The National Health Service is paying £2bn a year to private hospitals to care for mental health patients because it doesn’t have enough beds of its own, The Guardian can reveal.
The independent sector receives around 13.5% of the £14.8bn NHS England spends on mental health, a dramatic increase since 2005, when £951m was paid out. Nine out of 10 of the 10,123 mental health beds run by private operators are occupied by NHS patients.
The NHS’s growing reliance on independent care providers comes despite concerns from some heads of health services that there are persistent, and sometimes fatal, problems with the quality and safety of care in many of the care units. mental health they manage.
Those fears, shared by NHS psychiatrists, mental health nurses and charities, are confirmed by reports of inspections by the Care Quality Commission (CQC). Figures it has provided to The Guardian show that 71 different psychiatric facilities run by non-NHS providers serving adults or those under 18 were found to be “inadequate” since the beginning of 2017, more than one in four of the total 269 facilities. this type. units.
According to the latest research by leading healthcare market analysts LaingBuisson, independent mental health providers are paid £1.964m a year for treating NHS patients. They have gained a dominant role as the NHS has reduced its own stock of mental health beds despite growing demand for residential psychiatric care.
The revelation that the NHS in England is handing out such a large sum of money to independent operators prompted Dave Munday, the chief professional officer of Mental Health Association of Nurses, to denounce “the scandalous privatization of the services on which the most vulnerable people depend to survive.”
Paul Farmer, chief executive of Mind, said the “dangerous phasing out” of NHS beds in recent years had left it worryingly dependent on the private sector.
“While this use of private care providers is not in itself concerning, the fact that some patients are being transferred to private providers on the other side of the country, or even providers that the CQC has deemed to provide inadequate standards of care It’s incredibly worrying. , particularly as some of these referrals appear to have had tragic and fatal consequences,” said Farmer, who chaired England’s NHS mental health task force in 2015.
LaingBuisson’s research also shows that:
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Independent mental health care providers now get 91% of their income from the NHS.
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Their typical profit margins are 15% to 20%.
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Most hospital care for those under 18 is now outsourced, with independent operators taking care of 55% of all hospitalized children and young people.
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Non-NHS providers earn £316m a year from treating children and young people.
Overall, the four largest operators – the for-profit companies Cygnet Health Care, Priory Group and Elysium Healthcare and the charity St Andrew’s Healthcare – receive £1.356bn, two-thirds of the nearly £2bn total. This reflects that between them they manage 182 hospitals that contain 6,700 (66%) of the total of the independent sector of 10,123 mental health beds. In another sign of their dominant role, the quartet hold nearly 40% of all of England’s secure mental health beds, reserved for the sickest patients.
While private sector beds increased from 9,291 in 2010 to 10,123 in 2021, the number of mental health beds in the NHS fell from 23,447 to 17,610, a drop of 5,837.
The NHS watchdog gave 10 of 71 ‘inadequate’ hospitals its lowest rating twice when, on subsequent visits, CQC inspectors found that urgent improvements they had ordered to improve care for patients had not been made. people with conditions such as psychosis and bipolar disorder. with patients still exposed to danger.
Dr Andrew Molodynski, Mental Health Policy Lead at the British Medical Association, said: “The government’s persistent underfunding of NHS services and failure to address the shortage of mental health beds has led to a worrying over-reliance on private providers, many of whom have been responsible for a catalog of patient safety failures, placing highly vulnerable patients at increased risk of inadequate care or, at worst, of self-harm and suicide.
The big four non-NHS operators said staffing problems were hampering their efforts to always provide the best possible care for patients with challenging and often complex illnesses, and that only a small number of their facilities had been rated as inadequate.
A spokesperson for Priory said: “Priory works in partnership with the NHS and the availability of independent mental health services allows the NHS to give very ill patients immediate access to treatment that they often lack adequate facilities or capacity to offer, and free to create much-needed NHS ER and ER beds occupied by patients in need of specialist mental health treatment.”
A Cygnet spokesperson said the safety and well-being of the service’s users was its “top priority”, adding that regulators rated 82% of its installations as “good” or “outstanding”.
Elysium said it was proud to provide care to people at “the most vulnerable point in their lives.” He added, “While we take pride in the cutting-edge care and therapies we provide at our hospitals, we never stop striving to learn and improve.”
Jess Lievesley, the chief executive of St Andrew’s, said that while five of the nine services it operates had been rated ‘good’ by the CQC, three had been rated ‘needs improvement’ and one ‘inadequate’.
“This is not a level of service we are happy with and we have been restructuring our charity over the last few years to drive improvement in the quality of care we provide,” he said. That included cutting the number of beds it operates by a third and investing more in community mental health services.
A spokesman for NHS England said: “The NHS has made it clear that we expect all services to provide safe, high-quality care and meet our commitments in their contracts, regardless of whether they are NHS or run by an independent sector.”
