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“That doesn’t happen in social care”
RRN conference
13.11.15
Marie Lovell
Co produced with
people who use
services, families,
providers and
trainers by Skills
for Care and
Skills for Healthhttp://www.skillsforcare.org.uk/Skills/Restrictive-
practices/Restrictive-practices.aspx
Positive and proactive care, &
A positive and proactive
workforce
All of social care and health
Minimising restrictive practices
Restrictive practices;
Stopping someone doing
something, or making them
do something that they don’t
want to do
More than just ‘restraint’
Page 12
A positive and proactive workforce
Who is ‘the workforce?
What do they do? where?
When?
What skills knowledge,
attitudes do they need? And
what do they already have?
When and how can we develop
the skills that are needed?
Developing workers to minimise all restrictive
practices.
ƒAll complete training in the Mental Capacity Act up to QCF unit MCA01, (level 3) and
other relevant legislation
ƒLearning about human rights based, positive approaches before any training or use of
restrictive interventions.
ƒSignificantly more time learning about pro-active approaches & non-restrictive
alternatives.
ƒBank / agency / casual / self-employed workers should receive the same training.
ƒLearning must be offered to individuals for whom restrictive practices are planned.
And their family carers or support network as appropriate
ƒInformation must be offered to anyone experiencing planned or unplanned restrictive
practices, and to their carers
All delivering learning or assessing competence should be occupationally competent
and hold a recognised teaching / training qualification*.
ƒAll learning should be co-produced; including the voices of the people & their carers ƒ
Workers in all social care and health services must have an appropriate level of
awareness of the specific needs of people with whom they may come into contact. ƒ
Workers should have an understanding of how to access specialist advice and
support including advice on the impact of culture and the environment.
ƒExecutive board members and their equivalents authorise the use of restrictive
interventions & must fully understand PBS and any physical interventions authorised
Services offering Positive Behaviour support (PBS) must meet the specifications for a
well trained workforce described in Ensuring Quality Services EQS
Ensuring Quality Services - workforce
1. All support workers receive training in PBS; refreshed at least annually.
2. All support workers with a leadership role should have completed or are
undergoing more extensive training in PBS which includes practice-based
assignments and independent assessment of performance.
3. All workers with a role (which may be peripatetic or consultant) of
assessing or advising on the use of PBS with individuals have completed,
or are undergoing, externally-validated training in PBS including both
practice and theory-based assignments with independent assessment of
performance at National Qualifications Framework level 5 or above.
4. All workers involved in the development or implementation of PBS
strategies receive supervision from an individual with more extensive PBS
training and experience. Workers in consultant roles are supervised by an
individual (within or outside the organisation) with a relevant postgraduate
qualification, e.g. applied behaviour analysis, positive behaviour support,
clinical psychology.
• Positive behavioural Support e-learning package
• “Winterbourne View – time for change 2014” (Sir Stephen Bubb) and
review report July 2015
• Think Autism, HM Government (2014)
• Children and Families act / “SEND” Code of Practice
• Transforming Care – Next Steps, NHS England and System Partners
(Feb 2015)
• The 2015 NAO Report Care Services for People with Learning
Disabilities and Challenging Behaviour.
• January 2015; mental health act revised code of practice
• NICE Guideline: Challenging behaviour and learning disabilities (Draft
May 2015) https://www.nice.org.uk/guidance/ng11 and service model
• Care certificate
• PBS competencies framework May 2015
• LD Competency framework August 2015
• NHS England draft service model
http://www.skillsforcare.org.uk
/Skills/People-whose-
behaviour-
challenges/Positive-
behaviour-support.aspx
Restrictions
Is this a planned restriction as part of a care plan?
Are you considering restricting someone?
Is there a real risk of serious harm to the individual or someone else?
Does the person
have the mental
capacity to make
this decision
themselves?
has every effort
been make to help
them decide ?
Is a restriction in
their best
interests?
does the
restriction need to
be carried out
now?
Is the person
detained under the
mental health act?
Is the restriction
necessary for their
treatment?
have you tried all reasonable non-
restrictive alternatives?
Is this the least
restrictive option?
Pages 15 and 16
Key Questions
A personal exampleEvidence, risks, tripping hazzards and MICROMORTS!
http://understandinguncertainty.org/
Professor David Spiegelhalter FRS. Winton Professor
of the Public Understanding of Risk.
and listen to the murmur of the cottonwood
trees,
Send me off forever but I ask you please,
“Don't fence me in” “Just turn me loose”
“Let me be by myself in the evenin' breeze,
“I want to ride to the ridge where the west
commences, and gaze at the moon till I
lose my senses”
“I can't look at hobbles and I can't stand
fences”
.
.
.
Dad and us 3 agency
‘care-givers’1 ‘manager +
finance function’
Day
centre
Carers support
SPECIALIST COMMUNITY
SUPPORT; occasional or
intermittent
GP
MAINSTREAM
SERVICES
Hospitals and community
health services, podiatry,
continence advice and
equipment, district nurses,
eye hospital
Blue badge
The ‘memory
clinic’; consultant
and CPN
DIRECT SUPPORT
optician
dentist
Annie and
Rhona
Care home
It’s all abut the balance
RISK
SAFETY FREEDOM
CONTRAINTS
Risk
“Physical health and safety can sometimes be bought at too
high a price in happiness and emotional welfare. What good
is it making someone safer if it merely makes them
miserable? . . And if this is where safeguarding takes us,
then is it not, in truth, another form of abuse?”
Lord Justice Munby
MICROMORT!
http://understandinguncertainty.org/
Professor David Spiegelhalter FRS. Winton
Professor of the Public
Understanding of Risk. Statistical
Laboratory in the University of Cambridge.
In fairness, I can see why Dad got
mixed up!
Free to leave?
“Even now Mark will take himself to ground when he
feels threatened… He felt out of control when he was
held by 4 people at school as part of their approach to
challenging behaviour” - Kadie
I know we all agreed (the medication) was for the best
for him and those around him………but I still feel I
killed him.” - Sister of a man with dementia
“When he said all this, his head was in his hands and
the look of grief and terror in his eyes. Nightmares
and panic attacks too …” Man’s mother
Five steps to Mental Wellbeing
How well do our services support people to follow this advice?
http://www.nhs.uk/conditions/stress-anxiety-
depression/pages/improve-mental-wellbeing.aspx
1. Connect with family, friends, colleagues and neighbours.
2. Be active – Take a walk, go cycling. Find the activity that you
enjoy and make it a part of your life.
3. Keep learning – learning new skills can give you a sense of
achievement and a new confidence. So why not a cooking
course, learning to play a musical instrument, or to fix your bike?
4. Give to others – even the smallest act can count; a thank you
or a kind word. Or volunteering at a community centre.
5. Take notice – be more aware of the present moment; feelings
and thoughts, your body and the world around you; "mindfulness"
“people” who use the service and those who work there!
If you have to take
something away. .
. find something to
put back
Questions
www.skillsforcare.org.uk
www.skillsforhealth.org.uk
Marie.Lovell@skillsforcare.org.uk
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