Recurring concern

Unsafe reliance on independent providers for NHS mental health beds

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First reported 19 Sep 2023•Latest report 14 Jun 2024

Definition

What this concern includes

Includes assertions that NHS mental health services rely on independent providers to supply acute, PICU or specialist mental health beds and that this reliance creates or exposes patients to safety risks such as unsuitable placement, excessive distance from home teams or families, fragmented continuity, or inadequate provider integration.

Not included

  • Excludes general shortages of NHS or independent mental health beds where provider reliance is not itself identified as the unsafe condition.
  • Excludes failures limited to finding, funding or allocating a particular specialist placement when independent-provider reliance is not materially involved.
  • Excludes ordinary use of independent providers where arrangements are suitable, integrated and do not create an identified patient-safety risk.
  • Excludes generic mental health service underfunding, bed-management or discharge failures without a supported independent-provider dependence condition.
Reports
2

Distinct published reports

Individual concerns
2

A report can raise multiple concerns

Date range
2023–2024

First to latest report issue date

Stated actions
1

Described in published responses

Reports over time

Reports over time

Reports about this concern issued each year.

* 2026 is projected from reports observed to 7 Sep 2026.

Most frequent recipients

Most frequent recipients

Reports about this concern sent to each recipient.

Department of Health and Social Care2
NHS England2

Concerns and responses across reports

Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.

  1. Manchester South

    AI-generated summary

    Amina Ahmed Ismail · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    Amina Ahmed Ismail, aged 19, died on 15 September 2023 at Pankhurst Ward, Priory Hospital Cheadle, after self-ligaturing; the medical cause of death was ligature strangulation. The report describes her prolonged stay in a PICU, deterioration in her mental health, shortages of appropriate specialist care beds, and delays in arranging and funding a suitable placement as concerns contributing to the circumstances of her death.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below.

    PFD Monitor interpretation

    Over-reliance by the NHS on independent mental health-bed providers

    Wider context from the report

    “This is now the third inquest (two within the past 8 months) I have heard where the delayed transfer of an out-of-area patient from an independent provider’s hospital has been a contributory factor in that patient’s death. Two of those cases involving prolonged stays on PICU units; in this case some 13 months and in the other, some 11 months. These cases illustrate, a) Underfunding for local mental health beds. It took some 6 weeks in 2022 to transfer Amina from the PD specialist placement at Nield House (where the treating team felt that they could not keep Amina safe) to a PICU some 90 miles from home. Further, there were no local PICU beds available for transfer out of The Priory, Cheadle in May/June/July 2023 when a PD placement could not be found. b) An over-reliance by the NHS on independent providers for mental health beds whether general acute beds, PICU beds or specialist units. c) A national scarcity of specialist PD rehabilitation units The inquest heard evidence from two treating psychiatrists in Amina’s history (Nield House and The Priory), FTB PACT assessor, and the court appointed independent expert that there was, and is, a national shortage of specialist PD rehabilitation units/beds, paraphrasing, ‘rehabilitation beds for female patients with PD are limited – demand exceeding what is available nationally’. ‘shortage of rehabilitation placements nationally – impeding on young persons’ mental health treatments’ ‘simply not enough beds (NHS or Independent) to cater for such complex patients as Amina – transfers not being accepted by such units even if not full because the acuity of their existing patients’. ‘PD rehabilitation beds are scarce – spread nationally often in isolated units far from home, family and the local/home team. Each having its own admission criteria/exclusions, such as the possible need for NGT feeding’. Following the PACT assessment FTB, in early 2023, were only able to find two PD units that had a bed available. One of them, Eleanor House, was re-opening its doors having voluntarily closed at the end of 2022. It had 14 beds available. However, its extant CQC rating was overall inadequate and it was in the process of appealing a Notice of Decision. The other, Cygnet Alders, declined the referral. Three other units were identified as possibilities but each declined a referral, without any assessment, based on the acuity of their own patients. Just 5 beds available over a period 6-7months, before Fern Unit accepted Amina. In the meantime Amina remained in a PICU, some 90 miles from home which was wholly unsuited to her presentation and unable (through no fault of its own) to deliver the care and therapy that she needed resulting in a deterioration in her mental state with increasing risks/incidents of self-harm. d) A funding process for rehabilitation units that is not fit for purpose. The inquest heard evidence about the funding set-up for secondary mental health care in the Birmingham area, which is replicated nationally. The ICB commissioned FTB to provide secondary mental health services, both community and in-patient. FTB are able to commission NHS and independent sector acute beds and PICU’s, both in and out of area. However, FTB are not able to commission specialist placement, including PD units. These are commissioned/funded directly by the ICB upon application by the FTB; having found a unit that would accept a patient. This system, for funding specialist/rehabilitation beds, is inadequate; particularly in light of the shortage of such specialist/rehabilitation beds. The inquest heard evidence that the process from application to funding approval takes weeks, sometimes months. In this case it took from 13.03.23 to 04.05.23 for a negative outcome. The shortage of beds/units means that when a bed becomes available there are a number of patients in competition for it. The beds are not kept open for any particular patient and, in essence, allocation becomes a race on funding. It is surprising that a ‘home team’ (in this case FTB) commissioned by an ICB to provide secondary mental health services is not permitted to make its own funding decisions for specialist units, as it can for acute wards and PICU’s. As can be seen from the evidence Amina was able to be transferred within 24hrs once a PICU accepted her on 01.08.23, albeit it took a wholly unsatisfactory 6 weeks to find a PICU bed. ”

