The leaked Southern Health review exposed a gap of knowledge about quality of care. Shaun Lintern asks whether the problem is limited to only one trust
NHS England has no way of knowing if the governance problems identified in the leaked draft report on Southern Health Foundation Trust are present in other mental health and learning disability providers.
There is also no way for regulators or ministers to know whether these apparent process failures, including those involving the trust’s board and leadership, had an impact on the actual quality of care patients received.
They just don’t know.
This is not a tenable situation – and it gives us a hint of what the most enduring impact of the Southern Health furore may prove to be for the wider sector. There is a risk that arguments about mortality rates and methodologies will become a distraction from these very real concerns that need to be addressed. Assurance over the quality of care for patients must be a top priority.
The leaked Mazars review described a lack of “effective systematic management and oversight” in the trust over the reporting of deaths and investigations, and criticised the trust board for failing to address concerns, including those of coroners.
It claimed that the trust investigated just 1 per cent of the deaths of patients with learning disabilities – a figure health secretary Jeremy Hunt described as “totally and utterly unacceptable”.
There can be no assurance that care quality was unaffected
The trust accepts its processes were not adequate and says it has made improvements. However, the Mazars review did not examine the actual quality of care patients received, and therefore there can be no assurance that care quality was unaffected.
Concern is mounting in senior circles that failures to investigate unexpected deaths may be more prevalent in the mental health and learning disability sector. By extension, the same gap of knowledge about quality of care for patients at Southern Health must remain for the wider NHS.
Southern Health has raised 300 objections to the Mazars review methodology and process and commissioned an academic to rebut the claims around mortality figures. A debate is now raging over whether the trust is the victim of a poor piece of work, a canary in the mine for systemic issues in the mental health and learning disability sectors, or a genuine outlier.
What is clear is that the post Mid Staffordshire era has seen a relentless focus in the acute sector on mortality rates, avoidable harm and never events data, which has not been present to the same extent in mental health and learning disabilities.
Speaking in the House of Commons this week, former health minister Norman Lamb raised the prospect of a public inquiry. Notably, Mr Hunt did not rule it out.
His legitimate concerns over the length of time such an investigation would take could potentially be addressed by instead using existing powers under Section 48 of the Health and Social Care Act 2008. This allows the Care Quality Commission to carry out a special investigation of a care provider looking at aspects of the provision of care over a specific period.
An investigation could determine what lessons can be learned for the wider NHS
This could determine whether there are genuine quality concerns at Southern Health, and more importantly what lessons can be learned for the wider NHS.
Such a move could give assurance to the wider system and provide confidence to the public and families that concerns are being addressed.
The problems at Southern Health are a signal for action.
The Mazars review, when it is eventually published in full, is only a first step.