House of Commons - Health

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;

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 & Wiltshire	1,660,560	12,309	0.70
Bedfordshire & Hertfordshire	1,217,575	-10,386	-0.79
Birmingham & the Black Country	1,998,522	-4,660	-0.22
Cheshire & Merseyside	2,110,005	37,845	1.74
County Durham & Tees Valley	1,026,298	-26,019	-2.36
Coventry, Warwickshire, Herefordshire & Worcestershire	1,173,430	1,143	0.09
Cumbria & Lancashire	1,662,500	15,100	0.87
Dorset & Somerset	961,547	14,249	1.41
Essex	1,222,360	-29,291	-2.21
Greater Manchester	2,318,902	-17,363	-0.71
Hampshire & Isle of Wight	1,375,289	5,702	0.39
Kent & Medway	1,265,400	16,333	1.24
Leicestershire, Northamptonshire & Rutland	1,112,291	-21,525	-1.78
Norfolk, Suffolk & Cambridgeshire	1,656,497	-9,783	-0.55
North and East Yorkshire & Northern Lincolnshire	1,300,751	3,307	0.24
North Central London	1,202,965	5,635	0.45
North East London	1,436,425	-9,443	-0.62
North West London	1,748,122	-22,688	-1.22
Northumberland, Tyne & Wear	1,294,778	102	0.01
Shropshire & Staffordshire	1,152,081	-18,317	-1.48
South East London	1,464,661	66,063	4.49
South West London	1,121,877	-68	-0.01
South West Peninsula	1,309,299	19,310	1.4
South Yorkshire	1,154,619	-1,670	-0.14
Surrey & Sussex	2,096,146	49,463	2.28
Thames Valley	1,527,990	-44,246	-2.63
Trent	2,101,193	-24,916	-1.11
West Yorkshire	1,796,387	-6,187	-0.33
ENGLAND TOTAL	41,468,469

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 Targets Progress

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 September	1998	1999	2000	2001
England	818.163	867.553	911.601	899.074

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
	1998	1999	2000	2001
England	10,070	10,160	10,050	10,190

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 stay	1991	1995	1996	1997 (1)	1998	1999	2000	2001
Number of patients
All Durations	22,100	11,400	10,500	—	8,400	7,100	6,050	6,500
Under 1 year	2,200	2,200	2,000	—	1,900	1,950	1,350	1,500
1 to 2 years	1,200	1,200	1,100	—	800	650	700	600
2 to 3 years	1,300	1,000	600	—	650	500	550	600
3 to 5 years	1,600	1,000	900	—	700	900	750	750
5 years and over	15,900	6,100	6,000	—	4,400	3,100	2,700	3,100
Rates per 100,000 population
All Durations	46	23	21	—	17	14	12	13
Under 1 year	5	5	4	—	4	4	3	3
1 to 2 years	2	2	2	—	2	1	1	1
2 to 3 years	3	2	1	—	1	1	1	1
3 to 5 years	3	2	2	—	1	2	2	2
5 years and over	33	13	12	—	9	6	5	6

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)

England	Estimated numbers and rates per 100,000 population
Duration of stay	1991	1995	1996	1997 (1)	1998	1999	2000	2001
Number of patients
All Durations	48,700	34,800	34,600	—	31,750	30,800	29,900	31,550
Under 1 year	25,000	20,800	22,500	—	23,500	22,900	21,200	22,750
1 to 2 years	5,300	4,300	3,000	—	2,700	2,750	3,400	2,750
2 to 3 years	4,300	2,500	2,500	—	1,450	1,500	1,600	1,850
3 to 5 years	4,000	2,400	2,400	—	1,750	1,600	1,550	2,150
5 years and over	10,100	4,700	4,100	—	2,350	2,050	2,150	2,000
Rates per 100,000 population
All Durations	101	71	71	—	64	62	60	63
Under 1 year	52	43	46	—	48	46	43	46
1 to 2 years	11	9	6	—	5	6	7	6
2 to 3 years	9	5	5	—	3	3	3	4
3 to 5 years	8	5	5	—	4	3	3	4
5 years and over	21	10	8	—	5	4	4	4

Footnotes:

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

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)

