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Mental health beds shortage is actually a 'discharge crisis'


A perceived crisis in the availability of mental health beds is actually caused by delayed patient discharges, according to an inquiry chaired by 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.

“It is a discharge crisis and an alternative to admissions crisis”

Lord Crisp

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, identified concerns around variations in standards, poor data, lack of support for staff and fractured commissioning systems.

Lord Crisp, former NHS chief executive and permanent secretary of the Department of Health, said: “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,” he told Nursing Times’ sister title Health Service Journal.

“The biggest area to target… is discharges and alternatives to admission rather than saying we need more beds,” he said.

Lord Crisp

Lord Crisp

Lord Crisp added that 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%, 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.

According to the survey, 16% of patients per ward were identified as a delayed discharge. The main cause for this was a lack of suitable housing, which made up 49% of the reason for delays.

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.


Readers' comments (5)

  • During 2007, when I was a student on a medical ward, the best part of one bay were women waiting for care home places/funding.

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  • What a load of tosh. Yes delayed discharge blocks bed but if they stopped closing down Mental health wards there wouldn't be such a shortage.

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  • When dear old Maggie decided to bring in care in the community and close down all the old Mental health hospitals and sell them off to property developers she opened a can of worms that has slowly got bigger and bigger. One of the hospitals I trained at was 1200 beds and closed in the late 80's,I remember that 6 months or so later banner headlines in the local newspaper. "Local health authority worried about local mental health bed shortage. Study says the is a shortage of around 1000-1200 beds locally" Now I wonder why that was? Mind you it made a lovely housing estate

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  • What nonsense. Lack of beds, lack of services and a massive lack of care in the community. I saw one man aged 70+ shovelled round hospitals/facilities in the county because no one wanted him and they didn't want to sort housing for him. They all said he didn't need to be an inpatient but equally there was no CPN available in the community. They then tried to fob him off to his family as it seems is the current NHS way. It's not how can we help, but how quickly can we get rid of them.

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  • I believe the disconnect between NHS and Social Services is recognised and fully addressed in the plans now being formulated to integrate the two. The worry is the that mental health won't get a big enough slice of the new cake, but I do think there is sufficient focus on this area now to ensure a positive result.

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