Effectiveness and Experience (NHS Oversight Framework series): The Hidden Crisis of Patient Experience

Part 2 of a 4-part series exploring how acute hospital staff support patients in mental health crisis, and why this directly impacts NHS Oversight Framework metrics that determine organisational performance.

The Strategic Case for Mental Health

The NHS Oversight Framework evaluates trusts on their effectiveness across multiple domains. Part 1 of this series explored how mental health patient presentations directly impact emergency department flow and 4-hour targets – a crisis in access to care. This week, we examine patient experience – and how the often hidden crisis in the experience of patients attending hospital due to their mental health creates significant costs for trusts.

To measure patient experience, the NHS Oversight Framework looks at readmission rates and the Care Quality Commission’s (CQC) patient satisfaction survey results. Both provide powerful insight into a trust’s ability to successfully manage patients’ care needs.

If trusts are to meet acceptable performance thresholds within this domain, the experience of mental health patients cannot be overlooked. Over one million people attend emergency care due to their mental health each year. These patients are among the most at risk of receiving poor care – experiencing difficulties accessing services, unacceptably long wait times, and negative interactions with staff throughout their care journey (Mind/YouGov, 2024; Royal College of Emergency Medicine, 2022).

This is a strategic issue. Mental health patient experience directly impacts readmission rates and patient satisfaction scores – metrics by which acute hospitals are judged.

Why This Happens

While awareness about mental health is increasing, public attitudes towards severe mental illnesses have actually worsened, and these societal attitudes are reflected amongst healthcare staff. The most frequently cited source of stigma is from healthcare professionals, particularly in accident and emergency settings (Mind/YouGov, 2024). Patients reported encountering staff who minimised their condition, dismissed their concerns, or treated them with frustration.

This is not to say staff do not care. We know that staff want to provide support to patients in distress. But when professionals, already under immense pressure, are asked to provide care without the foundational knowledge, skills and confidence to do so, they often act hesitantly, nervously, and sometimes resentfully towards patients who need their help.

These negative experiences have measurable consequences. A negative emergency department experience is directly linked to future risk and re-attendance. Patients experience barriers to feeling heard and having their concerns addressed. A negative experience during the initial emergency department visit can contribute to patients’ perceived need for a return visit, as they feel ill-equipped to manage their condition at home (Journal of Advanced Nursing, 2023).

In short, poor patient experience drives poor outcomes – including higher readmission rates and lower satisfaction scores that directly affect organisational performance ratings.

The Solution: Transforming Culture

It is essential that any response to this issue takes a systemic approach. Safeguarding wasn’t always seen as everyone’s responsibility – there was once stigma around asking questions and supporting people with safeguarding concerns. But culture shifted when every member of staff understood their role in creating a culture of safeguarding. Mental health is the same. Hospital staff need foundational mental health knowledge, skills, and confidence to contribute positively to a culture of mental health and safety.

The most effective way to improve hospital culture around mental health is by actively challenging stigma. The Lancet Commission Report synthesised the best evidence-based interventions for stigma reduction. Their analysis of 216 systematic reviews revealed that interventions based on the principle of social contact between those with and without lived experience of mental illness provided the most effective, evidence-based method of reducing stigma. The success was maintained whether the intervention was in-person, virtual or indirect (Lancet, 2022). This approach is also supported by Mind’s YouGov study, which found that the most effective anti-stigma campaigns were based on individual, human stories (Mind/YouGov, 2024).

To provide a positive experience, staff need the confidence that comes from practical knowledge and evidence-based skills. But when stigma abounds in wider culture, part of increasing confidence lies in re-humanising the issue of mental health. Patients attending emergency care due to mental health issues are there because they want help and have nowhere else to go. They need to be met with both competence and compassion.

We Can Talk connects staff emotionally to patient experience by hearing directly from patients who have attended hospital in a mental health crisis. Using high-quality video paired with practical resources and strategies for immediate use, our approach cuts through negative attitudes and stereotypes in a way that traditional learning cannot – transforming how staff view their role in supporting patients’ mental health.

For our partner trusts, the evidence of transformation is compelling. Where We Can Talk has been deployed, we have seen the following:

• Staff report a 22% increase in agreement with the statement “supporting patients in mental health distress is part of my job”
• Most significantly, staff who initially agreed least with this statement – indicating greatest resistance – see the greatest shift after training. For this cohort (1 in 4 staff), agreement increases by 196%
• Free text responses show consistent increases in self-reported “openness,” “compassion,” and “empathy” towards patients in mental health distress

(We Can Talk, 2026)

This shift in attitude is not abstract. Staff tell us directly:

• “I will be more mindful and compassionate to patients who are in crisis or are suffering with their mental health. I will ask direct questions and feel more confident doing this.”
• “I will be more mindful of the way I communicate with patients, including my body language and tone of voice, to help them feel heard and safe.”
• “I will be less fearful of asking the direct questions to ensure the safety of the patients.”
• “I will  listen carefully and be more empathetic”

Mali, a lived experience advisor, reflects on what changes when staff are equipped: “It doesn’t take much to do things differently. A question. A check-in. A moment of reassurance. We know that when staff do ask about risk, outcomes improve. When staff feel confident, they act. And when they act, patients feel safer and care improves.”

When staff feel equipped and confident to support patients in crisis, they provide compassionate care. Patients feel heard and supported. Experience improves. Readmission rates fall.

Improving patient experience and performance within this domain cannot occur without equipping staff with the understanding and training they need to meet the demands of their job. Investing in mental health training should be a strategic priority for trusts serious about improving patient satisfaction scores and reducing readmissions – both critical to NHS Oversight Framework performance.

Stay Updated on the NHS Oversight Framework Series

This is the second in a four-part blog series exploring how acute hospital staff support patients in mental health crisis, and why this directly impacts NHS Oversight Framework performance.

Part 1 -Access to Services: The Mental Health Crisis in Emergency Care

Part 3 – Patient Safety: Is Mental Health and Safety at Risk?

Part 4 – People and Workforce: Why Patient Mental Health is a Workforce Crisis