The CQC has published new supporting information for hospital and social care inspectors about how to identify and respond to ‘closed cultures’ in health and social care settings. The regulator says that when a service has a ‘closed culture’, people are more at risk of abuse and human rights breaches.
It firstly makes the point, however, that providers have the primary responsibility. CQC also state that the principles apply to all settings where people may be less able to self-advocate or are less likely to have their communication needs supported or be listened to and believed than others.
With regard to:
- Mental health this includes mental health wards for children and young people, mental health rehabilitation wards, wards for people with an acquired brain injury (ABI) or dementia.
- Adult social care this includes services for people with dementia, mental health conditions or ABI.
- Acute or community hospitals this includes wards for people with dementia or frail older people that are essentially “closed” at night.
- Other services this includes healthcare services in criminal justice settings.
It is important to note as well that the supporting information is published ahead of the findings of the two independent reviews the CQC commissioned into its regulation of Whorlton Hall.
The supporting information also dovetails with the CQC’s wider review on restraint, seclusion and segregation of children and young people with mental health problems, learning disability or autism.
Its purpose is threefold says the regulator:
- Support inspectors to identify services where there may be a high inherent risk of a closed culture that might lead to abuse or breaches of human rights.
- Help inspectors identify warning signs that there may be a closed culture or a risk of such culture developing and confirms that the CQC will have a low threshold for carrying out an inspection
- Sets how to use strengthened regulatory policy, methods and processes when there is a high inherent risk and/or warning signs. This includes gathering information from families early in the inspection planning.
Inherent risk factors will look at:
- Experience of people receiving care
- Leadership and management
- Skill and experience of staff providing care
- External oversight
Warning signs will look at the above as well as:
- Use of restrictions
- Use of restraint
- Physical environment
The 29 page document includes at Appendix A a flow chart of how to identify and respond to closed cultures and Appendix B sets out additional prompts for mental health services.
The CQC’s supporting information is an important step for ensuring that people receiving care who are often less able to self-advocate are free from abuse and have their human rights upheld.
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