Restraint, segregation and seclusion review: Progress report (March 2022)

Page last updated: 25 March 2022

This report describes the progress made on the recommendations in our Out of sight – who cares? report, published in October 2020, which looked at the use of restraint, seclusion and segregation in care services.

This progress report highlights the main areas where further work is still needed. It builds on the December 2021 progress report.

Summary of findings

The recomendations in Out of sight – who cares? were made for people with mental ill health, people with a learning disability and autistic people. However, there is more of a focus on people with a learning disability and autistic people, as we visited more services where they lived. This is reflected in the balance of evidence in this report.

This report updates on key themes, which means some recommendations are grouped together, rather than being in numerical order. We have reported on progress. We have also drawn attention to where progress has not been made.

We have shown whether each recommendation has been achieved, partly achieved, or not achieved.

We have come to these conclusions through weighing up the evidence from what stakeholders, including people with lived experience, have told us; what progress has been made; and what impact this has had on outcomes for people. Where we have no evidence of a positive impact on the outcomes people experience, we have concluded that the recommendation has not been achieved. Where some impact is evident, we have concluded that the recommendation has been partly achieved.

We have reviewed national published data to inform this report, including the NHS Mental Health Services Data Set (MHSDS) and Assuring Transformation data set and inspection reports of services for children and young people with special educational needs and disability. Data on mental health inpatients from MHSDS covers all people receiving care in a mental health hospital, including autistic people and people with a learning disability.

We have also used data and insight that we have gained from our engagement with our Expert Advisory Group, voluntary and community sector organisations, provider representatives, government departments, health and social care leaders, non-departmental government bodies, advocacy organisations, practitioners and people using services in health and social care. Throughout this report, we include stories of people’s experiences of care. We have not used their real names.

Our findings from these sources have been corroborated, and in some cases supplemented, with input from subject matter experts.

CQC made a commitment to monitor and report on the recommendations. The responsibility for delivery of the majority of the recommendations lies with partners. Governance of those recommendations relating to people with a learning disability and autistic people must lie with the Department of Health and Social Care Building the Right Support delivery board to hold members to account and deliver the recommendations. The Department of Health and Social Care and partner organisations need to clarify how the recommendations relating to services for people with mental ill health will be progressed.

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