Part Two

Outwith NHS Scotland placements

Patients treated outwith NHS Scotland:

• 124 patients in the 2023 Census were funded by NHS Scotland but receiving treatment outwith NHS Scotland.
• these patients had been in hospital for an average of 3 years at the time of the Census.
• 20 patients (16%) had a diagnosis of learning disability or autism.

There are patients in the Census who are classified as being outwith NHS Scotland. These are patients with mental health, learning disability, or addiction diagnoses who are funded by NHS Scotland but treated elsewhere, for instance NHS England, private facilities, or local authority care.

Some patients with highly complex, specialist needs are treated outwith NHS Scotland facilities. It can be more cost-effective to send patients to facilities outwith NHS Scotland due to individual needs. Each care package is individually and carefully considered by Boards. In total, there were 124 patients treated outwith NHS Scotland in the 2023 Census.

Table 17: Patients outwith NHS Scotland, by NHS Board funding, 2014 – 2023

Psychiatric, addiction or learning disability inpatients, funded by but treated outwith NHS Scotland, March/April Census 2014 – 2023.

c - Suppressed due to small numbers

Reasons and Locations for Treatment

• 91% (113) of patients were treated in private facilities, 6% (7) in NHS England, and 3% (4) were ‘Other’. Most patients (78%) were treated in Scotland, while 21% were treated in England. Data was missing for 1 patient.

• 46% of patients were placed outwith NHS Scotland because there was no facility that could meet the patients’ needs within NHS Scotland, when there was no alternative to admitting the patient. 41% were placed outwith NHS Scotland because there were no available beds in an appropriate facility.

Figure 13: The majority of patients treated outwith NHS Scotland are treated in private facilities, while a smaller proportion are treated in NHS England and other facilities.

Psychiatric, addiction or learning disability inpatients, funded by but treated outwith NHS Scotland, March/April Census 2014 – 2023.

Patient Demographics

Patients treated outwith NHS Scotland tend to be older on average than those treated in NHS Scotland facilities. For example, 60% were under the age of 65, compared to 66% within NHS Scotland patients. Just below one third of patients (29%) were aged under 40. There were more male patients (74 patients, 60%) than female (50 patients, 40%).

Figure 14: The largest proportion of patients treated outwith NHS Scotland are over the age of 65 and 60% are male.

Psychiatric, addiction or learning disability inpatients, funded by but treated outwith NHS Scotland, 2023 census.

Length of Stay

The average (median) length of stay for patients treated outwith NHS Scotland was 1104 days (approximately 3 years). This is 244 days shorter than the average (median) length of stay in 2022. It is also almost 8 times longer than patients treated within NHS Scotland facilities.

Table 18: Average (median) days since admission (outwith NHS Scotland), 2023

Psychiatric, addiction or learning disability inpatients, funded by but treated outwith NHS Scotland, 2023 census.

Time since last care plan review

Information on the length of time that has passed since the patients’ last care plan review was provided for 114 (92%) patients. Of these, 17 patients (15%) treated outwith NHS Scotland had their last care plan review less than two weeks prior to the 2023 Census. Meanwhile, 97 patients (85%) had their last care plan review at least 6 months prior to the Census.

Diagnoses and anticipated discharge

Of the 124 patients receiving treatment outwith NHS Scotland:

• 40% of patients were receiving Hospital-Based Complex Clinical Care.
• 34% were under forensic services
• 16% had a learning disability or autism

16% of outwith NHS Scotland patients had a primary or secondary diagnosis of a personality disorder, 34% had dementia, 23% had schizophrenia, and 6% had schizotypal and delusional disorders.

Figure 15: The most common diagnosis for patients treated outwith NHS Scotland was dementia (42 patients, 34%) followed by schizophrenia (29 patients, 23%).

 Psychiatric, addiction or learning disability inpatients, funded by but treated outwith NHS Scotland, 2023 census. 

Data is provided, where possible, on anticipated discharge/transfer and date of discharge/transfer. 14% of patients are anticipated to return to NHS Scotland within one year.