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Select Committee on Health Memoranda


3.3 Hospital and Community Health Services Allocations and Distance from Targets

  3.3.2  Could the Department include a commentary explaining the key factors that determined those percentage growth increases shown in the table? [4.5b]

  1.  Allocations for 2002-03 take account of general medical services non-cash limited (GMSNCL) expenditure. GMSNCL baselines and targets are added to unified baselines and targets to form composite baselines and targets. Composite distances from target are derived to inform the allocation of the extra resources for unified allocations. GMSNCL expenditure will continue as now. It will not be subject to a resource limit or cash limit.

  2.  The pace of change policy attempts to balance two objectives:

    (a)  to maintain continuity and stability in the service and make progress nationally in priority areas; and

    (b)  to move as quickly as practical to fair shares.

  3.  Objective (a) has been pursued by distributing some additional funds to all HAs; objective (b) by distributing the remaining funds mainly to bring under target HAs nearer their target.

3.3  Hospital and Community Health Services Allocations and Distance from Targets

  3.3.3  Could the Department update the Committee on recent developments in allocations of HCHS resources and provide the timetable for any planned changes? [4.5c]

  1.  A review of the existing weighted capitation formula is currently taking place. The intention is that, following the review, the new formula will be ready for 2003-04 allocations.

  2.  For 2002-03 allocations three changes were introduced into the formula:

    (a)  a General Medical Services Non Cash Limited (GMSNCL) component has been introduced in the formula;

    (b)  the way additional need (ie over and above age) is measured in the General Medical Services Cash Limited (GMSCL) component has been changed;

    (c)  the staff Market Forces Factor has been updated.

  3.  In addition the health inequalities adjustment based on rates of years of life lost has been extended to include infant deaths under one year for all causes. This followed the announcement of an additional target for tackling health inequalities based on infant mortality.

3.3  Hospital and Community Health Services Allocations and Distance from Targets

  3.3.4  Could the Department provide data on allocations covering HCHS and FHS for each SHA area together with estimates of distances from target needs based expenditure?

  1.  The information requested is contained in the Table 3.3.4.

  2.  Table 3.3.4 aggregates the 2002-03 allocations and DFT figures from Table 3.3.1 at StHA level. These allocations are for HCHS, prescribing and general medical services (GMS) discretionary expenditure.

  3.  The weighted capitation formula that informs allocations has HCHS, prescribing and general medical services discretionary components. From 2002-03 it also has a GMS non-discretionary component. This allows the cash limited unified allocations to take account of the distribution of GMS non-discretionary expenditure. But this component is not used to allocate GMS non-discretionary funding. That remains non-cash limited.

  4.  The Department does not make allocations for FHS non-discretionary expenditure. This expenditure is not cash limited and HAs/PCTs draw down funding from the Department as required to meet their expenditure. Apart from the GMS non-discretionary formula referred to above there are no formulas to calculate target shares of FHS non-discretionary expenditure.

Table 3.3.4

STRATEGIC HEALTH AUTHORITY ALLOCATIONS
Strategic Health Authorities 2002-03 total allocation
£000s
Distance from target £000s%
Avon, Gloucestershire & Wiltshire1,660,560 12,3090.70
Bedfordshire & Hertfordshire1,217,575 -10,386-0.79
Birmingham & the Black Country1,998,522 -4,660-0.22
Cheshire & Merseyside2,110,005 37,8451.74
County Durham & Tees Valley1,026,298 -26,019-2.36
Coventry, Warwickshire, Herefordshire & Worcestershire 1,173,4301,1430.09
Cumbria & Lancashire1,662,500 15,1000.87
Dorset & Somerset961,547 14,2491.41
Essex1,222,360-29,291 -2.21
Greater Manchester2,318,902 -17,363-0.71
Hampshire & Isle of Wight1,375,289 5,7020.39
Kent & Medway1,265,400 16,3331.24
Leicestershire, Northamptonshire & Rutland 1,112,291-21,525-1.78
Norfolk, Suffolk & Cambridgeshire1,656,497 -9,783-0.55
North and East Yorkshire & Northern Lincolnshire 1,300,7513,3070.24
North Central London1,202,965 5,6350.45
North East London1,436,425 -9,443-0.62
North West London1,748,122 -22,688-1.22
Northumberland, Tyne & Wear1,294,778 1020.01
Shropshire & Staffordshire1,152,081 -18,317-1.48
South East London1,464,661 66,0634.49
South West London1,121,877 -68-0.01
South West Peninsula1,309,299 19,3101.4
South Yorkshire1,154,619 -1,670-0.14
Surrey & Sussex2,096,146 49,4632.28
Thames Valley1,527,990 -44,246-2.63
Trent2,101,193-24,916 -1.11
West Yorkshire1,796,387 -6,187-0.33
ENGLAND TOTAL41,468,469


3.4 Public Health

  3.4.1  Saving lives: Our Healthier Nation set targets in four areas: cancer, CHD and stroke, accidents and mental health. How is the Department monitoring individual primary care trusts' progress towards the targets set in Saving lives? What assessment is being made of the effectiveness of any additional spending committed in response to these targets? What progress has been made to date? [3.1a]

  How is the Department monitoring individual primary care trusts' progress towards the targets set in Saving lives?

  1.  New Health Authorities, (which will become Strategic Health Authorities (StHAs) from 1 October 2002), currently agree local performance improvement arrangements with individual Primary Care Trusts (PCTs). The existence of National Service Frameworks (NSFs) for Mental Health, Older People, CHD and Cancer (the Cancer Plan), mean that standards for these areas are built into PCTs' local planning.

  2.  According to section 7 of the Priorities and Planning Framework 2003-2006 published September 2002:

    —  StHAs will hold all NHS organisations to account for performance.

    —  The Department of Health will hold StHAs to account for the performance of the NHS within their area.

  3.  All PCTs are now required to appoint a Director of Public Health (DPH) at board level. This post requires full involvement with the community with an emphasis on health promotion, prevention and improvement. PCTs are currently developing Health Improvement and Modernisation Plans (HIMPs), which are the local health systems three-year strategic plans for health improvement and to address health inequalities. However DH is currently reviewing all planning arrangements for the NHS with a view to massively reducing the planning burden on NHS bodies. This is likely to be concluded by September with a new three-year planning framework to support performance monitoring in place for 2003-2006.

  4.  Work is currently underway to develop the national performance indicator set for PCTs.

  What assessment is being made of the effectiveness of any additional spending committed in response to these targets?

  5.  The only specific additional item of spending committed as a result of the Our Healthier Nation (OHN) targets was the Public Health Development Fund. The Public Health Development Fund has been used for a variety of purposes linked to the delivery of the public health strategy set out in "Saving lives: Our Healthier Nation". The effectiveness of the resources made available in this way has been kept under review: where appropriate, initiatives pump-primed in this way have been extended or rolled out; in others the delivery of new services has been brought within the mainstream of Departmental funding.

  6.  A number of initiatives in the four OHN priority areas, for example, New Opportunities Fund funding for cancer services, will be contributing positively towards achieving the OHN targets, but are not specifically OHN initiatives. These are attributable to NSFs, the NHS Plan or Task Forces, as appropriate.

  7.  At national level centrally-held resources deployed to facilitate delivery of the OHN targets are regularly scrutinised for effectiveness. That process is further sharpened by regularly testing the need for such resources to be retained centrally rather than included in general allocations to PCTs in line with "Shifting the Balance of Power".

  8.  As part of the general arrangements for monitoring performance, NHS bodies need to demonstrate progress in delivering the priorities set for them and, in doing so, for their efficient and effective use of resources.

