Exploring the Complexities of Restrictive Practices in Person-Centred Care Planning

In a comprehensive discussion, Rebecca Bauers, Interim Director for People with a Learning Disability and Autistic People, and Chris Dzikiti, Director for Mental Health, delve into the new cross-sector policy position statement on restrictive practice by the Care Quality Commission (CQC). This statement holds implications for service providers and underscores the rights of healthcare recipients. The conversation encompasses the diverse forms restrictive practices can assume, underscoring the pivotal role of person-centred, trauma-informed care. Recognising that these practices, including restraint, seclusion, and segregation, can inflict trauma, the CQC urges providers to curtail their usage swiftly, emphasising person-centred care at all times. The policy builds upon existing legislation and newfound powers that enable the evaluation of collaborations between local authorities and healthcare providers. It serves as a vehicle to ensure the delivery of recovery-promoting care that aligns with individual life goals. The CQC intends to enforce this cross-sector perspective across its regulatory scope. This demands that health and social care providers become well-versed in identifying restrictive practices and actively work towards their reduction. What defines restrictive practice? It involves compelling individuals to act against their will or obstructing activities they desire, employing restraint, confinement, or deprivation of liberty. These practices profoundly impact mental and physical health, sometimes violating human rights. The CQC acknowledges that restrictive practices might be necessary for safety in select cases. However, they must be proportionate, the least restrictive option, and only used to prevent severe harm. Proper authorisation is mandatory; any occurrence demands therapeutic support and comprehensive care plan revisions. While restraint, seclusion, and segregation are recognised as extreme, subtler restrictive practices can inadvertently permeate daily routines due to perceived risks or time constraints. The insidious nature of these practices calls for vigilant review to ensure they don't become the norm. Blanket policies represent another dimension of restrictive practices. These sweeping policies applied universally, irrespective of individual needs, are counter to person-centred, trauma-informed care. The CQC's stance challenges providers to re-evaluate and align with tailored care plans, recognising each individual's unique requirements. The policy mandates immediate action by leaders, systems, and care personnel to identify and minimise restrictive practices. Their approach must be grounded in understanding events leading to such incidents, learning from them, and proactively diminishing their occurrence. In its quest to reduce restrictive practices, the CQC positions itself as an advocate for person-centred care. They anticipate service providers will embrace positive cultures that foster trust, prioritise safety, and heed individual needs. Restrictive practices are envisioned as rare exceptions, overshadowed by well-considered, trauma-informed care plans designed to empower and nurture each individual's well-being. Ultimately, the CQC's emphasis on reducing restrictive practices underscores a collective responsibility within health and social care to uphold the principles of person-centred, trauma-informed care. This endeavour aims to create a system where restrictive practices are minimised and replaced by individualised, recovery-oriented care. For further insights, comprehensive courses are available both in-house and online via Learning Connect: https://www.learningconnect.co.uk/Inhouse/Person-Centred-Care-Planning and https://www.learningconnect.co.uk/Course/Care-Certificate/Standard-5-Work-in-a-Person-Centred-Way.