Published: 30/05/2002, Volume II2, No. 5807 Page 8 9

A mental health trust with one of the highest rates of bed occupancy in the UK has slashed its expenditure on the private sector and reinvested the money to fund NHS patient care.

South London and Maudsley trust took the step to reduce 'dependency on expensive privatesector placements'. The move helped ensure the trust balanced its budget in March, despite fears earlier in the financial year that it was facing a£4m-£5m deficit.

Earlier this month, the Commons health select committee's report examining NHS links with the private sector urged the government to look more closely at whether the private sector was offering genuine value for money.

It warned of a danger the NHS could become 'dependent' on the private sector through the controversial concordat.

South London and Maudsley trust chief executive Stuart Bell said: 'The pressure on our acute services is among the highest in the country. This is illustrated by rates of psychosis in parts of [our] area which are six times the national average.Historically, this has led to dependency on expensive privatesector placements. To address this, we have set out to release money spent outside the trust on privatesector placements for investment in local NHS services.'

The motivation was to 'improve the quality of care for patients', rather than financial, he said.

Trust figures in March showed occupancy of Lambeth's adult mental health beds was on average 148 per cent, in Southwark 136 per cent and 134 per cent in Lewisham over the previous year.

Many patients ended up at private medium-secure units in York and Manchester. The distance from family and friends in London was not aiding their recovery, a spokesperson added. 'We wanted to ensure there were no gaps in our services to make rehabilitation more effective.'

The trust has launched home treatment teams across Lambeth, Southwark, Lewisham and Croydon, increased acute inpatient beds and introduced a Lambeth early onset team.

A women's house is being set up in Lambeth to support people before they reach crisis point. And the trust is submitting planning applications for an 89-bed secure unit at Bethlem Royal Hospital and a 24-bed unit at Lambeth Hospital.

Chief executive of the Sainsbury centre for mental health Matt Muijen told HSJ that it was a picture reflected across the country.

'It really is a win-win situation now.Many trusts have faced similar problems and many are moving away from reliance on the private sector. The reasons are quite simple. In the past, there were perverse financial incentives for health authorities to send people away. That was bad for patients in their recovery.' He said primary care trusts now had control of the budgets and many would ensure services were delivered locally.

There would always be a role for the private sector in providing some services but the South London and Maudsley trust situation showed 'the danger of dependency on the private sector'.