Thursday 30 January 2014

The CQC's latest findings on how the Mental Health Act is being used in services raise a series of concerns around patient rights and involvement

‘Patients are being threatened with the Mental Health Act’s powers but offered none of its protections’

The CQC's latest findings on how the Mental Health Act is being used in services raise a series of concerns around patient rights and involvement

on January 29, 2014 in Mental Health, Your Say

Image: Rex Features/Phaney

Share on facebook Share on twitter Share on email Share on pinterest_share More Sharing Services 12

By Martin Coyle, director of True Voice

A number of significant problems in the mental health system are identified in a report released this week by the Care Quality Commission on use of the Mental Health Act. For me, some of the most important issues identified in the report relate to barriers that are preventing people from leaving psychiatric care, specifically a lack of care planning, discharge planning and the concerning trend of people being subject to ‘de facto detentions’.

Let’s start with de facto detentions, an issue where people who have voluntarily agreed to come to hospital for treatment – as opposed to being detained under the Act – are then told by staff they will be detained if they try to leave. This amounts to people being kept in hospital when there is no legal basis to do so.

The issue was brought to attention by a Health Committee report last summer. At the time the committee said: “It appears that this practice is not extensive within the mental health system; nonetheless, the committee regards it as completely unacceptable.”

Yet this week’s CQC report suggests that far from de facto detentions being a practice that “is not extensive”, it is in fact increasingly routine. The CQC found that in 20% of cases:

“…patients who were not formally detained may be prevented from leaving. Measures of this included whether informal patients said that they were unable to leave the ward, where staff reported that they would automatically use holding powers to stop an informal patient leaving, or where staff were uncertain which patients were informal and which were detained.”

This is a clear breach of the Mental Health Act Code of Practice, item 4.12, which states:

“The threat of detention must not be used to induce a patient to consent to admission to hospital or to treatment (and is likely to invalidate any apparent consent).”

The upshot of this is that a large number of treatment decisions are being made without valid consent – a situation that should be a major concern to the professionals involved. It means that voluntary patients face the powers of the Mental Health Act without its protections (such as the right to independent advocacy). The importance of this situation cannot be downplayed. It is, as the Health Committee report stated, “completely unacceptable”.

A lack of patient involvement

The CQC also identified serious problems with care and discharge planning. The mental health system is meant to promote recovery and enable people to have a positive discharge from hospital. Care viewed in this way should see the patients as a partner in recovery, someone actively involved in their care planning.

Remember the government mantra that in NHS care there will be “no decision about me, without me”? The CQC’s findings show that this isn’t the case in mental health. More than a quarter (27%) of care plans showed no evidence of patients being involved in them. Over one in five (22%) showed no sign of the patient’s view having been taken into account. These are major documents that inform care decisions. That’s quite a lot of decisions being made about me, without me. It’s hard to imagine another system that would settle for failing to meet a fundamental performance measure in a quarter of cases.

As for an effective discharge from hospital, the CQC found that one third of care plans contained no sign of discharge planning. This is difficult to reconcile with a service supposedly focused on recovery. The report correctly states that hospitals have a legal responsibility to provide ongoing planning of aftercare, so why is this so frequently absent?

The CQC’s report demands to be read and acted on. It suggests a system of coercion not collaboration, of containment instead of recovery. It is commendable that the CQC is picking up these failings but concerning that the problems with lack of involvement in discharge and care planning have remained the same for two years. The CQC describes this as unacceptable. I agree. The question is – what will drive change now?

People being excluded from their care decisions, people whose discharge is given no thought, people being wrongly deprived of their freedom, these people need services to radically change the way they operate; putting people back in control of their lives. Failing in one fifth, one quarter, one third of cases is not good enough. Merely saying that things have been unacceptable for two years is not enough. Should services continue to resist change, we need a regulator that will challenge and change those systems.

Department of Health consults on 11 fundamental standards against which CQC will measure health and social care providers

CQC to prosecute providers without warning for serious care failings under government plans

Department of Health consults on 11 fundamental standards against which CQC will measure health and social care providers

by Chloe Stothart on January 27, 2014 in Adults, Care Work, Inspection and regulation

Credit: Image Broker/Rex Features

Share on facebook Share on twitter Share on email Share on pinterest_share More Sharing Services 23

The Care Quality Commission would be able to prosecute providers without warning for the most serious care failings under proposals issued for consultation by government.

Under the proposed draft regulations, the existing 16 essential standards of quality and safety would be replaced by 11 “fundamental standards” against which the CQC would measure providers.

