Many NHS patients say they are not involved enough in decisions about their care, a survey reveals.
Patients feel left out of care decisions
The Healthcare Commission quizzed 300,000 patients and found most wanted more input into their care, especially those with a mental illness.
Of 27,000 people using mental health services, 15% said they did not have enough say in care decisions and 44% only had a say to some extent.
Nearly a fifth said their diagnosis had not been discussed with them.
Lack of information
Contrary to recommended national standards, less than half of mental health service users had access to crisis care, such as a phone number of someone in the service that they could call out of hours.
In some of the 568 English NHS trusts examined, only a quarter had access to crisis care.
Only half had been given or offered a written care plan and only half had received at least one care review in the last 12 months.
About a third had not received help with getting benefits and another third had not had received help with finding work.
Over three quarters of people using mental health services were happy with the standard of care they received, however.
This was the first survey of mental health services by the Healthcare Commission. It also looked at the ambulance service and young hospital patients for the first time and revisited adult inpatient services and primary care trusts for the second time.
The responses echoed those for mental health services.
Although most had trust and confidence in clinical staff, nearly half of adults in hospital said they would have liked to be more involved in decisions about their care and treatment.
A fifth thought they had been given too little information.
Nearly a third of people visiting GPs said they were not involved in their care as much as they wanted to be.
Half of young patients said they wanted to be more involved in their care and about a third said they had not understood information given to them by their doctor or nurse.
A fifth of patients said they did not fully understand the ambulance crew's explanation of care and treatment.
The Healthcare Commission's chairman Professor Sir Ian Kennedy said: "While there has been a great improvement in communication between NHS staff and their patients there is still much to be done to ensure that patients understand the information they are given and can influence decisions.
"Asking patients what they think about the care and treatment they have received is an important step towards improving care for patients in hospitals and other health services."
Mental health charity Mind said the true picture was worse.
Richard Brook, chief executive of Mind, said:
"It only tells part of a very mixed picture. Mind's work suggests people get even less information about their diagnosis and treatment than this survey suggests.
"Reading between the lines of this survey, mental health care remains very much a hit and miss experience in twenty-first century Britain."
It will publish a report in September revealing over a quarter of people who had been in-patients said they rarely felt safe while in hospital.
National Director for Mental Health, Louis Appleby, said: "The survey shows that most people who are under Mental Health Care are positive about the service they receive.
"It's time to recognise the excellent work of mental health staff around the country. Too often their efforts are denigrated by critics of mental health services and these criticisms are wrong."
But he added: "I'm not complacent about the less positive parts of the survey. Improving access to help for people in crisis is a priority."
A spokesman from the Sainsbury Centre for Mental Health said: "Speedy access to help in a crisis is still lacking for many people.
"Extra investment in better crisis care, without denuding the rest of the service of resources, will be needed to meet the new target of offering it to all who need it by the end of next year."
Margaret Edwards, head of strategy at the mental health charity SANE, said: "It is completely unacceptable that so many of those using mental health services are not given information critical to managing their illness, despite the fact that nearly a third of those surveyed were living alone.
"These findings, together with the recent star ratings of mental health trusts, show that in many parts of the country the NHS is still failing to provide the fundamentals of mental health care."
Liberal Democrat Shadow Health Secretary Paul Burstow, said: "These results demonstrate yet again that simply talking about choice of hospital misses the point. Some of the most vulnerable patients are not even being given a say in how they are treated."
Rethink's chief executive Cliff Prior said: "This survey confirms the findings of our own research over the past three years: the positive effects of mental health reforms have yet to be felt by everyone on the front line."
Lord Adebowale, Chief Executive of Turning Point said: "Too often people are expected to fit into services rather than having health and social care provision designed around their needs.
"It is a poor reflection on service delivery that we are still arguing that service users should be centrally involved in decisions that directly affect their lives."
Conservative Shadow Health Secretary Andrew Lansley said: "The surveys...give clear confirmation that patients want more choice in healthcare.
"We will ensure everyone has the right to make an informed choice about the NHS treatment they receive."