New guidance and training aims to stop inappropriate use of restraint in care settings

The government has launched new guidance that aims to reduce the use of restraint and restrictive interventions in health and adult care settings. 

To back this up, the government has also announced it is investing £1.2 million in a new training programme, called Positive and Safe, which will support staff to avoid the use of all restrictive interventions, which include physical, chemical, medical and mechanical restraint and seclusion.

The new guidance on the use of face-down restraint and other restrictive interventions has been developed jointly by health and care professionals and service users, and led by the Royal College of Nursing (RCN). It will ensure staff are given the best possible information and support, enabling them to give high quality care while also keeping themselves safe.

This forms part of a 2-year strategy to overhaul the out-dated use of restrictive interventions in all health and care services.

The guidance does recognise there might be rare occasions where staff need to restrain people – for example, to stop someone from harming themselves or others – but emphasises this is only used as a last resort and for the shortest time possible.

Care and Support Minister, Norman Lamb, said: “No-one should ever come to harm in the health or care system. Although it is sometimes necessary to use restraint to stop someone hurting themselves or others, the safety of patients must always come first.

“This new guidance will stop inappropriate use of all types of restraint, reduce this out-dated practice and help staff to keep patients safe.”

No repeat of Winterbourne View

Dr Peter Carter, chief executive of the RCN, said: “Nobody wants to see a repetition of the horrific events of Winterbourne View. Nurses have been at the forefront of developing the new approach, which is the result of committed co-operation between professionals, and which makes use of the views of those who have experienced physical intervention.

“This moment is a major step forward in making difficult situations more manageable, and it is at the heart of compassionate care. The Government’s resolve in bringing about this change is to be applauded and the RCN will be working with them to make this approach a reality for all vulnerable people.”

Paul Farmer, chief executive of mental health charity Mind, welcomed the guidance as: “a significant step towards changing attitudes to restraint and ending face-down restraint.

“We know that healthcare staff do a challenging job and sometimes need to make difficult decisions very quickly. This is comprehensive guidance that looks to address the system as a whole, transforming cultures and attitudes so that difficult situations are less likely to arise and so that staff are supported to use alternatives to restraint when faced with challenging behaviour.

“When someone is in a mental health crisis they need help, not harm. Physical restraint can be humiliating, dangerous and even life-threatening and our own research indicates that some trusts are currently using it too quickly. We look forward to seeing this guidance implemented in health and social care services across England for the benefit of all people with mental health problems and the frontline staff who support them through crisis.”

Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health) at the Care Quality Commission (CQC), added: “This guidance is an important contribution to ensuring that people with mental health problems receive services that are compassionate and caring. Positive relations should be the basis of good, safe care and the use of restraint should always be a last resort. 

“CQC’s work has shown that people who provide care services too often lack a proper understanding of when or how restraint should be used. This new guidance from the Department of Health is an important step in improving that understanding. CQC is working with the NHS Confederation to develop supplementary guidance explaining how we will interpret and apply the new DH guidance and explaining the implications for organisations.”