CQC concern at wrongly certifying mental health patients as consenting to treatment

Many detained mental health patients who have been certified as consenting to treatment appear to be refusing to give consent or lack the capacity to do so, the Care Quality Commission has warned in its second annual report.

The Commission said the issue was a particular area of concern and that many services needed to substantially improve their practices. It suggested that some mental health services applied security measures in ways that placed unnecessary restriction on autonomy or compromised privacy.

The State of Care report revealed that the Commission had observed “over-occupied inpatient wards, lack of one-to-one work with patients, or unnecessary restrictions of liberty”. It also said people from minority ethnic groups continued to be over-represented among those detained under the Mental Health Act.

The watchdog’s community mental health survey added that there was significant variation in the extent to which mental health services involved patients in planning their care and reviewing their treatment.

Other key findings from the report, which looked at the state of health care and adult social care in England, included:

• Health and social care services improved in the years leading up to the implementation of the Health and Social Care Act 2008. However, “there are still some areas which have not improved fast enough”.
• There has been a steady increase in the number of councils which are performing “well” or “excellently”. Similarly the proportion of NHS trusts scoring “excellent” or “good” for the quality of their services has risen from 41% in 2005/06 to 63% in 2008/09. Waiting times for NHS hospital treatment have shown progress.
• People now have greater control over their care as a result of more choice in areas such as appointment times, choice of location of care and choice of providers. However, the report said there was still wide variation in progress in giving people access to personalised services through direct payments or personal budgets
• The quality of private-sector run care services “is generally lower” than those run by councils or voluntary organisations. However, council and voluntary organisation run services represent a fraction of the market
• There has been a substantial increase in the number of care homes and home care services meeting safe care standards. But further improvements in medicine management are still needed
• The quality of care arranged by councils between September 2008 and September 2009 improved. Councils also made significant improvements in adult safeguarding and in maintaining the dignity and respect of vulnerable people
• Some organisations “still lag behind the pack”. Key areas of concern include: safe care; choice and control (particularly in mental health); person-centred services; and standards of care and support
• Councils find it challenging to extend further options for independent living, and community-based services have been reduced. “The rapid growth of demand for support, especially due to the rising number of older people, has not been matched by growth in the availability for more person centered support,” the CQC said, adding that the number of people over 75 who had repeated emergency admissions increased, “suggesting a lack of effective community support”
• Only 31% of councils were monitoring how well they were meeting targets on equalities
• 91% of NHS organisations are meeting the minimum standard for challenging discrimination, promoting quality and respecting human rights. “But all organisations should have met this standard in 2004, and performance is low in comparison to most other minimum standards”.

CQC's chairwoman, Dame Jo Williams, said: “There have been significant improvements in outcomes for people who use services and these services should be congratulated for the work they have done. However, the overall picture is far from perfect and it will be vital for all parts of the health and social care system to continue this upward trend and consolidate the best of what has worked well for people who use services.”

“The next few years will be a crucial time for health and social care in England. There will be important changes such as the creation of HealthWatch, Monitor as the economic regulator for health and social care, GP led commissioning consortia, Health and Well Being Boards and the National Health Service Commissioning Board.”

Dame Jo added that the new system of regulation under the 2008 Act worked much more in real time, allowing the CQC to respond more quickly to poor standards of quality and safety where they are identified.

The CQC is to publish another report later in 2011 examining the care system after registration under the 2008 Act.