Mental Health Trust eliminates acute out of area placements for two years

A Mental Health Trust in Sheffield has eliminated acute out of area placements for patients for almost two years and has been able to invest £2m in extra community services.

Over the last four years, Sheffield Health and Social Care Foundation Trust (SHSCFT) has reduced the total number of mental health inpatient beds it needed to use by 40 per cent – from around 140 bed nights per day to 85.

It has reduced its length of stay from an average of 50 to 31 days and has been able to reinvest £2m in community services, including Home Treatment Teams (HTT) increasing support to prevent crises and supporting people at home as far as possible.

Dr Mike Hunter, Consultant Psychiatrist at SHSCFT said:  “We’ve been really pleased at what we’ve been able to do for service users in Sheffield and are proud to say we’ve had no out acute of area placements for almost two years.

“We believe the direction of travel should be to continue investment in community resources, recognising there will be times when people need in patient care and we want brilliant and well-staffed therapeutic wards if that time comes.”

The Mental Health Taskforce which reported in March said only half of the country offered a 24/7 community-based mental health crisis service and new funding should be made available so by 2020/21 Crisis Resolution and Home Treatment Teams (CRHTTs) can offer intensive home treatment as an alternative to acute inpatient admission in each part of England.

The Sheffield trust recognised that their length of stay was causing bed blocking and resulted in sending patients out of area, so they developed a length of stay approach to bed management.

By working with patients from the start to think about how long they would need to stay this has resulted in shorter more appropriate lengths of stay. Ward managers were key to making the change with regular meetings to discuss patient discharge.

“Nobody wants to be in hospital longer than they have to be,” said Dr Hunter. “So we helped our team to manage people’s care across the whole system to help people move on. The feedback is that people find it very reassuring that the team are talking to them about a planned stay and how long they are going to be in for; they don’t have the frightening impression that they will be there indefinitely.

“It’s not about how many beds we’ve got but that if you need one we’ve got one for you. It’s simple to say but challenging and rewarding to do.”

The HTT has increased in size by 50 per cent since the reinvestment, helping more people to either stay at home or leave hospital earlier. The trust has always had low rates of readmission and this has continued proving that the new system is working well.

They have also worked closely with patients, carers, commissioners and staff to ensure the rebalancing of resources towards intensive community support is working.

Prof Tim Kendall, NHS England’s National Clinical Director for Mental Health who is also a medical director at the Sheffield Trust, said: “It’s fantastic to be able to show a real example of how ending acute out of area placements can be done consistently and with the best interests of the patient at the heart of care.

“This isn’t about cutting beds but about re-balancing the resources already in the system to improve the patient pathway. By doing this we can see that patients spend less unnecessary time in hospital and are well supported by boosted home treatment teams to prevent spiralling into a crisis which then needs in-patient care.”