased people care in the for Mental older people Healthin the Mental Health toolkit. toolkit.

Older Adult occupied bed days (excluding leave) per 100,000 population

40,000 35,000 30,000 25,000

T00:

n/a

Mean:

16,640

Median:

15,398

Upper Q:

18,542

Lower Q:

12,080

20,000

SHA:

15,000

Trusts:

10,000 0

T46 T05 T71 T68 T66 T30 T56 T75 T37 T20 T19 T39 T31 T32 T48 T10 T61 T12 T34 T06 T77 T18 T72 T03 T53 T67 T59 T80 T60 T27 T13 T50 T41 T14 T21 T16 T33 T52 T11 T36 T42 T04 T07 T23 T51 T55 T17 T24 T76 T73 T25 T08 T47 T29 T26 T44 T65 T28 T35 T38 T45

5,000

Figure 14


21

Older Adult - emergency readmissions within 30 days of discharge This indicator focuses on unplanned emergency readmissions and excludes readmissions associated with planned discharges to receive physical healthcare from other NHS providers. Readmissions remain an important indicator of service performance, and organisations whose rate of emergency readmission within 30 days is high may wish to examine local systems or processes which contribute to this figure.

There has been a slight decrease in emergency readmissions to older adult beds, from 4% in 2013 to 3.6% {BMChart16-Mean} this year. The rate ofthis older year. adult Thereadmissions rate of olderisadult also readmissions lower than that is also for acute loweradult than beds, that for shown acuteinadult figure 8 beds, (a mean shown figure in of figure 8.7%). 8 (aThis mean mayfigure be due of to {BMChart9-Mean}). the longer lengthsThis of stay mayfor beolder due to adult the beds, longerand lengths the relatively of stay for older lower bedadult occupancy beds, and for older the relatively adults suggesting lower beddemand occupancy for for beds, older andadults therefore suggesting to discharge demand patients for beds, and therefore sooner, is less of to adischarge pressurepatients in older sooner, adult wards is less than of aon pressure adult acute in older wards. adult wards than on adult acute wards.

Readmission rate - Older Adults T00:

16% 14% 12% 10%

n/a

Mean:

3.6%

Median:

3.0%

Upper Q:

4.5%

Lower Q:

2.1%

8%

SHA:

6%

Trusts:

4%

0%


2%

Figure 15


22

Specialist beds This section has been expanded this year at the request of members, to reflect the importance of specialist beds and the significant proportion of resources (budget and workforce) that are invested in these areas. Specialist beds can be delivered for both core district populations and also for external populations. Beds can be commissioned locally or through specialist commissioning routes, and these beds are sometimes also traded commercially. Due to the varied range and coverage of specialist bed portfolios it is not possible to robustly benchmark them on a per capita population basis. However, it is possible to draw comparisons of bed provision, utilisation, and length of stay which will add value to the knowledge base of Trusts and Health Boards. The benchmarking toolkit explores many of these areas in great detail.

The following chart shows Trust and Health Board positions for specialist beds against average provision rates for peers. Although there may be a level of ambiguity for individual Trusts / LHBs regarding the definition of specialist beds in local circumstances, the standard definition used for benchmarking purposes is that specialist beds are “all beds except Adult Acute and Older Adult beds”, and complies with the Mental Health Network’s guidance on bed definitions. The figure below shows your organisation's proportion of beds in each category as a percentage of all your specialist beds (inner ring) compared to the national average of beds in each category (outer ring). Typically, many specialist beds are in low and medium secure services which together account for over 40% of specialist bed provision. This report, and related mental health toolkit, will allow participants to test their provision and service models against both peers and wider market averages.

120 100

PICU Eating Disorders Mother and Baby

Low Secure Medium Secure High Secure High Dependency Rehabilitation Longer Term Complex / Continuing Care Other Mental Health Beds (excludes CAMHS, Substance Misuse, and MoD)

100%

Figure 16 The following pages analyse specialist bed provision by mean length of stay and bed occupancy and consultant psychiatrists and qualified nurses per 10 beds. Where an organisation is missing from the data, they have either not reported figures in this area or do not provide these specialist services.


23

PICU Around 80% of contributors provider Psychiatric Intensive Care Units. The length of stay in PICU beds is shown in the chart below. This relates solely to the period of time spent in PICU beds, which may be part of a longer admission. The mean length of stay across all member organisations with these beds is 42.6 days. {BMChart17-Mean} This compares to a mean days. of This 48compares days last year. to a mean of 48 days last year. This year's data shows a quartile range of 28.6 {BMChart17-LQ} to 48.0 daysto which {BMChart17-UQ} is also a reduction days which compared is also toalast year reduction (31 to 52 days). compared The full to last data year range, (31 however, to 52 days). runs The from full data 15.0 range, to 119.0 however, days which runsillustrates from {BMChart17-Min} differing to {BMChart17-Max} approaches to the usedays of these which beds illustrates between differing organisations. approaches Longtostays the use demonstrate of these beds opportunities between for organisations. Trusts and LHBs Long in stepping stays demonstrate down patients opportunities more rapidly. for Trusts and LHBs in stepping down patients more

PICU - Mean length of stay (excluding leave and unadjusted for outliers)

120 100 80 60

2.5 T00:

n/a

Mean:

42.6 2.0

Median:

40.4

Upper Q:

48.0 1.5

Lower Q:

28.6

1.0

SHA: Trusts:

40

0.5

20 T30 T68 T56 T55 T48 T10 T16 T13 T27 T79 T38 T42 T47 T29 T01 T17 T28 T46 T65 T61 T33 T80 T34 T32 T37 T50 T31 T19 T51 T36 T18 T44 T23 T53 T03 T35 T41 T12 T21 T39 T70 T20 T24 T45 T11 T52 T60 T66 T04 T72 T77 T08

0

0.0

Figure 17 PICU bed occupancy is, on average, lower than bed occupancy of adult acute beds (the PICU median is 85.5% {BMChart18-Median} compared to the adultcompared acute median to the ofadult 93%).acute Providers median andofcommissioners {BMChart4-Median}). must tryProviders to strike the andright commissioners balance between must availability try to strike of beds the for right new balance admissions between andavailability good levelsofofbeds occupancy. for new PICU admissions bed occupancy and good levels has however of occupancy. still increased PICU bed from occupancy 82.3% inhas 2013. however still increased from 82.3% in 2013.

35.0

PICU bed occupancy T00:

n/a

30.0

Mean:

82.9%

Median:

85.5% 25.0

Upper Q:

93.1% 20.0

Lower Q:

74.9%

15.0

SHA: Trusts:

10.0

T53 T29 T68 T28 T10 T50 T21 T46 T30 T33 T13 T25 T20 T03 T44 T18 T04 T07 T48 T51 T31 T70 T27 T52 T55 T65 T77 T12 T66 T37 T80 T42 T36 T41 T35 T75 T16 T60 T17 T08 T32 T56 T19 T24 T34 T11 T01 T39 T23 T45 T38 T47 T79 T72

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

The numb shows a W the mean


24

The following graphs show the number of whole time equivalent (WTE) consultant psychiatrists and nurses per 10 PICU beds. These denominators are used to allow for accurate comparisons between organisations of different sizes who provide PICU beds. For PICU the mean number of consultant psychiatrists per 10 beds is 0.7 {BMChart67-Mean} but the range is from but the 0.1range to 2.0is from {BMChart67-Min} consultants per 10 bedsto showing {BMChart67-Max} that in someconsultants organisations, perpatients 10 beds in showing PICU beds thatmay in some receive organisations, significantly patients more senior in PICU medical bedsinput. may receive There may significantly also be some morevariation senior medical between input. howThere medical maystaff alsoare be some allocated variation in between organisations, different how medical staff withare some allocated specialties in different having organisations, dedicated consultant with some input specialties and others having having dedicated consultant input consultants who and workothers acrosshaving severalconsultants specialties.who work across several specialties.

PICU - WTE Consultant Psychiatrists per 10 beds 2.5 2.0 1.5

T00:

n/a

Mean:

0.7

Median:

0.6

Upper Q:

0.8

Lower Q:

0.5

SHA:

1.0

Trusts:

T36

T75

T24

T50

T79

T45

T48

T38

T34

T47

T44

T27

T56

T01

T13

T21

T42

T65

T28

T55

T35

T23

T08

T33

T18

T39

T29

T46

T66

T68

T11

T53

T41

T31

T72

T04

0.0

T52

0.5

Figure 19 The number of qualified nurses per 10 beds is also a useful benchmark for comparison. Figure 20, below, shows a WTE total for qualified nurses (incorporating Agenda for Change Band 5 and above). For PICU beds, the mean is 14.4 {BMChart68-Mean} qualified nursesqualified per 10 beds. nurses per 10 beds.

PICU - WTE Qualified nurses per 10 beds T00:

35.0 30.0

n/a

Mean:

14.4

Median:

14.0

25.0

Upper Q:

17.2

20.0

Lower Q:

10.4

15.0

SHA: Trusts:

10.0

0.0

T52 T70 T50 T33 T29 T80 T75 T08 T41 T17 T04 T60 T77 T30 T72 T68 T01 T36 T12 T35 T13 T34 T31 T42 T66 T21 T45 T19 T39 T48 T46 T03 T53 T27 T24 T56 T18 T44 T05 T11 T47 T20 T38 T28 T55 T65 T23 T79 T32

5.0

Figure 20


25

Eating Disorders Eating Disorders beds are identified in this adult focused report although it is acknowledged that some may be occupied by patients from a slightly younger age group where CAMHS provision in this specialty is not available. The mean length of stay in an Eating Disorders bed is 91 {BMChart72-Mean} days although thedays Trust although with thethe shortest Trust with the stays report shortest a LOSstays of just report 42 days, a LOSless of just than{BMChart72-Min} half the national mean. days, less Fewer than than halfone thethird national of participants mean. Fewer than one report provision third ofof participants specialist beds report forprovision eating disorders of specialist (17 of beds thefor 66 eating contributors). disorders (17 of the 66 contributors).

