Surge in patients sent hundreds of miles for care

A 2021 date to stop “inappropriate out of area placements” was initially set by government and NHS England in 2016 but, despite inital reductions, the target was missed, with hundreds of patients still affected each month.

Demand and bed pressures in the wake of covid appeared to make it more difficult and numbers have been rising.  

Analysis of the latest NHS Digital data this month shows 825 active inappropriate placements in February 2024 following a steady rise from December 2023, when there were 700 (see chart).

The year on year increase from February last year is 15 per cent, but there has been a 46 per cent rise since a low of 565 just 14 months previously, in December 2022. 

Being sent out of area can disrupt the patient’s care, make it less likely patients will be visited, harder for them to return home and to community support, and is also often very expensive as places are bought at short notice from independent providers.

NHSE acknowledged pressures on OAPs in 2024-25 planning guidance but asked systems to “work towards” eliminating them, saying they are “detrimental to patient safety, experience and outcomes”. National mental health director Claire Murdoch last month told HSJ   they represented “poor care at relatively high costs”.

An OAP – when someone with acute mental health needs is admitted to a unit that does not form part of the usual network of services – is recorded as “appropriate” only in certain limited situations, such as safeguarding concerns or when someone becomes ill while away from home. If the reason is a lack of beds in their home area, it is considered inappropriate.

An NHSE spokesperson said: “Mental health services are committed to ending inappropriate out-of-area placements for patients as quickly and as safely as possible, and this year’s planning guidance asks systems to work towards eliminating them.”

They added: “While mental health services are being expanded and transformed thanks to additional funding of £2.3bn each year, there is no doubt they are under significant pressure, with community crisis services seeing a 30 per cent increase in referrals since before the pandemic, and delays in discharging patients who are clinically ready to leave hospital to places such as social care affecting how quickly patients can access beds.”

Centre for Mental Health CEO Andy Bell said eliminating them would require additional “investment in local mental health services”, with both capital and revenue, and added: “Being admitted to hospital far from home can make an already frightening and traumatic time even more difficult for someone, and extremely hard for their families and friends. Too often, people in beds far from home lose vital contact with home, and get disconnected from their local mental health services.”

Mind policy and campaigns manager Gemma Byrne highlighted other mental health statistics published last week also showing five-year highs, including the number of under-18 urgent referrals to crisis care teams (4,073) and the number of people detained under the Mental Health Act (21,527).

Ms Byrne said: “Stark trends like these have now become commonplace in mental healthcare. NHS staff are working tirelessly to support people, but there is a limit to what they can do when faced with decades of underinvestment and a surge in demand.”