Service capacity in England
Guaranteeing patient safety and improving patient flow are priorities of the College. We have long been concerned about the pressure on adult psychiatric inpatient services and the adverse effects of high bed occupancy on patient care and staff well-being.
Across the country, members have reported that many areas are struggling to meet the demand for mental health care within the available bed and wider system capacity.
This has led to:
- Frequent and persistently high use of inappropriate out of area placements, where patients are sent out of their area for mental health care that should be provided locally.
- Delayed urgent admissions and the reliance on Mental Health Act (MHA) assessments and formal admissions as the only means of accessing inpatient services.
- People in a mental health crisis staying too long in A&E or being admitted to a general and acute hospital bed, where there is often a lack of psychiatric expertise.
- Unrelenting pressure on the staff to provide care for inpatients and manage their discharge from hospital.
- High rates of patient readmission, with the pressure to discharge patients before they are clinically ready and the lack of community provision, including crisis care and supported housing, leading to their return.
Despite the welcome commitments in the NHS Long Term Plan and NHS Urgent and Emergency Care Plan, as well as the development of the NHS 10 Year Health Plan, these problems continue to persist.
A College membership survey was conducted in early 2025 to gather member experiences of local inpatient capacity pressures - across England, 860 members participated. The survey findings further compound the challenging conditions under which psychiatrists and mental health professionals are working to attempt to consistently deliver safe and therapeutic care:
- Almost half of the respondents (47%) faced daily delays in timely admissions and/or provision of inpatient mental health treatment, due to a lack of local or specialist capacity.
- 44% heard daily about patients staying in a place of safety or in General Hospital Emergency Departments while waiting to be transferred to a suitable inpatient bed.
- Nearly three quarters (73%) felt they had to make a decision on admission or discharge as a result of external pressures, rather than the patient's best interests.
- The majority (81%) have experienced of witnessed 'moral injury' (a strong cognitive and emotional response following an event that violates a person's ethical code, such as feeling they are delivering substandard care) when making decisions around patient admission or discharge.
Service capacity was comprehensively reviewed in the 2016 commission on the provision of acute inpatient psychiatric care for adults in England, chaired by Lord Crisp. The final report, Old problems, new solutions (PDF), set out the pressures on mental health beds and established a clear way forward through a quality improvement approach.
In December 2018, the College also commissioned NHS Midlands and Lancashire Commissioning Support Unit to undertake analysis of the factors affecting service capacity. Their independent report, ‘Exploring Mental Health Inpatient Capacity across Sustainability and Transformation Partnerships’ (published in November 2019) found clear evidence that many areas are struggling to manage levels of demand within the available bed capacity.
There is no single solution to this complex issue and a whole-service perspective is essential to reducing the pressure on inpatient services. The College believes that a blended and complementary approach is required, so we are calling on the Government to implement a package of measures. More detail about the solutions we propose can be found in the briefing document linked below.
1. Invest in high quality community mental health services
The long-term focus should be to increase the capacity and capability of integrated community mental health services. The provision must be supported by local implementation of the Community Mental Health Framework for Adults and Older Adults (CMHF). The 10 Year Health Plan presents the perfect opportunity to deliver a clear ambition for the prevention and treatment of severe mental illness, both in the community through the CMHF and the roll out of psychological therapies, and in high quality inpatient settings.
2. Additional mental health beds are required in priority areas
For some patients, inpatient care is the most appropriate provision. Priority areas with consistently high rates of inappropriate out of area placements and/or persistently high bed occupancy should be given the resources to invest in additional local mental health beds that are properly staffed and resourced.
3. Maximise the therapeutic value of inpatient stays and undertake a local service capacity assessment
To reduce variation in inpatient care, there should be a national programme to support mental health providers to ensure time spent in hospital has clear clinical objectives and value. We also believe Integrated Care Boards (ICBs) should undertake and publish a service capacity assessment and quality improvement programme, to ensure bed capacity meets local demand for support. In some areas, this may require additional beds where proportional to population need.
4. Improve workforce capacity
No employee should experience moral injury in the workplace, especially those providing life-saving care to others. Improving service capacity including bolstering the inpatient and community mental health workforce will reduce this risk. Alongside the 10 Year Health Plan, we need to see an updated Long Term Workforce Plan with a recommitment to double medical school places, as well as bolder promises to retain the workforce and increase specialty training places.
- Use our monitoring tool Mental Health Watch, to track progress and highlight the areas that are succeeding in reducing pressures on inpatient beds and those that are not.
