Mental Health BenchmarkingDec 11, 2014 · The terms of reference for the project have been...

Comparison with all respondents, unweighted population

Mental Health Benchmarking

NHS Benchmarking Network


2014

Report for Trust: T00

1Mental Health Benchmarking Report 2014


Index 2

Executive Summary 3

Introduction 4

Bed provision 8

Adult Acute Admissions 10

Length of Stay 12

Emergency readmissions 14

Bed Provision Older Adults 15

Older adult LOS 17

Older Adult Admissions 19

Older adult readmissions 20

Specialist beds 21

Eating Disorders 24

Low Secure 26

Medium Secure 28

High Dependency Rehab 30

Longer Term Complex Care 32

Clustering 34

Use of the Mental Health Act 38

Community 39

Workforce 44

Finance 47

Quality 50

Balance of care 57

Conclusion 60

Index of Charts 61

Contents




Executive Summary

This year's Mental Health Benchmarking Report analyses data from 1st April 2013 to 31st March 2014 across all Mental Health Trusts in England, all Local Health Boards in Wales, and a number of independent sector providers of inpatient care. Comparisons are available between organisations nationally and within local geographical peer groups using former SHA boundaries. Where relevant, data from 2011/12 and 2012/13 is included in key indicators to show the trends of the past few years.

This report confirms the reduction in acute beds between 2011/12 and 2012/13 has continued and this year's figures for adult and older adult acute beds are lower than any previously reported. Length of stay has not changed significantly in adult services, while bed occupancy has continued to rise. This is an expected result of the increased pressure of operating a reduced bed base.

A detailed analysis of the mental health workforce is provided and shows wide variation between different specialisms. The specialties with the highest staffing are PICU, secure services and mother and baby units. In the community, the highest staffed teams are Early Intervention and Crisis Resolution and Home Treatment.

Cluster data illustrates higher acuity of patients within acute beds compared to previous years. This is consistent with bed closures resulting in higher thresholds for admission and thus the typical patient cohort being more acutely unwell than in previous years. A further impact of this may be an increased pressure on community services. Analysis of this area confirms an increased demand for community teams, shown by higher caseloads.

Quality data looks at measures such as serious incidents, patient feedback, violence, use of seclusion and restraint. Rates have generally increased this year, although it is likely that this is, in part, due to more thorough reporting of incidents at the local level.

The overall theme of this year's report is increased pressure on both community and bed-based services on a national scale. The Mental Health Toolkit which accompanies this report provides a great number of benchmarking comparisons that look in more detail at some of the points raised here.

We would like to thank all of our members for their contributions to the 2014 benchmarking process.

This year's Mental Health Benchmarking Report analyses data from 1st April 2013 to 31st March 2014 across all Mental Health Trusts in England, all Local Health Boards in Wales, and a number of independent sector providers of inpatient care. Comparisons are available between organisations nationally and within local geographical peer groups using former SHA boundaries. Where relevant, data from 2011/12 and 2012/13 is included in key indicators to show the trends of the past few years.

This report confirms the reduction in acute beds between 2011/12 and 2012/13 has continued and this year's figures for adult and older adult acute beds are lower than any previously reported. Length of stay has not changed significantly in adult services, while bed occupancy has continued to rise. This is an expected result of the increased pressure of operating a reduced bed base.

A detailed analysis of the mental health workforce is provided and shows wide variation between different specialisms. The specialties with the highest staffing are PICU, secure services and mother and baby units. In the community, the highest staffed teams are Early Intervention and Crisis Resolution and Home Treatment.

Cluster data illustrates higher acuity of patients within acute beds compared to previous years. This is consistent with bed closures resulting in higher thresholds for admission and thus the typical patient cohort being more acutely unwell than in previous years. A further impact of this may be an increased pressure on community services. Analysis of this area confirms an increased demand for community teams, shown by higher caseloads.

Quality data looks at measures such as serious incidents, patient feedback, violence, use of seclusion and restraint. Rates have generally increased this year, although it is likely that this is, in part, due to more thorough reporting of incidents at the local level.

The overall theme of this year's report is increased pressure on both community and bed-based services on a national scale. The Mental Health Toolkit which accompanies this report provides a great number of benchmarking comparisons that look in more detail at some of the points raised here.

We would like to thank all of our members for their contributions to the 2014 benchmarking process.



Introduction

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

The benchmarking process has been member driven from inception and we would like to acknowledge the contribution made by the mental health reference group who have shaped the content of the project and definitions used to ensure like for like comparisons have been developed. We would also like to acknowledge the significant input of member organisations who took time to collect and validate data. All comparisons within the report use the financial year 2013/14 which creates a highly timely picture of the mental health sector across England and Wales.

In addition to the 78 specific comparisons presented in the report, we would also like to reference the supporting mental health benchmarking toolkit which will be made available to all contributors. This is a bespoke software tool that allows around 5,000 individual comparisons to be viewed for each contributor. This guarantees a richness of content and understanding which can be used to fully profile local services and positions against peers.

This version of the report looks at metrics benchmarked against a weighted population measure. Respondents also receive a report using a GP registered population. The interactive toolkit allows users to view a still wider range of metrics, with both weighted and registered population views.

Edward Colgan Stephen WatkinsChief Executive DirectorSomerset Partnership NHS Trust NHS Benchmarking Network& Chair of NHSBN Mental Health Reference Group

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

The benchmarking process has been member driven from inception and we would like to acknowledge the contribution made by the mental health reference group who have shaped the content of the project and definitions used to ensure like for like comparisons have been developed. We would also like to acknowledge the significant input of member organisations who took time to collect and validate data. All comparisons within the report use the financial year 2013/14 which creates a highly timely picture of the mental health sector across England and Wales.

In addition to the 78 specific comparisons presented in the report, we would also like to reference the supporting mental health benchmarking toolkit which will be made available to all contributors. This is a bespoke software tool that allows around 5,000 individual comparisons to be viewed for each contributor. This guarantees a richness of content and understanding which can be used to fully profile local services and positions against peers.

This version of the report looks at metrics benchmarked against a weighted population measure. Respondents also receive a report using a GP registered population. The interactive toolkit allows users to view a still wider range of metrics, with both weighted and registered population views.

Edward Colgan Stephen WatkinsChief Executive DirectorSomerset Partnership NHS Trust NHS Benchmarking Network& Chair of NHSBN Mental Health Reference Group



Mental Health Reference Group Members

definitions used to ensure like for like comparisons have been developed. We would also like to acknowledge

The following people advised on the benchmarking process throughout and also shaped the content of this report.

Edward Colgan Somerset Partnership NHS Foundation TrustTracy White Central and North West London NHS Foundation TrustJayne Flynn Coventry and Warwickshire Partnership NHS TrustJennifer Illingworth Northumberland, Tyne & Wear NHS Foundation TrustCatherine Magee Berkshire Healthcare NHS Foundation TrustIan Minto Manchester Mental Health & Social Care TrustToby Rickard Avon & Wiltshire Mental Health Partnership NHS TrustLee Cornell Somerset Partnership NHS Foundation TrustChris Lanigan Tees Esk and Wear Valleys NHS Foundation TrustGordon Folkard Avon & Wiltshire Mental Health Partnership NHS TrustSophie Donnellan Oxleas NHS Foundation TrustCharlotte Hunt Oxford Health NHS Foundation TrustMel Conway South Essex Partnership NHS Foundation TrustNick Jenvey Dorset Healthcare NHS Foundation TrustSally Wilson Hertfordshire Partnership NHS FTWendy Copeland Blair Mersey Care NHS TrustJonathon Artingstall Camden and Islington FTEmma Baker Dorset Healthcare NHS FTKevin Daley North Staffordshire Combined Healthcare NHS TrustJoanna Wood South Staffordshire & Shropshire Healthcare NHS FTLucy Macro Hertfordshire Partnership NHS Foundation TrustDr Mohit Venkataram East London NHS Foundation TrustPaul Sailes Dorset Healthcare NHS FTMichael McMillan Central and North West London NHS Foundation TrustKeren Corbett Birmingham Children’s HospitalDr Arokia Antonysamy Lancashire Care NHS Foundation TrustAnne Forbes Devon Partnership NHS TrustRony Arafin Devon Partnership NHS TrustJoanne Pinnington 5 Boroughs Partnership NHS Foundation TrustAlan Davies Cardiff and Vale University Health BoardShane Mills Cardiff and Vale University Health BoardEsther Provins Dorset Healthcare NHS Foundation TrustMark Landau Hertforshire Partnership NHS Foundation TrustAdrian Clarke NHS WalesNeil Griffiths Cheshire and Wirral Partnership NHS Foundation Trust

definitions used to ensure like for like comparisons have been developed. We would also like to acknowledge

The following people advised on the benchmarking process throughout and also shaped the content of this report.

Edward Colgan Somerset Partnership NHS Foundation TrustTracy White Central and North West London NHS Foundation TrustJayne Flynn Coventry and Warwickshire Partnership NHS TrustJennifer Illingworth Northumberland, Tyne & Wear NHS Foundation TrustCatherine Magee Berkshire Healthcare NHS Foundation TrustIan Minto Manchester Mental Health & Social Care TrustToby Rickard Avon & Wiltshire Mental Health Partnership NHS TrustLee Cornell Somerset Partnership NHS Foundation TrustChris Lanigan Tees Esk and Wear Valleys NHS Foundation TrustGordon Folkard Avon & Wiltshire Mental Health Partnership NHS TrustSophie Donnellan Oxleas NHS Foundation TrustCharlotte Hunt Oxford Health NHS Foundation TrustMel Conway South Essex Partnership NHS Foundation TrustNick Jenvey Dorset Healthcare NHS Foundation TrustSally Wilson Hertfordshire Partnership NHS FTWendy Copeland Blair Mersey Care NHS TrustJonathon Artingstall Camden and Islington FTEmma Baker Dorset Healthcare NHS FTKevin Daley North Staffordshire Combined Healthcare NHS TrustJoanna Wood South Staffordshire & Shropshire Healthcare NHS FTLucy Macro Hertfordshire Partnership NHS Foundation TrustDr Mohit Venkataram East London NHS Foundation TrustPaul Sailes Dorset Healthcare NHS FTMichael McMillan Central and North West London NHS Foundation TrustKeren Corbett Birmingham Children’s HospitalDr Arokia Antonysamy Lancashire Care NHS Foundation TrustAnne Forbes Devon Partnership NHS TrustRony Arafin Devon Partnership NHS TrustJoanne Pinnington 5 Boroughs Partnership NHS Foundation TrustAlan Davies Cardiff and Vale University Health BoardShane Mills Cardiff and Vale University Health BoardEsther Provins Dorset Healthcare NHS Foundation TrustMark Landau Hertforshire Partnership NHS Foundation TrustAdrian Clarke NHS WalesNeil Griffiths Cheshire and Wirral Partnership NHS Foundation Trust



Terms of Reference

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

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 around contributing to continuous service improvement will be taken forward by the NHS Benchmarking Network through the knowledge exchange and networking services provided by the network.

Mental health is an important aspect of the NHS Benchmarking Network’s wider work programme and will continue as an on-going area of project work in future years. The commitment to further enhance and develop the network’s mental health workstream in future years provides an excellent platform for future service provision to members and engagement with the wider member community.

Members should also note that additional products are available to mental health providers that support additional analysis on other aspects of services offered by many mental health providers. Examples include CAMHS benchmarking which is now in its fifth cycle. New projects for 2014 also include projects on learning disabilities and pharmacy which contains elements of relevance to many Trusts. All of these products can be accessed from the NHS Benchmarking Network's website

www.nhsbenchmarking.nhs.uk

This year, 66 participants have taken part in the benchmarkingorganisations last year and 42 in 2012. This includes English Mental Health Trusts and Welsh Local Health Boards. In addition, we have some new private sector members who have taken part for the first time.

Participant organisations in the 2014 benchmarking study are as follows:

2gether NHS Foundation Trust5 Boroughs Partnership NHS Foundation Trust Abertawe Bro Morgannwg UHBAneurin Bevan UHBAvon and Wiltshire Mental Health Partnership NHS TrustBarnet, Enfield and Haringey Mental Health TrustBerkshire Healthcare NHS FoundationBetsi Cadwaladr UHBBirmingham and Solihull NHS FoundationBlack Country Partnership NHS Foundation TrustBradford District Care TrustCambridgeshire and Peterborough NHS Foundation TrustCamdenCardiff & Vale UHBCentral and North West London NHS Foundation TrustCheshire & Wirral Partnership NHS Foundation TrustCornwall Partnership NHS Foundation TrustCoventry & Warwickshire Partnership TrustCumbria Partnership NHS Foundation TrustCwm Taf LHBDerbyshire Community Health Services NHS TrustDerbyshire Healthcare NHS Foundation TrustDevon Partnership NHS TrustDorset HealthCare University NHS Foundation TrustDudley & Walsall Mental Health Partnership NHS TrustEast London NHS Foundation TrustGreater Manchester West Mental Health NHS Foundation TrustHertfordshire Partnership University NHS Foundation TrustHumber NHS Foundation TrustHywel Dda UHBIsle of Wight NHSKent and Medway Partnership TrustLancashire Care NHS Foundation TrustLeeds and YorkLeicestershire Partnership NHS TrustLincolnshire Partnership

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

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 around contributing to continuous service improvement will be taken forward by the NHS Benchmarking Network through the knowledge exchange and networking services provided by the network.

Mental health is an important aspect of the NHS Benchmarking Network’s wider work programme and will continue as an on-going area of project work in future years. The commitment to further enhance and develop the network’s mental health workstream in future years provides an excellent platform for future service provision to members and engagement with the wider member community.

Members should also note that additional products are available to mental health providers that support additional analysis on other aspects of services offered by many mental health providers. Examples include CAMHS benchmarking which is now in its fifth cycle. New projects for 2014 also include projects on learning disabilities and pharmacy which contains elements of relevance to many Trusts. All of these products can be accessed from the NHS Benchmarking Network's website

www.nhsbenchmarking.nhs.uk

This year, 66 participants have taken part in the benchmarkingorganisations last year and 42 in 2012. This includes English Mental Health Trusts and Welsh Local Health Boards. In addition, we have some new private sector members who have taken part for the first time.


2gether NHS Foundation Trust5 Boroughs Partnership NHS Foundation Trust Abertawe Bro Morgannwg UHBAneurin Bevan UHBAvon and Wiltshire Mental Health Partnership NHS TrustBarnet, Enfield and Haringey Mental Health TrustBerkshire Healthcare NHS FoundationBetsi Cadwaladr UHBBirmingham and Solihull NHS FoundationBlack Country Partnership NHS Foundation TrustBradford District Care TrustCambridgeshire and Peterborough NHS Foundation TrustCamdenCardiff & Vale UHBCentral and North West London NHS Foundation TrustCheshire & Wirral Partnership NHS Foundation TrustCornwall Partnership NHS Foundation TrustCoventry & Warwickshire Partnership TrustCumbria Partnership NHS Foundation TrustCwm Taf LHBDerbyshire Community Health Services NHS TrustDerbyshire Healthcare NHS Foundation TrustDevon Partnership NHS TrustDorset HealthCare University NHS Foundation TrustDudley & Walsall Mental Health Partnership NHS TrustEast London NHS Foundation TrustGreater Manchester West Mental Health NHS Foundation TrustHertfordshire Partnership University NHS Foundation TrustHumber NHS Foundation TrustHywel Dda UHBIsle of Wight NHSKent and Medway Partnership TrustLancashire Care NHS Foundation TrustLeeds and YorkLeicestershire Partnership NHS TrustLincolnshire Partnership



Participants

This year, 66 participants have taken part in the benchmarking cycle. This is an increase from 57 organisations last year and 42 in 2012. This includes English Mental Health Trusts and Welsh Local Health Boards. In addition, we have some new private sector members who have taken part for the first time.


2gether NHS Foundation Trust5 Boroughs Partnership NHS Foundation Trust Abertawe Bro Morgannwg UHBAneurin Bevan UHBAvon and Wiltshire Mental Health Partnership NHS TrustBarnet, Enfield and Haringey Mental Health TrustBerkshire Healthcare NHS Foundation TrustBetsi Cadwaladr UHBBirmingham and Solihull NHS Foundation TrustBlack Country Partnership NHS Foundation TrustBradford District Care TrustCambridgeshire and Peterborough NHS Foundation TrustCamden and Islington NHS Foundation TrustCardiff & Vale UHBCentral and North West London NHS Foundation TrustCheshire & Wirral Partnership NHS Foundation TrustCornwall Partnership NHS Foundation TrustCoventry & Warwickshire Partnership TrustCumbria Partnership NHS Foundation TrustCwm Taf LHBDerbyshire Community Health Services NHS TrustDerbyshire Healthcare NHS Foundation TrustDevon Partnership NHS TrustDorset HealthCare University NHS Foundation TrustDudley & Walsall Mental Health Partnership NHS TrustEast London NHS Foundation TrustGreater Manchester West Mental Health NHS Foundation TrustHertfordshire Partnership University NHS Foundation TrustHumber NHS Foundation TrustHywel Dda UHBIsle of Wight NHSKent and Medway Partnership TrustLancashire Care NHS Foundation TrustLeeds and York NHS Partnership TrustLeicestershire Partnership NHS TrustLincolnshire Partnership NHS Foundation Trust

This year, 66 participants have taken part in the benchmarking cycle. This is an increase from 57 organisations last year and 42 in 2012. This includes English Mental Health Trusts and Welsh Local Health Boards. In addition, we have some new private sector members who have taken part for the first time.


