CQC tells care providers to minimise use of restraint on people with dementia and learning disabilities

The Care Quality Commission has called on care providers to implement policies that minimise the use of restraint on people with dementia and severe learning disabilities, after it found too many are being inappropriately restrained.

It also wants care providers and commissioners of services for vulnerable adults to improve their understanding of the Mental Capacity Act and the Safeguards.

The CQC has published a report on its monitoring of the Deprivation of Liberty Safeguards which revealed there is still a widespread lack of understanding of the wider Mental Capacity Act (MCA).

David Behan, chief executive of the CQC said: “If someone has dementia or has a severe learning disability they can still contribute to decisions about their care. If this is done properly then people will receive appropriate care; if it is not done then people can be deprived of their liberty. Understanding the Mental Capacity Act and the way it is applied is critical to good quality, safe care. Those providing services, must ensure that their staff understand the Act and what it means for the care and treatment of people.”

The CQC report found there is confusion among care staff about the basic MCA requirements especially relating to the use of restraint. The use of restraint is not always recognised or recorded properly and because of this it is not easy to monitor.

The report identified a lack of training and in some cases it was reported managers and senior staff had received training, but other types of care staff had not. This variation suggests that while some form of training is being provided it is not consistent.

Lack of training and proper monitoring can lead to the use of restraint becoming routine, as then it can be hard for staff to gauge whether restraint is proportionate and in someone’s best interests, said the report.

Another theme identified was poor practice in services where non-detained patients were on wards alongside patients detained under the MHA and their rights were being restricted alongside those of the detained patients. This seemed to be due to a lack of staff knowledge and awareness concerning the differences between the MCA and Mental Health Act.

The Mental Capacity Act is a very important mechanism for protecting the rights of people who do not have the ability (mental capacity) to make certain decisions for themselves. CQC’s evidence shows that in some care homes and hospitals, people’s freedom to make decisions for themselves is restricted without proper consideration of their ability to consent or refuse. Some care homes and hospitals showed little or no evidence of any attempt to maximise a person’s decision-making capacity before resorting to restriction or restraint.

During 2011/12 CQC took a number of steps to strengthen the relevant skills and knowledge of compliance inspectors in order to promote a wider and more consistent understanding of the MCA in general and the Safeguards in particular.

CQC devised an e-learning package for inspectors, and related learning has been included as an important and integral part of both permanent and bank inspector induction courses.

There has been a year on year increase in the number of applications for the Safeguards since their first introduction. There were 11,393 applications in 2011-12, which represents a 27 per cent increase on the 8,982 in 2010/11 and a 59 per cent increase on the 7,157 applications in 2009/10, the first year of the new Safeguards.

In 2011/12, a total of 8,213 applications were made to local authorities (by care homes), while 3186 applications were made by hospitals to Primary Care Trusts (PCT). Dementia accounted for 53 per cent of all applications.