Inpatient Census 2019: parts one and two

7. Out of Scotland NHS Placements

• 126 patients in the 2019 Census who were funded by NHS Scotland were receiving treatment out with NHS Scotland
• At the time of the 2019 Census these patients had been in hospital an average of 2 years and 8 months
• 40 patients (32%) had a diagnosis of learning disability or autism

Patients 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) are classified in the Census as being "Outwith" NHS Scotland.

Some patients with highly complex, specialist needs are treated outwith NHS Scotland facilities. Each care package is individually and carefully considered by Boards. In total there were 126 patients treated outwithNHS Scotland in the 2019 Census.

Table 18: Number of patients (Outwith NHS Scotland) by NHS Board funding, 2014 – 2019

* Suppressed due to small numbers

Of the 126 patients treated outwith NHS Scotland, 115 (91%) were treated in private facilities and 11 (9%) in NHS England. The majority of patients, 82 (66%), were being treated in Scotland, while the remaining 43 (34%) were being treated in England. Data was not returned for 1 patient.

A reason for placement was provided for all outwith NHS Scotland patients. Of these, 116 (92%) 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
Psychiatric, Addiction or Learning Disability Patients, Outwith NHS Scotland, 2019 Census

Patients treated outwith NHS Scotland tend to be younger on average than those treated in NHS Scotland facilities; 92% were aged under 65 (compared to 62% within NHS Scotland patients). Just over half (52%) were aged under 40. There was a similar split between male (52%) and female (48%) patients.

Figure 15: The majority of patients treated outwith NHS Scotland are under the age of 40, while there is an almost even split between males and females
Psychiatric, Addiction or Learning Disability Patients, Outwith NHS Scotland, 2019 Census

The average (median) number of days for patients treated outwith NHS Scotland was 975 days (approx 2 years and 8 months). This is 42 days longer than the average (median) length of stay in 2018 and is almost 7 times longer than that of patients treated within NHS Scotland facilities.

Table 19: Average (median) days since admission, Outwith and within NHS Scotland, 2019

Of the patients treated outwith NHS Scotland, 96 (76%) had been in hospital for at least one year at the time of the 2019 Census, while 37 patients (29%) 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 119 (94%) patients. Of these, 13 patients (11%) treated outwith NHS Scotland had their last care plan review less than two weeks prior to the 2019 Census, while 32 (27%) had their last care plan review at least 6 months prior to the Census.

Of the 126 patients treated outwith NHS Scotland:

• 50 patients (40%) were receiving Hospital Based Complex Clinical Care
• 37 patients (29%) were under forensic services
• 40 patients (32%) had a learning disability or autism.

A total of 38 (30%) of outwith NHS patients had a diagnosis, either primary or secondary, for a personality disorder. There were 24 (19%) patients with schizophrenia, while 12 (10%) had a diagnosis of schizotypal and delusional disorders.

Figure 16: The most common diagnosis for patients treated outwith NHS Scotland was a personality disorder (30%), followed by schizophrenia (19%)
Psychiatric, Addiction or Learning Disability Patients, Outwith NHS Scotland, 2019 Census

* Patients can have multiple diagnoses

Data is provided, where possible, on anticipated discharge/transfer and date of discharge/transfer. A total of 12 (10%) patients are anticipated to return to NHS Scotland within one year.