A lack of patient involvement
The CQC also identified serious problems with care and discharge planning. The mental health system is meant to promote recovery and enable people to have a positive discharge from hospital. Care viewed in this way should see the patients as a partner in recovery, someone actively involved in their care planning.
Remember the government mantra that in NHS care there will be “no decision about me, without me”? The CQC’s findings show that this isn’t the case in mental health. More than a quarter (27%) of care plans showed no evidence of patients being involved in them. Over one in five (22%) showed no sign of the patient’s view having been taken into account. These are major documents that inform care decisions. That’s quite a lot of decisions being made about me, without me. It’s hard to imagine another system that would settle for failing to meet a fundamental performance measure in a quarter of cases.
As for an effective discharge from hospital, the CQC found that one third of care plans contained no sign of discharge planning. This is difficult to reconcile with a service supposedly focused on recovery. The report correctly states that hospitals have a legal responsibility to provide ongoing planning of aftercare, so why is this so frequently absent?
The CQC’s report demands to be read and acted on. It suggests a system of coercion not collaboration, of containment instead of recovery. It is commendable that the CQC is picking up these failings but concerning that the problems with lack of involvement in discharge and care planning have remained the same for two years. The CQC describes this as unacceptable. I agree. The question is – what will drive change now?
People being excluded from their care decisions, people whose discharge is given no thought, people being wrongly deprived of their freedom, these people need services to radically change the way they operate; putting people back in control of their lives. Failing in one fifth, one quarter, one third of cases is not good enough. Merely saying that things have been unacceptable for two years is not enough. Should services continue to resist change, we need a regulator that will challenge and change those systems.
Sounds like a real winner.