Recommendation 9

HM Government · verbatim extract Accepted in Part

We agree with this recommendation in principle. We agree and expect that people with a learning disability and autistic people should experience high-quality care and treatment in inpatient settings. The NHS is committed to providing autistic children, young people, and adults or those with a learning disability with the best possible care and treatment. The NHS will take action to avoid people with a learning disability and autistic people being admitted to hospital settings rated inadequate by CQC, including people being moved from a unit that is closing. There may, however, be exceptional occasions when a person is admitted to a unit rated inadequate. For this reason, we are not accepting this recommendation in full. We are clear that where, exceptionally, admissions to an inadequate hospital setting occur, this will be with the involvement of the person (where they have capacity or based on a best interest decision making process where they do not) and their carer/family. It will also be based on an assessment of the risks and benefits that concludes this is the most favourable option for that person. Additional mitigations and safeguards will be put in place to monitor their safety, wellbeing, and treatment. NHSE will monitor this approach to admissions to inadequate rated services, by reviewing the number of any exceptional new admissions over the next six months, to ensure we are delivering this as intended. We will check progress on this approach to admissions to mental health inpatient units rated inadequate by CQC. We will agree with NHSE and CQC the best way for this to be reported to the Building the Right Support Delivery Board. In Chapter 1 of the Building the Right Support action plan, we set out the wider range of actions we are taking to ensure people have safe, appropriate care in inpatient settings. This includes robust regulation by CQC, which is welcomed. CQC are taking action to ensure that providers of learning disability and autism services meet expectations for high quality care. They have already taken significant action against services that are poorly performing, which has included cancellation of several providers’ registrations (stopping The treatment of autistic people and people with learning disabilities: Government Response 15 them from delivering regulated activity), restricted admissions, warning notices and reduced ratings. ‘Right Support, Right Care, Right Culture’ sets out what CQC expect good care to look like for people with a learning disability and autistic people. We recognise the importance of commissioners having the right knowledge and skills to buy services that are best for people with a learning disability and autistic people. Evidence from work such as the independent reviews of people in long term segregation and the CQC’s ‘Out of Sight’ report indicate that commissioners would benefit from additional support to build knowledge and design creative commissioning solutions that best meet the needs of people with a learning disability and autistic people of all ages. That is why Chapter 3 of the Building the Right Support action plan sets out the actions we are taking to support commissioners. We will continue to roll out an accredited commissioning qualification for current and aspiring commissioners by April 2023. This commissioning qualification has been developed to support the commissioning workforce to develop their skills, knowledge, and expertise in commissioning for people’s lives. Training providers for the commissioning qualification engage families and people with personal experience as co-trainers. Furthermore, by April 2023, a training programme for senior leaders will be rolled out to increase their skills and knowledge to support local commissioners. Chapter 2: Reforming inpatient facilities