Care Quality Commission
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Too many mental health patients let down on key aspects of hospital care, says CQC

The biggest-ever national survey of people’s experiences of acute mental health inpatient services reveals that too great a proportion feel they were let down in some important aspects of the care they received, says the Care Quality Commission (CQC).

In the survey published today (24 September) by the Commission, more than 7,500 people recently discharged from 64 NHS trusts across England gave their views on each stage of their care from the moment they were admitted to hospital to the support they got after they left. 

The findings from the survey underline two key issues that have been previously identified as priority areas for improvement: focusing on individuals’ needs and ensuring the safety of patients.

Involving patients in decisions about their care and treatment is an important part of meeting their individual needs. When asked about this, though, only a third (34%) of people who responded to the survey said they were involved as much as they wanted to be. 

On patient safety, less than half (45%) said they ‘always’ felt safe on the ward, while 39% ‘sometimes’ felt safe and 16% did not feel safe at all.

Focusing on individuals’ needs and ensuring patient safety were flagged up as the two top priorities for improvement in a review last year of NHS acute inpatient mental health services. Many trusts had performed poorly in both these areas of care.

But as importantly, the new survey showed:

  • a lack of activities available to patients, with 35% saying that there was too little to do on weekdays and even more, 54%, reporting the same for weekends and evenings;
  • limited access to talking therapies (such as counselling, cognitive behavioural therapy and anxiety management), with less than half of the 52% who wanted talking therapies getting any.

Large proportions of patients also reported shortcomings in other aspects of the care they received during their hospital stay:

  • of those who were detained (‘sectioned’) under the Mental Health Act, 27% said they did not have their rights explained in a way they could understand;
  • most patients (86%) reported having physical health checks in hospital – but only 44% of those with physical health problems felt that these were ‘definitely’ taken care of;
  • almost half (48%) of patients said the potential side effects of medicines that  were prescribed to them while in hospital were not explained in a way they could understand.

According to the results of the survey, which was co-ordinated for CQC by the National Centre for Social Research (NatCen), 85% of patients said they were made to feel welcome when they were admitted to hospital.

There was a mixed response about patients’ relationships with hospital staff. Most respondents said that psychiatrists, and to a slightly lesser extent nurses, treated them with respect and dignity, and listened to what they had to say. However, only half of patients said they were ‘always’ given enough time to discuss their condition and treatment with psychiatrists, and the figure for nurses was lower at 41%.

Barbara Young, CQC Chairman, said: “This survey gets to the heart of what it means to provide care that meets people’s individual needs.

“As the care services regulator, we have pledged to ensure that the voices of everyone who uses care services are heard.  This survey shows us that there is considerable room for improvement in patients’ experiences of acute inpatient mental health services, and that there remains a particular need to ensure that services are focused on meeting the needs of people as individuals. 

“It is not acceptable for people to feel unsafe in hospital or for them not to be to given basic information about their care and treatment. All trusts must provide a therapeutic environment in which patients can feel safe and recover. A therapeutic
environment must include adequate access to activities and talking therapies.

“We will be writing to all the trusts covered by the survey to underline the findings, and we will continue to push for improvement through our assessment and registration systems.”

More information on the survey

Notes to Editor:

The 64 trusts covered by the survey include combined mental health and social care trusts, and those foundation trusts and primary care trusts that provide acute mental health hospital inpatient services. It excluded secure and specialist units. Questionnaires were sent to patients aged 16 to 64 who had been discharged following a stay on an acute ward or psychiatric intensive care unit of at least 48 hours. The survey was carried out between April and June this year, and up to 1,000 people per trust discharged from hospital in the 6 months ending 31st December 2008 were sent questionnaires.

The response rate was 28%. Of the respondents, 44% had been detained – or ‘sectioned’ – under the Mental Health Act at some time during their most recent stay in hospital. Only 15% were in paid employment at the time of the survey. Fifty-five per cent of the respondents were female and 17% were from black and minority ethnic groups; 26% were aged 16-35, 43% between 36 and 50, and 31% between 51 and 65.
The results from CQC surveys are used by NHS trusts to help them understand and improve their performance. The Commission has also used the results from each trust in this survey in its annual assessment of their performance (the annual health check for 2008-09) which will be published on 15 October.

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