Addressing the shortage of Health Based Places of Safety in England

April 07, 2017
Jim ODwyer

There are currently 165 Health Based Places of Safety sites in England. However, not all of them are always adequately staffed, nor are they all open 24 hours a day and most can only see one patient at a time.

Crisis Care is a Postcode Lottery!

Provision of 'Health Based Places of Safety' varies considerably across the country, as can be seen from the diagram below, produced by the Care Quality Commission (CQC).

CQC has also published an interactive Online map showing the location of designated ‘Health Based Places of Safety’ sites across England, with details of opening hours, capacity, age groups accepted and the local areas they are intended to serve.

The problem

Unfortunately, for some considerable time now a shortage in certain areas of available ‘Health Based Places of Safety’ has been seriously impacting on the quality of care that can be delivered to people in mental health crisis and directly contributing to the number of people who end up being detained (and in effect ‘criminalised’) in a police cell. The shortage is in spite of the fact that demand for Places of Safety has been escalating noticeably in recent years and the trend is likely to continue.

The lack of available ‘Health Based Places of Safety’ has also meant a significant and expensive drain on police and ambulance service resources.


Who is responsible for the shortage?

Ultimately, responsibility for unavailability of a ‘Health Based Place of Safety’ lies with the local Clinical Commissioning Group (CCG).

More info about CCGs: https://www.nhscc.org/ccgs/

Find your local CCG here: https://www.england.nhs.uk/ccg-details/


Why is there a shortage of available Health Based Places of Safety in certain areas?

Where they exist, shortages of available ‘Health Based Places of Safety’ are directly attributable to inadequate commissioning by Clinical Commissioning Groups (CCGs) arising from ineffective oversight of capacity issues and failure to accurately monitor and respond to demand for the service. In turn, this is a consequence of failure on the part of healthcare staff, ambulance crews, local authority staff (social care staff) and police to record and submit relevant data to their CCG, thereby failing to ‘evidence’ the clear case for improvement and helping to maintain the status quo.

It really is as simple as that! Inspector Michael Brown O.B.E., Mental Health Coordinator at the College of Policing and author of the Mental Health Cop Blog, proved it. His work informed CCGs in the West Midlands area of the problem and in two years they went from having zero provision of Health Based Places of Safety to a situation where 98% of people went to Health Based Places of Safety’.


Action needed by Clinical Commissioning Groups

CCGs must install and maintain a suitable and robust ‘reporting mechanism’ that ensures commissioners are kept appraised of whether or not service provision meets local needs and - where need is not being met – must address this as a priority.

CCGs must ensure that 'situation reports' are considered regularly and at least quarterly.

In order to gain all the required information, CCGs will need multi-agency co-operation and must also facilitate and ensure that each agency actively and fully contributes to the cause.


Data collection should, as a minimum, include:

− The age, gender and ethnicity of people identified as being ‘in need’ of a Health Based Place of Safety’.

− The number of requests received from the police for people to be brought to the Place of Safety; the number of people referred to the Place of Safety who are resident out of area; the number of times people were accepted; how often Health Based Places of Safety cannot be immediately accessed; and the reasons for each time this happens (including staffing problems.)

− The time taken to start MHA assessments, the reasons for delays, transfers between places of safety and the reasons for using alternatives to the designated Place of Safety.


Standards expected

To assist CCGs, the independent regulator of health and social care in England, CQC, has published quantitative data that provides information on expected standards* and shows how local provision of Health Based Places of Safety compares with other areas.

*Relevant standards are detailed in:


Monitoring by CQC

The Care Quality Commission (CQC) has declared Health Based Places of Safety a ‘core service’ that will always be inspected as part of comprehensive inspections of specialist mental health care providers.


‘Real Time’ monitoring of capacity and usage by NHS England

In order to help streamline the process for police and ambulances to access a place of safety, NHS England is expected to imminently implement ‘capacity management systems’ that will provide real-time information on the availability of Health Based Places of Safety.


Additional monitoring by HMIC

Her Majesty’s Inspectorate of Constabulary (HMIC) is separately monitoring the use of police custody as a 'Place of Safety' and collating data on the time spent by police dealing with situations that appropriate service provision by CCGs would have avoided. HMIC’s intention is to, in everyone’s best interests, evidence a case for completely removing police cells as a Place of Safety in the Mental Health Act 1983 and also minimise the amount of officer time spent dealing with s.136 detentions. The College of Policing estimates 20-40% of police time and vast amounts of money are taken up dealing with incidents involving people with mental health problems. Metropolitan police officers have estimated in the past that mental health issues account for at least 20% of police time.

 

Hopefully...

The means to initiate improvement is clearly in the hands of front-line service personnel. I just hope that the weight of the 'extra attention to reporting' isn't the straw that breaks the camel's back and that we can all now look optimistically forward to appropriate commissioning and better care for those experiencing a mental ill health crisis.

 

Jim O'Dwyer
Senior Consultant
AEGIS Protective Services
T: 01202 773736