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Rob Assall-Marsden, Interim Deputy Chief Inspector of Adult Social Care updates on our restraint, seclusion and segregation in hospitals and care services work.

I want to use this month’s blog to update you on progress on the thematic review, but also to let you know that CQC are providing inspectors with supporting information on closed environments.

What do we mean by closed environments? We mean environments where people are situated away from their communities, where people may stay for months or years at a time and where staff often lack the right skills, training or experience to support people.

Supporting information for inspectors

Although our review of restraint, segregation and seclusion is separate to this work, the information that inspectors and Mental Health Act Reviewers have been given today should lead to a greater focus on the care for people with a learning disability and or autism who might be at risk of being in a poor environment.

We know that people with a learning disability and or autism are sometimes not able to advocate for themselves, for a number of reasons, including some people being non-verbal. We also know that this lack of understanding can lead to people’s needs being ignored and restrictive practices being used to manage them.

Our review on restraint, segregation and seclusion is looking at how restrictive practices are being used and we are working with stakeholders to understand how these can be reduced or stopped completely in some cases.

However, we know there are some instances where restrictions are used in punitive ways, that can lead to abusive cultures developing. This is a breach of people’s human rights and is completely unacceptable. The new supporting information we are issuing today tells inspectors and Mental Health Act reviewers what they need to be looking for to help them to identify when this is happening.

Implementing the recommendations of the interim report

We’re also working closely Department of Health and Social Care, BILD and NHS England to take forward the recommendations from our interim report.

The Department are working to get a team in place to review the care of people we identified as being in segregation in our interim report, and we will keep you updated on this through these blogs.

We gathered feedback through an online survey from August until 1 October and are currently analysing the results of this to take this forward in November. At the November summit we will be working with international and domestic experts in the field to translate the #BetterSystem proposals into a meaningful action plan. Watch this space for a final online survey on the results of the day.

Update on final visits to services

The second half of the review is almost complete. We have now visited 11 many mental health services, and 27 social care services, and gathered additional information through a survey from over three hundred social care services. As we’ve highlighted before, we’ve found there is much less central accountability and oversight for the use of restraint in social care, so we will be raising these issues in our final report.

When the final report and recommendations publish in March 2020, we need every single person who has a stake in this work, to take responsibility for their part of the recommendations. We ask that you think about how you can put pressure on the part of the system you are responsible for.

If you want to speak to someone about the review, please email The team will get back to you as soon as possible.


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