Intended for healthcare professionals

Head To Head Maudsley Debate

Should NHS mental health services fear the private sector? No

BMJ 2010; 341 doi: (Published 04 October 2010) Cite this as: BMJ 2010;341:c5385

Private sector dementia care relies on NHS to drive up standards of care

Elaine Murphy and Philip Sugarman highlight that "almost all long
term care for dementia" is provided in the private sector. I hardly think
that this a good example of successful private mental health care.

Many nursing and residential homes are understaffed and the staff
working in them are often undertrained in dementia care. As a result
dementia patients are overprescribed antipsychotics and other
tranquillising medications. When homes are no longer able to manage
patients because of Behavioural and Psychological Symptoms of Dementia
(BPSD) the fall back is nearly always the NHS.

NHS Older Adult Community Mental Health Teams (OACMHTs) have begun to
develop inreach services into private nursing/ residential homes to
address these issues of care and training and we are now beginning to set
up proactive reviews of all patients in nursing and residential homes
prescribed antipsychotic drugs.

Although there are a few examples of exemplary care, by and large the
private sector has failed to provide a quality service for the long term
care of patients with dementia. Without the active input and support of
local NHS OACMHTs many long term dementia patients in the private sector
will continue to experience substandard care.

If the experience of long term dementia care in the private sector is
anything to go by, other mental health service users have much to fear
from privatisation.

Competing interests: The author is a practising NHS Consultant Psychiatrist

25 October 2010
Patrick S G Chance
Consultant Psychiatrist
Aneurin Bevan Health Board (NHS)