Too many people with learning disabilities or autism receiving ‘undignified and inhumane care’ – CQC

Too many people with learning disabilities or autism are receiving “undignified and inhumane care” in specialist hospitals, the care regulator has found.

Some patients were not able to access fresh air or go to the toilet at certain times, risking a breach of their human rights, the Care Quality Commission (CQC) said.

Inspectors found that most of the mental health wards it inspected were not therapeutic environments and could be “noisy, chaotic and unpredictable”.

People were not seen as individuals but “as a condition or a collection of negative behaviours”, with the response often being restraint, seclusion or segregation, it found.

The regulator was commissioned by Health Secretary Matt Hancock in October 2018 to review the use of restraint, seclusion and segregation of autistic people.

It visited 43 hospital wards for people with a learning disability or autism, and specialist child and adolescent mental health wards, and other facilities.

Patients were “often” subject to restrictive practices because they did not receive care early on, it found.

Some 81% of 313 wards for children and young people had used physical restraint in the previous month, the regulator found after a request for information.

The regulator said it was also concerned that some people are being prosecuted for injuring staff, when failure to treat their needs may have contributed to their aggression.

The CQC found the length of time that people spent in long-term segregation ranged from three days to 13 years.

A lack of suitable care in the community was preventing the discharge of 60% of people it saw during its review.

Ward staff stopped the mother of one 24-year-old in long-term segregation from visiting for five months, prevented the patient from using the toilet on occasion, and left her in pain for months after her arm was injured.

In some cases, people in seclusion were not allowed to wear their own clothes, while others lacked a clean environment and amenities such as crockery, cutlery, toilet paper and toiletries.

The CQC found that the ward environment and a lack of specialised training and support for staff meant patients’ care did not always meet their needs.

People in community-based services experienced a better quality of life than their peers in hospitals, restraint was used less and the environments were more “homely”.

However, quality of care was affected by the number of staff available and their skill level, the CQC found.

Since the coronavirus outbreak, which occurred after the review, the regulator’s concerns have intensified.

Its report, Out Of Sight – Who Cares?, is calling for improved capacity in the community and across education and health and care to provide earlier care and prevent hospital admission.

It said there should be a requirement to report restrictive interventions used in social care services, as there is with hospitals.

Dr Kevin Cleary (pictured), deputy chief inspector of hospitals and lead for mental health, said seclusion and restraint should be “only used in extreme cases”.

He said: “During our review we saw people receiving poor care in unsuitable noisy and chaotic ward environments, undoubtedly causing them distress.

“We saw too many examples where people were subject to unnecessary restrictions and examples of people’s human rights at risk of being breached.

“Where we saw poor care or risks to people’s rights in our review we took action.

“People often ended up in hospital because they did not have the right support, early on, in the community at the time they and their families needed it.

“We found that once in hospital, people were often not receiving specialist treatment and care and there was often nothing in place to support them to leave hospital.

“There is no excuse for this.”

Edel Harris, chief executive of the learning disability charity Mencap, said the findings were “shocking but sadly not surprising”, adding: “People deserve to live in homes, not hospitals”.

Minister for Care Helen Whately called the report’s revelations “deeply concerning”.

“The Health and Care Secretary commissioned this important review, prompted by rising concerns about the use of restraints and seclusion in mental health hospitals. The quality of care uncovered in the report is deeply concerning,” she said in a statement.

“Nobody should be receiving such poor care and we are already taking action, including investment in community services, independent case reviews of people in long term segregation, and the ongoing work overseen by Baroness Hollins.

“I am determined that this level of care should no longer have any place in our health system, and will carefully consider the recommendations in this report.”

An NHS spokesperson said: “Supporting people with a learning disability or autism is a priority for the NHS and since 2015 the number of people in a specialist hospital has reduced by nearly a third while the NHS Long Term Plan commits to reducing this number further through increasing investment in community support and improvements in the quality of inpatient care.

“The NHS has funded a restrictive practice programme led by the Royal College of Psychiatrists which has already resulted in the reduction of physical restraint and seclusion, and this will be backed by intensive support for the 20 young people’s inpatient services where the use of restraint is most prevalent.”

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