A key feature of my role is working with colleagues and stakeholders system wide. Central in my recent conversations has been a shared determination to harness this Government’s focus on social care and see, together, what we can achieve. In addition, a current priority for my team and me is the experience that autistic people and people with a learning disability have of health and social care. Knowledge of the inequalities that people face in their interactions with the sector underpins the work we do.
Earlier this year, we published a report highlighting the enablers and barriers to supporting people out of long-term segregation – something we identified through undertaking Independent Care (Education) and Treatment Reviews or IC(E)TRs. These reviews examine a collaborative, objective and comprehensive view of the care and treatment of autistic people or people with a learning disability living in long-term segregation. The aim is to ensure people’s rights are upheld, restrictions kept to a minimum and to make sure plans are made to move people out of long-term segregation and out of hospital into a home of their own.
Through the reviews we listened to the stories and lived experiences of many people in long-term segregation, as well as those of their families and supporters. While there were examples of both positive and poor practice, we found that care is not consistently person centred. Too often, the intention to provide good care is undermined by avoidable barriers. These include a lack of specialist skills, poor communication, environments that do not meet sensory needs and uninformed decision-making – particularly where people and their families and supporters are not meaningfully listened to. I encourage providers to read the report and use the insights and experiences shared to reconsider approaches to care.
Person-centred care remains key
Keeping the person at the centre of their care planning is essential. As we noted in the IC(E)TR report, the care a person needs and receives must be tailored to them and adapted as their needs change. Earlier this summer, we rated Mansfield Supported Living as ‘outstanding’ on its first inspection. The service cares for autistic people and people with a learning disability in supported living settings. The service stood out as being genuinely exceptional, where the quality of care was making a real and lasting difference to people’s lives.
There were numerous examples of people who had achieved outcomes that had once been considered unlikely. Staff recognised people’s potential, adapted approaches to meet their communication needs and patiently nurtured their confidence over time. This had a profound impact on people’s ability to express their wishes, engage with others and participate more fully in decisions about their life. The commitment from staff and leaders to balancing safety with people’s rights and aspirations resulted in improved quality of life and more opportunities for people to achieve their goals.
Make the most of training
The requirement to ensure staff in CQC-registered services have training on learning disability and autism – including how to interact with autistic people and people with a learning disability – at a level appropriate to their role has been in place since 2022. We have just passed the first anniversary of the publication of the Oliver McGowan Code of Practice. This sets out the standards that training on learning disability and autism need to meet – both in content, and how it is delivered.
We have seen some innovative and positive examples of providers working hard to ensure staff are able to meet the specific needs of autistic people and people with a learning disability who receive care. However, there is still more to do. Not all providers are actively seeking appropriate training for their staff despite this being a regulatory requirement.
We know, from our work on the IC(E)TR report as well as our day-to-day regulatory activity, that with appropriate training and a commitment to person-centred care and planning, the improved outcomes and experiences for autistic people and people with a learning disability can be life changing.
To read CQC’s IC(E)TR report, visit its website. Then, comment on this feature or join the conversation to share your thoughts.
Chris Badger is Chief Inspector of Adult Social Care and Integrated Care at CQC. Email: [email protected] LinkedIn @Care-Quality-Commission