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From YouTube: CQC Connect: Out of Sight progress report - an update and exploring some key themes from the report
Description
In this episode of CQC Connect, the podcast from the Care Quality Commission, Lizzy Dobres, CQC Communications and Engagement Manager, is joined by Julie Newcombe, mother of an autistic son and co-founder of Rightful Lives, Amanda, who has lived experience, and Debbie Ivanova, Deputy Chief Inspector for people with a learning disability and autism at CQC.
They explore some key themes of the latest Out of Sight progress report, which is a full update on the review into restraint, segregation and seclusion in care services for people with a learning disability, autism or mental ill health.
Read the out of sight progress report: https://www.cqc.org.uk/publications/themed-work/restraint-segregation-seclusion-review-progress-reports
Listen to more podcasts from the CQC: https://soundcloud.com/carequalitycommission
Find out more information about the CQC and how it regulates health and social care in England: https://www.cqc.org.uk/
A
Welcome
to
this
episode
of
cqc
connect
in
this
episode,
we're
going
to
explore
our
latest
out
of
sight
progress
report.
It's
a
progress,
update
on
the
review
that
we
did
into
restraint,
segregation
and
seclusion
in
care
services
for
people
with
a
learning
disability,
autistic
people
or
people
with
mental
ill
health.
A
A
I'm
really
pleased
and
excited
to
be
joined
by
julie,
newcomb
today,
who's,
the
mother
of
an
autistic
son
and
he's
the
co-founder
of
rightful
lives,
a
human
rights
organisation
and
debbie
venaeva,
deputy
chief
inspector
for
people
with
a
learning
disability
and
autistic
people
at
cqc,
as
well
as
amanda,
who
is
also
joining
us.
Welcome
and
thank
you
for
joining
us
today.
Can
we
start
by
introducing
who
you
are
and
why
this
topic
is
important
to
you
I'll
quickly,
go
first
and
then
I'll
come
to
julie
and
amanda
and
debbie.
A
And
when
I
met
with
julie
and
alexis,
I
just
really
felt
that
we
hadn't
done
well
enough
as
a
system
and
we
needed
to
do
a
lot
better
and
the
more
families
and
people
who
I've
spoken
to
the
more
angry.
It
makes
me
that
we
haven't
really
done
better
as
a
system
to
solve
this
problem.
Quick
enough.
So
that's
probably
it
for
me.
So
I'll
go
to
julie,
hi.
B
You're
talking
about
abuse,
you're
talking
about
medication,
you're
talking
about
isolation,
segregation
and
denigration
of
the
family,
you
know
nothing
positive
about
the
experience
at
all
and
when
I
came
away
from
that
when
we
finally
got
him
out
and
I
met
up
with
other
parents,
who'd
been
through
the
same
sort
of
situation,
I
decided
you
know
we
need
to
do
something
about
this,
so
got
into
campaigning.
Firstly,
through
seven
days
of
action,
and
then
I
co-founded
rightful
lives,
which
is
a
creative
campaign.
B
If
you
like
to
look
at
the
human
rights
of
autistic
people
and
people
with
learning
disabilities,
and
one
of
the
things
we
focus
on
is
the
issues
around
inpatient
settings
and
we
have
autistic
people
on
our
admin
team
who
are
very
committed
to
to
contributing
to
solutions
and
raising
awareness.
For
me,
I
mean
the
crux
of
the
matter:
is
you
go
back
over
all
the
years?
Even
pre-winter
porn
view
people
have
been
saying
for
ages.
This
needs
to
change.
This
is
horrific.
B
C
A
D
I'm
debbie
ivanova
and
I'm
a
social
worker
by
profession
and
I've
worked
really.
Most
of
my
career
has
been
about
working
with
people
with
learning
disabilities,
both
in
this
country
and
in
other
countries
in
eastern
europe.
But
with
this
particular
review,
I've
been
involved
now
over
the
last
three
years,
and
it's
because
of
this
review
that
I'm
actually
doing
the
job
that
I'm
doing
right
now.
