Restraint Reduction Network Pledge

Restraint Reduction Network: Advantage pledges its support

Advantage Accreditation is delighted to announce its support for the Restraint Reduction Network. We have taken the “pledge” to help advance best practices and improve outcomes for those subject to restraint in health and social care environments.

The Restraint Reduction Network states that its mission is to:

“… reduce reliance on restrictive practices and make a real difference in the lives of people who use across education, health and social care services​.

We achieve this mission by sharing learning and developing quality standards and practical tools that support reduction. Our aim is to share learning and facilitate best practice and access to guidance that supports the minimisation of all restrictive and coercive practices:

Manual: Physical Restraint, Clinical Holding, Mechanical Restraint
Chemical: As Required Medication, Coerced Medication, Rapid Tranquillisation
Environmental: Low Stimulus or Segregation Area, Seclusion, Secure/Locked Facility
Psychosocial: Time Out, Restricted Leisure, Social or Occupational Activities, Electronic Tagging

Our work is steered by a cross sector Steering group that includes representation from experts by experience relevant professional bodies, regulators and government departments (and is chaired by Professor Joy Duxbury).”

The NHS Long-Term Plan: What it means for training

NHS Long Term Plan - Advantage AccreditationThe Government published its long-term plan for the NHS this week. We’ve looked at what it means for mandatory, clinical and specialist training for the next decade:


Focus on mental health

There has been a huge emphasis on mental health in the media and in politics in recent times, and this has carried over into the NHS. Mental health training features on a number of occasions. There is a recognition in the plan that certain groups of young people are particularly vulnerable to mental health issues, and it says that teams will receive “information and training to help
them support young people more likely to face mental health issues – such as Lesbian, Gay, Bisexual, Transgender (LGBT+) individuals or children in care”. The plan recognises that “preventative support” is important to help address problems before they have serious repercussions.

The plan also says that ambulance staff will receive training to help deal with people with mental health issues who are “in a crisis”. Some trusts are already doing this, but growing awareness of the scale of mental health problems in the UK and the impact it has on 999 calls means that all ambulance staff will soon be able to help with issues.

Training to improve end of life care

One of the aims of the plan is to “personalise” and “improve” end of life care. This, it says, will mainly be accomplished by training to help staff identify patients’ needs as they head into the final stages of their life. The plan hopes that this will reduce emergency admissions, but the majority of people will see this as a necessary part of a caring modern society.

There is little new about a wish to improve end of life training. Former guidance has included breaking down training into “bite-sized” sessions to build knowledge quickly, as well as role modelling good practice at every opportunity. It will be interesting to see how this new commitment bears out in practice, and whether it will mean mandatory, classroom-based courses for practitioners.

Learning disabilities and autism awareness

The plan states an intent to roll out training in awareness of learning disabilities and/or autism to NHS teams. The plan alludes to a consultation published in 2018, which says that the aim of the training is ultimately to help staff “support people with a learning disability, their families and carers; to ensure that perceptions of learning disability do not prevent a robust assessment of physical health, and that staff can make personalised, reasonable adjustments to care”. The skills and competencies required for this awareness have already been outlined in the Learning Disabilities Core Skills Education and Training Framework.

If this roll-out follow the recommendations included in the consultation, it means that a further consultation on proposals will begin in March this year, as well as an audit on skills in the NHS workforce. The CQC will monitor the uptake of the training from its full introduction.

Dealing with violence

The long-term plan mentions that a programme has already been launched to train staff in how to handle violence. This may include positive behaviour support, de-escalation training, and breakaway techniques. Its inclusion in the plan emphasises that this is a growing problem and such training is here to stay.

Click here to see what courses Advantage Accreditation can support you to deliver.


Elderly lady - Advantage Accreditation

New research on vascular dementia

The Alzheimer’s Society has produced a spotlight on ongoing research into vascular dementia, the second most common form of dementia.

