Inpatient census 2022: parts one and two

Results of the sixth Mental Health & Learning Disability Inpatient Census and Out of Scotland NHS Placements Census, 2022.


7. Outwith NHS Scotland placements

  • 162 patients in the 2022 Census who were funded by NHS Scotland were receiving treatment outwith NHS Scotland
  • At the time of the 2022 Census these patients had been in hospital an average of 3 years and 8 months
  • 33 patients (20%) had a diagnosis of learning disability or autism

Patients with a main diagnosis of a mental health condition, learning disability or addiction who are funded by NHS Scotland, but are treated either by the NHS outwith Scotland (e.g. by NHS England) or outwith the NHS (e.g. in a private/voluntary sector/local authority care home or private hospital) are classified in the Census as being outwith NHS Scotland.

Some patients with highly complex, specialist needs are treated outwith NHS Scotland facilities. The individual variability means that it is more cost effective to send patients to outwith NHS Scotland facilities than creating dedicated facilities in NHS Scotland. Each care package is individually and carefully considered by Boards. In total there were 162 patients treated outwith NHS Scotland in the 2022 Census.

Table 18: Patients Outwith NHS Scotland, by NHS Board funding, 2014 – 2022
NHS Board responsible for funding 2014 2016 2017 2018 2019 2022
NHS Ayrshire & Arran 34 29 c c c 20
NHS Borders c c c 27 c 16
NHS Dumfries & Galloway 10 c c c c c
NHS Fife c c c c c 7
NHS Forth Valley c c c c 0 0
NHS Grampian 18 14 14 15 16 20
NHS Greater Glasgow & Clyde 11 c c c c c
NHS Highland c 10 c 20 19 9
NHS Lanarkshire c 10 14 15 15 43
NHS Lothian 20 25 24 59 24 22
NHS Orkney c c c c c c
NHS Shetland c c c c 0 0
NHS Tayside 16 13 11 14 12 *
NHS Western Isles * 12 * 13 * 8
National Services Division c c c c c c
Not Known c
All 143 137 109 197 126 162

* c - Suppressed due to small numbers

Of the 162 patients treated outwith NHS Scotland, 148 (91%) were treated in private facilities, 6 (4%) in NHS England and 8 (5%) were voluntary sector. The majority of patients, 126 (79%), were being treated in Scotland, while the remaining 34 (21%) were being treated in England. Data was not returned for 2 patients.

A reason for placement was provided for all outwith NHS Scotland patients. Of these, 84 (52%) patients were placed outwith NHS Scotland because “facility to meet the patient’s needs does not exist within NHS Scotland and there is no alternative to admission”.

Figure 14: The majority of patients treated outwith NHS Scotland are treated in private facilities, while a smaller proportion are treated in NHS England and other facilities. Psychiatric, addiction or learning disability patients treated outwith NHS Scotland, 2022
The number of patients treated outwith NHS Scotland in private facilities have increased from 113 in 2016 to 148 in 2022, whereas those treated in NHS England have decreased from 18 in 2016 to 6 in 2022.

Patients treated outwith NHS Scotland tend to be older on average than those treated in NHS Scotland facilities; 58% were aged under 65 (compared to 65% within NHS Scotland patients). This is a change from the 2019 census when patients treated outwith tended to be younger. One in four patients (25%) were aged under 40. There were more male patients (96, 59%) than female (66, 41%).

Figure 15: The largest proportion of patients treated outwith NHS Scotland are over the age of 65 and 59% are male. Age and gender of psychiatric, addiction and learning disability patients outwith NHS Scotland, 2022
Proportion of patients treated outwith Scotland were 59% male and 41% female, 25% were aged under 40, 33% were aged between 40 and 64 and 42% were aged 65 and over.

The average (median) number of days for patients treated outwith NHS Scotland was 1348 days (approx 3 years and 8 months). This is 373 days longer than the average (median) length of stay in 2019 and is almost 10 times longer than that of patients treated within NHS Scotland facilities.

Table 19: Average (median) days since admission (Outwith NHS Scotland), 2019
Group Average (median) number of days since admission Approx. number of years / months
Outwith NHS Scotland patients 1348 3 years, 8 months
Within NHS Scotland patients 136 4.5 months

Of the patients treated outwith NHS Scotland, 75 (46%) had been in hospital for between one and five years at the time of the 2022 Census, while 58 patients (36%) had been in hospital for more than five years.

Information on the length of time that has passed since the patients’ last care plan review was provided for 153 (94%) patients. Of these, 53 patients (35%) treated outwith NHS Scotland had their last care plan review less than two weeks prior to the 2022 Census, while 30 (20%) had their last care plan review at least 6 months prior to the Census.

Of the 162 patients treated outwith NHS Scotland:

  • 86 patients (53%) were receiving Hospital Based Complex Clinical Care.
  • 38 patients (23%) were under forensic services.
  • 33 patients (20%) had a learning disability or autism.

A total of 24 (15%) of outwith NHS patients had a diagnosis, either primary or secondary, for a personality disorder. There were 51 (31%) patients with dementia, and 30 (19%) patients with schizophrenia, while 9 (6%) had a diagnosis of schizotypal and delusional disorders.

Figure 16: The most common diagnosis for patients treated outwith NHS Scotland was dementia (51 patients, 31%) followed by a learning disability (33 patients, 20%). Psychiatric, addiction or learning disability patients treated outwith NHS Scotland, 2022
Number of patients treated outwith NHS Scotland with a diagnosis of dementia was 51, followed by learning disability (33), schizophrenia (30) and personality disorder (24).

* Patients can have multiple diagnoses

Data is provided, where possible, on anticipated discharge/transfer and date of discharge/transfer. A total of 9 (6%) patients are anticipated to return to NHS Scotland within one year.

Contact

Email: MHIC@gov.scot

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