NHS Benchmarking Network Collections & Reports

NHS Benchmarking Network Collections & Reports

A Summary and Update

December 2019 Deborah Cundey | Service Development Manager | Clinical Operations

Intro

• NHS Benchmarking Network

• Getting it Right First Time (GIRFT)

– Crisis & Emergency Care

– Rehab

• Learning Disabilities

– Provider Services

– NHSE & NHSI Learning Disability Improvement Standards project

• Mental Health Benchmarking

NHS Benchmarking Network

• www.nhsbenchmarking.nhs.uk • Our mission is to support members to improve the quality

of health and social care services through the use of our unique, high value benchmarking service, by sharing excellent practice, and to inform national policy.

• As a member we have access to: – Secure online comparisons – Networking with peers – Shared learning and good practice – On demand data expertise and support – Extensive work programme – Summary and bespoke reporting – Knowledge forum – Customised projects

http://www.nhsbenchmarking.nhs.uk/

GIRFT

• 2 workstreams involve SHSC

– Crisis & Acute Mental Health • Lead: Dr Ian Davidson,

Cheshire & Wirral

– Psychiatric Rehabilitation • Lead: Dr Sridevi Kalidindi,

SLaM

• Information submission, report findings and deep dive visit

https://gettingitrightfirsttime.co.uk/

https://gettingitrightfirsttime.co.uk/

https://www.youtube.com/watch?v=OXmuqHCBRuM

https://www.youtube.com/watch?v=Dr-b8qb5RbY

LD Provider Services

• The project compares the main service portfolios of LD service providers and quantifies the nature and shape of services provided.

• Open to specialist providers, participants have a 360 degree view of their services, providing insight to support operational service improvement, and strategic development at a senior level.

LD Improvement Standards project

https://www.nhsbenchmarking.nhs.uk/nhsild

• Second year of this project

• Data collection opened November 2019, comprising 3 elements: – Organisational level collation of data on policies,

activity, the impact of the care delivered, service quality and outcomes.

– A staff survey, completed by individual staff members, used to survey the workforce, training and skills.

– A patient survey, used to survey the quality of care received by people with learning disabilities, and overall patient experience.



MH Benchmarking Highlights

• Key findings

• SHSC v National

• SHSC 2018/19 v 2017/18

• Further reading

– NHS BN

– MH Benchmarking Summary Brief

– National reports

https://s3.eu-west-2.amazonaws.com/nhsbn-static/Other/2019/Mental Health Services 201819 highlights hires.pdf

Our 2019 Dashboard

Weighted Population Benchmarking

Adult Acute Inpatient SHSC 2019 Position

2019 National Mean

SHSC 2018 Position

2018 National Mean

Adult acute beds per 100,000 weighted population

10.9 19.9 11 19

Adult acute bed occupancy excluding leave

97% 93% 95% 91.7%

Adult acute length of stay excluding leave

34 31.6 31 31.3

Adult acute admissions under the Mental Health Act

79% 40% 73% 37.3%

Adult acute WTE vacancies as % of staff in post 4% 17% 4% 17%

Adult acute spend on Bank and Agency (as a % of total spend on staffing)

36% 23% 24% 23%

Adult acute restraint per 10,000 occupied bed days

187 103 210 103

Adult acute prone restraint per 10,000 occupied bed days

1 17 0 20

Adult acute emergency readmissions 3.9% 8.8% 4.4% 9.4%

Adult Acute

Specialist - PICU

Specialist - Rehab

Restraint/RI


Older Adults Inpatient SHSC 2019 Position

2019 National Mean

SHSC 2018 Position

2018 National Mean

Older adult beds per 100,000 weighted population

18.2 29.1 18.4 29.1

Older adult admissions per 100,000 weighted population

59.4 118.9 55.1 117.1

Older adult bed occupancy excluding leave

90% 86% 89.7% 86.2%

Older adult length of stay excluding leave 68 70 104 74.3

Older adult delayed transfers of care 20.7% 8.2% 14.2% 10.3%

Older Adult


Community SHSC 2019 Position

2019 National Mean

SHSC 2018 Position

2018 National Mean

Total community caseload per 100,000 weighted population

1188 1483 866 1372

Total community contacts per 100,000 weighted population

25,471 27,091 27,037 26,364

Community total WTE per 100,000 weighted population (age 16+)

60 74 ~ ~

Generic CMHT cost per patient on the caseload

£3190 £3294 £4690 £3367

Early Intervention referrals received per 100,000 weighted population

158 84 98 74

Early Intervention caseload per 100,000 weighted population

95 64 81 63

NHS Friends and Family Test (FFT) Patient Satisfaction Score

98% 87% 95% 88%

Community

Early Intervention

Adult Acute Beds

Adult Acute Bed Occupancy

Adult Acute Length of Stay

Adult Acute Admissions (MHA)

Adult Acute WTE vacancies

Adult Acute Bank and Agency Spend

Adult Acute Restraint

Adult Acute Prone Restraint

Adult Acute Readmissions

Older Adult Beds

Older Adult Admissions

Older adult Bed Occupancy

Older Adult Length of Stay

Older Adult DTOC

Community Caseload

Community Contacts

Community WTE

Generic CMHT cost per patient

Early Intervention Referrals

Early Intervention Caseload

Friends & Family Test

Final Report October 2019

Mental Health Benchmarking

Inpatient and Community Mental Health Benchmarking

Report for MH07

Contents

Section Page

Executive summary 3

Bed profile 5

Community summary 6

Dashboard 7

Introduction 8

Reference group 9

Participants 10

Terms of reference 12

Adult Acute 13

Older Adult 29

Specialist beds 37

Cluster profiling 44

Community care 46

Workforce 68

Finance 75

Quality 78

Incidents 80

Balance of care 84

Conclusion 86

Index of charts 87


Inpatient and Community Mental Health

Executive Summary

Length of stay - national position

3032 32 33

31 31 32

67

72 7274

7674

70

49

4345

50

46 46

42

2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

Adult Acute Older Adult PICU

Length of stay for PICU and older adult acute beds has reduced this year. Figures for adult acute ALOS have increased, although remain within the parameters that have been seen in recent years.

This report provides an overview of the findings from this year's NHS Benchmarking Network Mental Health project. The key findings are summarised on the following pages at national level. This is followed by a bespoke dashboard showing your organisation's unique position on key metrics.

Page 3

Bed occupancy - national position

95%88% 90%

78%93% 94%

87%78%

64% 68%74% 76%

0%

20%

40%

60%

80%

100%

120%

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Bed occupancy 2018/19

Including Leave Excluding Leave

85% bed occupancy excluding leave is a level that remains challenging for many bed types, due to the combination of demand, admission levels, length of stay and bed numbers. Tightest bed occupancy is reported in adult acute services, who report an average position of 94.9% excluding leave, but rising to 100% if patients on leave are also included in the figures.

Bed occupancy in other specialties also shows marginal increases in many areas, including old age and secure care.

Adult beds continue to report higher bed occupancy than CAMHS beds, which are included on the chart below for context.

Page 4

Bed Profile - national position of beds by specialty

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 1 1 1 1 1 0 0 0 0 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0

6% 5% 1% 3%

3%

High Dep Rehab Long Term Complex Neuropsychiatry Other MH Beds

Acute admission beds for adults and older adults together represented 56% of the total bed stock

on 31st March 2019. Just under a quarter (22%) of beds were in the Low, Medium and High Secure

categories which remains unchanged since last year. However, this position is for NHS providers

across the UK and does not include a number of independent sector sites who offer a range of

specialist bed types including secure, eating disorder and rehabilitation.

Adult Acute Older Adult PICU Eating Disorders

37% 19% 5% 1%

Mother and Baby Low Secure Medium Secure High Secure

1% 9% 10%

Page 5

Community - national positions

1435 1473 1400 1397 1486

2800 28382544 2412 2457

2014/15 2015/16 2016/17 2017/18 2018/19

Community caseloadsper 100,000 population

Working age adults Older adults

32,013 34,420 32,330 30,955 31,145

38,375 39,266

32,670 32,216 32,207

2014/15 2015/16 2016/17 2017/18 2018/19

Community contactsper 100,000 population

Working age adults Older adults

Community care remains of key importance nationally. This year, the benchmarking data set includes all Northern Irish providers for the first time, which has influenced the mean average positions. On the whole, Northern Ireland provide higher levels of community care per capita than the other UK countries.

A central aspiration of the NHS Long Term Plan is to strengthen community services, so recent reductions in service capacity in England may begin to reverse in the coming years.

Page 6

Dashboard - your organisation's positions

Metric Low High MH07 Mean Median

20.6 19.6

National

Adult acute restraint per 10,000

occupied bed days187

79% 40% 40%

32 32

Adult acute beds per 100,000

registered population12.3

Adult acute cost per bed152,880£ 144,837£ 143,196£

Older adult beds per 100,000 registered

population35.6 42.9 38.6

Older adult bed occupancy excluding

leave90% 86% 88%

Older adult length of stay excluding

leave68 70 72

Total community caseload per 100,000

registered population1527 1685 1477

Generic CMHT cost per patient on the

caseload3,190£ 3,294£ 3,050£

Total community contacts per 100,000

registered population32,745 31,095 30,522

Community total WTE per 100,000

registered population (age 16+)78 84 80

Adult acute bed occupancy excluding

leave97% 93% 95%

Adult acute length of stay excluding

leave34

Adult acute admissions under the

Mental Health Act

Adult acute registered nurses per 10

beds10.7 8.2 8.0

Adult acute prone restraint per 10,000

occupied bed days1 17 11

Adult acute WTE vacancies as % of staff

in post4% 17% 15%

103 98

The following dashboard shows your organisation's position on key metrics included within this report, compared to other participants. It highlights which quartile your organisation's response falls into when all participants are ranked. It should be noted, however, that on some metrics the range is very small and therefore being high or low is only relative to other responses, and may not signify a high or low outlying position.

Page 7

Introduction

This report examines the state of mental health services in the UK in 2019. It summarises the results of this year's NHS Benchmarking Network Mental Health collection, and provides a commentary on the position of NHS mental health services.

This year brings the highest ever level of participation in the project. In addition to every English Mental Health Trust and every Welsh Health Board, we now also have data from every Health and Social Care Trust in Northern Ireland, along with representation from Scotland and the Channel Islands. This large number of participants provides the critical mass needed to provide robust and comprehensive data about the state of mental health services. The report examines activity from the 2018/19 financial year, supplemented by a number of year-end stocktake positions (for example staff in post on 31st March 2019).

2018/19 marks the eighth consecutive year of benchmarking data collection on adult and older adult mental health services. Building on last year's report, this document offers expanded time series trend analysis on every metric, and allows participants to explore the direction of travel for both inpatient and community services. It also includes a bespoke dashboard showing your organisation's positions on key metrics, in a one page summary.

The benchmarking process has been member driven from its inception, and we would like to acknowledge the contribution made both by member organisations and by the Mental Health Reference Group who continue to shape and champion the mental health benchmarking process.

This is a final report, with validated positions. It forms part of a suite of outputs including:

- Bespoke reports featuring registered population analysis for all participants

- Bespoke reports featuring weighted population analysis for English participants, using the NHS England PRAMH weighting formula which is used in CCG baseline allocations

- A comprehensive, interactive mental health toolkit which provides over 10,000 comparisons and allows all participants the opportunity to drill down into particular areas of interest

Detailed findings will be presented at this year's mental health benchmarking conference which will take place in London on 16th October 2019.

Julian Emms Stephen WatkinsChief Executive DirectorBerkshire Healthcare NHS Foundation Trust NHS Benchmarking Networkand Chair, NHSBN Mental Health Reference Group

Page 8

Reference Group

We would like to thank members of the Mental Health Reference Group who helped shape this year's collection and provided interpretation on findings.

Adrian Clarke NHS WalesAndy Blaxill Hertfordshire Partnership NHS Foundation TrustAnna Foster Northumberland, Tyne and Wear NHS Foundation TrustAnne Thompson Lancashire Care NHS Foundation TrustArokia Antonysamy The Priory GroupBabs Dhillon West London NHS TrustBelinda Iringe-Koko Central and North West London NHS Foundation TrustCatherine Magee Berkshire Healthcare NHS Foundation TrustCheryl Adams North Staffordshire Combined Healthcare NHS TrustChris Lanigan Tees Esk and Wear Valleys NHS Foundation TrustChris Woon 2gether NHS Foundation TrustDawn Painter NHS WalesDonna Hanson Greater Manchester Mental Health NHS Foundation TrustElaine Eannetta Black Country Partnership NHS Foundation TrustJames Thackray Hertfordshire Partnership NHS Foundation TrustJanet McDonald Mersey Care NHS Foundation TrustJason Rowlands Sheffield Health & Social Care NHS Foundation TrustJayne Flynn Coventry and Warwickshire Partnership NHS TrustJoanna Wood Midlands Partnership NHS Foundation TrustJulian Emms Berkshire Healthcare NHS Foundation TrustKeeley Twigg NHS WalesKevin Wilkinson Greater Manchester Mental Health NHS Foundation TrustLea Marsden Betsi Cadwaladr University Health BoardLee Cornell Somerset Partnership NHS Foundation TrustLeon Leroux Lancashire Care NHS Foundation TrustLindsey White Dorset Healthcare University NHS Foundation TrustLyn Sansom 2gether NHS Foundation TrustMandip Bal Black Country Partnership NHS Foundation TrustMark Polczyk-Przybyla South London and Maudsley NHS Foundation TrustMichael Harradine Pennine Care NHS Foundation TrustMike Garnham South West Yorkshire Partnership NHS Foundation TrustMiranda Washington Greater Manchester Mental Health NHS Foundation TrustMohit Venkataram East London NHS Foundation TrustPhilip Horner Lancashire Care NHS Foundation TrustPuneet Kaura Mersey Care NHS Foundation TrustRichard Morris Public Health WalesRony Arafin Devon Partnership NHS TrustSally Wilson Hertfordshire Partnership NHS Foundation TrustSarah Meakin Black Country Partnership NHS Foundation TrustSarah Smith Tees Esk and Wear Valleys NHS Foundation TrustShane Mills NHS WalesToby Rickard Avon and Wiltshire Mental Health Partnership NHS TrustTracy White Central and North West London NHS Foundation Trust

Page 9

Participants

This year, participants include 100% of English Mental Health Trusts, 100% of Welsh University Health Boards, 100% of Northern Ireland Trusts and representation from Scotland, the Channel Islands and the Independent Sector.

Participant organisations for 2019 are as follows:

England

2gether NHS Foundation TrustAvon and Wiltshire Mental Health Partnership NHS TrustBarnet, Enfield and Haringey Mental Health TrustBerkshire Healthcare NHS Foundation TrustBirmingham and Solihull Mental Health NHS Foundation TrustBlack Country Partnership NHS Foundation TrustBradford District Care NHS Foundation TrustCambridgeshire and Peterborough NHS Foundation TrustCamden and Islington NHS Foundation TrustCentral and North West London NHS Foundation TrustCheshire & Wirral Partnership NHS Foundation TrustCornwall Partnership NHS Foundation TrustCoventry & Warwickshire NHS Partnership TrustCumbria Partnership NHS Foundation TrustDerbyshire Healthcare NHS Foundation TrustDevon Partnership NHS TrustDorset HealthCare University NHS Foundation TrustDudley & Walsall Mental Health Partnership NHS TrustEast London NHS Foundation TrustEssex Partnership University NHS Foundation TrustGreater Manchester Mental Health NHS Foundation TrustHertfordshire Partnership University NHS Foundation TrustHumber Teaching NHS Foundation TrustIsle of Wight NHS TrustKent and Medway NHS and Social Care Partnership TrustLancashire Care NHS Foundation TrustLeeds and York Partnership NHS Foundation Trust Leicestershire Partnership NHS TrustLincolnshire Partnership NHS Foundation TrustMersey Care NHS Foundation Trust Midlands Partnership NHS Foundation TrustNorfolk and Suffolk NHS Foundation TrustNorth East London NHS Foundation TrustNorth Staffordshire Combined Healthcare NHS TrustNorthamptonshire Healthcare NHS Foundation Trust

Northumberland, Tyne & Wear NHS Foundation TrustNorth West Boroughs Healthcare NHS Foundation TrustNottinghamshire Healthcare NHS Foundation TrustOxford Health NHS Foundation TrustOxleas NHS Foundation TrustPennine Care NHS Foundation TrustRotherham, Doncaster and South Humber NHS Foundation TrustSheffield Health and Social Care NHS Foundation TrustSolent NHS Trust Somerset Partnership NHS Foundation TrustSouth London and Maudsley NHS Foundation TrustSouth West London & St George's Mental Health NHS TrustSouth West Yorkshire Partnership NHS Foundation TrustSouthern Health NHS Foundation TrustSurrey and Borders Partnership NHS Foundation TrustSussex Partnership NHS Foundation Trust Tees, Esk and Wear Valleys NHS Foundation TrustWest London NHS TrustWorcestershire Health and Care NHS Trust

WalesAneurin Bevan University Health BoardBetsi Cadwaladr University Health BoardCardiff & Vale University Health BoardCwm Taf Morgannwg University Health BoardHywel Dda University Health BoardPowys Teaching Health BoardSwansea Bay University Health Board

ScotlandNHS Greater Glasgow and Clyde

Northern IrelandBelfast Health and Social Care TrustNorthern Health and Social Care TrustSouth Eastern Health and Social Care TrustSouthern Health and Social Care TrustWestern Health and Social Care Trust

Channel IslandsStates of Jersey

OtherCygnet Health CareLivewell SouthwestSt Andrew's Healthcare

Page 10







Page 11

Terms of reference

The terms of reference for the project have been developed by the Mental Health Benchmarking Reference Group. They reflect the project’s overall objectives and are reviewed by the reference group on an on-going basis.

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

Wider objectives of contributing to continuous service improvement are 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 enhance and develop the Network’s mental health workstream in upcoming years provides an excellent platform for future service provision to members and engagement with the wider mental health community.

Members should also note that additional products are available to mental health providers that support further analysis on other aspects of services offered by many mental health providers. Examples include CAMHS benchmarking and a range of bespoke projects undertaken with members, including a national stocktake of specialist Perinatal mental health services, recent work on the size and scope of Community Mental Health Services, surveys of the CAMHS and IAPT workforce and a detailed work programme to explore secure mental health services.

Further projects of interest to mental health provider organisations include projects on learning disabilities, community physical healthcare services and pharmacy, which contain elements of relevance to many Trusts and Health Boards. All of these products can be accessed from the NHS Benchmarking Network's website.

www.nhsbenchmarking.nhs.uk

Page 12

Adult Acute

MH07 Mean Median


100%

34.0

101%104%

141 232

31.6

205

... 16% 14%

2%

32.3

Adult acute bed occupancy excluding leave97% 93% 95%

National trend

Adult acute beds per 100,000 registered

population20.6 19.612.3

Adult acute bed occupancy including leave

Adult acute admissions per 100,000 registered

population

Adult acute admissions - patients not previously

known to services

Adult acute delayed transfers of care

Adult acute emergency readmissions9%

Adult acute admissions - patients of no fixed

abode

Adult acute length of stay including leave

Adult acute admissions under the Mental Health

Act


Act per 100,000 registered population

Adult acute length of stay for Mental Health Act

detentions

2%1%

40% 40%

44.7 45.0

8%

36 34.8 36

111.3 83.6 85.0

2% 5% 4%

4%

34

79%

Trends for adult acute beds in recent years have seen a fluctuation in length of stay but a sustained reduction in bed numbers since the project's inception in 2012. This bed reduction has now stabilised with a benchmark position of 19 beds per 100,000 population evident for the 5th consecutive year.

A positive finding is the fall in emergency readmission rates, to the lowest rate reported in this project in eight years of data collection. Length of stay has increased marginally this year, but remains within the range maintained over the last 8 years.

Page 13

Adult Acute beds

2322.6

20

1919.7

19.2 19.219.6

32

30

32.4 32.3

33.4

31.0 31.3 31.6

3.5 3.8 4.1 4.43.7

5.6

4.2 4.1

10

9 8.89.2

8.48.8

9.3

8.1

2012 2013 2014 2015 2016 2017 2018 2019

Adult Acute Trends2012-2019

10

15

20

25

30

35

40

Length of stay - days

Beds per 100,000 population

Emergency readmissions %

DTOC %

Trends for adult acute beds in recent years have seen a fluctuation in length of stay but a sustained reduction in bed numbers since the project's inception in 2012. This bed reduction has now stabilised with a benchmark position of 19 beds per 100,000 population evident for the 5th consecutive year.

A positive finding is the fall in emergency readmission rates, to the lowest rate reported in this project in eight years of data collection. Length of stay has increased marginally this year, but remains within the range maintained over the last 8 years.

Page 14

MH07: 12.3

Mean: 20.6

Median: 19.6

Upper Q: 23.6

Lower Q: 17.0

Region:

Trusts:

Figure 1

0

5

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04M

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64

Adult acute beds per 100,000 registered population

The largest bed type for most providers is their adult acute bed stock. These beds form part of the core service offer from NHS Trusts and Health Boards, and are predominantly designed to serve a working age (16 - 64) cohort. Older adult acute beds provide a similar function for older people (age 65 and over) and these are discussed in the next section.

Adult acute beds support service users with a broad range of mental health conditions. This is in contrast to specialist beds which may support a specific cohort of patients, for example those with eating disorders or people on a forensic / criminal justice pathway. These specialist beds are profiled later in the report.

In recent years, providers have reported a reduction in adult acute bed numbers although this has now stabilised. In 2011/12, there were 23 adult acute beds per 100,000 population age 16-64. This year, participants reported an average position of 19.6 beds, consistent with the levels reported over the last 6 years.

The table below highlights your position compared to local and national peers. The map on the following page shows the geographical distribution of adult acute beds. Both use a stocktake position of beds in the system on 31st March 2019. Regional variations are evident in the data.

Page 15

Adult Acute beds per 100,000 registered population

11 37

© NHS Benchmarking Network 2019

Greater London

Channel Islands

Page 16

Adule Acute Bed Occupancy

MH07: 97.4%

Mean: 92.7%

Median: 94.9%

Upper Q: 97.7%

Lower Q: 88.2%

Region:

Trusts:

Figure 2

MH07: 104.1%

Mean: 101.1%

Median: 100.0%

Upper Q: 107.5%

Lower Q: 96.0%

Region:

Trusts:

Figure 3

0%

10%

20%

30%

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MH

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MH

61M

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MH

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MH

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H40

MH

12M

H58

MH

94M

H02

MH

95M

H15

MH

34M

H93

MH

56M

H43

MH

63M

H52

MH

28M

H53

MH

66M

H55

MH

60M

H06


0%

20%

40%

60%

80%

100%

120%

140%

MH

71M

H59

MH

20M

H51

MH

33M

H01

MH

61M

H70

MH

11M

H54

MH

10M

H65

MH

50M

H23

MH

26M

H22

MH

36M

H27

MH

64M

H72

MH

19M

H94

MH

07M

H21

MH

67M

H52

MH

58M

H39

MH

32M

H03

MH

56M

H12

MH

37M

H18

MH

44M

H40

MH

38M

H35

MH

24M

H57

MH

83M

H04

MH

92M

H74

MH

41M

H84

MH

05M

H43

MH

09M

H29

MH

85M

H45

MH

08M

H16

MH

53M

H34

MH

15M

H95

MH

02M

H68

MH

66M

H93

MH

25M

H42

MH

28M

H55

MH

69M

H63

MH

60M

H06


Bed occupancy figures show the number of days in a year that beds were occupied, as a proportion of all available beds. This allows services flexibility where beds were temporarily open or closed for portions of the year. Bed occupancy excluding leave cannot exceed 100%. However, when leave days are included, the figure can rise above this as an inpatient bed may be re-allocated while a patient has a period of leave.

Participants have reported bed occupancy increasing in recent years, from 91% in 2011/12. This year's median average position is 94.9% and 100% when leave is included.

Page 17

Adult Acute Admissions

MH07: 140.6

Mean: 231.9

Median: 204.7

Upper Q: 279.5

Lower Q: 166.8

Region:

Trusts:

Figure 4

0

100

200

300

400

500

600

700

800

MH

85M

H94

MH

60M

H58

MH

67M

H55

MH

42M

H83

MH

35M

H18

MH

16M

H74

MH

69M

H06

MH

11M

H19

MH

45M

H26

MH

34M

H95

MH

84M

H59

MH

37M

H53

MH

23M

H12

MH

01M

H68

MH

08M

H09

MH

03M

H61

MH

52M

H38

MH

25M

H70

MH

44M

H93

MH

22M

H39

MH

15M

H63

MH

29M

H43

MH

21M

H41

MH

51M

H66

MH

56M

H54

MH

72M

H71

MH

10M

H24

MH

32M

H65

MH

04M

H28

MH

07M

H50

MH

40M

H27

MH

20M

H57

MH

05M

H92

MH

36M

H02

MH

33M

H17

MH

64Adult acute admissions per 100,000 registered population

10%

20%

30%

40%

50%

60%

0%

1%

2%

3%

4%

5%

6%

7%

Admission rates triangulate with bed numbers and length of stay to give an overall picture of an inpatient service. This year's median average position of 204.7 admission per 100,000 population compares to 213 in 2016/17 and 212 in 2017/18.

Admissions are also profiled by patients not previously known to services. In this context, this means admissions for anyone who has not been admitted to a Trust mental health bed before, and has not been on a community mental health team caseload. This year, admissions for this cohort accounted for 14.0% of all patients admitted.

Rates of admissions for patients of no fixed abode remain steady, but the chart highlights the regional variation seen on this metric, suggesting particular challenges in certain areas.

Page 18

MH07: ...

Mean: 16.3%

Median: 14.0%

Upper Q: 21.8%

Lower Q: 7.3%

Region:

Trusts:

Figure 5

MH07: 1.1%

Mean: 2.3%

Median: 1.9%

Upper Q: 3.1%

Lower Q: 1.1%

Region:

Trusts:

Figure 6

0%

10%

20%

30%

40%

50%

60%

MH

06

MH

17

MH

24

MH

95

MH

94

MH

45

MH

74

MH

93

MH

63

MH

18

MH

43

MH

53

MH

11

MH

65

MH

23

MH

44

MH

03

MH

92

MH

05

MH

27

MH

37

MH

33

MH

26

MH

69

MH

22

MH

04

MH

52

MH

58

MH

61

MH

72

MH

35

MH

41

MH

10

MH

59

MH

51

MH

25

MH

57

MH

21

MH

38

MH

28

MH

56

MH

16

MH

08

MH

36M

H0

2M

H1

9M

H1

5M

H2

0M

H4

2

Adult acute admissions - patients not previously known to services (as a % of all patients admitted)

0%

1%

2%

3%

4%

5%

6%

7%

MH

11M

H19

MH

21M

H74

MH

23M

H27

MH

44M

H68

MH

12M

H38

MH

61M

H71

MH

41M

H53

MH

72M

H45

MH

22M

H94

MH

28M

H10

MH

24M

H59

MH

92M

H33

MH

65M

H43

MH

02M

H32

MH

70M

H56

MH

03M

H67

MH

17M

H95

MH

66M

H83

MH

25M

H54

MH

35M

H40

MH

51M

H37

MH

20M

H69

MH

84M

H07

MH

93M

H18

MH

58M

H57

MH

06M

H26

MH

39M

H05

MH

42M

H01

MH

08M

H15

MH

04M

H16

MH

63

Adult acute admissions - patients of no fixed abode (as a % of all patients admitted)

Page 19


MH07: 34.0

Mean: 31.6

Median: 32.3

Upper Q: 39.0

Lower Q: 24.7

Region:

Trusts:

Figure 7

MH07: 36.0

Mean: 34.8

Median: 36.0

Upper Q: 42.0

Lower Q: 26.0

Region:

Trusts:

Figure 8

0

10

20

30

40

50

60

MH

40M

H17

MH

19M

H36

MH

05M

H10

MH

27M

H57

MH

41M

H33

MH

74M

H56

MH

11M

H29

MH

54M

H70

MH

51M

H37

MH

39M

H02

MH

24M

H92

MH

04M

H23

MH

26M

H43

MH

28M

H07

MH

20M

H44

MH

22M

H52

MH

72M

H38

MH

95M

H32

MH

16M

H84

MH

65M

H71

MH

53M

H34

MH

93M

H61

MH

59M

H15

MH

35M

H69

MH

03M

H42

MH

01M

H18

MH

21M

H25

MH

94M

H09

MH

67M

H63

MH

06M

H58

MH

60M

H45

MH

55M

H66


0

10

20

30

40

50

60

70

80

90

MH

17M

H40

MH

19M

H36

MH

68M

H10

MH

56M

H11

MH

33M

H38

MH

54M

H70

MH

51M

H29

MH

37M

H27

MH

05M

H57

MH

41M

H23

MH

74M

H12

MH

52M

H39

MH

02M

H43

MH

20M

H64

MH

28M

H24

MH

26M

H04

MH

71M

H07

MH

22M

H32

MH

95M

H65

MH

44M

H72

MH

50M

H53

MH

84M

H59

MH

34M

H94

MH

15M

H69

MH

93M

H61

MH

35M

H09

MH

03M

H21

MH

08M

H18

MH

42M

H06

MH

83M

H01

MH

25M

H66

MH

67M

H63

MH

58M

H60

MH

55M

H45

MH

85


Length of stay for adult acute beds sees variation on both a year to year basis and within year across different participants. However, over the last 8 years, national average positions have remained within the range 30 to 33 days. This year's position is 31.6 days excluding leave. When leave days are included, this rises to 34.8 days.

The following page shows the regional variation on this metric.

Adult acute mean length of stay (excluding leave)

9 55


Greater London

Channel Islands

Page 20

Length of stay

0 - 3 days

4 - 13 days

14 - 59 days

60 days or longer

60 - 89 days

90 days or longer

In addition to average length of stay across all admissions, it can be useful to consider the profile of patients in an individual provider. The table below shows national average positions for length of stay, broken down by time period.

The charts on the following page show individual participant positions on the proportion of patients with very short (0


9 55


Greater London

Channel Islands

Page 21

Length of stay 2016/17 2017/18 2018/19

0 - 3 days 16% 16% 15%

4 - 13 days 31% 31% 30%

14 - 59 days 38% 39% 40%

60 days or longer 15% 14% x

60 - 89 days x x 7%

90 days or longer x x 8%

National trend

10%

15%

20%

25%

30%

35%

40%

45%

10%

12%

14%

16%


The charts on the following page show individual participant positions on the proportion of patients with very short (0 - 3 days) and very long (90 days or over) stays.

Page 22

MH07: 6.8%

Mean: 15.2%

Median: 13.2%

Upper Q: 17.8%

Lower Q: 9.7%

Region:

Trusts:

Figure 9

MH07: 5.3%

Mean: 7.9%

Median: 8.0%

Upper Q: 9.9%

Lower Q: 5.4%

Region:

Trusts:

Figure 10

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

MH

06

MH

58

MH

01

MH

45

MH

61

MH

71

MH

19M

H6

0M

H5

9M

H6

3M

H6

7M

H42

MH

21

MH

94

MH

25

MH

03

MH

15M

H6

9M

H2

4M

H7

2M

H1

8M

H35

MH

74

MH

93

MH

51

MH

34

MH

16M

H0

8M

H1

7M

H2

6M

H5

2M

H12

MH

22

MH

27

MH

95

MH

23

MH

02M

H5

7M

H2

8M

H3

7M

H8

4M

H32

MH

11

MH

38

MH

43

MH

04

MH

44M

H6

4M

H5

3M

H1

0M

H0

5M

H36

MH

65

MH

56

MH

54

MH

70

MH

39M

H3

3M

H0

7M

H4

1M

H9

2M

H40

MH

20

MH

29

MH

09

Proportion of patients discharged with length of stay 0-3 days

0%

2%

4%

6%

8%

10%

12%

14%

16%

MH

40M

H20

MH

36M

H17

MH

51M

H41

MH

92M

H57

MH

32M

H39

MH

33M

H74

MH

10M

H27

MH

64M

H18

MH

23M

H11

MH

12M

H29

MH

26M

H54

MH

24M

H71

MH

37M

H56

MH

70M

H28

MH

05M

H22

MH

72M

H53

MH

38M

H52

MH

95M

H43

MH

65M

H16

MH

61M

H59

MH

09M

H04

MH

84M

H34

MH

03M

H35

MH

58M

H15

MH

01M

H07

MH

21M

H02

MH

42M

H44

MH

93M

H25

MH

94M

H19

MH

63M

H06

MH

69M

H08

MH

67M

H60

MH

45

Proportion of patients discharged with length of stay 90 days or longer

Page 23

Occupied Bed Days

MH07 Mean Median

Proportion of OBDs (excluding leave) for patients

discharged with length of stay 60-89 days 19% 14% 14% Not available


discharged with length of stay 90 days or longer 29% 37% 38% Not available





National trend



Participants reported the proportion of their OBDs in adult acute beds that could be attributed to patients with different lengths of stay. Individual positions can be explored further in the Mental Health Benchmarking Toolkit. The chart below illustrates the comparison between proportion of patients in each length of stay band and the proportion of OBDs each cohort occupied. This shows that although 15% of patients are discharged within 0-3 days, they only occupy 1% of bed days. At the other end of the scale, only 8% of patients stay 90 days or longer in adult acute beds, but this group occupy 41% of all bed days on these wards. Patients that stay 60 days or more account for 14% of admissions but 55% of bed days.

15%

31%

40%

6% 8%

1%

8%

36%

14%

41%

0-3

day

s

4-1

3 d

ays

14 -

59

day

s

60 -

89

day

s

90 d

ays

or

lon

ger

Discharges by LOS and OBD profile

Patients discharged

OBDs

Page 24

Mental Health Act

MH07: 79.1%

Mean: 40.2%

Median: 39.9%

Upper Q: 51.8%

Lower Q: 29.6%

Region:

Trusts:

Figure 11

MH07: 111.3

Mean: 83.6

Median: 85.0

Upper Q: 100.5

Lower Q: 55.8

Region:

Trusts:

Figure 12

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

MH

07M

H33

MH

17M

H11

MH

36M

H09

MH

29M

H22

MH

44M

H43

MH

65M

H28

MH

10M

H92

MH

52M

H05

MH

41M

H57

MH

32M

H40

MH

56M

H20

MH

39M

H12

MH

24M

H23

MH

25M

H27

MH

38M

H94

MH

03M

H64

MH

02M

H68

MH

19M

H01

MH

37M

H18

MH

08M

H74

MH

51M

H50

MH

53M

H06

MH

45M

H60

MH

63M

H26

MH

93M

H69

MH

42M

H15

MH

95M

H35

MH

54M

H21

MH

71M

H61

MH

72M

H84

MH

04M

H59

MH

70M

H67

MH

83M

H55

MH

58M

H66


0

50

100

150

200

250

MH

94M

H11

MH

09M

H60

MH

44M

H22

MH

23M

H29

MH

12M

H52

MH

18M

H43

MH

19M

H07

MH

74M

H42

MH

37M

H35

MH

06M

H41

MH

01M

H45

MH

68M

H10

MH

39M

H25

MH

53M

H33

MH

69M

H03

MH

65M

H38

MH

26M

H56

MH

28M

H08

MH

36M

H32

MH

95M

H24

MH

92M

H05

MH

57M

H40

MH

17M

H20

MH

51M

H93

MH

63M

H27

MH

15M

H02

MH

84M

H67

MH

21M

H50

MH

59M

H54

MH

71M

H61

MH

55M

H64

MH

83M

H58

MH

72M

H04

MH

70M

H66

Adult acute admissions under the Mental Health Act per 100,000 registered population

100

120

Analysis of use of the Mental Health Act shows that 40.2% of admissions to adult acute beds in 2018/19 were for patients who were detained at the point of their admission. In addition to this, some patients are admitted on a voluntary basis but then subject to detention during their episode of care.

It is also useful to consider background detention rates relative to population size, as these are less influenced by bed numbers and admission rates. In 2018/19 there were 83.6 admissions to adult acute beds under the Mental Health Act per 100,000 population age 16-64. Some regional variation is evident in this data although other determinants are evident including access to community care, and clinical practice.

Page 25

MH07: 34.0

Mean: 44.7

Median: 45.0

Upper Q: 51.1

Lower Q: 36.2

Region:

Trusts:

Figure 13

0

20

40

60

80

100

120

MH

17M

H70

MH

59M

H26

MH

54M

H38

MH

19M

H11

MH

10M

H23

MH

51M

H36

MH

74M

H37

MH

24M

H56

MH

05M

H57

MH

52M

H27

MH

61M

H28

MH

68M

H29

MH

15M

H95

MH

02M

H39

MH

72M

H20

MH

84M

H22

MH

04M

H92

MH

53M

H33

MH

43M

H65

MH

42M

H35

MH

94M

H32

MH

71M

H06

MH

44M

H18

MH

93M

H25

MH

07M

H08

MH

03M

H21

MH

66M

H01

MH

41M

H69

MH

60M

H09

MH

63M

H55

MH

45

Adult acute mean length of stay for Mental Health Act detentions

Adult Acute admissions under the Mental Health Act per 100,000 registered population

8 187


Greater London

Channel Islands

Page 26

Adult Acute Delayed Transfers of Care

MH07: 2.0%

Mean: 4.9%

Median: 4.1%

Upper Q: 7.0%

Lower Q: 2.0%

Region:

Trusts:

Figure 14

0%

2%

4%

6%

8%

10%

12%

14%

16%

MH

39M

H21

MH

57M

H05

MH

71M

H43

MH

44M

H06

MH

27M

H67

MH

03M

H25

MH

26M

H72

MH

52M

H20

MH

33M

H37

MH

42M

H64

MH

10M

H53

MH

24M

H60

MH

50M

H59

MH

35M

H04

MH

66M

H83

MH

36M

H28

MH

11M

H18

MH

22M

H15

MH

23M

H38

MH

55M

H40

MH

12M

H92

MH

93M

H07

MH

63M

H74

MH

45M

H19

MH

32M

H95

MH

08M

H34

MH

41M

H29

MH

56M

H94

MH

54M

H65


Participants continue to report inconsistencies in the measuring of delays, in particular the point at which a delay is formally acknowledged.

