Mental health and learning disabilities services: the role of the independent sector
Key points
The independent sector is one of a number of valuable contributors within the health and care system. In mental health and learning disabilities services, they provide support for patients with some of the most complex needs.
Use of the independent sector by the NHS is dynamic and tailored to the needs of local people.
The NHS retains control and oversight for much of the work done.
Independent sector organisations are regulated by the same regulatory bodies as NHS organisations and are contractually required to meet the same standards.
The independent sector not only provides services, but also develops new ways of treating patients that lead to improvements in quality of care, safety and outcomes.
The independent sector has played a leading role in the development of new forms of good practice and improvement, many of which were co-produced with patients themselves, some of which we detail here.
Background
Independent sector providers of mental health care are commissioned by the NHS to provide free-at-the-point-of-use health services to the general population. They are a valuable addition to the health and care system, adding much-needed capacity and delivering a range of skilled services across the country. This includes inpatient care, outpatient therapy, community-based mental health support and specialist services, such as eating disorder treatment and substance use programmes.
As demand for services across the system has risen, independent sector providers have played an increasingly important role in helping the NHS to meet demand. Independent sector providers often provide the most specialist care to those who have the most complex needs. They are also leaders in innovation, improvement and the adoption of new technologies.
This briefing explores the role and importance of the independent sector in NHS mental health and learning disability service provision. It has been developed by the NHS Confederation’s Mental Health Network, which represents members from across the mental health system, including NHS, voluntary, community and social enterprise and independent sector organisations. We work with the Independent Healthcare Partners Network to support members, including through our independent sector providers forum.
How the independent sector operates within NHS mental health and learning disability services
Regulation and governance
Independent providers enter into contracts with NHS trusts, local authorities or integrated care boards (ICBs) to deliver specific services. These contracts can be for short-term projects or long-term service provision.
The commissioning process, where the NHS decides what services to contract out, is based on an assessment of the needs of local people and the best way of meeting those needs through finite resources.
Typically, independent providers will be used to provide additional capacity that the NHS cannot meet alone. They can also be used to expand coverage over geographical areas where services are lacking, as well as providing care for patients with the most complex needs.
In addition to its NHS-commissioned services, the independent sector has access to private sector capital which can play an important role when it comes to investment in estates and other capital needs, which is a challenge within the public sector.
Independent providers work collaboratively, and throughout the period that they are contracted to deliver services, they maintain close links with the NHS bodies that commission them. For example, when it comes to inpatient care, admissions are at the discretion of the NHS, which also has the agency to transfer or discharge patients from any facility they are commissioning.
NHS commissioners provide overall oversight for the delivery of commissioned services under the guidance of the NHS Standard Contract. NHS organisations will also regularly be in contact with independent providers to check on progress made by patients as part of their overall engagement with the health and care system.
All providers of NHS services, including NHS trusts and independent providers, are regulated by the Care Quality Commission (CQC). They must meet the same regulatory standards as NHS providers, to ensure the quality and safety of care, and they respond to investigations run by regulators and patient investigator organisations such as the Health Services Safety and Investigation Branch.
As with other services, the CQC carries out inspections of specific facilities or service functions and publishes reports. In CQC’s 2022/23 ratings data, the majority of NHS and independent mental core services were rated as good. However, where issues are identified, action is taken to ensure that improvements are made.
Staff are trained through the same systems, are expected to meet the same standards, and are regulated by the same professional bodies as NHS counterparts.
Under the NHS Standard Contract, the Patient Safety Incident Response Framework (PSIRF) and the Patient and Carer Race Equality Framework (PCREF) are both contractual requirements. This makes both frameworks mandatory for services under the contract, including acute, ambulance, mental health and community healthcare providers.
Independent providers in action
Independent providers are agile members of the system with investment and capacity for innovation and improvement of mental health services.
They invest in the health and social care workforce through training and apprenticeship schemes. They have also implemented digital innovations to improve patient safety, created new roles to support people to move back into the community, and helped reduce out-of-area placements.
Workforce training
Priory: Mental health nursing
Since 2021, Priory has enrolled 200 trainee nurses onto its pioneering nurse apprenticeship scheme, which sees up to 45 healthcare assistants sponsored each year to become registered mental health nurses, all while remaining in work without the burden of student debt. In total, Priory has invested £10 million into its wider Earn As You Learn apprenticeship programmes – with 35 different apprenticeships running currently – and has committed a further £4 million to in 2024.
The Priory also became the first independent mental health and social care provider to be awarded the National Preceptorship Interim Quality Mark by Health Education England (now NHS England Workforce, Training and Education) in recognition of the delivery of high-quality training programmes to its newly qualified nurses. The award means that new nurses at Priory can expect a high-quality preceptorship with specialist training and guidance in a supportive environment.
