Improvement review of adult community mental health services 2005/2006

The joint review of adult community mental health services conducted by the Healthcare Commission and the Commission for Social Care Inspection (CSCI) assessed key community services in local implementation team areas that contributed to mental health and social care services for adults aged between 18 and 65 in 2005/2006. The improvement review included mental health trusts, health and social care trusts, primary care trusts, Councils with Social Service Responsibilties and local voluntary and independent healthcare sector services.

Report: National review of adult specialist community mental health services in England

One in six people suffers from mental health problems, such as depression and schizophrenia, at some stage of their life. Despite social attitudes becoming more inclusive, these people continue to face exclusion from areas of life that many of us take for granted: jobs; family support; community involvement and choice about their care and treatment.

The majority of people who suffer from mental illness receive their treatment and care in their own community, not in hospital. Community mental health services should therefore offer people in the locality flexible services which meet their needs without disrupting their homelife.

Such services are coordinated and commissioned by local implementation teams (LITs), of which there are 174 in England. These teams pool the work of mental health trusts, health and social care trusts, primary care trusts, councils with social service responsibilities and local voluntary and independent healthcare sector services.

In 2005/2006, the Healthcare Commission and the Commission for Social Care Inspection (CSCI) conducted the first, national, joint review of adult specialist community mental health services. Each LIT was assessed on three criteria: the involvement of the people who use services; access to appropriate care and treatment (such as talking therapies); and recovery and social inclusion.

Service users were asked what they thought about the care they receive and we also looked at whether the services were helping people to recover and become part of their local communities again.

All organisations assessed then received a detailed report outlining where they have performed well and where they can improve. The assessment data was published in September 2006.

This report uses this data to provide a national picture on the state of adult specialist community mental health services in England. It includes recommendations on how services can improve, and summarises the fieldwork carried out at 11 of the worst-performing LITs.

Services will have been working to improve their performance since the time of this review and the results will be assessed as part of our forthcoming Mental Health Patient Survey 2007 to identify the level of improvement.

No voice, no choice: A joint review of adult community mental health services in England (pdf 745kb) (opens new window)

No voice, no choice: A joint review of adult community mental health services in England - summary report (pdf 576kb) (opens new window)

Press release, 30th July 2007

Media briefing note (pdf 42kb) (opens new window)

A summary of the scoring framework for the Joint Review of Community Mental Health Services (pdf 317kb) (opens new window)

Results of the Review

All organisations assessed as part of the improvement review have received a detailed report outlining where they have performed well and where they can improve. This report sets out their score and the data used to calculate these scores.

There are two formats to view the data:

1. Instant Atlas

Please note, to view the detailed results, you will first need to download free ‘Instant Atlas’ software:

Instructions on how to download Instant Atlas software (pdf 21kb) (opens new window)

Access the full detailed results of the review, including underlying data (opens new window)

Access the full detailed results of the review, including underlying data - 256 colour (opens new window)

If at any time you need help with the functionality of the software you should click on ‘HELP’ in the report.

The following guidance file contains the details of how the framework is scored throughout, and also details of the construction of each data item and statistical analysis.

Joint CMH Review Scoring Framework Guidance v4 (pdf 787kb) (opens new window)

Joint CMH Review Scoring Framework Guidance v4.doc (doc 1040kb) (opens new window)

2. Excel files

Final excel reports for all organisations are available here, plus technical information on how the scores and items were calculated, and how organisations were mapped to Local Implementation Team areas.

If you would like to manipulate the data in the excel spreadsheets it is advised to right click on each file and ‘save target as’.

Please note when opening each file you will be asked:

‘Do you want to enable macros’ – click YES. If you do not get this message, you will need to change your security settings to allow you to do this. If you are a trust or council, you may need to contact your IT department to change this setting.

