Inside CQC: Debbie Ivanova

Debbie Ivanova, Deputy Chief Inspector of Adult Social Care at the Care Quality Commission (CQC) shares how the thematic review of restraint is progressing ahead of its publication in Spring.

In November, Mary Cridge talked in this column about the progress of our thematic review of restraint, segregation and prolonged seclusion, and I want to use this opportunity to continue that conversation as we near the publication of the final report this Spring.

The CQC was commissioned in November 2018 by Secretary of State for Health and Social Care, Matt Hancock to look at the use of restrictive interventions. Throughout the review, we have looked at how places providing inpatient care for people with mental health issues, a learning disability, and/or autism use these interventions.

We published our interim report in May last year. It focused exclusively on the experiences of 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. The report made a number of recommendations for organisations across the health and care system, including CQC. In the second half of the review, we have included visits and surveys of care services where people with learning disabilities and autism live.

At the end of January, we held our final expert advisory group for the review. It was great to have an even split between provider representatives and people with lived experience – or family members with lived experience – in the room, leading to an open and meaningful conversation. If it weren’t for the time and commitment these people have put into the four expert advisory groups that we have held, and the work that surrounds this, we would not have properly understood just how the current system is failing people and the impact of that.

Families and people with lived experience led the first session at the final expert advisory group, in which we reflected on all of the other reports, recommendations and policies that have been created in this area over recent years. A quick internet search will show you just how many recommendations have been made to reduce the use of restrictive practices, yet our interim report showed that, at that time, there were at least 62 people in segregation, with 16 of those people having been in segregation for over a year.

So why are we still seeing shocking figures like these? There’s a whole host of reasons that recommendations to improve the system for people with a learning disability or autism have not had an impact. They range from budget pressures to lack of staff training, and include many other reasons, some of which were discussed at the meeting.

When the final report publishes in Spring this year, we will be taking a view of restrictive practice in health and care, including the wider quality of care, and ensuring that we take a human rights approach and put the voices of people who use services at the centre of the report.

We will also be creating recommendations which hold key partners accountable for their actions, but we need everyone who has a stake in this work to look at themselves and what they can do to improve the system.

Later this year, we will also be publishing our report looking at sexual safety and sexuality in adult social care. This is another topic which needs to be talked about. In her blog in March, Kate Terroni hopes to share more about this report and its key themes.

Debbie Ivanova is Deputy Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts and feedback on Debbie’s column by leaving a comment below.

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