Volume 1

The regulation of private and other independent healthcare : fifth report / Health Committee.

  • Great Britain. Parliament. House of Commons. Health Committee.
Date:
1999
Catalogue details

Licence: Open Government Licence

Credit: The regulation of private and other independent healthcare : fifth report / Health Committee. Source: Wellcome Collection.

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    Planning in the context of local NHS provision 67. One structural problem we encountered was the fact that many mentally ill patients were treated in hospitals remote from their homes. Not only does this make maintaining contact with friends and relatives difficult it also hampers the development of the Care Programme Approach (CPA) by creating physical obstacles to the involvement of local authority and other agencies who ought to be involved in the programme.'”” The General Health Care Group (Partnerships in Care) told us that the CPA was adopted fairly early on by the independent sector and that, in the event of difficulties in developing CPA, their hospitals were advised to work with the Mental Health Act Commission (MHAC) which they had found to be very helpful in assisting liaison with the local referring team. Dr Tim Jerram, representing the MHAC, told us “there are enormous problems not only for the independent sector but for the secure units generally liaising with home authorities. They are often quite distant. I have to say that they are often quite reluctant to take on these responsibilities”. '*' 68. The IHA argued that the absence of formal requirements on the part of the NHS to include the independent sector in the planning, development and provision of mental health service was a cause of concern to providers.'” St Andrew's Hospital, the UK’s largest independent psychiatric hospital, also complained about a lack of co-ordinated provision.'”> We therefore sought to establish the extent to which the independent psychiatric hospitals are seeking to respond to unmet needs, the extent to which they are viewed as part of a comprehensive mental health service and the extent to which they may hamper the development of NHS services. 69. The IHA suggested it was wrong to depict the independent mental health sector as being in competition with the NHS. The independent sector aimed “to provide mental health services, some of them greatly needed and not adequately provided within the NHS”.'** For St Andrew’s Hospital, Dr Michael Harris considered that, far from his hospital damaging the development of NHS mental health provision, the NHS, had effectively opted out of certain services. In his view it had chosen “to close hospitals, [and] not to provide certain facilities”. He believed that the independent sector had taken up the challenge to provide some of these services.'”” This view has, however, been questioned by some within the NHS.'° 70. Ms Quest of the IHA told us there was scope for greater co-operation. She argued that common planning projects, either through workforce planning, education consortia, or health authority planning forums, would yield dividends. Ms Margaret Cudmore from Westminster Health Care agreed: “when there is good dialogue on planning, a better balance [can] be achieved where services are required to be local’”’.'*” She gave an example of her organization working with a health authority over a five year period to provide the level of investment required to provide a local NHS child and adolescent service. As part of this exercise a reduction in the intake of a private in-patient unit was planned.'”* 71. Notwithstanding these instances, we remain of the opinion that private providers have an obvious financial incentive to compete with state services. We are particularly anxious that local provision is available to meet the needs of the mentally ill. We think it important, given the reliance of the state on the independent sector in the provision of mental health services, that an approach is taken to planning that takes account of both state and private provision. One obvious 1 QQ424, 429. CPA was introduced in 1991 to provide a framework for effective mental health care. Its essential elements are: systematic arrangements for assessing the health and social needs of people accepted into specialist mental health services; the formation of a care plan tailored to those needs; the appointment of a key worker to keep in close touch with the service user and to monitor and co-ordinate care; and regular reviews of the care plan. 21 468. er gts. 23 Q448. 24 Ibid. 125 Q446; see also Ev., pp194-195. 26 Q443. 127 Q442. 128 Q447.