National projects designed to reduce long term segregation and restrictive practice

The NHS Long Term Plan has set out an ambitious programme to transform mental health services for people with a learning disability and autistic people, with a focus on improving community services and being less dependent on inpatient care. The NHS England Mental Health, Learning Disability and Autism Inpatient Quality Transformation Programme works to improve the quality of inpatient services for children and young people and adults with a learning disability or who are autistic. A series of national projects aim to improve the experiences of people who are being cared for in hospital including those in long-term segregation.

Each project is a direct response to recommendations made in Baroness Hollins’ review of the independent Care (Education) and Treatment Reviews of people with a learning disability and autistic people who are living in the restricted way described as long-term segregation.

We are working in co-production with people with a learning disability and autistic people, their families and paid and unpaid carers to help reduce long-term segregation and the levels of restrictive practice.

Reducing restrictive practice resources

We have produced two resources for adults and children with a learning disability, autistic adults and children, the staff who support them and their families to inform and empower people to speak up about restrictive practice.

Both resources have been co-produced and piloted with people with lived experience of restrictive practice in hospital settings and professionals.

The resources take a human rights approach and aim to help people understand their restrictions and be more involved in developing least restrictive options. They also include information about who to speak to if there are any concerns about the way restrictions are used.

• The What are restrictive practices easy read booklet is designed for autistic adults and adults with a learning disability. It includes information about different kinds of restrictive practice and why they may be used.
• The My Rights magazine – (pdf, version to print and guidance) is designed for young people. It is written in plain English and in a style that allows young people to easily turn to the topic they need and to personalise it through writing and doodles. It includes information about rights, types of restrictive practice, real stories and top tips from young people about ways to speak up.

Young people were very clear that the magazine will be most useful as a hard copy. They wanted to be able to write or draw on it, rip out and keep key pages or tips, and take it with them to meetings to remind them and others about their rights and needs. Please consider how you can work in partnership to promote this great resource and achieve hard copies for the young people in your area.

Staff working in hospital settings should share these resources with the people they support and actively work with them to help them understand and be involved in decision making around the use of restrictive practice.

Independent Care (Education) and Treatment Reviews (IC(E)TR)

Phase two of IC(E)TRs was completed in March 2023. The IC(E)TR oversight panel, chaired by Baroness Hollins, has monitored the progress of IC(E)TRs during phase two and their final report is expected to be published in Autumn 2023. The Department of Health and Social Care, NHS England and the Care Quality Commission will continue to work together following the end of phase two and are making plans to recommence these reviews.

The NHS England Mental Health, Learning Disability and Autism Quality Transformation team are continuing to work with regional teams to identify and prioritise people who need an IC(E)TR. This ensures, during the current pause in the reviews, continued oversight of people in long-term segregation within the most restrictive mental health hospital environments. People will continue to receive Care (Education) and Treatment Reviews in line with the latest policy guidance.

HOPE(S)

The HOPE(S) model is an ambitious human rights-based approach to working with people in long term segregation developed from research and clinical practice. In partnership with Mersey Care NHS Foundation Trust, NHS England is funding the roll out of this model across services in England.

The clinical model was developed by Mersey Care NHS Foundation Trust to reduce the use of long term segregation sometimes experienced by autistic adults, adults with a learning disability and children and young people when in hospital.  Sixteen specialist practitioners have been recruited to deliver this important programme.

Visit www.merseycare.nhs.uk/hopes-model for further information; and watch the short films below, about the importance of the HOPES model, by Claire Murdoch, NHS England’s National Mental Health Director, and Dr Roger Banks, National Clinical Director for Learning Disability and Autism.

Senior Intervenors project

The national Adult Senior Intervenors pilot project was set up in response to Baroness Hollins’ recommendation for the introduction of an additional senior person to support local services to plan for discharge, guide where there is challenge and agree actions to facilitate a reduction in restrictions. This project built on the positive evaluation of the pilot of Children & Young People’s Senior Intervenors.  The ultimate goal of the Senior Intervenors is to establish and oversee a robust plan for discharge from both long term segregation and hospital.

The Senior Intervenor’s work focuses on cases where progress is not being made and there is concern for the individual’s wellbeing. The Senior Intervenor works with people on a case by case basis to find solutions to barriers that may be preventing the individual from moving to less restrictive settings or into the community.

Prioritisation of who senior intervenors will work with considers length of time in long term segregation alongside CQC rating of the unit, and any concerns about quality of care that the person, family and system have.

NHS England recruited Senior Intervenors to work with up to three people at a time to provide senior level challenge and intervention..  The Adult Senior Intervenors project was funded until March 2022 although has been extended to ensure those individuals who have a Senior Intervenor continue receiving an intervention. An evaluation will be undertaken to review the impact of the pilot.