Lots of notes for this because the English NHS is confusing. There are four separate NHS systems in the UK, one for Scotland, one for Wales, one for NI, and one for England. These are run by...
Lots of notes for this because the English NHS is confusing.
There are four separate NHS systems in the UK, one for Scotland, one for Wales, one for NI, and one for England. These are run by different governments, and they're not linked. This article talks about the NHS in England.
The relevant government department in England is the Department for Health and Social Care. This government department hands off most of the budget and responsibility to the "executive non-departmental public body" that runs the NHS, NHS England
NHS England take the budget from DoH&SC and they do a few things:
Commissioning is the process where service specifications and budgets are set, then competing providers put in tenders to bid to run those services and are awarded the contract. Provider organisations are usually, but not always, NHS organisations. NHS Gloucestershire commissions services for the county of Gloucestershire. Gloucestershire Hospitals NHS Foundation Trust provides physical health hospital services, and Gloucestershire Health and Care NHS Foundation Trust provides, er, community and hospital mental health services (and some other stuff). It's complex
Mental Health Services are split into roughly three groups: primary care, secondary care, and specialist commissioning. Primary care services would tend to be low level interventions such as short form talking therapy. Secondary services are commissioned by ICSs and cover most community MH care, but also most MH inpatient services. Specialist services are commissioned by NHS England.
One of the things coroners in England can do is produce a Report to Prevent Future Death. These public documents highlight a risk to people's lives and ask the relevant organisation to take action to prevent future death. (There are lots of problems with this system. The idea is good. The implementation is poor.)
Over the years there have been repeated scandals in services for people with mental illness and / or learning disability and / or autism. Some of the more well known scandals are Winterbourne View, Whortlton Hall, St Andrews, and there are others.
One provider of mental health service had higher than expected deaths by suicide of patients, and coroners were producing reports to prevent future death, and the providers and commissioners were not doing enough to prevent deaths from happening. So, there was an inquiry into services provided by that region. Because the inquiry had limited powers they found that staff were refusing to speak to them. The inquiry will now be a public inquiry, and will have powers to compel people to speak, but will also be able to provide protections to people who speak. The secretary of state for the DoH&SC has said that there will also be a national inquiry into safety of services.
The submitted article is talking about two problems:
There is not enough local provision of mental health service. This causes the NHS to send people to hospitals far away to get a bed. This out of county provision is carefully counted and it's seen as a bad thing. But also
Specialist commissioning (eg, inpatient eating disorder services) are often going to be out of county, and they're not counted in the out of county numbers because, er, reasons.
A lot of these services will be provided by non-NHS providers. One of the big ones is Priory Group. The quality of this provision is shocking. Really, genuinely awful conditions. Yet for some reason the NHS cannot sort it out and it's kind of mysterious even to people who work in patient safety.
Lots of notes for this because the English NHS is confusing.
There are four separate NHS systems in the UK, one for Scotland, one for Wales, one for NI, and one for England. These are run by different governments, and they're not linked. This article talks about the NHS in England.
The relevant government department in England is the Department for Health and Social Care. This government department hands off most of the budget and responsibility to the "executive non-departmental public body" that runs the NHS, NHS England
NHS England take the budget from DoH&SC and they do a few things:
Commissioning is the process where service specifications and budgets are set, then competing providers put in tenders to bid to run those services and are awarded the contract. Provider organisations are usually, but not always, NHS organisations. NHS Gloucestershire commissions services for the county of Gloucestershire. Gloucestershire Hospitals NHS Foundation Trust provides physical health hospital services, and Gloucestershire Health and Care NHS Foundation Trust provides, er, community and hospital mental health services (and some other stuff). It's complex
Mental Health Services are split into roughly three groups: primary care, secondary care, and specialist commissioning. Primary care services would tend to be low level interventions such as short form talking therapy. Secondary services are commissioned by ICSs and cover most community MH care, but also most MH inpatient services. Specialist services are commissioned by NHS England.
One of the things coroners in England can do is produce a Report to Prevent Future Death. These public documents highlight a risk to people's lives and ask the relevant organisation to take action to prevent future death. (There are lots of problems with this system. The idea is good. The implementation is poor.)
Over the years there have been repeated scandals in services for people with mental illness and / or learning disability and / or autism. Some of the more well known scandals are Winterbourne View, Whortlton Hall, St Andrews, and there are others.
One provider of mental health service had higher than expected deaths by suicide of patients, and coroners were producing reports to prevent future death, and the providers and commissioners were not doing enough to prevent deaths from happening. So, there was an inquiry into services provided by that region. Because the inquiry had limited powers they found that staff were refusing to speak to them. The inquiry will now be a public inquiry, and will have powers to compel people to speak, but will also be able to provide protections to people who speak. The secretary of state for the DoH&SC has said that there will also be a national inquiry into safety of services.
The submitted article is talking about two problems:
There is not enough local provision of mental health service. This causes the NHS to send people to hospitals far away to get a bed. This out of county provision is carefully counted and it's seen as a bad thing. But also
Specialist commissioning (eg, inpatient eating disorder services) are often going to be out of county, and they're not counted in the out of county numbers because, er, reasons.
A lot of these services will be provided by non-NHS providers. One of the big ones is Priory Group. The quality of this provision is shocking. Really, genuinely awful conditions. Yet for some reason the NHS cannot sort it out and it's kind of mysterious even to people who work in patient safety.
Thank you for sharing this. Absolutely tragic. Outsourcing to for-profit care orgs is a shitty way to approach the behavioral health epidemic.