CQC logoCare regulator the Care Quality Commission (CQC) is to put greater emphasis on inspecting the care that people with mental ill health receive in the community.

More than 1.5 million adults used community mental health services last year. To date, CQC’s inspections have tended to focus on hospitals, but recognising the importance of community services to people’s experience of care – including the experience of people on community treatment orders – CQC will now inspect more of these services.  

This new approach will also look at how community mental health services work with other organisations that are important in supporting recovery in mental health.

The main changes proposed are:

  • Including Mental Health Act specialists on all inspections of mental health services and bringing together CQC’s work under the Mental Health Act and how it regulates mental health services 
  • Inspection teams of specialist inspectors, experts by experience and professional experts 
  • Ratings for mental health services. These will be outstanding, good, requires improvement, or inadequate 
  • New ways of engaging with people who use services, their carers and families, during inspections and at other times 
  • Greater focus on community mental health services 
  • Looking at how people are cared for as they move between services. 

CQC will pilot its new inspection approach, starting with the NHS but with the aim of expanding it to other specialist mental health providers, including independent sector services. In the first wave of pilot inspections, 5 trusts have been selected, which provide some or all of the identified core services.

The five trusts are: Coventry & Warwickshire Partnership NHS Trust; Devon Partnership Trust; Dudley & Walsall Mental Health Partnership NHS Trust; South West London & St George’s Mental Health NHS Trust; and Solent NHS Trust.

The new way of regulating mental health services will also reflect emerging concerns, for example:

  • Deaths under mental health care – people in the care of specialist mental health services are a high risk group for suicide; unidentified, poorly treated or preventable physical illness contribute to premature mortality, as well as specific concerns such as deaths caused by restraint
  • The experience of people who have a mental health crisis or who are admitted to hospital – the availability and responsiveness of services to supporting people through crisis and preventing admission to hospital; growing numbers of people being admitted to hospital far away from their home because of severe pressures on their local acute or admission wards
  • Transitions and interfaces between services – including the transitions between child and adolescent and adult mental health services and between services for adults and older adults and interfaces between services for people in contact with the criminal justice system who have mental health needs.

New approach

Professor Sir Mike Richards, CQC’s chief inspector of hospitals, said: “Our new approach will bring together both strands of CQC’s work in relation to mental health – our work under the Mental Health Act and how we regulate mental health services.

“I am appointing a deputy chief inspector for mental health who will work with me, leading expert inspection teams who will spend more time listening to people who use services, carers and staff.”

Minister for Care and Support Services, Norman Lamb said: “We are determined to reach a point where mental health has equal priority with physical health on the NHS.

“Improving inspections of mental health services plays a key part to this – the new chief and deputy chief inspector of hospitals will help root out poor mental health care and point to interventions when things need to be put right. Introducing specialist inspectors and new ratings will also help drive up standards across the board and improve care.”

Jenny Edwards CBE, chief executive of The Mental Health Foundation, welcomed the greater emphasis on an individual’s legal rights under the Mental Capacity Act and Deprivation of Liberty Safeguards. 

“We look forward to seeing the guiding principles of the Act firmly embedded in every day practice by mental health services,” she said. “We are dealing with some of the most vulnerable members of our society and it is vital that their voices are at the heart of the regulation of mental health services.”

Paul Farmer, chief executive of Mind, also welcomed the CQC’s new approach. “It is vital people with mental health problems have a high level of confidence in the services they use, especially as it is one of the very few areas of care where vulnerable people can be treated against their will,” he said. “This approach has the potential to be a step-change that will look in detail at the journeys of people throughout different parts of the system and which seeks to involve people with experience at every point in the scrutiny of services.”

CQC board member, Professor Louis Appleby, said: “At the heart of CQC’s new approach is that it will tailor the focus of inspections on the issues that matter to people. Protecting the rights of detained patients is of particular significance for CQC, not only because of its dual responsibilities under the Mental Health Act and Health and Social Care Act but also because this is the only group of people who are treated against their will – so focusing on the rights and the experience of people subject to detention is critical.”