A perceived crisis in the availability of mental health beds is actually caused by delayed patient discharges, according to an inquiry chaired by former chief executive of the NHS Lord Crisp.
An interim report by the Commission on Acute Adult Psychiatric Care has identified significant factors that could lie behind a shortage of beds in mental health services, including a lack of suitable local authority housing or supported accomodation. The shortage has been blamed for the increase in patients forced to travel hundreds of miles for a bed.
The report, commissioned by the Royal College of Psychiatrists, identifies concerns around:
- variations in standards;
- poor data;
- lack of support for staff; and
- fractured commissioning systems.
Lord Crisp told LGC’s sister title Health Service Journal: “We were asked to look at the so called beds crisis but when we looked at it we discovered the real issue was delayed discharges and people in beds who shouldn’t be there. It is a discharge crisis and an alternative to admissions crisis.
“The biggest area to target… is discharges and alternatives to admission rather than saying we need more beds.”
According to the survey, 16% of patients per ward were identified as a delayed discharge. The commission found a lack of suitable housing was a factor in 49% of delayed discharges, three times as many as were due to problems with transfer to a rehabilitation unit, the next most significant factor.
Lord Crisp said the commission had also identified variations in the service quality.
He said: “We visited trusts where people were obviously in crisis management mode all the time. People were under pressure, doctors were fighting to get people admitted, nurses were struggling, patients were unhappy and the whole thing felt like a real pressure cooker. These were good people in a bad way.
“But we have also visited places where people were much more purposeful and understood where they were going and able to deliver a good service calmly.”
He added: “I am sure we will be saying something about quality improvement methodology and systematic change.”
He also pointed to a lack of quality data, which had hampered the commission’s work, and suggested this would be a focus of its final report early next year.
To understand pressures in the system the inquiry carried surveyed consultants at 56 mental health trusts and received 122 responses across 119 inpatient wards.
The findings showed trusts had an average bed occupancy rate of 104 per cent, sometimes rising to 147%. More than 91% of wards operated above the recommended 85% bed occupancy level.
Ninety-two per cent of consultants reported treating patients who could have been treated by other services. The commission said this meant three patients on each ward did not need to be there.
Lord Crisp described commissioning as a universal concern among mental health providers. He added: “They all made the point that having different people doing different commissioning led to difficulties with patients in one level of facility when they might be in another, partly because of who is paying.”
He also suggested the commission would examine the treatment of black and minority ethnic communities. He said there was evidence of discrimination in the way BME patients were treated and they were less happy with the service they received.