Inpatient census 2022: parts one and two

Results of the sixth Mental Health & Learning Disability Inpatient Census and Out of Scotland NHS Placements Census, 2022.


1. Overview of patients being treated in NHS Scotland facilities

  • 2,876 mental health, addiction and learning disability inpatients in NHS Scotland at the 2022 Census
  • Bed occupancy in NHS Scotland was 85% at the 2022 Census, though this ranged from 67 - 97% across individiual NHS Boards
  • The proportion of patients whose discharge from hospital was delayed was 10%, with an average (median) length of delay of just over 2 months

Number of patients, available beds and occupancy rates

There were 2,876 inpatients being treated in NHS Scotland at the 2022 Census, a 13% decrease compared with the 2019 Census and a 26% decrease since the first Census in 2014. Table 1 shows there is variability across NHS Boards throughout the six Census points, though all NHS Boards have fewer patients at the 2022 Census compared with the first Census in 2014.

Note that NHS Grampian, NHS Greater Glasgow & Clyde, NHS Lothian and NHS Tayside contain Regional Units which provide services to patients from other NHS Boards. NHS Fife also provide a low secure Learning Disability Regional Unit for the treatment of patients from other boards. NHS Orkney and NHS Shetland do not have any mental health, learning disability or addiction inpatient beds; their patients are treated by other health boards or other healthcare providers on their behalf.

Table 1: Number of patients in psychiatric, addiction or learning disability beds in NHS Scotland, 2014 – 2022
NHS Board of treatment 2014 2016 2017 2018 2019 2022
NHS Ayrshire & Arran 198 184 192 201 184 166
NHS Borders 59 45 50 53 c c
NHS Dumfries & Galloway 77 49 55 55 65 68
NHS Fife 256 184 253 238 234 186
NHS Forth Valley 217 206 214 210 167 171
NHS Grampian 339 319 297 291 272 233
NHS Greater Glasgow & Clyde 1,105 1,111 1,002 937 984 904
NHS Highland 169 173 160 141 132 105
NHS Lanarkshire 346 312 301 269 284 119
NHS Lothian 670 596 611 603 558 470
NHS Tayside 334 322 312 325 274 304
NHS Western Isles 18 15 14 12 c c
State Hospital 121 117 111 108 109 113
NHS Scotland 3,909 3,633 3,572 3,443 3,310 2,876

* c - Suppressed due to small numbers, secondary suppression also applied

There were 3,366 available mental health, addiction and learning disability beds in Scotland at the 2022 Census, a 14% decrease on available beds at the 2019 Census. The number of available beds has been consistently decreasing each Census, with a 26% decrease compared to 2014.

Table 2: Number of psychiatric, addiction or learning disability beds in NHS Scotland, 2014 – 2022
NHS Board of treatment 2014 2016 2017 2018 2019 2022
NHS Ayrshire & Arran 299 265 273 264 225 193
NHS Borders 65 57 63 63 63 49
NHS Dumfries & Galloway 107 85 85 85 85 81
NHS Fife 346 252 289 286 287 225
NHS Forth Valley 240 249 251 248 213 198
NHS Grampian 383 367 353 351 314 273
NHS Greater Glasgow & Clyde 1,176 1,154 1,128 1,061 1,054 1,030
NHS Highland 195 189 174 173 165 108
NHS Lanarkshire 450 440 411 393 411 174
NHS Lothian 711 645 649 639 623 581
NHS Tayside 409 402 380 379 357 329
NHS Western Isles 19 17 17 13 5 5
State Hospital 132 132 132 120 120 120
NHS Scotland 4,532 4,254 4,205 4,075 3,922 3,366

The decrease in available mental health beds is a trend observed across other countries in Europe. Data from Eurostat shows that the number of psychiatric care beds in the European Union in 2019 was estimated to be 73 per 100,000 population in comparison to 75 in 2014. Table 3 shows the number of available beds per 100,000 population in Scotland to be lower than the European Union average, though caution should be applied as 2019 is the last year we have comparable data and there are likely to be differences in definition and methodology between nations.

Table 3: Available beds and inpatients per 100,000 population in NHS Scotland, 2014 – 2022
Measure 2014 2016 2017 2018 2019 2022
Beds per 100,000 population 84.7 78.7 77.5 74.9 71.8 61.4
Patients per 100,000 population 73.1 67.2 65.8 63.3 60.6 52.5

The national occupancy rate of psychiatric, addiction or learning disability beds in NHS Scotland at the 2022 Census was 85%, one percentage point higher than in 2019. Occupancy rates have varied between 84 – 86% since the first Census in 2014. However there is wide variation in occupancy rates between NHS Boards.

Hospitals in highly populated areas (e.g. NHS Greater Glasgow & Clyde and NHS Lothian) tend to have higher bed occupancy rates than rural areas. This is because it is easier for hospitals in close proximity to each other to move patients between facilities to maximise efficiency, whereas it is more important for rural hospitals to have spare capacity to accommodate an increase in the number of patients requiring an admission to hospital.

