Payers of $8.4 million for false claims Universal Health Services take over Cygnet Health Care for £205 Million.

cyg-photo

Cygnet Health Care is one of the three controlling providers of mental health services in England.

In 2014 Cygnet was bought by USA’s Universal Health Services (UHS) for £205 million..
http://www.healthinvestor.co.uk/ShowArticle.aspx?ID=4285

Simons Stevens was chief executive of the group’s global division and advised Blair on NHS public investment is now chief executive of NHS

England.https://www.theguardian.com/society/2014/oct/23/simon-stevens-nhs-chief-private-past-uk?CMP=share_btn_tw

Cygnet Health Care then increased UHS’s UK mental health footprint by a £95 million acquisition of Alpha Hospitals .

http://www.healthinvestor.co.uk/ShowArticle.aspx?ID=4274&search=Alpha

In September 2012, UHS, and its subsidiaries, Keystone Education and Youth Services LLC and Keystone Marion LLC,Keystone Marion Youth Center, agreed to pay over $6.9 million, to settle allegations that they had submitted false and fraudulent claims to Medicaid.

Between October 2004 and March 2010, these subsidiaries, had provided substandard psychiatric counselling and treatment to adolescents in breach of Medicaid requirements.

And, the United States alleged, that UHS had falsely represented Keystone Marion Youth Centre, as a residential treatment facility, providing inpatient psychiatric services to Medicaid enrolled children, when in fact, it was a juvenile detention facility.

It further alleged, that neither a medical director, nor, licensed psychiatrist provided the required direction for psychiatric services or for the development of initial or continuing treatment plans.

The settlement also settled allegations, that the service providers filed false records or statements to Medicaid, when they filed treatment plans, that falsely represented the level of services that would be provided to the patients.

See below under Other Medicaid Matters p33.

https://www.justice.gov/sites/default/files/dag/legacy/2013/02/12/hcfacreport2012.pdf

In July 2002, the New York State Insurance Department fined United Health Care $1.5 million for ‘cheating patients out of money’.

Is this the sort of ethos that should now control a quarter of public, enforced, secret unaccountable services to our most vulnerable and receive a tenth of our NHS budget ?

In 2011 Cygnet was warned by the Care Quality Commission that staffing levels at Cygnet Wing Blackheath were inadequate..

http://www.cqc.org.uk/media/cqc-warns-cygnet-health-care-limited-it-failing-protect-safety-and-welfare-people-0

Improvements were still required at the CQC inspection in April 2014.

In 2013 the Care Quality Commission issued a warning to Cygnet Hospital Bierley because the service was failing to ensure that appropriate records were kept.
http://www.cqc.org.uk/node/779979

John Hughes, an American founded Cygnet in 1987 after turning the Priory around.

In 2004 Cygnet was valued at £120m in a deal with Barchester Healthcare, which earned Hughes a £19m cash windfall.

Barchester, is part-owned by John Magnier and JP McManus, the Irish racing tycoons who owned Winterbourne View’s Castlebeck,.

They bought a quarter of Cygnet’s business for £30m, and Hughes, and a fellow director took a £7m stake in Barchester.

Hughes completed a £340m buy-out in 2008, backed by Mr Wilson’s health care group Grove, which had bought a 25pc stake in Cygnet years earlier.

And would have received another windfall.

In 2014 Hughes’ sale to UHS earned him a £30 million windfall.

http://www.telegraph.co.uk/finance/newsbysector/banksandfinance/privateequity/11037997/Priory-Group-in-talks-to-buy-psychiatric-rival-Cygnet.html

So tycoons have made millions from mental health services now 87% financed by public NHS money, whilst public trusts are cash strapped and in debt.

And, are set to make far more profit from the governments drive ‘to parity with physical health’, and spend a quarter of the NHS budget on their private services.

Robert Kehoe , psychiatrist, advertises himself, as an ‘expert witness’, is now the medical director of Cygnet, and, has apparently, advertised some of their units as being for ‘resistant service users’.

http://www.kehoemedical.co.uk/curriculum_vitae.html

https://www.cygnethealth.co.uk/news/dr-robert-kehoe/

Dr Kehoe was an NHS Consultant for nine years and Assistant Medical Director at Airedale NHS Trust and produces 80 to 100 psychiatric reports per year for Courts and Tribunals.

