Section one Context self-management skills, particularly when preparing for discharge. An inspection of the Iveagh unit, a hospital inpatient facility for young people with a learning disability and additional mental health problems, revealed ongoing delays in the discharge of children to suitable alternatives in the community. This has been raised as an area for improvement with the host trust and is also being monitored by the Northern Ireland Commissioner for Children and Young People. CQC found a number of serious failings in its ICETRs regarding appropriate and suitable care for children and adolescents who have a learning disability and/or autism who are admitted to hospital. CQC found: overly restrictive conditions; unsuitable environments and inappropriate placements with inadequate specialist involvement; poor discharge and/or transition planning; and failures of communication with patients, their families and/or their carers.152 The CCE is concerned about informal admissions to mental health hospitals, with evidence that children are being asked to agree to be ‘informal’ patients and not to be sectioned. In particular, the CCE is concerned that children only agree to be ‘informal’ patients because they think they will be sectioned if they do not, which in effect removes the element of ‘choice’.153 Ofsted reported the closure of one secure children’s home (SCH) in England in the reporting year, which further reduced the capacity of the service to 13 homes (compared to the 29 operational in 2002). The National Secure Welfare Commissioning Unit reported that high numbers of children (around 25) are waiting for places every day, while around 20 children are placed in Scottish SCHs at any time due to the lack of provision in England. Ofsted, the CCE and local authorities remain concerned about England’s insufficient capacity to ensure very vulnerable children with complex needs have placements. During this reporting period, Ofsted found a decline in the performance of SCHs compared to previous years, which have generally seen positive inspection judgements. Of the 13 SCHs, three were ‘inadequate’, two were ‘requires improvement to be good’, six were ‘good’ and two were ‘outstanding’. Those judged as less than good generally had issues with weaknesses in leadership, management and monitoring activity. Other areas of concern included SCHs regularly having to challenge placing authorities so that plans are in place for suitable accommodation and support for when children leave the home. Four settings were served with compliance notices, and one was also served with a notice restricting new placements.154 152 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] 153 CCE, May 2019, Far less than they deserve: Children with learning disabilities or autism living in mental health hospitals, https://www.childrenscommissioner.gov.uk/wp-content/uploads/2019/05/CCO-far-less-than-they-deserve-2019.pdf, [accessed 10/11/2020] 154 The aim of compliance notices is to clarify to the provider that they must remedy a specific matter. An offence is committed if they do not complete the step(s) set out in a compliance notice by the date specified. A restriction notice prevents a provision from accepting any new placements, while allowing the children residing at the home to remain. 49