This report sets out CQC's activity and findings from our engagement with people subject to the MHA and review of services registered to assess, treat and care for people detained using the MHA during 2021/22. The Mental Health Act 1983 (MHA) is the legal framework that provides authority for hospitals to detain and treat people who have a mental illness and need protection for their own health or safety, or the safety of other people. The MHA also provides more limited community-based powers, community treatment orders and guardianship. Key messages include: workforce issues and staff shortages mean that people are not getting the level or quality of care they have a right to expect, and the safety of patients and staff is being put at risk; gaps in community mental health care are compounding the rising demand on inpatient services, with delays in admission, transfer and discharge; urgent action is needed to tackle the over-representation of people from some ethnic minority groups and, in particular, the over-representation of Black people on community treatment orders; the quality of ward environments is an ongoing concern, with many inpatient environments in need of immediate update and repair; despite the challenges facing services, we have seen examples of good practice around advance planning and applying the principle of least restriction.
(Edited publisher abstract)
This report sets out CQC's activity and findings from our engagement with people subject to the MHA and review of services registered to assess, treat and care for people detained using the MHA during 2021/22. The Mental Health Act 1983 (MHA) is the legal framework that provides authority for hospitals to detain and treat people who have a mental illness and need protection for their own health or safety, or the safety of other people. The MHA also provides more limited community-based powers, community treatment orders and guardianship. Key messages include: workforce issues and staff shortages mean that people are not getting the level or quality of care they have a right to expect, and the safety of patients and staff is being put at risk; gaps in community mental health care are compounding the rising demand on inpatient services, with delays in admission, transfer and discharge; urgent action is needed to tackle the over-representation of people from some ethnic minority groups and, in particular, the over-representation of Black people on community treatment orders; the quality of ward environments is an ongoing concern, with many inpatient environments in need of immediate update and repair; despite the challenges facing services, we have seen examples of good practice around advance planning and applying the principle of least restriction.
(Edited publisher abstract)
Subject terms:
mental health law, mental health services, compulsory treatment, monitoring, health inequalities, black and minority ethnic people;
This report looks at how community treatment orders (CTOs) have been used in nine boroughs across London. Introduced as part of the Mental Health Act (MHA) in 2007, CTOs enable people detained under the MHA to be discharged into the community providing they meet certain conditions. This may include, for example, living in a certain place, attending appointments with mental health professionals, or not taking drugs and drinking alcohol. If they don’t comply, they may be recalled to hospital under the MHA. We were concerned that figures around the use of CTOs were not providing an accurate picture, and that CTOs were being used in an overly restrictive way. This report found that there were differing views among professionals, including responsible clinicians and approved mental health professionals (AMHPs), about the added value of CTOs. Some felt they played a key role in preventing long hospital admissions. However, others were unsure about how effective they were in supporting people in the community. There are some fundamental issues around the use of CTOs. While CTOs are more restrictive than life in the community, they are less restrictive than hospital admission and relatives see them as essential to preventing relapse. However, concerns remain, in particular around the disproportionate impact on Black British patients. The government's MHA reform bill sets out proposals for changes to CTOs. While we welcome the proposals for change, we will continue to evaluate whether these reforms will lead to improvements for patients, their families and carers.
(Edited publisher abstract)
This report looks at how community treatment orders (CTOs) have been used in nine boroughs across London. Introduced as part of the Mental Health Act (MHA) in 2007, CTOs enable people detained under the MHA to be discharged into the community providing they meet certain conditions. This may include, for example, living in a certain place, attending appointments with mental health professionals, or not taking drugs and drinking alcohol. If they don’t comply, they may be recalled to hospital under the MHA. We were concerned that figures around the use of CTOs were not providing an accurate picture, and that CTOs were being used in an overly restrictive way. This report found that there were differing views among professionals, including responsible clinicians and approved mental health professionals (AMHPs), about the added value of CTOs. Some felt they played a key role in preventing long hospital admissions. However, others were unsure about how effective they were in supporting people in the community. There are some fundamental issues around the use of CTOs. While CTOs are more restrictive than life in the community, they are less restrictive than hospital admission and relatives see them as essential to preventing relapse. However, concerns remain, in particular around the disproportionate impact on Black British patients. The government's MHA reform bill sets out proposals for changes to CTOs. While we welcome the proposals for change, we will continue to evaluate whether these reforms will lead to improvements for patients, their families and carers.