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Training resident doctors
Independent sector organisations have trained 4,000 resident doctors since 2020. to support the wider health and care system. The Independent Healthcare Providers Network (IHPN) formed an agreement in 2020 with NHS England, Health Education England and the Confederation of Postgraduate Schools of Surgery, to ensure the independent healthcare sector can play its part in training the next generation of medical professionals.
Cygnet Healthcare: Expert by Experience
Cygnet Healthcare has long championed and valued co-production across their services, using the voices, views and insight from service users to provide the very highest standards of care. In 2018, Cygnet became the first independent provider of healthcare services to invest in a full-time expert by experience lead. They now work with more than 300 experts by experience to help ensure the opinions of service users are heard and considered across the organisation and that feedback is actioned upon to improve our services.
Digital investment and innovation
Priory: Investing in digital
Priory has upgraded the connectivity of 100 of its 290 sites and, by the end of 2024, will have invested over £900,000 in Wi-Fi technology as well as £2 million in new systems including staff rostering, appointment booking and quality and risk management tools.
Priory also deployed electronic care records across adult social care services to improve quality and record-keeping. This allows colleagues in residential care, for example, to make care observations from a mobile device and verbally, giving a more comprehensive picture of a resident’s day. Priory has also now deployed live dashboards enhancing real-time data visibility and operational efficiency, as well as fully implementing e-prescribing across all healthcare services following an initial pilot which saw an average of eight patient details errors per month and 35 prescribing errors reduced to zero upon the introduction of e-prescribing.
St Andrew’s Healthcare: Safety and quality improvement data platform
St Andrew’s Healthcare created an integrated safety and quality improvement platform, that brings together all its internal data collection. This includes data on safe staffing, level of acuity, rates of observations and safety incidents, patient self-reported assessment and progress reports for both physical and mental health, delivery of therapeutic care interventions, patient-reported experience measures (PREMs), patient-reported outcome measures (PROMs) and clinician-rated outcome measures (CROMs). The safety framework ward dashboard has been used to support reductions in the use of seclusion and restraints.
Oxehealth: Oxevision
Oxehealth came out of Oxford University’s Institute of Biomedical Engineering. It has built Oxevision in collaboration with patients, nurses and doctors. Oxevision is a contactless patient monitoring platform for inpatient mental health. It helps clinicians to observe, intervene and plan patient care for improved safety, patient experience and quality of care.
A study in two acute purpose-built mental health hospitals showed a 44 per cent reduction in self-harm incidents in patient bedrooms compared to the control wards. A study in a dedicated older adult mental health hospital showed a 48 per cent reduction in falls at night in patient bedrooms and a 68 per cent reduction in transfers to A&E.
Feedback from patients across seven NHS England mental health trusts shows 81 per cent of patients felt safer and 87 per cent staff felt able to provide better care.
The organisation works closely with Oxford University and continues to undertake novel research and development.
Care closer to home
Priory has developed assessment and transition director roles, responsible for supporting autistic patients with complex needs from the point of admission to hospital through to their transition into a community setting. They work with the individuals, families, and Priory teams to plan the patient’s onward move, ensuring a smooth and successful transition and preventing placement breakdown. Since 2022, their work has resulted in 80 patients with complex autism being transitioned out of hospitals run by Priory, the NHS and other providers and into residential or supported living services to help them live more independently and in the right environment for them.
Priory: Bespoke therapeutic placements (BTPs)
Priory has developed a new model of care in its hospitals known as bespoke therapeutic placements (BTPs) to support people with complex autism who have challenging support needs. They are single occupancy, safe and secure environments, purpose-designed around an individual’s needs and preferences. Priory currently has 16 BTPs in the UK with the aim to reduce length of stay for autistic patients and provide them with the support they need to thrive in a community setting.
Cygnet Healthcare: Out-of-area placements
Independent sector providers also work with provider collaboratives, which bring together partners to shift the approach in commissioning mental health specialist services and transforming care pathways. For example, Cygnet Healthcare is part of the East Midlands IMPACT provider collaborative, which has reduced patients out of area from 20 per cent to 5 per cent in the past 12 months.
Moving forward
The NHS Confederation’s mental health network recognises the important role that independent providers play in working alongside the NHS to deliver mental health and learning disability services.
We will continue to work with our NHS and independent members, along with national bodies to develop and build these relationships to ensure patients receive the care and support they need.
To find out more about independent sector provision in the mental health and learning disabilities sectors, please contact MHN@nhsconfed.org
