Providers offered control of NHSE budgets worth billions

The organisation has set a new target for setting up “provider collaboratives” - which are expected to take on the responsibilities and budgets - across the whole of England by 2022, and in 75 per cent of areas by 2020.

They will have a lead provider which will coordinate services.

It will involve substantial input from private organisations which are major providers on inpatient mental health and learning disabilities beds.

NHS England launched the new care models programme for mental health in 2016, which delegated specialised commissioning budgets for child and adolescent mental health in-patient and adult secure services to 14 provider groups.

People familiar with the work have estimated the national commissioning budget affected to be worth around £2bn annually, although some involved so far have said NHSE has been very slow to release the money to local control.

A letter last week from new care models programme director Stephen Firn told chief executives of both NHS and independent sector providers: “This letter is to inform you of our intention to issue a call for applications from prospective provider collaboratives for children and adolescent mental health inpatient services, adult secure mental health services, and adult eating disorder services.

“It is our expectation that people with learning disabilities and/or autism are included in the population served by the provider collaborative. The ambition is for 75 per cent of the country to be covered by provider collaboratives by April 2020, increasing to 100 per cent in the subsequent two years.

“Provider collaboratives will assume full responsibility for the budget for their population, along with the freedom to innovate and develop new services, in line with national clinical and service standards and local ICP/STP plans. They will also assume much of the responsibility for some critical commissioning functions including contract management, quality assurance and workforce planning.”

The letter said prospective provider collaboratives should submit a “high level” application by the summer which will propose a lead provider for their group.

LD and autism included

The decision to include learning disability and autism in the projects - which have not so far been part of the collaboratives - comes after NHSE failed to hit its target to reduce the number of LD and autism inpatient beds by at least 35 per cent by March 2019. 

This target was mandated under the national transforming care programme, which also aimed to enhance community services. NHSE specialised commissioning is currently responsible for inpatient forensic and CAMHS learning disability services, while clinical commissioning groups commission community services and adult inpatient beds. Local government commissions care packages and home services.

It is not clear whether the providers will be delegated responsibility for locally held LD and autism budgets as well as NHSE’s specialised budgets.

A separate NHSE presentation seen by HSJ confirms it wants to begin implementing a new approach to transforming care by 2020-21. 

NHS England was approached for comment. 

Commenting on the plans, Barbara Keeley, Labour’s shadow Cabinet minister for mental health and social care, warned of the risks of giving private providers an expanded role. She said “We have seen too many examples of private providers cutting corners, and not giving service users the support that they need. There is a real danger that any greater involvement for private providers means that a focus on the person using services is lost.

“It is not acceptable for private hospitals to be involved in commissioning decisions for services for which they are bidding. Ministers must explain how they will avoid conflicts of interest in this new system.”