This report describes the progress made on the recommendations in our Out of sight – who cares? report, published in October 2020, which looked at the use of restraint, seclusion and segregation in care services.
This progress report highlights the main areas where further work is still needed. It builds on the December 2021 progress report.
Summary of findings
The recomendations in Out of sight – who cares? were made for people with mental ill health, people with a learning disability and autistic people. However, there is more of a focus on people with a learning disability and autistic people, as we visited more services where they lived. This is reflected in the balance of evidence in this report.
This report updates on key themes, which means some recommendations are grouped together, rather than being in numerical order. We have reported on progress. We have also drawn attention to where progress has not been made.
We have shown whether each recommendation has been achieved, partly achieved, or not achieved.
We consider these recommendations have not been achieved
- Recommendation 1 – people have a home and the right support in place
- Recommendation 2 – people have the right community services commissioned
- Recommendation 3 – people have the right support to avoid crisis
- Recommendation 4 – people have their rights understood
- Recommendation 5 – people receive the right support in hospital
- Recommendation 7 – people have skilled staff to support them
- Recommendation 8 – people have bespoke services
- Recommendation 11 – people who experience restrictive interventions have these reported to CQC
- Recommendation 13 – people who are segregated in hospital experience good quality regular independent reviews
- Recommendation 14 – people have meaningful Care (Education) and Treatment Reviews because providers and commissioners are accountable
- Recommendation 15 – all people in segregation in hospital are recognised through updating the definition of long-term segregation
- Recommendation 16 – people see a reduction in the use of restrictive interventions
- Recommendation 17 – people in children’s and adult social care services experiencing restrictive interventions would have these reported to regulators
We consider these recommendations have been partly achieved
- Recommendation 6 – improving how CQC regulates services for people with a learning disability and autistic people
- Recommendation 9 – recording data to improve local services
- Recommendation 10 – people’s experience of person-centred care
- Recommendation 12 – people who experience restrictive interventions have regular oversight by commissioners
We consider that no recommendations have been fully achieved
We have come to these conclusions through weighing up the evidence from what stakeholders, including people with lived experience, have told us; what progress has been made; and what impact this has had on outcomes for people. Where we have no evidence of a positive impact on the outcomes people experience, we have concluded that the recommendation has not been achieved. Where some impact is evident, we have concluded that the recommendation has been partly achieved.
We have reviewed national published data to inform this report, including the NHS Mental Health Services Data Set (MHSDS) and Assuring Transformation data set and inspection reports of services for children and young people with special educational needs and disability. Data on mental health inpatients from MHSDS covers all people receiving care in a mental health hospital, including autistic people and people with a learning disability.
We have also used data and insight that we have gained from our engagement with our Expert Advisory Group, voluntary and community sector organisations, provider representatives, government departments, health and social care leaders, non-departmental government bodies, advocacy organisations, practitioners and people using services in health and social care. Throughout this report, we include stories of people’s experiences of care. We have not used their real names.
Our findings from these sources have been corroborated, and in some cases supplemented, with input from subject matter experts.
CQC made a commitment to monitor and report on the recommendations. The responsibility for delivery of the majority of the recommendations lies with partners. Governance of those recommendations relating to people with a learning disability and autistic people must lie with the Department of Health and Social Care Building the Right Support delivery board to hold members to account and deliver the recommendations. The Department of Health and Social Care and partner organisations need to clarify how the recommendations relating to services for people with mental ill health will be progressed.