Response to the Healthcare Commission’s review of NHS acute inpatient mental health services

Embargoed until Wednesday, July 23, 2008

The Royal College of Psychiatrists welcomes this detailed review of NHS acute inpatient mental health services by the Healthcare Commission.

It is encouraging to see that two-fifths of trusts exceeded the minimum level of service provision. However, it is disappointing that no trusts were scored excellent on all four of the key criteria against which performance was assessed.

Professor Dinesh Bhugra, president of the Royal College of Psychiatrists, said: “It is a matter of great concern to us that, according to the Healthcare Commission’s analysis, trusts scoring ‘weak’ not only operate larger wards but are more likely to be serving an urban, more deprived population. There is a postcode lottery in terms of mental health services, and these types of inequalities should be unacceptable in this day and age.”

The Royal College of Psychiatrists acknowledges that some progress has been made in bringing average bed occupancy rate down, and congratulates trusts who have made improvements. But significant variations remain.

Professor Bhugra said: “We are pleased that the average bed occupancy rate is now down to 87%. However, this figure conceals major regional variation. As the report points out, there has been an ‘escalation’ of bed occupancy rates in some areas. Two-fifths of trusts have occupancy rates over 90% and one in 10 have rates in excess of 100%.

“We note with interest that these trusts serve more urban-based populations and have a higher number of service users from black and minority ethnic groups. We are concerned that there are particular groups of people who are still not getting the quality of care they deserve. We agree that more work needs to be done in partnership with patients and carers. Our Fair Deal campaign deals with many of these issues and we look forward to developing these themes further.”

Professor Bhugra paid tribute to the dedication of mental health professionals across England. He said: “We appreciate the hard work that staff are putting in under difficult circumstances. However, as this report highlights that there remain clear gaps in staff training which must be taken on board by service providers. For example, only a quarter of staff say they have received training in how to ask service users about their use of alcohol or drugs. We need improved training for staff on working with people with a dual diagnosis.”

The Royal College of Psychiatrists is delighted that the Healthcare Commission has acknowledged the success of a number of College initiatives on quality assurance, such as the Accreditation for Acute Mental Health Services (AIMS) and the ECT Accreditation Service (ECTAS).

Many of the recommendations made in the report tie in closely with the College’s current work. Professor Sue Bailey, the Registrar of the Royal College of Psychiatrists, said: “We are very pleased that one of the Healthcare Commission’s key priorities is to increase the effectiveness of the acute care pathway (priority area 4). This is a priority for us too, and we are currently recruiting a new College lead on pathways of care.”

Professor Bailey continued: “Other priorities identified by the Commission include ensuring the safety of service users, staff and visitors (priority area 2), and providing appropriate and safe interventions (priority area 3). Within the last two months, the Royal College of Psychiatrists has published two reports on these issues. Our Rethinking Risk to Others in Mental Health Services report makes ten recommendations to improve the assessment and management of risk, which the College is already working on with other agencies. And our Psychological Therapies in Psychiatry and Primary Care report outlines ways to improve the provision of these therapies in both primary and secondary care settings.” 

Professor Bhugra concluded: “The Royal College of Psychiatrists looks forward to continuing its work with the Healthcare Commission and other key stakeholders on improving the quality of mental health services across all jurisdictions."

References:

The Healthcare Commission (2008) The Pathway to Recovery - A review of NHS acute inpatient mental health services