D
D
So
a
real,
clear
focus
on
stopping
people
moving
into
services
that
aren't
safe,
stopping
services
operating
if
they're
not
able
to
meet
the
needs
of
the
people
in
those
services
and
using
our
ability
to
influence
and
improve
services
to
try
to
make
sure
people
get
the
care
that
they
do
need.
Thanks.
A
Everyone
some
powerful
introductions
there,
so
I'm
going
to
start
with
a
few
questions
now
and
I've
got
a
question
for
you
debbie.
The
progress
report
highlights
that
some
work
is
underway
to
try
and
fix
a
lot
of
these
problems,
but
so
much
more
needs
to
be
done
collectively,
especially
around
restraint.
Segregation.
Seclusion.
D
D
What
progress
has
been
made
to
make
that
recommendation
a
reality?
What
have
people
using
services
and
their
families
told
us
about
what's
happening
to
them
now
and
then
looking
at
what
are
the
gaps?
So
this
progress
report,
I
think,
is
really
important,
because
it's
about
keeping
up
the
pressure,
keeping
the
focus
and
continuing
to
shine
that
light
on
areas
where
we
still
haven't
seen
enough
progress.
We
can't
allow
kovid
to
be
a
reason
for
not
putting
renewed
energy
into
getting
this
agenda
sorted.
D
As
julie
said,
this
has
been
going
on
for
years
and
we
keep
saying
something
must
change
and
we
can't
allow
that
pressure
to
stop.
So
this
report
does
show
some
of
the
promising
signs,
such
as
the
introduction
of
some
new
schemes
and
programs
and
an
example
of
that
which
I'll
mention
is
the
hopes
programme.
So
nhse
have
commissioned
mercy
care
to
offer
a
program
across
mental
health
learning,
disability
and
services.
D
People
with
autism
and
this
program
offers
training,
support
and
clinical
interventions
to
reduce
restrictive
practice,
develop
positive
cultures,
strengthen
clinical
leadership,
but
there
are
lots
of
those
little
initiatives.
It
really
isn't
enough
for
for
people
with
a
learning
disability,
the
arrange
and
availability
of
community
support
and
places
to
live
hasn't
developed
sufficiently.
D
A
Thanks
debbie
and
it's
clear
what
you
say
about
you
know
kavan.
I
think
it's
important
we
think
about
that,
but
at
the
same
time
it's
not
an
excuse
now,
especially
where
we
are
now
to
not
focus
on
this
again
and
make
sure
that
we
can
get
the
change
that's
needed.
Were
there
any.
I
guess
overarching
themes
that
came
out,
particularly
in
the
report,
that
the
system
needs
to
focus
on
for
improvement,
especially
around
restraint,
segregation
and
seclusion.
D
The
problem
we
have
is
that
the
right
support
isn't
available
in
the
right
places,
so
people
aren't
getting
the
support
to
stop
them
going
to
hospital
and
not
getting
the
right
support
to
help
them
get
out
of
hospital.
So
that
means
that
there
are
still
too
many
people
in
hospital
and
we're
still
hearing
too
many
stories
of
inpatient
units
where
there's
poor
care
and
treatment.
D
We're
also
hearing
that
the
care,
education
and
treatment
review
process
isn't
working
well
enough.
It
needs
to
become
statutory
so
that
people
must
implement
the
recommendations
that
are
there
they're
a
good
process,
but
unless
those
things
actually
result
in
change,
then
it's
not
enough
we're
hearing
that
people
are
still
finding
access
to
community
mental
health,
as
I
mentioned
before,
more
difficult.
Obviously,
the
pandemic
has
contributed
to
that,
but
being
able
to
get
that
support
at
the
right
time.
Early
on
to
stop
people
becoming
more
unwell
really
has
to
be
a
focus
going
forward.
D
More
autistic
people
without
a
learning
disability
have
also
told
us
they
feel
that
they're
hidden
from
services
that
needs
to
change
people
with
lift
experience,
their
families
and
commissioners
tell
us
that
there's
not
enough
provision
of
housing
with
the
right
support
available.
So
those
are
some
of
the
really
strong
themes.
I
think
that
come
through
in
the
report.
