The must-read stories and debate in health policy and leadership.

Safe care in long stay units

A care quality theme of this year has been repeated and growing concern about mental health, learning disability and autism hospitals. 

There have been a number of terrible cases, the most high profile being Whorlton Hall, as highlighted by BBC’s Panorama in the spring. Often, though far from universally, the concerns seem to relate to independent providers.

We have covered much of this mounting concern, and lately have been analysing the Care Quality Commission’s interventions – called actions – on this.

In relation to “safe care and treatment” independent providers have indeed seen substantially more interventions than the NHS since 2017. These actions cover some of the big areas of concern, like ability to assure residents’ safety and protection, including staff supervision and training.

But it is far from a simple picture: The NHS provides many more beds in these categories, but the most complex and long-stay patients are often in private sector units – and these often have the biggest problems. And NHS providers have substantially more action notices for another regulation, “staffing”, which covers staff numbers, training and experience.

The theme appears to be – and the CQC’s new mental health lead seems to agree – that the high-complexity long-stay units, where vulnerable people often stay for many months, a long way from family or friends, with high potential for neglect, are where the issue is. These tend to be in the independent sector and, in turn, these providers more often have governance problems, especially with recruitment and oversight of staff.

This story will clearly go on, with more CQC attention due this week, and NHS England having suggested a move away from private sector dominance in these services, while kicking off an independent “taskforce”.

Campaign fodder

Queen’s Speech or Conservative party manifesto?

With the Brexit deadline, a minority government, and the looming prospect of a winter general election, it’s hard to say if any of the 26 bills proposed on Monday by her majesty, on behalf of Boris Johnson, will be anything more than campaign fodder.

Two of those bills concern the health service: a medicines and medical devices bill that would seek to loosen up regulation on trials and potentially see more professions prescribing; and a patient safety bill that would put the Health Service Safety Investigations Body on a statutory footing.

The former health secretary Jeremy Hunt is so concerned the latter will be lost in a general election he has asked other parties to include a similar commitment in their own manifestos (or could he be engaging in a little politicking himself?)

Other reforms proposed in the Queen’s Speech – to the Mental Health Act and to adult social care – have already been criticised for their vagueness. King’s Fund chief executive Richard Murray suggested that the government should stop pledging to fix social care without sharing a plan.

There was also a commitment to draw up a draft bill on legal change needed for the NHS long-term plan, as requested by NHS England.

Many in the health service will be unconvinced by the government’s commitment in the speech to “support and strengthen” workforce and resources, with it being unclear how this will come about, and immigration proposals also featuring in Monday’s agenda set to make the problem worse not better.