This chart measures delayed transfers of care as a percentage of all occupied bed days. The 2018/19 average of 4.1% can be compared to 4.2% in 2017/18 and 5.6% the year prior to that. The chart shows considerable variation which may be impacted by both clarity and consistency of reporting, and underlying service models and patient flow.

Page 27

Adult Acute Emergency Readmissions

MH07: 3.9%

Mean: 8.8%

Median: 8.1%

Upper Q: 10.9%

Lower Q: 5.9%

Region:

Trusts:

Figure 15

0%

5%

10%

15%

20%

25%

MH

58M

H55

MH

18M

H59

MH

06M

H60

MH

53M

H34

MH

45M

H71

MH

84M

H04

MH

01M

H16

MH

74M

H61

MH

26M

H37

MH

42M

H51

MH

93M

H21

MH

25M

H19

MH

11M

H35

MH

05M

H28

MH

41M

H56

MH

23M

H67

MH

36M

H94

MH

15M

H92

MH

27M

H38

MH

72M

H33

MH

69M

H52

MH

50M

H54

MH

57M

H20

MH

12M

H02

MH

68M

H08

MH

39M

H22

MH

10M

H03

MH

95M

H24

MH

09M

H64

MH

70M

H65

MH

07M

H43

MH

44M

H63

Adult acute emergency readmissions

"Emergency readmissions" refers to unplanned or unexpected readmission to an adult acute bed of people discharged from an adult acute bed within the last 28 or 30 days (depending on local definitions). The figure is calculated as a percentage of overall admissions. This year, 8.1% of admissions to adult acute beds were emergency readmissions for patients recently discharged. This figure remained between 8.4% and 10% of admissions in the 7 years to 2017/18. The reduction in emergency readmissions is welcomed and marks a significant improvement on previous years.

Page 28

Follow Up Post Discharge

MH07 Mean Median

Not available

Not available

Not available

72% 73%

91% 94%

93% 96%

Percentage of all patients having a first follow-up

appointment within 3 days of discharge from in-

patient care

Percentage of CPA patients having a first follow-

up appointment within 7 days of discharge from

in-patient care



patient care

62%

93%

91%

National trend



in-patient care56% 73% 72% Not available

Members of the mental health benchmarking reference group requested the inclusion of new metrics concerning follow up appointments for patients discharged from inpatient care.

Categories include patients on CPA and all patients, and follow up within 3 days and 7 days of discharge. The figures suggest that in most circumstances, follow up occurs within 3 days, with only a small proportion of patients first followed up between 4 and 7 days post discharge.

Early follow up post discharge has been identified as a key safety issue by The National Confidential Inquiry into Suicide and Safety in Mental Health. The strong performance on 3-day follow up is welcomed and confirms the commitment of many providers to reducing risks in the post-discharge period.

Participants can explore their individual positions on these metrics further using the NHS Benchmarking Network Mental Health Toolkit.

Page 29

Older Adult

MH07 Mean Median

Older adult delayed transfers of care

National trend

Older adult beds per 100,000 registered


Older adult bed occupancy including leave94% 90% 92%

Older adult bed occupancy excluding leave90% 86% 88%

Older adult admissions per 100,000 registered

population116 175 160

Older adult length of stay excluding leave68 70.3 72.0

Older adult emergency readmissions2% 3% 3%

Older adult length of stay including leave72 76 76

8% 7%21%

Older adult bed numbers have stabilised in 2018/19 with the smallest reduction in capacity since the benchmarking project began. Average length of stay has also reduced, as have DTOCs. Readmissions also remain lower than in working age adult services. The findings from the older adult inpatient sector should be read alongside the data from community based care which are described later in the report.

Key metrics for older adult inpatient care also tell a story of effective management of capacity at a time of system pressure. Inpatient bed capacity has reduced marginally in the last year but this has been delivered alongside reductions in average length of stay.

Page 30

6260

50

47

44.042.8

38.9 38.6

70

67

72 7274.0

76.074.3

70.3

67

8 8.19.5

12.2

10.1

7.3

54 3.7

2.8 2.5 3.2 3.1 3.0

6260

50

47

44.042.8

38.9 38.6

70

67

72 7274.0

76.074.3

70.3

67

8 8.19.5

12.2

10.1

7.3

54 3.7

2.8 2.5 3.2 3.1 3.0

2012 2013 2014 2015 2016 2017 2018 2019

Older Adult Trends2012-2019

Length of stay - days

Beds per 100,000 population

Emergency readmissions %

DTOC %

Older adult bed numbers have stabilised in 2018/19 with the smallest reduction in capacity since the benchmarking project began. Average length of stay has also reduced, as have DTOCs. Readmissions also remain lower than in working age adult services. The findings from the older adult inpatient sector should be read alongside the data from community based care which are described later in the report.

Page 31

Older Adult Beds

MH07: 35.6

Mean: 42.9

Median: 38.6

Upper Q: 51.7

Lower Q: 32.2

Region:

Trusts:

Figure 16

0

20

40

60

80

100

120

140

160

MH

69M

H16

MH

51M

H71

MH

83M

H45

MH

68M

H34

MH

57M

H01

MH

94M

H74

MH

53M

H72

MH

11M

H55

MH

28M

H60

MH

37M

H26

MH

43M

H29

MH

58M

H36

MH

23M

H24

MH

93M

H66

MH

35M

H20

MH

67M

H08

MH

59M

H95

MH

09M

H32

MH

54M

H65

MH

05M

H92

MH

61M

H04

MH

39M

H07

MH

03M

H10

MH

18M

H63

MH

42M

H52

MH

21M

H64

MH

56M

H41

MH

40M

H02

MH

33M

H50

MH

27M

H84

MH

25M

H22

MH

17M

H19

MH

06M

H15

MH

44M

H38

MH

70M

H12

Older adult beds per 100,000 registered population

Older adult beds have shown a marginal decline, though rates relative to population size are still much larger than for adult acute. There were 38.6 older adult beds per 100,000 population age 65 and older, compared to 19.6 adult acute beds per 100,000 population age 16 to 64.

Page 32

Older Adult Bed Occupancy

MH07: 90.0%

Mean: 86.0%

Median: 88.2%

Upper Q: 92.2%

Lower Q: 82.5%

Region:

Trusts:

Figure 17

MH07: 93.9%

Mean: 90.3%

Median: 91.9%

Upper Q: 96.5%

Lower Q: 85.7%

Region:

Trusts:

Figure 18

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

67M

H03

MH

74M

H51

MH

27M

H02

MH

92M

H10

MH

41M

H95

MH

59M

H24

MH

44M

H54

MH

09M

H57

MH

19M

H26

MH

42M

H25

MH

64M

H05

MH

11M

H43

MH

07M

H61

MH

60M

H40

MH

50M

H39

MH

04M

H32

MH

38M

H84

MH

23M

H45

MH

36M

H15

MH

22M

H01

MH

93M

H06

MH

37M

H08

MH

83M

H35

MH

65M

H29

MH

18M

H20

MH

63M

H70

MH

12M

H72

MH

52M

H21

MH

94M

H53

MH

56M

H34

MH

58M

H33

MH

71M

H28

MH

66M

H55


0%

20%

40%

60%

80%

100%

120%

MH

61M

H02

MH

10M

H67

MH

03M

H54

MH

45M

H92

MH

09M

H36

MH

74M

H40

MH

43M

H24

MH

84M

H51

MH

27M

H26

MH

19M

H59

MH

44M

H41

MH

64M

H32

MH

11M

H95

MH

07M

H39

MH

57M

H50

MH

42M

H25

MH

15M

H04

MH

22M

H60

MH

23M

H05

MH

18M

H70

MH

06M

H38

MH

93M

H08

MH

65M

H94

MH

12M

H69

MH

35M

H20

MH

37M

H52

MH

29M

H53

MH

01M

H63

MH

83M

H72

MH

34M

H16

MH

56M

H68

MH

21M

H33

MH

58M

H71

MH

28M

H66

MH

55

Older adult bed occupancy including leave

Bed occupancy for older adult beds should be seen in the context of higher rates of bed provision compared to adult acute services. In 2018/19, participants reported bed occupancy of 88.2% excluding leave in older adult services. This is notably below the figure of 94.9% reported in adult acute beds.

The 88.2% position reported in old age services is the highest reported in the 8 year history of the benchmarking project, confirming ongoing increases in capacity utilisation.

Page 33


MH07: 116.2

Mean: 175.2

Median: 159.8

Upper Q: 209.5

Lower Q: 124.4

Region:

Trusts:

Figure 19

050

100150200250300350400450500

MH

69M

H16

MH

71M

H45

MH

60M

H83

MH

94M

H11

MH

26M

H93

MH

51M

H43

MH

55M

H67

MH

58M

H66

MH

03M

H24

MH

34M

H61

MH

57M

H36

MH

59M

H53

MH

72M

H01

MH

35M

H08

MH

29M

H54

MH

74M

H37

MH

39M

H65

MH

20M

H84

MH

04M

H63

MH

18M

H95

MH

28M

H09

MH

32M

H10

MH

19M

H68

MH

42M

H23

MH

50M

H02

MH

64M

H27

MH

56M

H21

MH

07M

H40

MH

44M

H22

MH

52M

H92

MH

33M

H25

MH

17M

H41

MH

06M

H15

MH

05M

H70

MH

38M

H12

Older adult admissions per 100,000 registered population

Older adult admission rates reflect both diminishing bed availability and higher length of stay in the old age sector. This year's median position of 159.8 per 100,000 population compares to 159 in 2017/18 and 161 in 2016/17. This suggests a broad equilibrium in admission rates enabled by increases in bed occupancy and reductions in length of stay and bed numbers.

Page 34


MH07: 68.0

Mean: 70.3

Median: 72.0

Upper Q: 84.0

Lower Q: 57.5

Region:

Trusts:

Figure 20

MH07: 72.0

Mean: 75.9

Median: 76.0

Upper Q: 89.0

Lower Q: 62.0

Region:

Trusts:

Figure 21

0

20

40

60

80

100

120

MH

23M

H57

MH

40M

H41

MH

74M

H05

MH

52M

H38

MH

17M

H10

MH

20M

H29

MH

34M

H02

MH

37M

H28

MH

01M

H70

MH

69M

H25

MH

72M

H92

MH

95M

H42

MH

33M

H65

MH

04M

H54

MH

26M

H59

MH

16M

H35

MH

56M

H53

MH

43M

H58

MH

07M

H15

MH

39M

H36

MH

24M

H22

MH

06M

H67

MH

63M

H11

MH

27M

H84

MH

94M

H21

MH

61M

H19

MH

03M

H32

MH

71M

H18

MH

60M

H55

MH

44M

H45

MH

93M

H09

MH

66

Older adult length of stay excluding leave

0

20

40

60

80

100

120

140

160

MH

12M

H51

MH

23M

H57

MH

40M

H52

MH

68M

H74

MH

41M

H05

MH

34M

H17

MH

70M

H69

MH

10M

H20

MH

02M

H28

MH

29M

H64

MH

37M

H33

MH

72M

H92

MH

95M

H25

MH

65M

H54

MH

01M

H42

MH

38M

H26

MH

36M

H56

MH

04M

H35

MH

53M

H59

MH

43M

H39

MH

07M

H58

MH

15M

H08

MH

24M

H22

MH

50M

H06

MH

11M

H63

MH

67M

H84

MH

27M

H61

MH

94M

H19

MH

32M

H21

MH

03M

H18

MH

71M

H66

MH

60M

H45

MH

83M

H55

MH

44M

H93

MH

09

Older adult length of stay including leave

Length of stay in older adult beds continues to be more than twice the figure seen in adult acute beds, which service a working age adult cohort. In 2018/19, older adult length of stay was 70.3 days excluding leave, compared to 31.6 days in adult acute beds.

Page 35

Older Adult Delayed Transfers of Care

MH07: 20.7%

Mean: 8.2%

Median: 7.3%

Upper Q: 12.6%

Lower Q: 2.9%

Region:

Trusts:

Figure 22

0%

5%

10%

15%

20%

25%

30%

35%

MH

44M

H57

MH

07M

H05

MH

59M

H25

MH

21M

H06

MH

39M

H11

MH

33M

H52

MH

64M

H26

MH

20M

H36

MH

54M

H40

MH

71M

H03

MH

15M

H83

MH

10M

H53

MH

67M

H37

MH

60M

H08

MH

23M

H04

MH

50M

H66

MH

42M

H32

MH

72M

H22

MH

43M

H45

MH

94M

H93

MH

55M

H63

MH

92M

H27

MH

18M

H12

MH

24M

H65

MH

35M

H02

MH

56M

H29

MH

28M

H41

MH

38M

H74

MH

34M

H19

MH

95


Due to the complexity of discharge arrangements for some patients, delays in transfers of care occur much more frequently in older adult services than in services serving working age adults. This metric is calculated using the percentage of all occupied bed days that were attributed to delays. This year's figure of 7.3% for older adult beds compares to 4.1% for adult acute.

Page 36

Older Adult Readmissions

MH07: 1.8%

Mean: 3.5%

Median: 3.0%

Upper Q: 4.7%

Lower Q: 1.7%

Region:

Trusts:

Figure 23

0%

2%

4%

6%

8%

10%

12%

MH

01M

H16

MH

84M

H65

MH

61M

H55

MH

93M

H26

MH

52M

H54

MH

05M

H37

MH

18M

H57

MH

39M

H56

MH

58M

H34

MH

67M

H10

MH

19M

H21

MH

74M

H51

MH

35M

H33

MH

59M

H12

MH

36M

H27

MH

72M

H03

MH

50M

H04

MH

15M

H25

MH

38M

H53

MH

02M

H23

MH

06M

H24

MH

07M

H70

MH

28M

H71

MH

43M

H63

MH

94M

H11

MH

20M

H22

MH

69M

H42

MH

64M

H41

MH

08M

H92

MH

44M

H09

Older adult emergency readmissions

Emergency readmissions to older adult beds occur less frequently than in adult acute beds. This may be due to the higher level of support offered post discharge to this cohort, through ongoing packages of care or residential placements, which can help keep people well and reduce the risk of deterioration to the extent that an emergency readmission is necessitated.

Calculated as the percentage of all admissions that were emergency readmissions in the immediate period after discharge, the average position of 3.0% for older adults compares to 8.1% in adult acute beds.

Page 37

Specialist beds

MH07 Mean Median National trend

PICU length of stay excluding leave42 42 36

Eating Disorders length of stay excluding leave... 107 99

PICU bed occupancy excluding leave99% 86% 90%

Eating Disorders bed occupancy excluding leave... 77% 78%

Low Secure length of stay excluding leave286 697 542

Low Secure bed occupancy excluding leave84% 91% 93%

683 722...Medium Secure length of stay excluding leave

348 360...

213

High Dependency Rehabilitation length of stay

excluding leave

High Dependency Rehabilitation bed occupancy

excluding leave...

Longer Term Complex / Continuing Care bed

occupancy excluding leave72% 79% 78%

Longer Term Complex / Continuing Care length of

stay excluding leave

85% 87%

516 360

Medium Secure bed occupancy excluding leave... 93% 94%

100

120

140

160

180

100%

In this context, "Specialist beds" refers to all beds that are not for acute admission (adult acute and older adult acute). Some of these beds are linked to specific conditions (such as eating disorders) while others support patients on different pathways (such as low and medium secure beds for patients on a forensic/criminal justice pathway).

Mother and baby units are not included here because they are reported in a detailed analysis piece. High Secure beds are excluded due to the small number of national providers, and the additional benchmarking that goes on in these areas.

Benchmarks per 100,000 population are not used in this section, as population catchment footprints vary and are not mutually exclusive across providers.

Page 38

MH07: 42

Mean: 42

Median: 36

Upper Q: 46

Lower Q: 30

Region:

Trusts:

Figure 24

MH07: 99%

Mean: 86%

Median: 90%

Upper Q: 94%

Lower Q: 78%

Region:

Trusts:

Figure 25

0

20

40

60

80

100

120

140

160

180

MH

68M

H65

MH

06M

H40

MH

42M

H01

MH

38M

H04

MH

72M

H39

MH

37M

H41

MH

25M

H35

MH

94M

H44

MH

84M

H33

MH

64M

H92

MH

24M

H05

MH

07M

H34

MH

61M

H20

MH

31M

H60

MH

52M

H29

MH

23M

H74

MH

18M

H36

MH

51M

H11

MH

02M

H54

MH

28M

H90

MH

95M

H19

MH

50M

H03

MH

21M

H57

MH

09M

H10

MH

15M

H26

MH

32M

H08

MH

17M

H22

MH

59M

H63

MH

45M

H70

MH

55M

H67

MH

66

PICU length of stay excluding leave

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

61M

H74

MH

44M

H40

MH

07M

H66

MH

05M

H10

MH

59M

H83

MH

67M

H39

MH

24M

H41

MH

50M

H60

MH

17M

H35

MH

38M

H03

MH

09M

H36

MH

57M

H72

MH

26M

H21

MH

01M

H95

MH

23M

H25

MH

92M

H64

MH

29M

H54

MH

32M

H45

MH

11M

H37

MH

58M

H20

MH

22M

H70

MH

31M

H84

MH

04M

H94

MH

63M

H33

MH

19M

H18

MH

52M

H08

MH

65M

H12

MH

90M

H42

MH

28M

H06

MH

34M

H15

MH

55M

H02

PICU bed occupancy excluding leave

100

150

200

250

100%

Page 39

MH07: ...

Mean: 107

Median: 99

Upper Q: 108

Lower Q: 85

Region:

Trusts:

Figure 26

MH07: ...

Mean: 77%

Median: 78%

Upper Q: 85%

Lower Q: 68%

Region:

Trusts:

Figure 27

0

50

100

150

200

250

MH

90

MH

22

MH

08

MH

36

MH

18

MH

63

MH

40

MH

38

MH

05

MH

23

MH

44

MH

57

MH

09

MH

17

MH

10

MH

27

MH

04

Eating Disorders length of stay excluding leave

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

23

MH

90

MH

44

MH

04

MH

36

MH

09

MH

05

MH

08

MH

38

MH

10

MH

40

MH

27

MH

17

MH

22

MH

63

MH

57

MH

18

Eating Disorders bed occupancy excluding leave

1,000

1,500

2,000

2,500

100%

Page 40

MH07: 286

Mean: 697

Median: 542

Upper Q: 815

Lower Q: 446

Region:

Trusts:

Figure 28

MH07: 84%

Mean: 91%

Median: 93%

Upper Q: 96%

Lower Q: 87%

Region:

Trusts:

Figure 29

0

500

1,000

1,500

2,000

2,500

MH

10M

H06

MH

08M

H25

MH

94M

H31

MH

65M

H38

MH

17M

H52

MH

37M

H24

MH

42M

H28

MH

44M

H26

MH

72M

H41

MH

90M

H04

MH

74M

H57

MH

21M

H56

MH

35M

H05

MH

20M

H43

MH

92M

H22

MH

02M

H15

MH

18M

H23

MH

63M

H03

MH

59M

H01

MH

54M

H19

MH

27M

H09

MH

07M

H29

MH

84M

H32

MH

51M

H36

Low Secure length of stay excluding leave

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

23M

H94

MH

27M

H18

MH

21M

H41

MH

72M

H38

MH

35M

H22

MH

74M

H10

MH

03M

H44

MH

25M

H52

MH

36M

H09

MH

05M

H20

MH

08M

H84

MH

17M

H12

MH

02M

H26

MH

65M

H04

MH

92M

H63

MH

37M

H28

MH

24M

H19

MH

32M

H90

MH

59M

H29

MH

43M

H07

MH

31M

H42

MH

54M

H15

MH

57M

H01

MH

06M

H56

Low Secure bed occupancy excluding leave

1,000

1,200

1,400

1,600

1,800

100%

Page 41

MH07: ...

Mean: 683

Median: 722

Upper Q: 823

Lower Q: 521

Region:

Trusts:

Figure 30

MH07: ...

Mean: 93%

Median: 94%

Upper Q: 97%

Lower Q: 90%

Region:

Trusts:

Figure 31

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

MH

06

MH

28

MH

52

MH

31

MH

01

MH

67

MH

44

MH

08

MH

25

MH

15

MH

74

MH

24

MH

72

MH

90

MH

10

MH

94

MH

20

MH

04

MH

37

MH

18

MH

22

MH

35

MH

03

MH

17

MH

41

MH

09

MH

32

MH

27

Medium Secure length of stay excluding leave

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

35

MH

37

MH

22

MH

09

MH

32

MH

44

MH

20

MH

27

MH

25

MH

08

MH

31

MH

90

MH

10

MH

94

MH

18

MH

52

MH

01

MH

24

MH

28

MH

74

MH

17

MH

41

MH

03

MH

04

MH

06

MH

15

MH

67

MH

72Medium Secure bed occupancy excluding leave

1,000

1,200

100%

Page 42

MH07: ...

Mean: 348

Median: 360

Upper Q: 442

Lower Q: 205

Region:

Trusts:

Figure 32

MH07: ...

Mean: 85%

Median: 87%

Upper Q: 90%

Lower Q: 77%

Region:

Trusts:

Figure 33

0

200

400

600

800

1,000

1,200

MH

70

MH

24

MH

02

MH

52

MH

90

MH

23

MH

38

MH

95

MH

09

MH

37

MH

01

MH

06

MH

39

MH

25

MH

10

MH

28

MH

22

MH

35

MH

51

MH

36

MH

08

MH

74

MH

11

MH

03

MH

92

MH

43

MH

20

MH

67

MH

58

MH

55

MH

93

MH

17

MH

19

MH

32

MH

27

MH

45

MH

66

High Dependency Rehabilitation length of stay excluding leave

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

100%

MH

67

MH

11

MH

10

MH

74

MH

03

MH

09

MH

23

MH

17

MH

02

MH

45

MH

38

MH

37

MH

95

MH

01

MH

92

MH

36

MH

24

MH

90

MH

28

MH

25

MH

58

MH

55

MH

27

MH

19

MH

35

MH

43

MH

20

MH

52

MH

08

MH

93

MH

39

MH

32

MH

22

MH

66

MH

70

MH

06High Dependency Rehabilitation bed occupancy excluding

leave

1,000

1,200

1,400

1,600

1,800

100%

Page 43

MH07: 213

Mean: 516

Median: 360

Upper Q: 611

Lower Q: 227

Region:

Trusts:

Figure 34

MH07: 72%

Mean: 79%

Median: 78%

Upper Q: 89%

Lower Q: 72%

Region:

Trusts:

Figure 35

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

MH

09

MH

31

MH

52

MH

37

MH

23

MH

68

MH

51

MH

05

MH

69

MH

02

MH

28

MH

25

MH

11

MH

57

MH

08

MH

35

MH

10

MH

60

MH

55

MH

63

MH

50

MH

56

MH

07

MH

67

MH

01

MH

44

MH

04

MH

15

Longer Term Complex / Continuing Care length of stay excluding leave

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

100%

MH

21

MH

10

MH

55

MH

05

MH

31

MH

23

MH

11

MH

02

MH

57

MH

60

MH

44

MH

52

MH

08

MH

04

MH

28

MH

01

MH

50

MH

12

MH

67

MH

07

MH

35

MH

56

MH

15

MH

25

MH

63

MH

37

MH

09Longer Term Complex / Continuing Care bed occupancy

excluding leave

Page 44

Cluster profiling


Occupied bed days - clusters 1-817% 24% 26%



10%

15%

20%

25%

30%

35%

40%

45%

50%

10%

20%

30%

40%

50%

60%

70%

80%

90%

10%

15%

20%

25%

30%

35%

40%

NHS England's Care Clusters for people who use specialist mental health services can be grouped into three main categories:

Non Psychosis1 Common mental health problems (low severity)2 Common mental health problems3 Non psychotic (moderate severity)4 Non psychotic (severe)5 Non psychotic (very severe)6 Non psychotic disorders of overvalued ideas7 Enduring non psychotic disorders (high disability)8 Non psychotic chaotic and challenging disorders

Psychosis10 First episode in psychosis11 Ongoing or recurrent psychosis (low symptoms)12 Ongoing or recurrent psychosis (high disability)13 Ongoing or recurrent psychosis (high symptom and disability)14 Psychotic crisis15 Severe psychotic depression16 Dual diagnosis (substance abuse and mental illness)17 Psychosis and affective disorder difficult to engage

Organic18 Cognitive impairment (low need)19 Cognitive impairment or dementia (moderate need)20 Cognitive impairment or dementia (high need)21 Cognitive impairment or dementia (high physical or engagement)

Inpatient activity is driven by bed availability, and the continued decline in older people's beds is reflected in the ongoing reduction in occupied bed days for patients whose episodes fall into clusters 18 to 21.

Page 45

MH07: 17%

Mean: 24%

Median: 26%

Upper Q: 30%

Lower Q: 17%

Region:

Trusts:

Figure 36

MH07: 70%

Mean: 62%

Median: 61%

Upper Q: 71%

Lower Q: 53%

Region:

Trusts:

Figure 37

MH07: 13%

Mean: 14%

Median: 13%

Upper Q: 15%

Lower Q: 9%

Region:

Trusts:

Figure 38

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

MH

93

MH

53

MH

08

MH

54

MH

02

MH

95

MH

56

MH

42

MH

27M

H7

2M

H2

0M

H1

9M

H3

3M

H6

4M

H3

2M

H6

6M

H1

5M

H36

MH

43

MH

63

MH

18

MH

24

MH

05

MH

45

MH

41

MH

40

MH

39M

H0

3M

H6

0M

H2

6M

H9

2M

H3

7M

H0

4M

H2

9M

H2

5M

H61

MH

22

MH

38

MH

57

MH

07

MH

65

MH

06

MH

35

MH

28

MH

10M

H0

9M

H2

1M

H2

3M

H1

2M

H9

4M

H5

2M

H1

1M

H7

4M

H44

Occupied bed days - clusters 1-8

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

MH

44M

H11

MH

74M

H52

MH

94M

H10

MH

09M

H23

MH

22M

H12

MH

65M

H35

MH

06M

H28

MH

07M

H38

MH

25M

H29

MH

57M

H40

MH

37M

H03

MH

18M

H04

MH

61M

H92

MH

27M

H41

MH

26M

H32

MH

43M

H24

MH

95M

H64

MH

36M

H66

MH

33M

H56

MH

19M

H20

MH

63M

H05

MH

54M

H02

MH

39M

H21

MH

72M

H60

MH

42M

H15

MH

08M

H45

MH

53M

H93


0%

5%

10%

15%

20%

25%

30%

35%

40%

MH

21M

H45

MH

60M

H93

MH

39M

H15

MH

05M

H63

MH

72M

H42

MH

53M

H61

MH

02M

H57

MH

08M

H20

MH

19M

H66

MH

26M

H04

MH

36M

H24

MH

07M

H92

MH

54M

H12

MH

33M

H43

MH

56M

H41

MH

28M

H25

MH

38M

H29

MH

06M

H64

MH

32M

H35

MH

37M

H94

MH

23M

H03

MH

65M

H95

MH

18M

H40

MH

09M

H27

MH

74M

H52

MH

10M

H44

MH

11M

H22


Page 46

Community care

MH07 Mean Median

Older adult teams - community contacts per

100,000 registered population49,435 32,207 30,799

Working age adult teams - community contacts

per 100,000 registered population28,740 31,145 30,899

National trend

Working age adult teams - community caseload

per 100,000 registered population

Total community contacts per 100,000 registered

population

747

32,745

1,486

Total community caseload per 100,000 registered

population

Older adult teams - community caseload per

100,000 registered population

1,477 1,685 1,527

4,777 2,457 2,079

1,382

31,095 30,522

The two key measures of community capacity are caseloads and contacts. Caseload provides a snapshot of open cases on 31st March 2019. Participants can explore their positions for individual team types in the NHS Benchmarking Mental Health Toolkit. Contacts is a measure of the number of face to face and non face to face contacts delivered by a community team to patients on their caseload, and to those who are being assessed.

Community caseloads and contacts, for both working age and older adults, have seen declines in recent years.

Community based care is the most frequently accessed NHS specialist mental health service, serving around 700,000 people across the UK at 31st March 2019. Most people who access NHS specialist mental health services use community based services at some point in their patient journey.

Page 47

Community caseloads

MH07: 1,527

Mean: 1,685

Median: 1,477

Upper Q: 2,098

Lower Q: 1,286

Region:

Trusts:

Figure 39

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

MH

68M

H92

MH

83M

H70

MH

93M

H35

MH

55M

H94

MH

59M

H40

MH

60M

H18

MH

95M

H10

MH

16M

H74

MH

08M

H69

MH

42M

H85

MH

45M

H32

MH

29M

H26

MH

05M

H65

MH

71M

H66

MH

38M

H36

MH

39M

H33

MH

51M

H07

MH

37M

H58

MH

01M

H44

MH

61M

H54

MH

72M

H57

MH

25M

H22

MH

09M

H56

MH

15M

H41

MH

24M

H53

MH

28M

H11

MH

12M

H03

MH

43M

H52

MH

63M

H02

MH

23M

H21

MH

19M

H67

MH

64M

H27

MH

34M

H06

MH

20M

H17

MH

84M

H04

MH

50

Total community caseload per 100,000 registered population

1,000

1,500

2,000

2,500

3,000

3,500

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Community services are reported here benchmarked per capita by caseload size and by number of contacts delivered. Caseload is a snapshot position of all open cases on 31st March 2019. For the purposes of this report, the national definition of caseload is applied, i.e. patients who have had two or more face to face appointments as part of this episode of care. This therefore excludes people who are still in the assessment phase, and may not commence treatment with a team.

Total community caseload shows the sum of all individual community team caseloads, against a population of those age 16 and older. Working age adult teams include all those who predominantly serve working age adults, against a population of age 16 - 64. Older adult teams include old age community teams and memory services, against a population of age 65+.

This year's total community caseload of 1,685 compares to 1,598 per 100,000 population last year.

Page 48

MH07: 747

Mean: 1,486

Median: 1,382

Upper Q: 1,877

Lower Q: 1,084

Region:

Trusts:

Figure 40

MH07: 4,777

Mean: 2,457

Median: 2,079

Upper Q: 3,177

Lower Q: 1,324

Region:

Trusts:

Figure 41

0

500

1,000

1,500

2,000

2,500

3,000

3,500

MH

68M

H94

MH

92M

H60

MH

40M

H70

MH

59M

H95

MH

74M

H93

MH

35M

H10

MH

18M

H85

MH

42M

H83

MH

16M

H32

MH

08M

H05

MH

71M

H65

MH

55M

H58

MH

36M

H26

MH

29M

H61

MH

03M

H15

MH

45M

H01

MH

43M

H38

MH

56M

H57

MH

51M

H53

MH

44M

H09

MH

37M

H24

MH

52M

H41

MH

12M

H22

MH

28M

H66

MH

69M

H25

MH

67M

H39

MH

27M

H72

MH

23M

H54

MH

02M

H21

MH

63M

H33

MH

11M

H64

MH

34M

H06

MH

84M

H20

MH

07M

H04

MH

17M

H19

MH

50

Working age adult teams - community caseload per 100,000 registered population

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

MH

83M

H69

MH

55M

H35

MH

68M

H07

MH

70M

H45

MH

33M

H11

MH

92M

H93

MH

18M

H66

MH

40M

H59

MH

16M

H39

MH

60M

H08

MH

29M

H10

MH

54M

H95

MH

26M

H51

MH

22M

H38

MH

72M

H42

MH

37M

H25

MH

94M

H32

MH

74M

H19

MH

44M

H28

MH

65M

H05

MH

63M

H71

MH

41M

H36

MH

09M

H24

MH

01M

H50

MH

02M

H57

MH

12M

H64

MH

56M

H53

MH

34M

H20

MH

17M

H15

MH

61M

H52

MH

04M

H21

MH

06M

H23

MH

67M

H84

MH

58M

H27

MH

43M

H03

Older adult teams - community caseload per 100,000 registered population

Participants reported the proportion of their caseloads on 31st March 2019 who had been seen for a face to face appointment during the 3 months prior to that date (1st January to 31st March 2019). Although there is variation between team types, the typical experience appears to be that most patients will have had a face to face contact during that time.

The figure below shows national average positions, while the charts on the following page show individual participant positions for three key team types: Generic CMHT, Early Intervention in Psychosis, and Older People. Other team types can be explored in the toolkit.

Page 49

Figure 42

Figure 43

Figure 44

100%

100%

100%

90%

87%

81%

78%

77%

76%

68%

67%

63%

60%

52%

Assertive Outreach

Early Intervention in Psychosis

Perinatal

Generic CMHT

Community rehabilitation

Eating Disorders

Older People

Forensic

Other community teams

Memory services

Assessment and Brief Intervention

Proportion of caseload with a F2F contact in previous 3 months

Yes No



Page 50

MH07: 90%

Mean: 78%

Median: 80%

Upper Q: 86%

Lower Q: 69%

Region:

Trusts:

Figure 42

MH07: 94%

Mean: 87%

Median: 93%

Upper Q: 96%

Lower Q: 89%

Region:

Trusts:

Figure 43

MH07: 80%

Mean: 68%

Median: 74%

Upper Q: 82%

Lower Q: 61%

Region:

Trusts:

Figure 44

0%

20%

40%

60%

80%

100%

MH

06M

H0

3M

H6

1M

H0

4M

H3

6M

H3

3M

H1

6M

H0

7M

H1

9M

H9

2M

H6

5M

H1

7M

H6

3M

H0

8M

H9

4M

H93

MH

72

MH

57

MH

02

MH

21

MH

41

MH

24

MH

28

MH

22

MH

20

MH

95

MH

25

MH

66

MH

27

MH

11

MH

55M

H1

5M

H3

7M

H7

1M

H5

2M

H6

0M

H4

3M

H1

0M

H7

4M

H4

5M

H2

3M

H5

3M

H5

4M

H1

2M

H6

9M

H44

MH

35

MH

42

Proportion of caseload on 31st March 2019 who had at least one face to face contact during previous 3 months - Generic

CMHT

0%

20%

40%

60%

80%

100%

MH

33M

H61

MH

36M

H59

MH

03M

H02

MH

94M

H60

MH

95M

H54

MH

10M

H04

MH

25M

H06

MH

21M

H07

MH

11M

H28

MH

16M

H18

MH

08M

H19

MH

27M

H66

MH

92M

H20

MH

22M

H52

MH

17M

H65

MH

42M

H72

MH

44M

H63

MH

15M

H37

MH

41M

H74

MH

23M

H93

MH

24M

H55

MH

45M

H53

MH

35M

H12

MH

68

Proportion of caseload on 31st March 2019 who had at least one face to face contact during previous 3 months - Early

Intervention

0%

20%

40%

60%

80%

100%

MH

36M

H12

MH

03M

H43

MH

21M

H94

MH

11M

H19

MH

06M

H17

MH

04M

H41

MH

28M

H93

MH

07M

H15

MH

57M

H16

MH

27M

H23

MH

02M

H20

MH

25M

H65

MH

92M

H24

MH

74M

H44

MH

33M

H08

MH

22M

H71

MH

60M

H45

MH

10M

H63

MH

66M

H95

MH

37M

H54

MH

69M

H55

MH

53M

H35

MH

68M

H72

MH

42

Proportion of caseload on 31st March 2019 who had at least one face to face contact during previous 3 months - Older

People

Page 51

Community contacts

MH07: 32,745

Mean: 31,095

Median: 30,522

Upper Q: 35,901

Lower Q: 23,536

Region:

Trusts:

Figure 45

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

MH

68M

H09

MH

84M

H74

MH

43M

H65

MH

85M

H93

MH

69M

H41

MH

08M

H92

MH

27M

H45

MH

32M

H53

MH

42M

H60

MH

10M

H06

MH

44M

H39

MH

18M

H55

MH

02M

H37

MH

94M

H07

MH

28M

H16

MH

54M

H66

MH

20M

H03

MH

34M

H40

MH

25M

H21

MH

01M

H70

MH

38M

H95

MH

57M

H35

MH

19M

H83

MH

52M

H33

MH

56M

H15

MH

05M

H26

MH

22M

H24

MH

23M

H11

MH

63M

H36

MH

51M

H72

MH

50M

H64

MH

71M

H04

MH

17M

H29

MH

59M

H58

Total community contacts per 100,000 registered population

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

Community contacts averaged 31,095 per 100,000 population in 2018/19. This compares to 30,817 the previous year. When viewing this data, it is useful for participants to consider the nature and duration of the contacts they offer, and how this may differ from other participants. Year to year comparisons of individual participants are also of value.

