National Preventive Mechanism Eleventh Annual Report 2019–20 In its subsequent visits, Ofsted noted improvement in all four settings, which complied fully with the notices. A follow-up inspection to the home where a restriction notice was served noted significant improvement and the restriction was lifted. Across SCHs in England, physical and emotional health provision has been further strengthened through commissioning with NHS England and the embedding of the ‘secure stairs’ model (an integrated care framework that addresses the needs of children in the secure estate). CIW reported improvements to the management of Wales’ only SCH, while CI noted that four of the five secure accommodation services for children and young people in Scotland continued to be of a good quality and achieve high evaluations. However, CI was particularly concerned about children who are not in a registered secure setting but whose liberty or rights may be restricted. This includes services, many of which are small, set up as ‘alternatives to secure’ accommodation which provide placements some distance from a child’s home, including placements for children from other parts of the UK. CI has identified issues around potential isolation, the challenges these services face in properly understanding and meeting children’s’ needs and the availability of appropriate education and timely and informed access to health provision, including provision of mental health services. In May 2019, the CCE published a report on the detention of children in England across all settings. As there are various methods of reporting on the detention of children, the CCE combined data from a range of sources and found that 1,465 children in England were securely detained in March 2018. Of these, 873 were detained in youth justice settings, 505 were detained under the Mental Health Act and 87 were placed in SCHs for their own safety. In total, the CCE estimated that it costs over £300 million a year to look after these children. They also found that there are at least 200 children deprived of their liberty in other settings that are unknown to the public due to a lack of data. The CCE is concerned that there is no proper oversight for these vulnerable children.155 The IMB continued to report severe problems and delays in transferring seriously mentally ill young people from the youth justice estate into mental health and secure care, due to a lack of sufficient alternative provision (particularly for those approaching 18 years of age).156 Also in May 2019, the CCE published a report on children with learning disabilities or autism living in mental health hospitals. They found that many children were being unnecessarily admitted to secure hospitals. In some cases children were spending months and even years in institutions. The average time children with autism and/ or a learning disability had spent in their current hospital was six months. One in four did not appear to have had a formal review of their care plan in over six months. Of 250 children in these settings, 95 were staying at sites known to be more than 31 miles 155 CCE, May 2019, Who are they? Where are they?, https://www.childrenscommissioner.gov.uk/report/who-are-they-whereare-they/ [accessed 24/08/2020] 156 IMB, September 2020, Independent Monitoring Boards National Annual Report, 2019-20 https://s3-eu-west-2.amazonaws. com/imb-prod-storage-1ocod6bqky0vo/uploads/2020/10/IMB-national-annual-report-201920-amended-FINAL-.pdf [accessed 30/10/2020] 50