2gether NHS Foundation Trust5 Boroughs Partnership NHS Foundation Trust Abertawe Bro Morgannwg UHBAneurin Bevan UHBAvon and Wiltshire Mental Health Partnership NHS TrustBarnet, Enfield and Haringey Mental Health TrustBerkshire Healthcare NHS Foundation TrustBetsi Cadwaladr UHBBirmingham and Solihull NHS Foundation TrustBlack Country Partnership NHS Foundation TrustBradford District Care TrustCambridgeshire and Peterborough NHS Foundation TrustCamden and Islington NHS Foundation TrustCardiff & Vale UHBCentral and North West London NHS Foundation TrustCheshire & Wirral Partnership NHS Foundation TrustCornwall Partnership NHS Foundation TrustCoventry & Warwickshire Partnership TrustCumbria Partnership NHS Foundation TrustCwm Taf LHBDerbyshire Community Health Services NHS TrustDerbyshire Healthcare NHS Foundation TrustDevon Partnership NHS TrustDorset HealthCare University NHS Foundation TrustDudley & Walsall Mental Health Partnership NHS TrustEast London NHS Foundation TrustGreater Manchester West Mental Health NHS Foundation TrustHertfordshire Partnership University NHS Foundation TrustHumber NHS Foundation TrustHywel Dda UHBIsle of Wight NHSKent and Medway Partnership TrustLancashire Care NHS Foundation TrustLeeds and York NHS Partnership TrustLeicestershire Partnership NHS TrustLincolnshire Partnership NHS Foundation Trust



Manchester Mental Health & Social Care TrustMersey Care NHS Trust Norfolk and Suffolk NHS Foundation TrustNorth East London NHS Foundation TrustNorth Essex Partnership NHS Foundation TrustNorth Staffordshire Combined Healthcare NHS TrustNorthamptonshire Healthcare Foundation Trust Northumberland, Tyne & Wear NHS Foundation TrustNottinghamshire Healthcare NHS TrustOxford Health NHS Foundation TrustOxleas NHS Foundation TrustPennine Care NHS Foundation TrustPlymouth Community Healthcare (CIC)Priory GroupRotherham Doncaster and South Humber NHS Sheffield Health and Social Care NHS Foundation TrustSolent NHS Trust Somerset Partnership NHS Foundation TrustSouth Essex Partnership NHS TrustSouth London and Maudsley NHS Foundation TrustSouth Staffordshire & Shropshire Healthcare NHS Foundation TrustSouth West London & St George's Mental Health NHS TrustSouth West Yorkshire Partnership NHS Foundation TrustSouthern Health NHS Foundation TrustSt Andrews HealthcareSurrey and Border Partnsership NHS Foundation TrustSussex Partnership NHS Foundation Trust Tees, Esk and Wear Valleys NHS Foundation TrustWest London Mental Health TrustWorcestershire Health and Care NHS Trust

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

Manchester Mental Health & Social Care TrustMersey Care NHS Trust Norfolk and Suffolk NHS Foundation TrustNorth East London NHS Foundation TrustNorth Essex Partnership NHS Foundation TrustNorth Staffordshire Combined Healthcare NHS TrustNorthamptonshire Healthcare Foundation Trust Northumberland, Tyne & Wear NHS Foundation TrustNottinghamshire Healthcare NHS TrustOxford Health NHS Foundation TrustOxleas NHS Foundation TrustPennine Care NHS Foundation TrustPlymouth Community Healthcare (CIC)Priory GroupRotherham Doncaster and South Humber NHS Sheffield Health and Social Care NHS Foundation TrustSolent NHS Trust Somerset Partnership NHS Foundation TrustSouth Essex Partnership NHS TrustSouth London and Maudsley NHS Foundation TrustSouth Staffordshire & Shropshire Healthcare NHS Foundation TrustSouth West London & St George's Mental Health NHS TrustSouth West Yorkshire Partnership NHS Foundation TrustSouthern Health NHS Foundation TrustSt Andrews HealthcareSurrey and Border Partnsership NHS Foundation TrustSussex Partnership NHS Foundation Trust Tees, Esk and Wear Valleys NHS Foundation TrustWest London Mental Health TrustWorcestershire Health and Care NHS Trust

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



Analysis overview

Figure 1

Acute Inpatient

Older Adults e.g. aged 65+ orappropriate frailty for organicillness

Specialist Beds

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

They key domains covered by this project are activity, finance, workforce and quality and a selection of metrics from each area is included here. The report also contains detail on specialist services such as PICU and Eating Disorders, allowing providers to see at a glance how their services compare.

While this report contains a short section on community services, further analysis of the different teams operating in the community is available in the mental health toolkit.

Similarly, an overview of staffing positions is included in this report, including benchmarks of consultant psychiatrists and of qualified nurses. A full breakdown of ward and community skill mix can be reviewed in the toolkit. This allows organisations to see not only how they compare in terms of numbers of qualified or unqualified staff, but also their proportion in each level of seniority compared to peers.

Mental Health service models are complex and different local solutions have emerged over time, meaning provision can vary on a local and regional level with no two Trusts or Health Boards offering an identical mix of core, specialist and community services. The diagram below shows the overall profile both of your individual organisation and the English and Welsh mental health systems as a whole. On average, organisations find that approximately 45% of their beds are specialist, 21% are for older peoples' services and 34% are general acute inpatient beds for working age adults, though this varies dramatically between organisations, with some providers having very few specialty beds.

In Figure 1, the inner ring represents the reported split in your organisation, and the outer ring reflects the English and Welsh average.

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

They key domains covered by this project are activity, finance, workforce and quality and a selection of metrics from each area is included here. The report also contains detail on specialist services such as PICU and Eating Disorders, allowing providers to see at a glance how their services compare.

While this report contains a short section on community services, further analysis of the different teams operating in the community is available in the mental health toolkit.

Similarly, an overview of staffing positions is included in this report, including benchmarks of consultant psychiatrists and of qualified nurses. A full breakdown of ward and community skill mix can be reviewed in the toolkit. This allows organisations to see not only how they compare in terms of numbers of qualified or unqualified staff, but also their proportion in each level of seniority compared to peers.

Mental Health service models are complex and different local solutions have emerged over time, meaning provision can vary on a local and regional level with no two Trusts or Health Boards offering an identical mix of core, specialist and community services. The diagram below shows the overall profile both of your individual organisation and the English and Welsh mental health systems as a whole. On average, organisations find that approximately 45% of their beds are specialist, 21% are for older peoples' services and 34% are general acute inpatient beds for working age adults, though this varies dramatically between organisations, with some providers having very few specialty beds.

In Figure 1, the inner ring represents the reported split in your organisation, and the outer ring reflects the English and Welsh average.



Bed provision - Adult Acute beds

T00: n/a

Mean: 21

Median: 19

Upper Q: 25

Lower Q: 17

SHA:

Trusts:

Figure 2

{BSPK_text_BMChart3} This considers the impact on demand for mental health services from a variety of factors including age, sex, ethnicity and mortality. A small number of Trusts and Health Boards have local populations whose mental health needs are higher than the normal range of need in the NHS, and some have local populations whose mental health needs are lower. These Trusts and Health Boards will find it useful to consider the weighted population analysis alongside the registered population analysis to gain a complete picture of their position when benchmarked nationally and against their local peers.

Provision across the NHS ranges from {BMChart3-Min} beds per 100,000 population to {BMChart3-Max} beds per 100,000 population, with a median position of {BMChart3-Median}. This compares to a median position of 22.6 beds per 100,000 population in 2013 and a median of {BSPK_Median_BMChart3} beds per 100,000 population in 2012.

0

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T07

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T34

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Adult Acute beds per 100,000 population

100%

The Royal College of Psychiatrists suggests a bed occupancy rate of 85% is optimal as it enables patients to be admitted in a timely fashion, reducing the risk of deterioration which may occur if a patient has to wait for a bed to become available. Similarly, this level allows flexibility for patients to take leave without the risk of losing a place in the same ward should that be needed.

Bed occupancy for Adult Acute beds, shown in Figure 3, is consistently high with a median occupancy this year of {BMChart4-Median}. This compares to a median bed occupancy of 89% in 2013 and 91% in 2012. This increase in bed occupancy rates of around 4% should be seen in the context of the reduced number of beds reported in figure 2. The range is relatively low, with a lower quartile of {BMChart4-LQ} and an upper quartile of {BMChart4-UQ} indicating that while the majority of organisations are above the RCPsyc recommendedthreshold, most are within a few percentage points of their peers on this measure. These figures relate to bed occupancy excluding leave, although comparisons including leave are also reported and are provided in the Mental Health toolkit.

The chart shows actual bed occupancy and has not been adjusted for any long or short stay outliersdata. The Mental Health toolkit can be used to adjust for the impact of long and short stay outliers on a number of metrics in adult acute care.The number of Adult Acute beds per Trust/LHB is shown here per 100,000 registered population of working

age adults. Additional reports are available which use a weighted population measure derived from the Department of Health. This considers the impact on demand for mental health services from a variety of factors including age, sex, ethnicity and mortality. A small number of Trusts and Health Boards have local populations whose mental health needs are higher than the normal range of need in the NHS, and some have local populations whose mental health needs are lower. These Trusts and Health Boards will find it useful to consider the weighted population analysis alongside the registered population analysis to gain a complete picture of their position when benchmarked nationally and against their local peers.

Provision across the NHS ranges from 11 beds per 100,000 population to 39 beds per 100,000 population, with a median position of 19. This compares to a median position of 22.6 beds per 100,000 population in 2013 and a median of 23 beds per 100,000 population in 2012.

The Royal College of Psychiatrists suggests a bed occupancy rate of 85% is optimal as it enables patients to be admitted in a timely fashion, reducing the risk of deterioration which may occur if a patient has to wait for a bed to become available. Similarly, this level allows flexibility for patients to take leave without the risk of losing a place in the same ward should that be needed.

Bed occupancy for Adult Acute beds, shown in Figure 3, is consistently high with a median occupancy this year of 93%. This compares to a median bed occupancy of 89% in 2013 and 91% in 2012. This increase in bed occupancy rates of around 4% should be seen in the context of the reduced number of beds reported in figure 2. The range is relatively low, with a lower quartile of 88% and an upper quartile of 97% indicating that while the majority of organisations are above the RCPsyc recommended threshold, most are within a few percentage points of their peers on this measure. These figures relate to bed occupancy excluding leave, although comparisons including leave are also reported and are provided in the Mental Health toolkit.

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



T00: n/a

Mean: 92%

Median: 93%

Upper Q: 97%

Lower Q: 88%

SHA:

Trusts:

Figure 3

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T28

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T38

Adult Acute bed occupancy

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

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



Adult Acute Admissions

T00: n/a

Mean: 240

Median: 229

Upper Q: 288

Lower Q: 171

SHA:

Trusts:

Figure 4

The number of admissions to acute adult beds is shown {BSPK_Admissionsintro_BMChart5}. This figure should be considered along side factors such as total number of beds provided by each Trust/LHB, length of stay of patients and the needs of the local population served by the Trust/LHB.

The median position is {BMChart5-Median} admissions {BSPK_Admissionsintro_BMChart5} of working age adults. This can be compared to a median figure of {BSPK_Admissions_BMChart5} admissions per 100,000 population in 2013, and a median figure of {BSPK_2012_admissions_BMChart5} admissions per 100,000 population in 2012. Thus, although the number of beds is reducing (Figure 2), number of admissions into those beds has not changed significantly over the last 3 years.

0

100

200

300

400

500

600

T60

T61

T37

T24

T72

T80

T31

T75

T68

T67

T66

T12

T51

T17

T46

T30

T77

T25

T42

T18

T34

T33

T28

T19

T56

T52

T59

T21

T13

T70

T06

T65

T03

T32

T08

T11

T26

T07

T36

T16

T35

T38

T29

T47

T41

T48

T44

T20

T50

T39

T45

T01

T14

T71

T27

T55

T05

T73

T04

T23

T53

T10

Adult Acute admissions per 100,000 population

Data on occupied bed days for adult acute beds is shown in Figure 5. This data excludes patient leave and the range is influenced by both the number of beds available and the average length of stay of patients in those beds. A measure of bed days is used to allow comparisons between organisations with varying sizes of catchment area.

In 2013 the mean position reported was {BSPK_BSPK_mean_BMChart6} occupied bed days {BSPK_Admissionsintro_BMChart5}. Notable change has been observed this year, with a 2014 mean position of {BMChart6-Mean} bed days per 100,000 population. The median position has dropped to {BMChart6-Median} bed days in 2014, from {BSPK_median_BMChart6} in 2013. This is likely to be due to the inclusion of new contributors for the first time which has skewed the distribution of the data.

The reduction in occupied bed days in the last year is largely consistent with the reduced number of beds available, despite the growth in bed occupancy.

10,000

12,000

14,000

The number of admissions to acute adult beds is shown per 100,000 registered population. This figure should be considered along side factors such as total number of beds provided by each Trust/LHB, length of stay of patients and the needs of the local population served by the Trust/LHB.

The median position is 229 admissions per 100,000 registered population of working age adults. This can be compared to a median figure of 236 admissions per 100,000 population in 2013, and a median figure of 234 admissions per 100,000 population in 2012. Thus, although the number of beds is reducing (Figure 2), number of admissions into those beds has not changed significantly over the last 3 years.

Data on occupied bed days for adult acute beds is shown in Figure 5. This data excludes patient leave and the range is influenced by both the number of beds available and the average length of stay of patients in those beds. A measure of bed days is used to allow comparisons between organisations with varying sizes of catchment area.

In 2013 the mean position reported was 8098 occupied bed days per 100,000 registered population. Notable change has been observed this year, with a 2014 mean position of 7,183 bed days per 100,000 population. The median position has dropped to 6,765 bed days in 2014, from 7087 in 2013. This is likely to be due to the inclusion of new contributors for the first time which has skewed the distribution of the data.

The reduction in occupied bed days in the last year is largely consistent with the reduced number of beds available, despite the growth in bed occupancy.



T00: n/a

Mean: 7,183

Median: 6,765

Upper Q: 8,616

Lower Q: 5,729

SHA:

Trusts:

Figure 5

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

T24

T46

T37

T30

T80

T18

T61

T31

T17

T12

T42

T07

T13

T28

T56

T67

T72

T32

T51

T59

T25

T19

T34

T41

T20

T68

T44

T14

T48

T77

T21

T33

T39

T50

T60

T08

T16

T03

T26

T06

T52

T35

T10

T75

T11

T36

T65

T45

T04

T29

T47

T01

T27

T55

T53

T38

T71

T23

T66

T73

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



Length of stay and delayed transfers

T00: n/a

Mean: 32.4

Median: 31.0

Upper Q: 38.2

Lower Q: 27.0

SHA:

Trusts:

Figure 6

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

This year, the mean length of stay is {BMChart7-Mean} days, compared to 30.2 days in 2013 and 32 days in 2012. It must be noted that the data in Figure 6, below, is the reported mean length of stay excluding leave and has not be adjusted for outliers (long-stay and short-stay patients). The mental health benchmarking toolkit includes alternative comparisons in these areas.

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

0

10

20

30

40

50

60

70

80

T06

T68

T31

T04

T10

T14

T01

T41

T27

T39

T20

T13

T32

T50

T48

T30

T36

T46

T45

T42

T56

T18

T55

T35

T80

T44

T17

T08

T16

T12

T11

T28

T47

T51

T29

T21

T52

T03

T23

T19

T59

T53

T71

T65

T26

T37

T24

T61

T33

T67

T38

T72

T77

T60

T75

T66

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

When there is pressure on bedsteams. Additionally patients and carers may express dissatisfaction and, in a worst case scenario, patients can deteriorate during this time.

Delays can be caused by patients who are fit for discharge being forced to wait for a bed or place elsewhere or for an alternative package of care to be agreed and put in place to facilitate discharge. The data for 2014 is shown below. In a number of cases there has been little change compared to previous years, with some organisations consistently reporting either above average or below average delays.

Delayed transfers of care are calculated as the number of bed days lost due to delays as a percentage of all occupied bed days. This takes into account both a few patientsmany patients, perhaps the majority, have a short to medium delay at the end of their stay.

