P. A Sugarman’s scientific contributions

Editor—We were surprised by the tone of and the stigmatising language and strong opinions without cited evidence in the editorial by Poole et al on the NHS, the private sector, and the virtual asylum.1 The article sets out many undisputed facts such as the decline of the county asylums and the current inadequate provision of mental health beds under the NHS. No evidence is, however, cited to support the description of difficult to manage patients in the independent sector, poorly staffed small units, or the lack of activity or rehabilitation for patients. What evidence there is does not support any of these claims.2,3 Paradoxically, the acknowledgement that larger independent facilities may give a higher quality of care than the NHS is also left unsupported. Further criticisms are made of NHS services and planning, again without evidence. No mention is made at all of the rapid regionalisation of independent sector facilities, a key development in meeting patients' needs more locally. Quite how the authors perceive a lack of any policy framework or regulation to protect patients is unclear. The Care Standards Act has introduced the national minimum care standards as part of a stringent framework of policy, clinical standards, and inspection, in addition to that provided for patients by the Mental Health Act Commission.4 Under the aegis of the Independent Healthcare Association, members of both the private sector and the voluntary sector are also subject to external quality control, such as the King's Fund Health Quality Service. Interestingly, the Care Standards Act does not apply to the NHS. Offering phrases such as private madhouse, acculturation to institutional life, and virtual asylum, Poole et al raise the possibility of the private sector being discredited in a destructive moral panic. No evidence is given as to why this has become in any way likely, except perhaps as an effect of such palpable hostility. Their piece is an example of the conflicted thinking on public-private partnership still prevalent in the state sector. This blights NHS planning for constructive partnership and needs to be addressed in the interests of patients.