Assessing the clinical and cost-effectiveness of inpatient mental health rehabilitation services provided by the NHS and independent sector (ACER): protocol

Helen Killaspy; Christian Dalton-Locke; Caroline S Clarke; Gerard Leavey; Artemis Igoumenou; Maurice Arbuthnott; Katherine Barrett; Rumana Omar

doi:10.1186/s12888-024-05524-6

Assessing the clinical and cost-effectiveness of inpatient mental health rehabilitation services provided by the NHS and independent sector (ACER): protocol

Helen Killaspy
, Christian Dalton-Locke
, Caroline S Clarke
, Gerard Leavey
, Artemis Igoumenou
, Maurice Arbuthnott
, Katherine Barrett
, Rumana Omar

University College London

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

71 Downloads (Pure)

Abstract

Background: Mental health rehabilitation services provide specialist treatment to people with particularly severe and complex problems. In 2018, the Care Quality Commission reported that over half the 4,400 mental health inpatient rehabilitation beds in England were provided by the independent sector. They raised concerns that the length of stay and cost of independent sector care was double that of the NHS and that their services tended to be provided much further from people’s homes. However, there has been no research comparing the two sectors and we therefore do not know if these concerns are justified. The ACER Study (Assessing the Clinical and cost-Effectiveness of inpatient mental health Rehabilitation services provided by the NHS and independent sector) is a national programme of research in England, funded from 2021 to 2026, that aims to investigate differences in inpatient mental health rehabilitation provided by the NHS and independent sector in terms of: patient characteristics; service quality; patient, carer and staff experiences; clinical and cost effectiveness.
Methods: ACER comprises a:1) detailed survey of NHS and independent sector inpatient mental health rehabilitation services across England; 2) qualitative investigation of patient, family, staff and commissioners’ experiences of the two sectors; 3) cohort study comparing clinical outcomes in the two sectors over 18 months; 4) comprehensive national comparison of inpatient service use in the two sectors, using instrumental variable analysis of routinely collected healthcare data over 18 months; 5) health economic evaluation of the relative cost-effectiveness of the two sectors. In Components 3 and 4, our primary outcome is ‘successful rehabilitation’ defined as a) being discharged from the inpatient rehabilitation unit without readmission and b) inpatient service use over the 18 months. Discussion: The ACER study will deliver the first empirical comparison of the clinical and cost-effectiveness of NHS and independent sector inpatient mental health rehabilitation services.
Trial registration: ISRCTN17381762 retrospectively registered.

Original language	English
Pages (from-to)	1-14
Number of pages	14
Journal	BMC Psychiatry
Volume	24
Issue number	1
Early online date	6 Feb 2024
DOIs	https://doi.org/10.1186/s12888-024-05524-6
Publication status	Published (in print/issue) - 6 Feb 2024

Bibliographical note

Funding

This article and the ACER study is funded by the National Institute for Health and Care Research (NIHR), Health and Social Care Delivery Research programme (NIHR130693). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. As part of the funding application process, the funder conducted an independent peer-review of the funding application.

Funder number
NIHR130693

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Mental health
Severe mental illness
Inpatient
Rehabilitation
NHS
Independent sector
Clinical effectiveness
Cost effectiveness
Length of stay
Instrument variable
Instrumental variable
State Medicine
Humans
Psychiatric Rehabilitation
Cost-Effectiveness Analysis
Inpatients
Cost-Benefit Analysis
Cohort Studies

