A trust-wide quality improvement programme to reduce out-of-area placements, length of stay and costs across inpatient mental health services.

Abstract

Background: In the UK, rising demand for inpatient mental healthcare and fewer beds has led to persistently high occupancy, delayed admission and increased out-of-area placements. Consequently, only the most complex cases are admitted, contributing to longer lengths of stay.

Methods: Between April 2024 and March 2025 East London NHS Foundation Trust ran a trust-wide, large-scale quality improvement programme across all geographical directorates, to eliminate out-of-area placements and reduce length of stay. The programme followed a structured improvement approach; directorates moved stepwise from identifying a quality issue through to implementing change ideas that resulted in improvement through testing.

Results: Out-of-area placements reduced 93%, (from 66.5 to 4.6 per week), avoiding £8.5 million in costs. Average length of stay on London adult mental health wards fell by 17.5%, (53 to 43.9 days). Trust-wide bed occupancy decreased from 106% to 92%, and service users clinically ready for discharge reduced by 51%, (111 to 55 per week).

Conclusion: Tailored interventions, real-time data, leadership and collaboration drove impact. Future work will focus on sustaining gains and enhancing community alternatives.