Inpatient census 2022: parts one and two

7. Outwith NHS Scotland placements

• 162 patients in the 2022 Census who were funded by NHS Scotland were receiving treatment outwith NHS Scotland
• At the time of the 2022 Census these patients had been in hospital an average of 3 years and 8 months
• 33 patients (20%) had a diagnosis of learning disability or autism

Patients with a main diagnosis of a mental health condition, learning disability or addiction who are funded by NHS Scotland, but are treated either by the NHS outwith Scotland (e.g. by NHS England) or outwith the NHS (e.g. in a private/voluntary sector/local authority care home or private hospital) are classified in the Census as being outwith NHS Scotland.

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 outwith NHS Scotland facilities than creating dedicated facilities in NHS Scotland. Each care package is individually and carefully considered by Boards. In total there were 162 patients treated outwith NHS Scotland in the 2022 Census.

* c - Suppressed due to small numbers

Of the 162 patients treated outwith NHS Scotland, 148 (91%) were treated in private facilities, 6 (4%) in NHS England and 8 (5%) were voluntary sector. The majority of patients, 126 (79%), were being treated in Scotland, while the remaining 34 (21%) were being treated in England. Data was not returned for 2 patients.

A reason for placement was provided for all outwith NHS Scotland patients. Of these, 84 (52%) 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”.

Patients treated outwith NHS Scotland tend to be older on average than those treated in NHS Scotland facilities; 58% were aged under 65 (compared to 65% within NHS Scotland patients). This is a change from the 2019 census when patients treated outwith tended to be younger. One in four patients (25%) were aged under 40. There were more male patients (96, 59%) than female (66, 41%).

The average (median) number of days for patients treated outwith NHS Scotland was 1348 days (approx 3 years and 8 months). This is 373 days longer than the average (median) length of stay in 2019 and is almost 10 times longer than that of patients treated within NHS Scotland facilities.

Of the patients treated outwith NHS Scotland, 75 (46%) had been in hospital for between one and five years at the time of the 2022 Census, while 58 patients (36%) had been in hospital for more than five years.

Information on the length of time that has passed since the patients’ last care plan review was provided for 153 (94%) patients. Of these, 53 patients (35%) treated outwith NHS Scotland had their last care plan review less than two weeks prior to the 2022 Census, while 30 (20%) had their last care plan review at least 6 months prior to the Census.

Of the 162 patients treated outwith NHS Scotland:

• 86 patients (53%) were receiving Hospital Based Complex Clinical Care.
• 38 patients (23%) were under forensic services.
• 33 patients (20%) had a learning disability or autism.

A total of 24 (15%) of outwith NHS patients had a diagnosis, either primary or secondary, for a personality disorder. There were 51 (31%) patients with dementia, and 30 (19%) patients with schizophrenia, while 9 (6%) had a diagnosis of schizotypal and delusional disorders.

* Patients can have multiple diagnoses

Data is provided, where possible, on anticipated discharge/transfer and date of discharge/transfer. A total of 9 (6%) patients are anticipated to return to NHS Scotland within one year.