Introduction

Everyone in health and social care has a role to play in upholding people’s rights. This includes the right to person centred and trauma informed care and support. Restrictive practice which includes restraint, seclusion, segregation and other less direct practices may form part of a person’s plan of care or support. This includes all people from infants and children, through to young people, adults, and older people. This policy states our position on the use of restrictive practice in all services, to ensure this being the ‘last resort’ and where the risks and benefits to the person have been considered within a legal, ethical and practical framework. This statement should be read in conjunction with the guidance for specific services.

Definition

Restrictive practice is defined as making someone do something they do not want to do or stopping them from doing something they do want to do, by restricting or restraining them, or depriving them of their liberty.1

Restrictive practices relate to different types of restraint. This can be physical, mechanical, chemical, cultural, environmental or psychological restraint, surveillance or blanket rules.

Policy position statement

The Care Inspectorate is committed to upholding and promoting human rights and the rights of the child. These rights may only be restricted as a last resort, including in the use of restraint. The use of restrictive practices, including physical restraint, must be considered within a context of the conflict in the promotion of rights, independence and choice for children and adults, versus promoting and maintaining our duty of care.2 In law3, the use of force in any form is required to be justifiable, reasonable and proportionate. Practitioners may be required to take protective action to keep children and adults safe from harm that may affect rights, including choice, dignity and freedom. However, this must be delivered within a context of positive risk taking and compassionate care.

Legislation and standards

Whilst there is no specific piece of legislation that focusses on restraint, the Care Inspectorate is guided by the following legislation and standards.

The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, which specifies:

  • under welfare of users that “A provider must ensure that no service user is subject to restraint, unless it is the only practicable means of securing the welfare and safety of that or any other service user and there are exceptional circumstances” (4(1)(c)).
  • under fitness of premises that “Accommodation must not be provided and used for the purpose of restricting the liberty of children in any residential premises where care services are provided unless such provision and use have been approved by the Scottish Ministers” (10 (3)).

The Health and Social Care Standards, which set out that:

  • “If my independence, control and choice are restricted, this complies with relevant legislation and any restrictions are justified, kept to a minimum and carried out sensitively” (1.3).
  • “My care and support meets my needs and is right for me” (1.19).
  • “Any treatment or intervention that I experience is safe and effective” (1.24).
  • “I experience warmth, kindness and compassion in how I am supported and cared for, including physical comfort when appropriate for me and the person supporting and caring for me” (3.9).
  • “I am protected from harm, neglect, abuse, bullying and exploitation by people who have a clear understanding of their responsibilities” (3.20).
  • “I experience care and support free from isolation because the location and type of premises enable me to be an active member of the local community if this is appropriate” (5.9).
  • “If I experience 24 hour care, I am connected, including access to a telephone, radio, TV and the internet” (5.10).
  • “I can independently access the parts of the premises I use and the environment has been designed to promote this” (5.11).
  • “If I live in a care home, I can control the lighting, ventilation, heating and security of my bedroom” (5.12).
  1.  CQC 2023
  2. Civil law
  3. Common law