On 1 October 2020, NHS England passed its budget for specialist mental health services to 10 groups of providers across England, but plans show that even after changes, there will be a considerable role for private companies – in particular for in-patient mental health services and learning disability services with some independent providers selected despite a very poor record of care at some of their sites.
The provider collaboratives will take on the budgets and the commissioning responsibility for mental health services within an area and for a designated service. NHS England will transfer its £400 million specialised mental health budget to these organisations. Seven of the ten organisations are based in London. Each organisation will be led by an NHS trust, acting as a lead provider.
Under the original plans, announced last year by NHS England, private companies could have held the lead provider contract, but following a backlash by campaigners and the exposure by BBC Panorama of the abuse at Whorlton Hall, NHS England backtracked, deciding that the lead provider must be an NHS organisation, but in some areas non NHS provision forms a major part of the available services.
The collaborative in the East Midlands, known as IMPACT, includes four non-NHS organisations, Cygnet Healthcare, The Priory, St Andrew’s Healthcare and Elysium Healthcare.
Cygnet, St Andrew’s and The Priory Group have been all involved with some shocking incidents of abuse of mental health patients and those with learning difficulties. The most recently reported was in September 2020 at Cygnet’s Yew Trees centre for women with learning difficulties, where the Care Quality Commission (CQC) saw evidence of physical and mental abuse some of which has now been passed to the police. Strikingly the CQC concluded that staff had allowed a culture to develop at the hospital that “increased the risk of harm to patients.”
In July 2019, the CQC placed two of The Priory’s’ hospitals into special measures – Priory Hospital Blandford in Dorset and Kneesworth House in Royston, Hertfordshire. The hospitals were found by the CQC to be unsafe and uncaring and rated them both as inadequate.
Under the revised plans for the collaborative networks, companies cannot take a lead role, but according to NHS England, commissioning plans will be made by a partnership board containing representatives from these private organisations, raising questions about future conflicts of interest.
Mental health services in the NHS have become more reliant upon capacity within the independent sector, due to the closure of inpatient beds, persistent underfunding and the drive towards competitive tendering.
From next April, NHS England plans to roll out budgets to collaboratives across the rest of the country, with provider collaboratives becoming the vehicle for delivering all appropriate specialised mental health, learning disability and autism services over the next five years.
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