Page 52

MH07: 28,740

Mean: 31,145

Median: 30,899

Upper Q: 36,192

Lower Q: 22,785

Region:

Trusts:

Figure 46

MH07: 49,435

Mean: 32,207

Median: 30,799

Upper Q: 38,479

Lower Q: 21,932

Region:

Trusts:

Figure 47

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

MH

68M

H09

MH

84M

H43

MH

74M

H65

MH

93M

H92

MH

85M

H27

MH

03M

H18

MH

53M

H08

MH

42M

H10

MH

02M

H32

MH

41M

H60

MH

40M

H06

MH

94M

H44

MH

55M

H34

MH

70M

H95

MH

54M

H25

MH

16M

H57

MH

45M

H66

MH

20M

H38

MH

37M

H69

MH

21M

H07

MH

28M

H35

MH

39M

H52

MH

15M

H83

MH

19M

H05

MH

33M

H26

MH

23M

H24

MH

71M

H36

MH

22M

H72

MH

56M

H11

MH

01M

H63

MH

64M

H04

MH

50M

H51

MH

59M

H17

MH

29M

H58

Working age adult teams - community contacts per 100,000 registered population

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

MH

69M

H45

MH

09M

H01

MH

39M

H68

MH

41M

H28

MH

07M

H44

MH

37M

H32

MH

55M

H06

MH

08M

H93

MH

51M

H16

MH

65M

H19

MH

60M

H54

MH

56M

H66

MH

43M

H35

MH

74M

H42

MH

20M

H33

MH

11M

H22

MH

83M

H50

MH

21M

H53

MH

94M

H10

MH

27M

H02

MH

63M

H25

MH

38M

H92

MH

84M

H18

MH

24M

H70

MH

05M

H26

MH

34M

H23

MH

15M

H52

MH

95M

H36

MH

57M

H29

MH

64M

H40

MH

72M

H17

MH

04M

H71

MH

03Older adult teams - community contacts per 100,000

registered population

Page 53

Waiting times

5.2

7.1

5.4

3.7

3.7

3.1

2.9

2.9

2.7

1.2

6.5

3.6

3.0

3.8

3.6

2.8

2.9

2.8

2.0

0.9

0 2 4 6 8 10 12

Memory Services

Other Adult CMHTs

Forensic

Generic CMHT

Eating Disorders

Perinatal

Assessment & Brief Intervention (incl PMHT)

Older People

Assertive Outreach

Early Intervention (incl Early Onset Psychosis)

Median waiting time (weeks)

Referral to 1st appointment 1st appointment to 2nd appointment

Waiting times show notable variation by team type. The above chart details national average positions for each team and shows that the shortest waits are reported within Early Intervention in Psychosis teams. This is the only community pathway currently subject to waiting time targets in England. Longest waits are reported by Memory Services teams.

Participants can explore their individual positions in detail in the NHS Benchmarking Mental Health Toolkit.

Page 54

Early Intervention


Early Intervention referrals received per 100,000


Early Intervention caseload per 100,000


Early Intervention referral acceptance rate47% 80% 87%

Early Intervention teams contacts per patient on

the caseload34 35 33

Total staff working in Early Intervention per

100,000 registered population10 7 6

Length of time on Early Intervention team

caseload (months)6 14 11

Early Intervention team DNA rate11% 11% 11%

100

150

200

250

300

100%As the only part of adult mental health services currently subject to national waiting time standards, there continues to be a focus on Early Intervention in Psychosis services.

Participants report a continued growth in referrals to these services, from 57 per 100,000 population in 2013/14 to 71 in 2018/19. Referral rate data suggests this year's referral acceptance rate of 80% dips below the pattern seen from 2013/14 of rates between 81% and 83% and may signify the start of increases in thresholds for treatment as a response to rising demand.

Staff working in Early Intervention in Psychosis services have ranged from 5.7 to 7.1 WTE per 100,000 population in the past 5 years. This year's position is 6.6 WTE.

Page 55

MH07: 158

Mean: 83

Median: 71

Upper Q: 94

Lower Q: 51

Region:

Trusts:

Figure 48

MH07: 47%

Mean: 80%

Median: 87%

Upper Q: 93%

Lower Q: 72%

Region:

Trusts:

Figure 49

0

50

100

150

200

250

300

MH

59

MH

37

MH

26

MH

29

MH

74

MH

07

MH

08

MH

41

MH

10

MH

94

MH

11

MH

39

MH

09

MH

38

MH

44

MH

36

MH

56M

H4

0M

H4

2M

H3

4M

H3

2M

H6

1M

H6

3M

H9

5M

H0

2M

H6

8M

H6

0M

H2

8M

H2

0M

H1

8M

H24

MH

05

MH

03

MH

66

MH

53

MH

22

MH

65

MH

50

MH

17

MH

06

MH

25

MH

92

MH

23

MH

72

MH

93

MH

27

MH

35

MH

45M

H6

4M

H5

2M

H1

6M

H5

4M

H1

9M

H3

3M

H1

5M

H0

4M

H5

5M

H7

0

Early Intervention referrals received per 100,000 registered population

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

11M

H61

MH

17M

H64

MH

29M

H41

MH

63M

H25

MH

56M

H53

MH

70M

H05

MH

08M

H50

MH

19M

H35

MH

27M

H68

MH

40M

H20

MH

42M

H26

MH

59M

H74

MH

22M

H92

MH

15M

H10

MH

65M

H18

MH

38M

H16

MH

93M

H94

MH

36M

H60

MH

95M

H39

MH

23M

H02

MH

03M

H52

MH

55M

H54

MH

06M

H37

MH

45M

H72

MH

28M

H34

MH

44M

H09

MH

07M

H66

MH

24M

H32

MH

33M

H04

Early Intervention referral acceptance rate

100120140160180200

10

12

14

16

18

Page 56

MH07: 95

Mean: 65

Median: 57

Upper Q: 82

Lower Q: 40

Region:

Trusts:

Figure 50

MH07: 9.8

Mean: 6.6

Median: 6.0

Upper Q: 8.0

Lower Q: 4.3

Region:

Trusts:

Figure 51

020406080

100120140160180200

MH

10

MH

74

MH

59

MH

26

MH

11

MH

37

MH

29

MH

35

MH

94

MH

07

MH

95

MH

08

MH

40

MH

41

MH

53

MH

32

MH

66

MH

42

MH

65

MH

38

MH

39

MH

56

MH

44

MH

24

MH

51

MH

60

MH

21

MH

22

MH

12

MH

36

MH

23

MH

52

MH

06

MH

45

MH

61

MH

63

MH

28

MH

25

MH

55

MH

93

MH

34

MH

27

MH

18

MH

17

MH

92

MH

15

MH

72

MH

68

MH

02

MH

03

MH

04

MH

50

MH

54

MH

20

MH

64

MH

05

MH

33

MH

16

MH

19

MH

01

MH

70

MH

09

Early Intervention caseload per 100,000 registered population

0

2

4

6

8

10

12

14

16

18

MH

10M

H29

MH

59M

H74

MH

32M

H26

MH

72M

H07

MH

61M

H09

MH

40M

H38

MH

34M

H94

MH

37M

H41

MH

42M

H11

MH

12M

H21

MH

08M

H53

MH

65M

H56

MH

20M

H60

MH

25M

H06

MH

93M

H15

MH

44M

H92

MH

28M

H23

MH

03M

H36

MH

63M

H24

MH

17M

H04

MH

22M

H52

MH

64M

H35

MH

02M

H27

MH

50M

H33

MH

16M

H54

MH

95M

H55

MH

18M

H05

MH

45M

H51

MH

19M

H01

MH

67Total staff working in Early Intervention per 100,000

registered population

10

20

30

40

50

60

70

80

90

10%

12%

14%

16%

18%

20%

Page 57

MH07: 34

Mean: 35

Median: 33

Upper Q: 40

Lower Q: 27

Region:

Trusts:

Figure 52

MH07: 11%

Mean: 11%

Median: 11%

Upper Q: 13%

Lower Q: 9%

Region:

Trusts:

Figure 53

0

10

20

30

40

50

60

70

80

90

MH

68

MH

54

MH

10

MH

20

MH

06

MH

32M

H0

3M

H9

3M

H4

4M

H6

6M

H2

5M

H2

1M

H3

4M

H1

9M

H0

4M

H0

2M

H0

8M

H3

6M

H6

5M

H2

7M

H3

9M

H3

8M

H4

2M

H7

4M

H4

0M

H2

6M

H6

0M

H0

7M

H92

MH

64

MH

41

MH

28

MH

72

MH

50

MH

18

MH

52

MH

53

MH

05

MH

16

MH

37

MH

45

MH

23

MH

63

MH

94

MH

59

MH

56

MH

22

MH

15

MH

17

MH

33

MH

11

MH

95M

H5

5M

H2

4M

H3

5M

H2

9M

H7

0

Early Intervention teams contacts per patient on the caseload

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

MH

63M

H28

MH

02M

H65

MH

09M

H16

MH

37M

H92

MH

23M

H18

MH

39M

H42

MH

52M

H22

MH

64M

H11

MH

24M

H59

MH

45M

H15

MH

34M

H25

MH

94M

H05

MH

44M

H40

MH

36M

H07

MH

20M

H56

MH

04M

H41

MH

08M

H32

MH

95M

H38

MH

35M

H10

MH

19M

H06

MH

27M

H03

MH

93M

H66

MH

17M

H55

MH

21M

H60

MH

53M

H33

MH

50M

H54

Early Intervention team DNA rate

10

15

20

25

30

35

40

45

The 14 month average time on caseload per Early Intervention service differs from historic guidance on early intervention support, which typically focussed on a 3 year pathway.

Page 58

MH07: 6

Mean: 14

Median: 11

Upper Q: 14

Lower Q: 9

Region:

Trusts:

Figure 54

0

5

10

15

20

25

30

35

40

45

MH

68

MH

33

MH

10

MH

23

MH

37

MH

09

MH

41

MH

11

MH

20M

H1

8M

H5

2M

H4

0M

H3

5M

H6

6M

H6

5M

H5

6M

H9

3M

H5

3M

H06

MH

32

MH

04

MH

21

MH

61

MH

36

MH

54

MH

22

MH

16

MH

45

MH

39M

H7

4M

H2

5M

H2

4M

H9

5M

H3

4M

H1

9M

H9

4M

H3

8M

H9

2M

H27

MH

60

MH

17

MH

03

MH

28

MH

59

MH

02

MH

07

MH

64

MH

44

MH

63

Length of time on Early Intervention team caseload (months)


Page 59

Crisis care

MH07 Mean Median

Psychiatric liaison contacts per 100,000 registered

population... 1867 1506

National trend

CRHT face to face contacts per 100,000 registered


Total staff working in psychiatric liaison per

100,000 registered population8 6 6

Total staff working in CRHT teams per 100,000

registered population9.7 17.5 15.6

Section 136 Assessments per 100,000 registered

population98 83 80

10,000

12,000

10

15

20

25

30

35

40

45

There has been an upward trend in the number of Section 136 Assessments participants report, which reached 79 per 100,000 population in 2017/18. This year's figure is 83 per 100,000 population.

There has also been movement on the size of the workforce in both crisis team and psychiatric liaison settings.

Page 60

MH07: 2,933

Mean: 4,040

Median: 3,634

Upper Q: 4,880

Lower Q: 2,781

Region:

Trusts:

Figure 55

MH07: 10

Mean: 17

Median: 16

Upper Q: 22

Lower Q: 13

Region:

Trusts:

Figure 56

0

2,000

4,000

6,000

8,000

10,000

12,000

MH

68

MH

10

MH

52

MH

44

MH

43

MH

65

MH

11

MH

32

MH

03

MH

39

MH

34

MH

84

MH

42

MH

59

MH

74

MH

53

MH

66

MH

27

MH

85

MH

18

MH

28

MH

55

MH

64

MH

09

MH

57

MH

02

MH

71

MH

33

MH

35

MH

36

MH

70

MH

08

MH

25

MH

45

MH

23

MH

95

MH

22

MH

01

MH

54

MH

04

MH

94

MH

40

MH

38

MH

37

MH

07

MH

56

MH

93

MH

21

MH

41

MH

26

MH

15

MH

19

MH

20

MH

92

MH

24

MH

63

MH

72

MH

60

MH

06

MH

05

MH

16

MH

29

CRHT face to face contacts per 100,000 registered population

0

5

10

15

20

25

30

35

40

45

MH

71M

H83

MH

18M

H29

MH

43M

H84

MH

61M

H51

MH

59M

H03

MH

32M

H65

MH

11M

H57

MH

34M

H74

MH

35M

H42

MH

93M

H20

MH

01M

H44

MH

92M

H52

MH

10M

H04

MH

39M

H33

MH

27M

H02

MH

41M

H40

MH

28M

H58

MH

45M

H05

MH

64M

H25

MH

70M

H19

MH

08M

H67

MH

55M

H26

MH

23M

H21

MH

15M

H09

MH

16M

H38

MH

24M

H53

MH

22M

H94

MH

54M

H56

MH

12M

H36

MH

07M

H72

MH

60M

H95

MH

63M

H50

MH

37

Total staff working in CRHT teams per 100,000 registered population

10

12

14

16

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Page 61

MH07: ...

Mean: 1,867

Median: 1,506

Upper Q: 1,985

Lower Q: 1,080

Region:

Trusts:

Figure 57

MH07: 8

Mean: 6

Median: 6

Upper Q: 8

Lower Q: 4

Region:

Trusts:

Figure 58

0

2

4

6

8

10

12

14

16

MH

60M

H42

MH

08M

H34

MH

06M

H28

MH

09M

H11

MH

04M

H43

MH

74M

H32

MH

58M

H24

MH

27M

H07

MH

41M

H23

MH

65M

H01

MH

70M

H63

MH

18M

H55

MH

52M

H38

MH

22M

H54

MH

44M

H15

MH

94M

H02

MH

03M

H56

MH

20M

H10

MH

12M

H25

MH

19M

H92

MH

83M

H21

MH

05M

H93

MH

64M

H33

MH

59M

H53

MH

36M

H84

MH

17M

H16

MH

37M

H51

MH

61M

H95

MH

26

Total staff working in psychiatric liaison per 100,000 registered population

100

150

200

250

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

MH

83

MH

08

MH

28

MH

43

MH

26

MH

27

MH

10

MH

55

MH

37

MH

09

MH

70

MH

52

MH

25

MH

65

MH

23

MH

38

MH

22

MH

01

MH

95

MH

60

MH

39

MH

32

MH

20

MH

35

MH

58

MH

92

MH

06

MH

15

MH

66

MH

02

MH

41

MH

24

MH

33

MH

12

MH

04

MH

16

MH

53

MH

19

MH

93

MH

34

MH

36

MH

64

MH

68

Psychiatric liaison contacts per 100,000 registered population

Page 62

MH07: 98

Mean: 83

Median: 80

Upper Q: 104

Lower Q: 55

Region:

Trusts:

Figure 59

0

50

100

150

200

250

MH

11

MH

67

MH

43

MH

25

MH

66

MH

41

MH

21

MH

57

MH

03

MH

01

MH

59

MH

92

MH

12

MH

51

MH

26

MH

06

MH

58

MH

07

MH

19

MH

02

MH

38

MH

32

MH

18

MH

35

MH

60

MH

74

MH

33

MH

27

MH

40

MH

55

MH

22

MH

54

MH

50

MH

10

MH

65

MH

24

MH

37

MH

08

MH

17

MH

61

MH

45

MH

15

MH

53

MH

23

MH

20

MH

04

MH

94

MH

95

MH

56

MH

71

MH

36

MH

28

Section 136 Assessments per 100,000 registered population

Page 63

Community clustering


Community caseload - Clusters 1-8 19% 39% 39%


Community contacts - Clusters 1-8 31% 40% 40%

Community caseload - Cluster 17 1% 2% 1%



Community contacts - Cluster 17 1% 3% 3%


10%

20%

30%

40%

50%

60%

70%

10%

20%

30%

40%

50%

60%

70%

There continues to be disparity between the proportion of caseload in each cluster and the intensity of provision (contact rates) to these cohorts. In particular, older people in clusters 18 - 21 represent 28% of total community caseloads, but receive 16% of total community contacts. The overall level of delivery to patients in clusters 18-21 has shown a decline in recent years. The share of caseload delivered to clusters 1-17 has increased over this period. Psychosis clusters 10-16 have shown the largest increase in share of total activity.

Page 64

MH07: 19%

Mean: 39%

Median: 39%

Upper Q: 46%

Lower Q: 31%

Region:

Trusts:

Figure 60

MH07: 31%

Mean: 40%

Median: 40%

Upper Q: 47%

Lower Q: 35%

Region:

Trusts:

Figure 61

0%

10%

20%

30%

40%

50%

60%

70%

MH

43

MH

27

MH

36

MH

60

MH

15

MH

40

MH

56

MH

65

MH

29M

H9

5M

H2

1M

H2

0M

H1

2M

H0

6M

H6

1M

H0

3M

H1

0M

H24

MH

54

MH

32

MH

92

MH

64

MH

18

MH

28

MH

25

MH

02

MH

94M

H5

2M

H7

2M

H0

9M

H0

4M

H2

3M

H4

1M

H0

8M

H5

7M

H53

MH

33

MH

05

MH

93

MH

19

MH

22

MH

63

MH

38

MH

37

MH

39M

H3

4M

H4

4M

H6

6M

H4

5M

H4

2M

H3

5M

H7

4M

H0

7M

H11

Community caseload - Clusters 1-8

10%

20%

30%

40%

50%

60%

70%

0%

10%

20%

30%

40%

50%

60%

70%

MH

27M

H33

MH

92M

H40

MH

60M

H25

MH

02M

H20

MH

36M

H54

MH

43M

H18

MH

21M

H03

MH

06M

H19

MH

53M

H08

MH

93M

H15

MH

72M

H05

MH

45M

H95

MH

57M

H39

MH

22M

H04

MH

66M

H24

MH

32M

H28

MH

09M

H10

MH

23M

H94

MH

41M

H34

MH

52M

H56

MH

38M

H07

MH

42M

H65

MH

63M

H44

MH

35M

H37

MH

74M

H11

Community contacts - Clusters 1-8

10%

20%

30%

40%

50%

60%

70%

Page 65

MH07: 23%

Mean: 32%

Median: 31%

Upper Q: 39%

Lower Q: 23%

Region:

Trusts:

Figure 62

MH07: 46%

Mean: 41%

Median: 40%

Upper Q: 51%

Lower Q: 32%

Region:

Trusts:

Figure 63

0%

10%

20%

30%

40%

50%

60%

70%

MH

44

MH

23

MH

94

MH

09

MH

52

MH

11

MH

35

MH

74

MH

34M

H3

7M

H9

5M

H2

9M

H5

3M

H3

8M

H6

5M

H2

1M

H6

4M

H41

MH

22

MH

42

MH

57

MH

06

MH

24

MH

10

MH

45

MH

04

MH

15M

H7

2M

H2

8M

H2

0M

H6

1M

H0

3M

H1

2M

H3

6M

H2

7M

H43

MH

60

MH

25

MH

56

MH

07

MH

08

MH

63

MH

40

MH

19

MH

33M

H0

5M

H6

6M

H3

2M

H1

8M

H5

4M

H9

2M

H3

9M

H9

3M

H02


0%

1%

2%

3%

4%

5%

6%

0%

10%

20%

30%

40%

50%

60%

70%

MH

65M

H74

MH

23M

H44

MH

35M

H37

MH

11M

H94

MH

52M

H38

MH

95M

H56

MH

09M

H34

MH

42M

H05

MH

32M

H07

MH

22M

H53

MH

10M

H41

MH

43M

H72

MH

24M

H57

MH

21M

H28

MH

06M

H36

MH

45M

H03

MH

60M

H20

MH

66M

H18

MH

40M

H02

MH

92M

H08

MH

54M

H25

MH

93M

H19

MH

15M

H04

MH

27M

H33

MH

63M

H39


10%

12%

14%

Page 66

MH07: 0.5%

Mean: 1.6%

Median: 1.3%

Upper Q: 2.1%

Lower Q: 0.8%

Region:

Trusts:

Figure 64

MH07: 1.2%

Mean: 2.9%

Median: 2.6%

Upper Q: 3.6%

Lower Q: 1.4%

Region:

Trusts:

Figure 65

0%

1%

2%

3%

4%

5%

6%

MH

63

MH

34

MH

09

MH

10

MH

08

MH

27

MH

29

MH

35

MH

94

MH

53

MH

45

MH

37M

H1

1M

H4

0M

H6

6M

H5

7M

H9

3M

H2

4M

H4

1M

H0

3M

H7

4M

H4

3M

H1

5M

H7

2M

H65

MH

36

MH

33

MH

18

MH

42

MH

39

MH

54

MH

22

MH

56

MH

92

MH

38

MH

12

MH

28

MH

61M

H2

3M

H0

6M

H6

0M

H2

5M

H0

2M

H9

5M

H0

4M

H0

5M

H5

2M

H6

4M

H0

7M

H2

1M

H44

MH

19

MH

32

MH

20

Community caseload - Cluster 17

10%

20%

30%

40%

50%

60%

70%

0%

2%

4%

6%

8%

10%

12%

14%

MH

10M

H93

MH

11M

H57

MH

63M

H08

MH

66M

H74

MH

03M

H35

MH

24M

H40

MH

09M

H37

MH

04M

H27

MH

34M

H36

MH

43M

H18

MH

05M

H54

MH

72M

H45

MH

53M

H92

MH

02M

H60

MH

65M

H94

MH

41M

H33

MH

22M

H42

MH

38M

H56

MH

23M

H28

MH

07M

H06

MH

15M

H95

MH

39M

H19

MH

20M

H21

MH

25M

H52

MH

44M

H32

Community contacts - Cluster 17

10%

20%

30%

40%

50%

60%

Page 67

MH07: 57%

Mean: 28%

Median: 27%

Upper Q: 38%

Lower Q: 19%

Region:

Trusts:

Figure 66

MH07: 21%

Mean: 16%

Median: 14%

Upper Q: 19%

Lower Q: 11%

Region:

Trusts:

Figure 67

0%

10%

20%

30%

40%

50%

60%

70%

MH

07

MH

66

MH

39

MH

93

MH

19

MH

05

MH

02

MH

33

MH

63M

H4

5M

H0

8M

H4

2M

H1

8M

H9

2M

H3

2M

H5

4M

H2

5M

H22

MH

11

MH

04

MH

38

MH

74

MH

72

MH

28

MH

57

MH

41

MH

35M

H4

0M

H0

3M

H5

6M

H6

1M

H3

7M

H1

2M

H3

4M

H5

3M

H60

MH

20

MH

24

MH

64

MH

10

MH

06

MH

15

MH

36

MH

21

MH

44M

H6

5M

H2

7M

H5

2M

H2

3M

H0

9M

H9

5M

H4

3M

H2

9M

H94


0%

10%

20%

30%

40%

50%

60%

MH

63M

H39

MH

04M

H15

MH

19M

H28

MH

66M

H07

MH

41M

H42

MH

93M

H25

MH

45M

H08

MH

54M

H24

MH

33M

H32

MH

18M

H06

MH

02M

H20

MH

03M

H27

MH

22M

H57

MH

60M

H92

MH

21M

H72

MH

56M

H44

MH

11M

H37

MH

34M

H38

MH

36M

H40

MH

10M

H52

MH

35M

H74

MH

09M

H53

MH

43M

H05

MH

94M

H65

MH

95M

H23


Page 68

Workforce

MH07 Mean Median

Adult acute consultant psychiatrists per 10 beds0.6 0.6 0.5

Older adult consultant psychiatrists per 10 beds0.3 0.4 0.4

Adult acute registered nurses per 10 beds10.7 8.2 8.0

Older adult registered nurses per 10 beds9.6 8.1 7.7

Adult acute staff sickness / absence %8% 6% 6%

Adult acute staff turnover %6% 12% 11%

Adult acute WTE vacancies as % of staff in post4% 17% 15%

Adult acute spend on Bank and Agency (as a % of

total spend on staffing)36% 23% 23%

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

Inpatient workforce rates are relatively stable, and consistently report rates equivalent to one consultant psychiatrist per ward (typically 18 - 22 beds).

Page 69

MH07: 0.6

Mean: 0.6

Median: 0.5

Upper Q: 0.6

Lower Q: 0.4

Region:

Trusts:

Figure 68

MH07: 0.3

Mean: 0.4

Median: 0.4

Upper Q: 0.5

Lower Q: 0.3

Region:

Trusts:

Figure 69

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

MH

54

MH

11

MH

65M

H8

3M

H0

1M

H5

8M

H2

0M

H1

7M

H0

8M

H29

MH

28

MH

59

MH

27

MH

16

MH

44

MH

41

MH

93M

H1

0M

H2

1M

H6

1M

H3

5M

H7

4M

H2

3M

H0

7M

H0

3M

H7

0M

H3

3M

H5

0M

H3

6M

H9

2M

H6

7M

H0

5M

H0

2M

H4

5M

H4

3M

H1

8M

H8

4M

H7

1M

H2

4M

H64

MH

09

MH

22

MH

06

MH

56

MH

52

MH

38

MH

12M

H3

7M

H3

2M

H6

9M

H1

5M

H5

1M

H4

0M

H1

9M

H2

5M

H3

4M

H5

7M

H6

0M

H0

4M

H9

4

Adult acute consultant psychiatrists per 10 beds

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

MH

58M

H36

MH

41M

H65

MH

74M

H25

MH

18M

H84

MH

11M

H70

MH

61M

H16

MH

08M

H32

MH

09M

H20

MH

33M

H59

MH

44M

H17

MH

64M

H02

MH

22M

H71

MH

10M

H43

MH

35M

H28

MH

24M

H40

MH

15M

H19

MH

05M

H67

MH

27M

H55

MH

03M

H38

MH

01M

H07

MH

50M

H51

MH

34M

H37

MH

45M

H23

MH

52M

H57

MH

21M

H54

MH

83M

H92

MH

93M

H29

MH

56M

H60

MH

26

Older adult consultant psychiatrists per 10 beds

10

15

20

25

10

12

14

16

18

20

Page 70

MH07: 10.7

Mean: 8.2

Median: 8.0

Upper Q: 8.9

Lower Q: 6.7

Region:

Trusts:

Figure 70

MH07: 9.6

Mean: 8.1

Median: 7.7

Upper Q: 8.5

Lower Q: 6.7

Region:

Trusts:

Figure 71

0

5

10

15

20

25

MH

44

MH

85

MH

25

MH

65

MH

84

MH

83

MH

07

MH

09

MH

71

MH

60

MH

70

MH

16

MH

54

MH

05

MH

67

MH

59

MH

95

MH

10

MH

02

MH

23

MH

21

MH

36

MH

51

MH

17

MH

34M

H5

3M

H4

1M

H9

4M

H52

MH

43

MH

55

MH

03

MH

61

MH

24

MH

20

MH

63

MH

58

MH

15

MH

32

MH

28

MH

01

MH

92

MH

56

MH

29

MH

42

MH

06

MH

19

MH

22

MH

33

MH

35

MH

39

MH

57

MH

18

MH

74M

H6

9M

H3

8M

H6

4M

H04

MH

12

MH

11

MH

08

MH

27

MH

50

MH

93

MH

40

MH

26

MH

37

MH

45

Adult acute registered nurses per 10 beds

0

2

4

6

8

10

12

14

16

18

20

MH

25M

H61

MH

43M

H83

MH

38M

H84

MH

18M

H94

MH

65M

H07

MH

54M

H09

MH

53M

H19

MH

06M

H34

MH

32M

H93

MH

17M

H56

MH

44M

H02

MH

52M

H71

MH

67M

H28

MH

15M

H33

MH

41M

H55

MH

42M

H74

MH

39M

H45

MH

03M

H58

MH

16M

H05

MH

69M

H59

MH

01M

H22

MH

04M

H29

MH

26M

H27

MH

23M

H20

MH

95M

H08

MH

64M

H63

MH

36M

H92

MH

51M

H35

MH

70M

H50

MH

40M

H57

MH

24M

H11

MH

10M

H60

MH

37M

H12

MH

21

Older adult registered nurses per 10 beds

10%

12%

10%

15%

20%

25%

Page 71

MH07: 8%

Mean: 6%

Median: 6%

Upper Q: 7%

Lower Q: 5%

Region:

Trusts:

Figure 72

MH07: 6%

Mean: 12%

Median: 11%

Upper Q: 15%

Lower Q: 8%

Region:

Trusts:

Figure 73

0%

2%

4%

6%

8%

10%

12%

MH

65

MH

45

MH

40

MH

58

MH

41

MH

56

MH

84

MH

07M

H9

2M

H4

4M

H1

6M

H3

7M

H0

1M

H7

4M

H0

3M

H5

9M

H5

7M

H9

4M

H9

3M

H2

9M

H2

4M

H3

8M

H6

7M

H8

3M

H2

8M

H3

2M

H0

8M

H3

4M

H43

MH

42

MH

04

MH

53

MH

26

MH

22

MH

70

MH

23

MH

27

MH

06

MH

10

MH

15

MH

60

MH

05

MH

19

MH

18

MH

55

MH

17

MH

12

MH

33

MH

11

MH

36M

H02

MH

64

MH

51

MH

25

MH

21

MH

52

MH

95

MH

63

MH

54

MH

20

MH

69

MH

35

MH

71

MH

50

Adult acute staff sickness / absence %

0%

5%

10%

15%

20%

25%

MH

33M

H45

MH

69M

H03

MH

22M

H35

MH

20M

H02

MH

95M

H74

MH

50M

H06

MH

34M

H04

MH

94M

H24

MH

71M

H21

MH

23M

H11

MH

25M

H17

MH

52M

H64

MH

56M

H40

MH

37M

H58

MH

15M

H83

MH

27M

H12

MH

53M

H60

MH

01M

H05

MH

92M

H93

MH

44M

H29

MH

32M

H10

MH

57M

H08

MH

51M

H43

MH

55M

H67

MH

18M

H84

MH

42M

H54

MH

36M

H65

MH

38M

H19

MH

07M

H63

MH

70M

H28

MH

16M

H26

MH

41M

H59

Adult acute staff turnover %

10%15%20%25%30%35%40%45%50%

10%

20%

30%

40%

50%

60%

70%

80%

Page 72

MH07: 4%

Mean: 17%

Median: 15%

Upper Q: 21%

Lower Q: 11%

Region:

Trusts:

Figure 74

MH07: 36%

Mean: 23%

Median: 23%

Upper Q: 28%

Lower Q: 17%

Region:

Trusts:

Figure 75

0%5%

10%15%20%25%30%35%40%45%50%

MH

45M

H69

MH

17M

H25

MH

07M

H29

MH

52M

H34

MH

21M

H03

MH

63M

H40

MH

50M

H09

MH

04M

H44

MH

36M

H95

MH

53M

H22

MH

37M

H35

MH

74M

H15

MH

93M

H65

MH

64M

H33

MH

24M

H41

MH

26M

H54

MH

57M

H18

MH

23M

H10

MH

05M

H27

MH

56M

H58

MH

02M

H20

MH

84M

H94

MH

61M

H85

MH

92M

H60

MH

83M

H39

MH

11M

H67

MH

08M

H42

MH

32M

H19

MH

51M

H55

MH

06M

H66

MH

28M

H01

MH

16M

H59

MH

12M

H70

MH

38M

H71

MH

43


0%

10%

20%

30%

40%

50%

60%

70%

80%

MH

45

MH

69

MH

04M

H3

3M

H0

3M

H1

7M

H2

6M

H5

5M

H5

0M

H6

3M

H5

2M

H1

8M

H6

4M

H3

5M

H9

5M

H1

2M

H1

0M

H6

7M

H2

4M

H2

5M

H1

5M

H4

0M

H2

3M

H2

2M

H5

6M

H4

1M

H2

1M

H5

7M

H1

1M

H6

1M

H7

1M

H6

0M

H2

7M

H5

4M

H3

4M

H8

5M

H1

9M

H3

6M

H4

4M

H0

2M

H8

4M

H2

0M

H8

3M

H5

3M

H3

7M

H16

MH

28

MH

01

MH

43

MH

94

MH

32

MH

42

MH

07M

H0

8M

H6

5M

H7

4M

H3

8M

H0

5

Adult acute WTE vacancies as % of staff in post

Page 73

Community workforce

MH07 Mean Median

MH07: 78

Mean: 84

Median: 80

Upper Q: 97

Lower Q: 73

Region:

Trusts:

Figure 76

Community total WTE per 100,000 registered

population (age 16+)77.6 83.8 80.3

0

20

40

60

80

100

120

140

MH

01M

H74

MH

71M

H18

MH

28M

H58

MH

32M

H51

MH

43M

H55

MH

94M

H16

MH

83M

H09

MH

93M

H35

MH

41M

H59

MH

92M

H65

MH

42M

H66

MH

08M

H56

MH

37M

H95

MH

15M

H05

MH

06M

H11

MH

70M

H84

MH

60M

H39

MH

29M

H24

MH

69M

H27

MH

02M

H53

MH

67M

H07

MH

72M

H21

MH

34M

H57

MH

61M

H10

MH

12M

H20

MH

38M

H40

MH

03M

H45

MH

44M

H64

MH

36M

H17

MH

33M

H19

MH

23M

H22

MH

63M

H04

MH

25M

H52

MH

26M

H50

MH

54

Community total WTE per 100,000 registered population (age 16+)

The largest determining factor in how many people can be supported in the community is the size of the community workforce. The chart below shows the total community workforce across all team types, benchmarked per 100,000 population age 16+. This figure has shown a reduction in recent years, but 2018/19 saw a marginal increase in total capacity.

Page 74

Peer support workers

MH07: ...

Mean: 0.2

Median: 0.1

Upper Q: 0.4

Lower Q: 0.0

Region:

Trusts:

Figure 77

MH07: 0.7

Mean: 0.6

Median: 0.6

Upper Q: 0.7

Lower Q: 0.3

Region:

Trusts:

Figure 78

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

MH

64

MH

84

MH

83

MH

63

MH

24

MH

27

MH

44

MH

20

MH

23

MH

16

Adult acute peer support workers (paid) per 10 beds

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

MH

24

MH

63

MH

44

MH

15

MH

64

MH

07

MH

18

MH

84

MH

92

MH

08

MH

02

MH

03

MH

65

MH

33

MH

54

MH

16

MH

23

Community - peer support workers (paid) per 100,000 registered population (age 16+)

The inclusion of paid peer support workers within the workforce has gained momentum in recent years, but numbers are still small and most organisations reported they did not have paid peer support workers in post in their adult acute wards, or within their community teams.

Page 75

Finance


Adult acute cost per bed 152,880£ 144,837£ 143,196£

Generic CMHT cost per patient on the caseload 3,190£ 3,294£ 3,050£

Older adult cost per bed 141,007£ 154,000£ 151,744£

£100,000

£150,000

£200,000

£250,000

£100,000

£150,000

£200,000

£250,000

£300,000

£350,000

Average bed costs have risen steadily over the last 6 years, from £113,055 in 2012/13 to £140,182 in 2017/18. This year's position exceeds this, at £144,837 per adult acute bed, per annum.

Similarly, older adult bed costs have risen from £113,565 in 2012/13 to £134,949 in 2017/18. This year, the figure reached £154,000.

Factors contributing to increases in bed costs may include staffing levels and workforce pay increases and use of bank and agency staff, along with estate and other corporate costs.

Although community costs are lower, these too have seen a rise in recent years. Cost per patient on a Generic CMHT caseload was £2,702 in 2012/13. This rose to £3,367 in 2017/18. This year's figure is £3,294.

Page 76

MH07: £152,880

Mean: £144,837

Median: £143,196

Upper Q: £155,384

Lower Q: £130,804

Region:

Trusts:

Figure 79

MH07: £141,007

Mean: £154,000

Median: £151,744

Upper Q: £170,959

Lower Q: £134,658

Region:

Trusts:

Figure 80

£0

£50,000

£100,000

£150,000

£200,000

£250,000

MH

59M

H69

MH

15M

H65

MH

45M

H21

MH

17M

H20

MH

39M

H25

MH

09M

H41

MH

37M

H50

MH

92M

H05

MH

85M

H67

MH

16M

H07

MH

95M

H52

MH

40M

H23

MH

54M

H63

MH

02M

H56

MH

11M

H22

MH

04M

H06

MH

34M

H35

MH

27M

H33

MH

70M

H10

MH

36M

H12

MH

83M

H93

MH

32M

H94

MH

43M

H64

MH

24M

H26

MH

71M

H01

MH

28M

H18

MH

44M

H60

MH

42M

H53

MH

08M

H03

MH

58M

H51

MH

84M

H19

MH

74M

H29

MH

66M

H61

MH

38

Adult acute cost per bed

£0

£50,000

£100,000

£150,000

£200,000

£250,000

£300,000

£350,000

MH

44M

H61

MH

93M

H41

MH

06M

H12

MH

45M

H52

MH

56M

H65

MH

67M

H15

MH

18M

H26

MH

38M

H25

MH

22M

H17

MH

39M

H08

MH

59M

H02

MH

94M

H32

MH

92M

H42

MH

66M

H19

MH

43M

H37

MH

54M

H20

MH

51M

H33

MH

16M

H40

MH

50M

H11

MH

34M

H74

MH

10M

H09

MH

28M

H04

MH

07M

H27

MH

95M

H35

MH

05M

H36

MH

23M

H71

MH

24M

H83

MH

53M

H03

MH

58M

H64

MH

69M

H29

MH

63M

H01

MH

21M

H70

MH

84M

H60

Older adult cost per bed

£1,000

£2,000

£3,000

£4,000

£5,000

£6,000

£7,000

£8,000

£9,000

Page 77

MH07: £3,190

Mean: £3,294

Median: £3,050

Upper Q: £4,109

Lower Q: £2,294

Region:

Trusts:

Figure 81

£0

£1,000

£2,000

£3,000

£4,000

£5,000

£6,000

£7,000

£8,000

£9,000

MH

17M

H71

MH

65M

H53

MH

69M

H01

MH

92M

H09

MH

93M

H20

MH

19M

H34

MH

37M

H21

MH

50M

H94

MH

28M

H42

MH

41M

H39

MH

66M

H22

MH

15M

H27

MH

23M

H64

MH

02M

H07

MH

32M

H08

MH

56M

H44

MH

95M

H67

MH

84M

H11

MH

38M

H43

MH

33M

H35

MH

12M

H61

MH

16M

H25

MH

52M

H45

MH

74M

H05

MH

54M

H24

MH

29M

H83

MH

59M

H03

MH

10M

H36

MH

58M

H40

MH

26M

H60

MH

70


Page 78

Quality


Community Teams Patient Satisfaction Score66% 68% 69%

NHS Friends and Family Test (FFT) Patient

Satisfaction Score 98% 87% 90%

100%

100%

The CQC undertake surveys to find out the experience of people who receive care and treatment. One of these covers community mental health teams and reports a position of people whose view was that overall they had a good experience of community mental health services. This year, the average position reported was 68%, taking it below the levels seen in the last 7 years (between 69% and 73%).

