Safety recommendation
HSSIB recommends that the Department of Health and Social Care works across government to review the statutory instruments, business processes and regulations that govern mental health services, social care and housing services impacting on mental health out of area placements and creates a proposal for the future accountability and integration of health and social care. This is to ensure that they are operating to consistent statutory, financial and regulatory frameworks. By addressing system integration and collaboration between health, social care and local authorities will define accountability and reduce or prevent out of area placements.
Response:
DHSC and NHSE are leading on the delivery of several actions which will contribute to addressing the safety recommendation, as outlined below.
The 10 Year Health Plan
The 10 Year Health Plan will set out our plans to improve health and social care for the benefit of patients, staff and the wider public. An important part of this will be how the integration of services, including the accountability & oversight and financial flow arrangements, can work better to drive value for patients. This also involves developing a vision for what effective, integrated care should look like by 2035 for people living with one or multiple long-term conditions (for example mental health conditions). Additionally, there will be a review of the current approach to accountability and oversight to determine whether it is fit for the future and can drive improvement and collaboration in our healthcare system.
Tools for Financial Integration
Financial integration via Section 75 arrangements allows for the pooling of budgets, sharing of resources and delegation of functions across NHS bodies and LAs. This is one of the important enablers for integration, and DHSC are undertaking a review of s75 arrangements to consider if there are changes we can make to the legislation to facilitate not only its greater use but also its ease of use.
Recent announcements on reform and investment
There have been announcements recently regarding reforms and investments to improve adult social care. This includes the independent commission into adult social care, which will be split over two phases and will set out a vision for adult social care, with recommended measures and a roadmap for delivery.
An £86 million boost to the disabled facilities grant was announced for financial year 24/25, supporting people to remain in their home with a reduction in hospital admissions which could impact the requirement for mental health out of area beds.
On 30 January, the government published its 2025 mandate to NHS England, laying the foundation for longer-term reform as part of the health mission. On the same day, NHS England published the NHS operational planning guidance, which set out the priorities for 2025/26. Together, these support addressing the safety recommendation through as follows:
1) A reduction of the number of targets for the NHS means NHS England has reduced the number of national priorities for 2025/26, giving local systems greater control and flexibility over how local funding is deployed to best meet the needs of their local population, which can help support system integration.
2) The mandate specifically sets out the need to improve patient flow through mental health crisis and acute pathways. The 2025/26 operational planning guidance is clear that ICB’s are expected to meet the Mental Health Investment Standard (MHIS) and work with providers to ensure that system discharge plans include mental health acute pathways to reduce average lengths of stay in the adult acute mental health pathway, improve local bed availability, and reduce the need for inappropriate out of area placements.
Mental Health Funding Allocations
The NHS is committed to reducing inappropriate out-of-area placements (OAPs) for mental health patients due to the associated risks, including higher rates of suicide following discharge and the susceptibility of out-of-area care to a closed culture which can have detrimental impact on quality and safety of care. All ICBs have published plans to localise inpatient care by 2026/27 under the national Commissioning Framework, improving both care quality and value for money. To support this, £75 million has been allocated in 2025/26 to assist systems and NHS-led Provider Collaboratives (PCs) in reducing one or more of the following:
- OAPs in Acute Care or Psychiatric Intensive Care Units (PICUs)
- Mental Health Learning Disability and Autism inpatient rehabilitation far from home
- Placements outside Natural Clinical Flow (ONCF) in Adult Medium and Low Secure and Children and Young People Inpatient Services.
Neighbourhood Mental health Centres
In addition, in summer 2024, NHSE launched 6 pilot neighbourhood mental health centres that comprise of a team of people from existing mental health services in that locality from health, social care and the voluntary sector. The team and associate local partners will work together to deliver a service 24 hours a day, 7 days a week with open access for anyone who requires mental health support. The aim is for these centres in the heart of the community to be firmly connected to both primary and specialist services which can be drawn on as required. A key feature of the model is Continuity of Care whereby the same team will support people with serious mental illnesses throughout all stages of their interaction with services, whether that be crisis support, psychological and social care support, or employment or housing support. The centres are based in people’s local neighbourhoods with the aim of reducing waiting times, hospital admissions and the need for OAPs.
Additional Measures
DHSC officials will work with officials at MHCLG to consider opportunities for collaboration to improve the way that mental health and housing services work together.
