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Wednesday, 13 October, 1999, 17:03 GMT 18:03 UK
Bed shortages 'cost NHS millions'
Mental health wards were closed in the 1980s
Health trusts in London may be spending up to 50m a year on private beds for mentally ill patients because of a shortage of NHS beds, says a study.

Mental Health
The Care Gap, a report by London Health Emergency and public service union Unison, catalogues the state of the capital's mental health problems two years after Labour came into power.

It says there have been some improvements, but there are concerns about the effect some new policies may have.

It specifically cites the proposal to introduce compulsory treatment orders which mean that mentally ill people will have to take their medication or risk being admitted to hospital and new provisions for people with severe personality disorder.

The report says these could impose "substantial new costs" on the NHS and "destabilise" community and hospital services.

Inherited problems

However, it states that many of the problems have been inherited from the previous government.

It says the Conservatives closed hospitals and beds without providing the community-based infrastructure to replace them.

Since 1982, London has lost almost 60% of its psychiatric beds, whilst demand for beds has increased, according to the report.

It claims each bed treats an average of almost six patients a year, compared with two patients a year 15 years ago.

Long-term care

But the report states that the government has failed to pledge any significant new money to the areas of mental health where pressure is worst.

It says the biggest proportional reduction in beds has been in the area of long-term psychiatric care for adults.

It is estimated that there is a shortage of up to 1,500 long-term beds in 24-hour nurses accommodation.

London's NHS may be paying up to 50m on private beds for the mentally ill
The report, written by John Lister of London Health Emergency (LHE) says reversing the shortfall would cost 70m in capital and 60m a year to provide extra staff.

It believes this is the key to relieving pressure on acute short-term beds.

Occupancy levels in acute beds in London are "well above 100% in most of London", says the report.

"Services are seen to be well below a minimal safety level," it states.

Private care

LHE says the knock-on effect means that NHS trusts are having to pay for people to be placed in private hospitals - sometimes far from their homes.

"There are no centrally available figures, but it appears that the bill for private placements of 'overspill' patients for whom there is no bed in London is costing the capital's NHS upwards of 50m a year - for care which NHS consultants warn is often of questionable quality," says the report.

It claims that, in south east London, 20% of mental health admissions overspill into private beds.

However, the NHS Executive says the government is planning to invest up to 100m in capital funding for mental health in the next three to five years - particularly in acute and mental health beds for offenders.

And it says extra money is already being invested in 24-hour nursed beds and outreach support.

Savings have also been made in administrative and management costs which are being ploughed into frontline services.

A spokesman said that modernising mental health was "a major priority" and that there was a commitment to providing "consistent services across the capital".

A pan-London strategy on mental health will be published in 2000.

The report welcomes the commitment to improve mental health.

And it says the setting up of an NHS Regional Office for London will help develop a London-wide mental health strategy by the end of the year.

It states that, currently, many areas of London offer different standards of care.


Unison, which is holding a major London conference on mental health on Thursday, has developed a mental health workers' charter to address some of the problems faced by staff.

It wants additional revenue spending of 100m per year to run the capital's mental health services.

The charter outlines concerns about training, safe workloads, staffing shortages, violence against staff and quality monitoring.

It says community staff should have no more than 20 people on their caseload and that they should be able to complain to nursing's disciplinary body about management policies which mean they cannot perform their job properly.

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