From Mental Health Law Online
The Care Quality Commission was created in October 2008 and became operational on 1/4/09. It is an amalgamation of the following organisations:
- Healthcare Commission (Commission for Healthcare Audit and Inspection)
- Commission for Social Care Inspection (CSCI)
- Mental Health Act Commission (MHAC)
- Health and Social Care Act 2008 - The legislation which created the Commission
National Archives: CQC website. Some documents are not available on the current CQC website, but many of these can be located in these archives
CQC - Reports on MHA
- CQC, 'Mental health services must improve the care they provide to patients' (news item, 30/1/13). This web page contains a brief summary of the report plus links to: (a) the report, (b) a summary document, (c) an easy-read version, and (d) the CQC's press release
- CQC, 'Monitoring the Mental Health Act in 2011/12' (30/1/13). The following are the report's key findings for each chapter, and its concluding recommendations: (1) Use of the Act: (a) The number of people subject to detention under the Act is rising. The number of detentions rose by 5% on the previous year; the number of community treatment orders rose by 10%. (b) Of the 4,576 patient records checked in 2011/12, 4% showed irregularities that called the legality of the detention into question. (c) Care planning was the most frequently raised category of concern; 85% of the care plans examined showed evidence of individualised planning, regular review and evaluation, 15% did not. This was no change on 2010/11 and amounted to just over 650 patients where basic expectations about care planning were not met. (d) The greater detail now available in the Mental Health Minimum Data Set has exposed a number of data quality issues that must be addressed before the data can realise its full potential. (2) Participation and Respect: (a) CQC’s MHA Commissioners visited many mental health wards where a great deal of respect was given to patients. (b) Patients were able to influence the running of their ward in almost all cases – 94% of all wards in 2011/12, up from 90%. (c) Patients were more involved in planning their own care: their views were recorded in 63% of care plans, a rise from 58%. But this means an unacceptably high proportion – more than a third – did not have their views written down. (d) More than half of patients were still not given a copy of their care plan. (e) Most patients (90%) were given general information about their rights when they were first detained. (f) But one patient in five was not informed of their right to an Independent Mental Health Advocate (IMHA). (g) This may reflect continuing difficulties that some services have in accessing IMHAs. There was no evidence of an IMHA service in one in seven of the wards CQC visited. (3) Coercion in practice: (a) The human rights of patients are often affected by controlling practices that only seem to serve the hospital’s needs. Hospitals have a difficult task in balancing the realities of detention and compulsory treatment with the requirement that they provide services according to a principle of least restriction on patients. But it has proved all too easy for cultures to develop in which blanket rules deny people their basic rights – especially the right to dignity. (b) In one in five visits – an unacceptably high number – MHA Commissioners thought that patients who were in hospital voluntarily might be detained in all but name. For example, in 88 out of 481 visits there were no signs on locked doors that explained to voluntary patients how they could leave the ward. (c) On 24 occasions, patients had been secluded but the ward staff had not realised this was classed as seclusion and they had not applied the proper safeguards. (d) In many hospitals restraint practices are generally safe and appropriate. Almost all staff will now have some degree of training not only in physical methods of restraint, but in ways to prevent confrontational situations. (e) However, CQC is still concerned at the lack of regulation of training programmes with regard to restraint. Safeguards could be improved. (f) CQC is talking with the Department of Health about how to promote best practice around support for positive behaviour. (4) Care pathways (a) CQC saw evidence that many Approved Mental Health Professionals are trying to find alternative care for people that avoids them having to be detained in hospital. (b) Pressures on beds continued to put services and patients under stress, making it harder to provide appropriate care for people in times of crisis. In 2011/12, 93 wards (6% of all wards) visited had more patients than beds; a further 10% were at full capacity. (c) Patients are being affected by reductions in staff numbers. For example, MHA Commissioners raised concerns in 77 visits that a lack of staff prevented patients taking escorted leave. (d) In some services MHA Commissioners saw excellent examples of patients benefitting from psychological therapies. But in others, services were too ready to rely on psychiatric medication as their response to patients’ distress. (e) Patients are benefitting from good discharge planning in a number of units – with considerable investment in time and effort being spent in identifying step down accommodation and suitable support arrangements. But an unacceptably high proportion – more than a third of care plans – still showed no evidence of discharge planning. (5) Consent to treatment: (a) Consent to treatment discussions (before the first administration of medication) improved in 2011/12 – 55% of records showed these, up from 46% in 2010/11. But this means that in almost half of cases there was no evidence that doctors had talked to patients about whether they consented to proposed treatment. (b) There was better evidence of consent discussions after the first use of medication (72% of records). But still this means consent was not discussed in more than a quarter of cases. (c) One patient in 10 (receiving medication for three months or more) was prescribed medication above the legally authorised care plan. (d) In CQC’s view, the assumption of a patient’s capacity to consent to or refuse treatment should be backed up by a written record. More than a third of records did not show any evidence of a capacity assessment (42% on admission; 36% at the end of three months or the last administration of medication). (e) Patients may be reluctant to say what they think about their treatment in public, particularly in a traditional ward round. CQC saw some good services that have developed private arrangements instead of ward rounds. (6) Community Treatment Orders: (a) CTOs are used widely by some providers, and used little by others. In an analysis of NHS organisations, the lowest reported ‘discharge rate’ onto a CTO was 4.0%; the highest was 45.5%. (b) There were also a number of NHS organisations – with considerable rates of detention under the Act – that provided nil returns for the use of CTOs. (c) A number of patients are worried that it isn’t clear when a CTO will have served its purpose – and therefore they do not know what they have to do to come off a CTO. (7) Recommendations: (a) Policy makers must consider the reasons why there are rising numbers of people subject to the Act and develop an appropriate policy response. (b) The Boards of mental health trusts, independent providers of mental health care, and community trusts are responsible and accountable for the quality of care people receive. They must drive the changes needed in their organisations. In particular they need to recognise and promote good practice and ensure that robust mechanisms are in place to understand individuals’ experience of their services. CQC reminds providers of their own duties to monitor how they use powers derived from the Act (see the Code of Practice) and their duties under the Health and Social Care Act 2008 to demonstrate how they have learned lessons from practice and have made consequent improvements. This is an area that CQC will focus on in the next 12 months in its regulatory activity. (c) The NHS Commissioning Board, local authorities, clinical commissioning groups and specialist commissioners must commission services that guarantee a person’s dignity, recovery and participation. Clinical commissioning groups and local authorities must ensure that local needs assessments for community services and commissioned models of care are informed by an understanding of their statutory duties under the Act and by the experiences of people who use services.
