Mencap responds to the Care Quality Commission’s “Out of Sight – who cares? Restraint, segregation and seclusion review: progress report”

Today (25^th March 2022) the Care Quality Commission (CQC) published its “Out of Sight – who cares? Restraint, segregation and seclusion review: progress report.”

This follows their Oct 2020 report into the use of restrictive practices in inpatient settings and other services for people with a learning disability, autistic people, and people with mental ill health.

That report made 17 key recommendations to stop unacceptable practice. Findings published in today’s progress report reveal that:

• 13 of the 17 recommendations for change have not been achieved at all. The other four recommendations have only been partially met.
• Restrictive interventions continue and are often used inappropriately when people communicate their distress and unmet needs. There are more people in long-term segregation now than there were in 2019.
• People’s human rights continue to be at risk. They are not benefiting from reasonable adjustments under the Equality Act or from an understanding of human rights.
• There are still too many people in hospital, in environments that are not therapeutic, and people are staying there too long.
• Commissioners are still not always working in partnership, and the focus remains on fitting people into available services with insufficient focus on designing the support that the person needs.
• Not enough people are able to have a home of their own with the right support in place.
• Where Care, Education and Treatment Reviews (CETRs) are taking place, people are not seeing their recommendations acted on.
• There is a single minister overseeing the Building the Right Support Delivery Board. However, the action plan is not yet finalised and without clarity of governance and clear responsibility for delivery, there is insufficient evidence of impact on people’s lives.

“This report sets out a damning assessment on lack of ​action by the Government, NHS England and local authorities ​in addressing key recommendations made by the commission 18 months ago. It’s shocking that ​in CQC’s assessment, these agencies have failed to ​make ​meaningful progress in tackling use of restrictive practices, including physical restraint, over-medication and solitary confinement​ against people with a learning disability and autistic people within modern-day asylums.

“Over 2,000 people who have a learning disability and/or autism continue to be locked away where they are at increased risk of abuse and neglect. This is a human rights scandal and there can be no more excuses. People need and deserve appropriate person-centred care that truly meets their needs.

“It has been several years since the Government called for this review into the devastating use of restrictive interventions. Yet we continue to see shocking evidence of human rights failures come to light, including at Cawston Park Hospital, where a series of failings led to the deaths of three people with a learning disability.

“The Government has missed repeated targets to close inpatient beds and develop the right community support. The reduction promised by 2019 has still not been met and the shocking findings of today’s report add to our concerns. At this rate of progress, NHS England stands to miss their target to deliver a 50% reduction in inpatient beds by 2024.

“The forthcoming cross-government action plan for the Transforming Care programme must fully address and action all of the recommendations outlined by the CQC, as well as developing and providing suitable care for people with a learning disability in their communities.”