A
B
Yeah,
I
mean
just
to
come
back
on
something
debbie
just
said
about
dtrs
being
made
statutory
with
that
we
have
to
have
the
power
to
enforce
where
laws
are
ignored,
and
that
happens
already.
Laws
like
the
care
act
or
the
autism
act
or
the
equality
at
the
human
rights
act,
etc,
etc.
Long
list
and
these
laws
are
ignored.
So
I
sometimes
think
that
you
know
asking
for
statutory
implementation,
isn't
necessarily
the
answer
unless
you
have
within
that
the
means
for
people
to
get
that
enforced
if
it's
not
happening
but
yeah.
B
To
answer
your
question
lizzie,
I
think
it's
worth
saying
in
terms
of
personal
experience,
and
this
is
the
truth
for
a
lot
of
people
that
I
think
there's
a
saying
that
the
the
atu
is
the
last
stop
on
the
send
journey
a
cnd
journey
and
I
think,
there's
a
lot
to
be
said
for
that.
So
when
we
talk
about
how
we
improve
things
in
inpatient
units,
I
think
we
need
to
remember.
B
At
that
point,
that's
already
avoidable.
If
you'd,
if
you'd,
had
the
right
support
at
the
right
time
once
in
hospital,
of
course,
that's
it.
You
know
it's
very
difficult
to
get
out.
As
we
know
he
had
a
broken
arm.
He
had
other
injuries.
He
was
over
medicated
well
to
the
point
where
he
couldn't
stand
up.
B
Things
like
the
color
of
the
paint
on
the
wall,
making
it
a
low,
arousal
environment,
him
being
part
and
parcel
of
choices
in
in
how
it's
laid
out.
You
know
where
the
train
drake
is
very
important.
You
know
stuff
like
that,
and
he
has
a
wonderful,
wonderful
staff
team
who
are
well
trained,
who
are
just
such
a
great
bunch
of
caring
people
and
who
understand
who
understand
him,
and
this
is
what
people
need
you
know
they.
B
They
need
the
right
kind
of
support,
the
right
kind
of
living
arrangements
which
reflect
the
fact
that
they
may
have
had
traumatic
experience
and
and
to
emphasize
as
well.
The
the
importance
of
life
planning,
which
I
think
is
is
starting
up
now.
Life
planning
can
really
help
with
identifying
a
person's
history
and
then
with
getting
to
grips
with
what
they're
going
to
need
when
they're
out
of
hospital-
and
it's
all
about
you
know
what
are
your
dreams?
What
do
you
like
doing?
How
do
you
like
to
spend
your
days
what's
important
to
you?
B
A
C
C
There's
lots
of
research
out
there
from
lots
of
different
organizations
and
individuals
to
say
that
people
with
disabilities,
particularly
children
with
disabilities,
including
autism
and
cleanliness
whispers,
are
more
likely
to
be
traumatized
or
abused.
So
you've
got
that
drama
in
the
first
place
and
then,
like
julie,
was
saying
about
her
son.
Being
hospitalized
in
a
restrictive
environment
adds
further
trauma
to
that
so
trauma
from
care.
C
However,
some
of
my
poor
experience
of
really
poor
community
care
has
been
when
there's
been
lack
of
communication
between
different
services.
So
no
one
knows
what
the
other
doctor
or
nurse
or
team
is
doing.
I've
even
come
out
of
hospital
without
a
discharge
summary,
despite
medication
being
changed,
and
then
you
try
and
get
your
gp
to
change
your
medicine.
C
C
C
I
personally
have
been
put
in
seclusion
and
segregation
illegally
when
I
wasn't
even
under
a
mental
health
activation.
But
at
that
point
in
my
life
I
didn't
know
enough.
This
was
well
before
I
started
working
with
cq,
so
I
didn't
know
enough
about
the
mental
health
act
to
know
that
what
was
happened
was
illegal,
but
I
wasn't
in
a
very
good
place
anyway,
and
that
made
me
so
much
worse.
C
Yeah
sensory
overload
because
of
the
environment
of
the
hospital
there's
always
light
sun,
usually
fluorescent
lighting,
there's
always
noise
and
movement.
Quite
often,
you
have
conflicting
noises,
so
there
might
be
in
one
area
a
tv
on
one
noise
and
a
radio
and
people
walking
past
and
talking
and
if
you're,
in
a
hospital
that
insists.
