Written evidence from Partnerships in
Care (COM 16)
1. PiC is the largest independent sector
provider of psychiatric beds in the United Kingdom with more than
1,200 beds in 23 hospitals, all purchased by the NHS. That purchasing,
usually through the offices of Specialist Commissioning Groups
or occasionally PCTs.
2. PiC welcomes the innovations in the Health
White Paper and particularly the changes in commissioning arrangements
that the liberation of the NHS will bring about. However, it is
imperative that the changes in the way that the NHS operate and
care is delivered, truly reflect the needs of the patients and
are not mere rhetoric.
3. Currently, commissioning in specialist
mental healthcare is based primarily on process rather than quality
and does not reflect individual patient need. NHS commissioners
continue to favour NHS providers rather than accept a wider market
for healthcare that has, in truth, existed for some years.
4. On occasions, NHS patients are removed
by commissioners from high quality independent sector beds and
placed in more expensive NHS services on the basis of negotiated
block contracts. Such arrangements do not reflect a true market
for healthcare.
5. PiC would urge the Select Committee to
consider the following points when coming to their decisions and
recommendations:
(a) The Any Willing Provider model of commissioning
reinvented yet again in the Health White Paper must be allowed
to be a principle driver for quality and outcomes. The AWP model
must include on the same basis all providers, be they independent
or NHS.
(b) Service costs must be whole and not hide
pension, training and capital costs. All commissioning must be
on the basis of an equitable "level playing field".
(c) Consideration should be given to the appetite
of GP consortia to commission services with less tangible outcomes
such as low secure and step down psychiatry. Consideration should
be given to the use of third party specialist commissioners for
in-patient psychiatry or, alternatively, such commissioning remains
with the NHS Commissioning Board.
(d) Consideration should be given to allowing
the new commissioning arrangements to commission the whole patient
care pathway at a fixed rate. Current changes of commissioning
along the pathway are clumsy and significantly disadvantage the
patient.
(e) The new commissioning arrangements must not
be allowed to favour the NHS above other providers. If block contracts
are to be let, they should be released to all willing providers.
(f) In secure mental healthcare, cognizance must
be paid by commissioners to a vibrant and effective independent
sector that already provides 40% of all secure beds. The engagements
of the independent sector in strategic planning is essential if
limited resources are to be used effectively.
(g) Regionalised outposts of the NHS Commissioning
Board must principally represent the centre and not be allowed
to set local contracts with local tariffs and quality standards.
The new commissioning landscape gives the opportunity for efficiency
and consistency in outcome measures across the whole of the United
Kingdom.
(h) It should no longer be assumed that for specialist
services local is necessarily best. The needs of the individual
patients must be considered and commissioning decisions based
primarily on outcomes and quality. There is a real risk that with
as many as 500 GP consortia, the opportunities for developing
national centres of excellence will be lost.
(i) We believe that the "choice agenda"
can be applied to secure psychiatry offering services to detain
patients. PiC will be happy to engage in detailed discussions
with your Committee on regards to choice.
(j) There is a body of research that suggests
that in forensic psychiatry, hospitalisation significantly reduces
long term risks and reoffending. PiC would welcome the opportunity
to enter the debate that might lead to commissioning for outcomes
that include reduced offending as well as health gain.
October 2010
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