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Right support, right care, right culture: how CQC regulates providers supporting autistic people and people with a learning disability
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2020
- Pagination:
- 49
- Place of publication:
- London
This statutory guidance applies to any service that currently, or intends to, provide regulated care to autistic people and people with a learning disability, including children and young adults, working age adults and older people. It describes the CQC regulatory approach for these services, covering registration, inspection, monitor and enforcement functions. Key requirements providers are expected to demonstrate include: there is a clear need for the service and it has been agreed by commissioners; the size, setting and design of the service meet people’s expectations and align with current best practice; people have access to the community; the model of care, policies and procedures are in line with current best practice. The document includes case studies illustrating how this guidance works in action in adult social care and hospitals. (Edited publisher abstract)
Who I am matters: experiences of being in hospital for people with a learning disability and autistic people
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2022
- Place of publication:
- London
This report looks what people with a learning disability and autistic people experience when they need physical health care and treatment in hospital. We looked specifically at: access to care; communication; care and treatment in hospital; other equality characteristics and quality of care; workforce skills and development. People have a right to expect: access to the care they need, when they need it and that appropriate reasonable adjustments are made to meet people's individual needs; staff communicate with them in a way that meets their needs and involves them in decisions about their care; they are fully involved in their care and treatment; the care and treatment they receive meets all their needs, including making reasonable adjustments where necessary and taking into account any equality characteristics such as age, race and sexual orientation; their experiences of care are not dependent on whether or not they have access to specialist teams and practitioners. However, people told us they found it difficult to access care because reasonable adjustments weren't always made. Providers need to make sure they are making appropriate reasonable adjustments to meet people's individual needs. There is no 'one-size-fits-all' solution for communication. Providers need to make sure that staff have the tools and skills to enable them to communicate effectively to meet people's individual needs. People are not being fully involved in their care and treatment. In many cases, this is because there is not enough listening, communication and involvement. Providers need to make sure that staff have enough time and skills to listen to people and their families so they understand and can meet people's individual needs. Equality characteristics, such as age, race and sexual orientation, risked being overshadowed by a person's learning disability or autism because staff lacked knowledge and understanding about inequalities. Providers need to ensure that staff have appropriate training and knowledge so they can meet all of a person's individual needs. Specialist practitioners and teams cannot hold sole responsibility for improving people's experiences of care. Providers must make sure that all staff have up-to-date training and the right skills to care for people with a learning disability and autistic people. (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)
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)
Identifying and responding to closed cultures: supporting information for CQC staff
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2019
- Pagination:
- 3
- Place of publication:
- Newcastle upon Tyne
Information to help CQC inspectors and their managers to identify and respond to ‘closed cultures’ in health and social care services, where abuse and human rights breaches may be taking place. Closed environments may develop in services where people are situated away from their communities, where people stay for months or years at a time, where there is weak management of these services and where staff often lack the right skills, to support people. The document includes advice on identifying risk factors and warning signs and how to use existing regulatory policy when enforcement action is required. The information will be particularly useful for regulating services for people with a learning disability or autistic people. However, the principles apply to all settings where people may be less able to self-advocate, including adult social care services for people with dementia or mental health conditions. (Edited publisher abstract)
Registering the right support: CQC's policy on registration and variations to registration for providers supporting people with a learning disability and/or autism
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2017
- Pagination:
- 28
- Place of publication:
- Newcastle upon Tyne
This policy statement provides guidance for registration managers and inspectors assessing providers of services for people with learning disability and/or autism. It aims to ensure the Care Quality Commission (CQC) have a consistent approach to registration of services for people with a learning disability and/or autism and also informs providers, people who use services and their families and carers of the Care Quality Commission (CQC) approach to registration. It applies to three key areas of registration: specialist hospital provision, such as an assessment and treatment unit for people with a learning disability and/or autism; opening a new care home or location; and new applications for registration and applications to change a location’s service type, for example from hospital services to care home or supported living services. Case studies are included to provide examples of applications that are likely to be approved, and application that are unlikely to be granted. Providers of services are more likely to have their application for registration granted if they can demonstrate how their model of support is: is in line with Building the Right Support and the accompanying service model, built on evidence-based care; and is in line with national policy. (Edited publisher abstract)
Transforming care for people with learning disabilities: next steps: progress briefing from the Transforming Care Delivery Board
- Author:
- TRANSFORMING CARE DELIVERY BOARD
- Publisher:
- Transforming Care Delivery Board
- Publication year:
- 2015
- Pagination:
- 19
- Place of publication:
- London
Summarises progress across the key areas outlined in Transforming Care for People with Learning Disabilities - Next Steps, which set out an ambitious programme of system wide change to improve care for people with learning disabilities and/or autism, and behaviour that challenges (learning disabilities). The programme is led by six national partners, working closely with commissioners, managers, practitioners, providers and people with learning disabilities and their families. The aim is to ensure that where people are able, they can live within their local communities, with the right level of support, and close to home. The report assesses the impact of the programme activities with respect to five priorities, including: giving people with learning disabilities and/or autism, and their families, more choice and say in their care; ensuring that the best care is delivered now, whilst re-designing services for the future; improving care quality and safety by developing the skills and capability of the workforce; tightening regulation and the inspection of providers, strengthening providers’ corporate accountability and responsibility, to drive up the quality of care; and making sure the right information is available at the right time for the people that need it. (Edited publisher abstract)
Department of Health review: Winterbourne View Hospital: interim report
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2012
- Pagination:
- 48p.
- Place of publication:
- London
In May 2011 a BBC Panorama programme showed abuse by staff of patients living in Winterbourne View Hospital, an independent sector hospital in Bristol. This interim report, published before the conclusion of police investigations, criminal proceedings and a serious case review, sets out initial findings from a review into the quality of health and care services received by people in England with learning disabilities, autism and challenging behaviour. It is based on Care Quality Commission inspection reports of 150 hospitals and care homes for people with learning disabilities and engagement with people with learning disabilities and autism, family carers' voluntary groups, and health and care commissioners, providers, professionals and regulators. It reports that initial findings indicate that abuse is not widespread and systemic but that there is evidence of poor quality care, and it identifies actions to be taken at a national level to improve the lives of people with learning disabilities or autism and behaviour which challenges. The final report will be published when criminal proceedings into events at Winterbourne View Hospital have concluded.