Vulnerable patients escaping from secure hospitals because they’re so short-staffed, regulator reveals

National review, prompted by an Independent investigation, suggests lack of staff is major contribution to failings

Mental health hospital buildings deemed ‘oppressive’ and ‘grim’ by staff and patients (Shutterstock)

Vulnerable mental health patients are being traumatised, sexually assaulted and physically harmed in UK hospitals – and have even managed to escape, the safety watchdog has warned in its first major national investigation.

The report by the Health Services Safety Investigation Body (HSSIB), launched by former health secretary Steve Barclay after The Independent exposed a series of failings in the sector, warns the government and healthcare leaders that cash starved “oppressive” mental health hospitals are causing harm to patients.

Inpatient mental health services across England are failing to keep highly vulnerable patients safe and are even re-traumatising them, according to the HSSIB.

It highlights a litany of concerns over safety, much of it driven by national shortages of mental health staff and warns the flagship NHS long-term workforce plan ambitions may be “unattainable”.

Other failings highlighted by the safety watchdog include:

• Short-staffed mental health wards are failing to protect patients from sexual harm as staff also “normalise” sexualised behaviour
• Female patients are still regularly housed in mixed-sex wards despite national rules banning this, as hospitals lack funding to change wards
• Patients are self-harming, subjected to violence and able to escape as hospitals lack the number of staff to prevent this
• Mental health patients are not getting therapeutic care in mental health wards
• “Oppressive” and “grim” hospital buildings are re-traumatising patients

The report is the first in a series which are due to be published by the HSSIB over the next year, which will also look at children’s inpatient care. It comes following a series of exposés by The Independent and Sky News over “systemic” failings within a group of private children’s hospitals.

Dr Sarah Hughes, chief executive of the charity Mind, said the report reveals the “brutal truth” about the state of mental health hospitals.

She said: “What should be places of recovery have, for too many people, become places of pain and fear. Therapeutic care is now the exception, not the norm.

“This is made even harder by the outdated Mental Health Act that doesn’t give people nearly enough say over their care. No-one under the care of the state should have their psychological, physical or sexual safety put at risk, or lose their life due to system failure.”

She said a lack of resources means mental health services are being “set up to fail” and called on the government to take action to improve inpatient mental health care.

Earlier this year an investigation by The Independent and Sky News, cited in HSSIB’s report, revealed thousands of sexual assaults and incidents of harassment have been reported on NHS mental health wards. Following this exposé the Department for Health and Social Care included sexual safety in the HSSIB’s investigation.

The investigation also revealed hospitals are using mixed-sex wards, despite NHS England guidance showing “zero-tolerance” for this. At the time, Wes Streeting, then shadow health secretary called on the Conservative government to act on the “soaring” number of mixed-sex wards.

According to the review, mental health managers warned they did not have enough staff to observe or intervene when patients were at risk of sexual harm.

Inspectors also warned patients who had previously suffered sexual trauma risked being “retraumatised” on wards and that managers were concerned some staff failed to act as they “normalised” certain sexual actions from patients.

Staffing shortages was mentioned as a key driver of safety issues by HSSIB inspectors.

The watchdog cited examples of patients able to seriously self-harm as stretched staff were unable to observe them as required and an example of a patient who was able to leave the hospital unescorted.

Patients and staff both reported to HSSIB inspectors a “fear for their own safety” as physical violence occurred on wards with a lack of nursing staff.

On some wards, it was “not uncommon” for at least 50 per cent of the staff to be agency staff while some wards had no permanent nurses, according to HSSIB.

In its report the HSSIB found mental health staff warned they were not always equipped to deal with physical healthcare problems. Examples found include a patient who died from a blood clot in their lung after a hospital failed to risk assess the patient and follow a dietitian’s advice. This patient had been sitting motionless the day before their death and had not drunk or eaten for two days.

The report also found multiple concerns over the state of mental health buildings, described by some patients and staff as “grim”, “oppressive” and “no longer fit for purpose”.

Due to a lack of capital funding hospitals have been unable to address safety risks which have led to patients breaking through locked doors or ligature risks attempting to take their lives.

A Department of Health and Social Care spokesperson did not directly comment on the recommendations or points about mixed-sex wards but said: “Patient safety is paramount, and anyone receiving treatment in an inpatient mental health facility deserves safe, high-quality care, and to be treated with dignity and respect. We are grateful to HSSIB for this report, which highlights important concerns that can help us to improve inpatient mental health services.”

It highlighted plans to follow through with the reform of the Mental Health Act and recruit 8,500 more mental health staff.

An NHS England spokesperson said: “Mental health services are seeing record demand with an increase of almost two-fifths compared to before the pandemic, and we know there is much more to do to provide better care for patients.

“We are working to improve the quality and safety of all mental health, learning disability and autism inpatient services, and plan to introduce hundreds of extra clinical roles across mental health services in the NHS.”