Section two Focus on detention issues belts on some detainees without proper risk assessment. IMBs continued to find excessive use of restraints on some other overseas escorts to charters throughout the year. There were five deaths in or immediately following immigration detention reported during the year, three of which were self-inflicted. In the previous year, there were six reported deaths, including two that were self-inflicted and one manslaughter. Prior to 2016–17, deaths in or immediately following immigration detention (other than from natural causes) were rare.17 Health and social care detentions Despite cuts to funding of health and social care services in England during the year, CQC found that services generally acted on matters raised during CQC’s visits, and there was a general trend towards improvement in the areas measured on visits by its Mental Health Act (MHA) reviewers. This echoes the experience of CQC’s regulatory visits, where 67% of the 93 NHS mental health trusts and independent hospitals originally rated as ‘requires improvement’ had improved to ‘good’ when they were reinspected. However, CQC remained concerned about the quality and safety of care provided on mental health wards, and in particular on acute wards for adults of working age. Improvements were needed to replace or refurbish wards located in unsuitable buildings, incentivise staff to work in these challenging environments, and ensure that patients had access to the full range of care interventions. These factors limited 17 the ability of services to provide the optimum care and treatment for patients detained under the MHA, and to do so in ways that met the expectations of the guiding principles set out in the MHA Code of Practice. CQC also raised concerns over safety from sexual assault and sexual harassment on mental health wards, including how services reacted to incidents. During the year, CQC’s findings in relation to Broadmoor and Rampton high secure hospitals led to CQC writing to the Secretary of State for Health and Social Care (at that time, the Rt Hon Jeremy Hunt MP) to advise him of concerns. These included a shortage of registered nurses, which led to restrictions on patients’ access to therapies and activities and sometimes increased risk to patients, and that staff did not always monitor and review patients in seclusion and long-term segregation in line with guidance in the Code of Practice. Following this intervention both hospitals showed considerable improvement. CQC continued to see variation in the application of Deprivation of Liberty Safeguards (DoLS) in England throughout the year, with unequal use across the health and social care sector. Delays in the processing of DoLS applications continued to be a problem. Regulatory changes to DoLS were planned by the government during the year. These changes aim to simplify the application and assessment process and reduce the bureaucracy of the present DoLs system. HIW found individualised, patient-focused care across Wales and patients and HM Chief Inspector of Prisons for England and Wales Annual Report 2017–18, July 2018, https://www.justiceinspectorates. gov.uk/hmiprisons/wp-content/uploads/sites/4/2018/07/6.4472_HMI-Prisons_AR-2017-18_Content_A4_Final_WEB.pdf, accessed 8 August 2018. 19