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Our work on closed cultures

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This project looks at how we will check for and tackle closed cultures in services.

Our work on closed cultures

This project looks at how we will check for and tackle closed cultures in services.

A closed culture is a poor culture in a health or care service that increases the risk of harm. This includes abuse and human rights breaches. The development of closed cultures can be deliberate or unintentional – either way it can cause unacceptable harm to a person and their loved ones.

Closed cultures are more likely to develop in services where:

  • people are removed from their communities
  • people stay for months or years at a time
  • there is weak leadership
  • staff lack the right skills, training or experience to support people
  • there is a lack of positive and open engagement between staff and with people using services and their families

In these services, people are often not able to speak up for themselves - this could be through lack of communication skills, lack of support to speak up or abuse of their rights to speak up.

Guidance for inspectors

We have updated our guidance for inspectors on closed cultures. This will enable CQC to better identify and take action with services that might be at risk of developing closed cultures. We worked with people who use services, Experts by Experience, families, Local Healthwatch and stakeholders to produce this.


Read the document


What this guidance will do

With this guidance we want:

  • to improve our ability to hear from people who use services in closed cultures, give more weight to what they tell us and then improve our ability to act on their concerns
  • our inspectors to be able to effectively identify where there’s a closed culture and be able to prioritise these services for monitoring and inspection
  • to continue to embed human rights into the work our inspection teams do
  • to improve our ability to collect and use intelligence to inform our understanding of these risks
  • to use the information we gather through our inspection activity and elsewhere to work with and influence system partners to the changes that are outside of CQC’s remit
Last updated:
13 May 2021