What this is
Positive and Proactive Care is Department of Health guidance for adult health and social care staff in England, published on 3 April 2014. It runs to 43 pages, with a four-page summary of key actions and an easy-read version. It came after the Transforming Care response to the abuse at Winterbourne View, a Mind report of June 2013, and a Care Quality Commission inspection of nearly 150 learning disability inpatient services, which found providers often uncertain about what was permitted and some over-reliant on restraint.
What it records
It defines restrictive interventions as approaches that limit a person’s movement, liberty or freedom to act independently, and requires a culture in which they are used only as a last resort, for the shortest possible time.
The key actions are specific. Staff must not deliberately restrain someone in a way that impacts on their airway, breathing or circulation, “such as face down restraint on any surface, not just on the floor”. A restrictive intervention must not include the deliberate application of pain. Where one is used, it must be the least restrictive option to meet the immediate need. Staff must not use seclusion other than for people detained under the Mental Health Act 1983. Everyone known to be at risk of restrictive intervention needs an individualised support plan, including a behaviour support plan, and people who use services, families and carers must be involved in planning and reviewing care.
The foreword states that restrictive interventions had been used not only when unnecessary but “to inflict pain, humiliate or punish”, and that they had been used too much and for too long.
Accountability is written in too: a board-level lead for reducing restrictive interventions, boards accountable for reduction programmes, and executive boards approving the behavioural support training taught to their staff.
How to read it
This is guidance, not a finding, and it decides nothing about any individual restraint. Its use is the opposite: it sets the standard that a lawful restraint can still fail.
The distinction that matters is between lawfulness and acceptability. A hold can be defensible in law and still breach this document, because the document requires the least restrictive option, no deliberate pain, no compromise of airway, the shortest time, and a support plan that made the restraint less likely in the first place. Where a service can show none of those, “it was lawful” is not an answer.
The foreword carries weight beyond the sections: it is the publisher’s own account of why the guidance was needed.
Where it stops
It covers adult services in England. It is guidance rather than a statutory code, backed by a two-year Positive and Safe initiative, cited by the Care Quality Commission and NHS England rather than enforced by them.
It describes 2014 practice, and was written against a system already inspected and found wanting. It does not set out a curriculum, a technique or a training standard, and it should not be quoted as though it did.
Sources
- Department of Health and Social Care, Positive and Proactive Care: reducing the need for restrictive interventions, 3 April 2014
- Department of Health, full guidance, 43pp
If you are reviewing how often restraint is used in your service, and what happens after it, our restraint reduction training covers the recording, the review and the debrief.
Reviewed 20 October 2026.