A collaborative approach to reducing inpatient bed occupancy in Bedfordshire & Luton

By Lucy Brewer (Senior Improvement Advisor)

Bedfordshire and Luton Adult Mental Health provide a wide range of community and inpatient services across these areas. These services include crisis teams, community mental health teams (CMHTs), and inpatient mental health wards. As with many services across the country, the impact of the Covid-19 pandemic saw an increase in demand and complexities in mental health services. This is subsequently leading to issues in accessing inpatient services, and service users being admitted to beds outside of Bedfordshire. 

The senior leadership team recognised that significant changes would be needed to the system to solve this incredibly complex problem. They started by reviewing data and feedback to understand the issues, and teams are currently working on different ideas and projects focused on flow. The aim of the work is to reduce average inpatient bed occupancy to 85% by the end of 2024, and have no patients admitted to private beds. They have created a driver diagram, pictured below, which identifies what they believe needs to be addressed to achieve their aim (Fig. 1). 

Fig.1: Driver Diagram identifying drivers and change ideas across the system.

Service leads met in January to review which areas of the system to prioritise and completed a priority/impact matrix to help identify which ideas to prioritise. One area of the pathway that is facing a significant bottleneck is the inpatient wards. Teams are experiencing high numbers of patients who are clinically ready for discharge (CRFD) but cannot be discharged from the ward, which has led to increased bed occupancy (Fig. 2) and increased length of stay.

The discharge hub team are currently testing ideas to try and address this issue. One idea they are testing is a 72-hour triage system to ensure any potential barriers to discharge are identified on admission, and social workers within the discharge team are supporting with discharge tasks. Other teams across the system are also looking at ideas they can either continue or start doing, to support in achieving the aim. Service leads continue to meet regularly to review progress of the work and effectiveness of ideas.