Conclusions and recommendations
Visits and the right to family life
1.Blanket visiting bans are contrary to the rights of both patients and their families under the European Convention on Human Rights, the Code of Practice to the Mental Health Act 1983 and NHS England guidance. Failure to adopt an individualised approach to the safety of visits will breach the Article 8 rights of both the patients and their families. (Paragraph 12)
2.NHS England must write immediately to all hospitals, including private ones in which it commissions placements, stating that they must (whatever nationwide restrictions may be re-imposed in future), allow families to visit their loved ones, unless a risk assessment has been carried out relating to the individual’s circumstances which demonstrates that there are clear reasons specific to the individual’s circumstances why it would not be safe to do so. Where a mental health hospital does identify cogent reasons for prohibiting visits to a particular individual, the reasons for this decision must be provided in writing both to the patient and to their family. Such decisions must be reviewed on a regular basis, at least every 48 hours. (Paragraph 13)
Use of restraint and solitary confinement
3.Restraint must only ever be used as a last resort where absolutely necessary. Solitary confinement of children, and prolonged solitary confinement of adults, is contrary to the UN Mandela Rules on Prisoners and must be avoided. In order to understand how restrictive practices are currently being used, figures on their use, including physical and medical restraint and any form of segregation, detailing any incidences which go beyond 22 hours per day, must be published weekly by the institutions. These figures must be provided to the Secretary of State for Health and Social Care and reported to Parliament. (Paragraph 20)
4.On every occasion that anyone is restrained or kept in conditions amounting to solitary confinement their families must be automatically informed. (Paragraph 21)
Inspections
5.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. (Paragraph 28)
6.The CQC must prioritise in-person inspections at institutions with a history of abuse/malpractice, and those which have been rated inadequate/requires improvement. (Paragraph 29)
7.A telephone hotline should be established to enable all patients, families, and staff to report concerns or complaints during this period. (Paragraph 30)
8.The CQC must report on reasons for geographical variation in practice with resultant harmful consequences. (Paragraph 31)
9.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. (Paragraph 32)
10.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. (Paragraph 33)
11.The Government must ensure inspectors have sufficient and appropriate personal protective equipment (PPE) so they can carry out inspections safely. (Paragraph 34)
Inappropriate detention and failure to discharge
12.Now, more than ever, rapidly progressing the discharge of young people to safe homes in the community must be a top priority for the Government. The recommendations from the Committee’s 2019 report must be implemented in full. In particular, legislation must be introduced to ensure the availability of sufficient community-based services. The required amendments to the Mental Health Act 1983 to prevent inappropriate detention, must not be delayed. (Paragraph 41)
Data on Covid-19 infections and deaths
13.It is essential that we have comprehensive and accessible data about the number of those who are autistic and/or learning disabled who have contracted and died of Covid-19. This must include a focus on those in detention, for whom the state has heightened responsibility for their right to life. The data must be presented to show the number of those who have died in acute hospitals, having been transferred from other settings, and be published on a weekly or daily basis and be broken down by age. (Paragraph 45)
Published: 12 June 2020