Eating disorders - Mean length of stay (excluding leave and unadjusted for outliers)

180

below. Th with senii medical

1.4 n/a

T00:

1.2

160

Mean:

91

140

Median:

85 1.0

120

Upper Q:

100

Lower Q:

101 0.8 74

0.6

SHA:

80

0.4

Trusts:

60

T52

T29

T47

T28

T27

T26

T44

T39

T48

T04

T18

T50

T80

T35

0

T20

0.0 T56

20 T11

0.2

T08

40

Figure 21 Bed Occupancy for Eating Disorders beds is shown below. On average, median bed occupancy sits at 80.5% {BMChart90-Median} which is lower than some which other is lower specialist than services. some other Thisspecialist would suggest services. that This access would tosuggest beds should that access be good, to bedsspaces and shouldshould be good, typically and spaces be available shouldwhen typically admission be available is required. when admission However itisisrequired. noted that However the relatively it is notednumber small that theof relatively providers small offering number inpatient of providers facilities offering for Eating inpatient Disorders facilities patients for Eating meansDisorders that equitable patients means to access that local equitable care cannot accessbetocertain local care across cannot all areas be certain of England across and all Wales. areas ofThe England MH toolkit and Wales. can also The beMH used toolkit to explore can the alsoextent be used to to which explore community the extent based to which Eatingcommunity Disorders services based Eating are provided Disorders byservices participants. are provided by participants.

3.5

Eating disorders - Bed Occupancy

n/a

3.0

Mean:

79.1%

Median:

80.5% 2.5

Upper Q: Lower Q:

84.1% 2.0 76.9%

1.5

SHA: Trusts:

1.0 0.5

T56

T39

T28

T80

T48

T35

T47

T08

T11

T52

T29

T20

T04

T27

T26

T44

T50

0.0 T18

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

T00:


26

Medical input for patients in Eating Disorders beds is an important measure, and can be seen in the chart below. The mean figure reported is 0.6 {BMChart73-Mean} WTE consultantsWTE per 10 consultants beds which peris10 comparable beds which with is comparable senior with senior medical input medical to PICU input andto low PICU secure and beds. low secure beds.

Eating disorders - WTE Consultant Psychiatrists per 10 beds T00:

n/a

Mean:

0.6

Median:

0.6

1.0

Upper Q:

0.8

0.8

Lower Q:

0.4

1.4 1.2

SHA:

0.6

Trusts:

0.4

T27

T04

T80

T35

T44

T26

T18

T08

T39

T29

T52

T56

T48

0.0

T50

0.2

Figure 23

The skill mix in Eating Disorder services is frequently different from other inpatient units. This graph shows the combined number of WTE clinical psychologists and OTs, which has a mean value of 1.8 {BMChart74WTE per 10 Mean}ItWTE beds. is useful per 10 to beds. see the It is impact usefulaccess to seetothe psychology impact access and occupational to psychologytherapy and occupational may have on therapy lengthmay of haveinonthese stay length beds. of stay Specialist in these therapists beds. Specialist are therefore therapists three are times therefore more prevalent three times onmore Eating prevalent Disorders onbeds Eatingconsultant than Disordersmedical beds than staff. consultant medical staff.

Eating disorders - WTE Therapists per 10 beds 3.5 3.0

T00:

n/a

Mean:

1.8

Median:

1.6

2.5

Upper Q:

2.1

2.0

Lower Q:

1.3

SHA:

1.5

Trusts:

1.0

T18

T29

T11

T44

T04

T52

T35

T39

T48

T20

T56

T08

T50

T28

T26

0.0

T80

0.5

Figure 24


27

Low Secure Low secure services treat patients who have been identified as requiring secure hospital admission for assessment or treatment but do not require intensive care. Low secure services can also be used as a step down from medium secure services. The length of stay measure relates to the time spent in a low secure bed which may be shorter than the patient's whole admission. Around two thirds of participants have provided data on low secure provision. The mean length of stay across all organisations is 487.5 {BMChart19-Mean} days, compared days, to 471 compared days into 2013. 471 The daysupper in 2013. and The upper lower quartiles and lower of 696.5 quartiles and 269.0 of {BMChart19-UQ} days respectively and indicate {BMChart19-LQ} significant variation days respectively of more than indicate onesignificant year variation across organisations. of more than one year across organisations.

The num {BMChar 0.7 consu consultan mean ave typicallyt shorter on an illn

1.6 1.4 1.2

Low Secure - Mean length of stay (excluding leave and unadjusted for outliers)

T00:

n/a

1.0

Mean:

487.5 0.8

Median:

464.0 0.6

Upper Q:

696.5 0.4

Lower Q:

269.0 0.2

SHA:

0.0

Trusts:

T11 T65 T55 T79 T68 T16 T10 T04 T17 T27 T80 T42 T61 T36 T39 T56 T33 T08 T13 T26 T35 T32 T31 T29 T20 T41 T03 T14 T21 T77 T70 T45 T71 T44 T37 T28 T24 T19 T18 T73 T67 T53 T52

1,000 900 800 700 600 500 400 300 200 100 0

10 low se beds), ind medical i are lower beds who

Figure 25 The median bed occupancy figure reported for low secure beds is 90.0% {BMChart69-Median} . This is less than . This the is adult lessacute than the adultoccupancy bed acute bedrate occupancy of 93%rate andof the{BMChart4-Median} medium secure bedand occupancy the medium rate of secure 91.5% bed occupancy rate of {BMChart75-Median}

Low secure - Bed Occupancy

Mean: Median:

90.0%

Upper Q:

94.4%

Lower Q:

86.0%

T00:

SHA: Trusts:

T70 T55 T20 T08 T56 T39 T04 T28 T13 T26 T24 T38 T53 T52 T35 T31 T19 T61 T21 T65 T11 T45 T41 T36 T48 T29 T80 T44 T14 T71 T33 T03 T16 T37 T18 T77 T79 T42 T27 T32 T68 T67 T73 T17 T10

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

18 16 14 n/a 12 89.1% 10


28

The number of Consultant Psychiatrists per 10 beds is shown in Figure 27 below and demonstrates a mean of {BMChart70-Mean} 0.7 consultants per 10 consultants beds but with per 10 a range beds but from with 0.1ato range 1.5 from consultants {BMChart70-Min} per 10 beds.toThe {BMChart70-Max} organisational consultants mean average peris10 virtually beds. identical The organisational to PICU beds mean where average patients is virtually typically identical have a to length PICUofbeds staywhere ten times patients typicallythan shorter havelow a length secureofbeds stay as tenPICU times targets shorter thethan mostlow acute secure phase beds onas anPICU illness. targets the most acute phase on an illness.

Low secure - WTE Consultant Psychiatrists per 10 beds 1.6 1.4 1.2 1.0

T00:

n/a

Mean:

0.7

Median:

0.6

Upper Q:

0.7

Lower Q:

0.5

0.8

SHA:

0.6

Trusts:

0.4

T14

T27

T33

T28

T17

T24

T18

T31

T53

T21

T79

T65

T42

T68

T04

T13

T08

T03

T52

T71

T80

T55

T35

T26

T56

T48

T44

T39

T61

T36

T41

T67

T45

T70

T11

0.0

T29

0.2

Figure 27 The number of qualified nurses per 10 low secure beds is illustrated below. The mean number of nurses per 10 low secure beds is 9.1 {BMChart71-Mean} WTE which is lessWTE thanwhich on PICU is less (14.4 than WTE on per PICU10({BMChart68-Mean} beds), indicating that WTE while persenior 10 beds), indicating medical input between that while the two senior specialties medical input is comparable, between the nursing two ratios specialties are lower is comparable, for patients nursing in lowratios secure are lower beds who,for as patients a cohort,inare low likely secure to be beds lesswho, acutely as aunwell. cohort, are likely to be less acutely unwell.

Low secure - WTE Qualified nurses per 10 beds T00:

n/a

Mean:

9.1

Median:

8.4

Upper Q:

10.0

Lower Q:

7.9

SHA: Trusts:


18 16 14 12 10 8 6 4 2 0

Figure 28


29

Medium Secure Medium secure services data has been provided by 24 of the project's 66 participant organisations confirming this as a specialist service provided by around one third of NHS mental health providers with additional input from independent sector providers. Medium secure services generally have a longer length of stay than less secure services. Member organisations reported a median position of 543 {BMChart91-Median} days for length of days stay this for length year. This of stay compares this year. to This 464.0 compares days for low to secure {BMChart19-Median} services, although days theforrange low secure for medium services, secure although bed LOS theisrange significant, for medium from 158 secure to bed 958 LOS isacross days significant, all organisations. from {BMChart91-Min} The mean LOS to in{BMChart91-Max} medium secure beds dayshas across decreased all organisations. this year, from The mean an average LOS in medium 574 days insecure 2013 beds has decreased this year, from an average 574 days in 2013

Consulta PICU, wit

1.6 1.4 1.2 1.0

T00:

n/a 0.8

Mean:

531 0.6

Median:

543 0.4

Upper Q:

707 0.2 266

Lower Q:

0.0

SHA:

T24

T53

T44

T04

T28

T26

T31

T21

T48

T08

T65

T80

T56

T37

T61

T68

T27

T32

T79

T38

T11

T16

T13

T10

Trusts:

T29

1,000 900 800 700 600 500 400 300 200 100 0

Medium Secure - Mean length of stay (excluding leave and unadjusted for outliers)

Figure 29 Bed occupancy for medium secure beds is one of the highest reported this year, with a median figure of {BMChart75-Median} 91.5% across participants, across similar participants, to the rate similar for adult to theacute rate for beds. adult There acute is minimal beds. There variation is minimal here, with variation here, with approximately approximately two thirds two of participants thirds of participants reporting bed reporting occupancy bed occupancy rates of 90% rates or above, of 90%and or above, the median and the medianhas figure figure not changed has not changed since 2013. since 2013.

14 12

Medium Secure - Bed Occupancy

T00:

n/a

Mean:

91.7%

Median:

91.5%

Upper Q:

97.1%

Lower Q:

88.5%

10

SHA:

T80

T65

T26

T38

T29

T44

T21

T56

T16

T08

T27

T68

T79

T48

T37

T31

T53

T28

T24

T13

T61

T04

T11

T32

Trusts:

T10

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%


30

Consultant medical input to medium secure beds is virtually identical to such input in low secure services and PICU, with all reporting a mean figure of 0.6 to 0.7 {BMChart76-Mean} WTE consultant psychiatrists WTE consultant perpsychiatrists 10 beds. per 10 beds.

Medium secure - WTE Consultant Psychiatrists per 10 beds 1.6 1.4 1.2 1.0

T00:

n/a

Mean:

0.7

Median:

0.7

Upper Q:

0.8

Lower Q:

0.6

0.8

SHA:

0.6

Trusts:

0.4

T80

T53

T79

T68

T28

T04

T13

T27

T61

T21

T26

T38

T24

T44

T31

T08

T48

T11

T29

0.0

T56

0.2

Figure 31

Qualified nurses per 10 medium secure beds is shown below. With a mean figure of 9.4 {BMChart77-Mean} this is only this is only marginally marginally higher higher than the than nursing the nursing ratio ofratio 9.1 WTE of {BMChart71-Mean} nurses per 10 low WTE secure nurses beds.per There 10 low is some secure variation beds. There on an organisational is some variation level, on with an organisational some respondents level, with reporting somefewer respondents qualifiedreporting nurses on fewer theirqualified mediumnurses secure on their wards than medium on their secure low secure wards than equivalents. on their low secure equivalents.

