Towards a better system — we want your views

Paul Lelliott, Deputy Chief Inspector of Hospitals and lead for mental health, and Debbie Ivanova, Deputy Chief Inspector of Adult Social Care, discuss the recent ‘Towards a better system’ event, and ask for your feedback on proposals for next steps

The CQC are reviewing the use of restrictive interventions in places that provide care for people with mental health problems, a learning disability and/or autism. The first phase of the review has focused around those at greatest risk in the system, those likely to be segregated.

On Tuesday 13 August the CQC, Department for Health and Social Care, BILD and NHS England, held a joint event to explore what a better system for people at risk of segregation in a hospital would look like. We want your views on how we take this work forward.

What we talked about at the event

Most people acknowledged that there have been many policies, pieces of guidance and work programmes, around people with a learning disability and or autism. One family member brought with her a briefcase filled with reports from previous meetings and events about the care of people with learning disabilities and autism. Despite all this thinking and all these recommendations, it is clear the status quo is simply not working.

The work started by this event is not trying to re-invent the wheel. Instead it is seeking to deliver a step change in how the health and care systems care for people with the most complex needs and who have a learning disability and or autism. The starting point for delivering this is to understand why we are still not getting it right. We want to work with people with expertise in learning disability and autism to bring about system change.

We looked at what changes are needed, and how these relate to the already existing policies and workstreams from the NHS Long-Term Plan to Building the Right Support to Transforming Care, and how the most important things can be delivered.

Some things were particularly clear from the day, such as the vital importance of listening to people and their families and drawing on their expertise. A voluntary representative said, “professionals don’t like listening to families, it upsets their powerbase”.

The value of risk registers, that local services are required to keep, came through as a way to identify children and others who are most at risk of future hospitalisation, not just to flag these risks, but to provide support to individuals and their families to help address their needs before they reach a crisis.

We want your feedback

Share your views and feedback on next steps here. If you have any questions about feeding back please email:

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

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