| > Given that the UK is one of the better countries in medical care quality, why are things still so bad? Some people have spoken about the GP missing EDS, and those are good points. There's a bit of work happening in England to improve rates of diagnosis for those patients. I want to talk a bit about the MH aspect. There are four separate systems in the UK. Scotland, Northern Ireland, Wales, and England all have separate NHS systems. I'm only going to talk about the English system. In England commissioning is split across clinical commissioning groups and NHS England. England has been split into geographical regions, and each region has a CCG. That CCG will commission the bulk of healthcare for their local population. This includes most, but not all, mental health care. Some conditions are rare and highly specialist, and so it doesn't make sense for those to be commissioned by CCGs. That commissioning ("specialist commissioning") is done by NHS England. This includes in-patient eating disorder treatment. Commissioners don't have to buy services from NHS provider organisations. I think the current law even says that commissioners are not allowed to prefer one type of provider over another - they're not allowed to say they'd prefer to give the contract to an NHS provider over a private provider. A lot of healthcare is paid for by the NHS, but provided by private providers. This is especially true when we look at specialist commissioning for mental health. There are a lot of low secure units, medium secure units, in-patient eating disorder units, etc that are provided by private companies. The quality of care from these private orgs is often terrible. The split between CCG commissioning and NHS England specialist commissioning means that it's very difficult to get the local system to understand or care about the poor quality of specialist commissioning. |