Full assessment results for LITs, and the overall review scores for Mental Health Providers, PCTs, CSSRs (xls 1320kb) (opens new window)

Data items are gathered at four organisational levels: LIT, mental health provider, Council with Social Services Responsibilities (CSSR) and PCT as appropriate. For this review the majority of data is gathered from national data sources, with the remainder coming from a special ‘bespoke’ data collection exercise.

You can view the organisations that contribute data to a particular LIT’s performance assessment:

Mental Health Local Implementation Team Community Mapping (pdf 74kb) (opens new window)

Scores for individual data items and their underlying source data can be found in the published data item files. These files show the data that has been used to calculate indicators and scores, and also information about data that was ‘not returned’ or ‘not available’.

Detailed data item information at Local Implementation Team level: LITs Item Data (xls 681kb) (opens new window)

Detailed data item information at Mental Health Providers level: Providers Item Data (xls 666kb) (opens new window)

Detailed data item information at PCT level: PCTs Item Data (xls 361kb) (opens new window)

Detailed data item information at Council with Social Services Responsibilities (CSSR) level: Councils Item Data (xls 435kb) (opens new window)

Information about the annual health check and the rules we will use to derive the annual rating from the scores of the components of the annual health check

Key messages from the review

Overall, 9% of Local Implementation Teams (LITs) were rated as ‘excellent’, 45% as ‘good’, 43% as ‘fair’ and only 3% as ‘weak’. LITs which scored excellent consistently performed well on all components of the review.

The Healthcare Commission will use the review data in its annual rating of mental health and primary care trusts. The assessment will also contribute to the annual CSCI performance assessment of Councils with Social Service responsibilities.

Press release: September 29th 2006: Health watchdog highlights gaps in communty mental health care

Plan improvement

Now that organisations have received their final results, those with the most room for improvement have been selected for follow-up fieldwork. The purpose of this fieldwork is to explore findings from the data analysis further and focus on identified areas of concern. This will enable selected services and both commissions to gain a mutually greater understanding of performance issues and then engage in improvement planning work. People who use mental health services and their carers will be central to this stage in the improvement review. This work will support improvement planning by providing a stronger and more comprehensive evidence base about performance across health and social care, and will focus on improved outcomes for service users and carers.

Process and Methodology

More information about this review’s process, the methodology used and other information is provided here:

Please refer to the Joint CMH Review Scoring Framework Guidance document (downloadable above) for full details of the scoring method, statistical analysis and use data items in the assessment stage of the review. Please note that some data items will be used as contextual indicators to support follow-up fieldwork, and have not been scored in the assessment.

Final assessment framework for community services (pdf 1056kb) (opens new window)

Management summary for community services (pdf 255kb) (opens new window)

Report on stakeholder engagement events (pdf 92kb) (opens new window)

Sample data collection forms (not for data submission purposes)

Mental Health Trust sample data collection questionnaire (pdf 102kb) (opens new window)

Mental health trust sample data submission form relating to NICE audit (pdf 110kb) (opens new window)

Local implementation team sample data collection questionnaire (pdf 128kb) (opens new window)

Council with Social Services Responsibilities sample data questionnaire (pdf 127kb) (opens new window)

Frequently asked questions (updated May 31st 2006) (pdf 77kb) (opens new window)

Announcement letter for Joint review of Community Mental Health Services (pdf 203kb) (opens new window)

NICE guideline for Schizophrenia Data Collection

The main data collection from mental health trusts consisted of a set of questions relating to recommendations in the NICE guideline for schizophrenia (2002), and a collection tool with guidance was issued directly to review leads for its completion. A set of instructions for the coordination of this audit can still be accessed below (for information purposes only). An instruction sheet for staff completing the audit can also still be accessed below. These instructions were adapted for local use to guide the completion and return of the audit questionnaire.

NICE audit coordinator instructions CMH joint review 2006 (pdf 76kb) (opens new window)

NICE Audit Completer instructions CMH joint review (doc 1118kb) (opens new window)