England	Numbers and percentages
Duration of stay	1990-91	1994-95	1995-96	1996-97	1997-98	1998-99	1999-2000	2000-01 (2)
All durations	50,350	54,820	53,680	54,910	56,390	49,710	38,550	34,420
Under 1 week	32,940	40,520	39,940	40,800	42,100	33,590	28,670	25,710
1 week—	12,230	10,780	10,190	9,820	10,570	9,150	7,530	6,350
1 month—	1,250	1,110	1,010	1,190	1,180	890	790	640
3 months—	660	800	760	940	440	740	620	600
1 year—	240	320	340	310	400	280	230	260
2 years—	510	370	440	430	390	360	230	350
5 years—	290	160	140	230	400	200	190	240
10 years +	2,220	740	820	1,150	760	510	250	270
Duration Unknown	10	10	60	40	160	3,990	40	10
Percentages (3)
All durations	100	100	100	100	100	100	100	100
Under 1 week	65	74	74	74	75	68	74	75
1 week—	24	20	19	18	19	18	20	18
1 month—	2	2	2	2	2	2	2	2
3 months—	1	1	1	2	1	1	2	2
1 year—	0	1	1	1	1	1	1	1
2 years—	1	1	1	1	1	1	1	1
5 years—	1	0	0	0	1	0	0	1
10 years +	4	1	2	2	1	1	1	1
Duration Unknown	0	0	0	0	0	8	0	0

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)

England	Numbers and percentages
Duration of stay	1990-91	1994-95	1995-96	1996-97	1997-98	1998-99	1999-00	2000-01 (2)
All durations	195,790	211,800	214,100	216,870	218,900	209,580	200,900	184,420
Under 1 week	38,890	46,520	46,350	48,300	47,500	47,250	45,640	41,380
1 week -	86,440	93,760	93,970	93,740	92,040	86,810	82,230	72,980
1 month -	48,980	52,020	51,820	52,890	54,500	51,250	50,500	46,780
3 months -	16,110	16,590	17,050	18,920	14,860	20,060	19,400	19,320
1 year -	1,780	1,330	1,560	1,590	5,490	1,820	1,770	2,130
2 years -	1,370	800	960	900	1,830	1,000	940	1,250
5 years -	630	240	290	220	830	260	240	360
10 years +	1,560	460	510	280	430	170	110	110
Duration Unknown	30	100	1,590	40	1,430	960	170	110
Percentages (3)
All durations	100	100	100	100	100	100	100	100
Under 1 week	20	22	22	22	22	23	23	22
1 week -	44	44	44	43	42	41	41	40
1 month -	25	25	24	24	25	24	25	25
3 months -	8	8	8	9	7	10	10	10
1 year -	1	1	1	1	3	1	1	1
2 years -	1	0	0	0	3	0	0	1
5 years -	0	0	0	0	0	0	0	0
10 years +	1	0	0	0	0	0	0	0
Duration Unknown	0	0	1	0	1	0	0	0

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 destination	length of stay less than one year	length of stay of one year or more	length of stay less than one year	length of stay of one year or more
Aged under 65
NUMBER OF DISCHARGES (2)	52,610	1,350	33,100	1,010
Percentage (3)
Usual Residence (4)	97	24	98	23
Temporary Residence	0	3	0	1
Other NHS provider (5)	1	40	2	52
LA residential	0	10	0	0
Non NHS institution (6)	0	18	0	3
Other and not known (7)	1	5	1	21
Aged 65 or over
NUMBER OF DISCHARGES (2)	685	370	190	110
Percentage (3)
Usual Residence (4)	75	19	63	18
Temporary Residence	1	2	1	2
Other NHS provider (5)	15	30	29	65
LA residential	1	11	0	0
Non NHS institution (6)	2	17	1	0
Other and not known (7)	6	22	6	15

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 destination	length of stay less than one year	length of stay of one year or more	length of stay less than one year	length of stay of one year or more
Aged under 65
NUMBER OF DISCHARGES (2)	136,080	1,680	126,660	2,740
Percentage (3)
Usual Residence (4)	88	44	88	43
Temporary Residence	3	8	3	6
Other NHS provider (5)	6	25	6	28
LA residential	1	7	0	1
Non NHS institution (6)	1	9	0	3
Other and not known (7)	1	8	2	19
Aged 65 or over
NUMBER OF DISCHARGES (2)	76,230	2,400	53,430	1,110
Percentage (3)
Usual Residence (4)	74	10	70	17
Temporary Residence	2	3	2	3
Other NHS provider (5)	8	21	13	55
LA residential	3	6	1	2
Non NHS institution (6)	8	10	2	4
Other and not known (7)	5	50	12	19

