Inpatient census 2018: parts one and two

6. Out of Scotland NHS Placements

• 197 patients in the Census who were funded by NHS Scotland were receiving treatment out with NHS Scotland
• At the time of the Census these patients had been in hospital an average of 2 years and 7 months
• 65 patients (33%) had a diagnosis of learning disability or autism

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 197 patients treated outwith NHS Scotland in the 2018 Census.

Table 22: Number of patients (Outwith NHS Scotland), by NHS Board funding and Census

* Suppressed due to small numbers

Of the 197 patients treated outwith NHS Scotland, 162 (82%) were treated in private facilities and 35 (18%) in NHS England.

A reason for placement was provided for all outwith NHS Scotland patients. Of these, 164 (83%) 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". A further 25 (13%) patients were placed outwith NHS Scotland because "facility able to meet the patient's needs exists within NHS Scotland but there are no available beds and no alternative to admission".

Figure 32: Number of patients (Outwith NHS Scotland), by sector and Census

Patients treated outwith NHS Scotland tend to be younger on average than those treated in NHS Scotland facilities; 93% were aged under 65 (compared to 60% of NHS Scotland patients), while 54% were aged under 40 (compared to 26% of NHS Scotland patients). There were more male patients,120 (61%) treated outwith NHS Scotland than female patients, 77 (39%). More than half (54%) of patients were males of working age.

Figure 33: Number of patients (Outwith NHS Scotland), by age, 2018 Census

The average (median) number of days for patients treated outwith NHS Scotland was 933 (approx 2 years and 7 months), which is an increase of approx 3 months on 2017, and is more than six times longer than that of patients treated within NHS Scotland facilities.

Table 23: Average (median) days since admission (Outwith NHS Scotland), 2018 Census

Of the patients treated outwith NHS Scotland, 148 (75%) had been in hospital for at least one year at the time of the 2018 Census, while 63 patients (32%) had been in hospital for more than five years.

Figure 34: Number of patients (Outwith NHS Scotland), time since admission, by Census

Information on the length of time that has passed since the patients' last care plan review was provided for 171 (87%) patients. Of these, 18 patients (11%) treated outwith NHS Scotland had their last care plan review less than two weeks prior to the 2018 Census, while 54 (32%) had their last care plan review at least 6 months prior to the Census.

Of the 197 patients treated outwith NHS Scotland:

• 49 patients (25%) were receiving Hospital Based Complex Clinical Care
• 41 patients (21%) were under forensic services
• 65 patients (33%) had a learning disability or autism.

A total of 51 (26%) of outwith NHS patients had a diagnosis, either primary or secondary, for a personality disorder. There were 38 (19%) patients with schizophrenia, while 26 (13%) had a diagnosis of psychological development.

Figure 35: Number of patients (Outwith NHS Scotland), mental health diagnosis, 2018 Census

* Patients can have multiple diagnoses

Data is provided, where possible, on anticipated discharge/transfer and date of discharge/transfer. A total of 17 (9%) patients are anticipated to return to NHS Scotland within one year.