You
can't
spend
your
day
time
in
the
bedroom
but
you're,
subject
to
that
in
the
communal
areas.
C
And
then
they
wonder
why
you
get
stressed.
I've
had
threats
of
restraint
and
threats
of
the
mental
health
act
and
forcible
medication,
and
I
appreciate
the
out-of-sight
report
was
looking
at
actual
restraint
and
seclusion.
But
coercion
and
threats
is
just
as
much
of
an
issue
in
my
personal
opinion
and
delays
to
discharge,
not
even
just
one
delay
but
multiple
delays
and
you
get
yourself
mentally
prepared
to
be
going
home
on
a
certain
date
and
then
to
put
back
a
week
and
another
two
weeks
and
that
can
instill
a
sense
of
hopelessness
in
itself.
A
A
I
mean
it
was
good
to
hear
amanda
about
some
of
the
good
things
that
you've
experienced
and
some
of
the
better
care
that
you
have
started
to
experience.
It's
just
a
shame
that
it
took
you
so
long
to
be
able
to
get
that
and
that
the
responsibility
it
felt
like
was
on
you
to
inform
yourself
about
your
own
rights
and
to
kind
of
advocate
for
yourself.
Instead
of
the
system
being
there
to
support
you,
so
sorry
about
that,
so
the
next
question
that
I've
got
is
is
about
the
barriers
you
know
we've
talked
about.
A
I
mean
me
and
julie
have
talked
a
lot
about.
You
know
it
seems
really
simple,
like
it's
not
rocket
science,
but
yeah
here
we
are
so
what
do
people
think
some
of
the
main
barriers
are?
If
you
don't
mind,
amanda
might
just
go
to
you
first
again
like.
Why
do
you
think
this
isn't
better
like?
What's
the?
How
do
we
overcome
it?
Thanks.
C
For
me,
a
personal
example
of
that
is
times.
I've
tried
to
avoid
hospital
admission
and
access
respite
care,
but
the
physical
health
respite
care
settings
wouldn't
take
me
because
of
my
mental
illness,
but
the
psychiatric
ones
wouldn't
take
me,
because
I
had
to
use
medical
equipment
be
that
a
catheter
or
a
feeding
tube,
even
though
I
use
them
independently
at
home
when
I'm
well,
they
refused
it.
So
I
had
to
be
hospitalized
because
there
wasn't
appropriate
respite.
C
C
One
of
the
things
debbie
mentioned
early
on
was
about
cetr's
care,
education
and
treatment,
reviews
that
this
has
been
they've
been
around,
since
I
think
2015
they've
been
best
practice
since
the
2017
nhs
england
advice.
It
was
reiterated
in
the
out-of-sight
report
in
2020,
yet
there's
so
much
variance
on
trying
to
get
them
done.
C
Despite
this
having
been
best
practice
since
2017
being
a
thing
since
even
before
then,
and
the
other
big
barrier
that
I
personally
have
found
is
even
when
hospitalization
may
be
necessary
for
someone's
safety,
and
I
I'm
definitely
the
opinion
that
therapeutic
risk
taken
in
the
community
is
often
the
preferred
option.
Even
when
that
is
needed.
A
B
As
amanda
said
earlier,
you
know
it's
completely
the
wrong
environment
and
completely
the
wrong
environment.
It's
too
big!
It's
too
noisy.
It's
too
bright.
It's
to
everything
I
mean,
and
I've
got
it
here.
It
says
in
the
mental
health
that
code
of
practice
that
compulsory
treatment
in
a
hospital
setting
is
rarely
likely
to
be
helpful
for
a
person
with
autism,
who
may
be
very
distressed
by
even
minor
changes
in
routine
and
is
likely
to
find
attention
in
hospital
anxiety.
B
B
Why
is
why?
Is
that
ignored?
So
I'm
gonna
defer
to
amanda
on
the
descriptions
of
the
environment
and
their
autistic
experience
of
that,
but
yeah
absolutely,
and
if
you
put
someone
in
in
a
situation
that
they
can't
tolerate
and
expect
them
to
behave
in
a
way
that
you're
imposing
on
them,
then
it's
not
exactly
gonna,
be
a
very
easy
for
that
person
to
succeed.
