Waiting times for patients undergoing a mental health crisis at St Thomas’ A&E do not meet national standards, according to a new report, amid an increase in the number of psychiatric patients during the Covid-19 pandemic.
The Care Quality Commission (CQC), which monitors healthcare in the UK, carried out an unannounced inspection of the urgent emergency department at the south London hospital in June.
The inspection looked at the safety, responsiveness and leadership of mental health services at St Thomas’ A&E, after concerns were raised. The rating for the hospital’s emergency department (A&E) remains outstanding because CQC did not produce a specific rating for those aspects of the service. The regulator commended St Thomas’ for its overall response to high demand and praised areas like safety management, record-keeping, care planning and separation from areas where people were being treated for Covid-19.
But CQC found that although people could access the service when they needed it and received the right care, waiting times from patient arrival to treatment and arrangements to admit, treat and discharge people undergoing a mental health crisis were not in line with national standards.
Other problems included:
- Staff often struggling to manage problems well enough to stop them recurring.
- The hospital lacking medical registrars (a senior doctor who provides advice to others) to meet the recommended guidance for the mental healthcare department or be able to develop the service, as well as lacking other clinical staff and having to rely on temporary workers
- In times of high demand and increased capacity there was sometimes a delay in adjusting and managing the ratio of nurses to patients
- Strong leadership and support for hospital staff
- Staff were well trained in key skills
- Good risk assessments and management of safety incidents, which were used to inform how future problems were handled
- The service planned care to meet the people’s individual needs and made it easy for people to give feedback
- Staff understood how to manage infection prevention and control, all areas were visibly clean and there was effective isolation and quarantine from Covid-19 treatment areas
Nicola Wise, CQC’s head of hospital inspection for London, said: “During our inspection of the emergency department at St Thomas’ Hospital, staff told us that during the COVID-19 pandemic they had seen an increase in patients who had been admitted for psychiatric reasons, and there were often delays in discharging them to a service that could provide ongoing care, due to a shortage of beds.
“We saw that one patient with mental health issues had been in the department for three days waiting for a suitable bed in a psychiatric intensive care unit. We were so concerned about this that we contacted local stakeholders to make them aware of the situation so that they could take action and find a suitable service for the patient to be discharged to.
“Although staff expressed their frustration about not being able to give the quality of care they would like to give patients with mental health issues due to high demand, people could access the emergency department when needed and were assessed promptly by mental health professionals who were available 24 hours a day. Security staff were also trained in how to deal with a patient experiencing a mental health crisis. Staff told us that it was very easy to get an assessment under the Mental Health Act and that the local authority was usually very responsive when emergency mental health assessments were needed.
“It was also encouraging to see that staff made sure that patients living with learning disabilities and dementia received the necessary care to meet all their needs. Sunflower lanyards were given to people with learning disabilities so that staff could quickly recognise disabilities that may be unseen. Similarly, they used blue wrist bands to identify patients with dementia. The enhanced care team then provided additional support to these patients.
“A new protocol for responding to mental health emergencies has now been introduced in the emergency department to facilitate a rapid response, along with a training course on mental health. We will continue to monitor the situation and acknowledge the response the trust has taken to the increased demand.”
Reached for comment on the report, a spokesperson for Guy’s and St Thomas’ NHS Foundation Trust said they had nothing more to add.
The NHS announced a new consultation on five improved standards for mental healthcare waiting times in July. NHS boss Sir Simon Stevens said the standards would be a “key milestone in the journey to putting mental health on an equal footing with physical health”. The consultation ended at the start of September.
These standards were:
- People who go to accident and emergency because of a mental health crisis will be treated face-to-face within an hour.
- ‘Very urgent’ referrals to mental health services will get specialist help in four hours
- Anyone referred ‘urgently’ to community-based mental health services because of a worsening in their psychological wellbeing will be treated within 24 hours
- Children and their relatives or carers who go to community mental health services should have their first appointment in four weeks
- Adults referred to the same service will also be given their first “therapeutic intervention” or “social intervention” or agree a care plan within four weeks
Given the strain on existing mental health services in hospitals like St Thomas’, some may be concerned that these standards are too ambitious – although the government has announced a further £2.3b in mental health funding that aims to improve access to services for two million more people, as well as a £500m mental health recovery plan.