Monthly column for providers and professionals working in healthcare from Professor Ted Baker, Chief Inspector of Hospitals

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You may be aware that CQC is currently conducting a review of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability or autism. We recently published an interim report, sharing early findings and recommendations for the health and care system, including ourselves as the regulator.

The interim report focuses on the experiences of 39 people who are cared for in segregation on a learning disability ward or a mental health ward for children and young people.

The review found that some people were experiencing delayed discharge from hospitals, and so prolonged time in segregation, due to there being no suitable package of care available in a non-hospital setting. Several people that we visited were not receiving high quality care and treatment, and in the case of 26 of the 39 people, staff had stopped attempting to reintegrate them back onto the main ward. There were also concerns around staff lacking the necessary training and skills.

The interim report makes six recommendations, including a call for an independent review of every person who is being held in segregation in mental health wards for children and young people and wards for people with a learning disability or autism.

The next phase of the review is about to start, and this will include visits to care homes and low secure and rehabilitation mental health services.

The importance of this review and making sure the recommendations are considered and implemented was laid bare in a recent Panorama which showed appalling abuse of vulnerable people. We have apologised for missing what was really going on at Whorlton Hall when we inspected in March 2018 and we are determined to learn how we can improve the way we assess the experience of care of people who may have impaired capacity, or who may be fearful to talk about how they are being treated.

We have commissioned an independent review into our regulation of Whorlton Hall between 2015 and 2019, which will include recommendations for how our regulation of similar services can be improved, in the context of a raised level of risk of abuse and harm.

In his latest blog, Dr Paul Lelliott, Deputy Chief Inspector of Hospitals and lead for mental health reflects on the Panorama programme and outlines what is next for our thematic review.

I’d like to make you aware of a development in our post-inspection process, which follows a recommendation from the Public Accounts Committee. To help ensure that the findings from our inspections are made available to the public as soon as possible, we have reintroduced post-inspection letters for all routine NHS inspections.

We expect trusts to discuss the findings of their inspection at the first public board meeting following their inspection, and where a final report isn’t available, the post-inspection letter can be used to facilitate this discussion. I would also encourage trusts to publish their post-inspection letter on their website. I hope trust leaders see this as a valuable opportunity for open and transparent dialogue with members of the public about our inspection findings.

Finally, earlier this year, we highlighted concerns about the quality and safety of independent ambulance services. One of our concerns was that many services inspected had a poor understanding of governance, which often led to weak recruitment processes and relevant checks for staff not being enforced consistently. I would like to remind all providers of their responsibilities regarding the ID and employment checks that must be completed for healthcare staff, and which applies to those people employed by ambulance trusts — either directly or through a subcontracting arrangement with independent ambulance providers. More information on the NHS Employment Check Standards is available on the NHS Employers website.

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