Mental Health System Profiling Tools User Guide
Contents
1. all indicators within the domain i e view data for CCG and LA and MHT where available in one domain before moving on e The Area Profile view is good for overview it allows sight of all domain indicators and shows where your area is an outlier e When moving to detail viewing indicators in Compare areas sorting by high low values allows assessment of relative position and identification of neighbours adopting good practice e Using the Trend view enables assessment of change over time Many service and quality and outcome indicators are updated quarterly so this view will become increasingly important Learn through comparison with areas like your own e Compared with similar areas statistical neighbours to identify own good practice and opportunities for improvement e Identify high performing statistical neighbours Are particular neighbours consistently high performing What can be gleaned from their profile How can you learn from them When interpreting results focus on where difference is real e Focus on key indicators e Focus on where your area is significantly different from the benchmark e Ask this difference is significant but is it meaningful What does this mean for you e Some values do not have confidence intervals use them with more caution e Focus on indicators where the local value is an outlier amongst the lowest or highest For each indicator you prioritise given local understan2. clients receiving services during the year Rate Show All Indicators a Li O o People in contact with services Rate per 100 000 population end of quarter snapshot 20x14 03 ona Social care mental health clients receiving services during the year Rate per 100 000 population 201273 England rude rate per 100 000 Most deprived decile Area Value Lower Upper cl cl England 404 401 406 NHS Tower Hamiets CCG NHS Liverpool CCG NHS North Manchester CC 4S City And Hackney CC 358 543 Most deprived decile 411 NHS Central Manchester 042 4 255 Middlesbrough 1 107 1 038 1 180 NHS Newham CCG 025 3944 4 107 Stoke on Trent 1 071 1 020 1 124 NHS Heywood Middleton 3 940 3 843 038 Blackpool 918 854 QQE Hackney 632 Manchester Ww Ww on co OF Liverpool Birmingham Tower Hamlets Ww WwW nm on Knowsley a N gt O Waltham Forest Kingston upon Hull iS Newcastle West CCG Haringey C est CC NHS Blackburn With Darw NHS Hull CCG 2 043 981 2 106 Islington NHS Wolverhampton CCG 1 979 917 2043 Sandwell NHS Waltham Forest CCG 57 88 nna Fnfernia Assoan ource Health amp Socis Care Newham oa no No 2 N Key indicators Key indicators will depend on the topic under consideration A range of indicators are provided on key services including primary care IAPT specialist care and social services Some present a general measure where as others focus on a particular element of service delivery In
3. HS Nottingham City CCG NHS South Sefton CCG 0 47 NHS Durham Dales Easin NHS Oldham CCG 0 47 NHS Bradford Districts NHS Bradford Districts 0 45 NHS South Tees CCG NHS East Lancashire CCG 0 43 NHS Oldham COG NHS Leeds South And Eas 0 42 NHS Bolton CCG NHS Barking And Dagenha 0 42 NHS Stoke On Trent COG NHS Sunderland COG 5 NHS Sunderland CCG NHS Halton CCG 0 40 NHS Walsall CCG E r VOORAAND S amp amp NHS Doncaster CCG 0 38 NHS Halton CCG NHS Brent CCG 0 38 NHS Doncaster CCG aS NHS Walsall CCG 0 30 NHS Barking And Dagenha DRAFT 15 06 14 ey Public Health England Key indicators e Estimated prevalence of a disorder is an estimate of annual cases taking into account age sex and where possible need e The numbers known to GPs is a count over a longer period and may include a wider range of conditions e Some indicators based on survey responses are included to show how people self report their mental health or wellbeing Indicator relationships e Prevalence measures and QOF register indicators should be considered alongside numbers of people living in deprivation and also with numbers of people accessing mental health services e Incidence measure should link with early intervention services e QOF registers should be considered alongside QOF patient management indicators in the Quality and Outcomes section for instance fewer than expected on the QOF register may play a part in low number of exceptions rec
4. Prevalence Services Quality and outcomes Finance Psychosis Pathway Risk and related Prevalence Services Quality and outcomes Finance Psychosis Pathway factors factors Overview Map Trends Area profiles Definitions Download Overvie w Map Trends Area profiles Definitions Download Area type CCG z Areas grouped by Deprivation decile Area type CCG z Areas grouped by Deprivation decile Area 4 P NHS Barking And Dagenha Deprivation decile Second most deprived Benchmark England Area 4 P NHS Barking And Dagenha Deprivation decile Second most deprived z Benchmark England indicator 4 gt Psychotic disorder Estimated of people aged 16 gt E Show All Indicators Indicator 4 gt Number of people with SMI known to GPs on register E Show All Indicators Psychotic disorder Estimated of people aged 16 0 2 Proportion Number of people with SMI known to GPs on register D 201213 Area Area England F England Second most deprived decile 0 50 Second most deprived decile NHS Lambeth CCG 0 77 NHS Lewisham CCG NHS Lewisham CCG 0 72 ini NHS Lambeth CCG unnel plot is NHS Southwark CCG 0 71 not available NHS Brent CCG NHS Greenwich CCG 0 65 NHS South Sefton CCG NHS Stoke On Trent CCG 0 57 NHS Southwark CCG NHS Nottingham City CCG 0 53 NHS Greenwich CCG NHS South Tees CCG 0 52 NHS Leicester City CCG NHS Leicester City CCG 0 50 NHS East Lancashire CCG NHS Bolton CCG 0 49 NHS Leeds South And Eas NHS Durham Dales Easin 0 48 N
