Quality statement 2: Out-of-area admissions

Quality statement

People admitted to specialist inpatient mental health settings outside the area in which they live have a review of their placement at least every 3 months.

Rationale

People should be treated for a mental health problem in a location that helps them to retain the contact they want with family, carers and friends, and to feel as familiar as possible with the local environment. If people with a non-acute mental health problem are admitted to a specialist inpatient mental health setting outside the area in which they live, they are particularly vulnerable to delayed discharges because case management and assessment of readiness for discharge is more difficult to deliver. When people are placed outside of the area in which they live, named practitioners from the person's home area and the inpatient ward can work together to ensure the placement is reviewed regularly, so that it does not last longer than necessary.

Quality measures

Structure

a) Evidence of local arrangements to monitor the length of placements of people admitted to a specialist inpatient mental health setting outside the area in which they live.

Data source: Local data collection, for example, identification systems.

b) Evidence of local arrangements to review placements at least every 3 months for people in an out-of-area placement in a specialist inpatient mental health setting.

Data source: Local data collection, for example, review protocols.

Process

Proportion of out-of-area placements in specialist inpatient mental health settings for which there is a review of the placement at least every 3 months.

Numerator – the number in the denominator for which there is a review of the placement at least every 3 months.

Denominator – the number of out-of-area placements in specialist inpatient mental health settings lasting longer than 3 months.

Data source: Local data collection, for example, from hospital patient records.

Outcome

a) Number of active out-of-area placements in specialist inpatient mental health settings.

Data source: Local data collection.

b) Length of stay in out-of-area placements in specialist inpatient mental health settings.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (specialist inpatient mental health services, such as those in high-dependence units or specialised rehabilitation units within the NHS or independent services) ensure that they work together to monitor the length of placements for people in an out-of-area placement in an inpatient mental health setting, so that named practitioners from the inpatient ward and the person's home area can review the placement at least every 3 months.

Health and social care practitioners (a named practitioner from the person's home area and a named practitioner from the ward) work together to monitor the length of placements of people admitted to specialist inpatient mental health settings outside the area in which they live and review these at least every 3 months.

Commissioners (clinical commissioning groups) ensure that placements are monitored and reviewed at least every 3 months when people are admitted to specialist inpatient mental health settings outside the area.

People who are admitted to a specialist mental health hospital outside the area where they live have a review of how their placement is going at least once every 3 months, to make sure they are not kept in hospital for longer than they need to be. This is carried out jointly by a person from the hospital ward and someone from their home area involved in their care.

Source guidance

Transition between inpatient mental health settings and community or care home settings (2016) NICE guideline NG53, recommendation 1.3.11

Definitions of terms used in this quality statement

Placement review

Named practitioners from the person's home area and the inpatient ward should work together to ensure that the person's current placement lasts no longer than required. Review should be carried out either in person or by audio or videoconference.

[NICE's guideline on transition between inpatient mental health settings and community or care home settings, recommendation 1.3.11.]

Specialist inpatient mental health setting outside the area in which the person lives

In this quality statement, a specialist mental health inpatient setting refers to an inpatient unit that provides non-acute complex care and does not form part of the usual local network of services. This means that it does not usually admit people living in the catchment of the person's local community mental health service and is somewhere the person cannot be visited regularly by their care coordinator to ensure continuity of care and effective discharge planning. Sending providers are to determine if a placement is classed as an out-of-area placement.

Examples of specialist mental health inpatient settings include high-dependence units or specialised rehabilitation units within the NHS or independent services. People admitted to specialist inpatient settings will often have multiple mental health problems.

[Adapted from NHS England's definition of out of area placements in mental health services for adults in acute inpatient care]