One characteristic that differentiates acute mental health services from acute hospital services is the fact that we don't have inpatient waiting lists - essentially all of our adult admissions are emergency admissions.
This presents some perennial challenges. During peaks of demand, the use of out-of-area private sector beds can prove expensive and take a service user many miles from family, friends and the local services that know them.
When the care trust was created in Camden and Islington, there was a record of£1.1m each year being spent on private-sector beds. This year we expect to spend less than 20 per cent of that. The twin pillars that have delivered this improvement in financial efficiency and service-user experience are our bed-management policy and bed-management group.
To deliver the policy, the bed-management group meets every week, come rain, snow or shine, personally led by the medical director. The group includes key staff at director, manager and practitioner level, and leaves no stone unturned in the quest for better bed management.
For some time the group reported direct to the weekly executive meetings, but this was faded out as the issue moved from the top of the problem list to much nearer the bottom.
Our four crisis teams have a key role in gatekeeping access to beds. Before a service user is admitted to hospital, the crisis team must take a referral. Most referrals from accident and emergency generate a face-to-face assessment as to whether or not the crisis team can support the service user and provide an alternative to hospital admission. This happens on a 24-hour basis. The crisis teams also have a growing role in supporting earlier discharge.
The policy has the underlying principle that all service users requiring urgent admission to hospital will be found a bed in their local service. The service always endeavours to admit inpatients to the correct sector ward in the first instance.
If this is not possible, staff work to ensure that the admission is taken within the correct locality, with a commitment to place the inpatient on the correct sector ward within 72 hours. Each sector has a designated number of beds and they have the responsibility to manage their admissions and discharges within their bed base. This requires the sector consultant, lead nurse and community mental health team manager with the support of the crisis team to work closely together to ensure that the sector wards have capacity to take admissions.
Ward teams inform consultants and community mental health team managers of the bed state situation for their sector inpatients. Ward teams also inform the local site duty nurse about bed-management decisions on every occasion rather than making decisions in isolation.
This is all some distance from what Barbara Castle had in mind during her battle against private beds as health secretary from 1974-76, but in a funny sort of way, she might well have approved of quite a lot of this.
David Lee is director of strategic development at Camden and Islington Mental Health and Social Care trust.