The Government has responded to the Care Quality Commission's (CQC) report on restraint, segregation and seclusion and accepted in full or in principle all the recommendations where the Department of Health and Social Care is identified as the lead department.
Out of sight – who cares?: restraint, segregation and seclusion review was published in October 2020 and looked at the use of restraint, seclusion and segregation in care services for people with a mental health condition, a learning disability or autistic people.
It concluded that the 66 people they met who were in segregation had been let down by the health and care system. Creating a package of care to meet their individual needs was often seen as too difficult to get right and they had fallen through the gaps.
Not getting the care and support in the community when people needed it started at a young age. This ranged from families not having the right support to help them care for their children at home when they first felt extra help was needed, to not having specialist support in a crisis.
This lack of support in the community often led to people becoming increasingly distressed and, in some cases, suicidal or violent. When people reached this ‘crisis point’, hospital was often the only option left.
Recommendations from CQC Out of Sight report
It recommended changes in four key areas:
- People with a learning disability and or autistic people who may also have a mental health condition should be supported to live in their communities. This means prompt diagnosis, local support services and effective crisis intervention.
- People who are being cared for in hospital in the meantime must receive high-quality, person-centred, specialised care in small units. This means the right staff who are trained to support their needs supporting them along a journey to leave hospital.
- There must be renewed attempts to reduce restrictive practice by all health and social care providers, commissioners and others.
- There must be increased oversight and accountability for people with a learning disability, and or autistic people who may also have a mental health problem. There must be a single point of accountability to oversee progress in this policy area.
Government response to the report
The Minister of State for Care, Helen Whately MP, wrote to Ian Trenholm, the Chief Executive of the CQC, and said that the findings were deeply concerning and having identified and determined what action needs to be taken, it is critical that they make sure it happens.
She agreed with the recommendation that there must be a single point of ministerial ownership for delivery of all the recommendations made in the report and has tasked the newly established Building the Right Support Delivery Board to monitor and drive progress in improving care for people with a learning disability and autistic people.
This board also includes Baroness Hollins as chairperson of the Oversight Panel for those in the most restrictive circumstances. The Board has already identified a number of priority areas to focus on which align with the recommendations the CQC has made, including housing, transitions into adulthood, community support and workforce.
Recommendations on workforce
The CQC report made a number of recommendations on workforce and the care minister said she agreed that everyone involved in the care of people with a learning disability and autistic people must have the right skills, so that every individual gets appropriate, tailored support and has a positive experience of health and care services.
This should be the case whether in the community or an inpatient setting. That is why they are committed to the Oliver McGowan Mandatory Training on learning disabilities and autism for all health and social care staff to ensure they have the skills they need. They are also working with Health Education England and Skills for Care to develop and test a standardised training package, backed by £1.4 million investment.
She added: "Beyond the Oliver McGowan Mandatory Training, we will of course continue to work with colleagues in NHS England, local government, Health Education England and Skills for Care to ensure the right workforce is in place, including through the Delivery Board which has also identified workforce as a priority theme."
Mental Health Act reform
As well as ensuring staff have the right skills she said the Government recognised that there is more to do to provide support in the community in order to prevent unnecessary admissions to inpatient care and to facilitate timely discharge.
She said reform of the Mental Health Act provides them with an opportunity to consider wider changes relevant to people with a learning disability and autistic people.
Whately added: "With regards to your recommendations, we set out in the White Paper that, for the first time, the Act will require that all patients subject to detention must have a care and treatment plan, with clear expectations about how and when this should be developed with the patient.
"For people with a learning disability or autistic people, the responsible clinician would also be required to take into account the findings and recommendations made as part of a Care (Education) and Treatment Review (C(E)TR), in the patient’s statutory care and treatment plan. We will consider changes to the Mental Health Code of Practice as part of this wider work on Mental Health Act reform."
She concluded: "I welcome the increased focus the CQC is placing on care for people with a learning disability and autistic people, including the recommendation that CQC must improve its regulatory approach for providers of services for people with a learning disability, autistic people and people with mental health conditions. We must continue to work together on this to achieve the change that we know is not only possible, but also vital."