1. Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance Efficiency and Productivity Mental Health Pathway Meeting the challenge - delivering better quality care with less resource WELCOME

2. Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance Efficiency and Productivity Mental Health Pathway The challenge ahead… Ruth Glassborow, Mental Health Lead, QuEST

3. Mental 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

4. Reframing the Challenge TACTICALSTRATEGIC DEALING WITH THE 5% SPENDING THE 95% BETTER PRODUCTIVITY & EFFICIENCY CRES SERVICE OPTIMISATION TRANSFORMATION

5. Mental Health Efficiency and Productivity What 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

6. Improving 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

7. We recognise that not all variation is bad and indeed some is good and necessary

8. What is going on in your system? Identify variation Understand the variation Act to reduce quality issues

9. Literature Review Stakeholder Opinion Expert Opinion Benchmarking Data Key Productive Opportunities

10. In 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

12. Inpatient/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.

13. Inpatient/Community Balance Figure 1a: Two-fold variation in bed days for all adult psychiatric admissions

14. Inpatient/Community Balance Five-fold variation in bed days for admissions with a primary diagnosis of psychoactive substance misuse (including WI fifteen fold)

15. Inpatient/Community Balance Five-fold variation in bed days for admissions with a primary diagnosis of adult personality and behavioural disorder (including WI forty fold)

16. Inpatient/Community Balance Ten-fold variation in length of stay for older people with psychosis

17. Next 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

19. Efficient 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

20. Effective and Efficient Community Mental Health Services Just new DNAs moving to mean represents approx £1million productive opportunities across Scotland. Nine-fold variation in DNAs as a % of new outpatient appointments for General Psychiatry

21. Effective and Efficient Community Mental Health Services Seven-fold variation in DNAs as a % of new outpatient appointments for Old Age Psychiatry

22. Effective and Efficient Community Mental Health Services Three-fold variation in ratio of new to returns for General Psychiatry outpatient appointments

23. Effective and Efficient Community Mental Health Services Five-fold variation in ratio of new to returns for Psychiatry of Old Age outpatient appointments

24. Effective and Efficient Community Mental Health Services 26% 45% 29%

25. Next 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)

27. Telehealth/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

28. Main barriers to adoption of telehealth/care Awareness of potential opportunities Set up costs Cultural barriers

29. Next steps nationally National telehealth/care strategy Project Ginsberg

30. Early detection and intervention in psychosis

31. Early 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

32. Next 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

33. Other Issues for Consideration /Further Work Dementia in General Hospitals Long Term Conditions and Mental Health co-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

34. This 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

37. Benchmarking 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)

38. Table 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?

39. Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance Feedback

40. Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance Efficiency and Productivity Mental Health Pathway Meeting the challenge - delivering better quality care with less resource

41. Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance Efficiency and Productivity Mental Health Pathway Meeting the challenge - delivering better quality care with less resource

42. Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance Efficiency and Productivity Mental Health Pathway Meeting the challenge - delivering better quality care with less resource

43. Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance Efficiency and Productivity Mental Health Pathway Meeting the challenge - delivering better quality care with less resource