Admission to hospital can cause distress and may lead to situations in which there is an increased chance of restrictive practice being used. Children and young people (CYP) and adults with a learning disability and autistic adults can struggle with such restrictions. As a result, they can sometimes be caught in a cycle of restrictive practice and increased security. The resulting impact on their wellbeing and human rights can cause trauma which may impact on their length of stay in hospital, experience and discharge to a home in the community.
NHS England and NHS Improvement and the Centre for Perfect Care, a part of Mersey Care NHS Foundation Trust, are working together to implement the HOPE(S) programme across England. Mersey Care has been chosen for this work because of its experience in this complex area.
The HOPE(S) clinical has a relentlessly positive approach to supporting people in long term segregation.
The model describes:
It encourages teams to Harness the system through key attachments and partnerships
Create Opportunities for positive behaviours, meaningful and physical activities;
Identify Protective and preventative risk and clinical management strategies;
Build interventions to Enhance the coping skills of both staff and people in services
Whilst engaging in these tasks clinical teams and the System needs to be managed and developed to provide support throughout all stages of the approach.
This work allows clinical teams and the person in segregation to understand the significant issues, barriers and systemic issues maintaining the segregation. It identifies three intervention targets to allow the team to prioritise interventions and resources, establish ‘quick wins’ and a sense of hope and direction for the person and the team. The model has been developed over a number of years and has been used in a wide range of settings.
Mersey Care has considerable experience of good practice in complex care settings and continues to collect clinical evidence as part of its commitment to learning.
A 2021 inquiry by parliament’s Health and Social Care Select Committee into the treatment of people with a learning disability and autistic people received evidence that indicates changes in culture and practice were critical for systemic change. As the report noted, families of people living in these conditions for prolonged periods of time can also be traumatised by the lack of access to their loved one. In response to this as part of the programme we are offering independent trauma support for families.
The Care Quality commission has issued a brief guide to long term segregation.