The Healthcare Commission Report Healthcare watchdog report on acute mental health in-patient care

Largest ever review of acute inpatient mental health services highlights areas for action and shows all have room to improve 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.

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 website.

The website 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 the website for their local trust by place name or postcode at: www.healthcarecommission.org.uk/mentalhealth.cfm

  Acute inpatient mental health service review scores table

Trust	Overall score	Sum of points
Dudley Primary Care Trust	4	15
Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust	4	15
Central and North West London NHS Foundation Trust	4	14
Dorset Healthcare NHS Foundation Trust	4	14
Milton Keynes Primary Care Trust	4	13
North Lincolnshire Primary Care Trust	4	13
Shropshire County Primary Care Trust	4	13
South Staffordshire Healthcare NHS Foundation Trust	4	13
Cornwall Partnership NHS Trust	3	12
Gloucestershire Partnership NHS Foundation Trust	3	12
North East Lincolnshire Primary Care Trust	3	12
Oxleas NHS Foundation Trust	3	12
South Essex Partnership NHS Foundation Trust	3	12
Barnsley Primary Care Trust	3	11
Berkshire Healthcare NHS Foundation Trust	3	11
Cheshire and Wirral Partnership NHS Foundation Trust	3	11
Hampshire Partnership NHS Trust	3	11
Lincolnshire Partnership NHS Foundation Trust	3	11
Camden and Islington Mental Health and Social Care Trust	3	10
Humber Mental Health Teaching NHS Trust	3	10
Northamptonshire Healthcare NHS Trust	3	10
Nottinghamshire Healthcare NHS Trust	3	10
Oxfordshire And Buckinghamshire Mental Health Partnership NHS Trust	3	10
Pennine Care NHS Trust	3	10
Portsmouth City Teaching Primary Care Trust	3	10
Suffolk Mental Health Partnership NHS Trust	3	10
Sussex Partnership NHS Trust	3	10
Tees, Esk And Wear Valleys NHS Trust	3	10
Barnet, Enfield and Haringey Mental Health NHS Trust	2	9
Bedfordshire and Luton Mental Health and Social Care NHS Trust	2	9
Bolton, Salford and Trafford Mental Health NHS Trust	2	9
Bradford District Care Trust	2	9
Cambridgeshire and Peterborough Mental Health Partnership NHS Trust	2	9
Devon Partnership NHS Trust	2	9
Dorset Primary Care Trust	2	9
Herefordshire Primary Care Trust	2	9
Isle Of Wight NHS Primary Care Trust	2	9
North Essex Partnership NHS Foundation Trust	2	9
Sandwell Mental Health NHS and Social Care Trust	2	9
Surrey and Borders Partnership NHS Trust	2	9
Coventry And Warwickshire Partnership NHS Trust	2	8
Cumbria Partnership NHS Foundation Trust	2	8
Hertfordshire Partnership NHS Foundation Trust	2	8
Leeds Mental Health Teaching NHS Trust	2	8
Mersey Care NHS Trust	2	8
North Staffordshire Combined Healthcare NHS Trust	2	8
Plymouth Teaching Primary Care Trust	2	8
Somerset Partnership NHS and Social Care Trust	2	8
South West London and St George’s Mental Health NHS Trust	2	8
South West Yorkshire Mental Health NHS Trust	2	8
5 Boroughs Partnership NHS Trust	2	7
Derbyshire Mental Health Services NHS Trust	2	7
East London and The City Mental Health NHS Trust	2	7
Kent And Medway NHS And Social Care Partnership Trust	2	7
Norfolk and Waveney Mental Health Partnership NHS Trust	2	7
South London and Maudsley NHS Foundation Trust	2	7
Walsall Teaching Primary Care Trust	2	7
Worcestershire Mental Health Partnership NHS Trust	2	7
Avon and Wiltshire Mental Health Partnership NHS Trust	1	6
Lancashire Care NHS Trust	1	6
Leicestershire Partnership NHS Trust	1	6
Manchester Mental Health and Social Care Trust	1	6
North East London Mental Health NHS Trust	1	6
North Yorkshire And York Primary Care Trust	1	6
Northumberland, Tyne And Wear NHS Trust	1	6
Sheffield Care Trust	1	6
West London Mental Health NHS Trust	1	6
Birmingham and Solihull Mental Health NHS Trust	1	5
Wolverhampton City Primary Care Trust	1	4
Source: Healthcare Commission