Mental Health Inpatient Census 2023 Part 3: hospital-based complex clinical care and long stay

Introduction 

Hospital Based Complex Clinical Care (HBCCC) was introduced in Scotland on June 1, 2015, following a review of NHS Continuing Care. This report provides an overview of the Hospital Based Complex Clinical Care Census. This was conducted by the Scottish Government and NHS Boards as of April 12, 2023. 

HBCCC patients are defined as those requiring long-term complex clinical care in a hospital setting. This includes those within NHS Scotland facilities and non-NHS Scotland facilities funded by NHS Scotland. For example private facilities or NHS facilities in other UK nations. HBCCC patients cannot have their care needs met anywhere other than a hospital due to the complexity of their condition. Patients receiving HBCCC cannot be considered as delayed discharge. This is where patients continue occupying beds beyond their ready-for-discharge date. Further information about HBCCC is available from the following link: 

Hospital Based Complex Clinical Care guidance 

Patients receiving Long Stay care, who have been in hospital for at least 6 months, are also considered. 

Changes in census definition 

The Census's definition and scope changed in 2017 after the first HBCCC Census in 2016. 

Analysis in the 2023 Census can't be directly compared to the 2016 HBCCC analysis. Data from 2017 to 2023 can be compared more easily. 

Additional analysis based on feedback 

Responding to user feedback, extra analysis has been included for Long Stay patients not receiving HBCCC. 

A Long Stay patient is one who has been in the hospital for at least 6 months (without HBCCC and no ready discharge date) as of the Census date. 

Census purpose 

The Census has two main goals. First, to monitor HBCCC's implementation. Second, to improve the understanding of HBCCC by the Scottish Government and NHS Scotland. 

This analytical evidence will help shape policy development and service planning. It will do so both at national and local levels. 

For further research and statistical analysis, portions of the Census datasets could be accessible to approved researchers.  

Census scope 

The Census consists of three parts, covering different patient categories. 

Part 1: Patients in psychiatric, addiction, or learning disability inpatient beds in NHS Scotland facilities. 

Part 2: Patients funded by NHS Scotland but treated outwith NHS Scotland facilities. 

Part 3: Patients receiving Hospital Based Complex Clinical Care (HBCCC) or Long Stay in general acute or community hospital inpatient beds. 

Focus of the report: 

This report primarily focuses on Hospital Based Complex Clinical Care (HBCCC) patients and Long Stay patients. 

Information is presented from Parts 1, 2, and 3 of the Census, including those meeting the HBCCC definition and Long Stay patients. 

This is the sixth year of HBCCC data collection, with continuous efforts to enhance data quality and consistency. 

HBCCC introduction and data collection: 

HBCCC was introduced in Scotland on June 1, 2015. 

This is the sixth year that HBCCC information has been collected. 

Systems for data collection and quality assurance are kept under review so that any improvements identified can be made.

Between 2016 and 2017, extra efforts were made with NHS Boards to enhance guidance and ensure consistent data collection. 

Feedback-driven improvements

After the 2016 report, users provided feedback requesting analysis for Long Stay patients. This change was implemented starting with the 2017 report and has continued in the 2023 report. 

Data validation and provisional figures 

Extensive validation of underlying data has been carried out by NHS Boards and Scottish Government Statisticians. This report is being published as Official Statistics.  Figures presented in the report are provisional and may change in future publications. 

The report for Parts 1 and 2 of the Inpatient Census was published alongside Part 3. 

Accompanying data 

An accompanying spreadsheet with data and summary information at NHS Board level is available for reference. 

Health and social care analysis statistics - gov.scot (www.gov.scot) 

Detailed analysis at hospital and ward levels can be accessed by staff in NHS Boards. Access is granted by a nominated NHS Board authoriser. For more details please contact mhic@gov.scot. 

Future plans 

A repeat of the Census is planned for the end of March 2024, informing any methodological changes based on this year's Census. 

Acknowledgements

We are extremely grateful to all those who assisted with the Inpatient Census, in particular, colleagues from the Health Boards, hospitals and care homes who provided information.

An Official Statistics Publication For Scotland

These statistics are official statistics. Official statistics are statistics that are produced by crown bodies, those acting on behalf of crown bodies, or those specified in statutory orders, as defined in the Statistics and Registration Service Act 2007.

Scottish Government statistics are regulated by the Office for Statistics Regulation (OSR). OSR sets the standards of trustworthiness, quality and value in the Code of Practice for Statistics that all producers of official statistics should adhere to.