Largest ever national review of mental health services

Largest ever national review of mental health services reports on findings - increases in efficiency evident in highly utilised services.

The NHS Benchmarking Network has published findings from a comprehensive review of NHS mental health services across England, Wales and Scotland.  All NHS mental health providers in England and Wales contributed with 57 mental health Trusts from the NHS in England, all Local Health Boards from the NHS in Wales, Greater Glasgow and Clyde Health Board from Scotland, and a number of large independent sector providers.

The review is the largest analysis of mental health provision ever undertaken in the NHS and provides insight about the range of service provision across the NHS.  Included within the review are inpatient services, community mental health services, finance, the mental health workforce, and a series of quality measures so that a rounded view on organisational performance can be taken.

The findings are to be presented at a national conference in London on 6th November 2015 where speakers include, National Clinical Director for Mental Health in England Dr Geraldine Strathdee, National Clinical Director for the Justice System Professor Louis Appleby, Chief Executive of MIND and Chair of the NHS England’s Mental Health Taskforce Paul Farmer, and a range of clinical experts from across the NHS.

The report shows interesting variation across the NHS in both service demand and provision arrangements.  Services are utilised at different rates potentially reflecting local commissioning priorities, levels of investment, service development decisions, history and practice.

 

The main findings from the review for adult and older adult mental health services are:

  • A reduction in adult mental health inpatient bed provision in the last year, around 5% fewer adult acute beds were available compared to the previous year.  A total reduction of 17% in the number of adult acute mental health beds has taken place in the last 3 years.
  • The reduction in the number of beds for older adults mental health is 6% in the last year. There has been a 24% reduction in bed numbers in the last 3 years.
  • Admission rates to mental health beds however appear to be consistent for the last 3 years although the acuity of these patients has increased in the last year as has the number of patients sectioned under the Mental Health Act.
  • The number of patients in mental health beds who have been sectioned under the Mental Health Act has increased by 10% in the last year.
  • This steady state level of admissions to inpatient beds with a reduced bed base demonstrates increases in efficiency although bed occupancy has increased for the 4th consecutive year with 94% of available bed days occupied for adult acute services.
  • Patients in adult acute mental health wards stayed for an average of 32 days in 2014/15.  Older adults stayed on average 72 days.
  • Hospital readmission rates for adults in mental health services are around 9% of patients being re-admitted within 30 days of discharge
  • Increased pressures within the health and care system are though evident with delayed transfer of care for adult inpatient services increasing to 4.7% of all bed days.  This relates to patients who were medically fit to be discharged but could not be discharged due to a number of reasons which could include the lack of a community care place or access to appropriate housing.
  • Waiting times for community based mental health services are improving in some areas.  Improvements are evident in waiting times for services to patients experiencing a first episode psychosis which now average 2 weeks, however, variation is evident with patients waiting up to 9 weeks in some areas.  The average maximum wait for a community mental health team appointment is currently 30 weeks.
  • The NHS has made substantial progress in maximising the amount of mental health care that is delivered in the community rather than in inpatient units.  Comparisons of where patients received care in 2014/15 confirmed that well over 90% of patients on mental health caseloads were treated in the community and did not require access to inpatient care.
  • Community mental health team caseloads have been increasing in recent years as more care shifts into the community setting. 
  • The national patient’s survey for 2015 for community mental health services shows service user satisfaction with community mental health services at a 69% level.
  • The national NHS staff satisfaction asked staff about their satisfaction with the quality of work and patient care they are able to offer which is now at a level of 76%.
  • A large number of indicators relating to service quality were collected. These include data on medication incidents, ligature incidents, violence and seclusion.  All of these indicators improved in the last year.

The inclusion of service quality measures for the second time in 2014/15 allows the progress on measures associated with safety and quality to be assessed.  Trusts and Health Boards generally reported fewer incidents in the last year than in 2013/14.  Feedback from participants suggests that quality systems are now well established with a commitment to transparency of reporting evident.

Stephen Watkins, Project Director from the NHS Benchmarking Network said “the review has produced a significant amount of new evidence to aid the understanding of how mental health care is delivered in the NHS.  It is pleasing to see the improvements in productivity that have been made by mental health services over the last year, along with parallel improvements in service quality.  We will be repeating the project in 2016 with an aim of measuring the progress made by mental health services on an on-going basis.”

Edward Colgan, Chief Executive of Somerset Partnership NHS Foundation Trust and Chair of the NHS Benchmarking Network’s Mental Health reference group said “This most recent benchmarking exercise provides a wealth of data and information for providers of mental health services in determining how well their services are performing across a range of measures.  It is critical that with the increased focus on patient safety and quality of services on the part of both commissioners and regulators, Boards need to fully understand the implications of the benchmarking data and areas where there is need to improve performance.  The benchmarking project has been developed from the rich data that providers hold.  We are actively encouraging providers to share their learning and performance with their commissioners to enable a more effective and evidence based planning of mental health services to take place.

The work this year on quality and patient safety is particularly important in the light of the Francis report – and we will look to build on this in future years”.

For further information please contact Zoe Page, Project Manager for Mental Health.

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