5. Public Health England Mental Health System Profiling Tools User Guide 2 Data to intelligence Draft Version 1 2 June 2014 DRAFT 15 06 14 ae Public Health England Contents dee NEO CIC TION eea A E E sens saccaacenasepatenasenetahesJeuashareersoneecee ssa tenecoeanncecne osdeaa 3 2 TOO COWIE a A E E T E anesaeanoueieeadeteneeerounees 4 LDT VON e E A 5 4 FOCUS on the detall sssrinin enn a E E E EE EE R ENE E E 7 Bee APIS Kal retera TO en E E E A 7 APEE E E E E E EEEE EE E EE E EE EEE EEEE E E EE E 8 do SOOO a E E E E ee ee eer eee 9 aA OY AVG OUI CON NCS e E E AER 11 KFN E E E ee ere ee 12 TOS A E E E E ence sade E A E E A E E nen 14 DRAFT 15 06 14 Public Health England 1 Introduction This document is a support guide for users of the Severe Mental Illness System Profiling Tool and the Common Mental Health Disorder System Profiling Tool It is primarily for those less familiar with data and aims to help them understand their population with a mental illness or at risk of developing a disorder and to consider the services in place to support them It assists with both asking and answering key questions and helps place tool interrogation within the overall intelligence gathering process It also focusses on benchmarking as the key route to highlight variation across the pathway These tools bring together a wide range of information across the mental health pathway The detail included supports users to take an in
6. ally presented in ways that enable comparison e g rates or percentages however on occasion it is only possible to present numbers e g prisoner numbers and certain prevalence estimates Care should be taken in use of these indicators Significance the majority of indicators show when a local value is statistically significant from the chosen benchmark value This significance is based on whether the 95 confidence interval of the area s measure overlaps with the benchmark value A significant difference means that the difference between the indicator and the benchmark is not likely to be due to chance It is important to consider that this is a marker of statistical significance and the difference may not necessarily have public health or policy significance In particular indicators based on very large numbers can have differences which are highlighted as statistically significantly different but the difference is actually very small Age groups data within the tool mostly relates to adults however the definition of adults does differ between indicators due to differences in definitions at source Within the tool adult can mean 16 64 16 74 or 18 and on occasion for instance with some of mental health minimum data set indicators are expressed as a rate per resident population aged 18 but the activity may include some younger people Use of mapped data the finance indicators use data mapped from PCT to CCG and
7. cus on recovery e ls data recording at an appropriate level e Are patients content with the services they receive e Do staff feel they are equipped to support patients effectively e Are Social Care clients supported to take control of their own care e Do cross cutting indicators suggest the overall pathway works well Risk and related Prevalence Services Quality and outcomes Finance Psychosis Pathway factors Map Trends Compare areas Area profiles Definitions ownloac Overview Map Trends F Compare areas Area profiles Definitions Download Area type Mental Health Trust Risk and related factors Prevalence Services Finance Area type County amp UA Areas grouped by Deprivation decile Area 4 gt Barnet Enfield And Haringa Commissioning region London X Jenchmark England Area 4 gt Derby Deprivation decile Fifth more deprived Benchmark England e Indicator 4 gt Excess under 75 mortality in adults with serious mental illness Standard Show All Indicators fe Barnet Commissioning England England region Enfield And E o o Harin indicator Period Mental Health Count Value Value Waluo lLewest Highest Excess under 75 mortality in adults with serious mental illness Standardised mortality ratio 20172 Directly standardised rate per 100 000 nsfers of care due to NHS m 4 Care per 1000 Q 1 039 5 0 20 1 9 04 49 7 Area Value Lower Upper av cl cl England 337 So Fifth more deprived decile Slough Te