In 2013 the median position for delayed transfers of care was 3.8%, a slight increase from 3.5% in 2012. This figure appears to have increased again this year, with a median of {BMChart8below. The range has also increased slightly this year with organisations reporting between {BMChart8and {BMChart8last year.

10%

12%

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

This year, the mean length of stay is 32.4 days, compared to 30.2 days in 2013 and 32 days in 2012. It must be noted that the data in Figure 6, below, is the reported mean length of stay excluding leave and has not be adjusted for outliers (long-stay and short-stay patients). The mental health benchmarking toolkit includes alternative comparisons in these areas.

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

When there is pressure on beds and demand surpasses supply, delayed discharges can be frustrating for ward teams. Additionally patients and carers may express dissatisfaction and, in a worst case scenario, patients can deteriorate during this time.


Delayed transfers of care are calculated as the number of bed days lost due to delays as a percentage of all occupied bed days. This takes into account both a few patients with long delays and also a situation where many patients, perhaps the majority, have a short to medium delay at the end of their stay.

In 2013 the median position for delayed transfers of care was 3.8%, a slight increase from 3.5% in 2012. This figure appears to have increased again this year, with a median of 3.9% shown in Figure 7 below. The range has also increased slightly this year with organisations reporting between 0.3% and 10.8% of their adult acute bed days lost to delays. This compares to a range of 0.7% to 10.8% last year.



T00: n/a

Mean: 4.0%

Median: 3.9%

Upper Q: 5.7%

Lower Q: 2.0%

SHA:

Trusts:

Figure 7




In 2013 the median position for delayed transfers of care was 3.8%, a slight increase from 3.5% in 2012. This figure appears to have increased again this year, with a median of {BMChart8-Median} shown in Figure 7 below. The range has also increased slightly this year with organisations reporting between {BMChart8-Min} and {BMChart8-Max} of their adult acute bed days lost to delays. This compares to a range of 0.7% to 10.8% last year.

0%

2%

4%

6%

8%

10%

12%

T28

T10

T68

T20

T17

T18

T32

T13

T67

T77

T30

T71

T16

T31

T25

T60

T80

T65

T34

T73

T07

T19

T21

T61

T72

T42

T44

T37

T75

T56

T08

T06

T41

T27

T66

T33

T26

T48

T23

T45

T38

T12

T50

T11

T24

T53

T59

T29

T14

T35

T03

T36

T46

T51

T52

T55

T04

T39

Delayed transfers of care - Adult Acute




In 2013 the median position for delayed transfers of care was 3.8%, a slight increase from 3.5% in 2012. This figure appears to have increased again this year, with a median of 3.9% shown in Figure 7 below. The range has also increased slightly this year with organisations reporting between 0.3% and 10.8% of their adult acute bed days lost to delays. This compares to a range of 0.7% to 10.8% last year.



Adult Acute emergency readmissions within 30 days of discharge

T00: n/a

Mean: 8.7%

Median: 8.8%

Upper Q: 11.0%

Lower Q: 6.4%

SHA:

Trusts:

Figure 8

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

There is significant range in the readmission rates from contributors, as Figure 8 shows, with figures from {BMChart9-Min} to {BMChart9-Max} being reported. The median position is {BMChart9-Median}, which is a marginal reduction on data from previous years (a median of 9% in 2013, and 10% in 2012). This is a positive finding for Trusts and Health Boards with readmissions reducing year on year.

0%

2%

4%

6%

8%

10%

12%

14%

16%

T72

T77

T66

T60

T17

T21

T47

T35

T44

T61

T75

T51

T12

T06

T01

T56

T53

T24

T59

T30

T42

T20

T07

T03

T34

T16

T50

T45

T14

T32

T10

T67

T08

T37

T13

T36

T29

T46

T27

T52

T48

T65

T39

T11

T05

T26

T73

T80

T18

T68

T55

T04

T31

T41

T28

T33

T19

T38

T23

T71

Readmission rate - Adult Acute

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

There is significant range in the readmission rates from contributors, as Figure 8 shows, with figures from 0.6% to 15.9% being reported. The median position is 8.8%, which is a marginal reduction on data from previous years (a median of 9% in 2013, and 10% in 2012). This is a positive finding for Trusts and Health Boards with readmissions reducing year on year.



Bed Provision - Older Adult beds

T00: n/a

Mean: 50

Median: 47

Upper Q: 65

Lower Q: 34

SHA:

Trusts:

Figure 9

The provision of Older Adult beds is a significant part of the business of specialist mental health providers and the second largest category of bed provision after Adult Acute services.

Older Adult services treat patients aged 65 years or older. Some Trusts and Health Boards operate an "ageless service" where patients are allocated to beds based on a functional / organic split rather than by age. Where an age profile was unavailable, these organisations are excluded from the data below.

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

0

20

40

60

80

100

120

140

T66

T05

T37

T75

T56

T20

T59

T39

T33

T67

T31

T32

T19

T10

T34

T06

T48

T61

T41

T12

T18

T03

T53

T42

T07

T80

T77

T21

T50

T16

T27

T52

T24

T11

T01

T36

T23

T17

T73

T04

T13

T25

T08

T29

T51

T26

T14

T44

T38

T65

T60

T45

T35

Older Adult beds per 100,000 population

100%

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

The provision of Older Adult beds is a significant part of the business of specialist mental health providers and the second largest category of bed provision after Adult Acute services.

Older Adult services treat patients aged 65 years or older. Some Trusts and Health Boards operate an "ageless service" where patients are allocated to beds based on a functional / organic split rather than by age. Where an age profile was unavailable, these organisations are excluded from the data below.

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

Once again, bed occupancy figures appear to have been influenced by the reduction in number of available beds. Figure 10 shows a median occupancy rate of 85.3% for older adult beds, an increase from 83% in 2013 and 82% in 2012. As the number of beds decreases and bed occupancy rises, organisations move towards the optimal number of beds for their local population, allowing good access to beds when needed but without excess provision in this area. Organisations will be able to interpret what this represents for them individually and use this information in future service planning.



T00: n/a

Mean: 83.5%

Median: 85.3%

Upper Q: 90.4%

Lower Q: 77.9%

SHA:

Trusts:

Figure 10

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

T13

T46

T19

T77

T36

T29

T28

T44

T71

T27

T80

T04

T51

T50

T26

T08

T21

T23

T05

T42

T16

T56

T53

T48

T20

T65

T39

T76

T14

T17

T68

T03

T35

T12

T31

T18

T61

T73

T30

T25

T75

T32

T60

T52

T11

T10

T66

T72

T06

T34

T41

T37

T24

T47

T07

T45

T38

T55

T67

T59

T33

Older Adult bed occupancy



Older Adult - Length of stay and delayed transfers

T00: n/a

Mean: 72

Median: 66

Upper Q: 82

Lower Q: 58

SHA:

Trusts:

Figure 11

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

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

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

0

20

40

60

80

100

120

140

160

180

T48

T56

T71

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T41

T55

T14

T52

T10

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T30

T32

T36

T04

T39

T20

T03

T18

T80

T27

T01

T12

T11

T13

T47

T08

T29

T19

T76

T61

T42

T16

T35

T24

T68

T75

T37

T44

T21

T53

T31

T65

T51

T26

T06

T66

T17

T77

T33

T59

T60

T28

T38

T72

T67

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

10%

15%

20%

25%

Delayed transfers of care are particularly prevalent on older people's wards. This year a mean position of {BMChart15-Mean} was reported. This is the percentage of all days spent on a ward which were the result of a delayed transfer of care and can be compared to a mean position of 7% last year. Delays often occur when older people are discharged home and require a package of care to be arranged, or when patients are transferred directly from an inpatient bed to a nursing or residential home placement and a period of waiting occurs until an appropriate bed is available.

The mental health toolkit allows additional analysis of the reasons for delays, whether due to internal or external factors.

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

This year, the mean length of stay in older adult beds is 72 days. In 2013 it was 67 days and in 2012 a 70 day length of stay was reported.

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

Delayed transfers of care are particularly prevalent on older people's wards. This year a mean position of 6.8% was reported. This is the percentage of all days spent on a ward which were the result of a delayed transfer of care and can be compared to a mean position of 7% last year. Delays often occur when older people are discharged home and require a package of care to be arranged, or when patients are transferred directly from an inpatient bed to a nursing or residential home placement and a period of waiting occurs until an appropriate bed is available.

The mental health toolkit allows additional analysis of the reasons for delays, whether due to internal or external factors.



T00: n/a

Mean: 6.8%

Median: 5.9%

Upper Q: 10.0%

Lower Q: 2.8%

SHA:

Trusts:

Figure 12

0%

5%

10%

15%

20%

25%

T41

T03

T28

T68

T45

T72

T27

T25

T16

T10

T13

T31

T75

T38

T08

T71

T06

T18

T52

T65

T35

T76

T04

T21

T48

T73

T59

T23

T44

T50

T32

T46

T17

T05

T11

T77

T67

T42

T34

T61

T60

T36

T53

T47

T14

T37

T33

T24

T19

T51

T39

T55

T12

T80

T30

T20

T26

T56

T29

Delayed transfers of care - Older Adult



Older Adult Admissions

T00: n/a

Mean: 236

Median: 227

Upper Q: 285

Lower Q: 165

SHA:

Trusts:

Figure 13

T00: n/a

Mean: 16,640

Median: 15,398

Upper Q: 18,542

Lower Q: 12,080

SHA:

Trusts:

Figure 14

The rate of older adult admissions {BSPK_Admissionsintro_BMChart5} is shown in figure 12. This year, the median reported figure is {BMChart12-Median} admissions per 100,000 population, compared to {BSPK_admissions2013a_BMChart12} in 2013 and {BSPK_admissions2012a_BMChart12} the previous year. This is linked to the sizeable reduction in available older adult beds demonstrated earlier, and the increased system pressures suggested by the average lengths of stay reported in 2014.

0

100

200

300

400

500

600

T68

T66

T67

T37

T46

T75

T30

T70

T60

T72

T31

T20

T32

T71

T12

T06

T59

T34

T39

T33

T27

T42

T21

T19

T61

T56

T36

T16

T11

T10

T13

T17

T07

T80

T77

T35

T03

T51

T53

T18

T14

T01

T50

T76

T44

T04

T24

T73

T65

T25

T48

T23

T08

T55

T29

T52

T41

T26

T47

T05

T28

T38

T45

Older Adult admissions per 100,000 population

Older adult bed days have a median position of {BMChart13-Median} {BSPK_Admissionsintro_BMChart5} for ages 65 and over this year, compared to {BSPK_bedday_BMChart13} in 2013. This figure can be considered along with the number of older adult admissions in figure 13 and length of stay shown in figure 11 . This data confirms reduced levels of provision of inpatient care for older people in 2014 although admitted patients are staying longer. This position can be compared with the level of community based care for older people in the Mental Health toolkit.

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

T46

T05

T71

T68

T66

T30

T56

T75

T37

T20

T19

T39

T31

T32

T48

T10

T61

T12

T34

T06

T77

T18

T72

T03

T53

T67

T59

T80

T60

T27

T13

T50

T41

T14

T21

T16

T33

T52

T11

T36

T42

T04

T07

T23

T51

T55

T17

T24

T76

T73

T25

T08

T47

T29

T26

T44

T65

T28

T35

T38

T45

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

The rate of older adult admissions per 100,000 registered population is shown in figure 12. This year, the median reported figure is 227 admissions per 100,000 population, compared to 243 in 2013 and 258 the previous year. This is linked to the sizeable reduction in available older adult beds demonstrated earlier, and the increased system pressures suggested by the average lengths of stay reported in 2014.

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



Older Adult - emergency readmissions within 30 days of discharge

T00: n/a

Mean: 3.6%

Median: 3.0%

Upper Q: 4.5%

Lower Q: 2.1%

SHA:

Trusts:

Figure 15

This indicator focuses on unplanned emergency readmissions and excludes readmissions associated with planned discharges to receive physical healthcare from other NHS providers.

Readmissions remain an important indicator of service performance, and organisations whose rate of emergency readmission within 30 days is high may wish to examine local systems or processes which contribute to this figure.

There has been a slight decrease in emergency readmissions to older adult beds, from 4% in 2013 to {BMChart16-Mean} this year. The rate of older adult readmissions is also lower than that for acute adult beds, shown in figure 8 (a mean figure of {BMChart9-Mean}). This may be due to the longer lengths of stay for older adult beds, and the relatively lower bed occupancy for older adults suggesting demand for beds, and therefore to discharge patients sooner, is less of a pressure in older adult wards than on adult acute wards.

0%

2%

4%

6%

8%

10%

12%

14%

16%

T06

T72

T17

T75

T35

T30

T12

T07

T60

T48

T21

T13

T14

T61

T68

T46

T53

T04

T51

T20

T39

T77

T29

T05

T44

T65

T50

T26

T56

T03

T47

T59

T34

T52

T73

T55

T36

T37

T08

T16

T33

T42

T66

T67

T28

T11

T18

T10

T23

T19

T71

T24

T31

T76

T27

T32

T80

T38

T41

Readmission rate - Older Adults

This indicator focuses on unplanned emergency readmissions and excludes readmissions associated with planned discharges to receive physical healthcare from other NHS providers.

Readmissions remain an important indicator of service performance, and organisations whose rate of emergency readmission within 30 days is high may wish to examine local systems or processes which contribute to this figure.

There has been a slight decrease in emergency readmissions to older adult beds, from 4% in 2013 to 3.6% this year. The rate of older adult readmissions is also lower than that for acute adult beds, shown in figure 8 (a mean figure of 8.7%). This may be due to the longer lengths of stay for older adult beds, and the relatively lower bed occupancy for older adults suggesting demand for beds, and therefore to discharge patients sooner, is less of a pressure in older adult wards than on adult acute wards.



Specialist beds

Figure 16

This section has been expanded this year at the request of members, to reflect the importance of specialist beds and the significant proportion of resources (budget and workforce) that are invested in these areas.

Specialist beds can be delivered for both core district populations and also for external populations. Beds can be commissioned locally or through specialist commissioning routes, and these beds are sometimes also traded commercially. Due to the varied range and coverage of specialist bed portfolios it is not possible to robustly benchmark them on a per capita population basis. However, it is possible to draw comparisons of bed provision, utilisation, and length of stay which will add value to the knowledge base of Trusts and Health Boards. The benchmarking toolkit explores many of these areas in great detail.

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

100

120

100%

PICU

Eating Disorders

Mother and Baby

Low Secure

Medium Secure

High Secure

High Dependency Rehabilitation

Longer Term Complex / Continuing Care

Other Mental Health Beds (excludes CAMHS, SubstanceMisuse, and MoD)

The following pages analyse specialist bed provision by mean length of stay and bed occupancy and consultant psychiatrists and qualified nurses per 10 beds.

Where an organisation is missing from the data, they have either not reported figures in this area or do not provide these specialist services.

This section has been expanded this year at the request of members, to reflect the importance of specialist beds and the significant proportion of resources (budget and workforce) that are invested in these areas.

Specialist beds can be delivered for both core district populations and also for external populations. Beds can be commissioned locally or through specialist commissioning routes, and these beds are sometimes also traded commercially. Due to the varied range and coverage of specialist bed portfolios it is not possible to robustly benchmark them on a per capita population basis. However, it is possible to draw comparisons of bed provision, utilisation, and length of stay which will add value to the knowledge base of Trusts and Health Boards. The benchmarking toolkit explores many of these areas in great detail.

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

The following pages analyse specialist bed provision by mean length of stay and bed occupancy and consultant psychiatrists and qualified nurses per 10 beds.

Where an organisation is missing from the data, they have either not reported figures in this area or do not provide these specialist services.



PICU

T00: n/a

Mean: 42.6

Median: 40.4

Upper Q: 48.0

Lower Q: 28.6

SHA:

Trusts:

Figure 17

T00: n/a

Mean: 82.9%

Median: 85.5%

Upper Q: 93.1%

Lower Q: 74.9%

SHA:

Trusts:

Figure 18

Around 80% of contributors provider Psychiatric Intensive Care Units. The length of stay in PICU beds is shown in the chart below. This relates solely to the period of time spent in PICU beds, which may be part of a longer admission. The mean length of stay across all member organisations with these beds is {BMChart17-Mean} days. This compares to a mean of 48 days last year.

