Updating you on our learning disability and autism work

Care Quality Commission
4 min readMay 13, 2021


Debbie Ivanova, Deputy Chief Inspector of Adult Social Care, 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

We are transforming the way we regulate services for people with a learning disability and autistic people at CQC. Above all else, we are focusing on making sure services for people with learning disability and autistic people are good. They must be able to provide the right care and support so people can lead their best lives.

As lead for the transformation, I am focusing on three key areas to make it happen. Most important is the difference this will make in the lives of people with a learning disability and autistic people. So, for each of the key areas, we are thinking about what success will look like for a person using services.

Three key areas

  1. Making sure we only register the right services — I use services that support me in the way I want to live and where I want to live.
  2. Making sure we support services to improve and take the right action where they don’t — I will not be asked to move to a service that isn’t safe, I won’t be expected to continue to live in a service that doesn’t meet my needs.
  3. Making sure we influence the improvement of pathways and wider healthcare of people with a learning disability and autistic people — I can access local services that meet my needs and get the right healthcare when I need it.

People want to live in their communities, and often close to home. Services must be in line with best practice and focus on supporting a person’s whole life, rather than only part of it — it’s not ok to see people as ‘placements’ or ‘beds’ that have been filled. If people need extra support then the service must meet their specific needs in the way that is right for them. This must be the case in all services — from hospitals, to adult social care, to GP practices and other primary care services.

‘It’s not ok to see people as ‘placements’ or ‘beds’ that have been filled’

We set out our expectations clearly in our policy Right Support, Right Care, Right Culture. We also set this out in our updated guidance released today to inspectors, which gives inspectors further support to identify warning signs of closed culture services.

We are now making sure this guidance is being used across the system, by having conversations with providers and strategic partners so they know what to expect. We ask that providers always contact us with any plans before taking forward new services so we can ensure this is in line with our policy.

What we have done so far?

We still have a long way to go, but I wanted to update you on what we have done so far.

  • We have completed three pilot inspections using our new methodology
  • We visit services at telling touch points in people’s daily life, such as their time to eat, or go to bed, or when a staff handover is taking place
  • We are not accepting care that is not safe and doesn’t meet people’s needs — this is already starting to have an impact on admission, closures and notices of proposals to cancel registration
  • We are spending more time speaking to people who use services and their families
  • We are using more specialist Experts by Experience who are helping us better understand the culture of a service
  • We have introduced the use of the Quality of Life Tool on inspections. This is a tool that looks at how well people’s care plans are delivered in practice.
  • We are currently evaluating the pilot and we will continue to rollout the methodology across more services over the coming months.

What next?

Our work is about so much more than inspection. We will be more aware of changes in services, constantly monitoring and gathering information, especially from people, their family and advocates. Using this evidence to act early, we will be spending more time observing care and engaging with people and the staff who support them and their families, and strengthening other ways to get this information such as via advocates.

We will also use evidence from the LeDeR reports and the data about Annual Health Checks to improve the questions we ask on all of our inspection and engagement activity. We will be using our independent voice more than ever to show how good people’s lives can be and to call out the challenges, the inequalities and unfairness facing people who need support.

‘We must not accept ‘good enough’ care but make sure all services are enabling people to follow their aspirations’

We will be reporting on the progress of actions from our restrictive practices review by the end of the year — and asking everyone from providers, to commissioners to national bodies what they have done to move this work forward.

I am determined to use this year to change the way we think about support for people with a learning disability and autistic people and this means changing the way we regulate services. We must not accept ‘good enough’ care but make sure all services are enabling people to follow their aspirations, accessing health care that responds to their needs, so they can lead a full and fulfilling life.



Care Quality Commission

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