Co-Produced initiative attempts to improve Least Restrictive Practice understanding

A patient and a staff member have teamed up to better understand how Least Restrictive Practice (LRP) is experienced and applied in secure services.

Regan Webb, Assistant Psychologist from Willow ward in Northampton, has been working closely with Phil from Cranford to identify where improvements can be made to ensure care is consistently patient-centred, safe, and effective.

The idea was born from Phil, after he had noticed that staff did not always demonstrate a consistent understanding of LRF.

Phil said: “In some cases, I noticed the term was being used incorrectly, or not being followed as it should be. I’ve been in secure services all my adult life, so there’ not much I don’t know about LRF.”

After further investigation, it became evident that understanding across secure services varied and most patients were unfamiliar with the concept altogether.

This prompted a broader piece of work to explore how LRP is understood and implemented across secure services.

So, Regan and Phil set to work to build a clearer picture of LRP by holding a series of focus groups. These sessions aimed to:

• Explore staff understanding of LRP
• Examine how it is applied through real-life scenarios
• Encourage discussion across multidisciplinary teams

Regan said: “It has been great working with Phil on a truly co-produced piece of work. He’s had some great ideas and his knowledge of the wards, service and LRF is vast. It has been invaluable having a patient perspective, ensuring their voice is truly heard throughout this project.”

The engagement has so far included all men’s medium secure wards and one female medium secure ward, with participation from Healthcare Assistants, Nurses, Student Nurses, and Deputy Ward Managers.

Key Findings

1. Training, knowledge and confidence

Feedback suggests that while some staff have received training on LRP, it is often either not retained or perceived as insufficient. Confidence in understanding and applying LRP varies significantly, particularly among non-registered staff.

2. Understanding and application

Encouragingly, staff broadly align with the principles of LRP, describing it as:

• Minimising risk using the least restriction possible
• Considering alternatives
• Being flexible and patient-centred

However, there is less confidence when applying these principles in practice. Many staff were unclear about “blanket rules,” where to find them, or how to apply them appropriately.

3. Ambiguity in Practice

A key theme emerging is the ambiguity around what LRP means in practice:

• Some staff associate it with promoting independence
• Others emphasise safety and risk management
• Some worry it could be interpreted as allowing patients to “do whatever they want”

There were frequent references to “grey areas,” highlighting the subjective interpretation of LRP. Staff also expressed uncertainty about how factors such as capacity and the secure environment should influence decision-making.

4. Operational Pressures

Staff described the challenge of balancing LRP with operational realities, particularly staffing levels. Decisions were often influenced by staff availability, with duty of care and safety understandably taking priority. This suggests that workforce pressures play a significant role in how LRP is applied in practice.

5. Organisational Systems

Several structural challenges were identified:

• Limited access to LRP logs
• Lack of clear induction or training
• Low awareness of blanket rules
• A need for clearer guidance rather than rigid rules

These findings indicate that inconsistencies in LRP are not solely due to individual understanding, but also reflect wider systemic and organisational factors.

Phil said: “We’re now planning on expanding this work to female wards so we can compare our findings. Once we have collated all the information we’d like to collate all the data and share with Secure Services management.”

Regan added: “While there is clear support among staff for the principles LRF, this work has highlighted important gaps in understanding, confidence, and consistency. Addressing these will require a combination of improved training, clearer guidance, and a focus on the operational realities staff face.

Bethan Evans, Divisional Director of Secure Services, said: “This is important work. This co-produced programme has provided us with the building blocks to strengthen shared understanding among staff and patients about LRP, drawing attention to the practice and making sure it is applied in a way that is both safe and truly patient-centred.”