Staffing pressures creating mental health ‘perfect storm’

The Care Quality Commission has stressed that increasing pressures on access and staffing risk creating ‘perfect storm’ for people using mental health and learning disability services.

The organisation’s State of Care report shows that quality ratings have been maintained overall – but people’s experience of care is determined by whether they can access good care when they need it.

The paper concedes that when people can’t access the services they need, the risk is that they are pushed into inappropriate care settings – ending up in emergency departments because they can’t access the care they need outside hospital, or in crisis because they can’t access community based mental health and learning disability services.

Considering the pressures faced by health and social care as a whole, but focusing particularly on inpatient mental health and learning disability services, the CWC finds that an overall picture of stability is masking ‘a real deterioration in some specialist inpatient services’.

According to CQC data, as of the end of September, 10 per cent of inpatient services for people with learning disabilities and/or autism were rated inadequate, as compared to one per cent in 2018, while seven per cent of child and adolescent mental health inpatient services rated inadequate, a four per cent increase on the previous year.

Since October 2018, 14 independent mental health hospitals that admit people with a learning disability and/or autism have been rated inadequate and put into special measures, and while two of these services have since improved, three are now closed and one service is still registered but is closed to new admissions with no people resident.

Furthermore, too many people using mental health and learning disability services are being looked after by staff who lack the skills, training, experience or support from clinical staff to care for people with complex needs. This reflects a national shortage of nurses in these areas of practice, with eight per cent fewer learning disability nurses registered with the Nursing and Midwifery Council in 2019 than 2015.

There are also particular barriers in some parts of the country, with patients sharing their experiences with CQC having described needing to ‘chase’ care in order to receive basic services, or experiencing worsening health as they move from service to service, unable to access the care they need.

Ian Trenholm, chief executive of the CQC, said: “Increased demand combined with challenges around workforce and access risk creating a perfect storm – meaning people who need support from mental health, learning disability or autism services may receive poor care, have to wait until they are at crisis point to get the help they need, be detained in unsuitable services far from home, or be unable to access care at all.

“We are strengthening our approach to how we look at these services, and how we use the information that people share with us, so that we can act more quickly to spot and act on poor care. But having the right staff to deliver good care is crucial to turning the tide – as are better integrated community services to prevent people ending up in the wrong place. We’ve seen some excellent care where services collaborate and we want to see more local services working together.

“While we’ll continue to call out staffing issues at provider level when these have an impact on care, we’re also calling for system-wide action on workforce planning which encourages more flexible and collaborative approaches to staff skills and career paths. The ambitious plans to expand the mental health workforce to meet an increase in demand must be accelerated. We’ll continue to celebrate the providers – like those highlighted in this report – who are thinking beyond barriers to work together in new ways that not only improve quality but give their teams more development opportunities and flexibility to work across different settings, supporting them to deliver great care.”

Ian Hudspeth, chairman of the Local Government Association’s Community Wellbeing Board, said: “This report shows that despite severe funding pressures, quality ratings across social care have been maintained overall, with 84 per cent of providers now rated as good or outstanding, up from 82 per cent last year.

“Thanks to the incredible efforts of every part of the social care workforce, we have helped to reduce the number of NHS beds being used unnecessarily, while commissioning services to best enable people to live the lives they want to lead in their local communities. Quality in adult social care is now more consistent but we know there is more to do and we continue to work with those who use and work in social care, families and care providers, to make sure that the right support is being offered at the right time and in the right place.

“The Queen’s Speech announcement on proposals for the future of adult social care also need to be substantive and brought forward as soon as possible, to reassure all those who use and work in this vital service.”