The NHS’s mental health review will fail to answer its darkest secret

The national investigation into mental health scandals announced this week by Steve Barclay, the health secretary, is long overdue and has been widely welcomed.

But almost immediately it became clear that his inquiry will not address the dirtiest, darkest secret of the UK’s mental health provision.

This is the NHS’s dependency on outsourcing care to a company that many families, including mine, have experienced as a fatally dangerous provider: the Priory Group.

Any national investigation into mental health care by Barclay should include a strategic review of the long-standing government policy of pushing the NHS to commission mental health care from private providers.

Once upon a time, the Priory was associated with treating the addictions of celebrities like Kate Moss and Amy Winehouse and it made excellent PR for decades. Rarely was the Priory mentioned in the media without a famous name attached. But this painted an entirely false picture.

Just as casinos are desperate to be associated with “high rollers” rather than the “grind” (the ordinary workers losing their wages that account for much of their profits), so it is with the Priory.

The Priory “grind” are the thousands of NHS patients dumped into its beds by NHS trusts all over the country with barely a backward glance. The company earns over £400m from NHS public sector contracts looking after the mentally ill and plenty more from social services.

In turn, the NHS is as hooked as a crack addict: it outsources the care of its most vulnerable patients even when that care is often known to be inadequate. But that’s a risk worth taking because the NHS also outsources accountability for when things go wrong.

You can hardly blame them. The NHS paid out £2.2bn in clinical negligence compensation in 2021/22, along with legal costs of £627m, although those figures don’t even include claims when it outsources to private hospitals like the Priory.

Sometimes the Priory’s grotesque negligence can’t be ignored – even by the government. In 2021 NHS England privately criticised the Priory’s chief executive for repeated service failures and threatened to take action unless there were “rapid improvements”.

This rising concern is not surprising, especially since the number of reported deaths at Priory sites rose by about 50 per cent between 2017 and 2020, according to the Care Quality Commission (CQC), the health regulator.

My son was just such a statistic.

Matthew, 23, had never had a medical diagnosis or treatment for any mental health disorder until he was sectioned under the Mental Health Act after suffering a psychotic episode in 2020. But within three days of being parcelled off to the Woodbourne Priory hospital in Birmingham, he was dead.

The Birmingham Women’s and Children’s NHS Trust that sent him there was so dangerously disconnected from its patients that one of its staff insisted to me that Matthew was alive and well, 40 days after I knew he was dead.

On the night he escaped I raced from London to Birmingham and was just 200 yards away from him when he was hit by a train. Mercifully, I didn't see or hear the moment of impact as the line was in a deep culvert.

An independent investigation by one of the UK’s top forensic psychiatrists found the Priory was responsible for two fundamental causes of Matthew’s death and 29 contributory factors.

The inquest jury concluded his death was “contributed to by neglect” by the Priory – the most damning judgment possible, short of unlawful killing. There were inadequate risk assessments, dire record-keeping and a gross failure to respond to previous security breaches. Finally, while left unattended in a courtyard, Matthew jumped over a dangerously low 2.3m fence over which other patients had escaped before.

The coroner also issued a Prevention of Future Deaths (PFD) report because she was so concerned about continuing dangers at the hospital 18 months after Matthew died.

Through working with the Inquest charity, I have met too many other bereaved families whose sons, daughters, wives and husbands were neglected to the point of death by the Priory.

But if you lift the stone you can see it may well get much worse.

The Priory’s accounts for 2020, the year my son died, show a pre-tax loss of £297.4m and a debt of £1.2bn. Then in 2021 Arcadia Healthcare sold the Priory Group at a loss to Waterland, a Dutch private equity firm, for £1.1bn.

Waterland is now combining the Priory with Median Kliniken, a German rehabilitation provider with 120 clinics.

The deal was financed by a sale and leaseback of 35 Priory healthcare properties to Medical Properties Trust, a US investor. Under this agreement, the rents are subject to annual inflation-based escalators, which means the Priory is exposed to sharply rising rental costs.

This separation of assets from day-to-day operational management is the precise scenario which led to the collapse of Southern Cross, the care home provider that bit the dust in 2011 after struggling with rising rents.

So much for the crystal ball. Meanwhile, life goes on much as before.

The Priory creeps closer to its ambition to become the NHS “overflow provider of choice”. The Woodbourne Priory, where Matthew died, is still rated by the CQC as “inadequate” yet the Birmingham Women’s and Children’s NHS Trust continues to send its unwitting patients there.

The CQC has launched a criminal investigation into the Priory and Victoria Colloby, the Woodbourne manager, over Matthew’s death. I await the decision on whether any prosecutions will follow.

Colloby, who also presided over another Priory hospital which was forced to shut by the CQC because it was deemed so dangerous, has since been promoted to director of wellbeing services.

I asked Dr Andre Schmidt, who was parachuted in from Median Kliniken to become chairman of the Priory, whether Colloby would be disciplined. He said not.

In fact, Schmidt took umbrage. He instructed me to reflect on how Matthew’s death might have affected Colloby. You really couldn’t make it up.

Richard Caseby is the founder of Caseman Communications. He is campaigning with the Inquest charity to set up an oversight body so that coroners’ recommendations to prevent future deaths are actually implemented. Sign the petition here