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
	1990-91	1994-95	1995-96	1996-97	1997-98	1998-99	1999-2000	2000-01
Total available beds/places	57,670	59,210	61,640	65,760	67,540	68,420	69,440	68,730
(excluding unstaffed)
Average daily number of available beds in NHS facilities	23,380	13,210	12,680	13,040	12,280	11,530	10,600	10,020
For children short stay	130	240	220	290	280	270	290	280
long stay	200	160	150	110	100	100	90	100
For other ages secure units		330	330	420	440	420	400	430
short stay	910	1,410	1,630	1,350	1,440	1,420	1,340	1,320
long stay	22,140	11,060	10,350	7,440	5,940	5,280	4,720	4,190
Residential Facilities (1)				3,430	4,080	4,040	3,760	3,700
Beds in private nursing homes, hospitals and clinics (2)	1,650	3,200	3,320	3,360	3,580	3,850	3,840	3,770
Children	80	100	70	60	70	100	50	60
Other ages	1,580	3,100	3,250	3,300	3,510	3,750	3,790	3,710
Places in staffed residential homes for adults2 4	30,470	36,290	38,180	40,500	41,580	42,610	44,130	43,660
Local authority	12,100	9,670	9,350	8,190	8,200	7,380	7,100	6,630
Voluntary	9,170	13,940	14,650	15,070	16,710	17,220	17,640	18,180
Private	9,190	12,680	14,190	17,230	16,670	18,010	19,390	18,850
Places in staffed residential homes for children2 5	2,170	1,760	1,770	1,480	1,720	1,590	1,430	1,540
Local authority	1,660	1,260	1,240	950	1,070	1,040	800	890
Voluntary	330	340	430	310	290	260	310	330
Private	170	160	100	220	350	290	320	320
Places in small registered residential homes (places) 2		4,760	5,700	7,390	8,390	8,840	9,440	9,740
Voluntary		890	1,210
Private		3,870	4,490
Places in local authorityunstaffed (group) homes2	2,920	2,650	2,650	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
	1990-91	1994-95	1995-96	1996-97	1997-98	1998-99	1999-2000	2000-01
Total available beds/places	84,800	89,810	92,800	104,190	104,910	103,240	104,230	104,370
(excluding unstaffed) 1
Average daily number of available beds in NHS facilities	55,240	41,830	39,480	38,780	37,880	37,060	35,470	35,490
For children short stay	650	500	470	430	400	420	390	410
long stay	120	60	110	110	120	120	100	120
For elderly short stay	5,470	6,390	6,390	7,370	7,380	7,290	7,350	7,620
long stay	17,020	10,760	9,330	8,230	7,410	6,990	6,040	5,540
For other ages secure units	870	1,080	1,370	1,580	1,920	1,750	1,880	1,950
short stay	16,310	15,210	15,080	14,500	14,460	14,420	14,120	14,380
long stay	14,810	7,830	6,730	5,410	4,910	4,710	4,310	4,200
Residential Facilities2				1,160	1,280	1,360	1,300	1,280
Beds in private nursing homes, hospitals and clinics3 4	10,770	24,190	27,450	28,510	28,280	28,940	28,710	28,780
Children	60	50	90	60	100	50	10	70
Elderly	7,630	19,330	22,140	21,450	19,130	20,770	21,830	21,490
Other ages	3,080	4,810	5,210	6,990	9,050	8,120	6,870	7,210
Places in staffed residential homes for adults1 3 5	18,790	22,180	23,970	34,190	36,160	34,780	37,790	37,780
Local authority	5,740	4,750	4,690	4,910	4,530	3,480	4,120	3,910
Voluntary	3,450	5,190	5,560	7,270	7,070	6,280	6,770	6,720
Private	9,590	12,250	13,710	22,010	24,560	26,030	26,900	27,150
Places in small registered residential homes (places)		1,610	1,910	2,710	2,590	2,460	2,260	2,320
Voluntary		190	220
Private		1,420	1,700
Places in local authority unstaffed (group) homes3	1,970	1,680	1,660	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
England	25,301 [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	71	134
Bradford Community Health	162	137	299
Calderdale Healthcare	83	72	155
County Durham and Darlington Priority Services	197	150	347
Dewsbury Health Care	34	52	86
Gateshead Health	57	90	147
Harrogate Health Care	48	55	103
Huddersfield Healthcare Services	129	86	215
