Improving patient flow in inpatient mental health wards at Central and North West London NHS Foundation Trust (CNWL)

Central and North West London NHS Foundation Trust (CNWL) is one of the largest mental health trusts in the United Kingdom, serving a population of approximately 3 million and providing comprehensive mental healthcare across community and inpatient settings. CNWL initiated a quality improvement programme aimed at reducing the average length of stay (LoS) by 10% by April 2024 in response to extended LoS in nine of its adult mental health inpatient wards. The programme focused on nine inpatient wards with an average baseline LoS of 46 days.The improvement strategy focused on key themes, including building relationships between inpatient and community teams, streamlining communication and enhancing discharge planning. Key measures included LoS, number of discharges per week, involvement of community teams and a balancing measure of readmissions within 30 days. An automated Tableau dashboard was developed to support continuous data collection and monitoring.During the programme, 14 change ideas were tested using Plan-Do-Study-Act (PDSA) cycles. Results showed a significant reduction in LoS to an average of 34 days (from 46 days), representing a 26.4% improvement. The programme also yielded productivity savings of approximately £4.5 million, largely through reduced reliance on Out of Area Placements (OAPs) and improved patient flow through acute medical systems.The involvement of service users and carers played an important role in shaping the programme, bringing valuable perspectives that linked clinical priorities with patient experiences. The programme’s success highlights the importance of collaborative data-driven approaches to improving patient flow and care quality in mental health services. The main challenges in this quality improvement programme were engaging all teams effectively and fully quantifying the productivity and quality gains.