The fundamental standards are:

a) care and treatment must reflect service users’ needs and preferences;
(b) service users must be treated with dignity and respect;
(c) care and treatment must only be provided with consent;
(d) all care and treatment provided must be appropriate and safe;
(e) service users must not be subject to abuse;
(f) service users’ nutritional needs must be met;
(g) all premises and equipment used must be safe, clean, secure, suitable for the purpose for which they are being used, and properly used and maintained;
(h) complaints must be appropriately investigated and appropriate action taken in response;
(i) systems and processes must be established to ensure compliance with these Fundamental Standards;
(j) sufficient numbers of suitably qualified, skilled and experienced staff must be deployed to meet these standards;
(k) persons employed must be of good character, have the necessary qualifications, skills and experience, and be capable of performing the work for which they are employed

The CQC would be allowed to prosecute providers for the most serious breaches of the first eight standards without issuing a warning notice first, as it is required to do now. This made it hard for the regulator to prosecute where there are serious failings, said the consultation paper.

The cases most likely to be prosecuted are those where there are particularly serious failings in care, multiple breaches at once or persistent breaches over time. The CQC would only be able to prosecute where there was enough evidence to bring a case and it was in the public interest to do so.

The consultation proposed that the CQC would continue to issue pre-prosecution notices for breaches of the final three of the 11 standards, failings against which would not warrant immediate prosecution according to government. The three standards concern having systems in place to ensure compliance with the standards, having sufficient numbers of qualified staff and employing staff of appropriate character and skill.

The CQC could prosecute later if the provider failed make the improvement required in the warning notice.

It would also not bring proceedings for breaches for some sub-sets of the other fundamental standards, such as where providers fail to encourage service users to make decisions about their care to the maximum possible extent.

Directors of care providers convicted of breaking any of the proposed standards could be hit with an unlimited fine.

The consultation on the draft regulations ends on 4 April 2014 and the regulations will come into force on 1 October 2014.

The paper did not cover the ideas of a “fit and proper persons test” for directors of CQC-registered care providers and placing a “duty of candour”, requiring providers to tell service users about serious failings in their care. The paper said there would be separate consultations on these ideas although they would be part of the same regulations as the fundamental standards.

The idea of fundamental care standards was proposed by the Francis Inquiry on why regulators and commissioners failed to spot the serious failings in care at the Mid Staffordshire NHS Foundation Trust sooner.

The Francis Report criticised the current standards as being over-bureaucratic and failing to “separate clearly what is absolutely essential from that which is merely desirable”.

Data obtained by BBC reveals children as young as 10 have been held in police cells due to problems accessing NHS units

Hundreds of children held in police cells after being detained under Mental Health Act

Data obtained by BBC reveals children as young as 10 have been held in police cells due to problems accessing NHS units

by Andy McNicoll on January 27, 2014 in Mental Health, Young people

Albanpix ltd/rex features

Share on facebook Share on twitter Share on email Share on pinterest_share More Sharing Services 20

This weekend another important story highlighting issues in the mental health crisis care system emerged. An investigation by the BBC’s The World this Weekend found that hundreds of children have been detained to police custody under the Mental Health Act because police officers did not have anywhere else to take them.

There were 305 detentions of under-18s to police custody in the first 11 months of 2013, data obtained under the Freedom of Information Act from 42 police forces in England and Wales showed. The data showed that in 2011 there were 385 detentions and in 2012 there were 317 detentions. A 10-year-old in Gwent, south Wales, was detained to a police cell as no bed was available.

Police officers have powers under the Mental Health Act to take people they suspect as being mentally unwell to a “place of safety” – ideally an NHS unit – for an assessment. The Home Office has previously stated that police cells are not a suitable place of safety for section 136 detentions and should only be used as a last resort. Police officers have previously warned of problems accessing NHS places of safety.

Care and support minister Norman Lamb told the BBC that the level of detentions of under-18s to police cells was “unacceptable”. Read the BBC’s investigation in full here.

Calls for a review of support for looked-after children in prison after inquest into the death of 17-year-old Ryan Clark ends

Care failures contributed to prison death of looked-after child

Calls for a review of support for looked-after children in prison after inquest into the death of 17-year-old Ryan Clark ends

by Tristan Donovan on January 28, 2014 in Children, Looked after children, Youth justice

Credit: Action Press/Rex Features

Share on facebook Share on twitter Share on email Share on pinterest_share More Sharing Services 12

The charity Inquest has called for an independent review of the care of young prisoners after a jury found that failures in support contributed to the death of a looked-after 17-year-old at HMYOI Wetherby.

