• The signal: June 2025 data show 439 out-of-area placements (OAPs) in adult mental health, +105 year-on-year. 24.5% of adults had inpatient stays >60 days, and 40.5% of older adults delayed >90 days.

 

• Why this matters: These aren’t just inefficiencies, they separate patients from families, erode continuity of care, and drive escalating system costs.

 

• What to do now: Commission three levers, crisis response, step-down rehab, and discharge brokerage, tied directly to measurable outcomes.

 

Context & system signals

• The Integrated Performance Report (Sept 2025) identifies MH OAPs and LoS as worsening while UCR and Cat-2 are improving.
• The Learning Disability & Autism Programme shows that inpatient reductions are possible when community alternatives are built, a lesson MH leaders must now apply.
• The NHS Oversight Framework makes productivity and outcome measurement non-negotiable.

Strategic implications

1. OAPs are a marker of system failure. When patients are sent out-of-area, it signals inadequate local capacity and poor integration.
2. Long stays show discharge is broken. High percentages of 60+ and 90+ day stays prove community discharge and step-down pathways are missing.
3. Financial drain is unsustainable. OAPs cost upwards of £500/day and long LoS block acute capacity. In deficit conditions, these are first-order risks.
4. Equity risk is high. Older adults and deprived communities bear the brunt of delayed discharge and OAPs, widening inequalities already under scrutiny.

Blueprint: three levers to bend the curve

1. Crisis capacity to avoid admission
   • 24/7 HTT teams integrated with ED liaison and urgent primary care.
   • Metric: admission avoidance rates, ED boarding times, 72-hour follow-up compliance.
   • Commissioning ask: outcome-linked contracts based on avoided admissions.
2. Step-down rehab that is time-bound
   • Transitional flats/placements with structured rehab and MDT review.
   • Metric: reduction in LoS >60 days, 30-day readmission rates.
   • Commissioning ask: block contracts adjusted for outcome delivery.
3. Complex discharge brokerage
   • Daily brokerage cell with LA/VCSE partners to resolve housing and placement issues.
   • Escalation ladder to exec sponsors for >7-day delays.
   • Metric: reduction in discharge-ready delay (DRD) days; number of housing delays resolved.

Inequalities lens

• Long stays and OAPs disproportionately impact deprived communities and older adults.
• Solutions must track OAP and LoS metrics by deprivation quintile and ethnicity.
• Cultural competence, flexible community clinics, and co-production with service users are critical.

How ProMedical would align

• Crisis Pods for Urgent Care: Deploy dedicated pods of psychiatrists and mental health nurses to strengthen Home Treatment Teams and ED liaison, ensuring safe crisis response capacity.
• Rehab Support Teams: Provide multi-disciplinary staffing for step-down and community rehab, working with Trust clinical leads to deliver outcome-focused rehabilitation goals.
• Discharge Brokerage with Live Reporting: Stand up discharge brokerage teams to help unblock flow, supported by daily dashboards and real-time reporting for commissioners.
• Equity in Service Delivery: Embed equity commitments by prioritising diverse recruitment, providing language support, and promoting culturally responsive care in partnership with local providers.

Final word — Altin Biba, MBA, AMBA

“If we reduce OAPs and long stays to single metrics, we miss the bigger picture. The solution lies in system integration: crisis teams that prevent admission, step-down pathways that accelerate recovery, and brokerage that unblocks discharge. That’s how we safeguard patients, support staff, and protect budgets, and that is where ProMedical makes the difference.”

References

• NHS England. Integrated Performance Report, September 2025 (Item 4.1)
• NHS England. NHS Oversight Framework metrics list, September 2025 (Item 4.1.1)
• NHS England. Healthcare Inequalities Improvement Programme & Race and Health Observatory report, September 2025 (Item 6)
• NHS England. Update on Learning Disability & Autism Programme, September 2025 (Item 7)