HUNDREDS more NHS mental health beds are needed urgently in England to help end the “shameful” practice of sending severely ill patients far from home for treatment, says the Royal College of Psychiatrists.
The practice, known as out-of-area placements (OAPs), happens when there isn’t a local hospital bed for the patient to be admitted to. Allowances are made where this is for highly specialist care.
The Government has pledged to end all inappropriate adult OAPs for acutely ill patients by 2021 but despite intensive efforts progress on reducing that number has stalled. On July 31, 745 people were being treated inappropriately out of area, official figures show.
The impact on patients and their loved ones can be devastating, causing huge emotional damage and even setting back those patients’ recovery. It can also be challenging for staff.
Some patients are sent hundreds of miles away from home and the College has calculated that those patients travelled a total of approximately 550,000 miles in the past year – equivalent to going around the world 22 times.
The crisis follows years of bed cuts as part of a drive to treat more people with mental illness in the community, close to their family and friends.
The College supports this change but adult community-based mental health services have failed to expand to compensate for bed closures.
With demand for mental health care on the rise, mental health trusts have been caught up in trying to meet immediate demand rather than plan for the future.
While Government plans aim to address this in the long-term, the College wants mental health trusts struggling with high bed-occupancy and inappropriate OAPs levels to be given more properly-staffed beds now as part of a package of measures.
An independent report commissioned by the College, published this week, estimates that 1,060 more mental health beds are needed to reduce bed-occupancy rates to acceptable levels alone.
RCPsych president Professor Wendy Burn said: “Cuts in the number of mental health beds have gone too far and patients and their families are suffering as a result.
“It’s clear that some parts of England urgently need more properly funded and staffed beds. Hundreds more are needed.
“Trusts struggling with dangerously high levels of bed occupancy are being forced to send seriously ill people hundreds of miles away from their homes for care. That must stop.
“Beds are being closed to move resource to the community so that people can be treated close to friends and family and without having to leave their homes. The RCPsych agrees with that principle. But the reality in many areas is that beds have been lost and investment in community services is only now starting.
“As a result, precisely the opposite effect has been achieved with some severely ill patients sent hundreds of miles for care. We calculate that in total patients in England have been forced to travel 550,000 miles in the past year – or 22 times around the world.
“Steps taken so far to tackle this shameful practice have not worked and that’s why we’re calling for more beds – although of course we recognise this is only part of the solution.
“The NHS is gearing up for winter pressures in emergency departments and more money is rightly found to alleviate these. In mental health services we have year-round pressures and these need to be addressed now.”
For patients, having to travel many miles from home for treatment can be devastating.
Simon Rose, 49, was treated out of area when he was severely depressed and feeling suicidal and there was no NHS mental health bed available near his Alfreton, Derbyshire home. He was sent to an NHS-funded bed at a private hospital in Harrogate, which is 80 miles away.
His wife, Janine, had just given birth to their daughter Louisa, who was only two months old when he became ill. He was in hospital for 14 weeks.
The father of four, who now works as a lived experience educator for Derbyshire mental health trust, said: “It was a nightmare being so far away from my wife and new baby and it definitely set back my recovery.
“My community psychiatric nurse couldn’t come up to Harrogate so I had to be well enough to travel back from Harrogate to Derbyshire on the train to start thinking about being discharged from hospital.
“The strain on my family was horrendous. My wife was trying to cope with having a newborn baby at a time when I was not just severely ill, but physically absent. They wanted to visit me regularly in hospital, but it was a two-hour drive, so that was impossible to do often.
“Being so far away and struggling to communicate properly hugely increased her worry and made it difficult for her to feel part of what was happening. And as older parents, our local support network was very limited.”
In 2016 a report by Lord Crisp called for a systemic assessment of demand for mental health care in each part of the country and the development of services to match that demand.[i]
Last year the College commissioned independent research by The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit (CSU) to review the provision of acute inpatient psychiatric care for adults.
Their report identifies 13 areas that are particularly struggling to manage levels of demand with the available bed capacity.
Those with persistent challenges with inappropriate OAPs are:
- Bristol, North Somerset and South Gloucestershire
- Hampshire and the Isle of Wight
- Lancashire and South Cumbria
- Norfolk and Waveney
Those with persistently very high bed occupancy are:
- Birmingham and Solihull
- Mid and South Essex
- North Central London
- South East London
- Sussex and East Surrey
In addition to the extra beds, as part of a co-ordinated approach the College is calling for:
- a national programme to support mental health providers to ensure time spent in hospital has clear clinical objectives and value and that all mental health trusts undertake local assessments of the demand for services in their area and make changes to their services accordingly (based on a Quality Improvement approach)
- continued investment in high-quality community mental health services in line with Long Term Plan and the new Community Mental Health Framework for Adults and Older Adults.
In January, the Government unveiled its NHS Long Term Plan which pledged to “set clear standards for patients requiring access to community mental health treatment and roll them out across the NHS over the next decade”.[ii]
In June, NHS England wrote to the regional directors of 10 NHS mental health trusts demanding they take action to address the level of inappropriate OAPs in their area.[iii]
In March 2017, it announced that 150 new inpatient beds for children and young people with mental health problems would be available by this year.[iv]
The College recommends a maximum bed occupancy of 85% to allow wards to run smoothly and be able to cope with a sudden influx of patients.[v]
In Scotland, the national bed occupancy rate is around that level.
Between 1987-88 and 2018-19 the number of NHS mental health beds in England was cut from around 67,000 to 18,400.[vi]
Notes to editors
- Interviews with College spokespeople and case studies are available on request.
- A copy of the NHS Midlands and Commissioning CSU report is available on request.
- It was commissioned by the College in December 2018 and found that 1,060 additional beds would be required to deliver 85% occupancy rates in all Sustainability and Transformation Partnerships.
- It broke down the 13 problematic areas identified in its report into two categories. The first was those areas that have had persistent challenges with inappropriate out of area placements – defined as consistently having three or more such cases a month per 100,000 weighted population. The second was those areas with persistent challenges around bed occupancy – defined by the independent researchers as consistently over 95% occupancy in the NHSE beds data.
- The areas in question are Sustainability and Transformation Partnership areas.
- This is how we calculated the 555,000 miles figure for inappropriate OAPs in a year: NHS Digital publish monthly reports on Out of Area Placements, which include data on the distances travelled by patients subject to an inappropriate out of area placement over the past month, quarter and full year across a range of distances (‘less than 25km’, ‘25km or greater and less than 50km’, ‘50km or greater and less than 100km’, ‘100km or greater and less than 200km’, ‘200km or greater and less than 300km’, ‘300km or greater’). The calculation of distance travelled was based on the middle distance for each interval and is based on a one-way journey for each placement. It was calculated for the 8,640 inappropriate out of area placements that were active at any point across England between August 2018 and July 2019, using the most recent NHS Digital data.[vii]
About the Royal College of Psychiatrists
- We are the professional medical body responsible for supporting over 18,000 psychiatrists in the UK and internationally.
- We set standards and promote excellence in psychiatry and mental healthcare.
- We lead, represent and support psychiatrists nationally and internationally to governments and other agencies.
- We aim to improve the outcomes of people with mental illness, and the mental health of individuals, their families and communities. We do this by working with patients, carers and other organisations interested in delivering high-quality mental health services.