REDUCING RESTRICTIVE PRACTICE
When restrictive practice keeps increasing
Policies, training and support plans may all be in place, yet restrictive responses can become more frequent, more intense or more routine.
The question is not simply what happened in the latest incident. It is what conditions are allowing the pattern to continue — and what needs attention first.
WHAT THIS CAN LOOK LIKE
You can see the restriction increasing. The reason is less clear.
Physical intervention, PRN medication, locked-door restrictions or other restrictive responses are becoming more frequent or more intense.
Previous changes have helped briefly, but progress has not held when staffing, leadership or pressure changed.
Measures introduced to manage an immediate risk have gradually become part of the ordinary routine.
Similar incidents are reviewed repeatedly, but the same pattern continues.
Responses vary between staff, shifts or teams, making risk depend too heavily on who is present.
Questions are emerging about whether everyday limits on choice, access or autonomy have themselves become restrictive.
These patterns do not establish the cause. They indicate that examining the latest incident alone is unlikely to be enough.
WHY THE PATTERN PERSISTS
The latest incident is part of the evidence, not the whole explanation.
When restrictive practice increases, attention understandably turns to the most recent event: what the person did, how staff responded and whether the correct procedure was followed. Those questions matter, but they may not explain why the same pattern keeps returning.
Across a service, early signs can be recognised yet acted on inconsistently. Plans can be sound individually and still be difficult to use together. Data can record incidents without showing leaders where practice is beginning to drift.
A response that reduces immediate pressure can also make restriction more likely next time.
Understanding the pattern means looking at what happens in practice, not only what policy intends; what changes when pressure rises; and whether emerging drift is noticed and acted upon.
The purpose is not to find one person or one decision to blame. It is to identify the conditions making restrictive responses more likely and decide what needs attention first.
WHERE TO BEGIN
Start with the level at which the pattern needs to be understood.
Restrictive practice may be increasing across a service, or recurring around the support of one person. Both situations require careful examination, but they involve different questions and need different starting points.
When the pattern is occurring across a service
The Restrictive Practice Under Pressure Diagnostic (RPP-D) examines the organisational conditions associated with increasing reliance on restrictive practice. It considers what is happening across staff, shifts and systems, where practice may be drifting and what needs attention first.
When the pattern centres on one person.
The Thrive Escalation Cycle Workshop helps a team examine recurring episodes around an individual whose escalation is not yet understood or described consistently. The team reconstructs what happens as pressure rises, identifies early indicators and considers how responses may affect what happens next.
How the RPP-D works
RPP-D is a structured service-level conversation supported by a focused review of available evidence.
Evidence considered in advance
Where available, the review begins with three months of restrictive-practice data, current behaviour support or positive-handling plans, and the most recent governance or quality meeting notes. If some information is unavailable, the diagnostic can still proceed. What cannot currently be verified is relevant to understanding the service's position.
A 60–90-minute conversation
The conversation is usually held with the person who has operational oversight and sufficient day-to-day knowledge of the service — typically a registered manager, clinical lead or equivalent. It requires protected time and specific examples of what happens in practice, particularly when pressure rises.
What the conversation covers
It considers how restrictive practice is defined, whether early signs are recognised and acted upon, and how the environment affects pressure. It then looks at which staff responses make restriction more or less likely over time, whether governance detects drift, how leaders respond under pressure, what the evidence demonstrates and what enables improvement to last.
The purpose is to establish where attention is needed before deciding whether the appropriate response is training, environmental change, practice leadership, governance work, individual Thrive Escalation Cycle work or a fuller assessment.
WHAT YOU RECEIVE
Three priorities, not another long action plan
You receive a concise written account of what the diagnostic has found and where action should begin.
A clear service-level picture
The 2–4-page report includes a red–amber–green profile, three current strengths and three areas of risk. It shows where practice appears reliable, where it is vulnerable to pressure and what could not yet be verified. Where an immediate concern is identified, the report also states any interim safeguards requiring attention.
Three priority actions
The report identifies exactly three priorities. Each states what needs to change, why it matters and the practical next step.
A findings conversation
A 30-minute follow-up discussion is included, giving you an opportunity to clarify the findings, consider the priorities and decide what should happen next.
Fee and scope
Standard fee: £650
Introductory commissioning fee: £550 for the first three commissions
The fee covers one service or defined operational setting. Multi-service or organisation-wide work is scoped separately. The written output is provided within ten working days of the diagnostic conversation.
Important boundaries
RPP-D is not an inspection, accreditation, safeguarding investigation or regulatory compliance review. It does not replace a full Positive Behaviour Support assessment or behaviour support plan.
The diagnostic identifies where action should begin. Reducing restrictive practice depends on what happens next — whether the priorities are acted upon and supported in everyday practice.
STARTING A CONVERSATION
Start with the pattern you are seeing
You do not need a completed brief, perfect data or an agreed explanation. Begin with what is happening, whether the pattern is appearing across a service or recurring around the support of one person.
David will help clarify the most appropriate starting point. This may be the RPP-D for a service-level pattern, the Thrive Escalation Cycle Workshop for work centred on one person, or a different response where neither is the right fit.