This year's data shows a quartile range of {BMChart17-LQ} to {BMChart17-UQ} days which is also a reduction compared to last year (31 to 52 days). The full data range, however, runs from {BMChart17-Min} to {BMChart17-Max} days which illustrates differing approaches to the use of these beds between organisations. Long stays demonstrate opportunities for Trusts and LHBs in stepping down patients more

0

20

40

60

80

100

120

T30

T68

T56

T55

T48

T10

T16

T13

T27

T79

T38

T42

T47

T29

T01

T17

T28

T46

T65

T61

T33

T80

T34

T32

T37

T50

T31

T19

T51

T36

T18

T44

T23

T53

T03

T35

T41

T12

T21

T39

T70

T20

T24

T45

T11

T52

T60

T66

T04

T72

T77

T08

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

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

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

T53

T29

T68

T28

T10

T50

T21

T46

T30

T33

T13

T25

T20

T03

T44

T18

T04

T07

T48

T51

T31

T70

T27

T52

T55

T65

T77

T12

T66

T37

T80

T42

T36

T41

T35

T75

T16

T60

T17

T08

T32

T56

T19

T24

T34

T11

T01

T39

T23

T45

T38

T47

T79

T72

PICU bed occupancy

0.0

0.5

1.0

1.5

2.0

2.5

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

10.0

15.0

20.0

25.0

30.0

35.0

Around 80% of contributors provider Psychiatric Intensive Care Units. The length of stay in PICU beds is shown in the chart below. This relates solely to the period of time spent in PICU beds, which may be part of a longer admission. The mean length of stay across all member organisations with these beds is 42.6 days. This compares to a mean of 48 days last year.

This year's data shows a quartile range of 28.6 to 48.0 days which is also a reduction compared to last year (31 to 52 days). The full data range, however, runs from 15.0 to 119.0 days which illustrates differing approaches to the use of these beds between organisations. Long stays demonstrate opportunities for Trusts and LHBs in stepping down patients more rapidly.

PICU bed occupancy is, on average, lower than bed occupancy of adult acute beds (the PICU median is 85.5% compared to the adult acute median of 93%). Providers and commissioners must try to strike the right balance between availability of beds for new admissions and good levels of occupancy. PICU bed occupancy has however still increased from 82.3% in 2013.

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



T00: n/a

Mean: 0.7

Median: 0.6

Upper Q: 0.8

Lower Q: 0.5

SHA:

Trusts:

Figure 19

T00: n/a

Mean: 14.4

Median: 14.0

Upper Q: 17.2

Lower Q: 10.4

SHA:

Trusts:

Figure 20

0.0

0.5

1.0

1.5

2.0

2.5

T52

T04

T72

T31

T41

T53

T11

T68

T66

T46

T29

T39

T18

T33

T08

T23

T35

T55

T28

T65

T42

T21

T13

T01

T56

T27

T44

T47

T34

T38

T48

T45

T79

T50

T24

T75

T36

PICU - WTE Consultant Psychiatrists per 10 beds

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

The following graphs show the number of whole time equivalent (WTE) consultant psychiatrists and nurses per 10 PICU beds. These denominators are used to allow for accurate comparisons between organisations of different sizes who provide PICU beds.

For PICU the mean number of consultant psychiatrists per 10 beds is {BMChart67-Mean} but the range is from {BMChart67-Min} to {BMChart67-Max} consultants per 10 beds showing that in some organisations, patients in PICU beds may receive significantly more senior medical input. There may also be some variation between how medical staff are allocated in different organisations, with some specialties having dedicated consultant input and others having consultants who work across several specialties.

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

T52

T70

T50

T33

T29

T80

T75

T08

T41

T17

T04

T60

T77

T30

T72

T68

T01

T36

T12

T35

T13

T34

T31

T42

T66

T21

T45

T19

T39

T48

T46

T03

T53

T27

T24

T56

T18

T44

T05

T11

T47

T20

T38

T28

T55

T65

T23

T79

T32

PICU - WTE Qualified nurses per 10 beds

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

The following graphs show the number of whole time equivalent (WTE) consultant psychiatrists and nurses per 10 PICU beds. These denominators are used to allow for accurate comparisons between organisations of different sizes who provide PICU beds.

For PICU the mean number of consultant psychiatrists per 10 beds is 0.7 but the range is from 0.1 to 2.0 consultants per 10 beds showing that in some organisations, patients in PICU beds may receive significantly more senior medical input. There may also be some variation between how medical staff are allocated in different organisations, with some specialties having dedicated consultant input and others having consultants who work across several specialties.



Eating Disorders

T00: n/a

Mean: 91

Median: 85

Upper Q: 101

Lower Q: 74

SHA:

Trusts:

Figure 21

T00: n/a

Mean: 79.1%

Median: 80.5%

Upper Q: 84.1%

Lower Q: 76.9%

SHA:

Trusts:

Figure 22

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

0

20

40

60

80

100

120

140

160

180

T08

T11

T56

T20

T35

T80

T50

T18

T04

T48

T39

T44

T26

T27

T28

T47

T29

T52

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

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

below. The mean figure reported is {BMChart73with senior medical input to PICU and low secure beds.

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

T18

T50

T44

T26

T27

T04

T20

T29

T52

T11

T08

T47

T35

T48

T80

T28

T39

T56

Eating disorders - Bed Occupancy

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Eating Disorders beds are identified in this adult focused report although it is acknowledged that some may be occupied by patients from a slightly younger age group where CAMHS provision in this specialty is not available. The mean length of stay in an Eating Disorders bed is 91 days although the Trust with the shortest stays report a LOS of just 42 days, less than half the national mean. Fewer than one third of participants report provision of specialist beds for eating disorders (17 of the 66 contributors).

Bed Occupancy for Eating Disorders beds is shown below. On average, median bed occupancy sits at 80.5% which is lower than some other specialist services. This would suggest that access to beds should be good, and spaces should typically be available when admission is required. However it is noted that the relatively small number of providers offering inpatient facilities for Eating Disorders patients means that equitable access to local care cannot be certain across all areas of England and Wales. The MH toolkit can also be used to explore the extent to which community based Eating Disorders services are provided by participants.

below. The mean figure reported is 0.6 WTE consultants per 10 beds which is comparable with senior medical input to PICU and low secure beds.



T00: n/a

Mean: 0.6

Median: 0.6

Upper Q: 0.8

Lower Q: 0.4

SHA:

Trusts:

Figure 23

T00: n/a

Mean: 1.8

Median: 1.6

Upper Q: 2.1

Lower Q: 1.3

SHA:

Trusts:

Figure 24

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

The skill mix in Eating Disorder services is frequently different from other inpatient units. This graph shows the combined number of WTE clinical psychologists and OTs, which has a mean value of {BMChart74-Mean} WTE per 10 beds. It is useful to see the impact access to psychology and occupational therapy may have on length of stay in these beds. Specialist therapists are therefore three times more prevalent on Eating Disorders beds than consultant medical staff.

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

T50

T48

T56

T52

T29

T39

T08

T18

T26

T44

T35

T80

T04

T27

Eating disorders - WTE Consultant Psychiatrists per 10 beds

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

T80

T26

T28

T50

T08

T56

T20

T48

T39

T35

T52

T04

T44

T11

T29

T18

Eating disorders - WTE Therapists per 10 beds

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

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



Low Secure

T00: n/a

Mean: 487.5

Median: 464.0

Upper Q: 696.5

Lower Q: 269.0

SHA:

Trusts:

Figure 25

T00: n/a

Mean: 89.1%

Median: 90.0%

Upper Q: 94.4%

Lower Q: 86.0%

SHA:

Trusts:

Figure 26

Low secure services treat patients who have been identified as requiring secure hospital admission for assessment or treatment but do not require intensive care. Low secure services can also be used as a step down from medium secure services. The length of stay measure relates to the time spent in a low secure bed which may be shorter than the patient's whole admission. Around two thirds of participants have provided data on low secure provision.

The mean length of stay across all organisations is {BMChart19-Mean} days, compared to 471 days in 2013. The upper and lower quartiles of {BMChart19-UQ} and {BMChart19-LQ} days respectively indicate significant variation of more than one year across organisations.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

T70

T55

T20

T08

T56

T39

T04

T28

T13

T26

T24

T38

T53

T52

T35

T31

T19

T61

T21

T65

T11

T45

T41

T36

T48

T29

T80

T44

T14

T71

T33

T03

T16

T37

T18

T77

T79

T42

T27

T32

T68

T67

T73

T17

T10

Low secure - Bed Occupancy

0

100

200

300

400

500

600

700

800

900

1,000

T11

T65

T55

T79

T68

T16

T10

T04

T17

T27

T80

T42

T61

T36

T39

T56

T33

T08

T13

T26

T35

T32

T31

T29

T20

T41

T03

T14

T21

T77

T70

T45

T71

T44

T37

T28

T24

T19

T18

T73

T67

T53

T52

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

The median bed occupancy figure reported for low secure beds is {BMChart69-Median} . This is less than the adult acute bed occupancy rate of {BMChart4-Median} and the medium secure bed occupancy rate of {BMChart75-Median}

The number of Consultant Psychiatrists per 10 beds is shown in Figure 27 below and demonstrates a mean of {BMChart70consultants per 10 beds.typically have a length of stay ten times shorter than low secure bedson an illness.

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

10 low secure beds is {BMChart71beds), indicating that while senior medical input between the two specialties is comparable, nursing ratios are lower for patients in low secure beds

10

12

14

16

18

Low secure services treat patients who have been identified as requiring secure hospital admission for assessment or treatment but do not require intensive care. Low secure services can also be used as a step down from medium secure services. The length of stay measure relates to the time spent in a low secure bed which may be shorter than the patient's whole admission. Around two thirds of participants have provided data on low secure provision.

The mean length of stay across all organisations is 487.5 days, compared to 471 days in 2013. The upper and lower quartiles of 696.5 and 269.0 days respectively indicate significant variation of more than one year across organisations.

The median bed occupancy figure reported for low secure beds is 90.0% . This is less than the adult acute bed occupancy rate of 93% and the medium secure bed occupancy rate of 91.5%

The number of Consultant Psychiatrists per 10 beds is shown in Figure 27 below and demonstrates a mean of 0.7 consultants per 10 beds but with a range from 0.1 to 1.5 consultants per 10 beds. The organisational mean average is virtually identical to PICU beds where patients typically have a length of stay ten times shorter than low secure beds as PICU targets the most acute phase on an illness.

10 low secure beds is 9.1 WTE which is less than on PICU (14.4 WTE per 10 beds), indicating that while senior medical input between the two specialties is comparable, nursing ratios are lower for patients in low secure beds who, as a cohort, are likely to be less acutely unwell.



T00: n/a

Mean: 0.7

Median: 0.6

Upper Q: 0.7

Lower Q: 0.5

SHA:

Trusts:

Figure 27

T00: n/a

Mean: 9.1

Median: 8.4

Upper Q: 10.0

Lower Q: 7.9

SHA:

Trusts:

Figure 28

The number of Consultant Psychiatrists per 10 beds is shown in Figure 27 below and demonstrates a mean of {BMChart70-Mean} consultants per 10 beds but with a range from {BMChart70-Min} to {BMChart70-Max} consultants per 10 beds. The organisational mean average is virtually identical to PICU beds where patients typically have a length of stay ten times shorter than low secure beds as PICU targets the most acute phase on an illness.

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

T29

T11

T70

T45

T67

T41

T36

T61

T39

T44

T48

T56

T26

T35

T55

T80

T71

T52

T03

T08

T13

T04

T68

T42

T65

T79

T21

T53

T31

T18

T24

T17

T28

T33

T27

T14

Low secure - WTE Consultant Psychiatrists per 10 beds

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

0

2

4

6

8

10

12

14

16

18

T80

T35

T52

T56

T27

T67

T05

T36

T68

T38

T33

T65

T20

T53

T04

T73

T70

T42

T55

T13

T48

T39

T17

T14

T18

T32

T77

T61

T41

T08

T21

T19

T26

T45

T44

T03

T71

T11

T24

T79

T28

T29

T31

Low secure - WTE Qualified nurses per 10 beds

The number of Consultant Psychiatrists per 10 beds is shown in Figure 27 below and demonstrates a mean of 0.7 consultants per 10 beds but with a range from 0.1 to 1.5 consultants per 10 beds. The organisational mean average is virtually identical to PICU beds where patients typically have a length of stay ten times shorter than low secure beds as PICU targets the most acute phase on an illness.

The number of qualified nurses per 10 low secure beds is illustrated below. The mean number of nurses per 10 low secure beds is 9.1 WTE which is less than on PICU (14.4 WTE per 10 beds), indicating that while senior medical input between the two specialties is comparable, nursing ratios are lower for patients in low secure beds who, as a cohort, are likely to be less acutely unwell.



Medium Secure

T00: n/a

Mean: 531

Median: 543

Upper Q: 707

Lower Q: 266

SHA:

Trusts:

Figure 29

T00: n/a

Mean: 91.7%

Median: 91.5%

Upper Q: 97.1%

Lower Q: 88.5%

SHA:

Trusts:

Figure 30

Medium secure services data has been provided by 24 of the project's 66 participant organisations confirming this as a specialist service provided by around one third of NHS mental health providers with additional input from independent sector providers.

Medium secure services generally have a longer length of stay than less secure services. Member organisations reported a median position of {BMChart91-Median} days for length of stay this year. This compares to {BMChart19-Median} days for low secure services, although the range for medium secure bed LOS is significant, from {BMChart91-Min} to {BMChart91-Max} days across all organisations. The mean LOS in medium secure beds has decreased this year, from an average 574 days in 2013

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

T10

T32

T11

T04

T61

T13

T24

T28

T53

T31

T37

T48

T79

T68

T27

T08

T16

T56

T21

T44

T29

T38

T26

T65

T80

Medium Secure - Bed Occupancy

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

Consultant medical input to medium secure beds is virtually identical to such inputPICU, with all reporting a mean figure of 0.6 to {BMChart76

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

0

100

200

300

400

500

600

700

800

900

1,000

T29

T10

T13

T16

T11

T38

T79

T32

T27

T68

T61

T37

T56

T80

T65

T08

T48

T21

T31

T26

T28

T04

T44

T53

T24

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

10

12

14

Medium secure services data has been provided by 24 of the project's 66 participant organisations confirming this as a specialist service provided by around one third of NHS mental health providers with additional input from independent sector providers.

Medium secure services generally have a longer length of stay than less secure services. Member organisations reported a median position of 543 days for length of stay this year. This compares to 464.0 days for low secure services, although the range for medium secure bed LOS is significant, from 158 to 958 days across all organisations. The mean LOS in medium secure beds has decreased this year, from an average 574 days in 2013

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

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



T00: n/a

Mean: 0.7

Median: 0.7

Upper Q: 0.8

Lower Q: 0.6

SHA:

Trusts:

Figure 31

T00: n/a

Mean: 9.4

Median: 9.6

Upper Q: 10.3

Lower Q: 8.1

SHA:

Trusts:

Figure 32

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

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

T56

T29

T11

T48

T08

T31

T44

T24

T38

T26

T21

T61

T27

T13

T04

T28

T68

T79

T53

T80

Medium secure - WTE Consultant Psychiatrists per 10 beds

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

0

2

4

6

8

10

12

14

T68

T48

T44

T13

T04

T27

T65

T21

T38

T08

T80

T53

T56

T31

T29

T32

T26

T11

T24

T28

T79

T61

Medium secure - WTE Qualified nurses per 10 beds

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

Qualified nurses per 10 medium secure beds is shown below. With a mean figure of 9.4 this is only marginally higher than the nursing ratio of 9.1 WTE nurses per 10 low secure beds. There is some variation on an organisational level, with some respondents reporting fewer qualified nurses on their medium secure wards than on their low secure equivalents.



High Dependency Rehabilitation

T00: n/a

Mean: 477

Median: 391

Upper Q: 610

Lower Q: 221

SHA:

Trusts:

Figure 33

T00: n/a

Mean: 86.6%

Median: 86.8%

Upper Q: 91.6%

Lower Q: 82.3%

SHA:

Trusts:

Figure 34

High Dependency Rehabilitation services provide rehabilitation to clients with active symptoms, more complex needs and challenging behaviours. The usual aim of treatment is to prepare patients to step down to other rehabilitation services prior to independent or supported living.

The mean length of stay for patients in these beds is shown here. With a mean position across all providers of {BMChart92-Mean} days it is clear that patients in these beds typically have complex rehabilitation needs requiring long lengths of stay. There is significant variation between members, however, with stays ranging from {BMChart92-Min} days to {BMChart92-Max} days for the lowest and highest providers. Patients can be admitted into these beds from a variety of sources, including secure services, PICUs and directly from the community. Average length of stay positions may be influenced by small numbers of extremely long stay

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

T19

T46

T80

T18

T04

T20

T48

T21

T29

T42

T35

T53

T32

T31

T73

T61

T14

T08

T56

T36

T13

T60

T68

T38

T10

T11

T16

T24

T75

T66

T67

High Dependency Rehabilitation - Bed occupancy

The number of Consultant Psychiatrists, measured per 10 High Dependency Rehabilitation beds, is among the lowest when compared to other services, with a mean position of {BMChart7910 beds. This indicates that senior medical input to these beds is limited and infrequent compared to other services.

