Inpatient Census 2019: parts one and two

1. Overview of patients being treated in NHS Scotland facilities

• 3,310 mental health, addiction and learning disability inpatients in NHS Scotland at the 2019 Census
• Bed occupancy in NHS Scotland was 84% at the 2019 Census, though this ranged from 60 - 93% across individiual NHS Boards
• The proportion of patients whose discharge from hospital was delayed was 8%, with an average (median) length of delay of almost 3 months

Number of patients, available beds and occupancy rates

There were 3,310 inpatients being treated in NHS Scotland at the 2019 Census, a 4% decrease compared with the 2018 Census and a 15% decrease since the first Census in 2014. Table 1 shows there is variability across NHS Boards throughout the five Census points, though all NHS Boards have fewer patients at the 2019 Census compared with the first Census in 2014.

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 their behalf.

Table 1: Number of patients in psychiatric, addiction or learning disability beds in NHS Scotland, 2014 – 2019

NHS Board of treatment	2014	2016	2017	2018	2019
NHS Ayrshire & Arran	198	184	192	201	184
NHS Borders	59	45	50	53	*
NHS Dumfries & Galloway	77	49	55	55	65
NHS Fife	256	184	253	238	234
NHS Forth Valley	217	206	214	210	167
NHS Grampian	339	319	297	291	272
NHS Greater Glasgow & Clyde	1,105	1,111	1,002	937	984
NHS Highland	169	173	160	141	132
NHS Lanarkshire	346	312	301	269	284
NHS Lothian	670	596	611	603	558
NHS Tayside	334	322	312	325	274
NHS Western Isles	18	15	14	12	*
State Hospital	121	117	111	108	109
NHS Scotland	3,909	3,633	3,572	3,443	3,310

* Suppressed due to small numbers, secondary suppression also applied

There were 3,922 available mental health, addiction and learning disability beds in Scotland at the 2019 Census, a 4% decrease on available beds at the 2018 Census. The number of available beds has been consistently decreasing each Census, with a 13% decrease compared to 2014.

Table 2: Number of psychiatric, addiction or learning disability beds in NHS Scotland, 2014 – 2019

NHS Board of treatment	2014	2016	2017	2018	2019
NHS Ayrshire & Arran	299	265	273	264	225
NHS Borders	65	57	63	63	*
NHS Dumfries & Galloway	107	85	85	85	85
NHS Fife	346	252	289	286	287
NHS Forth Valley	240	249	251	248	213
NHS Grampian	383	367	353	351	314
NHS Greater Glasgow & Clyde	1,176	1,154	1,128	1,061	1,054
NHS Highland	195	189	174	173	165
NHS Lanarkshire	450	440	411	393	411
NHS Lothian	711	645	649	639	623
NHS Tayside	409	402	380	379	357
NHS Western Isles	19	17	17	13	*
State Hospital	132	132	132	120	120
NHS Scotland	4,532	4,254	4,205	4,075	3,922

* Suppressed due to small numbers, secondary suppression also applied

The decrease in available mental health beds is a trend observed across other countries in Europe. According to Eurostat online data, the number of psychiatric care beds in the European Union has decreased from an estimated 71.7 per 100,000 population in 2014 to 68.8 in 2017. Table 3 shows the number of available beds per 100,000 population in Scotland to be higher than the European Union average, though caution should be applied as there are differences in healthcare systems between nations, as well as definitional and methodological differences across the data.

Table 3: Available beds and inpatients per 100,000 population, 2014 – 2019

Measure	2014	2016	2017	2018	2019
Beds per 100,000 population	84.7	78.7	77.5	74.9	72.1
Patients per 100,000 population	73.1	67.2	65.8	63.3	60.9

The national occupancy rate of psychiatric, addiction or learning disability beds in NHS Scotland at the 2019 Census was 84%, the same as 2018. Occupancy rates have varied between 84 – 86% since the first Census in 2014. However there is wide variation in occupancy rates between NHS Boards.

Hospitals in highly populated areas (e.g. NHS Greater Glasgow & Clyde and 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 maximise 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.