Medium secure - WTE Qualified nurses per 10 beds 14 12

T00:

n/a

Mean:

9.4

Median:

10

9.6

Upper Q:

10.3

8

Lower Q:

8.1

6

SHA: Trusts:

4

T61

T79

T28

T24

T11

T26

T32

T29

T31

T56

T53

T80

T08

T38

T21

T65

T27

T04

T13

T44

T48

0

T68

2

Figure 32


31

High Dependency Rehabilitation High Dependency Rehabilitation services provide rehabilitation to clients with active symptoms, more complex needs and challenging behaviours. The usual aim of treatment is to prepare patients to step down to other rehabilitation services prior to independent or supported living. The mean length of stay for patients in these beds is shown here. With a mean position across all providers of {BMChart92-Mean} 477 days it is clear that dayspatients it is clear in that thesepatients beds typically in thesehave bedscomplex typicallyrehabilitation have complexneeds rehabilitation requiring needs long requiring lengths oflong stay.lengths There isofsignificant stay. Therevariation is significant between variation members, between however, members, with however, stays ranging withfrom stays49 ranging days to from {BMChart92-Min} 1,784 days for the lowestdays andto highest {BMChart92-Max} providers. Patients days for canthe belowest admitted andinto highest these providers. beds from Patients a variety canofbe admittedincluding sources, into these secure beds services, from a variety PICUsof and sources, directlyincluding from thesecure community. services, Average PICUs and length directly of stay from positions the community. may be influenced Average bylength small numbers of stay positions of extremely may be long influenced stay patients. by small numbers of extremely long stay

The num lowest w 10 beds. indicates services.

1.2 1.0 0.8

High dependency rehabilitation - Mean length of stay (excluding leave and unadjusted for outliers)

0.6 T00:

n/a

1,600

Mean:

477

1,400

Median:

391 0.2

1,200

Upper Q:

610

1,000

Lower Q:

221

1,800

0.0

SHA:

800

Trusts:

600

The num Figure 33 represen the lowe

400

T04

T60

T19

T72

T53

T67

T66

T21

T24

T38

T36

T16

T10

T14

T08

T35

T73

T29

T80

T46

T18

T42

T61

T56

T32

T31

T11

T68

T20

T13

T48

200 0

0.4

Figure 33 14

Bed occupancy for High Dependency Rehabilitation beds is lower than in the majority of other services and the median position reported across members is 86.8%. {BMChart78-Median}. Over two thirdsOver of members two thirds report of members occupancy report levels occupancy of below 90%. levels of below 90%.

High Dependency Rehabilitation - Bed occupancy

T00:

10

n/a

Mean:

86.6%

Median:

86.8%

Upper Q:

91.6%

Lower Q:

82.3%

SHA:

T67

T66

T75

T24

T16

T11

T10

T38

T68

T60

T13

T36

T56

T08

T14

T61

T73

T31

T32

T53

T35

T42

T29

T21

T48

T20

T04

T18

T80

T46

Trusts:

T19

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

12


32

The number of Consultant Psychiatrists, measured per 10 High Dependency Rehabilitation beds, is among the lowest when compared to other services, with a mean position of 0.4 {BMChart79-Mean} WTE ConsultantsWTE per 10 Consultants beds. Thisper 10 beds. This indicates thatindicates senior medical that senior inputmedical to theseinput bedsto is limited these beds and isinfrequent limited and compared infrequent to other compared services. to other services.

High Dependency Rehabilitation - WTE Consultant Psychiatrists per 10 beds

T00:

n/a

Mean:

0.4

Median:

0.3

Upper Q:

0.5

0.8

Lower Q:

0.2

0.6

SHA:

1.2 1.0

Trusts:

0.4

T08

T75

T46

T53

T14

T48

T68

T66

T18

T31

T36

T56

T35

T13

T42

T11

0.0

T04

0.2

Figure 35 The number of qualified (band 5 or above) nurses per 10 High Dependency Rehabilitation beds is illustrated in Figure 33. The mean figure reported by members is 7.5 {BMChart80-Mean} qualified nurses per qualified 10 beds nurses which perrepresents 10 beds which one of represents the lowest staffing one of the levels lowest reported staffing thislevels year reported across allthis services. year across all services.

High Dependency Rehabilitation - WTE Qualified nurses per 10 beds

T00:

n/a

Mean:

7.5

Median:

7.4

Upper Q:

8.2

8

Lower Q:

6.0

6

SHA:

14 12 10

Trusts:

4

T53

T31

T18

T20

T13

T04

T46

T08

T11

T32

T38

T66

T48

T60

T73

T75

T56

T36

T35

T68

T14

T42

T67

0

T19

2

Figure 36


33

Longer Term Complex / Continuing Care Longer Term Complex Care services care for patients who have high levels of disability from complex mental health conditions. These patients may have limited potential for future improvement and contain significant risk to their own health or safety or that of others.

any servi figure rep beds or,w smaller

By its very definition, length of stay in longer term complex or continuing care is typically greater than in most other types of inpatient services. The median length of stay reported this year by members was 529.0 {BMChart81days Median} which compares days which to 391 compares days fortohigh {BMChart92-Median} dependency rehabdays beds. for high dependency rehab beds. 0.8 0.7

Longer Term Complex Care / Continuing Care - Mean length of stay (excluding leave and unadjusted for outliers)

1,600

T00: Mean:

1,400 1,200 1,000

n/a 0.6 589.7 0.5

Median:

529.0

0.4

Upper Q:

782.0

0.3

Lower Q:

321.4

800

SHA:

600

Trusts:

0.2 0.1

0.0

400

Nurse sta nurses re input com term for question providers

T42

T23

T28

T46

T68

T10

T71

T19

T52

T08

T65

T27

T39

T73

T61

T41

T20

T70

T48

T32

T11

T80

T55

T18

T29

T56

0

T14

200

Figure 37

Bed occupancy in this area has a median position of 88.1%, {BMChart93-Median}, comparable to 86.8% comparable for high to dependency {BMChart78Median} for high rehabilitation beds. dependency rehabilitation beds.

30.0 25.0

Longer Term Complex / Continuing Care - Bed Occupancy T00:

100% 80%

86.1%

Median:

88.1%

Upper Q:

92.7% 10.0 80.6%

Lower Q:

60%

n/a 20.0

Mean:

15.0

SHA:

40%

Trusts:

T19

T23

T56

T32

T11

T71

T27

T65

T39

T52

T10

T14

T73

T70

T61

T48

T55

T31

T08

T68

T18

T20

T42

T28

T80

T41

T29

0%

T46

20%

Figure 38


34

The mean number of consultant psychiatrists reported is 0.2 {BMChart82-Mean} WTE per 10 beds,WTE the per lowest 10 beds, figurethe reported lowestfor any service. figure reported Thisfor means any service. that in aThis typical means provider, that in1aconsultant typical provider, could look 1 consultant after up could to 50 beds look after or, more up tolikely, 50 a beds or,ward smaller morewould likely,have a smaller a partward timewould consultant have awho partalso time worked consultant in other whoareas. also worked in other areas.

Longer Term Complex / Continuing Care - WTE Consultant Psychiatrists per 10 beds

T00:

n/a

0.8

Mean:

0.2

0.7

Median:

0.1

0.6

Upper Q:

0.3

0.5

Lower Q:

0.1

0.4

SHA:

0.3

Trusts:

0.2

T23

T65

T18

T41

T80

T31

T68

T46

T39

T56

T48

T52

0.0

T61

0.1

Figure 39

Nurse staffing ratios for this area are also the lowest of any service, with a mean number of WTE qualified nurses reported as 7.0 {BMChart83-Mean} per 10 beds. It isper noted 10 beds. that the It islevel noted of that medical, the level nursing of medical, and therapy nursing input and fortherapy longer input complex term for longer and term continuing complexcare and is continuing much lower carethan is much for other lowerservices. than forThis other may services. raise questions This mayfor raise questions on providers forthe providers appropriateness on the appropriateness of the level ofof care theprovided. level of care provided.

30.0

Longer Term Complex / Continuing Care - WTE Qualified nurses per 10 beds

25.0 20.0 15.0

T00:

n/a

Mean:

7.0

Median:

5.6

Upper Q:

7.1

Lower Q:

4.2

SHA: Trusts:

10.0

T70

T31

T28

T32

T19

T18

T68

T23

T71

T41

T14

T55

T11

T39

T65

T52

T73

T56

T46

T48

T05

T08

T80

T20

0.0

T61

5.0

Figure 40


35

Clustering The use of mental health clusters adds huge potential to the benchmarking project for mental health providers operating within England. Cluster data was collected from Trusts and used a bed census date of 31st March 2014. It is noted that providers can now access detailed clustering data from the Health and Social Car Information Centre. Comments are therefore welcomed from members as to whether this content should continue into 2015 benchmarking reports.

30%

The calculation of prevalence of patients in each cluster group is based on the percentage of patients in clusters 0 to 21 who are defined in each cluster group. The benchmarking calculation excludes patients who had not yet been clustered from the overall denominator. Where an organisation has confirmed that 0% of their admissions fell into a particular category, this information is illustrated on the graph.

25%

Figure 41 below shows the percentage of patients occupying inpatient beds (all specialties) on the day of the census, who were classified as cluster 1 or 2 (non-psychosis, mild). This illustrates a range of between 0% and {BMChart98-Max} 12.0% with a median with prevalence a median of prevalence 0.6%. This ofsuggests {BMChart98-Median}. service users with Thisless suggests severeservice mentalusers health with problems less severe are being mental treated health more problems and more areinbeing community treatedservices, more and with more inpatient in community beds reserved services, forwith those inpatient who meet beds a reserved higher threshold. for thoseThis whoismeet consistent a higher with threshold. reductions This in is bed consistent numberswith seenreductions earlier. Therefore, in bed numbers the overall seenacuity earlier. of admitted Therefore, patients theinoverall beds isacuity likely to of admitted be increasing patients eachinyear beds and is likely ward to staff bemay increasing feel theeach impact yearofand thisward on a staffto day may dayfeel basis. the impact of this on a day to day basis.

