HSJ’s fortnightly briefing covering safety, quality, performance and finances in the mental health sector.

Do private institutions get an easier ride? This was a question asked of Paul Lelliot, the Care Quality Commission’s lead for mental health services, during a hearing of the human rights Parliamentary committee.

Dr Lelliot’s answer to the committee was: “Absolutely not.”

Indeed, there is no evidence suggesting CQC inspectors’ devote any different level of scrutiny to independent versus NHS mental health providers. 

However, the fallout from Whorlton Hall and numerous high-profile bad news stories stemming from the big four independent providers of inpatient mental health services – the Priory Group, Cygnet Healthcare, St Andrew’s Healthcare and Elysium Healthcare – have shone a light on how little this part of the sector is monitored and how little public information there is about their performance.

All private organisations providing NHS funded services are required to submit to the mental health services data set, as well as trusts, but this collection does not cover staffing levels – an important indicator of quality and safety.

It appears remarkably little is known by NHS England or local commissioners about whether independent providers of mental health services have adequate staffing levels and the skill mix used on their wards.

In the absence of any nationally-held data, HSJ asked the big four to share data on staffing levels for the last three financial years.

We asked them to provide, if possible, fill rates of registered nursing staff and health/care assistants, and ratios of locum staff. Providers were asked to share alternative data on staffing levels if these weren’t recorded.

St Andrew’s Healthcare has promised to release the stats by next Tuesday.

The Priory Group said it either met or exceeded its planned levels of care hours per day in 2018-19 for both nursing staff and healthcare assistants, but did not provide any other data or mention the other years.

Both Elysium and Cygnet declined to share their stats altogether. The latter, readers will be aware, received a critical CQC report just last week, which raised several serious concerns over staffing levels.

There’s not necessarily a cause for greater concern over the state of independent mental health services – a string of problems have come to light recently, but mental health trusts have also had their share of scandals.

But NHS organisations are legally obliged to publish regular board papers, which often contain information on staffing. In addition, they must regularly submit data on workforce to NHS Digital and NHS Improvement.

A look through recent CQC reports on the four providers mentioned above reveals high levels of locum staff is a repeated concern. Beyond these, we have no clear idea of the extent of agency staff use.

On this too, NHS trusts and FTs are heavily monitored – albeit for financial reasons rather than quality and safety.

Independent mental health providers, when delivering publicly funded services, should not be held to a lower standard of transparency.

Mental health in the long-term plan

NHS England has published its implementation framework for the long-term plan. For mental health – as elsewhere – relatively little new information was given; indeed, the guidance had even less detail than the LTP itself.

However, I hear there is more to come – let’s hope it offers some more detail.

For learning disability and autism services, one interesting point in the guidance was a statement about providing capital for “housing options and suitable accommodation”. If this comes to fruit, it could be a game changer for the transforming care programme, for which lack of housing has been a major setback.

A promise of this kind would presumably mean the NHS giving up its own capital allocations – which are currently extremely tight – for something not traditionally in its remit, however. It would be wise to be sceptical until we see delivery.

Mental Health Matters is written by HSJ’s mental health correspondent Rebecca Thomas. Tell her what you think, or suggest issues she could cover, by emailing her in confidence at rebecca.thomas@wilmingtonhealthcare.com or by sending a direct message on Twitter.