Date Published: 23 July 2008

Healthcare watchdog highlights best and worst NHS hospital care for people with acute mental health problems

The Healthcare Commission today (Wednesday) said the quality of the services varied widely across the country as it published the most comprehensive assessment of NHS acute inpatient mental health services ever undertaken.

The Commission assessed all 69 NHS trusts providing acute inpatient mental health services in England. This covered 554 wards providing almost 10,000 beds for patients between the ages of 18 and 65.

Overall, eight trusts were rated as “excellent” (accounting for 843 beds – 9%), 20 as “good” (2,808 beds – 28%), 30 as “fair” (3,985 beds – 40%) and 11 as “weak” (2,249 beds – 23%).

The Commission conducted the review following a number of reports over the last decade highlighting concerns about the quality of inpatient mental health services. It was also concerned that the recent focus on community mental health services meant that inpatient services do not always get the funding and attention they need.

The review showed that while some trusts struggle to meet standards, there are a number of high-performing trusts proving that it is possible to provide personalised, safe and good quality acute mental health care.

However, no trust was scored as “excellent” across all four of the key criteria, showing that every NHS mental health provider trust has room to improve services to patients.

The review showed that there were variations between trusts and there were also differences between wards in the same trust.

The higher performing trusts were those that actively involved inpatients in their care, provided meaningful activities in a therapeutic environment and that planned care around the needs of the service users.

The report highlighted a number of positive findings including good access to independent advocacy and to programmes to promote health, such as smoking cessation and healthy eating.

Although the wards assessed in the review are for adults aged 18 to 65, most trusts could access advice and support from specialists in caring for young people and for older people, when needed.

Improvements were noted in the proportion of mental health staff trained in diversity issues from 32% in 2005 to 48% of staff in 2006, and in the proportion of hospital care records that properly recorded the ethnicity of service users, rising from 79% in 2004/2005 to 91% in 2006/2007.

But the report identified areas for action, in particular improving the involvement of patients in their care. The Commission said that despite guidelines to include patients’ views in their care plans, this occurred in only 50% of cases.

Also, one in nine trusts scored “weak” on the criteria relating to safety, showing that in these trusts there was considerable room for improvement in ensuring the safety of service users, visitors and staff.

The Commission raised concerns that, in a six-month period, patients detained under the Mental Health Act 1983 were absent from services without authorisation on 2,745 occasions.

It pointed to high levels of violence, with 45% of nurses and 15% of patients reporting that they were physically assaulted in 2007.

The report said there was insufficient attention to the sexual safety of patients and overcrowding in some trusts. It said more work needed to be done to train staff and to provide specialist services to patients who have mental health problems and who misuse drugs or alcohol.

Crisis resolution home treatment (CRHT) teams, which should be involved in deciding whether admission to hospital is the most appropriate course of action, were only involved in 61% of admissions. Also, 6% of the time people spent in hospital was due to delays in finding accommodation or appropriate support to live within the community.

The report concluded that better co-ordination is needed to ensure that service users do not spend any longer in hospital than necessary and are supported when they move from hospital to community services.

Also, the report suggests that commissioners did not always use information to assess the needs of their communities. Only 18% of trusts said commissioners were present at key meetings to discuss strategic planning and co-ordination of local services.

Anna Walker, the Commission’s Chief Executive, said:

"On behalf of patients we have thrown an intense spotlight on these services in a way that has never been done before.

It is clear that it is possible to provide patients with excellent acute hospital care and that some organisations are doing exactly that. It is also clear that these can be tough places to work and I pay tribute to the dedicated staff who face the challenges on a daily basis.

But our report also shows that there are issues of significant concern and this is particularly true for some organisations.

There are cases where people are not always getting the personalised, safe, high quality care that they need. This is happening at a time of crisis in their lives and it cannot be ignored.

I think that society is sometimes reluctant to talk about mental health care concerns, but I’m afraid the problems are not going to just go away. We need to have the same high expectations for these services as we do for other parts of the NHS.

With the support of trust boards, commissioners and the government, we can get all services up to this benchmark and provide the high standard of care that patients deserve,” she said.

The Commission has almost completed follow-up visits at all 11 trusts rated as “weak”. Action plans are now being implemented to improve services, monitored by the strategic health authorities and by Monitor in the case of foundation trusts.

Organisations, service users and carers can access the results of the review and a range of other information relating to mental health trusts, on the Commission’s new mental health section of its site.

The new section also enables people to see at a glance what thousands of service users said about community mental health services across the country. People can search for their local trust by place name or postcode at: www.healthcarecommission.org.uk/mentalhealth.cfm

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