Actions planned to deliver safety recommendation:
1) Ongoing preparation on the 10 Year Health Plan includes working groups considering the integration of services, and the implications for accountability & oversight and financial flows.
Integration: Developing a vision for how the NHS can evolve to provide responsive, joined-up care to better support individuals with single or multiple long-term conditions (i.e. mental health), or complex health needs, who may require frequent, ongoing engagement with the NHS. This vision must shift to an integrated model where services work closely together, ensuring that patients experience improved continuity, coordination, and comprehensive support throughout their healthcare journey
Accountability & oversight: Reviewing the current approach to accountability and oversight to determine whether it is fit for the future and can drive improvement in our healthcare system. Work will be focused on clarifying roles and incentivising the right behaviours and ways of working.
Financial flows: Evaluating the finance and contracting implications of the 3 shifts, and identifying how these will need to change over the coming years. This includes considering how financial flows should change to achieve the emerging vision of the 10 Year Health Plan, improving patient outcomes, experience and choice. By when: Spring 2025 (tbc). Organisational lead: DHSC. Resources in place to deliver actions: Eleven working groups are supporting policy development for the 10 Year Health Plan.
2) S75 partnership arrangements review – Reviewing the legislation to see if there are any changes we can make to enable further use.
As part of this we are considering if we should widen the organisations that can enter into s75 arrangements to improve join up amongst public services and support a shift towards models of delivery that focus on preventative proactive care. By when: TBC. Organisational lead: DHSC. Resources in place to deliver actions: DHSC place team delivering s75 review.
3) Announcement in January 2025 of £86 million boost to the disabled facilities grant for financial year 24/25. This funding will support people to remain in their home with a reduction in hospital admissions which could impact the requirement for mental health out of area beds. By when: 2024/2025. Organisational lead: DHSC. Resources in place to deliver actions: £86 million boost to the disabled facilities grant for financial year 24/25.
4) Social Care Reform:
We are launching an independent commission into adult social care as part of our critical first steps towards delivering a National Care Service. The Commission will be split over two phases and will set out a vision for adult social care, with recommended measures and a roadmap for delivery:
Phase 1 – reporting in 2026, will focus on how we can make the most of existing resources to improve people’s lives over the medium term. These reforms will help build the foundation for a National Care Service, support NHS goals and improve local services, making recommendations for medium term improvements.
Phase 2 – reporting by 2028, will make longer-term recommendations for the transformation of adult social care, addressing demographic change, how services should be organised to deliver this and how to best create a fair and affordable adult social care system.
We will also be taking forward a range of initiatives in 25/26, including funding more home adaptations, promoting better use of care technologies, and professionalising the adult social care workforce. By when: 2028. Organisational lead: DHSC. Resources in place to deliver actions: DHSC Adult Social Care teams working on social care reform.
5) All ICBs have published plans to localise mental health inpatient care by 2026/27 under the national Commissioning Framework, improving both care quality and value for money.
Funding has been allocated to support systems and NHS-led Provider Collaboratives in reducing one or more of the following:
- OAPs in Acute Care or Psychiatric Intensive Care Units (PICUs).
- Mental Health Learning Disability and Autism inpatient rehabilitation fare from home.
- Placements outside Natural Clinical Flow (ONCF) in Adult and Children and Young People Medium and Low Secure services.
By when: 2026/27. Organisational lead: Integrated Care Systems. Resources in place to deliver actions: £75 million has been allocated in 2025/26 to assist systems and NHS-led Provider Collaboratives (PCs).
6) The Government’s 2025 mandate to NHS England reflects a reduced number of targets for the NHS in the mandate, which means NHS England has reduced the number of national priorities for 2025/26, giving local systems greater control and flexibility over how local funding is deployed to best meet the needs of their local population, and therefore supporting system integration.
The operational planning guidance published by NHSE is clear that ICB’s are expected to meet the Mental Health Investment Standard (MHIS) and work with providers to ensure that system discharge plans include mental health acute pathways to reduce average lengths of stay in the adult acute mental health pathway, improve local bed availability and reduce the need for inappropriate out of area placements. By when: 2025/26. Organisational lead: Integrated Care Systems. Resources in place to deliver actions: Allocated resources to systems.
Response received on 24 February 2025.