Case study: Care Quality Commission

Setting is a medium secure mental health unit with known issues about the staff–patient relationship. There has been a number of complaints made to the CQC from patients and family members. A CQC inspector finds only one advocacy service leaflet at reception in an area that patients can’t access. A user/patient interviewed is unhappy about her care and treatment on the ward but clearly has not used the advocacy service and does not know about her right to an IMHA.

I hate this place! I want to leave! The staff don’t give you time, some of the nurses are ok but some I really don’t like and they seem to be in a hurry all of the time … What is the advocacy service? Is that complaints? (Female patient in her 40s who is detained)

The staff here do more than they are asked to do. Pressures from the ‘top’ are causing staff to feel the stress of targets. Management do not know what is going on at the coal face … Yes there is an advocacy service but we don’t think it’s as good as it could be. Staff are aware of the advocate who comes to the unit sometimes but there isn’t much information for patients to signpost the advocacy service to them. (Experienced Staff Nurse, Band 6)

1. What should this staff nurse be doing to support the user/patient and help her exercise her rights?
2. As a nurse what could you do to make sure this user/patient knows about advocacy and understands her right to an IMHA?
3. What does the staff nurse’s response about advocacy tell you about the relationship between staff and advocates on this ward?

Note: Reflect on how you might approach these situations. If you’re not sure, discuss with your tutor or placement mentor