The ACER Study

Helen KILLASPY1

1University College London, London, United Kingdom

Background

Mental health rehabilitation services provide specialist treatment to people with particularly severe and complex problems. In England, disinvestment in local NHS provision of these services has resulted in over half of the 4000+ mental health inpatient rehabilitation beds now being provided by the independent sector. Concerns have been raised about independent sector services having longer lengths of stay and higher costs, the quality of care provided, and the fact that they are often further from the patient’s home than NHS services. However, there has been no research comparing the two sectors in detail and we therefore do not know whether these criticisms are justified. The ACER study (Assessing the Clinical and cost-Effectiveness of inpatient mental health Rehabilitation services provided by the NHS and independent sector) aims to compare the two sectors in terms of: patient characteristics; service quality; patient, carer and staff experiences; clinical and cost effectiveness.



Methods

​ACER comprises the following components: 1) a detailed survey of NHS and independent sector inpatient mental health rehabilitation services across England; 2) a qualitative investigation of patient, family, staff and commissioners' experiences of the two sectors; 3) a cohort study comparing clinical outcomes in the two sectors over 18 months; 4) a comprehensive national comparison of inpatient service use in the two sectors, using instrumental variable analysis of routinely collected healthcare data over 18 months; 5) a health economic evaluation of the relative cost-effectiveness of the two sectors. In Components 3 and 4, our primary outcome is 'successful rehabilitation' over the 18-month follow-up period, 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.