- Programme launched by NHSE in 2019 was expected to reduce readmission rates
- But proportion presenting at A&E within two months of discharge has actually increased
- Community transformation programme has had “minimal progress”
A ‘disappointingly slow’ transformation of community services means thousands of mental health patients are still presenting at emergency departments within weeks of being discharged from an inpatient facility.
Experts said an NHS England-led community transformation programme, launched in 2019 as part of a £2.3bn investment in mental health services, should have helped reduce readmission rates, but internal data seen by HSJ suggests the rates have actually increased since then.
The data reveals for the first time the proportion of patients discharged from inpatient care who then present to accident and emergency within two months. The cases were classed as mental health attendances, although some may have had physical health problems as well.
The proportion of adult patients was 11 per cent in 2018-19, when the investment programme was launched, and had increased to 12 per cent by 2022-23, representing around 6,000 adult cases.
The situation appears worse for children, with an 18 per cent readmission rate within two months, up from 17 per cent in 2018-19.
Jan Hutchinson, director of operations at the Centre for Mental Health charity, described the progress of the community transformation programme as “minimal” and “disappointingly slow” in reducing readmissions.
She added: “The numbers of people re-presenting to acute services suggest that community services are still lacking capacity to provide appropriate support. We hear that people are waiting too long for community appointments, and that issues such as being discharged to poor housing are contributing to relapse in their mental health.”
NHSE said mental health services are under “significant pressure”, with community crisis teams seeing a 30 per cent increase in referrals compared to before the pandemic, with urgent and emergency care services “treating record numbers”.
NHSE said evidence of reduced calls to crisis teams and A&E attendances were being seen in pilot sites which led the programme from 2019-20, with the national rollout coming the following year.
There was significant variation in readmission rates across the country, with the proportion of patients presenting in A&E within two months of discharge ranging from 6 to 16 per cent.
| Lowest readmission rates | 2022-23 | Highest readmission rates | 2022-23 |
|---|---|---|---|
| Cornwall Partnership Foundation Trust | 6% | Oxleas Foundation Trust | 16% |
| Berkshire Healthcare Foundation Trust | 7% | Southern Health Foundation Trust | 16% |
| Hertfordshire Partnership University Foundation Trust | 8% | Central and North West London Foundation Trust | 15% |
| Lancashire and South Cumbria Foundation Trust | 8% | Midlands Partnership University Foundation Trust | 15% |
| Leeds and York Partnership Foundation Trust | 9% | Solent Trust | 15% |
| Figures (unvalidated) are an average for 2022-23, showing the proportion of patients discharged from a mental health inpatient unit who then presented at A&E within two months | |||
Sean Duggan, chief executive of NHS Confederation’s mental health network, said: “Our members have been saying for a while now that workforce shortages are impacting on their ability to improve access and transform community services which have been overlooked for many years.”
Royal College of Emergency Medicine president Adrian Boyle said: “What I see with CAMHS patients is the long waiting lists make people get to a stage by which they end up coming to emergency departments, partly from a state of parental desperation. With the adults, it’s not quite so clear.
“We would absolutely support adequate investment for people in acute mental health crisis, because the alternative is that people end up in emergency departments, which is frequently the wrong place.”
The internal data also suggested the readmission rates within two weeks had remained at around 6 per cent since 2019, and around 7 per cent for children.
It also suggests less than 75 per cent of patients were followed up within three days of discharge in March 2023. NHSE has a target of following up at least 80 per cent of people within three days of discharge, as the risk of suicide is highest on the second and third days after leaving inpatient care.
‘Two days in A&E waiting for a bed’
Neil Howard took his own life last year after experiencing months of acute mental illness.
His sister, Linda Howard, described how in the months after her brother’s first stay as an inpatient at Atherleigh Park hospital – part of Greater Manchester Mental Health – he had struggled with the side-effects of new medication and experienced suicidal thoughts.
With nowhere else to turn, Mr Howard spent two days in Bolton Hospital A&E waiting for a psychiatric bed, only to be told there were none and was sent home. He tried again to be readmitted to Atherleigh Park, but was once again sent home because of a lack of available beds.
His sister said: “Neil texted me to say he was really struggling but the home team was still advising him to stay as an outpatient and continue with the medication despite it making him so ill and causing him to have suicidal thoughts again.
“He said all he could do was to follow their instructions and they said although there was a space inside Atherleigh House the week before, they didn’t think that was right for him.
According to Linda, Neil was also told he was unable to take part in “Think Wellbeing”, a talking therapy programme, as he was unable to access this alongside homecare services, which he was very upset about.
“Patients are clearly at their most vulnerable when changing medication but there wasn’t the appropriate support on hand.”
A GMMH spokeswoman said: “We express our deepest sympathies to Neil’s family and all who cared for him. We are unable to comment further until the inquest has concluded.”
Source
Internal data, interviews
Source Date
2022-23
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