Scope revealed of national mental health inpatient review

The terms of reference of a national investigation into safety issues in mental health hospitals have been published, and they include a focus on safe staffing and workforce conditions.

The former health and social care secretary, Steve Barclay, announced the probe last year to try and improve patient safety and boost the quality of mental health inpatient care in England.

The Healthcare Services Safety Investigations Body (HSSIB) has worked since June 2023 to determine the scope of the review and has been considering relevant evidence.

This week the government announced the four different investigations that will take place as part of the review, which together form the overall terms of reference.

Terms of reference

Learning from inpatient mental health deaths, and near misses, to improve patient safety

  1. Examine the mechanisms that capture data on deaths and near misses across the mental health provider landscape, including up to 30 days post discharge
  2. Examine local, regional and national oversight and accountability frameworks for deaths in mental health inpatient services
  3. Understand how providers ensure timely and effective investigations

The provision of safe care during transition from children and young person (CYP) to adult inpatient mental health services

  1. Determine and understand age related considerations for CYP and adult inpatient mental health services
  2. Consider how approaches to transition between CYP and adult inpatient mental health services are evaluated to support the recovery of people that use them
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The impact of out-of-area placements on the safety of mental health patients

  1. Identify factors which contribute to the use of out-of-area placements of patients
  2. Evaluate how the needs of local mental health inpatient service users are identified by integrated care boards and trusts and how this enables appropriate local provision
  3. Consider how local providers maintain oversight of out-of-area patients, including how they support them to return to appropriate services within their local area

Creating the conditions for staff to deliver safe and therapeutic care

  1. Examine the factors which impact on providers’ ability to safely staff their mental health inpatient wards
  2. Examine the conditions on mental health inpatient wards in which staff work and the impact conditions have on the delivery of safe and therapeutic care

In a ministerial statement announcing the launch of the terms of reference, current health and social care secretary Victoria Atkins said: “The investigations will identify risks to the safety of patients and the HSSIB will seek to address those risks by making recommendations to facilitate the improvement of systems and practices in the provision of mental health care in England.”

She further revealed that the review would include “consideration of patient and staff safety with regard to allegations of sexual assault and rape” in these settings.

Ms Atkins noted that the patient voice “will be integral to the HSSIB’s investigation and report”.

“They have been in touch with patients and families who have experienced poor care, as well as their parliamentary representatives, and are working with patient advocates and the charitable sector to arrange focus groups to support these investigations,” she said.

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The findings from each of the investigation will be published over the course of the year and will be concluded by the end of 2024.

This national investigation follows the launch of a special review by the Care Quality Commission (CQC) of mental health services at Nottinghamshire Healthcare NHS Foundation Trust.

It was at this trust where Valdo Calocane was being treated for paranoid schizophrenia, before he killed Barnaby Webber, Grace O’Malley-Kumar and Ian Coates.

The review into the trust is set to provide further answers for the victims’ families affected by the killings in June 2023, as well as focus on wider issues in mental health care provision in Nottinghamshire.

Ms Atkins said: “The CQC special review will focus on reviewing the care provided by Nottinghamshire Healthcare NHS Foundation Trust and identifying where things may have gone wrong.

“This will give the families much-needed answers and will help identify how to improve the standard of mental health care in Nottinghamshire.”

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