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Impact of COVID-19 on restraint, segregation and seclusion review and Right Support, Right Care, Right Culture

24 March 2020
  • Public

Over the past year CQC has been reviewing the use of restrictive interventions, including restraint, segregation and seclusion in hospitals and care homes across England.

We have particularly looked at the impact of this on people with a learning disability, or mental health condition and autistic people. In May last year we published our interim report which highlighted that the system of care for people with multiple needs is not fit for purpose. We recommended that people we visited in segregation in hospital have their care reviewed, that a more human rights approach should be looked at, and that the system of safeguards is strengthened.

Since then, we have visited and collected information from over 400 social care providers about restrictive practices for people with a learning disability and autistic people. We have worked closely alongside people who use services, their families, providers, staff, and other stakeholders in the form of our Expert Advisory Group. Our priority is to use this work to shine a light on how these practices affect people in services, and as a platform for their voice. Our final report and recommendations were due to publish this spring.

Engaging with our stakeholders is at the heart of this review and will be central to the development of the report and of the recommendations that will flow from it. Currently our ability to do this, and crucially the ability of stakeholders to engage with this work, is extremely limited due to the pressures being put on the health and care system by the unprecedented COVID-19 pandemic. We do not want to do this in a rushed way, that could result in people not being able to feed in properly. As a result, we have taken the difficult decision to delay the publication for now and will release a new date as soon as possible.

As our update to Registering the Right Support, soon to be ‘Right Support, Right Care, Right Culture’ is so closely linked with this work, this will be delayed along the same timescales. On this piece of work in particular, we received a lot of feedback from stakeholders and want to fully engage on the changes we have made to the guidance.

We are incredibly aware that people with a learning disability, or mental health condition and autistic people may be more at risk during the current COVID-19 outbreak. Our review found that people are often subject to restrictions and isolation and the current outbreak may have implications for staffing levels and the ability to keep people safe. We are concerned that this may lead to further restrictions of people’s lives and affect their mental health.

During COVID-19 we are adapting our regulatory approach to focus our activity where it is needed most to make sure that people receive safe care – this means concentrating on those areas where we see that the risk to the quality of care is the highest and where we can make the biggest difference.

We are also working closely with NHS England and the Department of Health and Social Care to ensure that people more at risk are included in any action plans. We continue to encourage people who use services, their families and those working across the health and social care system to raise concerns with us directly through the Give Feedback on Care service.

Last updated:
07 April 2020