International Day of Persons with Disabilities | Reducing restrictive practice in Wales
By David O’Brien, Senior Improvement Manager, Learning Disability
International Day of Persons with Disabilities, which takes place today (3 December), is backed by the United Nations. This is important because whether they take place on a specific day or over the course of a week or month, having high profile international awareness activities in the calendar can be a useful way of shining a spotlight on specific issues and causes.
With that in mind, I’d like to share learnings about one of the ways Improvement Cymru has been advocating for the rights of individuals with a learning disability through our work on reducing restrictive practice in Wales.
Why is it important to understand restrictive practice?
As the Care Council for Wales defines, ‘restrictive practices are a wide range of activities that stop individuals from doing things that they want to do or encourages them to do things that they don’t want to do. They can be very obvious or very subtle.’
It can take many forms but generally falls into these categories:
- Physical restraint
- Chemical restraint
- Environmental restraint
- Mechanical restraint
- Seclusion or enforced isolation
- Long term segregation
- Coercion/psychological
Restrictive practices in care settings are an important tool used to keep people safe by reducing risk, but it is not an intervention without consequences to those who are restricted and carers using them. Use of restrictive practices impacts on a person’s physical and emotional wellbeing and their human rights, which is why it’s becoming increasingly scrutinised. Restrictive practice use must be lawful, proportionate, time limited, and considered as a last resort with the appropriate recording, monitoring, and reviewing.
When its use in care settings becomes routine with little security or challenge it can become a punitive measure, a tool used to ensure compliance rather than mitigate harm. Our social values of liberty and freedom underpin the delivery of care and support in the United Kingdom. When care settings fail to follow society’s values, public outrage often follows, fuelled by a loss of trust and an audible demand for change.
Monitoring and reviewing the use of restrictive practices in care settings is a critical step in providing public and organisational assurance that use is lawful, proportionate and time limited.
How we have helped to reduce restrictive practice
As part of our remit to improve person-centred care and reduce the use of restrictive practices, Improvement Cymru’s Learning Disability programme has developed a resource pack for raising awareness of restrictive practice for people with a learning disability.
This was co-produced with stakeholders, including people with lived experience, and tested through a series of workshops around Wales. It was important to us to work with a broad spectrum of stakeholders. We collaborated with organisations like Learning Disability Wales and All Wales People First, along with health and social care professionals and carers, and service users themselves.
To ensure engagement with people across Wales, we held our events in Cardiff, Conwy and Kidwelly, working with local networks to ensure as many people could attend as possible. The cost and accessibility of public transport remains a challenge for people with a learning disability, which impacted attendance, but we still brought more than together 100 people over the three workshops.
From the discussions that were had, it was evident that people with a learning disability frequently experience restrictive practices. For some, this was a routine feature of daily care and support.
Some of the impactful insights and learning included:
- People with a learning disability understand little about restrictive practice and their legal rights.
- Restrictive practices have a negative impact on the well-being of people with a learning disability, people who use them, and people who witness them.
- Restrictive practices should never be used to compensate for staff shortages or other resource challenges.
- There is a need to ensure that, when possible, consent for using a restrictive practice is obtained.
Attendees used our training materials through a series of specific group tasks and feedback was provided at the end of the workshop, with changes made prior to the next session. The workshops were an effective way to test the resources and refine content together, aiming to raise awareness of properly delivered restrictive practice.
What are the standards care services should meet?
Care and support provision in Wales needs to work in a co-ordinated way to deliver high quality appropriate support for children and adults with a learning disability.
The All Wales Reducing Restrictive Practices Framework sets the Welsh Government’s expectations for policy and practice to ensure the rights of all people are respected.
Although non-statutory, it gives the overall context and can be applied across several settings, including (but not limited to) childcare, education, health, and social care.
Welsh Government expects organisations to:
- Have a clear policy in place.
- Set out a clear commitment to reduce use.
- Raise awareness amongst staff and public.
- Have a capable workforce, that is skilled and knowledgeable.
- Be responsible for the practices of commissioned third parties.
Using our resource pack to improve care services
We know restrictive practice is a sensitive and emotive subject that can be difficult to navigate, one that many people need additional guidance on.
That’s why we developed our educational resource pack for raising awareness of restrictive practice, enabling carers in Wales to better support people with a learning disability.
The pack features an interactive learning session for people with a learning disability, which can be delivered by anyone with a working understanding of restrictive practices.
Interested to learn more? Visit our website to access the resource pack and start planning to help people understand their rights. We all have a duty, on this day and every day.