B
In
my
opinion,
other
perverse
incentives
which
exist
are
the
the
financial
difficulties
in
terms
of
people
coming
out
of
hospital
that
may
be.
100
is
100
funded
by
the
national
health
service
to
a
setting
that
needs
to
be
funded,
at
least
in
part
by
the
local
authority
and
local
authority
budgets
being
as
as
tight
as
they
are.
They
don't
necessarily
want
to
be
too
quick
to
take
on
the
responsibility
for
the
care
of
someone
who
would
otherwise
not
you
know,
be
funded
by
the
nhs.
So
there
are
financial
issues
here.
B
The
workforce
is
poorly
trained,
poorly
supervised
and
poorly
paid,
and
I
know
there
are
some
great
people
working
in
these
hospitals
for
sure
who
deserve
much
better
than
that,
but
sadly,
the
way
things
operate.
It's
too
easy
for
the
close
cultures
to
develop
other
barriers.
The
discharge
for
me
are
lack
of
the
right
housing
and
very
much
poor
local,
commissioning
decision
making
and
lack
of
follow-up
where
people
are
in
services,
and
these
are
the
sorts
of
things
that
need
to
be
resolved
with
accountability
at
local
level.
B
Being
more,
you
know
required
we
might
actually
get
further,
but
there
isn't
any
accountability
really
for
poor
commissioning
decisions.
So
I
think
what
we
need
going
forward
is
a
rights
based
approach.
Human
rights
needs
to
be
at
the
core
of
this,
as
I
think
the
hopes
the
hopes
scheme
says
that
too
we
need
accountability.
B
We
need
upfront,
ring,
fenced
or
audited
funding
for
community
services,
but
as
well
as,
though,
all
that
we
need
trust-
and
the
way
I
describe
trust
is
you
know,
let's
have
proper
consultation
with
people
and
families.
Let's
make
sure
families
can
raise
concerts
safely,
let's
not
other
people
with
bizarre
language
that
professionals
like
to
use.
You
know
with
these
words
like
activities
of
daily
living,
which
you
only
have
to
do
if
you're
in
health
and
social
care
you
never
get
to
do
them
if
you're
just
living
in
all
my
ordinary
life.
D
B
A
D
D
So
I
think
there's
got
to
focus
on
partnership
work
and
we've
got
to
focus
on
people
and
people
in
the
services,
not
the
service
itself.
We've
got
to
think
about
what
is
the
right
support
for
that
person?
How
do
they
get
access
to
it
at
the
right
time,
with
the
right
thresholds
allowing
people
to
get
what
they
need
where
they
need
it,
we've
got
to
get
it
right.
First
time
we
can't
have
people
just
going
around
around
the
system
in
this
way.
D
Now
I
guess
for
me
underpinning
all
of
this
is
funding
and
commissioning
these
really
do
need
to
be
tackled,
and-
and
again
I
mean
julie's-
talked
about
some
of
the
first
incentives
and
things.
But
what
what
I
think
the
answer
has
to
be
is
that
local
areas
ics's
need
to
accept
the
responsibility
for
the
services
in
their
area
and
get
those
plans
in
place.
How
we're
going
to
meet
people's
needs
now
start
to
look
at
future
needs.
D
What
do
we
need
for
the
future,
and
I
think
we've
got
to
really
get
a
different
kind
of
view
on
some
of
this
start
thinking,
community
start
thinking,
citizenship
and
what
can
really
strengthen
those
local
communities
to
recognize
and
respect
every
individual
and
think
about
what
they
need
within
that.
So
I
sometimes
think
I
sound
a
bit
like
my
dad
who,
who
used
to
be
a
bit
a
preacher,
but
you
get
into
this
place.
You
think
we've
got
to
stop
some
of
the
things
that
we're
doing.
We've
got
to
stop
thinking
in
silos.
D
D
We've
got
to
change
our
approach
from
thinking
about
placements,
to
finding
a
life
for
people
and
and
those
things
that
that
julie
was
saying
about.
