Research by the BMA’s Doctor (3) magazine found NHS mental health rehabilitation wards have all but disappeared from 18 Clinical Commissioning Groups and NHS trusts (4) in England, leaving five million people in those areas reliant entirely on out-of-area private sector provision.
This is a costly option and of the 176 CCGs which responded, only 78 could provide spending figures for the past three years.
These showed a £21m increased spend on the private sector between 2016/17 and 2018 but an increase of just £2m for NHS providers.
Mental health rehabilitation which provides intensive support for severely ill patients to help get their lives back on track, costs the NHS £535m a year. Stays last months or years before people are settled back home and are known to last twice as long in the private sector (5) as in the NHS. Private firms were also shown to have become highly dependent on NHS outsourcing in mental health services and have increased their take of the NHS rehab budget year-on-year (from 54 per cent in 2016/17 to 57 per cent in 2017/18) as the NHS continues to cut beds.
Whilst many trusts and CCGs are spending most of their budget on private providers of this type of care, some are spending all of their budget. Over the last three years these include:
• NHS Sandwell and West Birmingham CCG at a cost of £ 20.26m
• NHS Walsall CCG at a cost of £12.5m
• NHS East Lancashire CCG at a cost of £12.44m
• NHS Blackburn with Darwen CCG at a cost of £11.08m
• NHS Greater Preston CCG at a cost of £10.26m
Commenting on the findings, the BMA lead for mental health, psychiatrist, Dr Andrew Molodynski, said:
“This practice goes against the very nature of rehabilitation which should be a transitional process, helping to reintegrate a patient back into society.
“As seen in the cases of Whorlton Hall and Winterbourne, the ‘cut-off’ nature of these institutions can be a breeding ground for the development of harsh and abusive cultures. This has no place in modern mental healthcare.”
“As well as the debilitating impact on the patient, the eye-watering sums being spent on out-of-area private providers is a clear sign that the Government must get a grip on this worrying practice. There are no positives here for patients, families, care services, or the public purse- quite the opposite. We need to ensure that care is available closer to home to give patients the best possible chance of recovery and reintegration.”
The Royal College of Psychiatrists said the data showed the NHS was failing high numbers of vulnerable patients in need of rehabilitation.
Dr Raj Mohan, Chair of the Rehabilitation and Social Psychiatry Faculty, Royal College of Psychiatrists said:
"The data is extremely concerning. The high numbers of people with longer term serious mental illness being sent out of area for treatment shows that we are failing those who need rehabilitation care.
"When mental health rehabilitation services are offered at the right time and in the right place, they can make an enormous difference to the lives of people live with the most complex and serious forms of mental illness. In many areas without rehabilitation resources, out of area care has now become the default position and CQC highlighted this in 2018. There is a huge human and financial cost to sending someone out of area. Each out of area placement is a vulnerable person sent away from their family, friends, and the places they know, and makes it harder for them to access the services they need when they are ready to live in the community again.
"Our #InSightInMind campaign is calling for an end to out of area placements, and investment in the local rehabilitation services that people with severe mental illness need.”
Paul Farmer, Chief Executive of Mind, said:
“Rehabilitation services play a vital role in helping people to return to living more independently in their communities. They help people get out of cycles of repeat A&E visits and acute inpatient admissions – which is better for them and for the health service. We know good care is possible and that there are places where people are having their needs met in appropriate settings. This should be the case everywhere.
"The lack of NHS rehabilitation services in some areas is further evidence of the need for significant investment to improve the state of the buildings where people receive care – so that wards provide safe, therapeutic environments for people.
"The NHS has rightly committed to improve mental health services and this must include ensuring that people can get the treatment they need, when they need it and close to home.”
Notes to editors:
1. The spending on private out of area beds by the 78 NHS organisations which gave financial data to the BMA’s investigation, has increased by £21m (£165,022,000 - £186,324,000) since 2016, whereas spending on NHS rehab beds increased by just £2m (£139,422,000 - £141,594,000).
2. The investigation found that the NHS put 700 patients in ‘locked rehab’ last year. The overwhelming majority are provided by private hospitals.
3. Link to the Doctor research can be found here. Using FOI data, The Doctor calculated travelling distances from a list of more than 2,600 rehab ‘out of area’ beds commissioned by the NHS over the past three years (2016/17 to 2018/19). Of those that responded, 140 beds were more than a seven-hour round trip away while a large number of patients sent on hundreds of miles round-trips to rehabilitation centres, including:
An overwhelming number of trusts and CCGs are spending the majority of their NHS budget on private providers with some spending 100 per cent including:
Mental health services
3. The areas were at least 90 per cent of spending is on private mental health wards: NHS Greater Preston CCG; NHS Sandwell And West Birmingham CCG; NHS Chorley And South Ribble CCG; NHS Blackburn With Darwen CCG; NHS East Lancashire CCG; NHS Walsall CCG; NHS St Helens CCG; NHS Barnet CCG; NHS Knowsley CCG; NHS Medway CCG; NHS Luton CCG; NHS Swale CCG; NHS Trafford CCG; NHS Dartford, Gravesham And Swanley CCG; NHS Bath And North East Somerset CCG; NHS Sutton CCG; NHS Herefordshire CCG; NHS South Sefton CCG.
4. The investigation found that the NHS put 700 patients in ‘locked rehab’ last year. The overwhelming majority are provided by private hospitals.
5. Read the CQC investigation