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How health and care servicesshould support people whosebehaviour is very difficult.
This is an EasyRead version of:Positive and Proactive Care: reducing theneed for restrictive interventions.
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What is in this paper
About us 1
About this paper 2
About restrictive intervention (RI) 5
About the Mental CapacityAct (2005)
9
Who this advice is for 12
What our advice says 18
The most important thingswe believe
21
Actions - the most importantthings to do 24
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About us
We are called the Department of Health.
We are in charge of health and adultsocial care and support in England.
We want to make sure abuse neverhappens.
This means services must understandbetter ways to support people.
We asked people about better ways ofsupporting people whose behaviour is verydifficult.
This paper is about our new advice for
making sure staff do this properly.
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About this paper
In 2011 there was a TV programme abouta hospital called Winterbourne View.
Some staff at Winterbourne View treatedthe people who stayed there very badly.
We looked at care in other services forpeople whose behaviour is very difficult.
We found many staff do not understandhow to support people when they dothings like:
l
hurt other people
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l hurt themselves
l run away.
Staff might stop them or make them dosomething they do not want to do.
This is called restrictive intervention.
We explain more about this in a moment.
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Sometimes staff have to do this to keepthe person or other people safe.
Sometimes it is wrong and is abuse.
This paper is about our advice for makingrestrictive intervention happen less in:
l health services
l adult social care.
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About restrictive intervention
Restrictive interventionis when staff:
l make someone do something they donot want to do or
l
stop them doing something they wantto do.
They must only do this if there is no other
way to keep people safe.
When we talk about restrictiveintervention in this paper, we use RIforshort.
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We want health and social care servicesto:
l only use RI when other things have notworked
l understand other ways of supportingpeople when their behaviour is verydifficult
l share good ways of working
LAW l stick to the law and tell other peoplewhen they use RI.
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Different types of RI
There are 4 main types of RI
1. Physical restraintor intervention
when you stop the person moving partof their body. For example, hold themso they cannot hurt other people.
Staff must keep talking to the person tocalm them. They must check that they aresafe.
2. Mechanical restraintwhen you usesomething else to stop the personusing part of their body. For example, a
helmet, belt or splint on their arm.
Staff should only do this when nothingelse stops the person hurting them self orother people.
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3. Chemical restraintwhen you makesomeone take medicine to calm down.
Staff should only do this in a realemergency and use as little medicine asthey can.
4. Seclusionwhen you keep someoneaway from other people, this could bein a locked room. It is usually so theycannot hurt them.
LAW
Staff can only do this if the law allows it.
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About the Mental Capacity Act(2005)
In the advice we talk a lot about the
Mental Capacity Act (MCA).
When we write MCAin this paper wemean the Mental Capacity Act.
The MCA is a law about making decisions.Mental capacitymeans being able tomake your own decisions.
Staff must tell you about treatment orcare in ways you understand. They mustask if you agree with it.
The Act tells them how to find out if youcan make your own decisions.
You might be able to make somedecisions, but not others.
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The Act tells people what to do if youcannot make some decisions for yourself.
1.2.3.4.5.
People must think about 5 importantthings when they use the Act:
1. Start off by thinking everyone canmake their own decisions
2. Give the person all the support theycan to help them make a decision
3. No-one should be stopped frommaking a decision just becausesomeone else thinks it is wrong or bad
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4. If someone does something or decidesfor someone who does not havecapacity they must think if this is whatthe person wants
5. If someone does something or decidesfor another person they must do it in away that makes sure the person keepsas many of their rights and freedom aspossible.
If you need treatment or care in a hospitalor care home you should be free to dothings you want to do.
The Act says what must happen if youcant make your own decisions and staffstop you from leaving a hospital or carehome to give you care or treatment.
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Who this advice is for
Services
Lots of different people must make sureservices use RI well and give safe care.
This includes:
l people who run and manage services
l people who plan and buy services
l people who check how good services
are
l staff who work in health and social
care services wherever they give care
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l local groups who check services aresafe
l people who train health and socialcare staff
l people who train about RI.
The advice will help staff care for peoplewhose behaviour can be very difficultbecause of:
l their mental health
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l autism
l learning disability
l dementiaan illness that can makepeople very confused. People over 65are more likely to get it than youngerpeople.
RULES
There are different rules for the police and
prison staff.
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The Care Quality Commission (CQC)
The CQC check health and adult socialcare services in England.
This advice will help them decide whetherservices give good safe care.
They will think about how services userestraint (hold people) to stop themhurting themselves or other people.
They will check that services write downevery time they do this.
October2014
NRUEWLE
From October 2014 CQC will have a newstandard or rule to check whether servicesgive people the right type of safe care.
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Other people
The advice might also help:
l people who use services
l families and carers
l advocates and advocacy organisations
l the police
RULESl organisations that make rules about
services
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l councils
l lawyers
l security staff in health and social careservices.
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What our advice says
We want to make sure abuse neverhappens.
Staff need to understand whysomeone might hurt other people.
Some people do not get the right serviceor cant say what they need.
This can make them upset or angry.
This might mean they hurt themselves or
other people.
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Some services know someone might needRI.
uve Bha i
o rnPo
Supp rt
la
They will have a behaviour support plan
that says:
l what might make them angry or upset
l how to help them get angry or upsetless often
l how to calm them down
l what people who support them need.For example, training for support staff.
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Some services like hospitals or the policedo not know people well.
They must make things better for anyonewho might get angry or upset.
