Evaluating the impact of in‐patient bed reduction and community nurse increases in one English Mental Healthcare Trust

This Mental Health Task Force funded project was designed to evaluate the impact of organizational changes in Northampton, a traditional English Mental Healthcare Trust. Services in Northampton were typically provided by a large ‘watertower’ Victorian hospital on the outskirts of the town. The hospital had been, over a period of some years, reducing the use of in‐patient beds. In February 1995 a further 10 beds were withdrawn enabling the closure of a complete building and the re‐deployment of some staff into the community. By reducing in‐patient beds, and increasing the number of community staff it was hoped that there would be a significant effect upon both hospital admissions, length of stay with resultant cost savings, and an increase in community nurse–patient contacts. To establish baselines quantitative data were gathered about pre‐existing acute and community services, with comparisons made from qualitative and quantitative data gathered during the initial change period. Information was collected concerning in‐patient admissions within the acute services, community psychiatric nurse (CPN) caseloads including new admissions, care delivery costs and interviews with service managers. The project found that changes in the general patient profile could not be attributed solely to the reduction in available beds but there did appear to be a direct correlation between bed reduction, increase in percentage bed occupancy and more demanding CPN caseloads. Concern was expressed about the ability of community staff to meet the needs of an increasingly female (age 20–39 years) user group. Savings to the Trust were estimated at £300 000 per annum. The paper concludes with recommendations for future changes.