Inpatient census 2017: parts one and two

1. Overview of patients being treated in NHS Scotland facilities

• 3,572 mental health, addiction and learning disability inpatients in NHS Scotland at March 2017
• 59% of patients were male at the Census . 40% of patients were aged 65+, 59% between 18 and 64
• The bed occupancy rate in NHS Scotland was 85%

Number of patients and occupancy rates, by NHS Board

There were 3,572 inpatients being treated in NHS Scotland facilities at the March 2017 Census, which is a 1.7% decrease compared with 3,633 at the March 2016 Census. Table 1 shows the number of mental health, learning disability and addiction inpatients being treated in each board across the three Censuses carried out to date.

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 behalf of NHS Orkney and NHS Shetland.

Table 1: Number of inpatients by NHS Board and Census

NHS Board of treatment	Patients (October 2014)	Patients (March 2016)	Patients (March 2017)
NHS Ayrshire & Arran	198	184	192
NHS Borders	59	45	50
NHS Dumfries & Galloway	77	49	55
NHS Fife	256	184	253
NHS Forth Valley	217	206	214
NHS Grampian	339	319	297
NHS Greater Glasgow & Clyde	1,105	1,111	1,002
NHS Highland	169	173	160
NHS Lanarkshire	346	312	301
NHS Lothian	670	596	611
NHS Orkney	0	0	0
NHS Shetland	0	0	0
NHS Tayside	334	322	312
NHS Western Isles	18	15	14
State Hospital	121	117	111
Scotland	3,909	3,633	3,572

Of the wards covered by the Census, there were 4,205 available mental health, addiction and learning disability beds in Scotland at the March 2017 Census. There were 3,572 patients occupying these beds, giving an occupancy rate of 85%, the same as in March 2016 (see table 2).

Table 2: Occupancy rates by NHS Board and Census

	October 2014		March 2016		March 2017
NHS Board	Available beds	% occupancy	Available beds	% occupancy	Available beds	% occupancy
NHS Ayrshire & Arran	299	66%	265	69%	273	70%
NHS Borders	65	91%	57	79%	63	79%
NHS Dumfries & Galloway	107	72%	85	58%	85	65%
NHS Fife	346	74%	252	73%	289	88%
NHS Forth Valley	240	90%	249	83%	251	85%
NHS Grampian	383	89%	367	87%	353	84%
NHS Greater Glasgow & Clyde	1,176	94%	1,154	96%	1,128	89%
NHS Highland	195	87%	189	92%	174	92%
NHS Lanarkshire	450	77%	440	71%	411	73%
NHS Lothian	711	94%	645	92%	649	94%
NHS Tayside	409	82%	402	80%	380	82%
NHS Western Isles	19	95%	17	88%	17	82%
State Hospital	132	92%	132	89%	132	84%
Scotland	4,532	86%	4,254	85%	4,205	85%

Table 3 shows the occupancy rates for different ward types. The majority of available beds are in acute wards, where occupancy is 88%, higher than the total occupancy figure of 85%. Due to a change in definitions, a comparison with 2014 is not available.

Table 3: Occupancy rates by ward type and Census

	March 2016		March 2017
NHS Board	Available beds	% occupancy	Available beds	% occupancy
Acute	1,543	87%	1,525	88%
Intensive Psychiatric Care	133	80%	139	76%
Rehabilitation (non-addict)	371	89%	318	81%
Addiction Wards	54	76%	72	82%
Continuing care/long stay	490	73%	500	74%
Forensic (non- LD)	382	90%	391	88%
Forensic ( LD)	80	88%	82	91%
Dementia Wards	818	86%	795	86%
Young People/Children	50	96%	54	70%
Learning Disability	177	90%	179	90%
Eating Disorder	22	82%	22	95%
Other	134	84%	128	84%
Scotland	4,254	85%	4,205	85%

Note that hospitals in highly populated areas (e.g. NHS Greater Glasgow & Clyde, 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.

Annex A contains analysis of available beds for each NHS Scotland facility.

Demographics

The age breakdown of patients occupying mental health, learning disability and addiction inpatients beds is largely unchanged across the three Censuses. The largest proportion of patients are in the older age groups, with an average age of 57. The only age group to observe an increase in patient numbers from 2016 to 2017 was the 18-39 group. See table 4 and figure 1 for further details.

Table 4: Number of patients by age group and Census

Age group	Patients (October 2014)		Patients (March 2016)		Patients (March 2017)		General Population (2016 MYE)
Under 18	50	1%	55	2%	36	1%	19%
18-39	842	22%	806	22%	836	23%	29%
40-64	1,369	35%	1,267	35%	1,259	35%	34%
65+	1,648	42%	1,505	41%	1,440	40%	18%
All	3,909	100%	3,633	100%	3,572	100%	100%

* 1 patient with unknown date of birth in 2017

Figure 1: Number of patients by age group and Census

Of the 3,572 patients in the March 2017 Census, 59% were male. In 2016 this figure was 58%. Males represented 49% of the general Scottish population in 2016, suggesting that males are over represented in the mental health Censuses. See table 5 and figure 2 for more details.

