Title: Positive and Safe: reducing the need for restrictive interventions
1Positive and Safe reducing the need for
restrictive interventions
2Why?
- 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
3Reducing 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
4Restrictive 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
5Reducing 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
6Reducing 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
7Positive 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.
8Positive 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
9Key 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
10But 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
11The 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.
12Positive 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.
13How 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
14How 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
15Issues 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