New evidence of the extent of the privatisation of mental healthcare in England is extremely concerning. Ministers and health bosses must explain why the independent sector is earning almost £2bn a year for treating patients with psychiatric conditions – or 13.5% of NHS England’s entire mental health budget. Overall, about 7% of spending is on private providers, although this rose during the pandemic. It is difficult to think of a good reason why the proportion of mentally unwell people treated by private providers should be so much higher than the proportion of those with other conditions.
If patient safety and care quality were the only considerations, extremely vulnerable mental health patients would seem to be among the least suitable candidates for outsourcing. After all, the general rule is that while standardised treatments such as cataract operations can be delivered via the independent sector relatively straightforwardly, more complex and long-term work is kept in-house. Why inpatient psychiatric care for under-18s should defy this rule, with 55% of all NHS-funded treatment delivered privately, is a troubling question for anyone who cares about the future of healthcare.
The short answer, of course, is that the NHS does not have the resources or the staff to do this work itself. This leaves doctors and managers with no choice, as one psychiatrist described at the weekend. Years of underinvestment in the health service have hit the mental health sector hard. Currently, there are 10,123 private mental health beds in England (the NHS has 17,610) and private mental health providers earn 91% of their income from the NHS. But psychiatrists, the Care Quality Commission and NHS England’s national mental health director, Claire Murdoch, have all raised concerns about the quality of the care on offer. In 2019, the Priory group was fined £300,000 over failings that led to the death of a 14-year-old girl, Amy El-Keria. Last week, an inquest jury found that neglect contributed to the death of Matthew Caseby in another Priory facility.
But there needs to be a longer answer too – one that addresses the underlying question of why, with average profit margins of 15%-20%, it has been made so easy to make money out of acute psychological distress. Also, whether the health and care bill that is on its way through parliament will lead to improvements or to further fragmentation, as the British Medical Association has warned that it could. Comparisons of the patient safety records of public and private providers are made difficult by a lack of data. Recent evidence has revealed grave failings in NHS hospitals too. But one doesn’t have to pretend that all is well in the public sector to reject as shameful the situation whereby businesses are enabled to make huge profits from delivering substandard care with weak oversight and minimal accountability. Patients and their families deserve better.