Hull and East Riding Community	233	110	343
Leeds Community & Mental Health Services	327	352	679
Leeds Teaching Hospitals	—	28	28
Newcastle City Health	194	228	422
Newcastle upon Tyne Hospitals	3	3	6
North Lakeland Healthcare	68	60	128
Northallerton Health Services	27	53	80
Northgate and Prudhoe	40	26	66
Northumberland Mental Health	87	75	162
Northumbria Healthcare	16	22	38
Priority Health Care Wearside	91	140	231
Scarborough and North East Yorkshire	1	—	1
South Tyneside Health Care	34	54	88
Tees & North East Yorkshire	333	267	600
Wakefield & Pontefract Community Health	121	103	224
West Cumbria Health Care	28	39	67
York Health Services	90	107	197
Trent	2,292 [1,856]	2,173 [1,864]	4,465 [3,720]
Barnsley Community & Priority Services	54	89	143
Bassetlaw Hospital & Community Services	40	16	56
Central Nottinghamshire Healthcare	100	111	211
Central Sheffield University Hospitals	1	—	1
CHS Southern Derbyshire	—	1	1
Community Health Care Service North Derbyshire	189	96	285
Community Health Sheffield	272	177	449
Doncaster and South Humber Healthcare	207	232	439
Leicestershire & Rutland Healthcare	338	398	736
Lincoln District Healthcare	117	83	200
Nottingham Healthcare	635	564	1,199
Rotherham Priority Health Services	67	108	175
Scunthorpe and Goole Hospitals	1	—	1
South Lincolnshire Healthcare	70	73	143
Southern Derbyshire Mental Health	201	225	426
Eastern	2,050 [2,125]	1,278 [1,512]	3,328 [3,637]
Addenbrookes	140	113	253
Bedfordshire & Luton Community Health	270	116	386
East and North Hertfordshire	126	99	225
Essex and Hertfordshire Care	105	62	167
Hinchingbrooke Health Care	34	25	59
Horizon	4	10	14
James Paget Healthcare	1	—	1
Kings Lynn & Wisbech Hospitals	15	60	75
Lifespan Healthcare Cambridge	9	5	14
Local Health Partnerships	174	172	346
Mid Essex Community and Mental Health	72	107	179
New Possibilities	8	4	12
Norfolk and Norwich Health Care	—	13	13
Norfolk Mental Health Care Unit	310	178	488
North East Essex Mental Health	152	92	244
North West Anglia Health Care	80	87	167
Norwich Community Health Partnership	16	2	18
South Essex Mental Health and Community Care	283	37	320
West Hertfordshire Community Health	251	96	347
London	6,895 [7,540]	4,777 [4,776]	11,672 [12,316]
Barnet Healthcare	180	122	302
Barts and The London	3	24	27
BHB Community Health Care	127	100	227
Brent, Kensington, Chelsea & Westminster Mental Health	706	671	1,377
Camden & Islington Community Health Service	773	341	1,114
Ealing, Hammersmith & Fulham Mental Health	458	298	756
East London and The City Mental Health	608	371	979
Enfield Community Care	153	79	232
Forest Healthcare	133	94	227
Haringey Health Care	252	217	469
Harrow and Hillingdon Healthcare	110	51	161
Hounslow & Spelthorne Community & Mental Health	137	118	255
Kingston and District Community	317	113	430
Oxleas	286	327	613
Redbridge Health Care	176	169	345
Royal Free Hampstead	246	94	340
South London & Maudsley	1,671	878	2,549
South West London and St George's Mental Health	410	578	988
South West London Community	4	—	4
The Hillingdon Hospital	138	111	249
University College London Hospital	7	11	18
South East	3,645 [3,576]	2,656 [2,721]	6,301 [6,297]
Aylesbury Vale Community Healthcare	61	58	119
Heatherwood and Wexham Park Hospitals	184	88	272
Milton Keynes	50	59	109
Hastings and Rother	80	68	148
South Downs Health	209	164	373
Eastbourne and County Healthcare	122
Eastbourne and County Healthcare	122	101	223
South Buckinghamshire	100	36	136
West Berkshire Priority Care Services	199	82	281
Worthing Priority Care Services	149	67	216
North Hampshire, Loddon Community	65	107	172
Southampton Community Health Services	190	86	276
