Wednesday 01 Apr 2009 @ 09:53
Care Quality Commission
Care Quality Commission
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MORE IMPROVEMENTS NEEDED IN ADULT COMMUNITY SPECIALIST MENTAL HEALTH SERVICES
Almost half of people needing specialist community mental healthcare still do not have a number to contact out-of-hours if they are in a crisis while 55% of people with schizophrenia have not been offered recommended psychological therapies.
The Healthcare Commission yesterday published a report detailing progress by all 68 NHS specialist community mental health trusts since it reviewed community adult mental health services in 2005/06. This was a follow-up review designed to promote further improvement in this area.
The report covers the period of 2007/08 and details some improvement in a number of important areas. These include: involvement of service users in their care and treatment; ensuring that people with mental health problems receive annual reviews of their physical health; offering an assessment of work status and vocational aspirations.
However, the Commission said there remained significant room for improvement before all trusts were meeting best practice and guidelines by the National Institute for Clinical Excellence (NICE).
There remain particular problems for people with schizophrenia in accessing recommended psychological therapies and in ensuring that their preferences for treatment and medication in the event of a psychotic episode are documented.
Support for service users out-of-hours has shown some improvement but still remains far below recommended levels.
The report also calls for more accessible and effective services to help people with mental health problems get back to work.
Anna Walker, the Commission’s chief executive, said: “It is right that people with mental health problems are increasingly getting care in the community, rather than as inpatients in a hospital. But it is vital that people have access to the services they need. While it is very encouraging that there have been some improvements since we reviewed this area in 2006, this report shows that significant gaps still exist, particularly in important areas such as access to out-of-hours support for people with a mental health problem and psychological therapies for people with a diagnosis of schizophrenia. This situation must change.”
Access to out-of-hours support: All people with mental health problems should be able to contact services and get support 24 hours a day. In the 2007/08 survey of community mental health service users 54.7% said they had an out-of-hours contact, up from 49.5% in 2005/06. One third of trusts improved performance in this area.
Access to psychological therapies: NICE guidelines are that 100% of people with schizophrenia who experience ongoing psychotic symptoms be offered psychological therapy. A review of 7,000 sampled case notes of the 68 adult specialist mental health trusts in 2007/08 revealed that only 45.2% of eligible people were offered this therapy, showing no overall improvement since 2005/06 (45.7%).
Service users receive a copy of their care plan: According to the National Service Framework for mental health, all people receiving treatment for mental health problems should receive a copy of their care plan. A review of case notes in 2007/08 showed that 59% of service users received a copy of their plan, up from 52.9% in 2005/06. More than 40% of trusts improved performance in this area.
Care plans containing ‘advance directives’ or ‘crisis and contingency plans’: According to NICE guidelines, care plans for all people with schizophrenia should contain a directive of how the patient wants to be treated in the event of an acute episode. A review of care records at each trust during 2007/08 showed that one in five of the care plans sampled did not contain an advance directive or crisis and contingency plan. 80.3% contained an advance directive, down from 81.9% in 2005/06.
Care plans outlining choice of antipsychotic drug: Under NICE guidelines, care plans for people with schizophrenia should also specify choice of antipsychotic drug. In 2007/08, 24.8% of relevant care plans contained a preference of antipsychotic drug, up from 21% in 2005/06. Twenty-six per cent of trusts improved in this area.
Involving people in decisions about their care and treatment: Involving people in their care is an important factor in recovery. In the 2007/08 survey of people who use community mental health services, 64.2% said they had enough say in their care and treatment, 63.5% said they had a say in decisions about their medication and 64.8% said their diagnosis was discussed with them. These are all slight improvements on the 2005/06 survey (63.5%, 62.4% and 63.3% respectively).
Physical health checks: People with mental health problems are more likely to experience physical health problems. NICE guidelines are that all people with schizophrenia are offered a physical health screen at regular intervals. A review of a sample of case notes at each trust showed that in 2006/07 82.1% of those with schizophrenia received a check, compared to 80.9% in 2005/06.
Assessment of work status and ambitions: People with mental health problems are much less likely to be employed than the general population. NICE guidelines are that all people with schizophrenia should have a comprehensive assessment, detailing whether they are working and what work they would like to do. A review of a sample of case notes at each trust in 2007/08 showed significant improvement in the number of people receiving such an assessment – 77.2% up from 64.3% in 2005/06.
Getting help to find work: While the results show significant improvement in the number of people with schizophrenia getting an assessment of their work status, the 2007/08 survey of community mental health service users shows there has been no improvement in the number that actually get help to find work. 49.4% of those who would like help did not receive it (49.6% in 2005/6).
Information on the Healthcare Commission
The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.
Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.
The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.
From 1 April 2009, the Care Quality Commission will bring together the work of the Commission for Social Care Inspection, the Healthcare Commission, and the Mental Health Act Commission. The new commission will regulate the quality of care in health and adult social care and look after the interests of people detained under the Mental Heath Act. This is the first time that independent regulation of health, mental heath and social care has been brought together in this way.
