Inside CQC: Debbie Ivanova

Debbie Ivanova, Deputy Chief Inspector of Adult Social Care at the Care Quality Commission (CQC), updates you on phase two of the thematic review of restraint, seclusion and segregation.

We are now into phase two of our restraint, seclusion and segregation review and I want to use this column to tell you what that means.

In May, we published an interim report containing the findings of the first phase of our review of restraint, seclusion and segregation.

The interim report focused exclusively on the experiences of those people cared for in segregation on a mental health ward for children and young people or on a ward for people with a learning disability or autism.

In the interim report, you can find a number of recommendations for the health and care system, including for the CQC.

The second phase of the review is looking at restrictive interventions in adult social care services, as well as mental health rehabilitation centres, low secure hospitals, and some children’s residential services.
From now until the end of October, our team will be visiting around 40 services and our findings will be in the final report to be published in March 2020.

You may have read columns elsewhere by my colleague Dr Paul Lelliot, Deputy Chief Inspector of Hospitals and lead for Mental Health at the CQC, who led phase one of the review.

As my background is in social care, I am leading on the second phase and am really pleased that we will be visiting adult social care settings, as we need to better understand how staff in social care settings use restrictive interventions and how extensively they are used.

As professionals in the sector, I hope that you would agree that adult social care is about giving people as full and independent a life as possible and it is therefore incredibly important that we understand and evaluate the use of these practices across the country.

As well as visiting 40 services during phase two of the review, we will be looking for as many opportunities as possible to speak to people who have lived experience. This could be from having experienced seclusion, segregation or restraint first-hand or from witnessing these practices being used.

We know that this is not an easy topic to talk about and it can bring up distressing memories for people, making them feel uncomfortable and emotional.

This means that we have to think hard about how we can best reach people with these experiences and we are therefore continually looking for new opportunities and ways of engaging with people who may be harder to contact.

So far in the second phase, we have held two expert advisory group meetings and two workshops to gather experiences and feedback, and we will be holding more of both over the coming months.

As well as face-to-face events, we are working with CHANGE people , a learning disability charity, and Advonet, a mental health organisation, to make sure the voice of those people with lived experience is heard at every step of the way.

This means that people’s views and experience will be guiding the recommendations for changes and improvements across care services that are part of the report.

The work we do at CQC must have impact and lead to improvements in the health and social care sector. I am confident that, working with all of our partners, this really important review can do that.

Debbie Ivanova is Deputy Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts and feedback on Debbie’s column in the comments section below.

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