Inside CQC: Debbie Ivanova

Debbie Ivanova, Deputy Chief Inspector of Adult Social Care at the Care Quality Commission (CQC) explores key recommendations in  Out of sight – who cares?

COVID-19 is dominating both media headlines and our lives at the moment but that doesn’t mean we can ignore other important findings in health and social care.

In fact, in the learning disability, autism and mental health sectors COVID-19 has accentuated existing poor practice and highlighted the need for urgent action to protect people.

Our latest report, Out of sight – who cares? highlights some of these urgent issues. It looks at the use of restraint, seclusion and segregation in services for people with a learning disability, autistic people and those with a mental health condition. It brings together people’s personal experiences with what we found during surveys and visits to select hospital, adult social care and children’s services.

We’ve told this primarily through the voice of people who have experienced restrictive practices, and the report has human rights at its core. We’re calling for increased national oversight in commissioning and across government, to stop people falling through the gaps.

Restrictive practices are not an appropriate way to care for people. They happen when we haven’t got the model of care right and haven’t properly understood people’s needs. Using a human rights perspective can help reduce the use of restraint significantly. When staff think about what an individual might need for them to have their basic rights, they see things differently.

When people receive undignified and inhumane care it is our collective responsibility to bring about change. This must be a change both in the model of care and the oversight of it.

Community-based services are the best place to care for people with a learning disability, autism and/or a mental health condition, and it is possible to make this a reality even for people who have been subject to long periods in hospital and cycles of restrictive practice.

A lack of training and support for staff means that they are not always able to care for people in a way that meets everyone’s individual needs. We must have community teams across the country with specialist skills to support autistic people, people with a learning disability and/or mental health conditions, intervene early and prevent people from having a crisis.

So, what does increased oversight look like?

We want the government to appoint a national commissioner for complex care who would deliver our recommendations, working with delivery partners in health, education, social care, justice and local government. Delivering good care in a system with complex funding arrangements and workforce shortages is undoubtedly difficult, but it can be done.

Key to this is our recommendation for a national reporting mechanism to be developed for the use of restrictive interventions in social care and children’s services to mirror that used in hospitals. We found that social care providers did not always recognise when they were using restrictive practice. We need common language, definitions and a unified system that allows us to track trends.

We’re also calling for enhanced monitoring by commissioners to help ensure a plan for ending an individual’s restrictions is in place and milestones for achieving it are met. The provider must have a named person with oversight who reports to the commissioner. Where progress is not made, this should be escalated.

As part of our recommendations, we’re stating that human rights must be embedded in the commissioning and delivery of care. This is especially the case for children and adults with a learning disability, autistic people and people with a mental health condition.

People must have accessible information about their rights such as resources produced by the British Institute of Human Rights and the Equality and Human Rights Commission. We’ll look for this on inspection and through our monitoring activity.

I cover only some of the recommendations here and I encourage you to read our report in full on the CQC website. We all have a part to play to ensure that improvements happen; our regulation is part of that. We’ll know that we’re succeeding when people who use services have their rights respected, are not segregated and restrained and have a true voice in determining where and how they live in the community.

Debbie Ivanova is Deputy Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts and feedback on Debbie’s column below and don’t forget to stay up to date with the latest social care news on CMM’s twitter feed:  @cmm_magazine





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