The desire to protect the vulnerable and to ensure distressed ill people are treated humanely and above all safely has motivated all of us working in - or with - the care and support sector to do more.
The Department of Health’s report into the scandal of abuse at Winterbourne View and its recent update - Transforming care one year on - demonstrates this resolve. Within its pages a promise was made to review existing guidance on the use of restraint, seclusion and other restrictive practices.
The Royal College of Nursing (RCN) has agreed to carry out a consultation on our behalf into the use of physical restraint across a wide range of health, adult social care settings and special schools. It presents a unique opportunity for service users, their families, staff and other interested stakeholders to respond to the consultation and help shape our final guidance, which will be published in March.
A broad team of experts will explore the use – and misuse – of physical restraint and other means of control.
It is already accepted that physical restraint should be used only as a last resort after all efforts to calm and reason with a person have failed. And where human force, straps, hand cuffs and other means of restraint are deployed, they must be done so by highly trained staff with the acute understanding this must be for the shortest possible duration.
One intended benefit of this consultation is to raise the standard and prevalence of appropriate training in the system. Health and care staff, wherever they work (in hospitals, A&E departments, ambulances, care homes and people’s own homes), should be able to perform physical interventions with minimal risk to the person involved. To this end, the Department’s partner organisations, Skills for Care and Skills for Health are to explore what more can be done in this area. More broadly, the National Institute of Clinical Excellence (NICE) is also developing quality standards on managing violence and aggression.
We urge you to contribute to this consultation and help protect the dignity and safety of vulnerable children and adults wherever they are in the care and support system.
13 comments
Comment by N . Clark posted on
Please engage with ALL health and social care professional bodies.
As part of inter professional teams and multidisciplinary working practice, this can take the opportunity of turning this situation into a proactive joined up working focus, to go forward in a professional manner and not as a scapegoating, stigmatizing campaign.
Comment by Andrew Wilson posted on
Some care staff are nervous about using positional aids such as lap straps and night time support systems as they fear being accused of restraining their clients. However such devices often enhanced safety, comfort and often function so are of genuine benefit and are provided to enhance daily living. This consultation is an opportunity to provide guidelines and reassurance for carers so that they can continue to use simple devices to improve quality of life.
Comment by Dr Felix Ugwumadu posted on
In recent times, there has been a significant increase of physical and verbal attacks on health and social care workers: on the wards; A&Es; residential/nursing homes and homecare settings. These have exposed workers to vulnerability, of which they could seriously be injured and, or in severe cases lost their lives. On reflection, staff cannot retaliate otherwise that could be deemed as abuse of vulnerable persons of which, they might be charged for abuse. Yet, if convicted would lose their pin number and be unable to practice their profession again. On the other hand, attacks on staff could open up floodgates for litigation against employers (health and social care sectors) for not safeguarding their staff at work. However, it is worth mentioning that, conditions in some of the setting such as; staff shortage could trigger of stresses and frustrations amongst patients and their families. And to some extent, they might exhibit challenging behaviours, which would be regarded as anti-social conducts and attitude. Addressing these issues requires a host of measures such as: 1. having dedicated trained staffs that are capable enough to intervene and arrest situations. 2. Having enough staff on duty to manage throughputs and quick discharges from wards and A&Es. 3. Having senior managers on duty who would work with frontline staff to address trivial issues that could instigate arguments and misunderstanding. 4. Effective communication between staff and patient/families whilst listening attentively to their needs and fraustrations.
Comment by Laurie Harper posted on
Let's remember to consult and engage with service users and patients and their representatives, too, not just "all health and social care professional bodies".
Comment by N Clark posted on
Yes, fair point. In my experience though service users and/or carers are usually involved, whereas other professional groups aren't.
Comment by Dr Nicky Guy posted on
Thanks to those of you who have commented. This is an important and highly emotive issue. The intention with this consultation and revised guidance is to minimise the use of restrictive practices and the damage they can do to individuals, whilst also protecting staff, other people and the individual too. We are consulting widely and asking for views from a range of professionals by experience, both professionals and service users, patients, their families and carers.