  9.  Good progress has been made across the full range of detailed policies as set out in "Saving lives". Since its publication the high-level targets for reducing avoidable mortality and morbidity from cancer and CHD have been built into the Cancer Plan and the CHD National Service Framework and are incorporated into the Department's Public Service Agreement. National targets for reducing health inequalities have been announced and are similarly reflected in the PSA; and cross-Government action has been prioritised through a Cross-Cutting Spending Review—one of only seven. In addition the Injury Prevention Task Force has completed its report and it should be published shortly.

  10.  The final stage of the "defibrillators in public places" initiative was completed on time and implementation of the Expert Patients Programme is near completion. The Health Development Agency and the network of regional public health observatories were in place within six months of publication of the White Paper. The new post of Specialist in Public Health has been introduced and, following "Shifting the Balance of Power", every PCT has a board-level Director of Public Health, by no means all of those so far appointed being medically qualified.

What progress has been made to date?

  11.  Nationally, the latest mortality monitoring data available are for the three years 1998-2000. These overlap the start of the OHN strategy (which was launched in July 1999), and therefore it is too early yet for initiatives emanating from OHN to show results in terms of improved mortality, which will take some years to fully work through. However, the current situation for each of the four targets is summarised in the table.

OHN TargetsProgress
Reduce substantially the mortality rates from major killers by 2010: from circulatory disease (CHD, stroke and related diseases) by at least 40 per cent in people under 75; from cancer by at least 20 per cent in people under 75; and from suicide and undetermined injury by at least 20 per cent; reduce the mortality rate from accidents and adverse effects by at least 20 per cent, and the rate of serious injury from accidents by at least 10 per cent.

Key to the delivery of these targets will be implementing the National Service Frameworks for coronary heart disease and mental health and the National Cancer Plan [and the report of the Accidents Task Force].
Current position:

Circulatory Disease: Too early yet to assess the effects of the strategy, since latest available data overlap the start of the strategy. However, movement to date is towards the target. Data for 1998-99-00 (3 year average) show a rate of 120.5 deaths per 100,000 population—a reduction of 13.7 per cent from the 139.6 baseline (1995-97).

Cancer: Too early yet to assess the effects of the strategy, since latest available data overlap the start of the strategy. However, movement to date is towards the target. Data for 1998-99-00 (3 year average) show a rate of 130.9 deaths per 100,000 population—a reduction of 6.3 per cent from the 139.7 baseline (1995-97).

Suicide and undetermined injury: Too early yet to assess the effects of the strategy, since latest available data overlap the start of the strategy. However, movement to date is away from the target. Data for 1998-99-00 (3 year average) show a rate of 9.4 deaths per 100,000 population—a rise of 4.1 per cent from the 9.1 baseline (1995-97).

Accidents and adverse effects: Too early yet to assess the effects of the strategy, since latest available data overlap the start of the strategy. However, movement to date is away from the target. Data for 1998-99-00 (3 year average) show a rate of 16.3 deaths per 100,000 population—a rise of 0.5 per cent from the 16.2 baseline (1995-97).

Hospital admissions for serious accidental injury: Too early yet to assess the effects of the strategy, since latest available data overlap the start of the strategy. However, movement to date is away from the target. Data for serious accidental injury for 1999-00 (financial year) show a rate of 320.9 hospital admissions per 100,000 population, a rise of 2.1 per cent from the 1995-96 baseline estimate of 314.4 hospital admissions per 100,000 population.


3.4  Public Health

  3.4.2  How many public health posts were there in English HAs in each year between 1998-2002? How many public health posts are there now in (a) PCTs and (b) Strategic Health Authorities?

Directors of Public Health

  1.  For the period 1998-2002 each of the 95 Health Authorities had a medical director of public health.

  2.  In accordance with Shifting the Balance of Power the strategic public health function of the former Health Authorities has been devolved to PCTs.

  3.  Directors of public health are now being appointed to the 303 PCTs thereby increasing by around threefold the number of directors of public health available to lead public health activity across the country. By the beginning of September 2002, 236 DPH had been appointed. Of those in post 14 had been appointed to serve more than one small PCT.

  4.  The multi-disciplinary basis of the specialist public health workforce is being considerably strengthened as set out in Saving Lives Our Healthier Nation. Whilst DPH posts were previously open only to medically qualified personnel, 16.4 per cent of the new PCT Directors of Public Health appointed to date are from non-medical backgrounds.

  Data source: returns from Government Offices for Regions

Table 3.4.2(a)

FIGURES FOR THE MEDICALLY QUALIFIED PUBLIC HEALTH WORKFORCE WITHIN HEALTH AUTHORITIES FOR THE PERIOD 1998-2002

Public Health Medicine (PHM) Staff

Whole-time equivalents
As at 30 September1998 199920002001
England818.163867.553 911.601899.074

Source:   Department of Health 2001 medical and dental workforce census.

  5.  There is no centrally collected data on non-medical public health posts within Health Authorities during the period 1998-2002. Aside from Directors of Public Health there is no data on the current specialist public health workforce within PCTs.

Public Posts within Strategic Health Authorities.

  6.  There is no data currently available regarding public health posts within Strategic Health Authorities. A substantial proportion of StHA Medical Directors has a public health background.

Public Health Practitioners

  7.  With respect to the public health practitioner workforce, data for health visitors is available for the period in question but is not collected for other groups of practitioners such as school nurses and health promotion workers.

Table 3.4.2(b)

HEALTH VISITORS IN ENGLAND BY HEALTH AUTHORITY AREA AS AT 30 SEPTEMBER EACH YEAR

NHS Hospital and Community Health Services (HCHS):
Whole-time Equivalents
19981999 20002001
England10,07010,160 10,05010,190

Data source: Department of Health non-medical workforce census

Non-NHS Public Health Posts

  8.  In addition to the NHS data provided above, each Government Office now has a public health group which plays an important role in supporting and developing public health in PCTs. There is also expertise in academic public health within Universities.

3.5 Care of Mental Health and Learning Disability Patients

3.5.1  Could the Department update the information given in Tables 2.4, on patients under the care of a learning disability or mental illness consultant, discharges by length of stay, ages and destination, and residential and other places available? Could the Department identify the number of individuals concerned, and hence the number of repeat discharges? [2.4a]

Care of Patients Under Learning Disability and Mental Illness Specialities

  1.  The estimated number of in-patients under the care of the learning disability speciality, at the end of each year, fell to 6,500 in 2001 from 22,100 in 1991—Table 3.5.1(a). This is mainly due to the fall in the number of very long stay patients, from 15,900 to 3,100 over the period. This fall in the number of very long stay patients resulted from the closure of long stay units and resettlement of patients in the community.

  2.  This is matched with a decrease in the number of in-patients under the care of mental illness specialists, at the end of the year, to 31,600 in 2001 from 48,700 in 1991. Again, this maybe due to large falls in the number of long stays patients Table 3.5.1(b).

  3.  There has been a substantial increase in the number of patients with learning disability discharged from hospital after a short stay. Table 3.5.1(c) shows that 75 per cent of patients had been in hospital for less than a week. This compares with 65 per cent of those in 1991; this probably reflects the increased provision of respite care.

  4.  Table 3.5.1(d) shows a decrease in the number of in-patient episodes of Mental Illness care lasting less than one month. There were 114,400 discharges in 2000-01 after short stay episodes (62 per cent of all discharges) compared with 125,300 in 1990-91 (64 per cent of all discharges)

  5.  Table 3.5.1(e) shows that most learning disability patients under 65 discharged after a length of stay of less than a year return to their usual place of residence (98 per cent in 2000-01). This compares with an estimated 88 per cent for mental illness patients in the same year, Table 3.5.1(f).

