Concern for specialist mental health services in ‘perfect storm’

In its annual State of care report, the Care Quality Commission said these issues were presenting challenges across all care settings, with geographic disparities causing particular problems in some areas.

The report considers the pressures faced by health and social care as a whole, but focuses particularly on inpatient mental health and learning disability services, where the CQC said there was an impact on quality.

It said the overall quality picture for the mental health sector remains stable, with quality ratings maintained overall. However, this masked a ‘real deterioration' in some specialist inpatient services, the regulator said. Using more up-to-date figures than the report itself, which used a cut off of the end of July, it highlighted the growth in inadequate ratings:

• 10% of inpatient services for people with learning disabilities and/or autism, compared to 1% in 2018
• 7% of child and adolescent mental health inpatient services (2018: 3%)
• 8% of acute wards for adults of working age and psychiatric intensive care units (2018: 2%)

Fourteen independent mental health hospitals that admit people with a learning disability or autism have been put into special measures since October last year. Two have since improved, three are closed and one is closed to new admissions with no people resident.

Ian Trenholm (pictured), CQC chief executive, said that the deterioration in inpatient mental health service ratings was connected to staff shortages or care delivered by staff who aren’t trained or supported to look after people with complex needs. ‘Increased demand combined with challenges around workforce and access risk creating a perfect storm,' he said, 'meaning people who need support from mental health, learning disability or autism services may receive poor care, have to wait until they are at crisis point to get the help they need, be detained in unsuitable services far from home, or be unable to access care at all.’

Sally Warren, director of policy at The King’s Fund said the report was further evidence that staffing is the make or break issue across the NHS and social care. ‘Staff are working under enormous strain as services struggle to recruit, train and retain enough staff with the necessary skills,’ she said. ‘The alarming decline in the quality of specialist inpatient services is a particular concern as these services care for some of society’s most vulnerable people.’ She called for workforce shortages to be addressed and models of care put in place that provide high quality care and support.

Sean Duggan, chief executive of the Mental Health Network, said mental health providers faced ‘incredible challenges’, with extreme workforce pressures and an urgent need for investment in modern, appropriate settings. ‘It is clear that more funding needs to reach mental health services, particularly for those with learning disabilities,’ he said. ‘And it is a testament to the hard work of staff that they have managed to sustain good-quality care under these conditions.’