Reducing long term segregation

National projects designed to reduce long term segregation

The NHS Long Term Plan has set out an ambitious programme to transform mental health services for people with a learning disability and autistic people, with a focus on improving community services and being less dependent on inpatient care. The NHS England and NHS Improvement Learning Disability and Autism programme Improving Quality team work with the National Quality Improvement Taskforce to improve the quality of inpatient services for people with a learning disability and autistic people.

A series of national projects aim to improve the experiences of people who are being cared for in long term segregation (LTS), in hospital.

Each project is a direct response to recommendations made in Baroness Hollins’ review of the Independent Care (Education) and Treatment Reviews of people with a learning disability and autistic people who are living in the restricted way described as long-term segregation.

We are working in co-production with people with a learning disability and autistic people, their families and paid and unpaid carers to help reduce long term segregation and the levels of restrictive practice.

Independent Care (Education) and treatment Reviews (IC(E)TR)

We are continuing with the independent reviews for all people currently in long term segregation, including those who were in the scope of 2019-2020 review and all those who have entered since.

The NHS England and NHS Improvement Learning Disability and Autism programme Improving Quality team have been working with regional teams to identify the people who need an IC(E)TR.  The project team includes the Care Quality Commission, Department of Health and Social Care and NHS England and NHS Improvement. The oversight panel, chaired by Baroness Hollins, will continue to monitor progress of IC(E)TRs. Prior to re-starting ICETRs the project team are facilitating ‘welcome’ sessions with Chairs, Senior Intervenors and Experts by Experience.

This booklet is to help the person and their family and/or advocate to plan their independent care and treatment review (ICETR). There is also a section for them to provide consent.  It helps explain the purpose of the ICETR and what happens next and makes sure that the person’s wishes and views are shared with the ICETR panel. It can be completed on a computer, or printed and filled in by hand.


The HOPE(S) model is an ambitious human rights-based approach to working with people in long term segregation developed from research and clinical practice. In partnership with Mersey Care Foundation Trust, NHS England and NHS Improvement is funding the roll out of this model across services in England.

The clinical model was developed by Mersey Care Foundation Trust to reduce the use of long term segregation sometimes experienced by autistic adults, adults with a learning disability and children and young people when in hospital.  They will be recruiting sixteen specialist practitioners to deliver this important programme.

Visit for further information; and watch the short films below, about the importance of the HOPES model, by Claire Murdoch, NHS England’s National Mental Health Director, and Dr Roger Banks, National Clinical Director for Learning Disability and Autism.

Senior Intervenors project

The national Adult Senior Intervenors pilot project is being set up in response to Baroness Hollins’ recommendation for the introduction of an additional senior person to support local services to plan for discharge, guide where there is challenge and agree actions to facilitate a reduction in restrictions. This project builds on the positive evaluation of the pilot of Children & Young People’s Senior Intervenors.  The ultimate goal of the Senior Intervenors is to establish and oversee a robust plan for discharge from both long term segregation and hospital.

The Senior Intervenor’s work focuses on cases where progress is not being made and there is concern for the individual’s wellbeing. The Senior Intervenor will be working with people on a case by case basis to find solutions to barriers that may be preventing the individual from moving to less restrictive settings or into the community.

Prioritisation of who senior intervenors will work with considers length of time in long term segregation alongside CQC rating of the unit, and any concerns about quality of care that the person, family and system have.

NHS England and NHS Improvement are recruiting six to eight Senior Intervenors whose role is to provide senior level challenge and intervention. Senior Intervenors will work with up to three people at a time.  The Adult Senior Intervenors project is focused on adults in long term segregation and will run to March 2022 when we will evaluate the impact.

Life planning

Life planning is a way of working with people to reduce restrictive practice and to improve quality of life. These individualised life plans help people to live a more fulfilling life while in hospital and generate collaborative ideas, actions and activities that will support their move into the community.

We are working with case managers to make sure a life plan is in place for every person with a learning disability  and autistic person  being cared for in long term segregation.

If someone does not have a life plan, we are providing funding to pay an independent provider to work with them, their families and the hospital team to understand what they want from their life both now and into the future.