8. dicator relationships e Numbers of service users relates to prevalence measures QOF registers and deprivation e Numbers of Social Care mental health clients and new Social Care assessments may relate to relate to prevalence measures QOF registers and deprivation measures e Relationship between IAPT referrals service attendance and service completion may relate to the service model in place e Allservice measures should be viewed in light of the appropriate prevalence and incidence measures For example Areas A and B may have the same population size and rate of new cases of psychosis supported by the early intervention team but B s estimated incidence is double that of A which may suggest Area B service requires more capacity e Inpatient bed use should be viewed alongside the delayed discharge indicators e Emergency admissions and use of the mental health act should be viewed in light of the QOF exceptions and patient care indictors in Quality and Outcomes and numbers supported by Social Care e Admissions for common mental health conditions may suggest that conditions are not being well managed in primary care Key data caveats e QOF data can be subject to some geographical variation in recording e Reporting mechanisms for IAPT have recently changed and there are some coding issues meaning incomplete or missing data for some CCGs e The level of detail included on MHMDS is the result of a new monthly reporting process As this is n
9. dicators The majority of indicators are derived from programme budgeting data showing overall soend on mental health and spend on the sub categories Psychosis in severe mental illness tool and Other in common mental health disorders tool Indicator relationships e To assess value for money spend indicators need to be considered alongside activity e To assess value for money spend indicators need to be considered alongside prevalence estimates e To assess value for money spend indicators need to be considered alongside patient outcomes Key data caveats e Finance measures are generally mapped from PCT to CCG e There are inconsistencies in coding of the programme budgeting data particularly for the sub categories e Indicators in this section are generally older than those in other sections Questions the process may prompt e Could commissioned services be more cost effective DRAFT 15 06 14 ae Public Health England 5 Outputs Completion of the assessment process should result in an understanding of key indicators that suggest differences in the local population that need further attention Key messages are strengthened when indicator results are repeated and or linked across domains The completed output should e Assess the local situation by benchmarking against a chosen peer group e Highlight areas of apparent good practice for the local area e Highlight areas of apparent risk e Identify the ar
10. ding of services and circumstances ask e If the local value is high or low compared to England and comparators why DRAFT 15 06 14 ae Public Health England e Does the degree of difference make sense i e is it higher or lower than expected e What does it mean What does it suggest to you about service user profile e How do values link to contributing factors e g deprivation staff numbers primary care management specialist care service organisation etc Assess relationships between indicators e Are there inconsistencies between indicators i e elements of services you believe should show similar results do not Is this due to data recording Or a service based reason e How do the indicators interact E g are demographic indicators reflected in prevalence rates And are both reflected in numbers of service users e Where outputs from different indicators support each other ask does this strengthen findings Ask are these areas which require particular attention DRAFT 15 06 14 ae Public Health England 4 Focus on the detail This section provides a guide to gathering intelligence from the five domains It highlights key indicators key questions key caveats and provides a basic interpretation of the relationship between indicators 4 1 Risk and related factors This section aims to support prevention of mental illness quantify key related factors within local areas and help identify population grou
11. eas for potential improvement e Identify areas for further investigation e Identify statistical neighbours who appear to be adopting good practice DRAFT 15 06 14
12. ew it is currently regarded as experimental data e Prescribing indicators only measure primary care prescribing DRAFT 15 06 14 ae Public Health England Questions the process may prompt e Is service need changing Growing e ls the mix of commissioned services in line with best practice e Is the mix of commissioned services in line with user requirements e Have new services come into the area e Are people from all areas and all population groups accessing services equally 4 4 Quality and Outcomes This domain aids assessment of service management and efforts to help people get better It covers a spectrum of important quality markers e g data associated with patient management and support patient experience effectiveness of the pathway and effectiveness of care processes There are a small number of indicators presented by Mental Health Trust which relate to patient and staff experience as this area is not well covered by available indicators at commissioner level The section also includes cross cutting measures i e data that can play a role in assessing effectiveness of the whole system e g suicide and excess mortality due to mental illness Key questions for the tool e Do quality measure in primary care suggest an optimal service e Do indicators suggest specialist service knowledge of patients is as expected e Do discharge indicators suggest the system is effective e Do indicators values suggest an appropriate fo
