A fresh start, our plans for checking mental health services

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1 A fresh start, our plans for checking mental health services An easy read version of: A fresh start for the regulation and inspection of mental health services Working together to change how we regulate and inspect specialist mental health services

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3 About the Care Quality Commission We are an independent organisation that checks health and social care for adults in England. Our job is to make sure services give people good, safe and kind care. We also want services to get better. Fundamentals We check services in England to make sure they meet the fundamentals of care. This is the new name for rules about how good a care service has to be.

4 We tell people what we find out and give services a score to say how well they are doing. This helps people choose a service. These are the things we believe in: we put people who use services at the centre of our work we are independent we work hard to get things right and are fair about what we do we listen to what people say and want people to be involved in our work

5 we work together with other organisations we really want to do a great job. We expect to learn and get better all the time and expect services to do the same we help make sure people are treated equally and fairly and get their human rights.

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7 What is in this paper? 1. A message from the head of CQC, David Behan 1 2. A message from Sir Mike Richards, our Chief Inspector of Hospitals 6 3. About this paper 9 4. Checking Mental Health Services 11 Plans 5. Our new plans What happens next? 36

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9 1. A message from the head of CQC, David Behan In April we wrote our plans for 2013 to The EasyRead was called: Making Services Better, Putting People First. These plans had some very different ways to how we check services. We made these plans after we asked lots of people what should be in them. People agreed we should do things like: have chief inspectors and expert teams who know about different services 1

10 use scores to help people choose care tell people about good care get better at listening to people who use services. In May 2013 we set up a special group to look at how we check mental health services. This group has helped us make these plans. 2

11 This group, made up of people who use services, carers and others will now help us check these plans to see if they work as well as they can. People liked our idea to ask 5 questions about a service: 1. Is it safe? 2. Is it doing what it should be doing? 3. Is it caring? 4. Does it change to meet people s needs? 5. Is it well led? 3

12 We know we need to check different services differently. We have thought about how we check services for people who are made to have treatment under the Mental Health Act. And how we do our other checks as well. These must work together. We will be making sure people are treated equally and fairly and we will be especially careful to make sure they get their rights. This is important because we know people who use mental health services, people with learning disabilities and people with autism are less likely to get fair treatment. 4

13 That is why these plans are so important. If these plans work they will make people s lives better. David Behan 5

14 2. A message from Sir Mike Richards, our Chief Inspector of Hospitals We have already started making changes to make how we check services better. We said we would look more closely at: the Mental Health Act the Mental Capacity Act, and Deprivation of Liberty Safeguards. These are the ways people who are made to have treatment have their rights protected. 6

15 We will also follow the ways other services are checked like: how we put a service on our lists to say they can give people care all services having to meet new rules about how good they must be how we use all the information we can find out about services the checking our experts will do the information we give people about how good we think services are, and the scores we give them 7

16 what we do to make services that are not good enough better how people in charge of bad services are punished.? We will ask the 5 questions David listed. My expert teams will spend more time listening to: people who use services carers, and staff. We will use what we find out to decide how good services are, to help make services for people using mental health services get better. Sir Mike Richards 8

17 3. About this paper We now have some plans about checking services. These are in part 5. We will now talk about these plans with: people who use services families and carers experts by experience, people who have used services groups speaking up for others services and others. 9

18 To do this we have set up a special group that has helped with these plans and 2 other groups to look at checking services for people with learning disabilities and people who take drugs.? Other groups will work for a short time on certain areas like our 5 main questions. We will also talk to people through Healthwatch and other groups, especially those who speak for people who find it difficult to get their views heard. 10

19 4. Checking Mental Health Services Our chief inspector of hospitals will be in charge of hospital services for: people with mental health needs people with learning disabilities people with autism, and people who are can t stop taking drugs or other things. We will write more about this next year. This includes people made to stay in hospital for treatment, support or care. And in charge of community services for people with mental health needs. 11

20 Andrea Sutcliffe, our chief inspector of Adult Social Care, will still be in charge of social care services. These are the services most people with learning disabilities get. We know people with mental health needs get care and support in other services like A&E or prisons. We also know people with learning disabilities and others who are unable to make their own decisions get care in other services. For people who are unable to make decisions about treatment we will make sure we respect their independence and do things in the easiest way possible. 12

21 This means we might do checks and work together with teams from other areas like social care. It means, for example, we would make sure a service supporting someone who can t make their own decisions knows when to get a special advocate in, called an Independent Mental Capacity Advocate. Working with others on these changes The special group we set up to work with us on these changes, have helped us on lots of areas, including: the most important things we should be looking at how checking could work better in mental health and other more difficult services 13

22 the most urgent services to check how to get more information from other people.? Now we will be working with smaller groups. These groups will: help us decide the questions we ask mental health services decide what a good service looks like how we do checks 14

23 how we decide more checks are needed what we tell services. People who use mental health services are on all of these groups. We are also working with: people who have been in prison local Healthwatch groups people running NHS hospital trusts with mental health services 15

24 advocacy groups and others. We will carry on involving people who use mental health services to make our checks better. Looking at the most important things We must make sure our checks look at the most important things. It is especially important we look at the rights of people made to have treatment or care in hospital. Plans The government wants mental health services to get better and has their own plans. There are some areas we worry about: people dying in mental health services. Sometimes because they kill themselves, sometimes because staff don t know they are ill or they are held down 16

25 people with mental health needs who suddenly get worse people being sent to hospitals far away from home problems when people move between services. There have been lots of reports recently saying how services should get better and we will look at everything they have to say in our checks. We know sometimes a service can t do anything about poor care and won t hold this against them. 17

