Delivering for Mental Health: plan

Manage better admission to, and discharge from, hospital

Shifting the balance of care from hospital to the community is a key challenge within Delivering for Health. There should also be an effective discharge process in place to minimise the incidence of delayed discharge and inappropriate readmission. However we know that though lengths of stay are reducing, people are often re-admitted soon after discharge.

We need to better manage the admission process, in particular, by ensuring that local crisis services are functioning effectively. To be effective crisis services must deliver several important functions. They will require to have rapid, same day response times, provide intensive specialist input of assessment, treatment and risk management including that for self-harm, in a community setting and focus on those people who might otherwise require admission to hospital.

The introduction of crisis response services is a major step in the redesign of existing mental health services and will enable people experiencing mental health difficulties to be treated in community settings and with the minimum of disruption to their lives. In Delivering for Health we committed to developing standards for crisis services in Scotland. This work has been taken forward by the Mental Health Foundation and the Scottish Association for Mental Health in conjunction with the service. These standards are important in enabling services to manage and care for people better in the community, the emphasis should be on safety but at the same time ensuring access to services which meet the individual's (and their family's) needs.

Commitment 8: Ensure that people are managed and cared for more effectively in the community and avoid inappropriate admissions by ensuring that the crisis standards are achieved by 2009.

Secondly, we need to make sure that for those admitted that inpatient services meet their needs. This is partly a function for local ICPs, but also about the quality of inpatient units themselves. The functions of an acute admission ward are to provide support and treatment in an acute phase of illness when it is no longer possible to provide safe effective care in the community.

Commitment 9: We will establish acute in-patient forums across all Board areas, comprising service providers, service users and carers as well as other stakeholders such as local authority colleagues.

These forums will undertake a service mapping exercise at the outset and look with others at policies around admissions, re-admissions and discharge planning. They will also assess ward environments and activities that take place and recommend areas for improvement. As well as this they will also look at the quality and usefulness of the information which is provided to both service users and carers.

Thirdly, we need to ensure that discharge processes work effectively and that community services and support are in place. Again, this is primarily the focus of the work on ICPs.

To draw these elements together, we have set a target of reducing the number of acute inpatient readmissions. While this focuses on one component of the service, achieving the target will require action in each of the areas identified above.

Target 3: We will reduce the number of readmissions (within one year) for those that have had a hospital admission of over 7 days by 10% by the end of December 2009.