Thousands of mental health patients still being cared for miles from home, despite Government pledge to end ‘harmful’ practice

by BMA media team

Press release from the BMA

Location: England
Published: Saturday 14 November 2020

An investigation by the BMA1 has found that thousands2 of acutely ill mental health patients are still being sent miles from where they live for treatment despite the Government pledging to end the ‘harmful and destructive’ practice by April next year.

The new findings come more than two years after the BMA first revealed how record numbers of ill patients were separated from families and local support services due to a lack of available beds in their local area.

The new analysis3 by The Doctor magazine4 found that of the trusts in England with comparable data between 2018 and 2020, almost half (47 per cent) had sent patients to what is termed, ‘out of area’ beds 100 times or more in the 12 months up to August 2020.

At least seven trusts (see notes to editors) doubled their number of out of area placements in the 12 months to August 2020 compared with the same period in 2017/18.

While there was some decreases across trusts, the number of inappropriate6 OOA placements increased in 38 per cent of the 40 trusts with comparable data between 2018 and 2020.*

The findings from Freedom of Information requests7 also revealed that very few of the Clinical Commissioning Groups which fund, and therefore set bed numbers, plan to increase local bed capacity – something which is very much needed if patients are to stop being sent miles from home for care.

The BMA concludes that it is now almost inevitable that the Government will miss its target of eradicating inappropriate6 out-of-area placements by April of next year – a commitment NHS England gave in its’ 2016 review of mental health care8.   

Now the BMA estimates that at least 1,000 extra beds for mental illness are needed in order to end this worrying practice with concerns that the impact of Covid-19 will only increase demand for beds.

As well as increasing the number of mental health beds as outlined above, the BMA is calling for:

  • A credible plan to recruit and retain more staff to build up the capacity of mental health services across the country
  • Stronger support for community mental health services
  • Greater analysis of high out of area placement use areas to inform the urgent development of CCG level plans to both increase capacity and strengthen community services
  • Trusts to ensure that the new NICE guidelines for complex psychosis (rehabilitation) are followed and that trusts have adequate rehab facilities for both community and inpatients

Commenting on the findings, BMA mental health policy lead Dr Andrew Molodynski said: “We are seeing nowhere near enough progress in ending the harmful and destructive practice of sending mental health patients out of area for treatment. This unacceptable and unnecessary practice causes distress to some of the most vulnerable in society, increases the risk of suicide and separates people from their friends and family when those bonds are most needed. 

“Despite mental healthcare leaders and providers all calling for an end to this practice for years now, the failure to invest in mental health beds and in good quality community care means the situation is as bad or even worsening in many trusts.

“Addressing this is even more urgent given the impact of the Covid-19 pandemic and the recession on the mental health of the population alongside an inevitable squeeze on public finances.

“It is absolutely crucial that the Government recommits to ending this practice by delivering on the much-needed extra beds and ensuring the optimum co-ordination of services before this spirals any further out of control. A moratorium on further bed cuts, given the damage done by reductions in recent years, is now essential alongside reprovision of both inpatient and community services where there are gaps.”

Dr Adrian James, President of the Royal College of Psychiatrists, said:

“People are much more likely to recover from their illness if they are treated close to home and near their family and friends.

“The Government is likely to miss its target of ending the practice of sending patients inappropriately out-of-area, but because of the pandemic we may not know how much they fall short by.

“NHS England deprioritised the collection of out-of-area data after the onset of Covid-19, meaning we currently do not know how bad the number is. The NHS must take action, make this data collection mandatory and ask those Trusts failing to share their numbers to do so.

“In the short term, areas with consistently high rates of inappropriate out-of-area placements should be given the resources they need to invest in beds that are properly staffed. In the longer term, community mental health services must be improved so that more patients can be treated in line with the commitments made in the NHS Long Term Plan.

“The new community framework for core mental health services gives some cause for optimism. Let’s hope the substantial promised investment reaches the frontline.”

Today’s findings come a year after the BMA revealed how NHS mental health rehabilitation wards have all but disappeared from many Clinical Commissioning Groups and NHS trusts in England, leaving as many as five million people in those areas effectively ‘warehoused’ in out-of-area private sector provision.

Ends

Notes to editors

The BMA is a trade union and professional association representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

  1. Investigation by The Doctor magazine is attached.
  2. There was a total of 6,935 out-of-area placements in England between 01 August 2019 and 31 July 2020. Some placements may involve the same patient.
  3. The Doctor carried out analysis of NHS Digital figures from July 2020 and July 2018.
  4.  Link to The Doctor magazine homepage.
  5. *NHSE deprioritised the collection of out-of-area data for COVID-19
  6. Inappropriate’ placements are defined as where patients are sent to a bed out-of-area for want of one locally.
  7. Regional findings available on request.

  8. The Five Year Forward View for Mental Health states that by 2020/21, out of area placements for acute care should be reduced and eliminated as quickly as possible.

  9.  

Mental Health Trust with 100 or more OOA placements in 2020

Placements 2018

Placements 2020

Increase

GREATER MANCHESTER MENTAL HEALTH NHS FOUNDATION TRUST

5

185

3600%

NORTH EAST LONDON NHS FOUNDATION TRUST

5

165

2100%

SHEFFIELD HEALTH & SOCIAL CARE NHS FOUNDATION TRUST

5

110

161%

BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS FOUNDATION TRUST

115

300

155%

SURREY AND BORDERS PARTNERSHIP NHS FOUNDATION TRUST

55

140

155%

DERBYSHIRE HEALTHCARE NHS FOUNDATION TRUST

110

240

118%

COVENTRY AND WARWICKSHIRE PARTNERSHIP NHS TRUST

50

100

100%