Policy position on the use of restrictive practices
Introduction
Everyone in health and social care has a role to play in upholding people’s rights. This includes the right to person centred and trauma informed care and support. Restrictive practice which includes restraint, seclusion, segregation and other less direct practices may form part of a person’s plan of care or support. This includes all people from infants and children, through to young people, adults, and older people. This policy states our position on the use of restrictive practice in all services, to ensure this being the ‘last resort’ and where the risks and benefits to the person have been considered within a legal, ethical and practical framework. This statement should be read in conjunction with the guidance for specific services.
Definition
Restrictive practice is defined as making someone do something they do not want to do or stopping them from doing something they do want to do, by restricting or restraining them, or depriving them of their liberty.1
Restrictive practices relate to different types of restraint. This can be physical, mechanical, chemical, cultural, environmental or psychological restraint, surveillance or blanket rules.
Policy position statement
The Care Inspectorate is committed to upholding and promoting human rights and the rights of the child. These rights may only be restricted as a last resort, including in the use of restraint. The use of restrictive practices, including physical restraint, must be considered within a context of the conflict in the promotion of rights, independence and choice for children and adults, versus promoting and maintaining our duty of care.2 In law3, the use of force in any form is required to be justifiable, reasonable and proportionate. Practitioners may be required to take protective action to keep children and adults safe from harm that may affect rights, including choice, dignity and freedom. However, this must be delivered within a context of positive risk taking and compassionate care.
Legislation and standards
Whilst there is no specific piece of legislation that focusses on restraint, the Care Inspectorate is guided by the following legislation and standards.
The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, which specifies:
- under welfare of users that “A provider must ensure that no service user is subject to restraint, unless it is the only practicable means of securing the welfare and safety of that or any other service user and there are exceptional circumstances” (4(1)(c)).
- under fitness of premises that “Accommodation must not be provided and used for the purpose of restricting the liberty of children in any residential premises where care services are provided unless such provision and use have been approved by the Scottish Ministers” (10 (3)).
The Health and Social Care Standards, which set out that:
- “If my independence, control and choice are restricted, this complies with relevant legislation and any restrictions are justified, kept to a minimum and carried out sensitively” (1.3).
- “My care and support meets my needs and is right for me” (1.19).
- “Any treatment or intervention that I experience is safe and effective” (1.24).
- “I experience warmth, kindness and compassion in how I am supported and cared for, including physical comfort when appropriate for me and the person supporting and caring for me” (3.9).
- “I am protected from harm, neglect, abuse, bullying and exploitation by people who have a clear understanding of their responsibilities” (3.20).
- “I experience care and support free from isolation because the location and type of premises enable me to be an active member of the local community if this is appropriate” (5.9).
- “If I experience 24 hour care, I am connected, including access to a telephone, radio, TV and the internet” (5.10).
- “I can independently access the parts of the premises I use and the environment has been designed to promote this” (5.11).
- “If I live in a care home, I can control the lighting, ventilation, heating and security of my bedroom” (5.12).
- CQC 2023
- Civil law
- Common law
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More information about this self-evaluation
We will undertake this self-evaluation in two phases.
Phase 1: National self-evaluation – 2 September to 20 November 2024
All local authorities will be asked to undertake a self-evaluation against Quality Indicator 6.4: Performance Management and Quality Assurance, using a specially developed tool. The below online briefing provides an overview of the approach, the templates and the submission process.
The Care Inspectorate team will analyse the responses to identify key strengths and challenges emerging from the evaluations.
Phase 2 – Validation activity – 20 January to 24 February 2024
The Care Inspectorate will select four local authority areas and will work with them to validate their self-evaluation. This will include review of documentary evidence and focus groups with staff and people who use services.
Participating local authorities will receive a validation letter and feedback on their self-evaluation.
A final thematic report will be prepared summarising the findings of the national self-evaluation and the key messages emerging from the validation activity. This will reflect national messages and share information about examples of innovative practice – findings will not be attributed to individual local authorities.
What you will need
We have developed a blank template, with guidance, to support you to undertake the self-evaluation. This template is available in word to allow you to develop your responses over time and share it with colleagues. However, final submission of the self-evaluation will be via the smart survey. If you have used the word version of the template to compile your responses, please paste your answers in to our smart survey using the link below.
This is the link to the smart survey for submission. This link will go live on Monday 2 September. Please make your final submission on or before Wednesday 20 November.
We have provided an exemplar of what a completed self-evaluation template may look like for your reference and guidance. We have also provided a Quality Indicator 6.4 illustration.
For further information on privacy in relation to how this review is conducted please see our privacy statement.
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More information about the review
What will we do?
Between July 2024 and December 2024 we will carry out a review that will focus on social work governance and assurance in Scotland. We will answer the following question.
How well do social work governance and assurance arrangements support leaders to:
- Ensure statutory duties are carried out safely and effectively?
- Enable social work staff to be supported, accountable and effective in their practice?
- Assist social work staff to uphold core social work values?
What is the purpose of the review?
The purpose of the review is to add to the understanding of the role, remit, effectiveness and the current challenges facing social work services. We will do this by exploring the impact of governance and assurance arrangements. The review will:
- highlight the areas of influence for chief social worker officers, principal social workers and other key social work leaders as they provide governance and assurance
- explore the support and assistance provided by leaders and managers to encourage staff to uphold social work values in practice
- identify and disseminate information about what is working well
- recognise the challenges faced by local leaders and staff across the country and identify areas where improvement is required.
How will we do this?
A team of strategic inspectors from the Care Inspectorate will carry out the review. The scope of the review is relative to the current pressures currently being experienced by the sector. It is designed to be mindful of the impact on those leading and working in social work services. We will take a collaborative, flexible and supportive approach when working with local areas. Each area is asked to nominate a co-ordinator to act as a main point of contact for the review. The timeline below (figure 1) illustrates the core tasks being undertaken through the review. The key dates are outlined below.
