Search results for ‘Subject term:"learning disabilities"’ Sort:
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Challenging behaviour, inpatient services and governance in England
- Author:
- JOYCE Theresa
- Journal article citation:
- Tizard Learning Disability Review, 25(3), 2020, pp.125-132.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to describe the current situation in relation to restrictive interventions, and some actions that could be taken to reduce them. The quality of care provided by inpatient services for people with intellectual disabilities has come under increasing scrutiny in recent years – from Winterbourne View in 2011 to Whorlton Hall in 2019, there has been increasing concern that admission to hospital does not always result in a good outcome for the patients. For some people, it has resulted in further deterioration in their physical and mental health, separation from families and supports and reduced probability of living as part of their community. This is in spite of knowledge and evidence of what good practice looks like. Design/methodology/approach: This paper examines the extent to which inpatient services deliver good practice in treatment and care and, where this is not happening, the extent to which they are subject to effective governance. Findings: People admitted to inpatient services can be at risk of poor-quality care and the overuse of restrictive interventions. There is guidance available that addresses what should be in place for them to receive high-quality care and treatment, and this clearly is available to many people. However, others can find themselves placed in increasingly restrictive environments and in circumstances where their human rights are at risk of being breached. There is increasing evidence that these services do not follow good practice guidance in terms of staff skills, development and implementation of effective care plans and governance arrangements that address these issues. Regulators, commissioners and managers could, and should, focus on these issues to ensure that the most vulnerable receive the care and treatment they need while in hospital. Originality/value: Service providers are aware of the difficulties in developing alternative community services. This places even more importance on the need to ensure that care and treatment in hospital is of a good standard, and that the use of restrictive interventions is minimised. McGill et al. (this issue) describe the features of a capable environment and it may be that hospitals consider that the requirements are unlikely to be implemented effectively in a ward/unit setting. However, a shift of focus in doing this could result in a reduction in restrictive interventions and a better experience – potentially for both the staff and the patients. And families could have some reassurance that their relative was receiving the best quality care and treatment, and that their human rights were being upheld. (Edited publisher abstract)
Out of sight: who cares? Restraint, segregation and seclusion review: progress report
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2022
- Pagination:
- 63
- Place of publication:
- Newcastle upon Tyne
This report describes the progress made on the recommendations made in ‘Out of sight – who cares?’ report, published in October 2020, which looked at the use of restraint, seclusion and segregation in care services. The recommendations 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. The report finds that no recommendations have been fully achieved. Seventeen recommendations have not been achieved, including: people have a home and the right support in place; people have the right community services commissioned; people have the right support to avoid crisis; people have their rights understood; people receive the right support in hospital; people have skilled staff to support them; people have bespoke services; people who experience restrictive interventions have these reported to CQC; people who are segregated in hospital experience good quality regular independent reviews; people have meaningful Care (Education) and Treatment Reviews because providers and commissioners are accountable; all people in segregation in hospital are recognised through updating the definition of long-term segregation; people see a reduction in the use of restrictive interventions; people in children’s and adult social care services experiencing restrictive interventions would have these reported to regulators. The report also finds that four recommendations have been partly achieved: improving how CQC regulates services for people with a learning disability and autistic people; recording data to improve local services; people’s experience of person-centred care; people who experience restrictive interventions have regular oversight by commissioners. (Edited publisher abstract)
Restraint, segregation and seclusion review: progress report (December 2021)
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2021
- Place of publication:
- Newcastle upon Tyne
