Comment / What does greater productivity look like in mental health services?

Efficiency and productivity. Maybe two of the most bandied about terms in the NHS at present, especially in finance circles. All too often the words are being used interchangeably to describe the overarching problem of delivering services while faced with increasing demand and already stretched financial resources.

At its simplest, efficiency is described as doing the same amount of work using fewer resources – or doing more with the same resources - and therefore at less unit cost. In contrast, productivity measures how many units of output are produced from one unit of input. You could argue that these boil down to the same thing – getting the best value for money for the taxpayer and delivering services using limited resources.

Productivity in mental health services is an area of much debate and a subject that the HFMA Hub Mental Health and Learning Disability Steering Group has agreed to focus on over the next few months. Mental health services are under significant pressure at the moment and we need an effective way to show the value they bring.

Ideally the plan is to come up with a set of metrics and suggestions for a dashboard on which to present them. A small subgroup has been set up to progress this work.

It is already clear that our first challenge is to define what productivity looks like in mental health services, then work out how to measure, record and compare it. Service users are often on complex pathways, interacting with multiple services; clustering has all but been abandoned by many providers and there is no currently mandated replacement currency as this remains in development; and patient-level costing remains in its infancy in many organisations.

It would be easy to relegate productivity measurement and improvement to the ‘too difficult’ pile. But the group concluded that the imperative is now, and there are already options for measures and metrics that we can develop with the data currently available.

We may struggle to benchmark with other organisations, especially when it comes to cost and activity measures, due to variation in data quality and in collection and costing methodology. But productivity could be considered to be about showing an improving trend over time and/or identifying and addressing unwarranted variation internally. This may be particularly relevant for trusts where similar services are being delivered across multiple locality teams.

The subgroup is aiming to identify a small number of key productivity metrics that can be measured using existing data sets. Metrics need to be able to track changes in one or more of the triumvirate of cost, activity and quality. Ideally we will start with a long list of ideas and whittle it down to an achievable number that all trusts can aim for as a start point. There is nothing stopping us expanding the list in the future!

The initial focus is likely to be on inpatient services, as data is more readily available and provides easy comparison. For example, we could look at metrics associated with length of stay, delayed discharges, out of area placement, and planned versus unplanned admissions to name just a few.

At this stage nothing is off the table and all ideas are welcomed.

Beyond the metrics, we need to think about how to present the data. We know there is a wealth of data visualisation tools out there, and staff with the appropriate skills and knowledge to use them. However, there is a recognition that these may not work in mental health organisations. And, frankly, it may be better to keep it simple at this stage. But that’s a discussion for future meetings.

If you have already had some success working out some of the issues that we’re grappling with, we’d be very happy to hear from you. Please feel free to contact the HFMA team ([email protected]) in the first instance.

Paul Sheldon is chief finance officer of Leicestershire Partnership and Northamptonshire Healthcare Group. He is a member of the HFMA Hub Mental Health and Learning Disability Steering Group and is leading the subgroup focusing on productivity.