Workforce shortage delays mental health safety checks

From the beginning of this month, the regulator has increased fees paid to consultant psychiatrists providing a “second opinion appointed doctor” service by 11 per cent to encourage more to join up.

The regulator is responsible for appointing an independent doctor to review the treatment of some patients who have been detained under the Mental Health Act.

Where a patient is detained, trusts are required to submit requests to the CQC for a second opinion. In these safeguarding visits, an appointed doctor reviews the patient’s medication, community treatment order, or electroconvulsive therapy, if the individual lacks the capacity to consent or is refusing that treatment.

The visits ensure the rights and choices of those patients are protected as prescribed under law.

Delays in attendances can potentially prevent the continuation of a patient’s treatment or delay new procedures.

The CQC has set itself clear standards for when a second opinion visit is meant to be completed. These vary depending on the type of treatment.

However, a workforce shortfall has affected the CQC’s overall performance, according to its annual report.

In 2016-17, only 53 per cent of all ECT visits were made on time. This has dropped from 65 per cent since 2015-16.

Similarly, 71 per cent of community treatment order visits and 88 per cent of medication review visits were made on time. Both of these are also slightly down from the previous financial year. The regualator has not published details for overall performance against the target.

The CQC’s internal target is to have 95 per cent of all visits conducted within the appropriate time frame.

A Freedom of Information request to the regulator has revealed the extent of variation in waiting times across the country.

The worst hit areas last year were Devon, Cornwall and the North West, although the Isle of Wight and Manchester also faced lengthy delays.

Some trusts have seen sharp increases in the average waiting times for a safeguarding visit. The wait at Central Manchester University Hospitals Foundation Trust more than doubled to 46 working days on average - the longest in the country. Cornwall Partnership FT’s average waits also more than doubled to 29 working days, while Northamptonshire Healthcare FT and Northumbria Healthcare FT both also saw sharp increases.

Overall, the average wait has gone from nine days in 2015-16 to 11 days in 2016-17.

A CQC spokeswoman said delays were partly caused by “there being low numbers of available doctors in hard to reach rural areas”.

She also said delays have occurred because of “increases in applications due to more people being cared for and treated under the Mental Health Act, as well as requests from providers being made at short notice”.

Sean Duggan, chief executive of the Mental Health Network, which is part of the NHS Confederation, agreed that the waits had been caused by a shortage of staff. He said: “It should be an issue that is considered as part of the government’s review of the Mental Health Act.

“We urge the government to stay true to its promise of putting mental health on a par with physical health. Securing a sustainable mental health workforce fit for the 21^st century would be a crucial step towards achieving this”.

As of this month, the CQC will pay an additional 10 or 20 per cent, on top of the universal 11 per cent rise, for doctors prepared to travel further or quickly respond to ECT visitation requests.

The CQC sent a letter to mental health trusts last December asking them to encourage their psychiatrists to join the service. That led to 28 new second opinion appointed doctors joining the service, bringing the number of available for work to 104.

Data released under FOI revealed that the average waiting time, across all trusts and treatment types, for a visit from a second opinion appointed doctor is 11 days from the time the CQC receives the request.

Since the start of April 2017 to the end of August 2017, the average wait has been reduced to seven days.

While the latest data suggests a possible improvement since the CQC wrote to mental health trusts in December, an accurate comparison cannot be made with previous years until a full year of data is available.

Top ten trusts that had the longest waits for a SOAD visit in 2016-17

Provider	Average time from request to visit in working days 2015-16	Average time from request to visit in working days 2016-17
Central Manchester University Hospitals NHS Foundation Trust	18	46
Cornwall Partnership NHS Foundation Trust	13	29
Devon Partnership NHS Trust	19	25
Northamptonshire Healthcare NHS Foundation Trust	6	21
Cumbria Partnership NHS Foundation Trust	16	18
Isle of Wight NHS Trust	10	17
Northumbria Healthcare NHS Foundation Trust	4	17
City Hospitals Sunderland NHS Foundation Trust	N/A	16
Oxleas NHS Foundation Trust	16	16
North East London NHS Foundation Trust	16	15