OOA placements – the fall in one area

OOA 82 times in 2017/18 OOA 20 times in 2018/19

around the country which provided figures showing a significant drop in ‘inappropriate’ OOA placements to The Doctor

The statistics suggest that the trust placed patients OOA 82 times in 2017/18, but that number decreased to 20 the following year and has not been above single figures for any financial year since.

Prevent and reduce

Dennis Okolo, the chief medical officer for the trust, says the organisation has always been keen to ‘prevent’ and ‘reduce’ admitting patients to private beds miles away and has put a lot of initiatives in place locally to avoid doing so.

Many of the projects Dr Okolo describes will be familiar to doctors across the country but, in a package, together, they are helping the team to avoid use of OOA placements. Dr Okolo says all patients who have been deemed to require a bed automatically go to the trust’s home-care team to justify their need for that bed and to ensure they cannot be cared for in their own environment.

Beyond that Dr Okolo says on-call doctors are encouraged to be part of assessments because they are more likely to know and understand patients and can make decisions with greater clarity.

He also identifies intense reviews of discharges, close work with local authorities, the liaison psychiatry team in the local emergency department, high-volume service user focus, having a strong personality disorder service, and a local psychiatric intensive care unit, as among the reasons for being able to manage demand efficiently.

Despite the moments of success, areas such as Leicestershire and North Staffordshire have reported there remain significant concerns for the future – in those areas and across the country.

The first piece in The Doctor ’s Paucity of Esteem series – published in March – revealed massive increases in demand and pressure across the mental health system, and huge rises in the number of mental health patients presenting at emergency departments in crisis and being trapped there for days or even weeks as a result of the pressure on, and state of, services elsewhere.

Doctors fear pressures are only likely to get worse owing to the cost-of-living crisis, the fall-out from the pandemic and the effects of austerity politics.

The Doctor has spoken to a wide range of mental health professionals and experts across the country while producing the Paucity of Esteem series and suggestions to tackle the issue of OOA placements have been varied.

All, however, unanimously agreed that the workforce is an urgent issue with huge numbers of vacancies and a growing sense of burnout among those in position.

The BMA is urging the Government to expand the number of inpatient mental health beds in England so NHS England can finally meet the missed target to eliminate inappropriate OOA mental health placements.

The association is also supporting the Royal College of Psychiatrists’ recommendation that all new integrated care partnerships conduct service-capacity assessments and target investment towards services driving inappropriate OOA placements locally.

As Dr Eldred says, OOA placements are not a ‘healthy thing from anyone’s point of view’.

The BMA presidency is the latest in a string of high-profile roles for Martin McKee, a doctor described as an ‘inescapable presence’ in the arena of public health. He talks to Peter Blackburn about Brexit, the economy, and his upcoming presidential project which aims to inspire doctors