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Positive and Safe: reducing the need for restrictive interventions

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Title: Positive and Safe: reducing the need for restrictive interventions


1
Positive and Safe reducing the need for
restrictive interventions
2
Why?
  • Winterbourne View
  • Restraint was not always used only as a last
    resort
  • Concerns about the use of anti-psychotic and
    anti-depressant medications
  • Other restrictive practices common
  • Subsequent investigations show that these
    findings are widespread

3
Reducing the need for restrictive interventions
  • Mind Report
  • Differences in the use of physical restraint
  • Over-use does occur
  • Not always as last resort
  • A number of deaths have been associated with the
    use of physical restraint
  • Mind Report
  • 49 NHS Trusts
  • 20,000 incidents of restraint
  • Range 3,000 less than 50 per Trust
  • 19,000 people retrained
  • 1,000 restraint related injuries (60 response)
  • Doesnt include Independent sector

4
Restrictive interventions current UK situation
  • Large variation in restrictive practices between
    hospitals / services
  • Rates unmonitored or declared
  • Creeping increases in coercive practices
    locking, CTOs, detentions, expansion of MSUs,
    opening of seclusion rooms
  • Evidence of scope for reduction not just
    seclusion and manual restraint, but also rapid
    tranquillisation, special observation, PRN
  • No evidence for increasing violence or injuries
    to staff
  • Currently 4 reduction strategies
  • Six core strategies Huckshorn, Duxbury
  • No Force First Ashcraft, Recovery Inc., -
    Trenchard
  • Positive Behavioural Support long history in LD
    and US Schools
  • Safewards Bowers

5
Reducing the need for restrictive interventions
  • 10 shared commitments
  • Above all - health care services should be
    positive, caring and safe
  • Promoting a therapeutic environment, enabling
    positive, compassionate caring that promoting
    physical and emotional wellness
  • Treating all people with dignity caring and
    talking to them in a safe and therapeutic way
  • Restrictive practices have no place in a modern,
    compassionate health and care service
  • Restraining, secluding or excessively medicating
    people should only ever be used as a last resort

6
Reducing the need for restrictive interventions
  • 10 shared commitments
  • Promoting positive alternatives, such as positive
    behaviour support and de-escalation techniques,
    are the most effective means of reducing
    restrictive interventions
  • Being open, honest and transparent about the use
    of restraint and restrictions. They must be
    recorded, reported openly and reviewed. Patients
    and families should be communicated with
  • Genuine co-production, with experts by
    experience, of policies and training. These
    should include alternative, positive measures and
    means of de-escalation
  • Destructive and dangerous cultures must change.
    Leaders must stand up publicly for stopping
    outdated and damaging restraint and restrictions
    in health and care services
  • Assault is assault. The intentional use of pain,
    restraints or restrictions to punish, hurt or
    humiliate is never acceptable and will not be
    tolerated

7
Positive and Proactive Care
  • Key Principles
  • Compliance with the relevant rights in the
    European Convention on Human Rights
  • Understanding peoples behaviour allows their
    unique needs, aspirations, experiences and
    strengths to be recognised and their quality of
    life to be enhanced
  • Involvement and participation of people with care
    and support needs, their families, carers and
    advocates is essential
  • People must be treated with compassion, dignity
    and kindness
  • Services must support people to balance safety
    from harm and freedom of choice
  • Positive relationships between the people who
    deliver services and the people they support must
    be protected and preserved.

8
Positive and Proactive Care
  • Aims
  • Cultural change
  • Therapeutic environments
  • Focus on quality of life
  • Governance models
  • Reducing reliance on restrictive interventions
  • Learning, sharing and promoting practice
    innovation
  • To ensure that restrictive interventions are used
    in a transparent, legal and ethical manner

