来源：《卫报》
原文刊登日期：2022年4月25日
New evidence of the extent of the privatisation of mental healthcare in England is extremely concerning. Ministers and health bosses must explain why the independent sector is earning almost £2bn a year for treating patients with psychiatric conditions – or 13.5% of NHS England’s entire mental health budget. It is difficult to think of a good reason why the proportion of mentally unwell people treated by private providers should be so much higher than the proportion of those with other conditions.
英格兰精神卫生保健私有化程度的新证据令人极为担忧。部长和卫生主管必须解释，为什么独立部门每年因治疗精神病患者而获得近20亿英镑的收入——相当于英格兰国家医疗服务体系（NHS）整个精神卫生预算的13.5%。很难想出一个好的理由来解释为什么精神疾病患者接受私人医疗机构治疗的比例要远远高于其他疾病患者。
If patient safety and care quality were the only considerations, extremely vulnerable mental health patients would seem to be among the least suitable candidates for outsourcing. After all, the general rule is that while standardised treatments can be delivered via the independent sector relatively straightforwardly, more complex and long-term work is kept in-house. Why inpatient psychiatric care for under-18s should defy this rule, with 55% of all NHS-funded treatment delivered privately, is a troubling question for anyone who cares about the future of healthcare.
如果患者安全和护理质量是唯一的考虑因素，极度脆弱的精神健康患者似乎是最不适合外包的对象。毕竟，一般的规则是，虽然标准化治疗可以通过独立部门相对直接地进行，但更复杂和长期的工作则由NHS内部进行。为什么18岁以下的住院精神科治疗要违反这一规定，在这一块儿，NHS资助的所有治疗中，有55%是私人提供的，这对任何关心医疗保健未来的人来说都是一个令人不安的问题。
The short answer, of course, is that the NHS does not have the resources or the staff to do this work itself. This leaves doctors and managers with no choice, as one psychiatrist described. Years of underinvestment in the health service have hit the mental health sector hard. Currently, there are 10,123 private mental health beds in England (the NHS has 17,610) and private mental health providers earn 91% of their income from the NHS. But psychiatrists, the Care Quality Commission and NHS England’s national mental health director, Claire Murdoch, have all raised concerns about the quality of the care on offer. In 2019, the Priory group was fined £300,000 over failings that led to the death of a 14-year-old girl, Amy El-Keria. Last week, an inquest jury found that neglect contributed to the death of Matthew Caseby in another Priory facility.
当然，简而言之，NHS没有足够的资源或人手来完成这项工作。正如一位精神病学家所描述的那样，这让医生和管理者别无选择。多年来对卫生服务的投资不足严重打击了心理卫生部门。目前，英格兰有10123个私人心理健康床位(NHS有17610个)，私人心理健康提供商91%的收入NHS。但是精神病学家、护理质量委员会和英格兰国民健康服务中心的国家精神健康主任克莱尔·默多克都对其所提供的护理质量表示担忧。2019年，Priory集团因过错导致14岁女孩El-Keria死亡而被罚款30万英镑。上周，一个验尸陪审团发现，疏忽导致马修·凯斯比在Priory集团的另一处医院中死亡。
But there needs to be a longer answer too – one that addresses the underlying question of why, with average profit margins of 15%-20%, it has been made so easy to make money out of acute psychological distress. Also, whether the health and care bill that is on its way through parliament will lead to improvements or to further fragmentation, as the British Medical Association has warned that it could. Comparisons of the patient safety records of public and private providers are made difficult by a lack of data. Recent evidence has revealed grave failings in NHS hospitals too. But one doesn’t have to pretend that all is well in the public sector to reject as shameful the situation whereby businesses are enabled to make huge profits from delivering substandard care with weak oversight and minimal accountability. Patients and their families deserve better.
但也需要一个更长远的答案——解决一个根本问题：为什么从严重的心理困扰中赚钱如此容易，平均利润率高达15%-20%？此外，议会正在通过的医疗保健法案是否会带来改善，还是会像英国医学协会警告的那样，导致进一步碎片化？由于缺乏数据，很难比较公立和私立医疗机构的患者安全记录。最近的证据显示，NHS医院也存在严重缺陷。但是，人们不能够自认为公共部门除了问题没什么事儿，就不以私营部门出现的这种情况为耻，企业在监管薄弱和责任最小的情况下，通过提供不合格的医疗服务赚取巨额利润。病人及其家属理应得到更好的对待。