The NHS Friends and Family Test was created to help service providers and commissioners understand whether their patients are happy with the service provided, or where improvements are needed. It includes a number of measures of patient and staff satisfaction. This year, participants reported an average patient satisfaction score of 87%.

Page 79

MH07: 66%

Mean: 68%

Median: 69%

Upper Q: 71%

Lower Q: 67%

Region:

Trusts:

Figure 82

MH07: 98%

Mean: 87%

Median: 90%

Upper Q: 92%

Lower Q: 85%

Region:

Trusts:

Figure 83

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

24M

H18

MH

05M

H20

MH

03M

H92

MH

93M

H04

MH

33M

H38

MH

53M

H12

MH

37M

H17

MH

22M

H40

MH

74M

H28

MH

66M

H10

MH

29M

H63

MH

11M

H56

MH

06M

H57

MH

26M

H64

MH

72M

H44

MH

27M

H21

MH

15M

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Page 80

Incidents


Adult acute restraint per 10,000 occupied bed

days187 103 98

Older adult restraint per 10,000 occupied bed

days112 85 65

Adult acute prone restraint per 10,000 occupied

bed days1 17 11

PICU restraint per 10,000 occupied bed days354 476 426

Older adult prone restraint per 10,000 occupied

bed days1 2 1

PICU prone restraint per 10,000 occupied bed

days3 91 74

100

150

200

250

10

20

30

40

50

60

70Incident rates provide another perspective on the quality of a service, by flagging any areas of concern in an inpatient environment. Because of the differences in patient cohort between services, this data is disaggregated to ward type. The charts on the following page show positions for adult acute, older adult and PICU wards. Participants can explore their positions for all other bed types in the NHS Benchmarking Network Mental Health Toolkit.

Participants have reported clear reductions in use of prone restraint in the last three years.

Page 81

MH07: 187

Mean: 103

Median: 98

Upper Q: 131

Lower Q: 73

Region:

Trusts:

Figure 84

MH07: 1

Mean: 17

Median: 11

Upper Q: 24

Lower Q: 7

Region:

Trusts:

Figure 85

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Page 82

MH07: 112

Mean: 85

Median: 65

Upper Q: 110

Lower Q: 33

Region:

Trusts:

Figure 86

MH07: 1

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Figure 87

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Older adult prone restraint per 10,000 occupied bed days

1,000

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Page 83

MH07: 354

Mean: 476

Median: 426

Upper Q: 599

Lower Q: 287

Region:

Trusts:

Figure 88

MH07: 3

Mean: 91

Median: 74

Upper Q: 127

Lower Q: 23

Region:

Trusts:

Figure 89

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Page 84

Balance of Care

Community

MH07: 49.1%

Mean: 53.2%

Median: 53.3%

Hospital

MH07: 50.9%

Mean: 46.8%

Median: 46.7%

Figure 90

Community

MH07: 90.6%

Mean: 85.7%

Median: 86.8%

Hospital

MH07: 9.4%

Mean: 14.3%

Median: 13.2%

Figure 91

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Balance of Financial Investment

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Balance of Activity

There have been small but sustained changes in the balance between inpatient and community services in recent years.

The balance of financial investment has seen a marginal increase in spend on community services as a proportion of overall investment. This year's figure of 53% represents the 5th annual increase, however the pace of change is slow, and the figure in 2013/14 was 51%.

The balance of workforce has continued to move in the opposite direction, likely as a result of safer staffing initiatives dictating minimum levels for inpatient environments (a noticeable increase took place in 2014/15). In 2013/14, participants reported 39% of their workforce was based in a community setting. This has increased to 48% this year, the highest figure reported over the last 6 years.

Page 85

Community

MH07: 55.4%

Mean: 51.6%

Median: 52.5%

Hospital

MH07: 44.6%

Mean: 48.4%

Median: 47.5%

Figure 92

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Balance of Workforce

Page 86

Conclusion

The NHS Benchmarking Network are delighted to publish the 2019 edition of our mental health benchmarking report. The report provides a state of the nation view of NHS specialist mental health services.

We would like to express our thanks to all contributors in the 2019 UK mental health benchmarking process which has again revealed interesting findings for the NHS. The depth and breadth of the data helps to generate confidence in the comparisons discussed in this report. Due to the consistent positions of many data items the focus on interpreting the data has shifted in many places to one of describing time-series changes in the data observed over the last 8 years of annual benchmarking. The 8-year benchmarking horizon allows firm conclusions to be made about overall trends in service demand and provision across the UK over this period.

The discussion of findings often begins with inpatient care and the debate around bed numbers. Data from 2018/19 shows a further stabilisation in capacity for Adult services and a slow down in the rate of bed reductions for inpatient Older People’s care.

Admission rates to Adult services have been reducing steadily over recent years, and this year participants reported a further reduction in capacity in this area in conjunction with an increase in length of stay.

Bed occupancy across most inpatient bed types is now high, with Adult Acute, Older People, PICU, Low Secure, Medium Secure and High Dependency Rehabilitation beds all averaging above the 85% target suggested by RCPsych and the CQC. The only areas where bed occupancy is notably below this level are CAMHS and Mother and Baby.

Each year our benchmarking results reaffirm the position that most service users receive their care in the community setting. Although increases in caseload size for both adult and older adult teams were reported in 2018/19, it should be noted that this year’s data set includes representation from all Health and Social Care Trusts in Northern Ireland for the first time. Northern Irish providers typically provide greater levels of community support per capita than peers in England. The background rate for England this year appears static, though this should be considered in the context of IAPT services which continue to grow and now support around 1.1 million people per annum in England.

Waiting times for community services show much variation by team, with most rapid access provided by Early Intervention in Psychosis and Assertive Outreach services. For Generic CMHTs, the median referral to treatment time is now 7.5 weeks.

The mental health workforce in 2018/19 demonstrates many of the characteristics evident in previous years’ data with providers relying on high levels of bank and agency staff in the inpatient environment. Variations are evident in workforce size and shape which link closely to wider trends in the UK labour market. The gradual switch of registered to unregistered nursing posts also continues.

Analysis of service quality metrics reveals a stable position across most providers. Data from the Friends and Family test in England confirms that 87% of service users say they would recommend services to their friends and family. Analysis of service quality metrics reveals a commitment to transparency in reporting of adverse incidents. Further reductions in the use of prone restraint are particularly pleasing as is a potential “topping out” in the overall level of use of restrictive interventions.

One of the central themes of the benchmarking work is to encourage providers to explore the balance of care between inpatient services and community care. Providers are encouraged to consider how best to ensure an appropriate balance of care between acute and community services. Data on the deployment of the mental health workforce and associated investment confirms an approximately equal split between bed and communitybenchmarking data by reference to key metrics including; waiting times to access community based care and scale of community offer, extent of use of out of area acute beds, and perceptions of service quality reported by service users and carers.

It is an ongoing privilege for the NHS Benchmarking Network to be able to analyse data from member organisations. We hope that the process is a rewarding one for members that provides crucial intelligence for both local assurance and strategy development processes. We look forward to the opportunity to discuss this year’s benchmarking findings with members at our annual mental health benchmarking conference in London on 16th October 2019.

Further comments or questions on any aspect of this report should be addressed to either Stephen Watkins or Zoe Morris on [email protected] or [email protected]

Page 87



One of the central themes of the benchmarking work is to encourage providers to explore the balance of care between inpatient services and community care. Providers are encouraged to consider how best to ensure an appropriate balance of care between acute and community services. Data on the deployment of the mental health workforce and associated investment confirms an approximately equal split between bed and community-based services. The ability to achieve an appropriate system balance can be tested in the benchmarking data by reference to key metrics including; waiting times to access community based care and scale of community offer, extent of use of out of area acute beds, and perceptions of service quality reported by service users and carers.



Page 88

Index of charts

Figure 1 - Adult acute beds per 100,000 registered population

Figure 2 - Adult acute bed occupancy excluding leave

Figure 3 - Adult acute bed occupancy including leave

Figure 4 - Adult acute admissions per 100,000 registered population

Figure 5 - Adult acute admissions - patients not previously known to services

Figure 6 - Adult acute admissions - patients of no fixed abode (as a % of all patients admitted)

Figure 7 - Adult acute length of stay excluding leave

Figure 8 - Adult acute length of stay including leave

Figure 9 - Proportion of patients discharged with length of stay 0-3 days

Figure 10 - Proportion of patients discharged with length of stay 90 days or longer

Figure 11 - Adult acute admissions under the Mental Health Act

Figure 12 - Adult acute admissions under the Mental Health Act per 100,000 registered population

Figure 13 - Adult acute mean length of stay for Mental Health Act detentions

Figure 14 - Adult acute delayed transfers of care

Figure 15 - Adult acute emergency readmissions

Figure 16 - Older adult beds per 100,000 registered population

Figure 17 - Older adult bed occupancy excluding leave

Figure 18 - Older adult bed occupancy including leave

Figure 19 - Older adult admissions per 100,000 registered population

Figure 20 - Older adult length of stay excluding leave

Figure 21 - Older adult length of stay including leave

Figure 22 - Older adult delayed transfers of care

Figure 23 - Older adult emergency readmissions

Figure 24 - PICU length of stay excluding leave

Figure 25 - PICU bed occupancy excluding leave

Figure 26 - Eating Disorders length of stay excluding leave

Figure 27 - Eating Disorders bed occupancy excluding leave

Figure 28 - Low Secure length of stay excluding leave

Figure 29 - Low Secure bed occupancy excluding leave

Figure 30 - Medium Secure length of stay excluding leave

Figure 31 - Medium Secure bed occupancy excluding leave

Figure 32 - High Dependency Rehabilitation length of stay excluding leave

Figure 33 - High Dependency Rehabilitation bed occupancy excluding leave

Figure 34 - Longer Term Complex / Continuing Care length of stay excluding leave

Figure 35 - Longer Term Complex / Continuing Care bed occupancy excluding leave

Figure 36 - Occupied bed days - clusters 1-8



Figure 39 - Total community caseload per 100,000 registered population

Figure 40 - Working age adult teams - community caseload per 100,000 registered population

Page 89

Figure 41 - Older adult teams - community caseload per 100,000 registered population

Figure 45 - Total community contacts per 100,000 registered population

Figure 46 - Working age adult teams - community contacts per 100,000 registered population

Figure 47 - Older adult teams - community contacts per 100,000 registered population

Figure 48 - Early Intervention referrals received per 100,000 registered population

Figure 49 - Early Intervention referral acceptance rate

Figure 50 - Early Intervention caseload per 100,000 registered population

Figure 51 - Total staff working in Early Intervention per 100,000 registered population

Figure 52 - Early Intervention teams contacts per patient on the caseload

Figure 53 - Early Intervention team DNA rate

Figure 54 - Length of time on Early Intervention team caseload (months)

Figure 55 - CRHT face to face contacts per 100,000 registered population

Figure 56 - Total staff working in CRHT teams per 100,000 registered population

Figure 57 - Psychiatric liaison contacts per 100,000 registered population

Figure 58 - Total staff working in psychiatric liaison per 100,000 registered population

Figure 59 - Section 136 Assessments per 100,000 registered population

Figure 60 - Community caseload - Clusters 1-8

Figure 61 - Community contacts - Clusters 1-8



Figure 64 - Community caseload - Cluster 17

Figure 65 - Community contacts - Cluster 17



Figure 68 - Adult acute consultant psychiatrists per 10 beds

Figure 69 - Older adult consultant psychiatrists per 10 beds

Figure 70 - Adult acute registered nurses per 10 beds

Figure 71 - Older adult registered nurses per 10 beds

Figure 72 - Adult acute staff sickness / absence %

Figure 73 - Adult acute staff turnover %

Figure 74 - Adult acute WTE vacancies as % of staff in post

Figure 75 - Adult acute spend on Bank and Agency (as a % of total spend on staffing)

Figure 76 - Community total WTE per 100,000 registered population (age 16+)

Figure 77 - Adult acute peer support workers (paid) per 10 beds

Figure 42 - Proportion of caseload on 31st March 2019 who had at least one F2F contact during previous 3 months -

Generic CMHT

Figure 43 - Proportion of caseload on 31st March 2019 who had at least one F2F contact during previous 3 months - Early

Intervention

Figure 44 - Proportion of caseload on 31st March 2019 who had at least one F2F contact during previous 3 months - Older

People

Page 90

Figure 78 - Community - peer support workers (paid) per 100,000 registered population (age 16+)

Figure 79 - Adult acute cost per bed

Figure 80 - Older adult cost per bed

Figure 81 - Generic CMHT cost per patient on the caseload

Figure 82 - Community Teams Patient Satisfaction Score

Figure 83 - NHS Friends and Family Test (FFT) Patient Satisfaction Score

Figure 84 - Adult acute restraint per 10,000 occupied bed days

Figure 85 - Adult acute prone restraint per 10,000 occupied bed days

Figure 86 - Older adult restraint per 10,000 occupied bed days

Figure 87 - Older adult prone restraint per 10,000 occupied bed days

Figure 88 - PICU restraint per 10,000 occupied bed days

Figure 89 - PICU prone restraint per 10,000 occupied bed days

Page 91

Final Report October 2019

Weighted population


Inpatient and Community Mental Health Benchmarking

Report for MH07

Contents

Section Page

Executive summary 3

Bed profile 5

Dashboard 6

Introduction 7

Reference Group 8

Participants 9

Terms of reference 11

Adult Acute 12

Older Adult 28

Specialist beds 35

Cluster profiling 42

Community care 44

Early Intervention 52

Crisis care 57

Community clustering 61

Workforce 66

Finance 73

Quality 76

Incidents 78

Balance of Care 82

Conclusion 84

Index of charts 86


Inpatient and Community Mental Health

Executive Summary

Length of stay - national position

3032 32 33

31 31 32

67

72 7274

7674

70

49

4345

50

46 46

42

2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

Adult Acute Older Adult PICU

Length of stay for PICU and older adult acute beds has reduced this year. Figures for adult acute ALOS have increased, although remain within the parameters that have been seen in recent years.

This report provides an overview of the findings from this year's NHS Benchmarking Network Mental Health project. The key findings are summarised on the following pages at national level. This is followed by a bespoke dashboard showing your organisation's unique position on key metrics.

Page 3

Bed occupancy - national position

95%88% 90%

78%93% 94%

87%78%

64% 68%74% 76%

0%

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Bed occupancy 2018/19

Including Leave Excluding Leave

85% bed occupancy excluding leave is a level that remains challenging for many bed types, due to the combination of demand, admission levels, length of stay and bed numbers. Tightest bed occupancy is reported in adult acute services, who report an average position of 94.9% excluding leave, but rising to 100% if patients on leave are also included in the figures.

Bed occupancy in other specialties also shows marginal increases in many areas, including old age and secure care.

Adult beds continue to report higher bed occupancy than CAMHS beds, which are included on the chart below for context.

Page 4

Bed Profile - national position of beds by specialty

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 1 1 1 1 1 0 0 0 0 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0

Acute admission beds for adults and older adults together represented 56% of the total bed stock

on 31st March 2019. Just under a quarter (22%) of beds were in the Low, Medium and High Secure

categories which remains unchanged since last year. However, this position is for NHS providers

across the UK and does not include a number of independent sector sites who offer a range of

specialist bed types including secure, eating disorder and rehabilitation.

Adult Acute Older Adult PICU Eating Disorders

37% 19% 5% 1%

Mother and Baby Low Secure Medium Secure High Secure

1% 9% 10%

6% 5% 1% 3%

3%

High Dep Rehab Long Term Complex Neuropsychiatry Other MH Beds

Page 5

Dashboard - your organisation's positions

Metric Low High MH07 Mean Median

Adult acute prone restraint per 10,000

occupied bed days1 17 11

Adult acute WTE vacancies as % of staff

in post4% 17% 15%

103 98

Adult acute admissions under the

Mental Health Act

Adult acute weighted nurses per 10

beds10.7 8.2 8.0

Adult acute bed occupancy excluding

leave97% 93% 95%

Adult acute length of stay excluding

leave34

Generic CMHT cost per patient on the

caseload3,190£ 3,294£ 3,050£

Total community contacts per 100,000

weighted population25,471 27,091 25,300

Community total WTE per 100,000

weighted population (age 16+)60 74 70

Older adult length of stay excluding

leave68 70 72

Total community caseload per 100,000

weighted population1188 1483 1323

Older adult beds per 100,000 weighted


Older adult bed occupancy excluding

leave90% 86% 88%

19.9 19.4

National

Adult acute restraint per 10,000

occupied bed days187

79% 40% 40%

32 32

Adult acute beds per 100,000 weighted

population10.9

Adult acute cost per bed152,880£ 144,837£ 143,196£

The following dashboard shows your organisation's position on key metrics included within this report, compared to other participants. It highlights which quartile your organisation's response falls into when all participants are ranked. It should be noted, however, that on some metrics the range is very small and therefore being high or low is only relative to other responses, and may not signify a high or low outlying position.

Page 6

Introduction

This report examines the state of mental health services in the UK in 2019. It summarises the results of this year's NHS Benchmarking Network Mental Health collection, and provides a commentary on the position of NHS mental health services.

This year brings the highest ever level of participation in the project. In addition to every English Mental Health Trust and every Welsh Health Board, we now also have data from every Health and Social Care Trust in Northern Ireland, along with representation from Scotland and the Channel Islands. This large number of participants provides the critical mass needed to provide robust and comprehensive data about the state of mental health services. The report examines activity from the 2018/19 financial year, supplemented by a number of year-end stocktake positions (for example staff in post on 31st March 2019).

2018/19 marks the eighth consecutive year of benchmarking data collection on adult and older adult mental health services. Building on last year's report, this document offers expanded time series trend analysis on every metric, and allows participants to explore the direction of travel for both inpatient and community services. It also includes a bespoke dashboard showing your organisation's positions on key metrics, in a one page summary.

The benchmarking process has been member driven from its inception, and we would like to acknowledge the contribution made both by member organisations and by the Mental Health Reference Group who continue to shape and champion the mental health benchmarking process.

This is a final report, with validated positions. It forms part of a suite of outputs including:

- Bespoke reports featuring registered population analysis for all participants

- Bespoke reports featuring weighted population analysis for English participants, using the NHS England PRAMH weighting formula which is used in CCG baseline allocations

- A comprehensive, interactive mental health toolkit which provides over 10,000 comparisons and allows all participants the opportunity to drill down into particular areas of interest

Detailed findings will be presented at this year's mental health benchmarking conference which will take place in London on 16th October 2019.

Julian Emms Stephen WatkinsChief Executive DirectorBerkshire Healthcare NHS Foundation Trust NHS Benchmarking Networkand Chair, NHSBN Mental Health Reference Group

Page 7

Reference Group

We would like to thank members of the Mental Health Reference Group who helped shape this year's collection and provided interpretation on findings.

Adrian Clarke NHS WalesAndy Blaxill Hertfordshire Partnership NHS Foundation TrustAnna Foster Northumberland, Tyne and Wear NHS Foundation TrustAnne Thompson Lancashire Care NHS Foundation TrustArokia Antonysamy The Priory GroupBabs Dhillon West London NHS TrustBelinda Iringe-Koko Central and North West London NHS Foundation TrustCatherine Magee Berkshire Healthcare NHS Foundation TrustCheryl Adams North Staffordshire Combined Healthcare NHS TrustChris Lanigan Tees Esk and Wear Valleys NHS Foundation TrustChris Woon 2gether NHS Foundation TrustDawn Painter NHS WalesDonna Hanson Greater Manchester Mental Health NHS Foundation TrustElaine Eannetta Black Country Partnership NHS Foundation TrustJames Thackray Hertfordshire Partnership NHS Foundation TrustJanet McDonald Mersey Care NHS Foundation TrustJason Rowlands Sheffield Health & Social Care NHS Foundation TrustJayne Flynn Coventry and Warwickshire Partnership NHS TrustJoanna Wood Midlands Partnership NHS Foundation TrustJulian Emms Berkshire Healthcare NHS Foundation TrustKeeley Twigg NHS WalesKevin Wilkinson Greater Manchester Mental Health NHS Foundation TrustLea Marsden Betsi Cadwaladr University Health BoardLee Cornell Somerset Partnership NHS Foundation TrustLeon Leroux Lancashire Care NHS Foundation TrustLindsey White Dorset Healthcare University NHS Foundation TrustLyn Sansom 2gether NHS Foundation TrustMandip Bal Black Country Partnership NHS Foundation TrustMark Polczyk-Przybyla South London and Maudsley NHS Foundation TrustMichael Harradine Pennine Care NHS Foundation TrustMike Garnham South West Yorkshire Partnership NHS Foundation TrustMiranda Washington Greater Manchester Mental Health NHS Foundation TrustMohit Venkataram East London NHS Foundation TrustPhilip Horner Lancashire Care NHS Foundation TrustPuneet Kaura Mersey Care NHS Foundation TrustRichard Morris Public Health WalesRony Arafin Devon Partnership NHS TrustSally Wilson Hertfordshire Partnership NHS Foundation TrustSarah Meakin Black Country Partnership NHS Foundation TrustSarah Smith Tees Esk and Wear Valleys NHS Foundation TrustShane Mills NHS WalesToby Rickard Avon and Wiltshire Mental Health Partnership NHS TrustTracy White Central and North West London NHS Foundation Trust

Page 8

Participants

This year, participants include 100% of English Mental Health Trusts, 100% of Welsh University Health Boards, 100% of Northern Ireland Trusts and representation from Scotland, the Channel Islands and the Independent Sector.

Participant organisations for 2019 are as follows:

England

2gether NHS Foundation TrustAvon and Wiltshire Mental Health Partnership NHS TrustBarnet, Enfield and Haringey Mental Health TrustBerkshire Healthcare NHS Foundation TrustBirmingham and Solihull Mental Health NHS Foundation TrustBlack Country Partnership NHS Foundation TrustBradford District Care NHS Foundation TrustCambridgeshire and Peterborough NHS Foundation TrustCamden and Islington NHS Foundation TrustCentral and North West London NHS Foundation TrustCheshire & Wirral Partnership NHS Foundation TrustCornwall Partnership NHS Foundation TrustCoventry & Warwickshire NHS Partnership TrustCumbria Partnership NHS Foundation TrustDerbyshire Healthcare NHS Foundation TrustDevon Partnership NHS TrustDorset HealthCare University NHS Foundation TrustDudley & Walsall Mental Health Partnership NHS TrustEast London NHS Foundation TrustEssex Partnership University NHS Foundation TrustGreater Manchester Mental Health NHS Foundation TrustHertfordshire Partnership University NHS Foundation TrustHumber Teaching NHS Foundation TrustIsle of Wight NHS TrustKent and Medway NHS and Social Care Partnership TrustLancashire Care NHS Foundation TrustLeeds and York Partnership NHS Foundation Trust Leicestershire Partnership NHS TrustLincolnshire Partnership NHS Foundation TrustMersey Care NHS Foundation Trust Midlands Partnership NHS Foundation TrustNorfolk and Suffolk NHS Foundation TrustNorth East London NHS Foundation TrustNorth Staffordshire Combined Healthcare NHS TrustNorthamptonshire Healthcare NHS Foundation Trust







Page 9







Page 10

Terms of reference

The terms of reference for the project have been developed by the Mental Health Benchmarking Reference Group. They reflect the project’s overall objectives and are reviewed by the reference group on an on-going basis.

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

Wider objectives of contributing to continuous service improvement are 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 enhance and develop the Network’s mental health workstream in upcoming years provides an excellent platform for future service provision to members and engagement with the wider mental health community.

Members should also note that additional products are available to mental health providers that support further analysis on other aspects of services offered by many mental health providers. Examples include CAMHS benchmarking and a range of bespoke projects undertaken with members, including a national stocktake of specialist Perinatal mental health services, recent work on the size and scope of Community Mental Health Services, surveys of the CAMHS and IAPT workforce and a detailed work programme to explore secure mental health services.

Further projects of interest to mental health provider organisations include projects on learning disabilities, community physical healthcare services and pharmacy, which contain elements of relevance to many Trusts and Health Boards. All of these products can be accessed from the NHS Benchmarking Network's website.

www.nhsbenchmarking.nhs.uk

Page 11

Adult Acute

MH07 Mean Median


40%

44.7 45.0

8%

36 34.8 36

98.9 80.7 80.8

2% 5% 4%

4%

34

79%

9%

Adult acute admissions - patients of no fixed

abode



Act


Act per 100,000 registered population

Adult acute length of stay for Mental Health Act

detentions

2%1%

40%


Adult acute admissions per 100,000 registered

population

Adult acute admissions - patients not previously

known to services



Adult acute bed occupancy excluding leave97% 93% 95%

Adult acute beds per 100,000 weighted

population19.9 19.410.9

100%

34.0

101%104%

125 226

31.6

194

... 16% 14%

2%

32.3

10

15

20

25

30

35

40

45

50

Em

Page 12

MH07: 10.9

Mean: 19.9

Median: 19.4

Upper Q: 22.3

Lower Q: 16.2

Region:

Trusts:

Figure 1

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60M

H04

MH

07

Adult acute beds per 100,000 weighted population

The largest bed type for most providers is their adult acute bed stock. These beds form part of the core service offer from NHS Trusts and Health Boards, and are predominantly designed to serve a working age (16 - 64) cohort. Older adult acute beds provide a similar function for older people (age 65 and over) and these are discussed in the next section.

Adult acute beds support service users with a broad range of mental health conditions. This is in contrast to specialist beds which may support a specific cohort of patients, for example those with eating disorders or people on a forensic / criminal justice pathway. These specialist beds are profiled later in the report.

In recent years, providers have reported a reduction in adult acute bed numbers although this has now stabilised. In 2011/12, there were 23 adult acute beds per 100,000 population age 16-64. This year, participants reported an average position of 19.4 beds, consistent with the levels reported over the last 6 years.

The table below highlights your position compared to local and national peers. The map on the following page shows the geographical distribution of adult acute beds. Both use a stocktake position of beds in the system on 31st March 2019. Regional variations are evident in the data.

Em

Page 13

Adult Acute beds per 100,000 weighted population

11 44


Greater London

Channel Islands

Page 14

Adule Acute Bed Occupancy

MH07: 97.4%

Mean: 92.7%

Median: 94.9%

Upper Q: 97.7%

Lower Q: 88.2%

Region:

Trusts:

Figure 2

MH07: 104.1%

Mean: 101.1%

Median: 100.0%

Upper Q: 107.5%

Lower Q: 96.0%

Region:

Trusts:

Figure 3

0%

10%

20%

30%

40%

50%

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70%

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90%

100%

MH

44M

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MH

61M

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MH

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MH

26M

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MH

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MH

22M

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MH

37M

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MH

65M

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MH

32M

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MH

08M

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MH

92M

H25

MH

42M

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MH

84M

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MH

19M

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MH

45M

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12M

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MH

94M

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MH

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MH

34M

H93

MH

56M

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MH

63M

H52

MH

28M

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MH

66M

H55

MH

60M

H06


0%

20%

40%

60%

80%

100%

120%

140%

MH

71M

H59

MH

20M

H51

MH

33M

H01

MH

61M

H70

MH

11M

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MH

10M

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MH

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MH

56M

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37M

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MH

44M

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MH

38M

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MH

24M

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MH

83M

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92M

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MH

41M

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MH

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MH

09M

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MH

85M

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MH

08M

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MH

53M

H34

MH

15M

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MH

02M

H68

MH

66M

H93

MH

25M

H42

MH

28M

H55

MH

69M

H63

MH

60M

H06


Bed occupancy figures show the number of days in a year that beds were occupied, as a proportion of all available beds. This allows services flexibility where beds were temporarily open or closed for portions of the year. Bed occupancy excluding leave cannot exceed 100%. However, when leave days are included, the figure can rise above this as an inpatient bed may be re-allocated while a patient has a period of leave.

Participants have reported bed occupancy increasing in recent years, from 91% in 2011/12. This year's median average position is 94.9% and 100% when leave is included.

Page 15

Adult Acute Admissions

MH07: 125.1

Mean: 226.1

Median: 194.4

Upper Q: 273.6

Lower Q: 159.9

Region:

Trusts:

Figure 4

0

100

200

300

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MH

85M

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58M

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MH

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20M

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MH

04M

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MH

57M

H40

MH

09M

H36

MH

07M

H05

MH

17M

H33

MH

10Adult acute admissions per 100,000 weighted population

10%

20%

30%

40%

50%

60%

0%

1%

2%

3%

4%

5%

6%

7%

Admission rates triangulate with bed numbers and length of stay to give an overall picture of an inpatient service. This year's median average position is 194.4 admission per 100,000 weighted population.

Admissions are also profiled by patients not previously known to services. In this context, this means admissions for anyone who has not been admitted to a Trust mental health bed before, and has not been on a community mental health team caseload. This year, admissions for this cohort accounted for 14.0% of all patients admitted.

Rates of admissions for patients of no fixed abode remain steady, but the chart highlights the regional variation seen on this metric, suggesting particular challenges in certain areas.

Page 16

MH07: ...

Mean: 16.3%

Median: 14.0%

Upper Q: 21.8%

Lower Q: 7.3%

Region:

Trusts:

Figure 5

MH07: 1.1%

Mean: 2.3%

Median: 1.9%

Upper Q: 3.1%

Lower Q: 1.1%

Region:

Trusts:

Figure 6

0%

10%

20%

30%

40%

50%

60%

MH

06

MH

17

MH

24

MH

95

MH

94

MH

45

MH

74

MH

93

MH

63

MH

18

MH

43

MH

53

MH

11

MH

65

MH

23

MH

44

MH

03

MH

92

MH

05

MH

27

MH

37

MH

33

MH

26

MH

69

MH

22

MH

04

MH

52

MH

58

MH

61

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72

MH

35

MH

41

MH

10

MH

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MH

51

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MH

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MH

21

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MH

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MH

08

MH

36M

H0

2M

H1

9M

H1

5M

H2

0M

H4

2

Adult acute admissions - patients not previously known to services (as a % of all patients admitted)

0%

1%

2%

3%

4%

5%

6%

7%

MH

11M

H19

MH

21M

H74

MH

23M

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MH

44M

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MH

12M

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MH

61M

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MH

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MH

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MH

22M

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MH

28M

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MH

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MH

92M

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MH

65M

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MH

02M

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MH

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MH

03M

H67

MH

17M

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MH

66M

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MH

25M

H54

MH

35M

H40

MH

51M

H37

MH

20M

H69

MH

84M

H07

MH

93M

H18

MH

58M

H57

MH

06M

H26

MH

39M

H05

MH

42M

H01

MH

08M

H15

MH

04M

H16

MH

63

Adult acute admissions - patients of no fixed abode (as a % of all patients admitted)

Page 17


MH07: 34.0

Mean: 31.6

Median: 32.3

Upper Q: 39.0

Lower Q: 24.7

Region:

Trusts:

Figure 7

MH07: 36.0

Mean: 34.8

Median: 36.0

Upper Q: 42.0

Lower Q: 26.0

Region:

Trusts:

Figure 8

0

10

20

30

40

50

60

MH

40M

H17

MH

19M

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MH

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MH

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MH

85


Length of stay for adult acute beds sees variation on both a year to year basis and within year across different participants. However, over the last 8 years, national average positions have remained within the range 30 to 33 days. This year's position is 31.6 days excluding leave. When leave days are included, this rises to 34.8 days.

The following page shows the regional variation on this metric.


9 55


Greater London

Channel Islands

Page 18

Length of stay

0 - 3 days

4 - 13 days

14 - 59 days

60 days or longer

60 - 89 days

90 days or longer


The charts on the following page show individual participant positions on the proportion of patients with very short (0


9 55


Greater London

Channel Islands

Page 19

Length of stay 2016/17 2017/18 2018/19

0 - 3 days 16% 16% 15%

4 - 13 days 31% 31% 30%

14 - 59 days 38% 39% 40%

60 days or longer 15% 14% x

60 - 89 days x x 7%

90 days or longer x x 8%

National trend

10%

15%

20%

25%

30%

35%

40%

45%

10%

12%

14%

16%


The charts on the following page show individual participant positions on the proportion of patients with very short (0 - 3 days) and very long (90 days or over) stays.

Page 20

MH07: 6.8%

Mean: 15.2%

Median: 13.2%

Upper Q: 17.8%

Lower Q: 9.7%

Region:

Trusts:

Figure 9

MH07: 5.3%

Mean: 7.9%

Median: 8.0%

Upper Q: 9.9%

Lower Q: 5.4%

Region:

Trusts:

Figure 10

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

MH

06

MH

58

MH

01

MH

45

MH

61

MH

71

MH

19M

H6

0M

H5

9M

H6

3M

H6

7M

H42

MH

21

MH

94

MH

25

MH

03

MH

15M

H6

9M

H2

4M

H7

2M

H1

8M

H35

MH

74

MH

93

MH

51

MH

34

MH

16M

H0

8M

H1

7M

H2

6M

H5

2M

H12

MH

22

MH

27

MH

95

MH

23

MH

02M

H5

7M

H2

8M

H3

7M

H8

4M

H32

MH

11

MH

38

MH

43

MH

04

MH

44M

H6

4M

H5

3M

H1

0M

H0

5M

H36

MH

65

MH

56

MH

54

MH

70

MH

39M

H3

3M

H0

7M

H4

1M

H9

2M

H40

MH

20

MH

29

MH

09

Proportion of patients discharged with length of stay 0-3 days

0%

2%

4%

6%

8%

10%

12%

14%

16%

MH

40M

H20

MH

36M

H17

MH

51M

H41

MH

92M

H57

MH

32M

H39

MH

33M

H74

MH

10M

H27

MH

64M

H18

MH

23M

H11

MH

12M

H29

MH

26M

H54

MH

24M

H71

MH

37M

H56

MH

70M

H28

MH

05M

H22

MH

72M

H53

MH

38M

H52

MH

95M

H43

MH

65M

H16

MH

61M

H59

MH

09M

H04

MH

84M

H34

MH

03M

H35

MH

58M

H15

MH

01M

H07

MH

21M

H02

MH

42M

H44

MH

93M

H25

MH

94M

H19

MH

63M

H06

MH

69M

H08

MH

67M

H60

MH

45

Proportion of patients discharged with length of stay 90 days or longer

Page 21

Occupied Bed Days









discharged with length of stay 90 days or longer 29% 37% 38% Not available



Participants reported the proportion of their OBDs in adult acute beds that could be attributed to patients with different lengths of stay. Individual positions can be explored further in the Mental Health Benchmarking Toolkit. The chart below illustrates the comparison between proportion of patients in each length of stay band and the proportion of OBDs each cohort occupied. This shows that although 15% of patients are discharged within 0-3 days, they only occupy 1% of bed days. At the other end of the scale, only 8% of patients stay 90 days or longer in adult acute beds, but this group occupy 41% of all bed days on these wards. Patients that stay 60 days or more account for 14% of admissions but 55% of bed days.