The jury at the inquest into the death of Ryan Clark, who was found hanging in his cell on 18 April 2011, concluded that his actions were more a ‘cry for help’ than an attempt to take his own life and ruled that his death was accidental.

The jury noted that Clark, who was subjected to repeated verbal abuse and physical threats by other inmates while the prison, did not receive all the support he could have and that Wetherby’s system for challenging the bullying he experienced was ineffective.

During the hearings the jury was told by Jane Held, the independent chair of Leeds Safeguarding Children Board, that the system failed Clark, who had been in care since he was 16 months old.

She said that during the final year of his life, Clark had no single consistent professional who was responsible for him and that his care plan was insufficient.

Deborah Coles, co-director of Inquest, said: “The jury’s conclusion is a serious indictment of a system that fails time and again to protect children in its care. It is clear that basic safeguards that should have been implemented to protect Ryan, a vulnerable 17-year-old, were either absent, ineffectual or simply ignored.

“Deaths of children and young people do not just raise criminal justice issues but important issues outside the prison walls such as the role of social services, support for looked-after children and questions as to why a vulnerable child was imprisoned in the first place.

“There have been a pattern of deaths of children and young people with worryingly familiar themes which is why we are calling for an independent, wide-ranging and holistic review into the deaths of children and young people in prison.”

Ruth Bundey, the solicitor for Clark’s family, said: “It is welcome that the jury has recognised the very serious failings in the lead up to Ryan’s death. However it is also clear that he was failed by those who were supposed to protect his welfare for a long time before that.

“Over 50% of the children held in Wetherby Young Offender Institution are looked-after children. Ryan’s death has raised serious questions about the protections afforded by the state to very vulnerable young people.”

Lin Hinnigan, chief executive of the Youth Justice Board, said: “Every death of a child in custody is a tragedy and the Youth Justice Board takes our responsibility for children in custody very seriously.

“We have noted the jury’s findings and will give careful consideration to the issues identified by the inquest and what action they require us to take to make improvements.”

Teachers and social workers shouldn't be afraid to shame bad parents, says Ofsted boss

Ofsted chief inspector Sir Michael Wilshaw told MPs that social workers and headteacher need to tell parents when they are behaving badly
Said communities should play help support problem families
'Families need to know that they can't go on treating their children like this'
Government should also consider rewarding 'good citizens' to knock on their neighbours' doors and tell them they are being bad parents

By ANNA EDWARDS

PUBLISHED: 10:34, 23 January 2014 | UPDATED: 13:16, 23 January 2014

View
comments

Sir Michael Wilshaw said communities should play more of a role in supporting problem families

Teachers and social workers should tell people that they are bad parents and to stop failing their children, the head of Ofsted has warned.

Ofsted chief inspector Sir Michael Wilshaw told MPs that, as a former head teacher, he 'saw the result of children being brought up badly by their parents' and would routinely tell parents when they were failing.

He also said communities should play more of a role in supporting problem families, referring to the 'old phrase "a child is brought up by the village".'

Sir Michael said third parties needed to get involved when they saw children being treated badly by their parents - such as youngsters not being sent to school.

'These families need to know that they can't go on treating their children like this, they can't go on behaving in this manner and they've got to hit the targets that are being set by social workers,' he said.

'As a headteacher I used to tell parents that they were behaving badly and that they were bad parents.

'It didn't often go down extremely well but nevertheless that was my responsibility and it's a responsibility of social workers.'

More...

'As an ex-headteacher I saw the result of children being brought up badly by their parents, so society has got to worry about what's happening in families and families in particular parts of the country, and children's services have got a part to play in helping and supporting those families, but families have got a huge part to play and communities have got a huge part to play in supporting children.'

The Ofsted boss said headteachers and society has must worry about what's happening in families and raise concerns

The Government should also consider rewarding 'good citizens' to knock on their neighbours' doors and demand why their children are not in school, the Chief Inspector of Education has said.

He told the Commons Education Committee: 'Well, communities have got a big part to play in supporting our most difficult families and most vulnerable children.

'In my experience in the most difficult communities there are always going to be good people who want to help.

'How do you incentivise good citizens, good people, good family members to engage with the most difficult members of society, and that's a policy issue for Government.

