Risk of closed cultures

Page last updated: 21 October 2022

A closed culture is ‘a poor culture that can lead to harm, including human rights breaches such as abuse’.

In these services, people are more likely to be at risk of deliberate or unintentional harm. This risk has been further exacerbated during the pandemic by more services becoming closed environments due to a lack of visitors, and from the potential impacts of staffing and management pressures.

We are committed to improving our regulation of services where there is a closed culture or is a high risk of a closed culture developing. As part of this, we will continue to review whistleblowing concerns, feedback about the quality of care from people using services and their carers and staff, and notifications that services must send us – to proactively identify services we think could be at risk of developing a closed culture. We also continue to review these risks through our work and our visits to services to monitor the operation of the Mental Health Act.

In our July 2021 Insight report, we shared our learning from a sample of 29 inspections where we have found evidence of closed cultures. In this, we identified the six common features of closed cultures:

  • incidents of abuse and restrictive practice
  • issues with staff competence and training
  • cover-up culture
  • lack of leadership and management oversight
  • poor-quality care generally
  • poor-quality reporting.

While closed cultures can develop in any type of health and care setting, we are particularly aware of the increased risk in services that care for people with a mental health condition, people with a learning disability and autistic people.

Where we find concerns about a service, we continue to monitor them as part of our ongoing regulation.

Where we have identified services as having a closed culture, we have taken appropriate action. This has ranged from initiating focused inspections, issuing urgent notices to restrict admissions, placing services into special measures and, where necessary, ensuring people are relocated to other care services. In these cases, we have worked with the local authority to find suitable alternative accommodation.

As an organisation, we are continuing to improve our regulation of services at risk of developing a closed culture. We are testing a new methodology that is designed to get under the culture of a service and better understand what it is like for people who live there. This includes using feedback more effectively and addressing concerns quickly when the risks of a closed culture are found. Human rights are at the heart of our new approach, and we will always look at services from the perspective of people using them.

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