Paying a dowry

Last week, the Equality and Human Rights Commission warned the Department of Health and Social Care it would launch a judicial review over the failure to implement the Transforming Care programme.

Rather than going straight to court, EHRC has asked the government to lay out a “timetabled” plan for how it plans achieve a major shift of care for people with learning disabilities from inpatient facilities to the community — on the understanding that, if this is not done within three months, it will be pressing ahead with legal action.

The move from the EHRC is significant, but whether it will result in any real solutions being found in the next three months is questionable.

Moreover, even a successful judicial review would only really deem the DHSC’s inaction incompatible with human rights law and send the government back to the drawing board, with no guarantees a fix for the current situation will be found.

The dowry solution

The most direct and likely response is to extend the use of dowries.

Dowries were essentially built within the programme to allow NHS funding to follow a patient when they are discharged from an inpatient unit into social care (the original idea was introduced in the 1980s when the government began closing long stay mental health hospitals).

Aside from being unfortunately named, dowries have so far failed to address the key problem they were designed to tackle — that Transforming Care does not incentivise local authorities to hold up their end of the deal.

First, they have been limited to patients who have been an inpatient for five years or more and discharged on or after April 2016, which ignores a large cohort of patients.

Second, the policy has hardly been policed, with very little standardisation imposed on local areas.

It is highly unlikely any response from the DHSC to the judicial review would lead to an expansion of dowries to all patients within assessment and treatment units, with more attention paid to areas where they are not being implemented.

Walking the walk

In related news, St Andrew’s Healthcare appears to be walking the walk following promises earlier this year to downsize and move care into the community.

After agreeing to sell a 64-bed hospital at its Nottinghamshire site to Nottinghamshire Healthcare Foundation Trust, the charity has said it will now be closing more than two-thirds of beds in a children and adolescent mental health unit at the same location.

This unit was rated “inadequate” in April 2019 and has been at the centre of a media storm over the care of a young girl with autism.

St Andrew’s newish chief executive Katie Fisher has called the current service model “wrong” and said it has led to an overstretched workforce.

While the movement away from inpatient services signals quite a step change for St Andrew’s, it is unlikely to lead to an immediate overhaul of the independent sector.

Nor would the NHS want it to — the rapid closing of all private units, without the supporting community infrastructure, would only lead to more patients being sent out of area.

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.