IMHSA research finds delayed discharges are 31% higher in trusts with 100% block contracts

NHS mental health trusts with 100% block contracts have a third more days of delayed discharge per month than NHS trusts providing mental health services without a block contract, new research from the Independent Mental Health Services Alliance (IMHSA) has found.

The research comes after it emerged the NHS faces a £2bn deficit this year, and will add pressure on the government to look for new ways of commissioning services to save money and improve outcomes for patients.

In total, in 2014/15 more than half of mental health trusts continued to use block contracts which pay a provider a lump sum fee to offer services for a certain patient population. These contracts are usually in place for a year, although they can be rolled over to subsequent years.

Those NHS trusts providing mental health services without a block contract in 2014/15 performed better than those trusts with a block contract on key factors, including:

  • Mental health trusts with a 100% block contract in 2014/15 had on average 31% more days of delayed discharge per month than those trusts providing mental health services without a block contract.
  • Mental health trusts with some element of a block contract in 2014/15 had on average 17% more days of delayed discharge per month than those trusts providing mental health services without a block contract.
  • In 2014/15, NHS trusts providing mental health services without a block contract had on average 4% fewer emergency readmissions within 30 days than those with a block contract.

In light of this, IMHSA is calling on NHS England to phase out unaccountable block contracts in mental healthcare. This is essential to improving patient outcomes and access to care, as well as transparency and value for money.

IMHSA Chair Joy Chamberlain, said:

“The continued use of unaccountable, ill-defined, block contracts for mental health commissioning is detrimental to appropriate access to mental health services for a large number of patients and is wasting money in a number of cases. When used improperly they act as a disincentive to service improvements and restrict innovation.

NHS England has previously stated that unaccountable block contracts should be phased out for mental health – but over half of all mental health trusts continued to use them in 2014/15.

Poor monitoring and accountability mean that these providers are often not incentivised to drive quality or innovation and providers that want to offer high quality services are unable to do so – even if they can better meet the needs of local patients.

IMHSA, and others, have long called for the removal of unaccountable block contracts. Some block contracts can provide efficient access to services for patients and stability for providers. However, our findings show the detrimental impact unaccountable block contracts can have on patients through a higher average number of days of delayed discharge. We hope that NHS England will look at this and move forward on their longstanding commitment to phase out unaccountable block contracts as soon as possible.”

ENDS

Notes to Editors:

1. For more information, please contact Rebecca Brake at This email address is being protected from spambots. You need JavaScript enabled to view it. or on 0203 102 3621.

2. IMHSA is a leading group of seven independent mental health service providers. Members are the Ansel Group, Cygnet Health Care, the Huntercombe Group, Partnerships in Care, the Priory Group, In Mind and The Retreat at York. The Retreat at York is a registered charity.

3. IMHSA believes services for people with mental health needs must be high quality, deliver excellent health and care outcomes and enhance the patient experience. We aim to provide improved access and outcomes for people with mental health needs, in a system where they can access quality care and support in a timely manner.

4. The data used for the research was taken from parliamentary questions and the Health and Social Care Information Centre (HSCIC).

5. The changing nature of the mental health sector means that some trusts listed as providing mental health services in 2014/15 were not primarily mental health trusts and as such are no longer listed in 2015/16. Similarly certain trusts appear to have offered services for only part of 2014/15. We have included these in our analysis as they did have mental health patient contacts during this time.

6. IMHSA analysed data for the 62 NHS Trusts providing mental health services in 2014/15. Of those, 35 had a contract in place with a block element. In addition, Plymouth Community Healthcare (CIC), an independent social enterprise, had a block contract of less than 50% in 2014/15. However, as Plymouth Community Healthcare is not an NHS Trust we have not included it in our analysis.