Access to Document

10.1186/s12888-024-05524-6

s12888-024-05524-6Final published version, 1.79 MBLicence: CC BY

Cite this

@article{13ea2ec2453742859384a002bb8bf9d4,

title = "Assessing the clinical and cost-effectiveness of inpatient mental health rehabilitation services provided by the NHS and independent sector (ACER): protocol",

abstract = "Background: Mental health rehabilitation services provide specialist treatment to people with particularly severe and complex problems. In 2018, the Care Quality Commission reported that over half the 4,400 mental health inpatient rehabilitation beds in England were provided by the independent sector. They raised concerns that the length of stay and cost of independent sector care was double that of the NHS and that their services tended to be provided much further from people{\textquoteright}s homes. However, there has been no research comparing the two sectors and we therefore do not know if these concerns are justified. The ACER Study (Assessing the Clinical and cost-Effectiveness of inpatient mental health Rehabilitation services provided by the NHS and independent sector) is a national programme of research in England, funded from 2021 to 2026, that aims to investigate differences in inpatient mental health rehabilitation provided by the NHS and independent sector in terms of: patient characteristics; service quality; patient, carer and staff experiences; clinical and cost effectiveness. Methods: ACER comprises a:1) detailed survey of NHS and independent sector inpatient mental health rehabilitation services across England; 2) qualitative investigation of patient, family, staff and commissioners{\textquoteright} experiences of the two sectors; 3) cohort study comparing clinical outcomes in the two sectors over 18 months; 4) comprehensive national comparison of inpatient service use in the two sectors, using instrumental variable analysis of routinely collected healthcare data over 18 months; 5) health economic evaluation of the relative cost-effectiveness of the two sectors. In Components 3 and 4, our primary outcome is {\textquoteleft}successful rehabilitation{\textquoteright} defined as a) being discharged from the inpatient rehabilitation unit without readmission and b) inpatient service use over the 18 months. Discussion: The ACER study will deliver the first empirical comparison of the clinical and cost-effectiveness of NHS and independent sector inpatient mental health rehabilitation services. Trial registration: ISRCTN17381762 retrospectively registered.",

keywords = "Mental health, Severe mental illness, Inpatient, Rehabilitation, NHS, Independent sector, Clinical effectiveness, Cost effectiveness, Length of stay, Instrument variable, Instrumental variable, State Medicine, Humans, Psychiatric Rehabilitation, Cost-Effectiveness Analysis, Inpatients, Cost-Benefit Analysis, Cohort Studies",

author = "Helen Killaspy and Christian Dalton-Locke and Clarke, \{Caroline S\} and Gerard Leavey and Artemis Igoumenou and Maurice Arbuthnott and Katherine Barrett and Rumana Omar",

note = "{\textcopyright} 2024. The Author(s).",

year = "2024",

month = feb,

day = "6",

doi = "10.1186/s12888-024-05524-6",

language = "English",

volume = "24",

pages = "1--14",

journal = "BMC Psychiatry",

issn = "1471-244X",

publisher = "BioMed Central Ltd.",

number = "1",

}

TY - JOUR

T1 - Assessing the clinical and cost-effectiveness of inpatient mental health rehabilitation services provided by the NHS and independent sector (ACER): protocol

