National Preventive Mechanism Annual Report 2009–10 Care Quality Commission T he Care Quality Commission (CQC) is an independent, statutory organisation responsible for the registration, review and inspection of health and adult social care services in England.25 A key part of this role involves monitoring the operation of the Mental Health Act 1983, including visiting those who are detained under mental health law. Such visits are carried out by Mental Health Act (MHA) commissioners, people appointed by CQC on the basis of their expertise and experience. MHA commissioners come from a range of professional backgrounds, including law and medicine, but all must have knowledge of the MHA and mental health services. Commissioners visit services where people are detained under mental health legislation to find out about their experiences and to check that their rights are being protected. Commissioners may also visit patients who are subject to community treatment orders. In line with its wider role of regulating and inspecting all health services, CQC participates in inspections of prisons and immigration detention by HMIP, and inspections of police custody by HMIP and HMIC. Methodology CQC makes announced visits at short notice and unannounced visits to psychiatric wards where patients are detained under mental health law. Currently, psychiatric wards are visited at no more than 18-month intervals, although many wards are visited more frequently according to perceived need. MHA commissioners are afforded free access to patients, premises and records, including medical records. CQC is committed to involving service users in its work and, on some occasions, a specially trained person with experience of being detained will help the commissioner to plan and carry out a visit. Following each visit, a summary report is sent to the manager of the ward and overall findings are collated into an annual report for the NHS trust or independent hospital. These annual reports are also published on the CQC website. OPCAT compliance As with some other members of the UK’s NPM, CQC’s founding legislation enables the government to direct it to examine certain areas of the government’s choosing. There are concerns that this compromises CQC’s independence and has the potential to distort CQC’s own priorities, particularly at a time of scarce resources. For example, regulations made under the Health and Social Care Act 2008 require CQC to be notified of the unauthorised absence of a detainee from hospital. This has turned into a considerably bureaucratic task and takes resources away from work CQC itself has prioritised. Summary of activities In 2009–10, CQC carried out visits to 1,733 wards in 701 hospitals where patients were detained under the MHA. On these visits, it met in private with 4,943 patients, checked 5,673 detention documents, and met 113 patients in groups. Key issues CQC has identified a number of key issues arising from its visits to places of detention. In particular, it is concerned at the safety and security of child and adolescent patients admitted to adult mental health facilities, although this practice is becoming less 25 CQC was created by the Health and Social Care Act 2008. It became fully operational on 1 April 2009 when it took over the activities of the Commission for Social Care Inspection, the Healthcare Commission and the Mental Health Act Commission. 32