The government has asked the Care Quality Commission (CQC) to review the use of restrictive interventions on those with mental health problems and learning disabilities and/or autism in hospitals and care homes.
It will review and make recommendations on the use of physical restraint, prolonged seclusion and segregation in settings that provide inpatient or residential care for people with mental health problems and a learning disability and/or autism.
The announcement follows longstanding concerns about the care and treatment of this group, including excessive use of restraint, institutional abuse, poor care and people being placed in inappropriate settings, often far from home.
More on learning disability
The ongoing Transforming Care programme, set up in the wake of the 2011 Winterbourne View scandal, is designed to address these problems. However, an investigation by the BBC’s File on 4 programme broadcast last month found a substantial increase from 2016 to 2017 in the use of restrictive practices in inpatient settings for this group.
Assessing a variety of settings
The review will first look at specialist NHS and independent hospital wards for adults and children, including assessment and treatment units, where problems are believed to be greatest, before moving on to consider mental health rehabilitation and low secure wards.
It will then carry out exploratory work to identify whether and how restrictive interventions are used in specialist care homes and children’s homes, and secure children’s homes.
Section 6 of the Mental Capacity Act 2005 (MCA) defines restraint as when someone “uses, or threatens to use, force to secure the doing of an act which the person resists or restricts a person’s liberty whether or not they are resisting”. Restraint can be physical, including controversial prone restraints that involve holding a person chest down, chemical, involving medication, or mechanical, involving some kind of device such as a belt or cuff.
Meanwhile, seclusion and segregation are ways to manage the threat or actual use of violence by confining or isolating a person, for example in a locked room or one the person is otherwise prevented from leaving.
The CQC review will include visits to services, interviews with people who have been subject to segregation or prolonged seclusion and with families and carers, in addition to analysis of relevant data, guidance and reseach.
NHS England, NHS Improvement and Ofsted will work with the CQC on the review, which is scheduled to report back to the government in March 2020, with interim findings expected in May 2019.
However, there has been some criticism over the 15-month timescale of the review.
‘Woeful’ report timescale
Sara Ryan, the mother of Connor Sparrowhawk, who died preventably in an NHS Trust unit in 2013, said: “The timescale is woeful and reflects a layer of indifference to this issue that is symptomatic of the sustained impoverished treatment of certain people in our society.”
“I would like the CQC to actually think about the people and children who will experience restraint, prolonged exclusion and segregation for a further fourteen months. These people are human and should not be subjected to such barbaric practices,” added Ryan, who is also a disability academic and a campaigner for the rights of people with learning disabilities.
Public concern surrounding use of restraint
CQC deputy chief inspector of hospitals (lead for mental health) Dr Paul Lelliot acknowledged there was “public concern” over the use of restraint and other restrictive techniques used on people with learning disabilities, he said:
“It is vital that services minimise the use of all forms of restrictive practice and that providers and commissioners work together to find alternative, and less restrictive, care arrangements for people who are currently subject to seclusion or segregation. Failure to do this has the potential to amount to inhuman and degrading treatment of some of the most vulnerable people in our society.
“The experience and perspective of the people affected by these practices, either as a patient or as a carer, will be central to this work. It is vital that society protects the rights, welfare and safety of children and adults with a mental illness, learning disability or autism and that they receive the safe, high quality care that they deserve.”