Vanessa Ford recently joined us as national advisor for mental health nursing. We caught up with Vanessa to talk to her about her role and what brought her to CQC.
For the benefit of those who don't know about the work you do, perhaps you could briefly explain the role please?
Myself and Jonathan Warren (fellow mental health nursing national advisor) have been chairing inspections, we've sat on NQAGs (National Quality Assurance Groups) which is where reports are quality assured and supported, and we've been asking questions around how assurance is given, how the reports come to their decisions and what the ratings are.
When questions have come up out of the NQAGs (for example around seclusion or care planning), we have been asked to provide specific guidelines or an advisory position. What we have done, is set up a network of directors of nursing – all experts in their field, so if we are providing advice, we go out to consultation with those people. An example that came up recently was around dormitories in rehabilitation wards, we asked those experts what CQC's position should be.
After seeking that advice, we drafted guidelines and sent them out to the mental health nurses to see if they fitted with what they would expect. We then made the relevant adjustments, and it went through to Paul (Lelliot) to consider with the policy team to make sure that the inspections are as practical as possible and support service development.
I think part of what I see my role doing is trying to safe guard the CQC from the unintended consequences. I will give you an example. Say that the CQC is constantly remarking on documentation in terms of how it gets its evidence, but then that doesn't triangulate with what the patients are actually experiencing. We might end up with our nursing staff in mental health wards spending hours and hours sat in front of a computer in order to meet the regulation at the expense of providing direct clinical care. Those are the balances that myself and Jonathan and the other national professional advisors help Paul to weigh up.
We are also doing some training for the hospital inspectors and also get emailed questions and telephone calls from them. When they are on inspections and they have questions, they come to us. Eventually I think we will be giving supervision and support for the specialist national advisors who go out on the inspections to make sure they get improved consistency.
What attracted you to the role in the first place?
I was the interim Director of Nursing at Devonshire Partnership Trust, which was one of the pilot organisations for the new CQC hospitals inspections for mental health, so from a provider point of view I led that inspection and there was a lot of learning on both sides.
I wanted to influence the way CQC works and Paul was particularly committed to quality improvement. I could see how the CQC inspections can help services improve. I wanted to be part of that.
What do you think our biggest challenges are in terms of inspecting mental health nursing services currently and in the near future?
Getting a model that really allows community services to be inspected on an equal footing to the inpatient settings. The current model has been taken from the big hospitals on the general side (NHS acute) and so the community side is a developing model. I think the other challenge is that the CQC only inspects the providers.
In mental health there is a big commissioning challenge in terms of how the funding is distributed, I don't want to get too political on that but it's about bridging the gap. Also, in mental health things are not quite as concrete as they are in general health, we don't have quite so much concrete guidance and some of the feedback we are given isn't quite as solid, so I think it's about that too. It's about constantly weighing up those challenges.
What do you think we're getting right as a regulator?
I have been inspected as part of the pilot and I've also been inspected a year and a half on from that, when I moved to West London Mental Health Trust. From a provider point of view, I've seen how the model has developed and improved and the way in which the inspections are carried out are superior, stronger and better balanced than they were. The inspection regime is improving, and I do think it is helping trusts to focus on quality improvement. In the lead up to an inspection as a provider, you really do prepare your organisation and the result of that is that patients get a better experience and CQC is partly responsible for that.
As a registered mental health nurse and director of mental health nursing what are the biggest challenges you currently face on a day to day basis in the field?
At the moment, there is a big agenda around reducing restrictive practice and there's a real balance to be struck. It is absolutely the right thing to do, and I would say that our acute wards are more acute than ever. It's about having a balance between the least restrictive environments as possible and safeguarding individuals at the same time. Ligature risk management is something that has come up in a number of CQC reports. For example, how do we balance ligature risk management with the least restrictive practice in terms of allowing people certain items of their property or to have a 'homely' environment.
Having old estate is another one; I think transforming local services and making sure people have care as close to their primary care source as possible is important. There is a big agenda around 'shifting settings of care', moving people back to primary care and making sure mental health is everybody's business. In mental health, we really need to get better at supporting people with their physical health needs.
We also have the new guidance around the Mental Capacity Act, which has been a steep learning curve and from a ward and community perspective. Also, the use of legal highs are a challenge, particularly the change in presentation with the use of different illicit substances, that has had a big effect on our acute wards and 136 presentation.
Finally, what are the main things you'd like to achieve by working with CQC?
To influence a regulatory regime that improves services for people with mental health difficulties and those who support them, to move to a position of real quality improvement as well as quality assurance and to identify and share best practice.
I could see how the CQC inspections can help services improve. I wanted to be part of that.