Dr Paul Lelliott’s blog

Care Quality Commission
3 min readJun 4, 2019


Restraint, seclusion and segregation in hospitals and care homes: an update on our work from Dr Paul Lelliott, Deputy Chief Inspector of Hospitals and lead for mental health

Dr Paul Lelliott

A significant number of people with a learning disability or autism are admitted to a hospital because the health, care and education system has failed to support them to live fulfilling lives in their own home. Once there, they may become stuck in the hospital because of the absence of any alternative. Recent events have highlighted the risk that these hospitals may become closed and punitive institutions.

The Panorama programme depicted appalling abuse at Whorlton Hall. It has triggered renewed demands for action and further questions about the effectiveness of attempts to change the system of care. In response to this, we at CQC are changing the way that we monitor and inspect hospitals that are at risk of developing an unhealthy culture; to try to find better ways of getting under their skin. This work has already started. The independent review that CQC has commissioned into our regulation of Whorlton Hall will feed into this.

Our thematic review of seclusion and segregation is another source of learning. We published our interim report last week, which I hope many of you will have read. We listened carefully to the views of our expert advisory group and these greatly influenced the end result. The report addresses some of the big issues the group has highlighted over recent months. This includes our recommendation that the current system of safeguards, including the role of advocates, is strengthened.

When the review was commissioned we committed to publishing an interim report, so we could share findings as soon as they emerge. This was to ensure that all those who play a role as part of the system could start thinking now about what needs to change — that includes us. We still have to fully analyse the evidence gathered during phase one of the review. Our final report and its recommendations will take full account of this analysis and will be produced in close collaboration with our expert advisory group.

We are now starting the second phase of the review. Over the coming months, our team will be visiting care homes, and low secure and rehabilitation mental health services. Their particular focus will be on the use of restraint and seclusion. We will look at how providers and staff minimise the use of restraint. If they are not doing this, we will unpick why that is, and what is needed to ensure that all services follow the principle of ‘no force first’.

We now have a maximum eight months to complete this work. To do this, we need input and advice from those working across the sector — only people who have experienced this first-hand fully understand what change is needed. We are therefore committed to listening to the experiences of people who use services and their families and making sure that our final report represents their voices.


If you have information you’d like to share, or would like to speak to someone about this work, please email RSSthematic@cqc.org.uk



Care Quality Commission

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