15%

31%

40%

6% 8%

1%

8%

36%

14%

41%

0-3

day

s

4-1

3 d

ays

14 -

59

day

s

60 -

89

day

s

90 d

ays

or

lon

ger

Discharges by LOS and OBD profile

Patients discharged

OBDs

Page 22

Mental Health Act

MH07: 79.1%

Mean: 40.2%

Median: 39.9%

Upper Q: 51.8%

Lower Q: 29.6%

Region:

Trusts:

Figure 11

MH07: 98.9

Mean: 80.7

Median: 80.8

Upper Q: 96.1

Lower Q: 64.6

Region:

Trusts:

Figure 12

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

MH

07M

H33

MH

17M

H11

MH

36M

H09

MH

29M

H22

MH

44M

H43

MH

65M

H28

MH

10M

H92

MH

52M

H05

MH

41M

H57

MH

32M

H40

MH

56M

H20

MH

39M

H12

MH

24M

H23

MH

25M

H27

MH

38M

H94

MH

03M

H64

MH

02M

H68

MH

19M

H01

MH

37M

H18

MH

08M

H74

MH

51M

H50

MH

53M

H06

MH

45M

H60

MH

63M

H26

MH

93M

H69

MH

42M

H15

MH

95M

H35

MH

54M

H21

MH

71M

H61

MH

72M

H84

MH

04M

H59

MH

70M

H67

MH

83M

H55

MH

58M

H66


0

50

100

150

200

MH

18M

H12

MH

06M

H23

MH

19M

H94

MH

43M

H11

MH

25M

H32

MH

39M

H42

MH

44M

H22

MH

07M

H29

MH

01M

H45

MH

68M

H95

MH

69M

H53

MH

52M

H60

MH

93M

H65

MH

41M

H92

MH

33M

H03

MH

28M

H08

MH

09M

H36

MH

17M

H56

MH

63M

H74

MH

24M

H64

MH

38M

H37

MH

26M

H35

MH

20M

H57

MH

15M

H05

MH

50M

H27

MH

40M

H51

MH

02M

H61

MH

10M

H84

MH

21M

H67

MH

59M

H71

MH

55M

H83

MH

72M

H54

MH

58M

H70

MH

04M

H66

Adult acute admissions under the Mental Health Act per 100,000 weighted population

100

120

Analysis of use of the Mental Health Act shows that 40.2% of admissions to adult acute beds in 2018/19 were for patients who were detained at the point of their admission. In addition to this, some patients are admitted on a voluntary basis but then subject to detention during their episode of care.

It is also useful to consider background detention rates relative to population size, as these are less influenced by bed numbers and admission rates. In 2018/19 there were 80.7 admissions to adult acute beds under the Mental Health Act per 100,000 population age 16-64. Some regional variation is evident in this data although other determinants are evident including access to community care, and clinical practice.

Page 23

MH07: 34.0

Mean: 44.7

Median: 45.0

Upper Q: 51.1

Lower Q: 36.2

Region:

Trusts:

Figure 13

0

20

40

60

80

100

120

MH

17M

H70

MH

59M

H26

MH

54M

H38

MH

19M

H11

MH

10M

H23

MH

51M

H36

MH

74M

H37

MH

24M

H56

MH

05M

H57

MH

52M

H27

MH

61M

H28

MH

68M

H29

MH

15M

H95

MH

02M

H39

MH

72M

H20

MH

84M

H22

MH

04M

H92

MH

53M

H33

MH

43M

H65

MH

42M

H35

MH

94M

H32

MH

71M

H06

MH

44M

H18

MH

93M

H25

MH

07M

H08

MH

03M

H21

MH

66M

H01

MH

41M

H69

MH

60M

H09

MH

63M

H55

MH

45

Adult acute mean length of stay for Mental Health Act detentions

Adult Acute admissions under the Mental Health Act per 100,000 weighted population

9 178


Greater London

Channel Islands

Page 24

Adult Acute Delayed Transfers of Care

MH07: 2.0%

Mean: 4.9%

Median: 4.1%

Upper Q: 7.0%

Lower Q: 2.0%

Region:

Trusts:

Figure 14

0%

2%

4%

6%

8%

10%

12%

14%

16%

MH

39M

H21

MH

57M

H05

MH

71M

H43

MH

44M

H06

MH

27M

H67

MH

03M

H25

MH

26M

H72

MH

52M

H20

MH

33M

H37

MH

42M

H64

MH

10M

H53

MH

24M

H60

MH

50M

H59

MH

35M

H04

MH

66M

H83

MH

36M

H28

MH

11M

H18

MH

22M

H15

MH

23M

H38

MH

55M

H40

MH

12M

H92

MH

93M

H07

MH

63M

H74

MH

45M

H19

MH

32M

H95

MH

08M

H34

MH

41M

H29

MH

56M

H94

MH

54M

H65


Participants continue to report inconsistencies in the measuring of delays, in particular the point at which a delay is formally acknowledged.

This chart measures delayed transfers of care as a percentage of all occupied bed days. The 2018/19 average of 4.1% can be compared to 4.2% in 2017/18 and 5.6% the year prior to that. The chart shows considerable variation which may be impacted by both clarity and consistency of reporting, and underlying service models and patient flow.

Page 25

Adult Acute Emergency Readmissions

MH07: 3.9%

Mean: 8.8%

Median: 8.1%

Upper Q: 10.9%

Lower Q: 5.9%

Region:

Trusts:

Figure 15

0%

5%

10%

15%

20%

25%

MH

58M

H55

MH

18M

H59

MH

06M

H60

MH

53M

H34

MH

45M

H71

MH

84M

H04

MH

01M

H16

MH

74M

H61

MH

26M

H37

MH

42M

H51

MH

93M

H21

MH

25M

H19

MH

11M

H35

MH

05M

H28

MH

41M

H56

MH

23M

H67

MH

36M

H94

MH

15M

H92

MH

27M

H38

MH

72M

H33

MH

69M

H52

MH

50M

H54

MH

57M

H20

MH

12M

H02

MH

68M

H08

MH

39M

H22

MH

10M

H03

MH

95M

H24

MH

09M

H64

MH

70M

H65

MH

07M

H43

MH

44M

H63


"Emergency readmissions" refers to unplanned or unexpected readmission to an adult acute bed of people discharged from an adult acute bed within the last 28 or 30 days (depending on local definitions). The figure is calculated as a percentage of overall admissions. This year, 8.1% of admissions to adult acute beds were emergency readmissions for patients recently discharged. This figure remained between 8.4% and 10% of admissions in the 7 years to 2017/18. The reduction in emergency readmissions is welcomed and marks a significant improvement on previous years.

Page 26

Follow Up Post Discharge




in-patient care56% 73% 72% Not available



patient care



in-patient care



patient care

62%

93%

91%

Not available

Not available

Not available

72% 73%

91% 94%

93% 96%

Members of the mental health benchmarking reference group requested the inclusion of new metrics concerning follow up appointments for patients discharged from inpatient care.

Categories include patients on CPA and all patients, and follow up within 3 days and 7 days of discharge. The figures suggest that in most circumstances, follow up occurs within 3 days, with only a small proportion of patients first followed up between 4 and 7 days post discharge.

Early follow up post discharge has been identified as a key safety issue by The National Confidential Inquiry into Suicide and Safety in Mental Health. The strong performance on 3-day follow up is welcomed and confirms the commitment of many providers to reducing risks in the post-discharge period.

Participants can explore their individual positions on these metrics further using the NHS Benchmarking Network Mental Health Toolkit.

Page 27

Older Adult

MH07 Mean Median


Older adult emergency readmissions2% 3% 3%

Older adult length of stay including leave72 76 76

8% 7%21%

Older adult admissions per 100,000 weighted

population59 119 97

Older adult length of stay excluding leave68 70.3 72.0

Older adult bed occupancy excluding leave90% 86% 88%

Older adult bed occupancy including leave94% 90% 92%

National trend

Older adult beds per 100,000 weighted


Key metrics for older adult inpatient care also tell a story of effective management of capacity at a time of system pressure. Inpatient bed capacity has reduced marginally in the last year but this has been delivered alongside reductions in average length of stay.

Page 28

Older Adult Beds

MH07: 18.2

Mean: 29.1

Median: 24.1

Upper Q: 31.2

Lower Q: 17.7

Region:

Trusts:

Figure 16

0

20

40

60

80

100

120

140

160

MH

69M

H51

MH

71M

H83

MH

68M

H01

MH

55M

H43

MH

58M

H16

MH

67M

H59

MH

53M

H45

MH

61M

H04

MH

72M

H57

MH

93M

H34

MH

36M

H20

MH

23M

H26

MH

60M

H39

MH

18M

H28

MH

74M

H64

MH

05M

H29

MH

66M

H37

MH

32M

H84

MH

24M

H94

MH

63M

H35

MH

03M

H65

MH

02M

H41

MH

08M

H11

MH

95M

H56

MH

54M

H07

MH

92M

H42

MH

21M

H27

MH

52M

H25

MH

06M

H09

MH

10M

H40

MH

70M

H50

MH

17M

H19

MH

15M

H12

MH

33M

H22

MH

44M

H38

Older adult beds per 100,000 weighted population

Older adult beds have shown a marginal decline, though rates relative to population size are still much larger than for adult acute. There were 24.1 older adult beds per 100,000 population age 65 and older, compared to 19.4 adult acute beds per 100,000 population age 16 to 64.

Page 29

Older Adult Bed Occupancy

MH07: 90.0%

Mean: 86.0%

Median: 88.2%

Upper Q: 92.2%

Lower Q: 82.5%

Region:

Trusts:

Figure 17

MH07: 93.9%

Mean: 90.3%

Median: 91.9%

Upper Q: 96.5%

Lower Q: 85.7%

Region:

Trusts:

Figure 18

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

67M

H03

MH

74M

H51

MH

27M

H02

MH

92M

H10

MH

41M

H95

MH

59M

H24

MH

44M

H54

MH

09M

H57

MH

19M

H26

MH

42M

H25

MH

64M

H05

MH

11M

H43

MH

07M

H61

MH

60M

H40

MH

50M

H39

MH

04M

H32

MH

38M

H84

MH

23M

H45

MH

36M

H15

MH

22M

H01

MH

93M

H06

MH

37M

H08

MH

83M

H35

MH

65M

H29

MH

18M

H20

MH

63M

H70

MH

12M

H72

MH

52M

H21

MH

94M

H53

MH

56M

H34

MH

58M

H33

MH

71M

H28

MH

66M

H55


0%

20%

40%

60%

80%

100%

120%

MH

61M

H02

MH

10M

H67

MH

03M

H54

MH

45M

H92

MH

09M

H36

MH

74M

H40

MH

43M

H24

MH

84M

H51

MH

27M

H26

MH

19M

H59

MH

44M

H41

MH

64M

H32

MH

11M

H95

MH

07M

H39

MH

57M

H50

MH

42M

H25

MH

15M

H04

MH

22M

H60

MH

23M

H05

MH

18M

H70

MH

06M

H38

MH

93M

H08

MH

65M

H94

MH

12M

H69

MH

35M

H20

MH

37M

H52

MH

29M

H53

MH

01M

H63

MH

83M

H72

MH

34M

H16

MH

56M

H68

MH

21M

H33

MH

58M

H71

MH

28M

H66

MH

55

Older adult bed occupancy including leave

Bed occupancy for older adult beds should be seen in the context of higher rates of bed provision compared to adult acute services. In 2018/19, participants reported bed occupancy of 88.2% excluding leave in older adult services. This is notably below the figure of 94.9% reported in adult acute beds.

The 88.2% position reported in old age services is the highest reported in the 8 year history of the benchmarking project, confirming ongoing increases in capacity utilisation.

Page 30


MH07: 59.4

Mean: 118.9

Median: 96.5

Upper Q: 146.5

Lower Q: 67.1

Region:

Trusts:

Figure 19

050

100150200250300350400450500

MH

69M

H71

MH

83M

H51

MH

43M

H55

MH

67M

H58

MH

93M

H59

MH

61M

H01

MH

60M

H84

MH

45M

H16

MH

26M

H04

MH

66M

H68

MH

03M

H36

MH

53M

H39

MH

18M

H94

MH

20M

H24

MH

72M

H34

MH

11M

H63

MH

64M

H57

MH

35M

H29

MH

02M

H65

MH

32M

H27

MH

19M

H08

MH

23M

H54

MH

37M

H50

MH

95M

H74

MH

42M

H56

MH

06M

H28

MH

70M

H25

MH

21M

H17

MH

10M

H41

MH

07M

H40

MH

09M

H15

MH

44M

H92

MH

22M

H52

MH

05M

H33

MH

38M

H12

Older adult admissions per 100,000 weighted population

Older adult admission rates reflect both diminishing bed availability and higher length of stay in the old age sector. This year's median position is 96.5 per 100,000 weighted population.

Page 31


MH07: 68.0

Mean: 70.3

Median: 72.0

Upper Q: 84.0

Lower Q: 57.5

Region:

Trusts:

Figure 20

MH07: 72.0

Mean: 75.9

Median: 76.0

Upper Q: 89.0

Lower Q: 62.0

Region:

Trusts:

Figure 21

0

20

40

60

80

100

120

MH

23M

H57

MH

40M

H41

MH

74M

H05

MH

52M

H38

MH

17M

H10

MH

20M

H29

MH

34M

H02

MH

37M

H28

MH

01M

H70

MH

69M

H25

MH

72M

H92

MH

95M

H42

MH

33M

H65

MH

04M

H54

MH

26M

H59

MH

16M

H35

MH

56M

H53

MH

43M

H58

MH

07M

H15

MH

39M

H36

MH

24M

H22

MH

06M

H67

MH

63M

H11

MH

27M

H84

MH

94M

H21

MH

61M

H19

MH

03M

H32

MH

71M

H18

MH

60M

H55

MH

44M

H45

MH

93M

H09

MH

66

Older adult length of stay excluding leave

0

20

40

60

80

100

120

140

160

MH

12M

H51

MH

23M

H57

MH

40M

H52

MH

68M

H74

MH

41M

H05

MH

34M

H17

MH

70M

H69

MH

10M

H20

MH

02M

H28

MH

29M

H64

MH

37M

H33

MH

72M

H92

MH

95M

H25

MH

65M

H54

MH

01M

H42

MH

38M

H26

MH

36M

H56

MH

04M

H35

MH

53M

H59

MH

43M

H39

MH

07M

H58

MH

15M

H08

MH

24M

H22

MH

50M

H06

MH

11M

H63

MH

67M

H84

MH

27M

H61

MH

94M

H19

MH

32M

H21

MH

03M

H18

MH

71M

H66

MH

60M

H45

MH

83M

H55

MH

44M

H93

MH

09

Older adult length of stay including leave

Length of stay in older adult beds continues to be more than twice the figure seen in adult acute beds, which service a working age adult cohort. In 2018/19, older adult length of stay was 70.3 days excluding leave, compared to 31.6 days in adult acute beds.

Page 32

Older Adult Delayed Transfers of Care

MH07: 20.7%

Mean: 8.2%

Median: 7.3%

Upper Q: 12.6%

Lower Q: 2.9%

Region:

Trusts:

Figure 22

0%

5%

10%

15%

20%

25%

30%

35%

MH

44M

H57

MH

07M

H05

MH

59M

H25

MH

21M

H06

MH

39M

H11

MH

33M

H52

MH

64M

H26

MH

20M

H36

MH

54M

H40

MH

71M

H03

MH

15M

H83

MH

10M

H53

MH

67M

H37

MH

60M

H08

MH

23M

H04

MH

50M

H66

MH

42M

H32

MH

72M

H22

MH

43M

H45

MH

94M

H93

MH

55M

H63

MH

92M

H27

MH

18M

H12

MH

24M

H65

MH

35M

H02

MH

56M

H29

MH

28M

H41

MH

38M

H74

MH

34M

H19

MH

95


Due to the complexity of discharge arrangements for some patients, delays in transfers of care occur much more frequently in older adult services than in services serving working age adults. This metric is calculated using the percentage of all occupied bed days that were attributed to delays. This year's figure of 7.3% for older adult beds compares to 4.1% for adult acute.

Page 33

Older Adult Readmissions

MH07: 1.8%

Mean: 3.5%

Median: 3.0%

Upper Q: 4.7%

Lower Q: 1.7%

Region:

Trusts:

Figure 23

0%

2%

4%

6%

8%

10%

12%

MH

01M

H16

MH

84M

H65

MH

61M

H55

MH

93M

H26

MH

52M

H54

MH

05M

H37

MH

18M

H57

MH

39M

H56

MH

58M

H34

MH

67M

H10

MH

19M

H21

MH

74M

H51

MH

35M

H33

MH

59M

H12

MH

36M

H27

MH

72M

H03

MH

50M

H04

MH

15M

H25

MH

38M

H53

MH

02M

H23

MH

06M

H24

MH

07M

H70

MH

28M

H71

MH

43M

H63

MH

94M

H11

MH

20M

H22

MH

69M

H42

MH

64M

H41

MH

08M

H92

MH

44M

H09

Older adult emergency readmissions

Emergency readmissions to older adult beds occur less frequently than in adult acute beds. This may be due to the higher level of support offered post discharge to this cohort, through ongoing packages of care or residential placements, which can help keep people well and reduce the risk of deterioration to the extent that an emergency readmission is necessitated.

Calculated as the percentage of all admissions that were emergency readmissions in the immediate period after discharge, the average position of 3.0% for older adults compares to 8.1% in adult acute beds.

Page 34

Specialist beds

MH07 Mean Median

Longer Term Complex / Continuing Care bed

occupancy excluding leave72% 79% 78%

Longer Term Complex / Continuing Care length of

stay excluding leave

85% 87%

516 360

Medium Secure bed occupancy excluding leave... 93% 94%

348 360...

213

High Dependency Rehabilitation length of stay

excluding leave

High Dependency Rehabilitation bed occupancy

excluding leave...

Low Secure bed occupancy excluding leave84% 91% 93%

683 722...Medium Secure length of stay excluding leave

Eating Disorders bed occupancy excluding leave... 77% 78%

Low Secure length of stay excluding leave286 697 542

PICU bed occupancy excluding leave99% 86% 90%

Eating Disorders length of stay excluding leave... 107 99

National trend

PICU length of stay excluding leave42 42 36

100

120

140

160

180

100%

In this context, "Specialist beds" refers to all beds that are not for acute admission (adult acute and older adult acute). Some of these beds are linked to specific conditions (such as eating disorders) while others support patients on different pathways (such as low and medium secure beds for patients on a forensic/criminal justice pathway).

Mother and baby units are not included here because they are reported in a detailed analysis piece. High Secure beds are excluded due to the small number of national providers, and the additional benchmarking that goes on in these areas.

Benchmarks per 100,000 population are not used in this section, as population catchment footprints vary and are not mutually exclusive across providers.

Page 35

MH07: 42

Mean: 42

Median: 36

Upper Q: 46

Lower Q: 30

Region:

Trusts:

Figure 24

MH07: 99%

Mean: 86%

Median: 90%

Upper Q: 94%

Lower Q: 78%

Region:

Trusts:

Figure 25

0

20

40

60

80

100

120

140

160

180

MH

68M

H65

MH

06M

H40

MH

42M

H01

MH

38M

H04

MH

72M

H39

MH

37M

H41

MH

25M

H35

MH

94M

H44

MH

84M

H33

MH

64M

H92

MH

24M

H05

MH

07M

H34

MH

61M

H20

MH

31M

H60

MH

52M

H29

MH

23M

H74

MH

18M

H36

MH

51M

H11

MH

02M

H54

MH

28M

H90

MH

95M

H19

MH

50M

H03

MH

21M

H57

MH

09M

H10

MH

15M

H26

MH

32M

H08

MH

17M

H22

MH

59M

H63

MH

45M

H70

MH

55M

H67

MH

66

PICU length of stay excluding leave

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

61M

H74

MH

44M

H40

MH

07M

H66

MH

05M

H10

MH

59M

H83

MH

67M

H39

MH

24M

H41

MH

50M

H60

MH

17M

H35

MH

38M

H03

MH

09M

H36

MH

57M

H72

MH

26M

H21

MH

01M

H95

MH

23M

H25

MH

92M

H64

MH

29M

H54

MH

32M

H45

MH

11M

H37

MH

58M

H20

MH

22M

H70

MH

31M

H84

MH

04M

H94

MH

63M

H33

MH

19M

H18

MH

52M

H08

MH

65M

H12

MH

90M

H42

MH

28M

H06

MH

34M

H15

MH

55M

H02

PICU bed occupancy excluding leave

100

150

200

250

100%

Page 36

MH07: ...

Mean: 107

Median: 99

Upper Q: 108

Lower Q: 85

Region:

Trusts:

Figure 26

MH07: ...

Mean: 77%

Median: 78%

Upper Q: 85%

Lower Q: 68%

Region:

Trusts:

Figure 27

0

50

100

150

200

250

MH

90

MH

22

MH

08

MH

36

MH

18

MH

63

MH

40

MH

38

MH

05

MH

23

MH

44

MH

57

MH

09

MH

17

MH

10

MH

27

MH

04

Eating Disorders length of stay excluding leave

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

23

MH

90

MH

44

MH

04

MH

36

MH

09

MH

05

MH

08

MH

38

MH

10

MH

40

MH

27

MH

17

MH

22

MH

63

MH

57

MH

18

Eating Disorders bed occupancy excluding leave

1,000

1,500

2,000

2,500

100%

Page 37

MH07: 286

Mean: 697

Median: 542

Upper Q: 815

Lower Q: 446

Region:

Trusts:

Figure 28

MH07: 84%

Mean: 91%

Median: 93%

Upper Q: 96%

Lower Q: 87%

Region:

Trusts:

Figure 29

0

500

1,000

1,500

2,000

2,500

MH

10M

H06

MH

08M

H25

MH

94M

H31

MH

65M

H38

MH

17M

H52

MH

37M

H24

MH

42M

H28

MH

44M

H26

MH

72M

H41

MH

90M

H04

MH

74M

H57

MH

21M

H56

MH

35M

H05

MH

20M

H43

MH

92M

H22

MH

02M

H15

MH

18M

H23

MH

63M

H03

MH

59M

H01

MH

54M

H19

MH

27M

H09

MH

07M

H29

MH

84M

H32

MH

51M

H36

Low Secure length of stay excluding leave

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

23M

H94

MH

27M

H18

MH

21M

H41

MH

72M

H38

MH

35M

H22

MH

74M

H10

MH

03M

H44

MH

25M

H52

MH

36M

H09

MH

05M

H20

MH

08M

H84

MH

17M

H12

MH

02M

H26

MH

65M

H04

MH

92M

H63

MH

37M

H28

MH

24M

H19

MH

32M

H90

MH

59M

H29

MH

43M

H07

MH

31M

H42

MH

54M

H15

MH

57M

H01

MH

06M

H56

Low Secure bed occupancy excluding leave

1,000

1,200

1,400

1,600

1,800

100%

Page 38

MH07: ...

Mean: 683

Median: 722

Upper Q: 823

Lower Q: 521

Region:

Trusts:

Figure 30

MH07: ...

Mean: 93%

Median: 94%

Upper Q: 97%

Lower Q: 90%

Region:

Trusts:

Figure 31

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

MH

06

MH

28

MH

52

MH

31

MH

01

MH

67

MH

44

MH

08

MH

25

MH

15

MH

74

MH

24

MH

72

MH

90

MH

10

MH

94

MH

20

MH

04

MH

37

MH

18

MH

22

MH

35

MH

03

MH

17

MH

41

MH

09

MH

32

MH

27

Medium Secure length of stay excluding leave

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

35

MH

37

MH

22

MH

09

MH

32

MH

44

MH

20

MH

27

MH

25

MH

08

MH

31

MH

90

MH

10

MH

94

MH

18

MH

52

MH

01

MH

24

MH

28

MH

74

MH

17

MH

41

MH

03

MH

04

MH

06

MH

15

MH

67

MH

72Medium Secure bed occupancy excluding leave

1,000

1,200

100%

Page 39

MH07: ...

Mean: 348

Median: 360

Upper Q: 442

Lower Q: 205

Region:

Trusts:

Figure 32

MH07: ...

Mean: 85%

Median: 87%

Upper Q: 90%

Lower Q: 77%

Region:

Trusts:

Figure 33

0

200

400

600

800

1,000

1,200

MH

70

MH

24

MH

02

MH

52

MH

90

MH

23

MH

38

MH

95

MH

09

MH

37

MH

01

MH

06

MH

39

MH

25

MH

10

MH

28

MH

22

MH

35

MH

51

MH

36

MH

08

MH

74

MH

11

MH

03

MH

92

MH

43

MH

20

MH

67

MH

58

MH

55

MH

93

MH

17

MH

19

MH

32

MH

27

MH

45

MH

66

High Dependency Rehabilitation length of stay excluding leave

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

100%

MH

67

MH

11

MH

10

MH

74

MH

03

MH

09

MH

23

MH

17

MH

02

MH

45

MH

38

MH

37

MH

95

MH

01

MH

92

MH

36

MH

24

MH

90

MH

28

MH

25

MH

58

MH

55

MH

27

MH

19

MH

35

MH

43

MH

20

MH

52

MH

08

MH

93

MH

39

MH

32

MH

22

MH

66

MH

70

MH

06High Dependency Rehabilitation bed occupancy excluding

leave

1,000

1,200

1,400

1,600

1,800

100%

Page 40

MH07: 213

Mean: 516

Median: 360

Upper Q: 611

Lower Q: 227

Region:

Trusts:

Figure 34

MH07: 72%

Mean: 79%

Median: 78%

Upper Q: 89%

Lower Q: 72%

Region:

Trusts:

Figure 35

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

MH

09

MH

31

MH

52

MH

37

MH

23

MH

68

MH

51

MH

05

MH

69

MH

02

MH

28

MH

25

MH

11

MH

57

MH

08

MH

35

MH

10

MH

60

MH

55

MH

63

MH

50

MH

56

MH

07

MH

67

MH

01

MH

44

MH

04

MH

15

Longer Term Complex / Continuing Care length of stay excluding leave

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

100%

MH

21

MH

10

MH

55

MH

05

MH

31

MH

23

MH

11

MH

02

MH

57

MH

60

MH

44

MH

52

MH

08

MH

04

MH

28

MH

01

MH

50

MH

12

MH

67

MH

07

MH

35

MH

56

MH

15

MH

25

MH

63

MH

37

MH

09Longer Term Complex / Continuing Care bed occupancy

excluding leave

Page 41

Cluster profiling

MH07 Mean Median



National trend


10%

15%

20%

25%

30%

35%

40%

45%

50%

10%

20%

30%

40%

50%

60%

70%

80%

90%

10%

15%

20%

25%

30%

35%

40%

NHS England's Care Clusters for people who use specialist mental health services can be grouped into three main categories:

Non Psychosis1 Common mental health problems (low severity)2 Common mental health problems3 Non psychotic (moderate severity)4 Non psychotic (severe)5 Non psychotic (very severe)6 Non psychotic disorders of overvalued ideas7 Enduring non psychotic disorders (high disability)8 Non psychotic chaotic and challenging disorders

Psychosis10 First episode in psychosis11 Ongoing or recurrent psychosis (low symptoms)12 Ongoing or recurrent psychosis (high disability)13 Ongoing or recurrent psychosis (high symptom and disability)14 Psychotic crisis15 Severe psychotic depression16 Dual diagnosis (substance abuse and mental illness)17 Psychosis and affective disorder difficult to engage

Organic18 Cognitive impairment (low need)19 Cognitive impairment or dementia (moderate need)20 Cognitive impairment or dementia (high need)21 Cognitive impairment or dementia (high physical or engagement)

Inpatient activity is driven by bed availability, and the continued decline in older people's beds is reflected in the ongoing reduction in occupied bed days for patients whose episodes fall into clusters 18 to 21.

Page 42

MH07: 17%

Mean: 24%

Median: 26%

Upper Q: 30%

Lower Q: 17%

Region:

Trusts:

Figure 36

MH07: 70%

Mean: 62%

Median: 61%

Upper Q: 71%

Lower Q: 53%

Region:

Trusts:

Figure 37

MH07: 13%

Mean: 14%

Median: 13%

Upper Q: 15%

Lower Q: 9%

Region:

Trusts:

Figure 38

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

MH

93

MH

53

MH

08

MH

54

MH

02

MH

95

MH

56

MH

42

MH

27M

H7

2M

H2

0M

H1

9M

H3

3M

H6

4M

H3

2M

H6

6M

H1

5M

H36

MH

43

MH

63

MH

18

MH

24

MH

05

MH

45

MH

41

MH

40

MH

39M

H0

3M

H6

0M

H2

6M

H9

2M

H3

7M

H0

4M

H2

9M

H2

5M

H61

MH

22

MH

38

MH

57

MH

07

MH

65

MH

06

MH

35

MH

28

MH

10M

H0

9M

H2

1M

H2

3M

H1

2M

H9

4M

H5

2M

H1

1M

H7

4M

H44


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

MH

44M

H11

MH

74M

H52

MH

94M

H10

MH

09M

H23

MH

22M

H12

MH

65M

H35

MH

06M

H28

MH

07M

H38

MH

25M

H29

MH

57M

H40

MH

37M

H03

MH

18M

H04

MH

61M

H92

MH

27M

H41

MH

26M

H32

MH

43M

H24

MH

95M

H64

MH

36M

H66

MH

33M

H56

MH

19M

H20

MH

63M

H05

MH

54M

H02

MH

39M

H21

MH

72M

H60

MH

42M

H15

MH

08M

H45

MH

53M

H93


0%

5%

10%

15%

20%

25%

30%

35%

40%

MH

21M

H45

MH

60M

H93

MH

39M

H15

MH

05M

H63

MH

72M

H42

MH

53M

H61

MH

02M

H57

MH

08M

H20

MH

19M

H66

MH

26M

H04

MH

36M

H24

MH

07M

H92

MH

54M

H12

MH

33M

H43

MH

56M

H41

MH

28M

H25

MH

38M

H29

MH

06M

H64

MH

32M

H35

MH

37M

H94

MH

23M

H03

MH

65M

H95

MH

18M

H40

MH

09M

H27

MH

74M

H52

MH

10M

H44

MH

11M

H22


Page 43

Community care

MH07 Mean Median

2,441 1,632 1,241

1,314

27,091 25,300

National trend

Working age adult teams - community caseload

per 100,000 weighted population

Total community contacts per 100,000 weighted

population

665

25,471

1,464

Total community caseload per 100,000 weighted

population

Older adult teams - community caseload per

100,000 weighted population

1,323 1,483 1,188

Older adult teams - community contacts per

100,000 weighted population25,257 20,880 17,594

Working age adult teams - community contacts

per 100,000 weighted population25,560 30,490 27,777

The two key measures of community capacity are caseloads and contacts. Caseload provides a snapshot of open cases on 31st March 2019. Participants can explore their positions for individual team types in the NHS Benchmarking Mental Health Toolkit. Contacts is a measure of the number of face to face and non face to face contacts delivered by a community team to patients on their caseload, and to those who are being assessed.

Community caseloads and contacts, for both working age and older adults, have seen declines in recent years.

Community based care is the most frequently accessed NHS specialist mental health service, serving around 700,000 people across the UK at 31st March 2019. Most people who access NHS specialist mental health services use community based services at some point in their patient journey.

Page 44

Community caseloads

MH07: 1,188

Mean: 1,483

Median: 1,323

Upper Q: 1,675

Lower Q: 1,052

Region:

Trusts:

Figure 39

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

MH

68M

H18

MH

93M

H83

MH

70M

H92

MH

55M

H59

MH

95M

H69

MH

32M

H40

MH

85M

H35

MH

71M

H61

MH

42M

H45

MH

08M

H39

MH

60M

H51

MH

66M

H05

MH

65M

H12

MH

36M

H94

MH

58M

H01

MH

25M

H15

MH

29M

H26

MH

74M

H64

MH

10M

H72

MH

33M

H63

MH

16M

H43

MH

57M

H02

MH

07M

H38

MH

53M

H41

MH

24M

H28

MH

56M

H44

MH

03M

H54

MH

67M

H22

MH

06M

H37

MH

23M

H19

MH

21M

H27

MH

52M

H50

MH

17M

H20

MH

84M

H04

MH

09M

H11

MH

34

Total community caseload per 100,000 weighted population

1,000

1,500

2,000

2,500

3,000

3,500

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Community services are reported here benchmarked per capita by caseload size and by number of contacts delivered. Caseload is a snapshot position of all open cases on 31st March 2019. For the purposes of this report, the national definition of caseload is applied, i.e. patients who have had two or more face to face appointments as part of this episode of care. This therefore excludes people who are still in the assessment phase, and may not commence treatment with a team.

Total community caseload shows the sum of all individual community team caseloads, against a population of those age 16 and older. Working age adult teams include all those who predominantly serve working age adults, against a population of age 16 - 64. Older adult teams include old age community teams and memory services, against a population of age 65+.

This year's total community caseload of 1,483 compares to 1,372 per 100,000 weighted population last year.

Page 45

MH07: 665

Mean: 1,464

Median: 1,314

Upper Q: 1,717

Lower Q: 1,090

Region:

Trusts:

Figure 40

MH07: 2,441

Mean: 1,632

Median: 1,241

Upper Q: 1,738

Lower Q: 857

Region:

Trusts:

Figure 41

0

500

1,000

1,500

2,000

2,500

3,000

3,500

MH

92M

H18

MH

68M

H93

MH

95M

H32

MH

70M

H59

MH

61M

H40

MH

85M

H83

MH

42M

H08

MH

12M

H71

MH

55M

H15

MH

65M

H58

MH

05M

H36

MH

60M

H94

MH

35M

H03

MH

64M

H74

MH

45M

H01

MH

43M

H57

MH

51M

H53

MH

10M

H26

MH

29M

H25

MH

56M

H63

MH

24M

H02

MH

39M

H66

MH

72M

H16

MH

28M

H27

MH

38M

H69

MH

41M

H67

MH

44M

H23

MH

21M

H06

MH

52M

H33

MH

22M

H37

MH

54M

H17

MH

84M

H20

MH

50M

H09

MH

04M

H07

MH

34M

H19

MH

11

Working age adult teams - community caseload per 100,000 weighted population

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

MH

83M

H69

MH

55M

H68

MH

70M

H59

MH

93M

H18

MH

35M

H51

MH

07M

H39

MH

45M

H66

MH

92M

H33

MH

71M

H40

MH

60M

H01

MH

29M

H25

MH

11M

H26

MH

08M

H72

MH

16M

H54

MH

05M

H95

MH

32M

H19

MH

10M

H38

MH

42M

H22

MH

12M

H41

MH

63M

H37

MH

36M

H65

MH

64M

H02

MH

61M

H44

MH

28M

H04

MH

50M

H74

MH

24M

H20

MH

53M

H15

MH

94M

H06

MH

17M

H67

MH

56M

H84

MH

57M

H58

MH

09M

H43

MH

34M

H23

MH

21M

H52

MH

27M

H03

Older adult teams - community caseload per 100,000 weighted population



Page 46

Figure 42

Figure 43

Figure 44

100%

100%

100%

90%

87%

81%

78%

77%

76%

68%

67%

63%

60%

52%

Assertive Outreach

Early Intervention in Psychosis

Perinatal

Generic CMHT

Community rehabilitation

Eating Disorders

Older People

Forensic

Other community teams

Memory services

Assessment and Brief Intervention

Proportion of caseload with a F2F contact in previous 3 months

Yes No



Page 47

MH07: 90%

Mean: 78%

Median: 80%

Upper Q: 86%

Lower Q: 69%

Region:

Trusts:

Figure 42

MH07: 94%

Mean: 87%

Median: 93%

Upper Q: 96%

Lower Q: 89%

Region:

Trusts:

Figure 43

MH07: 80%

Mean: 68%

Median: 74%

Upper Q: 82%

Lower Q: 61%

Region:

Trusts:

Figure 44

0%

20%

40%

60%

80%

100%

MH

06M

H0

3M

H6

1M

H0

4M

H3

6M

H3

3M

H1

6M

H0

7M

H1

9M

H9

2M

H6

5M

H1

7M

H6

3M

H0

8M

H9

4M

H93

MH

72

MH

57

MH

02

MH

21

MH

41

MH

24

MH

28

MH

22

MH

20

MH

95

MH

25

MH

66

MH

27

MH

11

MH

55M

H1

5M

H3

7M

H7

1M

H5

2M

H6

0M

H4

3M

H1

0M

H7

4M

H4

5M

H2

3M

H5

3M

H5

4M

H1

2M

H6

9M

H44

MH

35

MH

42

Proportion of caseload on 31st March 2019 who had at least one face to face contact during previous 3 months - Generic

CMHT

0%

20%

40%

60%

80%

100%

MH

33M

H61

MH

36M

H59

MH

03M

H02

MH

94M

H60

MH

95M

H54

MH

10M

H04

MH

25M

H06

MH

21M

H07

MH

11M

H28

MH

16M

H18

MH

08M

H19

MH

27M

H66

MH

92M

H20

MH

22M

H52

MH

17M

H65

MH

42M

H72

MH

44M

H63

MH

15M

H37

MH

41M

H74

MH

23M

H93

MH

24M

H55

MH

45M

H53

MH

35M

H12

MH

68

Proportion of caseload on 31st March 2019 who had at least one face to face contact during previous 3 months - Early

Intervention

0%

20%

40%

60%

80%

100%

MH

36M

H12

MH

03M

H43

MH

21M

H94

MH

11M

H19

MH

06M

H17

MH

04M

H41

MH

28M

H93

MH

07M

H15

MH

57M

H16

MH

27M

H23

MH

02M

H20

MH

25M

H65

MH

92M

H24

MH

74M

H44

MH

33M

H08

MH

22M

H71

MH

60M

H45

MH

10M

H63

MH

66M

H95

MH

37M

H54

MH

69M

H55

MH

53M

H35

MH

68M

H72

MH

42

Proportion of caseload on 31st March 2019 who had at least one face to face contact during previous 3 months - Older

People

Page 48

Community contacts

MH07: 25,471

Mean: 27,091

Median: 25,300

Upper Q: 32,396

Lower Q: 19,737

Region:

Trusts:

Figure 45

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

MH

68M

H84

MH

43M

H93

MH

18M

H85

MH

69M

H06

MH

32M

H65

MH

55M

H39

MH

27M

H02

MH

92M

H41

MH

53M

H09

MH

45M

H08

MH

74M

H42

MH

01M

H70

MH

25M

H20

MH

66M

H28

MH

95M

H44

MH

83M

H21

MH

03M

H07

MH

64M

H19

MH

57M

H15

MH

40M

H54

MH

60M

H63

MH

37M

H34

MH

50M

H23

MH

51M

H38

MH

10M

H05

MH

56M

H33

MH

35M

H36

MH

24M

H94

MH

72M

H71

MH

16M

H52

MH

26M

H22

MH

04M

H17

MH

11M

H59

MH

29M

H58

Total community contacts per 100,000 weighted population

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

Community contacts averaged 27,091 per 100,000 weighted population in 2018/19. This compares to 26,364 the previous year. When viewing this data, it is useful for participants to consider the nature and duration of the contacts they offer, and how this may differ from other participants. Year to year comparisons of individual participants are also of value.

