Mental health services have been slammed as 'inadequate' by investigators as patients have been left to deteriorate without the knowledge of staff. The Care Quality Commission (CQC) carried out the inspection into two of Manchester's community-based mental health care teams after receiving information from whistle-blowers concerned about the standard of care, reveals a damming report published today (June 29).
Adult and working age patients 'struggled to contact the service for support or when in crisis, leaving people at risk of harm as they had no way to tell staff their mental health had worsened', the inspection found. The service was also chronically understaffed amid high turnover rates, according to investigators, with people not being seen 'regularly enough to keep them safe'.
Patient care plans went with a lack of up to date information about their care and treatment, adds the report, as 'staff were often unaware of patients decline in mental health'. Meanwhile, there were 'no plans' on how the understaffing would be rectified to meet demand, and such a shortage of inpatient beds that the mental health of patients left to be treated in the community was deemed severe.
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In total, there were 428 patients waiting for assessment, 221 patients waiting for treatment across the two teams and more than 260 patients without a care coordinator - someone to plan and be in charge of their treatment. "Many of these patients were not contacted or reviewed during this time," said the report, including patients with serious "safeguarding" concerns.
"The service was not aware of potential changes in the level of risk for these patients as this was not assessed and monitored effectively. This meant that some patients could deteriorate significantly, and reach crisis point before they were able to access the support they needed.
"Opportunities for staff to deliver interventions to reduce the risk of some patients relapsing were therefore missed."
Greater Manchester Mental Health Trust has been slapped with a warning following the report, as the trust operates the Central West and Central East Manchester borough community mental health teams looked at by the watchdog.
Along with waiting times, the CQC alerted: "Patients and carers were unable to contact the service with ease via telephone or other methods regarding care and treatment.
"The service did not effectively monitor patients waiting for an assessment and treatment. Patients did not have an up-to-date risk assessment or processes in place.
"Staff did not always act upon safeguarding alerts promptly. Staffing shortages were too low to meet patient's levels needs and provide safe care and treatment.
"Staff were not appropriately or consistently assessing and managing risks to patients. Staff did not always assess risks to patients, act on them or keep good care records."
The watchdog also found that "there were significant problems within the mental health care pathway that meant access to crisis teams and inpatient beds was limited. Therefore, the acuity of community patients was high and very burdensome to the service.
"This was an additional pressure to staff who were already working at capacity or beyond."
In particular, in the Central East team most of the experienced staff had left and only newly qualified staff remained, added the report.
Brian Cranna, CQC’s head of hospital inspection, said: “When we inspected the community-based mental health services for adults of working age, we found that managers supported and supervised newly qualified staff well and patients said the service was good, however, people using the service and their carers also told us they struggled to contact the service for support or when in crisis. This left people at risk of harm as they had no way to tell staff their mental health had worsened.
“The service suffered from low staffing levels and high turnover rates. We found managers hadn’t reviewed staffing levels for some time and there were no current plans to do this to meet demand. Due to this people were waiting too long to be seen for their first appointment, and people weren’t being seen regularly to keep them safe. It was also concerning that people’s care plans didn’t contain up to date information about their care and treatment.
“Due to our findings, we have served the trust a warning notice so that they are clear about what changes must be made to improve patient care and safety. We will continue to monitor the service and return to check on the progress of these changes.”
Greater Manchester Mental Health Trust bosses say the pandemic is behind a large rise in demand on services, while hiring new staff is 'increasingly difficult'.
Deborah Partington, Chief Operating Officer at Greater Manchester Mental Health NHS Foundation Trust responded to the report, saying: “We acknowledge the findings of the CQC’s inspection of two of our Central Manchester-based Community Mental Health Teams and will address the concerns within their report.
“Before the inspection, we were aware of the challenges faced by Central Manchester’s mental health teams and there are already plans in place to improve waiting times for service users. In line with the national picture, recruitment of registered professionals for community mental health teams is increasingly difficult and this inevitably puts pressure on the capacity of services. Therefore, we are looking at ways to make roles attractive for newly-qualified and experienced staff to want to join our teams, including supporting roles.
“The pandemic has had a significant impact on the mental health of our communities which has led to an increase in demand for our services and we are also seeing higher levels of mental illness which is requiring more intensive care and support. However, we have a process whereby we review, prioritise and monitor individuals who are waiting for assessment and treatment, with face to face appointments for those who are in the most urgent need of support.
"We are also making better use of technology and using a management and supervision tool which helps mental health professionals review key data to identify the risks of a service user going into a crisis, which is vital when working with sizeable caseloads.
“Our staff have had a very challenging two years and therefore we are delivering projects on staff health and wellbeing to support those who are at work to remain well and to help those who are off sick to return when they are recovered, as safely as possible.
“Along with our partners, we will continue to work as hard as we can to improve our services for those who need us, and we would like to reassure people that service users in our care are safe. We monitor the safety and risk of service users very carefully and prioritise those who need urgent help or a safeguarding risk. There are processes in place for service users to contact our teams when they need to, as well as a 24/7 helpline for anyone in an immediate mental health crisis.”
Following this inspection, the safety rating for this service has dropped from requires improvement to inadequate and CQC has issued the trust with a warning notice to focus their attention on making significant and immediate improvements in this area. As this was a focused inspection, just looking at safety, the service’s overall rating remains as requires improvement and the trust’s overall rating remains as good.
If you or someone you know is struggling with your mental health, or are feeling as though you’re in a mental health crisis and need urgent support and help, GMMH’s 24/7 helpline is available. You can call 0800 953 0285 if you’re in Bolton, Salford, Trafford or Manchester, or 0800 051 3253 if you're in Wigan , at any time, day or night.
If you are concerned about an immediate risk of harm - either to yourself or someone else - phone 999. If it is not an emergency but you require urgent advice, call 111. Visit your local Accident & Emergency department if necessary.
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