Mental Health Matters: Private sector must change its offer

Last month’s BBC Panorama expose into the abuse of patients with learning disabilities at Whorlton Hall – a privately-run hospital in Durham – has incited fierce public outrage.

Aside from questions over how the horrifying abuse was missed (the Care Quality Commission has launched two independent reviews into the incident), the scandal has given renewed vigour to debate over the private sector’s role within NHS-commissioned mental health and learning disability services.

Plans to include private sector providers in new care model collaboratives, which are set to be given more powers to commission specialised mental health services, prompted a considerable backlash from campaigners last month.

Initially, NHS England shied away from directly addressing the presence of the private sector within its new care model plans.

But, after the Whorlton Hall scandal turned the spotlight on privately run inpatient units, the national regulator could no longer ignore the elephant in the room.

Last week, it sent a letter to mental health, learning disability and autism service provider chiefs, stating only NHS organisations would be able to lead its new care models.

Under the new care model plans, provider collaboratives will be required reduce the number of patients within a specialist inpatient setting. Independent providers form a sizable part of the expansive specialist inpatient market, and so these plans could cut into their profits.

Does this mean the private sector will be eliminated from future NHS mental health services?

Unlikely. But reading between the lines suggests leaders are sending a message to those in the sector that, if they want to remain at the table, they’ll have to change their offer to the NHS.

They’ll have to do this by developing offers which rely more on treating service users in the community and reducing the reliance on bed-based solutions.

The NHS itself will have to be careful in this market management that it does not end up disrupting service delivery during the transition.

An independent view

To finish off a month of news exposing failures in the care of patients with learning disabilities and autism, last week my colleague Shaun Lintern revealed faults in the programme originally aimed at helping the NHS learning from those failures.

The learning disabilities mortality review programme was setup with the intention of ensuring lessons are learned from failures in the care of patients with a learning disability, so such situations can hopefully be avoided in the future.

The programme’s success, however, relies on a robust and trustworthy review process. But last week’s news called this process into question, revealing how one clinical commissioning group tampered with a LeDeR review for the death of 18-year-old Oliver McGowan.

While the initial LeDeR report into Oliver’s death deemed it avoidable, HSJ saw emails showing CCG staff not involved in the original review altered the report to leave this question unanswered and remove other elements to get rid of suggestions of blame.

The fact the commissioner – an organisation with a clear conflict of interest – can change the outcome of a review has to raise some questions over the credibility of LeDeR programme in its current form.

Current guidance on whether reviews should be independent is vague. Could this be due to the cost involved making LeDeR reviews officially independent?

So far, NHS England has only really shelled out funding to train local reviewers and the annual national review, which is carried out by the independent Bristol University.

Avid Twitter users may have noticed an interesting tweet from the Bristol University, revealing the organisation has signed a “confidentiality” agreement.

As for the local LeDeR reviews, considerably more funding would be needed if an independent organisation were commissioned carry them out.

If the process does not become independent, NHS England will have to make clear the steps it is taking to quality assure every LeDeR review once completed.

Mental Health Matters is written by HSJ’s mental health correspondent, Rebecca Thomas. Tell her what you think, or about issues she could write about, by emailing her in confidence at rebecca.thomas@wilmingtonhealthcare.com or by sending a direct message on Twitter.