Commissioning conflicts add to unnecessary restraint of people with learning disabilities

Conflicting commissioning incentives, as well as a lack of specialist homes, are contributing to unnecessary restraint and segregation of adults with a learning disability and/or autism in hospital, a report has found.  

Looking at segregation in hospitals in England of people with a learning disability or autism, the Care Quality Commission found that a third (13) of 39 people reviewed were experiencing delayed discharge from hospital, and so prolonged time in segregation, due to there being no suitable package of care available in a non-hospital setting.

The CQC has also learned that the cost and question of funding alternative placements to hospital can delay discharge. In one example a suitable property in the community, that would meet the person’s needs, could not be found for the budget available. This raises the potential for conflicting commissioning incentives, the CQC believes.

The review into segregation in hospitals precedes a review of segregation and restrictive practices in care homes for adults with a learning disability and/or autism in England, which will start next month. A final report looking at all care settings for this population cohort will be published in the spring of 2020.  

The CQC found that people can remain in segregation due to increased levels of violence and aggression, and also for the person’s benefit, for example, reducing exposure to the “less predictable environment of the open ward”.

The CQC says: “The treatment and care provided have not enabled [people with a learning disability and/or autism] to live anything approaching a normal life. Their world is narrowed to a highly restricted existence.”


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