He is also responsible office for Cygnet Healthcare with national responsibilities for the regulation and revalidation of medical practitioners.

So, one expert, now controls the appraisals and code of conduct of all psychiatrist services and opinions, in a multimillion pound conglomerate, serving a quarter of all mental health services.

Universal Health Services and Cygnets’ overriding ethos, is to make as much profit as possible for its directors, managers and investors.

Does this not conflict with the professional independence of the psychiatrists, psychologists, practitioners, who work for Cygnet, and are subject to Cygnet’s stringent codes of conduct and continual appraisal systems ?

And how does this promote, the diversity of opinion needed for best practice, particularly, in the uncertain arena of psychiatric medicine ?

Amy’s Story- Nearly a Million spent on education, and torture/ death in the Priory.

Everyone said, ‘In there at least she’s going to get help’ but she didn’t 99641453_amy-el-keria-news-large_transqvzuuqpflyliwib6ntmjwfsvwez_ven7c6bhu2jjnt8get anything at all.”

Amy’s mother on her removal to the Priory Hospital Ticehurst House, in August 2012.

3 months later 14 year old Amy was dead.

Amy was a troubled, confused teenager, but why ?

Her mother described her as having ‘ a warm heart and a great sense of humour.

’ She never liked to see people treated unfairly and would be the first to stand and say ‘that’s not right’’

But the tragic irony was, that Amy herself was treated beyond unfairly, and no one, systemically, could stand up for her.

Amy’s forthrightness and conviction, contributed to her CAMH’s diganoses of oppositional defiant disorder (ODD), defined as a pattern of angry/irritable mood, argumentative/defiant behaviour.

And Conduct disorder(CO) a range of antisocial types of behaviour displayed in childhood or adolescence.

It appears normal teenage behaviour, could per se, constitute a ‘disorder’.

It is unknown, what is within this ‘range’ of ‘antisocial’ behaviours, let alone, what would be a normal reaction to living in an enforced residential ‘special needs’ school .

But High Close School, run by Barnados, had had enough of Amy, despite her £200,000 tax free a year income, and, the only place that remained, on Amy’s sad slippery slope, was a £1000 a day Priory Hospital Room.

But what did Amy’s ‘special ‘ education do for the equivalent of the cost 4 Eton places ?

And why, without learning disability diagnoses, are Amy, and ever more ‘troubled’ teenagers, excluded from ordinary schools and placed in such expensive residential care?.

High Close does not appear to have had any pupils attaining a single GCSE, and a parent comment the only I could find states,

poor School
Mark Rating:
I have a child in this School and have come to the conclusion that the place offers a poor teaching environment and the unit staff lie and cover for each other when things go wrong.

http://www.schoolsnet.com/uk-schools/school-details-reviews/wokingham/high-close-school/16180339/0/221304.html

As in my daughter’s National Autistic Residential School, ‘pupils’, only obtain P Scales , as teaching appears not to be towards the National Curriculum.

As Amy appeared intelligent, might not boredom/inappropriate education, have lead to her third label, attention deficit hyperactivity disorder (ADHD), a rare, some say non existent condition, that, has now been extended into a  pharma lucrative epidemic, see
ADHD The Disorder The Drugs The Inside Story. By Alan Schwarz.

Tourette’s, and gender identity dysphoria, distress at the gender assigned at birth, recently made a DSM mental disorder, and now increasingly diagnosed in children, were  added to Amy’s list.

Yet despite all these ‘disorders’, Amy must have managed to be chirpy, as depression was not added.

Despite Amy, being so unhappy in school, she had drawn a picture of herself killing herself and had written underneath: ‘If only this could happen, but I haven’t got the guts.’

Exactly as George Werb had done, when he had been trapped by the Priory and his medication..

Why hadn’t her school tried to help such an unhappy child ?

Amy and her mother, would have been unable to systemically complain .

As a care order, enforcing any chosen state provision would have been obtained.

So what was life like for this unhappy, and officially disordered child in the Priory ?

Did she receive any kindness or understanding, in her troubled isolation, living alone with strangers ?