0.0

0.2

0.4

0.6

0.8

1.0

1.2

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

T48

T13

T20

T68

T11

T31

T32

T56

T61

T42

T18

T46

T80

T29

T73

T35

T08

T14

T10

T16

T36

T38

T24

T21

T66

T67

T53

T72

T19

T60

T04

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

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

The number of qualified (band 5 or above) nurses per 10 High Dependency RehabilitationFigure 33. The mean figure reported by members is {BMChart80represents

10

12

14

High Dependency Rehabilitation services provide rehabilitation to clients with active symptoms, more complex needs and challenging behaviours. The usual aim of treatment is to prepare patients to step down to other rehabilitation services prior to independent or supported living.

The mean length of stay for patients in these beds is shown here. With a mean position across all providers of 477 days it is clear that patients in these beds typically have complex rehabilitation needs requiring long lengths of stay. There is significant variation between members, however, with stays ranging from 49 days to 1,784 days for the lowest and highest providers. Patients can be admitted into these beds from a variety of sources, including secure services, PICUs and directly from the community. Average length of stay positions may be influenced by small numbers of extremely long stay patients.

The number of Consultant Psychiatrists, measured per 10 High Dependency Rehabilitation beds, is among the lowest when compared to other services, with a mean position of 0.4 WTE Consultants per 10 beds. This indicates that senior medical input to these beds is limited and infrequent compared to other services.

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

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



T00: n/a

Mean: 0.4

Median: 0.3

Upper Q: 0.5

Lower Q: 0.2

SHA:

Trusts:

Figure 35

T00: n/a

Mean: 7.5

Median: 7.4

Upper Q: 8.2

Lower Q: 6.0

SHA:

Trusts:

Figure 36

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

0.0

0.2

0.4

0.6

0.8

1.0

1.2

T04

T11

T42

T13

T35

T56

T36

T31

T18

T66

T68

T48

T14

T53

T46

T75

T08

High Dependency Rehabilitation - WTE Consultant Psychiatrists per 10 beds

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

0

2

4

6

8

10

12

14

T19

T67

T42

T14

T68

T35

T36

T56

T75

T73

T60

T48

T66

T38

T32

T11

T08

T46

T04

T13

T20

T18

T31

T53

High Dependency Rehabilitation - WTE Qualified nurses per 10 beds

The number of Consultant Psychiatrists, measured per 10 High Dependency Rehabilitation beds, is among the lowest when compared to other services, with a mean position of 0.4 WTE Consultants per 10 beds. This indicates that senior medical input to these beds is limited and infrequent compared to other services.

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



Longer Term Complex / Continuing Care

T00: n/a

Mean: 589.7

Median: 529.0

Upper Q: 782.0

Lower Q: 321.4

SHA:

Trusts:

Figure 37

T00: n/a

Mean: 86.1%

Median: 88.1%

Upper Q: 92.7%

Lower Q: 80.6%

SHA:

Trusts:

Figure 38

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

By its very definition, length of stay in longer term complex or continuing care is typically greater than in most other types of inpatient services. The median length of stay reported this year by members was {BMChart81-Median} days which compares to {BMChart92-Median} days for high dependency rehab beds.

0

200

400

600

800

1,000

1,200

1,400

1,600

T14

T56

T29

T18

T55

T80

T11

T32

T48

T70

T20

T41

T61

T73

T39

T27

T65

T08

T52

T19

T71

T10

T68

T46

T28

T23

T42

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

Bed occupancy in this area has a median position of {BMChart93-Median}, comparable to {BMChart78-Median} for high dependency rehabilitation beds.

figure reported for any service. This means that in a typical provider, 1 consultant could look after up to 50 beds or, more likely, a smaller ward would have a part time consultant who also worked in other areas.

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0%

20%

40%

60%

80%

100%

T46

T29

T41

T80

T28

T42

T20

T18

T68

T08

T31

T55

T48

T61

T70

T73

T14

T10

T52

T39

T65

T27

T71

T11

T32

T56

T23

T19

Longer Term Complex / Continuing Care - Bed Occupancy

Nursenurses reported as {BMChart83input for longer term complex and continuing care is much lower than for other services. This may raise questions for providers on the appropriateness of the level of care provided.

10.0

15.0

20.0

25.0

30.0

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

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

Bed occupancy in this area has a median position of 88.1%, comparable to 86.8% for high dependency rehabilitation beds.

any service. This means that in a typical provider, 1 consultant could look after up to 50 beds or, more likely, a smaller ward would have a part time consultant who also worked in other areas.

Nurse staffing ratios for this area are also the lowest of any service, with a mean number of WTE qualified nurses reported as 7.0 per 10 beds. It is noted that the level of medical, nursing and therapy input for longer term complex and continuing care is much lower than for other services. This may raise questions for providers on the appropriateness of the level of care provided.



T00: n/a

Mean: 0.2

Median: 0.1

Upper Q: 0.3

Lower Q: 0.1

SHA:

Trusts:

Figure 39

T00: n/a

Mean: 7.0

Median: 5.6

Upper Q: 7.1

Lower Q: 4.2

SHA:

Trusts:

Figure 40

The mean number of consultant psychiatrists reported is {BMChart82-Mean} WTE per 10 beds, the lowestfigure reported for any service. This means that in a typical provider, 1 consultant could look after up to 50 beds or, more likely, a smaller ward would have a part time consultant who also worked in other areas.

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

T61

T52

T48

T56

T39

T46

T68

T31

T80

T41

T18

T65

T23

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

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

0.0

5.0

10.0

15.0

20.0

25.0

30.0

T61

T20

T80

T08

T05

T48

T46

T56

T73

T52

T65

T39

T11

T55

T14

T41

T71

T23

T68

T18

T19

T32

T28

T31

T70

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

The mean number of consultant psychiatrists reported is 0.2 WTE per 10 beds, the lowest figure reported for any service. This means that in a typical provider, 1 consultant could look after up to 50 beds or, more likely, a smaller ward would have a part time consultant who also worked in other areas.

Nurse staffing ratios for this area are also the lowest of any service, with a mean number of WTE qualified nurses reported as 7.0 per 10 beds. It is noted that the level of medical, nursing and therapy input for longer term complex and continuing care is much lower than for other services. This may raise questions for providers on the appropriateness of the level of care provided.



Clustering

T00: n/a

Mean: 1.4%

Median: 0.6%

Upper Q: 2.0%

Lower Q: 0.0%

SHA:

Trusts:

Figure 41

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

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

Figure 41 below shows the percentage of patients occupying inpatient beds (all specialties) on the day of the census, who were classified as cluster 1 or 2 (non-psychosis, mild). This illustrates a range of between 0% and {BMChart98-Max} with a median prevalence of {BMChart98-Median}. This suggests service users with less severe mental health problems are being treated more and more in community services, with inpatient beds reserved for those who meet a higher threshold. This is consistent with reductions in bed numbers seen earlier. Therefore, the overall acuity of admitted patients in beds is likely to be increasing each year and ward staff may feel the impact of this on a day to day basis.

0%

2%

4%

6%

8%

10%

12%

14%

T47

T17

T79

T13

T67

T01

T73

T71

T03

T30

T31

T26

T39

T38

T25

T53

T42

T48

T52

T56

T04

T16

T44

T28

T45

T19

T65

T10

T61

T41

T36

T46

T27

T08

T50

T05

T18

T37

T34

T35

T51

T76

T14

T59

T24

T60

T29

T20

T55

T06

T32

T12

T33

T66

T23

T21

T11

Inpatient cluster profiles - 1 - 2 prevalence %

10%

15%

20%

25%

30%

10%

15%

20%

25%

30%

35%

40%

45%

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

Figure 43 shows the prevalence of all patients with a nonaccount for up to a minor change compared to last year (22%). When viewed in conjunction with the two previous charts, this shows that where patients are still being admitted with nonincreasingly to be in clusters 5

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

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

Figure 41 below shows the percentage of patients occupying inpatient beds (all specialties) on the day of the census, who were classified as cluster 1 or 2 (non-psychosis, mild). This illustrates a range of between 0% and 12.0% with a median prevalence of 0.6%. This suggests service users with less severe mental health problems are being treated more and more in community services, with inpatient beds reserved for those who meet a higher threshold. This is consistent with reductions in bed numbers seen earlier. Therefore, the overall acuity of admitted patients in beds is likely to be increasing each year and ward staff may feel the impact of this on a day to day basis.

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

Figure 43 shows the prevalence of all patients with a nonaccount for up to 44.4% of patients in beds. The median figure is 23.6%. This is a minor change compared to last year (22%). When viewed in conjunction with the two previous charts, this shows that where patients are still being admitted with nontherefore of greater acuity than in previous years.



T00: n/a

Mean: 9.0%

Median: 7.6%

Upper Q: 11.4%

Lower Q: 5.1%

SHA:

Trusts:

Figure 42

T00: n/a

Mean: 23.7%

Median: 23.6%

Upper Q: 28.6%

Lower Q: 17.8%

SHA:

Trusts:

Figure 43

0%

5%

10%

15%

20%

25%

30%

T47

T17

T73

T67

T01

T42

T19

T25

T26

T71

T39

T50

T03

T53

T20

T66

T31

T04

T41

T52

T21

T79

T44

T06

T13

T28

T61

T32

T16

T30

T34

T65

T36

T35

T29

T48

T24

T60

T45

T27

T38

T10

T33

T05

T46

T23

T51

T56

T12

T14

T59

T18

T76

T08

T37

T11

T55


0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

T47

T17

T19

T01

T44

T26

T60

T38

T51

T59

T23

T25

T73

T14

T66

T50

T42

T03

T31

T21

T11

T27

T24

T67

T20

T53

T79

T32

T29

T06

T34

T41

T65

T33

T04

T35

T16

T45

T39

T28

T61

T36

T13

T10

T52

T56

T08

T71

T18

T37

T48

T55

T05

T30

T46

T12

T76


10%

20%

30%

40%

50%

60%

70%

80%

10%

15%

20%

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

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



T00: n/a

Mean: 51.2%

Median: 51.5%

Upper Q: 57.4%

Lower Q: 44.3%

SHA:

Trusts:

Figure 44

T00: n/a

Mean: 6.8%

Median: 6.1%

Upper Q: 9.1%

Lower Q: 3.7%

SHA:

Trusts:

Figure 45

0%

10%

20%

30%

40%

50%

60%

70%

80%

T30

T66

T18

T55

T13

T12

T46

T37

T08

T35

T28

T41

T61

T31

T04

T39

T32

T36

T26

T24

T48

T67

T45

T56

T21

T19

T27

T52

T25

T38

T53

T11

T34

T60

T16

T33

T14

T29

T03

T47

T79

T42

T73

T50

T71

T44

T65

T01

T06

T23

T59

T51

T05

T10

T20

T17

T76


0%

5%

10%

15%

20%

T48

T16

T46

T33

T50

T65

T52

T20

T01

T04

T36

T08

T61

T11

T39

T44

T34

T47

T23

T13

T59

T71

T55

T41

T21

T25

T29

T37

T53

T38

T56

T32

T03

T26

T79

T51

T67

T14

T27

T31

T10

T45

T05

T12

T24

T17

T19

T06

T42

T60

T35

T18

T30

T28

Inpatient cluster profiles - 17 prevalence %

100%

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

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

Clusters 18 to 21 relate to organic disorders such as cognitive impairment or dementia. Figure 44 shows a median position of {BMChart103(15%). Thesefrailty. This can be explored further in the mental health benchmarking toolkit. The outlying organisation here predominantly provides older adult mental health services and therefore this level of clustering is to be expected.

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

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

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



T00: n/a

Mean: 17.8%

Median: 14.5%

Upper Q: 21.2%

Lower Q: 11.2%

SHA:

Trusts:

Figure 46

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

T76

T05

T10

T06

T71

T20

T79

T51

T73

T17

T65

T29

T59

T45

T23

T42

T12

T53

T14

T52

T27

T34

T60

T44

T24

T28

T03

T33

T36

T32

T50

T16

T11

T21

T37

T56

T48

T39

T35

T18

T61

T31

T25

T01

T38

T30

T46

T04

T55

T41

T08

T67

T26

T13

T19

T47

T66

Inpatient cluster profiles - 18- 21 prevalence %

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

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



Use of the Mental Health Act

T00: n/a

Mean: 29.7%

Median: 28.6%

Upper Q: 34.7%

Lower Q: 24.0%

SHA:

Trusts:

Figure 47

Figure 48

0%

10%

20%

30%

40%

50%

60%

70%

T06

T27

T10

T46

T48

T04

T13

T56

T55

T52

T41

T39

T78

T28

T26

T16

T38

T14

T44

T21

T80

T29

T53

T30

T08

T67

T18

T20

T77

T35

T42

T05

T19

T36

T47

T59

T65

T23

T37

T32

T51

T31

T03

T70

T01

T33

T12

T24

T11

T73

T75

T60

T71

T68

T72

T61

T66

Adult Acute beds - Percentage of all admissions under the Mental Health Act

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

Section 2

Section 3

Section 37

Section 37 / 41

Section 47

Section 47/49

The extent to which patients occupying beds are there as the result of a Mental Health Act section being applied gives useful background, in conjunction with the clustering analysis shown earlier. It is also important to consider these alongside bed occupancy rates and average length of stay.

Figure 47 below shows the percentage of patients in adult acute beds whose admissions were enforced under the Mental Health Act. The mean figure is 29.8% compared to 29% in 2013 and 25% in 2012. The increasing use of compulsion will have implications for bed availability for patients not admitted under a section and may limit spaces available to this cohort. Organisations who have seen a rise in line with the average increase may also find that acuity of patients has increased as patients detained under the Mental Health Act may have more complex needs.

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



Community Services

Figure 49

Figure 50

Organisations report both their face to face and nonnumber of face to face contacts across all community mental health teams. While the caseload, shown above, has increased over the last year, the number of contacts has grown marginally from {BSPK_contacts_BMChart117}that individual patients will be receiving fewer contacts, perhaps because the mental health workforce has not increased in line with the increase in demand noted from the caseload numbers.mental health reference group members include the reduction in the number of Assertive Outreach teams and Older People's CMHTs as new service models emerge.

A substantially greater number of mental health service users access community mental health services than occupy inpatient beds at any given time. Some patients may move between inpatient and community care, while others may never be admitted to hospital and be cared for entirely in the community. Although acuity of this caseload can be less than that of the inpatient cohort, it should be noted that most inpatients are also users of community mental health services. Community mental health services play an important role in non-bed based service delivery with step up and step down models of care clearly established in specialist mental health services. The term “community mental health services “can be interpreted in different ways. For the purposes of this report community mental health services are defined as services that support service users outside of the hospital context, often in a domiciliary or community clinic location. Community mental health services work with people with severe and enduring mental illness through well-defined care pathways and protocols. Although it is recognised that services have evolved since the publication of the National Service Framework in 1999, the reference group have adopted a definition of community mental health services that recognises the core principles and shape of the NSF. The following core services have been included within the definition of community mental health services:

* Community Mental Health Teams (generic CMHTs) * Crisis Resolution and Home Treatment (CRHT) * Assertive Outreach * Early Intervention (including early onset psychosis)* Assessment and Brief Intervention (including Primary Mental Health Teams) * Rehabilitation and Recovery * Older People * Memory services * Other Adult Community Mental Health Teams

Each of these services is analysed in detail across many domains within the benchmarking toolkit. Areas explored include:

* Activity and caseloads * Referrals * DNAs * Access and waiting times * Complaints * Incidents * Finance * Workforce

1,000

2,000

3,000

4,000

5,000

6,000

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Figure 49, below, details the total combined caseload for all community mental health teams, benchmarked per 100,000 population. This is an aggregate figure which includes total caseload across all teams listed in the introduction to this section. The mean position this year is {BMChart116{BSPK_Caseload_BMChart116}overall reported prevalence ranges from {BMChart116population showing significant variation across different parts of the England and Wales. The growth in reported caseloads requires further validation with participants.benchmarking project, reference group members observed that the impact of IAPT may be reflected in new, larger caseload volumes. Reference group members also noted that discharging service users from community caseloads is becoming increasingly difficult.

