I hope, like me, you have never experienced - or ever will experience - face-down restraint or other restrictive interventions. However, I know some of you may have witnessed such events or restrained someone yourselves. I can only imagine what this must feel like. It is traumatic enough to feel out of control, but so much more distressing to experience others attempting to control you – sometimes in very intrusive and physical ways.
We call these actions ‘restrictive interventions’. They include seclusion and physical, chemical, medical and mechanical restraint. It is our view – as policy makers and clinicians - that they have been used far too often in our health and care services.
That’s why I’m delighted we’ve launched Positive and Safe today – a two year programme with the principle aim to radically reduce all restrictive interventions, including ending the use of face down restraint and - outside the Mental Health Act - seclusion.
Restraining people can be frightening and dangerous for staff and patients alike and we want to reduce – as far as possible – the circumstances where such actions are taken. At the launch of Positive and safe, we heard personal testimony from three people who had experienced restraint. They described what it felt like and the impact it had on them.
We have already seen terrible examples where the approach has been wrong or where staff have demonstrated callous disregard for the humanity and dignity of those they are meant to care for. The scandal of abuse at Winterbourne View is testament to this terrible fact.
That is why Positive and Safe is so desperately needed. It is a primary action arising from Closing the Gap: Priorities for Essential Change in Mental Health and also ties in to the aims and ideals of the recently launched Mental Health Crisis Care Concordat. However, the programme covers not just mental health but all health and adult social care settings.
Positive and Safe’s two-year programme will support making health and care services safe for both service users and staff, promoting therapeutic environments which respect service users’ dignity. To make the required changes requires high quality training and the recruitment and nurturing of staff who have the values and skills to make compassionate and safe judgements about the options available to them. Management and staff will receive guidance and training to adopt more positive behaviours and to create environments where patients feel safe and secure.
Thanks especially to the Royal College of Nursing for their lead on developing the new guidance. We have also worked closely with Skills for Care and Skills for Health to deliver workforce guidance and we thank them for their dedication and insight. Thanks also to MIND, the NHS Confederation, Challenging Behaviour Foundation and other partners in providing advice and counsel on key points.
We’re not saying good practice isn’t already out there in the system. We are already seeing great examples of joined-up approaches to policy and procedures and a reduction in the use of restrictive interventions. This is across a range of settings, including statutory providers and the independent sector.
In Salford, they have one policy for adult services focused on supporting individuals who exhibit challenging behaviour. This policy covers all staff working in health, the local authority and the voluntary sector. It sits alongside their pooled budget and allows them to support providers to build the appropriate skills through training offered by the joint service to all commissioned services.
It means everyone is on the same page and committed to supporting people with challenging behaviour, using the least restrictive practices and improving their quality of life. This has led to the removal of physical intervention from nearly all individuals’ support plans in the nine years since the single policy was introduced.
Offering consistent training and support is one thing, but we also need to make sure there is oversight of the system. That’s why we’re also very pleased to have the support and endorsement of the Care Quality Commission (CQC) in this enterprise:
We are absolutely supportive of the principles and will continue to focus on restraint and restrictive practices in our regular inspections [using] the legislative frameworks of the Mental Capacity Act and the Mental Health Act and this guidance.
Dr Julie Hankin, National Professional Advisor – Mental Health, CQC
In the meantime, we will be working closely with health and care providers, partner organisations, people who use health and care services, their families and carers and support organisations to implement the Positive and Safe programme. We will do this by sharing best practice and setting and monitoring standards of good care.
No one, whatever their mental or physical date, should endure restraint or control that traumatises or risks further harm to them or other people. I am very proud to be part of this enterprise – and if you work in care settings, especially with vulnerable people – I’m sure you will be too.
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