The end of parity of esteem? Patients face increasing risks as NHS funding announcements neglect mental health
06 October 2019
Mental health patients are being placed at increasing levels of risk from ageing and often unsafe mental health buildings, while the government continues to neglect mental health services in its NHS capital investment programme, new evidence gathered by NHS Providers reveals.
The analysis stands in contrast to the recent funding announcements from prime minister Boris Johnson. None of the six hospital trusts given funding to develop a new hospital or the 21 trusts given seed funding in the government’s health infrastructure plan, and just three of the 20 hospital projects which received funding earlier in the summer, are mental health trusts.
None of the six hospitals trusts given funding to develop a new hospital or the 21 trusts given seed funding in the government’s health infrastructure plan, and just three of the 20 hospital projects which received funding earlier in the summer, are mental health trusts.
This is despite the conclusions of Care Quality Commission’s 2018 State of Care report on mental health that many mental health wards throughout the country are “unsafe and provide poor quality care” in “old and unsuitable buildings.”
NHS Providers’ analysis shows this continued under prioritisation of investment in the mental health estate is having a real impact on patients:
- The number of reported patient safety incidents caused by infrastructure (staffing, facilities, environment) in 2018/19 was 19,088 compared to 17,693 in 2017/18. These incidents include unsafe environments with a risk to personal safety and inappropriate clinical environments.
- The number of infrastructure incidents, such as inappropriate disposal of clinical waste or wards that are too hot or too cold, in mental health trusts has increased by 28% from 2015/16 to 2018/19, compared to a 16% increase for incidents in all trusts.
- There were seven never events reported in mental health trusts in 2018 as a result of a shower/curtain rail failing to collapse and one as a result from a fall from a window.
The risks to patient safety from infrastructure failures in mental health trusts is severe.
Mental health trusts, which provide vital health and social care services for people with mental health problems, continue to be neglected despite clear evidence that critical improvements are required. Their leaders are increasingly concerned that the lack of investment places their patients at increased risk:
Claire Molloy, chief executive of Pennine Care NHS Foundation Trust, which runs mental health and learning disability services within Greater Manchester, said:
“The environment has a significant impact on mental health patients, as well as the staff caring for them.
“It affects the rehabilitation and recovery of people at an incredibly vulnerable and difficult point in their lives, and yet so many of the buildings are old and unsuitable.
“People with lots of complex and enduring mental health symptoms may often require inpatient care, and they need modern, safe and quality facilities as much as patients with physical health conditions. However, without additional investment , it is very difficult to provide this without making big savings elsewhere.”
Liz Romaniak, director of finance, contracting and facilities and deputy chief executive at Bradford District Care NHS Foundation Trust, said:
“National advocacy of parity of esteem means we have clear mental health priorities, backed by an explicit £2.3bn revenue commitment. Access to capital is equally important. People are typically admitted to our acute wards when they’re at their most vulnerable and stay for longer compared to a typical general hospital admission, so having high quality therapeutic environments is key.
“Recognised best practice for mental health care has progressed significantly in recent years. Whilst we are continually improving our service models, we now need to invest around £40m in Bradford to replace our oldest adult acute mental health wards and ensure our built environments keep pace. Individual recovery journeys are unique. To ensure we’re sensitive to this we want to develop state-of-the-art facilities through co-design with service users and carers. This will ensure the right combination of outside space, good quality therapeutic environments, en-suite accommodation and assistive technologies to ensure the recovery, comfort and safety of those in our care.”
Ifti Majid, chief executive, Derbyshire Healthcare NHS Foundation Trust said:
“There is strong evidence that investment in better NHS accommodation and facilities leads to better health outcomes for patients. Looking at mental health care, for example, many of those with acute mental health needs will come into hospital at the most vulnerable point in their lives; we have a duty to provide them with a physical environment where they feel calm and safe, and where their privacy and dignity are maintained.
“For our trust, whilst we have some very modern facilities for our acute dementia inpatient services, there is currently a challenge to maintain privacy, dignity and a therapeutic environment in our acute mental health inpatient services, which are housed in older buildings that offer dormitory-style accommodation rather than single bedrooms. Greater capital investment in these services would, I feel, make a huge difference to our patients’ recovery and improve the morale of our hard-working, dedicated staff.”
Saffron Cordery, deputy chief executive of NHS Providers, said:
“Of course last weekend’s announcement of additional capital funding for selected acute hospitals was great news for those trusts, their staff and their patients. And there was a further, longer list of trusts provided with seed funding to develop future projects.
“Incredibly though, there was not a single mental health trust included in any of these plans. How can that be?
“As our research shows, we have seen repeated warnings of the risks – sometimes fatal - arising from the long term neglect of our mental health estate. And we have heard repeated pledges from government to ensure parity of esteem for mental health conditions.
How bad does the situation have to get before these warm words translate into practical steps to ensure a safe therapeutic environment that respects the dignity and privacy of patients who rely on these services?Deputy Chief Executive
“How bad does the situation have to get before these warm words translate into practical steps to ensure a safe therapeutic environment that respects the dignity and privacy of patients who rely on these services?
“And how can we hope to overcome the severe recruitment challenges we face in mental health without a clear commitment to improve the often unacceptable physical infrastructure?
“This was a damaging and regrettable oversight which must be put right.”
- The analysis of infrastructure incidents is based on the National Reporting and Learning System’s Organisation patient safety incident reports, the latest version is 2018/19. Infrastructure incidents are patient safety incidents caused by infrastructure (including staffing, facilities and environment) and include incidents such as exposure to cold/heat, unsafe or inappropriate clinical environments (including clinical waste), and unsafe environments (light, temperature, noise and air quality).
- The analysis of clinical service incidents is based on the annually published Estates returns information collection, the latest version is for 2017/18.