  6.  In the case of learning disability, patients aged 65 or over, 63 per cent return to their usual place of residence with a further 29 per cent transferred to other NHS providers. This compares to 70 per cent and 13 per cent respectively for mental illness patients.

  7.  Of the learning disability patients under 65 discharged after a stay of a year or more (an estimated 1,000 in 2000-01), 23 per cent returned to their usual place of residence, 52 per cent transferred to another NHS provider and 3 per cent to local authority homes or other non-NHS institutions. In comparison, of discharged mental illness patients (an estimated 2,740 in 2000-01), 43 per cent returned to their usual place of residence, 28 per cent transferred to another NHS provider and only 4 per cent to local authority homes or other non-NHS institutions.

  8.  Only an estimated 110 learning disability patients aged 65 or over were discharged after a stay of a year or more in 2000-01, compared with 1,100 for mental illness patients; the estimates of destination on discharge are based on small numbers and are unlikely to be reliable.

  9.  Table 3.5.1(g) shows that, in NHS facilities, the average daily number of beds on wards for patients with learning disabilities has fallen to 10,000 in 2000-01 from 23,400 in 1990-91. There has been a fall in the average daily number of beds available for mentally ill patients in NHS facilities to 35,500 in 2000-01 from 55,200 in 1990-91 Table 3.5.1(h). The number of long stay adult beds in learning disability wards has fallen to 4,200 in 2000-01 from 22,100 in 1990-91 with little change in the number of short stay beds. Similarly the number of long stay beds in mental illness wards has fallen to around 28 per cent of the number in 1990-91 with only a slight drop in the number of short stay beds.

  10.  In private nursing homes the number of learning disabilities beds for adults has approximately doubled over the ten-year period to 3,800 beds in 2000-01. In staffed residential care (excluding small homes), the number of beds for adults has increased by 43 per cent in the ten-year period to 43,700 in 2000-01. Residential places for children decreased to 1,500 in March 2001 from 2,200 in March 1991.

  11.  The number of mental illness beds in private nursing homes and hospitals increased to 28,800 in 2000-01 from 10,800 in 1990-91. Most of the increase was in places for elderly patients.

Number of Repeat Discharges in Tables 3.5.1

  12.  The number of repeat discharges is not available. It is not possible to generate data on the number of times individual patients are discharged over a period of time after completing their spell in hospital.

  13.  The Department does however compile, as an indicator, the number of emergency psychiatric re-admissions. Emergency psychiatric re-admissions are defined as patients aged 16-64 re-admitted as an emergency to the care of a psychiatric specialist within 90 days of discharge. These include patients under the care of a consultant with Mental illness, Forensic Psychiatry and Psychotherapy specialities (codes: 710,712 and 713) excluding those with a primary diagnosis of drug dependency, alcohol dependency or eating disorder, (ICD 10 codes: F10 to F19, F50, Z502 and Z503). The re-admission method must be those counted as an emergency. It is important to note that the definition and coverage of this indicator differs from that applied to psychiatric discharges in Tables 3.5.1(c) and 3.5.1(d).

  14.  In 2001-02 the number of emergency re-admissions in England were 13,300 compared to 104,400 discharges in the same year (discharges are measured with the coverage described above for psychiatric re-admissions). This represents a re-admission rate of 12.7 per cent.

Table 3.5.1(a)

PATIENTS UNDER THE CARE OF LEARNING DISABILITIES CONSULTANT AT 31 MARCH BY DURATION OF STAY, ENGLAND: 1991, 1995 TO 2001 (2)
England
Estimated numbers and rates per 100,000 population
Duration of stay1991 19951996 1997 (1) 1998 19992000 2001
Number of patients
All Durations22,10011,400 10,5008,400 7,1006,0506,500
Under 1 year2,2002,200 2,0001,900 1,9501,3501,500
1 to 2 years1,2001,200 1,100800 650700600
2 to 3 years1,3001,000 600650 500550600
3 to 5 years1,6001,000 900700 900750750
5 years and over15,900 6,1006,0004,4003,1002,700 3,100
Rates per 100,000 population
All Durations4623 2117 141213
Under 1 year55 44 433
1 to 2 years22 22 111
2 to 3 years32 11 111
3 to 5 years32 21 222
5 years and over3313 129 656

Footnotes:

  1.  Figures for 1997 are not available, trust level data not submitted for this exercise.

  2.  Figures for 1995 to 2001 have been estimated from the number of unfinished consultant episodes at 31st March. They are estimates based on returns to the Department from Trusts. These are not directly comparable with figures for earlier years, as the data from Hospital Episode Statistics is incomplete.

Table 3.5.1(b)

PATIENTS UNDER THE CARE OF A MENTAL ILLNESS CONSULTANT AT 31 MARCH BY DURATION OF STAY, ENGLAND: 1991, 1995 TO 2001 (2)
EnglandEstimated numbers and rates per 100,000 population
Duration of stay1991 19951996 1997 (1) 1998 19992000 2001
Number of patients
All Durations48,70034,800 34,60031,750 30,80029,90031,550
Under 1 year25,00020,800 22,50023,500 22,90021,20022,750
1 to 2 years5,3004,300 3,0002,700 2,7503,4002,750
2 to 3 years4,3002,500 2,5001,450 1,5001,6001,850
3 to 5 years4,0002,400 2,4001,750 1,6001,5502,150
5 years and over10,100 4,7004,1002,3502,0502,150 2,000
Rates per 100,000 population
All Durations10171 7164 626063
Under 1 year5243 4648 464346
1 to 2 years119 65 676
2 to 3 years95 53 334
3 to 5 years85 54 334
5 years and over2110 85 444

Footnotes:

  1.  Figures for 1997 are not available. Required data not collected from Trusts.

  2.  Figures for 1995 to 2001 have been estimated from the number of unfinished consultant episodes at 31st March. They are estimates based on returns to the Department from Trusts. These are not directly comparable with figures for earlier years, as the data from Hospital Episode Statistics is incomplete.

Table 3.5.1(c)

ESTIMATED DISCHARGES OF LEARNING DISABILITIES PATIENTS FROM NHS FACILITIES BY DURATION OF STAY 1990-91 AND 1994-95 TO 2000-01 (1)
EnglandNumbers and percentages
Duration of stay1990-91 1994-951995-96 1996-971997-98 1998-991999-2000 2000-01 (2)
All durations50,35054,820 53,68054,91056,390 49,71038,55034,420
Under 1 week32,94040,520 39,94040,80042,100 33,59028,67025,710
1 week—12,23010,780 10,1909,82010,570 9,1507,5306,350
1 month—1,2501,110 1,0101,1901,180 890790640
3 months—660800 760940440 740620600
1 year—240320 340310400 280230260
2 years—510370 440430390 360230350
5 years—290160 140230400 200190240
10 years +2,220740 8201,150760 510250270
Duration Unknown1010 6040160 3,9904010
Percentages (3)
All durations100100 100100100 100100100
Under 1 week 657474 74756874 75
1 week—2420 191819 182018
1 month—22 222 222
3 months—11 121 122
1 year—01 111 111
2 years—11 111 111
5 years—10 001 001
10 years +41 221 111
Duration Unknown00 000 800

Source: HES

Footnotes:

  1.  Figures include transfers to other NHS providers. All durations include age unknown data.

  2.  Estimates for 2000-01 are provisional.

  3.  Percentages have been calculated using unrounded figures.

Table 3.5.1(d)