10%

Inpatient cluster profiles - 1 - 2 prevalence % T00:

14% 12% 10% 8%

Figure 43 account f a minor last yearc shows still being th n/a increasin therefore 1.4%

Median:

0.6%

Upper Q:

2.0%

Lower Q:

0.0%

Trusts:

4%

T47 T17 T79 T13 T67 T01 T73 T71 T03 T30 T31 T26 T39 T38 T25 T53 T42 T48 T52 T56 T04 T16 T44 T28 T45 T19 T65 T10 T61 T41 T36 T46 T27 T08 T50 T05 T18 T37 T34 T35 T51 T76 T14 T59 T24 T60 T29 T20 T55 T06 T32 T12 T33 T66 T23 T21 T11

2% 0%

15%

Mean:

SHA:

6%

20%

Figure 41

45% 40% 35% 30% 25% 20% 15% 10%

Figure 42 shows the percentage of patients in inpatient beds who fell within clusters 1 to 4 (non-psychosis, mild to moderate). The median position of 7.6% {BMChart99-Median} is a further decrease is a further compared decrease to 10%compared in both 2013 to 10% andin both 2013 2012. This metric and 2012. should Thisbe metric considered shouldalongside be considered the number alongside andthe types number of beds andavailable types of in beds individual available in individual organisations, organisations, and availability and availability and caseloads and caseloads of community of community services inservices those areas. in those areas.


36

Inpatient cluster profiles - 1 - 4 prevalence % T00:

n/a

Mean:

9.0%

Median:

7.6%

Upper Q:

11.4%

20%

Lower Q:

5.1%

15%

SHA:

30% 25%

Trusts:

10%

80% 70%

0%

60% T47 T17 T73 T67 T01 T42 T19 T25 T26 T71 T39 T50 T03 T53 T20 T66 T31 T04 T41 T52 T21 T79 T44 T06 T13 T28 T61 T32 T16 T30 T34 T65 T36 T35 T29 T48 T24 T60 T45 T27 T38 T10 T33 T05 T46 T23 T51 T56 T12 T14 T59 T18 T76 T08 T37 T11 T55

5%

50%

Figure 42

40% 30%

Figure 43 shows the prevalence of all patients with a non-psychosis diagnosis (clusters 1 to 8) which can account for up to 44.4% {BMChart100-Max} of patients inof beds. patients The median in beds.figure The median is 23.6%. figure Thisisis{BMChart100-Median}. a minor change compared Thistois a minor last yearchange (22%). When compared viewed to last in conjunction year (22%). with When the viewed two previous in conjunction charts, with this shows the two that previous wherecharts, patients this are shows still being thatadmitted where patients with non-psychosis are still beingdiagnoses, admitted these with non-psychosis patients tend diagnoses, increasinglythese to bepatients in clusters tend 5-8 and increasingly therefore of to greater be in clusters acuity than 5-8 in and previous therefore years. of greater acuity than in previous years.

20% 10%

Inpatient cluster profiles - 1 - 8 prevalence % T00: Mean:

23.7%

Median:

23.6%

Upper Q:

28.6%

Lower Q:

17.8%

SHA: Trusts:

20% 15%


45% 40% 35% 30% 25% 20% 15% 10% 5% 0%

n/a

10%

Figure 43


37

In previous years, a measure of all patients with psychosis was used, however this year patients in cluster 17 ( Psychosis and Affective Disorder) have been analysed separately at the request of the Mental Health Reference Group. Figure 44 shows patients in clusters 10 to 16. This group can account for up to 76.7% of {BMChart101-Max} adult acute bed occupants, of adultthough acute bed theoccupants, median figure though is 51.5%. the median Combined figurewith is {BMChart101-Median}. the measure for cluster 17 in Combined Figure 45 which with the follows measure (6.1%) forthis cluster suggests 17 inlittle Figure variation 45 which from follows the 57% ({BMChart102-Median}) reported as the 2013this median suggests for little variation clusters 10 - 17. from the 57% reported as the 2013 median for clusters 10 - 17.

Clusters 1 median p (15%). Thc clusters frailty. can be Th ex predomin expected

Inpatient cluster profiles - 10 - 16 prevalence % n/a

T00:

80%

Mean:

70%

Median:

51.2% 100% 51.5%

60%

Upper Q:

57.4%

50%

Lower Q:

44.3%

40%

SHA:

30%

Trusts:

20% 0%


10%

Figure 44

Figure 45, below, shows the prevalence of patients in cluster 17 occupying adult acute beds on 31st March 2014. These patients occupy a significant number of beds in some organisations with a median of 6.1% of {BMChart102-Median} beds solely for this oneof cluster. beds solely for this one cluster.

Inpatient cluster profiles - 17 prevalence % T00:

20% 15%

n/a

Mean:

6.8%

Median:

6.1%

Upper Q:

9.1%

Lower Q:

3.7%

SHA:

10%

Trusts:

0%


5%

Figure 45


38

Clusters 18 to 21 relate to organic disorders such as cognitive impairment or dementia. Figure 44 shows a median position of 14.5% {BMChart103-Median} across all organisations across all which organisations has changed which littlehas from changed last year little (15%). fromThese last year (15%). These clusters can refer clusters to typical can refer older toadults typicalillnesses older adults but also illnesses to working but also age toadults working with ageenhanced adults with frailty. enhanced This frailty. can be This explored can be further explored in the further mental in health the mental benchmarking health benchmarking toolkit. The toolkit. outlyingThe organisation outlying organisation here here predominantly provides older adult mental health services and therefore this level of clustering is to be expected.

Inpatient cluster profiles - 18- 21 prevalence % T00: Mean:

17.8%

Median:

14.5%

Upper Q:

21.2%

Lower Q:

11.2%

SHA: Trusts:


100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

n/a

Figure 46


39

Use of the Mental Health Act The extent to which patients occupying beds are there as the result of a Mental Health Act section being applied gives useful background, in conjunction with the clustering analysis shown earlier. It is also important to consider these alongside bed occupancy rates and average length of stay. Figure 47 below shows the percentage of patients in adult acute beds whose admissions were enforced under the Mental Health Act. The mean figure is 29.8% compared to 29% in 2013 and 25% in 2012. The increasing use of compulsion will have implications for bed availability for patients not admitted under a section and may limit spaces available to this cohort. Organisations who have seen a rise in line with the average increase may also find that acuity of patients has increased as patients detained under the Mental Health Act may have more complex needs.

Adult Acute beds - Percentage of all admissions under the Mental Health Act 70% 60% 50%

T00:

n/a

Mean:

29.7%

Median:

28.6%

Upper Q:

34.7%

Lower Q:

24.0%

40%

SHA:

30%

Trusts:

20%

0%


10%

Figure 47 Figure 48 below shows how your organisation's use of the different parts of the Mental Health Act compares to the average nationally. The inner ring represents your organisation, and the outer ring is the average for all organisations, showing of uses of the Act, what proportion were attributable to each section. If only one ring is shown, this indicates your organisation did not provide data on this metric. Section 2 and Section 3 are the most frequently used sections accounting for over 90% of sections.

Section 2 Section 3 Section 37 Section 37 / 41 Section 47 Section 47/49 Figure 48 Mental Health Benchmarking Report 2014 NHS Benchmarking Network

40

Community Services A substantially greater number of mental health service users access community mental health services than occupy inpatient beds at any given time. Some patients may move between inpatient and community care, while others may never be admitted to hospital and be cared for entirely in the community. Although acuity of this caseload can be less than that of the inpatient cohort, it should be noted that most inpatients are also users of community mental health services. Community mental health services play an important role in nonbed based service delivery with step up and step down models of care clearly established in specialist mental health services. The term “community mental health services “can be interpreted in different ways. For the purposes of this report community mental health services are defined as services that support service users outside of the hospital context, often in a domiciliary or community clinic location. Community mental health services work with people with severe and enduring mental illness through well-defined care pathways and protocols. Although it is recognised that services have evolved since the publication of the National Service Framework in 1999, the reference group have adopted a definition of community mental health services that recognises the core principles and shape of the NSF. The following core services have been included within the definition of community mental health services: * Community Mental Health Teams (generic CMHTs) * Crisis Resolution and Home Treatment (CRHT) * Assertive Outreach * Early Intervention (including early onset psychosis) * Assessment and Brief Intervention (including Primary Mental Health Teams) * Rehabilitation and Recovery * Older People * Memory services * Other Adult Community Mental Health Teams Each of these services is analysed in detail across many domains within the benchmarking toolkit. Areas explored include: * Activity and caseloads * Referrals * DNAs * Access and waiting times * Complaints * Incidents * Finance * Workforce

Figure 49 per 100,0 introduct {BSPK_Ca on the ca overallser 5,094 re populatio and Wale reported is exclude benchma be reflec largerfro users cas caseload

6,000 5,000 4,000 3,000 2,000 1,000

Figure 49

Organisa number o has incre {BSPK_co per 100,0 that indiv perhaps increased from the mental h reduction Older Pe emerge.

80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000

Figure 50


41

Figure 49, below, details the total combined caseload for all community mental health teams, benchmarked per 100,000 population. This is an aggregate figure which includes total caseload across all teams listed in the introduction to this section. The mean position this year is 2,231 {BMChart116-Mean} compared to the compared figure of to 1781 theservice figure of users {BSPK_Caseload_BMChart116} on the caseload per 100,000 population service users reported on the incaseload 2013. Theper overall 100,000 reported population prevalence reported ranges in 2013. fromThe 967 to overallservice 5,094 reported users prevalence per 100,000 ranges population from {BMChart116-Min} showing significant tovariation {BMChart116-Max} across different service parts users of the perEngland 100,000 population and Wales. showing The growth significant in reported variation caseloads acrossrequires different further parts validation of the England with and participants. Wales. The Although growthIAPT in data reported is excluded caseloads from therequires benchmarking further project, validation reference with participants. group members Although observed IAPT data thatisthe excluded impactfrom of IAPT themay benchmarking be reflected in project, new, larger reference caseload group volumes. members Reference observed group thatmembers the impact also ofnoted IAPT may thatbe discharging reflected service in new, largerfrom users caseload community volumes. caseloads Reference is becoming group members increasingly also noted difficult. that discharging service users from community caseloads is becoming increasingly difficult.

