Sixteen percent of NHS mental health trusts are providing a “weak” standard of care in psychiatric wards, according to the Healthcare Commission.
The largest review of in-patient services ever undertaken in England also revealed serious concerns about poor security, violence, overcrowding, and lack of service user involvement.
Overcrowding was a problem in 42% of trusts which had bed occupancy rates higher than 90%. A key recommendation is better commissioning and assessment of local needs after eight trusts had surpassed 100% occupancy. The worst problems were in Walsall Teaching Primary Care Trust, which had an occupancy rate of 106%.
The recommended level is 85%, and the report cites research showing that overcrowding on wards increases the risk of aggression among service users.
The section on violence bears this correlation out, as the level of aggression found on wards “would not be acceptable in other hospital settings” with 45% of nurses suffering assaults in 2006-7.
Only two-thirds of staff were trained in preventing or handling violence, while just 22% had been trained in handling intoxicated patients.
The number of detained patients going missing is a “key safety concern”. In a six-month period, 2,745 unauthorised absences were reported, with each detained patient taking unauthorised leave for an average of two to three days.
Overall, the Pathway to Recovery unearthed stark variations in quality and safety across 69 mental health NHS trusts, 550 wards and 9,900 beds.
For example, some acute wards had entire rosters of permanent staff, while one trust relied on bank or agency workers for 54% of its workforce.
Although 40% of trusts are rated as either “excellent” or “good”, they are more likely to be smaller capacity and situated in rural areas. The lower standards of care are largely found in larger, inner-city organisations serving deprived communities.
In addition to the safety of staff and service users, other priority areas include providing appropriate and safe interventions and involvement of service users and carers.
The fact that 50% of care plans inspected did not record service users’ views was “unacceptable”, the report says.
Anna Walker, chief executive of the Healthcare Commission, said: “There has been a lot of emphasis on community services, but it’s tended to mean that in-patient services have been overlooked.”
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