How will we report our findings?
The review will conclude in December 2024. Using the principles of the European Framework for Quality Management (EFQM) model, we will analyse all of the information gathered systematically and will draw together messages for the sector. A national report will be published on our website in March 2025. We will also use other methods, such as webinars, to share the learning from the review.
For more information, please visit our website here.
Review timeline
Figure 1: Review timeline
Details about the review timeline
Date |
Type of activity |
More details |
| 15 July 2024 | Notification | Local authorities and HSCPs formally notified and asked to nominate a co-ordinator to act as a single point of contact by 19 July 2024.The following week co-ordinators receive detailed guidance about the review. |
| 5 - 16 August 2024 | Briefing sessions for co-ordinators | Co-ordinators invited to attend a virtual briefing session with the review team from the Care Inspectorate.Information about the review will be shared and there will be opportunities for co-ordinators to ask questions. |
| 19 August - 4 October 2024 | Staff survey | Local authority areas/HSCPs asked to share a staff survey for all frontline social work staff and first line managers. |
| 27 August 2024 | Document return | Co-ordinators asked to return a short list of documents to the partnership by this date. |
| 30 September - 1 November 2024 |
Interviews with leaders and focus groups | Structured interviews with Chief Social Work Officers and a maximum of two other people during this period.Middle/senior managers (e.g. operations managers, service managers) from each local authority invited to participate in themed virtual focus groups. |
| 17 March 2025 | National review report publication | National review report published on the Care Inspectorate website. A local staff survey report will be provided to each area after publication.Further opportunities to discuss findings will be arranged, including webinars. |
Key definitions
Some definitions to clarify the remit of the review:
By governance and assurance we mean: A robust system for assuring high standards in the delivery of safe, personalised and effective social work services [adapted from the definition in “Governance for quality social care in Scotland” SWS 2018]
By statutory duties we mean: those outlined in the “Role of the registered social worker in statutory interventions: guidance for Local Authorities” in relation to the wide range of statutory duties across children’s, adults and justice social work services [source: Role of registered social worker in statutory interventions: guidance for Local Authorities SG 2010].
By social work staff we mean: social workers and other staff employed to fulfil or support the delivery of statutory social work duties such as occupational therapists, paraprofessionals (social work assistants and justice assistants). For the purposes of this review, we will not involve staff who work in registered services (such as residential care home staff, housing support staff or similar), because they are already involved in inspections of regulated services.
By core social work values we mean: those outlined in the SSSC code of practice (May 2024) underpinned by the ethical principles of human rights and dignity, social justice and professional integrity [source: BASW Code of Ethics 2021]
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Self-evaluation of performance and quality assurance in justice social work
This justice social work self-evaluation will focus on the current capacity of services to evidence performance, quality and outcomes in relation to community based sentences. The self-evaluation activities will be undertaken in two phases between September 2024 and March 2025. A national report will be published in May 2025.
The approach to this work will be informed by Quality Indicator 6.4 (Performance Management and Quality Assurance) which is drawn from the Care Inspectorate’s Guide to Self-Evaluation for Community Justice in Scotland. The aim is to develop a clear understanding of strengths and develop an evidence-base that informs local and national improvement initiatives.
By using a self-evaluation approach rather than a traditional inspection model, we hope to minimise the burden on local authorities whilst building capacity for improvement across the sector.
Useful links:
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Review of social work governance and assurance in Scotland
The Care Inspectorate has now published its final report following the review of social work governance and assurance across Scotland.
The review took place between July and December 2024 and sought to answer the following question.
How well do social work governance and assurance arrangements support leaders to:
- Ensure statutory duties are carried out safely and effectively?
- Enable social work staff to be supported, accountable and effective in their practice?
- Assist social work staff to uphold core social work values?
We looked at all areas of statutory social work including adults, children and justice social work services across all local authority areas in Scotland.
We heard from
- 32 chief social work officers
- 64 senior leaders at head of service or equivalent level
- 159 operational managers
- 8 chief officers of health and social care partnerships
- 8 local authority chief executives
- 3,935 staff who responded to our survey
- Reviewed 1032 documents
Key Messages
Our review found that
- Overall, social work leaders and managers worked effectively within often complicated governance arrangements. In most cases these arrangements were well understood by staff.
- Levels of oversight and assurance were enhanced by dedicated ‘social work governance boards’ or their equivalent.
- Social work influence was at times more limited within health and social care partnerships where it had a less equal level of representation.
- The role of the chief social work officer was important in promoting and amplifying the voice of social work.
- Staff, managers and leaders felt confident to promote and uphold values within social work services. There was a strong belief in the importance of social work values to support ethical practice.
- Overall social work assurance was mostly effective.
- Social work services were managing significant levels of risk relating to financial and staffing resources. The impact of both of these risks was amplified in island and rural settings.
- Overall, staff were supported to deliver effective services.
- Most social work staff benefitted from appropriate professional supervision arrangements and received learning and development opportunities which supported them to deliver their role.
High level messages for national consideration
- Scotland’s social work services were finding the ability to match supply with demand exacerbated by increased levels of complexity. This meant that social work was at risk of being unable to fulfil its statutory duties in some service areas.
- Staff were concerned that traditional relationship-based practice was being replaced by ‘transactional’ or ‘episodic’ engagement with people and children who use services. This was particularly the case within adult social work.
- A national approach is required to tackle the recruitment and retention crisis. Social work sustainability is particularly impacted by the enduring financial position. Change is needed to support the vital role of social work services.
We would like to thank everyone who participated in the review.
Our review report was published on 6 May 2025. You can read the full report below.
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