Mentally ill 'denied quality care'

Up to 50% of care is provided by agency or bank nurses

As many as half of some inner city hospitals are relying on bank and agency staff to run wards for the acutely mentally ill at night.

Nurses fear this means patients are not getting quality care and may even be at risk.

Martin Ward, director of the Royal College of Nursing's mental health programme, says a recent survey of London mental health wards found that at least 30% of staff in 26 wards were agency or bank nurses.

The proportion increased to 50% at night and half of the wards were actually run by bank and agency staff.

He said this meant vulnerable patients did not have continuity of care. "It is very ad hoc," he said.

Bank and agency staff were often put in charge of one-to-one care, including observation of the most seriously ill patients.

Risk of self-harm

Patients under observation are those who are most at risk of harming themselves or others.

Mr Ward said it was one of the most complex areas of care. Staff needed to develop a relationship with patients to help them improve, he said.

He felt the quality of care being offered was not adequate and said statistics showing that a high number of young inpatients who have been under observation have committed suicide on discharge backed this up.

"We are involved in defensive care nowadays," he said, adding that lack of resources and staff meant inpatient wards were home only to the most seriously disturbed.

This increased the pressures on staff.

Mental health strategy

The RCN, which is holding its annual congress in Harrogate this week, has launched a Mental Health Strategy, to address what it sees as the main areas affecting mental health nursing.

They are:

• Clinical interventions: the need for training and support for staff;
• Nursing safety which covers bank and agency nurses and the need for more permanent staff;
• Admission and bed issues;
• Culture and ethnicity: the need for mental health staff to understand other cultures' attitudes to mental health and for staff from ethnic minorities to have an input into training programmes. Research shows over half of patients on some London mental health wards are from ethnic minorities;
• Human resources: the RCN says staff shortages mean care has become very defensive, with few experimental techniques being used and an over-reliance on drugs and restraint measures;
• Research and practice development.

The strategy has been developed over the last year. Mr Ward says there are fears that the extra money announced by the government for mental health beds will end up going to new units for people with severe personality disorder.

On Tuesday, the RCN passed a resolution at its congress, highlighting the problems of staffing on mental health wards.

It called for the RCN to take whatever action was necessary to ensure that inpatient mental health wards are staffed by nurses on permanent contracts.