Progress on implementation of the report from the Commission on
Acute Adult Psychiatric Care in England, one year after
In 2015, the Royal College of Psychiatrists set up an
independent Commission in response to widespread concerns about the
provision of acute inpatient psychiatric beds and alternatives to
admission available for patients. The Commission was chaired by
Lord Nigel Crisp, former Chief Executive of the NHS in England and
Permanent Secretary of the UK Department of Health between 2000 and
The Commission found that too many people do not have swift
access to high-quality acute care when they need it most - a
symptom of ‘whole system’ failure requiring new, system-wide
What the report concluded
made 12 recommendations, including the need to:
- Introduce waiting time targets for admission to an acute
psychiatric ward or acceptance for home-based treatment
- Eliminate the practice of sending people out of area for acute
inpatient care due to local acute bed pressures
- Ensure Crisis Resolution and Home Treatment Teams (CRHTTs) are
adequately resourced to offer intensive home treatment as an
alternative to an acute inpatient admission
- Undertake local service capacity assessment and improvement
- Ensure there is an adequate supply of housing and strong
interfaces with social care to enable timely discharge from
- Improve the collection and availability of data
- Achieve financial parity with physical health.
Resources for members
We’ve created this short video to help psychiatrists embed the
report’s recommendations in their area.
- The Government has set a national ambition to eliminate
inappropriate Out-of-Area Placement (OAPs) in acute adult care
services by no later than 2020/21.
The first national definition of an acute OAP was published
following an extensive consultation process; and data is now being
collected nationally. The definition recognises that both distance
travelled and continuity of care should be taken into account. A
new data collection opened in October 2016 in order to monitor
the reduction of OAPs and the progress being made.
- Further dataset changes have been approved for
implementation from April 2017.
The objective is to provide more comprehensive information on
acute care activities, including the use of different types of bed
and delayed transfers of care, which directly impact on bed
pressures and OAPs.
As recommended by the CAAPC, the Mental Health Services Data Set
(MHSDS) is being reviewed and will be updated annually to ensure
that it captures all relevant data items to accurately measure
performance and delivery.
Collaborative work is guided by the Mental Health Data and
Information Programme Board to ensure the right information is
being shared with providers and commissioners in a useful manner,
and that local systems are able to make the data flow
- More than £400m for crisis resolution and home
treatment teams (CRHTTs) will be introduced over 4 years from April
This new money will be available through CCG baselines. Local
expenditure on mental health will be visible via the Mental
Health Dashboard, designed to help monitor progress against the
delivery of the national mental health strategy (the
Five Year Forward View for Mental Health).
- A range of organisations has used the CAAPC report as a
lever to undertake further work aiming to improving people’s
experiences of acute care.
Following the Commission’s call for patients and carers to be
further involved in service design and provision, Rethink Mental
Illness examined how CCGs involve people with experience of mental
illness in the commissioning of mental health services. Their
report, Progress through Partnership, will be published in
A full joint response to the CAAPC report will be published by
NHS England and the NHS Arms-Length Bodies (ALBs) in England
(publication planned for April 2017). It will set out the details
of the work carried out by NHS England, NHS Improvement, NHS
Digital, Health Education England, Public Health England and the
Care Quality Commission (CQC) to implement the recommendations of
the CAAPC report.
The role of the Royal College of Psychiatrists
For the past twelve months, we have worked with a wide range of
stakeholders, including NHS England, the Cabinet Office, other
Royal Colleges and voluntary sector organisations. We have engaged
with the Councillors who have signed up as Mental Health Champions;
the clinical and managerial leads from all the Mental Health
Clinical Networks, as well as commissioners and providers.
As well as engaging stakeholders, the College has worked to
directly implement some of the CAAPC recommendations, as
- We have played an active role on the Acute Mental
Health Care Expert Reference Group, set up by the National
Collaborating Centre for Mental Health (NCCMH) to develop an
evidence-based treatment pathway (EBTP) for acute mental health
care for NHS England and NICE.
Due to be published in April, this pathway will play a key role
in ensuring timely and equal access to acute mental health
services. As advocated by the CAAPC, it will recommend a four-hour
response time from the point of referral to accessing acute
It will also include quality standards and a step-by-step
process to help local areas undertake a service capacity assessment
and improvement programme, in partnership with organisations
working in the housing, social care, rehabilitation and voluntary
The pathway also aims at reducing the systemic health
inequalities prevalent across acute mental health services. A
multi-disciplinary approach was taken and a Race Equality Reference
Group, comprising experts-by-experience from BAME backgrounds,
actively contributed to this work, which is part of a suite of
packages to improve mental health at every stage of patients’
- The College Centre for Quality Improvement (CCQI) is
currently developing a national quality assessment and improvement
scheme to support and assess early implementation of the acute
mental health care EBTP.
From Autumn 2017 this will allow local areas to self-assess
against the key access and quality guidelines and benchmarks. NHS
England will then undertake a baseline audit and gap analysis of
the system’s current performance against the new guidelines and
- Meanwhile, we are actively promoting Quality
Improvement (QI) methods to support local healthcare
We established a QI Experience Reference Group in order to
support the development of QI knowledge and skills amongst members,
map learning needs, set up a network and ensure QI is embedded in
the education curriculum of those yet to become psychiatrists. We
are also appointing a College’s Lead for QI, who will have
first-hand experience of using QI methods in mental health
- We are working hand-in-hand with the Royal College of
Nursing (RCN) to embed a culture of medical leadership and
management through services for the benefit of
Our Leadership and Management Committee (LMC) has been
developing and supporting systems, structures and processes to
equip psychiatrists for roles as leaders and managers.
Simultaneously, the RCN has designed bespoke products for
clinicians to develop their leadership skills as well as their
ability to create a culture of innovation in the workplace.
The RCN is now engaging with mental health & learning
disability directors and commissioners throughout the UK to discuss
the leadership development support they can offer.
What will happen next
The College will continue its work to ensure that:
- Information is robustly monitored and used
The data collected so far confirms that a large number of people
continue to be sent out of area treatment inappropriately. The
latest report shows that 506 patients were receiving out of area
placements on 31 December 2016 due to the unavailability of local
As the data around acute mental health care becomes more robust,
we will need to ensure that commissioners and providers are held to
account to eliminate OAPs and implement the guidelines and
benchmarks mentioned above.
In order to improve transparency and availability of
information, we will continue to analyse the data included in the
Mental Health Dashboard to ensure spending pledges reach the front
line. We will update the CAAPC website regularly in order to share
our findings as well as best practice and innovation occurring
across the country.
- All the recommendations get implemented
The CAAPC highlighted ‘whole system’ failure, requiring
solutions involving stakeholders from a wide range of sectors.
We will continue to encourage everyone to take action and make
changes. We will also continue to work closely with RCPsych in
Northern Ireland to make sure that the implementation of the
Commission’s companion report for Northern Ireland, Building
on Progress (published in June 2016) is high on the agenda
of the new Government being elected on 2 March.
Although much more needs to be done, many of the building blocks
are now in place for achieving a genuine shift in the quality of
and access to acute adult psychiatric care in England.
If you would like further information or if you have any
queries, please contact Zoé Mulliez, Policy Analyst on firstname.lastname@example.org
Please contact us if you would like this briefing in another
language or format.