• NHS England has highlighted 10 trusts which are failing to reduce inappropriate out of area placements
  • National director Claire Murdoch says there is not “sufficient grip” on OAP outliers
  • CCGs will have their spending plans reviewed in order to ensure money is targeted at reducing OAPs

Ten mental health trusts have been singled out by NHS England for dragging down the national performance on mental health out of area placements, HSJ has learned.

In a letter to regional directors, NHS England’s national lead for mental health Claire Murdoch demanded action be taken and she warned future transformation funding would be denied if improvements weren’t delivered.

She told regional leads they must ”take urgent action” as the 10 trusts accounted ”for the majority of out of area placement activity” nationally.

She warned: ”I am not confident that we have sufficient grip on the handful of OAPS outliers across the country” and outlined plans for trusts to begin reporting on a monthly basis.

In her letter, dated 3 June, she told the regional directors ther poor performance by the small number of providers was causing “considerable concern not only within NHS England and Improvement, but to ministers at the Department for Health and Social Care”.

She told the directors: “The associated financial cost is extensive and unjustified in systems where the broader pressures on mental health services are significant”, adding that the activity in the 10 top worst trusts was not only consistently high but rising ”and is now offsetting progress across the rest of the country.”

She said it was critical that action was taken in the next six months if the NHS was to hit its target to eliminate inappropriate out of area placements in two years’ time.

An analysis of NHS Digital statistics by the Royal College of Psychiatrists has revealed a spike in inappropriate out of area placements during the last quarter of 2018-19, with the number of placements in March hitting the highest levels since August 2017. 

According to the data, Lancashire Care Foundation Trust and Devon Partnership Trust have the worst performance, accounting for just over 20 per cent of out of area bed days in March.

According to data for March 2019, the below trusts had the highest number of inappropriate OAP days in the month.

 Number of inappropriate OAP days in the period

England

24,265

LANCASHIRE CARE NHS FOUNDATION TRUST

2,430

DEVON PARTNERSHIP NHS TRUST

2,430

NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST

2,310

NORFOLK AND SUFFOLK NHS FOUNDATION TRUST

1,785

SOUTH LONDON AND MAUDSLEY NHS FOUNDATION TRUST

1,505

BARNET, ENFIELD AND HARINGEY MENTAL HEALTH NHS TRUST

1,180

SOUTHERN HEALTH NHS FOUNDATION TRUST

1,065

COVENTRY AND WARWICKSHIRE PARTNERSHIP NHS TRUST

960

BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS FOUNDATION TRUST

890

AVON AND WILTSHIRE MENTAL HEALTH PARTNERSHIP NHS TRUST

740

A spokesman for Lancashire Care Foundation Trust told HSJ: “We are in discussions with our commissioners to secure short-term rehabilitation beds and learning disability beds within Lancashire. We would point out that some of our patients who are classed as being out of area are actually in private sector provision within our locality.”

A spokesman for Devon Partnership Trust said: ”We know that we are around 45-50 adult mental health beds (or community alternatives) short in Devon, when we compare ourselves with other parts of the country, and this means that our inpatient services are often under pressure. We have, however, now received funding for a brand new adult mental health ward in Torbay and this will help to address the shortfall in bed capacity.”

Murdoch: CCG spending must be reviewed

NHS England has said CCG spending plans for mental health services must be reviewed in order to ensure they deliver reduced out of area placements.

In an annex to Claire Murdoch’s 3 June letter, she effectively said CCGs were spreading their investment too widely across adult SMI (severe mental illness services) which meant when aggregated nationally offered ”limited assurance that sufficient additional investment has been made in the specific services (as profiled in the LTP) that will support STPs to sustainably reduce OAPs.”

She added: ”We therefore recommend that regional colleagues review investment in the following adult subcategories that will enable the delivery of OAP reduction: A&E and ward liaison MH services, crisis resolution home treatment teams, community mental health and early intervention psychosis.”

NHS England revealed it plans to invest £281m across these services. Within this £134m will come from national investment and £146m will go into CCG baseline budgets.”

 

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