(Edited publisher abstract)
Subject terms:
supervised community treatment, mental health law, community care, black and minority ethnic people;
This report looks what people with a learning disability and autistic people experience when they need physical health care and treatment in hospital. We looked specifically at: access to care; communication; care and treatment in hospital; other equality characteristics and quality of care; workforce skills and development. People have a right to expect: access to the care they need, when they need it and that appropriate reasonable adjustments are made to meet people's individual needs; staff communicate with them in a way that meets their needs and involves them in decisions about their care; they are fully involved in their care and treatment; the care and treatment they receive meets all their needs, including making reasonable adjustments where necessary and taking into account any equality characteristics such as age, race and sexual orientation; their experiences of care are not dependent on whether or not they have access to specialist teams and practitioners. However, people told us they found it difficult to access care because reasonable adjustments weren't always made. Providers need to make sure they are making appropriate reasonable adjustments to meet people's individual needs. There is no 'one-size-fits-all' solution for communication. Providers need to make sure that staff have the tools and skills to enable them to communicate effectively to meet people's individual needs. People are not being fully involved in their care and treatment. In many cases, this is because there is not enough listening, communication and involvement. Providers need to make sure that staff have enough time and skills to listen to people and their families so they understand and can meet people's individual needs. Equality characteristics, such as age, race and sexual orientation, risked being overshadowed by a person's learning disability or autism because staff lacked knowledge and understanding about inequalities. Providers need to ensure that staff have appropriate training and knowledge so they can meet all of a person's individual needs. Specialist practitioners and teams cannot hold sole responsibility for improving people's experiences of care. Providers must make sure that all staff have up-to-date training and the right skills to care for people with a learning disability and autistic people.
(Edited publisher abstract)
This report looks what people with a learning disability and autistic people experience when they need physical health care and treatment in hospital. We looked specifically at: access to care; communication; care and treatment in hospital; other equality characteristics and quality of care; workforce skills and development. People have a right to expect: access to the care they need, when they need it and that appropriate reasonable adjustments are made to meet people's individual needs; staff communicate with them in a way that meets their needs and involves them in decisions about their care; they are fully involved in their care and treatment; the care and treatment they receive meets all their needs, including making reasonable adjustments where necessary and taking into account any equality characteristics such as age, race and sexual orientation; their experiences of care are not dependent on whether or not they have access to specialist teams and practitioners. However, people told us they found it difficult to access care because reasonable adjustments weren't always made. Providers need to make sure they are making appropriate reasonable adjustments to meet people's individual needs. There is no 'one-size-fits-all' solution for communication. Providers need to make sure that staff have the tools and skills to enable them to communicate effectively to meet people's individual needs. People are not being fully involved in their care and treatment. In many cases, this is because there is not enough listening, communication and involvement. Providers need to make sure that staff have enough time and skills to listen to people and their families so they understand and can meet people's individual needs. Equality characteristics, such as age, race and sexual orientation, risked being overshadowed by a person's learning disability or autism because staff lacked knowledge and understanding about inequalities. Providers need to ensure that staff have appropriate training and knowledge so they can meet all of a person's individual needs. Specialist practitioners and teams cannot hold sole responsibility for improving people's experiences of care. Providers must make sure that all staff have up-to-date training and the right skills to care for people with a learning disability and autistic people.
(Edited publisher abstract)
This survey looks at the experiences of people who use community mental health services. The 2022 community mental health survey received feedback from 13,418 people. Those aged 18 and over were eligible to take part if they were receiving specialist care or treatment for a mental health condition between 1 September 2021 and 30 November 2021. This report shows that people's experiences of mental health services provided in the community remain poor. Many of the areas with the poorest historical results, are still the poorest in 2022. Most notably, access to care, crisis care, involvement in care and support and wellbeing are key areas which have been highlighted as being poor over a number of years. Consistent with 2021 results, findings this year showed that people who received their care via telephone, younger people (aged 18 to 35) and those with more challenging and severe non-psychotic disorders were less likely to report positive experiences. There are few results, or areas of care, where the majority of people reported good experiences. However, some areas show signs of improvement.
