National Mental Health Dementia & Neurology Intelligence Networks Summary and overview – April 2014 James Seward

Mental Health Dementia & Neurology Intelligence Networks The MHDNIN is due for Ministerial launch on 18 th June with the go-live of a shared web resource comprising:  Mental Health & Wellbeing Intelligence Network (MHIN)  Dementia Intelligence Network (DIN)  Neurology Intelligence Network (NIN) The Networks operate collectively with a shared website The aim to support the delivery of improved physical and mental wellbeing based on reliable intelligence by: –developing shared system-wide leadership & governance –identifying & meeting the needs of end-users through the intelligence products delivered 2

The Health Intelligence Networks PHE has the system-wide responsibility to lead and develop Health Intelligence Networks in: o National Cancer Intelligence Network ( o Child and Maternal Health Observatory ( o End of Life Care & o National Cardiovascular Disease Intelligence Network ( o Mental Health, Dementia and Neurology Intelligence Networks HINs are ‘NHS-facing’, mirroring and supporting NHS E’s Strategic Clinical Networks (SCNs) – e.g. Mental Health (all age), Dementia & Neurology Networks 3

Short and long term goals 4 Practical support to strategic clinical networks and others Getting health intelligence tools and resources to the right people at the right time in the right place Eyes on the long term prize: –data linkage across clinical pathways –efficient translation of research findings –shift in resources towards primary and secondary prevention –better outcomes and reduced health inequalities

Ways of working 5

Mental Health Intelligence Network (MHIN)

The problem ‘Mental health’ approached as an amorphous blob Relative lack of MHWB information v physical health care data Patchy use of evidence to drive local commissioning decisions, improve the quality of services provided and deliver meaningful user-centred outcomes Risks in not demonstrating best value in times of financial challenge Inefficiency & duplication in the system Short-termism – early intervention is investing in community resilience 2

The opportunity Wide range of MHWB data (45 sets) is available in the public domain held by a range of national agencies (13 agencies) System alignment – assembling data ‘once for all’ – to overcome duplication Information for improvement - MHIN offers a shared intelligence hub bringing together publicly available data and presenting it geographically (CCG/LA) to support local systems Tune support products & further products to needs of end- users – MHIN succeeds only where its products are applied & improvement is achieved More effective system-wide MH Analytical community 2

Where are we now? Closing the Gap (Jan ‘14) committed the Government to leading an ‘information revolution’ in mental health & to launching the MHIN to achieve this MH System Board has established a National MH Information & Intelligence Strategy Group to support the National Information Board MHIN to assemble and collate the publicly available data by CCG/LA & use ERGs to map gaps in each care pathway Develop joined-up support products and approaches harnessing inputs from all the key agencies (e.g. if we are asking what are PH Consultants for, we are doing it wrong) 3

10 System-wide approach

Who is the Network for? The system-wide MH analytical community Principal audience in the short-term: Commissioners & Providers of MHWB –Health & Wellbeing Boards (LAs, CCGs, DsPH) –Providers (Primary Care, Trusts, Vol & Independent Sector) BUT this data, information & intelligence will be more transparent by being in the public domain Moving forward, we need to respond to: –National agencies with statutory and political responsibilities for MHWB (Ministers, DH, NHS E, PHE) (e.g. MH Dashboard) –People interested in mental health and wellbeing (the public, service users, their families, local councillors) –Researchers and academia (AHSNs, FPH) 3

What will the Network include? Intelligence hub –Web platform providing mental health & well-being information & intelligence resources Community of Practice –Community of Practice through an inter-agency Network –Mental health intelligence Literacy –Local support initiatives Information tools –Data & planning tools linked to web platform Knowledge Management Portal –Interactive space & dissemination of best practice 4

The MHIN web presence is in development The following screenshots show the draft MHIN web presence. There will be a welcome, about, contact and resources sections. Content follows good practice from the Government Digital Service and PHE style guide. It complements the National Cardiovascular Intelligence Network (NCVIN) and is also a subsite on the YHPHO website managed by Northern and Yorkshire Knowledge and Intelligence Team (NYKIT). It will be maintained until the transfer of content to the PHE website (gov.uk) is complete. It will be accessed from: o Gov.uk - redirecting to YHPHOhttps:// o Google o Other PHE health intelligence networks o PHE knowledge and data gateway 5