13. l e Do you require the inputs of neighbouring commissioners to assess specialist services e Are the outcomes of commissioned services good enough e How can they be improved e What steps need to be put in place to make this happen 4 5 Finance This domain helps check if value for money is being achieved It should seldom be used in isolation i e rates of spend should generally be viewed in light of prevalence of conditions and numbers accessing services At this time only data on health services are presented Key questions for the tool e How much is invested in commissioned services e Are you achieving value for money e How do local costs compare with others e ls this data recent enough to meaningfully assess spend e Does mapping data from PCT work well for your area DRAFT 15 06 14 ae Public Health England Risk and related Prevalence Services Quality and outcomes Psychosis Pathway factors Overview Map Trends Compare areas Area profiles Definitions Download Area type CCG X Areas grouped by Deprivation decile Area 4 gt NHS Birmingham Crosscity Deprivation decile Most deprived Benchmark England z Lower Similar Higher O Not compared us uality Significant concerns JSomeconcerns Robust Birmingham Deprivation England England Crosscity i Indicator Period Count Value Value Value Lowest Highest Specialist mental health services spend rate 000s
14. lford and Wrekin Bristol Stockton on Tees g wma a no WwW WwW Y N o a Expenence of access and waiting Patient experience summary score aOWw a Experience of safe high quality care Patient experience score Experience of better information more ia au ak s O 749 Southampton choice Patient experience score Bournemouth Expenence of Building closer ne 7 a ae 7 7 ii ij 86 Sefton relationships Patient experience score E non Calderdale Derby Kirklees Dudley Ealing Portsmouth CO m th development in last 12 months Percentage of staff receiving health HPRO CAA a and safety training in last 12 months 2 WWW WwW www wv Q nr M amp amp Percentage of staff witnessing potentially harmful errors near misses 01 14 69 12 7 i Kensington and Chelsea of incidents in last month Westminster Overall staff engagement score Key indicators Key indicators will depend on the topic under consideration A range of quality indicators are provided on services such as primary care IAPT specialist care and social services QOF data includes measures relating to physical health as well as mental health There are also data presented by Mental Health Trust which provides intelligence on patient and staff views Indicators on suicide self harm and mortality and DRAFT 15 06 14 ay Public Health England excess mortality due to mental illness are included as cross cutting indicators which are ke
15. nd social care data by local authority Key datasets such as mental health minimum dataset MHMDS and Improving Access to Psychological Therapies IAPT will be updated on a quarterly basis to allow up to date analysis assessment of recent trend Key questions for the tool e Given the risk profile are service utilisation rates as expected e Is need the key driver of service utilisation for health e Is need the key driver of service utilisation for social care e Are service utilisation rates changing DRAFT 15 06 14 ae Public Health England e What is the balance between acute and community services e What is the balance between crisis emergency services and routine care e Are health and social care services working together Risk and related Prevalence Quality and outcomes Finance Psychosis Pathway Risk and related Prevalence Quality and outcomes Finance Psychosis Pathway factors factors Trends Area profiles Definitions Download Overview Map Trends Area profiles Definitions Download Areas grouped by Deprivation decile Area type County amp UA bd Areas grouped by Deprivation decile bd Area 4 gt NHS Liverpool CCG Deprivation decile Most deprived Benchmark England Dg Je c C i X enchma Indicator 4 gt People in contact with services Rate per 100 000 population end of quai M Show All Indicators Area 4 b Liverpool Deprivation decile Most deprived Benchmark England Indicator 4 gt Social care mental health
16. ng care Rate per 10 000 lt 18 population M Domestic abuse incidents recorded by the police Rate per 1 000 population amp Prisoner population Number E Sep 2013 Violent crime rate per 1 000 population IJ People with leaming disabilities known to GPs on register O English Language skills of people who cannot speak English speak it well HJ Population turnover internal migration Rate per 1 000 resident population HJ Migrant GP registrations Rate per 1 000 resident population HJ 4 i Pe HIT TAE aL Mellel UO 3 O Key indicators e Deprivation is a key determinant of population level risk of mental illness Overall deprivation is a summary measure and some key component elements are also presented e Key population groups with elevated risk of mental illness include long term unemployed the homeless prisoners and people with a learning disability e A large range of indicators are presented for the common mental health disorders tool which represent a selection of the many social and lifestyle factors known to be risk factors DRAFT 15 06 14 ae Public Health England e Some population groups encounter some barriers to accessing services such as communication issues or lack of engagement with mainstream services Indicators relationships to consider e Numbers living in deprivation is likely to relate to prevalence of mental illness and should be considered alongside numbers of people accessing mental heal
