ECHR

HRA

MHA (1983) + MCA (2005) + DoLs + HSCA (2008)

DEPARTMENT OF HEALTH GUIDANCE ON REDUCING THE NEED FOR RESTRICTIVE

INTERVENTIONS

P.R.I.C.E.

GRAHAM MCKNIGHT, OCT 2014

WHAT ARE ‘RESTRICTIVE INTERVENTIONS’?‘DELIBERATE ACTS THAT RESTRICT SOMEONE’S MOVEMENT, LIBERTY AND/OR FREEDOM IN ORDER TO:

• TAKE CONTROL OF A DANGEROUS SITUATION WHERE THERE IS A POSSIBILITY OF HARM TO A PERSON OR

OTHERS IF NO ACTION IS TAKEN; AND

• END OR REDUCE THE DANGER TO THE PERSON OR OTHERS; AND

• LIMIT THE PERSON’S FREEDOM FOR NO LONGER THAN IS NECESSARY.’*

* POSITIVE AND PROACTIVE CARE: REDUCING THE NEED FOR RESTRICTIVE INTERVENTIONS, APRIL 2014

SOCIAL CARE, LOCAL GOVERNMENT AND CARE PARTNERSHIP DIRECTORATE GRAHAM MCKNIGHT, OCT 2014

GRAHAM MCKNIGHT, OCT 2014

• THE DEPRIVATION OF LIBERTY

SAFEGUARDS (DoLS) ARE AN

ADDITION TO THE MENTAL CAPACITY

ACT 2005.

• THEY AIM TO MAKE SURE THAT

PEOPLE IN CARE HOMES, HOSPITALS

AND SUPPORTED LIVING ARE LOOKED

AFTER IN A WAY THAT DOES NOT

INAPPROPRIATELY RESTRICT THEIR

FREEDOM.

• HOWEVER, IN 2012/13 CQC IDENTIFIED

A LACK OF AWARENESS OF DoLS

AMONG FRONTLINE STAFF.

Image taken from the BBC Panorama Special which uncovered horrific abuse taking place at Winterbourne View Hospital.

GRAHAM MCKNIGHT, OCT 2014

STOPPING ANOTHER ‘WINTERBOURNE’• 2012 PANORAMA INVESTIGATION FOUND ‘HORRIFIC

ABUSE’ AT HOSPITAL FOR VULNERABLE ADULTS.

• VULNERABLE ADULTS IN HOSPITAL CARE URGENTLY

REVIEWED BY CQC. SUSPECTED ABUSE VICTIMS MOVED

TO COMMUNITY BASED SUPPORT BY SUMMER 2013.

• GOVERNMENT PLEDGED NEW LEGISLATION TO

STRENGTHEN CQC’S ABILITY TO TAKE ACTION AGAINST

OR SHUT DOWN ORGANISATIONS THAT ABUSE SERVICE

USERS AND NEW GUIDANCE FOR EMPLOYERS &

EMPLOYEES BY 2014.

GRAHAM MCKNIGHT, OCT 2014

NEW LEGISLATION

• THE HEALTH AND SOCIAL CARE ACT (2008) ALREADY TELLS CQC WHAT TO INSPECT AT UNITED

RESPONSE.

• CQC NOW VERY INTERESTED IN REGULATION 11 OF THE ACT – SAFEGUARDING SERVICE USERS

AGAINST ABUSE.

• NEW LEGISLATION DUE IN OCTOBER 2014 WILL PLACE MORE EMPHASIS ON APPROPRIATE USE

OF RESTRAINT …

GRAHAM MCKNIGHT, OCT 2014

• …NEW LEGISLATION WILL ALSO GIVE CQC BETTER

DEFINED POWERS TO ACT AGAINST CARE PROVIDERS

WHO USE RESTRAINT METHODS THAT: ARE NOT

PERMITTED BY GUIDANCE* ISSUED BY

PROFESSIONALS AND EXPERTS, OR ARE UNLAWFUL,

OR ARE NOT NECESSARY, OR ARE NOT

PROPORTIONAL.

• GUIDANCE* FORWARDED BY THE MINISTER FOR CARE

AND SUPPORT WILL BE ONE OF THE SOURCES CQC

USE WHEN DECIDING IF A PROVIDER IS DELIVERING

SAFE AND APPROPRIATE CARE, ONCE THE NEW LAW

COMES IN TO FORCE.

* POSITIVE AND PROACTIVE CARE: REDUCING THE NEED FOR RESTRICTIVE INTERVENTIONS, APRIL 2014

SOCIAL CARE, LOCAL GOVERNMENT AND CARE PARTNERSHIP DIRECTORATEGRAHAM MCKNIGHT, OCT 2014

NEW GUIDANCE

• ENCOURAGES A CULTURE IN ORGANISATIONS LIKE UNITED RESPONSE THAT ONLY USES PHYSICAL

INTERVENTIONS AS A LAST RESORT.

