Inpatient census 2019: hospital based complex clinical care and long stay

Introduction

Hospital Based Complex Clinical Care (HBCCC) was introduced in Scotland on the 1^st June 2015 following a review of NHS Continuing Care. This report represents an overview of the results of the Hospital Based Complex Clinical Care Census carried out by the Scottish Government and NHS Boards as at 23:59, 28 March 2019. 

A patient is defined as receiving HBCCC if they cannot have their care needs met in any setting other than hospital and require long-term complex clinical care. This includes patients within NHS Scotland facilities (e.g. acute general hospitals, community hospitals, psychiatric hospitals) as well as those patients funded by NHS Scotland but treated in non-NHS Scotland facilities (e.g. Private Facilities or NHS facilities elsewhere in the UK). By definition, patients in receipt of HBCCC cannot be a Delayed Discharge, which occurs when a hospital patient who is clinically ready for discharge from inpatient hospital care continues to occupy a hospital bed beyond the date they are ready for discharge. Further information about HBCCC is available from the following link:

http://www.sehd.scot.nhs.uk/dl/DL(2015)11.pdf 

The definition and scope of the Census changed in 2017 following the first HBCCC Census in 2016. 2019 analysis is therefore not directly comparable to previously published HBCCC analysis in 2016. Data published between 2017 and 2019 can be compared more readily.

Following feedback from users of this report, additional analysis has been presented for long stay patients who are not in receipt of HBCCC. A patient is defined as being a Long Stay patient if they have been in hospital for at least 6 months (and are not in receipt of HBCCC and do not have a ready for discharge date) as at the Census date. 

The purpose of the Census is to firstly monitor the implementation of HBCCC and secondly, to enhance the Scottish Government and NHS Scotland’s’ understanding of HBCCC. This analytical evidence will inform policy development and service planning, both nationally and locally. 

To enable further research and statistical analysis, extracts of the Census datasets may be made available for approved researchers.

Scope of census

Following on from the first Mental Health & Learning Disability Inpatient Bed Census held in October 2014, a review of the scope, frequency and questions were undertaken by the Scottish Government in collaboration with NHS Boards. This led to a number of differences between the 2014 and 2016 Censuses. Most notably, a third part to the Census was introduced in 2016 in order to reduce duplication for NHS Boards. The 2019 Census is similar in nature to the 2016, 2017 and 2018 Censuses; 

Part 1: Mental Health and Learning Disability Inpatient Bed Census

Part 2: Mental Health, Addiction and Learning Disability Patients: Out of NHS Scotland Placements Census

Part 3: Hospital Based Complex Clinical Care and Long Stay Census  (for patients who are not occupying Mental Health, Addiction and Learning Disability Inpatient Beds)

Collectively, the three parts to the Census make up the Inpatient Census. This report is entirely focused on patients in receipt of Hospital Based Complex Clinical Care and Long Stay patients, therefore, information is presented from Parts 1, 2 and 3 of the Census about all patients who meet the HBCCC definition. It also includes patients who have been in hospital for at least 6 months, irrespective of HBCCC status.

It should be noted that HBCCC was introduced in Scotland on the 1^st June 2015 and as this is the fourth year for which HBCCC information has been collected, the data collection systems and quality assurance processes in place are still being developed. Between 2016 and 2017 there was further work undertaken with NHS Boards to improve the guidance and therefore consistency in data collection between NHS Boards. Following the 2016 report, users also fed back that they would like analysis to be presented for Long Stay patients (those who have been in hospital for at least 6 months but do not have a delayed discharge date). This change was implemented for the 2017 report and continues in the 2019 report.

The underlying data has undergone extensive validation by NHS Boards and Scottish Government Statisticians and is therefore being published as Official Statistics. All figures are provisional and may be subject to change in future publications.

The report for the first two parts of the Inpatient Census (Mental Health & Learning Disability Inpatient Bed Census, Out of NHS Scotland Placements Census) was published on 08 October 2019.

https://www.gov.scot/publications/inpatient-census-2019-part-1-mental-health-learning-disability-inpatient-bed-census-part-2-out-scotland-nhs-placements/ 

Accompanying data

An accompanying spreadsheet containing the data behind this report, as well as some summary information at NHS Board level will also be made available at the following link:

https://www2.gov.scot/Topics/Statistics/Browse/Health/Data/MHBC 

Staff in NHS Boards will also be able to request access to more detailed analysis, which will be accessed through a secure online website. This will provide more graphical representations of the data, as well as drilling down to hospital and ward level for users’ health boards. Access is granted by a nominated NHS Board authoriser, for more details please contact swstat@gov.scot. It is our intention that this information will be available in the near future.

Future plans for the census

A repeat of the Census is intended to be carried out at the end of March 2020, and any methodological changes will be informed by this year’s Census.