For further information contact Emma Reynolds in the press office on 0207 448 9237, or on 07917 232 143 after hours.
The Healthcare Commission yesterday published a report detailing progress by all 68 NHS specialist community mental health trusts since it reviewed community adult mental health services in 2005/06. This was a follow-up review designed to promote further improvement in this area.
The report covers the period of 2007/08 and details some improvement in a number of important areas. These include: involvement of service users in their care and treatment; ensuring that people with mental health problems receive annual reviews of their physical health; offering an assessment of work status and vocational aspirations.
However, the Commission said there remained significant room for improvement before all trusts were meeting best practice and guidelines by the National Institute for Clinical Excellence (NICE).
There remain particular problems for people with schizophrenia in accessing recommended psychological therapies and in ensuring that their preferences for treatment and medication in the event of a psychotic episode are documented.
Support for service users out-of-hours has shown some improvement but still remains far below recommended levels.
The report also calls for more accessible and effective services to help people with mental health problems get back to work.
Anna Walker, the Commission’s chief executive, said: “It is right that people with mental health problems are increasingly getting care in the community, rather than as inpatients in a hospital. But it is vital that people have access to the services they need. While it is very encouraging that there have been some improvements since we reviewed this area in 2006, this report shows that significant gaps still exist, particularly in important areas such as access to out-of-hours support for people with a mental health problem and psychological therapies for people with a diagnosis of schizophrenia. This situation must change.”
Access to out-of-hours support: All people with mental health problems should be able to contact services and get support 24 hours a day. In the 2007/08 survey of community mental health service users 54.7% said they had an out-of-hours contact, up from 49.5% in 2005/06. One third of trusts improved performance in this area.
Access to psychological therapies: NICE guidelines are that 100% of people with schizophrenia who experience ongoing psychotic symptoms be offered psychological therapy. A review of 7,000 sampled case notes of the 68 adult specialist mental health trusts in 2007/08 revealed that only 45.2% of eligible people were offered this therapy, showing no overall improvement since 2005/06 (45.7%).
Service users receive a copy of their care plan: According to the National Service Framework for mental health, all people receiving treatment for mental health problems should receive a copy of their care plan. A review of case notes in 2007/08 showed that 59% of service users received a copy of their plan, up from 52.9% in 2005/06. More than 40% of trusts improved performance in this area.
Care plans containing ‘advance directives’ or ‘crisis and contingency plans’: According to NICE guidelines, care plans for all people with schizophrenia should contain a directive of how the patient wants to be treated in the event of an acute episode. A review of care records at each trust during 2007/08 showed that one in five of the care plans sampled did not contain an advance directive or crisis and contingency plan. 80.3% contained an advance directive, down from 81.9% in 2005/06.
Care plans outlining choice of antipsychotic drug: Under NICE guidelines, care plans for people with schizophrenia should also specify choice of antipsychotic drug. In 2007/08, 24.8% of relevant care plans contained a preference of antipsychotic drug, up from 21% in 2005/06. Twenty-six per cent of trusts improved in this area.
Involving people in decisions about their care and treatment: Involving people in their care is an important factor in recovery. In the 2007/08 survey of people who use community mental health services, 64.2% said they had enough say in their care and treatment, 63.5% said they had a say in decisions about their medication and 64.8% said their diagnosis was discussed with them. These are all slight improvements on the 2005/06 survey (63.5%, 62.4% and 63.3% respectively).
Physical health checks: People with mental health problems are more likely to experience physical health problems. NICE guidelines are that all people with schizophrenia are offered a physical health screen at regular intervals. A review of a sample of case notes at each trust showed that in 2006/07 82.1% of those with schizophrenia received a check, compared to 80.9% in 2005/06.
Assessment of work status and ambitions: People with mental health problems are much less likely to be employed than the general population. NICE guidelines are that all people with schizophrenia should have a comprehensive assessment, detailing whether they are working and what work they would like to do. A review of a sample of case notes at each trust in 2007/08 showed significant improvement in the number of people receiving such an assessment – 77.2% up from 64.3% in 2005/06.
Getting help to find work: While the results show significant improvement in the number of people with schizophrenia getting an assessment of their work status, the 2007/08 survey of community mental health service users shows there has been no improvement in the number that actually get help to find work. 49.4% of those who would like help did not receive it (49.6% in 2005/6).
Information on the Healthcare Commission
The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.
Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.
The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.
From 1 April 2009, the Care Quality Commission will bring together the work of the Commission for Social Care Inspection, the Healthcare Commission, and the Mental Health Act Commission. The new commission will regulate the quality of care in health and adult social care and look after the interests of people detained under the Mental Heath Act. This is the first time that independent regulation of health, mental heath and social care has been brought together in this way.
For further information contact Emma Reynolds in the press office on 0207 448 9237, or on 07917 232 143 after hours.
