• CQC reports on “alarming trend” of mental health locked rehabilitation
  • Finds long stays, a long way from patients’ home areas, at substantial cost
  • Says DHSC and national officials must take action

The care watchdog has called on government and national officials to draw up a plan to address the “alarming trend” of patients being locked in rehabilitation units miles from home.

The Care Quality Commission today publishes the findings of its investigation into mental health rehabilitation inpatient services, after it raised concerns last year about out of area treatment, particularly for patients in locked rehab wards.

The majority of locked rehabilitation placements are with independent providers.

The watchdog found that residential rehab placements in the independent sector were nearly twice as long as similar placements in the NHS, more than three times as far away, and twice as expensive.

It estimates that £535m is spent a year on residential rehab, of which approximately £353m is for placements out of area, mainly by clinical commissioning groups.

The CQC’s report calls for the Department of Health and Social Care, NHS England and NHS Improvement to draw up an action plan to tackle the problem.

Among other things it says the plan should:

  • Ensure regions know how many places they commission, the cost, and how many; and
  • Require each sustainability and transformation partnership to develop a plan to repatriate patients, prevent new placements, minimise length of stay, and “innovate” in commissioning models.

The DHSC has said it accepts the recommendations. NHS England and NHSI t have not said whether they do.

A spokesman for NHS England and NHSI said work to eliminate out of area placements was underway as part of the Mental Health Five Year Forward View.

He added: “This will clearly need to ensure people in need of rehabilitation get this care as close to home as possible whilst recognising that it is unlikely that all CCGs will have access to such specialist services within their own geographies.”

CQC deputy chief inspector and lead for mental health Paul Lelliott said: “The attention now must be on developing services that are focused on people’s recovery and that are not ‘long stay’ wards in disguise, that are closer to where people live, and that are well connected to the wider local system including services that will provide aftercare.”

The report is based on an analysis of responses from 134 of the 141 mental health trusts and independent providers questioned about their rehab units in November last year.

Of the 311 residential rehab wards the CQC examined, 118 were locked and 85 per cent of those were in the private sector.

It found 63 per cent of placements in residential rehab services were out of residents’ home area, with three quarters of those (78 per cent) in the independent sector.

The review, carried out in collaboration with NHS England and NHSI, found independent sector stays averaged 14.5 months compared to 7.5 in NHS beds; and were on average 49km from residents’ home compared to 14km in the NHS. It said managers at private providers were about half as likely as in the NHS to know which trust would be responsible for aftercare; and while independent placements were not much more expensive per day, the longer length of stay meant the average annual cost was £162,000 compared to £81,000 in the NHS.

Royal College of Psychiatrists rehabilitation faculty chairman Rajesh Mohan said the problem stemmed from the “alarming” closure of NHS rehab services - falling from 130 in 2009 to 82 in 2015.

He added: “That’s why we’re calling on the government to reverse this alarming trend and ensure every part of the country has comprehensive inpatient and community rehabilitation services. That way, as many patients as possible would be treated locally.”