Wednesday, 20 April 2016

The doctor won't see you now

This third statistical blogpost to accompany #7daysofaction is a bit different to the first two – rather than using inpatient census information to look at trends over time from 2006 to 2015, this post uses Assuring Transformation information (see here for the latest information http://www.hscic.gov.uk/catalogue/PUB20499 ). This is collected and collated monthly by the Health and Social Care Information Centre from reports by health service commissioners of inpatient services in England (Clinical Commissioning Groups and NHS England specialist commissioners), and has now been collected consistently for just over a year.

To justify their existence, much is made of the highly ‘specialist’ nature of inpatient services, where multiple professionals come together to understand and work with ‘complex’ individuals. In this post I want to look at a really straightforward indicator of professional practice within inpatient services, reviews. Every month, the Assuring Transformation dataset reports the length of time since everyone in inpatient services last had a review done by their service. Whatever type of inpatient service someone is in, for whatever reason, a highly specialist service should be reviewing pretty regularly what’s happening for the person, what impact their ‘treatment’ is having, and whether/what anything needs to change to help people.

The graph below shows the length of time since people in learning disability specialist inpatient services last had a review. Because of complications about how the overall number of people in these places is collected in the Assuring Transformation dataset which I won’t bore you with (read this http://chrishatton.blogspot.co.uk/2015/11/impatient-inpatient.html if you really want to know more), I’ve done these as percentages of people in inpatient services rather than the raw numbers. [Overall, the number of people in inpatient services over the year is likely to have stayed pretty static].

What does the graph show us? Well, just over a year ago, in March 2015, most people in inpatient services had been reviewed pretty recently (probably due to pressure from NHS England). Nearly a third of people (31%) had had a review less than 12 weeks before, nearly half of people (46%) had had a review between 12 weeks and 6 months before, and around a fifth of people (21%) had had a review between 6 months and a year before. Only 1% of people at this time had not had a review for over a year.

Fast forward to March 2016. Now, only a fifth of people (21%) had had a review less than 12 weeks before, less than a third of people (29%) had had a review between 12 weeks and 6 months before, and a fifth of people (21%) had had a review between 6 months and a year before. Now, over a quarter of people in inpatient services (28%) had not had a review for over a year, and for 1% of people there is no review date recorded.


Surely reviewing how people are doing, on a fairly regular basis, is fundamental to any claims these services are making about their specialist nature?


4 comments:

  1. I had an interesting experience yesterday attending the Birmingham Autism Partnership Board (which I invited myself to) which was made up of NHS, LA and 3rd Sector bods with some interest in Autism.

    A presentation was being made on the poor collection of information re autism. The Chair asks that the section showing 8 brief NICE recommendations be shown because he wanted to concentrate on recommendations 4 and 5 which the board should be focusing on re social support. A brief mention was made to the last two which was around clinical interventions and medications. It wasn't important to the point being made.

    Yet... Up pipes the St Andrews representative (a psychiatrist) who insists on the importance of medication and that it was a necessity for many autistic people. She did qualify this unnecessary intervention by stating that the services didn't exist in the community so they had to be in the hospital and therefore medicated. But even in the community, medication would be necessary was the implication.

    As I said, it was an unnecessary comment given the context of the discussion. So there was a defensiveness there. And obviously a justification as well. The room felt awkward as well.

    Just a bit depressing really.

    ReplyDelete
    Replies
    1. On (corporate) message - that is depressing.

      Delete
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