Consultation and Bed Allocation Policy

1. Introduction

This protocol provides a clear directive for bed/ flow managers, general managers
and clinical teams for bed/ capacity management within the organisation.

The principles which inform this guidance are:

 Patients should be cared for in their own community, ensuring care is

delivered by their own services, ensuring family involvement, continuity of care
and within the least restrictive alternative.

 To ensure the above happens, all patients referred for admission must be
offered a gate keeping assessment by the Intensive Home Based Treatment
Teams (IHBTT)/ Crisis Resolution Home Treatment Team (CRHTT)

 If Patients require admission then an age and speciality appropriate bed within
their own district (bed best placed to meet their needs) should be accessed.
However where this is not possible due to bed pressures, bed managers/
patient flow managers will collaborate and cooperate to ensure the patient
receives their care in the best possible place to meet their needs. To enable
this, the escalation process/ procedure will be enacted to ensure rapid
solutions are found wherever possible within SWYPFT. This will ensure
patients will not be referred to other NHS providers or the private sector when
beds or alternative short term solutions are available within SWYPFT.

 Where patients are placed within other NHS or the private sector beds this will
be following a process of negotiation and co-operation between BDUs at the
general manager level ensuring all options for SWYPFT bed usage have been
explored and exhausted

 This protocol ensures that patient’s safety and clinical needs are met in a
responsive, safe and dignified way that meets quality and Care Quality
Commission (CQC) standards.

 A key principle is that SWYPFT bed capacity crises should be anticipated and
managed. This should be within hours, supported by clear communication and
cooperation between Business Delivery Unit’s (BDU’s). This means that beds
should only be held for local admissions where it is clear that there is a bed
required for patients currently under assessment within the gatekeeping or
MHA assessment process. Please see Section 7 for further guidance in
relation to Barnsley BDU
 When a bed capacity crisis occurs, consideration will be given to creating capacity
within inpatient facilities alongside consideration of how demand may be reduced
via gatekeeping processes. This reflects a principle of
looking inward and outward when managing such crises.

Aims & Objectives

This guidance covers all areas of processes for bed management. It describes how
beds will be utilised in each 24-hour period taking account of:

 The safety of Service Users and staff

 The Service User experience

 Making the best use of available beds at any point within a 24-hour period by
providing a clear framework that supports decision making in and out of hours
around potential bed management issues.

 Ensuring that communication between all parties involved in the process is

clear and ensures the optimum use of and access to beds to provide timely
and appropriate Service User care and treatment.

2. Key Personnel - Duties and Responsibilities

Executive Management Team (EMT)

The Executive Management Team will note this policy and be responsible for
ensuring it has been developed according to Trust requirements.

Deputy District Directors

The lead Deputy Director responsible for this protocol is the Deputy District Director
for Barnsley and Wakefield BDUs. Other Deputy Directors will need to ensure that
this Protocol is widely known and implemented throughout their areas of
responsibility.

General Managers
All managers within service areas must ensure that they are aware of this Protocol
and know how it applies within their sphere of control. They also have a duty to
ensure that staff within their service areas are aware of this Protocol and of the
various procedures referred to in this document and are suitably supported to
understand their role in the process.

Employees
All staff are responsible for ensuring that they are aware of the procedure and follow
it appropriately. Where there is uncertainty they should ensure they seek
appropriate advice and support from their line manager or senior colleagues. Staff
must ensure that they are familiar with their responsibilities and follow the Protocol
fairly and consistently.
3. Role of the On Call Consultant

The On Call Consultant takes the role of Senior Clinician and will be contacted
where advice and clinical recommendations are required in relation to potential
admissions. Key responsibilities will include:

 Decisions on the immediate clinical intervention needed to provide safe, effective

care.
 To review alternatives to hospital admission.
 To assess the possibility of freeing up a currently occupied bed.
 To work with other On Call Consultants and Managers in each BDU to achieve a
Trust Wide solution.

