NHS mental health trusts are sending a growing number of patients to out-of-area hospitals up to 300 miles away from home as demand for hospital care outstrips local bed capacity, an investigation by Community Care and BBC News has found.
We found that on some days the pressure on the mental health crisis care system reached the point that trusts struggled to find beds anywhere in the country, a situation that led to one patient who was not hearing impaired being admitted to a deaf unit.
Data obtained under the Freedom of Information Act from 30 of England’s 58 NHS mental health trusts revealed that the number of patients sent to out-of-area hospitals rose 33% last year and has more than doubled since April 2011. Acutely unwell patients are being sent up to 300 miles for care, with trusts spending millions buying bed space at private hospitals due to NHS units being full.
Sending people out-of-area can be appropriate in cases where patients need highly specialist services that aren’t provided locally. Yet trusts that had sent more patients out-of-area said rising demand for inpatient admissions, not specialist need, was often the driving factor.
Social workers said being sent long distances for care was distressing for patients, damaged continuity of care and made it hard for families and care teams to visit. Leading charities have called the situation scandalous and a disgrace.
‘I was taken at 3am in an ambulance. It was a bit of a shock. Not being near friends and family I suffered. I had anxiety, I wanted to speak to people and have familiarity around me’ Alison*, who was sent 200 miles for care
Our investigation found that:
- More patients are being sent out-of-area: The trusts had sent 3,024 mental health patients out-of-area in 2013-14, up 33% from 2012-13 and more than double the 1,301 sent in 2011-12.
- Patients are being sent up to 300 miles away for care: We found several examples of patients being sent to hospitals over 200 miles away from their local areas (see above). The furthest was 300 miles – the distance Devon Partnership Trust sent patients to a private hospital in East Yorkshire. The trust said it had managed to “significantly reduce” the number of people it was sending out-of-area in recent years but acknowledged long distances had “a huge impact” on patients and their families.
- The situation is costing NHS trusts millions: Of 23 trusts that provided costing data, spending on out-of-area beds rose from £21.1m in 2011-12 to £35.5m in 2013-14. Kent and Medway Partnership Trust saw its spending on out-of-area beds rise from £140,000 on care for 20 patients in 2011-12 to £4.9m on care for 334 patients at private hospitals in 2013-14. The trust said it had seen an “unusually high” demand for inpatient care last year and was in the process of increasing its local bed base. Lancashire Care NHS Foundation Trust saw its spending on out-of-area beds rise from £93,000 on care for 36 patients in 2011-12 to £3.1m on care for 218 patients in 2013-14. The trust said it was working with commissioners on bed capacity.
- On some days no beds are available in the country: In some cases the pressure on the system was so severe that trusts could not even find appropriate beds out-of-area for patients. One patient complained to Birmingham and Solihull mental health trust after she was admitted to a specialist deaf people’s unit due to there being no female mental health beds available in the country. The trust said it now had “a procedure in place that means this should not happen again”.
- Social care cuts are contributing to the problem: Cuts to housing and residential placements had led to problems discharging patients. One trust told us that at any one time around one in five of its inpatients was well enough to be discharged but waiting for appropriate accommodation to become available. Last week, the Health Service Journal revealed that problems discharging patients had seen one London mental health trust place scores of patients in bed and breakfasts to free-up beds.
In response to our findings, care and support minister Norman Lamb said out-of-area beds should be “a last resort” and said it was “unacceptable” that patients were being sent hundreds of miles for care.
“An inpatient bed is not always the best place for patients with an acute mental health problem, but beds must always be available for those that need them. Earlier this year we launched a crisis care concordat so that patients have the services they need when they need them. It makes clear that health-based places of safety and beds must be available 24/7 in case someone experiences a mental health crisis,” he said.
In March of this year social workers at the mental health trust that services Lamb’s north Norfolk constituency alerted the minister to the fact their approved mental health professionals could “no longer operate on a legal basis” due to problems accessing beds for patients. Last week, union officials began preparations to ballot members on industrial action after staff reported bed availability and the use of out-of-area placements had “worsened to a critical stage”. Our investigation found that Norfolk and Suffolk NHS Foundation Trust sent 90 patients out-of-area in 2013-14, compared to 22 in 2011-12.
Pressure on beds ‘a barometer for the system’
Mental health trust directors said the pressure on beds had been exacerbated by rising demand for care, which some trusts attributed to welfare cuts and the economic downturn.
Lisa Rodrigues, chief executive of Sussex Partnership Trust, where spending on out-of-area beds increased from £83,000 to £1.1m over two years, said: “One of the reasons that we think we’re seeing extended lengths of stay in hospital, which means we’re having to use out-of-area beds because our own beds are full, is because people don’t have access to the support in the community that they used to have.”
“Mental health services are a barometer of how the system is operating and if you remove some of the lower levels of support that people rely on to maintain their lives, it’s not surprising that they’ll present in crisis. We are seeing people coming to hospital who are much, much more ill when they are arrive so we have higher numbers of detained patients, but much more than that we’re seeing people have to stay in hospital for longer,” she added.
Southern Health sent 134 patients out-of-area in 2013-14, up from 0 in 2011-12. At a board meeting last month, a non-executive director raised concerns that the trust’s plans to close beds conflicted with the current strain on services. The same board papers state that the trust has seen “exponential demand” for care in the Southampton area and a rise in GP referrals.
Dr Lesley Stevens, the trust’s clinical director of mental health, said: “We do our utmost to make sure people receive treatment and support as close as possible to their homes and loved ones. In a minority of urgent cases it is necessary for people to receive care ‘out-of-area’. Whenever this happens, our aim is to return people to their homes, or a closer hospital, as soon as we can.”
Wider system pressures
The findings are the latest in a mounting body of evidence that England’s mental health services are struggling to cope with rising demand for crisis care.
In a series of investigations over the past year, Community Care has established that mental health trusts have closed over 1,700 mental health beds since April 2011; detailed how trusts have been hit by real-terms funding cuts from commissioners of an average of 2.7% that have left many community and crisis services overstretched, and exposed how local authority and NHS cuts to children’s services and commissioning failures by NHS England have led to serious problems in care for acutely unwell young people. Levels of stress among frontline mental health staff have also hit record levels.
The funding crisis facing services looks set to deepen after NHS England and Monitor imposed 20% higher cuts to the tariff prices paid to mental health trusts in 2014-15 than for acute hospitals, a move care minister Lamb has said is “unacceptable”.
Faye Wilson, chair of the British Association of Social Workers’ mental health forum, said national action was needed to address the failings in crisis care.
“These are hugely complex cases, people are at their most vulnerable, and they are being sent miles from their local teams and their families. Would you want that for yourself or your relative? It’s also costing a massive amount in resources that could be spent on improving local services,” she said.
“Serious issues with the system are being raised time and time again but it feels like there is a lack of anyone getting a real grip on the problems at national level,” added Wilson.
Paul Farmer, chief executive of mental health charity Mind, said it was a “disgrace” that people in crisis were being sent so far from their family and friends or being admitted to inappropriate settings.
“The government continues to make important and very welcome commitments to improving care but it is obvious that there is an increasing gap between the government’s good intentions and the reality for people trying to access services. Continued cuts to funding for mental health services are taking a significant toll on the quality and availability of services, meaning more and more people are reaching crisis point and need to be hospitalised,” he said.
“Meanwhile, some trusts are closing wards and reducing bed numbers at a time when they are seeing increased demand. The cuts are self-evidently a false economy but the real scandal is that services are failing people with mental health problems and putting lives in danger as a result.”