Table 5: Number of patients by gender and Census

Patients by gender	Patients (October 2014)		Patients (March 2016)		Patients (March 2017)		General Population (2016 MYE)
Male	2,270	58%	2,092	58%	2,096	59%	49%
Female	1,639	42%	1,541	42%	1,474	41%	51%
All	3,909	100%	3,633	100%	3,572	100%	100%

* 2 patients with unknown gender in 2017

Figure 2: Number of patients by age group and Census

A total of 3,354 (94%) of patients identified as being white in the March 2017 Census, the majority of which described themselves as White Scottish. The 94% figure is broadly in line with the general population figure of 96% who described themselves as White in Scotland’s Census 2011. See table 6 for more details.

Table 6: Number of patients by ethnicity, March 2017 Census

Patients by ethnicity	Patients (March 2017)
White Scottish	2,880	81%
Other White	474	13%
Asian, Asian Scottish or Asian British	48	1%
African, African Scottish or African British	19	1%
Other/multiple ethnic groups	29	1%
Refused/Not Known	122	3%
All	3,572	100%

Almost half (48%) of the patients in the Census have never been married, while 20% were currently married and a further 14% were widowed. As expected, this changed with age where the oldest age group (65+) were more likely to be married (37%) or widowed (31%) than never married (15%). The vast majority of patients (85%) did not have any dependents.

Ward Types and Security Levels

As part of the Census, NHS Boards were asked to record the security level of the ward in which the patients were staying. A total of 2,712 (76%) of all patients at the Census were in a ‘General Psychiatric Ward’, see figure 3. The split is similar to that observed in 2016.

Figure 3: Number of patients by ward security level, March 2017 Census

The largest ward type in the March 2017 Census was ‘Acute’, in which there were 1,349 patients (38%), see figure 4 below. The occupancy rates for many of these wards can be found in table 3 reported earlier in this report.

Figure 4: Number of patients by ward type, March 2017 Census

Observation level

All patients in mental health inpatient settings will receive some degree of observation. However, levels of observation will vary according to the patients’ individual needs. Based on current guidelines the level of observation of patients at the time of the Census was recorded. The observation levels are:

• “General Observation” – Staff should have a knowledge of the patients’ general whereabouts.
• “Constant Observation” – Staff should be constantly aware of the precise whereabouts of the patient.
• “Special Observation” – Patient should be in sight and within arm’s reach of a member of staff.
• Enhanced care plan for therapeutic engagement – Aims to improve observation practice through therapeutic engagement with suicidal, violent or vulnerable patients to prevent them from harming themselves or others at times of high risk during their recovery.

Figure 5 shows that most patients (92%) fall under the General Observation category. This is similar to the 93% figure reported last year.

Figure 5: Number of patients by observation level, March 2017 Census

* Not applicable can relate to either patients who are being treated in care homes where an observation level may not apply, or patients on pass

Information on the number of staff involved in observations for the 244 patients on Constant, Special or Enhanced Observations shows that 41 (17%) have at least two members of staff involved, while the remaining patients have one member of staff involved.

The most common reason for a patient being on a Constant, Special or Enhanced Observation level was due to ‘risk of harm to others’ (28% of reasons given) followed by ‘risk of self harm’ (20% of reasons given) and ‘protection of vulnerable adults’ (19% of reasons given). Figure 6 gives more details.

Figure 6: Number of patients by reason for constant, special or enhanced observation level, March 2017 Census

* Patients can have more than 1 reason for being on Constant, Special or Enhanced Observation

* Figure excludes some categories due to small numbers

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. At the March 2017 Census there were 152 patients (4%) in Scotland who were on pass for at least that overnight period . Of those patients, 113 (74%) were on pass to home.

Boarding from another hospital

If a patient is “boarding” from another hospital, then they are staying in a hospital outwith their local catchment area. A total of 38 patients were boarding in from another hospital at the March 2017 Census. Of these, 30 (79%) were boarding to another hospital in the same NHS Board as their local catchment area.

Hospital Based Complex Clinical Care

From 2016, the Inpatient Census collected 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, or have been in hospital for over 6 months. At the March 2017 Census there were 924 patients receiving HBCCC who were occupying a mental heatlh or learning disability inpatient bed at the Census date. This is 26% of all patients covered by the Census.

Note, under the definition of HBCCC, no patient can be a delayed discharge.

A separate, more detailed report on HBCCC will be published by the Scottish Government in October 2017. 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

At the Census, 282 patients were a delayed discharge. This is 8% of patients for which this information is known (information was not returned for 95 patients). Of these patients, 66 (23%) had a learning disability.