Blanket restrictions are policies applied across a group of patients or residents in learning disability or mental health settings regardless of need. They are the subtle ways people with learning disabilities and autism can see their quality of life eroded.
Having everyone in bed early on a Friday evening or preventing people from venturing into their own kitchens — these are the kind of blanket policies that can turn homes into institutions.
The Care Quality Commission (CQC) announced in the summer plans to crackdown on these restrictions that slip under the radar. This was after members of the CQC’s advisory group for people with a learning disability and autistic people told the watchdog it needed to take a stronger position on restrictive practice.
The CQC says its new policy position is designed to support people to “lead their best lives”. They want all health and social care providers to know what restrictive practice looks like and actively work to reduce it.
The CQC’s interim director for people with a learning disability and autistic people, Rebecca Bauers, and its director for mental health, Chris Dzikiti, released a joint statement on the new policy. They said that while restraint and seclusion are the “more extreme forms of restrictive practice”, there are “subtle forms” that become “day-to-day responses to perceived risk or lack of time”. There was a danger that these approaches are eventually passed off as “just the way we do things here”.
Examples of subtle restrictive practice and blanket restrictions include making people use incontinence pads to manage their toilet needs and denying them access to visitors, friends or food because it is easier for staff.
The CQC believes subtle restrictive practice can be used as a way of punishing people when they communicate distress and say this is “completely unacceptable”.
Other blanket policies the CQC say impinge on people’s human rights and restrict their liberty include remote closed circuit television monitoring, limited access to bathrooms and bedrooms being locked at certain times of day.
The CQC is training its inspectors with support from charities the British Institute of Learning Disabilities and the Restraint Reduction Network to improve reporting when they identify restrictive practice.
Bauers and Dzikiti say there are “limited situations where restrictive practice could be needed to keep people safe”. But it should only be used to prevent “serious harm” and has to be the “least restrictive option, applied for the shortest possible time”.
In their joint statement Bauers and Dzikiti wrote: “We expect everyone in health and social care to be actively working towards reducing the use of restrictive practice, to the point where its use is rare, and it is considered a failure of care across a system.
“In its place, we expect to see regularly reviewed, person-centred, trauma-informed care plans that are tailored to each individual’s specific needs.”
The charity Stay up Late campaigns against set bedtimes in the care sector, saying it wants people with learning disabilities to have “active and fun social lives”. Its manifesto for an “ordinary life” was written after taking soundings from people with learning disabilities.
It calls for respect for the rights of people with learning disabilities to have relationships, a paid job and a say in who supports them. And they should have the freedom to choose how they spend their time as well as when they go to bed.
Stay Up Late run a Gig Buddies volunteering programme that matches adults who have a learning disability to a volunteer with similar interests so they can attend events together. The charity says it has 300 matched pairs in the UK and 463 around the world.
Stay up Late’s campaigns coordinator, Florence Little, said the everyday freedoms that subtle restrictions undermine “contain some of what makes life really wonderful”.
Little, who accompanies her learning disabled brother Herbie, 23, on nights out to clubs, added, “It’s kind of the things that truly matter to humans — so social connections, having an enriched social life full of things that you’re passionate about. That can be so many different things to different people.”
She believes subtle restrictions are “quite common” in the care sector and she “very often” hears about a 10:30pm curfew.
The 26-year-old campaigner, from Brighton, said she speaks to support workers who are given values-based training that does not seem to be carried through in the homes where they start work.
And Little believes the culture of restrictions in care settings can end up shaping the people who live in them, whereby they do not demand and expect freedoms and considerations they have never enjoyed.
Little is also concerned about how the CQC’s new policy will be enforced and hopes it does not end up being a well-meaning initiative never backed up by action.
“We are a campaign that works on joy as an act of resistance and we’re going to keep hoping and working towards that ourselves and using this framework that we’ve provided and I hope other people do too,” she added.
Mary Woodall, who is a self-advocate representative with charity Learning Disability England, said irrespective of the service setting people should be supported to “live their life” without blanket restrictions.
Receptionist Woodall, from south London, added, “Being a staff member doesn’t give the right to control people’s lives. Sometimes staff can be bossy or take over without any reason or explanation. It’s people’s home. Let them live their lives.”
Professor Martin Green, chief executive of Care England, a representative body for the care sector, said he “welcomes” the CQC’s efforts to end “inappropriate restrictive practice”.
He said the CQC must recognise the “role it needs to play in driving improvement across the health and social care sectors”.
Green said the recent CQC report, Out of Sight: Who Cares? made 17 recommendations for reducing restraint and seclusion, but the watchdog has only met four of these.
He added that the CQC must now take steps to “drive the system level change we require”.