'How do you financially incentivise these people to get up in the morning, knock on the neighbours door, and say your children are not up yet, they've not had their breakfast yet, why aren't you taking them to school?

Sir Michael, who was appointed Her Majesty's Chief Inspector of Education, Children's Services and Skills in January 2012, was speaking as he appeared at the Commons Education Committee to give evidence on Ofsted's recent report on the state of children's services.

He said that in the wake of high profile cases such as the death of Baby P, children's services have never been under so much pressure.

He said: 'The national consciousness of what can go badly wrong in terms of children's services is much greater than it's ever been because of the high profile deaths that have taken place over the past few years, and as a consequence of those tragedies the volume of cases under scrutiny have gone up, and the pressure on children's services have gone up and our inspection frameworks are much more rigorous as a result of that.

'We've also got to worry about the parlous state of children's services throughout the country and worry about those children who don't die and don't hit the headlines but actually are going through miserable lives because they are not being properly supported.'

Bad parents are to blame for society’s ills, says Ofsted chief: Sir Michael Wilshaw attacks 'hollowed out and fragmented families'

Oftsed chief inspector said child abuse and neglect were the product of social breakdown
Sir Michael described 'national obsession with pussyfooting around'
The former school principal named Birmingham as one of the worst places to grow up in the developed world

By STEVE DOUGHTY

PUBLISHED: 00:40, 16 October 2013 | UPDATED: 00:52, 16 October 2013

561

View
comments

Sir Michael Wilshaw branded Birmingham 'a national disgrace'

Parents who fail to teach their children right from wrong are at the root of Britain’s biggest problems, Ofsted’s chief inspector has said.

Sir Michael Wilshaw attacked ‘hollowed out and fragmented families’ where parents suffer a ‘poverty of accountability’.

He said child abuse and neglect were not the fault of councils alone. Such issues were the product of social breakdown.

Sir Michael warned that the problems exposed in child abuse scandals were being deepened by an apparent national obsession with ‘pussyfooting around’ and ‘making excuses’ for bad parents.

He said many children were ‘alienated’ from their natural father and that this lay at the root of the wider problems.

‘Some people will tell you that social breakdown is the result of material poverty – it’s more than this,’ he said.

‘These children lack more than money: They lack parents who take responsibility for seeing them raised well. It is this poverty of accountability which costs them.

‘These children suffer because they are not given clear rules or boundaries, have few secure or safe attachments at home, and little understanding of the difference between right and wrong behaviour.

‘If we believe that the family is the great educator – and I certainly do believe that – and the community the great support system, then we as a society should worry deeply about the hollowing out and fragmentation of both.’

More...

He spoke as Ofsted’s first report on England’s 152 children’s services departments found 20 areas where children are poorly protected.

He said Birmingham was one of the worst places to grow up in the developed world.

The city recently published a review of the murder of two-year-old Keanu Williams by his mother in 2011.

His comments come after a review of the murder of two-year-old Keanu Williams was published

His comments come after a review of the death of two-year-old Keanu Williams was published

Sir Michael said: ‘It is an absolute disgrace and government needs to look at this with real urgency.

'Why is it that nearly a third of children in the city live in households on low incomes?

‘Why is it that infant mortality is almost twice the national average, worse than in Cuba and on a par with Latvia and Chile?

‘These are shocking statistics and a national disgrace. They are a testament to failure of corporate governance on a grand scale.

'What is shocking is that this is the city council with responsibility for more children than any other, our second city, the largest unitary local authority in the country.

'This is a city that should be nipping at London’s heels for power, status and influence.’

'Sir Michael said children’s services had been undermined because one in three of the country’s departmental directors have either quit or been sacked in the past year – 50 out of the total of 152.

‘Incompetent and ineffective leadership must be addressed quickly,’ he added. ‘But where those in leadership positions have capacity and potential, this must be recognised and nurtured.’

The report found 86 of the 152 councils had children’s services that were ‘less than good’. The 20 judged inadequate were Barnsley, Bexley, Birmingham, Blackpool, Calderdale, Cambridgeshire, Cheshire East, Cumbria, Devon, Doncaster, Herefordshire, Isle of Wight, Kingston on Thames, Medway, Norfolk, Northamptonshire, Rochdale, Sandwell, Slough and Somerset.

A spokesman for Birmingham council said: ‘This is a long-standing problem which we acknowledge.
‘While we can only agree with the seriousness of what Sir Michael has said – indeed we have said it ourselves – we now need improvement rather than further diagnosis.’