DHSC Consultation response on the notification of restrictive practices

In the summer of 2024, the Department for Health and Social Care held a consultation to consider a new statutory notification process to the Care Quality Commission. The notification process was for a mental health provider registered with the CQC to notify them within 72 hours of the use of any physical, mechanical or chemical restraint or of isolation (which encompasses both seclusion and segregation) of any patient who is being assessed or treated as an inpatient for a mental disorder in a mental health unit.

There have previously been concerns that the CQC are not being notified quickly enough about such incidents, which can have significant impact on individuals, and that the current data set that is being used to notify them is not sufficiently accurate, as it was not a compulsory step which needed to be taken by providers, and notification was only being shared with the CQC 3 months after an incident. It is hoped that this notification will inform the CQC’s decision whether an inspection of the service is required, an action plan is needed to reduce the use of restrictive practices, or a warning notice to the provider is required. 

Background

The role of the CQC is to monitor and inspect services to see whether they are safe, effective, caring, responsive and well-led, and they will publish their findings including quality ratings.

At the end of 2018, the Secretary of State for Health and Social Care asked the CQC to undertake a review of autistic people, and people with a learning disability and/or mental health condition who may be subject to restrictive practices, as a result of ongoing concerns in this area. In this context, restrictive practices are those which make someone do something they don’t want to do, or stops them doing something they want to do, by restricting or restraining them or depriving them of their liberty.  

A report called ‘out of sight- who cares?’ was published in 2020 and it found that the environment of mental health hospitals was often not therapeutic, with inappropriate use of restrictive practices including blanket restrictions, as well as examples of good practice and care, noted to be mainly in the community. Recommendations were made around increased oversight and monitoring as well as renewed attempts to reduce the use of restrictive practices.

As a result of this, DHSC proposed to extend the notification process to all of those with a mental disorder, and not just in relation to autistic people and/or those with a learning disability. When proposed, a concern was raised as to the onerous nature of the requirements on providers, but it has been considered that the information required is that which ought to be held by providers in any event in line with section 6 of the Mental Health Units (use of Force) Act 2018. 

The Government’s response to the results of the consultation has been published on 18 December 2024. It outlines that 217 responses were received to the consultation, including 28 from the Easy Read version. It should be noted that some of these (34%) will be organisations and not individuals.

The following broad themes were identified in the consultation from the use of the ‘free text box’:

• Overall that this is a positive change and step towards in reducing inequalities and encouraging scrutiny of the use of restraint
• Concerns about the length of time of the window to report –in terms of data needing scrutiny to remove identifiable information or protected characteristics prior to the reports being shared with the CQC, or consent to share being required from families, both of which were felt to be difficult to do in 72 hours
• Unanticipated burden upon staff – it was felt that this could divert focus away from patient care, whilst some also highlighted the possibility of duplication of work
• Concerns around CQC’s ability to process and review reports or not understanding how the CQC would act upon the information
• Clearer guidance being required on the evidence behind the proposed changes and how they will be practically applied – this was in relation to both the CQC and providers.

In terms of applicability, the consultation responses generally agreed that the processes should be implemented across all Mental Health Units, as well as making a suggestion to extend this to other care settings, which reflects the position that this will have a positive impact on reducing the levels of restraint. There was a concern that this may cause data inaccuracies, if the system is extended too far.

In terms of the impact on providers registered with the CQC, it was recognised through the responses of both the burdens on providers but also that it was an achievable and positive step forwards so long as appropriate staff training was provided on the appropriate use of restraint, seclusion and segregation.

The consultation response concludes that whilst there was a general support for the proposed changes, further policy development work is necessary on the practical implementation before it can be introduced. The timescale for this is not clear, and so this will be a matter to keep under review.