NHS ICB to use data to improve mental health services

NHS Cheshire and Merseyside, an integrated care board (ICB), is planning to make better use of data to help it improve mental health services.

The organisation’s three-year plan says that data is a “key enabler” in realigning services to make sure that inpatient provision is better able to meet the needs of the population. The plan follows a self-assessment involving different stakeholders through a series of face-to-face and online meetings. The stakeholders included ICB place commissioners, ICB quality leads, chief operating officers of NHS provider organisations and senior clinical and operational staff.

The plan, which focuses on the quality of the service it offers to inpatients, the flow through inpatient services and community alternatives to inpatient provision, emphasises the need to co-produce services with people who have lived experience of mental health problems. It hopes to meet patients’ needs better by investing in workforce development, improved collaboration and better leadership and governance

Emphasising the need to offer better community mental health support, the plan mentions the need for “continued development and collaboration to provide strong community alternatives to inpatient provision to optimise the time people can spend at home and in their communities, through early intervention, prevention, and dedicated support and active system collaboration to facilitate discharge from hospital at the earliest opportunity.”

Increased risks for inpatients placed outside the local area

A key part of the plan is the investment by the integrated care system (ICS) in SHREWD real-time reporting, which, it hopes, will “allow for improved data and insight into the demands in the system and reasons why”.

It adds: “Relevant and meaningful system wide metrics will be defined and developed to support each aspect of the plan, including monitoring outcomes and any unintended consequences of new initiatives and these will inform areas for improvement and prioritisation of work.”

The plan recognises that, although sometimes necessary, inpatient care “does not always offer the best outcomes for people, especially when people are placed outside of a local pathway of care. It is known there are increased risks for people placed out of area and concerns regarding quality assurance through spot purchase provision.”

For adult mental health, year one of the plan focuses on addressing barriers to discharge through improved data reporting, and increasing data quality to support the monitoring of progress and the identification of priority areas. Year two aims to use data to identify gaps in community and inpatient provision, improving flow, while year three will look at redesigning pathways and planning for future investment to make sure that it enables the “best use of available resource”.

Flow is a particular problem. The average length of stay across adult, older adult and paediatric intensive care wards in Cheshire and Merseyside has remained higher than the national average, the plan notes, adding: “There has been a gradual increase over previous years and, in the past year, Cheshire and Merseyside reported that 31% of their inpatients were discharged after an inpatient stay of over 60 days and 19% over 90 days. It has been identified that this is due to both people taking longer to reach a point where their needs can be appropriately met in the community and for those who are clinically ready for discharge, to be discharged because of internal and external barriers.”

Improved flow through adult mental health services, the plan says, will lead to reduced waits for mental health inpatient beds for people in community setting as well as a reduction in numbers of people being accommodated in emergency departments in Cheshire and Merseyside while waiting for discharge into the community or a mental health inpatient bed. The plan also aims to eradicate waits of more than 48 hours for mental health patients in emergency departments, which it describes as “clinically inappropriate”.

Better data reporting and the use of data to identify gaps in provision is also central to the three-year plans for rehabilitation, learning disability and provision for autistic people, where it will be used to plan for future demand and capacity.