Concern over physical restraints by mental health NHS trust

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Concerns have been raised about the number of times patients have been physically restrained under a local NHS trust.

Physical restraint was sometimes “unavoidable” and incidents were “a reality” but the trust is working to reduce it as much as possible, councillors were told.

Last year the Care Quality Commission (CQC) told the Tees Esk and Wear Valleys NHS Foundation Trust, which provides mental health and learning disability services, to make urgent improvements.

A joint scrutiny committee meeting has now been updated on the latest progress since the regulator’s report.

Statistics presented in the meeting held at Roseberry Park Hospital in Middlesbrough showed about a third of patients – about 27.5% in Durham and Darlington, 34% in Teesside – did not feel safe on the wards.

Read more: Tees, Esk and Wear Valleys NHS Trust told to ‘urgently improve’ by watchdog

They also recorded the number of incidents of physical intervention or restraint per 1,000 occupied bed days.

This figure was about 36 in Durham and Darlington, 75 in Teesside – with a target of 19 – for the last quarter of 2021 to 2022.

Chris Lanigan, associate director of strategic planning and programmes, said some of this was linked to adult learning disability and patients with specific and complex needs.

He said feeling safe and personalised care planning were among the priorities for the year ahead.

Hartlepool councillor Rachel Creevy said: “I’m particularly concerned about the number of incidents of physical intervention.

“I think that being so far off target is a real concern.”

Cllr Rachel Creevy. Picture: Northern Echo.

Avril Lowery, the trust’s director of quality governance, said they wanted to reduce this “where that is absolutely possible and that restraint is safe for both patients and staff”.

She added: “We’ve been reviewing our policies and practices.

“We would agree that we would always want to be reducing any type of physical restraint as much as possible.

“It’s about how realistic it is in terms of what we can reduce that to, given the patients that we are caring for, and enabling them to get as well as they possibly can.

“Sometimes it’s unavoidable I would say, but we do have a whole work programme.

Read more: TEWV – Trust chief faces stark accounts of ‘let down’ staff and patients

“Reducing physical restraint and restrictive practices is one of our key work streams.

“We have a whole range of interventions in terms of skilling staff to understand when restraint is required, how best to do that.”

He said they planned “assurance panels” for senior staff to look at and learn from restraint incidents.

Mark Speight, associate medical director in the secure inpatient service, said they had reflected on incidents, “making sure that’s a very open and no-holds-barred discussion as to what people could have done better”.

He said the introduction of safety plans had “a massive impact upon how we interact with service users”, and understanding had developed in the last few years.

Read more: Call for national inquiry at Tees, Esk and Wear Valley NHS trust

He added: “You have that information about a specific individual as to what behaviours mean, what to do in these situations and what not to do as well.

“It’s that information and communication that’s key.

“We have reviews of the safety plans on a very regular basis. Any incidents can be discussed and reviewed in real time.

“We’re working in an environment where there will be incidents and that is a reality. But I think that we are trying to take steps to minimise the level of involvement.”

Stockton councillor Lynn Hall said: “This is a really high percentage in the Tees.

“We haven’t seen an improvement. We were supposed to see a rapid reduction in restraints. I expected to see a bigger shift.”

The Northern Echo: Cllr Lynn Hall. Picture: Dave Charnley Photography.Cllr Lynn Hall. Picture: Dave Charnley Photography.

Director of operations Dominic Gardner said: “Not every incident leads to a restrictive intervention.

“There are multiple types of restraints that can occur. There are multiple other types of interventions.

“The numbers have dropped. In inpatient services, where we’ve seen a rise in incidents, we’re not seeing a proportionate rise in the level of restrictive interventions or restraints.

“So I think that’s giving some form of assurance that actually people are attempting to use de-escalation and aren’t rushing to restraint.

“It’s an incredibly complex area.”

Patrick Scott, managing director for the Durham, Tees Valley and forensic care group, said: “This is a real significant area of focus for us, one of our priorities.”

He said getting care planning right would help understand people’s needs and “how best to respond at times or severe distress”, and they could learn from other organisations.

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