East Midlands Patient Safety Collaborative delivers the NHS Mental Health National Patient Safety Improvement Programme, which aims to reduce the use of restrictive practice for in-patients of mental health services. You can find out more in our benchmarking report.
Mark Phillips, Trust-wide Professional Lead for Violence Reduction Training with Nottinghamshire Healthcare NHS Foundation Trust, tells us about his role and the changes he has made to ensure strong governance around the content and delivery of training in restrictive interventions.
So why does this training need to be developed?
Previously, the trust has relied on a variety of training techniques, methods, and approaches, including a range of theoretical packages across the trust for over 25 years, and with such unnecessary variation, this has seen in-house training courses evolve over the years.
Within our trust, we currently have five training centres supporting staff across a diverse patient population. Previously, these centres have been independent of each other, following internally developed models with little oversight and scrutiny.
However, since 2016, the trust has aligned with the Positive and Safe Violence Reduction (PSVR) training manual. This was produced for trainers and has allowed us to condense considerable technical variations, and for a modular approach for individual services.
Our new approach ensures that if any physical techniques are applied to any patient in our care, they will have undergone an independent legal, ethical, and medical review.
What is the ‘one trust’ approach?
In 2020, we began the transition to a ‘one trust’ approach in the delivery of Prevention and Management of Violence and Aggression (PMVA) training. Having been appointed in March 2020, I outlined my vision and strategy to achieve a single approach to PMVA training.
Building on the existing work around training technique alignment in 2016, we have taken greater steps to align all theoretical packages within the trust.
Theoretical training within PMVA has been aligned to three bespoke training packages, which have been designed by David Jones, Nurse Consultant and a specialist in violence reduction, and Hayley Batty, a speech and language specialist at Rampton Hospital. Their involvement has transformed our communication training which supports staff working within individual services with de-escalation strategies.
Utilising, ‘Talk First’ and ‘What Gives Us the Right’, PMVA communication training is now being delivered to all direct care staff within the trust. These programmes place significant emphasis on promoting the human rights of patients, working in person-centred ways, and preventing and managing distress rather than managing aggression.
These packages are the foundation of our delivery and adapted to our unique services, which are responsive to clinical need and changes in national guidance.
Why is this different?
The trust is large and diverse, employing over 9,000 staff and has one of the largest forensic services in the UK. This gives gravity to the challenge at hand and the ongoing work by everyone involved to ensure that we stay true to our approach, and our primary focus of improving the care and the experiences of the patients in all of our services.
The fundamental difference is around the governance of violence reduction training trust-wide. With the PSVR manual, we now see an end to internally developed techniques. The manual allows for a bespoke and independent approach for all services in Nottinghamshire, including adult mental health, learning disability, CAMHS, MHSOP, acute dementia, forensic (medium and low services) and high secure. As professional lead, this allows for a total overview of all training content within the trust and the techniques used.
My role also provides an overview for breakaway disengagement methods, including trust-endorsed use of force – escape and rescue techniques, and the use of mechanical restraints, which are designed for exceptional circumstances in the management of life-threatening or life-altering injuries and high levels of violence to others. I also have an overview of the use and training of personal protective equipment – shield training specifically within Rampton Hospital.
What benefits are you seeing?
One of the main benefits is the development of a live dashboard that allows every part of the trust to have access to their own data around restrictive interventions within each clinical area, which is directly inputted from the trust reporting systems.
This allows for ward teams to take ownership of local practices around restraint and provides real-time insight into data analysis including trends, environmental impacts and methods used.
The trust has a huge commitment to the reduction of unnecessary use of physical restraint, and the hard work of developing a ‘one trust approach’ will now see us move to tackle and reduce our levels of restrictive interventions.
Ultimately this provides assurances to the trust’s board members that we are taking steps to tackle any unnecessary use of physical restraint and ensure best practice when responding.
What achievements have you celebrated as a trust?
The trust has recently achieved the Restraint Reduction Network certification, and we are also aligned to the NICE-endorsed Positive and Safe Violence Reduction (PSVR) training manual, which our trust currently chairs.
Call to action
Please
Find out more about other EMAHSN mental health programmes in our innovations portfolio.