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Mental health inspection blueprint unveiled

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The chief inspector of hospitals has acknowledged plans to inspect mental health services are behind the acute sector but has said he is determined to achieve “parity of inspection”.

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Sir Mike Richards has revealed details of the Care Quality Commission’s planned approach to inspecting mental health services, LGC’s sister title Health Service Journal reports.

Like the new inspection regime for acute hospitals it will feature specialist teams of inspectors and a greater focus on patient experience.

The Mental Health Network has previously raised concerns the sector was being “shoehorned” into an inspection model designed for the acute sector.

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Sir Mike Richards, Chief Inspector of Hospitals, seen here at the Care Quality Commission 22 July 2013

Sir Mike admitted mental health was “one step further back” in terms of the development of an inspection methodology but said this was because it had no equivalent to the Keogh review of hospitals with persistently high mortality rates. The methodology of this review, which took place during the summer, became the model for the CQC’s new inspection regime.

There is also currently no equivalent to the acute trust intelligent monitoring system for mental health. The system uses more than 100 data points to band acute trusts into levels of risk. Instead, Sir Mike said the regulator intended to rely heavily on “intelligence” from complaints and service users, as well as GPs and commissioners when determining risk in mental health services.

However, he stressed the sector would have “parity of esteem” through “parity of inspection” - demonstrated through a commitment to inspect and rate every NHS mental health provider by the end of 2015, the same deadline that had been set for acute NHS providers.

“This will be a developmental phase,” he said. “I personally believe we will learn a great deal and be able to say a great deal about the quality of these services. I know it’s going to take time to get it absolutely right but we are committed to doing so.”

The first five organisations to be inspected under the new regime will be Coventry and Warwickshire Partnership Trust, Devon Partnership Trust, Dudley and Walsall Mental Health Partnership Trust, South West London and St George’s Mental Health Trust and Solent Trust.

The aspirant foundation trusts were chosen at the request of Monitor and the NHS Trust Development Authority, which wanted assurance on the quality of the services they provide before progressing their foundation trust applications.

Sir Mike said he believed the CQC would be able “to give them a verdict on that”.

CQC inspection teams will visit all mental health inpatient sites. They will take a “sampling” approach to community services, however this represents a greater focus on out of hospital services than was the case under the previous regime.

Asked how the teams would inspect services delivered in the community, Sir Mike said they were still working on the detail but it would involve talking to the teams delivering them, as well as service users.

They would also be asking trust management how they assured themselves of the quality of these services. “A well led trust will know,” Sir Mike said.

He said because mental health trusts tended to cover large geographical areas it was not easy to hold single public listening events, a key element of the new acute trust inspections, but the CQC was working on plans to capture patient and public voice.  

The CQC is currently in the process of recruiting a deputy chief inspector with responsibility for mental health.

Asked whether integrated trusts would be rated separately for their community and mental health services, or community and acute services, Sir Mike said the long term ambition was to provide ratings for individual services but they would initially receive an overall rating.

He said in future integrated trusts would see all of their services inspected at the same time but by separate inspection teams with particular expertise.

The new style inspections will pay particular attention to deaths in mental health care, the experience of people who have a mental health crisis or who are admitted to hospital and the transition from child and adolescent to adult services.

Sir Mike said he hoped all independent sector providers would also have been inspected by the end of 2015 under a hybrid of the CQC’s current and new models, in recognition of the fact they tended to be smaller and less complex than NHS mental health trusts.

Mind chief executive Paul Farmer welcomed the regulator’s new approach but described it as an “ambitious plan”.

He added: “I’m being reassured the resources exist to make this happen.”

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