Inpatient census 2017: parts one and two

5. Out of Scotland NHS Placements

• 109 patients in the Census who were funded by NHS Scotland were receiving treatment out with NHS Scotland
• At the time of the Census these patients had been in hospital an average of 2 years and 4 months
• 27 patients (25%) had a diagnosis for learning disability or autism

Patients classified in the Census as being “Outwith” NHS Scotland are every patient with a main diagnosis of a Mental Health condition, Learning Disability or Addiction who NHS Scotland funds, but are treated either out of Scotland (e.g. by NHS England) or out of NHS (e.g. in a private/voluntary/local authority care home or private hospital).

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 Out of NHS Scotland facilities than creating dedicated facilities in NHS Scotland. Each care package is individually and carefully considered by Boards. In total there were 109 patients treated outwith NHS Scotland. Of these 109 patients, 72 (66%) were treated in a non- NHS facility in Scotland, while 37 were treated elsewhere in the UK.

Table 12: Number of patients (Outwith NHS Scotland), by NHS Board funding, March 2017

	Patients treated Outwith NHS Scotland
NHS Board responsible for funding	October 2014	March 2016	March 2017
NHS Ayrshire & Arran	34	29	*
NHS Borders	*	*	0
NHS Dumfries & Galloway	10	*	*
NHS Fife	*	*	*
NHS Forth Valley	*	*	*
NHS Grampian	18	14	14
NHS Greater Glasgow & Clyde	11	*	*
NHS Highland	*	10	*
NHS Lanarkshire	*	10	14
NHS Lothian	20	25	24
NHS Orkney	*	0	*
NHS Shetland	*	0	*
NHS Tayside	16	13	11
NHS Western Isles	0	12	*
National Services Division	*	*	*
All	143	137	109

*Suppressed due to small numbers

Of the 109 patients treated outwith NHS Scotland, 93 (85%) were treated in Private facilities and 15 (14%) in NHS England and 1 in other facilities.

A reason for placement was provided for 100 (92%) outwith NHS Scotland patients. Of these, 76 (76%) patients were placed outwith NHS Scotland because ‘facility able to meet the patient’s needs does not exist within NHS Scotland and there is no alternative to admission’. A further 16 (16%) patients were placed outwith NHS Scotland because ‘facility able to meet the patient’s needs exists within NHS Scotland but there are no available beds and no alternative to admission’.

Figure 31: Number of patients (Outwith NHS Scotland), by sector and Census

Patients treated Outwith NHS Scotland tend to be younger on average than those treated in NHS Scotland facilities; 90% were aged under 65 (compared to 60% of NHS Scotland patients), while 53% were aged under 40 (compared to 24% of NHS Scotland patients). There was a similar split between male patients, 56 (51%), treated Outwith NHS Scotland and female patients, 53 (49%).

Figure 32: Number of patients (Outwith NHS Scotland), by age and Census

The average (median) number of days for the 109 patients treated outwith NHS Scotland was 853 (approx 2 years and 4 months), which is a decrease of approx 2 months on 2016, however it is more than five times longer than that of those patients treated within NHS Scotland facilities.

Table 13: Average (median) days since admission (Outwith NHS Scotland), March 2017

Group	Average (median) number of days since admission	Approx. number of years / months
NHS Scotland patients treated outwith NHS Scotland	853	2 years, 4 months
All NHS Scotland patients (excluding ‘outwith’ patients)	156	5 months

Of the 109 patients treated Outwith NHS Scotland 82 (75%) had been in hospital for at least 1 year at the time of the Census date, while 30 patients (28%) had been in hospital for more than five years.

Figure 33: Number of patients (Outwith NHS Scotland), time since admission, by Census

Figure 34 shows the length of time that has passed since the patients’ last care plan review. This information was provided for 106 (97%) of patients. Of these, 16 patients (15%) treated outwith NHS Scotland had their last care plan review less than two weeks prior to the Census, while 25 (24%) had their last care plan review at least 6 months prior to the Census. A further 11 (10%) patients last had a care review over one year prior to the Census.

Figure 34: Number of patients (Outwith NHS Scotland), by time since care plan, March 2017

* Date of last care plan review was not available for 3 patients

Of the 109 patients treated outwith NHS Scotland:

• 51 patients (47%) were receiving Hospital Based Complex Clinical Care
• 38 patients (35%) were under Forensic Services
• No patients were flagged as a delayed discharge (this information was not returned for a small number of patients).

A total of 32 (29%) of 109 patients had a diagnosis, either primary or secondary, for a Personality Disorder. There were 27 (25%) patients with a Learning Disability or Autism, while 22 (20%) had Schizophrenia and 11 (10%) had a diagnosis of Psychological Development.

Figure 35: Number of patients (Outwith NHS Scotland), mental health diagnosis, March 2017

* Patients can have multiple conditions

Finally, data is provided, where possible, on anticipated discharge/transfer and date of discharge/transfer. A total of 20 (18%) patients are anticipated to return to NHS Scotland. Of these, the majority are expected to return within one year.