Government efforts to improve care in the community will fail unless shortages of supported and secure accommodation are remedied, according a report.

Management consultants Mental Health Strategies says a third of trusts do not have access to sufficient numbers of low and medium-secure beds or 24-hour accommodation. It blames underfunding for failures to provide appropriate support to patients with serious mental health problems.

Bed blocking leads to the loss of 200,000 annual bed days, the equivalent of 30 wards, suggests its survey, which found that 13 trusts lost more than 1,000 bed days. Major causes of bed blocking were the absence of 'step-down' facilites or supported housing.

Over half the trusts surveyed found beds for patients using extra-contractual referrals within the NHS, but more than 40 per cent used the independent sector. HAs spent an average of 736,000 on ECRs for secure accommodation.

The report also highlights communication problems between HAs and trusts, and notes a 'suspicion among trusts that HAs do not fully appreciate the bed pressures they face'.

Forty per cent of health authorities had not carried out needs assessments for 24-hour nursed beds or for other forms of secure accommodation.

'This must be of concern since the government is making resources available for these client groups,' says the report, which surveyed all mental health trusts and received a 70 per cent response.

Salle Dare, Mental Health Strategies' senior consultant and co-author of the report, said she hoped the findings would prompt a national response.

'Health authorities will have to get to grips with this - but that alone will not solve the problems. It's a resource issue,' she said.

Shaping our futures: 24 hour nursed care, medium & low secure accommodation. Mental Health Strategies, Four Wharfside, The Old Boatyard, Worsley, Manchester M28 2WN. 10.