Inside CQC: Rob Assall-Marsden

Rob Assall-Marsden, Interim Deputy Chief Inspector updates you on the second phase of the Care Quality Commission’s (CQC’s) restraint review.

In August, my colleague, Debbie Ivanova wrote the Inside CQC column to tell you about the progress of our thematic review of restraint, seclusion and segregation as we entered the second phase of the review. The second phase, which is looking at restrictive interventions in adult social care services, as well as mental health rehabilitation centres and low secure hospitals, and some children’s residential services, is now well underway and I want to take this opportunity to update you on the review and how we are taking forward the recommendations we made in our interim report in March 2019.

We are working closely with the Department of Health and Social Care, The British Institute of Learning Disabilities (BILD) and NHS England to make sure the right people are involved. As part of this, from August to October, we held an online survey to gather views on our draft proposals for a better (more integrated and preventative) system and we are currently analysing the feedback we received. In November we are holding a summit where we will be working with international and domestic experts in the field to turn our #BetterSystem proposals into an action plan which will make a difference to improve the lives of people with learning disabilities and or autism.

The Department of Health and Social Care has also recently announced that it is working to create a team of people who will review the care of people we identified in segregation during phase one of the review and I hope to update you about this in a future column.

Since August 2019 and the beginning of phase two of the review, we have visited 11 mental health services and 27 social care services. During these visits, we have found that there is little central accountability and oversight for the use of restraint in social care, which we have highlighted before, so these issues will be raised in our final report. This final report is due to be published in March next year, and we need every person who has a stake in this work to take responsibility for their part of the recommendations.

As well as the work we have done in phase two of the review, this month we have also provided our inspectors and inspection managers with supporting information on closed environments. When we say closed environments, we are talking about environments where people are placed away from their communities, where people may stay for months or years at a time and where staff often lack the right skills, training or experience to support people.

This work is separate to our review of restraint, seclusion and segregation but we want to ensure that going forward there is a greater focus on the care for people with a learning disability and or autism who might be at risk in these closed environments, and the information provided to inspectors and Mental Health Act reviewers this month will hopefully help with this.

We know that, often, people with a learning disability and or autism are unable to advocate for themselves, for a number of reasons, including being non-verbal and other difficulties in communicating. We also know that this lack of understanding can lead to people’s needs being ignored and restrictive practices being used where they otherwise might not need to be.
Our review is looking at how restrictive practices are being used and we are working with stakeholders from all parts of health and social care to better understand how these can be reduced or stopped altogether.

We know that there are times where restrictions are used in punitive ways, which can lead to the development of abusive cultures. This is absolutely not acceptable under any circumstances and is a breach of human rights. The new information which we issued on 1st November tells inspectors and Mental Health Act reviewers what they need to look for to help them identify when there is a possibility of this happening.

I hope that I have given you some insight into the work we have done since Debbie last wrote about the review, and that you will visit our website or contact the team if you want more information or wish to speak to someone about the review.

Rob Assall-Marsden is Interim Deputy Chief Inspector at the Care Quality Commission. Share your thoughts and feedback on Rob’s column in the comments section.

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