There is growing recognition among professional bodies and government departments (and arm’s length bodies) that whilst the use of any kind of restraint may on rare occasions be necessary to keep people safe, it is also traumatic and must be minimised in therapeutic settings.
NHS England is leading a significant improvement programme to reduce restrictive practices. This work builds on the Use of Force Act (2018). As part of this work, NHS England has commissioned the Restraint Reduction Network to develop standards for the training, prevention and use of restrictive interventions. We are also developing a process for certificating the training with a view to all providers of NHS-funded mental health and learning disability services using approved training providers.
These Standards will be mandatory for all training with a restrictive intervention component that is delivered to NHS-commissioned services (England only) for people with mental health conditions, learning disabilities, autistic people and people living with dementia in England. Implementation will be via commissioning requirements and inspection frameworks from April 2020.
The Restraint Reduction Network welcomes the increased focus on restraint reduction across the NHS, adult social care and education settings in the UK. The Restraint Reduction Network Training Standards 2019 aim to facilitate culture change, not just technical competence. The Standards focus on the human rights, restraint reduction, prevention, de-escalation, safe use and recovery. They focus on the fundamental principles that apply to all populations and settings. However, considerations for specific populations and settings are included in the appendices.
The Standards have been written to apply across health and social care services, as well as education settings (although it will initially only be mandatory across NHS services). Training providers are required to demonstrate compliance with the Training Standards through (UKAS accredited)Certification. This includes in-house training (eg within an NHS Trust) and commercial training providers. Across the NHS in England implementation will be via commissioning requirement and inspection frameworks that will require certificated training that is recognised by UKAS from April 2020.
Certification must be accredited by the United Kingdom Certification Service (UKAS). UKAS is recognised by government to assess, against agreed standards, organisations that provide certification, testing and inspection services. Certification by UKAS demonstrates the competence, impartiality and performance capability of these evaluators. UKAS certification provides an assurance of the competence, impartiality and integrity of conformity assessment bodies.
As the certification process can take approximately one year to complete, we are encouraging all training providers to start the process of certification in early 2019, ahead of UKAS recognised certificated training becoming a requirement from April 2020.
The Standards will provide a national and international benchmark for training in supporting people who are distressed in education, health and social care settings. These standards will ensure that training is directly related and proportional to the needs of populations and individual people. They will also ensure that training is delivered by competent and experienced training professionals who can evidence knowledge and skills that go far beyond the application of physical restraint or other restrictive interventions.
In addition to improving training and practice, the standards will:
- protect people’s fundamental human rights and promote person centred, best interest and therapeutic approaches to supporting people when they are distressed
- improve the quality of life of those being restrained and those supporting them
- reduce reliance on restrictive practices by promoting positive culture and practice that focuses on prevention, de-escalation and reflective practice
- increase understanding of the root causes of behaviour and recognition that many behaviours are the result of distress due to unmet needs
- where required, focus on the safest and most dignified use of restrictive interventions including physical restraint
The Standards were published in April 2019 (and have now replaced the BILD Code of Practice). Version 1.1 (August 2019) is available to download here.
Please follow this link to the executive summary of the evaluation of the RRN Training Standards and the BILD Association of Certified Training certification.
Five pilot organisations tested the scheme from end to end and feedback was gathered at a number of touch points including a final feedback survey and forum. Forty two training organisations who were certificated under a previous scheme also began the transition to the new Certification Scheme and new Standards during 2019. Their experience of the Standards and Scheme are also captured in this report.