Guidance

Terms of reference for rapid review into data on mental health inpatient settings

Published 14 February 2023

Applies to England

Purpose

The purpose of the rapid review will be to produce recommendations to improve the way data and information is used in relation to patient safety in mental health inpatient care settings and pathways, including for people with a learning disability and autistic people.

The review will look at a range of data and information, including complaints, user voice and whistleblowing alerts, and consider how data and information is used about providers of NHS-funded care, including NHS trust and independent sector providers.

Objectives

The objectives of the review are to:

• review the data that is collected on mental health inpatient services by national bodies, regional teams, local systems, providers of NHS-funded care and others with a role in collecting information related to patient safety, and to understand how data streams are used and acted upon
• understand how the experiences and views of patients, families, staff and advocates relevant to mental health inpatient services are collected, analysed, collated and used
• understand whether data and intelligence are collected and used in such a way as to identify risk factors for inpatient safety and aid our understanding of:
  • patient and carer experience
  • whether people are receiving high quality care
  • whether people are cared for in a safe and therapeutic environment
  • how data and intelligence is used by providers and local commissioners to reduce risk and drive a proactive culture of improvement
  • identify ways in which the collection and use of data can better identify settings where patient safety might be at risk and to make sure that decision-makers at all levels have the information they need to monitor and improve patient safety effectively - this should take into account the importance of minimising the burden of data collection, particularly for frontline staff

Outputs

A report will be produced on the findings, including a set of agreed recommendations for improvements in the way local and national data is gathered and used to monitor patient safety in mental health inpatient services.

Scope

The review is intended as the first step towards improving the way data is used to monitor quality of care and risk to patient safety. The review should:

• consider the data and evidence that is collected by national and regional bodies and local systems on NHS-funded mental health inpatient services and how it is used, including complaints, user voice and whistleblowing alerts
• consider whether the data and evidence that is collected is appropriate for aiding the identification of sites where patient safety issues may arise or are already arising based on existing evidence about risk factors, including considering whether data collections should be changed or additional data needs to be collected and how the data collection burden on staff can be reduced
• consider data and evidence collected about NHS-commissioned mental health inpatient services provided by NHS trusts and by the independent sector and the different challenges faced by trust and independent sector providers
• consider where data is not collected or reported effectively, where the data quality is poor, and what can be done to improve data quality, including incentivising better provision of data and reducing the data burden on frontline staff
• consider how to improve the way data is communicated and used so that key decision-makers get useful, accessible data that allows them to mitigate risks to patient safety including by addressing contributory factors linked to safety risks such as staffing levels and the blend of skills in the workforce
• identify case studies of good practice nationally and internationally, in the healthcare and other exemplar sectors

The review will also consider how data and evidence relates to the specific needs and experiences of groups of people in mental health inpatient settings who are more likely to be affected by closed cultures, such as children and young people, autistic people, people with a learning disability, ethnic minorities and women with trauma.

Both NHS England^{[footnote 1]}, through its Mental Health Inpatient Quality Transformation Programme, and the Care Quality Commission (CQC), through the work it is doing on its new single assessment framework, are making changes to the way they monitor and collect data about these settings, and so the review should consider the potential impact of these changes.

This review should be focused on inpatient mental health settings only, including but not limited to children and young people’s mental health (CYPMH) services, secure hospitals and acute adult psychiatric wards, and including people with a learning disability and autistic people using these services. It will consider the whole patient pathway from admission to discharge.

Community services are out of scope of this review at this stage, though the review should also consider the risks to patients post-discharge and the social determinants or disparities that could be a source of risk to inpatients.

The final report should make recommendations on:

• what additional data should be collected, if required, and where data streams can be reduced or eliminated
• what can be done to improve the way that data and evidence is collected and used, including how to support decision-makers at every level with better information and how to incentivise and improve compliance with high quality data provision
• how to improve the use, analysis, reporting and communication of data to help identify mental health inpatient settings at risk of developing patient safety issues and to inform timely improvement

Following the conclusion of the initial 8-week period , the review may be extended for an additional 4 weeks to allow for additional data gathering and to produce a ‘snapshot’ of the current picture with regards to risks to patient safety across mental health inpatient settings in England.

Timings

The report, and subsequent recommendations, must be submitted to the Department of Health and Social Care (DHSC) by spring 2023.

Governance

The independent chair of the rapid review will be appointed by, and accountable to, the Secretary of State for Health and Social Care for delivery of the review. The chair will meet with ministers at the halfway point of the review to discuss findings to that point.

1. NHS England now includes NHS Digital and Health Education England will officially merge with NHS England in April 2023. See NHS Digital merges with NHS England. ↩