17. orded or high performance in quality of care indicators e QOF registers could also be considered alongside emergency and crisis service indicators e g fewer than expected on the register may link with more people accessing specialist services at times of crisis Key data caveats e Prevalence estimates should be treated as a baseline guide to numbers with a condition e QOF counts can be subject to some variation in recording e Prevalence estimates relate to a year QOF registers cover a period of years this should be born in mind when comparing the two e Some estimates are only based on the age sex profile and make no adjustment for local risk factors e Self reported survey measures do not represent validated diagnoses of mental health conditions Questions the process may prompt e ls current service planning based on need similar to that estimated in the tool If not what is the impact of this e ls prevalence of mental illness increasing e Are early intervention services reaching expected numbers If not what steps will be taken to investigate and address e Are numbers on the QOF register as expected If higher or lower why What is the range across practices Are indicators of risk at practice level known 4 3 Services This section helps the user consider if people are being supported by the right services in the right numbers across the care pathway It presents health care data generally by clinical commissioning group a
18. per 100 000 aged 18 2012 13 33 686 26 756 14 296 mapped from PCT M spend on specialist mental health services of all secondary care service spend categorised as mental health mapped from PCT amp Primary care prescribing spend on mental health rate 000s per 100 000 aged 18 2012 13 1 931 2 021 746 mapped from PCT M Cost of GP prescribing for psychoses and related disoders Net Ingredient Cost quarterly per 1 000 population Secondary Care spend on mental health rate 000s per 100 000 aged 18 2012 13 gt 16 337 gt 12 518 440 mapped from PCT M Community care spend on mental health rate 000s per 100 000 aged 18 2012 13 6 499 5 094 0 mapped from PCT amp Spend on psychosis services rate 000s per 100 000 population aged 18 mapped 2012 13 6 280 4 789 458 from PCT W spend on psychosis of all mental health spend categorised as psychosis 2012 13 18 6 17 9 1 7 mapped from PCT W Primary care prescribing spend on psychosis rate E000s per 100 000 aged 2012 13 703 541 159 18 mapped from PCT W Secondary Care spend on psychosis rate 000s per 100 000 aged 18 mapped 2012 13 gt 5 460 3 051 0 from PCT E D D 3 Q D O 49 755 2012 13 12 4 11 9 8 1 19 1 3 933 2013 14 Q3 590 703 802 885 667 294 1 476 34 267 19 965 15 576 48 5 1 388 O 13 513 The in
19. ps who are at risk The section also includes data on broad ethnic group and data that give an indication of risks associated with accessing services Data are predominantly presented at upper tier local authority level supplemented by indicators at lower tier and clinical commissioning group Note topics covered primarily reflect data availability Many important risk and related factors are not easily quantified using routinely available national data Key questions for the tool e What are the key population characteristics in your area Are they changing e What are your important local risk factors for mental illness e Does consideration of segments of the population help identify risk Risk and related Prevalence Services Quality and outcomes Finance Psychosis Pathway factors Overview Map Trends Compare areas Area profiles Definitions Download Area type County amp UA Areas grouped by Region Area 4 gt Derby Region East Midlands Benchmark England x Derby Region England Engiand indicator Period Count Value Value Value Lowest Highest Socioeconomic deprivation overall IMD score ai P oO d J4t 21 94 Socioeconomic deprivation of people ining in 20 most depnved areas 24 long term unemployment of working age population oO Statutory homelessness rate per 1000 households J Children in poverty living in low income households W Looked after children Rate per 10 000 lt 18 population W Children leavi
