A trust-wide quality improvement programme to reduce out-of-area placements, length of stay and costs across inpatient mental health services (McAllister, Aurelio, Baker, Brewer, Moore, Ndlovu, Rutley, Stafford, Shah, 2026)
McAllister, Sarah, Aurelio, Marco, Baker, Philip, Brewer, Lucy, Moore, Joanna, Ndlovu, Edwin, Rutley, Angharad, Stafford, Jamie, Shah, Amar
In Future Healthcare Journal March 2026 13(1)
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.