Safety has been pinpointed as the “biggest concern” for mental health services in England by the Care Quality Commission, after carrying out its annual review of ratings for health and social care providers.
A total of 9% of both NHS and independent mental health services had a rating of “inadequate” for safety, according to the regulator’s latest data.
In addition, all but three of the health service’s 47 mental health trusts were rated as either “inadequate” or “requires improvement” when assessed for safety.
“In the medium term, providers must manage the risks posed by older buildings to improve patient safety”
CQC State of Care report
The regulator scores providers across five different domains – safety, effectiveness, caring, responsive, well-led. In its analysis of just NHS services, the CQC looked at how safety ratings fared across different types of core services.
Acute wards for working age adults and psychiatric intensive care units were the worst, with 80% receiving inadequate or requires improvement ratings for safety.
This was followed by child and adolescent mental health wards, long stay/rehabilitation wards for working age adults, and wards for older people, which all received one of the poorer ratings in about 60% of cases.
Community mental health and learning disabilities services came out on top, with only 9% assessed as being either inadequate or in need of improvement for safety.
Staffing shortages had contributed to poor safety ratings, said the CQC in its State of Care report, noting national figures showing a continuing decline in mental health nurses.
”Our inspectors have also flagged a problem with experienced staff reaching retirement age, and not enough nurses being trained or retrained,” said the report.
“Our inspectors have flagged a problem with experienced staff reaching retirement age, and not enough nurses being trained”
CQC State of Caring report
Problems with the physical environment “frequently” contributed to inadequate or requires improvement ratings in inpatient services, the CQC emphasised.
Common issues were problems with the layout of some wards that meant staff had poor lines of sight and difficulty in observing some parts of the ward, risks from potential ligature anchor points, failure to remove mixed-sex accommodation as per guidance and seclusion rooms that did not meet requirements.
“In a number of reports, inspectors explicitly linked the problems they found with the fact that the wards were housed in old or unsuitable buildings,” noted the regulator in its review.
“In the long term, there needs to be greater investment in purpose-built wards that are more suitable for mental health care. However, in the medium term, providers must manage the risks posed by older buildings to improve patient safety,” said the report.
Meanwhile, when comparing overall ratings, NHS mental health providers received worse scores than independent providers.
Around 2% of the 47 NHS providers were rated as inadequate and the majority – 64% – as requires improvement. Just 34% were assessed as good, and none as outstanding at the time data was collected at the end of July – though two providers have since achieved this rating.
In contrast, at the 161 independent mental health service locations, while 5% were rated as inadequate and 27% were told they required improvement, 64% were assessed as being good and seven (4%) were outstanding.
The report noted a high proportion of mental health services were provided by independent mental health hospitals, adding that they offered a lot of the same services as NHS mental health services and were, therefore, often commissioned by the NHS.
The CQC’s annual report also highlighted trends in social care and mental health settings.