The CQC is already under fire following the Wholrton Hall and Winterbourne View scandals. Various public enquiries have highlighted a number of serious concerns about the treatment of service users with learning difficulties and/or autism in Assessment and Treatment Units (“ATUs” and other mental health hospitals, and in particular on the issue of restraint.
The Joint Committee on Human Rights published a report late last year which concluded that a number of human rights abuses of young adults in this user group sector were taking place. This included being detained unlawfully contrary to their right to liberty, being subjected to solitary confinement, being more prone to self-harm and abuse and being deprived of the right to family life. In a new report published last week, the Committee concludes that Covid-19 has made the situation even worse.
The summary of the new report states “Now that institutions are closed to the outside world as a result of the Covid-19 pandemic, the risk of human rights abuses are even greater.” It concludes that “Unlawful blanket bans on visits, the suspension of routine inspections, the increased use of restraint and solitary confinement, and the vulnerability of those in detention to infection with Covid-19 (due to underlying health conditions and the infeasibility of social distancing) mean that the situation is now a severe crisis.”
In response to the “severe crisis”, the Report makes a number of recommendations to the CQC. This includes recommending that the CQC prioritises inspections of services which are rated “Requires Improvement” or “Inadequate” and making all inspections unannounced. It also recommends that the CQC act more quickly in adopting a “new strategy to improve the regulation of mental health, learning disability and/or autism services”.
Whilst this is understandable and the promotion and protection of human rights of service users is to be championed, it may encourage the CQC to inspect all services of the relevant type which are not rated Good or Outstanding. This is likely to be sooner rather than later, and may still be at a time when those providers remain under significant pressures brought about by Covid-19.
Routine inspections remain suspended but the CQC have announced a few times of late that they will be starting to send more inspectors “over the threshold” of services where this is necessary. To date, they have suggested that they will go over the threshold of service where concerns have been identified. Those concerns could have arisen from complaints or reports received, or by the CQC’s own evidence gathering, or within the new “Emergency Support Framework”.
We anticipate that services which cater for the relevant service user group who are rated Inadequate or Requires Improvement are likely to be high up on the list of whose threshold the CQC will look to cross in the near future. Whether the CQC decide to formally confirm that they will re-commence routine inspections for these services, or whether the CQC will maintain the suspension of routine inspections but call these “focussed” inspections is largely irrelevant for present purposes. Providers of these services should expect a visit from the CQC, even where things may seem to be going well.
Perhaps more concerning, is that the report is likely to have an impact far beyond CQCs decision to inspect or not. We are seeing multiple cases which lead us to believe that the CQC has taken a position in which it is targeting ATUs or other mental health hospitals which detain young adults with learning disabilities and/or autism for closure, even when services are being provided in a safe, caring, effective, responsive and well-led fashion. The recommendations, whilst understandable, do add fuel to the CQC’s fire here and we hope that the CQC do not use them as an excuse to shape a political agenda (or a “new strategy”) to close all services of this nature, which it will then blindly follow at the expense of some of the most vulnerable individuals in our society.
Whilst it is understandable that service users in these services may have a higher risk of abuse than those in other types of services and of course it is important that suitable safeguards are in place and that the regulator learns lessons from the past, it should be remembered that for some individuals, a caring, effective, safe, responsive and well-led mental health hospital or ATU can provide positive outcomes. For many service users, suitable alternative community care, or suitable alternative residential services simply will not be available if the CQC were to continue the perceived agenda to close as many of these services as possible. If these specialist services close, there is a risk that these individuals will have to be placed very far away from their family or existing community ties, or even in services which are less suitable to their needs, or are even more restrictive.
It is important that in the CQC remembers that not every ATU or mental health hospital should be tarred with the Wholrton Hall brush. There is no one size fits all when it comes to providing person-centred, quality care and the CQC would be well minded to remember that. The fact remains that there are some fantastic services out there which provide excellent care and treatment and where that is the case, the CQC should be seeking to support and protect those services, not make life difficult for them.
In any event, providers should keep an eye out for further development in this area.