You
know
the
activities
of
daily
living
we've
got
to
get
away
from
that
we've
got
to
think
about
what
is
our
ambition
for
people
and
their
lives
and
really
make
a
difference
in
the
way
and
the
approach
that
we
have.
A
D
To
think
about
is
how
do
we
really
improve
the
care
that's
delivered
in
hospitals?
I
think
it
means
what
we
really
need
to
focus
on
is:
what
is
the
model
of
care
that
we
actually
want,
and
what
is
the
culture
of
those
services?
For
me,
the
most
important
thing
is
culture:
how
is
the
service
recognizing
and
respecting
each
person's
humanity,
each
person's
rights
each
person's
aspirations
for
for
their
lives?
How
are
staff
working
with
each
individual
to
plan
their
care
around
those
things
recruiting
training
and
supporting
staff?
D
I
think
it
was
it
was,
as
judy
said,
you
know,
is
essential
to
getting
this
right.
That's
what
we
need
to
think
about
is
is
that
sort
of
high
quality
specialist
care
for
people
who
are
in
hospital,
which
hopefully
will
be
for
a
very
short
time,
and
it
should
start
by
focusing
on
discharge.
So
what?
What
does
that?
What
does
that
mean
for
people
I?
I
guess
it
means
that
people
would
only
be
admitted
to
hospital,
occasionally
as
a
last
resort
and
for
the
shortest
time
possible.
D
So,
rather
than
think
about
how
many
hospitals
a
week,
do
we
need,
and
what
do
we
need
thinking
about?
Actually
what
how
do
we
meet
that
the
focus
right
from
the
beginning
needs
to
be
on
discharge
and
planning,
for
that
would
start
before
you're
even
admitted
so
people
will
be
properly
involved
in
that
planning,
alongside
their
families
and
all
those
involved
with
their
support.
D
Perhaps
people
would
be
assessed
by
community
teams
before
admission,
so
people
who
actually
understand
them
and
understand
their
needs
back
to
what
what
amanda
was
saying
about
having
that
that
care
education,
treatment
plan
before
you
go
in
into
a
hospital
setting
objective
should
be
set.
What
is
this
placement
for?
What's
it
going
to
actually
do
and
then
measured,
so
that
people
are
actually
getting
high
quality
care
for
that
short
period
of
time
to
get
them
back
out
again?
C
I
think
one
thing
that
really
has
irked
me
on
almost
every
psychiatric
commission
to
have
is
the
activities
that
are
provided
on
the
ward,
assuming
they
even
go
ahead,
which
half
the
time
they
don't,
because
there's
not
enough
staff.
Are
they
really
meaningful
and
individualized
like
th
there's
a
few
adults?
I
know
that
would
like
coloring,
but
many
people
an
hour
coloring
in
coloring
pages,
with
heavily
supervised
pencil
crayons
is
not
meaningful
and
is
not
going
to
help
them
get
back
into
the
community.
C
If
you're
going
to
do
cooking
with
the
occupational
therapist,
are
you
cooking
something
that
you
actually
want
to
eat
that
you
might
eat
and
prepare
when
you're
back
at
home?
Or
are
you
cooking
something
that
is
deemed
easy
for
a
group
of
six
people
who
can
fit
in
the
kitchen
to
cook
together,
so
the
activities
need
to
be
meaningful
and
with
discharge
planning
I
I
would
love
to
see
levels
of
step
down
services
day
day.
Hospitals
are
out
of
fashion
now,
but
my
personal
experience
is
they've.
C
Helped
me
go
from
that
inpatient
thing
to
having
daily
support,
but
without
the
restrictions
of
a
hospital
but
having
the
consistent
staff
people.
I
know
a
place.
I
know
having
that
step
down
to
facilitate
earlier
discharge,
but
still
with
support,
whether
that's
a
day
host
or
whether
that's
something
else
but
yeah.
A
A
B
B
A
D
D
D
We
don't
talk
about,
I'm
going
to
access
the
community
this
weekend,
I'm
going
to
go
for
an
activity
by
going
to
the
pub
you
know
we
go
to
the
pub
we
go
out
for
the
day.
