Service provision during the pandemic

Page last updated: 12 May 2022

In last year’s report, we highlighted the unprecedented challenge that mental health services faced from the pandemic. With social distancing and other restrictions in place, services had to balance of a duty of care towards patients at the same time as upholding the principle of least restriction. We noted that many services were reconfigured to reduce the numbers of occupied beds, enable patients with COVID-19 to be cared for separately, and manage staff shortages.

Overall, we found that services rose to the challenges of lockdowns and the additional burdens that this placed on their patients and staff. However, we heard varying accounts about the impact of the pandemic, and changes made in response to this, on patients and staff. While some people we spoke with told us they felt supported, others were less positive.

In some instances, reconfigurations helped to improve multidisciplinary working between teams and in turn improve patients’ experience. For example, at one service, community team staff were brought in to help manage staffing shortages on an acute mixed gender ward. We heard that this led to a much better understanding and ongoing liaison between the teams, and supported care planning and discharge planning. This highlights how, in more normal times, functional splits between inpatient and community teams can create barriers that need to be overcome for effective care planning (see section on care planning).

Many of our remote reviews reflected patients and carers’ experience of staffing pressures. For example, a frequent complaint from patients was that there were not enough activities and/or contact with nursing staff. Carers also found it difficult to contact the ward staff. Staff members also told us of the stresses of nursing during the pandemic, in some cases with many colleagues absent.

In many services, we heard that staff were leaving for higher paid roles in community teams, or leaving active nursing because of burnout. In one service, we were told that they were not able to fill nursing posts at the same rate that nurses were leaving. This put additional pressure on the remaining nurses, which increased the likelihood of them also leaving.

Some specialist services – such as women’s secure services – told us that it could be hard to retain staff due to the needs and behaviours of the patient group, but they tried to manage this with additional support and training opportunities.

In a number of services, staff, and sometimes patients, told us that they were concerned about an increase in levels of disturbance, threat of violence and actual violence from patients towards staff. In many cases, we heard concerns that staff may not be able to actively manage incidents because the pandemic had delayed training courses, including physical intervention training and some induction training, further reducing the number of staff able to actively manage incidents.

Staffing shortages and reconfigurations of services also meant that services had to make changes to their therapeutic activities. Pandemic restrictions stopped many community activities.

In some cases, for example where therapy staff had been redeployed onto wards, we heard that this had helped to improve patient engagement in activities.

However, in other cases, staffing shortages had limited patients’ opportunities to take part in activities. In one case, we identified that this was rooted in gaps in occupational therapy staff posts.

Other restrictions imposed by pandemic tested the effectiveness of some services. For example, we heard that on some eating disorder units infection prevention control (IPC) measures had stopped staff from eating meals with patients, even though this was part of their therapy. On one remote review, both staff and patients told us that not sharing meals detracted from the therapeutic experience. It was especially difficult for patients that had had multiple admissions to the unit and had to get used to the changes.

The provision and availability of psychological therapies also varied across mental health inpatient services. Some services had a wide range of therapies that met the needs of patients.

However, in other services issues with staffing numbers meant that there was limited capacity to provide psychological therapies to all those who would benefit. For example, an inspection of one trust in winter 2019 showed that the service had a low number of clinical psychologists providing therapeutic input compared to similar trusts. We said that the trust should ensure they have the capacity to provide support and cover for clinical psychologists, and ensure that there is psychology input to the acute wards at all times. The pandemic may have delayed action on this, but also exacerbated its impact:

Next page

Person-centred care during the pandemic

Previous page