Delayed transfers of care occur when a person remains in a hospital or a mental health bed for longer than they clinically need to be there. This is a growing problem for the NHS. In mental health, the latest figures from the Health and Social Care Information Centre show that, in October 2015, there were 23,321 ‘bed days’ - about 3% of all bed days that month - lost through delayed transfers of care in mental health settings. Analyses of available data have estimated that delayed transfers in mental health affect about 6,000 service users, absorb one in 20 bed days and cost the NHS £2 million a year.

This is troubling in mental health for many reasons, especially given the impact on service users. Extended stays can reduce a person’s capacity to return to their community independently and with confidence, leading often to further crisis and a return to inpatient care. When wards become too full, other service users struggle to get timely access to an appropriate bed when they are in crisis. To compensate, people may be placed ‘out of area’ to receive treatment. This can be necessary to ensure a person receives crisis care as soon as possible, but it can also increase the likelihood of an extended stay and the associated problems for a person’s recovery.

There have been some significant improvements in mental health crisis response achieved through the Crisis Care Concordat to date; these show what can be achieved when involved partners at both national and local level focus on meeting common goals to improve the experience of mental health service users.

For the NHS as a whole, delayed transfers negatively affect how well NHS staff feel they can meet the needs of patients and service users in their care. They are inefficient and expensive: a warning that the NHS needs to work in a more coordinated and patient-centred way.

Last summer NHS Providers convened the Right place, right time commission: a panel of experts in health, local government, social care and housing, led by Rt. Hon Paul Burstow (now chair of Tavistock and Portman NHS Foundation Trust), to review the available evidence around why delayed transfers of care occur across the NHS and what can be done to address them. The commission found that, in particular for mental health services, the primary reasons for delayed transfers included:

• insufficient resources, including funding and staff, to meet demand for services
• a lack of coordinated community-based support (housing, primary care, social services)
• limited coordination of care for service users along pathways of care
• a 10% increase in use of the Mental Health Act in recent years
• poor quality data across the system, due to unclear definitions of ‘delayed transfers’ and ‘out of area placements’ in mental health settings
• insufficiently detailed information about the characteristics of service users, who often present unique and complex physical and mental healthcare challenges.

However, the commission’s review also found that delayed transfers are preventable. There is no blueprint - solutions must be found locally in line with specific population needs and services. But, by focusing on the needs and lives of service users, many of our members have successfully worked with local partners to adjust services and care pathways in ways that tackle the causal problems. For example:

• Leeds and York Partnership NHS Foundation Trust’s Accommodation Gateway program gives service users a role in determining the best housing placement for them. The program has reduced delayed discharges, improved service user experience and given the local partners a more coordinated and efficient process for managing and meeting service users’ accommodation needs.

• Northumberland, Tyne and Wear NHS Foundation Trust’s bed management and transfers system has, since its introduction 18 months ago, significantly improved coordination between primary and secondary community mental health services, improved responsiveness to people in crisis and significantly reduced out of area placements.

• By providing service users with a care navigator, commissioners for the London Borough of Waltham Forest have improved post-discharge care and treatment attendance and reduced the incidence and duration of crises amongst service users.

• Camden and Islington NHS Foundation Trust works with a social housing charity and the local council to provide more tailored clinical and support care for service users with complex mental health care needs - reducing admissions, length of stay, and costs.

The commission’s report sets out a series of calls to action for all parts in the system including national bodies, local government, social care, housing and providers. Three changes that we believe will achieve significant rapid improvements for transfers of care in mental health, and also contribute significantly to delivering the core principles and outcomes of the Crisis Care Concordat, are:

• ensuring people with lived experience of mental illness are involved in service design and care planning
• a more coordinated approach amongst local partners to care planning, housing placements and moving service users along care pathways
• commissioning that ensures community-based mental health care and crisis resolution home treatment teams are available to support people who no longer clinically need to remain in inpatient care.

Soon we will learn the recommendations to government from the mental health taskforce and the commission on acute adult psychiatric care. In responding, we encourage ministers and policymakers to draw on the very helpful advice produced by frontline experts in the Right place, right time commission report.

Delayed transfers negatively affect how well NHS staff feel they can meet the needs of patients and service users in their care. They are inefficient and expensive: a warning that the NHS needs to work in a more coordinated and patient-centred way.

There have been some significant improvements in mental health crisis response achieved through the Concordat to date; these show what can be achieved when involved partners at both national and local level focus on meeting common goals to improve the experience of mental health service users.

The strengthened partnerships that have grown through the Crisis Care Concordat provide a strong framework to address the causes of delayed transfers of care, for the benefit of all people who suffer mental health crisis.

This blog has been adapted by Mind for publication on the Crisis Care Concordat website