Localising and realigning inpatient services, harnessing the potential of people and communities

Many mental health inpatient services across the country are delivering good care and outcomes. They show what is possible and achievable. However, while significant progress has been made, some parts of the country still rely on certain types of poor quality and outdated bed-based provision (including out of area placements).

Recent inquiries and rapid reviews into mental health inpatient services, including those specifically for people with a learning disability and autistic people, have identified particular ‘setting conditions’ and/or characteristics of service models which negatively contribute to the delivery of high quality, person-centred care but also, within this carry some of the inherent risk factors for developing a ‘closed culture’.

The Quality Transformation programme aims to support every system to achieve a bold, reimagined model of mental health inpatient care. This model draws on the evidence base to present a vision for the future that is characterised by strong therapeutic relationships achieved through continuity of care, and underpinned by citizenship and the rights and responsibilities that this denotes.

To support local systems to redesign the current model of inpatient care to mitigate the inherent risk factors, it is critical that changes to care models focus on:

  • care being delivered close to people’s homes and communities
  • least restrictive models of inpatient care
  • models which promote the therapeutic relationship through continuity of care

In the NHS 2023/24 planning guidance, systems were asked to co-produce a strategic plan, to localise and realign mental health inpatient services over a 3-year period in line with a Commissioning Framework.

A Commissioning framework for inpatient services and associated baselining tools have been produced to support integrated care boards (ICBs) with this task. The guidance provides a clear and shared understanding of ‘what good looks like’ and pays particular attention to models of inpatient care where people are in hospital for years at a time, such as inpatient rehabilitation.

Redesign deliverables

  • support ICBs to have oversight of and report on use of inpatient settings for their population and understand inequalities within this.
  • support each ICB to localise and realign inpatient care in line with the Commissioning Framework, with 3-year plans due July 2024​
  • pilot new approaches in the community which help to keep people close to home and promote people’s citizenship

Publications and useful resources