New Incisive Health analysis – carried out over Christmas – has shed light on the growing problem of out-of-area placements for people with mental health issues, with record numbers of patients set to spend over 100km from friends and family in December. The story has received press coverage in the Daily Mail, the Telegraph and the Sun. Thomas Stephens gives the detail on the findings.   

Over the past three years, amidst growing pressures on the NHS, we’ve seen sharp increases in the number of patients with mental health needs given so-called ‘out of area placements’, away from their usual local network of services. Whilst some of these placements are justified, over 90% are deemed ‘inappropriate’ by NHS England – brought about by factors such as a lack of bed space or provision in their own local areas.

At the same time, we’ve also seen rises in the number of patients placed very far away from their homes – some over 100km (62 miles) away –; and increases in the length of time people have spent in inpatient units and on placements.

The major political parties have all acknowledged that this is a growing problem. The previous Conservative Government set a national ambition to eliminate inappropriate placements for adults in acute inpatient care by 2020/21, whilst the Labour manifesto similarly pledged to end the use of inappropriate placements. However, the figures have yet to improve, and things have continued to deteriorate year-on-year.

In order to understand these challenges more,  we’ve analysed NHS Digital Out of Area Placements data across three periods: December 2016, December 2017 and December 2018. We’ve then used these figures to project what we could see this December, if current trends continue.

You can find further information in the tables below, which provide a full breakdown of the figures and the projections. In line with the above, they show that the percentage of placements which are long-distance has increased over the past three years, as has the percentage of placements ended which lasted 31 or more days.

The figures also show that the cost of Out of Area Placements has also increased by 42% over the same period, from £6.8 million in December 2016 to £9.6 million in December 2018. On average, one day in an Out of Area Placement in an inpatient unit cost £550 in December 2018, so a month’s stay cost an average of £17,000. Our forecast predicts that this could rise further if current trends continue.

Nobody wants to see their friends, family or other loved ones placed in an inappropriate placement, but an out of area placement during the Christmas period can be especially distressing. These figures underline the pressures that NHS mental health services are under, and give a clear indication of what could happen if current trends continue. Now that the General Election is over, addressing this issue – and living up to their bold promises on mental health – will be a key test for the political parties.

Incisive Health has provided the following quote for the media story, which has been covered in the Sun, the Daily Mail and the Telegraph:

“For three Christmases in a row, bed shortages and staffing pressures have seen a steady rise in out-of-area placements. If current trends continue, this Christmas will be the worst on record, with unprecedented numbers placed in inpatient units hundreds of kilometres away from their loved ones. These figures are a stark reminder of the strain that the NHS’s mental health services are under – and the impact this is having on patients and their families.

“During the General Election, all the main political parties made bold pledges on mental health, backed up by investment plans for hospital NHS infrastructure and beds. Addressing out-of-area placements and avoiding repetition of previous winters will be a key test for the new Government.”

Table 1 – Number of OAPs Active by Distance travelled (England)

Dec-16 Dec-17 Dec-18 Dec-19 (projection)
Total 961 1175 1200 1351
>25km 216 280 250 283
25-50km 245 280 220 223
50-100km 250 270 300 323
100-200km 166 220 275 329
200-300km 61 85 115 141
>300km 23 40 40 51


Table 2 – Percentage of OAPs Active by Distance travelled (England)

Dec-16 Dec-17 Dec-18 Dec-19 (projection)
Total 100% 100% 100% 100%
>25km 22% 24% 21% 21%
25-50km 25% 24% 18% 17%
50-100km 26% 23% 25% 24%
100-200km 17% 19% 23% 24%
200-300km 6% 7% 10% 10%
>300km 2% 3% 3% 4%


Table 3 – Number of OAPs ended in month by length of stay (England)

Dec-16 Dec-17 Dec-18 Dec-19 (projection)
Total 509 570 645 711
1-7 nights (%) 157 180 145 149
7-14 nights (%) 116 125 130 138
15-30 nights (%) 161 165 190 201
31+ nights (%) 75 100 180 223


Table 4 – Percentage of OAPs ended in month by length of stay (England)

Dec-16 Dec-17 Dec-18 Dec-19 (projection)
Total 100% 100% 100% 100%
1-7 nights (%) 31% 32% 22% 21%
7-14 nights (%) 23% 22% 20% 19%
15-30 nights (%) 32% 29% 29% 28%
31+ nights (%) 15% 18% 28% 31%