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Inpatient Census, 2016 - Part 1: Mental Health & Learning Disability Inpatient Bed Census - Part 2: Out of Scotland NHS Placements.

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1. Overview of patients being treated in NHS Scotland facilities

Info Graphic

Number of patients and occupancy rates, by NHS Board

There were 3,633 inpatients being treated in NHS Scotland facilities at the March 2016 census, which is a decrease compared with 3,909 at the October 2014 census. The table below shows the number of mental health, learning disability and addiction inpatients being treated in each board.

Note that NHS Grampian, NHS Greater Glasgow & Clyde, NHS Lothian and NHS Tayside contain Regional Units which provide services to patients from other NHS Boards. NHS Fife also provide a low secure Learning Disability Regional Unit for the treatment of patients from other boards. NHS Orkney and NHS Shetland do not have any mental health, learning disability or addiction inpatient beds, their patients are treated by other health boards or other healthcare providers on behalf of NHS Orkney and NHS Shetland.

NHS Board of treatment Patients (October 2014) Patients (March 2016)
NHS Ayrshire & Arran 198 184
NHS Borders 59 45
NHS Dumfries & Galloway 77 49
NHS Fife 256 184
NHS Forth Valley 217 206
NHS Grampian 339 319
NHS Greater Glasgow & Clyde 1,105 1,111
NHS Highland 169 173
NHS Lanarkshire 346 312
NHS Lothian 670 596
NHS Orkney 0 0
NHS Shetland 0 0
NHS Tayside 334 322
NHS Western Isles 18 15
State Hospital 121 117
Scotland 3,909 3,633

Of the wards covered by the census, there were 4,254 available mental health, addiction and learning disability beds in Scotland at the March 2016 census. There were 3,633 patients occupying these beds, giving an occupancy rate of 85%, which is similar to 86% in October 2014 (see table below).

October 2014 March 2016
NHS Board Available beds % occupancy Available beds % occupancy
NHS Ayrshire & Arran 299 66% 265 69%
NHS Borders 65 91% 57 79%
NHS Dumfries & Galloway 107 72% 85 58%
NHS Fife 346 74% 252 73%
NHS Forth Valley 240 90% 249 83%
NHS Grampian 383 89% 367 87%
NHS Greater Glasgow & Clyde 1,176 94% 1,154 96%
NHS Highland 195 87% 189 92%
NHS Lanarkshire 450 77% 440 71%
NHS Lothian 711 94% 645 92%
NHS Tayside 409 82% 402 80%
NHS Western Isles 19 95% 17 88%
State Hospital 132 92% 132 89%
Scotland 4,532 86% 4,254 85%

Note that hospitals in highly populated areas (e.g. NHS Greater Glasgow & Clyde, NHS Lothian) tend to have higher bed occupancy rates than rural areas. This is because it is easier for hospitals in close proximity to each other to move patients between facilities to maximize efficiency, whereas it is more important for rural hospitals to have spare capacity to accommodate an increase in the number of patients requiring an admission to hospital.

Annex A contains analysis of available beds for each NHS Scotland facility.

Demographics

The age and gender breakdown of patients occupying mental health, learning disability and addiction inpatients beds is largely unchanged between the October 2014 and March 2016 censuses. The following table and chart shows the age breakdown for the two years: in both cases there are more patients in the older age groups than the younger ones.

Age group Patients (October 2014) Patients (March 2016)
Under 18 50 55
18-39 842 806
40-64 1,369 1,267
65+ 1,648 1,505
All 3,909 3,633

Number of patients, by age group (2014 v 2016)

Number of patients, by age group (2014 v 2016)

Of the 3,633 patients in the March 2016 census, 58% were male. This is the same as in October 2014 (see below table and chart).