Community Mental Health Teams - Caseload per 100,000 population

T00:

The ben contacts Treatme

Figure 5 services show a m average graphsavw show available ran n/a wide

Mean:

2,231

Median:

2,083

Upper Q:

2,509

4,000

Lower Q:

1,644 30.0

3,000

SHA:

6,000 5,000

25.0

Trusts:

2,000 20.0 1,000 15.0 T71 T31 T11 T37 T16 T39 T52 T42 T48 T51 T59 T29 T26 T33 T36 T19 T05 T07 T53 T77 T20 T25 T21 T17 T28 T80 T44 T10 T04 T24 T35 T56 T34 T68 T73 T41 T01 T55 T13 T67 T23 T32 T38 T14 T08 T45 T18 T50 T47 T03 T72 T30 T65 T46 T70 T66 T75 T27

0

10.0

Figure 49 Organisations report both their face to face and non-face to face contacts. The graph below shows the total number of face to face contacts across all community mental health teams. While the caseload, shown above, has increased over the last year, the number of contacts has grown marginally from 36,329 in 2013 to 35,566 {BSPK_contacts_BMChart117} per 100,000 population this year. in 2013 This suggests to {BMChart117-Mean} that individual patients per 100,000 will be population receivingthis fewer year. contacts, This suggests that individual perhaps because patients the mental will be health receiving workforce fewer has contacts, not increased perhaps in because line with thethe mental increase health in demand workforce noted has not increased from the caseload in line with numbers. the increase Otherin factors demand noted noted by mental from the health caseload reference numbers. group Other members factorsinclude noted the by mental health reduction in the reference number group of Assertive members Outreach include teams the reduction and OlderinPeople's the number CMHTs of Assertive as new service Outreach models teams and Older People's CMHTs as new service models emerge. emerge.

Community Mental Health Teams - Face to Face Contacts per 100,000 population

n/a

Median:

35,566 14,000.0 34,359

Upper Q:

44,188

Lower Q:

27,169

Mean:

12,000.0 10,000.0

SHA: Trusts:


80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0

T00:

The num {BSPK_C on avera

Figure 50


42

The benchmarking toolkit provides detail on the range of community services on offer, including caseloads, contacts and waiting times. In this report, the Early Intervention Teams and Crisis Resolution Home Treatment service have been selected to highlight examples of the metrics available in the toolkit.

The abilit play an im hospital a

Figure 51, below, shows the maximum reported waits for a first routine appointment in Early Intervention services. which has a mean average of 8.8 {BMChart28-Mean} weeks. Waiting times weeks. forWaiting urgent times appointments for urgent show appointments a median show a median average of 5 days average for Early of 5Intervention days for Early services. Intervention The Mental services. Health Thetoolkit Mentalprovides Health toolkit furtherprovides graphs which further graphsaverage show which show waiting average times waiting for routine times appointments for routine appointments and also for urgent and also appointments. for urgent appointments. This is available This forisa available wide range forofa other wide range community of other services. community services.

This year weeks, approxim can be used tous e commun services,

3

Early Intervention - maximum waiting time for routine appointment (weeks)

30.0 25.0 20.0 15.0

T00:

n/a

Mean:

8.8

Median:

6.9 2

Upper Q:

12.3

Lower Q:

4.2

1

SHA: Trusts:

10.0

0

T52

T16

T10

T11

T31

T27

T21

T17

T36

T42

T20

T28

T26

T38

T03

T32

T73

T04

T29

0.0

T14

5.0

CRHT tea bed occu below sho subseque mean figu well as aro central

Figure 51 The number of face to face contacts for CRHT teams has decreased minimally this year, from 4392 to 4,339 {BSPK_CRHTcontact_BMChart29} on average, per 100,000 population to served. {BMChart29-Mean} on average, per 100,000 population served.

Crisis Resolution and Home Treatment Teams - Face to Face Contacts per 100,000 population

T00:

n/a

14,000.0

Mean:

4,339

12,000.0

Median: Upper Q:

4,126 100% 5,373

Lower Q:

2,818

10,000.0 8,000.0

SHA:

6,000.0

Trusts:

4,000.0 0.0


2,000.0

Figure 52


43

The ability of a CRHT team to respond swiftly to demand for services is an important indicator. CRHT services play an important role in gate keeping admissions to bed based services, and the successful avoidance of hospital admission depends on good, prompt access to this service. This year, the average waiting time for a routine appointment with as CRHT team was 0.5 {BMChart104-Mean} weeks, or weeks, or approximately approximately 3 to 4 days. 3 to This 4 days. compares This compares to an average to anwaiting average time waiting of 1 week time of in 2013. 1 weekThe in 2013. toolkitThe cantoolkit be can be used toused examine to examine averageaverage waitingwaiting times for times urgent for urgent appointments, appointments, and waiting and waiting times for times other forcommunity other community services, both services, routineboth and routine urgent. and urgent.

Crisis Resolution Home Treatment Team - average waiting time for routine appointments 3

2

T00:

n/a

Mean:

0.5

Median:

0.1

Upper Q:

0.4

Lower Q:

0.1

SHA: Trusts:

T42

T51

T26

T03

T73

T38

T36

T59

T21

T45

T18

T17

T14

T80

T32

T27

T53

T31

T20

0

T52

1

Figure 53 CRHT teams work hard to prevent avoidable admissions, an important role when access to beds is limited (or bed occupancy is high), or when treatment in the community is more advantageous for a patient. The chart below shows the percentage of all referrals to the CRHT team from other community teams which subsequently resulted in the patient being admitted to an inpatient bed. In 2013, organisations reported a mean figure of 27%, which has increased to 34.0% {BMChart105-Mean} this year. This may this year. reflect This patient may reflect acuity as patient well as acuity a more as well as arole central more played central by CRHTs role played as anby admission CRHTs astriage an admission service. triage service.

CRHT % of referrals that resulted in admission to an inpatient bed

T00:

100% 80% 60%

n/a

Mean:

34.0%

Median:

30.2%

Upper Q:

40.2%

Lower Q:

21.2%

SHA:

40%

Trusts:

T13

T73

T36

T26

T21

T68

T32

T48

T53

T38

T52

T35

T42

T37

0%

T47

20%


44

Mental Health Services Workforce The 2014 benchmarking programme expands on the commitment to review the mental health workforce and provide a wide range of comparisons for participants. The data provided allows detailed profiling of both inpatient and community workforce. A wide range of sub-analysis is also possible including analysis by professional group and Agenda for Change pay bandings. For non-NHS organisations, staff have been mapped based on salaries and equivalent levels of responsibility. A small number of comparisons are presented in the report to illustrate the potential of workforce benchmarking. Network members should refer to the benchmarking toolkit for more detailed workforce comparisons in these and other areas.

Analysis o position 100,000 Last year from {BM suggestin organisat

The following commentary for adult acute inpatient services relates to core district services and excludes specialist inpatient beds (which can be explored in the benchmarking toolkit). The first chart presented is the WTE number of clinical staff employed in inpatient services. The definition of clinical staff includes Nursing, Medical, Psychology, Occupational Therapy, Other Therapists, Social Workers, Support Workers, and Mental Health Practitioners. A denominator of 100,000 bed days is used for these workforce benchmarks. In practice very few Trusts / Health Boards will generate 100,000 bed days which would require around 300 beds, but this consistent denominator should allow participants to factor their own positions.

40 35 30 25 20 15

The mean position reported is 492 {BMChart33-Mean} WTE clinical staffWTE perclinical 100,000 staff bedper days 100,000 in adult bed acute daysservices in adult(figure acute 55) services (figure compared to 498 55)WTE compared in 2013.to 498 WTE in 2013.

Adult Acute Inpatient Workforce - clinical staff per 100,000 bed days 1,000 800 600

10

T00:

n/a

Mean:

492

Median:

466

Upper Q:

545

Lower Q:

412

Nursing s The figur bed days There to be disc co guidance available compare peers on

SHA:

400

Trusts:

200 T29 T55 T80 T71 T72 T25 T06 T52 T20 T45 T65 T11 T17 T68 T34 T03 T56 T75 T60 T14 T13 T66 T67 T23 T26 T41 T04 T28 T01 T33 T73 T39 T77 T48 T38 T12 T36 T47 T35 T42 T18 T61 T53 T30 T44 T24 T59 T31 T27 T32 T08 T46 T19 T21

0

500

Figure 55

400 300 200 100


45

Analysis of Consultant Psychiatrists per 100,000 bed days in adult acute beds is shown below. The mean position of this measure has changed only slightly this year, from 14.4 to 15.1 {BMChart34-Mean} WTE per 100,000 WTE bedper days. 100,000 Last year's bed spread days. has Lastremained year's spread virtually has remained unchanged, virtually with this unchanged, year's quartiles with this ranging year'sfrom quartiles 10.6 to ranging 18.6 WTE from {BMChart34-LQ} suggesting continued substantial to {BMChart34-UQ} variation between WTE suggesting organisations. continued substantial variation between organisations.

Adult Acute Inpatient Workforce - Consultant psychiatrists (WTE) per 100,000 bed days

T00:

n/a

40

Mean:

15.1

35

Median:

13.6

30

Upper Q:

18.6

25

Lower Q:

10.6

20

SHA:

15

Trusts:

35%

5

30%

0

25%

T47 T25 T11 T55 T18 T68 T56 T67 T29 T26 T03 T66 T34 T80 T53 T65 T28 T42 T36 T52 T17 T21 T33 T08 T23 T39 T61 T13 T45 T27 T14 T01 T48 T71 T41 T75 T46 T31 T04 T50 T35 T72 T24 T44 T20 T73

10

20%

Figure 56

15%

Nursing staff ratios are discussed in detail in the specialist services section of this report and in the toolkit. The figure below shows the number of WTE qualified nurses (AfC bands 5 and above) per 100,000 adult acute bed days. This has a mean position of 235 {BMChart35-Mean} WTE compared WTE to thecompared 261 WTE to reported the 261inWTE 2013. reported There continues in 2013. There to be discussion continues nationally to be discussion regarding nationally the optimal regarding staffing the for optimal inpatient staffing wards. for inpatient Until national wards. guidance Until national is guidance for available is available Mental Health, for Mental this Health, sort of comparison this sort of comparison is useful to show is useful organisations to show organisations how they compare how they to compare peers on atoregional peers onand a regional nationaland basis. national basis.

