There has been poor progress on minimising the use of restraint, seclusion, and segregation in health and care services in England, 4 years after a major review was launched into the area

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In 2018, the Department of Health and Social Care commissioned the Care Quality Commission (CQC) to review the use of restrictive practices in the care of people with a learning disability, autism, or mental health issues.

In a new progress report published on 25 March, the CQC said that not enough work has been done to implement the 17 key recommendations made in its review report Out of sight—who cares?, which was published in October 2020.

None of the recommendations fully met

No single recommendation has been fully achieved—just four have been partially met, and 13 not met at all, the CQC said.

Other partial progress was made, outside of the key recommendations, with greater investment by the Department of Health and Social Care and NHS England and NHS Improvement into projects aimed to support people to come out of long-term segregation, and funding allocated to increase community support. ‘We recognise that many staff have been working hard to try and bring about the changes needed,’ the report also acknowledges.

The CQC said that there are still too many people with a learning disability being hospitalised, however, though this number has nearly halved since March 2015. Once in hospital they often stay too long, do not always experience therapeutic care, and are still subject to restrictive interventions.  

Meanwhile, the number of inpatient autistic people has increased considerably (by 61%) over the same period. 

Crucially, little progress has been made in reducing the use of restraint, and there are more people known to be in long-term segregation now than when the CQC review was commissioned in 2018. 

CQC’s latest progress report also found:   

  • challenges remain in accessing early intervention and crisis support in the community—this can be particularly difficult for autistic people, the CQC pointed out
  • although Independent Care (education) and treatment reviews took place, they have not resulted in real changes to people’s lives, as they are still unable to leave segregation and be discharged from hospital
  • there are persistent challenges with the commissioning of services, which are often not patient-centred and delivered in silos.

Much more work to be done

Debbie Ivanova, CQC Deputy Chief Inspector for people with a learning disability and autistic people, said: ‘The Out of Sight report was intended to improve care for people and lever the change that must happen to improve the lives of people with a learning disability, autistic people, and/or those with mental ill health. 

‘This has not happened and there are still too many people in mental health inpatient services.’

She acknowledged that the COVID-19 pandemic has 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.’

Responding to the report’s findings, the Deputy Chief Executive of NHS Providers, Saffron Cordery said: ‘CQC is right that there is much more to do to make sure that people with a learning disability, autistic people, and people with mental ill health get the care and support they need.

‘We welcome CQC highlighting that many staff are working hard to bring about the necessary changes. Our 2020 report Getting it right for everyone showed how NHS trusts are working to provide high-quality care for people with learning disabilities and autistic people. However, progress remains unacceptably slow and systemic challenges persist, which mean that too many individuals can’t get the care and support they need and deserve.’

This article originally appeared on Medscape, part of the Medscape Professional Network.

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