This short report comments on the progress following publication of ‘Out of sight – who cares?’ report and highlights the main areas where further work is still needed. ‘Out of sight – who cares?’, published in October 2020, looked at the use of restraint, seclusion and segregation in care services for people with a mental health condition, a learning disability or autistic people. The health and care system has taken action to understand the needs of people with a learning disability and autistic people in inpatient units. However, there is still much to be done. Too many people have still not seen their care improved. While the health and care system has made a commitment to increase the range of community support available to help prevent hospital admissions, this commitment now needs to be converted into real change. The findings of this report show that too many people are still in inpatient wards and they are spending too long in hospital. Getting the right care provision, support services and early intervention in the community will prevent hospital admissions, reduce the time it takes to discharge people into the right support and enable people to live their best lives. (Edited publisher abstract)
DHSC's response to CQC's 'Out of sight – who cares?: restraint, segregation and seclusion' report
- Author:
- GREAT BRITAIN. Department of Health and Social Care
- Publisher:
- Great Britain. Department of Health and Social Care
- Publication year:
- 2021
- Place of publication:
- London
The Government response to the Care Quality Commission's report on the use of restraint, seclusion and segregation in care services. The report described the current state of the care system for children, young people and adults who are subject to restrictive interventions, and who are cared for in a range of settings, focusing on learning disabilities and autism. The report made four key recommendations: people with a learning disability and or autistic people who may also have a mental health condition should be supported to live in their communities; people who are being cared for in hospital must receive high-quality, person-centred, specialised care in small units; there must be renewed attempts to reduce restrictive practice by all health and social care providers, commissioners and others; there must be increased oversight and accountability for people with a learning disability, and or autistic people who may also have a mental health problem. (Edited publisher abstract)
Out of sight: who cares? A review of restraint, seclusion and segregation for autistic people, and people with a learning disability and/or mental health condition
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2020
- Pagination:
- 74
- Place of publication:
- Newcastle upon Tyne
This report describes the current state of the care system for children, young people and adults who are subject to restrictive interventions, and who are cared for in a range of settings. While the focus of this report is learning disabilities and autism, the findings have also implications and learning for settings that support people who have a mental health condition and/or who are living with dementia. The review found that often people were not getting the care they need, when they need it. There were many examples of care that was undignified, inhumane and that potentially breached people’s basic human rights. While it is possible to support people well in the community, care packages are often not available; and people are frequently not receiving the hospital care that they are entitled to. While the use of restrictive practice is not inevitable, nearly all of the services (hospitals and adult social care services) visited as part of this review used some form of restrictive practice. Where there was evidence of people being restrained, secluded or segregated, it was claimed that this was for their own safety or the safety of others. The report makes four key recommendations: people with a learning disability and or autistic people who may also have a mental health condition should be supported to live in their communities; people who are being cared for in hospital must receive high-quality, person-centred, specialised care in small units; there must be renewed attempts to reduce restrictive practice by all health and social care providers, commissioners and others; there must be increased oversight and accountability for people with a learning disability, and or autistic people who may also have a mental health problem. (Edited publisher abstract)
Use of seclusion: good practice guide
- Author:
- MENTAL WELFARE COMMISSION FOR SCOTLAND
- Publisher:
- Mental Welfare Commission for Scotland
- Publication year:
- 2019
- Pagination:
- 26
- Place of publication:
- Edinburgh
Updated good practice guidance for health and social care professionals in Scotland on the use of seclusion when working with people who are being treated for mental illness, dementia, learning disability or related conditions in health and social care settings. The view of the Mental Welfare Commission is that services should minimise the use of all forms of restrictive practice, and that in most cases, proactive behavioural support plans would mean that the use of seclusion would be unnecessary. The guidance aims to ensure that where seclusion takes place, the safety, rights and welfare of the individual are safeguarded. It looks at what any policy for seclusion should cover, including: maintaining the safety of the secluded person, care planning, record keeping, assessment and review during a period of seclusion, the impact of seclusion and staff training. The guide also provides a summary of good practice points, a summary of relevant legislation in Scotland and case studies to illustrate areas of good and poor practice. (Edited publisher abstract)