ESTIMATED DISCHARGES OF MENTAL ILLNESS PATIENTS FROM NHS FACILITIES BY DURATION OF STAY 1990-91 AND 1994-95 TO 2000-01 (1)
EnglandNumbers and percentages
Duration of stay1990-91 1994-951995-961996-97 1997-981998-991999-00 2000-01 (2)
All durations195,790211,800 214,100216,870218,900 209,580200,900184,420
Under 1 week38,89046,520 46,35048,30047,500 47,25045,64041,380
1 week -86,44093,760 93,97093,74092,040 86,81082,23072,980
1 month -48,98052,020 51,82052,89054,500 51,25050,50046,780
3 months -16,11016,590 17,05018,92014,860 20,06019,40019,320
1 year -1,7801,330 1,5601,5905,490 1,8201,7702,130
2 years -1,370800 9609001,830 1,0009401,250
5 years -630240 290220830 260240360
10 years +1,560460 510280430 170110110
Duration Unknown30100 1,590401,430 960170110
Percentages (3)
All durations100100 100100100 100100100
Under 1 week 202222 22222323 22
1 week -4444 444342 414140
1 month -2525 242425 242525
3 months -88 897 101010
1 year -11 113 111
2 years -10 003 001
5 years -00 000 000
10 years +10 000 000
Duration Unknown00 101 000

Source: HES

Footnotes:

  1.  Figures include transfers to other NHS providers. All durations include age unknown data.

  2.  Estimates for 2000-01 are provisional.

  3.  Percentages have been calculated using unrounded figures.

Table 3.5.1(e)

ESTIMATED DISCHARGES OF LEARNING DISABILITY PATIENTS FROM NHS FACILITIES BY AGE, LENGTH OF STAY AND DESTINATION 1994-95 AND 2000-01
EnglandNumbers and percentages 1994-95 2000-01 (1)
Intended discharge destinationlength of stay less than one year length of stay of one year or more length of stay less than one yearlength of stay of one year or more
Aged under 65
NUMBER OF DISCHARGES (2) 52,610 1,35033,1001,010
Percentage (3)
Usual Residence (4) 97 249823
Temporary Residence0 301
Other NHS provider (5) 1 40252
LA residential010 00
Non NHS institution (6) 0 1803
Other and not known (7) 1 5121
Aged 65 or over
NUMBER OF DISCHARGES (2) 685 370190110
Percentage (3)
Usual Residence (4) 75 196318
Temporary Residence1 212
Other NHS provider (5) 15 302965
LA residential111 00
Non NHS institution (6) 2 1710
Other and not known (7) 6 22615

Source: HES.

Notes:

1. Estimates for 2000-01 are provisional.

2. Age unknowns data are not included.

3. Percentages relate to intended discharge of patients as recorded inpatients' notes are based on unrounded data.

4. Usual residence excludes the other categories listed in this table. It includes private dwellings whether owner occupied or rented and sheltered accommodation but not residential or nursing care. It includes patients with not fixed abode.

5. Other NHS Trust hospitals or NHS run nursing homes.

6. Independent residential or nursing care homes and private hospitals.

7. Prison, high security psychiatric hospitals, not known.

Table 3.5.1(f)

ESTIMATED DISCHARGES OF MENTAL ILLNESS PATIENTS FROM NHS FACILITIES BY AGE, LENGTH OF STAY AND DESTINATION 1994-95 AND 2000-01
England Numbers and percentages

1994-95 2000-01 (1)
Intended discharge destinationlength of stay less than one year length of stay of one year or more length of stay less than one yearlength of stay of one year or more


Aged under 65
NUMBER OF DISCHARGES (2) 136,080 1,680126,6602,740
Percentage (3)
Usual Residence (4) 88 448843
Temporary Residence3 836
Other NHS provider (5) 6 25628
LA residential17 01
Non NHS institution (6) 1 903
Other and not known (7) 1 8219
Aged 65 or over
NUMBER OF DISCHARGES (2) 76,230 2,40053,4301,110
Percentage (3)
Usual Residence (4) 74 107017
Temporary Residence2 323
Other NHS provider (5) 8 211355
LA residential36 12
Non NHS institution (6) 8 1024
Other and not known (7) 5 501219

Source: HES.

Notes:

1. Estimates for 2000-01 are provisional.

2. Age unknowns data are not included.

3. Percentages relate to intended discharge of patients as recorded inpatients' notes are based on unrounded data.

4. Usual residence excludes the other categories listed in this table. It includes private dwellings whether owner occupied or rented and sheltered accommodation but not residential or nursing care. It includes patients with not fixed abode.

5. Other NHS Trust hospitals or NHS run nursing homes.

6. Independent residential or nursing care homes and private hospitals.

7. Prison, high security psychiatric hospitals, not known.

Table 3.5.1(g)

HOSPITAL BEDS AND PLACES IN RESIDENTIAL AND NURSING CARE HOMES FOR PEOPLE WITH LEARNING DISABILITIES, ENGLAND: 1990-91, 1994-95 TO 2000-01
Numbers

1990-911994-95 1995-961996-97 1997-981998-99 1999-20002000-01
Total available beds/places57,670 59,21061,64065,760 67,54068,42069,440 68,730
(excluding unstaffed)
Average daily number of available beds in NHS facilities 23,38013,21012,680 13,04012,28011,530 10,60010,020
For children short stay130 240220290 280270290 280
long stay200160 150110100 10090100
For other ages secure units 330330420 440420400 430
short stay9101,410 1,6301,3501,440 1,4201,3401,320
long stay22,14011,060 10,3507,4405,940 5,2804,7204,190
Residential Facilities (1) 3,430 4,0804,0403,760 3,700
Beds in private nursing homes, hospitals and clinics (2) 1,6503,2003,320 3,3603,5803,850 3,8403,770
Children80100 706070 1005060
Other ages1,5803,100 3,2503,3003,510 3,7503,7903,710
Places in staffed residential homes for adults2 4 30,47036,29038,180 40,50041,58042,610 44,13043,660
Local authority12,100 9,6709,3508,190 8,2007,3807,100 6,630
Voluntary9,17013,940 14,65015,07016,710 17,22017,64018,180
Private9,19012,680 14,19017,23016,670 18,01019,39018,850
Places in staffed residential homes for children2 5 2,1701,7601,770 1,4801,7201,590 1,4301,540
Local authority1,6601,260 1,2409501,070 1,040800890
Voluntary330340 430310290 260310330
Private170160 100220350 290320320
Places in small registered residential homes (places) 2 4,7605,700 7,3908,3908,840 9,4409,740
Voluntary 890 1,210
Private 3,870 4,490
Places in local authorityunstaffed (group) homes2 2,9202,6502,650 2,990

  Source: KO36, RAC5, RAC5(S), RAU1, KH03, RHN(A) and RA(Form A)

  Footnotes:

  1.  NHS residential facilities were recorded for the first time in 1996-97. Some of these beds may previously have been recorded under other headings.

  2.  Data relate to 31 March.

  3.  Excludes nursing care places in dual registered homes.

  4.  Registered residential care homes and local authority Part III homes.

   = not applicable, = not available.