We
we
do
voluntary
work,
we
get
involved
in
things
in
our
communities,
all
those
things
that
make
us
people
of
value,
and
I
think
those
things
are
really
important.
B
But
there's
the
obvious
things
I
think,
like
obviously
invest
in
housing,
invest
in
the
workforce,
make
sure
you've
got
good
community
teams
with
with
you
know,
psychology
speech
and
language
therapy.
Occupational
therapy
make
sure
it's
not
psychiatry-led
it's.
You
know
it
should
be
led
by
therapists
really
and
then
good
crisis
supports
if
needed,
but
I
think
you
know
we
could
be
ambitious
and
say
if
we
have
good
systems,
we
might
not
even
get
to
crisis.
B
C
C
C
Yes,
autism
and
learning
disabilities
are
lifelong
things,
but
other
things
stresses
because
your
house
isn't
appropriate
stressors
because
you've
just
lost
your
voluntary
work
or
you've
had
a
bereavement.
They
can
make
illnesses
or
presentations
different
at
different
times,
but
services
aren't
always
flexible
to
meet
those
different
needs.
When
you
might
need
a
bit
more
or
a
bit
less
input
people
willing
to
take
therapeutic
risks
or
positive
risks.
You
know
don't
say
someone
has
had
this
incident.
They
must
be
put
in
hospital
to
keep
them
safe.
How
about
thinking?
What?
C
What
can
we
do
to
help
this
person
stay
safe
in
the
community?
Can
we
put
in
equipment
support
whatever
and
two
things
that
I'd
like
to
throw
in,
as
what
would
be
my
ideas
would
be
budgets
that
go
across
health
and
social
care
and
follow
one
individual
and
even
complex
care
consultants
for
wanting
a
better
phrase,
someone
or
just
letting
a
gp
who's
known
the
patient
for
years,
potentially
have
authority
to
say
this
person
may
have
a
mental
illness
of
depression
anxiety,
but
they
also
have
autism.
They
also
have
this
stomach
problem.
A
C
Susie,
as
we've
discussed,
there's
so
many
things,
but
I
think
the
key
thing
for
me
would
be
access
to
care
at
the
point
of
need
in
the
community
if
things
are
beginning
to
escalate
being
able
to
get
support
as
soon
as
possible
as
active
and
flexible
as
possible,
so
that
hospitalization
isn't
considered
the
only
option.
That
would
be
my
main
thing,
but
there's
so
much.
A
B
Think
we
should
definitely
take
a
close
look
at
commissioning
and
supporting
commissioners
better,
possibly
by
membership
of
a
central
body
in
the
same
way
as
other
professionals
are,
that
could
provide
training
and
cpd,
and
you
know
possibly
examinations
if
necessary.
All
that
kind
of
support
that
commissioners
could
have.
B
I
do
think
we
need
to
possibly
regulate
commissioning
more
closely,
because
commissioners
have
an
awful
lot
of
money
at
their
disposal
and
a
lot
of
power
over
people's
lives.
So
I
think
we
we
definitely
ought
to
be
taking
a
long,
hard
look
at
how
commissioning
functions
and
how
that
can
be
improved.
A
Thanks:
okay:
well,
it's
been
a
really
interesting
discussion.
I
think
everyone
shared
some
really
interesting
ideas,
some
quite
powerful
and
personal
stories
as
well,
so
special
thanks
to
julie
and
amanda.
For
that-
and
I
know
you've
both
told
your
stories-
probably
upwards,
of
100
200
times
different
people
across
the
system,
so
really
appreciate
you
telling
our
listeners
your
story
again.
I
hope
it
will
make
a
difference
and
I
hope
people
will
listen
to
it
and
take
action
as
a
result.
A
A
Please
do
keep
up
to
date
with
all
of
the
work,
we're
doing
to
try
and
transform
the
way
that
cqc
can
change
services
for
people
with
a
learning,
disability
and
autistic
people
in
our
blogs,
bulletins,
etc,
and
other
links
are
in
the
podcast
description
too,
and
we've
got
lots
more
cqc
podcasts
coming
up,
so
please
do
look
out
for
those
soon.
Thanks
again,.