Out of sight – who cares? Restraint, segregation and seclusion review

On 22 October 2020, the health and social care regulator, the Care Quality Commission (CQC), published a report into the use of restraint, seclusion and segregation in care services for autistic people and people with mental health conditions and learning disabilities. The Secretary of Health and Social Care, Matt Hancock, had asked the CQC to undergo this review in October 2018, due to ‘ongoing concerns in this area’.

CQC’s review concluded that some people who needed complex care were ‘fall[ing] through the gaps’ in the health and care system. It reported that people were not getting the right care in the community and that hospital settings were often not therapeutic. People’s care needs assessments and plans for their care and treatment were often unclear and poor quality. This led to more frequent and inappropriate use of restrictive practices. Too many people experienced restraint techniques such as chemical and physical restraints, as well as long-term segregation and seclusion in poor conditions, sometimes for years. The review concluded that the use of these practices did not meet people’s needs and prevented them from getting better.

The CQC recommended that people with learning disabilities, autism and mental health problems should be supported to live in their communities as much as possible. They also stated that the quality of care provided in hospitals should improve and be ‘person-centred, specialised care in small units’. The CQC recommended that health and social care providers should reduce restrictive practices. The CQC also proposed increased oversight and accountability of providers of services for people with a learning disability and autism.

Response

On 21 July 2021, Minister of State for Social Care Helen Whately responded to the CQC’s report by letter. She expressed concern about the review’s findings, accepted its recommendations and said that work had started on implementing them.

Later developments

The CQC published subsequent reports in December 2021 and March 2022 examining progress towards the recommendations of the initial review and the key areas where work was most needed.

The first progress report found that there continued to be too many individuals in inpatient settings, often for too long, and a significant number of people were subject to restrictive interventions. The second progress report concluded that most of the recommendations had not been achieved at all, from people having their rights understood to the provision of bespoke services. There was some progress in a small number of areas, such as recording data to improve local services and improving CQC regulation of services for people with a learning disability and autistic people.