We have published our report Learning from Independent Care (Education) and Treatment Reviews in 2024 and 2025. It shows that 40% (35 out of 88) of people with a learning disability or autism diagnosis whose care was reviewed, were supported to be able to leave long-term segregation (LTS) through the review process and access more appropriate care.
The IC(E)TR is led by an independent chair, who plays a central role in overseeing the review of the care and treatment of a person in LTS. The chair leads the panel and engages with the person’s multidisciplinary team, family, supporters, and mental health advocates. This collaborative approach enables a comprehensive and objective review of the person’s care, including their lived experience, care plans, and relevant policies. The aim is to determine whether continued segregation remains the least restrictive option and, where necessary, to make recommendations to the care provider to support improvement, so that the person can leave LTS.
The report details the findings from the IC(E)TRs carried out by CQC between May 2024 and November 2025. It highlights the enablers and barriers to supporting people out of LTS, alongside excerpts from people’s stories and lived experiences of people in LTS.
We found some providers’ knowledge about a person was limited and did not fully consider their past experiences and requirements, also staff did not always have the right skills, training or attitude to communicate with and support autistic people and people with a learning disability. The report also found that people often did not have discharge plans to help them to leave LTS, and that people did not always have personalised adjustments in place which could have reduced their distress in the LTS environment. All of this resulted in people becoming stuck in LTS. However, the report also notes the importance of skilled staff who have the right training, are able to build trusting relationships, and can understand the person and what they want. It also notes the importance of a full assessment of people’s requirements, integrated into effective care plans to reduce people’s distress, as well as putting personalised adjustments in place to protect their rights and dignity. Alongside this, staff, professionals and services need to provide joined-up care, involving people and their families, to support people to leave LTS.
Since May 2024, CQC has completed 88 IC(E)TRs. As of 30 March 2026, 40% (35 of 88) of those people left LTS and have been either discharged into their own homes in the community, moved to a more appropriate hospital or are actively engaged in future discharge plans.
Rebecca Bauers, Director for people with a learning disability and autistic people and Adult social care South Region Operations (London and South), said:
Long-term segregation has a significant, often traumatic impact on a person’s health, wellbeing and quality of life, and is often used alongside other forms of restrictive practice. These reviews challenge whether segregation is necessary. The independent review chairs aim to identify and make recommendations for the best approach to care, support, and treatment for each individual, working in partnership with the person, their families and supporters, and the multidisciplinary team. In nearly half of the reviews we conducted, people were supported to leave long term segregation and get more appropriate care. While this report draws on data from across roughly half of the reviews conducted in this phase, the implications, both for the individuals concerned and for the care of autistic people and people with a learning disability more widely, are significant. It shows that with proper planning and a focus on safe, compassionate discharge, there can be a way out of long-term segregation, with benefits for both people who receive care and those that deliver it.
We listened to the stories and lived experiences of many people in long-term segregation, as well as those of their families and supporters. While there were examples of both positive and poor practice we found that care is not consistently person-centred. Too often, the intention to provide good care is undermined by avoidable barriers. These include a lack of specialist skills, poor communication, environments that do not meet sensory needs, and uninformed decision-making - particularly where people and their families and supporters are not meaningfully listened to.
Providers across all sectors should use the insights and experiences shared in this report to reconsider their approach to care and their policy position on the use of restrictive practices for autistic people and people with a learning disability. The enablers both to prevent admission to, and support discharge from, long-term segregation are clearly identified throughout this report.
Upholding people’s human rights and building trusted, person-led relationships must be at the heart of care. These principles are fundamental to enabling people with a learning disability and autistic people to lead safe, meaningful, and fulfilled lives.
The Independent Care (Education) and Treatment Reviews (IC(E)TRs) were set up in May 2024, at the request of the Department of Health and Social Care (DHSC) following publication of Baroness Hollins’ report and recommendations 'My heart breaks'. Previously DHSC and NHS England had led this programme to look into the care of autistic people and people with a learning disability in LTS within mental health hospitals in England.
The programme was set to conclude in 2026; however, as a result of the progress to date and the impact for people with a learning disability supported to leave LTS, DHSC has confirmed additional funding for CQC to continue the programme until March 2028.