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

Capital and capacity

Stories about privately-run mental health units being rated “inadequate” are becoming a regular occurrence in HSJ.

The interesting issue with this week’s unit was that unlike most of the cases, the hospital was not a long-term unit for the most complex patients. Readers will note the Care Quality Commission’s concerns earlier this month that units where patients are more complex and stay longer are more likely to develop poor cultures and safety risks.

This unit, based in Manchester, however, was used only in the short term by NHS trusts when there were no NHS-run beds. The idea with this unit is that patients are admitted for a short time until a bed is found or until discharged into the community.

The CQC has rated this unit “inadequate” primarily due to concerns around the state of its facilities – dirty bathrooms with no running water, stained walls, and damp. It also said there were clear worries about the provider’s risk assessment processes – it appears patients were able to leave the unit without leave or permission on multiple occasions.

While the state of capital-starved NHS facilities has made headlines of late, not much attention has been given to the physical state of privately-run facilities. Presumably because capital for this sector should not be a public policy issue.

But beyond CQC inspections, who is checking this? There seems to be a responsibility on the commissioners, which in this case were various NHS trusts.

This story also brings up an issue which could bite in the not-too-distant future: poor privately-run units are increasingly being shut down – with good reason. However, NHS beds are currently not abundant, so where are patients going instead? Witness the “scandal” of long waits in accident and emergency caused by mental health capacity, as called out by Sir Hugh Taylor in recent days.

When six become one

It may have been on the cards for a little while but the six Nottingham and Nottinghamshire clinical commissioning groups have now announced they have received NHS England’s green light for full merger.

It is the latest of a spate of merger approvals to be confirmed over the last couple of weeks – apparently we are condemned to learn of them via a drip-feed rather than a good old list of decisions from the centre.

Nottingham and Notts has been edging closer to this over the last year as Amanda Sullivan was appointed joint chief officer in 2018, but, as she told HSJ, the official seal represents a “crucial piece of architecture” for the health system.

Ms Sullivan said she hoped the merger would increase system oversight and help join up out-of-hospital care.

Effectiveness will be crucial for this system, where the major acute trust Nottingham University Hospitals has been on black alert multiple times this year, following years of performance troubles.

However, it’s unclear how much focus on improving performance there can be with one of the main motives for merger being a speeding up of management cost reductions.