Another inquest for a death in a private mental hospital – why do we even have private hospitals?

 

On 11th June 2019 Brooke Martin, who was 19, was found suspended from a ligature point in her bedroom at Chadwick Lodge Hospital run by Elysium Healthcare. She had diagnoses of Autism and Emotionally Unstable Personality Disorder and had been detained under s.3 of the Mental Health Act. The inquest ended on 1st July 2021.

The solicitor for her family stated that the inquest had revealed “stark failures in risk assessment, information sharing and observation setting in a mental health hospital dealing with an exceptionally vulnerable patient group.”

The inquest heard that only 5 days before her death she had tried to hang herself, but this incident was not properly recorded or communicated with staff and there was no risk assessment or review of her observations. Earlier that evening Brooke was twice found by staff to have something that could be used as a ligature which she had concealed under her duvet. No action was taken as a result of this that could have protected her.

Elysium Healthcare admitted that had they taken appropriate action, Brooke would not have died.

Elysium Healthcare was founded in 2016 and is owned by BC Capital. They bought up several mental health hospitals, mainly from the Priory Group and Partnerships in Care.

For the year ended 2019 Elysium reported a turnover of over £74 million. This came predominantly from either NHS England or Clinical Commissioning Groups – in other words, public money that would otherwise have been spent on services within the NHS.

A couple of weeks ago I reported on the death of Peggy Copeman, who died in a private ambulance on the hard shoulder of a motorway, while being transferred from the Cygnet Hospital in Taunton, another private hospital. She was allowed to leave the hospital despite her being “the most poorly patient on the ward”.

Another major provider of private mental health beds is Priory Healthcare.

In 2017 the Priory Roehampton was rated “inadequate” by the CQC, and there had been little improvement when it was inspected a few months later.

Priory Healthcare also owns St John’s House in Suffolk. This is a specialist unit providing a low and medium secure environment for men and women with learning disabilities. They are all detained under the Mental Health Act.

In December 2020 it was placed in special measures, after a CQC inspection saw CCTV footage showing "a patient being dragged across the floor... a patient being pushed over and the seclusion room door trapping a patient's arm and making contact with a patient's head when closed". On five occasions staff were asleep when they should have been completing patient observations. There was low staffing, with a heavy dependency on agency workers, poor record-keeping and 204 instances of physical restraint in a six-week period.

A subsequent inspection in April 2021 discovered that many issues causing concern “remained unchanged”.  They again found staff were asleep when they should have been observing patients, including all three members of staff assigned to one patient. The CQC said "Our latest inspection found the overall quality of care had not improved and many of the issues we previously raised remained unchanged."

You might think that private psychiatric hospitals would offer levels of care superior to NHS hospitals, since isn’t that what you would expect if you were paying for care and treatment? But frequently the reverse is the case.

A Guardian report from 5th July 2021 revealed that there were 23,447 NHS mental health beds in 2010-11 but only 17,610 in 2020-21, a reduction of 5,837 (25%). This is in spite of the fact that there has been a 21% increase in people involved with mental health services since 2016,  and an increase of 53% of people being detained under the Mental Health Act, 13,437 in March 2016 to 20,494 in March this year. This has inevitably led to a huge increase in people being admitted to out of area beds – this being a euphemism for “private hospitals”. These beds are frequently over 100 miles away.

In March 2021 alone the NHS spent £11.5 million on funding out of area placements.

These private placements can be enormously expensive. As Keir Harding, who has long been a champion of improving servicers for people with personality disorder, has pointed out, a locked rehabilitation unit claiming to be a specialist personality disorder unit will charge around £250,000 a year per patient.

For over 10 years, the Conservative Government has tampered with the NHS and services for people with mental health needs, weakening or destroying effective community based services, cutting funding to local authorities, who are responsible for social care, and forcing the increased use of private hospitals.

You can reduce the numbers of psychiatric hospital beds, or you can cut back on community services, but if you do both, it won’t save money, it will simply put pressure on other public services, such as A&E departments, the courts, and the police and ambulance services. Most importantly it creates misery for people who are denied the care and treatment they need, forcing them into avoidable and traumatising situations.

One example of this is the now discredited Serenity Integrated Mentoring (SIM) scheme, which many areas have been introducing (without any significant evidence of efficacy) as a means of managing people with emotionally unstable personality disorder who appear to be disproportionately coming to the attention of A&E, police and ambulance services. Rather than offering a therapeutic approach to dealing with their distress, the outcome is often to criminalise people and if anything to increase their distress.

Private, for profit, hospitals should have no place in the effective provision of mental health services. The only solution is reinstating proper funding for health and social care. The new Health and Social Care Secretary, Sajid Javid, has an opportunity to rectify this. As MarkTrewin recently said in Community Care:

"We have a new Secretary of State who has the opportunity to put right some of the mistakes of the past. Let’s have a social care reform plan before the end of this year that is creative and radical, that includes mental health, younger people and autism and that is designed with people who use services to genuinely improve the lives of all those people with mental health issues currently struggling within the system, and the hard-working professionals who work with them."