Mental health trusts are spending millions of pounds placing growing numbers of patients in private services miles from their home, a Community Care investigation has revealed.
Data obtained under the Freedom of Information Act from 23 of the 58 mental health trusts in England revealed that the number of patients funded for out-of-area care at private services rose by a third (32%), from 1,103 in 2011-12 to 1,452 in 2012-13.
A quarter of these trusts had increased their expenditure on private sector placements over the same period with a total outlay of £24.6m in 2012-13.
Social workers warned that sending patients miles from their support networks due to local bed shortages exacerbates distress. But mental health trusts defended the placements as necessary for providing “safe and effective care” when demand for beds outstrips capacity or where specialist services are not available locally.
Avon and Wiltshire Mental Health Partnership NHS Trust spent £2.7m on private sector out-of-area placements in 2012-13, up from £1.8m in 2011-12. The trust closed four wards, reducing bed numbers from 634 to 568, over the same period.
In a statement, the trust said that out-of-area placements were used when necessary services were unavailable locally and when demand for psychiatric intensive care beds “exceeds available capacity”. “The return to trust services of such patients is given high priority,” a spokesperson said.
Kent and Medway NHS and Social Care Partnership NHS Trust spent £994,666 on private sector out-of-area placements in 2012-13, seven times the £140,770 spent in 2011-12.
“Spikes in demand for inpatient beds” meant that the trust had to use out-of-area placements to ensure it provided “safe and effective care,” a statement said.
Camden and Islington NHS Foundation Trust, which saw 90 inpatient beds cut after six wards were shut in late 2011, increased its spending on private sector out-of-area placements from £933,330 in 2011-12 to £1.5m in 2012-13.
A surge in demand in spring and autumn 2012 lay behind the increase, said a trust spokeswoman. “Usage of private sector placements has reduced since November 2012,” she added.
Joe Godden, professional officer at the British Association of Social Workers, said the growing use of out-of-area placements was a concern.
“People are removed from their communities and support networks. There are many occasions where intensive, community-based support would be a better alternative to hospitalisation, but these facilities are so often non-existent or not sufficient,” he said.
Many residents at Winterbourne View had been admitted for out-of-area placements under the Mental Health Act, said Godden. “The consequences of sending people miles from home and out of sight haunt us still,” he added.
One mental health social worker based in London said his mental health trust regularly sent patients who had been detained under the Mental Health Act to a private hospital over 50 miles away due to bed shortages. He said the trust often uses providers out of London because bed fees are “cheaper”.
“I just think for patients it is a disgrace,” he said. “If you’re sectioned, you’re distressed, and then you’re shipped off – how is that therapeutic? How are your family going to access you? You’re isolated.”
The data on the direct expenditure by the 23 mental health trusts is only a part of the total NHS and social care outlay on private sector out-of-area placements for mental health patients.
Arrangements set out by NHS and social care commissioners over who is responsible, and pays, for out-of-area care for different patient groups – such as forensic, learning disabilities and CAMHS - varies locally. Definitions of what constitutes ‘out-of-area’ can also differ.
Rebecca Cotton, acting deputy director at the NHS Confederation’s Mental Health Network, warned that there are longstanding issues over the quality of data on out-of-area placements but said that clinical need was key to whether placements should be used.
“In some cases it is always going to be clinically appropriate to provide specialist treatment at a regional or national level, for example with specialist eating disorders. So we can’t fall into the trap of thinking that every time someone has to travel to a specialist service then that’s necessarily a bad thing,” said Cotton.
“But at the same time, where people don’t have really specialist needs and they want to be treated near home then we have to make sure that the right types of services are commissioned locally.”
A spokesperson for Partnerships in Care, a private provider that runs 23 hospitals across the UK, said that its services took steps to promote family and friend support for patients placed out-of-area.
“We encourage family to visit the patient within six weeks of admission and in some cases offer practical help to make this possible,” the spokesperson said.
The company said it had seen a reduction in the number of NHS-commissioned out-of-area placements in some areas, particularly in the midlands and north west of England. Independent sector providers worked in partnership with the NHS to provide “highly specialist care that would be difficult to provide” in generic settings, the spokesperson added.
Private provider Cygnet Healthcare said that a reduction in NHS bed capacity had been one of the “main drivers” behind a 30% increase in the number of service users the company has supported since 2011-12.
“We’re delighted to be able to ensure that services are available to those who need them and are working more closely with the NHS than ever; including the development of new and innovative formal partnership arrangements,” a Cygnet spokeswoman said. “We provide very specialised services to NHS users, and work hard to ensure that service users can be as close to home as possible.
Andy McNicoll is Community Care’s community editor