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

A substantially greater number of mental health service users access community mental health services than occupy inpatient beds at any given time. Some patients may move between inpatient and community care, while others may never be admitted to hospital and be cared for entirely in the community. Although acuity of this caseload can be less than that of the inpatient cohort, it should be noted that most inpatients are also users of community mental health services. Community mental health services play an important role in non-bed based service delivery with step up and step down models of care clearly established in specialist mental health services. The term “community mental health services “can be interpreted in different ways. For the purposes of this report community mental health services are defined as services that support service users outside of the hospital context, often in a domiciliary or community clinic location. Community mental health services work with people with severe and enduring mental illness through well-defined care pathways and protocols. Although it is recognised that services have evolved since the publication of the National Service Framework in 1999, the reference group have adopted a definition of community mental health services that recognises the core principles and shape of the NSF. The following core services have been included within the definition of community mental health services:

* Community Mental Health Teams (generic CMHTs) * Crisis Resolution and Home Treatment (CRHT) * Assertive Outreach * Early Intervention (including early onset psychosis)* Assessment and Brief Intervention (including Primary Mental Health Teams) * Rehabilitation and Recovery * Older People * Memory services * Other Adult Community Mental Health Teams

Each of these services is analysed in detail across many domains within the benchmarking toolkit. Areas explored include:

* Activity and caseloads * Referrals * DNAs * Access and waiting times * Complaints * Incidents * Finance * Workforce

Figure 49, below, details the total combined caseload for all community mental health teams, benchmarked per 100,000 population. This is an aggregate figure which includes total caseload across all teams listed in the introduction to this section. The mean position this year is 2,231 compared to the figure of 1781 service users on the caseload per 100,000 population reported in 2013. The overall reported prevalence ranges from 967 to 5,094 service users per 100,000 population showing significant variation across different parts of the England and Wales. The growth in reported caseloads requires further validation with participants. Although IAPT data is excluded from the benchmarking project, reference group members observed that the impact of IAPT may be reflected in new, larger caseload volumes. Reference group members also noted that discharging service users from community caseloads is becoming increasingly difficult.



T00: n/a

Mean: 2,231

Median: 2,083

Upper Q: 2,509

Lower Q: 1,644

SHA:

Trusts:

Figure 49

T00: n/a

Mean: 35,566

Median: 34,359

Upper Q: 44,188

Lower Q: 27,169

SHA:

Trusts:

Figure 50

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

10.0

15.0

20.0

25.0

30.0

10,000.0

12,000.0

14,000.0

0

1,000

2,000

3,000

4,000

5,000

6,000

T71

T31

T11

T37

T16

T39

T52

T42

T48

T51

T59

T29

T26

T33

T36

T19

T05

T07

T53

T77

T20

T25

T21

T17

T28

T80

T44

T10

T04

T24

T35

T56

T34

T68

T73

T41

T01

T55

T13

T67

T23

T32

T38

T14

T08

T45

T18

T50

T47

T03

T72

T30

T65

T46

T70

T66

T75

T27

Community Mental Health Teams - Caseload per 100,000 population

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

T37

T31

T48

T16

T17

T59

T06

T53

T24

T25

T51

T50

T33

T32

T45

T67

T11

T55

T28

T44

T21

T71

T42

T29

T14

T41

T36

T20

T26

T18

T56

T39

T38

T75

T07

T52

T10

T08

T66

T65

T13

T05

T04

T03

T34

T70

T30

T46

T01

T47

T35

T19

T27

T23

T73

T80

T68

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

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

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

Figure 51, below, shows the maximum reported waits for a first routine appointment in Early Intervention services. which has a mean average of show a median average of 5 days for Early Intervention services. graphs which show average waiting times for routine appointments and also for urgent appointments. This is available for a wide range of other community services.

The number of face to face contacts for CRHT teams has decreased minimally{BSPK_CRHTcontact_BMChart29}

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

Figure 49, below, details the total combined caseload for all community mental health teams, benchmarked per 100,000 population. This is an aggregate figure which includes total caseload across all teams listed in the introduction to this section. The mean position this year is 2,231 compared to the figure of 1781 service users on the caseload per 100,000 population reported in 2013. The overall reported prevalence ranges from 967 to 5,094 service users per 100,000 population showing significant variation across different parts of the England and Wales. The growth in reported caseloads requires further validation with participants. Although IAPT data is excluded from the benchmarking project, reference group members observed that the impact of IAPT may be reflected in new, larger caseload volumes. Reference group members also noted that discharging service users from community caseloads is becoming increasingly difficult.


Figure 51, below, shows the maximum reported waits for a first routine appointment in Early Intervention services. which has a mean average of 8.8 weeks. Waiting times for urgent appointments show a median average of 5 days for Early Intervention services. The Mental Health toolkit provides further graphs which show average waiting times for routine appointments and also for urgent appointments. This is available for a wide range of other community services.

The number of face to face contacts for CRHT teams has decreased minimally this year, from 4392 to 4,339 on average, per 100,000 population served.



T00: n/a

Mean: 8.8

Median: 6.9

Upper Q: 12.3

Lower Q: 4.2

SHA:

Trusts:

Figure 51

T00: n/a

Mean: 4,339

Median: 4,126

Upper Q: 5,373

Lower Q: 2,818

SHA:

Trusts:

Figure 52

0.0

5.0

10.0

15.0

20.0

25.0

30.0

T14

T29

T04

T73

T32

T03

T38

T26

T28

T20

T42

T36

T17

T21

T27

T31

T11

T10

T16

T52

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

0.0

2,000.0

4,000.0

6,000.0

8,000.0

10,000.0

12,000.0

14,000.0

T48

T21

T55

T39

T66

T46

T59

T67

T28

T18

T50

T51

T25

T17

T30

T24

T44

T16

T65

T13

T31

T73

T14

T08

T29

T06

T01

T56

T38

T37

T11

T47

T03

T34

T33

T32

T52

T10

T19

T36

T75

T27

T42

T53

T70

T71

T35

T26

T07

T20

T68

T45

T23

T80

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

0

1

2

3

100%


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

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

The ability of a CRHT team to respond swiftly to demand for services is an important indicator. CRHT services play an important role in gate keeping admissions to bed based services, and the successful avoidance of hospital admission depends on good, prompt access to this service.

This year, the average waiting time for a routine appointment with as CRHT team was {BMChart104weeks,can be used to examine average waiting times for urgent appointments, and waiting times for other community services, both routine and urgent.

CRHT teams work hard to prevent avoidable admissions, an important role when access to beds is limited (or bed occupancy is high), or when treatment in the community is more advantageous for a patient. The chart below shows the percentage of all referrals to the CRHT team from othersubsequently resulted in the patient being admitted to an inpatient bed. In 2013, organisations reported a mean figure of 27%, which has increased to {BMChart105well as a more central


Figure 51, below, shows the maximum reported waits for a first routine appointment in Early Intervention services. which has a mean average of 8.8 weeks. Waiting times for urgent appointments show a median average of 5 days for Early Intervention services. The Mental Health toolkit provides further graphs which show average waiting times for routine appointments and also for urgent appointments. This is available for a wide range of other community services.

The number of face to face contacts for CRHT teams has decreased minimally this year, from 4392 to 4,339 on average, per 100,000 population served.


This year, the average waiting time for a routine appointment with as CRHT team was 0.5 weeks, or approximately 3 to 4 days. This compares to an average waiting time of 1 week in 2013. The toolkit can be used to examine average waiting times for urgent appointments, and waiting times for other community services, both routine and urgent.

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



T00: n/a

Mean: 0.5

Median: 0.1

Upper Q: 0.4

Lower Q: 0.1

SHA:

Trusts:

Figure 53

T00: n/a

Mean: 34.0%

Median: 30.2%

Upper Q: 40.2%

Lower Q: 21.2%

SHA:

Trusts:

Figure 54

0

1

2

3

T52

T20

T31

T53

T27

T32

T80

T14

T17

T18

T45

T21

T59

T36

T38

T73

T03

T26

T51

T42

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

0%

20%

40%

60%

80%

100%

T47

T37

T42

T35

T52

T38

T53

T48

T32

T68

T21

T26

T36

T73

T13

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


This year, the average waiting time for a routine appointment with as CRHT team was {BMChart104-Mean} weeks, or approximately 3 to 4 days. This compares to an average waiting time of 1 week in 2013. The toolkit can be used to examine average waiting times for urgent appointments, and waiting times for other community services, both routine and urgent.

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


This year, the average waiting time for a routine appointment with as CRHT team was 0.5 weeks, or approximately 3 to 4 days. This compares to an average waiting time of 1 week in 2013. The toolkit can be used to examine average waiting times for urgent appointments, and waiting times for other community services, both routine and urgent.

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



Mental Health Services Workforce

T00: n/a

Mean: 492

Median: 466

Upper Q: 545

Lower Q: 412

SHA:

Trusts:

Figure 55

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

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

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

Analysis of Consultant Psychiatrists per 100,000 bed days in adult acute beds is shown below. The mean position of this measure has changed only slightly this year, from 14.4 to {BMChart34100,000 bed days. Last year's spread has remained virtually unchanged, with this year's quartiles ranging from {BMChart34organisations.

10

15

20

25

30

35

40

Nursing staff ratios are discussed in detail in the specialist services section of this report and in the toolkit. The figure below shows the number of WTE qualified nurses (AfC bands 5 and above) per 100,000 adult acute bed days. This has a mean position of {BMChart35There continues to be discussion nationally regarding the optimal staffing for inpatient wards. Until national guidance is available for Mental Health, this sort of comparison is useful to show organisations how they compare to peers on a regional and national basis.

0

200

400

600

800

1,000

T29

T55

T80

T71

T72

T25

T06

T52

T20

T45

T65

T11

T17

T68

T34

T03

T56

T75

T60

T14

T13

T66

T67

T23

T26

T41

T04

T28

T01

T33

T73

T39

T77

T48

T38

T12

T36

T47

T35

T42

T18

T61

T53

T30

T44

T24

T59

T31

T27

T32

T08

T46

T19

T21

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

100

200

300

400

500

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

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

The mean position reported is 492 WTE clinical staff per 100,000 bed days in adult acute services (figure 55) compared to 498 WTE in 2013.

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

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



T00: n/a

Mean: 15.1

Median: 13.6

Upper Q: 18.6

Lower Q: 10.6

SHA:

Trusts:

Figure 56

T00: n/a

Mean: 235

Median: 224

Upper Q: 249

Lower Q: 197

SHA:

Trusts:

Figure 57

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

0

5

10

15

20

25

30

35

40

T47

T25

T11

T55

T18

T68

T56

T67

T29

T26

T03

T66

T34

T80

T53

T65

T28

T42

T36

T52

T17

T21

T33

T08

T23

T39

T61

T13

T45

T27

T14

T01

T48

T71

T41

T75

T46

T31

T04

T50

T35

T72

T24

T44

T20

T73

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

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

0

100

200

300

400

500

T55

T38

T72

T80

T29

T25

T20

T60

T52

T06

T66

T41

T13

T03

T50

T14

T77

T34

T28

T65

T36

T71

T59

T56

T39

T08

T68

T04

T01

T23

T17

T18

T11

T61

T47

T75

T48

T73

T26

T67

T44

T30

T45

T33

T32

T46

T35

T42

T53

T19

T21

T12

T27

T31

T24

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

10%

15%

20%

25%

30%

35%

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

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



T00: n/a

Mean: 12.4%

Median: 11.3%

Upper Q: 17.5%

Lower Q: 6.5%

SHA:

Trusts:

Figure 58

Participants can use the mental health toolkit to explore themes impacting on nurse staffing levels including the level and role of support workers and the use of bank and agency staff.

Figure 58 shows the vacancy rates for all staff as a percentage of WTE in establishment. In 2013, the mean position was 13% compared to {BMChart36-Mean} this year. Again, the variation is significant, with a lower quartile of {BMChart36-LQ} and an upper quartile of {BMChart36-UQ} which indicates there may be regional variation with some organisations finding it more difficult to recruit and retain suitably qualified staff. Vacancy rates are a useful measure for wards who may use bank or agency staff to fill gaps, or operate at a reduced staffing level. In some circumstance, the result may be a detrimental patient experience such as more violence or increased use of restraint as patients are cared for by staff less familiar with them or receive less supervision than is optimal.

0%

5%

10%

15%

20%

25%

30%

35%

T59

T28

T52

T08

T19

T38

T27

T21

T67

T46

T32

T65

T47

T48

T18

T24

T75

T29

T03

T13

T05

T14

T31

T26

T56

T53

T70

T33

T39

T04

T72

T23

T11

T36

T30

T34

T45

T80

T20

T66

T17

T42

T35

T44

T68

T73

T41

T01

T79

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

Participants can use the mental health toolkit to explore themes impacting on nurse staffing levels including the level and role of support workers and the use of bank and agency staff.

Figure 58 shows the vacancy rates for all staff as a percentage of WTE in establishment. In 2013, the mean position was 13% compared to 12.4% this year. Again, the variation is significant, with a lower quartile of 6.5% and an upper quartile of 17.5% which indicates there may be regional variation with some organisations finding it more difficult to recruit and retain suitably qualified staff. Vacancy rates are a useful measure for wards who may use bank or agency staff to fill gaps, or operate at a reduced staffing level. In some circumstance, the result may be a detrimental patient experience such as more violence or increased use of restraint as patients are cared for by staff less familiar with them or receive less supervision than is optimal.



Finance

T00: n/a

Mean: £117,708

Median: £121,453

Upper Q: £139,937

Lower Q: £108,096

SHA:

Trusts:

Figure 59

£0

£20,000

£40,000

£60,000

£80,000

£100,000

£120,000

£140,000

£160,000

£180,000

T80

T45

T65

T34

T28

T29

T08

T72

T59

T19

T71

T03

T23

T13

T53

T51

T55

T50

T17

T36

T01

T27

T18

T48

T30

T11

T38

T26

T56

T66

T44

T39

T68

T04

T70

T31

T41

T75

T14

T20

T46

T73

T35

T42

T33

T60

T21

T24

T12

T52

T67

Cost per Adult Acute bed

£100

£200

£300

£400

£500

£600

£1,000

£1,500

£2,000

£2,500

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

Figure 59 shows the costs per adult acute bed, including all direct, indirect, overhead and corporate costs. This has a mean position of {BMChart39-Mean} which is an increase compared to £104,000 per bed in 2013. Spending is relatively similar across England and Wales and, as was the case last year, the quartile thresholds remain relatively narrow at an annual cost of {BMChart39-LQ} and {BMChart39-UQ} per bed. Increased costs per bed in the last year may suggest that overall inpatient service costs have not reduced despite the reduction in bed numbers.

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

Psychiatricexample for PICUto {BMChart41bed occupancy in these units, shown earlier in the Specialist Beds section of the report.

Cost per bed day is also a useful measure for comparison. In 2013 the mean position was £352 which compares to a mean figure of {BMChart40Costs of providing both inpatient and community services are collected as part of the benchmarking process

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

Figure 59 shows the costs per adult acute bed, including all direct, indirect, overhead and corporate costs. This has a mean position of £117,708 which is an increase compared to £104,000 per bed in 2013. Spending is relatively similar across England and Wales and, as was the case last year, the quartile thresholds remain relatively narrow at an annual cost of £108,096 and £139,937 per bed. Increased costs per bed in the last year may suggest that overall inpatient service costs have not reduced despite the reduction in bed numbers.

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

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

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



T00: n/a

Mean: £352

Median: £369

Upper Q: £400

Lower Q: £321

SHA:

Trusts:

Figure 60

T00: n/a

Mean: £707

Median: £659

Upper Q: £790

Lower Q: £550

SHA:

Trusts:

Figure 61

£0

£100

£200

£300

£400

£500

£600

T80

T59

T34

T65

T38

T45

T13

T08

T03

T29

T71

T28

T55

T66

T75

T19

T11

T14

T23

T01

T36

T72

T51

T56

T50

T17

T27

T48

T68

T30

T41

T26

T53

T18

T39

T60

T31

T04

T44

T35

T73

T46

T20

T33

T42

T21

T24

T12

T52

T67

Cost per bed day, Adult Acute

£0

£500

£1,000

£1,500

£2,000

£2,500

T52

T45

T72

T08

T17

T34

T31

T41

T13

T80

T39

T56

T50

T65

T03

T36

T33

T60

T70

T35

T11

T29

T42

T01

T04

T53

T44

T30

T38

T66

T19

T48

T23

T68

T75

T21

T27

T24

T46

T12

T79

T18

T28

T20

T51

PICU, cost per bed day

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

£1,000,000

£1,500,000

£2,000,000

£2,500,000

£3,000,000

£3,500,000

£4,000,000

£4,500,000

£5,000,000

£10,000


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

In 2013 the average cost per patient on the caseload was £3,340. This has reducedMean}. This is consistent with the community metrics highlightedaverage per capita caseloads and also suggest service users have received fewer contacts on average this year than in 2013 although the change may also be due to the inclusion of additional contributors this year.