In less than three months of being there, Amy was subjected to at least six incidents of restraint, sometimes involving forced injections.

The first restraint happened just 48 hours after her admission; the last  the day before her death, when she was held by five staff members, and orally sedated

Her inquest heard of several incidents, when she had been physically restrained by staff, sometimes for 15 minutes at a time.

The Priory had a high reliance on agency staff, including some with no psychiatric experience.

They had insufficient time even to read patients’ paperwork or clinical notes, let alone get to know Amy.

Amy was also being bullied, and the Priory had failed to deal with this, or, even care enough to share details of the many times she had said she wanted to kill herself.

Staff admitted, they were under so much pressure, they had not always been able to give the teenager one-to-one time.

So much so, a Jury ruled staffing levels were inadequate, and a lack of one-to-one time caused, or contributed to Amy’s death in a ‘significant’ way

Even basic training for her Tourettes was not given, a member of senior staff had ‘put on training on Tourette’s, but nobody had attended’.

So Amy was alone, ignored, no doubt on medication, bullied, subject to continual excessive prolonged restraints, and crying out continually for help, in the only way she could, by threatening her own life, and was still ignored.

Her last cry for help killed her.

3 months after entering the Priory Amy yet again, told a member of staff she wanted to kill herself.

Only the evening before she had been restrained by 5 members of staff and sedated.

Staff did not assess the risk of her being able to take her own life in her room; and opportunities were missed to help Amy in her room before her death, she was left alone, and this was held by a jury to have caused, or contributed ‘significantly’ to her death.

On the day she died, her risk rating was downgraded to medium.

And a  delay in checking on her in the evening, contributed significantly to her death, at a time when she should have been under even closer scrutiny.

A care assistant eventually belatedly, checked on her in her room and found Amy unconscious, a football scarf tied around her neck.

The scarf had been seen in her room two weeks earlier, but not removed, as the hospital had no list of banned items.

A panic ensued, and staff delayed calling 999, and didn’t summon a doctor immediately .

They also had not been trained in resuscitation, though one care assistant had requested the training.

Amy was vomiting profusely.

When paramedics eventually arrived, an oxygen mask was two small to fit over her mouth, and the lift too small to take a stretcher, so she had to be placed on a body board.

The Jury found that but for all this, her life might have been saved.

Amy’s unhappy last years, culminated in an excruciating death, after 3 months of bullying , restraint, injections and torture .

And, the Priory will have claimed a £1000 for that day’s ‘care’.

Less than a year later George Webb was sectioned to the Priory, as were many more who are now dead.

Freedom of Information request show the Government has no idea how many young people killed themselves while being ‘treated’

Yet do know, a third suffer from a mental ‘disorder’ and want to help them.

And are willing to pay the Priory over £440million a year, £6800 a week ,to do so..

Yet Amy, was not mentally ill, she was merely deemed to have ‘conduct ‘disorders, that private mental services, a quarter of the NHS budget, could make millions out of.

http://www.dailymail.co.uk/news/article-3621508/Priory-condemned-neglect-death-girl-14.html

https://www.theguardian.com/society/2016/jun/04/child-deaths-priory-hospitals-cancel-nhs-contrac

forced_injection_image

Add 3 more adults and you have the restraint Amy suffered the night before she died.

 

How The Priory/CAMHS’s Treatment lead to the death of George Werb.

kgeorge-werbI feel completely brain fried 20mg was too much for me and someone should have protected me from myself’. ‘By the way this is the only time in my life I ever strongly felt that suicide was the only option’.

George was referring to his enforced anti psychotic olanzapine.

He had continually asked the dosage be reduced, as had his parents.

The day before his death, George tried to negotiate a reduction in return for the Prozac his consultant added .

And despite this psychiatrist, rarely, making notes of his consultations, preferring ‘an oral hand over’, he did took the time to record;

’I tried to persuade him to persuade him that olanzapine was the answer to his problems not the cause’

George thought he was suffering from various diseases since he was 13, and his parents sought help from various professionals, but had got no where, and were never offered therapy.

Eventually, after a 10 month wait CAMH’s diagnosed him with ‘delusional’ depression.

