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Government waters down out-of-area beds pledge

child sitting on bench
LOST BOYS: Children with mental health problems face lengthy journeys to receive care

The Government has been accused of ‘smoke and mirrors’ after changing the definition of out-of-area beds for vulnerable children with mental health problems.

It means children and adolescents can travel more than 200 miles from home – such as from Cornwall to Gloucestershire – but still be classed as ‘in area’.

The definition, unearthed as part of a series of BMA Freedom of Information enquiries, is based on the 10 NHS English regions. It was previously similar to the one used for adults, and resulted in smaller geographical areas.

BMA consultants committee deputy chair and child and adolescent psychiatrist Gary Wannan said: ‘Patients and their families who are forced to travel for hours and hours to hospital will not have their beds counted as out of area. This is a very real harm that is not being accounted for.

‘It can be an incredible wrench for children to leave their homes and families; being based far away is not going to help a young person in crisis.’

In a 2014 report, NHS England defined OOA (out-of-area) placements as those ‘where young people are harmed by the distance and disconnection from local services, family and friends’.

In 2015, this was changed to one based on ‘commissioning hubs’, which have the same boundaries as NHS regions.

Using NHS regions – which encompass several English counties and many clinical commissioning group areas – inevitably means that placements that previously would have been well out of area, are no longer defined as such.

And yet, earlier this year, NHS England gave a statement to the BMA and the media in which it said it had actually ‘toughened up’ the definition for CAMHS (children and adolescent mental health services).


Visiting rights

For adults in mental healthcare, the definition of an OOA placement is, in contrast, based on whether a connection can be sustained with the patient’s home area.

It says OOA placements are where ‘the person cannot be visited regularly by their care coordinator to ensure continuity of care and effective discharge planning’.

This suggests not only that mental health services lack – to quote the Government’s stated ambition – ‘parity of esteem’ with physical health, but within mental health services themselves there is further inequality concealed by changes in the way statistics are presented.

The Government has said it will eliminate CAMHS OOA placements by 2021, but Dr Wannan said: ‘It’s simply shocking that this measure is looser for children and young people than for adult patients.

‘We can have no confidence in NHS England’s drive to end this practice until the definition is completely revamped.’

Under the new definition, 1,365 children and adolescents were admitted to beds outside their region in 2016-17. But of these, less than half – 627 – are deemed by the Government to be for ‘capacity reasons’ and therefore officially ‘out of area’.

Among those excluded from the figures are more than 200 where information has not been supplied by the local NHS. So the number of OOA placements caused by lack of beds, even under the new and much broader definition – could be higher than the official figures suggest.

Other patients who were treated out of area but part of what NHS England calls a ‘planned clinical flow’ are also excluded.

Dr Wannan said: ‘Doctors welcome the Government’s ambition to end OOH placements but this way of keeping track of the problem is all smoke and mirrors.'

A spokesperson for NHS England said mental health services for children were ‘expanding at their fastest rate in over a decade, including new and enhanced eating disorder teams with shorter waits for specialist care, and a major increase in specialist inpatient facilities for underserved parts of the country’.

He added: ‘Improving mental health care for children and young people is an absolute priority for the NHS and although transformation won’t happen overnight work is well under way to make sure the right care is available at home or as close to home as possible.’

Read the BMA News feature on OOA beds 'Far from hope, far from home'

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