Assessing the Clinical and cost-Effectiveness of inpatient mental health Rehabilitation provided by the NHS and independent sector

Mental health rehabilitation services provide specialist treatment to people with particularly severe and complex problems. These services include inpatient units and supported accommodation in the community. When people have access to local rehabilitation services, most gain the skills to manage with less support over time, progressing from inpatient care to higher, and then lower, supported accommodation. Over recent years there has been a reduction in the provision of NHS inpatient mental health rehabilitation services across England and now around half of these beds are provided by the independent sector. In 2018, the Care Quality Commission raised concerns that people receiving inpatient rehabilitation in the independent sector were staying twice as long as those treated in the NHS and they were much further from their home. This situation has been criticised in the press, but we do not know whether the services provided by the NHS and independent sector differ in quality or patient outcomes. For example, it could be that NHS Trusts send their most complex patients for treatment in the independent sector as their needs cannot be met locally and that is why they stay in hospital longer. There have been no studies investigating the effectiveness of inpatient rehabilitation services that have included the independent sector. Our study aims to address this gap.

As we cannot compare NHS and independent sector services through a randomised trial, our programme will draw together findings from five components to assess the effectiveness of these services:

Component 1

Survey of 60 inpatient mental health rehabilitation services across England (30 NHS and 30 independent sector) (study months 6-24)

Component 2

In depth interviews with users, relatives/carers, staff and commissioners of these services to explore their experiences and perspectives (study months 6-30)

Component 3

Cohort study to compare outcomes for 500 patients of the NHS and independent sector rehabilitation services surveyed in Component 1, using statistical methods that take account of any differences between them such as the severity of their mental health problems (study months 6-42)

Component 4

Comparison of outcomes for all users of NHS and independent sector inpatient rehabilitation services in England on a specific census date, using anonymised electronic NHS records (study months 12-42)

Component 5

Health economic evaluation to assess the cost effectiveness of inpatient rehabilitation services provided by the NHS and the independent sector (study months 39-42)


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