Page 49

MH07: 25,560

Mean: 30,490

Median: 27,777

Upper Q: 36,546

Lower Q: 22,305

Region:

Trusts:

Figure 46

MH07: 25,257

Mean: 20,880

Median: 17,594

Upper Q: 24,645

Lower Q: 12,749

Region:

Trusts:

Figure 47

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

MH

68M

H18

MH

93M

H84

MH

92M

H43

MH

32M

H27

MH

02M

H65

MH

06M

H85

MH

53M

H08

MH

03M

H95

MH

42M

H25

MH

74M

H64

MH

09M

H20

MH

41M

H55

MH

66M

H70

MH

40M

H57

MH

45M

H15

MH

21M

H39

MH

69M

H28

MH

44M

H19

MH

54M

H63

MH

07M

H38

MH

83M

H34

MH

60M

H72

MH

10M

H50

MH

23M

H33

MH

05M

H24

MH

71M

H36

MH

37M

H01

MH

52M

H35

MH

56M

H94

MH

26M

H16

MH

22M

H51

MH

04M

H17

MH

59M

H11

MH

58M

H29

Working age adult teams - community contacts per 100,000 weighted population

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

MH

69M

H01

MH

68M

H39

MH

55M

H51

MH

41M

H06

MH

45M

H43

MH

83M

H93

MH

09M

H32

MH

07M

H28

MH

84M

H44

MH

70M

H37

MH

19M

H20

MH

65M

H66

MH

53M

H56

MH

02M

H27

MH

08M

H60

MH

50M

H18

MH

25M

H35

MH

54M

H63

MH

42M

H21

MH

16M

H05

MH

22M

H15

MH

04M

H74

MH

64M

H23

MH

92M

H38

MH

33M

H24

MH

10M

H26

MH

36M

H94

MH

11M

H34

MH

17M

H29

MH

95M

H71

MH

52M

H57

MH

72M

H40

MH

03Older adult teams - community contacts per 100,000

weighted population

Page 50

Waiting times

5.2

7.1

5.4

3.7

3.7

3.1

2.9

2.9

2.7

1.2

6.5

3.6

3.0

3.8

3.6

2.8

2.9

2.8

2.0

0.9

0 2 4 6 8 10 12

Memory Services

Other Adult CMHTs

Forensic

Generic CMHT

Eating Disorders

Perinatal

Assessment & Brief Intervention (incl PMHT)

Older People

Assertive Outreach

Early Intervention (incl Early Onset Psychosis)

Median waiting time (weeks)

Referral to 1st appointment 1st appointment to 2nd appointment

Waiting times show notable variation by team type. The above chart details national average positions for each team and shows that the shortest waits are reported within Early Intervention in Psychosis teams. This is the only community pathway currently subject to waiting time targets in England. Longest waits are reported by Memory Services teams.

Participants can explore their individual positions in detail in the NHS Benchmarking Mental Health Toolkit.

Page 51

Early Intervention

MH07 Mean Median

Early Intervention team DNA rate11% 11% 11%

Length of time on Early Intervention team

caseload (months)6 14 11

Total staff working in Early Intervention per

100,000 weighted population10 7 6

Early Intervention teams contacts per patient on

the caseload34 35 33

Early Intervention referral acceptance rate47% 80% 87%

Early Intervention caseload per 100,000 weighted

population95 64 60

National trend

Early Intervention referrals received per 100,000

weighted population158 84 69

100

150

200

250

300

100%As the only part of adult mental health services currently subject to national waiting time standards, there continues to be a focus on Early Intervention in Psychosis services.

Participants report a continued growth in referrals to these services, to 69 in 2018/19. Referral rate data suggests this year's referral acceptance rate of 80% dips below the pattern seen from 2013/14 of rates between 81% and 83% and may signify the start of increases in thresholds for treatment as a response to rising demand.

Staff working in Early Intervention in Psychosis services have ranged from 5.7 to 7.1 WTE per 100,000 population in the past 5 years. This year's position is 6.9 WTE.

Page 52

MH07: 158

Mean: 84

Median: 69

Upper Q: 95

Lower Q: 49

Region:

Trusts:

Figure 48

MH07: 47%

Mean: 80%

Median: 87%

Upper Q: 93%

Lower Q: 72%

Region:

Trusts:

Figure 49

0

50

100

150

200

250

300

MH

59

MH

37

MH

26

MH

29

MH

74

MH

07

MH

08

MH

41

MH

10

MH

94

MH

39

MH

09

MH

38

MH

44

MH

36

MH

56

MH

40

MH

34

MH

32

MH

61

MH

95

MH

02

MH

60

MH

28

MH

20

MH

18

MH

24

MH

05

MH

03

MH

66

MH

53

MH

22

MH

65

MH

50

MH

17

MH

06

MH

92

MH

23

MH

93

MH

27

MH

35

MH

45

MH

64

MH

52

MH

16

MH

54

MH

19

MH

33

MH

15

MH

04

MH

55

MH

70

Early Intervention referrals received per 100,000 weighted population

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

11M

H61

MH

17M

H64

MH

29M

H41

MH

63M

H25

MH

56M

H53

MH

70M

H05

MH

08M

H50

MH

19M

H35

MH

27M

H68

MH

40M

H20

MH

42M

H26

MH

59M

H74

MH

22M

H92

MH

15M

H10

MH

65M

H18

MH

38M

H16

MH

93M

H94

MH

36M

H60

MH

95M

H39

MH

23M

H02

MH

03M

H52

MH

55M

H54

MH

06M

H37

MH

45M

H72

MH

28M

H34

MH

44M

H09

MH

07M

H66

MH

24M

H32

MH

33M

H04

Early Intervention referral acceptance rate

100

150

200

250

10

15

20

25

30

Page 53

MH07: 95

Mean: 64

Median: 60

Upper Q: 82

Lower Q: 31

Region:

Trusts:

Figure 50

MH07: 9.8

Mean: 6.9

Median: 6.2

Upper Q: 8.0

Lower Q: 4.0

Region:

Trusts:

Figure 51

0

50

100

150

200

250

MH

28

MH

74

MH

03

MH

37

MH

35

MH

29

MH

07

MH

08

MH

41

MH

53

MH

32

MH

66

MH

65

MH

38

MH

56

MH

44

MH

24

MH

60

MH

21

MH

22

MH

12

MH

36

MH

06

MH

45

MH

34

MH

27

MH

18

MH

15

MH

04

MH

93

MH

92

MH

20

MH

59

MH

55

MH

05

MH

33

MH

16

MH

19

MH

51

MH

70

MH

01

MH

09

Early Intervention caseload per 100,000 weighted population

0

5

10

15

20

25

30

MH

03

MH

28

MH

74

MH

29

MH

32

MH

07

MH

09

MH

38

MH

34

MH

37

MH

41

MH

12

MH

21

MH

08

MH

53

MH

65

MH

56

MH

20

MH

60

MH

06

MH

15

MH

44

MH

36

MH

24

MH

04

MH

22

MH

35

MH

93

MH

92

MH

27

MH

33

MH

16

MH

59

MH

18

MH

05

MH

45

MH

19

MH

55

MH

01

MH

51Total staff working in Early Intervention per 100,000

weighted population

10

20

30

40

50

60

70

80

90

10%

12%

14%

16%

18%

20%

Page 54

MH07: 34

Mean: 35

Median: 33

Upper Q: 40

Lower Q: 27

Region:

Trusts:

Figure 52

MH07: 11%

Mean: 11%

Median: 11%

Upper Q: 13%

Lower Q: 9%

Region:

Trusts:

Figure 53

0

10

20

30

40

50

60

70

80

90

MH

68

MH

54

MH

10

MH

20

MH

06

MH

32M

H0

3M

H9

3M

H4

4M

H6

6M

H2

5M

H2

1M

H3

4M

H1

9M

H0

4M

H0

2M

H0

8M

H3

6M

H6

5M

H2

7M

H3

9M

H3

8M

H4

2M

H7

4M

H4

0M

H2

6M

H6

0M

H0

7M

H92

MH

64

MH

41

MH

28

MH

72

MH

50

MH

18

MH

52

MH

53

MH

05

MH

16

MH

37

MH

45

MH

23

MH

63

MH

94

MH

59

MH

56

MH

22

MH

15

MH

17

MH

33

MH

11

MH

95M

H5

5M

H2

4M

H3

5M

H2

9M

H7

0

Early Intervention teams contacts per patient on the caseload

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

MH

63M

H28

MH

02M

H65

MH

09M

H16

MH

37M

H92

MH

23M

H18

MH

39M

H42

MH

52M

H22

MH

64M

H11

MH

24M

H59

MH

45M

H15

MH

34M

H25

MH

94M

H05

MH

44M

H40

MH

36M

H07

MH

20M

H56

MH

04M

H41

MH

08M

H32

MH

95M

H38

MH

35M

H10

MH

19M

H06

MH

27M

H03

MH

93M

H66

MH

17M

H55

MH

21M

H60

MH

53M

H33

MH

50M

H54

Early Intervention team DNA rate

10

15

20

25

30

35

40

45


Page 55

MH07: 6

Mean: 14

Median: 11

Upper Q: 14

Lower Q: 9

Region:

Trusts:

Figure 54

0

5

10

15

20

25

30

35

40

45

MH

68

MH

33

MH

10

MH

23

MH

37

MH

09

MH

41

MH

11

MH

20M

H1

8M

H5

2M

H4

0M

H3

5M

H6

6M

H6

5M

H5

6M

H9

3M

H5

3M

H06

MH

32

MH

04

MH

21

MH

61

MH

36

MH

54

MH

22

MH

16

MH

45

MH

39M

H7

4M

H2

5M

H2

4M

H9

5M

H3

4M

H1

9M

H9

4M

H3

8M

H9

2M

H27

MH

60

MH

17

MH

03

MH

28

MH

59

MH

02

MH

07

MH

64

MH

44

MH

63

Length of time on Early Intervention team caseload (months)


Page 56

Crisis care

MH07 Mean Median

Section 136 Assessments per 100,000 weighted

population87 83 74

Total staff working in CRHT teams per 100,000

weighted population8.6 17.4 15.6

Total staff working in psychiatric liaison per

100,000 weighted population6 5 5

National trend

CRHT face to face contacts per 100,000 weighted


Psychiatric liaison contacts per 100,000 weighted

population... 1632 1374

10,000

12,000

101520253035404550

There has been an upward trend in the number of Section 136 Assessments participants report, which reached 77 per 100,000 population in 2017/18. This year's figure is 83 per 100,000 population.

There has also been movement on the size of the workforce in both crisis team and psychiatric liaison settings.

Page 57

MH07: 2,609

Mean: 3,909

Median: 3,601

Upper Q: 5,085

Lower Q: 2,554

Region:

Trusts:

Figure 55

MH07: 9

Mean: 17

Median: 16

Upper Q: 21

Lower Q: 11

Region:

Trusts:

Figure 56

0

2,000

4,000

6,000

8,000

10,000

12,000

MH

68

MH

32

MH

64

MH

18

MH

10

MH

43

MH

39

MH

65

MH

44

MH

84

MH

03

MH

52

MH

59

MH

02

MH

42

MH

66

MH

27

MH

53

MH

85

MH

28

MH

55

MH

57

MH

34

MH

71

MH

25

MH

95

MH

33

MH

93

MH

36

MH

11

MH

70

MH

08

MH

45

MH

23

MH

01

MH

74

MH

04

MH

40

MH

35

MH

15

MH

21

MH

54

MH

22

MH

92

MH

56

MH

07

MH

63

MH

19

MH

20

MH

41

MH

38

MH

09

MH

72

MH

37

MH

26

MH

24

MH

06

MH

94

MH

05

MH

60

MH

16

MH

29

CRHT face to face contacts per 100,000 weighted population

05

101520253035404550

MH

18M

H71

MH

61M

H32

MH

83M

H93

MH

43M

H84

MH

51M

H59

MH

64M

H03

MH

65M

H57

MH

29M

H92

MH

42M

H20

MH

02M

H39

MH

01M

H27

MH

34M

H25

MH

04M

H33

MH

15M

H74

MH

28M

H35

MH

12M

H19

MH

58M

H45

MH

44M

H11

MH

40M

H41

MH

70M

H05

MH

08M

H67

MH

55M

H52

MH

21M

H23

MH

24M

H53

MH

10M

H26

MH

56M

H38

MH

72M

H36

MH

22M

H54

MH

50M

H63

MH

07M

H95

MH

16M

H09

MH

94M

H60

MH

37

Total staff working in CRHT teams per 100,000 weighted population

10

12

14

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Page 58

MH07: ...

Mean: 1,632

Median: 1,374

Upper Q: 1,612

Lower Q: 999

Region:

Trusts:

Figure 57

MH07: 6

Mean: 5

Median: 5

Upper Q: 7

Lower Q: 4

Region:

Trusts:

Figure 58

0

2

4

6

8

10

12

14

MH

06M

H42

MH

04M

H43

MH

08M

H32

MH

28M

H60

MH

58M

H34

MH

18M

H27

MH

23M

H63

MH

01M

H70

MH

24M

H65

MH

55M

H41

MH

11M

H74

MH

07M

H15

MH

09M

H02

MH

12M

H20

MH

25M

H03

MH

22M

H44

MH

52M

H56

MH

38M

H54

MH

83M

H93

MH

64M

H19

MH

92M

H21

MH

05M

H94

MH

59M

H10

MH

84M

H53

MH

36M

H17

MH

33M

H61

MH

51M

H37

MH

16M

H95

MH

26

Total staff working in psychiatric liaison per 100,000 weighted population

100120140160180200

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

MH

83

MH

08

MH

43

MH

28

MH

27

MH

55

MH

26

MH

70

MH

25

MH

10

MH

32

MH

65

MH

01

MH

23

MH

37

MH

06

MH

39

MH

58

MH

95

MH

20

MH

52

MH

15

MH

12

MH

92

MH

02

MH

22

MH

38

MH

09

MH

66

MH

64

MH

93

MH

35

MH

60

MH

04

MH

41

MH

24

MH

19

MH

53

MH

33

MH

36

MH

34

MH

16

MH

68

Psychiatric liaison contacts per 100,000 weighted population

Page 59

MH07: 87

Mean: 83

Median: 74

Upper Q: 111

Lower Q: 54

Region:

Trusts:

Figure 59

020406080

100120140160180200

MH

67

MH

25

MH

43

MH

12

MH

66

MH

11

MH

18

MH

06

MH

92

MH

21

MH

57

MH

41

MH

32

MH

02

MH

01

MH

03

MH

59

MH

51

MH

19

MH

58

MH

50

MH

07

MH

26

MH

27

MH

33

MH

55

MH

38

MH

61

MH

40

MH

65

MH

17

MH

24

MH

35

MH

15

MH

08

MH

54

MH

60

MH

22

MH

74

MH

45

MH

20

MH

53

MH

23

MH

37

MH

10

MH

95

MH

04

MH

94

MH

71

MH

56

MH

36

MH

28

Section 136 Assessments per 100,000 weighted population

Page 60

Community clustering

MH07 Mean Median


Community contacts - Cluster 17 1% 3% 3%



Community caseload - Cluster 17 1% 2% 1%



National trend


10%

20%

30%

40%

50%

60%

70%

10%

20%

30%

40%

50%

60%

70%

There continues to be disparity between the proportion of caseload in each cluster and the intensity of provision (contact rates) to these cohorts. In particular, older people in clusters 18 - 21 represent 28% of total community caseloads, but receive 16% of total community contacts. The overall level of delivery to patients in clusters 18-21 has shown a decline in recent years. The share of caseload delivered to clusters 1-17 has increased over this period. Psychosis clusters 10-16 have shown the largest increase in share of total activity.

Page 61

MH07: 19%

Mean: 39%

Median: 39%

Upper Q: 46%

Lower Q: 31%

Region:

Trusts:

Figure 60

MH07: 31%

Mean: 40%

Median: 40%

Upper Q: 47%

Lower Q: 35%

Region:

Trusts:

Figure 61

0%

10%

20%

30%

40%

50%

60%

70%

MH

43

MH

27

MH

36

MH

60

MH

15

MH

40

MH

56

MH

65

MH

29M

H9

5M

H2

1M

H2

0M

H1

2M

H0

6M

H6

1M

H0

3M

H1

0M

H24

MH

54

MH

32

MH

92

MH

64

MH

18

MH

28

MH

25

MH

02

MH

94M

H5

2M

H7

2M

H0

9M

H0

4M

H2

3M

H4

1M

H0

8M

H5

7M

H53

MH

33

MH

05

MH

93

MH

19

MH

22

MH

63

MH

38

MH

37

MH

39M

H3

4M

H4

4M

H6

6M

H4

5M

H4

2M

H3

5M

H7

4M

H0

7M

H11


10%

20%

30%

40%

50%

60%

70%

0%

10%

20%

30%

40%

50%

60%

70%

MH

27M

H33

MH

92M

H40

MH

60M

H25

MH

02M

H20

MH

36M

H54

MH

43M

H18

MH

21M

H03

MH

06M

H19

MH

53M

H08

MH

93M

H15

MH

72M

H05

MH

45M

H95

MH

57M

H39

MH

22M

H04

MH

66M

H24

MH

32M

H28

MH

09M

H10

MH

23M

H94

MH

41M

H34

MH

52M

H56

MH

38M

H07

MH

42M

H65

MH

63M

H44

MH

35M

H37

MH

74M

H11


10%

20%

30%

40%

50%

60%

70%

Page 62

MH07: 23%

Mean: 32%

Median: 31%

Upper Q: 39%

Lower Q: 23%

Region:

Trusts:

Figure 62

MH07: 46%

Mean: 41%

Median: 40%

Upper Q: 51%

Lower Q: 32%

Region:

Trusts:

Figure 63

0%

10%

20%

30%

40%

50%

60%

70%

MH

44

MH

23

MH

94

MH

09

MH

52

MH

11

MH

35

MH

74

MH

34M

H3

7M

H9

5M

H2

9M

H5

3M

H3

8M

H6

5M

H2

1M

H6

4M

H41

MH

22

MH

42

MH

57

MH

06

MH

24

MH

10

MH

45

MH

04

MH

15M

H7

2M

H2

8M

H2

0M

H6

1M

H0

3M

H1

2M

H3

6M

H2

7M

H43

MH

60

MH

25

MH

56

MH

07

MH

08

MH

63

MH

40

MH

19

MH

33M

H0

5M

H6

6M

H3

2M

H1

8M

H5

4M

H9

2M

H3

9M

H9

3M

H02


0%

1%

2%

3%

4%

5%

6%

0%

10%

20%

30%

40%

50%

60%

70%

MH

65M

H74

MH

23M

H44

MH

35M

H37

MH

11M

H94

MH

52M

H38

MH

95M

H56

MH

09M

H34

MH

42M

H05

MH

32M

H07

MH

22M

H53

MH

10M

H41

MH

43M

H72

MH

24M

H57

MH

21M

H28

MH

06M

H36

MH

45M

H03

MH

60M

H20

MH

66M

H18

MH

40M

H02

MH

92M

H08

MH

54M

H25

MH

93M

H19

MH

15M

H04

MH

27M

H33

MH

63M

H39


10%

12%

14%

Page 63

MH07: 0.5%

Mean: 1.6%

Median: 1.3%

Upper Q: 2.1%

Lower Q: 0.8%

Region:

Trusts:

Figure 64

MH07: 1.2%

Mean: 2.9%

Median: 2.6%

Upper Q: 3.6%

Lower Q: 1.4%

Region:

Trusts:

Figure 65

0%

1%

2%

3%

4%

5%

6%

MH

63

MH

34

MH

09

MH

10

MH

08

MH

27

MH

29

MH

35

MH

94

MH

53

MH

45

MH

37M

H1

1M

H4

0M

H6

6M

H5

7M

H9

3M

H2

4M

H4

1M

H0

3M

H7

4M

H4

3M

H1

5M

H7

2M

H65

MH

36

MH

33

MH

18

MH

42

MH

39

MH

54

MH

22

MH

56

MH

92

MH

38

MH

12

MH

28

MH

61M

H2

3M

H0

6M

H6

0M

H2

5M

H0

2M

H9

5M

H0

4M

H0

5M

H5

2M

H6

4M

H0

7M

H2

1M

H44

MH

19

MH

32

MH

20

Community caseload - Cluster 17

10%

20%

30%

40%

50%

60%

70%

0%

2%

4%

6%

8%

10%

12%

14%

MH

10M

H93

MH

11M

H57

MH

63M

H08

MH

66M

H74

MH

03M

H35

MH

24M

H40

MH

09M

H37

MH

04M

H27

MH

34M

H36

MH

43M

H18

MH

05M

H54

MH

72M

H45

MH

53M

H92

MH

02M

H60

MH

65M

H94

MH

41M

H33

MH

22M

H42

MH

38M

H56

MH

23M

H28

MH

07M

H06

MH

15M

H95

MH

39M

H19

MH

20M

H21

MH

25M

H52

MH

44M

H32

Community contacts - Cluster 17

10%

20%

30%

40%

50%

60%

Page 64

MH07: 57%

Mean: 28%

Median: 27%

Upper Q: 38%

Lower Q: 19%

Region:

Trusts:

Figure 66

MH07: 21%

Mean: 16%

Median: 14%

Upper Q: 19%

Lower Q: 11%

Region:

Trusts:

Figure 67

0%

10%

20%

30%

40%

50%

60%

70%

MH

07

MH

66

MH

39

MH

93

MH

19

MH

05

MH

02

MH

33

MH

63M

H4

5M

H0

8M

H4

2M

H1

8M

H9

2M

H3

2M

H5

4M

H2

5M

H22

MH

11

MH

04

MH

38

MH

74

MH

72

MH

28

MH

57

MH

41

MH

35M

H4

0M

H0

3M

H5

6M

H6

1M

H3

7M

H1

2M

H3

4M

H5

3M

H60

MH

20

MH

24

MH

64

MH

10

MH

06

MH

15

MH

36

MH

21

MH

44M

H6

5M

H2

7M

H5

2M

H2

3M

H0

9M

H9

5M

H4

3M

H2

9M

H94


0%

10%

20%

30%

40%

50%

60%

MH

63M

H39

MH

04M

H15

MH

19M

H28

MH

66M

H07

MH

41M

H42

MH

93M

H25

MH

45M

H08

MH

54M

H24

MH

33M

H32

MH

18M

H06

MH

02M

H20

MH

03M

H27

MH

22M

H57

MH

60M

H92

MH

21M

H72

MH

56M

H44

MH

11M

H37

MH

34M

H38

MH

36M

H40

MH

10M

H52

MH

35M

H74

MH

09M

H53

MH

43M

H05

MH

94M

H65

MH

95M

H23


Page 65

Workforce

MH07 Mean Median

Adult acute WTE vacancies as % of staff in post4% 17% 15%

Adult acute spend on Bank and Agency (as a % of

total spend on staffing)36% 23% 23%

Adult acute staff sickness / absence %8% 6% 6%

Adult acute staff turnover %6% 12% 11%

Adult acute weighted nurses per 10 beds10.7 8.2 8.0

Older adult weighted nurses per 10 beds9.6 8.1 7.7

Adult acute consultant psychiatrists per 10 beds0.6 0.6 0.5

Older adult consultant psychiatrists per 10 beds0.3 0.4 0.4

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

Inpatient workforce rates are relatively stable, and consistently report rates equivalent to one consultant psychiatrist per ward (typically 18 - 22 beds).

Page 66

MH07: 0.6

Mean: 0.6

Median: 0.5

Upper Q: 0.6

Lower Q: 0.4

Region:

Trusts:

Figure 68

MH07: 0.3

Mean: 0.4

Median: 0.4

Upper Q: 0.5

Lower Q: 0.3

Region:

Trusts:

Figure 69

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

MH

54

MH

11

MH

65M

H8

3M

H0

1M

H5

8M

H2

0M

H1

7M

H0

8M

H29

MH

28

MH

59

MH

27

MH

16

MH

44

MH

41

MH

93M

H1

0M

H2

1M

H6

1M

H3

5M

H7

4M

H2

3M

H0

7M

H0

3M

H7

0M

H3

3M

H5

0M

H3

6M

H9

2M

H6

7M

H0

5M

H0

2M

H4

5M

H4

3M

H1

8M

H8

4M

H7

1M

H2

4M

H64

MH

09

MH

22

MH

06

MH

56

MH

52

MH

38

MH

12M

H3

7M

H3

2M

H6

9M

H1

5M

H5

1M

H4

0M

H1

9M

H2

5M

H3

4M

H5

7M

H6

0M

H0

4M

H9

4

Adult acute consultant psychiatrists per 10 beds

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

MH

58M

H36

MH

41M

H65

MH

74M

H25

MH

18M

H84

MH

11M

H70

MH

61M

H16

MH

08M

H32

MH

09M

H20

MH

33M

H59

MH

44M

H17

MH

64M

H02

MH

22M

H71

MH

10M

H43

MH

35M

H28

MH

24M

H40

MH

15M

H19

MH

05M

H67

MH

27M

H55

MH

03M

H38

MH

01M

H07

MH

50M

H51

MH

34M

H37

MH

45M

H23

MH

52M

H57

MH

21M

H54

MH

83M

H92

MH

93M

H29

MH

56M

H60

MH

26

Older adult consultant psychiatrists per 10 beds

10

15

20

25

10

12

14

16

18

20

Page 67

MH07: 10.7

Mean: 8.2

Median: 8.0

Upper Q: 8.9

Lower Q: 6.7

Region:

Trusts:

Figure 70

MH07: 9.6

Mean: 8.1

Median: 7.7

Upper Q: 8.5

Lower Q: 6.7

Region:

Trusts:

Figure 71

0

5

10

15

20

25

MH

44

MH

85

MH

25

MH

65

MH

84

MH

83

MH

07

MH

09

MH

71

MH

60

MH

70

MH

16

MH

54

MH

05

MH

67

MH

59

MH

95

MH

10

MH

02

MH

23

MH

21

MH

36

MH

51

MH

17

MH

34M

H5

3M

H4

1M

H9

4M

H52

MH

43

MH

55

MH

03

MH

61

MH

24

MH

20

MH

63

MH

58

MH

15

MH

32

MH

28

MH

01

MH

92

MH

56

MH

29

MH

42

MH

06

MH

19

MH

22

MH

33

MH

35

MH

39

MH

57

MH

18

MH

74M

H6

9M

H3

8M

H6

4M

H04

MH

12

MH

11

MH

08

MH

27

MH

50

MH

93

MH

40

MH

26

MH

37

MH

45

Adult acute weighted nurses per 10 beds

0

2

4

6

8

10

12

14

16

18

20

MH

25M

H61

MH

43M

H83

MH

38M

H84

MH

18M

H94

MH

65M

H07

MH

54M

H09

MH

53M

H19

MH

06M

H34

MH

32M

H93

MH

17M

H56

MH

44M

H02

MH

52M

H71

MH

67M

H28

MH

15M

H33

MH

41M

H55

MH

42M

H74

MH

39M

H45

MH

03M

H58

MH

16M

H05

MH

69M

H59

MH

01M

H22

MH

04M

H29

MH

26M

H27

MH

23M

H20

MH

95M

H08

MH

64M

H63

MH

36M

H92

MH

51M

H35

MH

70M

H50

MH

40M

H57

MH

24M

H11

MH

10M

H60

MH

37M

H12

MH

21

Older adult weighted nurses per 10 beds

10%

12%

10%

15%

20%

25%

Page 68

MH07: 8%

Mean: 6%

Median: 6%

Upper Q: 7%

Lower Q: 5%

Region:

Trusts:

Figure 72

MH07: 6%

Mean: 12%

Median: 11%

Upper Q: 15%

Lower Q: 8%

Region:

Trusts:

Figure 73

0%

2%

4%

6%

8%

10%

12%

MH

65

MH

45

MH

40

MH

58

MH

41

MH

56

MH

84

MH

07M

H9

2M

H4

4M

H1

6M

H3

7M

H0

1M

H7

4M

H0

3M

H5

9M

H5

7M

H9

4M

H9

3M

H2

9M

H2

4M

H3

8M

H6

7M

H8

3M

H2

8M

H3

2M

H0

8M

H3

4M

H43

MH

42

MH

04

MH

53

MH

26

MH

22

MH

70

MH

23

MH

27

MH

06

MH

10

MH

15

MH

60

MH

05

MH

19

MH

18

MH

55

MH

17

MH

12

MH

33

MH

11

MH

36M

H02

MH

64

MH

51

MH

25

MH

21

MH

52

MH

95

MH

63

MH

54

MH

20

MH

69

MH

35

MH

71

MH

50

Adult acute staff sickness / absence %

0%

5%

10%

15%

20%

25%

MH

33M

H45

MH

69M

H03

MH

22M

H35

MH

20M

H02

MH

95M

H74

MH

50M

H06

MH

34M

H04

MH

94M

H24

MH

71M

H21

MH

23M

H11

MH

25M

H17

MH

52M

H64

MH

56M

H40

MH

37M

H58

MH

15M

H83

MH

27M

H12

MH

53M

H60

MH

01M

H05

MH

92M

H93

MH

44M

H29

MH

32M

H10

MH

57M

H08

MH

51M

H43

MH

55M

H67

MH

18M

H84

MH

42M

H54

MH

36M

H65

MH

38M

H19

MH

07M

H63

MH

70M

H28

MH

16M

H26

MH

41M

H59

Adult acute staff turnover %

10%15%20%25%30%35%40%45%50%

10%

20%

30%

40%

50%

60%

70%

80%

Page 69

MH07: 4%

Mean: 17%

Median: 15%

Upper Q: 21%

Lower Q: 11%

Region:

Trusts:

Figure 74

MH07: 36%

Mean: 23%

Median: 23%

Upper Q: 28%

Lower Q: 17%

Region:

Trusts:

Figure 75

0%5%

10%15%20%25%30%35%40%45%50%

MH

45M

H69

MH

17M

H25

MH

07M

H29

MH

52M

H34

MH

21M

H03

MH

63M

H40

MH

50M

H09

MH

04M

H44

MH

36M

H95

MH

53M

H22

MH

37M

H35

MH

74M

H15

MH

93M

H65

MH

64M

H33

MH

24M

H41

MH

26M

H54

MH

57M

H18

MH

23M

H10

MH

05M

H27

MH

56M

H58

MH

02M

H20

MH

84M

H94

MH

61M

H85

MH

92M

H60

MH

83M

H39

MH

11M

H67

MH

08M

H42

MH

32M

H19

MH

51M

H55

MH

06M

H66

MH

28M

H01

MH

16M

H59

MH

12M

H70

MH

38M

H71

MH

43


0%

10%

20%

30%

40%

50%

60%

70%

80%

MH

45

MH

69

MH

04M

H3

3M

H0

3M

H1

7M

H2

6M

H5

5M

H5

0M

H6

3M

H5

2M

H1

8M

H6

4M

H3

5M

H9

5M

H1

2M

H1

0M

H6

7M

H2

4M

H2

5M

H1

5M

H4

0M

H2

3M

H2

2M

H5

6M

H4

1M

H2

1M

H5

7M

H1

1M

H6

1M

H7

1M

H6

0M

H2

7M

H5

4M

H3

4M

H8

5M

H1

9M

H3

6M

H4

4M

H0

2M

H8

4M

H2

0M

H8

3M

H5

3M

H3

7M

H16

MH

28

MH

01

MH

43

MH

94

MH

32

MH

42

MH

07M

H0

8M

H6

5M

H7

4M

H3

8M

H0

5

Adult acute WTE vacancies as % of staff in post

Page 70

Community workforce

MH07 Mean Median

MH07: 60

Mean: 74

Median: 70

Upper Q: 86

Lower Q: 58

Region:

Trusts:

Figure 76

Community total WTE per 100,000 weighted

population (age 16+)60.3 74.2 69.8

0

20

40

60

80

100

120

140

160

MH

18M

H01

MH

71M

H32

MH

93M

H58

MH

51M

H43

MH

55M

H83

MH

59M

H28

MH

06M

H61

MH

12M

H64

MH

15M

H92

MH

41M

H70

MH

84M

H65

MH

74M

H66

MH

39M

H02

MH

69M

H95

MH

67M

H42

MH

27M

H05

MH

53M

H56

MH

20M

H72

MH

08M

H24

MH

35M

H21

MH

17M

H57

MH

63M

H07

MH

94M

H03

MH

16M

H29

MH

45M

H36

MH

23M

H40

MH

09M

H37

MH

19M

H25

MH

34M

H04

MH

60M

H38

MH

44M

H50

MH

33M

H11

MH

22M

H10

MH

52M

H26

MH

54

Community total WTE per 100,000 weighted population (age 16+)

The largest determining factor in how many people can be supported in the community is the size of the community workforce. The chart below shows the total community workforce across all team types, benchmarked per 100,000 population age 16+. This figure has shown a reduction in recent years.

Participants can explore positions for each of their community team types, including skill mix and discipline

Page 71

Peer support workers

MH07: ...

Mean: 0.2

Median: 0.1

Upper Q: 0.4

Lower Q: 0.0

Region:

Trusts:

Figure 77

MH07: 0.6

Mean: 0.6

Median: 0.5

Upper Q: 0.9

Lower Q: 0.3

Region:

Trusts:

Figure 78

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

MH

64

MH

84

MH

83

MH

63

MH

24

MH

27

MH

44

MH

20

MH

23

MH

16

Adult acute peer support workers (paid) per 10 beds

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

MH

63

MH

24

MH

64

MH

15

MH

18

MH

44

MH

84

MH

07

MH

92

MH

02

MH

08

MH

03

MH

65

MH

33

MH

54

MH

23

MH

16

Community - peer support workers (paid) per 100,000 weighted population (age 16+)

The inclusion of paid peer support workers within the workforce has gained momentum in recent years, but numbers are still small and most organisations reported they did not have paid peer support workers in post in their adult acute wards, or within their community teams.

Page 72

Finance

MH07 Mean Median

Older adult cost per bed 141,007£ 154,000£ 151,744£

Generic CMHT cost per patient on the caseload 3,190£ 3,294£ 3,050£

National trend

Adult acute cost per bed 152,880£ 144,837£ 143,196£

£100,000

£150,000

£200,000

£250,000

£100,000

£150,000

£200,000

£250,000

£300,000

£350,000

Average bed costs have risen steadily over the last 6 years, from £113,055 in 2012/13 to £140,182 in 2017/18. This year's position exceeds this, at £144,837 per adult acute bed, per annum.

Similarly, older adult bed costs have risen from £113,565 in 2012/13 to £134,949 in 2017/18. This year, the figure reached £154,000.

Factors contributing to increases in bed costs may include staffing levels and workforce pay increases and use of bank and agency staff, along with estate and other corporate costs.

Although community costs are lower, these too have seen a rise in recent years. Cost per patient on a Generic CMHT caseload was £2,702 in 2012/13. This rose to £3,367 in 2017/18. This year's figure is £3,294.

Page 73

MH07: £152,880

Mean: £144,837

Median: £143,196

Upper Q: £155,384

Lower Q: £130,804

Region:

Trusts:

Figure 79

MH07: £141,007

Mean: £154,000

Median: £151,744

Upper Q: £170,959

Lower Q: £134,658

Region:

Trusts:

Figure 80

£0

£50,000

£100,000

£150,000

£200,000

£250,000

MH

59M

H69

MH

15M

H65

MH

45M

H21

MH

17M

H20

MH

39M

H25

MH

09M

H41

MH

37M

H50

MH

92M

H05

MH

85M

H67

MH

16M

H07

MH

95M

H52

MH

40M

H23

MH

54M

H63

MH

02M

H56

MH

11M

H22

MH

04M

H06

MH

34M

H35

MH

27M

H33

MH

70M

H10

MH

36M

H12

MH

83M

H93

MH

32M

H94

MH

43M

H64

MH

24M

H26

MH

71M

H01

MH

28M

H18

MH

44M

H60

MH

42M

H53

MH

08M

H03

MH

58M

H51

MH

84M

H19

MH

74M

H29

MH

66M

H61

MH

38

Adult acute cost per bed

£0

£50,000

£100,000

£150,000

£200,000

£250,000

£300,000

£350,000

MH

44M

H61

MH

93M

H41

MH

06M

H12

MH

45M

H52

MH

56M

H65

MH

67M

H15

MH

18M

H26

MH

38M

H25

MH

22M

H17

MH

39M

H08

MH

59M

H02

MH

94M

H32

MH

92M

H42

MH

66M

H19

MH

43M

H37

MH

54M

H20

MH

51M

H33

MH

16M

H40

MH

50M

H11

MH

34M

H74

MH

10M

H09

MH

28M

H04

MH

07M

H27

MH

95M

H35

MH

05M

H36

MH

23M

H71

MH

24M

H83

MH

53M

H03

MH

58M

H64

MH

69M

H29

MH

63M

H01

MH

21M

H70

MH

84M

H60

Older adult cost per bed

£1,000

£2,000

£3,000

£4,000

£5,000

£6,000

£7,000

£8,000

£9,000

Page 74

MH07: £3,190

Mean: £3,294

Median: £3,050

Upper Q: £4,109

Lower Q: £2,294

Region:

Trusts:

Figure 81

£0

£1,000

£2,000

£3,000

£4,000

£5,000

£6,000

£7,000

£8,000

£9,000

MH

17M

H71

MH

65M

H53

MH

69M

H01

MH

92M

H09

MH

93M

H20

MH

19M

H34

MH

37M

H21

MH

50M

H94

MH

28M

H42

MH

41M

H39

MH

66M

H22

MH

15M

H27

MH

23M

H64

MH

02M

H07

MH

32M

H08

MH

56M

H44

MH

95M

H67

MH

84M

H11

MH

38M

H43

MH

33M

H35

MH

12M

H61

MH

16M

H25

MH

52M

H45

MH

74M

H05

MH

54M

H24

MH

29M

H83

MH

59M

H03

MH

10M

H36

MH

58M

H40

MH

26M

H60

MH

70


Page 75

Quality

MH07 Mean Median

NHS Friends and Family Test (FFT) Patient

Satisfaction Score 98% 87% 90%

National trend

Community Teams Patient Satisfaction Score66% 68% 69% 100%

100%

The CQC undertake surveys to find out the experience of people who receive care and treatment. One of these covers community mental health teams and reports a position of people whose view was that overall they had a good experience of community mental health services. This year, the average position reported was 68%, taking it below the levels seen in the last 7 years (between 69% and 73%).

