Introduction
This blog covers the CQC Eight Principles for the use of restraint. The CQC has recently provided updated guidance for inspectors to help them understand the use of restraint and they’ve included eight basic principles to follow. Although designed for CQC inspectors, it is a useful tool for all services who support people where restrictive interventions might be required. This blog highlights how Timian can support your organisation to satisfy these principles.
The following CQC Eight Principles, are all covered in our training. We believe that these eight principles are the bare minimum standards any service should be targeting.
Although we are discussing the CQC Eight Principles for the use of restraint, it must be remembered, that we are primarily engaged in trying to reduce the use of restrictive practices and restraint. Any training must include a plan for the reduction of restrictive interventions.
Non-Punishment Principle
Restrictive interventions should never be used to punish or for the sole intention of inflicting pain, suffering or humiliation.
CQC Guidance Brief guide: restraint (physical and mechanical)
During Timian’s training we explore this basic principle in our Core Values chapter. The Core Values module covers relationship building and the impact of trauma. The use of restraint as punishment is counter to our core values and is never taught on our training. We don’t teach anything designed to inflict pain or the fear of pain, suffering or humiliation.
Risk of Harm Principle
There must be a real possibility of harm to the person or to staff, the public or others if no action is undertaken.
CQC Guidance Brief guide: restraint (physical and mechanical)
Our philosophy is based on the statement. “In this place and with these people I feel safe.” It is our core Philosophy and underpins all our training. We would only ever use a restrictive intervention to keep staff, the public or the person safe and training content is based on a Training Needs Analysis. Any risk of harm must also include the risk of psychological harm which is also considered during our restrictive intervention training.
Proportionate Risk Principle
The nature of techniques used to restrict must be proportionate to the risk of harm and the seriousness of that harm.
CQC Guidance Brief guide: restraint (physical and mechanical)
Unfortunately, for far too many people, the type of restraint used, is often disproportionate to the risk of harm. Restrictive interventions should be designed to keep people safe. Timian’s restrictive interventions are designed to create a safe space for staff and the person being held. All our physical interventions have been risk assessed biomechanically from the perspective of the staff and the person being supported.
Least Restrictive Principle
Any action taken to restrict a person’s freedom of movement must be the least restrictive option that will meet the need.
CQC Guidance Brief guide: restraint (physical and mechanical)
Defining a least restrictive approach is complex when supporting people with complex needs. We want everyone to be safe, unfortunately that might require a restrictive approach. However, this approach must be the least restrictive in the circumstances. In line with our BILD ACT Certification, we would determine any restrictive interventions during a Training Needs Analysis. When implemented, there must be a specific justifiable purpose to it. It must use the least amount of force and include the person in the planning.
Minimum Time Principle
Any restriction should be imposed for no longer than absolutely necessary.
CQC Guidance Brief guide: restraint (physical and mechanical)
The length of time someone is held must be based on the criteria for taking hold in the first place. If the person or others are no longer at risk, then the person being held must be released if safe to do so. We discuss criteria for holding and releasing in chapters three, four and five of our training.
Audit Principle
What is done to people, why and with what consequences must be subject to audit and monitoring and must be open and transparent.
CQC Guidance Brief guide: restraint (physical and mechanical)
We work with organisations to ensure that they use consistent language to audit incidents. As part of the training, we talk about the use of language and describing exactly what was done and by who. We also support staff on our training to understand and develop appropriate debriefing skills using active listening. This is also covered in our Training Needs Assessment prior to working with an organisation.
Last Resort Principle
Restrictive interventions should only ever be used as a last resort.
CQC Guidance Brief guide: restraint (physical and mechanical)
We agree that restrictive interventions should be the last strategy used. Unfortunately, the term “last resort” is often subjective. When supporting vulnerable people, we need to be more specific in our terminology. When we discuss the application of restraint on our course, we spend time looking at the language and principles behind restrictions. We ask why we are using any intervention for behaviour and what the purpose of that intervention is. There must be a clear criteria for intervention supported by a restraint reduction plan.
Person Centred Principle
People who use services, carers and advocate involvement is essential when reviewing plans for restrictive interventions.
CQC Guidance Brief guide: restraint (physical and mechanical)
Timian uses several tools to involve the people that use the services in reviewing their plans. This includes visual tools with augmented reality developed by Timian, verbal descriptions and including the person in debriefing strategies.
If you want to know more about how our training can help you, and support you in the CQC Eight Principles, contact us here
James Hourihan
Director Timian Learning and Development
