Recent analysis from the Royal College of Psychiatrists has found that patients with acute mental health needs continue to be sent miles away from home because there isn’t a bed available locally.
From October-December 2021, the number of inappropriate Out of Area Placements (OAP) days was 58,735. There were 660 active inappropriate out of area placements at the end of December. Nearly 80% of inappropriate placements that ended in December lasted for 15 or more nights while 44% for 31 or more nights.
It is a practice which cost the NHS £120m last year and can harm patients by increasing their distress, separating them from their family and slowing their recovery.
The Government promised to end adult mental health inappropriate out of area placements by the end of 2020/21. Despite ongoing efforts to expand community services and to reduce the number of new inappropriate out of area placements, progress on reducing the total number of bed days spent out of area has stalled.
Dr Trudi Seneviratne, Registrar of the Royal College of Psychiatrists, said:
"Sending mental health patients hundreds of miles away from home, because there isn't the right bed available locally is completely unacceptable. It can have a devastating impact on patients and their loved ones. Treating patients close to home speeds up recovery, reduces the risk of suicide and shortens hospital stays.
"Out of area placements are not only devastating for patients, but are also costly for the health service, which spent £120.653 million on inappropriate out of area placements last year.
"Despite some areas of progress, it is extremely disappointing that the promise to eliminate the shameful practice of inappropriate out of area placements in mental health by March 2021 has been broken. We need urgent action to ensure that local mental health beds are readily available for all patients that need them. In some areas that are really struggling, this will mean funding for additional beds that are properly staffed.
"To reduce overall pressure on beds the government must also continue the welcome investment and development of community mental health services so that people can get the right support earlier on, reducing the likelihood of reaching crisis point."
Reasons for Out of Area Placements
There are numerous factors driving inappropriate out of area placements, these include:
- Over the last 30 years, the total number of inpatient mental health beds has fallen by over 70%, as the focus shifted towards offering mental health care in the community. While an increased focus on community care is to be welcomed, capacity has not grown to match demand and patients are now left waiting or facing/ travelling long distances to receive the treatment they need.
- A relatively small number of mental health trusts are responsible for a significant proportion of inappropriate out of area placements, meaning they consistently lack the capacity to meet local demand.
- Finding pathways to reduce the length of long term inpatient stays as per the NHS Long Term Plan would free up some capacity, but likely not enough to reduce bed-occupancy levels to acceptable levels on its own.
Complex problems require complex solutions. The following have been identified as key interventions to drive down the harmful practice of inappropriate out of area placements:
- Continue to invest in the expansion of community services so that fewer people will reach crisis point and need hospital admission. This investment needs to be in line with post-pandemic demand.
- Invest in alternative or additional step-up and step-down care that prevents avoidable inpatient admission and supports people to be discharged as quickly as possible once medically fit to do so.
- Targeted investment in areas that consistently have insufficient inpatient capacity to meet demand, to provide additional, properly-staffed beds.
- Action to improve the therapeutic value of inpatient admission, so that people are supported to get better more quickly, and are less likely to be re-admitted.
- Where patients are sent out of area, it is absolutely vital that there is a proper care plan, discharge planning and concrete support for carers to continue visiting their loved ones.
Royal College of Psychiatrists analysis of out of area placements data
There were 725 OAPs active at the end of December, 91.0% of which were inappropriate.
660 cases were therefore inappropriate. This is the second-highest number since May (685) but is also lower than December 2020 (also 685), albeit with the caveat about the continued challenge regarding participation (74% in this month, 86% in December 2020).
Across the period from October-December 2021, the number of inappropriate OAP days was 58,735. This is 3.4% lower than the number for October-December 2020 (60,775) but also slightly higher (1.2%) than the previous rolling quarter of September-November 2021 (58,060).
- 260 new cases were recorded in December that were the result of an unavailable bed, varying from 20 in the South East and South West to 50 in London, Midlands and North East & Yorkshire. Meanwhile, 275 such OAPs also concluded in the month.
- 84% of OAP days involving unavailable beds had costs recorded. On the basis of this, the total reported financial impact for December was £10.068m and over the past twelve months, the total cost was £120.653m.
- Of the OAPs active at any point during December that were the result of bed unavailability, 76.1% involved distances travelled of 50km plus or 56.3% involved travelled distances of 100km plus. There remains regional variation in the proportion of cases involving distances of 100km plus, with the percentages varying from 27.8% in London to 67.9% in the Midlands and East combined.
- Among the OAPs that ended during December and were the result of bed unavailability, 77.8% lasted for 15 or more nights (the highest percentage on record and 12.5 percentage points higher than December 2020). 44.4% had lasted for 31 or more nights (second highest on record and 14.6 percentage points higher than December 2020).
- Inappropriate OAP days per participating sending provider where beds are unavailable varied from 270.0 in the South to 844.5 in the North. The North had its highest number of days to date – 9,290 – despite five of sixteen providers not submitting data this month.
Statistics used in this news story were taken from the latest Out of Area Placements in mental health services report by NHS Digital, which provides data for December 2021. The data can also be examined in more depth on the College's Mental Health Watch website.