“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