Getting it right for people admitted to a mental health ward

Dr Paul Lelliott, Deputy Chief Inspector of Hospitals and lead for mental health at the Care Quality Commission

All those who would benefit from treatment for a mental health problem should be able to access high quality, safe care, and be protected from avoidable harm.

Part of CQC’s role is to speak honestly and openly about what we find when we inspect services and to say what we think should be done to address problems. Last year, in our report on the State of care in mental health services 2014–2017, we talked about the difficult conditions on many mental health wards. Since then, CQC has used State of Care and its ‘independent voice’ to raise the profile of this issue. We have published reports on Sexual safety on mental health wards and on Mental health rehabilitation services. Also, CQC is working with NHS Improvement to deliver the Mental health safety improvement programme — whose early priorities are the use of restraint and sexual safety on mental health wards.

We are concerned about the high levels of violence on mental health wards, the sexual safety of patients and staff, staff shortages, old and unsuitable buildings that are not fit for the 21st century, shared-sleeping arrangements where two or more people sleep in the same room, and the high number of people admitted to wards many miles from their home. We have also commented on the great variation between providers in how frequently staff use restrictive practices and physical restraint to manage challenging behaviour.

With the publication today of the Independent Review of the Mental Health Act, and the imminent publication of the long-term plan for mental health, there is an opportunity to make real improvements. We hope and anticipate that the long-term plan will include a genuine and funded commitment to improve conditions on mental health wards for the many thousands of people who are admitted each year — some of whom spend many months, or even years, in hospital.

For its part, CQC will ensure that its inspections of mental health inpatient services properly assess whether wards offer a fit environment for safe and dignified care, whether they have enough staff with the necessary skills, whether patients and staff are protected from harm and whether patients have access to the full range of effective treatments — and not just medication. Our ratings and judgments must accurately reflect what we find.

To this end, we plan to work with partners, providers and those with lived experience to ensure that we are applying CQC’s ratings characteristics appropriately to mental health inpatient services; so that our ratings properly reflect the experience of patients.

We will also be looking further into restrictive practices in the new year. The Secretary of State for Health and Social Care has asked CQC to undertake a review of segregation, prolonged seclusion and restraint. The review will focus on people with mental health problems, a learning disability and/or autism who are receiving care on mental health wards or in other types of residential settings. This review very much relates to our concerns about the safety and quality of the physical, social and therapeutic environment of mental health wards. We are committing to ensuring this review is robust, and that the findings and recommendations bring about meaningful improvement. We will therefore be publishing an interim report in May and a final report by spring 2020. However, we will share learning with partner organisations as we go along.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

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