Table 3.5.1(h)

HOSPITAL BEDS AND PLACES IN RESIDENTIAL AND NURSING CARE HOMES FOR PEOPLE WITH MENTAL ILLNESS, ENGLAND: 1990-91, 1994-95 TO 2000-01
Numbers
1990-911994-95 1995-961996-97 1997-981998-99 1999-20002000-01
Total available beds/places84,800 89,81092,800104,190 104,910103,240104,230 104,370
(excluding unstaffed) 1

Average daily number of available beds in NHS facilities 55,24041,83039,480 38,78037,88037,060 35,47035,490
For children short stay650 500470430 400420390 410
long stay12060 110110120 120100120
For elderly short stay5,470 6,3906,3907,370 7,3807,2907,350 7,620
long stay17,02010,760 9,3308,2307,410 6,9906,0405,540
For other ages secure units870 1,0801,3701,580 1,9201,7501,880 1,950
short stay16,31015,210 15,08014,50014,460 14,42014,12014,380
long stay14,8107,830 6,7305,4104,910 4,7104,3104,200
Residential Facilities2 1,160 1,2801,3601,300 1,280
Beds in private nursing homes, hospitals and clinics3 4 10,77024,19027,450 28,51028,28028,940 28,71028,780
Children6050 9060100 501070
Elderly7,63019,330 22,14021,45019,130 20,77021,83021,490
Other ages3,0804,810 5,2106,9909,050 8,1206,8707,210
Places in staffed residential homes for adults1 3 5 18,79022,18023,970 34,19036,16034,780 37,79037,780
Local authority5,7404,750 4,6904,9104,530 3,4804,1203,910
Voluntary3,4505,190 5,5607,2707,070 6,2806,7706,720
Private9,59012,250 13,71022,01024,560 26,03026,90027,150
Places in small registered residential homes (places) 1,6101,910 2,7102,5902,460 2,2602,320
Voluntary 190 220
Private 1,420 1,700
Places in local authority unstaffed (group) homes3 1,9701,6801,660 1,840

  Source: KO36, RAC5, RAC5(S), RAU1, KH03, RHN(A) and RA(Form A)

  Footnotes:

  1.  Discontinuity in data due to reclasification of some Elderly homes as homes for Elderly Mentally Ill patients.

  2.  NHS residential facilities were recorded for the first time in 1996-97. Some of these beds may previously have been recorded under other headings.

  3.  Data relate to 31 March.

  4.  The method of data collection was changed in 1997-98 so the figures for 1997-98 are not strictly comparable with those for earlier years.

  5.  Excludes nursing care places in dual registered homes.

   = not applicable, = not available.

3.5  Care of Mental Health and Learning Disability Patients

  3.5.2  Could the Department provide a table showing:

    (i)  number of people sectioned, by trust and by type of section?

    (ii)  number of people sectioned in proportion to HA population? If the data are not available, will the Department consider obtaining it from the HES?

    (iii)  number of people sectioned in proportion to number of admissions?

(iv) proportion of people who appeal against being sectioned and the outcomes of the appeals? [2.4b]

Number of People Sectioned by Trust and the Type of Section

  1.  Table 3.5.2(a) presents information on the number of admissions to NHS facilities (trusts and high security hospitals) where the patient was detained under the Mental Health Act 1983 at admission and the number of occasions a patient already in hospital as an informal patient was placed under detention. Table 3.5.2(b) shows similar information for private mental nursing homes in each HA area (these data are collected by HAs for return to the Department). There were a total of 25,300 formal admissions to NHS facilities in 2000-01 with a further 1,400 formal admissions to private facilities. Another 20,900 changes from informal to formal detentions were recorded (20,500 in the NHS and 400 in private facilities). There may be double counting of patients where a patient has been detained more than once in the year.

Number of People Sectioned in Proportion to HA Population

  2.  It is not possible to produce reliable figures on the numbers of people sectioned by HA area of residence. The data provided on the aggregate return is provider based and does not collect geographic information on the area of residence. The Hospital Episode Statistics (HES) system does have some information on patients treated by area of residence, but the quality of data is poor on admissions of formally detained patients.

  3.  It is possible to look at the variation in the rate of psychiatric activity by health authority area of residence. Table 3.5.2(c) shows 2000-01 rate of consultant episodes varied from less than one to more than ten, per 1000 with an average of almost five per 1000 population. This does not imply similar variations in the rates for those sectioned.

Number of People Sectioned in Proportion to Admissions

  4.  In England, in 2000-01, there were 26,700 formal admissions to hospital (including high security hospitals and private hospitals) under the Act and a further 20,900 changes from informal status to detention where patients were already in hospital. A patient subject to more than one period of detention under the Act during the year will be counted in these figures each time they are admitted to hospital under detention or have a change from informal status while in hospital. It is therefore not possible to determine the number of people sectioned. Around 14 per cent of all admissions [estimated as 181,500] under psychiatric specialities in NHS hospitals in 2000-01 were formal admissions. [25,300]

Table 3.5.2(a)

ADMISSIONS TO NHS FACILITIES UNDER THE MHA 1983 AND CHANGES FROM INFORMAL TO DETAINED STATUS WHILE IN HOSPITAL, ENGLAND: 2000-01 (2)
Admitted to
hospital
under Section
Subject to
Section after
admission
(1)
Total
detentions
in hospital
England25,301  [25,287] 20,504  [20,271]45,805  [45,558]


Northern and Yorkshire
2,466[2,585]2,380  [2,484] 4,846  [5,069]


