Press Release
Regulator calls summit to address issue of restraint in the care of older people
17 December 2007
Key stakeholders in social care recently discussed ways of addressing the use of various forms of ‘restraint’, which, while often intended to keep people safe, can compromise their rights to take risks and their freedom. The discussion was centred on a paper published today (17 December) by the Commission for Social Care Inspection (CSCI).
Rights, risks and restraints explores the use of restraint in the care of older people and says that clear guidelines and well resourced services are needed to ensure dignity of care for people who use services.
The study examines the issues and dilemmas around restraint, particularly the tensions between respecting people’s rights to freedom and to make choices, while at the same time ensuring people’s safety. Although there is policy and legislation to respect people’s human rights, CSCI’s report suggests that in practice care workers and ordinary families caring for relatives have been left largely unsupported to deal with these tensions and to know what is best to do.
Dame Denise Platt, CSCI Chair, said: “Our paper highlights some examples of poor practice that are clearly not acceptable. Wherever we find these, we will not hesitate to deal with them.
“Our paper also argues that people should be able to make choices about their lives and to take risks, whether they are in their own homes or in a care home. While they should also be able to expect that the care they receive will support their dignity, some people have told us they have found security in some types of restraint.
“So there are no simple solutions. That’s why our study has explored this sensitive issue and attempts to raise questions and prompt debate about the balance that needs to be found. To what extent is restraint in the care of older people ever acceptable? What responsibilities do others have to stop the improper use of restraint?”
Rights, risks and restraints is not a prevalence study but gives details of unacceptable examples of the use of restraint, and sets outs evidence that restraint does not always make people’s lives safer. Some people believe, for example, that electronic tagging can be employed as a careful part of a care regime, but the report suggests that this should not be a substitute for inadequate staffing.
CSCI’s study also suggests that different forms of restraint, including chemical and physical restraint and how they are used should be made more transparent and clear. A panel of interested parties, care providers, commissioners, regulators and Government, discussed this report last week. Everyone present agreed that there was a shared responsibility for supporting care staff and sharing best practice.
Julie Jones, Chief Executive of Social Care Institute for Excellence (SCIE), said: “This report raises some serious and difficult issues and it is right that they should be highlighted. Staff and carers should be able to expect better advice and support to ensure that practice improves in all settings. SCIE will be responsible for working with the sector to develop materials which help people make the best possible decisions in these difficult and distressing circumstances.”
Martin Green, Chief Executive of the English Community Care Association, said: “The CSCI report highlights the complexity of the issues of restraint, and I am pleased that CSCI brought together a range of stakeholders to debate the report and to think about how the sector responds in ways that both ensure people’s safety but also respect their dignity and autonomy”.
Help the Aged’s Director of Policy and External Relations, Paul Cann, added: "This is a difficult and sensitive subject - but one that requires discussion and guidance. This report is therefore very welcome.
"Greater clarity and guidance must be given to care staff - many of whom work in very challenging and exceptional circumstances. This report sets out clearly just how urgent the need for this guidance is.
"While restraint exists within care settings, it is imperative that the dignity of older people is maintained at all times - it is simply non-negotiable. Policies and practices must be shaped to preserve the dignity of those being cared for - that calls for planning in advance. Many situations where restraint is currently used can be avoided altogether by anticipating behaviour that may cause difficulties. Advanced planning should involve all parties concerned, including relevant staff, families and the older person themselves. Any decisions taken must be consultative and avoid the imposition of blanket 'one size fits all' policies. The individual's own circumstances are paramount."
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