Not one recommendation achieved, two years after CQC restraint and seclusion review

Not a single one of the 17 recommendations made two years ago by a government-commissioned review into the use of restraint, seclusion and segregation of disabled people has been carried out, the care regulator has concluded.

The Care Quality Commission (CQC) said that 13 of the recommendations it made in October 2020 had not been achieved, while the other four had only “partly been achieved”, following the report into serious concerns about the treatment of autistic people, people with learning difficulties, and people with mental distress.

This week’s report says that little progress has been made since CQC’s interim Out of Sight – Who Cares? report was published in 2019, and that “far too many people are still subject to restraint and seclusion and more people than before are in long-term segregation”.

There are more people in long-term segregation now than there were in November 2018 when the government commissioned the report, it says.

And while data from December 2021 shows the number of people with learning difficulties in inpatient services has nearly halved since March 2015, the number of autistic people in such services has risen by three-fifths.

There has also been an increase in the number of autistic people and people with learning difficulties in hospitals more than 50 kilometres from their local community.

And more than 350 autistic people or people with learning difficulties in a mental health hospital (one sixth of the total) have been in hospital for more than 10 years.

CQC says that its 2020 report called for the development of resources to ensure that people could be supported in the community and so avoid hospital admission.

But it says: “Far from an improvement, we have seen that people have found accessing community mental health support more difficult.

“This is partly due to the impact of COVID-19. The pandemic has led to a mental health crisis in a system that was already overloaded.”

Because the government has failed to implement proposals for care and treatment reviews to become statutory, there is no accountability that ensures service-providers and commissioners carry out review recommendations.

As a result, the recommendations are often not carried out, says the report.

Reviews that were carried out uncovered restrictions on access to personal possessions, fresh air, activities, telephones, and visitors “for which there was no justifiable reason or clear rationale”, CQC said.

Steps taken to “manage people’s risks did not consider the impact on their dignity and were frequently unnecessarily harsh or overly restrictive”, while CQC also found that people’s physical health needs were not being considered or met, such as staff denying them access to dentists or opticians.

The CQC report warns that people’s human rights “continue to be at risk” and services continue to fail to provide them with reasonable adjustments under the Equality Act.

The report concludes: “We know that there are still too many people in hospital unnecessarily, that too many people are subject to restrictive interventions, and that not enough people are able to access the support they need in the community. This must change.”

Debbie Ivanova, CQC’s deputy chief inspector for people with a learning disability and autistic people, said: “The pandemic has clearly had an impact on services and the people that use them in a way that could not have been foreseen.

“However, progress on the recommendations we made for change have not been happening quickly enough.

“We are calling on all partners to commit to a renewed effort to move forward, sharing responsibility for implementing the changes needed.

“The focus must be on meeting people’s individual needs.

“Improved collaboration at system level, provider level and at an individual level with people and their families is also required to deliver the necessary improvements.

“Services must fit around people rather than trying to fit people into services that can’t meet their needs.”

Picture: Winterbourne View, a private hospital for people with learning difficulties and autistic people near Bristol, where the BBC uncovered serious allegations, including staff use of seclusion, segregation and restraint, in 2011

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