Service capacity in England

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 out of area placements, where patients are inappropriately sent out of their area for the care that should be provided locally.
  • Reports of a ‘waiting list’ for admission in some areas.
  • 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 to inpatients and manage their discharge from hospital.

This was comprehensively reviewed in the 2016 commission on the provision of acute inpatient psychiatric care for adults in England, chaired by Lord Crisp. Its final report, Old problems, new solutions, set out the pressures on mental health beds and established a clear way forward through a quality improvement approach.

Several years on from the Commission, and despite the welcome commitments in the Five Year Forward View for Mental Health and NHS Long Term Plan, these problems are persisting.

In December 2018, the College commissioned NHS Midlands and Lancashire Commissioning Support Unit to undertake further 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 in the short, medium and long term, and so we are calling on the Government to implement a package of measures.

1. Immediate: additional mental health beds are required in priority areas

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.

2. Over the next 2 years: 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 local areas should undertake and publish a service capacity assessment and quality improvement programme.

3. Over the next 2 to 5 years: invest in high quality community mental health services

The long-term focus should be to increase the capacity and capability of community mental health services in line with Long Term Plan, its mental health implementation plan and the new Community Mental Health Framework for Adults and Older Adults. 

  • 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.
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