Too many people could be being placed in residential mental health rehabilitation services that are far away from where they live, for too long and that are costly for the NHS.
In a report published today the Care Quality Commission (CQC) has found through an information request to providers that nearly two thirds (63%) of placements in residential-based mental health rehabilitation services are ‘out of area’, which means they are in different areas to the clinical commissioning groups (CCGs) that arranged them.
‘Out of area’ placements can mean that people are often further away from where they live, further away from their families and friends and further away from the local support services that will care for them once they have been discharged – all of which can affect their onward recovery and wellbeing.
The majority (78%) of ‘out of area’ placements are with independent sector providers rather than the NHS.
CQC has found from its inspections that the quality of care in residential mental health rehabilitation services is very similar between NHS and independent sector providers.
CQC found that the daily cost for residential mental health rehabilitation is similar (£350 for a NHS bed, compared to £364 for an independent sector bed). However, because of the longer stays, independent services can end up costing twice as much as NHS services – average cost of current is stay £162,000 in comparison to £81,000.
CQC estimates that £535 million is spent on residential mental health rehabilitation annually, with ‘out of area’ placements accounting for around two thirds of this expenditure.
In its report, CQC has made a number of recommendations, including for local bodies – CCGs, NHS trusts and local authorities – to review how appropriate their current placements are of patients in residential mental health rehabilitation services, so that they can be confident they are fully enabling patients’ rehabilitation and onward recovery.
This is consistent with the Five Year Forward View for Mental Health (published by NHS England in February 2016), which states that people should not be cared for in restrictive settings longer than they need to be and that the NHS should expand its community-based services to support people to live safely as close to their homes as possible.
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (lead for mental health) at the Care Quality Commission, said: “Inpatient rehabilitation services have a vital role to play in supporting people with severe mental health problems to recover and return home. Collectively, the independent sector and the NHS make a valuable contribution to the delivery of mental health rehabilitation and in helping people to step back on the road to living more independently.
“However, we are concerned about the high number of beds in mental health rehabilitation wards that are situated a long way from the patient’s home. This dislocation can mean that people can become isolated from their friends, from their families and from the services that will provide care once they have been discharged.
“Also, we are concerned that our evidence shows that on average, people in ‘out of area’ placements can end up staying in residential rehabilitation for twice as long as they would have done in a local NHS bed, which can increase their sense of institutionalisation, affect their onward recovery, and can be very costly.