(Edited publisher abstract)
This survey looks at the experiences of people who use community mental health services. The 2022 community mental health survey received feedback from 13,418 people. Those aged 18 and over were eligible to take part if they were receiving specialist care or treatment for a mental health condition between 1 September 2021 and 30 November 2021. This report shows that people's experiences of mental health services provided in the community remain poor. Many of the areas with the poorest historical results, are still the poorest in 2022. Most notably, access to care, crisis care, involvement in care and support and wellbeing are key areas which have been highlighted as being poor over a number of years. Consistent with 2021 results, findings this year showed that people who received their care via telephone, younger people (aged 18 to 35) and those with more challenging and severe non-psychotic disorders were less likely to report positive experiences. There are few results, or areas of care, where the majority of people reported good experiences. However, some areas show signs of improvement.
(Edited publisher abstract)
Subject terms:
surveys, user views, community care, mental health services, access to services;
This report sets out the CareQualityCommission's assessment of the state of care in England in 2021/22. We use data from our inspections and ratings, along with other information, including that from people who use services, their families and carers, to inform our judgements of the quality of care. The evidence used in this report includes national published data and reports, as well
(Edited publisher abstract)
This report sets out the CareQualityCommission's assessment of the state of care in England in 2021/22. We use data from our inspections and ratings, along with other information, including that from people who use services, their families and carers, to inform our judgements of the quality of care. The evidence used in this report includes national published data and reports, as well as evidence generated by CQC. The report examines the current gridlocked care; access to care; inequalities in care; areas of specific concern, including maternity care, people with a learning disability and autistic people, children and young people's mental health, and Deprivation of Liberty Safeguards; workforce and staff shortages; systems' challenges and opportunities, including Integrated care systems and CQC's role. The report finds that the health and care system is in gridlock and this is clearly having a huge negative impact on people's experiences of care. At the heart of these problems are staff shortages and struggles to recruit and retain staff right across health and care. The repercussions of the COVID-19 pandemic continue to be felt by individuals, families and care staff - people are still being affected by problems ranging from frustrations in accessing regular appointments to delays that stop people getting the life-saving treatment they need when they need it. Inequality continues across large parts of health and social care. It is vital that everyone, inclusively, has good quality care, and equal access, experience and outcomes from health and social care services. To maintain and develop the required workforce, as well as to plan for the future, providers and systems need to be clear about demands in the longer term, including the required workforce skillsets. A strong understanding of local community needs is required to ensure the right services, including preventative health measures and plans for improving health outcomes, are delivered.
(Edited publisher abstract)
Subject terms:
adult social care, care workforce, Covid-19, health inequalities, access to services, waiting lists, performance evaluation, health care, Deprivation of Liberty Safeguards, integrated care;
This survey looks at the experiences of people who stayed at least one night in hospital as an inpatient. People were eligible to take part in the survey if they stayed in hospital for at least one night during November 2021 and were aged 16 years or over at the time of their stay. The results show some change in people's experience of inpatient care compared with the previous survey in 2020, and for the most part is a decline in opinions. Areas with the largest increase in negative results are those relating to patients' fundamental needs, such as getting enough help to wash or keep clean and to eat meals, as well as being able to get help from staff when needed. Respondents who reported having Dementia or Alzheimer's, a mental health condition, a heart problem and those with a neurological condition reported poorer experiences for more than half of the questions. In contrast, older people, people who were in hospital for an elective admission, those who stayed in hospital for only one night, and those considered less frail generally reported better experiences. Hospital discharge remains a challenging part of people's experiences of care. Patients were not always involved in decisions about discharge and did not always know what would happen next with their care, with both having deteriorated compared with 2020. Fewer patients said staff discussed with them whether they may need further health and social care services after leaving hospital: 79% compared with 81% previously. After leaving hospital, less than half (46%) of patients said they definitely got enough support from health and social care services to help them recover or manage their condition, which is also a decrease compared with 51% previously.
(Edited publisher abstract)
This survey looks at the experiences of people who stayed at least one night in hospital as an inpatient. People were eligible to take part in the survey if they stayed in hospital for at least one night during November 2021 and were aged 16 years or over at the time of their stay. The results show some change in people's experience of inpatient care compared with the previous survey in 2020, and for the most part is a decline in opinions. Areas with the largest increase in negative results are those relating to patients' fundamental needs, such as getting enough help to wash or keep clean and to eat meals, as well as being able to get help from staff when needed. Respondents who reported having Dementia or Alzheimer's, a mental health condition, a heart problem and those with a neurological condition reported poorer experiences for more than half of the questions. In contrast, older people, people who were in hospital for an elective admission, those who stayed in hospital for only one night, and those considered less frail generally reported better experiences. Hospital discharge remains a challenging part of people's experiences of care. Patients were not always involved in decisions about discharge and did not always know what would happen next with their care, with both having deteriorated compared with 2020. Fewer patients said staff discussed with them whether they may need further health and social care services after leaving hospital: 79% compared with 81% previously. After leaving hospital, less than half (46%) of patients said they definitely got enough support from health and social care services to help them recover or manage their condition, which is also a decrease compared with 51% previously.
