Is it just me…?

Editor in Chief, Robert Chamberlain, considers the impact of growing numbers of delayed discharges for mental health NHS patients.

The latest data from NHS England (January 2017) makes alarming reading in respect of delayed transfers of care in mental health trusts. Delayed transfers of care are rising rapidly across the NHS, however the increase is particularly rapid in mental health trusts.

BBC News reported the figures (6th January 2017) and they made stark reading. From November 2015 to October 2016, there was a 56% rise of such incidents in mental health trusts and a 30% increase in numbers at acute trusts. More than 17,500 bed days were lost due to delayed discharge across the 24 specialist trusts in October 2016 alone.

The reasons

A lack of psychiatric support in the community and other diminishing support services was said to be a contributing factor. Budget cuts and lack of investment, especially in light of growing demand, are, of course, the root cause. A lack of social care services is also part of the problem.

The irony, as always, is the cost of such delays to the NHS. Across the whole of the NHS in England, not just mental health, the National Audit Office estimates the costs of delayed transfers of care to be in excess of £800m per year.

The Government has pledged £400m for crisis resolution and home treatment teams from 2017/18 to deliver 24/7 crisis response and intensive home treatment in communities and homes as a safe and effective alternative to inpatient care. But sinking another £400m into the NHS as it is currently managed makes little sense.

Surely, poor financial management across the whole NHS is a priority that must be addressed. So many separate budgets with apparent protectionism of each and a reluctance to integrate services, ie spend budget outside of the NHS system, are costing millions.

The BBC News story gave an account from an individual who had experienced delays in discharge. He claimed the reason for not being discharged was arguments between different trusts over who was responsible for paying for his ongoing care. It seems that finance management trumps the needs of the people trusts are meant to care for.

Re-thinking

How could the cost of delayed discharge be reinvested in the NHS to develop much needed services to ease the problem?

Here’s a radical idea. Why not embrace social care partners and create new services designed specifically to provide ongoing support post-discharge? This would undoubtedly have a major impact on improving people’s quality of life and provide a far more effective use of existing budgets.

The current lack of social care provision is largely down to the failure of integration. I would be surprised if there was no appetite from care providers to fill this void should sustainable funding be made available. I have written a number of times about the reported slow (or lack of) progress in integration of services across the nation, yet control of these budgets remains in the same hands. What is being done to improve how the money is spent?

Forward View

The Five Year Forward View for Mental Health is in place, but its positive impact is yet to filter through. Failing those with mental health needs due to funding or infrastructure problems is no longer acceptable.

The Government has committed to funding for implementing the mental health forward view. But we really need to see better management of funding to ensure it impacts the frontline, reducing the discharge issue and improving the lives of those being affected.

To quote Paul Farmer, Chief Executive of Mind, ‘The time after leaving hospital is critical as that is when people are at the greatest risk of taking their own lives. People need the right support to recover and manage their mental health properly, and trusts should be planning properly for discharge from the point at which someone goes into hospital.’

It is time to lose the rhetoric and put the available funding to its intended purpose. The current situation cannot continue if we truly are to see improvements in mental health support.

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