Question from twitter :
C Jane Haines @CJaneHaines
Struggling to find any data on the number of people who enter inpatient mh services on a voluntary basis, no crime committed, and end up in forensic services.
Where does one start looking for such statistics? Can’t imagine that any manually populated database would be able to cope with such a query.
CQC and the Quality Network for Forensic Mental Health Services at the Royal College of Psychiatry have been suggested. Anything better?
I would suggest the CCG. ( I have read Ms Haines’ terrible story behind her twitter posting and my situation with my 73 year old brother trapped in the mh system is similar.)
I raised a question last year at the Surrey Heartlands CCG AGM about the NHS funding of private hospitals. Surrey and Borders is the NHS Trust covering the whole of Surrey and other bits of the country… The Trust has 198 mental health short stay beds for adults . So there is extensive use of private beds where there is no limit to length of stay. Some of the private beds are in Surrey and some in other counties.
My question was :
“How are budgets shown for NHS Mental Hospital inpatients and private hospitals which are funded from NHS? Also, how many private hospitals are currently in use?”
The question wasn’t answered last year but this week the Surrey Heartlands CCG Head of Corporate Governance and Risk emailed me apologising for not giving me a response and to say she could send me information. I now have detailed information In particular, information about how private hospital placements are authorised and monitored by the CCG. The answer is that Surrey Heartlands CCG do NOT monitor at all or even have statistics. Although the CCG is given as being responsible for the funding of these contracts, The NHS gives money for these referrals, placements and monitoring directly to Surrey and Borders. This is what the CCG sent me by email on 22 September::
“At the present time we do not hold any direct contracts with Independent Mental Health Hospitals, as the access is managed via countywide approval process administered by Surrey and Borders NHS Trust. Out of Area placements are reviewed on a monthly basis with SABP to transfer back to facilities closer to home as soon as possible.”
I was already aware that Surrey and Borders make the referrals without involving the CCG…
A month ago I sent an FOI to Surrey and Borders asking about the contract with Oldercare (Haslemere) Ltd, who own St Magnus a private forensic mental hospital. I have received an acknowledgement from the SABP Information Governance but no reply yet.
As for how outcomes are measured, I don’t think they are.
Don’t CCGs only decide what services to commission or purchase? Isn’t it the Primary NHS Trust which manages patient medical records?
If anyone could produce aggregated data on this (for England) it would be NHS Digital They receive and collate data from the NHS Mental Health Minimum Dataset, in theory from all hospitals (whether NHS or private) which treat NHS patients
In principle, for every NHS funded mental health patient in England the dataset contains (amongst a lot of other things) a record of their Mental Health Act Status (eg informal, section 3, s37 hospital order) and changes to that status over time. It should also include data that shows whether they have moved from an open ward to a secure ward.
What the data quality is like, I don’t know (publications from the dataset tend to come with warnings about missing data). Nor do I know how practical it would be for NHS Digital to extract the numbers you want (it isn’t something they routinely publish), nor whether they would be prepared to try (either for free, or at a charge).
That said, I wonder what any such data would actually signify. In the absence of details about individual cases, progression from informal admission on an open ward to detention on a secure ward could just as easily be consistent with good care as rotten care.
Thanks very much for the link - though the Data Set seems to have really poor quality data on restricted patients - particularly after 2016.
CCG’s should have records of expenditure on adult acute and PICU placements, either by patient, or increasingly as delegated funding given top the Trust as part of the ‘new care models’, likely to be subsumed in to ICS’s.
However, currently NHS England Specialised Commissioning commission all low, medium and high secure beds, which would apply to any one in forensic care (though this will likely change with ‘new care models’ and advent of ICS’s). They should be able to tell whether in independent sector or NHS, and in area or out of area.
In my experience, robust commissioning of high costs beds in a proper integrated pathway with expenditure tracking by CCGs and Spec Com has rarely been done well, with may patients falling between the two. Hence the need for ‘NCM’ which puts ownership of the pathway with one organisation.