Mental Health Inpatient Census 2022 Parts 1 and 2

Part One

1. Overview of patients being treated in NHS Scotland facilities

• there were 2,959 mental health, addiction, and learning disability inpatients in NHS Scotland at the time of the 2022 Census
• bed occupancy in NHS Scotland was 86% at the 2022 Census, though this ranged from 67 - 97% across individiual NHS Boards
• 10% of patients discharge from hospital was delayed with an average (median) length of delay of just over 2 months

Number of patients, available beds and occupancy rates

There were 2,959 inpatients being treated in NHS Scotland at the time of the 2022 Census, an 11% decrease compared with the 2019 Census and a 24% 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.

Table 1: Number of patients in Psychiatric, Addiction, or Learning Disability psychiatric, addiction, or learning disability beds in NHS Scotland, 2014 – 2022

* These years are missing some hospital wards and figures are approximate.

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

There were 3,451 available mental health, addiction, and learning disability beds in Scotland at the time of the 2022 Census, a 12% decrease on available beds from the 2019 Census. This follows the overall trend where the number of available beds has been consistently decreasing each Census, with a 24% decrease compared to the first census in 2014.

Table 2: Number of Psychiatric, Addiction, or Learning Disability psychiatric, addiction, or learning disability beds in NHS Scotland, 2014 – 2022

* These years are missing some hospital wards and figures are approximate.

The decrease in available mental health beds is a trend seen in other European countries as well. For instance, OECD data shows that psychiatric beds for the UK as a whole declined from 46 per 100,000 people in 2014 to 35 per 100,000 in 2022. However the data is incomplete for some years and countries, and there may also be variations in methodologies between the nations. It is therefore important to exercise caution when interpreting the data.

Table 3: Available beds and inpatients per 100,000 population in NHS Scotland, 2014 – 2022

* These years are missing some hospital wards and figures are approximate.

The national occupancy rate of Psychiatric, Addiction, or Learning Disability psychiatric, addiction, or learning disability beds in NHS Scotland at the 2022 Census was 86%, two percentage points 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 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.

Table 4: Occupancy rates for Psychiatric, Addiction, or Learning Disability psychiatric, addiction, or learning disability beds in NHS Scotland, 2014 – 2022

* These years are missing some hospital wards and figures are approximate.

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 70 patients were boarding from another hospital at the 2022 Census. Of these, 47 (67%) were boarding to another hospital in the same NHS Board as their local catchment area. It should be noted that this can still involve large distances between the patient’s home and the hosptial of treatment even when a patient is being treated in the same NHS Health Board (HB). Some of the 70 patients also include people funded by the NHS in another UK nation but being treated in NHS Scotland.

Table 5: Number of patients “boarding” from another hospital in NHS Scotland, 2016 – 2022  

* These years are missing some hospital wards and figures are approximate.

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 an overnight period. Of those patients, 40 (63%) were on pass to home.

Hospital Based Complex Clinical Care

From 2016, the Inpatient Census has collected 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. This is eight percentage points lower than 22% of patients in 2019. NHS Greater Glasgow & Clyde or NHS Lothian treated 67% of these patients in 2022.

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

Delayed discharge occurs when a hospital patient who is clinically ready for discharge from inpatient hospital care continues to occupy a hospital bed.

Timely discharge from hospital is an important indicator of quality and a marker for person-centred, effective, integrated, and harm-free care. A delayed discharge can indicate issues such as insufficient post-hospital care, poor coordination between services, resource constraints, complex patient needs, or administrative delays.

At the 2022 Census 257 patients were a delayed discharge and this accounts for 10% of patients for which this information is known (information was not known for 187 patients and data not returned for 159 patients) and is two percentage point higher than the 2019 census. NHS Tayside had the highest proportion of delayed discharges, as a proportion of known patients, with 1 in 3 (33%) of patients delayed. Of the larger health boards, NHS Greater Glasgow & Clyde and NHS Lanarkshire have the lowest proportion, with 5% of patients delayed. NHS Western Isles and the State Hospital had no delayed discharges.

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.

Table 6: Average (median) length of delayed discharge in NHS Scotland, 2014 – 2022 

* These years are missing some hospital wards and figures are approximate.

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 132.5 days (4.4 months), which is a marginal decrease from the 2019 Census. Although quite variable, the average (median) length of stay has reduced from 160 days (5.3 months) in 2014.  

Table 7: Average (median) length of stay in NHS Scotland, 2014 – 2022  

* These years are missing some hospital wards and figures are approximate.