The must read stories and talking points from Tuesday

Third strike

In the last 10 days, HSJ has reported on highly critical CQC reports on three independently run mental health units for young people. All three had shared failings around staffing and management, leading to concerns about the safety of patients in their care. All three closed to new admissions – and one has closed indefinitely.

These units – run by Cygnet in Woking and Sheffield, and Huntercombe in Torquay – provided care to some of the most vulnerable young people in the country, often in psychiatric intensive care units and detained under the Mental Health Act. Some patients had eating disorders or were persistent self-harmers: even under close supervision, suicide attempts and self-harm continued. Most of the places were commissioned by NHS England – costing the taxpayer tens of thousands of pounds a week.

With the CQC expected to issue a report on CAMHS any day now, this rush of failing units raises questions about the model for providing care. Many tier four beds are run by private providers – but the issues around staffing are common across the NHS mental health sector as well.

The Cygnet and Huntercombe facilities were relatively small units – Watcombe Hall in Torquay had just 10 places – and isolation, both geographically and from peer support for staff, may have played a part in allowing some of the problems to persist.

NHS England has been adamant it worked with the providers to improve care. But many of the young people stayed in these units for a long time because there was no space for them in a more appropriate unit. These are delayed discharges that don’t get reported in official figures. Nor is much information on the units’ performance in the public domain – no public board meetings or CCGs poring over serious incident reports.

The development of better early interventions and community support may reduce the need for such units – and prevent young people being placed miles from family and friends. But, given the failings at Woking, eyebrows have been raised at the inclusion of Cygnet in one of the pioneering new care models CAMHS.

With limited tier four beds for these specialist cases, the NHS would struggle without these private providers.

Surgery theatrics

Does the NHS have hundreds of thousands of operations worth of unused capacity in its theatres?

Headline findings of an NHS Improvement study briefed out on Tuesday suggest the NHS could do an extra 280,000 elective operations a year if elective operating lists were better organised.

It’s an eyecatching claim, which won NHSI a lot of national media coverage. The final study isn’t ready for publication yet, so it could be a while before we can scrutinise it in detail.

However, sensible people are raising an eyebrow at the idea that all that theatre downtime can be used for more operations. The Royal College of Surgeons was quick to point out that the reason some operations begin late is that there isn’t capacity elsewhere in the hospital to transfer people out to after surgery. As ever, patient flow and delayed discharges hold much of the answer.

Nigel Edwards of the Nuffield Trust said the study looked like a valuable, detailed piece of work. But: “There is an important question about whether there would be enough capacity in other parts of the hospital, like intensive care, to do operations in this time.

“Cancellations will often reflect staff shortages or the impact of emergency care elsewhere.”

Meanwhile, NHS Providers’ head of analysis Phillippa Hentsch told us it wasn’t clear how NHSI have calculated if those extra operations went ahead “the NHS could have generated and £400m in additional income”.

We expect commissioners might have something to say about that, and look forward to the full report.