The Care Quality Commission (CQC) has published an important review into the use of restraint, seclusion and segregation in the care of autistic people, and people with a learning disability and/or mental health condition. The health regulator found many shocking examples of restrictive practices in hospitals, with poor physical environments and restrictive practice cultures.

This simply should not be happening and cannot be allowed to continue. The report reaffirms the urgent need to reform mental health and social care services for autistic people, as we and many other campaigners and charities have been calling for years.

The CQC has made a lot of welcome recommendations, including calling for a single national commissioner and minister to make sure these changes happen. Alongside making these changes, the Government must give enough funding to mental health and social care services for autistic people in next month’s Spending Review.

Background

The CQC was commissioned by Health Secretary Matt Hancock to review the use of restrictive interventions in October 2018. Since then, the CQC has visited 43 hospital wards and 27 care homes, as well as other health and care services, and spoken to many people with lived experience and their families. The report looks at a variety of restrictive practices, including people being physically restrained, separated from other people around them temporarily or placed in long-term segregation.

What the report says

The report describes what it found about children, young people and adults who have diverse needs and are cared for in a range of settings. Worryingly, the report shows that for many people who need complex care, including autistic people, the current system lets them down and they don’t receive the care they need – leading to too many people experiencing inappropriate restrictive practices.

One of the most important points in the report is how unsuitable many hospital wards are. They are often noisy, chaotic and unpredictable. This can sometimes lead to the use of restrictive practices, with people becoming distressed, and then being restrained. The CQC found that a shocking 81% of wards visited had used physical restraint.

Many people were also placed in long-term seclusion that was not suitable for them and struggled to re-integrate back into the ward. 

The report is clear that community-based services are more likely to make sure people do not experience restrictive practices like these. Increased support in the community can also stop people from needing to go into hospital. Overall, restraint was used a little less in community-based services and more of these services had a positive social environment, with activities that were relevant to each person’s needs and interests. However, the quality of care people received varied and was affected by the number and skills of the staff available. 

Among its many recommendations, the report says improving hospital environments should be a priority, and there should be more funding to ensure people in hospital can get back into their community. The CQC also calls for a new named specialist commissioner for complex care to be appointed, and for a single Minister to oversee the delivery of its asks.

Our response

Jane Harris, Director of External Affairs at the National Autistic Society, said: "This is a disturbing report, with many shocking examples of undignified and inhumane care. The current system is broken. It’s failed autistic people and needs urgent reform.

“For too long, local NHS groups and local councils have failed to give autistic people the care they need close to home. If each area puts in place the right social care and housing services, hundreds of autistic people won’t need to go into hospital in the first place. 

“We fully support the CQC’s call for a single national commissioner and minister to make sure this happens. Alongside this, the Government must give enough funding to mental health and social care services for autistic people in next month’s Spending Review.”

Further information

• Read the CQC’s Out of Sight report in full (links to PDF report).
• For confidential support and advice, including our Autism Inpatient Mental Health Service casework service, visit the Help and Support section of our website.
• To find out more about local and national services for autistic people and their families, visit our Autism Services Directory.
• To find out more about the UK’s only autism-specific quality assurance programme for all those providing services to autistic people, visit our Autism Accreditation page.