People in rehabilitation for mental health problems often face lengthy stays far from home and local support, with those in private providers most affected, the Care Quality Commission has found.
It warned today that too many people were being placed in residential mental health rehabilitation services that were far away from where they lived, for too long and that were costly for the NHS.
“This dislocation can mean that people can become isolated from their friends, from their families”
The CQC found that 63% of placements in residential-based mental health rehabilitation services were “out of area” – in different places to the clinical commissioning groups that arranged them.
A key factor highlighted by the regulator appeared to be whether the rehabilitation provider commissioned by the CCG was in the NHS or the independent sector.
The freedom of information request by the CQC found that 78% of out of area placements were with independent sector providers rather than the NHS.
But its review also showed that services provided by the independent sector were more likely to be further from their homes than those staying in NHS services – 49km compared to 14km.
In addition, those looked after in the private sector were more likely to stay there for longer – 14.5 months on their current ward, compared to 7.5 months in a NHS service.
“It’s good news that the CQC has uncovered the extent of this problem”
They also faced a greater risk of having their aftercare compromised, because the managers there were less likely to know which NHS trust would care for them following discharge, warned the CQC.
It highlighted that 99% of managers of NHS rehabilitation services were able to name the trust that would provide their patients’ aftercare, in comparison to 53% for independent services.
As a result of these problems, the regulator concluded that the cost of the services provided by the independent sector often worked out more expensive than those provided by the NHS.
It found that the daily cost for residential mental health rehabilitation was similar at £350 for a NHS bed, compared to £364 for an independent sector bed.
However, because of the longer stays, independent services could end up costing twice as much as NHS services – average cost of current is stay £162,000 in comparison to £81,000.
Overall, the CQC estimated that £535m was spent on residential mental health rehabilitation each year, with out of area placements accounting for around two thirds of this expenditure.
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However, it noted that its inspection reports suggested the quality of care in residential mental health rehabilitation services was very similar between NHS and independent sector providers.
Following its findings, the CQC recommended that CCGs, trusts and councils review how appropriate their current placing of patients in residential mental health rehabilitation services were.
It highlighted that the Five Year Forward View for Mental Health stated that people should not be cared for in restrictive settings longer than they need to be.
It added that the national plan, published by NHS England in February 2016, also said the NHS should expand its community-based services to support people to live safely as close to their homes as possible.
Health and social care secretary Jeremy Hunt has accepted the recommendations in the CQC’s new report on mental health rehabilitation inpatient services, which was published today.
Dr Paul Lelliott, CQC deputy chief inspector of hospitals and mental health lead, said: “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.
Dr Paul Lelliott
“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,” said Dr Lelliott.
“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,” he noted.
“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,” he said.
Dr Lelliott said this trend could increase their “sense of institutionalisation, affect their onward recovery, and can be very costly”.
“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.”
Catherine Gamble, the Royal College of Nursing’s professional lead for mental health, said: “People with serious mental health problems are isolated enough without having to spend long periods in rehabilitation units far away from their family and friends, who are so important to aiding recovery.
“However, the problem is not just that many people are having to go to centres too far away – it’s also the quality of the care that is provided,” she said. “At the moment, it’s a lottery as to whether robust, supportive, recovery-based treatment is available.
‘Disappointing’ lack of progress in community mental health
“It’s good news that the CQC has uncovered the extent of this problem, but the focus must now be on developing much better services that are closer to where people live,” she added.
The CQC review identified 4,397 beds for residential mental health rehabilitation across England – 2,050 in the NHS and 2,347 in the private sector – with the average stay on a ward being 323 days.
Such services work with people with complex psychosis and other serious mental health problems, whose needs cannot be met by general adult mental health services.
The CQC first expressed concerns about inpatient rehabilitation last July, after completing its initial round of comprehensive inspections of mental health services. At that point, it committed to explore the issue further.