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We have published our Mental Health Monitoring Annual Report 2022-2023

The report sets out our assurance activity and findings during the period from April 2022 to March 2023, and explores the standards of care being delivered by mental health and learning disability healthcare services across Wales during this time.

Mental Health Hospitals, Learning Disability Hospitals and Mental Health Act Monitoring Annual Report 2022-2023

During our inspection visits in 2022-23 we focused on a number of key areas including:

  • Considering whether patients lawfully detained and if the care and treatment appropriate 
  • Considering whether patients are informed about their rights, at the point of detention, and then at regular intervals. We will also consider whether patients understand the significance of their detention or not 
  • Considering whether treatment considers the patient’s wishes and whether they feel they are treated with dignity and respect. 

Mental health and learning disability services continue to face many challenges that are affecting outcomes for patients. There continues to be severe pressure on in‑patient beds and there are many challenges faced by the health boards and independent providers of care in providing a range of diverse services to vulnerable patients. This year we have extended our inspection programme to include community services.

One positive aspect of our inspections was the appreciation by patients and relatives of the quality of staff and patient interaction. Our staff observed patients being engaged in a positive manner with an appropriate level of explanation to ensure patients understood the care and treatment they were receiving.

Some areas continue to cause concern for us, these areas are: 

  • Workforce challenges – issues with recruitment and retention of staff 
  • Medicines management – a range of issues with the storage, administration, and audit 
  • Patient observations – training of staff, lack of effective recording, and the timely review of policies/procedures 
  • Patient information – lack of information available for patients on key topics 
  • Risk assessments and care planning documentation – including risk assessments not completed and lack of a timely review 
  • Environment of care – a lack of audits and the management of environmental ligature risks 
  • Governance - a lack of audit and oversight of key areas including training. 

During the reporting period we conducted a total of 22 onsite inspections to a range of healthcare settings of both NHS and independent hospitals. Within the total of 22 onsite inspections, we jointly visited three Community Mental Health Teams (CMHTs) with Care Inspectorate Wales (CIW). We reviewed 902 notifications of incidents received about events relating to patient safety that occurred within independent mental health and learning disability healthcare settings. 

In addition, we received 694 requests for a visit by a Second Opinion Appointed Doctor (SOAD). This represents a decrease in requests from 759 for the period April 2021 to March 2022.

Although our work allowed us to observe some examples of good practice across different aspects of service delivery, significant improvement was often required and there was a large degree of variability in the quality of care delivery.

Mental Health Hospitals, Learning Disability Hospitals and Mental Health Act Monitoring Annual Report 2022-2023