William Eichler 21 May 2019

Hancock pledges review of every patient in long term segregation or seclusion

Health secretary Matt Hancock today ordered a review of the care that patients in long term segregation or seclusion receive.

The announcement coincides with the publication of the Care Quality Commission’s (CQC) interim report on its review of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability or autism.

The CQC assessed the care of 39 people across 35 wards and found that many services could not meet the needs of the patients.

It found that a high proportion of people in segregation had autism and it reported that some of the wards did not have a built environment that was suitable for autistic people.

Many staff also lacked the necessary training and skills, the interim report revealed.

In the case of 26 of the 39 people, staff had stopped attempting to reintegrate them back onto the main ward, usually because of concerns about violence and aggression.

Some people were also experiencing delayed discharge from hospital due to there being no suitable package of care available in a non-hospital setting. This led to prolonged time in segregation.

‘The 39 people we have visited who are cared for in segregation are in a very vulnerable situation,’ said Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health) at the CQC.

‘Their world is narrowed to a highly restricted existence in a single room, or small suite of rooms. For many, their interactions with other people are characterised by distress and sometimes by the use of force by staff who consider this necessary to protect the person or others from harm.

‘They have little or no say over decisions about their lives or their future. Many are also a long way from home – which can make it difficult for families to maintain contact.

‘We are calling for urgent action to strengthen the safeguards that protect the safety, welfare and human rights of people held in segregation.’

There are currently 2,245 patients in mental health inpatient settings in England, and the Government has committed to halving this number by 2024. Since 2015, the number has reduced by 22%.

As well as ordering a review of the care that patients in long term segregation or seclusion receive, Matt Hancock said the Government would fund specialist, independent advocates to work with families, join up services and work to move people to the least restrictive care and out into the community.

‘I have been deeply moved and appalled by the distressing stories of some autistic people and people with learning disabilities spending years detained in mental health units,’ said Mr Hancock.

‘These vulnerable people are too often left alone, away from their families, friends and communities.

‘At its best, the health and care system provides excellent support to people, backed by a dedicated workforce. But a small proportion of some of the most vulnerable in society are being failed by a broken system that doesn’t work for them.

‘I commissioned the Care Quality Commission to review the use of segregation in health and care settings to tackle this issue head on. Today I have accepted their recommendations in full.’

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