  Airedale
63 71134
  Bradford Community Health162 137299
  Calderdale Healthcare83 72155
  County Durham and Darlington Priority Services 197150347
  Dewsbury Health Care34 5286
  Gateshead Health57 90147
  Harrogate Health Care48 55103
  Huddersfield Healthcare Services129 86215
  Hull and East Riding Community233 110343
  Leeds Community & Mental Health Services 327352679
  Leeds Teaching Hospitals2828
  Newcastle City Health194 228422
  Newcastle upon Tyne Hospitals3 36
  North Lakeland Healthcare68 60128
  Northallerton Health Services27 5380
  Northgate and Prudhoe40 2666
  Northumberland Mental Health87 75162
  Northumbria Healthcare16 2238
  Priority Health Care Wearside91 140231
  Scarborough and North East Yorkshire 11
  South Tyneside Health Care34 5488
  Tees & North East Yorkshire333 267600
  Wakefield & Pontefract Community Health 121103224
  West Cumbria Health Care28 3967
  York Health Services90 107197
Trent2,292  [1,856] 2,173  [1,864]4,465  [3,720]
  Barnsley Community & Priority Services 5489143
  Bassetlaw Hospital & Community Services 401656
  Central Nottinghamshire Healthcare 100111211
  Central Sheffield University Hospitals 11
  CHS Southern Derbyshire11
  Community Health Care Service North Derbyshire 18996285
  Community Health Sheffield272 177449
  Doncaster and South Humber Healthcare 207232439
  Leicestershire & Rutland Healthcare 338398736
  Lincoln District Healthcare117 83200
  Nottingham Healthcare635 5641,199
  Rotherham Priority Health Services 67108175
  Scunthorpe and Goole Hospitals1 1
  South Lincolnshire Healthcare70 73143
  Southern Derbyshire Mental Health 201225426
Eastern2,050  [2,125] 1,278  [1,512]3,328  [3,637]
  Addenbrookes140 113253
  Bedfordshire & Luton Community Health 270116386
  East and North Hertfordshire126 99225
  Essex and Hertfordshire Care105 62167
  Hinchingbrooke Health Care34 2559
  Horizon410 14
  James Paget Healthcare1 1
  Kings Lynn & Wisbech Hospitals 156075
  Lifespan Healthcare Cambridge9 514
  Local Health Partnerships174 172346
  Mid Essex Community and Mental Health 72107179
  New Possibilities8 412
  Norfolk and Norwich Health Care1313
  Norfolk Mental Health Care Unit310 178488
  North East Essex Mental Health152 92244
  North West Anglia Health Care80 87167
  Norwich Community Health Partnership 16218
  South Essex Mental Health and Community Care 28337320
  West Hertfordshire Community Health 25196347
London6,895  [7,540] 4,777  [4,776]11,672  [12,316]
  Barnet Healthcare180 122302
  Barts and The London3 2427
  BHB Community Health Care127 100227
  Brent, Kensington, Chelsea & Westminster Mental   Health 7066711,377
  Camden & Islington Community Health Service 7733411,114
  Ealing, Hammersmith & Fulham Mental Health 458298756
  East London and The City Mental Health 608371979
  Enfield Community Care153 79232
  Forest Healthcare133 94227
  Haringey Health Care252 217469
  Harrow and Hillingdon Healthcare110 51161
  Hounslow & Spelthorne Community & Mental Health 137118255
  Kingston and District Community317 113430
  Oxleas286327 613
  Redbridge Health Care176 169345
  Royal Free Hampstead246 94340
  South London & Maudsley1,671 8782,549
  South West London and St George's Mental Health 410578988
  South West London Community4 4
  The Hillingdon Hospital138 111249
  University College London Hospital 71118
South East3,645  [3,576] 2,656  [2,721]6,301  [6,297]
  Aylesbury Vale Community Healthcare 6158119
  Heatherwood and Wexham Park Hospitals 18488272
  Milton Keynes50 59109
  Hastings and Rother80 68148
  South Downs Health209 164373
  Eastbourne and County Healthcare122
  Eastbourne and County Healthcare122 101223
  South Buckinghamshire100 36136
  West Berkshire Priority Care Services 19982281
  Worthing Priority Care Services149 67216
  North Hampshire, Loddon Community 65107172
  Southampton Community Health Services 19086276
  Oxford Learning Disability5 5
  Winchester and Eastleigh Healthcare 5470124
  Portsmouth Healthcare225 148373
  North Hampshire Hospitals1 1
  Rockingham Forest102 43145
  Northampton General Hospital1 23
  Stoke Mandeville Hospital44
  Oxfordshire Mental Healthcare408 228636
  Northampton Community Healthcare141 73214
  Sussex Weald and Downs210 182392
  Mid Sussex4141 82
  Bournewood Community and Mental Health Services 9081171
  Isle of Wight Healthcare78 31109
  Invicta Community Care132 96228
  Oxford Radcliffe Hospital9 1120
  Surrey Hampshire Borders146 88234
  Thames Gateway155 155310
  East Kent Community287 269556
  Surrey Oaklands151 218369
South West2,310  [2,128] 1,792  [1,673]4,102  [3,801]
  Avon & Wiltshire Mental Health Care 6773741,051
  Bath and West Community8 311
  Cornwall Health Care203 170373
  Dorset Community103 72175
  Dorset Healthcare185 246431
  East Gloucestershire64 126190
  Exeter & District Community Health Services 189183372
  North Bristol1 23
  North Devon Healthcare41 2566
  Plymouth Community Services224 99323
  Royal Cornwall Hospitals3 3
  Salisbury Health Care91 78169
  Severn14085 225
  Somerset Partnership NHS and Social Care 207178385
  South Devon Healthcare150 75225
  Swindon and Marlborough33
  Wiltshire and Swindon Health Care 247397
West Midlands2,407  [2,293] 2,058  [2,014]4,465  [4,307]
  First Community11
  The Foundation130 85215
  Walsall Hospitals2 68
  Herefordshire PCT62 47109
  Walsall Community Health102 111213
  Solihull Healthcare81 87168
  North Staffordshire Combined Healthcare 223216439
  Royal Shrewsbury Hospitals13 215
  Coventry Healthcare150 140290
  Dudley Priority Health69 70139
  South Birmingham Mental Health123 426549
  Northern Birmingham Mental Health 391160551
  Premier Health89 77166
  Birmingham Children's Hospital3 47
  Black Country Mental Health91 95186
  Wolverhampton Health Care104 71175
  Birmingham Heartlands and Solihull 66
  North Warwickshire157 63220
  South Warwickshire Combined Care87 61148
  Shropshire's Community & Mental Health Services 326181455
  Birmingham Specialist Community Health 44
  Worcestershire Community and Mental Health 200155355
North West3,151  [3,094] 3,390  [3,226]6,541  [6,3220]
  Aintree Hospitals118 126244
  Bay Community186 154340
  Blackburn, Hyndburn and Ribble Valley Health Care 235140375
  Blackpool, Wyre and Fylde Community 155213368
  Bolton Hospitals166 193359
  Burnley Health Care114 151265
  Bury Health Care45 74119
  Calderstones30 535
  Central Manchester Healthcare152 72224
  Cheshire Community Healthcare1 1
  Chorley & South Ribble87 90177
  East Cheshire88 83171
  Guild Community Healthcare95 48143
  Halton General Hospital35 85120
  Mental Health Services of Salford 143114257
  North Manchester Healthcare96 92188
  North Mersey Community166 249415
  North Sefton and West Lancashire Community 9077167
  Oldham9294 186
  Rochdale Healthcare108 84192
  South Manchester University Hospitals 102149251
  Southport and Ormskirk Hospital2 46
  St Helens and Knowsley Community Health 415
  St Helens and Knowsley Hospitals114 79193
  Stockport78158 236
  Tameside and Glossop Community and Priority
  Services
78112190
  The Mid Cheshire Hospitals79 97176
  Trafford Healthcare88 113201
  Warrington Community Health Care62 65127
  Wigan and Leigh Health Services111 169280
  Wirral and West Cheshire Community 231299530
High Security Hospitals85  [90] —  [1]85  [91]
  Ashworth Hospital Authority35 35
  Broadmoor Hospital Authority22 22
  Rampton Hospital Authority28 28

  Source: KP90.

Footnotes:

  1  Includes all changes from informal status to detention under the Act, and detentions where the patient was initially brought to hospital under Section 136 (Place of Safety Order).

  2  The figures in brackets are the totals for 1999-2000.

Table 3.5.2(b)

ADMISSIONS TO PRIVATE FACILITIES UNDER THE MHA 1983 AND CHANGES FROM INFORMAL TO DETAINED STATUS WHILE IN HOSPITAL, ENGLAND: 2000-2001 (1)(3)

Numbers
Admitted to
hospital
under Section
Subject to
Section after
admission
(2)
Total
detentions
in hospital
Private facilities by RO and HA area
England1,406  [1,413] 410  [555]1,816  [1,968]
Northern and Yorkshire52  [54] 8  [19]60  [73]
  Bradford77
  County Durham6 39
  Leeds88
  Newcastle & North Tyneside3 3
  Northumberland2 2
  Tees11
  North Yorkshire20 525
  Calderdale & Kirklees5 5
Trent17  [42] —  [1]17  [43]
  North Derbyshire3 3
  Lincolnshire66
  North Nottinghamshire7 7
  South Humber11
Eastern150   [74] 16   [36]166   [110]
  North Essex6513 78
  South Essex5151
  Suffolk1818
  Cambridgeshire6 39
  Norfolk1010
London742  [771] 201   [276]943   [1,047]
  Kensington, Chelsea & Westminster 19235227
  Enfield & Haringey36 67103
  Redbridge & Waltham Forest40 1252
  Bromley1518 33
  Lambeth, Southwark & Lewisham 7429103
  Merton, Sutton & Wandsworth46 1763
  Brent & Harrow98 2100
  Ealing, Hammersmith & Hounslow 761591
  East London & the City165 6171
South East274  [290] 137  [163]411  [453]
  Berkshire6220 82
  Buckinghamshire9 9
  East Kent272 29
  West Kent92 11
  East Surrey410 14
  West Surrey193 22
  East Sussex, Brighton & Hove105 53158
  Northamptonshire25 2651
  Portsmouth & South East Hampshire 77
  Southampton & South West Hampshire 72128
South West42   [47] 11  [11]53  [58]
  South & West Devon5 16
  Wiltshire11
  Avon2810 38
  Cornwall & Isles of Scilly6 6
  Dorset22
West Midlands27   [30] 10  [15]37  [45]
  Birmingham1110 21
  North Staffordshire12 12
  South Staffordshire4 4
North West102   [105] 27   [34]129  [139]
  Manchester1111
  Salford & Trafford33
  Sefton92 11
  Stockport4619 65
  North Cheshire1 1
  South Cheshire3 25
  East Lancashire5 5
  Wigan & Bolton27 128

Source: KP90

Footnotes:

  1.  The table only includes health authorities in which there were private mental nursing homes that had detained patients during the year.  