Oxford Learning Disability	5	—	5
Winchester and Eastleigh Healthcare	54	70	124
Portsmouth Healthcare	225	148	373
North Hampshire Hospitals	1	—	1
Rockingham Forest	102	43	145
Northampton General Hospital	1	2	3
Stoke Mandeville Hospital	—	4	4
Oxfordshire Mental Healthcare	408	228	636
Northampton Community Healthcare	141	73	214
Sussex Weald and Downs	210	182	392
Mid Sussex	41	41	82
Bournewood Community and Mental Health Services	90	81	171
Isle of Wight Healthcare	78	31	109
Invicta Community Care	132	96	228
Oxford Radcliffe Hospital	9	11	20
Surrey Hampshire Borders	146	88	234
Thames Gateway	155	155	310
East Kent Community	287	269	556
Surrey Oaklands	151	218	369
South West	2,310 [2,128]	1,792 [1,673]	4,102 [3,801]
Avon & Wiltshire Mental Health Care	677	374	1,051
Bath and West Community	8	3	11
Cornwall Health Care	203	170	373
Dorset Community	103	72	175
Dorset Healthcare	185	246	431
East Gloucestershire	64	126	190
Exeter & District Community Health Services	189	183	372
North Bristol	1	2	3
North Devon Healthcare	41	25	66
Plymouth Community Services	224	99	323
Royal Cornwall Hospitals	3	—	3
Salisbury Health Care	91	78	169
Severn	140	85	225
Somerset Partnership NHS and Social Care	207	178	385
South Devon Healthcare	150	75	225
Swindon and Marlborough	—	3	3
Wiltshire and Swindon Health Care	24	73	97
West Midlands	2,407 [2,293]	2,058 [2,014]	4,465 [4,307]
First Community	—	1	1
The Foundation	130	85	215
Walsall Hospitals	2	6	8
Herefordshire PCT	62	47	109
Walsall Community Health	102	111	213
Solihull Healthcare	81	87	168
North Staffordshire Combined Healthcare	223	216	439
Royal Shrewsbury Hospitals	13	2	15
Coventry Healthcare	150	140	290
Dudley Priority Health	69	70	139
South Birmingham Mental Health	123	426	549
Northern Birmingham Mental Health	391	160	551
Premier Health	89	77	166
Birmingham Children's Hospital	3	4	7
Black Country Mental Health	91	95	186
Wolverhampton Health Care	104	71	175
Birmingham Heartlands and Solihull	—	6	6
North Warwickshire	157	63	220
South Warwickshire Combined Care	87	61	148
Shropshire's Community & Mental Health Services	326	181	455
Birmingham Specialist Community Health	4	—	4
Worcestershire Community and Mental Health	200	155	355
North West	3,151 [3,094]	3,390 [3,226]	6,541 [6,3220]
Aintree Hospitals	118	126	244
Bay Community	186	154	340
Blackburn, Hyndburn and Ribble Valley Health Care	235	140	375
Blackpool, Wyre and Fylde Community	155	213	368
Bolton Hospitals	166	193	359
Burnley Health Care	114	151	265
Bury Health Care	45	74	119
Calderstones	30	5	35
Central Manchester Healthcare	152	72	224
Cheshire Community Healthcare	1	—	1
Chorley & South Ribble	87	90	177
East Cheshire	88	83	171
Guild Community Healthcare	95	48	143
Halton General Hospital	35	85	120
Mental Health Services of Salford	143	114	257
North Manchester Healthcare	96	92	188
North Mersey Community	166	249	415
North Sefton and West Lancashire Community	90	77	167
Oldham	92	94	186
Rochdale Healthcare	108	84	192
South Manchester University Hospitals	102	149	251
Southport and Ormskirk Hospital	2	4	6
St Helens and Knowsley Community Health	4	1	5
St Helens and Knowsley Hospitals	114	79	193
Stockport	78	158	236
Tameside and Glossop Community and Priority Services	78	112	190
The Mid Cheshire Hospitals	79	97	176
Trafford Healthcare	88	113	201
Warrington Community Health Care	62	65	127
Wigan and Leigh Health Services	111	169	280
Wirral and West Cheshire Community	231	299	530
High Security Hospitals	85 [90]	— [1]	85 [91]
Ashworth Hospital Authority	35	—	35
Broadmoor Hospital Authority	22	—	22
Rampton Hospital Authority	28	—	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

