NHS trust spends millions sending vulnerable patients out of area

Lark Ward, at the Woodlands mental health unit in Ipswich, has been shut since April Picture: LUCY T

Lark Ward, at the Woodlands mental health unit in Ipswich, has been shut since April Picture: LUCY TAYLOR - Credit: LUCY TAYLOR

An NHS trust in Norfolk and Suffolk has spent millions of pounds sending mental health patients to other parts of the country for treatment.

Figures from the NHS show that between June 2017 and May 2018, the Norfolk And Suffolk NHS Foundation Trust (NSFT) placed patients with acute mental health needs in inappropriate Out of Area Placements (OAPs) on approximately 400 occasions – at a cost of nearly £4million.

An inappropriate placement is where a patient is admitted for treatment at a facility outside of their usual local network of mental health services because there are no beds available nearby.

The mental health charity Mind says the impact of being far away from home on a patient’s mental health “cannot be overstated” and could even increase the risk of suicide.

Some of the patients sent away by NSFT had to travel more than 180 miles from home.

The trust racked up a bill of around £3,963,000 over the 12 months to May paying for the care of patients on inappropriate placements, including the cost of additional ongoing placements that began prior to June 2017.

In May, the majority of the facilities that received patients from the trust were privately operated.

Earlier this year, the trust pledged to eradicate the use of out of area beds by 2021.

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But commitments to stop out of area placements have been made before.

In January 2014, NSFT bosses said they would stop sending patients out of the area for treatment within four months.

This was not achieved and more recently the trust set itself the goal of to October 2017, before being adjusted to the “more realistic” date of March this year.

This was again missed but now national targets have demanded all mental health services stop sending patients out of area by 2021.

The news comes as question marks surround the future of Lark Ward at Woodlands, Suffolk’s only psychiatric intensive care unit (PICU), which is currently shut to admissions due to “unsafe staffing levels”.

Bosses at NSFT decided to completely close all 10 beds on the ward in April until vacancies were filled.

But last month it emerged that it is unlikely to re-open until the autumn, despite an ongoing recruitment programme.

In May, the Care Quality Commission (CQC) returned to NSFT to check up on the trust’s progress.

Although the report found improvements had been made, there was concern the “pace of change had been slow in respect of some issues” and “patients did not benefit from safe services in all areas”.

Peter Devlin, NSFT’s Operations Director for Suffolk, said that only a small number of patients from Suffolk were sent out of area for treatment.

“In 2017/18, NSFT spent £377,000 on out of area placements (OOAs) for service users from Suffolk, which was approximately 7% of the Trust’s total spend on this matter,” he said.

“However, we consider one OOA as one too many and whenever this is necessary we always strive to ensure that the patient is treated as close to home as possible, and aim to repatriate them at the first available opportunity.

“Ipswich and East Suffolk CCG and West Suffolk CCG are the bodies responsible for OOAs and we are working closely with them to achieve the Government’s national ambition to eliminate inappropriate out of area placements by 2020/21.

“This work involves looking at alternatives to hospital for some patients, and supporting the timely discharge of people who no longer require hospital care.”

Mr Devlin confirmed that Lark Ward, Suffolk’s 10-bed Psychiatric Intensive Care Unit (PICU), was on schedule to re-open this autumn following a successful staff recruitment campaign.

An NSFT spokesman also said in April that two new OAP managers had been recruited to help bring numbers down.

He said: “They monitor bed requests to keep patients within area, wherever possible, and where patients have to go OOA (out of area) due to the lack of beds locally we look to bring them closer to home as soon as possible.”

A spokesman for NHS Ipswich and East Suffolk and NHS West Suffolk clinical commissioning groups, added:

“Both our CCGs have a very good record on ensuring people receive appropriate mental health treatment close to home.

“In east and west Suffolk there were two inappropriate out of area bed placements in 2016/17 and 36 during 2017/18, largely due to the temporary closure of the Lark Ward in Ipswich.

“Clearly, the re-opening of the Lark Ward is a priority and we are supporting NSFT in recruiting staff so that it can safely receive patients for treatment.

“We continue to invest more money every year on improving mental health services, with a forecast spend of £115 million this year compared to £103 million in 2016/17.”

Reaction from key figures

Dr John Lister, co-chair of campaign group Keep Our NHS Public said a “cash squeeze” had left NHS trusts under pressure to reduce frontline mental health services.

“The private sector are quite willingly cashing in on the gaps left in the NHS,” he said.

“These are expensive beds and they are poor value for money, as private providers have an incentive to keep patients in longer.

“This is a significant problem and it continues to be very worrying.”

The Government has pledged to eliminate inappropriate out of area placements for adults with acute mental health needs by 2020-21, and Mind says this “can’t happen soon enough”.

However, in the 12 months to May, there were still around 8,285 new inappropriate placements made across England.

Patients on inappropriate placements spent a combined total of 222,000 days in facilities away from their homes during this time, the vast majority of which were privately run.

Geoff Heyes, head of health policy and influencing at Mind, said: “When you’re experiencing a mental health crisis, you’re likely to feel scared, vulnerable and alone, so your support network of family and friends are instrumental to recovery.

“It’s unacceptable that people who are at their most unwell and in desperate need of care find themselves travelling across the country to get help because there’s a shortage of beds nearby.

“The quality of care you get, and how likely you are to respond to treatment, shouldn’t depend on where you live.”

A spokeswoman for the Department of Health and Social Care said: “It is completely unacceptable for patients to be sent away from their family and friends for treatment.

“That’s why the NHS is opening more specialist beds to tackle this and we have committed to eliminating inappropriate placements by 2020-21.

“We want to see parity between physical and mental health, which is why we’re transforming services supported by record amounts of funding, and ambitious plans to increase the workforce, and as part of our long-term plan for the NHS we will announce more on how we will improve mental health later this year.”

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