Mental health beds shortfall puts patients at 'intolerable' risk

In a meeting last week the joint commissioning board for the three Birmingham and Solihull clinical commissioning groups proposed an additional £8.1m over two years to ease pressure on adult mental health beds.

The plan comes after details emerged of a critical independent report, highlighting “unsafe” practices, while one major provider warned it may not accept excess acute mental health inpatients if commissioners did not agree to fund them.

The difficulties emerged just over a year after a major shake-up of Birmingham mental health services went live, with the intention of improving mental health pathways for young people.

The changes involved transferring services for young adults to a new combined service for people aged 0-25, called Forward Thinking Birmingham.

The process was heavily criticised at the time, with one independent assessment, leaked to HSJ, warning that it could have “catastrophic” consequences for service users.

The new service was procured via a competitive tender by Birmingham South Central CCG on behalf of Birmingham and Solihull’s three CCGs.

A paper to the commissioning board in June said an independent report produced by Mental Health Strategies had “unearthed unsafe clinical practice due to a shortfall in bedded capacity” for adult mental health services.

The report was commissioned by Birmingham and Solihull’s mental health system strategy board, which is made up of local NHS leaders along with senior figures from elsewhere in the public sector.

The shortfalls in beds were “significantly worse than all other systems in UK” and placed “individuals and carers at increased and intolerable levels of risk”, the paper said.

For instance, Forward Thinking Birmingham was originally commissioned to provide 28 inpatient mental health beds for young adults. Instead, this service consistently has about 51 inpatients, leading to 20 young adults having to be placed “out of area” every month.

At Birmingham and Solihull Mental Health Foundation Trust, which retains the contract for older adults, bed day activity was also 50 per cent higher than originally contracted.

“Do nothing” could not be regarded as an acceptable option, the independent report said.

Birmingham Women’s and Children’s FT board papers showed the trust has been locked in a dispute with CCGs over funding of the extra beds and claims it could be left with an extra £4m to £5m unfunded cost in 2017-18 if an agreement cannot be reached.

A report to the trust’s board even recommended sending a formal letter to commissioners, stating that “if the trust has filled its contracted bed numbers, it will seek commissioner authority for any new patient, anywhere in system, and payment confirmation, in advance of accepting them”.

The lack of inpatient beds was already impacting on accident and emergency services, the board paper said. Refusing to accept unfunded patients “will very likely have a further effect on flow in A&E departments across the city”, but the trust could “no longer afford the financial risk that the unfunded beds pose.”

A trust spokesperson told HSJ late last week that the trust had not yet sent such a letter.

“Our commissioners have developed a business case to meet these needs and we are currently in discussion about the terms and conditions of the funding, should demand be greater than the level proposed. We look forward to agreeing a solution over the coming months.”

The CCG’s latest funding proposal could alleviate some of this pressure.

The plan included an additional £3.9m in 2017-18 and £4.3m in 2018-19. This would help pay for an extra 16 young adult beds for Forward Thinking Birmingham, plus an additional 16 beds from Birmingham and Solihull Mental Health.

These beds would come online between June and December this year. The money could also pay for additional services aimed at reducing demand for inpatient beds.

Birmingham and Solihull Mental Health chief executive John Short said there had always been fewer inpatient beds in the area than elsewhere, partly because there were more developed community and crisis services.

However. he added there had been a recent rise in demand and welcomed plans for extra beds.

Dr Diane Reeves, Birmingham South Central CCG’s accountable officer and lead commissioner for the Forward Thinking Birmingham contract, said the CCGs were working together to “address these issues”, which included an “the current unprecedented increase in demand”.

The funding was still “being ratified by CCG gateway processes”, she said.