On August 3rd the Department of Health announced the publication of various statistics relating to what it calls Mental Health Community Teams Activity on its Transparency website. I think the most interesting data relates to admissions to psychiatric hospital.
The quarterly data on psychiatric hospital admissions is organized by PCT and provider. For NHS Gloucestershire (a PCT) the provider is the 2gether NHS Foundation Trust, but from April 2011 this trust has also been the provider for NHS Herefordshire (another PCT).
It seemed reasonable to adjust the figures for the two counties’ different population sizes (Gloucestershire’s being more than three times the size of Herefordshire’s), and then to compare them with the average for England as a whole.
It also seemed reasonable to add the figures for the two PCTs and compare them with the provider’s figures. This shows that the provider reported a shortfall in admissions every quarter, implying that a few patients were admitted to psychiatric hospitals out of county, hospitals operated by some other provider.
The resulting chart looks like this. Note that the 2gether shortfall is shown as the actual number, not per 100,000 population like the other statistics:
In Gloucestershire, psychiatric hospital admissions are about 30% below the average for England. This remains pretty steady despite some seasonal variation. Is it a good thing or a bad thing? I have no idea. Perhaps care in the community is so good that not many people need to be admitted. Perhaps hospital care is so bad that not many people would benefit from being admitted.
In Herefordshire, the admission rate started off much higher than the average at the time 2gether took over the contract, but then it fell over the course of a year or so to reach about the same level as in Gloucestershire. This makes it look as if the below-average rate is management’s deliberate policy.
In total, the number of admissions from the two counties exceeded 2gether’s capacity from the time the Herefordshire contract started, though the excess seems to have been brought under control as admissions from Herefordshire have continued to fall. In absolute terms the fall in Herefordshire was from 105 admissions in a quarter to 48, a much larger difference than the provider shortfall, which was 8 at its highest point.
This might or might not explain the remark in the NHS Gloucestershire and Swindon Cluster Board meeting in May, that for NHS Gloucestershire (page 86 in the PDF, page 6 in the Integrated Performance Report):
|An overspend position is being forecast in Mental Health||£1.6m overspend at month 12.||QIPP projects in place to reduce out of county placements for mental health and eating disorders.|
(QIPP is Quality, Innovation, Productivity and Prevention, not that knowing the words actually tells you anything.)
The papers for the NHS West Mercia Cluster Board meeting for May don’t help. There’s no suggestion that Herefordshire (which is part of that cluster) had a corresponding overspend in 2011-12 (although Worcestershire had). So the impression given is that NHS Gloucestershire paid for patients to be sent out of county at a time when the excess demand on the provider was coming from NHS Herefordshire. Odd.