Quality and clinical improvement: CQC on restraint, segregation and seclusion

The Care Quality Commission published Out of sight – who cares? report in October 2020, which looked at the use of restraint, seclusion and segregation in care services. They have recently published their second report commenting on the progress achieved so far and the areas where further work is still needed. 

In its full report the CQC made a total of 17 recommendations —you can read our earlier commentary on the report here.

The Foreword explains that their first report was written with the aim of highlighting and addressing issues of serious concern that had been known about and not addressed for too long. The report was intended to stop unacceptable practice and to challenge the status quo. However CQC state that this has not happened. Whilst they acknowledge the impact of the pandemic they conclude that developments have not been at the required pace.

A summary of the CQC's report findings and conclusions is outlined below.

• 13 of the 17 recommendations have not been achieved

• Only four recommendations have been partly achieved:

• improving CQC's regulatory approach
• recording data to improve local services
• people's experience of person-centred care
• people who experience restrictive interventions have regular oversight by commissioner

You will find eight chapters which look at the previous recommendations and explain what the position would be if the recommendation was fully implemented and set out in red or amber boxes the action needed. Several examples and stories (both good and bad) are set out in the report.

Points to note include:

• CCGs / Integrated Care Systems are expected to develop and maintain dynamic support registers to identify people with a learning disability and autistic people who might be at risk of being admitted to hospital.
• Latest ratings data for March 2022 show there are 16 independent hospitals and NHS Trusts that provide mental health services that are rated inadequate and 60 that are rated requires improvement.
• CQC have convened a Supported Living Improvement Coalition with representatives including care providers, CCGs and housing developers.
• CQC still await an action plan from Building the Right Support Delivery Board but that in addition to a plan, there needs to be delivery alongside further investment.
• We can expect a public consultation in autumn 2022 exploring regulatory change to improve information about the number of people in long-term segregation.
• Whilst the number of Care (Education) and Treatment Reviews carried out has risen and the proportion of pre admission C(E)TRs that resulted in a decision not to admit has also increased, recommendations made are often not being progressed by providers and commissioners.
• CQC welcome the confirmation that a named lead for learning disability and autism will be on each Integrated Care Board and confirm that NHS E/ I proposes to issue statutory guidance on this matter to assist ICBs.

They conclude that:

• There is more to be done to ensure that people with mental ill health, those with a learning disability and autistic people get the "right support at the right time".
• 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 is a reflection of the continuing lack of community service provision.
• Changes must be co-produced at system level, provider level and at an individual level, with families' views listened to and acted on.

While there has been some progress since the findings of the main report in 2020, there is still further work to be done with the CQC calling on all partners to move forward at pace.