CQC announces update to mental health inspections

New inspection criteria will focus on what matters most to service users

Jane Ray from the CQC spoke at the 2021 Design in Mental Health Conference
Jane Ray from the CQC spoke at the 2021 Design in Mental Health Conference

Wards for people with learning disabilities and autism, acute adult psychiatric wards, and intensive care units for children and young people with mental health conditions are among those most in need of improvement, according to regulators. 

Speaking at the recent Design in Mental Health Annual Conference in Coventry, Jane Ray, head of hospital inspection for mental health and community mental health services at the Care Quality Commission (CQC), said these three areas need the most attention when it comes to providing a therapeutic environment for recovery.

We have to decide about making the care that people receive as good as it can be and, for us, the most-important thing is hearing from people who use services about what they mean to them

She told the conference: “It is so important that the environment is as good as it can be.

“We have to decide about making the care that people receive as good as it can be and, for us, the most-important thing is hearing from people who use services about what they mean to them.

“We can make things better for people.”

But, she added: “These [three areas], I have to say, are often environments that when we go in they feel anything but therapeutic.”

She said inspections focus on several areas, but safety is always paramount.

“Safety is our biggest concern and it’s often where things go wrong,” she told the conference.

A fresh approach

And she revealed that a new assessment framework was being formulated which will be launched next year – the first major update in the way inspections are carried out for three or four years.

Focus areas are likely to be linked to the main concerns currently reported by inspectors, which include:

  • Sexual safety on mental health wards
  • Therapeutic observations
  • Access to call alarms for staff and patients
  • Physical healthcare for people with mental health problems
  • Use of physical restraints
  • Mental healthcare for people with physical health problems
  • Ligature risk
  • Staffing
  • Clinical information systems

And they will also be informed by feedback from service users.

This has found that what matters most to patients includes:

  • Lighting
  • Noise
  • Smells
  • Access to appropriate services
  • Same-gender care
  • Access to staff when help is needed
  • Safety from other unwell patients
  • Access to possessions
  • Safe storage of possessions
  • Privacy when seeing visitors
  • Time with a named nurse
  • Dignity when showering

“There are a number of key messages from the CQC about the way forward,” Ray said.

“Firstly, it’s vital to involve people who use services in design work. Remember, the environment needs to be therapeutic and if we did that right the environments would be much safer by default.”

Designing environments and services to improve staff wellbeing and retention will also be central to achieving good ratings moving forward.

The environment needs to be therapeutic and if we did that right the environments would be much safer by default

She said: “We want trusts to really think about the quality of care and how they deliver it and to remember the wellbeing of staff.

“We know how challenging it is for staff and if you think carefully about staff it will help to make things safer and more caring for patients.”

A balancing act

And, while figures show there was a 13% increase in ligature incidents in mental health units between 2019-2020, Ray insisted that the CQC was not putting ligature risk above the design of truly therapeutic environments.

“Some ligature risks can antagonise patients by increasing the ligature appetite,” she warned.

“It’s about looking at what designers and architects can do to balance that.

“I think that what is happening is that with ligature reduction, people are getting more creative.

It is an absolutely-shared vision for everybody to create more-therapeutic environments

“That’s the real challenge and that’s where we need to think holistically about the environment.

“We do want to know that trusts have thought about ligature safety and have come up with solutions, but we certainly do not want to be prescriptive.”

And she concluded: “We are thrilled the Department of Health and Social Care has given £400m in funding to abolish dormitory-style wards. This will improve the individual care that can be given to patients and patient safety.

“It is an absolutely-shared vision for everybody to create more-therapeutic environments.”

 

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