New figures uncovered by the BMA show a startling rise in the number of mental health patients being sent out of area for treatment, with one patient from Somerset being sent to a care facility in the Highlands, 587 miles away.
The figures, provided by trusts and clinical commissioning groups (CCG) in response to Freedom of Information requests, found that 5,876 adults were sent out of area for mental health treatment in 2016/17, a rise of almost 40 per cent from 4,213 in 2014/15.
The findings also revealed that the amount spent on placing patients in out-of-area beds rose by 47 per cent from £108m in 2014/15 to £159m in 2016/17.
Patients sent away from home for treatment could expect an average round-trip drive of up to seven and a half hours to see friends and family. If relying on public transport, the average travel time to an ‘out of area’ placement could be as great as 13 hours.
The five trusts which sent the most adults out of area in 2016/17 were:
• Kent and Medway NHS and Social Care Partnership Trust – 586
• Barnet, Enfield and Haringey Mental Health NHS Trust – 410
• Manchester Mental Health and Social Care Trust – 372
• Norfolk and Suffolk NHS Foundation Trust – 359
• Oxleas NHS Foundation Trust – 316
The five greatest distances patients had to travel to receive care were:
• Somerset Partnership NHS Foundation Trust to NHS Highland – 587 miles
• Oxford Health NHS Foundation Trust to New Craigs Hospital Inverness – 532 miles
• Oxford Health NHS Foundation Trust to Cornhill Hospital NHS Grampian – 497 miles
• Dorset Healthcare University NHS Foundation Trust to Priory Middleton – 323 miles
• Leeds and York Partnership NHS Foundation Trust to Glenbourne Unit Berrisode – 312 miles
The investigation also found that Leicestershire, Derbyshire and parts of north London have been left with no NHS beds for female patients in need of intensive psychiatric care.
In response to the findings, NHS consultant psychiatrist and mental health policy lead of the BMA’s consultants committee Dr Andrew Molodynski said:
“The practice of sending patients with severe mental health problems to beds hundreds of miles away from their home and families has become endemic in the NHS. The government needs to get a handle on this situation because patients are being routinely failed by a system at breaking point, with tragic consequences.
“Being sent long distances for treatment has an impact on patients’ care and recovery. There have been tragic cases where coroners have ruled that the difficulties families have visiting a relative receiving care, as well as poor communication between hospitals in other regions and local mental health services contributed to deaths.”
An inquest in 2016 into the death of David Knight, 29, who had been treated at a hospital 150 miles away from his home in Cornwall recorded a verdict of suicide and coroner Dr Emma Carlyon wrote to NHS England calling for a review into the provision of acute mental health beds in the county.
The coroner’s report noted “…the fact that Mr Knight was being treated out of County would have increased the risk of poor communication between the community treatment teams as the hospital would have been familiar with local service and it was very likely that this had a bearing on Mr Knight’s death”1.
Commenting on the difficulty in sourcing out of area beds, Dr Molodynski said:
“When NHS beds are available patients can be admitted within hours but if there are no free beds in the local area doctors have to take time away from other severely ill patients to find a space, often resorting to private hospitals which, unlike their NHS counterparts, can refuse patients who have not been detained under section leaving doctors with ethical dilemmas. Patients then face long waits before being taken miles in locked ambulances to unfamiliar places.
“The huge distances often involved rules out regular visits from friends and relatives at a time in their lives when their support matters most.”
The BMA is calling for parity of esteem between physical and mental health services.
Dr Molodynski added: “It is easier to slash NHS mental health beds to keep waiting lists down in A&E and for routine operations than to address the scale of the problem, and the budget cuts just keep on coming.
“We would never tolerate a situation in which a stroke victim in Somerset had to travel to the Highlands for treatment, and yet this is the reality for some mental health patients. The fact that there are some areas of the country without any beds for some female patients is extremely concerning.
“The government says the endemic shortage of NHS mental health beds can be solved by improving community care, but this is naïve. While better community care is welcome, it will not ease the bed crisis completely.”
Notes to Editors
The British Medical Association (BMA) is the voice of doctors and medical students in the UK. We are an apolitical professional organisation and independent trade union, representing doctors and medical students from all branches of medicine across the UK and supporting them to deliver the highest standards of care.
You can find out more about the BMA's investigation, how this research was conducted and view an online map of all out-of-area patient journeys here
You can find out more about the BMA’s work on mental health here.
David Knight's mother, Julie Nancarrow, spoke with the BMA about her son's experience receiving mental health treatment hundreds of miles from home and the coroner's report into his death in 2014. You can watch the video here.
1. The coroner’s report stated: “The expert psychiatrists considered that although misjudgement about leave could occur in any hospital setting, the fact that Mr Knight was being treated out of County would have increased the risk of poor communication between the community treatment teams as the hospital would have been familiar with local service and it was very likely that this had a bearing on Mr Knight’s death”. https://www.judiciary.gov.uk/publications/david-knight/