There was an increase in reported serious incidents in the second time period; the number of complaints was similar.
There was no further information available about the serious incidents to explore this finding further.
4.6.11 Hospital admissions
Table 20: Inpatient admissions
Admissions Average stay (n
days) Average monthly admissions rate (n per day) Average out of area placement (n days) Time period 1 217 36.2 1.19 18.7 Time period 2 306 51 1.69 26.5 Total 523
There was an increase in both admission rate and numbers of out of area placements between the two time periods but considerable variability on a monthly basis.
4.7 What this data tells us about the recent and current operation of FTB
The gaps in data, and in particular, the lack of individual outcomes data, makes it difficult for the evaluation to draw conclusions about how well or otherwise FTB is delivering a mental health service for children and young people that delivers improved clinical outcomes, within an early intervention framework. Below we provide responses to the questions it was agreed that the impact evaluation would focus on:
4.7.1: Is the new 0-25 model transforming access and equality of access to interventions for those that need it?
Given the data available we are unable to unable to answer this question. There is clearly a difference in referral rates by large postcode denominations are but we were unable to access individual postcode to examine if areas with higher levels of deprivation have differential referral rates. There is some suggestion this is the case. There are some postcode referral changes over the two time periods but this would need further investigation.
4.7.2: What are the pathways to care, patient flows and duration of untreated mental health difficulty, including: time to first assessment following first help-seeking contact and time to first assessment following receipt of referral?
With the data we have at present we can only give very tentative answers to this. We are, for example not able to distinguish new referrals from re-referrals.
The time to first assessment is relatively long, at around 50 days mean, but has reduced very slightly.
In understanding pathways to care (as well as considering the demand facing FTB), there is also the question of children and young people seen in PAUSE but where referral data is not entered onto CareNotes or RIO but instead goes onto the Children’s Society database MOSAIC (on the basis that their needs do not warrant creation of an NHS record – e.g. a drop in visit for general advice). Currently this largely sits outside of the main activity and outcomes data collected by FTB and although the Children’s Society report all PAUSE activity on a monthly basis to FTB, it is recognized these data can easily missed since they do not fall fit easily with NHS reporting categories such as ‘referrals to treatment.’
To date, the evaluation team has not been able to undertake any detailed analysis of PAUSE data but one conclusion is that further investigation is needed, to ensure all contacts with FTB are reflected in their outcomes/activity data
In particular, FTB are not able to track and understand the outcomes of those individuals who are not offered an appointment (46.5%) and then ‘signposted’ to a charitable or other VCS service for young people (72% of this group). This sit uneasily with the foundations of the new service.
4.7.3: To what degree is 0-25 successful in maximizing engagement of individuals and their families and delivering interventions, following access to an initial assessment?
Given the data we have we are unable to answer this question. We are aware that the DNA rates are relatively low and have reduced in the last 6 month of service operation. The data also suggest that people are being discharge from the service faster but it is not clear whether this is due to service pressure or improved outcomes.
Data gathered through the focus groups and interviews have highlighted concerns about FTB’s use of CAPA and long delays post a ‘Choice’ appointment and being seen for a treatment appointment, also concerns about shortages of clinicians within FTB causing blockages in individual assessments. Consistent with this, the VCS and other partners have highlighted high and increasing levels of signposting out from FTB following triage via the Access Centre and have questioned whether all of these are appropriate (see 6.4.5). There have also been repeated reports of high staff turnover and changes of young people’s care co-ordinators, with staff departures sometimes resulting in children or young people going back on to a waiting list. It is not clear to what extent these and other ‘internal waiting times’ may be reflected in the activity data provided to the evaluation team by FTB.
In addition, we requested FTB workforce (current establishment) data in order to review the capacity of the service and to provide some assessment of whether the capacity is adequate to meet both the level of demand (numbers of referrals) and the complexity of need presented by children and young people. Unfortunately we did not receive these data.
4.7.4: Is the 0-25 service transforming recovery and resilience such that further service use is reduced?
Given the data currently available, we are unable to unable to answer this question. There is clearly a high level of need in the population given the very high numbers of referrals made to the service (23247 in 15 months). However, the lack of individual clinical outcomes data is a significant deficit here since without this information, it is impossible to report on any changes (improvements or deterioration) in the mental health and wellbeing of those receiving treatment and care from FTB.
4.7.5: To what degree is 0-25 making use of established and emerging indicated prevention strategies (early identification of emerging mental health disorders), within the service and linked community settings?
specific data from these services. We have no evidence that FTB is making use of the latest developments in recognizing those young people at very high risk for e.g. Psychosis, bipolar disorder or eating disorders.
4.7.6: General limitations of the data
As stated above we have been unable to answer most of our initial questions with the data currently available from FTB. We have also noted the quality of the data was very variable, especially at the start of the evaluation when there was an appreciable amount of missing data.