This blogpost is the second of four, updating a series of blogposts on various aspects of Transforming Care/Building The Right Support I last updated in 2023. The first blogpost in this updated series looked at who was being admitted to inpatient units, where they were being admitted from, and the legal status and ward security of people in inpatient services. This second blogpost will focus on two aspects of what happens to people in inpatient services, how far people are from home and how long they are in inpatient services. They use information from the Assuring Transformation dataset, provided by NHS England/DHSC.
How far are people from home?
One of the main policies consistently trumpeted is having crisis and inpatient services close to home. The graph below reports information on the ‘distance from home’ of people in inpatient units, as reported in the Assuring Transformation dataset, from May 2017 to May 2026 (no data were published for May 2021).
The graph firstly shows that for substantial numbers of people (17% of people in May 2026), their distance from home is still recorded as 'unknown'. Over time, the number of 'unknowns' has got worse then slightly better, although the percentage of 'unknowns' was higher in 2026 than it was in 2017. This makes interpreting other apparent changes over time difficult, as we don't know how far these extra 'unknown' people are from home.
It's probably fair to say that the percentage of people in inpatient units less than 10km from home has increased over time, from 16% of people in May 2017 to 27% of people in May 2026. However, even by May 2026, a quarter (24%) of people were reported to be in inpatient units more than 50km from their home, a figure that has stayed fairly static from May 2022.
Just looking at information for March 2026, people in inpatient units further from home were more likely to have been in those inpatient units for longer.
How long are people in inpatient units?
A consistent policy aim of Transforming Care/Building The Right Support has been to reduce the length of time that people spend in inpatient units. The graph below shows how long people have been with their 'current provider' according to Assuring Transformation statistics, from March 2015 through to March 2026. There has been a slight change of wording in the Assuring Transformation spreadsheet here, from 'current unit' to 'current provider' - I'm not sure if this means exactly the same thing or if a person could be moved around within the same provider and be counted here.
There are very gradual trends towards a greater proportion of people being in their current inpatient unit for shorter lengths of time from 2015 to 2026. For example, in March 2026 22% of people had been with their current provider for 3 months or less, compared to 15% of people in March 2015. This might reflect the greater number of admissions to inpatient units we saw in the first blogpost. However, there are still substantial percentages of people who have been with their current service provider for long periods of time - in March 2026 12% of people had been with their current service provider for 5 years or longer, a percentage little changed for at least half a decade.
As we've seen in the previous post, substantial numbers of people are moved around different inpatient services without ever leaving the inpatient service system. Assuring Transformation also reports information on how long people have been continuously within inpatient services (not just how long they have been with their current provider). The graph below shows this information from March 2015 to March 2026.
The impact of people being transferred around can be clearly seen. The percentages of people in inpatient units for shorter periods has gradually increased over time. For example, the percentage of people in inpatient units for less than 6 months increased from 14% in March 2015 to 27% in March 2026. There have also been recent improvements in the percentage of people continuously in inpatient units for very long periods of time, although in March 2026, 29% of people had still been continuously in inpatient services for 5 years or longer.
Looking at information just for March 2026, people were likely to have been in inpatient units for two years or more if their legal status was MHA Part III (without restrictions, and particularly with restrictions), and more likely to have been in inpatient units for two years or shorter if their legal status was Part II or 'informal'.
Similarly, in March 2026 people in low secure, medium secure or high secure inpatient units were more likely to have been in inpatient units for two years or longer, and more likely to have been in inpatient units with a general level of security for two years or shorter.
Finally, Assuring Transformation also reports the average length of time that people have been with their current provider, and continuously in inpatient services. The graph below shows that in March 2026 people had been on average with their current provider for just over 2 years, with some recent improvement from March 2023. The total length of time people have been continuously in inpatient services showed a recent reduction from March 2022 to March 2026 but still stands at an average of 4 and a half years years.
What does this mean? First, despite some signs of gradual improvements over time, it’s obvious that inpatient services have not become radically more local as Transforming Care/Building The Right Support has ‘progressed’, with Assuring Transformation reporting that almost a quarter of people are more than 50km from home and this information simply not being reported for one in six people.
The information on how long people are staying in inpatient units, while gradually improving, reflects both the continuing ‘churn’ of people between inpatient units without seeing the outside world, and the possibility of a pattern of people experiencing a revolving door between their homes and inpatient units that might be suggested by the increasing number of admissions reported in the first blogpost.
In the next blogpost in this series, I will look at what Assuring Transformation tells us about reviews and planning when people are in inpatient units.
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