Developing a Positive and Proactive Workforce: Bridging the Gap between Policy and Practice

1. A positive and proactive workforce Kent challenging behaviour network event; “Bridging the gap between policy and practice” Friday 26th September 2014 Marie Lovell

2. Co produced with people who use services, families, providers and trainers by Skills for Care and Skills for Health

3. Positive and proactive care, &A positive and proactive workforce All of social care and health

4. A positive and proactive workforce – SFC & SFH, part of the picture • NHS Protect • Mental Health Crisis Care Concordat • NHS England and LGA Core Principles Commissioning Tool (for services for people who display behaviour that challenges) • NICE • Mental Health Act Code of Practice Skills for Care

5. Page 8

6. Current on-going work, allied projects and future products DH (due 14 / 15) Positive and Proactive: guidance on support and care of children and young people Deaths in Custody High level principles The Positive and Safe programme Ministry of Justice Safer custody: NHS care in prison Independent restraint advisory panel Children and young people Care Bill 2014 People in secure settings Everyone A place I call home. Winterbourne View Joint Improvement Programme People who have a learning disability / autism People with dementia RCN members’ forum Care Quality Commission NICE Guideline due 2014 / 15, Challenging Behaviour & Learning Disability People with mental health problems People in acute health crisis Restraint Free Futures Review of the Mental Health Act 1983 / 2008 Code of Practice. Health Education England NICE Guideline due 2014 / 15 Violence & Aggression Royal College of Psychiatrists Safewards; making psychiatric wards more peaceful places Mental Health Crisis Care Concordat NHS England 1. Physical restraint as a patient safety incident 2. Reporting NRLS Safety Board 3. Mental Health Expert Working group to consider whether physical restraint will be a priority

7. More than just ‘restraint’ Page 12

8. Are you considering restricting someone? have you tried all reasonable non-restrictive alternatives? Key Questions Is there a real risk of serious harm to the individual or someone else? Is the person detained under the mental health act? Does the person have the mental capacity to make this decision themselves? Is this a planned restriction as part of a care plan? has every effort been make to help them decide ? Is the restriction necessary for their treatment? Is a restriction in their best interests? does the restriction need to be carried out now? Is this the least restrictive option? Pages 15 and 16

9. A positive and proactive workforce Developing workers to minimise all restrictive practices. • Who is ‘the workforce? • What do they do? where? When? • What skills knowledge, attitudes do they need? And what do they already have? • When and how can we develop the skills that are needed?

10. Five steps to Mental Wellbeing • Connect with family, friends, colleagues and neighbours. • Be active – Take a walk, go cycling. Find the activity that you enjoy and make it a part of your life. • Keep learning – learning new skills can give you a sense of achievement and a new confidence. So why not a cooking course, learning to play a musical instrument, or to fix your bike? • Give to others – even the smallest act can count; a thank you or a kind word. Or volunteering at a community centre. • Take notice – be more aware of the present moment; feelings and thoughts, your body and the world around you; "mindfulness" How well do our services support people to follow this advice? “people” who use the service and those who work there! http://www.nhs.uk/conditions/stress-anxiety-depression/pages/improve-mental-wellbeing.aspx

11. Evidence • Risk what is a MICROMORT! http://understandinguncertainty.org/ Professor David Spiegelhalter FRS. Winton Professor of the Public Understanding of Risk.

12. and listen to the murmur of the cottonwood trees, Send me off forever but I ask you please, “Don't fence me in” “Let me be by myself in the evenin' breeze, “Just turn me loose” “Don’t fence me in” “I want to ride to the ridge where the west commences, and gaze at the moontill I lose my senses” “I can't look at hobbles and I can't stand fences”

13. In fairness, I can see why Dad got mixed up!

15. Risk “Physical health and safety can sometimes be bought at too high a price in happiness and emotional welfare. What good is it making someone safer if it merely makes them miserable? . . And if this is where safeguarding takes us, then is it not, in truth, another form of abuse?” Lord Justice Munby MICROMORT! http://understandinguncertainty.org/ Professor David Spiegelhalter FRS. Winton Professor of the Public Understanding of Risk. Statistical Laboratory in the University of Cambridge.

16. “Even now Mark will take himself to ground when he feels threatened… He felt out of control when he was held by 4 people at school as part of their approach to challenging behaviour” - Kadie I know we all agreed (the medication) was for the best for him and those around him………but I still feel I killed him.” - Sister of a man with dementia “When he said all this, his head was in his hands and the look of grief and terror in his eyes. Nightmares and panic attacks too …”Man’s mother

17. Winterbourne was years ago and it wasn’t the first. This year; April 2014– abuse of older people in a care home, again uncovered by panorama. Abusers using the excuse of challenging behaviour / restraint to carry out assaults and other restrictions such as moving call buttons out of reach

18. Questions

19. www.skillsforcare.org.uk www.skillsforhealth.org.uk Marie.Lovell@skillsforcare.org.uk