As the most vulnerable NHS mental health patients face growing waits for treatment, and ministers want to start talking about a new mental health strategy, it is time to recognise that partnerships with the private sector are no easy route to easing the NHS waiting lists.
Private health companies have a strong foothold in the NHS, established over decades, and market analysts Laing & Buisson estimate that over 30% of NHS mental health hospital capacity is now supplied by the private sector. These firms provide over half the NHS inpatient beds for children and teenagers with mental health problems, and almost all of the secure beds for adults.
The revenue that these companies accrue from NHS contracts has risen steadily in recent years and the biggest providers are now highly dependent upon NHS work as it makes up around 90% of the total market value, with self-pay and private medical insurance fees only accounting for 10%.
Prior to the pandemic both the NHS and the private sector had failed to respond adequately to rising demand. Within the NHS, inpatient mental health beds have fallen from 18,750 to 18,232 over the last five years. This shortage of hospital beds across the country means that vulnerable patients are being treated out of their local area, away from families, causing distress and slowing their recovery. Alternatively, patients are being treated in the community with greater risk.
The NHS regularly searches countrywide for mental health bed space for patients and has little option but to lean heavily on private providers. A recent study found that 99% of Out of Area placements for patients with personality disorders were provided by the private sector.
Although private providers are taking up more NHS work they too are facing difficulties in recruiting qualified staff which has caused them to cut the number of beds they can provide. A report in the FT notes that they have reduced beds for children and teenagers in England by 325 over the past five years, which leaves just 1,321.
The Priory, the UK’s largest private mental healthcare provider, told the FT that the closures of beds were “the result of having to address a sector-wide shortage of specialist child and adolescent clinical staff”. It reminds us too that the independent sector leaves the NHS to invest billions in the training of health specialists to secure future staff.
The weakness in NHS workforce planning, disabled for many years by underfunding, has left NHS providers to watch in dismay while the gap between supply and demand widens. In the 3 years before the pandemic patient demand for NHS mental health services rose by 21%. No wonder then that the increase of under 5% in NHS mental health nurses over the same period was simply not enough to cope. And the stark reality is that the current nursing workforce in mental health (38,897) is still lower than the number working in the NHS 12 years ago (40,602 – NHS Digital Oct 2021).
Shortages in mental health doctors have also been consistently highlighted by the health professions who point to the fact that the NHS has only 1 consultant psychiatrist for every 12,567 people in the country and 10% of posts are not filled.
In a survey by the mental health charity Stem4 published back in December 2019, 43% of UK family doctors were already telling the parents of children who were struggling with anxiety, depression, self-harm or eating disorders to seek treatment privately, a self-pay market which is rising sharply since the pandemic. Waiting times for assessments for conditions like ADHD are driving patients towards the private sector to such an extent that delays are evident there too.
Patients are getting sicker while they wait. Two-fifths of patients end up seeking treatment from emergency or crisis services, with one-in-nine (11%) ending up in A&E, research by the Royal College of Psychiatrists has found.
And the problem is going to get worse. Unsurprisingly since the pandemic the number of people asking for help has soared. In the 3 months from April to September 2021 there was an 81% increase in referrals for children and young people’s mental health services alone.
The need for a long term strategy to raise NHS capacity has never been stronger. And yet the health secretary has confirmed in his most recent speech that new NHS staff will have to be found from existing budgets. And so the NHS will continue to be undermined by its limited capacity and heavily reliant on the private sector to treat its patients even though there are widespread problems in accessing care through this approach – all evident even before the pandemic. Unfortunately the government is still to learn that the policy of underfunding the NHS and shifting more patients into the private sector is no guarantee for the quantity or quality of services that NHS patients need.
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