Cost per bed day is also a useful measure for comparison. In 2013 the mean position was £352 which compares to a mean figure of {BMChart40-Mean} this year. Detailed community metrics are also available in the toolkit, and a small sample are included here. The data

can be analysed in a number of ways including cost per contact, cost per patient on the caseload, or cost per 100,000 population served. Figure 62 below shows the cost of Generic CMHT services per 100,000 registered population . In 2013 the mean cost was £2,923,893 per 100,000 population. In 2014 this figure has reduced to £2,459,967 per 100,000 population


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

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

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



T00: n/a

Mean: £2,459,967

Median: £2,414,108

Upper Q: £3,208,651

Lower Q: £1,837,715

SHA:

Trusts:

Figure 62

T00: n/a

Mean: £2,962

Median: £2,868

Upper Q: £3,218

Lower Q: £2,232

SHA:

Trusts:

Figure 63

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

£0

£500,000

£1,000,000

£1,500,000

£2,000,000

£2,500,000

£3,000,000

£3,500,000

£4,000,000

£4,500,000

£5,000,000

T18

T44

T41

T51

T48

T21

T04

T13

T45

T72

T07

T56

T01

T70

T31

T28

T11

T68

T66

T80

T50

T53

T52

T30

T71

T19

T75

T35

T47

T14

T59

T26

T17

T65

T08

T03

T42

T23

T73

T60

T27

T34

T12

T20

T67

T55

Generic CMHT - cost per 100,000 population

£0

£2,000

£4,000

£6,000

£8,000

£10,000

T42

T80

T45

T41

T18

T73

T30

T44

T27

T68

T47

T34

T01

T35

T13

T75

T04

T28

T14

T07

T65

T66

T03

T08

T23

T70

T17

T53

T51

T56

T11

T48

T50

T21

T26

T59

T19

T71

T52

T31

T20

T55

T67

Generic CMHT - cost per patient on the caseload

In 2013 the average cost per patient on the caseload was £3,340. This has reduced this year to {BMChart43-Mean}. This is consistent with the community metrics highlighted earlier which confirm an increase in average per capita caseloads and also suggest service users have received fewer contacts on average this year than in 2013 although the change may also be due to the inclusion of additional contributors this year.

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

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



Quality

T00: n/a

Mean: 73.1%

Median: 74.0%

Upper Q: 75.0%

Lower Q: 71.0%

SHA:

Trusts:

Figure 64

Figure 67

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

T35

T36

T38

T42

T16

T30

T04

T34

T51

T14

T24

T39

T31

T19

T56

T11

T49

T59

T37

T25

T06

T32

T12

T33

T44

T23

T47

T52

T55

T10

T80

T08

T27

T61

T17

T48

T18

T50

T05

T20

T53

T21

T28

T45

T26

T65

T73

T29

T13

Community Mental Health Teams - Patient Satisfaction %

10%

20%

30%

40%

50%

60%

70%

80%

90%

The following measures are compared per 100,000 occupied bed days including all ward types reported. They give a good indication of the level of incidents that are occurring on wards and the overallof services

Trusts and Health Boards may wish to consider this informationnumber of wards and beds, bed occupancy and other figures.

Serious incidents are shown in Figure 66 and have a mean measure of {BMChart47per 100,000 bed days in 2013. This uses a definition consistent with STEIS data collection in England. The increase may be due to both additional incidents and more comprehensive reporting systems and reporting culture being in place.

The quality agenda is of ever increasing importance in the NHS and this year the benchmarking process included the largest ever number of quality metrics to allow Trusts and LHBs to see how they compare against local and national peers.

Patient and staff satisfaction is an important measure of what it is like to be treated in a service, or to provide care in the service. Patient satisfaction in community mental health teams is shown in Figure 64 below. This is taken from the CQC survey and measures the overall view of mental health services (percentage of patients feeling that overall they had a good experience). The mean figure is {BMChart45-Mean} and has changed positively since 2013 (70%)

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

The following measures are compared per 100,000 occupied bed days including all ward types reported. They give a good indication of the level of incidents that are occurring on wards and the overall quality and safety of services.

Trusts and Health Boards may wish to consider this information when they are looking at staffing levels, number of wards and beds, bed occupancy and other figures.

Serious incidents are shown in Figure 66 and have a mean measure of 78 compared to 75 per 100,000 bed days in 2013. This uses a definition consistent with STEIS data collection in England. The increase may be due to both additional incidents and more comprehensive reporting systems and reporting culture being in place.

The quality agenda is of ever increasing importance in the NHS and this year the benchmarking process included the largest ever number of quality metrics to allow Trusts and LHBs to see how they compare against local and national peers.

Patient and staff satisfaction is an important measure of what it is like to be treated in a service, or to provide care in the service. Patient satisfaction in community mental health teams is shown in Figure 64 below. This is taken from the CQC survey and measures the overall view of mental health services (percentage of patients feeling that overall they had a good experience). The mean figure is 73.1% and has changed positively since 2013 (70%)

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



T00: n/a

Mean: 76.3%

Median: 77.0%

Upper Q: 80.6%

Lower Q: 73.8%

SHA:

Trusts:

Figure 65

Figure 67

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

T19

T72

T48

T37

T41

T11

T80

T16

T18

T59

T10

T78

T28

T50

T31

T23

T76

T24

T55

T35

T05

T42

T08

T13

T46

T44

T73

T56

T32

T53

T47

T38

T04

T06

T51

T52

T36

T33

T66

T21

T30

T26

T20

T70

NHS Staff survey - satisfaction rate %

100

150

200

250

100

200

300

400

500

600

700

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



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

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



Serious incidents are shown in Figure 66 and have a mean measure of 78 compared to 75 per 100,000 bed days in 2013. This uses a definition consistent with STEIS data collection in England. The increase may be due to both additional incidents and more comprehensive reporting systems and reporting culture being in place.



T00: n/a

Mean: 78

Median: 67

Upper Q: 112

Lower Q: 37

SHA:

Trusts:

Figure 66

T00: n/a

Mean: 145

Median: 99

Upper Q: 173

Lower Q: 62

SHA:

Trusts:

Figure 67

0

50

100

150

200

250

T01

T06

T29

T59

T45

T14

T48

T25

T47

T72

T26

T79

T70

T65

T73

T55

T44

T50

T03

T21

T52

T38

T33

T67

T23

T56

T42

T34

T20

T27

T41

T32

T36

T19

T53

T05

T07

T46

T28

T60

T17

T04

T31

T30

T16

T77

T11

T66

T68

T10

T08

T35

T13

T18

T39

T37

T75

T71

Serious incidents per 100,000 bed days

0

100

200

300

400

500

600

700

T52

T17

T45

T34

T07

T47

T26

T70

T03

T04

T05

T30

T18

T48

T39

T27

T08

T14

T38

T16

T41

T20

T73

T21

T01

T24

T80

T33

T32

T71

T36

T23

T55

T35

T77

T25

T37

T29

T13

T75

T59

T42

T50

T11

T51

T44

T66

T28

T31

T72

T60

T10

T79

T56

Drug administration errors per 100,000 bed days

100

150

200

250

300

350

400

450

100

200

300

400

500

600

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

Complaints can provide useful feedback to organisations, and seen alongside patient satisfaction can give a more complete picture of the extent to which service users and their carers are content with a service. The number of complaints per 100,000 bed days is shown here with a mean of {BMChart49increase compared to 161 in 2013.

Drug administration errors are shown here per 100,000 bed days and show a mean of 145 compared to 115 per 100,000 bed days in 2013. This change may directly reflect an increase in the error rate, or highlight that identification and reporting of errors is more accurate than in previous years.

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



T00: n/a

Mean: 175

Median: 167

Upper Q: 220

Lower Q: 120

SHA:

Trusts:

Figure 68

T00: n/a

Mean: 129

Median: 91

Upper Q: 207

Lower Q: 52

SHA:

Trusts:

Figure 69

0

50

100

150

200

250

300

350

400

450

T52

T65

T34

T26

T05

T45

T73

T67

T21

T80

T03

T30

T06

T55

T46

T01

T47

T59

T36

T25

T29

T72

T77

T79

T17

T32

T38

T33

T13

T66

T41

T28

T16

T37

T27

T56

T10

T20

T18

T75

T53

T48

T19

T07

T14

T23

T39

T31

T60

T42

T44

T50

T04

T68

T11

T71

T35

T51

Number of complaints per 100,000 bed days

0

100

200

300

400

500

600

T67

T17

T25

T48

T14

T04

T06

T24

T59

T73

T07

T03

T79

T34

T01

T27

T44

T20

T08

T45

T41

T52

T33

T50

T36

T38

T32

T11

T21

T30

T42

T39

T55

T16

T80

T75

T23

T77

T05

T56

T10

T13

T71

T66

T29

T28

T18

T46

T37

T35

Ligature incidents per 100,000 bed days

1,000

1,000

1,500

2,000

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

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

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

Figure 70 shows a mean figure of {BMChart51bed days. This

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

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


Figure 70 shows a mean figure of 288 incidents of physical violence to patients per 100,000 bed days. This is an increase from 241 incidents per 100,000 bed days in 2013.



T00: n/a

Mean: 288

Median: 287

Upper Q: 356

Lower Q: 163

SHA:

Trusts:

Figure 70

T00: n/a

Mean: 588

Median: 495

Upper Q: 669

Lower Q: 299

SHA:

Trusts:

Figure 71

0

100

200

300

400

500

600

700

800

900

1,000

T70

T07

T52

T20

T38

T05

T45

T17

T25

T56

T24

T73

T33

T66

T29

T34

T44

T27

T42

T50

T23

T26

T79

T48

T67

T47

T01

T36

T18

T03

T39

T37

T71

T75

T28

T59

T14

T35

T60

T10

T13

T72

T32

T31

T46

T08

T21

T16

T77

T30

T04

T06

T41

T55

T51

T11

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

0

500

1,000

1,500

2,000

T70

T25

T07

T45

T03

T42

T20

T33

T67

T17

T52

T56

T66

T73

T59

T24

T36

T75

T44

T79

T26

T05

T29

T60

T48

T01

T80

T50

T37

T27

T39

T35

T23

T04

T38

T47

T71

T34

T18

T10

T32

T13

T08

T16

T72

T31

T28

T77

T14

T30

T21

T41

T06

T11

T46

T51

T55

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

100

200

300

400

500

600

700

800

900

1,000

1,500

2,000

2,500

3,000

2013. Where individual organisations have seen a sizeable increase in their


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

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

Many organisations have developed policies and protocols to try to reduce the use of seclusion and restraint by employing other approaches to defigures have continued to rise. Seclusion was, on average, used {BMChart53occupied bed days in 2013/14. This compares to 153 uses of seclusion per 100,000 occupied bed days last year.

Several organisations have reported similar levels of restraint to last year, with those using restraint most and least often last year occupying the same position on the graph this year. Overall, rates of restraint have continued to rise, to {BMChart54restraint per 100,000 bed days in 2012/13.


Figure 70 shows a mean figure of 288 incidents of physical violence to patients per 100,000 bed days. This is an increase from 241 incidents per 100,000 bed days in 2013.

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

Many organisations have developed policies and protocols to try to reduce the use of seclusion and restraint by employing other approaches to defigures have continued to rise. Seclusion was, on average, used 194 times for every 100,000 occupied bed days in 2013/14. This compares to 153 uses of seclusion per 100,000 occupied bed days last year.

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



T00: n/a

Mean: 194

Median: 155

Upper Q: 286

Lower Q: 56

SHA:

Trusts:

Figure 72

T00: n/a

Mean: 826

Median: 665

Upper Q: 978

Lower Q: 391

SHA:

Trusts:

Figure 73

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Incidence of use of seclusion per 100,000 bed days

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Incidence of use of restraint per 100,000 bed days

1,000

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

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

Feedback from mental health referenceAprilbecome more comprehensive in recent years which may explain the growth reported in many categories of incidents observed in this year's benchmarking report.

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

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

Feedback from mental health referenceAprilbecome more comprehensive in recent years which may explain the growth reported in many categories of incidents observed in this year's benchmarking report.



T00: n/a

Mean: 233

Median: 163

Upper Q: 270

Lower Q: 75

SHA:

Trusts:

Figure 74

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

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

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

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

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



Balance of care between inpatient and community services

Community

Hospital

Figure 75

The vast majority of Trusts and Health Boards provide both inpatient and community services and the trend in recent years has been towards reducing the number of available inpatient beds. At the same time, community based teams have seen an increase in their caseloads. There is no agreed universal figure regarding the correct balance between bed based and community services and this is very much influenced by local needs and existing provision.

Figure 75 below shows the balance of financial investment between core inpatient services (adult acute and older adult) and community based services. The typical profile sees on average {BMChart118-Mean} of total funding being allocated to inpatient services.

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Balance of Financial Investment

100%

In 2013, the average split between inpatient activity (calculated as number of admissions to adult acute and older adult beds) and community (caseload for all teams) was 10% hospital to 90% community. In 2014 this has shifted slightly to {BMChart119different mix of participants in this year's study as well as increased pressure in the inpatient sector.

This does, however, continue to show the high cost of acute services compared to community services, as 86% of activity takes place in the community, but only there.

In the census takenwere on a community basis, compared to just 2% occupying inpatient beds on that day.not changed since last year.

100%

The vast majority of Trusts and Health Boards provide both inpatient and community services and the trend in recent years has been towards reducing the number of available inpatient beds. At the same time, community based teams have seen an increase in their caseloads. There is no agreed universal figure regarding the correct balance between bed based and community services and this is very much influenced by local needs and existing provision.

Figure 75 below shows the balance of financial investment between core inpatient services (adult acute and older adult) and community based services. The typical profile sees on average 50% of total funding being allocated to inpatient services.

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

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

In the census takenwere on a community basis, compared to just 2% occupying inpatient beds on that day.not changed since last year.



Community

Hospital

Figure 76

Community

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Figure 77

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Balance of Activity

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

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

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

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Balance of care - Activity Census

The split of workforce between inpatient and community settings is also interesting, and shown here in Figure 78. The average figure has not changed since last year and remains {BMChart12162% community.

100%

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

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

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

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



Community

Hospital

Figure 78

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

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Balance of Workforce

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



Conclusion

The findings from the 2014 cycle of mental health benchmarking provide an authoritative platform against which changes in mental health provision can be measured. The involvement of all NHS providers in England and Wales is particularly pleasing and provides a definitive baseline for future comparisons. We also welcome the involvement of specialist providers from the independent sector in the 2014 project. We would like to express our thanks to all 66 member organisations who provided data.

The content of the project covers all the key benchmarking domains of activity, workforce, finance, safety and quality. The inclusion of these themes aims to provide a one-stop shop capability for participants in evaluating mental health services provision and performance. The ability to cross compare across domains will be important in gaining a full understanding of the story behind this year’s data.

As in previous years, the report shows levels of variation across the NHS in both service demand and provision arrangements. Services are utilised at different rates potentially reflecting local commissioning priorities, service development decisions, and history and practice. Members should actively use the 2014 desktop benchmarking toolkit to further understand the headline comparisons introduced in this report. The benchmarking toolkit will allow the local evidence on mental health service provision and performance to emerge for each participant organisation. The toolkit provides an ability to cross refer between inpatient and community services to draw conclusions about the overall balance of care between bed and community based care. The 2014 analysis has also expanded significantly into new areas around liaison psychiatry, home treatment, use of the mental health act, and additional quality indicators. The comparisons within the report also allow some inter-year comparisons to be drawn with positions reported in previous benchmarking cycles. We aim to enhance this facility in future years.

Headline findings for 2014 for inpatient services confirm an ongoing reduction in the number of inpatient beds. These reductions are particularly marked in adult acute services and older adult services. Reductions in bed numbers have been achieved against a backdrop of steady state levels of inpatient activity. This again suggests increases in efficiency have been delivered by mental health providers. Trends from previous years in observed reductions in length of stay have not taken place in the last year for adult acute and older peoples services. Efficiency has instead been driven through ongoing increases in bed occupancy. Anecdotes on mental health beds and bed occupancy abound but this year’s evidence confirms increases in occupancy on an already restricted bed capacity that now reports occupancy equivalent to 93% of all available mental health bed days, an astonishing level when compared with other areas of the NHS.

This increase in efficiency through bed occupancy should be viewed in the context of improvements in both readmission rates and delayed transfers of care, both of which have fallen in the last year for older adult beds. In adult services, meanwhile, readmissions have also reduced, although an increase in delayed transfers of care has been illustrated.

Specialist inpatient services also report increases in demand for beds. Services such as PICU, low and medium secure all report increases in bed occupancy. PICU demonstrates a notable 10% reduction in average length of stay although low and medium secure services both report increases in average length of stay in the last year. Participants will be able to review all their specialist services through the report and related toolkit.

caseloads have increased in the last year for many community teams. We also provide analysis of access arrangements and waiting times in mental health. We are all cognoscente of the definitional work which is still to take place on many areas of mental health access systems. In advance of this we can report that average waits in many services are well below 18waiting lists with large numbers of people waiting significantly longer than 18care.

Analysis of the mental health workforce reveals interesting findings. Absolute workforce levels have not reduced in the last year and users can access detailed profiles of medical, nursing and therapy input for specific inpatient and community services. However, it is evident that less acute services demonstrate significantly lower workforce levels than we might expect to see. For example, staffing levels for longer term complex and continuing care are much lower than for other services with low staffing levels evident for medical, nursing and therapies. The low intensity of workforce can be compared toof stay seen in this service.

Detailed costing data can be accessed in the report which compares both aggregate and unit costs across participants. Variation is again a theme.

