The principle by which mental health must be given equal priority to physical health is known as Parity of Esteem and was established in law by the Health and Social Care Act 2012. NHS England, through an NHS mandate, is required to work for parity of esteem with regard to mental and physical health. It is clearly laid out what it is that the NHS and commissioners need to do in order to deliver improvements in the way long-term conditions are treated and how health inequalities are addressed. Expanding access to psychological therapies and services, addressing access and waiting times for mental health care, and commissioning integrated support for those with coexisting physical and mental health conditions are examples of some actions. In some areas this is just not happening.
The Care Quality Commission (CQC) regulates all health and social care services in England. It also produces an annual report on the use of the Mental Health Act (MHA) determining how providers are caring for patients, and whether patients’ rights are being protected (CQC, 2019a). The CQC's remit includes independently run organisations. Significant numbers of privately run mental health units have been deemed ‘inadequate’ by inspectors in the past 3 years—such findings could mean that vulnerable patients are receiving substandard and potentially unsafe care. So far this year the CQC has rated 16 independently run mental health units as inadequate. In 2018 it had put four others in the same category and eight in 2017. A number of privately run mental health units are occupied by NHS-funded patients, who may spend months or years there.
Following a safeguarding alert, the CQC conducted an inspection in May 2019 of one provider registered to provide care and treatment to people with a learning disability or autism (CQC, 2019b). Inspectors reported that two carers had identified unexplained injuries to a patient, several interactions between staff and the people they supported were observed, and it was determined that nearly half of these interactions were poor. People had to repeat themselves to get attention and there were some staff who failed to interact or engage with people when they were offering them direct support. Staff files were reviewed and revealed one incident where an inappropriate restraint technique had been used and two episodes where members of staff were sleeping while they were on duty. This provider has since been put into special measures and patients are being cared for elsewhere. This is yet another hospital offering care to vulnerable people being put into special measures. This same service was previously inspected in December 2018 and received an ‘outstanding’ rating overall, being described then as well led and rated ‘good’ for being safe, effective and responsive. A further inspection of the same service was made in June in response to new whistleblowing information and the report of that inspection is to be published in due course.
The same provider ran another unit for people with learning disabilities and autism, Whorlton Hall, where an investigation in May 2019 showed that staff were abusing residents. This resulted in the arrest of 10 people. CQC inspections are frequently finding serious failures by private providers as they fail to care properly for people with a range of mental health conditions and other conditions. There is substantial variation in the quality of care between mental health services provided by NHS mental health trusts as well as independent mental health hospitals, and this variation is unacceptable. It is time to launch a public inquiry into these repeated serious failings to gain an understanding of what is going wrong and what needs to be done to ensure that this vulnerable group of people, some of whom are detained under the MHA, are in receipt of the highest standard of care that they should expect. There is no parity—of esteem or otherwise—and this is a national scandal.