Recommendation 10

HM Government · verbatim extract Accepted

We agree with this recommendation in principle. We agree that there are too many instances of restrictive practices being used for people with a learning disability and autistic people. We agree about the importance of gathering information about restrictive practises and ensuring that families and commissioners are involved as appropriate. We are clear that, where needed, inpatient care must provide a therapeutic benefit and be the least restrictive possible. We are taking action to ensure this. In relation to part (i) of this recommendation, we agree with the principle that there must be robust reporting around the use of restrictive practices. We are already taking steps to ensure and encourage this as usual practice. We publish monthly statistics from the Mental Health Services Data Set on the use of restrictive practices in the care of people 16 The treatment of autistic people and people with learning disabilities: Government Response with a learning disability and autistic people. We are committed to continue improving data quality and reporting compliance to ensure we build a strong understanding of the use of restrictive practices and identify any areas of concern. Over time, definitions in the Mental Health Services Data Set regarding restrictive practices have changed to be more inclusive to support greater transparency and oversight. As the Committee is aware, the Mental Health Units (Use of Force) Act—also known as Seni’s Law—received Royal Assent in November 2018 and has been partially commenced. The Act, which applies to NHS-funded care, aims to reduce their use of force and increase the transparency and accountability of the use of force (restraint) in mental health units so that force is only ever used proportionately and as a last resort. On 7 December 2021, we published the statutory guidance on the use of force in mental health settings and the government response to the consultation on the guidance. The majority of the provisions within the Act were brought into force on 31 March 2022 and the rest will be brought into force as soon as possible. The publication of the statutory guidance represents an important step in increasing accountability and reporting of the use of force. It states that the Secretary of State for Health and Social Care must ensure that, at the end of each year, statistics are published regarding the use of force by staff. Officials are working to commence the outstanding sections of the Act as soon as possible, which includes sections 6, 7 and 8 on data and reporting. In addition, the NHS Standard Contract (2022 to 2023) necessitates providers of mental health services to submit data and information to commissioners on a quarterly basis as part of reporting requirements. The NHS Standard Contract also includes a condition for providers of mental health and learning disability services and mental health and learning disability secure services to have regard to the Standards for Inpatient Mental Health Services to encourage high quality service provision. In relation to part (ii) of this recommendation, we agree with its principle and expect that families are involved in the care and support of their loved one, as appropriate, which includes notification of any incidences of restrictive practice. We are taking steps to ensure this is the case. Information about the use of force and patients’ rights must be published for patients. The Use of Force Act statutory guidance states that this should include a notification sent to the person(s) families, carers or independent advocate(s), identified in the patient’s care plan or positive behavioural support plan (or equivalent), following every use of force, and they must also be involved in post incident reviews. It also requires that the record of the use of force used on a patient by a member of staff must include whether a notification regarding the use of force was sent to the persons (if any) who are expected to be notified under the patient’s care plan. Furthermore, the Use of Force Act statutory guidance sets out how we expect mental health units to meet the requirements of the Act. The Act makes it a legal requirement for providers to have a policy to reduce the use of force within their mental health unit, and the statutory guidance includes expectations of what the policy should include and how it should be developed and published. This policy should include the details of how patients, their families, carers, and independent advocates will be involved in care planning. As the regulator, if CQC considers the requirements of the Mental Health Units (Use of Force) The treatment of autistic people and people with learning disabilities: Government Response 17 Act 2018 and this statutory guidance are not being met, it may take action as appropriate in accordance with its statutory powers and policies. CQC is also developing and improving its monitoring of the use of restraint at a provider level. Chapter 1 of the Build