Title: Efficiency and Productivity Mental Health Pathway Meeting the challenge - delivering better quality care with less resource WELCOME
1Efficiency and ProductivityMental Health
PathwayMeeting the challenge - delivering
better quality care with less resourceWELCOME
2Efficiency and ProductivityMental Health
PathwayThe challenge ahead
- Ruth Glassborow, Mental Health Lead, QuEST
3Mental Health The Challenge
- One of the top public health challenges. Mental
illness - affect more than a third of population each year
- second largest contributor to the burden of
disease (19 of DALYs) - account for just under 40 of years lived with
disability - Challenge of doing more with less
- significantly undertreated but growing levels
accessing treatment - increasing prevalence of dementia
- Growing evidence of extra physical health costs
associated with mental illness
4Reframing the Challenge
TACTICAL
STRATEGIC
PRODUCTIVITY EFFICIENCY
SERVICE OPTIMISATION
CRES
TRANSFORMATION
DEALING WITH THE 5
SPENDING THE 95 BETTER
5Mental Health Efficiency and ProductivityWhat we
set out to do
- Key opportunities for productivity and efficiency
savings - Assessment of productive opportunity
- Key actions to release productive opportunity
- Additional work nationally to support NHS Boards
in realising productive opportunity
6Improving quality whilst reducing costs Key Themes
- Evidence Based Care
- Removing unwarranted variation and waste
- Maximising the potential of the workforce
- Prevention of illness and relapse
- Self Management
- Co-production
- Involvement of families and communities
7We recognise that not all variation is bad and
indeed some is good and necessary
8What is going on in your system?
- Identify variation
- Understand the variation
- Act to reduce quality issues
9 Literature Review
Key Productive Opportunities
Expert Opinion
Benchmarking Data
10In addition the group highlighted Long Term
Conditions and Mental Health, Better response to
people with Borderline Personality Disorder, Out
of Area Admissions/Independent Contracting and
Proactive Management of Medically Unexplained
Symptoms as areas where further work is needed to
assess the productive opportunity and/or the key
actions for releasing them.
11- Optimising the number of psychiatric beds through
effective community services and infrastructures
12Inpatient/Community Balance
- Effective alternatives to inpatient admission and
facilitating early discharge - Crisis prevention approaches including targeting
high risk groups for admission
Hypothesis - significant quality gains and
efficiency savings attached to preventing the
crisis occurring in the first place.
13Inpatient/Community Balance
Figure 1a Two-fold variation in bed days for all
adult psychiatric admissions
14Inpatient/Community Balance
Five-fold variation in bed days for admissions
with a primary diagnosis of psychoactive
substance misuse (including WI fifteen fold)
15Inpatient/Community Balance
Five-fold variation in bed days for admissions
with a primary diagnosis of adult personality and
behavioural disorder (including WI forty fold)
16Inpatient/Community Balance
Ten-fold variation in length of stay for older
people with psychosis
17Next steps nationally
- Coding of beds so can benchmark acute, rehab,
intensive care and continuing care from April
2013. - Mental Health Strategy, Commitment 23
- Core data set to allow comparison of different
crisis resolution/home treatment models - Identify key components of crisis prevention
approaches
18- Effective and Efficient
- Community Mental Health Services
19Efficient and Effective CMHTs
- Reliable implementation of evidence based
practice - Effective Team Working (addition following recent
research) - Reducing DNAs (and CNAs)
- Reducing unwarranted variation in new to
follow-up ratios - Reducing time spent on non-value adding
activities - Remove duplication of work between professionals,
teams, sectors and agencies - Appropriate skill mix
- Better use of technology
20Effective and Efficient Community Mental Health
Services
Nine-fold variation in DNAs as a of new
outpatient appointments for General Psychiatry
Just new DNAs moving to mean represents approx
1million productive opportunities across
Scotland.
21Effective and Efficient Community Mental Health
Services
Seven-fold variation in DNAs as a of new
outpatient appointments for Old Age Psychiatry
22Effective and Efficient Community Mental Health
Services
Three-fold variation in ratio of new to returns
for General Psychiatry outpatient appointments
23Effective and Efficient Community Mental Health
Services
- Five-fold variation in ratio of new to returns
for Psychiatry of Old Age outpatient appointments
24Effective and EfficientCommunity Mental Health
Services
26
45
29
25Next steps nationally
- Effective and Efficient CMHT Toolkit prototype
being launched today - Database to reduce analytical time needed for
activity trackers - Address quality of national staffing data so have
credible comparative info on costs - Producing example set of Quality and Productivity
Reports (QDCAQ) for Community Mental Health
Services
26- Telehealth/Telecare
- (Making better use of new (and not so new)
technologies)
27Telehealth/Telecare
- Video conferencing to improve access and reduce
travel - Telephone/Webex to improve access reduce travel
- SMS Technology
- Better use of technology to streamline admin
processes - Better use of new technologies for self
management, peer to peer support, self
assessment, self referral and co-delivery of care
28Main barriers to adoption of telehealth/care
- Awareness of potential opportunities
- Set up costs
- Cultural barriers
29Next steps nationally
- National telehealth/care strategy
- Project Ginsberg
30- Early detection and
- intervention in psychosis
31Early Detection and Intervention in Psychosis
Five-fold variation in bed days for admissions
with a primary diagnosis of psychosis for
individuals aged 18-24 years
32Next Steps
- Mental Health Strategy Commitment
- Identify key components that need to be in place
within every mental health service to enable
early intervention services to respond to first
episode psychosis and encourage adoption of first
episode psychosis teams where that is a sensible
option
33Other Issues for Consideration/Further Work
- Dementia in General Hospitals
- Long Term Conditions and Mental Healthco-morbid
mental health problems raise total healthcare
costs by at least 45 - Borderline personality disorder
- Out of area admissions and independent
contracting - Proactive management of medically unexplained
symptoms - Mental Health Promotion/Prevention
34This work made considerable use of benchmarking
data
- Help to identify opportunities for improvement
rather than the basis of judgements - Needs to be complimented by other techniques
- Assessing practice against evidence base
- Process mapping
- Service User Experiences
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37Benchmarking data not just the scorecard
- Even more indicators are included in the toolkit.
- Summary of all the indicators on each table and
an example of the type of information in the
toolkit (which is in addition to the scorecard)
38Table Discussions
- Have you been/do you think you can use the NHS
Scotland Variation in Mental Health Activity
report to inform work locally? - Do you ever use the national benchmarking
scorecard and/or toolkit? - If your answer to either of the above is no, what
needs to change so you can use national
benchmarking data? - Do you have any insights into the reasons behind
any of the significant variation highlighted in
the NHS Scotland Variation in Mental Health
Activity report? - What additional national data would you find
useful to support you in identifying unwarranted
variation and waste locally? - What work are you progressing locally around
balanced scorecards/dashboards which will help in
identifying key quality and efficiency
opportunities?
39Feedback
40Efficiency and ProductivityMental Health
PathwayMeeting the challenge - delivering
better quality care with less resource
41Efficiency and ProductivityMental Health
PathwayMeeting the challenge - delivering
better quality care with less resource
42Efficiency and ProductivityMental Health
PathwayMeeting the challenge - delivering
better quality care with less resource
43Efficiency and ProductivityMental Health
PathwayMeeting the challenge - delivering
better quality care with less resource