The NHS Friends and Family Test was created to help service providers and commissioners understand whether their patients are happy with the service provided, or where improvements are needed. It includes a number of measures of patient and staff satisfaction. This year, participants reported an average patient satisfaction score of 87%.

Page 76

MH07: 66%

Mean: 68%

Median: 69%

Upper Q: 71%

Lower Q: 67%

Region:

Trusts:

Figure 82

MH07: 98%

Mean: 87%

Median: 90%

Upper Q: 92%

Lower Q: 85%

Region:

Trusts:

Figure 83

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

24M

H18

MH

05M

H20

MH

03M

H92

MH

93M

H04

MH

33M

H38

MH

53M

H12

MH

37M

H17

MH

22M

H40

MH

74M

H28

MH

66M

H10

MH

29M

H63

MH

11M

H56

MH

06M

H57

MH

26M

H64

MH

72M

H44

MH

27M

H21

MH

15M

H65

MH

42M

H19

MH

09M

H50

MH

34M

H39

MH

60M

H45

MH

08M

H23

MH

07M

H94

MH

95M

H25

MH

41M

H52

MH

02M

H54

MH

61M

H32

MH

35M

H36

Community Teams Patient Satisfaction Score

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

100%

MH

07M

H36

MH

34M

H56

MH

63M

H39

MH

66M

H20

MH

25M

H11

MH

37M

H42

MH

27M

H04

MH

38M

H24

MH

45M

H08

MH

06M

H54

MH

43M

H44

MH

33M

H10

MH

05M

H02

MH

41M

H35

MH

50M

H17

MH

23M

H26

MH

64M

H72

MH

65M

H94

MH

95M

H60

MH

09M

H32

MH

21M

H18

MH

19M

H03

MH

92M

H93

MH

28M

H01

MH

52M

H22

MH

53M

H74

MH

57M

H90


Page 77

Incidents

MH07 Mean Median

PICU prone restraint per 10,000 occupied bed

days3 91 74

Older adult prone restraint per 10,000 occupied

bed days1 2 1

PICU restraint per 10,000 occupied bed days354 476 426

Adult acute prone restraint per 10,000 occupied

bed days1 17 11

Older adult restraint per 10,000 occupied bed

days112 85 65

National trend

Adult acute restraint per 10,000 occupied bed

days187 103 98

100

150

200

250

10

20

30

40

50

60

70Incident rates provide another perspective on the quality of a service, by flagging any areas of concern in an inpatient environment. Because of the differences in patient cohort between services, this data is disaggregated to ward type. The charts on the following page show positions for adult acute, older adult and PICU wards. Participants can explore their positions for all other bed types in the NHS Benchmarking Network Mental Health Toolkit.

Participants have reported clear reductions in use of prone restraint in the last three years.

Page 78

MH07: 187

Mean: 103

Median: 98

Upper Q: 131

Lower Q: 73

Region:

Trusts:

Figure 84

MH07: 1

Mean: 17

Median: 11

Upper Q: 24

Lower Q: 7

Region:

Trusts:

Figure 85

0

50

100

150

200

250

MH

64

MH

60

MH

07

MH

92M

H4

1M

H9

3M

H0

4M

H5

7M

H2

8M

H2

5M

H1

8M

H2

4M

H0

2M

H1

0M

H3

3M

H3

2M

H6

3M

H1

9M

H9

4M

H2

7M

H1

2M

H2

2M

H0

6M

H34

MH

44

MH

52

MH

08

MH

95

MH

55

MH

43

MH

54

MH

53

MH

56

MH

23

MH

01

MH

74

MH

26

MH

21

MH

40

MH

05

MH

45

MH

66

MH

20

MH

71M

H5

0M

H3

6M

H0

3M

H3

5M

H1

1M

H6

5M

H6

1M

H3

7M

H6

7M

H5

8M

H3

8M

H8

3M

H7

0


0

10

20

30

40

50

60

70

MH

10M

H24

MH

22M

H92

MH

57M

H54

MH

94M

H28

MH

32M

H04

MH

27M

H52

MH

56M

H45

MH

44M

H19

MH

23M

H34

MH

71M

H26

MH

05M

H02

MH

74M

H20

MH

03M

H95

MH

33M

H08

MH

11M

H38

MH

55M

H61

MH

40M

H35

MH

60M

H93

MH

63M

H58

MH

67M

H25

MH

65M

H12

MH

06M

H37

MH

50M

H53

MH

84M

H66

MH

36M

H07

MH

83M

H21

MH

41M

H18

MH

64M

H01


100

150

200

250

300

350

10

12

Page 79

MH07: 112

Mean: 85

Median: 65

Upper Q: 110

Lower Q: 33

Region:

Trusts:

Figure 86

MH07: 1

Mean: 2

Median: 1

Upper Q: 3

Lower Q: 0

Region:

Trusts:

Figure 87

0

50

100

150

200

250

300

350

MH

34

MH

41

MH

28

MH

12

MH

57

MH

93

MH

32

MH

92M

H0

8M

H0

2M

H1

8M

H5

3M

H6

4M

H0

7M

H06

MH

55

MH

65

MH

61

MH

74

MH

58

MH

66

MH

43

MH

37

MH

10

MH

05

MH

26

MH

25

MH

63

MH

56

MH

04

MH

20

MH

35

MH

60

MH

54

MH

27

MH

22

MH

94

MH

45

MH

33

MH

24

MH

21

MH

44M

H4

0M

H6

7M

H1

9M

H3

6M

H1

1M

H2

3M

H03

MH

50

MH

95

MH

83

MH

01

MH

71

MH

38

Older adult restraint per 10,000 occupied bed days

0

2

4

6

8

10

12

MH

93M

H74

MH

28M

H22

MH

10M

H24

MH

05M

H32

MH

45M

H04

MH

54M

H94

MH

27M

H33

MH

44M

H02

MH

58M

H19

MH

35M

H52

MH

63M

H56

MH

12M

H03

MH

26M

H23

MH

66M

H07

MH

95M

H60

MH

40M

H53

MH

67M

H37

MH

08M

H57

MH

36M

H20

MH

92M

H34

MH

11M

H38

MH

21M

H06

MH

61M

H25

MH

41M

H18

MH

65M

H50

MH

64M

H83

MH

71M

H01

Older adult prone restraint per 10,000 occupied bed days

1,000

1,200

1,400

100

150

200

250

300

350

400

Page 80

MH07: 354

Mean: 476

Median: 426

Upper Q: 599

Lower Q: 287

Region:

Trusts:

Figure 88

MH07: 3

Mean: 91

Median: 74

Upper Q: 127

Lower Q: 23

Region:

Trusts:

Figure 89

0

200

400

600

800

1,000

1,200

1,400

MH

55

MH

18

MH

06

MH

08

MH

34

MH

63M

H6

4M

H2

8M

H1

2M

H0

2M

H4

1M

H0

5M

H6

6M

H3

3M

H9

2M

H1

9M

H3

2M

H5

0M

H3

1M

H1

0M

H0

4M

H6

5M

H74

MH

22

MH

57

MH

40

MH

24

MH

54

MH

38

MH

94

MH

01

MH

36

MH

07

MH

45

MH

37

MH

21

MH

61

MH

26

MH

17

MH

20M

H4

4M

H2

3M

H1

1M

H9

5M

H5

2M

H0

3M

H6

7M

H2

5M

H5

8M

H8

3M

H7

0M

H3

5M

H6

0

PICU restraint per 10,000 occupied bed days

0

50

100

150

200

250

300

350

400

MH

54M

H10

MH

22M

H19

MH

28M

H05

MH

34M

H32

MH

02M

H17

MH

12M

H74

MH

65M

H04

MH

45M

H24

MH

44M

H52

MH

57M

H08

MH

38M

H63

MH

31M

H92

MH

94M

H20

MH

67M

H03

MH

33M

H11

MH

06M

H23

MH

40M

H35

MH

61M

H37

MH

84M

H50

MH

26M

H66

MH

36M

H25

MH

95M

H83

MH

64M

H07

MH

21M

H41

MH

18M

H60

MH

01

PICU prone restraint per 10,000 occupied bed days

Page 81

Balance of Care

Community

MH07: 49.1%

Mean: 53.2%

Median: 53.3%

Hospital

MH07: 50.9%

Mean: 46.8%

Median: 46.7%

Figure 90

Community

MH07: 90.6%

Mean: 85.7%

Median: 86.8%

Hospital

MH07: 9.4%

Mean: 14.3%

Median: 13.2%

Figure 91

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

63M

H16

MH

18M

H26

MH

45M

H36

MH

54M

H11

MH

67M

H01

MH

37M

H23

MH

34M

H09

MH

52M

H06

MH

59M

H69

MH

19M

H61

MH

07M

H25

MH

74M

H22

MH

28M

H43

MH

40M

H41

MH

05M

H02

MH

10M

H39

MH

94M

H12

MH

03M

H56

MH

17M

H24

MH

35M

H38

MH

95M

H42

MH

70M

H92

MH

08M

H50

MH

15M

H21

MH

53M

H93

MH

58M

H84

MH

44M

H60

MH

29M

H83

MH

32M

H33

MH

65M

H66

MH

27M

H71

MH

64M

H20

Balance of Financial Investment

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MH

94M

H67

MH

06M

H84

MH

11M

H34

MH

04M

H19

MH

18M

H23

MH

58M

H63

MH

09M

H43

MH

52M

H20

MH

03M

H61

MH

53M

H50

MH

22M

H01

MH

21M

H45

MH

57M

H37

MH

69M

H27

MH

16M

H12

MH

42M

H74

MH

17M

H24

MH

25M

H26

MH

60M

H44

MH

15M

H51

MH

54M

H41

MH

55M

H72

MH

95M

H28

MH

65M

H35

MH

38M

H83

MH

56M

H71

MH

02M

H36

MH

64M

H08

MH

39M

H66

MH

29M

H59

MH

07M

H10

MH

68M

H05

MH

32M

H93

MH

70M

H33

MH

40M

H92

Balance of Activity

There have been small but sustained changes in the balance between inpatient and community services in recent years.

The balance of financial investment has seen a marginal increase in spend on community services as a proportion of overall investment. This year's figure of 53% represents the 5th annual increase, however the pace of change is slow, and the figure in 2013/14 was 51%.

The balance of workforce has continued to move in the opposite direction, likely as a result of safer staffing initiatives dictating minimum levels for inpatient environments (a noticeable increase took place in 2014/15). In 2013/14, participants reported 39% of their workforce was based in a community setting. This has increased to 48% this year, the highest figure reported over the last 6 years.

Page 82

Community

MH07: 55.4%

Mean: 51.6%

Median: 52.5%

Hospital

MH07: 44.6%

Mean: 48.4%

Median: 47.5%

Figure 92

0%

10%

20%

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64

Balance of Workforce

Page 83

Conclusion

The NHS Benchmarking Network are delighted to publish the 2019 edition of our mental health benchmarking report. The report provides a state of the nation view of NHS specialist mental health services.

We would like to express our thanks to all contributors in the 2019 UK mental health benchmarking process which has again revealed interesting findings for the NHS. The depth and breadth of the data helps to generate confidence in the comparisons discussed in this report. Due to the consistent positions of many data items the focus on interpreting the data has shifted in many places to one of describing time-series changes in the data observed over the last 8 years of annual benchmarking. The 8-year benchmarking horizon allows firm conclusions to be made about overall trends in service demand and provision across the UK over this period.

The discussion of findings often begins with inpatient care and the debate around bed numbers. Data from 2018/19 shows a further stabilisation in capacity for Adult services and a slow down in the rate of bed reductions for inpatient Older People’s care.

Admission rates to Adult services have been reducing steadily over recent years, and this year participants reported a further reduction in capacity in this area in conjunction with an increase in length of stay.

Bed occupancy across most inpatient bed types is now high, with Adult Acute, Older People, PICU, Low Secure, Medium Secure and High Dependency Rehabilitation beds all averaging above the 85% target suggested by RCPsych and the CQC. The only areas where bed occupancy is notably below this level are CAMHS and Mother and Baby.

Each year our benchmarking results reaffirm the position that most service users receive their care in the community setting. Although increases in caseload size for both adult and older adult teams were reported in 2018/19, it should be noted that this year’s data set includes representation from all Health and Social Care Trusts in Northern Ireland for the first time. Northern Irish providers typically provide greater levels of community support per capita than peers in England. The background rate for England this year appears static, though this should be considered in the context of IAPT services which continue to grow and now support around 1.1 million people per annum in England.

Waiting times for community services show much variation by team, with most rapid access provided by Early Intervention in Psychosis and Assertive Outreach services. For Generic CMHTs, the median referral to treatment time is now 7.5 weeks.



One of the central themes of the benchmarking work is to encourage providers to explore the balance of care between inpatient services and community care. Providers are encouraged to consider how best to ensure an appropriate balance of care between acute and community services. Data on the deployment of the mental health workforce and associated investment confirms an approximately equal split between bed and communitybenchmarking data by reference to key metrics including; waiting times to access community based care and scale of community offer, extent of use of out of area acute beds, and perceptions of service quality reported by service users and carers.



Page 84



One of the central themes of the benchmarking work is to encourage providers to explore the balance of care between inpatient services and community care. Providers are encouraged to consider how best to ensure an appropriate balance of care between acute and community services. Data on the deployment of the mental health workforce and associated investment confirms an approximately equal split between bed and community-based services. The ability to achieve an appropriate system balance can be tested in the benchmarking data by reference to key metrics including; waiting times to access community based care and scale of community offer, extent of use of out of area acute beds, and perceptions of service quality reported by service users and carers.



Page 85

Index of charts

Figure 1 - Adult acute beds per 100,000 weighted population

Figure 2 - Adult acute bed occupancy excluding leave

Figure 3 - Adult acute bed occupancy including leave

Figure 4 - Adult acute admissions per 100,000 weighted population

Figure 5 - Adult acute admissions - patients not previously known to services

Figure 6 - Adult acute admissions - patients of no fixed abode (as a % of all patients admitted)

Figure 7 - Adult acute length of stay excluding leave

Figure 8 - Adult acute length of stay including leave

Figure 9 - Proportion of patients discharged with length of stay 0-3 days

Figure 10 - Proportion of patients discharged with length of stay 90 days or longer

Figure 11 - Adult acute admissions under the Mental Health Act

Figure 12 - Adult acute admissions under the Mental Health Act per 100,000 weighted population

Figure 13 - Adult acute mean length of stay for Mental Health Act detentions

Figure 14 - Adult acute delayed transfers of care

Figure 15 - Adult acute emergency readmissions

Figure 16 - Older adult beds per 100,000 weighted population

Figure 17 - Older adult bed occupancy excluding leave

Figure 18 - Older adult bed occupancy including leave

Figure 19 - Older adult admissions per 100,000 weighted population

Figure 20 - Older adult length of stay excluding leave

Figure 21 - Older adult length of stay including leave

Figure 22 - Older adult delayed transfers of care

Figure 23 - Older adult emergency readmissions

Figure 24 - PICU length of stay excluding leave

Figure 25 - PICU bed occupancy excluding leave

Figure 26 - Eating Disorders length of stay excluding leave

Figure 27 - Eating Disorders bed occupancy excluding leave

Figure 28 - Low Secure length of stay excluding leave

Figure 29 - Low Secure bed occupancy excluding leave

Figure 30 - Medium Secure length of stay excluding leave

Figure 31 - Medium Secure bed occupancy excluding leave

Figure 32 - High Dependency Rehabilitation length of stay excluding leave

Figure 33 - High Dependency Rehabilitation bed occupancy excluding leave

Figure 34 - Longer Term Complex / Continuing Care length of stay excluding leave

Figure 35 - Longer Term Complex / Continuing Care bed occupancy excluding leave




Figure 39 - Total community caseload per 100,000 weighted population

Figure 40 - Working age adult teams - community caseload per 100,000 weighted population

Page 86

Figure 41 - Older adult teams - community caseload per 100,000 weighted population

Figure 45 - Total community contacts per 100,000 weighted population

Figure 46 - Working age adult teams - community contacts per 100,000 weighted population

Figure 47 - Older adult teams - community contacts per 100,000 weighted population

Figure 48 - Early Intervention referrals received per 100,000 weighted population

Figure 49 - Early Intervention referral acceptance rate

Figure 50 - Early Intervention caseload per 100,000 weighted population

Figure 51 - Total staff working in Early Intervention per 100,000 weighted population

Figure 52 - Early Intervention teams contacts per patient on the caseload

Figure 53 - Early Intervention team DNA rate

Figure 54 - Length of time on Early Intervention team caseload (months)

Figure 55 - CRHT face to face contacts per 100,000 weighted population

Figure 56 - Total staff working in CRHT teams per 100,000 weighted populationFigure 57 -

Psychiatri

Figure 58 - Total staff working in psychiatric liaison per 100,000 weighted population

Figure 59 - Section 136 Assessments per 100,000 weighted population





Figure 64 - Community caseload - Cluster 17

Figure 65 - Community contacts - Cluster 17



Figure 68 - Adult acute consultant psychiatrists per 10 beds

Figure 69 - Older adult consultant psychiatrists per 10 beds

Figure 70 - Adult acute weighted nurses per 10 beds

Figure 71 - Older adult weighted nurses per 10 beds

Figure 72 - Adult acute staff sickness / absence %

Figure 73 - Adult acute staff turnover %

Figure 74 - Adult acute WTE vacancies as % of staff in post

Figure 75 - Adult acute spend on Bank and Agency (as a % of total spend on staffing)

Figure 76 - Community total WTE per 100,000 weighted population (age 16+)

Figure 77 - Adult acute peer support workers (paid) per 10 beds

Figure 42 - Proportion of caseload on 31st March 2019 who had at least one F2F contact during previous 3 months -

Generic CMHT

Figure 43 - Proportion of caseload on 31st March 2019 who had at least one F2F contact during previous 3 months - Early

Intervention

Figure 44 - Proportion of caseload on 31st March 2019 who had at least one F2F contact during previous 3 months - Older

People

Page 87

Figure 78 - Community - peer support workers (paid) per 100,000 weighted population (age 16+)

Figure 79 - Adult acute cost per bed

Figure 80 - Older adult cost per bed

Figure 81 - Generic CMHT cost per patient on the caseload

Figure 82 - Community Teams Patient Satisfaction Score

Figure 83 - NHS Friends and Family Test (FFT) Patient Satisfaction Score

Figure 84 - Adult acute restraint per 10,000 occupied bed days

Figure 85 - Adult acute prone restraint per 10,000 occupied bed days

Figure 86 - Older adult restraint per 10,000 occupied bed days

Figure 87 - Older adult prone restraint per 10,000 occupied bed days

Figure 88 - PICU restraint per 10,000 occupied bed days

Figure 89 - PICU prone restraint per 10,000 occupied bed days

Page 88

Raising Standards through Sharing Excellence

Benchmarking Learning Disability

services

March 2019

NHS Benchmarking Network

Contents

Introduction 3

Project participation 4

Benchmarking results

o Overview metrics 5

o Adult inpatient learning disability services 13

o Adult community learning disability services 36

o Children’s learning disability services 47

Good practice 52

Conclusion and next steps 65

Summary infographic 66

2

▪ Welcome to the 2018 NHS Benchmarking Network Learning Disabilities project summary report presenting 2017/18 outturn data

to project participants. We would like to thank participants for submitting their data and are pleased to be in the position to

provide a view of the services delivered to people with learning disabilities commissioned by the NHS. This year the project ran

alongside the NHS Improvement learning disabilities improvement standards project, which ran for an initial pilot year and

provides not only quantitative information but qualitative benchmarking information on providers baseline position in achieving the

national improvement standards. Both projects are aligned with national policy and reference NHS England's Transforming

Care Programme. The NHS Benchmarking Network’s Learning Disability project provides a broad assessment of the state of

NHS learning disability services. The project plays a key role in understanding how services are commissioned, funded, and

provided. This is the 4th cycle of the project’s work which also provides an opportunity to track changes taking place over time.

This report is an overview of the aggregate position across all participant organisations.

▪ 52 organisations took part in the 2018 Learning Disabilities project. Participants cover providers in England, Wales and Northern

Ireland, and include NHS and Independent sector organisations. These organisations provided data on adult and children’s

learning disability services, covering inpatient and community services. Data collection was carried out in the autumn of 2018, and

a period of data validation was undertaken in early 2019.

▪ Many metrics in this report have been benchmarked per 100,000 GP registered population. These populations have been

provided to NHSBN by provider organisations, and represent the total population covered by Trusts. An online analysis tool is

available to participants to enable organisations to view their benchmarked positions on key indicators. A bespoke report has also

been made available to all participants, highlighting provider positions on a range of key metrics. The next iteration of this project

is scheduled to take place in 2019 and will enable further time series comparisons to take place. The next version of the project

will profile data relating to 2018/19 and will launch for data collection in September 2019.

▪ If you have any questions about the contents of this report, or the Learning Disabilities project, please contact Jessica Walsh

([email protected])

Introduction 3

mailto:[email protected]

Project participationA total of 52 provider organisations took part in the project. This included 47 English Trusts and Foundation Trusts, 4 Welsh

Local Health Boards and 1 Northern Ireland Health and Social Care Trusts.

• 2gether NHS Foundation Trust

• Abertawe Bro Morgannwg University Health Board

• Aneurin Bevan University Health Board

• Ashford and St Peter's Hospitals NHS Foundation Trust

• Avon and Wiltshire Mental Health Partnership NHS Trust

• Belfast Health and Social Care Trust

• Berkshire Healthcare NHS Foundation Trust

• Betsi Cadwaladr University Health Board

• Birmingham Community Healthcare NHS Foundation Trust

• Black Country Partnership NHS Foundation Trust

• Blackpool Teaching Hospitals NHS Foundation Trust

• Cambridgeshire and Peterborough NHS Foundation Trust

• Central and North West London NHS Foundation Trust

• Coventry and Warwickshire Partnership NHS Trust

• Cumbria Partnership NHS Foundation Trust

• Derbyshire Healthcare NHS Foundation Trust

• Devon Partnership NHS Trust

• Dorset HealthCare University NHS Foundation Trust

• East London NHS Foundation Trust

• Essex Partnership University NHS Foundation Trust

• Hertfordshire Partnership University NHS Foundation Trust

• Humber NHS Foundation Trust

• Hywel Dda University Health Board

• Kent and Medway NHS and Social Care Partnership Trust

• Kent Community Health NHS Foundation Trust

• Lancashire Care NHS Foundation Trust

• Leeds and York Partnership NHS Foundation Trust

• Leicestershire Partnership NHS Trust

• Livewell Southwest

• Mersey Care NHS Foundation Trust

• Midlands Partnership NHS Foundation Trust

• Norfolk and Suffolk NHS Foundation Trust

• North East London NHS Foundation Trust

• North Staffordshire Combined Healthcare NHS Trust

• North West Boroughs Healthcare NHS Foundation Trust

• Northamptonshire Healthcare NHS Foundation Trust

• Northumberland, Tyne and Wear NHS Foundation Trust

• Nottinghamshire Healthcare NHS Foundation Trust

• Oxford Health NHS Foundation Trust

• Sheffield Health and Social Care NHS Foundation Trust

• Solent NHS Trust

• Somerset Partnership NHS Foundation Trust

• South West London and St George's Mental Health NHS Trust

• South West Yorkshire Partnership NHS Foundation Trust

• Southern Health NHS Foundation Trust

• St Andrew’s Healthcare

• Surrey and Borders Partnership NHS Foundation Trust

• Sussex Partnership NHS Foundation Trust

• Tees, Esk and Wear Valleys NHS Foundation Trust

• The Huntercombe Group

• Wiltshire Health and Care

• Worcestershire Health and Care NHS Trust

4


Learning Disability Services – Adult

overview metrics

Population and prevalence

▪ In the UK, an estimated 1.5 million people have

a learning disability, that’s approximately 2.3%

of the population.

▪ Each year, GP’s provide information to NHS

England through the quality and outcomes

framework (QoF) on how many adults

registered within their practice have a learning

disability. The chart opposite shows figures

reported for CCG areas in England. The data

shows significant variation between areas with

a mean average of 0.47%. The gap between

expected prevalence and the rates recorded by

GPs are due to under-recording of people on

GP systems.

National data from Public Health England suggests that only 49% of people on GP Practice learning disabilities registers

received an annual health check. This data relates to 2016/17 but confirms a consistent under provision of annual health

checks.

The intention of annual health checks for people with learning disabilities, is to improve physical health. In 2017/18 participants

reported that 75.1% of people with a learning disability had a health check. This has increased since 2016/17, when it was

reported that 68.1% had received an annual health check. The organisations taking part in the NHSBN project therefore report

much higher achievement rates for annual physical health checks than in the wider population where less than 50% of people

receive a comprehensive annual health check. The under recording of LD status on practice systems and low coverage rates for

LD annual health checks represent an ongoing risk to the aspiration of improving mortality for people with a learning disability.

6

Commissioning arrangements

▪ In 2017/18 25% reported mixed contract arrangements, an increase from last year (22% in 2016/17) and cost per case

contract has reduced slightly this year from 4% in 2016/17 to 3.2% in 2017/18.

▪ None of the providers who took part in the project report a cost and volume contract commissioning arrangement.

▪ The move to population level health and care commissioning signified in the recently published NHS Plan will hopefully

provide a higher degree of assurance on the need to commission learning disability services effectively.

74%

4%

22%

This is the second year that

commissioning arrangements have

been reported in the project. 71% of

participants reported the most

common arrangement is block

contract, which is a decrease of 3%

from last year where 74% of providers

reporting this arrangement. Block

contracts can be a limiting factor in

service development aspirations but

also offer a degree of assurance. The

important background context for local

commissioning arrangements is of

course the extent to which baseline

contract values are protected by

commissioners and how LD services

are valued when compared with other

specialties.

7

Service overview – access arrangements

74%

4%

22%

▪ 79% of providers report that there is a single

point of access into the LD service. This is an

increase of 11% since 2016/17. This is a 20%

increase since 2013/14 where 58% reported

having a single point of access.

▪ There has also been an increase in

participants reporting using a screening tool

for initial assessment. The percentage with

this arrangement was 67% in 2016/17 and

has increased to 83% in 2017/18.

▪ 92% of providers have a specific referral

criteria into LD services in 2017/18, an

increase of 3% since 2016/17 (89%).

▪ In 2017/18 8% of providers advised they do

have functional mental health services

pathways from which LD service users are

excluded, an increase from the 4% reported in

2016/17 but still a reduction from the 14% of

providers who reported this in 2016. This

confirms a reduction in exclusion criteria to

specialist mental health services for service

users with a learning disability.

79% 83%

8% 92%

Single point of

accessScreening tool

Services exclude LD

service users

Specific referral

criteria to LD services

8

Access – hours of availability▪ There are a range of arrangements

for emergency access to services.

The percentage of providers with a

single speciality LD out of hours/on-

call team has risen from 32% in

2016/17 to 37% in 2017/18.

▪ Emergency duty team (social care)

services has reduced from 57% of

participants reporting they had this

service in 2016/17 to 54% in

2017/18.

▪ The availability of single speciality

LD OOHs/on-call team has

increased from 80 hours (Monday to

Friday) in 2016/17 to 85 hours

reported in 2017/18. Weekend

availability remains at same level as

2016/17 at 33 hours.

▪ Specific LD intensive intervention

teams are less commonly available

for emergency access to services,

This has reduced from 68 hours in

2016/17 to 60 hours in 2017/18. At

the weekend this has also reduced

from 24 hours (2016/17) to 19 hours

(2017/18).

9

We can therefore conclude from this analysis that a wide range of emergency

assessment services may be available in the out of hours period, but that access to

short notice interventions are much less available.

Specialist LD training

provided by Trusts

% of Trusts

who

reported

Yes

Patients 94%

Parents/ carer 93%

Education staff 63%

Registered/ unregistered 96%

Paid carers 87%

Third sector providers 87%

Other health/ social care 97%

Professional networks 87%

Peer support workers 58%

Other 31%

Workforce, leadership and trainingThe table opposite shows the percentage of Trusts who provide

specialist LD training. The most common recipients of this training

are patients and registered/unregistered nursing staff. The least

common recipients of specialist LD training are staff in the

education sector.

Alongside training offered, in 2017/18 90% of providers reported a

nominated medical lead for LD services, an increase from 83% in

2016/17. 91% reported a non-medical lead for LD services, an

increase from 89% in 2016/17.

32% of providers employ people with LD in the workforce. The

average WTE of the workforce employed with a LD is 0.34 WTE.

This low level of employment for people with a learning disability is

particularly surprising in the context of the wider service user and

carer engagement work that takes place across the sector.

The use of volunteers in the provision of LD services is reported by

55% of providers.

The average vacancy rate within adult LD services is 10%, this is a

decrease from 12% in 2016/17. There is wide variation however,

with providers reporting vacancy rates from 0% to 32%.

Sickness rate is reported at 5% and staff turnover rate is 12%. Both

rates being broadly consistent with wider NHS specialties. LD

services have much lower sickness absence rates than related

specialist services (including mental health services).

10

Patient and staff satisfaction ▪ Complaints and compliments are key metrics for

organisations to understand the experience of care

felt by patients and their carers. 94% of services

routinely carry out satisfaction surveys with LD

service users / carers, this is the same percentage

as the 2016/17 project reported.

▪ The average number of formal complaints per

10,000 occupied bed days is 11 in 2017/18. This

has reduced from 18 reported in 2016/17 and 22

reported complaints per 10,000 bed days in

2015/16.

▪ When measured against patient contacts, this

reduces to 2 formal complaints per 10,000

contacts.

▪ The average number of compliments per 10,000

occupied bed days is 99, an increase from 64 in

2016/17.

▪ Results from the national NHS staff survey report

that, on average, 80% of the learning disabilities

workforce feel satisfied with the quality of work and

patient care that they are delivering (see chart

opposite). This is a much higher staff satisfaction

rate than seen in related specialities.

11

CQC inspection

9%

81%

10%

7%24%

68%

▪ 62% of participants had a CQC inspection

during 2017/18. 21% have been inspected

within the last two years, and 18% have

not been inspected for more than two

years.

▪ The chart opposite shows the national

position across all Trusts as reported by

the CQC (inner ring).

▪ The outer ring shows the position of

project participants, of which 16% were

reported to be outstanding in 2017/18. 8%

of participants were rated outstanding

during 2016/17.

▪ 72% were reported as good and 12%

required improvement.

▪ The data therefore confirms a position

whereby project participants reported a

much better quality rating than the wider

LD provider sector. No organisations who

took part in the benchmarking project

reported a rating of inadequate.

12


Adult inpatient services

Service user demographics

20%

32%27%

14%

7%

87%

5%

• The charts below show the service user profile for adult inpatient services 2017/18.

• Service users are reported 84% White British ethnicity. This compares to 84% of the general population for England

and Wales. The area with the widest gap in terms of service user diversity is the prevalence of Asian British people

who account for 7% of the inpatient cohort but 10% of the general population. Over half (58%) of service users fall

within the age bracket 26 – 54. Service users over the age of 65 account for only 11% of total service users and may

unfortunately reflect the higher levels of premature mortality evident in people with a learning disability.

14

Bed based service portfolio

Bed based service

% of participants

who provide the

service (2017/18)

% of participants

who provide the

service (2016/17)

High secure forensic beds 0% 0%

Medium secure forensic beds 26% 18%

Low secure forensic beds 35% 37%

Acute admission beds within specialist LD units 71% 74%

Acute admissions beds within generic mental health

settings

29% 24%

Forensic rehabilitation beds 13% 9%

Complex continuing care & rehabilitations beds 29% 29%

Other beds including those for specialist

neuropsychiatric conditions

13% 9%

Step up/ step down beds 8% 12%

Crisis beds 2% 0%

Inpatient short breaks/ respite schemes 25% 29%

▪ Participants were asked which bed based services are provided by the organisation.

▪ Acute admission beds within specialist LD units, low secure forensic beds, and complex continuing care / rehabilitation beds are

the most commonly provided bed types. No providers reported the provision of crisis or high secure beds.

▪ The data confirms a marginal reduction in the number of providers with beds. The main bed provision of Learning Disability

Assessment and Treatment beds (i.e. Acute Admissions Beds) have reduced from 74% of providers to 71% of providers in the

last year.

15

▪ Participants were asked to report

the provision of specialist LD

beds within their organisation.

The charts in the online

benchmarking toolkit show

variation and the extent of

provision by each provider.

▪ An average of 5.8 beds are

provided per 100,000 population.

▪ The number of secure/ forensic

beds and complex continuing

care rehabilitation beds have

remained at a similar level as the

2016/17 and 2015/16 figures.

▪ A further reduction in both acute

admission specialised LD units

and complex continuing care and

rehabilitation is evident.

Provision of LD Specialist beds 16

▪ Overall bed numbers have fallen from 7.5 per 100,000 population in 2013/14 to 5.8 per 100,000 population in

2017/18 with ongoing reductions noted within the last 12 months.

Average length of stay

▪ Average length of stay is a key performance measure, which can be used to measure efficiency, to assess whether

appropriate patients are being admitted to beds, and assess the suitability of care pathways.

▪ Average length of stay has increased in acute admissions beds, compared to 2016/17 (237 days vs 230 days). Complex

continuing care and rehab beds average length of stay did though reduce to 649 days in 2017/18 from 1,036 days in 2016/17.

17

1036

▪ The average length of stay in acute admission beds within specialised LD units is 237 days, an increase from 230 days in

2016/17, and a decrease from the 2015/16 position of 244 days.

▪ There is a wide variation across providers in average length of stay within this data, from 7.2 days to 1,143 days (3 years).

Average length of stay – acute admissions in specialist LD units

18

Delayed transfers of care - % bed days lost

▪ Delayed transfers of care can be frustrating for ward teams, patients and carers, particularly when there is

pressure on beds. Delays can be caused by patients who are fit for discharge being forced to wait for a bed or

packages of care to be agreed and put in place before discharge can take place. Delayed transfers of care are

calculated as the number of bed days lost due to delays as a percentage of all occupied bed days.

▪ Where DTOCs were present, these accounted for 16% of total bed days for acute admissions to specialist LD

units, this is a 2% reduction since 2016/17 where the percentage was 18%. This may reflect the complexity of

inpatient care and difficulties in arranging community handover and appropriate supported living places.

19

Bed reductions

• In line with the Transforming Care Programme, providers have taken steps to reduce bed numbers in recent years. Within

the last 5 years 22% of beds have closed, with 23% of participants reporting they will close more beds within the next 12

months.

• In 2016/17 26% of participants reports they had plans to reduce bed numbers over the next 12 months, with the mean

average percentage of bed closures (for this group) being 13%. The percentage of bed closures within 12 months has

remained consistent these last two years. In 2015/16 46% of participants planned to close beds within 12 months, and of

these 24% of beds were planned to be reduced.

20

Skill mix by discipline

Participants can test their own skill mix (discipline and banding) on the online toolkit,

available on the members’ area of the website.

▪ For inpatient services, the workforce skill

mix by discipline shows unqualified

nursing accounts for 56% of the total

workforce.

▪ 24% of the total workforce is comprised of

RNLD nurses, this is 5% higher than the

figure reported in 2016/17 (21%). Mental

health and general nursing disciplines

comprise 5% of inpatient staff, this is 1%

lower than reported in 2016/17.

▪ Medical staff account for 2% of the

workforce and specialist therapies also

make up a small percentage of the

inpatient workforce.

▪ LD administration accounts for 5% of staff.

21

Qualified vs unqualified nursing staff

0%

20%

40%

60%

80%

100%

LD CAMHS Adult MH PICU OlderPeoples MH

Unqualified Qualified

67%

56%

51%

58% 60%

▪ For inpatient services,

the workforce skill mix by

discipline shows

unqualified nursing

accounts for 67% of the

Nursing workforce.

