The government is facing growing pressure to reduce the number of acutely unwell mental health patients being sent away from their local areas for beds after official figures suggested at least one in seven patients are in ‘out of area’ hospitals.
Experimental data published by the health and social care information centre (HSCIC) showed that 14,300 patients were receiving non-specialist inpatient care at the end of May 2015. Of these, 2,107 patients, or 14.7%, were in ‘out of area’ beds – defined by the HSCIC as a bed at a hospital that is not the patient’s ‘usual provider’.
The figure, although the best official barometer of out of area bed use, is likely to be an underestimate as several private sector providers that provide overspill beds to NHS trusts did not return data.
NHS providers use external beds for routine admissions when their own inpatient units are full. The bed spaces are often purchased from private hospitals. Out of area beds are also used for specialist treatment that may be delivered on a regional-basis, but these placements are not included in the HSCIC figures.
‘Set target to reduce placements’
The HSCIC started collecting data on ‘out of area’ bed use earlier this year at the request of Norman Lamb, who was care minister at the time under the coalition government.
Lamb told Community Care he had grown frustrated at being told his department had no figures on the issue after the minister was alarmed by several media reports that more patients were being sent out of area for non-specialist care. He said sending patients in crisis far from home was “a serious failure of care” and claimed work carried out by the Department of Health (DH) prior to the general election suggested the practice could be ended within 12 months.
“In the department I said ‘I want us to set a target to end this practice by the end of this calendar year ’. We didn’t reach the end of those discussions before I Ieft. We asked [governance bodies] Monitor and the Trust Development Authority to do deep dives into a number of trusts to identify the root of this problem. The advice I received after that was that it ought to be possible to end this practice,” said Lamb.
“Now I’m on the outside, my challenge to the department and to NHS England, and trusts themselves, is to set an objective to end this within 12 months. There are some trusts that appear to demonstrate that it’s possible to achieve that.”
A DH spokesperson said the government wanted to reduce the use of out of area placements and Monitor, the TDA and NHS England were working with commissioners and providers on the issue.
The government will also consider the findings of two reviews of mental health crisis care – one commissioned by NHS England and one commissioned by the Royal College of Psychiatrists. Both reviews are due to report later this year.
Lamb’s comments come weeks after a leading suicide prevention expert called for an end to the use of out-of-area placements for acute admissions. Professor Louis Appleby, who heads up the national confidential inquiry into suicide and homicide, warned that sending acutely ill patients away from their local areas increased the risk of suicide post-discharge.
Mental health charity Mind supported Appleby’s call to end out of area placements for acute admissions.
Ending the practice would only be possible if patients could be accommodated locally. This would require NHS commissioners to ensure that they commissioned adequate bed numbers from local trusts. It would also need issues that contribute to delays in people leaving hospital, such as social care and housing provision, to be addressed.
Figures obtained by Community Care under the Freedom of Information Act found that the number of mental health patients sent out of area rose 23% last year. The figures marked the third year in a row trusts reported an increase in use of out of area beds. Patients faced journeys of up to 370 miles for beds in 2014-15 as local services struggled to meet demand
Lamb said it was concerning that the practice appeared to be increasing: “This is not good care. These are people in crisis being sent far from home and their communities. I get the impression that there is a real risk of people being out of sight out of mind.”
Asked why the use of out of area beds appeared to have grown during the coalition’s time in power, Lamb said a major factor was the “disadvantage” mental health had suffered in funding allocations from NHS commissioners.
The coalition’s introduction of the first ever mental health waiting time targets was a direct attempt to ensure mental health services get a fair share of NHS funding, said Lamb. The collection of official data on out of area placements would also allow greater scrutiny of which CCGs and providers were using out of area placements most, as well as identifying areas of good practice, he added.
A Department of Health spokesperson said: “We want to reduce the use of out of area mental health services and are working with the HSCIC to continue to improve the data we have about where out of area placements happen.
“Monitor, TDA and NHS England are working with providers and commissioners to better understand the pressures and find solutions to make sure there is enough capacity.”