This is an extremely rare condition, unknown in hormonal teenagers, the delusions appear based on George’s hypochondria, and, usefully, justified treatment with anti psychotic medication.

Within seven weeks George was dead.

Neither the Coroner, nor the Serious Case Review, considered the accuracy of the diagnosis, the role olanzapine and Prozac , and their combination, and George’s enforced hospitalisation, played in his death, even after reading George’s suicide note.

How could they, when such ‘treatment’ is  the only treatment available. And promoted by an all party mental health task force.

Therefore, an open verdict, reflecting the very real likelihood, that medication caused George’s death could not considered, nor a jury verdict risked.

Instead, a narrative verdict was given, blaming the Priory for allowing George home.

Yet, hours before writing his note, George’s mother had picked him up from the Priory Hospital, and was shocked at his wide, staring, expression less eyes, and noticed he could not sit still.

Just after 6am, the next morning, a train driver reported that George, had ‘walked calmly and deliberately’ in front of his high speed train. He was just 15.

George was described by his parents as a popular, active, funny, talented boy;

“We remember George’s incredible life, his amazing achievements, his jovial personality, his very quick wittedness, his integrity, his beautiful smile, his contentedness, but above all we remember his absolute love of his life and his imperative place in our family.

“Living with George brought entertainment to us on a big scale, he was either singing, practicing lines, playing music or playing an instrument. He performed in talent shows, singing competitions, Oliver, and played the role of Bugsy in Bugsy Malone at the town hall, as well as singing in the local church choir and fundraising for the drama club that he belonged. He loved joining clubs and loved his sailing, badminton and karate lessons

“George had aspirations, he wanted to work at the Globe Theatre, either in performing arts or some other job, but it was one of his ambitions. He loved music and wanted to join a rock band. He loved cycling and coming home to tell us that he had found a new path or cycle route. He loved reading about World War One and Two and adventure fiction. He enjoyed school and was on track to achieve high GCSE grades and during May last year and while in hospital, he took biology GCSE and earlier this year we received his certificate and he achieved an A grade.

Read more at http://www.exeterexpressandecho.co.uk/parents-popular-east-devon-student-say-child/story-23056354-detail/story.html#JLvK9Duzh67suM0I.99

But all this zest and enthusiasm would have been removed by the dopomine block of  his anti psychotic, and George knew it was killing him, but no one listened.

Medication and unhappy encagement was the only ‘help’, he was given by CAMHS, and his family  noticed a ‘massive change’ in him.

And he had complained about the terrible way the medication made him feel, and was given melts, when he spat his tablets out.

It was then, that the state decided, he needed hospitalisation, for ‘assessment and treatment’

His parents removed him from the first hospital, as the room was ‘not fit for a dog’, his bed had no sheets, the curtains were too short, he was living out of a suitcase, he looked dishevelled and unclean, and another patient had threatened to kill him.

Despite being paid £800 per day it did not even provide basic accommodation.

George returned home for a short period, but was then sectioned under the MHA to the Priory, for ‘treatment and assessment’,and any objections were  made impossible.

But here, he did not even receive an accurate suicide risk assessment, let alone an assessment of his condition, the Coroner noting

The information used in the assessment was incomplete inaccurate and did not reflect the actual situation’.

And, the only ‘treatment’ he received was medication, which clearly was having a devastating effect on him.

The Priory were being paid £890 a day, including the days of home leave.

Even basic communication was not provided either with his parents, who complained of this from the start.

George was given home leave, but did not want to return, and on his return, was so unhappy he attempted to kill himself with a shower curtain, but his parents were not immediately informed.

When his father visited, George had looked ‘hideous,’ and he thought he was getting worse.

Dr Hoyos, his consultant psychiatrist, who had to be seconded from CAMHS by the Priory, explained, George did not want to be in the hospital, and had disengaged from staff, and refused to go to lessons.

George knew he was trapped now by section and medication, and felt so desperate, he drew pictures of his own suicide with the words ‘game over young lad’.

But this was treated, as part of his disorder, and ignored .

