Sexual safety on mental health wards

Care Quality Commission, September 2018

Care Quality Commission report based on an analysis of nearly 60,000 reports that found 1,120 sexual incidents involving patients, staff, visitors and others described in 919 reports – some of which included multiple incidents. More than a third of the incidents (457) could be categorised as sexual assault or sexual harassment of patients or staff.  Providers and people who use services told the CQC:

  1. People who use services do not always feel that they are kept safe from unwanted sexual behaviour
  2. Clinical leaders of mental health services do not always know what is good practice in promoting the sexual safety of people using the service and of their staff
  3. Many staff do not have the skills to promote sexual safety or to respond appropriately to incidents
  4. The ward environment does not always promote the sexual safety of people using the service
  5. Staff may under-report incidents and reports may not reflect the true impact on the person who is affected
  6. Joint-working with other agencies such as the police does not always work well in practice

Click here to view the full report.

Mental health rehabilitation inpatient services: Ward types, bed numbers and use by clinical commissioning groups and NHS trusts

Care Quality Commission, March 2018

Report from the Care Quality Commission looking at mental health rehabilitation inpatient services that finds:

  1. People are often receiving care a long way from where they live and from their support networks, which in turn can affect their onward recovery and wellbeing.
  2. People are being accommodated in services that are ‘dislocated’ from their home areas. This is more prevalent in the independent sector than in NHS services on average (49km) compared with NHS patients (14km).
  3. The independent sector
    1. Provided more wards that were categorised as either locked rehabilitation or complex care (75% of wards of this type) and fewer wards categorised as long stay, community or high dependency (25% of beds of this type).
    2. Accommodated patients who had been on that particular ward for longer (median 444 days compared with 230 days in the NHS) and in hospital continuously for longer (median 952 days compared with 492 days in the NHS).
    3. Because of the longer length of stay, accommodated patients whose current placement had cost twice as much (median £162K compared with £81K)

4. There is very wide variation between CCG areas in the use of rehabilitation beds, and in the use of beds that are out of area.
The report estimates that the annual expenditure on mental health rehabilitation beds is about £535 million. Out of area placements account for about two-thirds of this expenditure.   The 10% of CCGs that fund the highest number of places are spending an average of at least £19,000 per day on this element of provision – of which £8,200 is spent on independent sector provision; the majority of which is out of area.

Click here to view the full report.

Mental Health Act: the rise in the use of the MHA to detain people in England

Care Quality Commission, January 2018

Between 2005/06 and 2015/16, the reported number of uses of the Mental Health Act (MHA) increased by 40%. It is well established that people from Black and minority ethnic groups are much more likely to be detained than those in White British groups. In October 2017, in response to these and other concerns, the government announced an independent review of the MHA. This review will make recommendations for improvements to legislation and practice in late 2018.  This paper identifies the following key factors:

  • Changes in mental health service provision and bed management
  • Demographic and social change
  • Legal and policy developments that have influenced practice
  • Data reporting and data quality

Click here to view the full report.

State of Care 2016-17

Care Quality Commission, October 2017

The CQC’s annual report on the state of the health and social care shows that the quality of care has been maintained despite some very real challenges. However, the complexity of demand for health care and adult social care services in England continues to rise.  The number of people with complex, chronic or multiple conditions is increasing. We have an ageing population, and the total number of years people can expect to live in poorer health continues to rise. These and other factors present different pressures in different parts of the system and care providers are under increasing pressure.

Click here to view the full report.

A trade in people: the inpatient healthcare economy for people with learning disabilities and/or autism spectrum disorder

Centre for Disability Research, University of Lancaster (CeDR), June 2017

This report finds that around half of inpatient services for people with learning disabilities or autism are being run by the independent sector rather than the NHS. Over a quarter of a billion pounds of public money every year is being paid to independent sector companies to run these services.  The report calls for greater scrutiny of these independently provided services to ensure they are providing a high quality of care.

Click here to view this report.

Monitoring the Mental Health Act in 2015/16

NHS Confederation, November 2016

In its annual review of the Mental Health Act, published on Friday 18 November, the Care Quality Commission (CQC) outlined how several healthcare services in England are using the Act to maximise people’s recovery, wellbeing and support when they have been detained; however, it raises concerns that progress needs to happen at a faster pace for key issues, such as patient involvement and protection of rights.

Click here to view related materials.