- Care Quality Commission, 'Monitoring the Mental Health Act in 2010/11' (8/12/11). The detailed findings in this report are set out under the following chapter headings: (1) Patients' involvement and protection of their rights; (2) Consent to treatment; (3) Patients' experience of care and treatment; (4) Promoting patient safety; (5) Deaths of detained patients
- Care Quality Commission, 'Monitoring the use of the Mental Health Act in 2009/10' (27/10/10). CQC's first report on the MHA
- Coercion and consent: monitoring the Mental Health Act 2007–2009: The Mental Health Act Commission Thirteenth Biennial Report 2007-2009 - 19/7/09
CQC - DOLS
- CQC, 'Monitoring the use of the Mental Capacity Act Deprivation of Liberty Safeguards in 2011/12' (28/3/13)
- CQC, 'Monitoring the use of the Mental Capacity Act Deprivation of Liberty Safeguards in 2011/12: Summary' (28/3/13)
- CQC, 'CQC finds Mental Capacity Act not well understood across all sectors and calls for more work by providers and commissioners to improve' (press release, 28/3/13)
- Lucy Series, 'No longer early days' (The Small Places Blog, 7/4/13)
- Chris Doidge and Rob Cave, 'Majority of "deprivation of liberty" cases unreported, says report' (BBC, 7/4/13)
- BBC, '5 Live Investigates' (MP3 file, 7/4/13)
- CQC, 'The operation of the Deprivation of Liberty Safeguards in England, 2010/11' (March 2012). Key findings: '(1) 8,982 applications to deprive a person of their liberty were processed, of which 50 per cent were authorised. (2) Many services have developed good practice on the use of the safeguards, especially in involving people and their families in the decision-making process, but some were confused as to when restraints or restrictions on a person amounted to a deprivation of liberty. (3) Between a third and a quarter of care homes had not provided their staff with training on the safeguards, and in some cases only the manager had received training. (4) Most hospitals had held some training, but the proportion of staff involved ranged between 20-100 per cent.'
- CQC, 'The operation of the Deprivation of Liberty Safeguards in England 2009/10' (March 2011). The 'Issues Raised' are listed as: (1) the DH should consider developing clear, concise and practical briefings on what may constitute a 'deprivation of liberty' and when the Safeguards should be used; (2) staff should be trained effectively on the types of practice that may lead to deprivation of liberty, and should seek advice from their supervisory body in cases of doubt; (3) the move to regulation under the Health and Social Care Act 2008 will allow a monitoring role which is consistent across health and adult social care; (4) the DH should consider reducing the amount of paperwork required.
CQC - Other documents
- CQC, 'Changes to consent to treatment for patients subject to a CTO' (May 2012). This page explains the change to the regulations.
- What to expect if your rights are restricted under the Mental Health Act - 25/5/10 - Information for patients about about what to expect and how to complain (related press release)
- Statutory reporting related to the Mental Health Act 1983 - March 2010 - The page deals with new reporting requirements in relation to detained patients who go AWOL or die (in force on 1/4/10 for NHS service providers and 1/10/10 for independent service providers); it also covers s61 reports.
- A new registration system from April 2010 - 30/9/09 - In the future all health and adult social care providers who provide regulated activities will be required to register with the Care Quality Commission. New registration comes into effect on 1/4/10 for NHS trusts (including PCTs) and 1/10/10 for adult social care and independent healthcare providers
- New mental health report - 19/7/09 - CQC's press release and detailed response about MHAC 13th report
- CQC, 'CQC inspector dismissed for gross misconduct' (27/4/12). 'A CQC inspector has been dismissed for gross misconduct after an internal investigation revealed that the impartiality of their regulatory judgements had been seriously compromised. This came to light as a result of whistle-blowing information to the CQC. No additional detail can be provided as CQC has now referred this matter to the police.'
- Liberating the NHS: Report of the arms-length bodies review - 26/7/10 - The proposal for the CQC is: "Retain as quality inspectorate across health and social care, operating a joint licensing regime with Monitor. Host organisation for Healthwatch England. Current responsibility of assessing NHS commissioning moves to the NHS Commissioning Board. May receive functions from other organisations, e.g. HTA and HFEA"
- Care Quality Commission (16/11/07)
- Department of Health, 'Performance and Capability Review - Care Quality Commission' (gateway ref 17277, 23/2/12)
- Health and Social Care Bill 2007-08 (updated as the Bill progressed through Parliament)
- Lord Chancellor and Secretary of State for Justice, 'Monitoring places of detention: First annual report of the United Kingdom's National Preventive Mechanism: 1 April 2009 – 31 March 2010' (Cm 8010, February 2011)
- Andy McNicoll, 'CQC chief "sorry" for "very personal" comments on whistleblower's mental health' (Community Care, 12/9/12)