England 1,406  [1,413] 410  [555] 1,816  [1,968]

Northern and Yorkshire 52  [54] 8  [19] 60  [73]

  Bradford 7 — 7

  County Durham 6 3 9

  Leeds 8 — 8

  Newcastle & North Tyneside 3 — 3

  Northumberland 2 — 2

  Tees 1 — 1

  North Yorkshire 20 5 25

  Calderdale & Kirklees 5 — 5

Trent 17  [42] —  [1] 17  [43]

  North Derbyshire 3 — 3

  Lincolnshire 6 — 6

  North Nottinghamshire 7 — 7

  South Humber 1 — 1

Eastern 150   [74] 16   [36] 166   [110]

  North Essex 65 13 78

  South Essex 51 — 51

  Suffolk 18 — 18

  Cambridgeshire 6 3 9

  Norfolk 10 — 10

London 742  [771] 201   [276] 943   [1,047]

  Kensington, Chelsea & Westminster 192 35 227

  Enfield & Haringey 36 67 103

  Redbridge & Waltham Forest 40 12 52

  Bromley 15 18 33

  Lambeth, Southwark & Lewisham 74 29 103

  Merton, Sutton & Wandsworth 46 17 63

  Brent & Harrow 98 2 100

  Ealing, Hammersmith & Hounslow 76 15 91

  East London & the City 165 6 171

South East 274  [290] 137  [163] 411  [453]

  Berkshire 62 20 82

  Buckinghamshire 9 — 9

  East Kent 27 2 29

  West Kent 9 2 11

  East Surrey 4 10 14

  West Surrey 19 3 22

  East Sussex, Brighton & Hove 105 53 158

  Northamptonshire 25 26 51

  Portsmouth & South East Hampshire 7 — 7

  Southampton & South West Hampshire 7 21 28

South West 42   [47] 11  [11] 53  [58]

  South & West Devon 5 1 6

  Wiltshire 1 — 1

  Avon 28 10 38

  Cornwall & Isles of Scilly 6 — 6

  Dorset 2 — 2

West Midlands 27   [30] 10  [15] 37  [45]

  Birmingham 11 10 21

  North Staffordshire 12 — 12

  South Staffordshire 4 — 4

North West 102   [105] 27   [34] 129  [139]

