Ex-DH boss declares ‘scandal’ in mental healthcare

Sir Hugh Taylor is chair of Guy’s and St Thomas’ and King’s College Hospital foundation trusts, and was previously Department of Health permanent secretary.

At a GSTT board meeting he said the lack of inpatient mental health beds was driving up the number of “12-hour A&E breaches” – ie people waiting more than 12 hours to be admitted, after clinicians have decided to do so – across the country.

The two FTs have a combined turnover of £2.8bn and run three EDs across inner and outer south London.

Sir Hugh said the lack of mental health beds was behind the “growing problem of 12-hour A&E breaches which I know is an issue across the sector at the moment. It’s a national issue. It’s a scandal really.” He told the meeting last week that “a lot of work” was going into addressing the problem at GSTT.

GSTT chief operating officer Jon Findlay told the public board meeting: “It’s a real pressure. [It] has definitely ramped up, with some incredibly difficult cases. [There is a] really good psychiatric liaison team but accessing specialist mental health beds is the real problem.”

Chief nurse Dame Eileen Sills said the psychiatric liaison teams provided by South London and Maudsley Foundation Trust at the trust’s EDs were performing well, and that patients who came from outside the area had the longest ED stays.

The number of 12-hour breaches nationally increased from 123 in 2011-12 to 3,260 in 2018-19, and from 154 in September 2018 to 455 in September 2019.

Dame Eileen said the problem was worse at many other trusts because GSTT brought patients into its clinical decision unit as they approached the 12-hour wait, which was not an option for all.

Referring both to mental health patients’ long waits for beds, and other performance pressures at the trust, Sir Hugh said: “None of us feel comfortable with where we are at the moment. They are in most cases underlying issues and there are huge differences between supply and demand.”

The trust also had 128 patients who had been on an elective waiting list for more than a year as of the end of September, the meeting was told.

In June, NHS England and Improvement’s London region developed a “compact” between the capital’s mental health and acute providers, commissioners, police, ambulance trust and social care representatives, to try to ensure people in mental health crisis got “timely” access to a “health-based place of safety”.

A stipulation in the compact is that “admission should not be refused or delayed due to uncertainty or ambiguity as to which CCG is responsible for funding the care”.

Another rule is: “A decision to admit is recorded as the time the clinician/MHA decide the patient clinically requires a bed, and not the time at which a vacant bed has been found and the patient is awaiting transport.”

The compact was agreed by all London trust chief executives and clinical commissioning group accountable officers last month.

A spokeswoman for NHSE/I London said the work was a result of two years’ development, led by Oxleas Foundation Trust chief executive Matthew Trainer.

She said: “Summarising the collective ambition of all partners across London, it has been discussed, developed and accepted by numerous groups and organisations as a truly correlated document.”