Learning from Independent Care (Education) and Treatment Reviews in 2024 and 2025

Foreword

The use of restrictive practices, including restraint, seclusion and segregation can have a devastating impact on people, causing trauma and leading to breaches of their human rights.

We recognise this through our regulatory work and called for immediate action to end the abuses in human rights in Out of sight, our 2020 review of restraint, seclusion and segregation for autistic people, and people with a learning disability and/or mental health condition.

The introduction of Independent Care (Education) and Treatment Reviews (IC(E)TRs) was a direct response to this call for action. In May 2024, we were asked to carry on the work started by the Department of Health and Social Care and NHS England, and since then we have completed 88 reviews. During this time, we have seen how IC(E)TRs can make a real difference to people’s lives – at March 2026, two-fifths of people (35 out of 88) who had a review had left long-term segregation.

In this report, we share the findings from the IC(E)TRs that we carried out between May 2024 and November 2025. We explore the practices identified through the reviews that supported autistic people and people with a learning disability to leave long-term segregation and discuss the barriers that prevent this from happening.

As highlighted in our 2020 Out of sight report, people need to be at the centre of their care to enable them to thrive, supported by bespoke packages of trauma-informed care provided in the community.

However, there are systemic challenges in developing bespoke packages: complex commissioning and funding arrangements, and the need for joined-up working mean that too many autistic people and people with a learning disability are still in inappropriate settings, and subject to long-term segregation.

As we reflected in our 2024/25 Monitoring the Mental Health Act annual report, we welcome the reform of the Mental Health Act and the introduction of measures such as improved provision of suitable community-based services and investment in the sector to grow the workforce so that people can live fulfilled lives in the community with the support they need.

We recognise that there are still too many autistic people and people with a learning disability in long-term segregation. We are pleased to continue to lead on the programme of IC(E)TRs for a further 2 years, so that we can support people who remain in long-term segregation to leave. Our ability to review previous recommendations will put us in an even stronger position to drive improvements, using our regulatory powers where appropriate to reduce restrictive practices.

Through this report, we call for providers to actively take part with our IC(E)TR programme and engage with our recommendations in the best interests of individuals.

This extension will also allow us to inform commissioning practices to help break down barriers to discharge and to continue to listen to what autistic people and people with a learning disability want and need to thrive. This is in line with the ambitions of the 10 Year Health Plan for England and the requirements of the amended Mental Health Act.

Our IC(E)TR External Oversight Group has been at the heart of our work. The group comprises people with lived experience and valuable expertise in this sector, and we are grateful for their help in developing our programme and monitoring the impact of IC(E)TRs on the lives of autistic people and people with a learning disability.

Chris Badger
Chief Inspector of Adult Social Care and Integrated Care

Rebecca Bauers
Director of Adult Social Care (for people with a learning disability and autistic people)