Consultation on the use of restrictive practices

Topics covered: Ridouts professional advice

The Department of Health have commissioned the Royal College of Nursing, supported by an expert reference group, to develop new guidance on the use of restrictive practices for patients in health and adult social care settings.  The aim of the guidance is to reduce the risk and the need for physical interventions.  A draft version of the guidance has been produced and is open for public comment until 13 February 2014.

The guidance is intended to cover all health settings for both children’s and adults and all social care settings for adults, and special schools, in England.  It has been produced in response to the report “Transforming Care: A national response to Winterbourne View” and aims to help providers deliver the quality of services that must be provided if further Winterbournes are to be avoided.

Some of the key recommendations listed in the guidance aimed at providers with service users with challenging behaviours include:

  • Individual Behaviour Support Plans in place, put together in partnership with service users and the people who know them best.
  • Where Behaviour Support Plans include restrictive practices, these practices should only be used if necessary to avoid potential harm, they are proportionate, the least restrictive option is used, they are imposed for no longer than necessary and incidences of the practices are recorded in an open and transparent manner.
  • Regular reviews of Behaviour Support Plans included within services internal audit programmes.
  • The CQC should seek assurances during service visits and reviews that people who are subjected to restrictive practices are supported by Behaviour Support Plans.
  • All services should have local policies that minimise the use of restrictive practices and ensure they are used in a safe and ethically acceptable manner.
  • Services must provide an annually updated document that summarises the restrictive practices used at the service.  The document should specify the training strategy, techniques used and the reasoning for the use of these practices.  The document must be available to service users and their family carers.
  • A supportive debriefing and post incident review process should follow each use of restrictive practices.  They should invite the staff involved, the service user and their families and carers to take part in the process.

The guidance considers approaches to different methods of physical intervention, including different methods of restraint. In considering the approaches it takes account of existing guidance and published research into both PBS (positive behavioural support) and physical interventions.  The guidance is also being aligned with the current review of the Mental Health Act (1983) Code of Practice and guidance that covers physical interventions, seclusion and segregation.

The guidance requires important actions to be taken by a number of different individuals and bodies including service providers, registered managers, local safeguarding adult and children boards and the CQC.  It is understood that the Department of Health intends to publish the guidance as statutory guidance in spring 2014.

You can access the full consultation document by following the link below:–adult-social-care–special-schools/?

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