January 25 2023

Patients with autism and learning disabilities ‘routinely’ restrained

Patients with autism and learning disabilities ‘routinely’ restrained

Barbed wire, Flickr under creative comms licence, Terry Freeman

The use of restraints on patients with autism and learning disabilities in hospitals in England have risen to alarmingly high levels, according to new research. Data from NHS Digital indicates both children and adult inpatients are routinely subjected to physical restraint, seclusion, segregation and chemical ‘coshing’.

BBC File on 4 has reviewed the data and concluded that in 2019 there were 3,225 reported cases of seclusion – where individuals are confined to their rooms by themselves – and 850 of these cases related to children. In the first seven month of 2020, there were 2,000 reported incidents of secluding patients.

These figures follow the CQC’s report, Out of Site: Who Cares?, on the use of restrictive practices in care services for people with a learning disability or autism (see here). The review was launched after Health Secretary, Matt Hancock, apologised to 19-year-old ‘Bethany’ (not her real name) who was kept in seclusion for 21 months at St Andrew’s Hospital in Northampton, fed through a hatch-way, and left with a biro pen in her arm for 4 weeks.

The CQC report, published last month, showed that inspectors had visited 100 different hospitals and treatment units and found that some patients were held in seclusion for 13 years, whilst others were routinely restrained either physically or chemically.

It is particularly concerning that the practice of restraining patients has increased from 22,000 incidents in 2017 to 38,000 incidents in 2020. This equates to an average of 100 restraints a day, or 1 restraint every 15 mins.

Harriet Harman, Chair of the Joint Committee on Human Rights, told the BBC that people ‘are not supposed to be subject to inhumane and degrading treatment’. She called this a ‘human rights abuse’ and called on the Government for immediate action, noting that the ‘figures are shouting out for action’.

NHS Digital have suggested that the increase in figures can be explained by improvements in the quality and completeness of reporting. However, Dan Scorer, Head of Policy at Mencap, has suggested that not all treatment units are fully disclosing their use of restricted practices so the real figures could be much higher than these reports.

In addition, there has been a worrying rise in the use of ‘proning’, or holding patients face down on the floor. This practice is a violation of government guidance as it risks serious injury or, in the worst cases, death. Yet there were 4,000 reported incidents of proning in 2019, and 2000 reported incidents in 2020 as of July.

After the Winterbourne View scandal, the Government launched its Transforming Care programme with the aim of reducing the number of in-patients with autism and learning disabilities. The deadline to meet those targets has now been missed twice. There remain 2060 people in hospital with learning disabilities and autism, and the data obtained by File on 4 suggests that their care is falling far below acceptable standards.

The Joint Committee on Human Rights has called for a specialist unit in No 10 to dedicate itself to this issue and drive a cultural change that will truly transform care. The government has resisted those demands as duplicating resources and has instead created a taskforce that will develop a new policy on segregation in hospitals. The Department of Health also told the BBC, ‘government policy is that any kind of restraint should only be used as a last resort, and there is active work to reduce use of restrictive practice in mental health settings’.