Inpatient census 2016: parts one and two

5. Out of Scotland NHS Placements

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 137 patients treated outwith NHS Scotland. Of these 137 patients, 91 were treated in a non- NHS facility in Scotland, while 46 were treated elsewhere in the UK.

*Suppressed due to small numbers. See paragraphs on "Data Confidentiality" in Section 6 of this report.

Of the 137 patients treated outwith NHS Scotland, 113 were treated in Private facilities,
18 in NHS England and 6 in other facilities.

Mental health and Learning Disability patients funded by, but treated outwith, NHS Scotland (by sector)

Patients treated Outwith NHS Scotland tend to be younger on average than those treated in NHS Scotland facilities. 78% were aged under 65 (compared to 59% of NHS Scotland patients), while 46% were aged under 40 (compared to 24% of NHS Scotland patients). 75 patients (55%) treated Outwith NHS Scotland were male, 62 female.

Patients treated outwith NHS Scotland, by age group (2014 v 2016)

The average (median) number of days for the 137 patients treated outwith NHS Scotland was 914 (approx 2 years and 6 months) - this is more than five times longer than that of those patients treated within NHS Scotland facilities:

Of the 137 patients treated Outwith NHS Scotland 98 (72%) had been in hospital for at least 1 year at the time of the census date. 45 patients (33%) had been in hospital for more than five years.

Patients treated outwith NHS Scotland, time since admission, 2016

*Admission date was not recorded for 1 patient.

The following chart shows the length of time that has passed since the patients' last care plan review. 21 patients (15%) treated outwith NHS Scotland had their last care plan review less than two weeks prior to the Census, while the same number had their last care plan review at least 6 months prior to the Census.

Patients treated outwith NHS Scotland, time since care plan review, 2016

*Date of last care plan review was not recorded for 5 patients.

Of the 137 patients treated outwith NHS Scotland:

• 89 patients (65%) were receiving Hospital-Based Complex Clinical Care
• 38 patients (28%) were under Forensic Services

33 out of the 137 patients had a diagnosis, either primary or secondary, for a learning disability or autism (24% of all patients). The second most prevalent was Personality Disorders (28 patients), followed by Schizophrenia (21), Dementia (20) and Psychological Development (17).

Patients treated outwith NHS Scotland - Mental Health diagnosis (primary and secondary), 2016

Note: Patients can have multiple conditions.