There are distinct types of ward configuration and service provision within mental health, learning disabilities and autistic spectrum disorder inpatient services that cater for people with distinct needs. It is important to be able to understand this variation, particularly in context to different pathways of care, to ensure that inpatient capacity is effectively used to deliver mental health services. This is relevant in a wide number of strategic and operational areas in mental health services including; understanding Out of Area Placements, Delayed Transfers of Care, length of stay, and ensuring an optimal balance of care between inpatient and community-based services.
This has introduced the case for specifying a comprehensive list of ‘hospital bed types’ to define this element of variation within the system.
Development of ‘hospital bed type’ categories
The NHS Benchmarking Network (NHSBN) has been collecting inpatient activity by bed type for a number of years and the adult mental health categories used were agreed via a consensus exercise, led by the NHS Confederation Mental Health Network in 2012. These suggested categories are now familiar with providers and are used as a currency in national benchmarking assessments.
Categories for children and young people’s inpatient mental health services have been identified and are described further in NHS England’s Child and Adolescent Mental Health Services (CAMHS) Tier 4 Report (https://www.england.nhs.uk/wp-content/uploads/2014/07/camhs-tier-4-rep.pdf ) as well as being used in NHS England’s specialised commissioning contract specifications.
Whilst learning disability wards broadly map to the NHSBN categories, work is in progress by NHS England to consult and define further where required.
Development of central derivations
Using the provided ‘hospital bed type’ categories and associated definitions, NHS Digital commenced development of derivations aiming to centrally derive this information using existing data within the MHSDS. The continued collection of Ward Setting Type, Ward Security Level, Clinical Care Intensity and Treatment Function Code allow a detailed understanding of the configuration of the inpatient ward and the service delivered.
NHS Digital is currently using these derivations to produce information from MHSDS about people in adult acute inpatient care (including adult acute and Psychiatric Intensive Care Unit (PICU) beds) and specialised adult inpatient services (secure beds plus specialist mother and baby and eating disorder units). The derivation uses methods developed through consultation with provider organisations in 2014 and used in some experimental analysis from the Mental Health and Learning Disabilities Data Set (MHLDDS).
A need exists to consolidate reporting requirements to ensure that burden is minimised for data submitters.
Identifying and agreeing a solution for national reporting
Two options of obtaining the required information through the MHSDS in the long term were put forward for consideration and agreement for national reporting:
1. Option 1 - Direct collection of Hospital Bed Type for adult and CYP mental health and learning disabilities
2. Option 2 - Central derivation of such categories using existing defined properties of the Ward and service provision
NHS Digital consulted on MHSDS v2.0 requirements with a wide range of stakeholders throughout 2016 through public consultations, events and workshops. NHS England has also provided feedback from separate NHS Benchmarking Network consultations.
From feedback presented, a preferred solution was not directly identifiable and both methods provided a mixture of opinion across stakeholder groups. For example, direct collection would provide a more transparent analysis method but could produce ambiguities in the data set where the bed type is not consistent with other recorded properties such as Ward Security Level.
In the absence of a single preferred solution, a recommendation was made by the Independent Standards Assurance Service (ISAS) to provisionally dual run both solutions as a pilot exercise. This approach was agreed with senior representatives of NHS England, DH and NHS Digital and subsequently accepted by the Standardisation Committee for Care Information (SCCI); SCCI was superseded by the Data Coordination Board (DCB) on 1 April 2017.
MHSDS v2.0 Approach – ‘dual running’ pilot
In order to ascertain explicitly the best solution to collect the required information for all three service areas and to ensure the resulting categories are comprehensive and fit for purpose, both identified solutions have been ‘dual run’ for a limited period of time within the MHSDS.
Discharges from adult acute beds followed up within 72 hours
New statistics regarding discharges from adult acute beds followed up within 72 hours were introduced in the Performance April, Provisional May 2020 edition of this publication series. The new statistics are:
• MHS78: Discharges from adult acute beds eligible for 72 hour follow up in the reporting period
• MHS79: Discharges from adult acute beds followed up within 72 hours in the reporting period
• MHS80: Proportion of discharges from adult acute beds eligible for 72 hour follow up - followed up in the reporting period
An assessment was carried out as part of developing these statistics to determine which option for determining ‘hospital bed types’ would be the most appropriate method. It was determined that the directly collected hospital bed type information was the most appropriate method, and as such this has been implemented for these statistics.
All other statistics in this publication series relating to hospital bed types are still based on centrally derived categories using existing defined properties of the ward and service provision. These statistics will be assessed individually in future and will be migrated to using the directly collected hospital bed type information if the assessment finds it is appropriate to do so.
Further development of the directly collected hospital bed type information may be required before all statistics in this publication series relating to hospital bed types can be migrated to this method. For example, the relevance of the currently available categories when applied learning disabilities and autism inpatient services may need further investigation.
NHS Digital will provide updates on these developments in future editions of this publication series.