For example, having food or drink orsomewhere safe to go outside.
Their staff need to know about the MCA.
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The most important things webelieve
This advice is to help services only use RIwhen nothing else will work.
HumanRights Think about human rights the things that
every person has the right to expect.
For people whose behaviour is verydifficult this means:
l being involved in thinking about risk
and support
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LAW
HumanRights
l staff who know about the law andhuman rights
l not being treated worse than anyoneelse because of who you are or what
you believe in
l knowing about rights
l services that understand laws abouttreating people equally and fairly.
Understand the way people behave andhelp them do things that are important tothem.
LAW
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Involve people and their family or carerswhenever they can.
Treat people kindly and think about whatthings are like for them.
Support people to be safe without takingaway all their choices.
Make sure people who run services andpeople who use them can understand andtrust each other.
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Actions - the most importantthings to do
RI can be dangerous for both staff and forpeople whose behaviour is very difficult.
These things will help services:
l support people better
l keep everyone safe
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l give people better lives
l use RI much less.
Make care betterviou
r
Beha at
Suppor P
l n
People who might need RI must have abehaviour supportplan about how to help
them:
l not get angry and upset so often
l calm down if they get angry or upset.
viour
Beha at
Suppor P
l n This information will be in their care plan.
It will help staff use RI less often.
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Services will involve people, their familiesand carers in planning and checking alltheir care and support.
Staff must not hold people in ways thatcan stop them breathing.
Staff must not hurt people on purpose tomake them do something unlesssomeones life is in danger.
Staff should only use RI if they really needto and for as short a time as possible.
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Make sure services give good safecare
Directors or senior managers must show it
is important to use RI less.
They will have a plan for this and check ifit is happening.
They will also agree what training staffneed.
viour
Beha at
Suppor
Pl n
Directors or senior managers must look atbehaviour support plans each year.
They will use this to plan safer services.
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Services must write down how to keeppeople safe when they use RI.
Services must have a plan for using RI thatis easy for people and their carers tounderstand.
Services must tell commissionersif theyuse RI so they can check and act if theythink this is wrong.
Commissionersbuy services for localcouncils or health organisations.
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Check what is happening
The CQC will:
l think about how services use RI whenthey decide how good they are
l check how a service plans to use RIless often to give safe care
uve B ha iornPo
Supprt l
a
l look at behaviour support plans whenthey check services.
Commissioners will:
l make sure services are safe and rightfor the person
l check staff are well trained.
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Making sure RI happens less
RI should happen less because:
l it can hurt people
l sometimes it does not need to happen
l it stops people from doing what theywant
l it can mean people are left out.
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Services must have a plan that says:
l how managers will tell staff it is
important to use less RI
l how staff will involve people, theirfamilies and advocates
l better ways to support people
l how they will talk about it and learn ifthey have to use RI
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l how they will know RI happens less.
If staff need to use RI they must talk tothe person afterwards about:
l what it felt like for them
l whether they need any help or support
l why they got angry or upset
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l anything that could have been better
l how to stop it happening again.
If staff have to use RI
Some people have died or been hurt when
staff did not use RI properly.
LAW
Services must stick to the law and:
l only use RI if they really need to
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l only do RI for as short a time aspossible
l write down what they do and talkabout it afterwards
l be honest about what happened andwhy they did it
l never hurt someone to stop themdoing something
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l make sure the right staff are helpingwhen they do RI
l always think about what the person
wants.
LAW There are laws about treating people andmaking them stay in hospital.
Staff must talk to the person about whatthey are going to do.
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The MCA says what staff must do:
l if the person understands the decisionand refuses
l if the person does not understand thedecision.
What support organisations need to
do
Services that support people need to:uve B ha io
rnPo
Supp rt
la
l check plans about the support peopleneed, like their behaviour support
plans. CQC will look at these when theycheck services
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l have plans to keep staff safe and makesure they know the best ways to
support people
l write down when they use RI and why
they have used it. Let the public seethis information each year and sayhow they will make care safer
l services must also tell the NHS andother people who collect informationso services can learn how to do thingsbetter
l have clear plans about using RI safely.They should involve people who useservices and family carers or advocatesin writing the plans and checking howthey use them.
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Training
Staff who might use RI need specialtraining.
All staff need to understand RI and thinkabout:
l what it is like for people who useservices
l how to support people well
l what support staff need
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LAWl the law
l how to keep people safe
l how to talk to people after they haveused RI.
The training must help staff understandthe needs of people they support.
The training should involve people who
use services and carers. This will help staffknow what RI feels like for them.
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Staff must only use RI that they have beentrained to do.
What people who plan and buyservices must do
Commissionersbuy services for the NHSor local councils.
They must make sure services are safeand staff are well trained.
They must:
l only put people in services that haveplans to use RI less often
l make sure the service can support
them safely if their behaviour is verydifficult
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l check how the service is supportingthe person
l make sure the service trains its staffwell
l act quickly if they think a service is not
safe.
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Credits
This paper has been designed andproduced for the Department of Health bythe EasyRead service at Inspired ServicesPublishing Ltd. Ref ISL238/13. March 2014.
www.inspiredservices.org.uk
It meets the European EasyRead Standard.
It has been user-checked by theMaking It Easier Group of people withlearning disabilities.
Inspired
Artwork is from the Inspired Photo
collection and cannot be used anywhereelse without written permission fromInspired Services Publishing Ltd.
www.inspiredphotos.org.uk
