Transforming care: the challenges and solutions

Voluntary Organisations Disability Group, May 2018

Voluntary Organisations Disability Group report outlining challenges and solutions to moving people with learning disabilities, autism and/or mental health conditions out of long-stay inpatient care. This follows the implementation of a pilot project, the report offers recommendations for future steps.  The challenges involving commissioners, funders and care providers include:

  • delays in hospital discharge plans, including a lack of knowledge in local authorities about potential community support options
  • negative attitudes and aspirations towards people supported (for example, referring to people by patient identity number instead of by their name)
  • confusion about costs, with commissioners and funders underestimating the cost of initial support immediately after discharge and/or therapeutic support
  • a lack of support to families, despite the fact that responsive ongoing support to families is critical to the sustainability of support to their loved one.

Click here to view this report.


Mental health rehabilitation inpatient services: Ward types, bed numbers and use by clinical commissioning groups and NHS trusts

Care Quality Commission, March 2018

Report from the Care Quality Commission looking at mental health rehabilitation inpatient services that finds:

  1. People are often receiving care a long way from where they live and from their support networks, which in turn can affect their onward recovery and wellbeing.
  2. People are being accommodated in services that are ‘dislocated’ from their home areas. This is more prevalent in the independent sector than in NHS services on average (49km) compared with NHS patients (14km).
  3. The independent sector
    1. Provided more wards that were categorised as either locked rehabilitation or complex care (75% of wards of this type) and fewer wards categorised as long stay, community or high dependency (25% of beds of this type).
    2. Accommodated patients who had been on that particular ward for longer (median 444 days compared with 230 days in the NHS) and in hospital continuously for longer (median 952 days compared with 492 days in the NHS).
    3. Because of the longer length of stay, accommodated patients whose current placement had cost twice as much (median £162K compared with £81K)

4. There is very wide variation between CCG areas in the use of rehabilitation beds, and in the use of beds that are out of area.
The report estimates that the annual expenditure on mental health rehabilitation beds is about £535 million. Out of area placements account for about two-thirds of this expenditure.   The 10% of CCGs that fund the highest number of places are spending an average of at least £19,000 per day on this element of provision – of which £8,200 is spent on independent sector provision; the majority of which is out of area.

Click here to view the full report.

Mental Health Act: A focus on restrictive intervention reduction programmes in inpatient mental health services

Care Quality Commission, December 2017

This resource shares examples of good practice around reducing the use of restrictive practices. These practices include the use of restraint, seclusion and rapid tranquilisation. They also include wider practices: for example, preventing a patient from accessing outdoor space.

Click here to view the resource.

Leaving hospital: Briefing on discharge from mental health inpatient services

MIND, December 2017

Briefing on standards that those being discharged from hospital, after a mental health crisis, should expect out in terms of planning and follow up.  However, despite examples of excellent practice that show what can be done, MIND have  heard from hundreds of people whose experience does not measure up.  This briefing gives examples of good practice.

Click here to view the standards.

Inpatient provision for children and young people with mental health problems

Education Policy Institute, August 2017

This report examines the state of child and adolescent mental health inpatient services in England. The analysis explores the latest evidence and NHS data on admissions, quality of care, staffing and capacity.  The report finds that one in nine inpatient units in England failed to meet the minimum standard for staff to patient ratios, while around a quarter did not employ enough permanent staff.  The report also identifies problems with delayed discharge of patients and that inpatient mental health services for young people on average failed to meet 7% of minimum standards.

Click here to read the full report.

Old problems, new solutions: Improving acute psychiatric care for adults in England – Final report

The Commission to Review the Provision of Acute Inpatient Psychiatric Care for Adults, February 2016

Urgent action is needed to improve acute psychiatric care for severely ill adult mental health patients in England.  This report describes widespread problems with finding beds or receiving good home treatment but it also points to the improvements that can be made and gives examples where people are being well cared for in good services.

Click here to read the full report.

Four hour waiting time for acute psychiatric care urged

BMJ, 9 February 2016

A new waiting time target for admission to acute psychiatric care of four hours should be introduced, a commission convened by the Royal College of Psychiatrists has said…

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