Following on from the recent publication of the DH Atlas of Variation in Healthcare, Right Care have now released the equivalent atlas for children and young people.
The document and the online interactive atlas present variations across the breadth of child health services provided by NHS England. The aim is to highlight unwarranted variations that are driven not by the needs of the patient but by the limitations of the healthcare system and the healthcare professionals working within it. It is hoped that the data will allow clinicians, commissioners and service users to identify priority areas for improving outcome, quality and productivity.
The atlas contains a map that will be of particular interest to mental health professionals: Rate of inpatient admissions >3 days’ duration in children per population aged 0–17 years for mental health disorders by PCT 2007/08–2009/10.
This indicator focuses on children and young people who require more than three days’ admission to hospital for psychiatric treatment. The 3-day threshold excludes the large proportion of children and young people admitted overnight in general hospital settings following deliberate self-harm (a different patient population with regard to care), of whom only a minority will be admitted to dedicated psychiatric units.
For PCTs in England, the rate of inpatient admissions >3 days’ duration in children per 100,000 population aged 0–17 years for mental health disorders ranged from 3.4 to 166.1 (49-fold variation). When the five PCTs with the highest rates and the five PCTs with the lowest rates are excluded, the range is 4.4–30.3 per 100,000 population aged 0–17 years, and the variation is sevenfold.
Many mental health disorders are strongly associated with deprivation. However, when the 2007/08–2009/10 admission rates are plotted against deprivation indices, there is no statistical correlation.
The atlas suggests the following options for action to address this variation in provision:
- Specialist ambulatory care services perform a gate-keeping role for inpatient care. The organisation, level of provision and extent of local services will affect admission rates. Intensive ambulatory or outreach services for vulnerable groups may be clinically and cost effective. However, appropriate admission can play a key role.
- Partnership working with social care can influence admission rates and lengths of stay.
- From 2012, the child and adolescent mental health (CAMHS) national dataset will enable commissioners to investigate a range of indicators measuring the performance of local services. Commissioners and clinicians need to review local data for case-mix, duration of treatment, and outcomes, and plan inpatient and ambulatory services accordingly.
NHS Atlas of Variation in Healthcare for Children and Young People: Reducing unwarranted variation to increase value and improve quality. Right Care, March 2012. Interactive online version (requires Flash). PDF version (5mb).
Child and Adolescent Mental Health Services (CAMHS) Secondary Uses Data Set. NHS Information Centre.