▪ This confirms an

increasing tendency for

unregistered Nursing

staff to be used at scale

in the Nursing team.

Unregistered staff now

outnumber registered

staff in all major mental

health inpatient

environments.

▪ Learning Disability has

the highest proportionate

reliance on unregistered

Nursing staff.

▪ Registered nursing staff (band 5

and above) account for 33% of

the LD inpatient nursing

workforce. The largest category

within the qualified staff group are

Registered Nurses in Learning

Disability (28% of total staff),

followed by General Nurses (4%)

and Mental Health Nurses (1%).

▪ Unregistered nursing staff and

support workers account for 67%

of the LD inpatient nursing

workforce

▪ The time-series position for

unregistered staff shows a

position of 68% unregistered

nursing staff in 2017, 66% in

2016 and 60% in 2014.

Inpatient workforce – nursing staff

Skill mix by band

Participants can test their own skill mix (discipline and banding) on the online toolkit,

available on the members’ area of the website.

▪ Inpatient workforce skill mix by band, shows

a similar picture to previous years. The

majority of staff are Band 3, which is

consistent with the largest part of the

workforce being support workers. Band 3’s

account for 44% of total inpatient

workforce.

▪ There has been a 2% increase in Band 5

staff compared to 2016/17 (20%). In

2017/18 22% of inpatient staff are Band 5.

▪ LD Consultant Psychiatrists account for 1%

of inpatient teams.

24

Medical staff

▪ The total WTE per 10 beds for medical staff shows a mean of 0.87 WTE in 2017/18, this has increased from 0.74 WTE

reported in 2016/17, but similar to the 2015/16 reported WTE. More information on workforce WTE can be found on the

online toolkit accessed through the NHS Benchmarking Network website: www.nhsbenchmarking.nhs.uk

▪ Learning disability services have higher staffing numbers than parallel mental health services, although the skill mix of

these staff is typically lower with higher use of support workers and unregistered staff. Medical staffing rates are though

higher than in parallel Adult Acute mental health services which typically average 0.6 WTE per 10 beds.

25

http://www.nhsbenchmarking.nhs.uk/

▪ The charts below show the variation in WTE per 10 beds for support workers and RNLD nursing staff. The

mean average WTE support workers per 10 beds (2017/18) is 19.7, this is a similar value to last year but lower

than 2015/16, where the mean average was 22.0 WTE.

▪ The mean average WTE nursing RNLD per 10 beds (2017/18) is 10.1. This is a similar level to 2015/16 where

the value was 10.3 WTE.

Nursing staff

Support worker

- 68%

Total WTE nursing (RNLD) per 10 bedsTotal WTE support workers per 10 beds

26

▪ The total cost of bed based services has decreased

compared to previous years and reflects the national

reduction in inpatient investment driven by

Transforming Care. This year the mean average total

costs of bed based services per 100,000 population

reported is £571,808. In 2016/17 the mean average

was £730,513 and in 2015/16 the mean average was

£896,216.

▪ The total pay costs for LD inpatient services per

100,000 population reduced this year compared to

2016/17. In 2017/18 the mean average total pay costs

were £469,280 per 100,000 population, compared to

£570,408 per 100,000 population reported in 2016/17.

▪ Total non-pay costs for LD inpatient services per

100,000 population decreased from a mean average of

£34,231 in 2016/17 to £31,264 in 2017/18.

▪ Indirect costs account for £71,264 per 100,000

population.

▪ Organisations reported a 1.7% average CIP in 2017/18.

Areas contributing to CIP include service redesign

(46%), nursing skill mix review (36%) working/shift

patterns (26%), income generation (27%), service

reduction (13%) and vacancy freeze (14%).

Cost of services 27

Forensic/ Non-forensic inpatient cost

▪ The total cost of forensic services in 2017/18 per

100,000 registered population is £705,605 (2016/17

= £944,639), compared to non-forensic costs of

£480,635 per 100,000 population (2016/17

participants reported a total cost of £457,742 per

100,000 population for non-forensic beds). This

confirms a higher intensity of input for forensic LD

patients.

28

▪ Average pay costs for forensic services is £360,717

per 100,000 population compared to £552,000 in

2016/17, with non-forensic services reporting

£368,182 per 100,000 population compared to

£389,000 in 2016/17.

▪ Bank and Agency costs

are an important proxy

measure for continuity of

care and workforce

stability. Project

participants reported an

average 22% of total

workforce costs attributed

to bank and agency staff

costs.

▪ There is notable variation

observed from 0.11% to

46%. Organisations at the

top of this range may wish

to review their positions

and workforce strategies.

▪ The infographic below

also shows how LD

shares similar positions to

mental health inpatient

services in its use of Bank

and Agency staff.

Emergency Care

departments also report

23% use of Bank and

Agency staff.

Bank and agency spend 29

Quality metric Mean average

per 10,000 bed

days 2017/18

Mean average

per 10,000 bed

days 2016/17

Mean average

per 10,000 bed

days 2015/16

Medication incidents 40 47 39

Prescribing errors 5 4 4

Patients prescribed anti-

psychotic medication27 27 14

Patients prescribed rapid

tranquilisation medication9 13 16

Drug administration

errors21 21 13

Ligature incidents 8 16 13

Service users AWOL 3 5 4

Safeguarding incidents 71 65 41

Quality metrics▪ Quality indicators were developed for a

series of metrics with an aim of

concluding on overall service quality and

effectiveness.

▪ Ligature incidents are a major risk

management and safety issue in mental

health and learning disability services.

The number of ligature incidents per

10,000 bed days in this report is 8, a

decrease from 16 ligature incidents

reported in 2015/16.

▪ Medication incidents and drug

administration errors have both increased

since last years LD benchmarking

project. Medication incidents are reported

at 40 per 10,000 bed days and drug

administration errors 19.

▪ Prescribing errors remains at a similar

level to 2015/16, and the number of

patients prescribed rapid tranquilisation

medication has reduced.

30

Restraint▪ The number of incidences of restraint during 2016/17 per 10,000 bed days is 620. The number of reported incidences

vary widely from 0 to 5,484, depending on provider size and service type, and approach to restrictive interventions.

▪ The chart below shows the 2017/18 number of incidences of prone restraint per 10,000 occupied bed days. The mean

number of incidences was 10.2, which is a decrease from the 2016/17 reported number of 19.8 incidences of prone

restraint per 100,000 occupied bed days. It should also be noted that almost half of providers reported zero use of

prone restraint in 2017/18.

31

Violent incidents▪ The number of violent incidents involving patient to patient violence per 10,000 bed days is 59. This compares to the

figure reported in 2016/17 of 45 and in 2015/16 of 53.

▪ The number of patients involved in violent incidents (patient to patient) per 10,000 occupied bed days was 24 in

2017/18. This is broadly similar to last year (2016/17) where the mean average number of patients reported was 22,

but is still less than reported in 2015/16 where the mean average reported was 28

32

▪ Care and Treatment Reviews (CTR) have been developed by NHS England as part of the Transforming Care

initiative. CTRs ensure that individuals are receiving the right care in the right place, and are carried out with

people receiving care in specialist LD or mental health hospitals, and those who are at risk of admission.

▪ The CTR guidance has a number of pathway standards for commissioners and providers. Questions were

included in the NHS Benchmarking Network’s LD project to test compliance against the standards, with the

headline findings shown below. Broad compliance with CTR standards was observed although gaps were evident

in some areas including that 47% of providers had a planned admission without a CTR.

Care and Treatment Reviews

collect

feedback on

Care and

Treatment

reviews

85% 82%

have a lead in

agencies to

ensure that

appropriate

packages of

support are in

place

had a planned

admission

without a care

and treatment

review

report that a

post admission

CTR was

carried out

within 10

working days in

all instances

report that

patients who

have been

admitted for

longer than 6

months have

received a CTR

92%

33

47%

82%

34

STOMP PledgeSTOMP aims to stop over medication of people with a learning disability, autism or both with psychotropic medicines.

The aim of STOMP is to improve quality of life for people with a learning disability, autism or both, by encouraging

people to have regular medication reviews, and ensuring healthcare professionals involve people and families in

decisions about medicines.

The charts below show the percentage of Trusts signed up to the STOMP pledge and the percentage of Trusts that

have undertaken a STOMP audit of the use of psychotropic medication in the last year. 85% of participants signed

up to the STOMP pledge in 2017/18 and 77% of participants had undertake a STOMP audit.

Quality - safeguarding

Quality 2017/18 2016/17 2015/16 2013/14

Number of safeguarding

incidents reported in

inpatient settings per 10,000

bed days

71 45 41 49

Number of recorded

incidences of self-harm per

10,000 bed days

84 133 224 241

Number of “never-events” of

service users per 10,000

bed days

0 0 0 0

Number of suicides per

10,000 bed days

0 0 0 1

Number of deaths per

10,000 bed days

1 1 0

35

• The table opposite

shows the change in

quality indicators for

safeguarding,

incidences of self-

harm, never-events,

suicides and deaths.

• The number of

safeguarding

incidents reported in

an inpatient setting

has increased from

45 to 71 per 100,000

bed days from

2016/17 to 2017/18.

• The recorded

incidences of self-

harm per 10,000 bed

days has reduced

from 133 in 2016/17

to 84 reported in

2017/18.


Adult community services

▪ It should be noted that the services described in this section

are services providing intensive and specialist services to

LD service users rather than universal health and care

services which are excluded from the scope of this project.

▪ Providers were asked to describe the range of specialist

community LD services offered. Community based LD

services are far more extensive in coverage than bed based

services and there is a broad offering from many

organisations. We estimate that 56,000 people are in

receipt of these services.

▪ The most frequent services provided are generic

community LD teams, positive behaviour services and

outpatient services.

▪ Liaison services offered has shown a positive increase

compared to last year, with 68% of providers reporting they

offer a primary care liaison service (compared to 60% in

2016/17). The percentage of providers offering a hospital

liaison service has reduced from 56% in 2016/17 to 53% in

2017/18.

▪ Intensive response / support services are in place in 47% of

organisations. 25% provide transitional services (a

reduction from 37% reported in 2016/17) and 33% offer a

community forensic service (an increase from 27% reported

in 2016/17).

Non bed based service % of

providers

who offer the

service

(2017/18)

% of

providers

who offer the

service

(2016/17)

Community LD team 97% 96%

Positive behaviour services 90% 87%

Outpatient services 76% 76%

Targeted work with service

users and carers82% 69%

LD primary care liaison 67% 60%

LD hospital liaison 53% 56%

Intensive response/ support

services47% 44%

Other 30% 27%

Transitional services 25% 37%

Community forensic service 33% 27%

LD day services 20% 23%

Community services portfolio 37

Waiting times ▪ The LD project explores the variations in waiting times

for services.

▪ Waiting times for routine (non-urgent) referrals to

assessment have increased during 2017/18 to 53 days.

There is wide variation across providers from 7 to 187

days.

▪ Time from assessment to treatment averages 86 days,

double the average waiting time in 2013/14 (45 days).

▪ There has been a three fold increase in the mean

waiting time from referral to emergency assessment

since 2013/14. This has increased from 4 to 12 days.

▪ Teams are generally able to mobilise, however, waiting

times for emergency treatment in excess of a few days

suggest sub-optimal access arrangements.

▪ Time from urgent assessment to treatment averages

18 days, the same waiting time was reported in

2015/16.

▪ Overall conclusions for 2017/18 appear to be that

access has become tighter with longer waiting times in

place in most organisations, when compared to the

position that was evident at the start of the project in

2013/14.

38

24%

26%26%

14%

9%

80%

12%

▪ The charts below show the service user profile for adult community services 2017/18.

▪ Service users are reported 75% White British ethnicity (84% for inpatient services). Over half (52%) of service users

fall within the age bracket 26 – 54 (58% for the inpatient cohort). Service users over the age of 65 account for 9% of

total service users (11% in inpatient services), again an under-represented group when compared to the wider

population.

▪ The ethnic group that is most under-represented in services are Asian British people who account for 6% of

community caseloads against a wider population profile of 10% of general population. Community caseloads contain

more ethnic diversity than the general population.

Service user demographics 39

Referrals to community services

26%

10%

3%4% 20%

6%

28%

▪ Referrals into LD services can be from a range of

sources and are analysed in detail in the chart opposite

and online toolkit.

▪ The largest source of identified new referrals into

specialist LD services are from primary healthcare, who

made 25% of new referrals into specialist LD services

in 2016/17.

▪ Local authorities referred 18% (20% in 2016/17) of new

referrals in to specialist LD services, and 12% of

referrals were internal from CMHTs (10% in 2016/17).

▪ 6% of new referrals were self-referrals and 3% were

from the independent sector and acute secondary care.

▪ 87% of referrals made to community adult services

were accepted in 2017/18.

▪ The average number of referrals accepted onto a

caseload in 2017/18 was 750.

▪ Data suggests a steady decline in the number of

referrals made and the number of referrals accepted.

The percentage of referrals accepted has also reduced

year on year. More information is available through the

online toolkit.

Referrals to community services

40

Community caseload

▪ The average caseload for community LD teams in

2017/18 was 129 per 100,000 registered

population. A reduction from 2016/17 where the

value reported was 136 per 100,000 registered

population, and 162 in 2015/16. Typical reasons

for caseload reduction include; the impact of

caseload review initiatives, focus on most acute

caseload, transfers and discharges to universal

services and reduction in baseline services

funding levels. The decline in community

capacity is consistent with parallel service

investment levels which have reduced since the

project’s inception in 2013/14.

▪ Variation is evident with a range from 2.5 to 354.

This highlights both the broad range in historic

funding at CCG level, and different approaches to

the provision of community based care.

▪ Average time on Learning Disability community

team caseload recorded in months is 36 months

(3 years) a reduction from 2016/17 where the

average time was 45 months (3 years 9 months),

This suggests that patients are moving on and off

the caseloads of specialist mental health and LD

Trusts more frequently that the previous year.

41

Community contacts▪ Community based contacts for LD clients average 2,724 per 100,000 population has reduced compared to 2016/17 (2,756

per 100,000 population). This has reduced from 3,281 contacts per 100,000 population in 2013/14. This represents an 17%

reduction in community contacts over the last 4 years.

▪ 61% of contacts delivered are face to face.

▪ An average of 111 patients are discharged per 100,000 population this is a reduction compared to last years value of 134

patients per 100,000 population, and is similar to the 2015/16 reported valued (115 per 100,000 population).

▪ Community service DNA rates average 7%, with variation from 0.01% to 19%.

42

Community team skill mix▪ A much wider variety of disciplines are

evident in the community LD team than in

specialist inpatient services.

▪ Therapy input is more available and support

workers are less evident in the community

team than in the inpatient workforce.

▪ Support workers make up 15% of the

community workforce (compared with 56% of

the inpatient workforce), and registered

nursing staff make up around 31% of the total

workforce.

▪ Clinical psychology represent 9% of the

community workforce, compared to 2%

evident in the inpatient discipline mix.

▪ Input from other AHP professions is also

evident including Physiotherapy, Occupational

Therapy, and Speech and Language Therapy.

▪ The community LD team typically has a broad

multi-disciplinary team that includes the

presence of staff focusing on both the

physical and mental health needs of service

users. Integration of community services with

wider universal services is an ongoing issue

that can be strengthened by the inclusion of

liaison roles within community teams.

43

Nursing staff▪ Registered nursing staff (Band 5 and above) account for

31% of the LD community nursing workforce.

▪ Unregistered nursing staff and support workers account

for 15% of all staff.

Total WTE nursing (RNLD) per 100,000 populationTotal WTE support workers per 100,000 population

44

Service costs▪ The total costs of community services per 100,000 population is £593,469, this is an increase from last years figure of £552,240. This

does though represent a decrease from £701,658 in 2015/16 and £908,819 in 2014/15. it is pleasing to see the first upward shift in

community team investment since the projects inception.

▪ The total direct costs have decreased year on year. The total direct costs of services in 2017/18 were £546,306 per 100,000 population,

compared £512,253 in 2016/17 and £611,131 in 2015/16. The benchmarking data suggests disinvestment has taken place in

community LD services direct care in the last 3 years, as there has been a 35% reduction in spend related to direct patient care.

▪ Bank and agency spend averages 5% in community learning disability services, and reflects a lower propensity to use temporary staff for

ongoing community care.

45

Safeguarding▪ Providers reported an average of 56 safeguarding incidents per 10,000 community contacts.

▪ There is notable variation observed from 0 to 799 safeguarding incidents per 10,000 contacts and may evidence

different approaches to safeguarding incident reporting across providers.

▪ A range of quality metrics are available on the online toolkit, which can be accessed via the members’ area of the

website.

46


Children's community services

Waiting times

Average waiting times (days)2017/18 2016/17 2015/16 2013/14

Assessment to treatment (routine) 70 72 56 20

Referral to assessment (routine – longest wait)

Average: 102

Range: 0 - 295

Average: 68

Range: 3 -

237

Average: 110

Range: 19 - 363

▪ The Children’s section of this report contains fewer data items due to the

smaller scope of the children’s specialist learning disabilities sector.

▪ The mean routine waiting time from referral to assessment is 34 days. This

has increased from last years waiting time position of 26 days.

▪ Time from assessment to treatment averages 70 days.

▪ The mean longest wait from referral to assessment was reported at 102 days.

▪ The mean longest wait from assessment to treatment was reported at 159

days.

▪ Waiting times for children’s community specialist care have increased since

project inception in 2013/14.

▪ Further information regarding emergency waiting times can be found in the

online toolkit.

48

Caseload and contacts ▪ The chart below shows the total caseload for child community teams per 100,000 registered population. The average

caseload for children’s community LD teams in 2017/18 was 110 per 100,000 registered population. This has reduced

from 129 per 100,000 population in 2016/17.

▪ Average time on children’s community team caseload recorded in months is 24 months (1 year and 11 months), in

2016/17 the average time was 22 months (1 year 10 months), in 2015/16 the average time on caseload was 25 months (2

years 1 month).

49

Workforce▪ There is an increased presence of

registered nursing staff within child LD

community teams, 43% of total workforce.

▪ Support workers account for 32% of the

child LD community workforce, the

comparative values reported in 2016/17

were 10% and 13% in 2015/16, indicating a

substantial shift towards support workers.

▪ Psychology input accounted for 6% of total

workforce in 2017/18, this is a reduction

from 14% in 2015/16.

▪ Input from other AHP professions is also

evident including Occupational Therapy

(3%) and Speech and Language Therapy

(1%).

▪ The children’s community LD team has

good presence from qualified nurses, who

form a substantial element of the multi-

disciplinary team (the largest single staff

group in the MDT).

50

Finance▪ Analysis shows total costs of children’s community services per 100,000 population reducing from £463,755 in 2016/17 to

£451,271 reported in 2017/18, this is however an increase from the cost of £400,715 reported in 2015/16. Children’s

community services have therefore faired better than adult community LD teams in recent years.

▪ A notable range exists in service investment levels from £28K per 100,000 population up to more comprehensive services

investing £1.1M per 100,000 population. This range again highlights the importance of legacy baseline investment levels in

shaping current capacity.

▪ Total pay costs for LD child community services per 100,000 population was reported as £324,977 compared to a mean

average of £317,951 reported in 2016/17.

51

Good practice compendiumExamples of good practice were provided by many project participants. The following section summarises the innovations

developed by individual sites. The NHS Benchmarking Network encourages networking across member organisations

and can provide further member contact details on request.

• Aneurin Bevan University Health Board

Adopted PBS model in all areas of LD services; we support private providers to adopt the PBS model; worked

collaboratively with Mental Health services in relation to supporting individuals requiring PBS input.

• Berkshire Healthcare NHS Foundation Trust

Closure of 7 inpatient beds and development of new community-based IST

More effective planning with Spec Comm and preparing for people to come back to local community

Implementing Active Support into specialist inpatient LD services.

Experience Based Co-Design

Trust is licensed to provide PROACT-SCIPr-UK(R) training - accredited by BILD

Individualised PBS plans developed by Behaviour Specialists from the IST in partnership with people and their families

52

Good practice compendium

• Birmingham Community Healthcare NHS Foundation Trust

The multidisciplinary community teams have a clear ethos and culture of providing a proactive, low arousal approach to

patient care with the aim of understanding individuals and ensuring that everyone who works with them, be they in health or

social care has the same tools to deliver consistent care delivery using a Show-Tell-Do approach to support this. This is

further enhanced through comprehensive modelling of services using both multidisciplinary clinical reference groups and co-

production of pathways and resources with service users and their careers.

Through the lifetime of the TCP programme these services have been developed and the Intensive Support Team is shortly

to increase the service to accommodate an extended service model that allows teams to work 8 – 8 Monday to Friday as well

as providing an admission avoidance, on-call service out of hours. To support this, and to support the increased case load in

both IST and Community Forensic Services the clinical workforce has been expanded to include additional psychology,

nursing, and AHP posts, including the potential use of several new roles such as nursing associate, physician associate, AHP

support roles and assistant practitioners in psychology. Each of the IST and Community Forensic teams also has dedicated

psychiatry support.

The development of the new and enhanced team structure is supported by a Training Needs analysis which supports the

whole MDT, included embedded social workers within IST and is based around the delivery of Positive Behavioural Support

(PBS). A coaching model is also being developed and 14 team members across the services are currently being trained to

deliver this. The team are also working with formal and informal carers to signpost them to appropriate supportive training

and where necessary providing wrap around training and information for all team members that are included in a specific

intervention.

Although the community model is based within health care it works across the formal and informal care sectors too, co-

creating templates and plans that can be used by all people working with an individual patient.

53

Good practice compendium• Derbyshire Healthcare NHS Foundation Trust

Happy, Healthy, Safe national benchmarking tool, designed by the CLDT

Undertaken service redesign with the intensive support team as per national TCP recommendations. Also created new posts

including a forensic LD team to specifically support the TCP cohort along with a TCP case manager.

We routinely use PBS for all service users open to the intensive support team will have an up to date PBS if appropriate. CLDT will

consider PBS as and when appropriate

• Devon Partnership NHS Trust

As part of transforming care work there is now a 3 bedded community living facility to support people to come back into area in a

timelier way

There has been a review of the inpatient service leading to clearer service criteria understood by the STP area and the appointment

of a discharge social worker.

Training programme throughout services to ensure skilled staff available to deliver PBS approach as an alternative to psychotropic

medication

Restrictive interventions project board established. Nurse consultant post developed to support training programme and education

regarding best practice

Mental Healthcare Pathway, Complex Physical Healthcare Pathway, Dementia Protocol as well as Autism, Trauma Informed Practice

and Dementia Training packages have all been evidenced in research papers.

54

Good practice compendium• Dorset Healthcare University NHS Foundation Trust

STOMP audits and action plans led by specialist Psychiatry. Embedding the Challenging Behaviour Pathway and rolling out

MDT led training in the pathway across all services.

We worked with the CCG and Priory HealthCare in development of an innovative residential alternative to hospitals. Sadly, this

project has ceased. However lessons from this are feeding in to our current TCP development work.

Working with Dorset People First to develop a peer led group therapy programme. Health Facilitation pilot programme in

Bournemouth. Further development of the LD IAPT pathway and presentation at NHS Awards. Actions from STOMP audit re

prescribing practice. Development of the Safe Holding process.

• East London Foundation Trust

Drop in sessions for those in crisis - run my IST as an evening Drop in. Health Faciliton have had leaflets pubished nationally as

part of Good Practice in taking bloods for people who have a learning disability. In addition, there has been 3 very successful QI

projects that have reduced waiting times for service users for assessment and treatment. The service has also redesigned its

PBS format with guidance from BILD

The Coppice has a smooth working relationship with Bedfordshire and Luton commissioners and holds regular and effective blue

light and ongoing CTR's for at risk or admitted patients. There is a monthly complex case panel with colleagues from the local

authority ALDT's to identify complex and risky individuals where a wider team approach is needed.

The CBP development team was established within the larger MDT in order to lead NHLD’s challenging behaviour strategy to

facilitate best practice and positive outcomes for Newham residents. This team is made up of all discipline leads; with the

addition of the Senior Behavioural Support Specialist and Clinical Service manager. This team meets monthly with additional

support provided to the team lead from Affina Organisational Development (AOD) in collaboration with Health Education England

and NHS England. AOD works with health & social care organisations to improve performance through team-based working.

55

Good practice compendium• East Sussex adult’s community service

PBS Sussex BILD accredited package delivered. Joint work with commissioners to establish PBS network with providers. HEKKS funded

project for service leaders working with the TC cohort re resilience. Pharmacy project to optimize medication in Hastings and Rother CCG

• Essex Partnership NHS Foundation Trust

Implementation of PBS plans, regular CTR meetings, closer working relationships with commissioners, facilitate the ability to look beyond

a hospital admission to enable an individual to remain in their community/placement

• Positive behavioural support is an embedded element of the management of people with LD within EPUT. The plans are discussed at

each staff handover as well as at the weekly clinical ward rounds. All newly admitted patients to the LD ward have a PBS plan in place

within 7 calendar days of admission.

• Lancashire Care NHS Foundation Trust (Central & West)

Challenging behaviour pathway. All care plans evidence based. Mapping against NICE guidance to undergoing interventions. People with

an LD being involved in the recruitment process for new LD staff. People with an LD are involved in the delivery LD awareness training to

GP and practice nurses through our links with React.

• Lancashire Care NHS Foundation Trust (Pennine)

Challenging behaviour pathway. All care plans evidence based. Mapping against NICE guidance to undergoing interventions. People with

an LD being involved in the recruitment process for new LD staff. People with an LD are involved in the delivery LD awareness training to

GP and practice nurses through our links with React.

56

• Leeds and York Partnership NHS Foundation Trust

All staff in the LD team have had 3 days training minimum in PBS. We have trained Nurse Behaviour Specilaists to

complement the psychology team and continue to invest in this training. Psychiatry input into STOMP-LD.

As part of our Community Review, we had the chair of Forum Central- the 3rd Sector collaborative organisation on the

programme board. We engaged with the organisations on the redesign which included residential and supported living

providers, therapy groups and advocacy services. Our inpatient service also has a relationship with Advonet as each

service user is provided with access to advocacy services. Development of clinical pathways based on NICE Guidance

Revised Community model implemented in September 2017. Creation of a Health Facilitation team to work with city wide

partner providers to make reasonable adjustments. Proposal for Intensive Support team produced Oct 2018. Inpatient

beds reduced from 12 (2015) to 8 (2017) locally. (move to 6 in 2018)

57Good practice compendium

Good practice compendium• Livewell Southwest

Psychiatry working with PLUS to create easy read appointment letters, accessible information standard, Dementia

Screening Programme, end of life pathways, build mentalisation therapy, EMDR, PTSD, OT activity workshops, PCL work

the team undertook work that focussed on the reduction of medication with alternative treatment prior to the creation of

STOMP. The inter-disciplinary nature of the team results in collaborative working with the replacement of psychotropic

medication with PBS/MDT interventions. The model of core team working leading interventions has been pivotal.

The work of the team in relation to repatriation of people from in-patient services predated the creation of TCP. The work of

this team has informed and shaped the development of the Devon TCP and informed other teams within our catchment of

effective processes and practices that lead to successful and sustainable discharges. The team developed the Seven Step

tracking tool, designed to provide an audit and measuring tool in relation to the processes of repatriation. The team

developed a governed and formal; tri-partite partnership with the CCG and provider teams, which has overseen the

repatriation of over 20 people. the team developed and adapted its model of service delivery to ensure that the provider

services received out of hours support. The team identified 2 dedicated nurses who started and saw the process through to

completion. This was achieved with no additional resources and the nurses maintained a caseload. The team-maintained

face to face contact with those in hospital; on a regular basis and worked collaboratively with the clinical and medical

teams within the hospital. A core team was identified while the person was in hospital and participated and engaged prior

to discharge. the team helped to develop and implement the process of individual service design and support planning that

has been so effective in the successful repatriation. Once repatriated, the team have provided continued extensive support

of the person.; Where appropriate, the team has signposted to other mainstream services and worked in conjunction with

them. The team worked closely with the police and developed police passports, which changed the way the police

interacted and supported people in times of difficulty.

58

Good practice compendium• North East London Foundation Trust

Carer and Service user forums which has representation at the LD Partnership Board. Staff trained to undertake an extended role in

specialist areas such as Epilepsy/PBS/Diabetes & Continence. Epilepsy protocols produced for B&D day centre relating to rescue

medication/seizure management for those with profound & multiple disabilities.

Direct Consultancy work. Identification of those Patients at most risk, direct work as an MDT alongside the provision of Level 1 and

Level 2 training of staff and Providers. Train the Trainer project for greater sustainability.

PBS - This a project in collaboration with NHSE which is to provide a comprehensive assessment and evidence-based solutions to the

prevention and management of complex challenging behaviour in people with LD and/or autism. At risk of admission register for high

priority cases discussed regularly at local level and CTR process in place to avoid admission where possible.

Open dialogue - is an innovative psychology-based intervention used primarily in crisis intervention. It has not been used in LD

services before and the Havering team have trained three practitioners to pilot the service.

Regular meetings with the CCG and children services to discuss and update individual cases

This is being actively promoted by the team and all the staff have been and will be going on training sessions which have been

arranged.

Clients assessed by clinical behavioural psychologist

Implementation of Health Action Plans for service users by LD nursing.

Referrals Screening System

59

Good practice compendium• Northamptonshire Healthcare

We have developed new roles around:

Administrator for DOLS/COP - which allows us to ensure education and knowledge is across teams. Applications are prompt and

systems allow us to ensure full and appropriate data collection.

Crisis and Admission Avoidance practitioner - this is an experienced practitioner that works alongside teams to advise and support

in looking at alternatives to admission and risk management. They hold a key role & responsibility in CTR and CeTR process and

education and training around these areas.

Autism Assurance practitioner - To educate and train services and providers, to develop standards and autism champions. To work

on the development and implementation of the autism strategy.

• Oxford Health NHS FT MH Learning Disabilities

The 2017 focus was to transfer services from Southern Health to Oxford Health and it is agreed that this happened very

successfully, by TCPB, CQC auditors and the Trust.

The Oxford University Patient Safety Academy (PSA) worked with Oxford Health managers, clinical staff and families to investigate

the causal factors underpinning emergency admissions to out of county placements for behaviours that challenge. The unique

nature of the cases, some of which are historic and involve multiple agencies has led to the PSA Human Factors team developing

a tool/model to analyse the events and circumstances leading to admissions. The tool is expected to be of significant use to other

health and social care, and education, providers in identifying potential risks and analysing events with this vulnerable group of

people.

Look @Me is the second joint PSA project to develop an intervention to improve safety from choking for people who experience

Dysphagia ‘swallowing problems. The need for education about dysphagia is noted in the Mazars review of deaths of people with a

Learning Disability (2015) and in government guidance on making reasonable adjustments for people who have learning

disabilities and problems swallowing (2017).

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Good practice compendium• Solent NHS Trust

Active review of people on ARoAR, combined register with children’s and AMH, enhanced housing, respite and day opportunities

offer

Active STOMP themed project linked with local care providers, enhanced physical health monitoring, clear process for engaging

carers in medication rationalisation

• Somerset Partnership NHS Foundation Trust

Admissions and crisis avoidance register - to provide proactive multi-agency support to divert crises where possible, and to

improve liaison between agencies and share learning.

PPI groups; QUIG groups to oversee and collate research and evidence-based practice across the service.

• Use of MDT consultation clinics to review medication and ensure least restrictive practice, MDT care pathways, SPA to ensure

MDT approach to health needs including concerns about medication.

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Good practice compendium• South Staffordshire & Shropshire Healthcare NHS FT

Development of CPA and CTR pathway to support all clinicians to understand their role in proactively supporting

service users to receive the support they need in community settings. Establishment of ISTs in South

Staffordshire and Shropshire. Development of PBS pathway and training (and PBS mentors) to support use of

evidence based behavioural approaches across clinical teams. Development of People at Risk of Admission

Registers for Shropshire and South Staffordshire which are regularly reviewed with commissioners.

Directorate involved in Beat-It the largest ever RCT for people with learning disabilities and low mood.

Involvement has enabled us to train several clinicians (nurses and psychologists) in 2 evidence-based treatment

for low mood – behavioural activation and guided self-help. Research will be published in Lancet Psychiatry.

• South West London and St George's

All teams and wards will have a PBS champion who will have undertaken a 2-day introduction/foundation course

in PBS. The LD teams are encouraged to seek out further and more in-depth training/qualifications. The CAMHS

LD team has regular PBS supervision from a behavioural specialist

We are working closely with transforming care at a crisis home to prevent admission and as a step down into the

community. This provision will also look to provide intensive in reach to people’s homes.

We now have practice standards which benchmarks good practice across the trust, regular training to

preceptorship and ICAN programme and starting induction shortly. Implementing PBS across the trust. Yearly

LD/ASD conference open to staff, careers, and agencies linked to the trust. A work experience pilot is currently

being set up across the trust and we have linked in with colleagues in our local council to aid this process.

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Good practice compendium• Southern Health NHS Foundation Trust

Development of the at Risk of Admission Register with the CCG and Local Authority to support identification of those at risk of

inpatient admission, the register is now in place, with regular meetings and reviews

The development of Forensic Community Learning Disability Teams in the Trust and pathway between them and the

Community Learning Disability Services. Agreement from the CCG to commission Hospital Liaison Nursing from April 2017,

service specification and KPI's agreed in preparation for the service commencing. The Intensive Support team development of

PBS pathway reactive strategies across all community teams. Service User and carer engagement in service development and

service review.

Work with the CCG and Local authority on the Least Restrictive Practice Project working with local providers to increase

knowledge and skills around PBS as well as our own health and social care staff. Aim is to work more proactively to reduce

crises and placement breakdown.

We have a nurse prescriber who works with Psychiatry to support people on our mental health pathway to ensure they get

timely access to medication reviews alongside the other therapies offered by the clinical team.

Our Health Facilitation Nurses have been working with local CCG's and GP practices to accredit the practices as Learning

Disability Friendly which is supporting access and reasonable adjustments. They have also been involved in national work to

develop the MIQUEST tool used for the annual health checks to ensure appropriate coding.

Intensive Support Team early intervention strategies and rapid response and formulation pathway for people whose behaviour

challenges services and support roll out across CTLDs.

Within the inpatient services there is a well embedded PBS model used by the MDT, the service also uses periodic service

review to identify opportunities for patients and staff to work proactively to optimise and work proactively with patients to

achieve their goals and reduce the use of psychotropic medication. The intensive support team will support discharge to a new

provider to ensure the PBS and period service review continue following discharge to maximise opportunities for success and

positive outcomes.

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Good practice compendium

• Sussex Partnership NHS Foundation Trust (Selden unit)

Introduction and redesign of Physical restraint training for whole trust, including more focus on preventative techniques.

Trust wide presentations on restraint reduction and PBS. PBS networks running across the trust (for families as well as

staff).

My Restraint Story, Restrictive Physical Intervention audit, 5 good communication standards, STOMP, PBS, Health and

wellbeing programme (Seldencise)

• The Huntercombe Group - Ashley House

As part of implementation of transforming care, we are developing a further step down from Eldertree Lodge. Oakwood Lodge

will open as a supported living service providing supported living accommodation in the community.

Positive Behaviour Support accredited by BILD

Positive Behaviour Support accredited by BILD has been embedded throughout the service, we have PBS Coaches identified

for all pathways as well as PBD champions delivering PBS to the patients and supporting staff. This is reviewed throughout

Clinical Governance and MDT and used as a proactive alternative to psychotropic medication.

• Wiltshire Health and Care

CPA process in place with care coordination. Work with CCG to support people coming back into county with complex needs

CTPLD has a challenging behaviour/mental health nursing workstream who work closely with Psychiatry, Psychology and

Learning Disability Intensive support team [AWP] to provide positive behavioural support. Challenging behaviour/Mental health

workstream nurses and train the trainer in PRT.

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Conclusions and next steps▪ This report summarises the results of the fourth round of the NHS Benchmarking Network’s Learning Disabilities benchmarking

project. We are delighted with the response from member organisations which has created a critical mass of data for the project

and coverage across 3 UK countries.

▪ Phase 1 of the project ran in 2014, and this year we have been able to make comparisons on how service provision has changed

over the last 4 years.

▪ The findings from the project describe a continually changing position for LD provision. Inpatient care is reducing in line with the

Transforming Care strategy although the rate of bed reduction has slowed. However, there is no evidence of a parallel increase in

community based provision. Costs of direct care continue to be significantly lower than when the project began in 2013/14. This

year we have seen a further increase in waiting times for community services. Baseline investment in specialist community LD

services increased marginally over 2016/17 levels but it is still 35% lower than in 2013/14.

▪ The largest part of the LD workforce continues to be support workers, especially in inpatient services. Community teams have a

richer skill-mix although overall capacity has reduced. The project now generates detailed data on incident rates and other quality

metrics. Providers need to ensure they are sighted on positions within the national range.

▪ All project participants have received a bespoke report highlighting their organisation’s position across a number of metrics, and

access to an online toolkit containing hundreds of benchmarked metrics. The Learning Disabilities benchmarking project will next

run in the 2019/20 work programme with a project launch date in September 2019.

▪ We would like to thank all participants for their involvement in this years project.

▪ If you have any questions about this report or the project, please contact Jessica Walsh ([email protected]).

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mailto:[email protected]

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Documents

NHS Benchmarking Network Collections & Reports