Healthcare Commission – National Audit of Violence 2006-7 Final Report Older Peoples Services

    Healthcare Commission – National Audit of Violence 2006-7 Final Report Older Peoples Services February 2008

Abstract

This is the second time that the Healthcare Commission and Royal College of Psychiatrists have joined forces to examine the needs of patients and staff with regard to violence in inpatient mental health services. For this audit, the focus has been on older people’s services, and comparison with their working age adult counterparts. So often the serious problems facing mental health services are believed to be confined to working age adults. This valuable report shows that violence and unsatisfactory conditions for staff and people admitted to hospital, apply equally to older people’s services. It may surprise some that nurses in older people’s units are more likely to be physically assaulted. Some of the most disturbing reading relates to those services that report lack of staff training, service-led rather than needs-led care and poor systems of incident reporting and governance. One cannot help but be reminded of the well publicised abuse cases in neglected older people’s mental health services over the past decade, and it is alarming to see such issues still unresolved. The Royal College of Psychiatrists and the Healthcare Commission remain resolute in their opposition to such neglect and will continue to work with others to highlight these issues and offer support and guidance to services wishing to improve their practice. Although it is yet to be tested, the new criminal offence of ill treatment or neglect of a person who lacks capacity introduced in the Mental Capacity Act might well be relevant in such circumstances.

The audit shows that understaffed wards and unsatisfactory physical environments that expose patients and professional carers to unnecessary risk remain common. Lack of opportunity for physical exercise with little choice of therapies or activities for patients and poor training in key areas are further important deficiencies. The problems arising from mixing patient populations should ring alarm bells for any service intending to create mixed age or mixed dementia and functional wards, as this puts patients and staff at increased risk of violence. This is not what needs-led and person-centred services are about. It is however heart warming that carers and patients recognise the difficult situations that clinical staff have to manage, and in the large majority of cases, believe that they still consistently deliver care with respect and dignity.

This report gives a clear direction to changes needed to improve the experience of hospital admission and reduce risk of violence. All services must read it thoroughly and look at their own performance carefully, honestly and quickly.