Adult Acute Inpatient Workforce - Qualified nurses (WTE) per 100,000 bed days 500 400 300

T00:

n/a

Mean:

235

Median:

224

Upper Q:

249

Lower Q:

197

10%

SHA:

200

Trusts:

0


100

Figure 57


46

Participants can use the mental health toolkit to explore themes impacting on nurse staffing levels including the level and role of support workers and the use of bank and agency staff. Figure 58 shows the vacancy rates for all staff as a percentage of WTE in establishment. In 2013, the mean position was 13% compared to 12.4% {BMChart36-Mean} this year. Again, thisthe year. variation Again, is the significant, variation is with significant, a lower quartile with a lower of quartile 6.5% andofan{BMChart36-LQ} upper quartile ofand 17.5% an upper whichquartile indicates of there {BMChart36-UQ} may be regional which variation indicates with there some may be regional variation organisations finding withit some more organisations difficult to recruit finding anditretain more suitably difficult qualified to recruitstaff. and retain Vacancy suitably rates qualified are a useful staff. Vacancy measure for wards rateswho are amay useful usemeasure bank or agency for wards staff who to may fill gaps, use or bank operate or agency at a reduced staff to fill staffing gaps, or level. operate In at a reduced some circumstance, staffingthe level. result In some may be circumstance, a detrimental thepatient result may experience be a detrimental such as more patient violence experience or increased such as more use of restraint violenceasorpatients increased areuse cared of restraint for by staff as less patients familiar are with caredthem for by orstaff receive lessless familiar supervision with them thanoris receive less supervision than is optimal. optimal.

Adult Acute Inpatient Workforce - vacancies as % of WTE in establishment 35% 30% 25%

T00:

n/a

Mean:

12.4%

Median:

11.3%

Upper Q:

17.5%

Lower Q:

6.5%

20%

SHA:

15%

Trusts:

10%

0%


5%

Figure 58


47

Finance Costs of providing both inpatient and community services are collected as part of the benchmarking process and analysed in great detail in the toolkit. A selection of metrics are also included here. Finance is one of the four key domains used in this benchmarking work (others being activity, workforce and quality measures) and gives organisations the chance to reflect on the cost of delivering the services they provide, how this compares nationally, and whether outcomes for patients (from length of stay to number of serious incidents) are impacted by the amount of money invested.

Cost per b compares

£600 £500

Figure 59 shows the costs per adult acute bed, including all direct, indirect, overhead and corporate costs. This has a mean position of £117,708 {BMChart39-Mean} which is anwhich increase is ancompared increase compared to £104,000 to per £104,000 bed inper 2013. bedSpending in 2013. is Spending is relatively similar relatively across similar England across andEngland Wales and, and as Wales was and, the case as was lastthe year, case thelast quartile year, the thresholds quartileremain thresholds remain relatively relatively narrow narrow at an annual at an cost annual of £108,096 cost of {BMChart39-LQ} and £139,937 and per bed. {BMChart39-UQ} Increased costs perper bed. bed Increased in the last costs per bed year mayinsuggest the lastthat yearoverall may suggest inpatient thatservice overallcosts inpatient have not service reduced costsdespite have not the reduced reduction despite in bed thenumbers. reduction in bed numbers.

£400 £300 £200

£100

£180,000

T00:

£160,000

Mean:

Costs per n/a detailed admissio £117,708

£140,000

Median:

£121,453

£120,000

Upper Q:

£139,937

£100,000

Lower Q:

£108,096

Cost per Adult Acute bed

£80,000

SHA:

£60,000

Trusts:

Psychiatr example to £707 {BMC bed occu these un

£40,000 £0

T80 T45 T65 T34 T28 T29 T08 T72 T59 T19 T71 T03 T23 T13 T53 T51 T55 T50 T17 T36 T01 T27 T18 T48 T30 T11 T38 T26 T56 T66 T44 T39 T68 T04 T70 T31 T41 T75 T14 T20 T46 T73 T35 T42 T33 T60 T21 T24 T12 T52 T67

£20,000 £2,500

Figure 59 £2,000 £1,500 £1,000


48

Cost per bed day is also a useful measure for comparison. In 2013 the mean position was £352 which compares to a mean figure of £352 {BMChart40-Mean} this year. this year.

Cost per bed day, Adult Acute T00:

£600 £500 £400 £300

n/a

Mean:

£352

Median:

£369

Upper Q:

£400

Lower Q:

£321

SHA:

£5,000,00 £4,500,00 £4,000,00 £3,500,00 £3,000,00 £2,500,00 £2,000,00 £1,500,00 £1,000,00

Trusts:

£200

T80 T59 T34 T65 T38 T45 T13 T08 T03 T29 T71 T28 T55 T66 T75 T19 T11 T14 T23 T01 T36 T72 T51 T56 T50 T17 T27 T48 T68 T30 T41 T26 T53 T18 T39 T60 T31 T04 T44 T35 T73 T46 T20 T33 T42 T21 T24 T12 T52 T67

£100 £0

Detailed can be an 100,000 {BSPK_Ad populatio populatio £2,459,9

Figure 60

Costs per bed day in all specialist services can be reviewed in the benchmarking toolkit which supports detailed analysis benchmarked in a number of ways including average cost per bed, average cost per admissions and average cost per occupied bed day.

Psychiatric Intensive Care Units are typically high cost services and analysis shows these costs are rising. An example for PICU beds is shown here. The cost per PICU bed day was £677 on average in 2013. This has risen to £707 {BMChart41-Mean} this year. This should this year. be This considered should be in conjunction considered in with conjunction data on staffing with data levels on and staffing bed levels occupancy and in bed occupancy these units, shown in these earlier units, in the shown Specialist earlierBeds in the section Specialist of theBeds report. section of the report.

PICU, cost per bed day £2,500

T00:

£1,500

n/a

Median:

£707 £10,000 £659

Upper Q:

£790

Lower Q:

£550

Mean:

£2,000

In 2013 t Mean}. T consisten average p caseload than in 2 although

SHA:

£1,000

Trusts:

£0

T52 T45 T72 T08 T17 T34 T31 T41 T13 T80 T39 T56 T50 T65 T03 T36 T33 T60 T70 T35 T11 T29 T42 T01 T04 T53 T44 T30 T38 T66 T19 T48 T23 T68 T75 T21 T27 T24 T46 T12 T79 T18 T28 T20 T51

£500


49

Detailed community metrics are also available in the toolkit, and a small sample are included here. The data can be analysed in a number of ways including cost per contact, cost per patient on the caseload, or cost per 100,000 population served. Figure 62 below shows the cost of Generic CMHT services per 100,000 registered {BSPK_Admissionsintro_BMChart5} population . In 2013 the mean cost was . In 2013 £2,923,893 the mean per cost 100,000 was population. £{BSPK_cost_BMChart42} In 2014 this figure per 100,000 has reduced to population. per £2,459,967 In 2014 100,000 this figure population has reduced to {BMChart42-Mean} per 100,000 population

Generic CMHT - cost per 100,000 population T00: Mean:

£2,459,967

Median:

£2,414,108

Upper Q:

£3,208,651

Lower Q:

£1,837,715

SHA: Trusts:

T18 T44 T41 T51 T48 T21 T04 T13 T45 T72 T07 T56 T01 T70 T31 T28 T11 T68 T66 T80 T50 T53 T52 T30 T71 T19 T75 T35 T47 T14 T59 T26 T17 T65 T08 T03 T42 T23 T73 T60 T27 T34 T12 T20 T67 T55

£5,000,000 £4,500,000 £4,000,000 £3,500,000 £3,000,000 £2,500,000 £2,000,000 £1,500,000 £1,000,000 £500,000 £0

n/a

Figure 62 In 2013 the average cost per patient on the caseload was £3,340. This has reduced this year to £2,962. {BMChart43This is Mean}. Thiswith consistent is consistent the community with the metrics community highlighted metrics earlier highlighted which confirm earlier which an increase confirm in average an increase per in capita average per caseloads and capita also caseloads suggest service and also users suggest have received service users fewer have contacts received on average fewer contacts this yearonthan average in 2013 this year than in 2013 although the although change may thealso change be due maytoalso thebe inclusion due to the of additional inclusion of contributors additional this contributors year. this year.

Generic CMHT - cost per patient on the caseload £10,000 £8,000 £6,000

T00:

n/a

Mean:

£2,962

Median:

£2,868

Upper Q:

£3,218

Lower Q:

£2,232

SHA:

£4,000

Trusts:

£0


£2,000


50

Quality The quality agenda is of ever increasing importance in the NHS and this year the benchmarking process included the largest ever number of quality metrics to allow Trusts and LHBs to see how they compare against local and national peers. Patient and staff satisfaction is an important measure of what it is like to be treated in a service, or to provide care in the service. Patient satisfaction in community mental health teams is shown in Figure 64 below. This is taken from the CQC survey and measures the overall view of mental health services (percentage of patients feeling that overall they had a good experience). The mean figure is 73.1% {BMChart45-Mean} and has changed and positively has changed since positively 2013 (70%) since 2013 (70%)

90% 80%

70%

Data from the NHS friends and family test will be included in the benchmarking review as soon as this is extended to mental health and data becomes available.

60% 50% 40%

Community Mental Health Teams - Patient Satisfaction %

30% T00: Mean:

73.1%

Median:

74.0%

Upper Q:

75.0%

Lower Q:

71.0%

20% 10%

SHA: Trusts:


90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

n/a

Figure 64

The follow give a goo of service

Trusts an number o

Serious in per 100,0 days in 20 increase to both am culture be


51

The data for Figure 65 on staff satisfaction is taken from the NHS staff survey and demonstrates a mean satisfaction rate of 76.3% {BMChart46-Mean} which again has which changed again positively has changed from positively the 74%from reported the 74% last reported year. Thislast survey year. This surveythe measures measures extent to the which extent staff to are which satisfied staff are with satisfied their work withand their the work support and the theysupport receivethey to do receive their to do their jobs effectively jobs effectively and safely. andItsafely. is pleasing It is pleasing to see satisfaction to see satisfaction rates increasing rates increasing in the past in the year. past year.

250 200

NHS Staff survey - satisfaction rate %

n/a 150

90%

T00:

80%

Mean:

76.3%

70%

Median:

77.0% 100

60%

Upper Q:

80.6%

50%

Lower Q:

73.8%

SHA:

40%

Trusts:

30% 20%

0%

T19 T72 T48 T37 T41 T11 T80 T16 T18 T59 T10 T78 T28 T50 T31 T23 T76 T24 T55 T35 T05 T42 T08 T13 T46 T44 T73 T56 T32 T53 T47 T38 T04 T06 T51 T52 T36 T33 T66 T21 T30 T26 T20 T70

10%

Figure 65

The following measures are compared per 100,000 occupied bed days including all ward types reported. They give a good indication of the level of incidents that are occurring on wards and the overall quality and safety of services. Trusts and Health Boards may wish to consider this information when they are looking at staffing levels, number of wards and beds, bed occupancy and other figures.