26 5. Our new plans Plans People told us about the most important changes we needed to make when checking mental health services. We are now asking lots of groups about our plans below. 1. Joining together our checking of mental health services with making sure people get their rights under the Mental Health Act. People said this was a good idea. It means we: will have more experts know more about how good and safe a service is can more quickly do something about poor services 18

27 can have just one report will help people understand what it is like to be made to stay in hospital will find out more and be able to tell others will have better information about how the Mental Health Act is working are making sure people get their rights. 19

28 2. What people say about their care We know it is important to listen to people. We will listen to: what people using services have to say in better ways advocacy and other groups families and carers information from Facebook and twitter. 20

29 3. Complaints We will use the information from complaints made by people who use services. We already look at complaints from people getting treatment under the Mental Health Act. We will also look at what other complaints say. It is important to remember we only use the information from these complaints, we don t follow them up for people. We will test out our new way of looking at complaints when we test our new ways of checking mental health services. 21

30 4. Experts We will have on our checking teams: Expert checkers experts who know a lot about one area experts by experience, people who have used services. We are changing from inspectors who check lots of different services to checkers who just look at services they know a lot about. So our inspectors will know a lot about checking mental health services. 22

31 People will also know a lot about the law on people who can t make their own decisions, the Mental Capacity Act. And other laws. Our experts will be up to date in the best ways of working. 5. Looking closely at services where we know people do not get a fair or equal service Checks must look at hospitals and community services. We will check which services are most important to check, at the moment they include: the wards people first go into in main hospitals places of safety 23

32 long stay units high security places where it is very difficult for people to get out mental health services for young people services for older people mental health services where people with learning disabilities and autism stay 24

33 community services for adults emergency services special services for people not eating properly. We will also think about other services like those for deaf people. We will also check other services we hear worries about. 25

34 When we check some of these services it will be at least 1 in 3. And we will test to see if this is right. There are also other groups we are looking at. 6. Moving to another service People can move to another service when they grow up or need a different sort of service. We will check these moves work well for people and make their lives better. This includes looking at where people live, if they have jobs and join in with their community. 26

35 For the first year we will look at people whose mental health has got suddenly much worse. This will help us use the things we find out for others later on. 7. Rules about how good services have to be and our 5 main questions We will work with people to make rules about what a good service must look like. Services must help to make sure: people get better people do not kill themselves 27

36 people do not die who should not die people have a good experience of care. We will look carefully at services that send people far away from where their families live. 28

37 8. Scores People wanted scores that: come out after our check have 4 points - really good (called outstanding ) - good - need to get better (called requires improvement ) - bad or poor (called inadequate ). are on parts of a service that makes most sense for people? are given for each of our 5 main questions 29

38 will be a help to everyone services can disagree with if we have not done our job properly. We will be testing how we give scores to lots of different services. 9. How often to check services We will check services that do not score well more often. And services with good scores less often. 30

39 If we hear worries about a good service we will check it again more quickly. Visits to talk to people getting care under the Mental Health Act will not be decided by scores since we need to check that they are being looked after on a regular basis. 10. Community services and community treatment orders Community treatment orders are where people are made to have care or treatment but they are living in the community.? We have not been clear about how we check these services. We know this is important and will do more on checking them and how they work with other services. 31

40 11. Using other information We will use information from: whistleblowers (people who work in a place that they think has problems) what other groups have found out surveys. We will keep this information up to date. We will test to make sure the information we keep is important. 32

41 We know it is important for some people to challenge themselves, even if this means taking risks. In the weeks before we check a service we will make a special effort to get more information from other people. What do these changes mean for people using services? We think these changes will: make it easier for people using services and others to tell people about their care people using services will be listened to more when we check their service involve local groups more 33

42 better checks of special mental health services give people better information to help make choices better services that have sorted out any problems we have found. Asking another doctor what is wrong People having care under the Mental Health Act can ask for another doctor who can give his view on what is wrong. This is called the SOAD (Second Opinion Appointed Doctor) service and is run by CQC. The SOAD service protects the rights of people who have not agreed to have care or treatment. Or they might not be able to make that decision. 34

43 SOADS look at whether the patient: has been listened to has their rights is getting the right treatment. About 15,000 people ask for a SOAD each year. About 3,000 have their care changed after a SOAD visit. We will look at how we can use the information from SOADS later on. 35

44 6. What happens next? We will set up the groups we talked about in part 3. We will keep people up to date with what we find out. We will start testing our new ways of checking some services. We will check 5 NHS trusts that have mental health services and want to be foundation trusts. These are: 1. Coventry and Warwickshire. 2. Devon. 3. Dudley and Walsall South West London and St George s Solent. 36

45 What happens when? We want to make these changes as quickly as possible. November 2013 March 2014 From November 2013 to March 2014 we will: ? talk with people about the 5 main questions talk about how we get information meet with other groups decide on how we test checking 37

46 check the 5 NHS trusts ask people what they think about our new rules and what we do about poor services. April 2014 June 2014 From April 2014 to June 2014 we will: have the next lot of test checking have a draft handbook for mental health services have final rules and rules about poor services. 38

47 July 2014 September 2014 From July 2014 to September 2014 we will: have the first scores for some services tell people what we have found out about some mental health services have a final handbook for mental health services. October 2014 In October 2014 we will: use our new way of checking and scoring with all services. We are always happy to hear what you think about our plans. If you would like to get in touch please 39

48 How to contact CQC Telephone our Customer Care Team on: Write to: CQC Citygate Gallowgate Newcastle upon Tyne NE1 4PA Follow us on Please tell us if you would like this information in a different language or format. Artwork is from the Valuing People Clipart collection and cannot be used anywhere else without written permission from Inspired Services Publishing Ltd. To contact Inspired Services: This publication is printed on paper made from a minimum of 75% recycled fibre. 40

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