The collection of service quality data has been facilitated by the inclusion of a suite of metrics that explore incidents, risks, harm, and patient and staff satisfaction. Positions on service user and staff satisfaction both show improvements on previous years. Analysis of incidents shows growth in the number of incidents in many areas. This is clearly an area to keep under close scrutiny although feedback from members and the mental health reference group suggests an increase in the completeness of incident reporting may be a major factor in this growth.

Variation in demand and provision is evident in all sectors of the NHS and the question of “what does good look like?” for mental health services remains a challenge. The benchmarking work provides a strong evidence base from which this discussion can be taken forward. The initial findings from the 2014 benchmarking report were discussed with the mental health reference group in early September. Participants were invited to feedback on the analysis and conclusions in their reports prior to thefindings at t

The NHS Benchmarking Network now involves 100% of Mental Health Trusts and Local Health Boards in its work programme and provides an excellent network through which the pursuit of good practice and continuous improvement can be taken forward.

We would like to express our thanks to NHS Benchmarking Network member organisations for providing data to the 2014 mental health benchmarking project. Members have been actively engaged in the project throughout. We would also like to express our thanks to the mental health reference group for their input in shaping the project. We look forward to progressing the mental health benchmarking work in partnership with members during 2014/15 and beyond.

The findings from the 2014 cycle of mental health benchmarking provide an authoritative platform against which changes in mental health provision can be measured. The involvement of all NHS providers in England and Wales is particularly pleasing and provides a definitive baseline for future comparisons. We also welcome the involvement of specialist providers from the independent sector in the 2014 project. We would like to express our thanks to all 66 member organisations who provided data.

The content of the project covers all the key benchmarking domains of activity, workforce, finance, safety and quality. The inclusion of these themes aims to provide a one-stop shop capability for participants in evaluating mental health services provision and performance. The ability to cross compare across domains will be important in gaining a full understanding of the story behind this year’s data.

As in previous years, the report shows levels of variation across the NHS in both service demand and provision arrangements. Services are utilised at different rates potentially reflecting local commissioning priorities, service development decisions, and history and practice. Members should actively use the 2014 desktop benchmarking toolkit to further understand the headline comparisons introduced in this report. The benchmarking toolkit will allow the local evidence on mental health service provision and performance to emerge for each participant organisation. The toolkit provides an ability to cross refer between inpatient and community services to draw conclusions about the overall balance of care between bed and community based care. The 2014 analysis has also expanded significantly into new areas around liaison psychiatry, home treatment, use of the mental health act, and additional quality indicators. The comparisons within the report also allow some inter-year comparisons to be drawn with positions reported in previous benchmarking cycles. We aim to enhance this facility in future years.

Headline findings for 2014 for inpatient services confirm an ongoing reduction in the number of inpatient beds. These reductions are particularly marked in adult acute services and older adult services. Reductions in bed numbers have been achieved against a backdrop of steady state levels of inpatient activity. This again suggests increases in efficiency have been delivered by mental health providers. Trends from previous years in observed reductions in length of stay have not taken place in the last year for adult acute and older peoples services. Efficiency has instead been driven through ongoing increases in bed occupancy. Anecdotes on mental health beds and bed occupancy abound but this year’s evidence confirms increases in occupancy on an already restricted bed capacity that now reports occupancy equivalent to 93% of all available mental health bed days, an astonishing level when compared with other areas of the NHS.

This increase in efficiency through bed occupancy should be viewed in the context of improvements in both readmission rates and delayed transfers of care, both of which have fallen in the last year for older adult beds. In adult services, meanwhile, readmissions have also reduced, although an increase in delayed transfers of care has been illustrated.

Specialist inpatient services also report increases in demand for beds. Services such as PICU, low and medium secure all report increases in bed occupancy. PICU demonstrates a notable 10% reduction in average length of stay although low and medium secure services both report increases in average length of stay in the last year. Participants will be able to review all their specialist services through the report and related toolkit.

caseloads have increased in the last year for many community teams. We also provide analysis of access arrangements and waiting times in mental health. We are all cognoscente of the definitional work which is still to take place on many areas of mental health access systems. In advance of this we can report that average waits in many services are well below 18waiting lists with large numbers of people waiting significantly longer than 18care.

Analysis of the mental health workforce reveals interesting findings. Absolute workforce levels have not reduced in the last year and users can access detailed profiles of medical, nursing and therapy input for specific inpatient and community services. However, it is evident that less acute services demonstrate significantly lower workforce levels than we might expect to see. For example, staffing levels for longer term complex and continuing care are much lower than for other services with low staffing levels evident for medical, nursing and therapies. The low intensity of workforce can be compared toof stay seen in this service.



Variation in demand and provision is evident in all sectors of the NHS and the question of “what does good look like?” for mental health services remains a challenge. The benchmarking work provides a strong evidence base from which this discussion can be taken forward. The initial findings from the 2014 benchmarking report were discussed with the mental health reference group in early September. Participants were invited to feedback on the analysis and conclusions in their reports prior to thefindings at t





Data on community services has been provided in great detail by participants. Our analysis suggests that caseloads have increased in the last year for many community teams. We also provide analysis of access arrangements and waiting times in mental health. We are all cognoscente of the definitional work which is still to take place on many areas of mental health access systems. In advance of this we can report that average waits in many services are well below 18-weeks, however, many providers report a long tail on waiting lists with large numbers of people waiting significantly longer than 18-weeks to access non-urgent care.

Analysis of the mental health workforce reveals interesting findings. Absolute workforce levels have not reduced in the last year and users can access detailed profiles of medical, nursing and therapy input for specific inpatient and community services. However, it is evident that less acute services demonstrate significantly lower workforce levels than we might expect to see. For example, staffing levels for longer term complex and continuing care are much lower than for other services with low staffing levels evident for medical, nursing and therapies. The low intensity of workforce can be compared to the long average lengths of stay seen in this service.



Variation in demand and provision is evident in all sectors of the NHS and the question of “what does good look like?” for mental health services remains a challenge. The benchmarking work provides a strong evidence base from which this discussion can be taken forward. The initial findings from the 2014 benchmarking report were discussed with the mental health reference group in early September. Participants were invited to feedback on the analysis and conclusions in their reports prior to the release of findings at the national conference on 7th November 2014.



Data on community services has been provided in great detail by participants. Our analysis suggests that caseloads have increased in the last year for many community teams. We also provide analysis of access arrangements and waiting times in mental health. We are all cognoscente of the definitional work which is still to take place on many areas of mental health access systems. In advance of this we can report that average waits in many services are well below 18-weeks, however, many providers report a long tail on waiting lists with large numbers of people waiting significantly longer than 18-weeks to access non-urgent care.

Analysis of the mental health workforce reveals interesting findings. Absolute workforce levels have not reduced in the last year and users can access detailed profiles of medical, nursing and therapy input for specific inpatient and community services. However, it is evident that less acute services demonstrate significantly lower workforce levels than we might expect to see. For example, staffing levels for longer term complex and continuing care are much lower than for other services with low staffing levels evident for medical, nursing and therapies. The low intensity of workforce can be compared to the long average lengths of stay seen in this service.



Variation in demand and provision is evident in all sectors of the NHS and the question of “what does good look like?” for mental health services remains a challenge. The benchmarking work provides a strong evidence base from which this discussion can be taken forward. The initial findings from the 2014 benchmarking report were discussed with the mental health reference group in early September. Participants were invited to feedback on the analysis and conclusions in their reports prior to the release of findings at the national conference on 7th November 2014.





Index of Charts

Figure 1 Bed ProfileFigure 2 Adult Acute beds per 100,000 populationFigure 3 Adult Acute bed occupancyFigure 4 Adult Acute admissions per 100,000 populationFigure 5 Adult Acute bed days per 100,000 populationFigure 6 Mean length of stay - Adult AcuteFigure 7 Delayed transfers of care - Adult AcuteFigure 8 Readmission rate - Adult AcuteFigure 9 Older Adult beds per 100,000 populationFigure 10 Older Adult bed occupancyFigure 11 Mean length of stay - Older AdultsFigure 12 Delayed transfers of care - Older AdultsFigure 13 Older Adult admissions per 100,000 populationFigure 14 Older Adult bed days per 100,000 populationFigure 15 Readmission rate - Older AdultsFigure 16 Specialist Beds ProfileFigure 17 PICU - mean length of stayFigure 18 PICU - bed occupancyFigure 19 PICU - WTE Consultant Psychiatrists per 10 bedsFigure 20 PICU - WTE Qualified nurses per 10 bedsFigure 21 Eating disorders - Mean length of stayFigure 22 Eating disorders - Bed OccupancyFigure 23 Eating disorders - WTE Consultant Psychiatrists per 10 bedsFigure 24 Eating disorders - WTE Therapists per 10 bedsFigure 25 Low secure - Mean length of stayFigure 26 Low secure - Bed occupancyFigure 27 Low secure - WTE Consultant Psychiatrists per 10 bedsFigure 28 Low secure - WTE Qualified nurses per 10 bedsFigure 29 Medium secure - Mean length of stayFigure 30 Medium secure - Bed occupancyFigure 31 Medium secure - WTE Consultant Psychiatrists per 10 bedsFigure 32 Medium secure - WTE Qualified nurses per 10 bedsFigure 33 High dependency rehab - Mean length of stayFigure 34 High dependency rehab - Bed occupancyFigure 35 High dependency rehab - WTE Consultant Psychiatrists per 10 bedsFigure 36 High dependency rehab - WTE Qualified nurses per 10 bedsFigure 37 Longer Term Complex Care / Continuing Care - Mean length of stayFigure 38 Longer Term Complex Care / Continuing Care - Bed occupancyFigure 39 Longer Term Complex Care / Continuing Care - WTE Consultant Psychiatrists /10 bedsFigure 40 Longer Term Complex Care / Continuing Care - WTE Qualified nurses /10 bedsFigure 41 Inpatient cluster profiles 1-2 prevalenceFigure 42 Inpatient cluster profiles 1-4 prevalenceFigure 43 Inpatient cluster profiles 1-8 prevalenceFigure 44 Inpatient cluster profiles 10-16 prevalenceFigure 45 Inpatient cluster profile 17 prevalence

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

Figure 1 Bed ProfileFigure 2 Adult Acute beds per 100,000 populationFigure 3 Adult Acute bed occupancyFigure 4 Adult Acute admissions per 100,000 populationFigure 5 Adult Acute bed days per 100,000 populationFigure 6 Mean length of stay - Adult AcuteFigure 7 Delayed transfers of care - Adult AcuteFigure 8 Readmission rate - Adult AcuteFigure 9 Older Adult beds per 100,000 populationFigure 10 Older Adult bed occupancyFigure 11 Mean length of stay - Older AdultsFigure 12 Delayed transfers of care - Older AdultsFigure 13 Older Adult admissions per 100,000 populationFigure 14 Older Adult bed days per 100,000 populationFigure 15 Readmission rate - Older AdultsFigure 16 Specialist Beds ProfileFigure 17 PICU - mean length of stayFigure 18 PICU - bed occupancyFigure 19 PICU - WTE Consultant Psychiatrists per 10 bedsFigure 20 PICU - WTE Qualified nurses per 10 bedsFigure 21 Eating disorders - Mean length of stayFigure 22 Eating disorders - Bed OccupancyFigure 23 Eating disorders - WTE Consultant Psychiatrists per 10 bedsFigure 24 Eating disorders - WTE Therapists per 10 bedsFigure 25 Low secure - Mean length of stayFigure 26 Low secure - Bed occupancyFigure 27 Low secure - WTE Consultant Psychiatrists per 10 bedsFigure 28 Low secure - WTE Qualified nurses per 10 bedsFigure 29 Medium secure - Mean length of stayFigure 30 Medium secure - Bed occupancyFigure 31 Medium secure - WTE Consultant Psychiatrists per 10 bedsFigure 32 Medium secure - WTE Qualified nurses per 10 bedsFigure 33 High dependency rehab - Mean length of stayFigure 34 High dependency rehab - Bed occupancyFigure 35 High dependency rehab - WTE Consultant Psychiatrists per 10 bedsFigure 36 High dependency rehab - WTE Qualified nurses per 10 bedsFigure 37 Longer Term Complex Care / Continuing Care - Mean length of stayFigure 38 Longer Term Complex Care / Continuing Care - Bed occupancyFigure 39 Longer Term Complex Care / Continuing Care - WTE Consultant Psychiatrists /10 bedsFigure 40 Longer Term Complex Care / Continuing Care - WTE Qualified nurses /10 bedsFigure 41 Inpatient cluster profiles 1-2 prevalenceFigure 42 Inpatient cluster profiles 1-4 prevalenceFigure 43 Inpatient cluster profiles 1-8 prevalenceFigure 44 Inpatient cluster profiles 10-16 prevalenceFigure 45 Inpatient cluster profile 17 prevalence

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



Figure 46 Inpatient cluster profiles 18-21 prevalenceFigure 47 Adult Acute beds - % of admissions under the Mental Health ActFigure 48 Use of the Mental Health Act by section typeFigure 49 Community Mental Health Teams - caseload per 100,000 populationFigure 50 Community Mental Health Teams - Face to Face contacts per 100,000 populationFigure 51 Early Intervention Teams - maximum waiting time for routine appointmentsFigure 52 CRHT - contacts per 100,000 populationFigure 53 CRHT - average waiting time for routine appointmentsFigure 54 CRHT referrals that resulted in admission to an inpatient bedFigure 55 Adult Acute inpatient workforce - clinical staff per 100,000 bed daysFigure 56 Adult Acute inpatient workforce - consultant psychiatrists per 100,000 bed daysFigure 57 Adult Acute inpatient workforce - qualified nurses per 100,000 bed daysFigure 58 Adult Acute inpatient workforce - clinical staff vacancies as % of establishment Figure 59 Cost per Adult Acute bedFigure 60 Cost per 100,000 bed days, Adult AcuteFigure 61 PICU cost per bed dayFigure 62 Generic CMHT cost per 100,000 populationFigure 63 Generic CMHT cost per patient on the caseloadFigure 64 CMHT Patient SatisfactionFigure 65 NHS Staff Survey satisfaction rateFigure 66 Serious incidents per 100,000 bed daysFigure 67 Drug administration errors per 100,000 bed daysFigure 68 Number of complaints per 100,000 bed daysFigure 69 Ligature incidents per 100,000 bed daysFigure 70 Incidents of physical violence to patients per 100,000 bed daysFigure 71 Incidents of physical violence to staff per 100,000 bed daysFigure 72 Incidence of use of seclusion per 100,000 bed daysFigure 73 Incidence of use of restraint per 100,000 bed daysFigure 74 Incidence of use of face down restraint per 100,000 bed daysFigure 75 Balance of financial investmentFigure 76 Balance of activityFigure 77 Balance of careFigure 78 Balance of workforce

Figure 46 Inpatient cluster profiles 18-21 prevalenceFigure 47 Adult Acute beds - % of admissions under the Mental Health ActFigure 48 Use of the Mental Health Act by section typeFigure 49 Community Mental Health Teams - caseload per 100,000 populationFigure 50 Community Mental Health Teams - Face to Face contacts per 100,000 populationFigure 51 Early Intervention Teams - maximum waiting time for routine appointmentsFigure 52 CRHT - contacts per 100,000 populationFigure 53 CRHT - average waiting time for routine appointmentsFigure 54 CRHT referrals that resulted in admission to an inpatient bedFigure 55 Adult Acute inpatient workforce - clinical staff per 100,000 bed daysFigure 56 Adult Acute inpatient workforce - consultant psychiatrists per 100,000 bed daysFigure 57 Adult Acute inpatient workforce - qualified nurses per 100,000 bed daysFigure 58 Adult Acute inpatient workforce - clinical staff vacancies as % of establishment Figure 59 Cost per Adult Acute bedFigure 60 Cost per 100,000 bed days, Adult AcuteFigure 61 PICU cost per bed dayFigure 62 Generic CMHT cost per 100,000 populationFigure 63 Generic CMHT cost per patient on the caseloadFigure 64 CMHT Patient SatisfactionFigure 65 NHS Staff Survey satisfaction rateFigure 66 Serious incidents per 100,000 bed daysFigure 67 Drug administration errors per 100,000 bed daysFigure 68 Number of complaints per 100,000 bed daysFigure 69 Ligature incidents per 100,000 bed daysFigure 70 Incidents of physical violence to patients per 100,000 bed daysFigure 71 Incidents of physical violence to staff per 100,000 bed daysFigure 72 Incidence of use of seclusion per 100,000 bed daysFigure 73 Incidence of use of restraint per 100,000 bed daysFigure 74 Incidence of use of face down restraint per 100,000 bed daysFigure 75 Balance of financial investmentFigure 76 Balance of activityFigure 77 Balance of careFigure 78 Balance of workforce



Mental Health BenchmarkingDec 11, 2014 · The terms of reference for the project have been...

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Transcript of Mental Health BenchmarkingDec 11, 2014 · The terms of reference for the project have been...