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

Marching orders

The government has long departed from the Health Act 2012 in spirit; now it appears it has also broken it in fact.

According to Andrew Lansley’s infamous legislation, the government’s mandate for the NHS must be laid before Parliament “before the start of each financial year”. It must specify “the objectives [NHS England] should seek to achieve in the exercise of its functions during that financial year”, as well as its funding for the year.

It is effectively meant to give the NHS its marching orders, and the money to fund it to meet them.

Yet this vital document has not yet been published.

Remarkably – while Parliament is now taking a holiday – the NHS so far seems to be carrying on as normal, 17 days into the new financial year (though presumably getting a bit nervous about the Easter bank holidays).

As to what has caused the hold up, we don’t quite know, but safe to assume it’s probably a deadly cocktail of Brexit, the health and social care secretary having the Conservative leadership on his mind, and tussles between NHS England and government over delivery requirements and funding matters.

Daily Insight also doesn’t know if there’s any Parliamentary or legal comeback for being late with the mandate, but hopes it involves a withering put-down from the increasingly legendary Commons speaker John Bercow.

Tragically wrong

It’s inconceivable the NHS would outsource nearly half the care of children and young people with life-threatening physical illnesses to the private sector. Yet that is what happens with young people requiring inpatient care for mental health issues.

A lot of the time that works well, with private providers arguing they have helped numerous young people to recover. But sometimes it goes tragically wrong – as in the case of 14-year-old Amy El-Keria, who died three months after she was sent to Ticehurst House, part of the Priory Group.

A 2016 inquest found her death may have been prevented. A Health and Safety Executive investigation found issues with risk assessment and control measures around ligature points. Amy was able to hang herself in a locked room.

The Priory seemed in line for a hefty fine, with a prosecutor suggesting a starting point of £2.4m after the provider indicated its intention to plead guilty. But, after arguing the failings it was being sentenced for were not the direct cause of Amy’s death, it was fined £300,000.

The Priory argues lessons have been learned and that steps have been taken since Amy’s death in 2012. But, not surprisingly, there are now calls for NHSE to review its commissioning of child and adolescent mental health services beds. Charity Inquest has called for an “urgent review” of whether these services should be commissioned from the Priory and is meeting with health minister Jackie Doyle-Price.

But NHSE is in a cleft stick. There are too few NHS facilities (which are not immune to the sort of failings seen in the private sector) to accommodate CAMHS patients. As it is short of capital to build more, it’s likely to continue pressing private providers to improve but has few options if they don’t.