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Too many CCGs’ residential mental health placements are out-of-area

People in residential mental health rehabilitation are too far from home and in for too long

Louise Prime

Thursday, 01 March 2018

Almost two thirds of placements in residential-based mental health rehabilitation services in England are in different areas to the clinical commissioning groups (CCGs) that arranged them, the Care Quality Commission (CQC) reported this morning. It also revealed that three quarters of out-of-area placements are with independent sector providers rather than the NHS, and for a longer period, making them costlier for the NHS. It concluded that too many people could be being placed in residential mental health rehabilitation services that are far away from where they live, for too long and that are costly for the NHS. However, CQC found that independent providers’ quality of care was very similar to that of NHS providers.

CQC made a freedom of information request to providers. This showed that not only are 63% of placements in residential-based mental health rehabilitation services out-of-area, with 78% of these with independent sector providers; but also, that people in residential mental health rehabilitation services provided by the independent sector are, on average:

  • More likely to be further from their homes than those staying in NHS services – 49km compared with 14km.
  • More likely to stay there for longer – 14.5 months on their current ward compared with 7.5 months on their current ward in a NHS service.
  • At a greater risk of having their aftercare compromised because the managers there are less likely to know which NHS trust would care for them following discharge – 99% of managers of NHS rehabilitation services were able to name the NHS trust that would provide their patients’ aftercare, compared with just 53% for independent services.

CQC reported that although the daily cost for residential mental health rehabilitation is similar for independent providers and the NHS (£364 compared with £350), the longer stays mean that independent services can end up costing twice as much – a mean of £162,000 compared with £81,000. It estimates that out-of-area placements account for about two-thirds of the £535m annual spend on residential mental health rehabilitation.

The regulator has made several recommendations in its report, including that CCGs, NHS trusts and local authorities should review how appropriate their current placements are of patients in residential mental health rehabilitation services, so that, “They can be confident they are fully enabling patients’ rehabilitation and onward recovery”. It pointed out that NHS England’s Five Year Forward View for Mental Health stated in 2016 that people should not be cared for in restrictive settings for longer than they need to be, and that the NHS should expand its community-based services to support people to live safely as close to their homes as possible.

CQC deputy chief inspector of hospitals (lead for mental health) Dr Paul Lelliott noted that the independent sector and the NHS make a valuable contribution to the delivery of mental health rehabilitation. But he said: “We are concerned about the high number of beds in mental health rehabilitation wards that are situated a long way from the patient’s home. This dislocation can mean that people can become isolated from their friends, from their families and from the services that will provide care once they have been discharged.

“Also, we are concerned that our evidence shows that on average, people in out-of-area placements can end up staying in residential rehabilitation for twice as long as they would have done in a local NHS bed, which can increase their sense of institutionalisation, affect their onward recovery, and can be very costly.”

He insisted attention should now be on developing services that are focused on people’s recovery and that are not ‘long-stay’ wards in disguise, as well as being closer to home and well connected to services that will provide aftercare.

Sean Duggan, chief executive of the Mental Health Network, which is part of the NHS Confederation, commented: “We value the findings in the CQC’s report, which support our long-held belief that the Mental Health Act needs refreshing.”

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