National mental health policy is moving on from the detailed specification of service inputs required by the national service framework to a greater focus on care outcomes.
National Institute for Health and Clinical Excellence guidelines set detailed expectations of how care will be delivered, and mental health trusts need to ensure that patients get high-quality care.
Going beyond this, mental health trusts need to focus on delivering a range of 'whole life' outcomes, to include improved physical health and improved employment prospects.
We can begin to apply the quantitative analysis of activity that is becoming commonplace in the acute sector within mental health, an area traditionally starved of good-quality management information.
Looking at the relationship between a range of activity variables by day of the week for all the English mental health trusts in quarter two of 2006, there is a strange anomaly on Mondays. Admissions are fairly high but there are very few discharges and a relatively low number of outpatient appointments and patient contacts. These are clearly patterns designed administratively, not around patterns of patient presentation.
Data on the proportion of spells with three or more admissions and the proportion of short stay admissions shows the variation across all trusts. In the first, for example, the range is from 5.7 per cent to zero; for the second the range is 29 per cent to 3 per cent.
The picture this builds could indicate that some trusts are relying more heavily on inpatient stays than community care. A high proportion of short stays could mean that patients who probably do not need an inpatient stay are having one, and a high proportion of multiple admissions could mean patients are not being discharged appropriately or are not being followed up properly in the community.
Trusts have either attained or are working towards foundation trust status, which requires trusts to take a business-like approach that focuses on corporate and financial risk management and value for money. As a consequence, having the right information about services provided is crucial. The kind of information presented here is required to target cost savings, negotiate contracts and match cost to income flows.