    Source location

    Amina Ahmed Ismail · Prevention of Future Deaths report
    Page 3 · concerns

    Open source report

    Source evidence

    How this respondent position was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Integrated care boards are responsible for developing three-year plans to localise and realign inpatient mental health care, including independent-sector provision.

    Verbatim wording from the response

    “In 2022 NHS England launched the mental health, learning disability and autism inpatient quality transformation programme. A core aim of the programme is to localise and realign care, harnessing the potential of people and communities. The programme is built upon the cornerstones of good mental healthcare; continuity of care, therapeutic relationships and a commitment to mental health care meeting the needs of the population. All integrated care boards have been tasked by NHS England with developing 3-year plans to localise and realign inpatient mental health care, including NHS-funded care provided by the independent sector, as part of this programme.”

    Source location

    Response from DHSC
    Page 2 · response
    Published 25 June 2024

    Open published response

  2. Manchester South

    AI-generated summary

    Lauren Elizabeth Bridges · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    Lauren Elizabeth Bridges, who was detained under the Mental Health Act and treated in out-of-area mental health placements, died on 26 February 2022 after a ligaturing incident two days earlier. The report identified concerns about delayed discharge and repatriation, the distance from home, missed opportunities to move her closer to home, and inadequate communication between relevant organisations. It also identified wider concerns about shortages of local mental health beds and reliance on independent providers.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below.

    PFD Monitor interpretation

    Over-reliance by the NHS on independent providers for mental health beds

    Wider context from the report

    “This is the second inquest I have heard where the delayed discharge/repatriation of an Out-of-Area patient from an independent provider’s hospital has been a contributory factor in that patient’s death. Lauren was 20 years of age. The other inquest involved a 15 years old patient - 115 miles from home. Both of these cases illustrate, a) Underfunding for local mental health beds. b) An over-reliance by the NHS on independent providers for mental health beds. ”

    Source location

    Lauren Elizabeth Bridges · Prevention of Future Deaths report
    Page 2 · concerns

    Open source report

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Support health and care systems to operationalise inpatient mental health care localisation plans through regional and national assistance.

    Verbatim wording from the response

    “To implement this, all ICBs have been tasked with developing 3-year plans to localise and realign inpatient mental health care, including care provided by the Independent Sector, as part of the mental health, learning disability and autism inpatient quality transformation programme launched in 2022. Health and Care systems across England are currently being supported to operationalise the guidance via 3-year plans with direct support from regional and national teams. The transformation programme is underpinned by a £36 million investment.”

    Source location

    Response from NHS England
    Page 2 · response
    Published 13 November 2023

    Open published response

    Source evidence

    How this respondent position was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Integrated care boards are responsible for developing three-year plans to localise and realign inpatient mental health care, including independent-sector provision.

    Verbatim wording from the response

    “Turning to your concerns around an over-reliance by the NHS on independent providers for mental health beds, private companies have always played a role in the NHS and patients should expect a safe and good quality service regardless of whether their care is delivered by independent sector or public sector providers. As set out in NHS England’s response to your report, all integrated care boards have been tasked with developing 3-year plans to localise and realign inpatient mental health care, including care provided by the Independent Sector, as part of NHS England’s mental health, learning disability and autism inpatient quality transformation programme.”

    Source location

    Response from Department of Health and Social Care
    Page 2 · response
    Published 13 November 2023

    Open published response
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Data last updated 7 September 2026