4Inspections
22.With families banned from visiting their loved ones and the Care Quality Commission (CQC) not carrying out routine inspections, these institutions are even more closed than before, and those in them are even more vulnerable to abuse. We are very concerned that the abuse that was happening in some services before lockdown, which was exposed by the media, may be even worse now.
Inspections during Covid-19
23.On 16 March 2020 the CQC wrote to health and social care providers announcing that it was suspending routine inspections in order to reduce the pressure on health and social care services.21 Dr Kevin Cleary told us that the regulator has nevertheless continued to carry out some inspection visits on a risk basis, taking into account an institution’s culture, the type of patients it looks after, complaints and whistleblowing. Two such physical inspections had to date been carried out in Child and Adolescent Mental Health (CAMHS) units, with two more planned. All such visits are currently unannounced.22
24.In addition to these physical visits, Mental Health Act reviewers are undertaking “virtual visits” in which they talk remotely to staff, patients and mental health advocates to get a picture of what is going on in the organisation. This information is then used as a basis for deciding whether a further visit is required. Last year Panorama revealed horrific abuse of patients at Whorlton Hall, which the CQC had failed to detect during a series of in-person inspections. The regulator attributed this failure to the difficulty of getting beneath the skin of the closed culture of such institutions. Given this, we have no confidence that the CQC will be able to get behind the closed culture of an institution during a “virtual visit.”
25.Following the Panorama programme, the CQC asked Professor Glynis Murphy to carry out a review into its regulation of Whorlton Hall between 2015 and 2019. Her first report published on 18 March 2020 concluded that the abuse could have been detected sooner if the CQC had carried out more unannounced visits and made a number of recommendations for how inspections must be improved in the future.23 Dr Kevin Clearly told us that any visits the CQC makes at the moment are unannounced and that this would be the case for the majority of visits for the foreseeable future.24
26.Individuals and/or their families are being encouraged to proactively communicate with the CQC to complain about poor or abusive care, through its online ‘Give Feedback on Care’ service.25 However, as we heard from Andrea and Adele, they have no confidence that if they report their concerns to the CQC, these will be adequately addressed. Andrea told us that she had reported her concerns about her daughter’s care to the CQC and that they had visited Dannielle as a result, concluding that “in the circumstances, her care was satisfactory.” Asked by Joanna Cherry MP, what she thought of that response Andrea said: “I emphatically disagree with that. It is not satisfactory at all. She is not safe.”26
The state’s positive obligation to protect against torture, inhuman or degrading treatment
27.The state is under various legal duties, including a positive obligation to protect against torture inhuman or degrading treatment (Article 3 ECHR). If, in response to Covid-19, institutions increase the use of restraint, segregation, and solitary confinement of young people detained by the state; the state fails to accelerate the safe discharge of young people from detention; and the regulator is only carrying out inspections in a very small number of cases, this cumulatively risks violations of Article 3.
Conclusion
28.We are pleased to see the CQC are now switching to unannounced inspections. The CQC should carry out all their inspections unannounced; this is particularly important where any allegation of abuse is reported by a young person, parent, or whistle-blower.
29.The CQC must prioritise in-person inspections at institutions with a history of abuse/malpractice, and those which have been rated inadequate/requires improvement.
30.A telephone hotline should be established to enable all patients, families, and staff to report concerns or complaints during this period.
31.The CQC must report on reasons for geographical variation in practice with resultant harmful consequences.
32.The CQC must monitor how providers are supporting the right to family life of young people, including by facilitating family visits, and report this as standard within their inspection reports.
33.Following the exposure of abuse at Whorlton Hall, the CQC’s work to incorporate Professor Murphy’s recommendations into a new strategy to improve the regulation of mental health, learning disability and/or autism services must continue at a greater pace.
34.The Government must ensure inspectors have sufficient and appropriate personal protective equipment (PPE) so they can carry out inspections safely.
21 Care Quality Commission, Routine inspections suspended in response to coronavirus outbreak, 16 March
22 Qq33 and 34 [Dr Kevin Cleary]
23 Care Quality Commission, CQC publishes independent review into its regulation of Whorlton Hall between 2015 and 2019, 18 March 2019
25 This is primarily an online service, although it is possible to access telephone help, if you find it difficult to do things online.
Published: 12 June 2020