Dr Paul Lelliott’s blog

Restraint, seclusion and segregation in hospitals and care homes: an update on our work from Dr Paul Lelliott, Deputy Chief Inspector of Hospitals and lead for mental health.

As well as registering and inspecting services, CQC uses its expertise and knowledge to raise important issues in health and care. One way we do this is through our ‘thematic reviews’. These provide CQC with a deeper insight into a particular aspect of care than we might get when we inspect a whole service.

Those working in mental health and learning disability services have unique powers to detain people against their will and treat them without consent — sometimes using force. Therefore, it is essential that providers, commissioners, and indeed ourselves as the regulator, reflect on how these powers are being used and are always open to questioning and external scrutiny.

It is essential that providers, commissioners, and indeed ourselves as the regulator, reflect on how these powers are being used.

Recently, there has been increased concern about the use of restraint, seclusion and segregation in mental health and learning disability hospitals. This prompted the Secretary of State for Health and Social Care to ask CQC to review these practices in England. He also asked us to extend the review to care homes and supported living services for people with a learning disability and secure services for children. This is the first of a monthly blog series that I will use to update you — as part of our commitment to share findings as they emerge.

We have worked quickly to assemble the review team, develop and pilot our methods and initiate a survey of providers. The survey has identified people who are being cared for in seclusion or segregation on a ward for people with a learning disability and/or autism or on a mental health ward for children and young people. Our visits to these wards are now underway. We plan to visit every patient in long-term segregation.

We have worked quickly to assemble the review team, develop and pilot our methods and initiate a survey of providers.

In these visits, we look not only at the quality of care that a person is receiving, but also at the pathway that led that person to being in that situation, whether their human rights are being protected and what part commissioners and other providers have played in influencing that person’s journey or in helping or hindering them to move on to a less restrictive setting.

Our first visits have already raised questions that we must answer over the duration of the thematic review:

Are people with an autism diagnosis particularly likely to be secluded or segregated?
Do staff have the specialist skills to manage behaviours they find challenging without having to resort to seclusion or segregation?
Do staff always know that how they are caring for a person amounts to segregation and therefore that the expected safeguards should be in place?
Are some people staying in segregation longer than necessary because of delays in putting in place a community care package or arranging transfer to a more suitable unit?

Our Expert Advisory Group, made up of providers, people who have used services, families, commissioners, staff and other national stakeholders, provides both wisdom and challenge. We will need both going forward because we already know that there is no easy fix for this issue. With their help, we will do all we can to ensure that the review brings about action to protect the welfare, safety and rights of people who are in a situation that makes them feel helpless and vulnerable.

We will have more findings to share in our interim report that’s coming out in late May after we’ve visited more units.

#CQCrestraintreview

If you have information you’d like to share, or would like to speak to someone about this work, please email RSSthematic@cqc.org.uk