The following table details these findings, the required actions and timescales for completion.
Findings | Recommendations | Responsibility | Timescale |
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National Data |
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F1 Classification and description of current mental health services is patchy and suffers from a lack of common definitions of similar types of services making it difficult to make meaningful comparisons. There is strong support from Boards and partners for the adoption of common definitions for mental health services. | R1NHS Boards classify and quantify their services using the service definitions detailed in the Technical Appendix to this report. | NHS Boards | April 2008 |
R2 Local Authority, social work, and voluntary organisations are equal partners with the NHS in contributing to the wellbeing, health and services provided to individuals with mental health problems. We recommend the work on service definitions and functions be extended into a comprehensive joint social work, health and partners listing. | Boards and partners | September 2008 |
F2 Nationally available data does not currently reflect the way in which the service is delivered. The majority of mental health services are delivered in the community but the national data does not fairly reflect this. | R3 Core definitions of mental health service functions are developed and mapped to the range of services and associated resources being delivered and planned across Scotland. The new national clinical/social data standards developed and piloted to cover community encounters/interventions ( ICIC) would provide the basis for the work. | MHBIG | April 2009 |
F3 The Scottish Health Services Cost Book does not encompass all the relevant direct, indirect, resource transfer and community costs and the data is not comparable, as services are described and managed differently in each Board with their respective partners from local authorities and other organisations. | R4 Boards and partners align costs with mental health activities using a consistent methodology across all NHS Boards and partners through the recommendations of the Mental Health Costing Pilots in Greater Glasgow and Clyde and Forth Valley, which are being undertaken in conjunction with partners. | Boards and partners | April 2009 |
R5MHBIG update the presentation and disclosure of mental health activities and costs in the Scottish Health Services Cost Book to fully reflect mental health service delivery and outcomes from the work undertaken in the costing pilots. | MHBIG | April 2009 |
F4 There are gaps in the areas of quality and patient satisfaction, which are critical areas for service improvement. | R6 The quality and patient satisfaction measures in the mandatory scorecard are developed and adopted. | MHBIG | April 2009 |
Reporting and Improvement |
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F5 There is wide variability as to the completeness and timeliness of the submission of national data by Boards, which results in relatively out of date comparisons. | R7 We recommend NHS data is sent timeously to ISD, analysed and reported on and social work data sets from supporting people, and local areas ( e.g. Care First) are analysed and reported on in conjunction with NHS data by MHBIG. | NHS Boards and MHBIG | April 2008 |
F6 There is also variation as to the completeness and timeliness of local data at partnership level, which results in inconsistency between parts of the system and long lead times before a meaningful review of information can be undertaken locally. A combination of competing clinical commitments, lack of streamlining and integration of information systems were found to be constraining factors at local level. | R8 Adoption of the draft definitions for health and development of joint definitions for health and partners will support integrated planning, reporting and performance management as will recommendation R7. | Boards and partners | September 2008 |
F7 Boards demonstrated differences in the capability of local information systems in terms of capture and reporting of information across partners, which meets users needs. There is currently no information system, which is considered fully fit for purpose. | R9 Coding of the datasets, which will flow from work on definitions and functions into systems currently in use and those undergoing development, will allow extraction and presentation of data on an integrated basis. Our work on the capability visits has confirmed that some systems do have the capability of supporting the necessary dataset. Some Boards are already creating joint data warehouses and/or joint systems to allow information sharing and enhance the integrated approach. | Boards and partners | To be confirmed |
R10 In the medium to long term, existing systems should be improved or new systems developed in line with the National IM&T strategy, that will adopt a whole system approach and to allow systems to link into each other. | MHBIG | To be confirmed |
Reporting and Improvement |
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F8 We found that data quality is varied across the service and that this related in part to individual practice and recording. Boards highlighted that information in support of the Mental Health Act should be improved and streamlined. | R11 While it is recognised that regular dissemination and review of information will lead to improvement in the quality of the data, all Boards should achieve a focus on improving data quality by undertaking an audit to identify gaps in data quality and implementing an action plan to address the gaps. The requirements from all areas of relevant legislation should be specifically addressed. It is expected that a systematic transparent approach to data quality checks and use of exception reporting highlighting missing codes, outliers, and shifts in activity etc. would form part of the plan. | NHS Boards | September 2008 |
F9 Generally there were few management reports available at frontline/client facing functions, with a broad range of approaches to management reporting at local level for mental health services both for NHS Boards and joint reporting for NHS Boards and partners. There are incomplete and inconsistent approaches to the provision of feedback on improvement activities. | R12 Boards should adopt a local reporting framework using the Balanced Scorecard Approach in support of accountability frameworks where performance is reported at Board, CHP, joint team and individual practitioner level. MHBIG will support Boards in developing the mandatory national indicators shown (see page 8). This approach will also support the performance management structure that has been put in place by the Mental Health Delivery Plan Implementation Board and will feed into the reviews that are undertaken with Boards, local authorities and others twice a year and the annual accountability reviews that Ministers undertake each summer. Boards should develop local reporting frameworks using the same approach to focus on local priorities. Suggested measures, which can be used, are shown in the Technical Appendix, Appendix C. | NHS Boards and MHBIG | April 2009 |
F10 Boards and partners have expressed an interest in developing multi-partner balanced scorecard approaches to performance in mental health services. | R13 It is recognised that the scope of mental health services is very wide and so, specific scorecards developed in the context of the high level mental health scorecard may be required for specific aspects of the service e.g. perinatal services. | MHBIG | As required |