People with severe mental ill health are being routinely ‘warehoused’ in locked private wards hundreds of miles from homes for want of NHS care close to home, an investigation reveals.
Research by The Doctor magazine has found that five million people live in clinical commissioning group (CCG) areas in England with no NHS wards at all for mental health rehabilitation, a service that helps people with severe illness get their lives back on track.
While some CCGs pay for such beds in the NHS, most depend heavily on private hospitals and care homes – and increasingly so, data released under Freedom of Information laws reveal.
Hundreds of private beds are hours and hours away from patients’ homes, analysis of 2,600 journeys found. Seven hundred are sold to CCGs as ‘locked rehab’, a type not recognised in NHS guidance – raising concerns about patient care and human rights.
Stays on private wards last twice as long as in the NHS, doubling the expense, the pain of separation from families, and frustrating efforts by local staff to bring people back home.
Consultant psychiatrist Andrew Molodynski, mental health policy lead for the BMA consultants committee, said: "Out-of-area placements in rehabilitation wards have become endemic in the NHS.
"Warehousing unwell people in locked wards far from home goes against the very nature of mental health rehab – to help them reintegrate back into society."
The road to independence
The British Medical Association say that mental health rehabilitation is supposed to help people regain independence. It unpicks and treats the mesh of social and health issues, which can arise with serious illness, trapping some in cycles of short stays on acute wards, where they’re only patched up.
It takes time. Stays last six months to a year, sometimes longer. Patients often start in ‘high-intensity’ wards. Most are detained under the Mental Health Act to keep them safe.
As they improve, they’re ‘stepped down’ to less secure units, before being settled back home by community teams, working closely with staff on the wards. Most return to supported accommodation.
This pattern of treatment or ‘care pathway’ has, however, become badly fractured in parts of England where permanent NHS mental health rehabilitation wards are closed and replaced by private beds far from home.
Many of these private placements are arranged ad hoc by CCGs, as ‘spot purchases’. This use of spot-purchased beds – especially in areas with no services of their own – raises an obvious concern: who checks on the care of these patients when they’re away?
Private beds cost twice as much as in the NHS
An extensive study of mental health rehabilitation by the Care Quality Commission (CQC) last year found that stays in private beds cost twice as much as in the NHS because they last twice as long. It found the annual cost of rehab was £535m and that private beds were on average 30 miles away from patients’ homes but just nine miles away in the NHS.
The NHS has taken steps since the CQC report. NHS Improvement launched a ‘Getting It Right First Time’ programme for mental health rehab last year, led by respected London consultant psychiatrist Sridevi Kalidindi. It helps trusts in England to improve.
‘This is an enormous, long overdue opportunity to upgrade rehabilitation services nationally,’ she says.
For its part, the CQC tweaked inspections. It now checks that the right staff with the rights skills are on wards and that they’re geared towards helping people leave; not acting as expensive hotels.
The investigation, however, points to a worsening picture for mental health rehab across England as parts of the NHS try to improve.