HSJ’s fortnightly briefing covering safety, quality, performance and finances in the mental health sector.

The Care Quality Commission was given a bit of a battering by the Parliamentary joint committee for human rights last week, in its report on the detention of children with learning disabilities and autism.

The committee claimed the regulator needed to “urgently reform” its inspection processes, which were failing to spot abusive practices within units.

While many would argue the NHS is better off for having the CQC regulate its services, the regulator’s processes may not be working for mental health.

Beyond the difficulties it faces in spotting abuse, there may be a more basic gap in the regulator’s approach.

While acute trusts are subject to location-level inspections, this isn’t the case for mental health, ambulance and community providers, which tend to run services across many more sites.

The same logic is applied to independent sector mental health providers, for which guidance says, “it may be more proportionate to carry out an inspection of only some, rather than all, services”.

Data collected by Peter Lindsey, a freelance journalist, shows just over one third of all locations run by NHS mental health trusts did not have an inspection in the last two years.

There does not seem to be a clear logic why all locations are not inspected.

The regulator says it uses a “risk-based” approach to mental health providers. It argued its current framework is “tailored to individual mental health services for people, rather than locations”, adding: “Many mental health providers deliver care and treatment to people using the same team, the same clinical pathways and the same governance processes from multiple locations.”

But what that means for people in unvisited locations is where the concerns will lie.

Missing the point

Today, the Department of Health and Social Care, off the back of the Parliamentary committee’s work, has said everyone with a learning disability or autism within an inpatient unit will receive a case review in the next 12 months.

An independent panel will oversee the case reviews for those in segregation.

The announcement also makes a vague promise for more data on inpatient admissions across the regions and a “dashboard” for and autism services.

It’s worth noting NHS Digital already publishes monthly admissions data, so, unless the proposed data is going to be dramatically better, this promise feels underwhelming.

Finally, there was the announcement of funding for mandatory training on LD and Autism. This is training the DHSC has been promising to commit to for a while.

If this is the extent of the government’s plans to tackle the detentions of people with autism and learning disabilities, it is missing the point.

Discharge and case reviews are things which should already be happening regularly and were a key feature of the Transforming Care programme.

Even if a patient receives a robust case review, what then?

In many, if not the majority, of areas there are no appropriate community-based services or housing to discharge patients into.

Further, creating plans for those within inpatient units won’t prevent people being admitted — adequate community crisis services are needed to address this.

It is these areas which the current government, and any future government, should focus on if we’re ever going to change the tide for this vulnerable group of people.

Regulating in the community

The Parliamentary report focussed on the regulation of inpatient units. But do we know if it is able to effectively regulate community housing and the services that patients will be discharged into?

Spotting poor staffing cultures or inappropriate services is likely to be more difficult within the community where patients are isolated.

The CQC may need to be more creative in the regulation of these community services, while NHS England and clinical commissioning groups will have a responsibility for monitoring the quality of care packages supplied to patients.

Ensuring discharges are properly managed by providers is also something the system will need to tackle.

Join us at the Transforming Mental Health Summit (28-29 November 2019, Hilton Leeds) as senior peers from across the NHS, local authority and wider mental health service delivery landscape discuss the remaining challenges as we reach the end of the Five Year Forward View. Register your interest here: http://bit.ly/2KbYAzJ