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MHMDS H&SCIC MHMDS H&SCIC National Mental Health Intelligence Hub – Conceptual Model Provider data NHS BC Provider data NHS BC MWB data WEMWBS MWB data WEMWBS Mental Health Intelligence Hub Expert Reference Groups The Public National Agencies Dementia Local Systems H&WBBs Local Systems H&WBBs Providers Research & Academia Rapid Adopter Indicator Tools Data Flows Quality data CQC Quality data CQC Primary Care QoF Primary Care QoF End Users Phase 1 Outputs PROCESS Intelligence Hub Algorithms

A Care Pathway approach: The ERGs The MHIN is driven by 7 ERGs & expert steering group:  Mental Wellbeing  Common Mental Health Disorders (CMHD)  Severe & Enduring Mental Illness (SEMI)  Drug & Alcohol/Dual Diagnosis  Children and Young People (with the ChiMat)  Dementia (with the Dementia Programme Board)  Neurology The ERGs are providing system-wide expert leadership in defining evidence based care pathways with applied data

ERGs’ key tasks Define the key data, information and intelligence issues Identifying gaps in the availability of information Developing responses to end-user requirements & recommend content & design of hub In practical terms, define the launch product(s) for the Dual Diagnosis element of the MHIN launch:  Website content – the topic, overview of data & intelligence, access to useful indictor tools (bespoke or links), sharing case studies of best practice  Baseline data reviews – what’s in the public domain in one place  Indicator tool development – e.g. Fingertips 4

Mental Health System Profiling Tools PHE Fingertips platform (used for Living Longer Lives) provides Atlases of Variation Presents range of public available data (MHMDS, QoF, PbR Cluster, IAPT, Social Care, ONS, Reference Costs) By CCG/LA enabling local benchmarking by geography, statistical neighbours and England Currently covers SEMI & CMHD with the aim to roll-out to Dual Diagnosis, Neurology and CYP for launch Dementia update of DH State of the Nation Report Wellbeing to focus on presenting key data items to support better evidence to support promotion and prevention commissioning 4

‘Mental illness’ is an umbrella term like ‘medicine’ or ‘surgery’. The 16 commonest MH conditions are below as per the International Classification of Diseases: Mental illnesses ( ICD classifications)Conditions 1.Psychoses High impact high cost conditions account for most of MH specialist commissioning & MHT inpatient admissions 10. Personality Development & trauma Conditions 11. Post-trauma Brain Injury 12. Conduct Disorders 2. Anxiety Disorders Highest primary care & acute care demand 13. Perinatal Conditions 3. Depression Highest primary care & acute care demand 14. Addictions – Alcohol and Drug Disorders 4. Obsessive Compulsive Disorders15. Dementia and Organic Disorders 5. Post Traumatic Stress Disorders16. Others e.g. ADHD and other developmental disorders 6. Somatoform Disorders Long-term condition related 7. Eating Disorders 8. Self Harm 9. Neurodevelopmental Disorders Autistic Spectrum and Aspergers Syndrome

Psychosis High impact, high cost (60%) - to provide data and indicator tools to help local systems monitor how well they are delivering these services Develop SMI Fingertips System Profiling Tool to provide Psychosis profile by CCGs/LAs: prevalence, risks, services, quality & outcomes, finance Pathway presentation of the data to provide CCG summaries by key pathway data items to support evidence based practice linked to & consistent with NHSE Commissioning for Value Packs Psychosis Care Pathway & data points development in collaboration with Imperial AHSN to develop the to support the Psychosis Summit led by Rethink on 10 th April Resources: link to MH Partnerships/Emotional Wellbeing websites; promote Crisis Concordat; profile London Crisis Case Studies

Common MH Disorders Common Mental Health Disorders (depression, anxiety disorders, LTCs/MUS) Fingertips System Profiling Tool by CCGs/LAs: prevalence, risks, services, quality & outcomes, finance Pathway approach – broader but consistent with IAPT CCG prevalence/treatment expectations (NHSE IAPT Atlas of Variation) Positive practice guidance – NICE, IAPT/RCPsych service standards, RCPsch Service Standards, Care Pathways by Condition; treatment protocols), Post Code Service Finder & case studies

Lower Higher Waterside CCG has a high incidence for psychosis, low proportion on CPA and high spend on Mental Health Services The indicators in the chart are colour co-ordinated to show whether the CCG is performing better or worse than similar 10 CCGs. The whiskers show the confidence intervals of the data. Psychosis pathway, Waterside CCG