Youth detention: solitary confinement and restraint: nineteenth report of session 2017-19
- Author:
- GREAT BRITAIN. House of Lords, House of Commons. Joint Committee on Human Rights
- Publisher:
- House of Commons
- Publication year:
- 2019
- Pagination:
- 45
- Place of publication:
- London
A report of an inquiry into the use of restraint and separation of children in detention in the UK and whether these practices are subject to appropriate limits and effective safeguards. The inquiry considered both restraint of children detained in detained in hospitals for therapeutic care and those detained in custody due to criminal convictions. The Committee heard evidence from children, their parents, and professionals that restraint and separation are harmful to children, and cause physical distress and psychological harm. Data also shows that children are restrained too often, with rates of restraint and separation even higher for Black, Asian and minority ethnic (BAME) children. This is partly due to insufficient staffing levels, insufficient staff training and inappropriate facilities. Data collection for all forms of restraint and separation in hospitals and custody also needs to be improvement. The Committee's recommendations include: a ban on the use of pain inducing techniques and solitary confinement of children in detention; improved data collection; and an improvement in the complaints and resolution process. (Edited publisher abstract)
Winterbourne View Hospital: a glimpse of the legacy
- Authors:
- FLYNN Margaret, CITARELLA Vic
- Journal article citation:
- Journal of Adult Protection, 15(4), 2013, pp.173-181.
- Publisher:
- Emerald
This paper concerns the fall-out from a TV programme “Undercover Care: the Abuse Exposed” which exposed cruelty at Winterbourne View Hospital, a private hospital that purported to provide assessment, treatment and rehabilitation to adults with learning disabilities, autism and mental health problems. It describes the principal findings of the Serious Case Review which was commissioned after the TV broadcast, and outlines some of the activities designed to reduce the likelihood of such abuses recurring. From policy, commissioning, regulation, management, service design and practice perspectives, events at Winterbourne View Hospital highlight a gulf between professionals, professionals and their organisations, and leadership shortcomings. The English government responded promptly and encouragingly to the circumstances of patients at Winterbourne View Hospital with a “Timetable of Actions”. (Edited publisher abstract)
The use of seclusion and emergency medication in a hospital for people with learning disability
- Authors:
- RANGECROFT M.E.H., TYRER S.P., BERNEY T.P.
- Journal article citation:
- British Journal of Psychiatry, 170, March 1997, pp.273-277.
- Publisher:
- Cambridge University Press
The management of disturbed behaviour in facilities for those with learning disabilities involves a spectrum of approaches including the prescription of emergency medication, restraint and seclusion. The use of these techniques has recently come under close scrutiny. All incidents requiring emergency medication or seclusion that occurred in a large hospital for those with learning disabilities were studied over a six-month period. The precipitating factors, course and outcome of those who had received emergency medication or seclusion were then examined. Concludes that despite concerns about the use of seclusion, the results of this survey suggest that procedures that remove the patients from the environment contributing to the disturbance may have certain advantages in this population.
Review of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability or autism: interim report
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2019
- Pagination:
- 43
- Place of publication:
- Newcastle upon Tyne
Interim findings from a review of the use of restrictive interventions in places that provide care for people with mental health problems, a learning disability and/or autism. The review focuses on the experiences of 39 people in segregation on a learning disability ward or a mental health ward for children and young people. It also draws on information from a request sent to 92 registered providers of services for people with a mental health problem, a learning disability and or autism. The report describes emerging themes about the pathway that these people have followed, their current care and treatment and what prevents them from leaving hospital. The findings show that: a high proportion of people in segregation had autism; some of the wards did not have a built environment that was suitable for people with autism; many staff lacked the necessary training and skills; and several people visited were not receiving high quality care and treatment. In the case of 26 of the 39 people, staff had stopped attempting to reintegrate them back onto the main ward, usually due to 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. The report makes a number of recommendations for the health and care system. They include for the care, safeguarding and discharge plan of every person with learning disabilities or autism held in segregation be examined, as well as that of children detained on mental health wards. (Edited publisher abstract)