Mental health patients requiring urgent hospital admission face long journeys − in some cases hundreds of miles − amid growing evidence of a shortage of beds, HSJ has learned.
Mental health bed shortage
A simultaneous reduction in beds and a rise in the number of mental health detentions means demand for beds often outstrips supply.
This has led to increased reports of trusts being forced to use out of area placements, in which patients are provided a bed outside their catchment area. These can often be with private providers and can cost more than £3,000 a week for patients with complex needs.
The number of beds available for mental health patients has suffered a sustained decline in recent years. NHS England figures show that from April to June 2013 there was an average of 22,109 mental health beds − a fall of 6 per cent on the same period in 2010 and 31 per cent on the 2003-04 level.
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There were 48,631 detentions in 2011-12 under the Mental Health Act, an increase of 6.4 per cent on the 2003-04 level. Care Quality Commission figures show 17,503 people were in mental health hospitals on 31 March last year, up 5 per cent on the same date a year before.
Meanwhile, data held by London’s 10 mental health trusts shows the number of beds across the city per 100,000 population has dropped from 51 in 2002 to 32 last month.
The shortfall is having a knock-on effect on emergency departments, in which mental health patients are forced to wait while a free bed is found.
HSJ has compiled a dossier of evidence cataloguing the extent of the problem. We discovered:
- There were no psychiatric beds available across London on at least two occasions during August.
- In July, one patient who waited over 12 hours in the emergency department at Royal Wolverhampton Hospitals Trust was eventually found a bed 100 miles away in Hertfordshire. Chief executive David Loughton subsequently referred to the “excessive removal of beds from mental health providers” in a report to his board.
- Manchester Health and Social Care Trust spent £1.7m in the first four months of 2013-14 sending 86 patients to a string of private providers, some as far away as Harrow in London − nearly 200 miles away. The trust said it had been “under-resourced for several years”.
- Hertfordshire Partnership Foundation Trust chief executive Tom Cahill has revealed his trust has received requests for placements from as far afield as Birmingham.
- A report to Milton Keynes Clinical Commissioning Group’s board in August highlighted the shortage of mental health beds for children and young people, which often led them to “be waiting in the hospital emergency department for quite some time until a bed is found”. It said they could be sent “some distance” away or admitted to a local adult unit.
David Monk, a partner at Symmetric Partnership, which is a consultancy used by London’s mental health trusts, said: “There are occasions when there are almost no beds available in the whole of London and there have been periods when you can’t find a bed anywhere across the UK.”
David Bradley, chief executive of South West London and St George’s Mental Health Trust, said: “We are seeing increased detentions and a larger number of first time presentations. There is more we could do if we could get more investment for community services but mental health has always been bottom of the pile. It is an easy target.
“It would be fair to ask: have we gone too far in cutting mental health beds? That is a debate we need to have.”
Health minister Norman Lamb told HSJ: “There is clearly, in some parts of the country, a shortage of beds.”
He criticised the sector for not using existing funds efficiently. Mr Lamb added: “There are many places with excessive lengths of stay; therefore we don’t have sufficient resource to provide beds for crisis care or for early intervention.
“Where action is taken to reduce the longer lengths of stay you can free up resources for those early interventions.”
- Acute care
- MANCHESTER HEALTH AND SOCIAL CARE NHS TRUST
- Mental health
- NHS Milton Keynes CCG
- Norman Lamb
- Patient experience
- Patient safety
- SOUTHWEST LONDON AND ST GEORGE'S MH NHS TRUST
- THE ROYAL WOLVERHAMPTON HOSPITAL NHS TRUST
- THE ROYAL WOLVERHAMPTON HOSPITALS NHS TRUST
- World Mental Health Day