(Edited publisher abstract)
Subject terms:
surveys, hospitals, hospital discharge, integrated care, user views, patients, adult social care;
People First is a resource to help system leaders and service providers. It aims to support the design of person-centred urgent and emergency care services; and encourage innovation across integrated care systems. It was designed and developed: using outcomes from CQC's urgent and emergency care workshop, held in May 2022; by members of the CQC National Emergency Medicine Specialist Advisor Forum. The resource recognises the unscheduled care pathway as a continuum, with solutions required across the artificial divides between primary, secondary, community and social care. The resource is divided thematically and covers the following topics: prevention; escalation; optimising pathways; leadership; equality; flow; innovation, information and technology; risk sharing; staffing and training; transformation. Each section shares the views of current system leaders on the pressures and challenges the sector faces. This is followed by actionable key suggestions and good practice examples. These aim to inspire other system leaders to effect positive change.
(Edited publisher abstract)
People First is a resource to help system leaders and service providers. It aims to support the design of person-centred urgent and emergency care services; and encourage innovation across integrated care systems. It was designed and developed: using outcomes from CQC's urgent and emergency care workshop, held in May 2022; by members of the CQC National Emergency Medicine Specialist Advisor Forum. The resource recognises the unscheduled care pathway as a continuum, with solutions required across the artificial divides between primary, secondary, community and social care. The resource is divided thematically and covers the following topics: prevention; escalation; optimising pathways; leadership; equality; flow; innovation, information and technology; risk sharing; staffing and training; transformation. Each section shares the views of current system leaders on the pressures and challenges the sector faces. This is followed by actionable key suggestions and good practice examples. These aim to inspire other system leaders to effect positive change.
(Edited publisher abstract)
Subject terms:
integrated care, emergency health services, care reform, quality improvement;
This consultation seeks views on proposed changes to the way Ofsted and the CareQualityCommission (CQC) jointly inspect local area partnerships to assess how they work together to improve the experiences and outcomes of children and young people who have special educational needs and/or disabilities (SEND). The new Special Educational Needs and Disabilities (SEND) inspection framework
(Edited publisher abstract)
This consultation seeks views on proposed changes to the way Ofsted and the CareQualityCommission (CQC) jointly inspect local area partnerships to assess how they work together to improve the experiences and outcomes of children and young people who have special educational needs and/or disabilities (SEND). The new Special Educational Needs and Disabilities (SEND) inspection framework will be introduced in England in 2023. It comprises nine proposals, including: focusing more on impact; criteria for evaluating impact; inspection outcomes; making recommendations in reports; updating and publishing strategic plans following an inspection; gathering more evidence directly from children and young people, and their families; including alternative provision; introducing monitoring inspections; and introducing engagement meetings. The consultation closes on 11 September 2022.
(Edited publisher abstract)
This report describes the progress made on the recommendations made in ‘Out of sight – who cares?’ report, published in October 2020, which looked at the use of restraint, seclusion and segregation in care services. The recommendations were made for people with mental ill health, people with a learning disability and autistic people. However, there is more of a focus on people with a learning disability and autistic people, as we visited more services where they lived. This is reflected in the balance of evidence in this report. This report updates on key themes, which means some recommendations are grouped together, rather than being in numerical order. The report finds that no recommendations have been fully achieved. Seventeen recommendations have not been achieved, including: people have a home and the right support in place; people have the right community services commissioned; people have the right support to avoid crisis; people have their rights understood; people receive the right support in hospital; people have skilled staff to support them; people have bespoke services; people who experience restrictive interventions have these reported to CQC; people who are segregated in hospital experience good quality regular independent reviews; people have meaningful Care (Education) and Treatment Reviews because providers and commissioners are accountable; all people in segregation in hospital are recognised through updating the definition of long-term segregation; people see a reduction in the use of restrictive interventions; people in children’s and adult social care services experiencing restrictive interventions would have these reported to regulators. The report also finds that four recommendations have been partly achieved: improving how CQC regulates services for people with a learning disability and autistic people; recording data to improve local services; people’s experience of person-centred care; people who experience restrictive interventions have regular oversight by commissioners.
