New supporting information for inspectors and Mental Health Act reviewers addresses the risk factors of closed environments

Published: 1 November 2019 Page last updated: 12 May 2022

We're giving inspectors and their managers new supporting information about how to identify and respond to ‘closed cultures’ in services.

When a service has a closed culture, people are more at risk of abuse and human rights breaches. The supporting information includes risk factors and warning signs of closed cultures in health and social care settings and how inspectors and their managers should consider and respond to these.

Closed environments may develop in services where people are situated away from their communities, where people stay for months or years at a time, where there is weak management of these services and where staff often lack the right skills, training or experience to support people. We are paying particular attention to services that provide care for people with a learning disability and or autism, but the information relates to services in any sector.

Why are we releasing this now?

In May 2019, BBC Panorama exposed a culture of abuse and human rights breaches of people with a learning disability and autistic people at Whorlton Hall. It reinforced how everyone involved in the care of people with a learning disability or autistic people has a part to play in identifying where abuse and human rights breaches may be taking place.

Since then we have written to providers to highlight that we have taken steps to strengthen the way we assess these types of services. We asked that providers consider what steps they can take to better protect the human rights of people in their service.

There are particular challenges in regulating services where there is a culture of concealment of abuse and human rights breaches. This supporting information will help our frontline staff to assess services where there may be a risk of abuse and abusive cultures. It will also help managers in CQC to support their frontline staff in this difficult task.

What’s the purpose of the information for inspectors, Mental Health Act Reviewers and their managers?

  • Helps inspectors and Mental Health Act Reviewers identify services where there may be a high inherent risk of a closed culture that might lead to abuse or breaches of human rights and lay outs how we should monitor these services
  • Helps inspectors and Mental Health Act Reviewers identify warning signs that there may be a closed or punitive culture, or risk of such a culture developing and confirms that we will have a low threshold for carrying out an inspection where warning signs are developing in a service with a high inherent risk
  • Sets out to inspectors and Mental Health Act reviewers how to use strengthened regulatory policy, methods and processes when there is a high inherent risk and/or warning signs. This includes gathering information from people who use services and their families early in the inspection planning, so their views can influence other evidence gathering, as well as a focus on inspection on the experience of people at the highest risk of human rights breaches.

What else will we be doing long-term?

We will be conducting a longer-term review of our methodology from a human rights perspective. We are committed to working closely with people who use services, families and professionals to develop this.

This will include implementing any recommendations from the independent reviews that we have commissioned into our regulation of Whorlton Hall.