woman sitting on hospital bed

The Care Quality Commission says not enough progress has been made on the care of patients with learning disabilities, autism and mental health conditions, in a progress report published 25 March.  

Not enough progress has been made to address the recommendations made by the Care Quality Commission (CQC) in its 2020 ‘Out of sight – who cares?’ restraint, segregation, and seclusion review. CQC finds that there are still too many people in hospital. Once in hospital they often stay too long, do not always experience therapeutic care and are still subject to restrictive interventions.   

In 2018 the Department of Health and Social Care commissioned CQC to review the use of restrictive practices in services for people with a learning disability, autistic people, and people with mental ill health. Progress on meeting the recommendations made by CQC in its review has been limited, with just four of the seventeen recommendations made in the 2020 report being partially met and thirteen not met at all.  

CQC’s progress report highlights that although there are still too many people with a learning disability in hospital, this has nearly halved since March 2015. However, the number of people with autism in hospital has increased considerably over the same period.  

Not enough progress has been made in reducing the use of restraints and challenges persist in the health and social care system which are preventing people from accessing early intervention and crisis support in the community. This can be particularly harmful for autistic people.  

The report also underlines persistent challenges with the commissioning of services. Currently, people are fitted into services that are available, rather than receiving support tailored to the individual’s needs. Commissioners are often not working in partnership with people, their families and different organisations when delivering services, leading to a breakdown in quality and continuity of care.  

CQC’s progress report also found:    

  • Although Independent Care (Education) and Treatment Reviews took place, they have not resulted in real changes to people’s lives as they are still unable to leave segregation and be discharged from hospital.   
  • There are more people known to be in long-term segregation now than when the CQC review was commissioned in 2018.  
  • All people with a learning disability and autism who are admitted, or who are at risk of admission to a mental health inpatient service, should have a Care Education and Treatment Review. However, recommendations made in Care (Education) and Treatment Reviews are often not being progressed by providers and commissioners.   

Debbie Ivanova, Deputy Chief Inspector for People with a Learning Disability and Autistic People at CQC, said: “The Out of Sight report was intended to improve care for people and lever the change that must happen to improve the lives of people with a learning disability, autistic people and or those with mental ill health.  

“This has not happened and there are still too many people in mental health inpatient services. Just four of our recommendations to improve services have been partially met and thirteen not met. The pandemic has clearly had an impact on services and the people that use them in a way that could not have been foreseen. However, progress on the recommendations we made for change have not been happening quickly enough.   

“We are calling on all partners to commit to a renewed effort to move forward, sharing responsibility for implementing the changes needed. The focus must be on meeting people’s individual needs. Improved collaboration at system level, provider level and at an individual level with people and their families is also required to deliver the necessary improvements. Services must fit around people rather than trying to fit people into services that can’t meet their needs.”  

Jemima Burnage, Deputy Chief Inspector of Hospitals and Lead for Mental Health at CQC, said: “Almost 18 months have passed since we recommended what must change to improve the care and support received by people with a learning disability, autistic people, and people with mental ill health.   

“Some investment has been made into projects supporting people to come out of long-term segregation, and funding has been allocated to increase community support. However, for real impact to be felt progress must now be accelerated. 

“Changes must now be co-produced at system level, provider level and at an individual level by collaborating with people and their families. Integrated Care Systems will play a key role in ensuring these changes are delivered and we welcome the announcement that a named lead for learning disabilities and autism will be on each local integrated care board.”