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On Christmas Eve 2002, the Department of Health published the financial allocations to Primary Care Trusts (PCTs) for 2003/4. As usual, this was accompanied by a detailed ‘exposition book’, setting out how the distribution of the available £45.3 bn was decided (Department of Health Finance and Investment Directorate, 2002). Three years ago, I wrote a short article showing how a close reading of this publication could be used to identify notional mental health budgets in these allocations (Glover, 1999). Bindman et al (2000) demonstrated that many health authorities, particularly those that service more deprived areas, spend substantially less on mental health care. As this is the first time financial allocations have been made directly to PCTs, it is helpful to repeat that calculation for the new organisations.
To examine what current routine statistics could show about the extent to which patients are admitted to hospital beds ‘out of area’, a quality indicator proposed in the National Service Framework.
Available data record that, on average, at least 6.9% of acute general psychiatry admissions in the English NHS happen outside the normal catchment area arrangement of a patient's health authority. However, deficiencies in the calculation – arising from lack of data, mainly about private sector admissions – and the absence of a central registry of NHS trust catchment areas suggest this is a substantial underestimate.
The most useful way for this issue to be examined is from year to year for individual trusts.
The greater frequency of mental illness in deprived and inner-city populations is well recognised; allocation of funds in the UK health service makes some allowance for this. However, it is not clear whether the differences are similar for all levels of mental health care need.
To study the range in prevalence of mental health problems and care at primary care, general secondary care and forensic care levels.
We used mainly descriptive statistics to study evidence available from existing sources – some based on indicators of likely need, some on observed prevalance of treatment.
Among English health authority areas, the most morbid have about twice the prevalence of primary care level mental illness of the least morbid. For secondary care the ratio is between 2.5 and 4 to 1, while for services for mentally disordered offenders it is in excess of 20:1.
Where needs indices are used for resource allocation, responsible authorities should ensure that they produce ranges reflecting the full compass of services funded. For forensic services the range of morbidity levels may be so great that funding needs to rest at a larger population level than that of health authorities.
When I was at school the big IT everyone talked about, some explored avidly and others shunned nervously was sex. In psychiatry today, as in so many other fields IT is information technology. This article is a polemic. I believe IT (the new sort) is indispensable for modern mental health care. In the British National Health Service we have a window of opportunity to get IT right and if clinicians fail to act decisively and quickly, there isa risk that the chance will be lost.
Mental health care is a complex undertaking. It involves care providers of many disciplines, administrative support staff, managers, funding bodies and of course carers and patients themselves. Each group has their own information needs; each, however, is primarily concerned with other things, and the importance of minimising the effort involved in amassing and accessing dependably accurate information cannot be stressed too highly.
The recent prominence of medical audit in psychiatry is due in large measure to the place given to the subject in the government's White Paper Working for Patients (DoH, 1989a). However, medical audit existed before the White Paper and covers a broader scope than the White Paper proposes. Thus in considering the introduction of audit into the mental health services it is important not to allow the White Paper to narrow the field of view.
Cochrane, in his studies of psychiatric admission rates amongst immigrant groups in Britain, allocated cases for which birthplace data was lacking by assuming that the patients were most likely to be British-born. A validation study shows this may not be justified. Estimates are made of the magnitude of the possible resulting error.
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