700 600

500 400 300

Serious incidents are shown in Figure 66 and have a mean measure of 78 {BMChart47-Mean} compared to 75 per compared 100,000tobed 75 per 100,000 days in 2013.bed Thisdays usesina2013. definition This uses consistent a definition with STEIS consistent data collection with STEISindata England. collection The increase in England. mayThe be due increase to both additional may be due incidents to bothand additional more comprehensive incidents and more reporting comprehensive systems andreporting reportingsystems cultureand being reporting in place. culture being in place.

200 100

Figure 67


52

Serious incidents per 100,000 bed days T00:

250

Mean:

200 150

Median:

67

Upper Q:

112

Lower Q:

100

Complain more com n/a number o increase 161 in 20 78

37 450

SHA:

400

Trusts:

350 300

50

250 200


0

150

Figure 66

100

Drug administration errors are shown here per 100,000 bed days and show a mean of 145 {BMChart48-Mean} compared to 115 compared per 100,000 tobed 115days per 100,000 in 2013. bed Thisdays change in 2013. may directly This change reflect may an directly increasereflect in thean error increase rate, or in highlight the errorthat rate, or highlight that identification andidentification reporting of and errors reporting is moreof accurate errors isthan more in accurate previous than years.in previous years.

Drug administration errors per 100,000 bed days 700 600

T00:

n/a

Mean:

145

Median:

99

500

Upper Q:

173

400

Lower Q:

62

300

SHA: Trusts:

200

600

100

500 T52 T17 T45 T34 T07 T47 T26 T70 T03 T04 T05 T30 T18 T48 T39 T27 T08 T14 T38 T16 T41 T20 T73 T21 T01 T24 T80 T33 T32 T71 T36 T23 T55 T35 T77 T25 T37 T29 T13 T75 T59 T42 T50 T11 T51 T44 T66 T28 T31 T72 T60 T10 T79 T56

0

400

Figure 67 300 200 100


53

Patients o in terms o Complaints can provide useful feedback to organisations, and seen alongside patient satisfaction can give a more complete picture of the extent to which service users and their carers are content with a service. The number of complaints per 100,000 bed days is shown here with a mean of 175, {BMChart49-Mean}, a slight increaseacompared slight to increase 161 in 2013. compared to 161 in 2013.

Figure 70 bedincrea an days

Number of complaints per 100,000 bed days 450

T00:

400

Mean:

n/a 1,000 175

350

Median:

167

300

Upper Q:

220

250

Lower Q:

120

SHA:

200

Trusts:

150 100

0


50

Figure 68 Ligature incidents on inpatient wards are a major risk management issue and subject to systematic review and learning by staff, governance teams and regulators such as the CQC. The number of ligature incidents reported has increased significantly this year to a mean position of 129 {BMChart50-Mean} from 72 ligaturefrom incidents 72 ligature per incidentsbed 100,000 perdays 100,000 in 2013. bed days Where in 2013. individual Where organisations individual organisations have seen a sizeable have seen increase a sizeable in their increase own figures in their own figurestocompared compared last year, to they lastmay year, wish they to may drill down wish tofurther drill down to determine further tothe determine locationsthe of these locations incidents of these and incidents the natureand of the ligatures nature ofand the ligature ligaturespoints and ligature being used points to being see if there used to is anything see if there that is anything can be learned that can to be learned to prevent further prevent rises further in therises future. in the future.

2,000

Ligature incidents per 100,000 bed days 600

T00: Mean:

n/a 1,500 129

500

Median:

400

Upper Q:

207

Lower Q:

52

300

SHA:

200

Trusts:

91 1,000

0

T67 T17 T25 T48 T14 T04 T06 T24 T59 T73 T07 T03 T79 T34 T01 T27 T44 T20 T08 T45 T41 T52 T33 T50 T36 T38 T32 T11 T21 T30 T42 T39 T55 T16 T80 T75 T23 T77 T05 T56 T10 T13 T71 T66 T29 T28 T18 T46 T37 T35

100


54

Many org by emplo figures h occupied days in 2 year.

Figure 70 shows a mean figure of 288 {BMChart51-Mean} incidents of physical incidents violence of physical to patients violence per 100,000 to patients bedper days. 100,000 This is bedincrease an days. This from is an 241 increase incidents from per241 100,000 incidents bed per days100,000 in 2013.bed days in 2013.

Incidents of physical violence to patients per 100,000 bed days

n/a

Mean:

288 900 287 800

Median: Upper Q:

356

700

Lower Q:

163

600

SHA:

500

Trusts:

400 300 200 100

T70 T07 T52 T20 T38 T05 T45 T17 T25 T56 T24 T73 T33 T66 T29 T34 T44 T27 T42 T50 T23 T26 T79 T48 T67 T47 T01 T36 T18 T03 T39 T37 T71 T75 T28 T59 T14 T35 T60 T10 T13 T72 T32 T31 T46 T08 T21 T16 T77 T30 T04 T06 T41 T55 T51 T11

1,000 900 800 700 600 500 400 300 200 100 0

T00:

Figure 70

In 2013, incidents of physical violence to staff had a mean figure of 449 per 100,000 bed days. This has increased to 588 {BMChart52-Mean} incidents per 100,000 incidents bedper days 100,000 in 2014. bed The days increase in 2014. in violence The increase towards in violence staff and towards towards staff and other patients towards correlates other patients with thecorrelates higher acuity withof the patients higher admitted acuity of patients (shown earlier admitted in the (shown analysis earlier of in the analysis ofprofiles) clustering clustering whose profiles) behaviour whose may behaviour be more may challenging be more challenging and harderand for staff harder to for control. staff to This control. may also This may alsoancontain contain element anof element increased of increased reportingreporting through wider through usewider of reporting use of reporting systems. systems.

Several o least ofte continue restraint 100,000

Incidents of physical violence to staff per 100,000 bed days 2,000 1,500

T00:

n/a

Mean: Median:

588 3,000 495

Upper Q:

669

Lower Q:

299 2,000

SHA:

1,000

Trusts:

500 0

2,500

1,500 1,000


e in their

Patients on mental health wards may be the victims or perpetrators of violence and this data is reported both in terms of violence towards other patients, and violence towards staff.

Figure 71


55

Many organisations have developed policies and protocols to try to reduce the use of seclusion and restraint by employing other approaches to de-escalate situations. However, as with other quality metrics, these figures have continued to rise. Seclusion was, on average, used 194 {BMChart53-Mean} times for every 100,000 times foroccupied every 100,000 bed occupied days in 2013/14. bed days This in 2013/14. comparesThis to 153 compares uses ofto seclusion 153 usesper of seclusion 100,000 occupied per 100,000 bed occupied days last year. bed days last year.

Incidence of use of seclusion per 100,000 bed days 900

T00:

n/a

800

Mean:

194

700

Median:

155

600

Upper Q:

286

500

Lower Q:

56 2,000

1,800 1,600 1,400 1,200 1,000

SHA:

400

Trusts:

300 200 100 T04 T79 T03 T25 T67 T21 T41 T37 T17 T38 T32 T20 T13 T33 T56 T16 T28 T47 T18 T24 T27 T14 T42 T34 T29 T30 T52 T73 T71 T08 T31 T35 T66 T77 T06 T50 T46 T44 T11 T55 T39 T05 T10 T07 T23

0

Figure 72

Several organisations have reported similar levels of restraint to last year, with those using restraint most and least often last year occupying the same position on the graph this year. Overall, rates of restraint have continued to rise, to 826 {BMChart54-Mean} on average this on year average compared this to year 654 compared documented to 654 incidences documented of restraint incidences per of restraintbed 100,000 per days 100,000 in 2012/13. bed days in 2012/13.

Feedback April become m incidents

Incidence of use of restraint per 100,000 bed days 3,000 2,500 2,000

T00:

n/a

Mean:

826

Median:

665

Upper Q:

978

Lower Q:

391

1,500

SHA:

1,000

Trusts:

0


500

Figure 73


56

Use of face down restraint has been collected for the first time this year as a new measure requested by Trusts and Health Boards. This type of restraint is more controversial and often associated with poorer outcomes for patients, so organisations will be interested to see how they compare on a scale of 100,000 bed days. Face down restraint is less common than restraint not in a prone position, and this year the mean position reported was 233 {BMChart89-Mean} incidences of face incidences down restraint of face per down 100,000 restraint bedper days. 100,000 bed days.

Incidence of use of face down restraint per 100,000 bed days n/a

Mean:

233

Median:

163

Upper Q:

270

Lower Q:

75

SHA:

T07

T71

T23

T24

T31

T11

T36

T72

T30

T21

T06

T44

T77

T18

T59

T13

T47

T39

T66

T42

T27

T17

T16

T28

T01

T03

T45

T04

T35

T37

T52

T56

T50

T34

T25

Trusts:

T79

2,000 1,800 1,600 1,400 1,200 1,000 800 600 400 200 0

T00:

Figure 74 Feedback from mental health reference group members on the issue of restraint suggests that only from April 2014 will data on restraint and other incidents become robust and complete. Information systems have become more comprehensive in recent years which may explain the growth reported in many categories of incidents observed in this year's benchmarking report.


57

Balance of care between inpatient and community services The vast majority of Trusts and Health Boards provide both inpatient and community services and the trend in recent years has been towards reducing the number of available inpatient beds. At the same time, community based teams have seen an increase in their caseloads. There is no agreed universal figure regarding the correct balance between bed based and community services and this is very much influenced by local needs and existing provision. Figure 75 below shows the balance of financial investment between core inpatient services (adult acute and older adult) and community based services. The typical profile sees on average 50% {BMChart118-Mean} of total funding being of total funding being allocated to inpatient allocated services. to inpatient services.

In 2013, t older adu has shifte different participa

This does 86% of ac there.

100%

Balance of Financial Investment Community Hospital

T29 T24 T68 T12 T70 T71 T75 T30 T72 T08 T65 T59 T34 T67 T46 T51 T14 T03 T19 T80 T13 T41 T53 T66 T42 T18 T52 T20 T31 T60 T48 T28 T36 T27 T35 T17 T04 T23 T50 T55 T56 T11 T21 T45 T26 T44 T73 T01

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Figure 75

In the cen were on a not chang

100%


58

In 2013, the average split between inpatient activity (calculated as number of admissions to adult acute and older adult beds) and community (caseload for all teams) was 10% hospital to 90% community. In 2014 this has shifted slightly to 14% {BMChart119-Mean} hospital care andhospital 86% community care and 86% care.community This may reflect care. the Thisdifferent may reflect mixthe of different mixinofthis participants participants year's study in this as well year's as study increased as well pressure as increased in the inpatient pressure sector. in the inpatient sector.

