Questions for AMs about mental health care

Another private care company has gone into administration.

Unlike the problems at Southern Cross, the problems at St Luke’s are much less well known attracting, as far as I can tell, no coverage in the Western Mail and only one paragraph in UK newspapers. The story is no less interesting for all that.

St Luke’s operate five centres in south Wales, all on the same site in Ebbw Vale, providing low-secure hospitals and residential care for up to 36 adults and adolescents with learning disabilities, autistic spectrum disorders, mental illness and brain injuries.

Don’t be fooled by the quasi-religious name – St Luke’s is actually operated by the rather less spiritual-sounding MILD Professional Homes Ltd, a company owned by four doctors, almost all of whom also own a string of other healthcare companies (one, a Dr JA Tweedie, is particularly prolific with directorships in 39 other companies).   MILD had pre-tax profits of £2.75 million in the year ending 2010, which on a turnover of £22 million is a healthy return. (As an aside, with 400 employees, each member of staff contributed £55,000 to the company’s profits – doubtless considerably more than their earnings).

Health Inspectorate Wales’s latest report on St Luke’s in Ebbw Vale is less good.  Even allowing for the emphasis in inspectors’ reports on process,  the ‘significant regulatory breaches’ found in an unannounced visit in 2010 are cause for concern. The breaches ranged from inadequately trained staff and lack of management supervision and leadership, to patients not being advised of their rights to withdraw consent to treatment and much more. In fairness to St Luke’s, it appears that they responded to HIW’s requirement that immediate action be taken, as most issues had been addressed by the time of a follow-up inspection.

That St Luke’s is now in administration should be a wake-up call to the Welsh Government. The Government might like to pride itself on healthcare in Wales being operated by the public sector, with there being no place for the market, but private sector health care is alive and well in independent hospitals across Wales.

In mental health alone, HIW’s website lists 22 different independent hospitals operated by 11 different companies (listed below).  Whilst the number of patients cared for in these settings is very small compared with the thousands treated by the NHS, they are very vulnerable and, as St Luke’s shows us, often highly profitable too.  Add to this the private healthcare acute services and clinics and the private sector is far from absent in Wales.  (These hospitals are in addition to social care, which is almost entirely private sector provided).

I have no doubt that the services provided by many of the private sector providers are excellent, offering specialist and personalized treatment and care that for some reason the NHS doesn’t seem able to provide.  But there is something deeply distasteful about making a profit from the needs of people with complex and serious illnesses, with the uncertainty about what happens when a company goes bust being an added issue.

Quite why the private sector has thrived in this niche of the health service, despite the commitment of Ministers, is far from clear. There are some important questions to be asked:

• How much does the Welsh NHS spend on commissioning specialist health care from private providers?
• What assessments are made of the financial risks to the Welsh NHS and patients of purchasing care from private providers?
• What arrangements are in place to secure the well-being of patients in the event of a private provider going out of business?
• Given the commitment to a public sector run NHS what steps are being taken to reduce commissioning of mental health services from the private sector?

List of Independent Mental Health Care Providers and Establishments in Wales

Acorn Care Ltd: Phoenix House, Welshpool

CAIS Ltd: Hafan Wen, Wrexham

Cambrian Healthcare Ltd: Delfryn House, Mold; St Teilo House, Rhymney;

Coed Du Hall Ltd: Coed Du Hall, nr Mold

Craegmoor Hospitals (& subsidiary Parkcare Homes): Caerlan House, Llantristant; Cefn Carnau Uchaf, Caerphilly; New House Farm, Cardiff; Ty Gwyn Hall; Tyn y Coed Hospital, Creigiau Nr Cardiff.

ISHealthcare: Llandbedr Court, Newport; Pinetree Court, Cardiff;

Ludlow Street Healthcare: Heatherwood Court, Pontypridd

MHC Ltd (a subsidiary of Castlebeck Ltd): New Hall, Wrexham; Plas Coch, St Asaph; St David’s, Corwen

Partnerships in Care: Llanarth Court, Abergavenny and Aderyn, Pontypool

Pastoral Care (Cymru) Ltd: Ty Catrin, Cardiff; Ty Cwm Rhondda, Ystrad;

Rushcliffe Group: Rushcliffe Independent Hospitals, Aberavon

 

Victoria Winckler is Director of the Bevan Foundation