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20 Oct 2023

SANE responds to Care Quality Commission’s state of care report

The nation’s health regulator, the Care Quality Commission (CQC), has published its annual assessment of the state of health and adult social care in England looking at the quality of care.

The CQC said that mental health services were a particular area of inspection focus this time, and while there was some good practice, the commission has seen too many examples of poor care and taken action to protect people when necessary. However, staff and leaders across all sectors are mitigating risks arising from staffing shortages and work hard to deliver good care in “very challenging conditions.”

Stark truth

Responding to the The state of health care and adult social care in England 2022-23, Marjorie Wallace, founder and chief executive of SANE, said: “This report reflects the stark truth that mental health services are not resourced to meet the current demand which is greater than last year and up by a quarter from before the pandemic.

“The stories we hear daily are of people who cannot find help when in crisis. Many wait for hours in A&E before being sent home, despite often being suicidal. Others report being driven many miles out of area because there are no local beds available. Those who do get a bed may find themselves in understaffed wards, being looked after by nurses who struggle against the odds.

“Patients can also wait days or even weeks for a home visit from overstretched community teams.

“The government must act to ensure mental health services are properly resourced, so that people receive appropriate and safe care when they need it.”

Pressure on services

The report notes that access to and quality of mental health care remain a key area of concern. Gaps in community care continue to put pressure on mental health inpatient services, with many inpatient services struggling to provide a bed, which in turn leads to people being cared for in inappropriate environments – often in A&E.

  • One acute trust reported that there had been 42 mental health patients waiting for over 36 hours in their emergency department in one month alone.
  • When people do get a bed in a mental health hospital, the quality of care is often not good enough.
  • As well as long waits, people are often facing the prospect of being sent far from home for care and treatment. Despite a government commitment to ending out-of-area placements, as at May 2023, there were 775 out-of-area placements across England.
  • Safety continues to be an area of concern, with 40% of providers rated as requires improvement or inadequate for safety.

Recruitment and retention of staff

Recruitment and retention of staff remains one of the biggest challenges for the mental health sector, with the use of bank and agency staff remaining high and almost one in five mental health nursing posts vacant.

The CQC adds that it has raised concerns staffing issues in mental health services are leading to the over-use of restrictive practices, including restraint, seclusion, and segregation, and called on providers to recognise and take steps to address this.


Further reading: Combination of cost-of-living crisis and workforce pressures risks ‘unfair care’ – longer waits, reduced access and poorer outcomes for some – Care Quality Commission (cqc.org.uk)


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