NHS spending £350m a year to send mental health patients miles from home

'Between organisations who are making money from keeping hold of patients, and an organisation worried about having them back, you’ve got a good environment to keep people for a long-time', experts warn

Reliance on out of area placements 'deeply concerning' and can undermine patients' long-term recovery (Rex)

The NHS is reliant on private mental health services to treat seriously ill patients, often miles away from loved ones, and is doing too little to ensure they are not being kept in treatment longer than necessary, the care watchdog has said.

A report by the Care Quality Commission (CQC) today warns the health service is spending £350m a year to send these patients “out of area” for care.

Experts told The Independent this reliance is down to a lack of inpatient services to support patients locally, and a lack of incentives for “specialist” centres to send patients home.

The CQC is now calling on NHS managers to draw up plans to "repatriate patients" and to ensure every patient has a care plan aimed at getting them better to bring them back into the community.

Patients cared for in inpatient services often have complex psychosis and other serious mental health problems, which might need more supervision or security and can’t be met by conventional services.

Three out of four of these patients are sectioned under the Mental Health Act and the aim is for them to recover and regain skills and confidence to live in the community again.

However out of area placements can be detrimental to the patients’ longer-term recovery and wellbeing as they are further from their support networks and from local services that they would eventually be discharged to.

They also end up costing the NHS far more.

Of the £535m bill for inpatient rehabilitation spent on inpatient care, two thirds is spent on out of area placements.

While private providers are 53 per cent of the total inpatient beds, they account for four out of five (78 per cent) of out of area placements.

The independent sector keeps patients for more than twice as long on average.

The CQC reports that patients in these non-NHS facilities stay 14.5 months, compared to 7.5 months in an NHS service, they are also further from home – 49km compared to 14km.

This means private placements cost on average £162,000, compared to £81,000 in the NHS.

Patients are often sent to a specialist service when their NHS provider believes they lack the expertise or specialist services to care for them safely.

But a fear of the risk a patient poses, to themselves and to the organisation should they come to harm is a major factor as well.

“Between organisations who are making money from keeping hold of patients, and an organisation that is worried about having them back, you’ve got a good environment to keep people in out of area placements for a long-time,” Keir Harding, clinical lead of Beam Consultancy, told The Independent.

Beam was set up to help NHS organisations avoid out of area placements for people with personality disorders, patients who can have a high risk of self-harm or suicide.

“In theory, trusts have got people who would check up on the care plan of patients sent out of area, but if you don’t have confidence in your local services, that can just be a case of asking ‘Is it all going alright? Good, see you in six months’.

“You should interrogate it more. You’re buying a service, so you shouldn’t be deferential about what they think is best.”

The types of patients Mr Harding works with can get worse when sent away from home, and too often this leaves managers thinking “what if something happens when they’re discharged and we get blamed’, he said.

“Sometimes people aren’t allowed to leave hospital until the behaviours that they only do in hospital have stopped.”

The CQC’s report also notes that out of area placements can have negative benefits for patients care, particularly as these organisations had poor relationships with the trusts patients would eventually go back to.

In its recommendations to the heads of NHS trusts, clinical commissioning groups (CCGs), and councils who pay for mental health services the CQC says they should “identify all patients in mental health rehabilitation wards whose care they are responsible for and to review the appropriateness of these patients’ current placement”.

It says they must also look at whether these providers are actually rehabilitating patients, and there are “active plans for discharge”.

Dr Paul Lelliott, the CQC’s lead for mental health said these residential services, in the NHS and independent sector, have a “vital role to play” in helping patients recover.

However the “dislocation” of being placed out of area can leave patients isolated, and can become “very costly for the NHS”.

“The attention now must be on developing services that are focused on people’s recovery and that are not ‘long-stay’ wards in disguise, that are closer to where people live, and that are well-connected to the wider local system including services that will provide aftercare,” he added.

Dr Rajesh Mohan, chairman of the Royal College of Psychiatrists’ rehabilitation faculty, said the findings were “deeply concerning”.

He added: “The reason more and more patients are being sent inappropriately out of area is because NHS rehabilitation services have been closing at an alarming rate – in 2009 there were more than 130 such services in England; by 2015 that number had fallen by a third to just 82.

“Patients treated many miles from home take longer to recover partly because they don’t have ready access to their friends and families, whose support is so vital in aiding their recovery.”

An NHS spokesperson said: “We have started to eliminate out of area placements for non-specialist in-patient admissions, so patients get timely, appropriate acute mental health treatment as close to home as possible.