Matt Hancock vows to fix 'broken' system segregating people with autism and learning disabilities

Every patient held in long-term segregation or seclusion is to be reviewed by independent advocates to fix a ‘broken’ care system for autistic people and those with learning disabilities, health secretary Matt Hancock has announced.

People with learning disabilities or autism are kept segregated in hospital for years. Credit: Aprilflower7

Too many people with learning disabilities or autism are admitted to hospital unnecessarily or kept segregated in hospital for years with little say over their own lives or future.

Today’s publication of the Care Quality Commission’s (CQC) report into the use of restraint and segregation in health and care settings, reveals poor staff training about autism and learning disabilities, a patient segregated for a decade and the segregation of children as young as 11-years-old.

Reasons for prolonged time in segregation included delayed discharge from hospital due to there being no suitable package of care available in a non-hospital setting.

The CQC has discovered patients’ interactions with other people are “characterised by distress and sometimes by the use of force by staff”.

Their life is made worse by the fact many are a long way from home and their families.

The safety of other patients or staff and an inability to tolerate living alongside others, were the most common reasons providers gave for why people were segregated.

Hancock: 'Appalled by distressing stories'

Matt Hancock said: “I have been deeply moved and appalled by the distressing stories of some autistic people and people with learning disabilities spending years detained in mental health units.

“A small proportion of some of the most vulnerable in society are being failed by a broken system that doesn’t work for them.”

Mr Hancock, who commissioned the CQC report, said: “Today I have accepted their recommendations in full. I hope this is a turning point so everyone receives the care they need. I will not let these people down - they deserve better.”

The health secretary has announced funding for specialist advocates to review the care of every patient in long-term segregation or seclusion and work with families to move people to the least restrictive care and out into the community.

He promised a new learning disabilities and autism working group, involving experts, clinicians, parents and carers, to develop a new care model and awareness campaign that will encourage staff and families to raise concerns about care.

There are currently 2,245 patients in mental health inpatient settings in England, and the Government’ NHS Long Term Plan seeks to halve the number of people in mental health hospitals with a learning disability or on the autism spectrum by 2024.

Jane has been in five different medium secure units

The CQC report highlighted the case of 'Jane' - an adult with autism and a borderline learning disability. Sometimes, she communicates her feelings of distress by becoming aggressive and violent and by harming herself.

Jane has been in specialist residential care from childhood but was admitted to hospital because she became violent and aggressive.

Since her teenage years, she has been in five different medium secure hospitals and is currently in long-term segregation on a learning disability rehabilitation ward.

‘World narrowed to a highly restricted existence’

Today’s announcement follows proposals earlier this year, to ensure all health and care staff have compulsory training on learning disability and autism.

Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health), at the CQC, said: “The 39 people we have visited who are cared for in segregation are in a very vulnerable situation. Their world is narrowed to a highly restricted existence in a single room, or small suite of rooms.

“In some hospitals, a high proportion of staff were unqualified, with little or no training in the skills essential for working with people with a learning disability or autism and complex needs.

“If a spell in hospital is right for the person, this should be close to home and not prolonged because of lack of an alternative place for them to go. In short, the system must put the person at the centre and be engineered around their needs.”

Last December, the CQC contacted 89 registered providers that manage mental health wards for children and young people or wards for people with a learning disability or autism.

The CQC is expanding its review to more settings in phase two of its review (June to December 2019) including adult social care services.

CQC will report its full findings in a final report scheduled for the Spring of 2020.

To read the CQC's interim report on restraint, seclusion and segregation, click here