CQC inspections in the mental health arena

CQC have published a 77 page draft mental health care assessment framework.

This framework was published last month alongside ones for adult social care, primary care and community services as well as hospitals (secondary and specialist care).

Each framework is built from the same components:

• Five key questions on quality and safety – is the service safe, effective, caring, responsive, well-led.
• Key lines of enquiry framed as structured questions that describe what CQC will look for on their assessments – these replace the current quality statements.
• Rating characteristics that describe what outstanding, good, requires improvement and inadequate care looks like in each sector.
• ‘I’ statements drawn from the Making It Real framework co-produced by Think Local Act Personal (TLAP) together with a wide range of partners and people with lived experience of health and care services. These are to ensure that people’s lived experience remains central to CQC’s assessments and set out what good care feels like from the perspective of those using services.

CQC have developed characteristics for each level of rating (outstanding, good, requires improvement and inadequate).

Is the service safe?

Under “safe” you'll find safety culture which asks: is there a positive and equitable safety culture, where risks are proactively managed, concerns are listened to, incidents are thoroughly investigated and lessons are learned to improve care? The scope includes duty of candour, incident management and learning from lives and deaths (LeDeR) reports.

An outstanding organisation will be one where, amongst other things:

• Learning from incidents, near misses and positive outcomes drives continuous improvement.
• Safety intelligence is treated as a critical asset for the service, with data reviewed continuously to identify and mitigate emerging risks.
• The service contributes to wider system improvement.
• There's an annual update of the use of force policy informed by insights from incidents and risks.

For example, also under “safe” you'll find safeguarding which asks – are there systems and processes in place to safeguard people from abuse and improper treatment and support their right to live safely? The scope includes protection of human rights, mental capacity and deprivation of liberty safeguards (DoLS).

A good organisation will be one where, amongst other things:

• A person is deprived of their liberty only when it's in their best interests to do so and in line with relevant legislation.
• Staff understand the relevant legal framework and use the appropriate codes of practice and processes correctly.
• There are no delays in recognising a potential DoLS and seeking appropriate authorisation.

Is the service effective?

Under “effective” you'll find assessing needs which asks: are people’s needs holistically assessed and reviewed with them, and their families and carers, to maximise the effectiveness of their care, treatment and support? The scope includes lawful, rights upholding assessment.

A good organisation will be one where:

• People who are subject to the Mental Health Act have their rights protected and staff comply with the Code of Practice.
• Any departure from the Code of Practice is clearly justified, risk assessed and communicated openly.
• For mental health units: information about the use of force is made available as soon after admission as possible.

Under “effective” you'll also find consent to care and treatment which asks: are people supported to understand and exercise their right to consent to care and treatment? The scope includes Mental Capacity Act, Mental Health Act and lawful rights based decisions.

A good organisation will be one where:

• Decisions are made in line with the Mental Capacity Act involving carers or advocates when needed.
• People’s rights are communicated in a way that meets their communication needs including their human rights, rights under the Mental Capacity Act, rights under the Equality Act and other relevant legislation.
• The law and principles that apply to consent for children and young people and those with parental responsibility are understood and adhered to.
• Where people who are subject to the Mental Health Act consent to care and treatment provisions, rights to access Independent Mental Health Advocates and the MHA Code of Practice are complied with.

Is the service caring?

Under “caring” you'll find independence, choice and control which asks: are people empowered to maintain their independence and to make choices about their care and plans for the future, where they're able to? The scope includes involved, lawful decisions.

An outstanding organisation will be one where:

• People’s rights, relationships and life choices are fully supported, including decisions at the end of life within a rights based, person led approach rooted in the Human Rights Act and Mental Capacity Act.

Is the service responsive?

Under “responsive” you'll find listening and responding to feedback which asks: are people supported to give feedback and raise concerns and are they confident that action will be taken as a result? The scope includes Mental Health Act complaints with CQC.

A good organisation will be one where:

• Staff investigate complaints and concerns openly and thoroughly within a suitable timeframe.
• People and those close to them are advised of the option to raise complaints over care and treatment under the Mental Health Act with the CQC.
• Learning from complaints and concerns is seen as an opportunity to improve the services.
• The provider can demonstrate where improvements have been made as a result of learning from reviews.

Is the service well-led?

Under “well-led” you'll find capable and compassionate leaders which asks: do leaders at all levels have the capacity and capability to effectively deliver high quality care with accountability and empathy? The scope includes Fit and Proper Person Regulations.

An outstanding organisation will be one where:

• Leaders actively create and sustain a culture of psychological safety, where staff feel confident to speak up, challenge and innovate.
• For mental health units the responsible person appointed in compliance with the Mental Health Units (Use of Force) Act 2018 meets regularly with colleagues who have delegated responsibility for compliance.
• The responsible person under the 2018 Act has an interest in reducing restrictive practice and a clinical background that includes experience of using restrictive practice.

Under “well-led” you'll also find governance which asks: are there clear roles and responsibilities and systems of accountability to support good governance? The scope includes robust Mental Health Act oversight.

A good organisation will be one where:

• Reports from CQC’s Mental Health Act reviewers are reviewed by non-executive members and the board is aware that any required action has been taken to address identified issues. 
• Statistical information on the use of the Mental Health Act is monitored, and patterns of admission and length of stay are considered and compared with national data.
• The board receives report on the performance of its Mental Health Act managers.
• The board makes sure that relations with stakeholders raise issues about Mental Health Act implementation.

So, lots to digest and form a view on.

CQC are seeking views on this by 12 June and you can share your feedback here.

Our content explained