Reducing long term segregation and restrictive practice

National projects designed to reduce long term segregation and restrictive practice

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 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.

What are restrictive practices? is a booklet we asked Speakup Self Advocacy to co-produce with people who have first hand experience of restrictive practice in hospital settings. The booklet is for people with a learning disability and autistic people, the staff who support them and families. It offers easy to understand information about different kinds of restrictive practice and why they may be used. The booklet takes a human rights approach to the subject, to help people understand their restrictions and be more involved in developing least restrictive options, deciding when a restriction is fair or unfair, how people want to be supported and changing the way someone is restricted. It also includes information about who to speak to if there are any concerns about the way restrictions are used.

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 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. The oversight panel, chaired by Baroness Hollins, continue to monitor  the progress of IC(E)TRs

This booklet is to help the person and their family and/or advocate to plan their Independent Care (Education) and Treatment Review (IC(E)TR). There is also a section for them to provide consent.  It helps explain the purpose of the IC(E)TR and what happens next and makes sure that the person’s wishes and views are shared with the IC(E)TR 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 NHS Foundation Trust, NHS England is funding the roll out of this model across services in England.

The clinical model was developed by Mersey Care NHS 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.  Sixteen specialist practitioners have been recruited 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 was 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 built 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 works 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 recruited Senior Intervenors to work with up to three people at a time to provide senior level challenge and intervention..  The Adult Senior Intervenors project was funded until March 2022 although has been extended to ensure those individuals who have a Senior Intervenor continue receiving an intervention. An evaluation will be undertaken to review the impact of the pilot.