Working together we have the potential to make considerable change to how services are delivered. The guidance is only the first part of the required cultural, leadership and professional practice changes that will be required to bring this about.
Comment by joe hannigan posted on
other means of control could be considered at the same time eg use of quiet room, medication by parenteral means or oral if quick acting. I have had patients who actually requested varying forms of restraint when troubled.but this entails a previous build up of trust and planning with the patient
Comment by Tina O'Callaghan posted on
I manage a residential home for people with Autism and challenging behaviour, we support some very vulnerable people to function in everyday life and in the community.
Restraint and whether it is justified is something I consider nearly every day, it is a very different story to be reading the paperwork from a restraint incident and deciding if the staff were justified, and making decisions when you are actually involved and faced with danger and injuries.
I feel it is vital that this consultation includes many frontline staff.
Comment by Sara Fulford posted on
It is crucial that any restraint policy/procedural document also covers equipment or restrictive practices which are employed to manage risk of harm (rather than just challenging behaviours). When we confined our procedures to physical interventions only, we found all sorts of other practices which could be used unnecessarily excessively, crept into use, without proper involvement and consultation with the right people. Most were used with 'best intention', (to protect people from harm) but without the right procedures. 'Best intention did not necessarily equate with 'best interests'. (The Cornwall enquiry also found similar restrictive practices, but used abusively. We shouldn't forget this learning when we also learn from Winterbourne View.)
Examples of these were restricting movement with lap belts, bed rails, removing mobility equipment, removing possessions eg cigarettes, money, clothing, restricting access to possessions, restricting access to food, use of listening or observational devices,Use of CCTV, observation, ‘peep’ holes in doors, locking doors etc.
Clearly many of these are used properly to manage agreed risks.
However, we had to make sure these were all covered in our Restrictive Practice Procedures. Used without the right risk assessment , discussion and procedures behind them, they can be mis-used abusively.
Comment by riapacker'virginmedia.com posted on
There are people who are abusing the authority they have by using the term 'best intention'I consider that my daughter and myself have sufferred considerably because of the mental health services generally and the unpleasant physical and mental restrictions which are imposed to manage patients. There is the ensuing long term anxiety which does not help the patient trying to retain a life in the community. Mrs. Ria Packer. The establishments themselves which were used to house patients are totally unsuitble..e.g. warren like buildings with no windows, harsh flourescent lighting, no outdoor space, no facilities for exercise, unqualified staff, staff who enjoy power over other people etc. etc.
Comment by Dr Nicky Guy posted on
Thank you everyone for your comments. I can confirm we are looking at how best to keep individuals receiving services and staff safe, increasing the use of positive behaviour support and minimising the use restrictive practices in the round (physical restraint, mechanical restraint, chemcial restraint and use of seclusion, segregation, plus environmental factors). I would really encorage people to respond to the consultation and feed in their views. It is crucial that this includes individuals, their families and carers, as well as professionals.
Comment by Dr Nicky Guy posted on
Hi everyone
I just wanted to flag that the RCN is still out to consultation but that this closes this Thursday. It would be great to get some more perspectives from professionals in social care and also service users and carers, so that we can make sure the guidance is right and that it works for social care settings.
The link is here: http://www.rcn.org.uk/support/consultations/pages/use_of_restrictive_practices_in_health_and_adult_social_care_and_special_schools
Many thanks
Nicky
Comment by J Sumnar posted on
I realise this is an old post but I found it when searching about restraint, as it still doesn't seem to be very clear when you should and shouldn't use it! At our home we use tilt-in-space chairs like https://www.yorkshirecareequipment.com/p/seating/lento-care-chair but tilt in space isn't always enough, we occasionally have to use chest harnesses to stop our dementia patients falling forwards and injuring themselves. However some of the families aren't happy with this so it's rather a difficult situation! would be glad of anyone else's thoughts...