CBF response to CQC State of Care report 2024
Children and adults with severe learning disabilities, and their families, rely on education, health and social care systems to provide support and services to enable them to live a good quality of life, On 25th October 2024, the Care Quality Commission (CQC) published their most recent State of Care report, which looks at the state of health and social care in England in 2023/24. The report identifies that people with a learning disability are still facing significant health inequalities and many are not receiving high-quality, person-centred support. Failure to deliver the right support in the right place in the right time can result in inappropriate inpatient admission, with a high human and financial cost.
The report highlights that none of the commitments included in the NHS Long Term Plan (2019) around reducing the number of people with a learning disability and autistic people in inpatient units have been met. As the recent Darzi review highlighted, the most recent failure to meet the target of reducing the number of people with a learning disability and autistic people detained in inpatient units by half by March 2024 must be taken in the context of repeated failures to meet targets reaching back to 2014. Without a clear and strategic plan for action and strong leadership at all levels, these targets will continue to be missed and people with learning disabilities will continue to be inappropriately detained in inpatient units.
Co-Producing a Lifelong Action Plan
Other issues with inpatient services for people with learning disabilities raised in the report include:
- As of June 2024, less than a quarter of people with a learning disability and/or who were autistic had a discharge date
- In 38% of cases where someone with a learning disability and/or who is autistic was due to be discharged, thelocal authority in question was not aware that they were going to be transferred/discharged to their area
- Lack of suitable housing was a factor in over half of cases of delayed discharge
Read the Housing section of the Action Plan
Restrictive practices remain a significant issue, both in inpatient units and in community settings. Following Baroness Hollins’s report on long-term segregation, CQC became responsible for the Independent Care, Education and Treatment Reviews programme, which reopened in May 2024. As of May 2024, there were 96 people with a learning disability and autistic people still in long-term segregation. CQC analysis has also found that people with a learning disability and autistic people living in residential care homes are significantly more likely to be restrained than people without learning disabilities/who aren’t autistic: in care homes where over half the residents were autistic and/or had a learning disability, the incidence of restraint was nearly 12 times higher than in care homes where no one had a learning disability/was autistic.
Read more about the CBF’s work to tackle restrictive practices
The report also highlights both the negative impacts of closed cultures, and how these form – where staff do not speak up because they are either part of the culture, do not recognise that what they are doing is restrictive, or are scared of repercussions. This finding echoes our own understanding of closed cultures both in inpatient settings and in the community. Our ‘Insider Voices’ project, co-produced with learning disability nurses and family carers, illustrates some of the issues with closed cultures and empowers staff in these cultures to act.
Watch the video from the Insider Voices project
The report also raises multiple issues with healthcare and social care outside of inpatient units. One of CQC’s “areas of specific concern” highlighted within the report is that only a quarter of people with a learning disability are on the GP learning disability register. This means that only a fraction of people with a learning disability are receiving the preventative and holistic support that helps enable them to live good and healthy lives. The report also discusses the need for improved communication, reasonable adjustments, and a person-centred approach.
This report reiterates many of the things that we have known for years, and which have been raised in previous reports. Without leadership and a clear plan, care will not be transformed, and people will continue to be inappropriately detained – and stuck – in inpatient units. Restrictive practices are widespread and harmful, and closed cultures must be addressed. The upcoming NHS 10 Year Plan provides a powerful opportunity to deliver real change for people with learning disabilities, learning from the mistakes of the past to get support right for current and future generations – so that whatever your needs, wherever you live, the system is able to support you to live a good life. We look forward to seeing how partners, including CQC, the NHS, and the new government, will work in equal partnership with people with lived experience to make this a reality.
You can read the full CQC State of Care report here:
CQC State of Care 2023/24