Positive and Safe Programme


David Allen was part of a panel that helped launch the new Positive and Safe programme in London on April 3rd. You can access the reports published on that day by following the links below:



Following increasing concerns about the inappropriate use of restrictive interventions across health and care settings; including ‘Transforming Care: a national response to Winterbourne View Hospital’ (DH 2012), ‘Mental Health Crisis Care: physical restraint in crisis’ (Mind 2013), and a recent inspection of inpatient learning disability services by the Care Quality Commission the Department of Health yesterday launched its new guidance about reducing restrictive interventions.

Please see the full report “Positive and Proactive Care: reducing the need for restrictive interventions: Guidance for all those working in health and social care settings: commissioners of services, executive directors, frontline staff and all those who care for and support people” along with a summary of key actions which includes:

Improving care:
• Staff must not deliberately restrain people in a way that impacts on their airway, breathing or circulation, such as face down restraint on any surface, not just on the floor.
• If restrictive intervention is used it must not include the deliberate application of pain.
• If a restrictive intervention has to be used, it must always represent the least restrictive option to meet the immediate need.
• Staff must not use seclusion other than for people detained under the Mental Health Act 1983.
• People who use services, families and carers must be involved in planning, reviewing and evaluating all aspects of care and support.
• Individualised support plans, incorporating behaviour support plans, must be implemented for all people who use services who are known to be at risk of being exposed to restrictive interventions.

Leadership, assurance and accountability:
• A board level, or equivalent, lead must be identified for increasing the use of recovery-based approaches including, where appropriate, positive behavioural support planning, and reducing restrictive interventions.
• Boards must maintain and be accountable for overarching restrictive intervention reduction programmes.

• Providers must ensure that internal audit programmes include reviews of the quality, design and application of behaviour support plans, or their equivalents.
• Accurate internal data must be gathered, aggregated and published by providers including progress against restrictive intervention reduction programmes and details of training and development in annual quality accounts or equivalent.
• Service commissioners must be informed by providers about restrictive interventions used for those for whom they have responsibility.

Monitoring and oversight:
• Care Quality Commission’s (CQC) monitoring and inspection against compliance with the regulation on use of restraint and its ratings of providers will be informed by this guidance.
• CQC will review organisational progress against restrictive intervention reduction programmes.
• CQC will scrutinise the quality of behaviour support plans which include the use of restrictive interventions.