Foreword

Our first Out of sight report was written with the aim of highlighting and addressing issues of serious concern that had been known about and not addressed for too long.

Cultures, behaviour, and the design of services did not always suit the people they were supposed to help. Restrictive interventions, such as restraint, seclusion and segregation, were used often and for many people.

The Out of sight report was intended to stop unacceptable practice, but also challenge the status quo to lever the change that must happen to improve the lives of people with mental ill health, autistic people, and people with a learning disability.

This has not happened and there are still too many people in mental health inpatient services. They often stay too long, do not experience therapeutic care and are still subject to too many restrictive interventions, which cause trauma. Families have told us clearly that the pain and harm for them and their family member continues.

The lack of community services, which can provide early intervention, crisis support and support for people living within their communities, means that people are more likely to end up in hospital. Additionally, for many people, the right housing is not available, nor the right support in place. This means that people are more likely to be living in unsuitable conditions, which then break down, which can lead to hospital admission. People end up moving around the system from one service to another because their needs are not being met.

Our first report made recommendations to improve services and the overall system. We acknowledge that the pandemic had an impact on services and the people that use them in a way that could not have been foreseen. We reflected on this in our progress report in December 2021. However, developments have not been at the required pace.

There has been some progress, though. There has been investment by the Department of Health and Social Care and NHS England and NHS Improvement into projects aimed to support people to come out of long-term segregation, and funding has been allocated to increase community support. We recognise that many staff have been working hard to try and bring about the changes needed.

People feel stuck in the system. We are calling on all partners to move forward, transferring the planning and good intentions into action, taking responsibility for implementing the changes needed. The focus must be on meeting people’s individual needs. We need to move onto ensuring services fit around people rather than trying to fit people into services that can’t meet their needs.

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People’s experience of person-centred care

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Summary