National Preventive Mechanism Eleventh Annual Report 2019–20 These targets included moving patients from inappropriate inpatient care to communitybased settings and reducing the reliance on inpatient care for people with a learning disability and autistic people. EHRC also called for the immediate implementation of recommendations made by the JCHR and Rightful Lives’ Eight Point plan.31 CQC published the interim report of its review of restraint, seclusion and segregation for adults and children, commissioned by the Secretary of State for the Department of Health and Social Care (DHSC), in May 2019.32 It examined the experiences of people cared for in segregation on a mental health ward for children and young people or on a ward for people with a learning disability and/or autism. In response to CQC recommendations made in its interim report on restraint, seclusion and segregation in May 2019, DHSC agreed that there would be an immediate in-depth review of the care provided and the discharge plan for people with a learning disability and autistic people who are being nursed in segregation in specialist mental health and learning disability inpatient settings. DHSC is leading on this work with NHS England and NHS Improvement and has established a programme of Independent Care Education and Treatment Reviews 31 32 33 34 35 18 (ICETRs). ICETRs provide a platform in which an independently chaired panel can raise key issues associated with individual care plans. Where serious concerns are identified, CQC can escalate issues to a local inspection team, make a safeguarding referral or conduct a targeted visit. From November 2019 to September 2020, 77 ICETRs took place.33 Reviews into mental health legislation The government commissioned an independent review of the Mental Health Act 1983 in October 2017. The review was chaired by Professor Sir Simon Wessely. An interim report on the review was published in May 2018.34 The review recommended wide-ranging legislative change. However, the publication of a white paper by the government is awaited. This has been delayed during COVID-19 and by the process of exiting the European Union. Guidance on the Mental Health Units (Use of Force) Act in England, known as Seni’s Law and enacted in November 2018, is also awaited. This Act will increase protections and oversight of use of force in mental health settings in England. Civil society organisations and the family of Seni Lewis, who died in 2010 following prolonged restraint while a voluntary inpatient in a mental health unit, have criticised the ongoing delay in the enforcement of the Act.35 EHRC, February 2020, Health Secretary faces legal challenge for failing patients with learning disabilities and autism, https://www.equalityhumanrights.com/en/our-work/news/health-secretary-faces-legal-challenge-failing-patientslearning-disabilities-and [accessed 24/08/2020] CQC, May 2020, Interim report: Review of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability and or autism, https://www.cqc.org.uk/publications/themed-work/interim-report-reviewrestraint-prolonged-seclusion-segregation-people [accessed 24/08/2020] ICETR reviews are undertaken by a panel comprising of an independent chair, Expert by Experience, clinical expert, commissioner and Mental Health Act Reviewer (MHAR). The focus of the ICETR is to make recommendations to improve the quality of care and treatment for a patient and to identify any barriers to discharge. Following the ICETR, the independent chair is responsible for producing a report, which is sent to the provider and to its oversight panel, chaired by Baroness Hollins. This process also provides information to CQC, and where serious concerns are identified these are escalated to a local inspection team. Independent Review of the Mental Health Act, May 2018, Interim Report: The Independent Review of the Mental Health Act, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/703919/The_ independent_Mental_Health_Act_review__interim_report_01_05_2018.pdf [accessed 10/11/2020] The Guardian, July 2020, Parents of man who died after police restraint challenge delay over Seni’s law, https://www. theguardian.com/society/2020/jul/20/parents-of-man-who-died-after-police-restraint-challenge-delay-over-senis-law [accessed 24/08/2020]