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Test sites & Rapid Adopters 4 CCG/LA Test Sites (Feb-March) agreed to ‘teat and trial’ indicators:  City & Hackney  Liverpool  Devon  West London Imperial Consortium (tbc) Test Sites will:  Test the validity and utility of the indicator tools  Better understand commissioner intelligence requirements  Inform the development of the NMHIN web platform  Initiate continuous improvement cycle with MHIN end users Rapid Adopter programme from April 2014 linked to the national CCG GP Mental Health Leadership Programme (

Rapid adopter - Initial learning Enables local system dialogue – provides objective profile evidence to provide a picture of the local MH system & identification of what’s working & areas for improvement Benchmarking CCGs – using High Level (Deep Dive indicators) is useful to get Board level engagement with key issues (where supported by more detailed underpinning data) Data interpretation - which indicators are most useful, what do they mean and which other indicators should they be compared with? Local extract reports – PDF Reports which allow end-users to automatically produce high/low scores across the rage of indicators to provide a snap shot of significant variation Key Indicator Summaries: Need, Spend & Outcomes – the tool should be supported by resources which enable end-users to produce a dashboard (in each pathway) of need, spend and outcomes to provide the most value for commissioners Glossary of indicators – provide a search facility or alphabetical content listing to provide easy navigation for users seeking out particular indicators

Neurology Intelligence Network (NIN)

Neurology Scope: Compendium of Neurology launched by H&SCIC in March - First national collection of HED, Prescribing, A&E data, includes 1m data items Aim to populate Fingertips Tool with key data items, initially focusing on Emergency Admissions by condition: intermittent, progressive, stable, sudden onset (the aspiration is to develop pathway across these conditions) Cost/ROI – seeking to identify the costs of people with neurological conditions & physical LTCs (low volume, high cost) – once hospitalised these cohorts have long, costly LOS Website – Fingertips Tool narrative, descriptors of the conditions groups, access to best practice guidance and case studies as appropriate

Dementia Intelligence Network (DIN)

Dementia Scope: aim to begin to define prevalence, diagnosis, access, WTs and outcomes Key issues: Lack of diagnosis data; available data is complex, variable in reliability & from a range of sources Aim: to create a Framework for Analysis to support integrated care – identify how many people with dementia have been diagnosed & the quality/outcomes of support offered (WTs, Treatment Options; Diagnsotic opportunities; Workforce accreditation) Opportunities: GPES; SCN London Benchmarking; establishing links with Neuropsychiatry CRG; substance misuse & dementia Resources/Guidance: Dementia Road Map - Look to how this might align and support ERG developments. (med/long)

Forward Look: Delivering & developing the MHDN Intelligence Networks 2014/15

Delivering the MDNHIN Phase 1: Ministerial launch a development ‘beta’ MHDNIN web pages (18 th June) Phase 2: (June to December 2014) –End user testing of initial web pages, indicator tolls & products & ERG Pathway Work Plans –Implement work programme to develop data and intelligence requirements across key pathways as part of system-wide mental health ‘ Intelligence-driven approach to driving value through system transformation’ programme Phase 3: (Spring 2015): ‘alpha’ website goes-live as part of PHE Health Intelligence Network migration to Government Digital Service (GDS) website 4

ERG Work Plan – Psychosis example DateProductsWork Programme JunePrevalenceIdentification of datasets to be pulled into Fingertips Identify prevalence and analyse by high risk groups JulyWhat does good look like Stratification products Best practice care pathway Best value dataset definition Best buys compendium (2-sides) SeptState of England State of England’s Mental Health Services: Psychosis Oct >Improvement Support Tools Information & intelligence Economic remodelling Service specifications Digital technology Workforce Contracting models

Change Management approach How will the intelligence and data tools be shaped by and reflect the needs of local systems?  Test site approach (building on Liverpool, east London & Devon)  Iterative approach key: ownership & meet end-user needs How will the intelligence and data tools be ‘landed’ in the most appropriate way to support local work? What will be the most effective dissemination/delivery routes? Who will be the key change agents?  SCN leadership  AHSNs  NHS Benchmarking Network How will we create momentum and build capacity?  GP MH Leadership programme participants  MH Literacy Module (commissioners) participants  Train-the-trainer consultancy approach

Mental Health Dementia & Neurology Intelligence Networks Mental Health James Seward, Programme Lead - Dementia Simon Rippon, Dementia Project Lead – Neurology Elizabeth Davis, Neurology Project Lead – 39 Find out more - contacts