20. telligence driven approach to planning and to consider a broad picture in relation to mental health It provides numbers and rates for local areas and is sufficiently interactive to enable bespoke comparison with both geographical and statistical neighbours This guide focuses on content and interpretation of the tools rather than functionality A companion using fingertips software guide is available which describes how to use the software DRAFT 15 06 14 Public Health England 2 Tool content A key guiding principle when developing the tool was to maximise data availability for users and bring together an array of relevant data items The following general points about the data are worth bearing in mind when using the tools Definitions amp caveats because data are included from a variety of sources e g MHMDS IAPT Census 2011 QOF Social Care returns for differing populations whole population adults sample survey and presented in a number of ways counts rates ratios each indicator has detailed metadata including caveats All indicator specific information is held within definitions Data quality indicators are included if they were viewed as of sufficient quality or on occasion they provide an important element of the picture that cannot be gained elsewhere Each indicator has been assessed for quality and validity and an overall quality ranking is appended to their title Comparison data are gener
21. th services e Indicators relating to segments of the population can inform planning of action to prevent or identify disorders early e Indicators on service access may relate to indicators on emergency and crisis services i e barriers to access may mean less routine contact and therefore more emergency contact Access barriers may also relate to lower than expected QOF management indicators Key data caveats e Some indicators present a population level measure e g census whereas some are the reporting of those accessing a service which can be subject to changing thresholds e g statutory homelessness and supported asylum seekers Questions the process may prompt e What can be done to reduce risk in the population e Does the risk profile help decide preventive and targeted early identification interventions e Would you expect barriers to accessing services How are these being addressed e Does local data enable identification of risk and barriers below LA CCG level 4 2 Prevalence Planning effectively to meet need requires understanding of likely numbers of people with conditions Key questions for the tool e How many people are likely to have specific forms of mental illness in the area e How many people are known to have conditions e Are there differences between these figures Why e How many new cases will there be each year e Has prevalence increased recently e How might prevalence change in future Risk and related
22. the Pathway domain presents a high level summary that necessitates some mapping of indicators to CCG from other geographies This mapping does not work well for the minority of CCGs which do not have a co terminus area relationship The aim is to phase out mapping of data from the tool as soon as practically possible Repeating indicators for convenience when indicators are available at more than one geography they are included for all geographies available However on occasion the source and reporting period can differ which accounts for difference in values for similar indicators DRAFT 15 06 14 Public Health England 3 Data review The main purpose of the tools is to help users gather intelligence to inform needs assessment strategy development or to make commissioning decisions When reviewing data consideration of the following principles may help achieve this The process should be informed by collective knowledge and local knowledge e Work ina multi disciplinary team e Add local data and perspective Know the questions you want to ask e Agree purpose and desired outputs e Know where and how to seek additional information It is important for the user to sense check the data i e compare with local intelligence and ask e Do the values seem correct If not why do you think not e How do you rate data completeness amp accuracy Staged approach to viewing indicators e Gain an overview begin by viewing
23. y to assessing the quality of the overall care pathway Indicator relationships e Numbers of QOF exceptions should be viewed in light of the overall register and prevalence estimates For instance there may be lower exceptions in areas where based on prevalence the register appears low QOF patient management indicators should also consider this e IAPT waiting times may link to overall service use e CPA management indicators should be viewed in light of the numbers and proportion of all patients on CPA e When comparing Social Care indicators on self directed support and self directed payments they should be viewed in context of the overall numbers of people support by Social Care Key data caveats e QOF data can be subject to some geographical variation in recording e QOF data uses the patients receiving the intervention rates i e the denominator includes exceptions and therefore the values differ from the commonly reported underlying achievement rate e The level of detail included on IAPT is the result of there being a new IAPT dataset This data is subject to some coding issues that will be eliminated over time e The level of detail included on MHMDS is the result of a new monthly reporting process As this is new it is currently regarded as experimental data Questions the process may prompt e Are service quality measure good enough e Can you will you assess quality of primary care services below CCG LA leve
Download Pdf Manuals
Related Search