• PROVIDES ADVICE ON USING MODELS OF RESTRICTIVE INTERVENTION REDUCTION (LIKE P.R.I.C.E.)

SO THAT LASTING REDUCTIONS IN THE USE OF RESTRICTIVE INTERVENTIONS CAN BE ACHIEVED.

• HELPS ENSURE THAT RESTRICTIVE INTERVENTIONS ARE USED IN A TRANSPARENT, LEGAL AND

ETHICAL MANNER.

GRAHAM MCKNIGHT, OCT 2014

GRAHAM MCKNIGHT, OCT 2014

*

* ECHA

THE ECHA AND US

• DEPENDING UPON THE PRIORITIES OF THE NEXT BRITISH GOVERNMENT, THE EHRA MAY BE

REPLACED WITH A ‘BRITISH BILL OF RIGHTS’.

• UNTIL THE OUTCOME OF THE 2015 GENERAL ELECTION IS KNOWN, WE ARE BOUND AT WORK

AND ELSEWHERE IN THE UK AND THE EU TO ACT IN ACCORDANCE WITH THE ECHA.

GRAHAM MCKNIGHT, OCT 2014

• THE HRA IMPOSES A DUTY ON PUBLIC AUTHORITIES, (INCLUDING NHS TRUSTS, LOCAL

AUTHORITIES, AND POLICE FORCES) AND SERVICES OF A PUBLIC NATURE NOT TO ACT IN A

MANNER THAT IS INCOMPATIBLE WITH THE ECHR - RIGHTS THAT HAVE BEEN MADE PART OF UK

LAW BY THE HRA.

• A HUMAN RIGHTS BASED APPROACH CAN BE ACHIEVED BY APPLYING WHAT HAS BEEN

DESCRIBED AS THE ‘PANEL’ PRINCIPLES…

GRAHAM MCKNIGHT, OCT 2014

KEY PRINCIPLE WHAT IT MEANS WHAT IT LOOKS LIKE

PARTICIPATIONENABLING EVERYONE TO GET INVOLVED IDENTIFYING AND REDUCING BARRIERS THAT

PREVENT PEOPLE FROM EXERCISING THEIR

RIGHTS

ACCOUNTABILITY IDENTIFYING WHO HAS WHAT LEGAL DUTIES TO

FULFILL AT WORK AND ELSEWHERE

STAFF KNOW WHAT THE MENTAL HEALTH ACT AND

MENTAL CAPACITY ACT ARE AND HOW THEY

APPLY TO THEIR ROLES AT WORK

NON-DISCRIMINATORYPAYING ATTENTION TO GROUPS OF PEOPLE THAT

ARE VULNERABLE TO ABUSE

STAFF KNOW THE RELIGIOUS BELIEFS, RACE,

CULTURAL TRADITIONS, GENDER AND SEXUAL

IDENTITY OF THE PEOPLE WE SUPPORT

EMPOWERMENTENCOURAGING STAFF AND PEOPLE WE SUPPORT

TO LEARN AND REMEMBER THEIR RIGHTS AND

RESPONSIBILITIES

STAFF COMPETENTLY EXPLAINING HOW HUMAN

RIGHTS CAN BE INFRINGED BY RESTRICTIVE

INTERVENTIONS

LEGALITYCOMPLYING WITH THE LAW (SPECIFICALLY: THE

HUMAN RIGHTS ACT, MENTAL HEALTH ACT,

MENTAL CAPACITY ACT)

IDENTIFYING THE LEGAL IMPLICATIONS OF A

PERSON WE SUPPORT’S CHALLENGING

BEHAVIOUR AND OUR RESPONSES TO THAT

BEHAVIOUR

GRAHAM MCKNIGHT, OCT 2014

THE HRA AND P.R.I.C.E.

• P.R.I.C.E. = PROTECTING RIGHTS IN A CARING ENVIRONMENT.

• STAFF AT UNITED RESPONSE COMPLETE REGULAR P.R.I.C.E. TRAINING TO HELP THEM LEARN, UNDERSTAND, REMEMBER,

REVISE AND UPDATE THEIR RIGHTS AND LEGAL RESPONSIBILITIES AT WORK.

• THE P.R.I.C.E. MODEL OF SUPPORT FOR ADULTS WITH LEARNING DIFFICULTIES AND SPECIAL NEEDS IS COMPATIBLE WITH

THE ECHA, HRA, MHA, MCA, HSCA (2008) AND UNITED RESPONSE’S COMMITMENT TO ENABLING THE PEOPLE WE SUPPORT TO

LIVE DIGNIFIED, MEANINGFUL AND FULFILLING LIVES AS EQUALS WITH US AND THE REST OF HUMANITY.

GRAHAM MCKNIGHT, OCT 2014