Policy paper

Letter from Helen Whately MP, the Minister of State for Care to Baroness Hollins, Chairperson of the Independent Care (Education) and Treatment Review

Published 21 July 2021

This letter regarding the independent reviews of those in long-term segregation is from Helen Whately MP, the Minister of State for Care. It is addressed to Baroness Hollins, Chairperson of IC(E)TR programme for people with a learning disability and autistic people in inpatient settings.

Dear Baroness Hollins,

Thank you for your letter of 18 December about the care and treatment of people with a learning disability or autistic people in long-term segregation (LTS).

I would like to express my strong support for your recommendations and for your call for urgent and immediate action to improve the circumstances of people in LTS. The Department of Health and Social Care (DHSC) has considered these, and we are in a position to be able to support all of the immediate actions in your interim report. A brief response to each of your recommendations is outlined in Annex A.

I am grateful to you for the substantial amount of work you have undertaken since the Secretary of State for Health and Social Care announced in November 2019 that people in LTS would have their care independently reviewed. Your unique approach to this work and the way in which you and the Oversight Panel sought input from relevant experts has been instrumental in the development of these clear and practical recommendations.

Your Thematic Review offers some important and distressing insights into some of the circumstances of individuals who are being detained in LTS. While I recognise the challenges of the pandemic, I am very disappointed to learn that little progress has been made in moving them to less restrictive settings and towards discharge to an appropriate community setting. I am determined to put this right and I am therefore fully committed to taking the urgent and immediate action you have highlighted in your letter. I would like to respond here to the three specific requests you highlighted in your letter.

Firstly, you asked for the development and implementation of a funded pilot for bespoke intensive case management and capacity building to support commissioners to resolve ‘blockages’ in the system that prevent individuals from being moved to more appropriate and less restrictive settings.

The department and NHS England and Improvement (NHSE/I) have worked at pace to develop a pilot for a Senior Intervenor role, which will be supported as part of a wider package of funding to support learning disability and autism services, to address the diagnostic backlog as a result of the pandemic, and support intervention to prevent children and young people with learning disability, autism or both escalating into crisis. The pilot will be modelled on NHSE/I’s Senior Children’s Intervenor (SCI) role, which has delivered some very positive initial outcomes for children and young people who were part of the pilot.

Building on the success of the SCI model, the main objectives of the Senior Intervenor pilot will be to reduce the length of time people with a learning disability or autistic people remain unnecessarily in inpatient care in segregation, as well as to support earlier transfers of care to appropriate community settings, or a transfer to a less restrictive setting while long term solutions are developed.​

The Senior Intervenor role will achieve this by focusing on:

• providing additional support, influence and challenge to senior service leaders (including local authorities, health commissioners and responsible clinicians) ​

• ensuring barriers are overcome for agreeing, planning and managing moves out of LTS​

• ensuring the long term needs of individuals with learning disabilities or autistic people who are part of the pilot are being met by working on their behalf and ensuring the implementation of personal care plans and ‘life plans’

• offering persistent oversight, challenge and support to the system to enable progress ​

Secondly, you asked that the Independent Care (Education) and Treatment Reviews (IC(E)TRs) continue for all people who are currently in segregation, including those who were in scope of the 2019 to 2020 reviews and all those who have entered since. You asked that the reviews should be undertaken within 2 weeks of the commencement of segregation and that progress should be reviewed every 3 months. Furthermore, you asked that clear and immediate action should be taken on review recommendations with automatic reporting to the department or to the Oversight Panel where previous recommendations have not been acted upon.

I strongly support the continuation of independent reviews for people in segregation and agree that all those who are still in segregation and those that have been newly admitted should be within scope for the continuing IC(E)TRs. The department will undertake an evaluation to inform and support the continuation of the reviews. As part of this evaluation, the department, NHSE/I and the Care Quality Commission (CQC) will consider a number of proposals to strengthen the IC(E)TR process. These include improving the process of identifying people in LTS so that they can be offered a review as soon as possible, as well as establishing a mechanism to follow up, review and assess progress against recommendations in individual cases.

Finally, in your letter you also recommended that the Oversight Panel’s contracts should be extended on current terms to 31 March, during which time the Panel will work with the department to propose new terms of reference for its continuing role. I strongly support the work of the Panel and to reduce and prevent the use of segregation and I am pleased that this work has continued. I would encourage you to continue to work closely with the department on the future role of the Oversight Panel. In doing so, I would urge that you consider how the Panel’s work on segregation will support and feed into the Building the Right Support (BtRS) Delivery Board and wider governance.

I would again like to express my gratitude to you and the members of the Oversight Panel. Your dedication and persistence to improving the situation for those in segregation is demonstrated through your considered and comprehensive interim findings and proposals. I hope you will be encouraged by the department’s support for all your immediate recommendations and that you will continue to offer your invaluable insight and expertise in the implementation of this work.

Helen Whately MP
Minister of State for Care