NHS Constitution Handbook

This is a very dry but important subject. The NHS has a constitution and recently published a revised handbook to the constiution you can download here. I believe the Department of Health continues to discriminate  against people with with a mental disorder when it comes to choice of a provider for treatment.

At the core  of the NHS is a commitment to provide “choice” as a right. When I first joined the NHS in 1982, patients could be referred by their GP to any NHS hospital. Introduction of the internal market, with its division of purchaser and provider, eroded this system; the provision of choice for medical and surgical problems returns us to roughly what we had before, with patients more involved in the decision about where they receive their care. The Department of Health states that the options available for “choice” will develop over time. This is understandable, especially in the light of the current financial climate. However, the first area where this has become a legal right is elective care: since 1 April 2009, patients have had a right to choose the organization that provides their treatment when they are referred for their first outpatient appointment with a consultant-led team. The legal right applies at present to referrals for elective care services only (that is, ones which are pre-arranged). The Department of Health now appears to discriminate against people who are disabled by their mental disorder, and needing elective care, as mental health services” are specifically excluded from the legal right for choice of referral. It is true that many referrals for mental health services are emergency or non-elective, but a significant number are not. I have had communications with many people with OCD or BDD (or their families) who are severely disabled, and who want to be referred to our service at the South London and Maudsley Trust because of our reputation and results. I am proud to say we provide cutting edge treatment and patients often seek to travel to our unit when local care has failed. They may be seeking an assessment for out-patient treatment at the Maudsley Hospital or for admission to a residential unit at the Bethlem Royal. However because they may not be able to obtain a referral or funding, it means individuals with mental health disorder and who are disabled are unable by legal right to obtain elective care at a hospital of their choice. Surely the Department of Health is discriminating on grounds of disability and the Equality Act and flouting the NHS Constitution? Either choice should be removed from all medical and surgical patients or also given to patients with a mental disorder?

I wrote about this to the Department of Health last year and was told that people with mental disorder and disability have a right to choose a provider for a consultant led team provided it is not a mental health service. Equally they argue that everyone is excluded from choice in mental health services whether they have a mental health problem or not! However this is nonsense as people with a mental disorder want choice in their mental health provider and people who do not have a long-term mental health disability do not need to be referred to mental health services.

They further argue that because the NHS has developed the Increasing Access to Psychological  Therapies (IAPT), there are effective choices. This is partly true. At a primary care level, there may be more choice but what happens to the people who need to be stepped up to secondary care when they failed treatment or have more complex or severe problems?  Public bodies have a statutory duty to be pro active in promoting equality. The Department of Health is not promoting equality for people who are disabled by their mental disorder and need mental health services. They say they will change this anomaly in time. Please write to your MP and Department of Health and keep up the pressure.

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