Mental Health Nursing

Measuring health and social functioning using HoNoS 41
are missing data items. Therefore, it is essential that every effort is made
to collect sufficient information to make a complete rating. This may
require staff to expend more time and energy on the assessment process
than before, particularly in relation to contacting other professionals and
agencies involved with the patient in order to build up a more comprehensive
profile of the client. Time and availability of information are
undoubtedly significant issues for staff in acute services. However, there
is no reason why missing information cannot be entered into the rating at
a later date, as long as the rater is considering the same time period (i.e.,
the two-week period prior to the rating). Where an incomplete rating is
made, it does not mean that the HoNOS rating is totally invalid because
of course the individual items that were scored can be compared, as can
completed sub-sets.
The other main advantage of gathering HoNOS data is that, once aggregated
and anonymised, it can, as Wing et al. (2000: 393) point out:
provide the opportunity to measure outcome in a service-wide context where it can fulfil
a vital role as a measure (not a predictor) of progress towards agreed targets and for
making local comparisons.
However, HoNOS cannot be used to compare wards, districts, treatment
regimes etc. unless context/background information is also collected (i.e.,
MDS) and like is compared with like. As the use of HoNOS becomes
more widespread and its use more sophisticated then it will become possible
for clinicians, managers and researchers to make more meaningful
comparisons. If the HoNOS data are to be used in an aggregated form as
part of a broader unit or service-wide assessment of the outcome of
service populations, then its inclusion in an MDS in some form of IT
system is essential. This will require, in many instances, significant
investment in IT systems to ensure that the routine recording and management
of data becomes possible. Experience of training mental health
staff, in a variety of settings, has highlighted that access to adequate
IT support systems remains far from a reality in many trusts and social
service departments.
HoNOS is not directly concerned with costs or the statistics of care
settings or the use of professional time (Wing et al., 1996) but it is not
unreasonable for HoNOS data to be used (as part of an MDS) in the decisionmaking
process.
Within the context of an in-patient setting, a very clear and systematic
method for the use of aggregated data is set out in Severe Mental Illness
Outcome Indicators (Charlwood et al., 1999). This outcome indicator is
based on the principle that the aim of an acute in-patient admission is to
restore the health and social functioning of those admitted and to plan discharge
from this period of treatment in such a way as to minimise, as far