Working towards holistic. physical healthcare. Paul Lelliott

Transcription

1 Working towards holistic regulation of mental and physical healthcare Paul Lelliott

2 CQC purpose and role Our purpose We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve Our role We 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 2

3 Five key questions We ask these questions of all services: Is it safe? Is it effective? Is it responsive? Is it caring? Is it well-led? 3

4 Rating four point scale High level characteristics of each rating level Innovative, creative, constantly striving to improve, open and transparent Consistent level of service that people have a right to expect, robust arrangements in place for when things do go wrong May have elements of good practice but inconsistent, potential or actual risk, inconsistent responses when things go wrong Significant harm has or is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve 4

5 CQC: What have we found? Wide variation between trusts and within trusts. The importance of leadership and culture. The NHS Staff Survey is the best indicator of our overall rating. s are being made. Some immediately; some take longer. In a small number of cases we have observed deterioration. 5

6 Mental health NHS trusts overall current ratings Source: CQC ratings extracted 10 April Numbers on bars are percentages, and may not sum to 100 due to rounding 6

7 Mental health current overall core service ratings Source: CQC ratings published up to 2 September Figures in brackets are number of service rated. Figures on bars are percentages. 7

8 Acute NHS hospital trusts overall current ratings Note: Values on the chart are percentages and where percentage totals do not add up to 100, this is due to rounding Source: CQC ratings for hospitals published up to 22/08/

9 NHSStaff Staff Survey 2015 Key Finding 1 versus CQC ratings overall trust Source: CQC ratings for hospitals (H1 primary inspection categories), published up to 30/04/2016. Ratings used are Overall and NHS Staff Survey Results/Staff Survey 2015 Detailed Spreadsheets/ 9

10 Variation between Mental Health Trusts Northumberland,Tyne & Wear NHS FT June 2016 Norfolk & Suffolk NHS FT February 2015 Safe Effective Caring Responsive Well led Overall Adult acute wards & PICU's Good Adult long stay / rehabilitation wards Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Forensic inpatient / secure wards CAMHS Good Good Good Good Good Wards for older people Good Wards for people with a learning disability or autism Good Adult community based Good services Community based crisis services & HBPoS Good Specialist communitybased services for children & young people Good Community based services for older people Good Good Community based services for people with a learning disability or autism Good Good Good Good Good Good Overall Good 10

11 Variation between Acute trusts/locations Frimley Park NHS Foundation Trust 2014 Wexham Park Hospital

12 and deterioration 33 trusts have been placed in Special Measures since July 2013 (30 acute, 2 ambulance, 1 mental health). 20 have now exited Special Measures (19 acute, 1 mental health) although 2 trusts which exited Special Measures have now reentered. A substantial number of trusts have moved from to Good with some moving from /Special Measures to Good. A small number of trusts have deteriorated over the same period moving from Good/ to. 12

13 : Wexham Park Hospital Safe Effective Caring Responsive Well led Overall Urgent and emergency services Medical care (including older people's care) Good Good Good Outstanding Outstanding Outstanding Good Good Good Good Good Good Surgery Good Good Good Good Outstanding t Good Critical Care Good Good Outstanding Good Outstanding Outstanding Maternity and Gynaecology Services for children and young people Good Good Good Good Good Good Good Good Good Good Good Good End of life care Good Good Good Good Good Good Outpatients and Diagnostic Imaging Good Inspected but not rated Good Good Good Good Overall Good Good Good Good Outstanding Good

14 : Calderstones Partnership NHS FT Calderstones Partnership NHS Foundation Trust 2014 (shadow ratings not published) Calderstones Partnership NHS Foundation Trust 2015 Safe Effective Caring Responsive Well led Overall Safe Effective Caring Responsive Well led Overall Forensic inpatient / secure wards Good Forensic inpatient / secure wards Good Good Good Good Good Good Community based services for people Good with a learning disability or autism Community based services for people with a learning disability or autism Good Good Good Good Good Overall Good Overall Good Good Good Good Good Good 14

15 Plans for next phase CQC has completed its first round of inspections of : All NHS trusts by June All independent health services (including substance misuse) by March 2017 We started our next phase approach for NHS trusts in June 2017: Annual cycle of inspection and re-rating Targeted, unannounced inspection of selected core services followed by an assessment of well led 15

16 Holistic regulation of mental and physical healthcare The Five Year Forward View for Mental Health Physical and mental health are closely linked people with severe and prolonged mental illness are at risk of dying on average 15 to 20 years earlier than other people..there is a lack of access to physical healthcare for people with mental health problems. People with long term physical illnesses suffer more complications if they also develop mental health problems.yet much of the time this goes unaddressed.dedicated mental health provision as part of an integrated service can substantially reduce these poor outcomes. 16

17 Quality of physical healthcare in mental health settings By 2020/21, at least 280,000 people living with severe mental health problems should have their physical health needs met. CQC has produced brief guides on: Physical healthcare in mental health settings Physical health monitoring on admission (for learning disability and autism) Psychoactive medicines (for learning disability) Monitoring post- rapid tranquilisation 17

18 Quality of mental health care in physical health settings Within its strategy for , the CQC should set out how it will strengthen its approach to regulating and inspecting NHS-funded services to include mental health. (FYFV - Rec 53) In response CQC is strengthening its approach to assessing: Mental healthcare delivered in acute hospitals Mental healthcare in primary care use of population groups in inspections of general practice to be strengthened, and improved guidance to provided for inspectors. 18

19 Quality of mental health care in physical health settings Assessing mental health care delivered in acute services demonstrates our commitment to the parity of esteem agenda and places ownership on acute providers to deliver high quality mental health care that is responsive to peoples needs. Over the past 18 months we have worked to develop a methodology that will enable CQC to monitor and inspect the delivery of mental health care across services provided by NHS acute trusts. 19

20 The methodology core service frameworks A comprehensive review of guidance and quality standards enabled us to establish what good mental health care looks like in each core service Additional prompts relating to mental health have been inserted into each of the acute core service frameworks Urgent and emergency service Services for children and young people Surgery Medical care Outpatients End of life care Critical Care Maternity 20

21 The methodology - pathway tracking Mapping the care pathway of a person experiencing a mental health crisis Exploring processes that services follow Asking specific questions about how someone experiencing a mental health crisis would be supported to access their service Build a picture of how well services work together 21

22 Piloting the methodology University Hospitals Southampton NHS Foundation Trust Weston Area Health Trust Warrington and Halton Hospitals NHS Foundation Trust Gloucestershire NHS Foundation Trust Lewisham and Greenwich NHS Trust

23 Implementation The approach to assessing physical healthcare in acute hospital settings is agreed. We plan to have assessed mental healthcare in every acute NHS trust within the next three years (as part of the next phase of inspection). Each inspection team that assesses physical healthcare in the acute setting will include a specialist mental health inspector. 23