I was asked to present my knowledge to one of my bosses on the latest Department of Health guidance on restrictive interventions with a focus on one of the six key principles underpinning the guidance.

2. 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

3. 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 GRAHAM MCKNIGHT, OCT 2014 PARTNERSHIP DIRECTORATE

4. 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.

5. Image taken from the BBC Panorama Special which uncovered horrific abuse taking place at Winterbourne View Hospital.
GRAHAM MCKNIGHT, OCT 2014

6. 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

7. 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

8. • …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 GRAHAM MCKNIGHT, OCT 2014 AND CARE PARTNERSHIP DIRECTORATE

9. 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

10. *
GRAHAM MCKNIGHT, OCT 2014
* ECHA

11. 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

12. • THE HRAIMPOSES 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

13. KEY PRINCIPLE WHAT IT MEANS WHAT IT LOOKS LIKE
PARTICIPATION ENABLING 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-DISCRIMINATORY PAYING 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
EMPOWERMENT ENCOURAGING 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
LEGALITY COMPLYING 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

14. 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