The main points of the Serious Case Review were as follows;

Despite a nurse recording that George was very suicidal on 24 June 2013, a decision was made to allow George on home leave on 27 June 2013, without an up to date risk assessment, and hours after he had been prescribed an anti-depressant, Fluoxetine, which has a known side effect of potentially increasing suicide.

Inadequate records were taken by the consultant psychiatrist following consultations with George

A risk assessment had been incorrectly written changing George’s suicide risk from YES to NO the day before George died

The management plan did not have any note of current or past risk of self-harm or suicide the day after George had made a suicide attempt

A staff meeting had concluded that George posed “no current risk of suicide” two days before he died, contradicting a report given a few days before which noted that George had woken up in a low mood and had felt suicidal.

A referral to the General Medical Council (GMC) was made regarding this consultant’s record-keeping.

However, this was not pursued by the GMC.

http://www.exeterexpressandecho.co.uk/hospital-admit-liability-following-tragic-death/story-28836848-detail/story.html#pKWyQ5perMTRCSzU.99
See the Coroner’s Report to NHS England and their response.

https://www.judiciary.gov.uk/publications/george-werb/

But George’s death did not affect the NHS use, and funding of the Priory Group, which increased, as public NHS beds are being phased out.

This is the ‘help’ available to the 1 in 4 teenagers purported to have ‘mental health’ issues.

At best George’s death, ensures their treatment makes them unable to end their tortured existence, which will continue, as long as the real reason for their problems, and the affect of medication continues to be ignored.

georgewerb

US Acadia Group pay 1.28bn for The Priory Group .NHS Mental feeds Venture Capital Profit.

tyqzneet

US Acadia, bought the Priory Group for 1.28 bn this year and now owns half of all mental services in England..

85% of The Priory Group income is now public money.

In 2015/16 it received over 250 million of NHS funds.

An expensive media and political campaign, heralded the solution to  Winterbourne-the transfer of all patients in Public ATUs to private provision and the phasing out of public NHS inpatient beds.

Ignoring the elephant in the room of Winterbourne View being just such private provision.

So Acadia know they are onto a winner.

Acadia was backed by Advent International, one of the largest private equity investors, controlling €26 billion.

Advent was advised by Rothschild, JP Morgan, Bank of America Merrill Lynch, Barclays, Numis and Freshfields on the transaction.

Advent International completes sale of Priory Group to Acadia Healthcare

Joey Jacobs, Acadia’s chief executive, commented on the deal:

We believe there will be a long-term increase in the need for independent sector support for inpatient behavioural health.”[This] will provide Acadia continuing long-term accretive organic growth and acquisition opportunities.”

http://www.telegraph.co.uk/finance/newsbysector/banksandfinance/privateequity/12080497/Priory-clinic-sold-to-US-mental-healthcare-chain-for-1.28bn.html

Priory Group Sold

Joey Jacobs received 8,241,847 dollars in salary, bonus and stock in 2015.

http://www1.salary.com/Joey-A-Jacobs-Salary-Bonus-Stock-Options-for-ACADIA-HEALTHCARE-CO-INChtml

This was not the first buy out backed by Advent.

In 2011 The Priory Group, had been sold by RBS (then 84% publically owned), and Lord Ashcroft, the former deputy chairman, and donor of the Conservative party to Advent International for 925m.

In 2007, Lord Ashcroft, the Conservative party donor, and his investment firm, Global Health Partners had paid around £45m for a 34pc stake in the company.

http://www.telegraph.co.uk/finance/newsbysector/banksandfinance/privateequity/8247844/Advent-set-to-buy-The-Priory-for-1bn.html

http://www.telegraph.co.uk/finance/newsbysector/banksandfinance/privateequity/8266597/Advent-buys-The-Priory-for-925m.html

Scott was the chief executive of Southern Cross, the failed care home, during its rapid expansion using a sale and leaseback property arrangement.

Acadia operates a network of 258 behavioural healthcare facilities with over 9,900 beds.

Its Mental Health services include psychiatric and neuro-rehabilitation, the later remaining its biggest earner, generating revenue of £259.8m in 2014 (2013: £230.6).

