Hospital Dr News

Mental health services at a cross roads with pressures compromising too many services

There are ongoing problems with access to, and the quality of, specialist mental health services, a CQC report concludes.

The report details the findings from the CQC’s inspections of specialist mental health services over the last three years.

CQC inspectors found that the clear majority of services are caring and compassionate towards their patients, with 88% of NHS and 93% of independent services being rated as good in this key area.

However, the report also identifies several areas of concern: difficulties around accessing services, physical environments not designed to keep people safe, care that is over-restrictive and institutional in nature, and poor recording and sharing of information that undermines the efforts of staff to work together to make sure that people get the right care at the right time.

Dr Paul Lelliott, Deputy Chief Inspector (Lead for Mental Health), commented: “The mental health sector is at a crossroads. The Five Year Forward View for Mental Health, published last year, points the way to a future where people have easy access to high quality care close to home and are able to exercise choice.

“To achieve this vision, the sector must overcome an unprecedented set of challenges – high demand, workforce shortages, unsuitable buildings and poor clinical information systems.

“Some services remain rooted in the past – providing care that is over-restrictive and that is not tailored to each person’s individual needs. This can leave people feeling helpless and powerless. But the best services are looking to the future by working in partnership with the people whose care they deliver, empowering their staff and looking for opportunities to work with other parts of the health and care system.”

By June 2017, CQC inspectors rated 68% of core services provided by NHS trusts and 72% of independent mental health locations as good; with 6% of NHS and 3% of independent core services rated as outstanding.

However, there are a substantial minority of NHS trust and independent services that need to improve the quality of care they provide.

Thirty-nine per cent of NHS trusts were rated as requires improvement as at 31 May 2017, as did 23% of independent services.

A small number were rated as inadequate: one NHS trust and three independent services.

The report identifies several areas of concern:

  • Concerns about ‘locked rehabilitation wards’
  • Great variation between wards in how frequently staff use restrictive practices and physical restraint to deescalate challenging behaviour
  • The impact of staffing shortages
  • Poor quality clinical information systems
  • Commissioning of crisis care services

Dr Andrew Molodynski, national mental health lead of the BMA’s consultants’ committee, said: “This report acknowledges mental health services are under unprecedented pressure as a combination of fewer beds and rising demand putting providers in a position where they rely on the independent or private sector to offer beds.

“The government says the endemic shortage of NHS mental health beds can be solved by improving community care, but this is naïve. While better community care is welcome, it will not ease the bed crisis completely. There needs to be a true parity of esteem between physical and mental health services before we see a meaningful change in the experiences of mental health patients.”

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