• NHS England has said some of the Care Quality Commission’s recommendations were “implausible”
  • Other CQC recommendations would need to be tested for feasibility, NHS England says
  • CQC called for a national plan to combat patients being locked in rehab units miles away from their homes
  • Report also raised concerns about the distance patients were being sent, lengths of stay and costs of the services

NHS England has branded one of the Care Quality Commission’s key suggestions for tackling the problem of locked rehabilitation for mental health patients as “implausible”.

The national body was responding to the CQC’s new report about residential rehab placements which was published today.

The regulator flagged up concerns about the distance patients were being sent, their length of stay at these units, and the cost of the placements.

It called for national bodies to draw up an action plan to tackle the problem, setting out a series of recommendations for commissioners, providers and sustainability and transformation partnerships.

But NHS England today responded by saying any uncosted plans would need to be tested for workforce feasibility, capital requirements, and affordability.

A spokesman for NHS England told HSJ: “The thrust of this report is sensible, with two important caveats.

“Any implication that every CCG needs to build or host its own local specialist rehab facility in order to avoid triggering the CQC’s own definition of an ‘out of area’ placement is implausible.

“Just as for specialist physical health services, not all specialist mental health services can or should be located in all 207 CCG areas.

“Second, the NHS already has a carefully planned and costed set of mental health improvement goals through to 2020.

“Before any new uncosted demands are placed on mental health providers and CCGs, including from this report, they would need to be rigorously stress-tested for their workforce feasibility, capital implications, and affordability, and rolled out in a planned and clinically safe way.”

The national commissioning body also stressed that having refreshed the planning guidance last month, it was not going to be adding to that just a few weeks later.

The CQC raised concerns last year about out of area treatments, particularly for patients in locked rehab wards, the majority of which are run by independent providers.

In its new report the regulator 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 a year is spent on residential rehab, of which approximately £353m is for placements out of area, mainly by clinical commissioning groups.

The CQC said a national action plan should: 

  • Ensure regions know how many places they commission, the cost, and how many
  • 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.

NHS England said that if more NHS alternative sites were needed, it would require capital and take some years.

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

A CQC spokesman said the review was a collaboration between the watchdog, NHS England and NHS Improvement, including discussions with the national clinical director for mental health, Professor Tim Kendall and the director of mental health for NHS England, Karen Turner.

He said its recommendations had been accepted by the health secretary and were entirely consistent with the intentions of the Five Year Forward View.

He added: “As our report makes clear, the evidence behind our concerns around dislocation extend beyond ‘out of area placements’, a term that is widely recognised in the mental health sector.

“Our focus is on the impact that being placed in locked services that are far from home and for long periods of time can have on the recovery and wellbeing of people with serious mental health problems.

“As the quality regulator, we will continue to speak out in people’s best interests and we will do everything we can to ensure they receive safe and high-quality care that meets their needs.”