The private sector v. the NHS: who's the good, the bad and the ugly?

For psychiatrists who care for National Health Service (NHS) patients in the private and voluntary sectors, it can sometimes be dispiriting when colleagues make inclusive overtures, but manage at the same time to vent their spleen about the independent sector. Alistair Stewart, in the September lead correspondence item in The Psychiatrist, ¹ admits that there is ‘the good, the bad and the ugly’ in all sectors, and even that there are ‘flagship private sector providers’, but only lists recent quality failures linked to the activities of private equity groups. He would want to eschew the term independent sector as a ‘polite fiction’, preferring frankness such as ‘the private sector milking the money which most taxpayers think is going to the NHS’. Are independent charitable providers and all well-meaning professionals outside the NHS to be tarred with the same brush?

Similarly, in response to an editorial I co-authored, ² another NHS psychiatric colleague ³ gives an unbalanced view, focusing on fraud in US healthcare, the profit motive and sharp practice, contrasting this with the NHS, which is apparently an example of ‘a system based on trust and common purpose’. Is the truth not that in-house NHS services across the country include both shining examples of excellence and dedication, and scandalous failures of care and management - just as much or as little as many other kinds of organisation?

It is important to see that all sectors have been caught up in the same economic cycle. In the boom years the for-profit, commercial sector brought major investment in modern hospitals and community homes, from which NHS mental health patients have greatly benefited. Many would otherwise be homeless or in prison. The ultimate source of this commercial investment is mostly the savings of ordinary people, funnelled through investment funds of various sorts. Of course this was boosted by irresponsible borrowing, leading now to an intense resource squeeze, to unacceptable quality failures, and to investors making substantial losses.

All this parallels huge government investment in health services in recent years, the consequent public debt, and now severe reductions in spending, especially in social care. Mental health patients are among the vulnerable people affected, as care providers, including many community mental health charities, struggle to survive. Charities have to learn lessons from and compete with state and commercial provision, despite being challenged by the downturn through little fault of their own.

I would encourage NHS colleagues to acknowledge good work done by psychiatrists and mental health workers in every sector, in the best interests of patients, and balance their critical comments with examples of poor clinical practice wherever they arise. It is painful to see the fallout of the international debt crisis roll through our society and affect the most vulnerable. The responsibility rests perhaps with key decision makers in international public and private finance, but let us not become so conflicted that we waste our energies blaming each other in the mental health world.