4 Role of the General Manager/ On Call Manager

Where potential capacity issues are identified across the system the general
managers and on call managers out of hours effectively form an interdepartmental
management team. This will assume a number of responsibilities which include:

 Overseeing the analysis of bed stock and the authorisation of bed usage across
the organisation.
 Supporting the review of patients by clinicians where early discharge may be
appropriate, allowing the creation of capacity. This will be from the perspective of
ensuring accountable clinicians are included in such decisions, ensuring an
ongoing investment in patient safety.
 Responsibility for informing and updating the Deputy Directors and on call
Director anticipating the likelihood to need funds for private placements (see
escalation section).
 The risk of ongoing crisis/ plans for resolution will also be held by General
Managers. The General Managers/ on call managers role will be to support the
decisions and ongoing requirements for bed management.
 Authorising funding for out of area placements within private sector beds.
 Intervening in disputes between respective BDU’s, ensuring a cohesive and
collaborative response is negotiated and held at the General Manager level.
 5. Documented Communications

All discussions regarding bed management, inclusive of rationale and outcome of

bed allocation will be documented on the Bed Management discussion template
located in the K drive. (K:\BDU Bed Management Discussion Folder)

Any practitioner who has responsibility for the locating/ negotiating/allocating of

beds should make timely recordings as above.

Only the final outcome/ agreement will be documented in the client RIO progress
notes.

The information recorded will identify the types of bed used i.e. absent without leave
(AWOL) Community Treatment Order (CTO) recall, leave or vacant and this
information may be audited to inform more broadly bed management and patient
flow.

6. Admission

People requiring admission to an acute inpatient bed must be gate kept by the
Intensive Home Treatment teams, which act as ‘gate keepers’ to acute admission
beds.

All requests for inpatient admissions should be considered after a full mental health
assessment has been completed. Consideration should always be given to any
other service that may be an acceptable alternative to inpatient care.

Beds are ordinarily allocated according to place of residence.

Under no circumstances should young people under the age of 16 years be

considered or accepted for admission. Where admission is required for young
people aged 16 – 18 year of ages please refer to Guidance re: Young Persons
Admitted to SWYT Adult Ward.

7. Definitions – Bed Usage

In recognition of the different commissioning arrangements for Barnsley BDU, as

compared with West Yorkshire BDU’s, (Barnsley Commissioners have not signed
up to the Shared Bed Base) it is essential that the bed capacity at Kendray
Hospital (including PICU) is prioritised in order to accommodate Barnsley
residents. In general, a minimum of a male, female and PICU bed will be made
available to accommodate local BDU service needs. Decisions to admit are
clinical decisions, ensuring that local resource is available to meet local demand,
in accordance with Commissioning demands.
 Leave beds

In general leave beds can be used, however it is the duty of the Consultant and
the Ward Manager (or their nominated Deputy) at the point of authorising leave
to determine the likelihood of the risks of leave breaking down.

 AWOL Beds

AWOL beds can be used. The rationale for not doing so must be clearly
documented on the Bed Management discussion template located in the K drive.

In hours the decision to use an AWOL bed will be made by the Inpatient
Consultant and Ward Manager (or their nominated Deputy) in consultation with
the Multi-Disciplinary Team (MDT).

Out of hours the decision will be made by the On Call Consultant in consultation
with the nurse in charge of the ward.

 PICU (Psychiatric Intensive Care) beds

Admission to PICU beds for patients requiring an acute bed should be within the
PICU Operational Guidance. In exceptional situations when the only available out
of area bed is in a PICU Unit the patient will be admitted into a local PICU bed
and the decision will be based on the same principles of clinical need and risk.
This will include full consideration of the risk of admitting patients requiring an
Acute bed into a PICU bed regardless of their Mental Health Act status.

Any service user admitted to PICU in these circumstances should receive:

 Full information about access and egress in a Psychiatric Intensive Care

(PICU) environment.
 Such admissions will be recorded on DATIX as a red incident in the first
instance as a potential breach of protocols may have occurred. The
incident must be reviewed and graded appropriately by the relevant clinical
lead within 24 hours. The service user will be a priority for return to a
suitable environment in line with the principle of least restrictive alternative.
 Where the service user is not moved on to an appropriate bed within 72
hours a further datix should be submitted and the General Manager
alerted.
  CTO (Community Treatment Order) Beds

Beds that are identified for CTO recall must be held available as there is a legal
obligation under the Mental Health Act to provide safe recall conditions.

