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Out of Sight – Who Cares? CQC report reveals shocking use of restraint, seclusion and segregation
Publication leads to calls for reform in care services
The Care Quality Commission has published a report which reveals the use of restraint, seclusion and segregation in care services, against people with a mental health condition, learning disability or autism.
Out of Sight – Who Cares? found that many care services that have been paid to provide therapeutic care to patients, relied on restriction, seclusion and punishment, instead of understanding, meeting needs and supporting distress in trauma-informed ways.
According to the report, poor leadership and cultures were a barrier to people receiving person-centred care, with staff often not feeling listened, or supported to look after the people in their care.
The bigger question is why so many people remain in hospital settings (many well run) despite the Transforming Care Agenda. The report states "Cumulatively, the evidence that we have gathered points to a system where people with complex needs fall through the gaps. We cannot be confident that their human rights are upheld, let alone be confident that they are supported to live fulfilling lives".
In relation to training and skills staff reported that they often did not always have the necessary training and skills to understand people’s needs and they lacked training on communication skills such as Picture Symbols and Makaton. Where they were not able to help people communicate, this also caused people further distress and led to an increase in restrictive practices.
The report also found that providers did not always recognise how distressing the use of restraint and other restrictive practices could be for people or the long-term impact it could have.
Few staff were trained in trauma-informed care. As a result, people were not given opportunities to talk about the nature of their distress and were not supported to move forward.
The CQC has called for tangible progress to be made in four key areas:
1. People with a learning disability and or autistic people who may also have a mental health condition should be supported to live in their communities
2. People who are being cared for in a hospital in the meantime must receive high-quality, person-centred, specialised care in small units. This means the right staff who are trained to support their needs supporting them along a journey to leave hospital
3. There must be renewed attempts to reduce restrictive practice by all health and social care providers, commissioners and others
4. There must be increased oversight and accountability for people with a learning disability, and or autistic people who may also have a mental health problem
CMM: Out of sight – who cares
Council for disabled children: The restraint review: a blog by Dame Christine Lenehan DBE
CQC: Out of sight – who cares?: Restraint, segregation and seclusion review
RRN: CQC publishes ‘Out of Sight – Who Cares?’, a review of restraint, segregation and seclusion
LGA: LGA responds to CQC report on use of restraint, prolonged seclusion and segregation
Maybo perspective
- Restrictive interventions continue to be used unnecessarily and excessively by some services, who could avoid these approaches through better understanding of the people they support.
- This report also highlights system failings that explain why so many people with complex needs remain in hospital settings who could do well with the right support in their communities.
- It states families are often not listened to and that commissioners do not always appear accountable for the placements they make or for monitoring how they are going.
- Gaps in skills and training are clear. Maybo training starts with an understanding of human rights and recognising restrictive practices (it is surprising how many staff don’t have a full understanding). We then develop practical skills for building positive relationships, reducing and managing behaviours of concern, as well as developing skills around trauma-informed approaches to care.
- Training is important, but we need to remember that 'culture eats policy and training for breakfast', so clear leadership and active supervision is essential. Greater focus on supervisory skills and accountability is needed to deliver and maintain healthy cultures.
- Well done CQC - we wait in anticipation for Government action on the reports recommendations.
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