Table 4: Occupancy rates for psychiatric, addiction or learning disability beds in NHS Scotland, 2014 – 2022
NHS Board of treatment 2014 2016 2017 2018 2019 2022
NHS Ayrshire & Arran 66% 69% 70% 76% 82% 86%
NHS Borders 91% 79% 79% 84% 70% 67%
NHS Dumfries & Galloway 72% 58% 65% 65% 76% 84%
NHS Fife 74% 73% 88% 83% 82% 83%
NHS Forth Valley 90% 83% 85% 85% 78% 86%
NHS Grampian 89% 87% 84% 83% 87% 85%
NHS Greater Glasgow & Clyde 94% 96% 89% 88% 93% 88%
NHS Highland 87% 92% 92% 82% 80% 97%
NHS Lanarkshire 77% 71% 73% 68% 69% 68%
NHS Lothian 94% 92% 94% 94% 90% 81%
NHS Tayside 82% 80% 82% 86% 77% 92%
NHS Western Isles 95% 88% 82% 92% 60% 80%
State Hospital 92% 89% 84% 90% 91% 94%
NHS Scotland 86% 85% 85% 84% 84% 85%

Boarding from another hospital

If a patient is “boarding” from another hospital, then they are staying in a hospital outwith their local catchment area. This could be because there were no beds available in a closer hospital or because their local hospital did not have the required services to provide them with appropriate treatment.

A total of 68 patients were boarding from another hospital at the 2022 Census. Of these, 47 (69%) were boarding to another hospital in the same NHS Board as their local catchment area. It should be noted that even in cases where a patient is being treated in the same NHS Health Board (HB), this can still involve large distances between the patient’s home and the hosptial of treatment. Some of the 68 patients also include people funded by the NHS in another UK nation but being treated in NHS Scotland.

Table 5: Number of patients “boarding” from another hospital in NHS Scotland, 2016 – 2022
Measure 2016 2017 2018 2019 2022
Number of patients “boarding” 55 38 39 37 68
Number of patients “boarding” same NHS HB 45 30 29 28 47

On Pass

Patients who are “On Pass” are still formally considered inpatients of a hospital, but are permitted planned leave for varying lengths of time as part of their recovery care plan. This includes those whose detention under the Mental Health Act has been suspended. If a patient is “On Pass”, their bed may be used by another patient.

At the 2022 Census there were 64 patients (2%) on pass for at least that overnight period. Of those patients, 51 (80%) were on pass to home.

Hospital Based Complex Clinical Care

From 2016, the Inpatient Census collects information on patients receiving Hospital Based Complex Clinical Care (HBCCC).

A patient is defined as receiving HBCCC if they have care needs that cannot be met in any setting other than hospital and require long-term complex clinical care. Under the definition of HBCCC, a patient cannot be a delayed discharge.

At the 2022 Census, 14% of patients (409) occupying a mental health or learning disability inpatient bed were receiving HBCCC, an 8% decrease from 2019, with 67% of these patients treated in NHS Greater Glasgow & Clyde or NHS Lothian.

A separate, more detailed report on HBCCC from the Scottish Government is also available. This covers HBCCC patients in mental health or learning disability inpatient beds, patients treated outwith NHS Scotland and patients in General Acute hospitals (Inpatient Census 2022: hospital based complex clinical care and long stay).

Delayed Discharge

Timely discharge from hospital is an important indicator of quality and is a marker for person-centred, effective, integrated and harm-free care. A delayed discharge occurs when a hospital patient who is clinically ready for discharge from inpatient hospital care continues to occupy a hospital bed beyond the date they are ready for discharge.

At the 2022 Census, 263 patients were a delayed discharge. This is 10% of patients for which this information is known (information was not known for 168 patients and data not returned for 158 patients), two percentage points higher than the 2019 census. As a proportion of known patients, NHS Tayside had the highest proportion of delayed discharges with over 1 in 3 (36%) patients delayed. NHS Greater Glasgow & Clyde has the lowest proportion, with 5% patients delayed.

The average (median) length of delayed discharge at the 2022 Census was just over two months (68 days), 20 days less than in 2019. Sixteen patients were delayed discharge but did not have a delayed discharge date in 2022.

Table 6: Average (median) length of delayed discharge in NHS Scotland, 2014 – 2022
Measure 2014 2016 2017 2018 2019 2022
Average (Median) Days 65 71 65 72 88 68
Average (Median) Banded 2.1 months 2.3 months 2.1 months 2.4 months 2.9 months 2.2 months

Length of Stay

The average (median) length of stay in a facility can have a large impact on service provision as longer lengths of stay reduce the turnover of patients and beds. The average (median) length of stay at the 2022 Census was 136 days (4.5 months), which is a marginal decrease from the 2019 Census. Although it is quite variable, the average (median) length of stay has reduced from 160 days (5.3 months) in 2014.

Table 7: Average (median) length of stay in NHS Scotland, 2014 – 2022
Measure 2014 2016 2017 2018 2019 2022
Average (Median) Days 160 147 156 136 142 136
Average (Median) Banded 5.3 months 4.8 months 5.1 months 4.5 months 4.7 months 4.5 months

Contact

Email: MHIC@gov.scot

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