 Gender Specific issues

The Trust is committed to providing gender specific bedroom accommodation in

line with Eliminating Mixed Sex Accommodation (EMSA) requirements.
Decisions to use gender specific beds to accommodate admissions of the
opposite sex must be authorised by the Consultant and Ward Manager (or their
nominated Deputies) and appropriate measures put in place to maintain the
privacy and dignity of service users until a bed in a gender specific area can be
made available.

If a patient is admitted to a bed which is not in the gender specific area it will be
covered by the EMSA Policy and according to this policy would be recorded on
DATIX in line with relevant Commissioner requirements.

8. Locating a Bed

The Bed allocation function is carried out by the gatekeeping function (Single
Point of Access (SPA)/ IHBTT) within each BDU which may differ slightly
according to local arrangements, but the principle in locating a bed is
standardised throughout the Trust. (See Bed Search Flow Chart at Appendix A).

The first priority is to locate local beds for local residents within the Host BDU. If
there is no bed available within the local BDU, a Trust wide bed search should be
conducted. If there is no bed available within the Trust, an Out Of Area bed
search should be conducted using the Bed Search List Template see Appendix
B. This list contains a list of NHS and privately provided MH Hospital facilities.

The authority to search for an Out Of Area bed during working hours lies with the
Patient Flow Manager/ Coordinator or the General Manager. Funding Requests
are authorised by the General Manager or his/ her deputies under local BDU’s
financial delegated authority.

The completed Bed Search List, together with Initial Admission form and relevant
administrative paperwork are to be archived with the Patient Flow Manager in
each BDU for auditing purposes.
 Absence of beds Nationwide

There will be some exceptional situations when all reasonable efforts have been
made to find a bed internally or out of area from other providers and IHBT is not a
viable option as an emergency measure, the service user should be admitted to a
ward in their own locality and made as comfortable as possible until a bed is
available. Service users and their families should have these circumstances fully
explained to them prior to admission by the team who have made the decision to
admit. Observations must be implemented to reflect any ongoing risks and the
incident recorded on DATIX and graded red in the first instance as a potential
breach of standards may have occurred. The incident must be reviewed and
graded appropriately by the relevant clinical lead within 24 hours.

Every effort must be made to ensure that the quality of accommodation offered is
carefully considered and that the privacy dignity, and safety of the service user is
protected at all times. Any accommodation must have been subject to the
routine environmental assessment as part of the Ligature Risk policy. Each
Ward Manager is responsible for formulating a Contingency Plan for their Ward
that can be initiated should this exceptional circumstance occur.

9. Locating a Bed Out of Hours

Bed allocation during Out of Hours is carried out by the IHTT/ SPA Team
depending on local BDU arrangement. The principle in locating a bed remains
the same as during Working Hours.

Authority to search an Out Of Area bed is delegated under local BDU

arrangement. Initial Admission paperwork should be signed by the IHBTT/ SPA
Practitioner in the absence of the Patient Flow Manager/Coordinator and General
Manager. Funding Requests out of hours are authorised by the General
Manager on call or his deputies under local BDU’s financial delegated authority.

The completed Bed Search List, together with the Admission form and relevant
administrative paperwork are to be archived, under local arrangement, for
auditing purposes. The completed Bed Search List, together with Initial
Admission form and relevant administrative paperwork are to be archived with
the patient flow manager in each BDU for auditing purposes.
10. Escalation

The Trust, via individual BDU’s, will operate an “early warning” system to alert
General Managers regarding the lack of or low availability of beds in any of the
respective BDU’s. This will trigger timely communication (by 12 o’clock mid-day)
between Bed Managers, Patient Flow Managers (or their equivalent), General
Managers and Clinical Leads. Where escalation is identified as required this will
trigger the formation of the inter-departmental management team.

The system will operate in line with REAP reporting:

 Normal Level 1 – Green

 Concern Level 2 – Yellow
 Moderate Pressure Level 3 – Amber
 Severe Pressure Level 4- Red
 Critical Level 5 – Purple
 Potential Service Failure Level 6 – Black

Each level will have a clear and concise escalation plan that will include the times
that actions need implementing and who the current situation needs to be
escalated to. This level of reporting and timings of progression will be mirrored
across the BDU’s although activity that sits underneath these parameters may
vary from locality to locality depending on service design.