  2.  Includes all changes from informal status to detention under the Act, and detentions where the patient was initially brought to hospital under Section 136 (Place of Safety Order).

  3.  The figures in brackets are the totals for 1999-00.

Table 3.5.2(c)

ALL CONSULTANT EPISODES (1) OF PATIENTS WITH A MENTAL ILLNESS BY HEALTH AUTHORITY OF RESIDENCE, 2000-01
HealthHealth Authority Names (2) Episodes (3) Rate per 1,000
Authority population (4)
Code
All England's Health Authorities 241,8804.84
QA2Hillingdon HA963 3.77
QA3Kensington, Chelsea & Westminster 1,6263.74
QA4Enfield & Haringey HA 3,0616.19
QA5Redbridge & Waltham Forest HA 2,6755.91
QA6Bedfordshire HA3,338 5.90
QA7Berkshire HA3,466 4.32
QA8Buckinghamshire HA 2,6933.89
QAABexley & Greenwich HA 2,1264.85
QACBromley HA1,047 3.46
QADCroydon HA2,250 6.62
QAEEast Kent HA2,156 3.51
QAFWest Kent HA2,741 2.79
QAGKingston & Richmond HA 2,0755.98
QAHLambeth, Southwark & Lewisham 7,0269.24
QAJMerton, Sutton & Wandsworth HA 3,7055.79
QAKEast Surrey HA4,400 10.24
QALWest Surrey HA2,825 4.34
QAMEast Sussex, Brighton & Hove H 3,6844.86
QANWest Sussex HA3,513 4.60
QAPBarking & Havering HA 1,1803.05
QAQBarnet HA363 1.05
QARBrent & Harrow HA 1,5703.34
QATCamden & Islington HA 3,5859.41
QAVEaling, Hammersmith & Hounslow 4,5536.59
QAWEast London & The City HA 4,0846.43
QAXNorth Essex HA2,612 2.86
QAYSouth Essex HA3,754 5.25
QC1South Lancashire HA 1,3174.19
QC2Liverpool HA2,961 6.47
QC3Manchester HA2,294 5.22
QC4Morecambe Bay HA 2,9169.34
QC5St Helens & Knowsley HA 1,6004.82
QC6Salford & Trafford HA 2,0654.65
QC7Sefton HA1,467 5.12
QC8Stockport HA893 3.07
QC9West Pennine HA2,253 4.79
QCCNorthamptonshire HA 2,6054.16
QCEOxfordshire HA2,256 3.57
QCFSuffolk HA2,526 3.72
QCGBarnsley HA1,739 7.62
QCHNorth Derbyshire HA 2,0065.39
QCJSouthern Derbyshire HA 2,7764.85
QCKDoncaster HA2,126 7.33
QCLLeicestershire HA 5,4575.81
QCMLincolnshire HA2,701 4.26
QCNNorth Nottinghamshire HA 2,0485.22
QCPNottingham HA2,621 4.10
QCQRotherham HA915 3.61
QCRSheffield HA2,661 5.02
QCTBury & Rochdale HA 1,8114.60
QCVNorth Cheshire HA 1,7735.69
QCWSouth Cheshire HA 2,7164.04
QCXEast Lancashire HA 2,5124.94
QCYNorth West Lancashire HA 1,5803.37
QD1North & Mid Hampshire HA 2,6364.69
QD2Portsmouth & South East Hampshire 3,2335.92
QD3Southampton & South West Hampshire 3,8116.95
QD4Isle of Wight HA 7115.49
QD5Somerset HA2,882 5.81
QD6South & West Devon HA 2,9774.98
QD7Wiltshire HA2,373 3.87
QD8Avon HA4,387 4.32
QD9Birmingham HA4,816 4.77
QDAWigan & Bolton HA 3,0595.28
QDCWirral HA1,471 4.49
QDDBradford HA2,407 4.95
QDECounty Durham HA 2,9934.93
QDFEast Riding HA1,602 2.79
QDGGateshead & South Tyneside HA 2,0205.78
QDHLeeds HA5,097 7.02
QDJNewcastle & North Tyneside HA 2,1164.55
QDKNorth Cumbria HA 1,5744.97
QDLSouth Humber HA482 1.57
QDMNorthumberland HA 3191.03
QDNSunderland HA1,295 4.47
QDPTees HA2,224 4.00
QDQWakefield HA1,806 5.60
QDRNorth Yorkshire HA 3,6114.79
QDTCalderdale & Kirklees HA 3,0595.19
QDVCornwall & Isles of Scilly HA 2,3424.69
QDWDorset HA4,085 5.85
QDXNorth & East Devon HA 2,9816.09
QDYGloucestershire HA 2,6354.67
QEACoventry HA1,371 4.54
QECDudley HA1,232 3.95
QEDHerefordshire HA 9025.33
QEESandwell HA1,194 4.14
QEFShropshire HA1,936 4.44
QEGSolihull HA674 3.29
QEHNorth Staffordshire HA 2,7755.93
QEJSouth Staffordshire HA 2,0633.49
QEKWalsall HA789 3.02
QELWarwickshire HA1,877 3.68
QEMWolverhampton HA 9323.88
QENWorcestershire HA 2,1363.94
QEPEast & North Hertfordshire HA 2,5675.06
QEQWest Hertfordshire HA 1,8983.49
QERCambridge HA3,660 5.01
QETNorfolk HA3,204 3.99


  Notes:

  1  Hospital in-patient are assigned to a Consultant who is responsible for their treatment, and their period of care under a Consultant is termed a "Consultant Episode".

  2  Health Authority of residence is the Health Authority in which the patient lived in before admission. This however may not be the same area where the treatment took place. The Health Authority codes were introduced in 1996-97, previously the District Health Authority codes were used.

  3  The figures are provisional as no adjustments have been made for the shortfalls in data.

  4  The population rates have been rounded to the nearest 2 decimal places.

Appeals

  5.  The Mental Health Review Tribunal is an independent judicial body which hears applications and references by and on behalf of patient's detained under the Mental Health Act 1983 as amended by the Mental Health (Patients in the Community) Act 1995. This includes patients admitted for assessment and /or treatment, hospital orders, guardianship, after-care under supervision and restricted patients which have come through the courts or transferred to hospital from prison. In some cases the nearest relative can also apply for the patient's detention to be reviewed. Most hearings are a result of applications by the patient or the patient's legal representative.

  6.  The act places a duty on Hospital Managers to refer a case to the tribunal at the end of specified periods where a patient has not had a hearing during that time. The Home Secretary in restricted cases is also obliged to refer cases to the Tribunal periodically and has a discretion to refer a patient's case at any time.

  7.  In the calendar year 2001 there were 20,368 applications and references for appeals. During the same period 6,033 cases were aborted mostly because the patient was discharged by the hospital or the application was withdrawn before the hearing. There were 11,580 decided cases resulting in 1,351 discharges (absolute, conditional, deferred or delayed).