9
Key Actions
Improving care Individualised support planning Behaviour Support Planning Greater user / carer involvement
Leadership, assurance accountability Board level responsibility Focus on proactive as well as reactive management Reduction plans Training Reporting to commissioners Post incident reviews
Transparency Publishing data
Monitoring oversight CQC monitoring and inspection Accountability
10
But this is part of a wider set of actions
  • NHS Protect
  • Mental Health Crisis Care Concordat
  • NHS England and LGA Core Principles Commissioning
    Tool (for services for people who display
    behaviour that challenges)
  • Skills for Health and Skills for Care
  • NICE
  • Mental Health Act Code of Practice
  • Childrens volume of Positive and Proactive Care

11
The Way Forwards
  • Government level support
  • Careful attention to policy and regulation
  • Service user, family and advocate involvement
  • Effective leadership
  • Training and education
  • New ways of working
  • Staffing changes
  • Using data to monitor the use of restrictive
    intervention
  • Effective review procedures and debriefing and
  • Judicious use of medication.

12
Positive and Safe - goals
  • Creating and sustaining safe, therapeutic and
    compassionate environments where the focus is on
    recovery and avoiding harm, which covers
    different conditions and is responsive to
    peoples individual needs.
  • Wherever the health or social care staff are
    delivering care, including in both hospitals and
    peoples homes and anywhere else it may be
    required.
  • To significantly reduce the need for the use of
    restrictive practices.
  • It is very important that we also remember
    Winterbourne View and ensure we have the right
    focus on different groups and their particular
    needs, including those with learning disability
    or autism and behaviour that can challenge as
    well as the experiences of other groups, such as
    those from minority ethnic communities.

13
How well achieve this five work streams
  • Transparency monitoring, reviewing and reporting
  • Baseline review of use of PBS and restrictive
    practices across NHS and LA funded provision
  • Revisit arrangements for NRLS reporting of high
    impact restrictive interventions
  • Support self reporting via Quality Accounts
  • NHS England led project on use of medication for
    LD and CB
  • Standards, guidance and maintaining compliance.
  • CQC fundamental standards
  • Positive and Proactive Care
  • Updating the MHA Code of Practice
  • Exploring the need for other legislative /
    national policy guidance
  • NICE guidance due 2015
  • Work with NHS Protect
  • Work with HSE
  • Children and Young People Guidance
  • Workforce, training and development.
  • Positive and proactive workforce
  • HEE mandate and Skills for Care programme
  • Explore issues re training accreditation
  • LD professional senate and / or MH Joint
    Commissioning Panel key principles for training
  • Develop expert by experience guide to training
  • Support access to PBS training
  • Explore eLearning opportunities
  • Commissioning and contracts
  • Revised NHS Standard Contract re PBS and policies
  • Develop work on mental health strategic clinical
    networks and Crisis Care Concordat
  • NHS LD service specification
  • Work with LGAand ADASS to develop social care
    facing projects
  • Communications, culture leadership
  • Champions initiative
  • Web based information and practice exchange
  • Sharing stories along the journey
  • Research and academic partners
  • User and carer group involvement e.g. MIND,
    mencap etc..
  • Explore behaviour change project
  • BME focused group re afro-carribean users and non
    discriminatory practice

14
How well achieve this reporting and partners
  • Partners
  • Patients, service users, carers, families and
    support and advocacy organisations
  • NHS England
  • LGA and ADASS
  • CQC
  • HEE, Skills for Health, Skills for Care
  • NICE, SCIE
  • NHS Protect
  • HSE
  • CCGs and LAs
  • providers, esp provider boards and senior
    management teams
  • Royal Colleges, directors of nursing and other
    professional leaders, trade unions and networks
  • Learning Disability Professional Senate
  • Academics and researchers
  • BILD
  • DfE, MoJ, Home Office
  • Etc

Mental Health Systems Board
Positive and Safe Steering Group
Champions Group
Agreed projects, initiatives and actions
15
Issues for today?
  • How can we work together to identify and agree
    the actions required from now to deliver the
    outcomes and establish and maintain momentum for
    this work, including leadership for particular
    activities or themes.
  • How can we co-ordinate various activities.
  • How can we identify and secure relevant resources
    within our organisations and recognise when we
    might be a resource to others
  • How we best communicate the cultural changes that
    are the programmes goal
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