AU - Killaspy, Helen

AU - Dalton-Locke, Christian

AU - Clarke, Caroline S

AU - Leavey, Gerard

AU - Igoumenou, Artemis

AU - Arbuthnott, Maurice

AU - Barrett, Katherine

AU - Omar, Rumana

PY - 2024/2/6

Y1 - 2024/2/6

N2 - Background: Mental health rehabilitation services provide specialist treatment to people with particularly severe and complex problems. In 2018, the Care Quality Commission reported that over half the 4,400 mental health inpatient rehabilitation beds in England were provided by the independent sector. They raised concerns that the length of stay and cost of independent sector care was double that of the NHS and that their services tended to be provided much further from people’s homes. However, there has been no research comparing the two sectors and we therefore do not know if these concerns are justified. The ACER Study (Assessing the Clinical and cost-Effectiveness of inpatient mental health Rehabilitation services provided by the NHS and independent sector) is a national programme of research in England, funded from 2021 to 2026, that aims to investigate differences in inpatient mental health rehabilitation provided by the NHS and independent sector in terms of: patient characteristics; service quality; patient, carer and staff experiences; clinical and cost effectiveness. Methods: ACER comprises a:1) detailed survey of NHS and independent sector inpatient mental health rehabilitation services across England; 2) qualitative investigation of patient, family, staff and commissioners’ experiences of the two sectors; 3) cohort study comparing clinical outcomes in the two sectors over 18 months; 4) comprehensive national comparison of inpatient service use in the two sectors, using instrumental variable analysis of routinely collected healthcare data over 18 months; 5) health economic evaluation of the relative cost-effectiveness of the two sectors. In Components 3 and 4, our primary outcome is ‘successful rehabilitation’ defined as a) being discharged from the inpatient rehabilitation unit without readmission and b) inpatient service use over the 18 months. Discussion: The ACER study will deliver the first empirical comparison of the clinical and cost-effectiveness of NHS and independent sector inpatient mental health rehabilitation services. Trial registration: ISRCTN17381762 retrospectively registered.

AB - Background: Mental health rehabilitation services provide specialist treatment to people with particularly severe and complex problems. In 2018, the Care Quality Commission reported that over half the 4,400 mental health inpatient rehabilitation beds in England were provided by the independent sector. They raised concerns that the length of stay and cost of independent sector care was double that of the NHS and that their services tended to be provided much further from people’s homes. However, there has been no research comparing the two sectors and we therefore do not know if these concerns are justified. The ACER Study (Assessing the Clinical and cost-Effectiveness of inpatient mental health Rehabilitation services provided by the NHS and independent sector) is a national programme of research in England, funded from 2021 to 2026, that aims to investigate differences in inpatient mental health rehabilitation provided by the NHS and independent sector in terms of: patient characteristics; service quality; patient, carer and staff experiences; clinical and cost effectiveness. Methods: ACER comprises a:1) detailed survey of NHS and independent sector inpatient mental health rehabilitation services across England; 2) qualitative investigation of patient, family, staff and commissioners’ experiences of the two sectors; 3) cohort study comparing clinical outcomes in the two sectors over 18 months; 4) comprehensive national comparison of inpatient service use in the two sectors, using instrumental variable analysis of routinely collected healthcare data over 18 months; 5) health economic evaluation of the relative cost-effectiveness of the two sectors. In Components 3 and 4, our primary outcome is ‘successful rehabilitation’ defined as a) being discharged from the inpatient rehabilitation unit without readmission and b) inpatient service use over the 18 months. Discussion: The ACER study will deliver the first empirical comparison of the clinical and cost-effectiveness of NHS and independent sector inpatient mental health rehabilitation services. Trial registration: ISRCTN17381762 retrospectively registered.

KW - Mental health

KW - Severe mental illness

KW - Inpatient

KW - Rehabilitation

KW - NHS

KW - Independent sector

KW - Clinical effectiveness

KW - Cost effectiveness

KW - Length of stay

KW - Instrument variable

KW - Instrumental variable

KW - State Medicine

KW - Humans

KW - Psychiatric Rehabilitation

KW - Cost-Effectiveness Analysis

KW - Inpatients

KW - Cost-Benefit Analysis

KW - Cohort Studies

UR - https://www.scopus.com/pages/publications/85184532784

UR - https://pure.ulster.ac.uk/en/publications/13ea2ec2-4537-4285-9384-a002bb8bf9d4

U2 - 10.1186/s12888-024-05524-6

DO - 10.1186/s12888-024-05524-6

M3 - Article

C2 - 38321443

SN - 1471-244X

VL - 24

SP - 1

EP - 14

JO - BMC Psychiatry

JF - BMC Psychiatry

IS - 1

ER -

Assessing the clinical and cost-effectiveness of inpatient mental health rehabilitation services provided by the NHS and independent sector (ACER): protocol

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

Other files and links

Fingerprint

Correction: Assessing the clinical and cost-effectiveness of inpatient mental health rehabilitation services provided by the NHS and independent sector (ACER): protocol

Cite this