A BBC File on Four report has highlighted once again the shocking levels of restraint and long term seclusion used in the care of adults with learning disabilities, particularly in hospital settings. The figures will come as no surprise to those familiar with the care sector, coming hard on the heels of the CQC’s report 'Out of sight, who cares?'.

But it is the CQC who hold the key to resolving the underlying crisis. The report makes clear that one of the primary causes of the challenging behaviour that leads to restraint is inappropriate accommodation. With the individuals concerned being far less likely to require restraint in accommodation within the community than in a hospital setting.

Throughout the country, there are many providers of high-quality person-centred care, who have demonstrated the improved outcomes that can be achieved when people are supported closer to home and with better access to the communities they live in. Almost all of them are keen to develop new services. Local authority and clinical commissioners are actively calling for that support.

So why are there still over 2,000 individuals accommodated in hospital settings, 8 years after the government strategy Transforming Care was launched with the aim of reducing such placements by 35% and following the awful events at Winterbourne View? That figure has remained stubbornly high, having reduced by only 400 in the last two years.

While the CQC are right to question the levels of restraint and seclusion, it is their own approach to registering new services which has stifled the development of appropriate accommodation in the community.

The objectives of their registration guidance 'Right support, right care, right culture'are laudable, with an emphasis on developing services for people in a home of their own within a normal residential setting. However, the approach is too rigid, with a fixation on whether a residential service with 7 beds and not 6 is too big or that 2 or more services in close proximity might be perceived as a campus and undermine interaction with the community.

With applications for registration only considered on completion, investment in new community-based services has been stalled, with providers unwilling to risk the substantial costs associated with development without any certainty their plans will be approved.

That approach also ignores the need to provide choice for those with the greatest need; the 2,000 individuals who remain in hospital because their needs are not being met by the single person services the CQC’s guidance promotes.   

The File on Four report highlights that positive changes can still be made for those who require the greatest levels of support, following the case of a teenager kept in seclusion for 21 months. She has now been found more suitable accommodation in an NHS specialist unit. That is far from the ideal model the CQC would propose, but the outcome for Bethany has been transformative.  "Since I've been here, the staff have been absolutely amazing. My behaviour's settled down and my anger's settled. And I've not done any self-harming for five or six months."  She now has her own bedroom, plays the piano, goes out for walks and shopping, and is learning circus skills.'

The CQC must take a more flexible and supportive approach to ensure that other individuals with the most challenging needs can be supported to lead fulfilling lives with the greatest level of access to the community. Only then will the need for restraint and seclusion be transformed.