The decision by the UK Ministry of Defence (MoD) to move its inpatient mental health contract from the independent sector into the NHS could both improve care for other patients and act as a welcome boost to the NHS in the difficult times ahead. The issues are discussed in a Comment published Online First (www.thelancet.com) and in an upcoming Lancet, written by Dr Martin Deahl, South Staffordshire and Shropshire NHS Foundation Trust, Stafford, UK.
Every year, between 200 and 300 service personnel require inpatient admission. The last military psychiatric unit for inpatients closed in 2003; thereafter, until January, 2009, patients were admitted into the independent sector. "Although value for money was an important consideration, the new contract was awarded after a rigorous inspection of all potential providers, mainly on criteria of quality and accessibility. The successful NHS bid was not the cheapest, and the recent decision of the US Armed Forces (Europe) to participate and admit their personnel into NHS acute psychiatric units is a further affirmation of quality.
Between January, 2009, and June, 2010, more than 360 service personnel from all three armed services have been admitted into NHS psychiatric wards alongside civilians. Admissions are typically brief (less than 10 days) with an expectation of recovery and return to duty. No profit is being made, public money remains in the public sector, and any surpluses are reinvested for the benefit of all service-users, military and NHS. Deahl says: "Patients' and the MoD's satisfaction are both positive, and the success of the partnership is exceeding expectation."
Deahl believes this contract sends a powerful signal that "private" no longer means "best", and acknowledges that the best inpatient facilities in the NHS are as good as, indeed better, than those within the independent sector. He adds that standards will be driven up by the reputational risk to both sides, adding: "Complaints by service personnel have the unique potential to seize media attention and generate publicity, unmatched by even the most heinous of untoward incidents that befall users of the NHS."
South Staffordshire and Shropshire NHS Foundation Trust has now formed and leads a collaboration of health trusts to deliver the contract nationwide and share best practice. Deahl is happy that the direct exposure of mental health professionals in the NHS to military personnel raises awareness of service-related issues. He says: "It also sensitises the NHS to the military ethos and culture, which not only benefits the service community but also provides a potential platform for the provision of care to service veterans, who routinely claim that the NHS is neither equipped nor understands their particular needs... Perhaps most importantly, the presence of service personnel on our wards itself reduces stigma."
He concludes: "The MoD contract is an affirmation of the improvement that has taken place in standards of mental health inpatient care in recent years. The NHS and MoD have embarked on a journey which might yet bring further unintended benefits... Harnessing public money currently spent in the independent sector and directing it to the NHS both makes economic sense and is morally just. Most importantly, if other uniformed services (many of whom also happen to be service veterans), as well as other public servants follow suit (who currently often use the private sector), this will boost public confidence about the quality of service provision in the NHS and do much to combat the stigma and fear traditionally associated with public-sector mental health services."
Dr Martin Deahl, South Staffordshire and Shropshire NHS Foundation Trust, Stafford, UK. T) +44 (0) 780-256-9700 E) martindeahl@doctors.org.uk
For full Comment, see: http://press.thelancet.com/nhsarmed.pdf
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Journal
The Lancet