'Perfect Storm' Warning Over NHS Mental Health Care

Peter Russell

October 15, 2019

Inspectors said they were concerned that growing pressures on hospitals in England risked creating a "perfect storm" for patients with mental health problems, learning disabilities, and autism.

An audit by the Care Quality Commission (CQC) also warned of deteriorating performance in hospital emergency departments.

Inpatient Mental Health Services

The annual report by the CQC assesses performance in the health and social care sector, but this year's State of Care focused particularly on inpatient mental health and learning disability services.

It found that while overall quality for the mental health sector remained stable, it masked deterioration in some specialist inpatient services. As of the end of September 2019:

  • 10% of inpatient services for people with learning disabilities and/or autism were rated inadequate, compared to 1% in 2018

  • 7% of child and adolescent mental health inpatient services were rated inadequate, compared to 3% in 2018

  • 8% of acute wards for adults of working age, and psychiatric intensive care units, were rated inadequate, compared to 2% in 2018

Between October 2018 and September 2019, 14 independent mental health or learning disability hospitals that admit people with a learning disability or autism were rated as inadequate and put into special measures, a situation the CQC described as "unacceptable".

Inspectors found that in the majority of cases where mental health inpatient services were rated as inadequate or needing improvement, a lack of appropriately trained staff was an issue, reflecting a national shortage of specialist nurses.

Ian Trenholm, CQC chief executive, commented: "Increased demand, combined with challenges around workforce and access risk creating a perfect storm – 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."

Plans to expand the mental health workforce to meet an increase in demand must be accelerated, the CQC said.

Sally Warren, director of policy at The King's Fund commented: "Long held ambitions to put mental health on a par with physical health can only be delivered if sufficient numbers of suitably qualified and skilled staff are available.

"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."

Accident and Emergency Departments

Performance in accident and emergency (A&E) departments continued to get worse while attendances and admissions continued to rise.

The audit found that 44% of urgent and emergency services were rated as requiring improvement, and 8% as inadequate.

Waiting times longer than 4 hours were highest in July than any previous July for at least the last 5 years.

What used to be a winter problem was now an all-year feature, the report said.

There had also been an increase in referral to treatment times over the last year, with 4.4 million people at the end of June 2019 waiting to start treatment – an increase of 40% since June 2014.

"Staff continue to do an incredible job, but the strain is starting to show," said Peter Wyman, CQC chair. "Emergency departments were the core service that our inspectors were most likely to rate as 'inadequate' or 'requires improvement'." 

Dr Nick Scriven of the Society for Acute Medicine described the situation as frightening.

"At some point in the near future all these sustained and repeated problems with increasing demand, inadequate workforce that is haemorrhaging senior cover, the pension tax crisis, crumbling estates, insufficient community medical care and community social care in general totally under provisioned, we will reach a vital tipping point and care will be compromised despite all the heroic efforts by the human side of this, the staff in post," he said.

Adult Social Care

The stability of the adult social care system remained a concern for the CQC.

It estimated that 1.4 million older people do not have access to all the care and support they needed.

Staffing problems were a key feature of the fragile market. On two occasions in 2018, the CQC had to notify local authorities of a credible risk to service disruption because of potential failure of a provider's business.

There was still no consensus on how adult social care should be funded in the future, the report noted.

In the Queen's speech on Monday, the Government promised to bring forward proposals to reform adult social care in England.

However, the Alzheimer's Society criticised ministers for failing to include any detailed plans. Jeremy Hughes, the Society's CEO said: "The dire state of social care is resulting in more and more people with dementia being rushed to hospital with falls, dehydration, infections, and other avoidable emergencies."

Richard Murray, chief executive of The King's Fund, said: "Whilst we welcome the Government's commitment to bring forward proposals to reform adult social care, it's time for the Government to stop just saying they will fix it and to show us how they plan to do so."

Prof Andrew Goddard, president of the Royal College of Physicians said: "The Government now needs to recognise the scale of the challenge. Only sustained investment and thoughtful transformation of social care will deliver a service that meets the growing needs of our ageing population."

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