The split Figure 78 62% com

This does, however, continue to show the high cost of acute services compared to community services, as 86% of activity takes place in the community, but only 50% {BSPK_Comp_BMChart119} of the funding is spent there. of the funding is spent there.

Balance of Activity

Community Hospital


100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

100%

Figure 76

In the census taken on 31st March 2014, on average 98% of service users under the care of Trusts / LHBs were on a community basis, compared to just 2% occupying inpatient beds on that day. These figures have not changed since last year.

Balance of care - Activity Census

Community Hospital


100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Figure 77


59

The split of workforce between inpatient and community settings is also interesting, and shown here in Figure 78. The average figure has not changed since last year and remains 38% {BMChart121-Mean} inpatient to 62%inpatient community. to 62% community.

Balance of Workforce Community Hospital


100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Figure 78


60

Conclusion The findings from the 2014 cycle of mental health benchmarking provide an authoritative platform against which changes in mental health provision can be measured. The involvement of all NHS providers in England and Wales is particularly pleasing and provides a definitive baseline for future comparisons. We also welcome the involvement of specialist providers from the independent sector in the 2014 project. We would like to express our thanks to all 66 member organisations who provided data. The content of the project covers all the key benchmarking domains of activity, workforce, finance, safety and quality. The inclusion of these themes aims to provide a one-stop shop capability for participants in evaluating mental health services provision and performance. The ability to cross compare across domains will be important in gaining a full understanding of the story behind this year’s data. As in previous years, the report shows levels of variation across the NHS in both service demand and provision arrangements. Services are utilised at different rates potentially reflecting local commissioning priorities, service development decisions, and history and practice. Members should actively use the 2014 desktop benchmarking toolkit to further understand the headline comparisons introduced in this report. The benchmarking toolkit will allow the local evidence on mental health service provision and performance to emerge for each participant organisation. The toolkit provides an ability to cross refer between inpatient and community services to draw conclusions about the overall balance of care between bed and community based care. The 2014 analysis has also expanded significantly into new areas around liaison psychiatry, home treatment, use of the mental health act, and additional quality indicators. The comparisons within the report also allow some inter-year comparisons to be drawn with positions reported in previous benchmarking cycles. We aim to enhance this facility in future years. Headline findings for 2014 for inpatient services confirm an ongoing reduction in the number of inpatient beds. These reductions are particularly marked in adult acute services and older adult services. Reductions in bed numbers have been achieved against a backdrop of steady state levels of inpatient activity. This again suggests increases in efficiency have been delivered by mental health providers. Trends from previous years in observed reductions in length of stay have not taken place in the last year for adult acute and older peoples services. Efficiency has instead been driven through ongoing increases in bed occupancy. Anecdotes on mental health beds and bed occupancy abound but this year’s evidence confirms increases in occupancy on an already restricted bed capacity that now reports occupancy equivalent to 93% of all available mental health bed days, an astonishing level when compared with other areas of the NHS. This increase in efficiency through bed occupancy should be viewed in the context of improvements in both readmission rates and delayed transfers of care, both of which have fallen in the last year for older adult beds. In adult services, meanwhile, readmissions have also reduced, although an increase in delayed transfers of care has been illustrated. Specialist inpatient services also report increases in demand for beds. Services such as PICU, low and medium secure all report increases in bed occupancy. PICU demonstrates a notable 10% reduction in average length of stay although low and medium secure services both report increases in average length of stay in the last year. Participants will be able to review all their specialist services through the report and related toolkit.


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Data on community services has been provided in great detail by participants. Our analysis suggests that caseloads have increased in the last year for many community teams. We also provide analysis of access arrangements and waiting times in mental health. We are all cognoscente of the definitional work which is still to take place on many areas of mental health access systems. In advance of this we can report that average waits in many services are well below 18-weeks, however, many providers report a long tail on waiting lists with large numbers of people waiting significantly longer than 18-weeks to access non-urgent care. Analysis of the mental health workforce reveals interesting findings. Absolute workforce levels have not reduced in the last year and users can access detailed profiles of medical, nursing and therapy input for specific inpatient and community services. However, it is evident that less acute services demonstrate significantly lower workforce levels than we might expect to see. For example, staffing levels for longer term complex and continuing care are much lower than for other services with low staffing levels evident for medical, nursing and therapies. The low intensity of workforce can be compared to the long average lengths of stay seen in this service. Detailed costing data can be accessed in the report which compares both aggregate and unit costs across participants. Variation is again a theme. The collection of service quality data has been facilitated by the inclusion of a suite of metrics that explore incidents, risks, harm, and patient and staff satisfaction. Positions on service user and staff satisfaction both show improvements on previous years. Analysis of incidents shows growth in the number of incidents in many areas. This is clearly an area to keep under close scrutiny although feedback from members and the mental health reference group suggests an increase in the completeness of incident reporting may be a major factor in this growth. Variation in demand and provision is evident in all sectors of the NHS and the question of “what does good look like?” for mental health services remains a challenge. The benchmarking work provides a strong evidence base from which this discussion can be taken forward. The initial findings from the 2014 benchmarking report were discussed with the mental health reference group in early September. Participants were invited to feedback on the analysis and conclusions in their reports prior to the release of findings at the national conference on 7th November 2014. The NHS Benchmarking Network now involves 100% of Mental Health Trusts and Local Health Boards in its work programme and provides an excellent network through which the pursuit of good practice and continuous improvement can be taken forward. We would like to express our thanks to NHS Benchmarking Network member organisations for providing data to the 2014 mental health benchmarking project. Members have been actively engaged in the project throughout. We would also like to express our thanks to the mental health reference group for their input in shaping the project. We look forward to progressing the mental health benchmarking work in partnership with members during 2014/15 and beyond.


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Index of Charts Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 21 Figure 22 Figure 23 Figure 24 Figure 25 Figure 26 Figure 27 Figure 28 Figure 29 Figure 30 Figure 31 Figure 32 Figure 33 Figure 34 Figure 35 Figure 36 Figure 37 Figure 38 Figure 39 Figure 40 Figure 41 Figure 42 Figure 43 Figure 44 Figure 45

Bed Profile Adult Acute beds per 100,000 population Adult Acute bed occupancy Adult Acute admissions per 100,000 population Adult Acute bed days per 100,000 population Mean length of stay - Adult Acute Delayed transfers of care - Adult Acute Readmission rate - Adult Acute Older Adult beds per 100,000 population Older Adult bed occupancy Mean length of stay - Older Adults Delayed transfers of care - Older Adults Older Adult admissions per 100,000 population Older Adult bed days per 100,000 population Readmission rate - Older Adults Specialist Beds Profile PICU - mean length of stay PICU - bed occupancy PICU - WTE Consultant Psychiatrists per 10 beds PICU - WTE Qualified nurses per 10 beds Eating disorders - Mean length of stay Eating disorders - Bed Occupancy Eating disorders - WTE Consultant Psychiatrists per 10 beds Eating disorders - WTE Therapists per 10 beds Low secure - Mean length of stay Low secure - Bed occupancy Low secure - WTE Consultant Psychiatrists per 10 beds Low secure - WTE Qualified nurses per 10 beds Medium secure - Mean length of stay Medium secure - Bed occupancy Medium secure - WTE Consultant Psychiatrists per 10 beds Medium secure - WTE Qualified nurses per 10 beds High dependency rehab - Mean length of stay High dependency rehab - Bed occupancy High dependency rehab - WTE Consultant Psychiatrists per 10 beds High dependency rehab - WTE Qualified nurses per 10 beds Longer Term Complex Care / Continuing Care - Mean length of stay Longer Term Complex Care / Continuing Care - Bed occupancy Longer Term Complex Care / Continuing Care - WTE Consultant Psychiatrists /10 beds Longer Term Complex Care / Continuing Care - WTE Qualified nurses /10 beds Inpatient cluster profiles 1-2 prevalence Inpatient cluster profiles 1-4 prevalence Inpatient cluster profiles 1-8 prevalence Inpatient cluster profiles 10-16 prevalence Inpatient cluster profile 17 prevalence


Figure 46 Figure 47 Figure 48 Figure 49 Figure 50 Figure 51 Figure 52 Figure 53 Figure 54 Figure 55 Figure 56 Figure 57 Figure 58 Figure 59 Figure 60 Figure 61 Figure 62 Figure 63 Figure 64 Figure 65 Figure 66 Figure 67 Figure 68 Figure 69 Figure 70 Figure 71 Figure 72 Figure 73 Figure 74 Figure 75 Figure 76 Figure 77 Figure 78

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Figure 46 Figure 47 Figure 48 Figure 49 Figure 50 Figure 51 Figure 52 Figure 53 Figure 54 Figure 55 Figure 56 Figure 57 Figure 58 Figure 59 Figure 60 Figure 61 Figure 62 Figure 63 Figure 64 Figure 65 Figure 66 Figure 67 Figure 68 Figure 69 Figure 70 Figure 71 Figure 72 Figure 73 Figure 74 Figure 75 Figure 76 Figure 77 Figure 78

Inpatient cluster profiles 18-21 prevalence Adult Acute beds - % of admissions under the Mental Health Act Use of the Mental Health Act by section type Community Mental Health Teams - caseload per 100,000 population Community Mental Health Teams - Face to Face contacts per 100,000 population Early Intervention Teams - maximum waiting time for routine appointments CRHT - contacts per 100,000 population CRHT - average waiting time for routine appointments CRHT referrals that resulted in admission to an inpatient bed Adult Acute inpatient workforce - clinical staff per 100,000 bed days Adult Acute inpatient workforce - consultant psychiatrists per 100,000 bed days Adult Acute inpatient workforce - qualified nurses per 100,000 bed days Adult Acute inpatient workforce - clinical staff vacancies as % of establishment Cost per Adult Acute bed Cost per 100,000 bed days, Adult Acute PICU cost per bed day Generic CMHT cost per 100,000 population Generic CMHT cost per patient on the caseload CMHT Patient Satisfaction NHS Staff Survey satisfaction rate Serious incidents per 100,000 bed days Drug administration errors per 100,000 bed days Number of complaints per 100,000 bed days Ligature incidents per 100,000 bed days Incidents of physical violence to patients per 100,000 bed days Incidents of physical violence to staff per 100,000 bed days Incidence of use of seclusion per 100,000 bed days Incidence of use of restraint per 100,000 bed days Incidence of use of face down restraint per 100,000 bed days Balance of financial investment Balance of activity Balance of care Balance of workforce


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