Mental health care? Or a we being side-lined yet again

For all the governments talk of parity of care, parity of esteem it seems that there is far too much disparity still at large. In a year when they have been pushing through new bills to change discrimination for those with mental health it seems the health and social care system has been quietly disintegrating care for those with mental health issues. The care quality commissions report clearly states that there has been a 3.1 % decrease in NHS healthcare provision for the mental health, learning disability and substance misuse services and 0.2 % decrease in independent health care provision for the same group surely a clear indication that they don’t care.

One wonders whether this has more to do with the bad press and extremely difficult circumstances that many health care providers have found themselves in the middle of rather than anything else but really if the NHS was putting mental health on equal parity with physical health then a real effort to invest more money and services for those with mental health issues would be appropriate.

It is also worrying that the CQC also noted that in general (not specifically mental health services)

 …that there is a growing disparity between trusts that are able to improve and those that, for a variety of reasons, are unable to pull themselves away from poor quality care.

And the biggest problem that they found within the mental health division was that they were failing to meet adequate staffing levels in 20% of cases this year compared to only 9% the year before.

It is also noteworthy that of the 21 criteria under inspection 6 became worse and 2 stayed the same of these one was at 100% met so this isn’t a big deal however of the others only 4 where now 100% compliant. These being,

Cleanliness and infection control (up 4%): Safety, availability and suitability of equipment (up 3%): Requirements relating to workers (up 11%): Complaints (0%)

Please note that the table in the report shows that the number of inspections for each criterion are not the same and although they have inspected for Care and welfare of people who use services 205 times they have only inspected for Safety, availability and suitability of equipment 4 times and therefore despite all the inspections showing that this criterion (safety, availability and suitability of equipment) is 100% compliant it makes the figure meaningless as you can't even be sure that the inspections were done at different facilities or by different providers.

Really in nine months they’ve only managed to inspect for this 4 times! In fact of the 4 criterion that gained 100% compliance only one was inspected more than 10 times and that ‘complaints’ was only inspected 29 times. Hardly a representative number of inspections. Maybe this is why they show 100% compliance. In fact 8 out of the twenty criterions have been inspected under 50 times, which means in all likelihood not even every provider has had a single inspection on each of these criterion let alone each facility.

More worrying though is what they have to say about independent health providers.

The gap between the quality of care in independent mental health and learning disability services, when compared with the rest of independent health care, is still wide overall.

And then later on

Because these private services look after people who are vulnerable because of their circumstances, but they are not open to scrutiny in the same way that public services are, it is also important that local communities find ways to hear and understand the experiences of people who are being cared for in this way.

One wonders precisely why they aren’t as open to scrutiny since they are providing the same care for the same types of people?

In fact it’s horrifying to think that independent care is worse than the NHS since that also has so many flaws but to have less scrutiny. I am completely confused as to how this became the norm and why it is continuing since the Winterbourne tragedy it would seem prudent to get this sorted as soon as possible.

And if you look at the list of improvements for these health care providers the list is impressive but only in the number. They are still falling well short of where they need to be

Services improved the way they planned and delivered care and treatment for patients. They met this standard in 86% of inspections, a rise from 69% for the whole of 2011/12.

They also improved support for their staff through training, supervision and appraisal. Services met the standard in 89% of inspections carried out, compared with 81% the previous year.

They were better at treating people with respect and involving them in discussions about their care: services met the standard in 93% of inspections, compared with 85% in the whole of 2011/12.

They did more to protect people from the risk of abuse and prevent it from happening: services met the standard in 93% of inspections carried out, a rise from 73% in the previous year.

They were better able to assure themselves of the quality of the care they provided and manage the risk to patients: services met the standard in 91% of inspections, compared with 82% in 2011/12.

And it seems to me that the moral of this is don’t use independent providers for this type of care unless you absolutely have to and have the time to make sure your relative is in good care. As for the rest of it, well it’s a bit difficult to tell anything much which I think is consequently why their report has said very little.
 

Take home message.

Mental health care provision is patchy and poor but can be good if you live in the right place. It is improving but slowly and not as fast as was expected something that will need to be addressed if the targets are to be met.

Not exactly a surprise but since many people don't seem to believe things until they're written down at least it is another source of information for the policy makers to use.

I think only time will tell if we’re being side-lined as the biggest question over the future is about investment. Investment in mental health care from training to facilities and research and only time can give us the answer.