3.5  Care of Mental Health and Learning Disability Patients

  3.5.3  Could the Department provide a table showing, over the last four years, the numbers of people with mental health problems and with learning disabilities who have been in special hospitals, prisons and regional secure units? [2.4c]

High Security Hospitals, Medium Secure Units and Prisons

  1.  Table 3.5.3 shows the total number of patients in the high security hospitals at 31 December in each of the last four years and the number of patients who were classified as having a learning disability (coming within the Mental Health Act 1983 categories of mental impairment or severe mental impairment). Overall patient numbers show an ongoing downward trend and will probably continue to do so for the immediate future, particularly since the NHS Plan has placed a renewed emphasis on the efforts to move inappropriately placed patients out of the high security hospitals. A high degree of priority will be given to the movement of women patients, many of whom do not require the levels of physical security provided by the high security hospitals. A figure was agreed with each Region as to its contribution to the NHS Plan target for moving up to 400 inappropriately placed patients out of the high security hospitals by 2004 and progress towards meeting the target is being monitored.

  2.  We will need to keep under close review the impact on high security hospital admissions once mental health prison in-reach teams are fully up and running. Whilst these teams should prevent some admissions by improving the standard of community-type care available in prison, they are also likely to improve the identification of prisoners who require transfer to hospital for treatment of mental health problems. Some of these individuals will require a high security setting, although the effect on hospital facilities providing medium and other levels of security is likely to be more significant.

  3.  Broadmoor and Rampton Hospitals are involved in pilot projects for the assessment and treatment of people with severe personality disorder. The impact on high security hospital patient numbers arising from the development of the policy for dealing with this client group will become clearer as the pilot projects are evaluated.

Table 3.5.3

TOTAL NUMBER OF PATIENTS RESIDENT IN HIGH SECURE HOSPITALS
As atAshworth BroadmoorRampton Total
31.12.98426426 4571,309
31.12.99416429 4471,292
31.12.00410410 4291,249
31.12.01405382 3921,179

TOTAL NUMBER OF PATIENTS WITH LEARNING DISABILITIES IN HIGH SECURE HOSPITALS
As atAshworth BroadmoorRampton Total
31.12.9890 104113
31.12.9900 9595
31.12.0030 8790
31.12.0130 8790

  Source:   HSPSCT

  4.  The first part of the table indicates a continuing downward trend in the total number of high security hospital patients while the second part of the table shows that the number with a diagnosis of mental impairment/severe mental impairment at 31 December 2001 was the same as at the end of the previous year. All figures exclude patients on trial leave of absence.

Number of People with Mental Health Problems in Medium Secure Units

  5.  The position remains, as in previous years, that we are unable to supply data over the last four years for the number of people with mental health problems and with learning disabilities who have been in medium secure units. According to a survey of medium secure facilities in England and Wales providing services for adults with a mental illness or with a learning disability which reported in February 2001 there were 1939 medium secure beds (1283 in the NHS and 656 in the independent sector) for adults with a mental illness. These were being provided in 27 NHS and 11 independent facilities. Just less than 99 per cent of these beds were open and average occupancy rates were over 90 per cent in almost all the facilities.

  6.  The same survey reported that there were 397 medium secure beds (352 in the NHS and 45 in the independent sector) for adults with a learning disability, which were being provided in 10 NHS facilities and 1 independent facility. Over 99 per cent of the beds were open and average occupancy rates were over 98 per cent in almost all the facilities.

  7.  Work is currently under way to update the survey information.

  8.  The development and modernisation of mental health services, which is one of the Government's core national priorities, has placed a focus on the local development of services to meet the needs of the local population. In line with this policy, Regional Specialised Commissioning Groups (RSCGs) took over responsibility for the commissioning of high and medium secure psychiatric services with effect from 1 April 2000. Each RSCG obtains the funding for these services from the Health Authorities within its Region. The RSCGs are providing a more focused mechanism for identifying the needs of their population and developing integrated local services accordingly. As part of this process, they are assessing to what extent additional medium secure beds are required, and are planning accordingly. This includes determining what role the independent sector should play in the provision of such services.

  9.  Each of the high security hospitals has now been integrated into an NHS Trust providing a wider range of mental health services. The arrangements for performance managing and commissioning high security psychiatric services are currently under review in the light of the "Shifting the Balance of Power" organisational changes taking place within the NHS. This is linked into a review of specialised commissioning more generally. For the time being the Regional Specialised Commissioning arrangements continue to apply. It seems probable that in the longer term funding will be passed to PCTs but that there will be an ongoing requirement for some sort of collaborative arrangements for commissioning high security psychiatric services.

Prevalence of Mental Health Problems in the Prison Population

  10.  The health of prisoners is the responsibility of the Prison Health Policy Unit and Prison Health Task Force, both of which are joint units reporting to the Prison Service and the Department of Health. It is not possible to state with any precision how many prisoners have mental health problems at any one time. That is not a question of the application of objective criteria but is essentially a matter for the clinical judgement of the psychiatrists responsible for each person's care and treatment. However, a study of the Psychiatric Morbidity of Prisoners in England and Wales, completed by the Office of National Statistics in 1997 on behalf of the Department of Health, does provide some useful information.

  11.  The ONS study estimated that around 90 per cent of prisoners have a diagnosable mental health problem, substance abuse problem, or both. For young offenders, that figures rises to 95 per cent. At any one time, around 5,000 prisoners have serious mental health problems. There are more than 7,000 self-harm incidents a year.

  12.  These are disturbing figures and the Government recognises that much needs to be done to improve the quality and range of mental health care available to prisoners. The National Service Framework for Mental Health makes clear that the 7 standards it sets out apply equally to prisoners. Similarly the NHS Plan makes specific commitments to improve services for prisoners, principally the 5,000 or so inmates who, at any one time, have severe and enduring mental illness. NHS funding is being made available to help fulfil this commitment. The prison mental health in-reach project is the mechanism by which the commitment is to be met. In-reach services, provided by NHS teams similar to existing Community Mental Health Teams, are already being implemented in 22 prisons in England and Wales. By March 2003 this will have increased to 47, with a further increase to around 70 establishments by the end of March 2004.

  13.  In December 2001 the Prison Health Policy Unit and Task Force published changing the Outlook, A Strategy for Developing and Modernising Mental Health Services in Prisons. The Strategy sets out what services are expected to look like in 3-5 years' time so that they better reflect NHS services and the standards in the NSF, as well as describing how the in-reach project fits into the wider reform programme. Prisons have been asked to work with their NHS partners to review their mental health needs assessments for their specific population in line with the strategy document, and to develop action plans to fill any gaps identified by 30 September 2002. For some prisons, these action plans may be quite quickly achievable, while others will need to take a longer focus of perhaps three years, depending on the needs identified and the capacity of the NHS and Prison Service locally to respond.

  14.  One area in which specific statistics are available is in relation to the numbers of prisoners transferred to psychiatric hospitals for in-patient treatment as restricted patients by direction of the Home Secretary under section 47 and 48 of the Mental Health Act 1983.

  15.  The overall figure for transfers from prison to hospital more than doubled between 1990 and 1994, but has remained relatively stable up to 1999. Of the 968 restricted patients admitted to hospital in 2000—the last year for which statistics have been published—664 were transferred under Section 47 (sentenced) and Section 48 (not sentenced or untried). Of these, 271 were under Section 47 and 393 under Section 48. The 393 transferred under Section 48 account for 41 per cent of all admissions, being the lowest number since 1992. The 271 Section 47 transfer figure compares with a 1993 high of 284. These decreases in transfers may reflect government initiatives, such as court diversion schemes, becoming somewhat more widely established. However, it would be wrong to draw any firm conclusions on the basis of one year's set of statistics.

  16.  The figures are taken from the Home Office Statistical Bulletin on Statistics of Mentally Disordered Offenders in England and Wales, which is published annually. The information is based upon data obtained from the Mental Health Unit at the Home Office which is responsible for authorising the transfer of prisoners under sections 47-48 of the Mental Health Act 1983. The information is in the public domain.


 
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