The issue has been highlighted in a new report by the Mental Welfare Commission (MWC) for Scotland, which found that one patient had been in residential care out-of-area for 28 years.
The watchdog said that while the majority of patients they reviewed “were positive about their care and treatment”, families raised concerns about the toll that travelling long distances to see their relative in care was having on relationships.
Discharging patients was “challenging and slow” due to problems securing funding from the person’s local health board and concerns that their area lacked appropriate services if the patient relapsed.
In addition, the MWC highlighted a lack of clarity around NHS spending on out of area referrals.
According to a census taken in 2022, there are 162 patients from Scotland with mental health issues or learning disabilities who are in out-of-area placements and whose care is funded by – but not provided by – the NHS.
Most are in private facilities and have “highly complex, specialist needs” where it is “said to be more cost effective to send patients out with their own NHS Scotland facilities rather than create dedicated facilities in NHS Scotland”.
This can include secure care for adolescents, mental health inpatient treatment for deaf people, specialist care for adolescents with learning disabilities, and high secure accommodation for women.
The MWC report focused on 59 individuals.
Of these, 36 had been away from their original board area for four years or more – the longest being 28 years. The average was more than eight years.
The report states that most people had been transferred due to “challenging behaviour” but that “very few had been given any detailed information relating to their move”.
However, most patients “felt that the move had been positive”, including having more staff available to them and more “choice with their care, their daily routine and their activities”.
Most relatives and carers said they were involved in decisions about the patient’s care, but “what was missing were plans for their relative’s discharge, and their involvement with this”.
The report found that discharge planning was problematic, adding: “For the current providers, they identified that getting engagement from the funding health board could be challenging and slow; for the funding service, it was around their concerns relating to a lack of an appropriate local service, and the risk of relapse for the individual”.
The MWC said its “very conservative estimate” is that over £13 million a year is being spent by Scottish NHS services on out of area private care and treatment for the 59 individuals covered by the report.
However, it expects that the true cost in higher and “considerably higher” for the 162 people in total identified as being treated out of area.
It has issued seven recommendations to the Scottish Government, including more accurate data gathering on out of area placements and a review of how the funding costs for out of area placements are monitored.
It said the Government should also “consider a human rights and health economics-based approach as to whether regional units should be developed for those individuals who are considered at greatest risk of being out of area”.
Claire Lamza, executive director (nursing) at the MWC, said: “When people with mental ill health or learning disability are placed outwith their NHS health board area for care and treatment, they are likely to have highly complex, specialist needs that have been assessed as not being able to be met by their local health services.
“This report examined in detail the care in place for 59 of the estimated 162 people who are living in out of NHS board areas, almost all of whom are in private sector facilities.
“We were reassured to hear positive feedback from individuals and relatives on the quality of care, but we also heard they were unsure of the plans that were being put in place for a return closer to home and about the impact on relatives of travelling to see their family member, and the toll that this took on their relationship.
“When we sought to clarify with health boards the costs and oversight of these placements we found gaps in information; we believe our funding estimates are likely to be considerably lower than the true costs.”
A spokeswoman for the Scottish Government said it welcomed the report and “will carefully consider its recommendations”, adding: “We expect each NHS Board to have a clear understanding of their patient caseload, whether they are treated locally or elsewhere.
“Initiatives like our Coming Home Implementation Report makes clear it is essential that Scotland provides support and services in a way which ensures that human rights are respected and protected.”