Inpatient census 2022: parts one and two

1. Overview of patients being treated in NHS Scotland facilities

• 2,876 mental health, addiction and learning disability inpatients in NHS Scotland at the 2022 Census
• Bed occupancy in NHS Scotland was 85% at the 2022 Census, though this ranged from 67 - 97% across individiual NHS Boards
• The proportion of patients whose discharge from hospital was delayed was 10%, with an average (median) length of delay of just over 2 months

Number of patients, available beds and occupancy rates

There were 2,876 inpatients being treated in NHS Scotland at the 2022 Census, a 13% decrease compared with the 2019 Census and a 26% decrease since the first Census in 2014. Table 1 shows there is variability across NHS Boards throughout the six Census points, though all NHS Boards have fewer patients at the 2022 Census compared with the first Census in 2014.

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 their behalf.

* c - Suppressed due to small numbers, secondary suppression also applied

There were 3,366 available mental health, addiction and learning disability beds in Scotland at the 2022 Census, a 14% decrease on available beds at the 2019 Census. The number of available beds has been consistently decreasing each Census, with a 26% decrease compared to 2014.

The decrease in available mental health beds is a trend observed across other countries in Europe. Data from Eurostat shows that the number of psychiatric care beds in the European Union in 2019 was estimated to be 73 per 100,000 population in comparison to 75 in 2014. Table 3 shows the number of available beds per 100,000 population in Scotland to be lower than the European Union average, though caution should be applied as 2019 is the last year we have comparable data and there are likely to be differences in definition and methodology between nations.

The national occupancy rate of psychiatric, addiction or learning disability beds in NHS Scotland at the 2022 Census was 85%, one percentage point higher than in 2019. Occupancy rates have varied between 84 – 86% since the first Census in 2014. However there is wide variation in occupancy rates between NHS Boards.

Hospitals in highly populated areas (e.g. NHS Greater Glasgow & Clyde and 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.

Boarding from another hospital

If a patient is “boarding” from another hospital, then they are staying in a hospital outwith their local catchment area. This could be because there were no beds available in a closer hospital or because their local hospital did not have the required services to provide them with appropriate treatment.

A total of 68 patients were boarding from another hospital at the 2022 Census. Of these, 47 (69%) were boarding to another hospital in the same NHS Board as their local catchment area. It should be noted that even in cases where a patient is being treated in the same NHS Health Board (HB), this can still involve large distances between the patient’s home and the hosptial of treatment. Some of the 68 patients also include people funded by the NHS in another UK nation but being treated in NHS Scotland.

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. If a patient is “On Pass”, their bed may be used by another patient.

At the 2022 Census there were 64 patients (2%) on pass for at least that overnight period. Of those patients, 51 (80%) were on pass to home.

Hospital Based Complex Clinical Care

From 2016, the Inpatient Census collects information on patients receiving Hospital Based Complex Clinical 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. Under the definition of HBCCC, a patient cannot be a delayed discharge.

At the 2022 Census, 14% of patients (409) occupying a mental health or learning disability inpatient bed were receiving HBCCC, an 8% decrease from 2019, with 67% of these patients treated in NHS Greater Glasgow & Clyde or NHS Lothian.

A separate, more detailed report on HBCCC from the Scottish Government is also available. This covers HBCCC patients in mental health or learning disability inpatient beds, patients treated outwith NHS Scotland and patients in General Acute hospitals (Inpatient Census 2022: hospital based complex clinical care and long stay).

Delayed Discharge

Timely discharge from hospital is an important indicator of quality and is a marker for person-centred, effective, integrated and harm-free care. A delayed discharge 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.

At the 2022 Census, 263 patients were a delayed discharge. This is 10% of patients for which this information is known (information was not known for 168 patients and data not returned for 158 patients), two percentage points higher than the 2019 census. As a proportion of known patients, NHS Tayside had the highest proportion of delayed discharges with over 1 in 3 (36%) patients delayed. NHS Greater Glasgow & Clyde has the lowest proportion, with 5% patients delayed.

The average (median) length of delayed discharge at the 2022 Census was just over two months (68 days), 20 days less than in 2019. Sixteen patients were delayed discharge but did not have a delayed discharge date in 2022.

Length of Stay

The average (median) length of stay in a facility can have a large impact on service provision as longer lengths of stay reduce the turnover of patients and beds. The average (median) length of stay at the 2022 Census was 136 days (4.5 months), which is a marginal decrease from the 2019 Census. Although it is quite variable, the average (median) length of stay has reduced from 160 days (5.3 months) in 2014.