'We have a No Restraint Policy'

'We have a no restraint policy'.This is something I hear a lot when I am talking to clients about FCP Physical Intervention (PI) and Disengagement Training. Many services in Care and Education will state categorically that they do not restrain under any circumstance. In-fact, for many the word ‘restraint’ has a negative association attached to it. Hence the word itself has been removed from many training providers literature, changing from ‘control and restraint’, to more palatable terms like ‘physical intervention’, or ‘handling’, ‘holding’ etc.

There are perhaps some obvious reasons that the term is seen less. There have been numerous high-profile deaths across sectors where the victims have been both children and adults. The most common cause? Positional asphyxia resulting from the use of prone and seated restraint positions. There have also been high-profile cases of physical abuse and degrading practices like those used at the now infamous Winterbourne View. I understand why there can be some anxiety when commissioning training relating to PI. We don’t want PI to become the ‘go-to’ and these techniques should only be considered as part of a wider tool kit of behavioural management interventions. The paradox being that I teach PI in the context that it should be used as little as possible. The last resort when all else has failed. There are efforts being made all over the country to reduce the instances of restraint, and where it is needed, to ensure that safer techniques are applied to avoid the risks associated with the dangerous practices highlighted above. Amen to that sentiment and approach as this is part of the consultancy services I offer. It will certainly mean vulnerable service are far less likely to be the victim of unnecessary or unsafe practices that degrade or put them at risk. But this does not mean that we can decide that all PI is effectively out of the window? I hope not.

I was delivering training to a dementia service and during the round of introductions I asked the nurses and care Assistants present about the type of risks they face. One person said words to the effect of ‘we just get paid to get beaten up’. I probed her further and she advised that they were sometimes being asked to deliver personal care to people whom could be very confused, anxious and display aggressive behaviour. The behaviour included hitting out, scratching and biting staff whilst the staff, often in groups of two or three, ensured that personal care was provided. Both she and some others had been injured and she explained it was simply 'part of the job'. In-spite of this the company did not provide any specific training around PI. I have sadly heard similar stories from NHS staff on other occasions also. The Manager later introduced herself and advised that they have a ‘no restraint policy’ when I discussed the comments and feedback from the group. So, we have a ‘no restraint policy’ but staff facing risks which are foreseeable, where they use their own ad-hoc physical skills to manage resistance and aggression to the care service they are providing? Yes. Ok then?! I advised, if staff are placing their hands on people to prevent themselves from being injured, to manage conflict between residents, or to simply escort or guide vulnerable service users who lack capacity from point A to point B this is Physical Intervention.  Without competent training provided to all staff what could go wrong? A lot.

Under Section 2 (C) of the Health and Safety at Work Act 1974 it states:

the provision of such information, instruction, training and supervision as is necessary to ensure, so far as is reasonably practicable, the health and safety at work of his employees;

Now it may be that you are sure you have an effective referral process and risk assessments that mean you will only accept service users who do not present a risk to staff. Hopefully, if the risks increase there are clear pathways to more suitable services the very moment that the behaviour becomes unmanageable under the ‘no restraint policy’ in order to keep your staff safe. Is this reality? Living in the real world these things can often take time to plan. If your staff face foreseeable risks organisations have a legal duty to ensure their safety. This can only be done via appropriate training and supervision. This means that PI training is certainly required in some services where there are risks to service-users and/or staff.

The lack of training means service -users are placed at potential risk from inappropriate handling from staff who may not be aware of the legal principles governing PI, or have a range of medically reviewed techniques which work safely in practice, and may do or fail to do something that leads to the injury of the person.  

Staff retention may be an issue, staff may be injured leading to absence, or there may be claims for compensation and other costly litigation to the organisation.

From my experience of talking with staff and leaders, the gap between those who write the policies and those working on the frontline can be vast in practice. Training is often only commissioned after a serious event that highlights the shortcomings of the strategies in place. Where there are foreseeable risks, competent, well trained staff will keep your service users safe while delivering an excellent service. It is a win-win.

I have still not heard back from the Manager following our conversations. It may be she has found a different training provider. Sadly, she may still be thinking about it.

Whether you work in private or public services, schools, health or care don’t hesitate to get in touch to find out more about the training FCP can offer to you.

Dan Stevens, FCP Training