Its Craegmoor specialist care, contributed £101m (2013: £93.2m), specialist education delivered £89.3m (2013: £91.1m) and its Amore Care homes for older people £70.5m (2013: £66.2m).

http://www.laingbuisson.co.uk/Newsletters/CCMnCompanyNews/tabid/203/itemid/24342/amid/707/turnover-and-profits-up-at-priory-group-of-companies.aspx

The Priory was once an expensive, exclusive haven for the rich and famous..

It thrived, and demanded in excess of £6,000 a week on the back of its excellent reputation for successful treatment and service.

But this was before the gold rush of NHS guaranteed public income without accountability

But The Priory still charges the NHS on average £6,ooo per week, but now the ‘clients’ are made captive by MHA section, and have no alternative ‘treatment’.

Since then it has been highly criticised , with many deaths and investigated by the CQC.

Now the Priory Group can, and do provide, any possibly  mental health/ conduct disorder service. In four divisions – healthcare, education and children’s services, adult care and older people’s care – which together support the needs of more than 30,000 people every year.

The Group recently cashing in on the extremely lucrative Autism and Aspergers Education Industry.

https://www.priorychildrensservices.co.uk/our-specialisms/autistic-spectrum-disorders/

This merger probably means that half of all our national mental health services are controlled by one of the largest international investment conglomerates.

As Acadia, have already  bought Partnerships in Care, the largest NHS income receiver  at £277,421,830 2013-15  in 2014 which meant Acadia now owns 50% of the UK Mental Health Market.

http://uk.reuters.com/article/uk-acadiahealthcare-acquisition-idUKKBN0EE1CU20140603

Four Seasons Healthcare Ltd, who  received 111,668.446 NHS money,  was sold to Terra Firma Capital Partners in 2012 for £825 millions.

In 2015 they sold £20 million of their properties to Monarch Alternative Capital, a US investment fund, which claims to specialise in swopping on ‘distressed and bankrupt’ companies.

The other two mental healthcare providers, NHS fund are Cygnet  and St Andrews Healthcare .

So it would appear, all mental health services, bar these two charities are owned by  just 4 venture capital investment groups.

Does this not effectively destroy any competition, bidding, and commissioning, for any. let alone the best services ?

Is this not an illegal, and dangerous monopoly ?

It surely would not have been allowed by the former Monopolies and Mergers committee.

The Competition and Marketing Committee did raise concerns and is investigating Acadia’s buy out of Priory Group.

https://www.gov.uk/government/news/acadiapriory-merger-faces-in-depth-investigation

And states;

There are relatively few private providers (and no public providers) for many of these services in England and Wales and, if the merger goes ahead, the incentives on providers to continue to supply the NHS with value for money services will reduce. Whilst quality of care is the main consideration when making referral decisions, cost is clearly another important factor when such services are funded by the public purse. The bargaining position of the NHS organisations and local authorities funding the treatment is stronger when they have a choice of providers.’

So,  with a handful of different private providers, the ones that exist, can effectively charge what they like for their services, as there is no alternative, and these services are effectively unaccountable.

The perfect business model for maximum profit.

But, it appears Acadia can avoid investigation by a small ‘diversion’ of its assets and more million pound windfalls for tycoons from NHS funds.

https://www.ft.com/content/2168ae84-7031-11e6-a0c9-1365ce54b926

http://www.laingbuisson.co.uk/Newsletters/CCMnCompanyNews/tabid/203/itemid/24903/amid/707/acadia-offers-to-divest-of-19-uk-facilities-to-appease-cma.aspx

The Priory Chief Executive has been named as the most influential independent health sector leader

http://www.healthinvestor.co.uk/ShowArticle.aspx?ID=7244

He would be if he now effectively controls half the ‘sector’.

But should public services for our most vulnerable be reduced to the mercenary machinations of a maximum achievable profit ‘sector’?

Our government, has allowed, those in need to be bought, sold and asset stripped.

And, this has been facilitated by the legislation of all political parties .

The plan hatched over 20 years ago, has now come to fruition- monopoly, unaccountable venture capital public service provision, with captive, mainly enforced, secret consumers.

Paid for by huge amounts of public money on the back of ‘cost cutting’.

This is not capitalism, as there is no competition, no free market, and no accountability, and a secure stream of increasing public income.

This is totalitarian extortion of our money, our services, and our people, for huge profits.