Government accepts regulator’s recommendations on restraint, seclusion and segregation

The Department of Health and Social Care has published its response to the CQC’s Out of sight – who cares? report which reviewed the use of  restraint, seclusion and segregation in care services for autistic people and people with a learning disability and/or mental health condition. You can read our earlier blog on the CQC ‘s report here.

The Minister of State for Care, Helen Whately MP has recently responded to the CQC’s report published back in October 2020 in a letter addressed to Ian Trenholm, the chief executive of the CQC.

A summary of the Minister of State’s response is set out below:

  • All recommendations are accepted in full or in principle where the DHSC is identified as the lead department.
  • It was agreed that there must be a single point of ministerial ownership for delivery of all the recommendations made by the CQC. The Minister 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 includes Baroness Hollins in light of her having been chairperson of the Independent Case Review Oversight Panel on improving the circumstances for people in long-term segregation, which followed the recommendation in the CQC interim report in May 2019, that individuals in long-term segregation should have their care independently reviewed. 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.

Workforce recommendations

  • The DHSC agree that everyone involved in the care of people with a learning disability and autistic people must have the right skills – whether in the community or an inpatient setting. The department has 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. The DHSC are working with Health Education England and Skills for Care to develop and test a standardised training package, backed by £1.4 million investment.
  • Beyond the Oliver McGowan Mandatory Training, DHSC will continue to work 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.

Commissioning

  • There is agreement with the principle that there should be a single named commissioner with oversight for commissioning for people with a learning disability and complex needs. According to the letter, DHSC are discussing implementing a stronger oversight arrangement and enhanced accountability for commissioning with the CQC and NHS England, within the current legal framework. It also says that it is important that health, social care and education work together effectively in local systems reflective of the direction of travel set out in the Health and Care Bill.
  • The DHSC consulted on new duties on commissioners to ensure adequacy of supply of community services, including that every local area should monitor the risk of crisis at an individual-level for people with a learning disability and autistic people through the creation of a local ‘at risk’ or ‘dynamic support’ register. The DHSC are reviewing the responses following consultation.

Mental Health Act reform

  • There is more to do to provide support in the community to prevent unnecessary admissions to inpatient care and to facilitate timely discharge recommendations.
  • For the first time, reform to the MHA 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. The DHSC will also consider changes to the Mental Health Code of Practice as part of this wider work on MHA reform.

Better reporting of restrictive practice

  • Reference is made to the Mental Health Units (Use of Force) Act 2018 and its purpose to increase the transparency and accountability of mental health services’ use of force. As well as setting out the requirements for recording and reporting the use of force (section 6) it makes clear that staff should be trained in the appropriate use (section 5) and that the Secretary of State must ensure that at the end of each year statistics are published regarding the use of force by staff who work in mental health units (section 7(1)).
  • The DHSC also reference their work on developing a proposal to amend the Health and Social Care Act 2008 (Regulated Activities) Regulations to improve reporting and transparency around the use of restrictive practice, including segregation. More immediately, changes are being made to the Assuring Transformation dataset to better capture use of restrictive practices.

In conclusion, the DHSC 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.​

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