  Manchester 11 — 11

  Salford & Trafford — 3 3

  Sefton 9 2 11

  Stockport 46 19 65

  North Cheshire 1 — 1

  South Cheshire 3 2 5

  East Lancashire 5 — 5

  Wigan & Bolton 27 1 28

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

Health	Health Authority Names (2)	Episodes (3)	Rate per 1,000
Authority			population (4)
Code
	All England's Health Authorities	241,880	4.84
QA2	Hillingdon HA	963	3.77
QA3	Kensington, Chelsea & Westminster	1,626	3.74
QA4	Enfield & Haringey HA	3,061	6.19
QA5	Redbridge & Waltham Forest HA	2,675	5.91
QA6	Bedfordshire HA	3,338	5.90
QA7	Berkshire HA	3,466	4.32
QA8	Buckinghamshire HA	2,693	3.89
QAA	Bexley & Greenwich HA	2,126	4.85
QAC	Bromley HA	1,047	3.46
QAD	Croydon HA	2,250	6.62
QAE	East Kent HA	2,156	3.51
QAF	West Kent HA	2,741	2.79
QAG	Kingston & Richmond HA	2,075	5.98
QAH	Lambeth, Southwark & Lewisham	7,026	9.24
QAJ	Merton, Sutton & Wandsworth HA	3,705	5.79
QAK	East Surrey HA	4,400	10.24
QAL	West Surrey HA	2,825	4.34
QAM	East Sussex, Brighton & Hove H	3,684	4.86
QAN	West Sussex HA	3,513	4.60
QAP	Barking & Havering HA	1,180	3.05
QAQ	Barnet HA	363	1.05
QAR	Brent & Harrow HA	1,570	3.34
QAT	Camden & Islington HA	3,585	9.41
QAV	Ealing, Hammersmith & Hounslow	4,553	6.59
QAW	East London & The City HA	4,084	6.43
QAX	North Essex HA	2,612	2.86
QAY	South Essex HA	3,754	5.25
QC1	South Lancashire HA	1,317	4.19
QC2	Liverpool HA	2,961	6.47
QC3	Manchester HA	2,294	5.22
QC4	Morecambe Bay HA	2,916	9.34
QC5	St Helens & Knowsley HA	1,600	4.82
QC6	Salford & Trafford HA	2,065	4.65
QC7	Sefton HA	1,467	5.12
QC8	Stockport HA	893	3.07
QC9	West Pennine HA	2,253	4.79
QCC	Northamptonshire HA	2,605	4.16
QCE	Oxfordshire HA	2,256	3.57
QCF	Suffolk HA	2,526	3.72
QCG	Barnsley HA	1,739	7.62
QCH	North Derbyshire HA	2,006	5.39
QCJ	Southern Derbyshire HA	2,776	4.85
QCK	Doncaster HA	2,126	7.33
QCL	Leicestershire HA	5,457	5.81
QCM	Lincolnshire HA	2,701	4.26
QCN	North Nottinghamshire HA	2,048	5.22
QCP	Nottingham HA	2,621	4.10
QCQ	Rotherham HA	915	3.61
QCR	Sheffield HA	2,661	5.02
QCT	Bury & Rochdale HA	1,811	4.60
QCV	North Cheshire HA	1,773	5.69
QCW	South Cheshire HA	2,716	4.04
QCX	East Lancashire HA	2,512	4.94
QCY	North West Lancashire HA	1,580	3.37
QD1	North & Mid Hampshire HA	2,636	4.69
QD2	Portsmouth & South East Hampshire	3,233	5.92
QD3	Southampton & South West Hampshire	3,811	6.95
QD4	Isle of Wight HA	711	5.49
QD5	Somerset HA	2,882	5.81
QD6	South & West Devon HA	2,977	4.98
QD7	Wiltshire HA	2,373	3.87
QD8	Avon HA	4,387	4.32
QD9	Birmingham HA	4,816	4.77
QDA	Wigan & Bolton HA	3,059	5.28
QDC	Wirral HA	1,471	4.49
QDD	Bradford HA	2,407	4.95
QDE	County Durham HA	2,993	4.93
QDF	East Riding HA	1,602	2.79
QDG	Gateshead & South Tyneside HA	2,020	5.78
QDH	Leeds HA	5,097	7.02
QDJ	Newcastle & North Tyneside HA	2,116	4.55
QDK	North Cumbria HA	1,574	4.97
QDL	South Humber HA	482	1.57
QDM	Northumberland HA	319	1.03
QDN	Sunderland HA	1,295	4.47
QDP	Tees HA	2,224	4.00
QDQ	Wakefield HA	1,806	5.60
QDR	North Yorkshire HA	3,611	4.79
QDT	Calderdale & Kirklees HA	3,059	5.19
QDV	Cornwall & Isles of Scilly HA	2,342	4.69
QDW	Dorset HA	4,085	5.85
QDX	North & East Devon HA	2,981	6.09
QDY	Gloucestershire HA	2,635	4.67
QEA	Coventry HA	1,371	4.54
QEC	Dudley HA	1,232	3.95
QED	Herefordshire HA	902	5.33
QEE	Sandwell HA	1,194	4.14
QEF	Shropshire HA	1,936	4.44
QEG	Solihull HA	674	3.29
QEH	North Staffordshire HA	2,775	5.93
QEJ	South Staffordshire HA	2,063	3.49
QEK	Walsall HA	789	3.02
QEL	Warwickshire HA	1,877	3.68
QEM	Wolverhampton HA	932	3.88
QEN	Worcestershire HA	2,136	3.94
QEP	East & North Hertfordshire HA	2,567	5.06
QEQ	West Hertfordshire HA	1,898	3.49
QER	Cambridge HA	3,660	5.01
QET	Norfolk HA	3,204	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 at	Ashworth	Broadmoor	Rampton	Total
31.12.98	426	426	457	1,309
31.12.99	416	429	447	1,292
31.12.00	410	410	429	1,249
31.12.01	405	382	392	1,179

TOTAL NUMBER OF PATIENTS WITH LEARNING DISABILITIES IN HIGH SECURE HOSPITALS

As at	Ashworth	Broadmoor	Rampton	Total
31.12.98	9	0	104	113
31.12.99	0	0	95	95
31.12.00	3	0	87	90
31.12.01	3	0	87	90

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.



© Parliamentary copyright 2003	Prepared 17 February 2003