CQC unveils new approach to inspecting specialist mental health services

29 November 2013

The Care Quality Commission (CQC) is to put a greater emphasis on inspecting the care that people with mental health problems receive in the community, the regulator revealed today (29 November).

The changes are set out in A fresh start for the regulation and inspection of mental health services.

More than 1.5 million adults used community mental health services last year. To date, CQC’s inspections have tended to focus on hospitals, but recognising the importance of community services to people’s experience of care, including the experience of people on community treatment orders, CQC will inspect more of these services. 

This new approach will also look at how community mental health services work with other organisations that are important in supporting recovery in mental health.

Specialist mental health services - in and out of hospital - are used by people whose health may make them particularly vulnerable and who may not have the capacity to make decisions for themselves. In cases where people are detained under the Mental Health Act for treatment or where they have had their liberty restricted, CQC will focus more sharply on ensuring that their rights are protected.

Central to CQC’s approach are new ways of engaging with people who use services, their families and carers, during inspections and at other times. This will include helping CQC to develop its new ways of working. Complaints made by people who use services will be a key source of information. People who use services, mental health experts and organisations are also helping CQC formulate its new approach.

The regulator will also introduce ratings for specialist mental health services that reflect the reality of the care people receive. Ratings are intended to drive improvements, making it clear that people should expect services that are good, not services that only aspire to meet minimum standards.

Professor Sir Mike Richards, CQC’s Chief Inspector of Hospitals, said:“The needs of people with mental health problems run through all the areas that CQC regulates and we have recognised that we need to strengthen our approach to regulating specialist mental health services to ensure that people get care that is safe, effective, caring, responsive to people’s needs and well led. I regard this as every bit as important as the changes I am making to the way we regulate acute hospitals.

“Our new approach will bring together both strands of CQC’s work in relation to mental health – our work under the Mental Health Act and how we regulate mental health services.

“I am appointing a Deputy Chief Inspector for Mental Health who will work with me, leading expert inspection teams who will spend more time listening to people who use services, carers and staff.”

Minister for Care and Support Services Normal Lamb said: “We are determined to reach a point where mental health has equal priority with physical health on the NHS.

“Improving inspections of mental health services plays a key part to this – the new Chief and Deputy Chief Inspector of Hospitals will help root out poor mental health care and point to interventions when things need to be put right.  Introducing specialist inspectors and new ratings will also help drive up standards across the board and improve care.”

Jenny Edwards CBE, Chief Executive of The Mental Health Foundation, said: “We welcome CQC’s new approach and commitment to improve mental health services, with its greater emphasis on community services and increased focus on listening to people with lived experience. We particularly welcome the greater emphasis on an individual’s legal rights under the Mental Capacity Act and Deprivation of Liberty Safeguards.

“We look forward to seeing the guiding principles of the Act firmly embedded in every day practice by mental health services. We are dealing with some of the most vulnerable members of our society and it is vital that their voices are at the heart of the regulation of mental health services.”

Paul Farmer, Chief Executive of Mind said: “We welcome this new approach by the CQC to monitoring and regulating mental health services. It is vital people with mental health problems have a high level of confidence in the services they use, especially as it is one of the very few areas of care where vulnerable people can be treated against their will. This approach has the potential to be a step-change that will look in detail at the journeys of people throughout different parts of the system and which seeks to involve people with experience at every point in the scrutiny of services.”

CQC Board member Professor Louis Appleby said: “At the heart of CQC’s new approach is that it will tailor the focus of inspections on the issues that matter to people. Protecting the rights of detained patients is of particular significance for CQC, not only because of its dual responsibilities under the Mental Health Act and Health and Social Care Act but also because this is the only group of people who are treated against their will – so focusing on the rights and the experience of people subject to detention is critical.”

