An update on engaging people on our closed cultures work and the Glynis Murphy review from Kate Terroni, Chief Inspector for Adult Social Care.

Kate Terroni, Chief Inspector for Adult Social Care

Today, the second [and final] part of the independent review by Professor Glynis Murphy into CQC’s regulation of Whorlton Hall has been published (which you can find here).

A lot has happened over the last 18 months which means as an organisation we have learnt about what needs to change for people who are at an increased risk of being in a ‘closed culture’.

We have already implemented significant changes to protect people, including training over 2000 inspectors in a more intensive approach for inspecting services where we think there may be a closed culture.

In the second part of the independent review, out today, Professor Murphy focused on reviewing evidence relating to detecting and preventing abuse. The report found that CQC have made good progress, but that there is more work to be done. Professor Murphy has made five further important recommendations for CQC to improve our regulation of similar services to Whorlton Hall. We are urgently looking at how we can best implement these.

These include:

  • Exploring how the use of restraint, seclusion and segregation can further impact on a services rating
  • Services should not be rated as ‘Good’ or ‘Outstanding’ if they cannot show how they support whistleblowing and reporting of concerns
  • trialling a tool to evaluate the culture of a service;
  • the trial of a recently developed tool to really find out what life is like for people living in hospitals, called ‘the Quality of Life Tool’
  • and the development of guidelines for when we might gather evidence using overt or covert surveillance.

We have already begun taking forward the Glynis Murphy’s first set of recommendations (published in March 2019).

For example, by:

  • developing a dashboard that brings together information such as safeguarding notifications, to help inform inspectors about the level of risk of a service, and whether to initiate an inspection
  • working to increase the number of out of hours inspections
  • developing new tools that will help our inspectors and reviewers gather information about people’s experience of care.

We will be using Right Support, Right Care, Right Culture — our updated policy on what we expect good care to look like for autistic people and people with a learning disability — in how we assess provision of care. As this second review highlights, it’s important we continue to develop these areas as well as taking forward the five new recommendations.

As well as independent reviews, we recently published our own review into the use of restraint, seclusion and segregation — ‘Out of Sight: Who Cares?’. Here we found that a human rights approach is central to reducing the use of restrictive practices. We found a lot of people failed to get the right community care early on and that mental health hospitals are rarely the right environment for people with a learning disability or autistic people, at the point of a crisis.

Regulation has a part to play in improving this, but we can’t do it alone. We need the rest of the system to take responsibility too. So we’re calling for increased specialist community care to ensure that people get the right support, by suitably trained professionals, to enable them to lead fulfilling lives and not end up in a crisis being placed too far from their own home, not having access to care to enable them to get better

We’re also calling for more oversight — this is desperately needed. We want there to be a named national specialist commissioner for complex care — and we want to see a Minister take ownership of this area.

What keeps me up at night is the fact that right now there are still almost a hundred people in highly restrictive environments. The fact is that in some months there are still one hundred people admitted to environments that won’t meet their needs — more needs to be done urgently to stop people receiving the wrong care.

This will require strengthening across all parts of how we work from registration, monitoring, inspection, rating and taking enforcement action.

We’ve asked those in the system to appoint leads for areas of work they are responsible for, and I want to match this within our organisation to ensure true accountability for this work. To help achieve this, Debbie Ivanova, who is currently a Deputy Chief Inspector in my team will provide this leadership as we drive forward the changes we need to make.

At a time of change for CQC it is important to me that we take the opportunity to use all of this learning to continue to support people with a learning disability and autistic people to live better lives.

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