(Edited publisher abstract)
This report describes the progress made on the recommendations made in ‘Out of sight – who cares?’ report, published in October 2020, which looked at the use of restraint, seclusion and segregation in care services. The recommendations were made for people with mental ill health, people with a learning disability and autistic people. However, there is more of a focus on people with a learning disability and autistic people, as we visited more services where they lived. This is reflected in the balance of evidence in this report. This report updates on key themes, which means some recommendations are grouped together, rather than being in numerical order. The report finds that no recommendations have been fully achieved. Seventeen recommendations have not been achieved, including: people have a home and the right support in place; people have the right community services commissioned; people have the right support to avoid crisis; people have their rights understood; people receive the right support in hospital; people have skilled staff to support them; people have bespoke services; people who experience restrictive interventions have these reported to CQC; people who are segregated in hospital experience good quality regular independent reviews; people have meaningful Care (Education) and Treatment Reviews because providers and commissioners are accountable; all people in segregation in hospital are recognised through updating the definition of long-term segregation; people see a reduction in the use of restrictive interventions; people in children’s and adult social care services experiencing restrictive interventions would have these reported to regulators. The report also finds that four recommendations have been partly achieved: improving how CQC regulates services for people with a learning disability and autistic people; recording data to improve local services; people’s experience of person-centred care; people who experience restrictive interventions have regular oversight by commissioners.
(Edited publisher abstract)
Subject terms:
autism, learning disabilities, mental health, restraint, physical restraint, hospitals, community care, quality improvement, inspection;
Annual report on the use of the Mental Health Act (MHA), looking at how providers are caring for patients, and whether patients' rights are being protected. The report sets out CQC’s activity and findings from our engagement with people subject to the MHA and review of services registered to assess, treat and care for people detained using the MHA during 2020/21. It is largely based on feedback letters on the 620 remote monitoring letters following reviews of 682 wards carried out during 2020/21. These involved private conversations with 1,895 patients and 1,111 carers. The report highlights three key findings. Firstly, the workforce is under extreme pressure; the pandemic has placed additional stresses on staff, patients and carers; staff are now exhausted, with high levels of anxiety, stress and burnout, and the workforce is experiencing high levels of vacancies. The negative impact of working under this sustained pressure poses a challenge to the safe, effective and caring management of inpatient services and to the delivery of care in a way that maintains people’s human rights. Secondly, community services are key to reducing levels of detention in hospital. Not getting the right help at the right time can lead to symptoms worsening and people needing inpatient care. During the pandemic this has been a particular concern for children and young people. We have seen an increase in the numbers of children and young people being cared for in inappropriate settings while they wait for an inpatient bed. Thirdly, urgent action is needed to address longstanding inequalities in mental health care. We remain concerned that Black or Black British people are more likely to be detained under the MHA, spend longer in hospital and have more subsequent readmissions than White people.
(Edited publisher abstract)
Annual report on the use of the Mental Health Act (MHA), looking at how providers are caring for patients, and whether patients' rights are being protected. The report sets out CQC’s activity and findings from our engagement with people subject to the MHA and review of services registered to assess, treat and care for people detained using the MHA during 2020/21. It is largely based on feedback letters on the 620 remote monitoring letters following reviews of 682 wards carried out during 2020/21. These involved private conversations with 1,895 patients and 1,111 carers. The report highlights three key findings. Firstly, the workforce is under extreme pressure; the pandemic has placed additional stresses on staff, patients and carers; staff are now exhausted, with high levels of anxiety, stress and burnout, and the workforce is experiencing high levels of vacancies. The negative impact of working under this sustained pressure poses a challenge to the safe, effective and caring management of inpatient services and to the delivery of care in a way that maintains people’s human rights. Secondly, community services are key to reducing levels of detention in hospital. Not getting the right help at the right time can lead to symptoms worsening and people needing inpatient care. During the pandemic this has been a particular concern for children and young people. We have seen an increase in the numbers of children and young people being cared for in inappropriate settings while they wait for an inpatient bed. Thirdly, urgent action is needed to address longstanding inequalities in mental health care. We remain concerned that Black or Black British people are more likely to be detained under the MHA, spend longer in hospital and have more subsequent readmissions than White people.
(Edited publisher abstract)
Subject terms:
mental health law, government policy, mental health professionals, stress, Covid-19, community care, health inequalities, black and minority ethnic people, mental health services, access to services;