Health CommitteeWritten evidence from the Huntercombe Group and Four Seasons Health Care (ETWP 91)

Key points covered in this submission by the Huntercombe Group:

The Huntercombe Group is one of Britain’s leading specialist independent healthcare providers and hosts accredited placements for trainee NHS clinical psychologists and trainee nurses. However, NHS medical deaneries have not routinely organised placements for trainee doctors (psychiatrists) with independent providers. Only NHS trusts have been approved to provide such psychiatrist training.

This status quo must change to reflect the contemporary NHS landscape for patients. NHS deaneries must be encouraged to recognise that independent providers not only have suitably-accredited consultant psychiatrists to supervise placements, but that such doctors lead clinical innovation in particular specialist fields. In the Huntercombe Group this includes brain injury rehabilitation, eating disorders and secure care for detained mental health and learning disability patients, including young people.

The status quo must also change in order to ensure (i) the provision of a flow of suitably-trained specialist psychiatrists for the benefit of NHS patients, and (ii) that NHS-trust employed psychiatrists (as well as independent-sector psychiatrists) gain vital knowledge and experience of specialised services offered by independent providers.

Working alongside Skills for Health and Skills for Care independent healthcare providers such as the Huntercombe Group are well-placed to advise on specialist mandatory training for healthcare support workers/healthcare assistants in specialised healthcare environments.

Part One

1. Introduction—The Huntercombe Group’s provision of specialist healthcare services for NHS patients

1.1 The Huntercombe Group is one of Britain’s leading independent specialist healthcare providers. The Group runs 60 care units and hospitals in England, and Scotland, offering a total of 1,658 beds.

The Huntercombe Group provides specialist services for NHS patients in the areas of (i) forensic learning disability and complex presentations of autism (ii) specialist child and adolescent services including eating disorders (iii) addictions, and (iv) acquired brain injury and rehabilitation. Such services meet the needs of patients where local NHS provision is unavailable.

1.2 The Huntercombe Group patients are, almost exclusively, NHS patients. The Huntercombe Group, part of Four Seasons Health Care, proudly sees itself as working in full partnership with the NHS.

1.3 The Huntercombe Group works with over 80 NHS primary care trusts, 50 local authorities and specialised commissioning groups in England, and health boards in Scotland, Wales and Ireland.

1.4 The Huntercombe Group employs over 3,000 clinical staff, including psychiatrists, clinical psychologists, nurses, speech therapists, occupational therapists, support workers and healthcare assistants.

Part Two

Independent healthcare providers must have a bigger role in specialist training for doctors (psychiatrists)

1.5 Leading specialist independent healthcare providers, such as the Huntercombe Group, already provide valuable NHS-accredited placements for trainee clinical psychologists and makes a substantial contribution nationally to the training of nurses through approved student placements. However, NHS medical deaneries have not historically offered post-graduate doctors (psychiatrists) clinical training placements with independent providers.

1.6 This is a particular anomaly when considering that (i) psychiatrists tend to be clinical leads of multi-disciplinary healthcare teams which include psychologists and nurses, and (ii) independent providers are leading clinical service innovation in particular specialist clinical fields. To provide just one example—46% of all care for detained NHS patients with a learning disability is now provided by the independent sector.1

1.7 This status quo on the training of psychiatrists needs to change because:

(i)Leading independent providers, such as the Huntercombe Group, now have over 40 experienced, suitably-qualified and accredited consultant psychiatrists to manage such clinical placements.

(ii)The NHS as whole needs to ensure that patients benefit from a steady flow of suitably-experienced consultant psychiatrists specialising in areas such as eating disorders and secure care for detained adults and young people. As highlighted above, the independent sector provides a significant proportion of such services to the NHS, and so has a wealth of expertise.

(iii)To ensure an ongoing productive partnership between the NHS and independent services, NHS psychiatrists need to gain experience of specialist independent-sector services. This will help patients move effectively between NHS-run and independent-run services. The independent sector should no longer be seen as running an “unknown” clinical service, especially considering again that its patients are almost entirely NHS patients.

1.8 To bring about this change, NHS medical deaneries should be levered to create more productive partnerships with independent providers.

1.9 The Huntercombe Group will, for its part, be proactive in securing partnerships with NHS medical deaneries, and to be proactive in offering approved specialist training placements for junior psychiatrists.

Part Three

The need for specialist training for support workers/healthcare assistants

1.10 We note that the Skills for Health and Skills for Care has been charged with producing minimum training standards for healthcare support workers and adult social care workers in England. This is with a view to establishing a voluntary register for healthcare support workers and adult social care workers in England. We entirely support this initiative, and welcome the opportunity to be involved in ongoing discussion with the Skills for Health and Skills for Care.

1.11 We note that the Health Secretary Andrew Lansley has said it is “absolutely critical” that employers take a leading role in supporting Skills for Health and Skills for Care in developing such standards to ensure they meet the needs of service and patients.

1.12 It is essential that the independent sector is engaged directly in providing such support. To this end, The Huntercombe Group, which employs over 2,000 support workers/healthcare assistant, will be stressing to the Skills for Health and Skills for Care that support workers/healthcare assistants for specialist, often highly-challenging, environments as outlined above should have appropriate specialist mandatory training to supplement their statutory mandatory training.

1.13 Examples of this type of supplemental training would include communication skills training for staff working with individuals with autism, behavioural management strategies for staff working with individuals with highly-challenging and outwardly aggressive behavior and specialist training in symptom management in child and adolescent services.

December 2011

1 The Mental Health Act Commission 13th Biennial Report 2007–09. (In 1998 15% of individuals with a learning disability were detained within independent hospitals. This had grown to 46% of individuals (545 of 1,184) in 2008)

Prepared 22nd May 2012