Table 4: Occupancy rates for psychiatric, addiction or learning disability beds in NHS Scotland, 2014 – 2019

NHS Board of treatment	2014	2016	2017	2018	2019
NHS Ayrshire & Arran	66%	69%	70%	76%	82%
NHS Borders	91%	79%	79%	84%	*
NHS Dumfries & Galloway	72%	58%	65%	65%	76%
NHS Fife	74%	73%	88%	83%	82%
NHS Forth Valley	90%	83%	85%	85%	78%
NHS Grampian	89%	87%	84%	83%	87%
NHS Greater Glasgow & Clyde	94%	96%	89%	88%	93%
NHS Highland	87%	92%	92%	82%	80%
NHS Lanarkshire	77%	71%	73%	68%	69%
NHS Lothian	94%	92%	94%	94%	90%
NHS Tayside	82%	80%	82%	86%	77%
NHS Western Isles	95%	88%	82%	92%	*
State Hospital	92%	89%	84%	90%	91%
NHS Scotland	86%	85%	85%	84%	84%

* Suppressed due to small numbers, secondary suppression also applied

Boarding from another hospital

If a patient is "boarding" from another hospital, they are staying in a hospital outwith their local catchment area. This could be because there were no beds available in a closer hospital or because their local hospital did not have the required services to provide them with appropriate treatment.

A total of 37 patients were boarding in from another hospital at the 2019 Census. Of these, 28 (76%) were boarding to another hospital in the same NHS Board as their local catchment area. It should be noted even in cases where a patient is being treated in the same NHS Board, this can still involve large distances between the patient's home and the hosptial of treatment. Some of the 37 patients also include people funded by the NHS in another UK nation but being treated in NHS Scotland

Table 5: Number of patients "boarding" from another hospital in NHS Scotland, 2016 – 2019

Measure	2016	2017	2018	2019
Number of patients "boarding"	55	38	39	37
Number of patients "boarding" same NHS HB	45	30	29	28

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. If a patient is "On Pass", their bed may be used by another patient.

At the 2019 Census there were 87 patients (3%) on passfor at least that overnight period. Of those patients, 76 (80%) were on pass to home.

Hospital Based Complex Clinical Care

From 2016, the Inpatient Census collects information on patients receiving Hospital Based Complex 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. Under the definition of HBCCC, a patient cannot be a delayed discharge.

At the 2019 Census, approximately 1 in 5 patients (742) occupying a mental health or learning disability inpatient bed were receiving HBCCC, with 63% of these patients treated in NHS Greater Glasgow & Clyde or NHS Lothian.

A separate, more detailed report on HBCCC will be published by the Scottish Government in late October 2019. 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

Timely discharge from hospital is an important indicator of quality and is a marker for person-centred, effective and integrated care. A delayed discharge occurs when a hospital patient who is clinically ready for discharge from inpatient hospital care continues to occupy a hospital bed beyond the date they are ready for discharge.

At the 2019 Census,262 patients were a delayed discharge. This is 8% of patients for which this information is known (information was not returned for 140 patients), the same proportion of patients since 2017. As a proportion of known patients, NHS Dumfries & Galloway had the highest proportion of delayed discharges with almost 1 in 5 (19%) patients delayed. NHS Greater Glasgow & Clyde has the lowest proportion, with 4% of patients delayed.

The average (median) length of delay at the 2019 Census was just under 3 months (88 days), the longest average delay since the first Census in 2014.

Table 6: Average (median) length of delayed discharge in NHS Scotland, 2014 – 2019

Measure	2014	2016	2017	2018	2019
Average (Median) Days	65	71	65	72	88
Average (Median) Banded	2.1 months	2.3 months	2.1 months	2.4 months	2.9 months

Length of Stay

The average (median) length of stay in a facility can have a large impact on service provision as longer lengths of stay reduce the turnover of patients and beds. The average (median) length of stay at the 2019 Census was 142 days (4.7 months), which is a marginal increase on last year. However, overall across each Census since 2014, the average (median) length of stay has not changed substantially, instead flucuating around 4.5 to 5 months.

Table 7: Average (median) length of stay in NHS Scotland, 2014 – 2019

Measure	2014	2016	2017	2018	2019
Average (Median) Days	160	147	156	136	142
Average (Median) Banded	5.2 months	4.8 months	5.1 months	4.5 months	4.7 months