Mental Health Information: NHS Trust Forum 26 th April 2010, Birmingham Botanical Gardens

Proposed changes to MHMDS v4.0 Consultation Exercise Reponses Paul Croft

Consultation Exercise Reponses  300+ individual comments received  20+ organisations including: - Trusts - Department of Health - Care Quality Commission (CQC) - National Mental Health Development Unit - NHS Data Model and Dictionary Service (NHS Connecting for Health)  Responses to be published on The NHS Information Centre website by Friday 7 th May  We will consider ALL comments and incorporate suggestions/address issues identified wherever possible

Scope Changes  Independent/Third Sector Mental Health Services  Primary Care Mental Health Services (not GP’s and excluding Improving Access to Psychological Therapies IAPT)  Early Intervention Services (where not provided by Adult Mental Heath Providers or currently included within MHMDS)  High Secure Services  Learning Disability Services (TBC) 1. Expansion of scope of MHMDS is NOT part of these proposed changes. 2. These will require testing/piloting to ensure that MHMDS could be implemented for these areas/services prior to seeking formal approval. 3. Testing will also identify existing data items/definitions/value lists that may need changing to reflect this activity. 4. Timescales will be dependent upon results of testing.

Diagnosis  Changes to move existing items from IPEP and Reviews Tables  Split between Primary/Secondary Diagnosis – might need to be reconsidered  Not requiring formal diagnosis to be captured from all settings – only where it is currently captured as part of clinical process.

Interventions/Procedures 1. Only intended to be ‘moved’ from ‘CPA Reviews’ table to new ‘Interventions’ table 2. This should reflect ‘planned’ interventions/ procedures NOT those that have occurred. 3. Most Trusts don’t have capability of reporting Read Codes – poor data quality currently 4. Improvement of recording and reporting of interventions key strategic aim – will undertake review of mental health interventions with view to include in future changes to MHMDS

Outcome Measures  HoNOS (Working Age Adult)  HoNOS 65+ (Older Persons)  HoNOS-CA (Child and Adolescent)  HoNOS-Secure (Secure Services)  HoNOS-LD (Learning Disability)  HoNOS-ABI (Acquired Brain Injury)  PHQ-9  EQ-5D 1.Variants of HoNOS/PHQ-9 NOT required – only need to include where used by clinicians 2. EQ-5D – removed due to potential licensing issues 3. CAMHS remains out of scope of MHMDS – only include as may be most clinically appropriate outcome measure e.g. for patients under 18 in adult mental health services 4. MHCT Assessment – HoNOS items can ALSO be included as a HoNOS where deemed clinically appropriate (Only Standard Working Age HoNOS)

Episodes  Still investigating whether Team Episodes would be more useful as a replacement for existing episodes for: - Community Episode (of Community Psychiatric Nursing (CPN)) - Acute Home Based Care Episode - Mental Health NHS Community Care Episode - Consultant Outpatient Episode - Professional Staff Group Episode -Still investigating whether Team Episodes would be more useful as a replacement for existing episodes for Any thoughts? Any thoughts?

Seclusion/Assaults/Self-Harm/Restraint 1.Required for monitoring of incidents for equality purposes following ending of Count Me In Census 2. These should only be captured for inpatients 3. Assaults – include reported assaults on patient by another patient only 4. Self-Harm – include suicide attempts 5. Investigating whether self-harm needed or if already included within incident reporting to NPSA

Equality Items 1.Required for equality monitoring purposes following ending of Count Me In Census 2. Should be captured for ALL patients not only Inpatients 3. Disability indicators – includes both perceived or registered disability. They do not necessarily have to be formally diagnosed. 4. Planning to adopt existing guidance from Count Me In Census for these Items – including extensive guidance for Sexual Orientation 5. Recording and reporting of ALL equality monitoring items being reviewed across NHS – will align MHMDS where required

Various  CPA – Only need periods for patient on CPA (new CPA)  Reviews – new reviews table should include ALL reviews. Formal CPA Reviews should also include items in CPA Review Table  Staff – Staff Name is being removed

Proposed New Data Items Some additional data items have been suggested:  Length of Seclusion (in minutes)  Reason for Delayed Discharge  Responsible Clinician/Care Coordinator Start and End Dates  HoNOS-Secure (Secure Services) – include in its entirety  HoNOS-LD (Learning Disabilities)  HoNOS-ABI (Acquired Brain Injury)

Timescales MHCT/Care Clusters ISN PublishedApril 2010 MHMDS v4.0 ISN PublishedJuly 2010 Capture MHCT and Care Clusters in local systemsApril 2011 Submission of MHMDS 4.0 – new table structuresQ Submission of proposed new data items in MHMDSQ (where already captured within local systems) Conformance by all Trusts (local capture and reporting)TBC

Exercise – Definitional Testing of Value Lists  Source of Referral  Outcome of Referral  Review Type  Location Type  Mental Health Team Type 1. Review values lists 2. Identify any values in lists that should be removed i.e. those that cannot occur 3. Identify any potential missing values