The NHS remains “heavily reliant” on inappropriate out-of-area mental health hospital placements despite a government target to eliminate them by March 2021, psychiatrist leaders have warned.
People spent almost 206,000 days in such placements in England in the year since the target passed, at a cost of £102m to the NHS, found an analysis of NHS Digital figures published yesterday by the Royal College of Psychiatrists.
Despite some variation, rates have averaged 60,000 bed days per quarter since 2017, the year after the government set the target – which relates to placements where a person is sent out of area because of the lack of a local bed.
Placements increasingly far from home
And the college found the problem was getting worse in some respects, with the proportion of those in hospitals over 100km from home rising from around a quarter in November 2016 to over half in every month since July 2021.
Nine local areas were between them responsible for a majority of inappropriate bed days during 2021-22, the analysis found, demonstrating a “significant and consistent mismatch between local inpatient capacity and demand”.
In some areas, community and crisis services’ capacity constraints meant people who might otherwise not require inpatient admission, including people with learning disabilities or autism, were still being sent out of area inappropriately, the paper said.
It added that with mental health services under massive additional strain since the pandemic, the use of inappropriate out-of-area placements would persist unless “concrete and additional action” was taken.
‘Inhumane and costly’ scandal
College president Dr Adrian James said the failure to eliminate inappropriate out of area mental health placements was a “scandal”.
“It is inhumane and is costing the NHS millions of pounds each year that could be spent helping patients get better,” he added.
“No one with a mental illness should have to travel hundreds of miles away from home to get the treatment they desperately need,” James said. “The health and social care system, both on a national and local level, must urgently come together and make sure no one ever has to.”
The college called for a “national plan” to address the issue, with ending inappropriate out-of-area placements becoming a key performance indicator for new integrated care boards, which take over responsibility for NHS commissioning next month.
‘Commissioners must be held to account’
“Commissioners must understand that investing locally, even if difficult, is always preferable to sending patients hundreds of miles away,” said the college briefing note.
It said investment must be “channelled towards those interventions that will enable more patients to access treatment close to home”, on the back of strategic needs assessments.
“NHS leaders must hold commissioners to account and offer additional support to those areas struggling with pressures that are insurmountable without central support, working with government to ensure they have the resources they need to get out of their ‘beds trap’,” it added.
James said it was crucial understand what was driving the practice in different parts of the country and to invest in local, properly staffed beds, alternatives to admission, and follow-up care in the community.
“Central to this is government backing to address the workforce crisis that continues to plague mental health services,” he said.
The college called on the government to fund an expansion of medical school places and psychiatry training posts. The organisation’s 2021 census found that about a tenth of consultant psychiatrist posts were not filled.
“In the short term, services will need to explore evolving their staffing mix to make the most of the multidisciplinary team and ensure posts across both inpatient and community services are able to attract and retain staff,” the new analysis said.
‘We would not allow this for physical health’
Responding to the briefing paper, NHS Providers described placing patients out of area as a “last resort” for the trusts it represents.
“It is unacceptable trusts do not have the resource they need to stop this happening, and this lack of investment underlines stigma around mental health,” said interim chief executive Saffron Cordery. “We would not allow this to happen routinely for physical health and we know it leads to a poorer patient experience and often slower recovery.”
Cordery said trusts were working hard to limit the number of out-of-area placements and were making progress in the face of challenges.
“While any out-of-area placement is one too many, the latest data shows that there has been improvement in the number both in the last month and when compared to the same time last year, and also 20% fewer than pre-pandemic,” she argued.
The Department of Health and Social Care (DHSC) said that Covid-related pressures had contributed to services missing the 2021 target to eliminate inappropriate out-of-area placements.
“Everyone should have access to safe, appropriate mental health care and we recognise the impact that receiving care far away from loved ones can have,” a DHSC spokesperson said. “That’s why we are investing an extra £2.3 billion per year to transform NHS mental health services by 2024, meaning more people will be able to receive care as close to home as possible.”