National Preventive Mechanism Tenth Annual Report 2018–19 discharging people due to a lack of suitable care in a non-hospital setting.93 In June 2019, the CQC reported on a review of the Mental Health Act Code of Practice.94 Concerningly, it found that providers lacked understanding about how to promote, apply and report on the guiding principles in the Code, which included the principles of using the least restrictive option and maximising independence, as well as involving and empowering patients, and treating them with dignity and respect. It proposed that further joint working was needed to ensure people in need of urgent care have timely access to a bed that is close to home, in line with the expectation of section 140 of the Mental Health Act. CQC reported a continued general trend of improvement in England, but a deterioration in ratings for safety in mental health services, which it attributed to shortages of staff and a lack of qualified staff.95 For example, people who needed support from mental health, learning disability or autism services were more likely than people without these conditions to get poor care or be at crisis point before they received the care they needed. They were also likely to be detained in unsuitable services far from home because they had not been helped sooner or were unable to access care at all. In particular, CQC stated that too many people with a learning disability and/or autism were in hospital because of a lack of local community services. Since October 2018, CQC has rated 14 mental health hospitals that admit people with a learning disability and/or autism ‘inadequate’ and placed them under special measures.96 In the majority of mental health inpatient services rated as ‘inadequate’ or ‘requires improvement’ since October 2018, the inspection reports identify a lack of appropriately skilled staff as an issue. CQC also reported that there was a 14% fall in the number of mental health beds between 2014–15 and 2018–19. In May 2019, BBC's Panorama exposed a culture of abuse at Whorlton Hall, a secure hospital for people with learning difficulties and/or autism in County Durham. Camera footage showed staff physically abusing and bullying and intimidating patients. CQC has commissioned an independent review into its regulation of Whorlton Hall by Professor Glynis Murphy.97 93 Care Quality Commission, May 2019, 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-review-restraint-prolonged-seclusion-segregation-people [accessed 05/12/19] 94 Care Quality Commission, June 2019, Mental Health Act Code of Practice 2015: An evaluation of how the Code is being used, https://www.cqc.org.uk/publications/major-report/mental-health-act-code-practice-2015-evaluation-how-codebeing-used [accessed 05/12/19]. Note the review was requested from the Department of Health and Social Care (DHSC) during the reporting period. 95 Care Quality Commission, October 2019, State of Care 2018–19, https://www.cqc.org.uk/publications/major-report/statecare#access [accessed 13/01/20] 96 These figures are taken from CQC’s State of Care 2018–19 (ibid). The data used comes from CQC’s inspections and ratings published as at 31 July 2019, meaning that some of these ratings may have been made outside of the timeframe of this annual report. 97 BBC, 22 May 2019, Whorlton Hall abuse and how it was uncovered, https://www.bbc.co.uk/news/health-48369500 [accessed 13/01/20]; Care Quality Commission, 19 June 2019, Update on independent review into regulation of Whorlton Hall, https://www.cqc.org.uk/news/stories/update-independent-review-regulation-whorlton-hall [accessed 13/01/20] 34