CQC: Review of Restrictive Practices, Seclusion and Segregation

The Government have made improving the care and treatment of autistic people and people with a learning disability a priority. Society is rightly judged on the way it treats its most vulnerable citizens.

In November 2018, the Secretary of State for Health and Social Care made a statement to the House of Commons following the reporting of the case of Bethany, a young autistic woman who was held in seclusion in hospital for too long.

Like everyone across the House, I have been moved by these individual cases and personal stories. I do not believe this is just about a few individual cases where things went wrong; this is about a system. A system across health, education, social care and criminal justice that needs to change.

We know there is good practice out there and excellent examples of staff working incredibly hard and supporting individuals and their families to receive the best possible care. We need to recognise and widely spread this practice so that it becomes the practice of all. However, there is variability and unacceptable practice. We must tackle this.

That is why the Secretary of State for Health and Social Care charged the Care Quality Commission (CQC) with undertaking a section 48 thematic review looking at the extent to which restrictive practice is being used in the NHS. This includes the use of segregation, prolonged seclusion and all forms of restraint: physical, mechanical or chemical.

We are adamant that no stone should remain unturned in identifying problems, poor practice and care which falls so far short of what we would expect for our own family.

The CQC is today publishing its interim report of this review, copies of which have been placed in the Library of the House. This report makes difficult reading. It provides early findings and recommendations on the use of segregation on mental health wards for children and young people and on wards for autistic people and/or those with learning disabilities.

This is an interim report and as the CQC themselves describe there is much work that remains to be done in the rest of the review. However, the Government accept these recommendations in full and are committed to working with partners across the health, education and care system to ensure that they are implemented.

It is absolutely essential that we take all necessary actions to learn from the issues raised in this interim report:

We will ensure each and every case of seclusion and long term segregation is thoroughly scrutinised and that every element of their care has been reviewed. We are clear that every possible step must be taken to ensure people get the care, support and treatment they need. We will ensure that they have access to specialist independent advocacy to support them and their families.

The model of care for autistic people and those with learning disabilities must be fit for purpose—we will convene an expert group for learning disabilities and autism, bringing together leading experts, including those from other countries, clinicians, academics, parents and carers and others, to develop a new care model taking the very best practice as the foundation.

We will strengthen safeguards, addressing the lack of join up across the reviews of care that people receive and working the Care Quality Commission to bolster the oversight arrangements for hospitals that use segregation.

We will empower specialist advocates to raise concerns when they know something is not right. We will also develop a new awareness raising campaign, to encourage staff, families and friends to come forward if they have concerns about care.

Hon. Members will be aware of the recent allegations of abuse at Whorlton Hall, into which Durham Constabulary are now leading a criminal investigation.

These allegations of abuse have been treated with the utmost seriousness. Steps have been taken to ensure the safety of residents at Whorlton Hall.

Where people—staff, family and friends—have concerns about any service they must raise them.

We will ensure that we continue to make progress across the board on fostering a just and open culture around safety and raising concerns in the NHS.

We need to improve the quality of concerns handling and ensure that this is true for every patient. Working with the Health Ombudsman we will deliver a single vision for improving how the NHS responds when concerns or complaints are raised, whether concerns are raised by patients, families, advocates or staff.

The National Guardian and the local network of Freedom to Speak Up Guardians are playing a crucial role across the country in providing safe avenues for staff to raise concerns within their own organisations. We will make it even easier for people to raise concerns about patient safety in the NHS by introducing a new digital reporting system.

Where it is essential that someone is supported at distance from home, we will make sure that those arrangements are adequately supervised. We cannot have people out of sight and out of mind. That is why we are introducing stronger oversight arrangements. Where someone with a learning disability or an autistic person is an inpatient out of area they will visited every six weeks if they are a child and every eight weeks if they are an adult, on site. The host Clinical Commissioning Group will also be given new responsibilities to oversee and monitor the quality of care.

But we must be clear: improving the quality of specialist inpatient care is critical. But we are committed to stopping people from going into crisis and being admitted into specialist inpatient care in the first place.

For example, we know that autistic children often have a range of needs. They require support from education, health and social care. We must strengthen this join up. That is why we are reviewing our autism strategy and will be extending it to include children.

We must ensure autistic children get the right support they need—at the right time—and as close to home as possible. By making our strategy all age we will look at how earlier intervention can stop escalating needs.

We know that autistic children and those with learning disabilities and their families can face difficulties when transitioning from child to adult services. We will continue to improve community services to support people appropriately from childhood into adulthood.

As part of the implementation of the NHS’s Long Term Plan there will be concerted effort in implementing arrangements to ensure that those at the highest risk of admission to a specialist hospital or other institutional setting are getting the help they need. We will ensure that every area has such ‘dynamic support registers’ in place.

We think all staff in every setting should have improved awareness of learning disability and autism. That is why, in the coming months, we will be setting out our response to our consultation on proposals to introduce mandatory training for all health and care staff.

We will continue to bring down inpatient numbers. We will take every step to take hold of the very best practice going on across the health and care system and make that the norm everywhere. There is no room for complacency.

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