improving patient care conference, richard brady presentation
TRANSCRIPT
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Tuesday 17th November 2015
Right here, right now: a call for action
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Regulatory Policy Officer, CQC
Richard Brady
CQC purpose and role
Our purposeWe make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.
Our roleWe monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care.
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How many people experience a mental health crisis?
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5% 1.8 m
c59% for self-harm
Over 125,000 admissions via A&E
Police used section 136 powers
24,000 times in 2013/14.
4,727 people died through suicide in 2013
45%consulted GP in
the previous month
A&E attendances related to mental health problems.
contacts with crisis teams.
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Right here, right now: mental health crisis review
CQC mental health crisis review
Focused on the experiences and outcomes of people at a time of mental health crisis.
We wanted to:
•Develop our approach to monitoring, inspecting and regulating the quality, safety and responsiveness of crisis care.
•Look at how organisations and agencies work together for three groups of people:
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Those that present to A&E (including those who self-harm)
Those who require access/ support from specialist mental health services
Those detained under Section 136 of the Mental Health Act
CQC mental health crisis review: key strands and milestones
What have we published?
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What did we do?
Survey of all providers of health-based places of safety (56 trusts and 2 CICs)
National call for evidence – over 1,750 responses
National review of available data sources
15 Local area inspections (2 pilots)
Apr: Health-based place of safety online map
2014
Oct: ‘A safer place to be’ report – findings from our national survey of health based places of safety
Nov: Mental health crisis care local area analysis
June: Publication of ‘Right Here, Right Now’ & 12 local area inspection reports
Oct: Health-based place of safety online map updated
2015
CQC mental health crisis review: key strands and milestones
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Crisis review: what we found
1.Quality varies depending on where people live and when they seek help.
2.Problems in accessing the right help at the right time:
Attitudes of staff towards people when they were in crisis
Accessibility and availability of care at all times
Quality of services offered, and responsiveness to people’s needs
Implications for safety, particularly in risks with self-harm.
3.Local services are innovating to provide a high-quality response to people in crisis – partnership working and integrated services are key to meeting people’s needs.
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Key findings: experience of care at a time of crisis
•14% of respondents felt the care was right and helped resolve their crisis.
•56% of local groups felt the quality and effectiveness of services was poor or very poor.
•10% of local groups felt that the support was equal out-of-hours;
•On average people came into contact with 3 to 4 different services during a crisis, some came into contact with up to 10.
•People’s experiences varied between services – most positive feedback for GPs, least positive about A&E.
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Key findings: experience of care at a time of crisis
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Key recommendations: local crisis care concordat partners and groups
Key recommendations for Crisis Care Concordat groups:
•Ensure that all ways into crisis care are focused on accessible and available help, care and support for all those who require it when they need it.
•Hold commissioners to account for commissioning crisis services that deliver care based on evidence-based good practice, in line with the Concordat key principles.
•Engage with local, regional and national partners to make sure innovative approaches to improving the experiences of those in
crisis are shared.
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Key areas for improvement: providers
•Community mental health teams should help people to develop crisis care plans, and be involved in decisions about their care.
•Crisis telephone helplines should be accessible when needed and meet expected standards.
•Acute hospital trusts to focus on improving experiences of people in crisis when they present to A&E for help, care and support:
• Joint-training sessions for staff run by members of the liaison psychiatry service.
• Improve A&E environments, ensuring that people presenting with self-harm are treated with warmth, compassion and empathy.
•Revisit the key findings from report on health-based places of safety, A safer place to be, to ensure sufficient local provision.
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CQC plans for action
CQC has …•Selected CRHTs and health-based places of safety as core services.
•Introduced a focus on liaison mental health
•Begun evaluating tools and methods used during thematic review
•Developed guidance and tools to support inspection.
•Published and consulted on a set of measures to monitor effectiveness of crisis care and shared with inspection teams.
•Developed training for inspectors and inspection teams.
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CQC plans for action
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CQC is…•Exploring options to develop inspections in acute hospitals.
•Working with the national steering group to allocate £15 million funding made available to improve health-based places of safety.
•Working with the Department of Health as part of the Crisis Care Concordat programme to evaluate the impact of Approved Mental Health Professionals (AMHPs).
•Working with the police to improve information sharing between agencies
