Daily Insight: A long way from home

Rising numbers of vulnerable people needing mental healthcare are being sent hundreds of miles from home, with one trust sending dozens up to 300km (186 miles) in a single month, according to HSJ analysis.

Ten trusts were responsible for more than half of “inappropriate” out of area bed days for adults in July, HSJ revealed yesterday.

The use of such placements has long been criticised and is considered to contribute to poor outcomes and sometimes harmful hospitals stays.

NHS England had set a target to eradicate the practice in all trusts by 2021 but failed to do so, citing covid-related pressures. It has spent £97m on such placements in the past year.

Fears over poor quality of NHS and private units, staffing pressures and bed closures are among contributing factors to rising placements cited by trusts.

The adult figures may also only be the tip of the iceberg, as many of the 10 worst-hit trusts said they were also struggling to find beds for children and young people.

NHSE is still working towards a goal to eliminate placements but said the pandemic had led to a significant increase in service pressures, bed closures, staff absences and higher levels of need.

NHSE also cited increase in length of stay and social care pressures as reasons for not reaching the goal.

Cleaning contract gets messy

Infection prevention control will be as challenging as ever this winter, with bed occupancy rates already running hot – and a few trusts may want to check their cleaning contracts after news this week from Cambridgeshire.

We reported that North West Anglia Foundation Trust had publicly accused its contractor of failing to meet nationally set cleaning standards – and that this had contributed to a “large spike” in hospital-acquired infections.

But outsourcer Medirest, part of the Compass Group, told HSJ that, while it was not cleaning to NHSE’s 2021 cleaning standards, it was cleaning “to the contractual cleaning standards set by Peterborough City Hospital”.

Whatever the contractual technicalities, one thing appears clear: Peterborough City Hospital is suffering from higher C difficile rates than usual, and with bed occupancy set to rise in the coming months, the hospital and its contractor need to sort out their differences quickly.