Are services able to identify whether they are moving in the right direction?
Mental health providers and primary care trust (PCT) commissioners need to analyse data to understand whether implementation of their service strategies is resulting in the desired shift in service provision, what the impact of changes in unit costs mean, as well as how organisations compare with each other and against national trends.
The Mental Health National Service Framework and the NHS Plan (2000) looked to strengthen community care, and in doing so, to take the pressure off acute beds.
PCTs and providers have been developing new services including:
- crisis resolution (home treatment) teams offering an alternative to inpatient admission;
- assertive outreach teams providing intensive support in the community to patients with complex health and social needs; and
- early intervention teams providing young people, who have developed a severe mental illness for the first time, with rapid assessment and treatment.
They need to know whether the newly developed community services have been offset by the desired decrease in inpatient activity, and what has happened to the costs. Reference cost data contains all of the data needed to answer this question and also to benchmark local services against each other and national trends.
Analysis of three years’ data shows that inpatient bed days have reduced in three- quarters of trusts. Nationally, bed days have fallen by 13.1 per cent since 2003/04. This is good news if resources have been reinvested in community mental health services or higher quality for those who do require hospital care.
Over the same period, spend on adult inpatient services increased by 6.5 per cent. We would expect unit costs to have risen as it is unlikely that reductions in activity can be matched pound for pound by reductions in cost. Analysis of unit costs shows they have increased by an average of 20 per cent but with considerable local variation.
Pay costs per whole time equivalent have increased by 13 per cent over the last two years. The increase in unit costs has outstripped the increase in pay costs. It is these kinds of measures which PCTs and providers need to review.