The spotlight highlights a number of ongoing projects working to understand how to prevent the disease taking hold. One such project, led by the University of Oxford, is testing to see whether surgical procedures undertaken to prevent the risk of a stroke has had a noticeable impact on the cases of vascular dementia in the test group.

Other research is delving deeper into causes of vascular dementia. One particularly interesting piece of work by Professor Roxana Carare of Southampton University is investigating as to whether conditions that drain fluid from the brain make vascular dementia more likely.

You can read up on all of these projects by clicking here.

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Not long left for Skills for Care managers’ survey

Skills for Care’s Managers and Nominated Persons survey ends tomorrow. The objective is to find out what the daily life and tasks of a care manager or nominated person consists of, so that Skills for Care can make recommendations for improvements.

The survey is in part triggered by a lack of knowledge, but also by a growing awareness of the high staff turnover among this class of care employees:

For registered managers the turnover and vacancy rates associated with the role are 23% and 11% respectively, and we expect that as many as 10,000 registered managers may retire in the next 15 years. For nominated individuals, the CQCs plans to look more closely at strategic leadership as part of inspection may have an impact on that role.

You can find a link to the survey by clicking here.


Care home opens its doors to toddlers

A care home in London has become the first intergenerational facility in Britain by opening a nursery in its building. The move is expected to lead to both economic benefits for the care facility, and welfare benefits for the elderly residents.

The facility is an example of an innovative, intergenerational solution to Britain’s care ghettoisation that we described in our Future of Care Report. On a similar theme, the first mixed student and elderly residential development is expected soon.

Read more about it by clicking here.

Old and young lady - Advantage Accreditation

CQC report finds good care in mental health services

Although the media will no doubt focus on the negatives, a new CQC report on the state of care in mental health services has actually uncovered a lot of good news.

A study of mental health services conducted between 2014 and 2017 has found that 68% of core services provided by the NHS are good and 6% outstanding, while the ratio is 72% and 4% respectively for independent services. Among those services for which special praise were delivered were community services for those with learning disabilities or autism. Even providers labelled as requiring improvement have made “real progress”.

Unfortunately, the report also highlights a “substantial minority” of services where improvement is needed, and cited a number of familiar areas of concern, including staffing shortages, locked rehabilitation wards, poor quality clinical information systems, and the variation in the use of physical restraint and restrictive practices.

The latter is certainly a hot topic in the sector today, and the reason behind Skills for Care’s recent push on positive behaviour support. Clearly, services needed to embed the latest guidance in their training programmes more deeply to achieve change.

The full report and data is available on the CQC website.

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Did you know about Skills for Care’s Leadership Programme?

Skills for Care are ramping up the publicity on their Leadership Programme, which is open to applications.

Skills for Care have a raft of leadership programmes (with a discount for members) that many seem unaware of. Although it can be hard to take time out of an organisation, it’s always important to ‘sharpen the saw’.

If you’re a leader in a care organisation and you feel like you’re constantly under pressure, then this is an opportunity to work ‘on’ the business rather than ‘in’ the business.

You can apply to the leadership programmes here.

Old and young lady - Advantage Accreditation

SCIE makes the case for intermediate care

The Social Institute for Excellence has published a new highlights paper on how intermediate care can deliver better outcomes for people in care.

The report has found that effective intermediate care reduces pressure on hospitals and on social care settings. For example, it has found that 72% of people who received intermediate care did not move into a more dependent care setting, and 70% who received intermediate care after a hospital stay returned home.

Intermediate care is designed to treat people to prevent the need to go into hospital or care. It is delivered prior to, or after a hospital stay, and aims to promote independence. Although it is not a new idea, it has received fresh attention with the drive to reduce pressure on the NHS and social care system.

However, it seems that there are a number of challenges to implementing intermediate care more widely, with the report citing effective leadership, integration, and unrealistic expectations. Of course, these seem to be challenges across the whole spectrum of health and social care.

What do you think about intermediate care? Do you think it is deserves more attention?

