Analysis

CQC to work with NHS Improvement to support mental health trusts

Regulator finds mental healthcare in reasonable shape, but significant problems remain

Regulator finds mental healthcare in reasonable shape, but significant problems remain. Nick Evans reports


Picture: iStock

If you look at the headline findings of the Care Quality Commission’s annual State of Care report, services for people with mental health problems appear to be in a reasonably good shape in England.

The 2017-2018 stocktake shows that more than three quarters of the 55 mental health trusts and 237 independent providers are rated as good or outstanding. However, services are still presented with issues.

Fragmented landscape

The landscape is fragmented, the CQC report says, making the experience of navigating services challenging.

Among the issues highlighted in the 134-page report are:

78%

of the 55 mental health trusts rated as good or outstanding

  • A lack of specialist staff to manage the complex needs of patients.
  • Investment needed to replace or refurbish outdated adult wards, with poor layout hindering observation.
  • Continued concerns about the use of physical restraint.
  • More needing to be done to tackle sexual safety – in one three-month period, an analysis found more than 1,100 sexual incidents.
  • Shared sleeping arrangements compromising safety and privacy – more than 1,000 beds are located in rooms with two or more beds.
  • Many services lack the full range of care interventions, such as specialist psychological therapies.
  • Lack of access to crisis services in some places.
  • Nearly two thirds of placements in residential-based mental health rehabilitation services are out of area, a costly practice that is unfair on patients and their families.
  • Lack of skilled staff and long waits for child and adolescent mental health services.

In fact, the CQC says it is so concerned about safety that it is working on a programme with NHS Improvement to support mental health trusts in particular.

But despite all the problems, there were some positive signs. The CQC says the quality of care remains strongest in community settings, with 96% of services for those with learning disabilities and autism rated as good or outstanding: the figure for older people’s services is 87%.

Trend improvement

The report also says there is a ‘general trend of improvement’ in the sector. More than half the 55 NHS trusts and independent providers that were previously rated as 'requires improvement' in their first inspection had improved to ‘good’ by the time they were reinspected.

The CQC says that, as in other sectors, good leadership and governance have been crucial in allowing services to make improvements. The report says these foster a ‘positive and inclusive culture’ where staff felt able to speak up and speak out, which in turn helped transform care.

63%

of mental health placements in residential-based rehab are out-of-area

Nonetheless, Royal College of Nursing mental health professional lead Catherine Gamble says the challenges remain significant and are taking their toll on staff.

‘Mental health nurses are under a lot of pressure. It's across the board – in the community and in secondary care. 

‘Vacancies are a problem and the funds to invest in senior clinical leadership posts, the consultant nurse role in particular, have significantly decreased. 


Catherine Gamble

‘Nurses carry the largest caseloads and carry the main burden of care, but unlike other professionals they have no ring-fenced time for reflection or supervision. 

‘Stress levels are high and nurses’ own mental health and well-being are suffering.’

The CQC report says a problem with funding remains. Despite promises from government that funding would be increasing, research by the Royal College of Psychiatrists suggested that mental health trusts have seen a fall in real terms since 2012.

Ms Gamble says the result is growing numbers of people with mental health problems turning up at emergency departments because they have no other option.

1,120

Number of sexual incidents in three-month period

She says: ‘Once there, they get turned away or admitted. Why is there no middle ground? Other than suggesting a GP appointment, staff have nowhere to signpost people to. It’s a sign of inadequate service provision.’ 

RCN Emergency Care Association chair Janet Youd agrees: ‘They can have difficulty accessing care in the community when they need it, which is often at night or out of hours.

‘It means they have little choice but to go to emergency departments. If they require admission they often have a lengthy wait for a bed to be found or are admitted on to wards that aren’t appropriate. 

‘This is particularly problematic for children aged 16 and 17 years old as they are too old for children’s wards.’

Further information

State of Care report 2017-2018 Care Quality Commission

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