Blog from Dr Paul Lelliott and Debbie Ivanova

Dr Paul Lelliott, Deputy Chief Inspector of Hospitals and lead for mental health and Debbie Ivanova, Deputy Chief Inspector of Adult Social Care update on our restraint, seclusion and segregation in hospitals and care services work

We are now in the second phase of the thematic review and are planning our visits to care services for people with a learning disability or autism and low secure and rehabilitation mental health services. We know little about how, and how extensively, staff in care services use restrictive interventions to manage behaviour that they find challenging. There is no system for collecting data on this centrally and the legal framework and guidance are even less robust than in healthcare settings.

On 19 June we held the first in a series of events in the second phase of the review, where we focused solely on the use of restraint. We asked questions to people who use services, their families and professionals including:

  • Why is restraint used in the first place?
  • How have some services managed to reduce the use of restraint?
  • Why have other services not succeeded in doing this?
  • What more can be done — over and above national work already underway?

Some of those attending the workshop felt strongly that a culture of restraint has been ingrained in health and care services for decades. Others felt that the environment of hospital wards, is inherently wrong and not conducive to providing care and treatment that does not involve the use of force.

The group talked at length about the ‘power dynamic’ of patients and staff. There was general agreement that a human rights-based approach must be the starting point to providing all health and care services.

Thanks to everyone that attended on the day for your contributions. There will be a full write up of this work shared with the attendees that will inform our final report.

As we move into the next stage of our work, we are looking for people with experience of restrictive practices in social care and supported living to join our expert advisory group and to contribute to shaping the final report and recommendations. It is crucial that we have people who have experience being restrained, secluded or segregated in social care services on our group as well as professionals working in and around this area. Please send your expressions of interest with details of your experience to


If you have information you’d like to share, or would like to speak to someone about this work, please email

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

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