The main changes proposed are:

• Including Mental Health Act specialists on all inspections of mental health services and bringing together CQC’s work under the Mental Health Act and how it regulates mental health services
• Inspection teams of specialist inspectors, experts by experience and professional experts
• Ratings for mental health services – services will be rated outstanding, good, requires improvement, or inadequate
• New ways of engaging with people who use services, their carers and families, during inspections and at other times
• Greater focus on community mental health services
• Making sure we have better information about mental health services and developing our intelligent monitoring system for these services
• Looking at how people are cared for as they move between services
• Recognising that mental health treatment and support is part of services in all sectors

We will begin to pilot our new inspection approach, starting with the NHS but with the aim of expanding this to other specialist mental health providers, including independent sector services. In our first wave of pilot inspections, we have selected five trusts that provide some or all of the identified cores services, including one trust that also provides community health services where we will carry out a joint inspection. The five trusts are: Coventry & Warwickshire Partnership NHS Trust; Devon Partnership Trust; Dudley & Walsall Mental Health Partnership NHS Trust; South West London & St George’s Mental Health NHS Trust; and Solent NHS Trust.

The new way of regulating specialist mental health services will also reflect emerging concerns, for example:

• Deaths under mental health care – people in the care of specialist mental health services are a high risk group for suicide; unidentified, poorly treated or preventable physical illness contribute to premature mortality, as well as specific concerns such as deaths caused by restraint;
• The experience of people who have a mental health crisis or who are admitted to hospital – the availability and responsiveness of services to supporting people through crisis and preventing admission to hospital; growing numbers of people being admitted to hospital far away from their home area because of severe pressures on their local acute or admission wards;
• Transitions and interfaces between services – including the transitions between child and adolescent mental health and adult mental health services and between services for adults and older adults and interfaces between services for people in contact with the criminal justice system who have mental health needs.

For media enquiries, call the CQC press office on 020 7448 9401 during office hours or out of hours on 07917 232 143.

For general enquiries, call 03000 61 61 61.

Notes to editors

The Chief Inspector of Hospitals is responsible for:

Hospital services for people with mental health needs, learning disabilities and problems with substance misuse

These services are for people with mental health needs, learning disabilities or autism, who are admitted to hospital to stay for assessment or treatment. This might include providing care, treatment and support for people detained under the Mental Health Act 1983 (MHA) or by an authorisation under the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLs).

These services may also include inpatient treatment for people with problems with substance misuse.

Community-based services for people with mental health needs

These services provide care, treatment and support in the community for people with mental health needs, through a wide range of services. They employ a broad range of health and social care professionals mainly in multi-disciplinary teams.

Community services may also have certain responsibilities to people subject to the Mental Health Act

Ratings will be made on a four-point scale: outstanding, good, requires improvement, inadequate.

Jenny Edwards CBE, Chief Executive of the Mental Health Foundation

Jenny has had an impressive and a varied career across a number of sectors and is passionate about social justice. She has over 20 years’ experience of operating at senior level in various organisations, including being CEO of the national charity Homeless Link, and interim CEO of Interights, a human rights charity. She was instrumental in founding the Making Every Adult Matter alliance on the multiple needs of mental health, addiction, homelessness and offending.

Over the years she has also worked in cultural organisations such as Arts England and ran the National Campaign for the Arts. For the last year she has been running her own consulting company, Taproot Consultancy, which focuses on severe and multiple disadvantages.

Jenny was awarded a CBE for services to disadvantaged people in 2011.

Paul Farmer, Chief Executive of Mind

Paul Farmer has been Chief Executive of Mind, the leading mental health charity working in England and Wales, since May 2006.

Paul is Chair of the Disability Charities Consortium and Chair of the Equalities and Diversity Forum panel on human rights. He is also Chair of the NHS England Mental Health Safety Board. He is an advisor to the Catholic Bishops on mental health and was on the Metropolitan Police commission on policing and mental health.

He is a trustee at the Mental Health Providers Forum, an umbrella body for voluntary organisations supporting people with mental distress.

In November 2012 Paul received an Honorary Doctorate of Science from the University of East London in recognition for achievements in promoting the understanding and support of mental health.

Nominated by sector experts and voted by chief executives, Paul was selected most admired charity chief executive in the Third Sector Most Admired Charities Awards 2013.