The use of restrictive interventions should always be as a ‘last resort’ and always in the context of a clear and agreed individualised plan of support. However, the events at Winterbourne View suggested that not only was this not always the case, but that in fact these approaches were sometimes being used to humiliate or punish individuals.
As a result of the subsequent serious case review, there was a clear call for a set of new guidelines, and the Department of Health have now produced new guidance, “Positive and Proactive Care: reducing the need for restrictive interventions.“
This guidance is clear that whilst restrictive interventions may be required in life threatening situations to protect people who use services and staff and reiterates the need for such interventions to be used as part of an agreed care plan.
The guidance will form part of a two year initiative by the Department of Health to improve reporting, training and governance.
The guidance is based on six key principles
- Compliance with the European Convention on Human Rights
- Understanding behaviour to ensure unique needs, aspirations, experiences and strengths are recognised and quality of life enhanced
- Involvement and participation of people supported, their families, carers and advocates
- Compassion, dignity and kindness
- Balance between safety from harm and freedom of choice
- Building and preserving positive relationships between people who deliver services and people they support
Interestingly, the guidance sets out a very clear practice framework, which stresses individualised approaches and positive behavioural support, and states that the “introduction of PBS or similar principles in a systematic, organisation wide context is an important mechanism by which o deliver many of the key elements associated with restrictive intervention reduction programmes”
There are also a series of key actions, broken down into areas, which include actions on improving care, for example, clear guidance on not using restraint in such a way that airways are compromised or blocked.
There are actions for leadership, assurance and accountability for example stronger requirements for provider agency board level or equivalent oversight of practice in line with the guidance.
There will be a need for greater transparency through provider audit programmes, better data collection and analysis and information for commissioners on the use of restrictive interventions.
Finally, the Care Quality Commission’s monitoring and inspection programme will be strengthened in light of the guidance and they will look at the quality of behaviour support plans where these include the use of restrictive interventions.
The guidance also draws attention to the accreditation scheme run by the British Institute of Learning Disabilities (BILD) and we are expecting BILD to publish the fourth edition of their code of practice or minimising the use of restrictive physical interventions later this month.
There is an easy read version of the guidance available from the DH site.