By John Tingle
The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. They have recently published a report of inspections on specialist mental health services. The report is very thorough and detailed and reveals both good and bad practices. When reading the report however the poor practices identified eclipse the good ones.
Patient safety concerns
Concerns about patient safety are a constant and overarching theme in the report. The CQC biggest concern in this care area is patient safety:
“For both NHS and independent mental health services overall, and for eight of the 11 core services, safe was the key question that we most often rated as requires improvement or inadequate. At 31 May 2017, 36% of NHS core services and 34% of independent core services were rated as requires improvement for safe; a further 4% of NHS core services and 5% of independent core services were rated as inadequate for safe “(29).
There are also other failings identified which require urgent remedy and these include, persistence of restrictive practice, access and waiting times and poor clinical information systems. Some care services appear rooted in the past.
Children and young people care services
Seventy-six per cent of child and young people wards were rated as good, and 6% as outstanding; 66% of community services were rated as good, and 9% as outstanding. Getting access to the services can often be a significant problem. Some services struggled to respond to staffing shortfalls because of inadequacies in systems to support the management of staff.
More focus on safety is needed in this area. A number of providers need to improve their risk assessment and management. In community services, some staff could not find risk assessments, either because they were not easily accessible or they were not routinely recorded. Staff knowledge of safeguarding procedures needs to be improved.
Services for working age adults
Fifty- six per cent of acute wards for working age adults were rated as good, and 5% as outstanding. For long stay/rehabilitation wards, 72% were rated as good and 4% as outstanding. Among community services, 69% were rated as good and 2% as outstanding. Safety of the ward environment was a key issue for Psychiatric intensive care units (PICU) and acute wards. Here the CQC rated only 28% of services as good for safe and 1% as outstanding for safe.
In many cases the underlying safety concerns were based on the ward environment compounded deficiencies in staffing. Some acute wards had mixed sex accommodation which can pose risks. Patients can be vulnerable to sexual abuse. Some wards were found with dormitory accommodation and the point is made in the report that patients who may not have agreed to hospital admission should not be expected to share sleeping accommodation with strangers, some of whom might be agitated.
Most concerning from a basic human rights perspective is the finding by the CQC that good practice in restrictive interventions such as physical restraint and seclusion was far from universal. Staff in some services did not keep good records of restrictive interventions. Blanket restrictions were found in some areas with some patients not having keys to their bedrooms and having restricted access to facilities such as gardens, toilets, drinks and snacks.
This report gives valuable information on what must be done in order to improve mental health care services. The problems have been scoped and action can be taken.History has however not served this care area well. The same problems identified in this report have been well chronicled before in the reports of many organisations over many years. Hopefully substantive and sustainable change will take place. The patient safety challenges identified so clearly in this report are very concerning.