Bed availability is always fluid and it is accepted that assessment of the situation
will need to take place continuously throughout each shift.

11. Dispute Resolution

If there is any local dispute over admission when a bed is available this should be
referred to the General Manager and/ or the Clinical Lead for the Acute Service Line
in line with the escalation procedure.

If there is any dispute over admission when a bed is available in another BDU then
this should also be referred to the General Manager and/ or the Clinical Lead for the
Acute Service Line in line with the escalation procedure.

General Managers and Clinical Leads must ensure there is a delegated

representative to undertake this role in their absence.

Disputes that arise out of hours will be discussed with the On Call Manager who can
obtain clinical advice from the On Call Consultant.

The Trust’s position is that the needs of the service user come first. There may be
exceptional circumstances e.g. when there is the potential for serious violence
 against a specific member of staff and/ or service user/s that will be addressed on an
individual basis in a ward or clinical environment.

12. Monitoring Service Users when placed out of area.

When a local bed is not available and patients are placed out of area, either in
another BDU or within the private sector the admitting team will communicate with
the local ward where the patient would have ordinarily been admitted.

It is then the responsibility of the parent ward and the Patient Flow
Co-ordinators/ bed managers for monitoring the progress of the service user, with a
view to repatriating them as soon as practicable back to their local ward. The Care
Co-ordinator will be informed and involved in this process enabling continued
awareness of progress and involvement with care. The Care Co-ordinator is
required to ensure the service user and carers access any available and appropriate
services.

13. Considerations when relocating a Service User

Service users admitted to a unit other than their local unit should be transferred back
to the home unit as soon as is practicable. Although this can prove disruptive to the
service user’s care, it remains the preferred option. Service users being discharged
from their local unit benefit from closer involvement of carers and community
services and a more co-ordinated discharge plan. In order to achieve transfer back
to local services close co-operation between the respective mental health units will
be essential.

Whenever possible the care co-ordinator should be informed prior to any service
user’s move.

Wherever possible service users should be relocated to their local area to maintain
contact with family, social networks and to promote continuity of care within their
local mental health services

The MDT will be responsible for determining whether a service user remains in an
out of area bed (this refers to beds in other BDUs within SWYPFT as well as those
outside of the organisation).

If a decision is made for a service user to remain in an out of area bed, agreement
between clinical teams needs to take place as part of the MDT decision making
process. Any decisions must be based on patient need and should be reviewed
regularly by clinical teams and care co-ordinator to ensure continuity of care.

If the repatriation of a service user creates a capacity problem within the BDU bed
base and prompting a need for escalation, then the repatriation should be delayed.
This would also apply to a service user in a private sector bed.
 Planned transfers of service users should not usually take place before 9am or after
8pm where possible.

14. Communicating with Service Users and Carers

Arranging admissions to units outside the local catchment area can cause problems
for service users and their carers. Any difficulties the placement may create for the
service user and carer should be acknowledged, recorded in the care record and
passed on as necessary to the Care Co-ordinator. The Care Co-ordinator should
discuss any concerns or difficulties this placement causes with service users and
carers as soon as possible.

15. Process of Implementation and Monitoring

This Protocol will be authorised by the Deputy District Directors and formally ratified
within the relevant Management and Governance systems within each BDU.

Once ratified, the Protocol will be uploaded onto the Trusts Intranet.

Each BDU will disseminate the Protocol to all relevant Wards and Departments, to
ensure that all relevant staff are aware of and have read the revised Protocol.

The Weekly Communications Bulletin will be utilised to inform all staff that ne
guidance has been agreed. This will include a brief summary of changes made.

General Managers in Acute Service Lines will ensure that reminders are issued to all
staff on a 6 monthly basis to encourage them to read and refresh their knowledge of
the Protocol.

Patient Flow/ Bed Managers will undertake compliance audits on a 6 monthly basis
to identify any inconsistencies in approach, or gaps in implementation across the
organisation. The results of these audits will be discussed with the General
Managers in Acute Service Lines for appropriate action to be taken.

16. Review of the Protocol

The Protocol will be reviewed 1 year after implementation.