Request for Information Under the Freedom of Information Act 2000 s1
Information Management
Isle of Wight NHS Primary Care Trust
St Mary’s Hospital
NEWPORT
Isle of Wight
PO30 5TG
Tel: 01983 552078
Fax: 01983 534893
Ref: FOI10294
Date: 22 October 2010
Dear Sir/Madam
Request for information under the Freedom of Information Act 2000
Please find below/attached the Isle of Wight NHS Primary Care Trust’s response to your request.
1. In the last 5 years, how many postnatal depression cases were treated by a mental health service commissioned by your PCT?
Response: Most people with post-natal depression are managed within primary care. MH&LD Commissioning do not hold information about the actual numbers of people with post-natal depression treated in secondary care. Two mothers with post-partum psychosis (a rare and very severe post-partum disorder) were admitted to the regional Mother and Baby Unit for specialist treatment under the Mental Health Act.
2. How many postnatal depression related serious untoward incidents (SUIs) have been reported in the last 5 years?
Response: None.
3. A. What is your commissioning strategy for mental health?
Response: Please see attached.
B. Does it include a specific strategy for postnatal depression and detection of suicide risk?
Response: No. However, the Trust has a detailed protocol on the management of post-partum mental disorders. As part of this, Health Visitors routinely carry out the Edinburgh Postnatal Depression Score and follow guidance on for referring mothers at risk to the GP within 24 hours. The protocol has just been re-written and has been submitted for approval at the necessary Trust Committees.
4. Is your PCT part of a clinical network for perinatal mental health, if so which one?
Response: Yes, South Central SHA. Katie Jubb (midwife) is a member of the South Central Clinical Leaders Network and is currently organising a conference in November 2010 on the Isle of Wight with specialist peri-natal staff from the region to raise awareness of post-partum disorders .
5. A. What methods of evaluation do you have or use to secure adherence to the NICE guidance ‘Antenatal and postnatal mental health’ - CG 45?
Response from MH&LD Commissioning: Schedule 3 Part 1: Quality Requirements of the NHS MH&LD Standard bi-lateral contract outlines contractual requirements as follows:
The provider will have a process for assessing, implementing and monitoring applicable NICE Technology Appraisals, Clinical Guidance, Interventional Procedures (as appropriate) and other national service frameworks and national best practice guidance for example: National Service Frameworks, National Confidential Enquires, National Inquires, National Audits, Health Service Circulars. The Provider will engage in interagency working in relation to the above and action plans with the Commissioner (subject to funding) prior to implementation (if appropriate).
B. How often do you evaluate your PCTs adherence to NICE CG 45?
Response: Quality requirements are evaluated monthly by MH SLA meetings and Clinical Effectiveness Group. Will also be reviewed within relevant Directorate Management Teams.
6. A. What methods of evaluation do you have or use to secure adherence to the NICE guidance ‘Depression’ - CG 90?
Response: See number 5a.
B. How often do you evaluate your PCTs adherence to NICE CG 90?
Response: See number 5b.
7. Do you have a named individual to lead on the implementation of NICE guidelines?
Response: Yes.
8. A. What systems do you use that provides a seamless transfer of information between the multi-professional services e.g. passing information from midwives in hospital to health visiting staff in the community?
Response from Commissioning: This is a contractual requirement under Clauses 18, 21, 22, 27, 31 of the NHS MH&LD Standard bi-lateral contract, and within service specifications.
Response from Provider - Community midwives transfer information verbally. Documentation and collaborative working patterns are currently under development.
B. Please give examples.
Response: Examples from MH&LD commissioning - Clause 18 of the NHS MH&LD Standard bi-lateral contract. 18.9 In the case of a Discharge from In-Patient Treatment back to the whole or partial care of the GP or other health or social care provider, the Provider shall give to the Service User at the time of such discharge: 18.9.1 a discharge letter in an appropriate format containing, without limitation, the information specified in Schedule 7 Part 3 (the “Discharge Letter”). Clause 31.3 It shall be a material breach by the Provider if the Provider does not co-operate fully with the Commissioner and the original Referrer in any re-referral of the Service User to another provider (including providing Service User Health Records, other information relating to the Service User’s Package of Care and clinical opinion if reasonably requested).
9. What is your referral rate to specialist mental health mother & baby units every year for the last 5 years?
Response from MH&LD Commissioning: Two known to current MH&LD commissioning post holders in last three years.
10. A. Under Patient Choice, do patients have the right to admit themselves to specialist mother and baby units if they do not wish to receive ‘Crisis Team’ care at home?
Response from MH&LD Commissioning: No, a healthcare professional would make an application under prior approval scheme or via an individual funding request to an appropriate panel. Under Patient Choice, MH services have only recently been added to choice, and referral must be made by a GP or a consultant for an assessment. Under patient choice it is not possible for a patient to admit themsleves into a specialist mother and baby unit.
B. How many self-referrals did you see in the last 5 years?
Response: None known in commissioning.
11. What measures do you have to monitor and review performance of your postnatal mental health services?
Response from MH&LD Commissioning: Monitor of services through service specifications.
12. A. Do you have a lead clinician of perinatal services?
Response: Katie Jubb (midwife) has 6.5 hours a week for peri-natal mental health work funded by maternity. Dr Sharon Johnson Specialty Doctor was the lead clinician for peri-natal services until August 2010 when she changed posts.
B. If so, what grade are they and are they an expert in the field of Perinatal Psychiatry?
Response: see above
13. Do use the ‘Whooley’ Questions as recommended in NICE CG 45 for screening mothers for antenatal or postnatal depression?
Response: Yes for all women at booking only.
14. Does your commissioned mental health services supply written information or use decision aids when explaining the risks of postnatal depression?
Response: Waiting for approval by PILS (on post-natal depression and keeping well in pregnancy)
15. A. What level of training does your PCT provide health visitors in regards to assessing mental health conditions and in giving psychological support during the antenatal and postnatal period?
Response: Midwives are trained annually at mandatory study day (only 30mins). Plans to develop more in depth study day for health visitors and midwives and community midwives (arranged for 21st January). Dr Gregoire (peri-natal consultant psychiatrist) coming to do study day on 6th December. E-Learning package available via training tracker
B. How many health visitors does your PCT provide?
Response: 20.
We would like to bring to your attention the unique set up of the Isle of Wight NHS Primary Care Trust. The Primary Care Trust is a commissioner of health services, and also incorporates multiple services including Acute, Mental Health, Ambulance and Community, which could lead to a higher reporting rate data in comparison to other PCTs. Therefore you will need to take this into account when reviewing our data against other NHS organisations.
This letter also confirms the completion of this request. A log of this request will be held on a database by the PCT. All hard copy correspondence relating to this request will be held for one year from the date of this letter, before being confidentially destroyed.
If you are unhappy about the response you have received your first line of action should be to write and request the Trust to undertake an internal review of your application. A senior member of staff, who was not involved with your initial application, will undertake this review. If after this process you are still not satisfied with the response you receive from the Trust you can complain to the Information Commissioner at the following address:
Information Commissioner
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF
Please don’t hesitate to contact this office if you have any further questions.
Yours sincerely
Audrey Green
Information Management Specialist