Decrepit NHS mental health wards put lives at risk

https://www.theguardian.com/society/2019/oct/06/decrepit-nhs-mental-health-wards-put-lives-at-risk

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Mental health patients are at risk of suicide because so many of the units they are treated in are dangerously decrepit, say NHS chiefs.

Crumbling old buildings are unsafe as they offer opportunities for mentally vulnerable people with conditions such as depression and schizophrenia to try to hang themselves or fall from a height, according to mental health trusts in England.

New figures show that patient safety incidents in mental health units caused by problems with staffing, facilities or the enviroment in which people are treated have risen by 8%. In all, 19,088 such incidents occurred in 2018-19 compared with 17,693 the year before.

Seven “never events” – incidents which are supposed to never happen – occurred in mental health trusts in 2018 involving a shower or curtain rail that failed to collapse. In another, someone fell from a window.

In a stark warning, NHS Providers, which represents health trusts, categorises the risk to patient safety from “infrastructure failures in mental health trusts” as severe. “Continued under-prioritisation of the mental health estate is having a real impact on patients,” it says. “Mental health trusts continue to be neglected despite clear evidence that critical improvements are required. Mental health trust leaders are increasingly concerned that the lack of investment places their patients at increased risk.”

The trusts have been prevented for years from replacing out-of-date buildings because ministers have repeatedly raided the NHS’s capital budget to help pay for the service’s day-to-day running costs, said Saffron Cordery, NHS Providers’ deputy chief executive.

The organisation is urging Boris Johnson to show his commitment to mental health by funding a generation of modern psychiatric hospitals to complement his £13bn pledge to build 40 new hospitals for physical illnesses.

Last year the Care Quality Commission (CQC), the NHS regulator, voiced its concern that too many mental health wards were “unsafe and provide poor quality care” in “old and unsuitable buildings”.

Several trusts have been prosecuted for safety lapses linked to the poor quality of their buildings, in cases that have sometimes involved a patient dying.

Ageing facilities, some of which date back to Victorian times, are also hampering patients’ chances of recovering from serious mental illness because they are so cramped and noisy, trusts say.

It’s a constant battle on the wards, because they don’t provide an ideal calm and therapeutic environment

Bradford District Care trust is worried that the adult acute wards at the 1960s-built main facility it runs in the city are potentially unsafe because they have too many “blind spots” where patients with personality disorder or schizophrenia may try to harm themselves.

“The layout of the wards in unhelpful because it means staff don’t always have a clear line of sight of certain patients at all times”, said Liz Romaniak, the trust’s director of finance and estates.

“We have installed CCTV to monitor blind spots, moved the nurses’ stations into the middle of our male and female wards in order to keep a better eye on people, and installed nurse call alarms for patients to use.

“But it’s a constant battle with the environment on the wards, because they don’t provide an ideal calm and therapeutic environment and give us proper lines of sight,” she said.

The trust installed the call buttons at patients’ bedsides after CQC inspectors last year highlighted that “staff could not clearly see all areas of the wards” and asked the trust to put in the alarms – which are common in more modern units – to help reduce the risk of self-harm and suicide.

The trust wants to gradually replace the wards but does not have the £40m it would cost.

Between 2014-15 and 2018-19, ministers diverted £4.29bn from the NHS’s capital budget into the revenue budget used to pay day-to-day running costs. That left NHS trusts with less money than planned to carry out urgent repairs, modernise facilities, erect new buildings and buy equipment such as scanners. In 2016-17 alone, £1.2bn earmarked for that purpose was raided.

Cordery claimed mental health was being overlooked in the hospital building programme outlined by the prime minister. None of the six new hospitals awarded £2.7bn or any of the 21 others given £100m to develop plans for replacements provides mental health care.

“Incredibly, there was not a single mental health trust included in any of these plans. How can that be?” said Cordery.

“We have seen repeated warnings of the risks – sometimes fatal – arising from the long-term neglect of our mental health estate. And we have heard repeated pledges from government to ensure parity of esteem for mental health conditions. How bad does the situation have to get before these warm words translate into practical steps to ensure a safe therapeutic environment that respects ths dignity and privacy of patients who rely on these services?”.

The Department of Health and Social Care said: “Mental health is a key priority for this government. We have announced over £400m to improve mental health estates since 2017 and we are transforming mental health services with a planned record spend of £12bn this year.

“We are transforming services through the NHS Long Term Plan – backed by an additional £2.3bn a year – so that 385,000 more people have access to vital mental health support.”