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Minimising Restrictive Practices - Guest Blog by Dr Ben Thomas

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Ben ThomasI would like to take this opportunity to tell you about the work  the Department of Health is undertaking to minimise the use of restrictive practices in health and social care settings. Later this year we will be publishing national guidance on best practice around promoting the use of Positive Behaviour Support and minimising restrictive practices, including the use of physical restraint across health and social care. 

For those of you who are not familiar with the term, Positive Behaviour Support  (PBS ) is a framework for developing an understanding of an individual’s challenging behaviour and using this understanding to develop more therapeutic and effective support.

The findings of Winterbourne View Hospital: a Serious Case Review, highlighted the misuse and over-use of restraint, where it was clearly not used as a last resort, the excessive and inappropriate use of medication, including anti-psychotics, along with other restrictive practices.

Follow-up reviews and inspections by the CQC have shown that these findings are more widespread than first envisaged. Moreover, discussions with nursing colleagues, service users and carers have indicated wide variations in practice, particularly in the use of seclusion and restraint.

There does seem to be a ground swell to adopt more positive therapeutic alternatives and  looking seriously at reducing the use of physical restraint and other restrictive practices. The guidance will provide clarity on the use of physical restraint as a last resort, with transparent reporting when this occurs, and a follow-up review so that lessons can be learnt. It recognises the difficult challenging work in which nurses are sometimes involved.

The Department of Health’s response to the findings of Winterbourne View committed to reviewing our previous guidance on the use of restraint and physical interventions and a number of stakeholders and organisations are involved in taking this work forward. As part of this work, I chair the ‘Positive Behaviour Support and Physical Intervention steering group.’ We have met regularly over the last year. Service users and carers, health and social care colleagues, representatives  from the public sector and charities have come together to ensure the guidance meets the needs of the people we serve. Together, we have reaped the benefits of collaborative working. 

We have commissioned the Royal College of Nursing to up-date the existing guidance. The RCN has led a multidisciplinary team to review and guide this process and, at the end of last year, published draft guidance on the minimisation of, and alternatives to, restrictive practices in health and adult social care, and special schoolsfor consultation. Details on the consultation can be found via the following link RCN Consultation on Restrictive Practices.  Already there has been a good response and I would encourage everyone who has an interest in this important area of patient care to respond by 13th February.

Several other areas of work will complement and further strengthen more positive and therapeutic approaches. Skills for Care and Skills for Health are developing a framework for commissioning training in PBS and the minimisation of restrictive practices. The Tizard Centre is developing a service specification on the use of PBS. NICE is developing quality standards on preventing and managing violence and aggression; and NHS England; e Health and Social Care Centre and the Care Quality Commission,  are working to improve the quality of the data and information reported on the use of restraint and other restrictive practices.

We realise that such transformational change cannot happen overnight and that is why we have developed a two year programme called ‘Positive and Safe.’ A major part of the programme will be to develop national training in PBS and other alternative positive practices. I know many of you have a real interest in the success of this programme. If you have any views or comments on this work and/or wish to be involved in its development, please contact me at

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