The latest updates on our learning disability and autism work

Debbie Ivanova (Deputy Chief Inspector - People with a learning disability and autistic people), updates on how we are working to transform the way we regulate services for people with a learning disability and autistic people.

Debbie Ivanova, Deputy Chief Inspector of adult social care

Since my last blog, it has been encouraging to see some positive developments in the approach to services for people with a learning disability and autistic people. We’ve changed a lot at CQC, and there have been several government announcements for wider policy changes.

Our work on learning disability and autism services

  • We’ve found our more in depth inspection model being piloted in services for people with a learning disability and autistic people really gets under the quality of care. We’ve now tested out this methodology on 10 of these visits across hospitals and social care services and are starting to roll out the approach to more services.
  • We have found problems with staffing and too much reliance on restrictive interventions​, some of which do not respect peoples human rights and as a result we’ve taken a range of enforcement action including closing some locations and restricting new admissions on others. We did also see one example of where a service had improved significantly after it was rated inadequate.
  • We’re reviewing how we regulate supported living services. We want to improve how we register, inspect and enforce in a way that is meaningful and makes sure these services meet Right support, right care, right culture. We are currently looking at what we can do to strengthen this.
  • In my last blog I also mentioned the Quality of Life Tool. People told us it would be helpful for us to publish this tool, even though it is at a stage of being ‘piloted’ and will change in the future. We are due to publish the first working version of the tool and it can be found on our website soon, along with an earlier, bigger version.

The primary purpose of the Quality of Life tool is to look at whether care plans (including communication plans and positive behaviour support plans) are good and, most importantly, are being delivered in practice. It looks at whether care is meeting the needs, aspirations and development of people with a learning disability and or autistic people.

We are improving this based on feedback and are reflecting on how we can use elements of it in our wider approach.

Provider collaboration review

Next, I want to update you on our provider collaboration review about care for people with a learning disability living in the community during the pandemic.

We looked at the care and support for people with a learning disability in seven areas of England in March 2021. These reviews aim to show the best of innovation across systems under pressure. They are also an opportunity to highlight common challenges and to drive system, regional and national learning and improvement.

We have seen how providers have responded quickly to try and minimise disruption to services for people with a learning disability. In particular, we have seen how the increased use of digital technology has improved collaboration with services and has helped to support people living in the community.

However, we know that there is no one-size fits all. What works for one person does not work for everyone. As a result, systems have needed to — and continue to need to — work hard to deliver the right care.

Many of the issues emerging from our review are not new. In a lot of cases, the pandemic has simply served to shine a light on pre-existing challenges, gaps and poor-quality care. But it has also introduced some new challenges.

I would encourage you to read the full report. This shares our full findings and highlights a number of challenges for systems and health and care providers. It centres on the stories of people with lived experience to help demonstrate the impact of the pandemic on their lives.

Next steps

Finally, I want to end this blog by acknowledging some of the other recent announcements from the Department of Health and Social Care. We were very pleased to see the launch of Autism Strategy which includes a focus on early intervention and better access to diagnosis.

Chapter 7 of this report is about building the right support in the community and supporting people in inpatient care. It references our report Out of sight: who cares? which published last year and describes the impact of reliance on restrictive practices across hospital and social care settings. We were therefore also pleased to see the Department’s response to this report and look forward to seeing the detail around how they will take forward these recommendations. In the next year we will be reporting progress of these recommendations.

It was also good to see the support from the Department for the recommendations made by Baroness Hollins and the oversight panel in the review of the Independent Care (Education) and Treatment Reviews. These reviews were an important recommendation of our interim report from our restrictive practices review.

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