Patients by gender Patients (October 2014) Patients (March 2016)
Male 2,270 2,092
Female 1,639 1,541
All 3,909 3,633

Number of patients, by gender (2014 v 2016)

Number of patients, by gender (2014 v 2016)

Ward Types and Security Levels

As part of the census, NHS Boards were asked to record the security level of the ward in which the patients were staying. 2,702 (74%) of all patients at the census were in a 'General Psychiatric Ward' (see below chart).

Number of patients, by ward security level, 2016

Number of patients, by ward security level, 2016

For 2016, the 'Ward Type' question in the census was expanded to include more categories. From the following chart, it can be seen that the largest ward type is 'Acute', in which there were 1,346 of the 3,633 patients (37%) were at the March census.

Number of patients, by ward type, 2016

Number of patients, by ward type, 2016

*IPCU - Intensive Psychiatric Care Unit

Observation level

All patients in mental health inpatient settings will receive some degree of observation. However, levels of observation will vary according to the patients' individual needs. Based on current guidelines the level of observation of patients at the time of the census was recorded. The observation levels are:

  • "General Observation" - Staff should have a knowledge of the patients' general whereabouts.
  • "Constant Observation" - Staff should be constantly aware of the precise whereabouts of the patient.
  • "Special Observation" - Patient should be in sight and within arm's reach of a member of staff.
  • Enhanced care plan for therapeutic engagement - Aims to improve observation practice through therapeutic engagement with suicidal, violent or vulnerable patients to prevent them from harming themselves or others at times of high risk during their recovery.

The following chart shows that most patients (93%) fall under the General Observation category.

Patients by nurse observation level, 2016

Patients by nurse observation level, 2016

Note: Not applicable relates to either patients who are being treated in care homes where an observation level may not apply, or patients on pass.

26 patients on Constant, Special or Enhanced Observations have at least 2 members of staff (this is 11% of those patients where this information was known).

Number of patients by number of staff involved in Constant, Special or Enhanced Observations, 2016

Number of patients by number of staff involved in Constant, Special or Enhanced Observations, 2016

The most common reason, as shown in the following chart, for being on a Constant, Special or Enhanced Observation level was due to 'risk of harm to others' (69 patients) followed by 'risk of self harm' (59 patients) and 'risk of absconding' (49 patients).

Note a patient can have more than 1 reason for being on Constant, Special or Enhanced Observation.

Number of patients by reason for Constant, Special or Enhanced Observations, 2016

Number of patients by reason for Constant, Special or Enhanced Observations, 2016

*Note a patient can have more than 1 reason for being on Constant, Special or Enhanced Observation.

On Pass

Patients who are "On Pass" are still formally considered inpatients of a hospital, but are permitted planned leave for varying lengths of time as part of their recovery care plan This includes those whose detention under the Mental Health Act has been suspended. At the March 2016 census there were 156 patients (4%) in Scotland who were on pass for at least that overnight period.

Boarding from another hospital

If a patient is "boarding" from another hospital, then they are staying in a hospital outwith their local catchment area. 55 people were boarding in from another hospital at the March 2016 census. 45 of these patients were boarding to another hospital in the same NHS Board as their local catchment area.

Hospital Based Complex Clinical Care

From 2016, the Inpatient Census collected information on patients receiving Hospital Based Complex Care (HBCCC).

A patient is defined as receiving HBCCC if they have care needs that cannot be met in any setting other than hospital and require long-term complex clinical care, or have been in hospital for over 6 months. At the March 2016 census there were 1,128 patients receiving HBCCC who were occupying a mental heatlh or learning disability inpatient bed at the census date.This is 31% of all patients covered by the census.

Note, under the definition of HBCCC, no patient can be a delayed discharge.

A separate, more detailed report on HBCCC will be pulished by the Scottish Government in late September. This will cover HBCCC patients in mental health or learning disability inpatient beds, patients treated outwith NHS Scotland and patients in General Acute hospitals.

Delayed Discharge

At the census, 255 patients were a delayed discharge. This is 7% of patients for which this information is known (information was not returned for 139 patients). Of the 255 patients, 49 had a learning disability.