The Equality and Human Rights Commission has published a guide called ‘Your Home Care and Human Rights’. It explains the community care and HRA obligations of local authorities and the standards required of care providers very simply and clearly, and will be of great value to advocates and social workers in helping people understand how the system of home care works and what their rights are.

‘The state of health care and adult social care in England: An overview of key themes in care in 2011/12’ CQC, November 2012

This comprehensive report contains a wealth of facts, figures, analysis, and examples of good and bad practice in health and social care. By way of example, we note:

  • More than 400,000 people in England live in residential care, 1.1 million receive care at home, and around 5 million care for a relative or friend.
  • As at 31 March 2012, there were 13,134 residential care homes with 247,824 beds registered in England and 4672 nursing homes with 215,463 beds.
  • An estimated 45% of care home places are self-funded.
  • 83% of councils have set their threshold for eligibility for state-funded care at ‘substantial’ (compared to 70% in 2008/9). 2% set it at ‘critical’.

The CQC provide a special focus on restrictive practices in mental health and mental capacity from at p.102ff of the report. In relation to the deprivation of liberty safeguards, it states (at p.103) that:

"All care homes and hospitals in England must apply for authorisation if they propose to deprive someone of their liberty by, for example: keeping them locked in; physically restraining them; placing them under high levels of supervision; forcibly giving them medicines; or preventing them from seeing relatives and friends.

A number of concerns about restrictive practices were identified, including:

  • Restraint: Inspectors found it difficult to identify from patient records how often, and for how long, restraint was used and what actually happened during the restraint, which raised questions about such decisions are accounted for and monitored.
  • Seclusion and segregation: Safeguards were not always implemented and an interesting range of terms was used to describe circumstances in which people might effectively be detained in seclusion: "Nursed in his room", "Placed in the low-stimulus area for a sustained period" or "Chose to be in the safe-care suite."
  • Blanket rules: Typically, blanket rules related to access to communal rooms, kitchens, the person’s own bedroom (whether locking them out of their bedroom during the day, or insisting on a general and often early bedtime), and gardens and outdoor space. There were also rules in some settings about when a patient or resident might have a drink or a snack, or go for a cigarette. This happened in all types of care setting. In some settings, staff members told people that their takeaway meal, or outing, would not be allowed as a punishment for certain behaviour.
  • Lack of understanding of the Mental Health Act 1983: for example, informal or voluntary patients were subject to de facto detention with little consideration whether their deprived was deprived.