1. A positive and proactive workforce Thursday 26 th June 2014, Birmingham Jim Thomas Marie Lovell

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

3. A positive and proactive workforce – SFC & SFH, part of the picture Skills for Care –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

4. Page 8

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

6. More than just ‘restraint’ Page 12

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

8. A positive and proactive workforce  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? Developing workers to minimise all restrictive practices.

9. Restrictions

10. difficulties

11. Five steps to Mental Wellbeing How well do our services support people to follow this advice? http://www.nhs.uk/conditions/stress-anxiety- depression/pages/improve-mental-wellbeing.aspx 1. Connect with family, friends, colleagues and neighbours. 2. Be active – Take a walk, go cycling. Find the activity that you enjoy and make it a part of your life. 3. 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? 4. Give to others – even the smallest act can count; a thank you or a kind word. Or volunteering at a community centre. 5. Take notice – be more aware of the present moment; feelings and thoughts, your body and the world around you; "mindfulness" “people” who use the service and those who work there!

12. Evidence  Risk what is a MICROMORT! http://understandinguncertainty.org/ Professor David Spiegelhalter FRS. Winton Professor of the Public Understanding of Risk. Statistical Laboratory in the University of Cambridge.  Clown Target  Obviously safer

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

14. 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. MICROMORT! http://understandinguncertainty.org/ Professor David Spiegelhalter FRS. Winton Professor of the Public Understanding of Risk. Statistical Laboratory in the University of Cambridge.

15. “I felt sick at the thought of sedating him. The staff made it clear that giving him ‘something to help with the behaviour’ would speed up the condition and he would deteriorate quickly. They said that if I didn’t agree, he would have to be moved to another home, if I did agree he would die sooner! Even now, I still feel I killed him. As the eldest it was my responsibility to make the decision. I know we discussed it as a family, I know we all agreed it was for the best for him and those around him………but I still feel I killed him.” Sister of a man with dementia

17. Please

18. Questions

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