CQC State of Care report 2018/2019

In October 2019, the Care Quality Committee published its annual State of Care Report 2018/2019. The report covers all sectors of the NHS, but the CQC highlighted issues in the mental health and learning disabilities sector.

The CQC found most of the care across England of good quality and, overall, the quality is improving slightly. But it found that people do not always have good experiences of care, sometimes with people not getting care until it’s too late and things have seriously worsened for them.

The report highlighted that too many people find it hard to even get appointments, but the lack of access is especially worrying when it affects people who are less able to speak up for themselves – such as children and young people with mental health problems or people with a learning disability.

Too often, people must chase around different care services even to access basic support. In the worst cases, people end up in crisis or with the wrong kind of care.

Some people are struggling to get access to the mental health services they need, when they need them. This can mean that people reach a level of ‘crisis’ that requires immediate and costly intervention before getting the care they need, or that they end up in inappropriate parts of the system.

Some people are detained in mental health services when this might have been avoided if they had been helped sooner, and then find themselves spending too long in services that are not suitable for them.

Too many people with a learning disability or autism are in hospital because of a lack of local, intensive community services.

The CQC is concerned about the quality of inpatient wards that should be providing longer-term and highly specialised care for people.

We have shone a spotlight this year on the prolonged use of segregation for people with severe and complex problems – who should instead be receiving specialist care from staff with highly specialised skills, and in a setting that is fully tailored to their needs.

Since October 2018, the CQC has rated as inadequate 14 independent mental health hospitals that admit people with a learning disability and/or autism, and put them into special measures.

The CQC also found that people with the most severe and enduring mental ill-health do not always have access to local, comprehensive rehabilitation services and are often in inappropriate placements far from home. This weakens support networks and the ability of family and commissioners to stay in close contact, sometimes with devastating consequences.

All of this is underpinned by significant issues around staffing and workforce.

CQC inspectors are seeing too many mental health and learning disability services with people who lack the skills, training, experience or clinical support to care for patients with complex needs. In the majority of mental health inpatient services rated as inadequate or requires improvement since October 2018, the inspection reports identified a lack of appropriately skilled staff as an issue.

The full report can be found here at the CQC