The NHS, the private sector, and the virtual asylum

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7375.1300/b (Published 30 November 2002) Cite this as: BMJ 2002;325:1300

Editorial was destructive

  1. Philip A Sugarman, medical director (psugarman@standrew.co.uk),
  2. Lorna Duggan, consultant forensic psychiatrist in developmental disabilities,
  3. Geoff Dickens, chair of research

    We are employees of the St Andrew's Group of Hospitals, a registered charity providing specialist psychiatric care in Northamptonshire, Essex, and Middlesex.

  1. St Andrew's Hospital, Northampton NN1 5DG
  2. Cygnet Health Care, Bowden House Clinic, Harrow HA1 3JL
  3. New Friends Hall, Bristol BS16 1EQ
  4. Mersey Care NHS Trust, Liverpool L8 7LF
  5. North West Mental Health Development Centre, Manchester M16 0BA
  6. Department of Nursing, University of Salford, Manchester M30 0NN

    EDITOR—We were surprised by the tone of and the stigmatising language and strong opinions without cited evidence in the editorial by Poole et al on the NHS, the private sector, and the virtual asylum.1 The article sets out many undisputed facts such as the decline of the county asylums and the current inadequate provision of mental health beds under the NHS. No evidence is, however, cited to support the description of difficult to manage patients in the independent sector, poorly staffed small units, or the lack of activity or rehabilitation for patients.

    What evidence there is does not support any of these claims. 2 3 Paradoxically, the acknowledgement that larger independent facilities may give a higher quality of care than the NHS is also left unsupported. Further criticisms are made of NHS services and planning, again without evidence.

    No mention is made at all of the rapid regionalisation of independent sector facilities, a key development in meeting patients' needs more locally. Quite how the authors perceive a lack of any policy framework or regulation to protect patients is unclear. The Care Standards Act has introduced the national minimum care standards as part of a stringent framework of policy, clinical standards, and inspection, in addition to that provided for patients by the Mental Health Act Commission.4 Under the aegis of the Independent Healthcare Association, members of both the private sector and the voluntary sector are also subject to external quality control, such as the King's Fund Health Quality Service. Interestingly, the Care Standards Act does not apply to the NHS.

    Offering phrases such as private madhouse, acculturation to institutional life, and virtual asylum, Poole et al raise …

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