The Care Quality Commission (CQC) has been leading on a project to review the care and treatment that people with learning disabilities and autistic people receive.
Britain’s care watchdog was asked by the Department of Health and Social Care (DHSC) to lead Independent Care (Education) and Treatment Reviews (IC[E]TR) over the next two years to help transform individual experiences of care and reduce restrictive practice where appropriate.
This request was sparked by reports such as the CQC’s 2020 ‘Out of sight – who cares?’ report and Baroness Hollins’ 2023 ‘My Heart Breaks’ report – her final report concluding her independent review into care for people with a learning disability and autistic people in long-term segregation.
Having started in May 2024, the CQC is working in partnership with NHS England for the first year of the IC(E)TRs before taking full responsibility for them in the second year.
Reviews make real difference to lives of people with learning disabilities and autistic people
The care watchdog has so far completed 32 reviews and says that they have already witnessed positive impacts on the lives of people with learning disabilities and autistic people.
Of those who have had a review:
- One individual was successfully discharged from long-term segregation in a high-secure setting
- One young person successfully moved to more appropriate adult services in single-person accommodation that better meets their needs
- One individual was discharged into their own accommodation in the community
The CQC says that these early success stories “demonstrate how these reviews can make real differences to people’s lives, supporting individuals to move to less restrictive environments when appropriate.”
The CQC’s Director for people with a learning disability and autistic people, Rebecca Bauers, has recently written a blog post to summarise some of the key learnings from the reviews and highlight the watchdog’s future plans.
In it, she is clear that the primary focus of an ICETR is to support “the person’s quality of life to improve, enabling them to lead the life they wish in an environment where they can thrive.”
Improving reviews into the care of people in segregation
Along the way, she says, the CQC has made several important improvements to how ICETRs are conducted. These include:
- Better preparation – the watchdog now gathers detailed information prior to the date of the review. The panel holds pre-meetings to ensure all arrangements are in place and they have enhanced their consent process to ensure full compliance with the Mental Capacity Act
- Accessible and inclusive communications for participants – ICETR reports have been redesigned to be more readable and easy read versions are now offered to those who need them. Video reports of recommendations are provided where required, and the CQC is working to ensure clear communication with service provides from the start of the process.
- Stronger follow-up and accountability – The CQC follows up directly with the individual, their family or advocate and other significant others after 4-6 months have passed. They now require action plans within 28 days and ensure these go through proper governance procedures. They check responses and return to providers if they’re not satisfactory. The CQC is also working with lead commissioners to ensure the integrated care system’s (ICS) executive lead for learning disability and autism is aware of all actions needed to support people moving out of long-term segregation.
‘Clear themes’ emerging from care and treatment reviews
Rebecca Bauers also says that the CQC has seen “clear themes emerging” from its work on ICETRs.
They have found that discharging people with learning disabilities and autistic people from segregated care can be supported by:
- Involving all parties in discharge planning and actively engaging social care teams
- Using innovative approaches to ensure care teams have “a clear understanding of the person and their needs, to facilitate person-centred planning of their care.” Examples can include using a Rix Wiki – a simple, accessible and secure personal website that uses pictures, words, video and sound to capture the person’s voice, skills, aspirations and needs.
The CQC has established an external oversight panel chaired by independent experts to provide quality assurance for the ICETRs, scrutinising their impact and ensuring they centre the voices and experiences of people with learning disabilities and autistic people.
The panel includes clinical experts, people with lived experience of learning disabilities and autism, organisations that represent people, family members and carers.
Committing to a better future for people with learning disabilities and autistic people
The CQC will continue their work on ICETRs throughout 2025. They have set a commitment to:
- Obtain and learn from feedback from people with learning disabilities and autistic people, and their families
- Work closely with commissioners and care providers
- Ensure their recommendations lead to real improvements in people’s lives
- Influence the shape of future services based on their learnings
- Complete reviews for all people with learning disabilities and autistic people who need them by Autumn 2025
- Evaluate the effectiveness of the programme in improving outcomes for people with learning disabilities and autistic people on an ongoing basis
In her blog post, Rebecca Bauers adds:
“We recognise that it is early in the programme and there are challenges ahead, particularly around complex discharges and ensuring all necessary partners are engaged in the process. However, we’re already seeing how this programme can make meaningful difference to people’s lives, and we remain committed to driving improvements in and support for people in long-term segregation.
“This programme represents an important step in improving the quality of life of autistic people and people with a learning disability currently in long-term segregation. Working together, the aim is for them to live fulfilled lives out of long-term segregation and in environments of their choosing in community settings. We look forward to continuing this vital work and sharing more success stories as the programme progresses.”
Rebecca Bauers has also written a blog post about the CQC’s position on reducing restrictive practice in care (December 2024), which focusses on the use of chemical restraint, particularly intubation.
Mandatory training for those supporting people with learning disabilities and autistic people
First Response Training (FRT) is a leading, national training provider.

They deliver over 7,000 courses each year in the fields of health and safety, first aid, fire safety, food safety, mental health, health and social care and other special focus topics.
Their diverse portfolio includes training awards designed for care workers, such as Learning Disability Awareness, Understanding Autism, Oliver McGowan Mandatory Training, Positive Behaviour Support, Safeguarding Adults, Equality, Diversity and Inclusion, Person Centred Care and Support and many others.
Their course portfolio spans Care Certificate standards, mandatory training awards, clinical skills, special focus courses and training for supervisors and managers.
FRT are approved to deliver Tier 1 and Tier 2 of the Oliver McGowan Mandatory Training Framework on Learning Disability and Autism with approved trained trios based across the UK.
The leading training provider, which works with many large and national learning disability care providers, has partnered with charitable organisations to source Experts with Lived Experience for their delivery teams.
The Facilitating Trainers have been handpicked from FRT’s team of over 100 highly qualified and experienced trainers. They combine relevant, personal experience with professional understanding and NHS England training.
The training package will enable health and care workers to better support people with a learning disability and autistic people, improving their understanding of how to communicate effectively with individuals and meet their needs.
The Health and Care Act 2022 wrote into law the mandatory requirement for all CQC-registered services to provide training for their staff on caring for people with a learning disability and autistic people, appropriate to their role.
It followed years of tireless campaigning by Oliver’s mother Paula McGowan.
The Oliver McGowan Mandatory Training programme is the government’s preferred and recommended route for health and care workers to satisfy this requirement.
A spokesperson from FRT said:
“We are incredibly proud to be able to deliver the Oliver McGowan Mandatory Training Framework on Learning Disability and Autism, with Trainer Trios trained and approved by NHS England.
“It follows years of committed campaigning by Oliver’s family, but this framework will now revolutionise training for those who work with and support individuals with learning disabilities and autistic people.
“Hopefully it will also revolutionise outcomes for the people accessing services and ensure that no one else has to experience what Oliver did.
“We urge anyone in health and care to make this training a top priority, and to get in touch with us as soon as possible if they need any assistance.”
You can download the Oliver McGowan Mandatory Training brochure here.
FRT also offers a free, downloadable resource providing a quick guide to Oliver’s Training.
For more information, please call freephone 0800 310 2300 or send an e-mail to info@firstresponsetraining.com.