As NHS trusts gear up for a fresh onslaught of industrial action over the first May bank holiday weekend and with thousands of nurses once again taking to the picket lines in their dispute with the government over pay, mental health trust leaders are warning of dire consequences to the safety of patients as nursing staff numbers are spread even more thinly than usual.
They are very concerned that if the Royal College of Nursing stands firm in its decision not to agree derogations for any services, including emergency and critical care, at either a national or local level, and does not agree to exempt high security and inpatient mental units then the risk of a severe and sustained impact on service users cannot be mitigated against.
The impact could mean that people become a risk to themselves including by self-harming or in extreme cases taking their own lives, as well as to others.
Mental health leaders are also sounding alarm bells that the current absence of derogation for some services, including the most acute inpatient facilities and for nursing staff who may be called on to support Mental Health Act assessments or provide care to people with severe mental illness living in the community, means patients will be put at risk.
When it comes to inpatient services mental health leaders are worried about the need to rapidly increase staff numbers in order to respond quickly to differing levels of patient risk, with examples including how patients are monitored by staff under general observation and then switched quickly to 1:1 mental health nursing when their needs escalate, as well as the ability to respond to changes impacting patient safety or clinical risk in real time.
One mental health leader in the Northeast said it was “extremely concerning” to note that no derogations had yet been agreed to. “I feel very strongly that crisis and emergency mental health services should be exempt", then said.
Specific derogations were agreed nationally last December by the RCN following a stark letter penned by the UK’s four chief nursing officers (CNOs) and supported by the NHS Confederation, which called for exemptions to some areas of mental health nursing, as well as cancer services and emergency care. These included mental health, learning disability and autism services across children and adolescent mental health services, and adults and older adults as part of an ‘emergency crisis response’.
At the time, the CNOs questioned how, without derogations, people with the highest level of mental health need and staff teams managing the highest levels of risk would be kept safe.
These were also extended to staffing for high-security inpatient units.
Sean Duggan, chief executive of the NHS Confederation’s mental health network, said: “We urge the RCN to reconsider its stance on derogations in this latest round of strike action.
“In particular, high secure and inpatient mental health services, as well as emergency departments, and critical care must be considered as life and limb services and therefore nursing provision must be granted in these areas.
“Unless these areas are made exempt by the RCN for the upcoming strikes, as they have been up until this point, patient safety will be put at direct risk.”
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