25 July 2008
All mental health trusts providing inpatient care have room to make their services more personal, efficient and safe, according to the Healthcare Commission.
The commission carried out the largest-ever review of acute inpatient mental health services, assessing all 69 trusts in England on their care of patients aged between 18 and 65. Its report, The pathway to recovery, published on July 23, said there were wide variations between trusts and between wards in the same trust.
Overall, eight trusts were rated 'excellent' (accounting for 9% of beds), 20 as 'good' (28%), 30 as 'fair' (40%) and 11 as 'weak' (23%). Weak trusts were more likely to be larger and serve an urban, more deprived population.
The trusts were assessed on four criteria: whether they had an effective care pathway from appropriate admission to timely discharge; personalised care; patients' involvement in their personal care plans; and adequate safety measures. No trust scored 'excellent' on all four measures.
The report raised a number of concerns, including high levels of violence and the absence without authorisation of patients detained under the Mental Health Act 1983 on 2,745 occasions over a six-month period.
There were positive findings, including good access to independent advocacy and health promotion programmes.
The report called for better co-ordination to ensure service users did not spend any longer in hospital than necessary and for greater commissioner involvement – only 18% of trusts said commissioners were present at crucial meetings.
Commission chief executive Anna Walker said it was possible to provide excellent acute hospital care but all trusts had room to improve. 'There are cases where people are not always getting the personalised, safe, high-quality care that they need. This is happening at a time of crisis in their lives and it cannot be ignored.'
The Department of Health said it has allocated £130m over the past two years to address the problems highlighted by the report.
NHS Confederation Mental Health Network director Steve Shrubb said: 'The focus on offering alternatives to hospital treatment in the community has led to a group of acute inpatients with more challenging needs. At the same time, inner-city communities still present a particularly difficult set of problems.'
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