Person-centred approaches - Advantage Accreditation

Person-centred approaches in healthcare

A new framework is being launched by Skills for Health, Skills for Care and Health Education England to put people-centred approaches at the heart of the health and social care sector.

The framework builds on a long-running trend to put people and their needs at the heart of health and social care, replacing the traditional top-down approach of yesteryear. Although to many this may seem like old news, there are still a number of health and social care settings who do not fully understand the implications of adopting a person-centred approach.

The framework, according to Skills for Health, was created by drawing on the experience and knowledge of professionals in the sector, and is designed to take person-centred principles and apply them to the current landscape. It is designed to help health and social care workers – or rather their managers, in reality – “put person-centred approaches into practice and to create sustained behavioural change”.

You can read the new framework here. As ever, although the thought must be applauded, drafting a framework and implementing that “sustained behavioural change” is the real challenge, and it isn’t clear from the framework how that is to be achieved in a realistic context. Much of the framework – as is clear in the central diagram – is based around conversations with service users. In health and social care settings where human resources are increasingly stretched, finding the time to have these conversations is easier mandated than done.

A more detailed analysis of the section on training and development will be posted shortly.

Is DoLS set to be replaced?

This may have slipped under everyone’s radar. A report that received little attention in the news from the Law Commission has recommended scrapping the current Deprivation of Liberties Safeguards, which it describes as “in crisis”, and replacing them with a new Liberty Protection Safeguards system.

Although this may seem like semantics, the new system is notably less onerous that the current safeguards. Although this may prove much more beneficial to a courts system struggling to deal with the massive increase in DoLS cases since the 2014 Cheshire West ruling, some will highlight that it poses a risk to the vulnerable. One notable change is the scrapping of ‘best interests’ assessments for all cases.

Law Commissioner Nicolas Paines QC has argued, however, that the current system is failing families because of the backlogs it creates: “There are unnecessary costs and backlogs at every turn, and all too often family members are left without the support they need.

“The Deprivation of Liberty Safeguards were designed at a time when considerably fewer people were considered deprived of their liberty. Now they are failing those they were set up to protect.”

Read more about the changes here.

Old lady

New report shows the importance of basic skills

A number of news outlets are leading today with the news that the CQC has found that 32% of nursing homes in England and Wales are failing on safety:

Inspectors making unannounced visits to care homes found medicines being administered unsafely, alarm calls going unanswered and residents not getting help to eat or use the toilet. Some residents were found to have been woken up by night-shift care workers, washed and then put back to bed, apparently to make life easier for staff.

Training, recruitment and retention of skilled staff was cited by the CQC's chief inspector of adult social care, Andrea Sutcliffe, as one of the key causes for failed safety standards across the sector:

“Many of these homes are struggling to recruit and retain well-qualified nursing staff and that means that this is having an impact on delivering good services to people who have got very complex needs".

This shows that staff training is still a difficult issue for many facilities. It is likely that this is going to become a hot issue for the CQC over the coming months and years. 

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No stop for health and social care integration efforts

The head of NHS England has signalled that there is no intention of ending plans to more closely link the British health and social care systems.

A report from the National Audit Office earlier this year suggested that health and social care integration was not being carried out effectively enough to deliver the desired results, although where it was done well there were undoubtedly benefits.

Addressing the NHS Confederation in Liverpool, Simon Stevens reiterated that the course had not changed, and said that his priority was to end the “fractured” health and social care system, with nine areas covering 7 million people to be targeted as priority areas for integration.

The integration at a local level will be driven by ‘accountable care systems’ (ACSs), which will bring together local NHS organisations with voluntary groups and care organisations. The intention is to build on those local areas where successes have been made, which has had a particular impact on hospital admissions.

Although many will, without debt, criticise some integration efforts, but the evidence from the NAO’s report does suggest that there are benefits when it is done well. Experimenting across different localities may not always be pretty, but we can all acknowledge that our care system needs a shake-up, and we should welcome any moves that improve welfare whilst alleviating burdens on overstretched public services.