The must-read stories and debate in health policy and leadership.

Hundreds of sexual assaults are reported each year on mixed-sex mental health wards in EnglandHSJ has revealed, highlighting the urgent need for investment to improve facilities.

New figures obtained by HSJ show there have been at least 1,019 reports of sexual assaults between men and women on mixed wards since April 2017 to October 2019.

This compares to just 286 reports of incidents on single-sex mental health wards over the same period.

Of those reports made on mixed-sex wards, 491 were considered serious enough to refer to safeguarding, and 104 were reported to the police.

The level of incidents still being reported suggests patients are not being protected from sexual assault on mixed wards, despite the issue being highlighted by several national reports in recent years.

We also report personal accounts of the trauma this can involve for patients.

The figures supplied to HSJ under freedom of information rules reveal there are hundreds of mixed-gender wards and communal areas still in use: The trusts which responded had in total 668 wards and 803 communal areas.

The responses show the major investment in mental health estate would be required for a universal move to single-sex wards.

As mental health correspondent Rebecca Thomas discusses in her latest briefing newsletter, without major change there is often no meaningful choice for inpatients who, in not unusual cases, are vulnerable and traumatised.

Covered up culture uncovered

Staff at a mental health provider complained about a “cover up culture” where allegations of poor care and abusive behaviour were concealed by falsifying records, according to a new Care Quality Commission inspection report.

The CQC’s inspection of the leadership of St Andrew’s Healthcare, a charity that provides mostly NHS-funded care in the Midlands, said staff complaints “pointed to a culture in which management sought to actively manage how their service was perceived by CQC”.

The regulator’s report, published today after visits in October, said: “Patients, staff and relatives raised concerns that management may either not be aware of or are not responding to issues including poor and selective reporting, falsifying records, intimidation of staff, and active deception of [the] CQC.

“[They] attributed these behaviours to management. However, it was not always clear from comments whether ‘management’ referred to senior leaders, or ward level management.”

There has been significant turnover in board members since July 2018, when previous chief executive Gil Baldwin left.

The CQC’s report said: “The newly formed leadership team had the capacity and capability to work towards the delivery of high-quality sustainable care for patients. There was a clearer focus on clinical leadership and a need to further define and develop the assurance function within a non-executive director and governor role.”

The provider said: “As the CQC highlighted such plans are in their infancy and cultural change can take time, especially in a complex mental healthcare setting.”