Message from Kate Terroni and Ted Baker

Update on our closed cultures work — in focus on our upcoming restrictive practices review

Kate Terroni, Chief Inspector of Adult Social Care, and Ted Baker, Chief Inspector of Hospitals, set out the next steps in our closed cultures work.

We want to give you a brief update on the progress of our closed cultures work this month as part of our commitment to share as much of this work as possible with you. Last month we updated you on new guidance that we released for our inspection teams on closed cultures — so firstly we want to let you know that almost 2,000 staff have now been given new training in line with the guidance.

We also want to use this blog to update you on the latest information about our restrictive practices review, which is part of our wider closed cultures work. We already know that services that use a high level of restrictive practice are more likely to show signs of being or developing a closed culture.

We took the decision to pause the publication of our review of restrictive practices in the spring because of COVID-19 — our teams were focused on responding to the initial crisis of the pandemic, and the system was not in a position to work with us on recommendations. However, we simply cannot wait any longer — we are now re-starting conversations with stakeholders and our Expert Advisory Group with the aim of releasing our findings and recommendations in the Autumn.

We know that COVID-19 has exacerbated many of the issues that people who are subject to restrictive practices face. Our review focused on the restrictive practices that are used with people with a learning disability, autistic people and those with a mental health condition and COVID-19 has particularly worsened the situation for people in these services.

Our interim report identified that people were being cared for in highly restrictive environments which were not right for them and were often isolated from the outside world. COVID-19 has meant that people have even less access to families and their communities.

In the run up to the final report, we will be working with our Expert Advisory Group and other stakeholders to gather input into our recommendations — to ensure that they can deliver the change that is needed. From our review, it was clear that significant improvements are needed for people that are in hospital with a learning disability, autistic people or mental health condition.

However, we also found that the right community care can be available when national and local services and commissioners work together to create bespoke packages of care. We found examples where this had happened well, even for those with lots of different needs and those who required specialist support. We will be talking more about these examples in our report when this is published this Autumn.

Our report will be told from the perspective of people who use services that we have spoken with. Their stories are central to us ensuring that the changes we make are right and sustainable.

By putting people’s needs and rights first, restrictive practice can be reduced and people can live in places that enable them to have a full and meaningful life. Look out for our final report and consider what you can do to improve the way we care for people.