The long term care conundrum
The grim BBC Panorama investigation into the Winterbourne View hospital outside Bristol, and this month’s serious case review, carry chilling echoes of older scandals in NHS long-term care: Ely, Normansfield and others.
But Winterbourne View was a private hospital. Primary care trusts commissioned most of its 24 beds, often as “spot” purchases, for people detained under the 1983 Mental Health Act. The average weekly cost of a place at Winterbourne View, we now know, was £3,500.
Yes, £3,500. That’s getting on for £200,000 a year. The NHS spends a lot of money on so-called “placements”.
Health minister Anne Milton, finding “failure at every level”, has been quick to criticise commissioners for their lack of monitoring. Margaret Flynn, who wrote the review, accuses the owners of Winterbourne View of taking “financial reward without the responsibility”. Yet how, in a substantially privatised sector, can scattered commissioners genuinely ensure accountability?
Recent figures for mental health show that in 2010-11 the NHS commissioned 82 per cent of an estimated £6.55bn spent on adult mental healthcare in England, and 25.8 per cent of that spending went to non-statutory providers.
Investment in continuing care, secure and high dependency care and accommodation from non-statutory providers together amounted to over £1.1bn.
Remember, 2010-11 was before the demise of PCT provider arms prompted a major expansion of social enterprises.
Spending on older people’s mental health is lower (£2.85bn), but the proportion of care bought from non-statutory providers is higher: 42 per cent in 2010-11. The non-statutory share was only 28 per cent as recently as 2007-08. That’s not bad growth for recessionary times.
But then, this remains a growth sector. While the collapse of Southern Cross Healthcare grabbed the headlines, Laing and Buisson, expert analysts in this field, report the number of older or physically disabled people living in care homes continues to rise: 421,000 UK-wide in 2010-11.
Although public policy favours non-residential care, demand seems to be running in a different direction.
There’s big money in long-term care, across all care groups, and big risks. NHS commissioners can’t afford to fixate on acute hospitals.
Noel Plumridge is an independent consultant and former NHS finance director, firstname.lastname@example.org