Ambitious new models of care which integrate mental and physical healthcare are being spearheaded by the NHS Vanguards as part of the NHS Five Year Forward View. But how effective will service redesign be without in depth mental health data at its core?
The paucity of existing mental health data intelligence is a real problem. It currently makes planning services appropriately and truly understanding the population’s mental health needs very difficult because we don’t have a sound grasp of the problems we’re dealing with.
During the recent review we carried out for the Strategic Clinical Network at NHS England (Wessex) for Mental Health, Dementia and Neurological Conditions, there was a look of incredulity from a patient representative: “How can you possibly develop a neurology strategy without data?”
It is a very good question and it applies to all long-term conditions, not least mental health.
There are huge challenges in improving care in people with mental health conditions, but having good information as a starting point, would make it a little easier to understand how we can be more effective.
People with mental health conditions often have complex needs, and currently even with the best will in the world it is extremely difficult to pull together a complete national or local picture of the health and care needs of people with mental health conditions.
A better data set would really help us understand how – and crucially why – people with mental health conditions use services and end up in hospital, so that we have a better sense of where we can act earlier and work together to improve their lives. With good quality data intelligence we can fully understand how we should be redesigning services.
So far the impact of the poor existing data has in some cases been services which are badly planned and fail to adequately respond to patients’ needs at the scale required. Ultimately this means services are expensive to deliver and patient outcomes suffer.
The data question hanging over mental healthcare provides a critical commissioning challenge – initially to benchmark local services, and then to plan ahead for value and improved outcomes from integrated, multi-agency sustainability and transformation plans-based footprint budgets in England.
We are involved in a number of data interpretation projects to begin this benchmarking process. Benchmarking is important as it provides detailed information and understanding about variation in demand, capacity and outcomes. It helps define what ‘good’ looks like too. This supports providers in delivering optimal services within resource constraints, whilst also allowing commissioners to achieve the best balance from available commissioning resources.
Crucially benchmarking gives CCGs and providers within a cluster or area (statistical neighbours) an idea of how they are doing compared to others and it allows delivery of good outcomes and excellent patient experience in sharing best practice across the NHS and other health and social care services.
We spoke to Dr Jill Rasmussen, South East Clinical Network Dementia Lead, about the importance of good data as the foundation of mental health care planning:
“Management of mental health in primary care needs to be underpinned by more co-ordinated data collection that will facilitate holistic management and one care plan for patients.
“For example, we need to have a care plan template that reflects all a patient’s illnesses and common needs arising out of those illnesses. The ‘care plan’ should have core components (weight, blood pressure, demographic, social data, Lasting Power of Attorney, DNAR [do not attempt resuscitation]) augmented by data about co-morbid conditions e.g. data specific to diabetes, dementia such as results of relevant blood tests.
“A mechanism needs to be developed whereby this primary care data can be captured and fed to Health & Social Care Information Centre to get a fuller understanding of health issues faced by patients, the care they receive across the different sectors and the outcomes that are achieved.”
What Dr Rasmussen is describing for primary care is what we are doing within mental health – a ‘care planned approach’ (CPA) for mental health. See the snap shot figure we recently produced which shows the variability of patients on a mental health care CPA within a CCG.
But with reference to how health data is currently analysed within primary care, Dr Rasmussen said:
“Currently systems look at disease templates for individual conditions rather than an integrated matrix across conditions. This fosters duplication, takes more time, creates perverse opportunities for missing out critical aspects of patients’ health and social care needs and hinders communication between professionals involved in patient care.
“The different care plans should also identify markers of different needs (end-of-life care, frailty, dehydration issues etc.) that are indicators of increased need.
“The suggested approach towards data capture and analytics converted to intelligence will achieve far better outcomes and efficiencies in the health system.”
If the system Dr Rasmussen describes could be unified with the CPA for mental health into a global care plan which incorporates primary care data, this would be a very powerful tool. With more focus on how primary care can support mental health services, this type of tool would allow GPs, for example, to see everything relevant to their patient such as the sub-plans for dementia, COPD, and asthma – along with mental health.
A global care plan approach is not only essential if we are to effectively integrate mental and physical health care, but it could also feedback a wealth of data. This is vital to understanding population needs, such as helping to identify those mental health patients who are most at risk of (often physical) comorbidities and would benefit from proactive intervention. This rich data must surely be the bedrock of transforming mental health services?
Disclaimer: Secondary care data are taken from the English Hospital Episode Statistics (HES) and Mental Health and Learning Disabilities Dataset (MHLDDS) databases produced by the Health and Social Care Information Centre (HSCIC, www.hscic.gov.uk/hes) Copyright © 2010 – 2015, re-used with the permission of the Health & Social Care Information Centre. All rights reserved. Please note that this (mental health) analysis does not include any information relating to compulsory detentions under the Mental Health Act so the inpatient information presented is incomplete.