What is the Positive and Proactive Care Framework in Health and Social Care?

The Positive and Proactive Care Framework plays a crucial part in health and social care services. Developed by the Department of Health, this framework sets out how organisations and individuals working in these sectors should support people whose behaviour may be perceived as challenging. Its focus is to reduce restrictive interventions—such as physical restraint, seclusion, and the inappropriate use of medication—by promoting compassionate, preventative, and person-centred care.

Background and Purpose

The release of the Positive and Proactive Care Framework in April 2014 followed widespread concerns about the overuse and misuse of restrictive practices, especially in mental health, learning disability, and autism services. Events such as the abuse at Winterbourne View Hospital brought these problems to public attention.

The framework’s main purpose is to guide services towards approaches that:

• Uphold the rights, safety, and dignity of the person
• Reduce reliance on restrictive interventions
• Ensure prevention and early intervention strategies receive priority
• Place the experience and perspective of people who use the service at the centre of all practice

What Are Restrictive Interventions?

Restrictive interventions restrict a person’s freedom of movement or liberty. These include:

• Physical restraint: When staff physically hold or block someone to stop them from moving freely
• Mechanical restraint: The use of devices or equipment to prevent movement
• Seclusion: Isolating someone in a room or area to manage behaviour
• Rapid tranquilisation: Giving medication quickly to manage severe agitation or aggression
• Environmental restraint: Changes to the environment to limit someone’s choices, like locking doors

Such interventions can have physical and psychological side effects, and their use carries risks of harm and trauma.

Person-Centred and Proactive Approaches

The framework draws attention to treating each person as an individual. Staff are expected to understand what matters most to the person, what triggers distress, and what helps them feel safe and in control.

Proactive approaches support people before crises develop. This involves:

• Knowing a person’s preferences, fears, and strengths
• Building supportive relationships based on trust and respect
• Creating environments which help people have routine, choice, and control

This shift in focus does not only improve outcomes for people using the services, but it reduces the risk of harm to staff and the individuals themselves.

Prevention and Early Intervention

Prevention is at the heart of the framework. Intervening early can defuse situations before they escalate. This means:

• Noticing early warning signs, such as changes in body language or mood
• Responding to these signs with empathy, calmness, and reassurance
• Offering meaningful activities and occupations to reduce boredom or frustration
• Supporting people to learn skills for managing stress and emotions

Early intervention reduces situations where restrictive actions might otherwise seem unavoidable.

Policy and Legal Context

The framework builds on a range of legal duties and policies to protect people’s rights. These include:

• Human Rights Act 1998: Safeguards individual rights and freedoms, including the right not to be treated in a degrading way
• Mental Health Act 1983 (and its amendments): Sets out when someone can be detained for treatment
• Mental Capacity Act 2005: Protects people who might not be able to make decisions for themselves and states that any restriction must be in their best interests and be the least restrictive

It is unlawful to use any form of restriction unless there is a clear, legal justification, and all less restrictive alternatives have been fully considered.

Organisational Values and Leadership

For the Positive and Proactive Care Framework to bring about change, organisations must:

• Display clear values about respecting people’s dignity and rights
• Make sure all staff receive regular training in positive behavioural support and alternatives to restrictive practice
• Provide strong leadership to monitor the use of restrictive interventions

Leadership teams are expected to collect data on all incidents, review patterns, and make sure lessons are learned.

Organisational culture plays a powerful role in guiding attitudes and behaviours. If leaders model compassionate care and set clear expectations, staff are more likely to follow positive and preventative practice.

Training, Development and Support

Staff training and support are vital. The framework recommends regular training in:

• Communication skills, including non-verbal communication
• Managing conflict and de-escalating challenging situations
• Positive behavioural support planning
• Understanding the effects of trauma and how it might affect behaviour
• Promoting respect for diversity, values, and beliefs

Support goes beyond training. It includes:

• Supervision and reflective practice: Time to discuss difficult situations openly
• Debrief after incidents: To understand what happened and how things could be done differently in the future
• Emotional support for staff who may find situations stressful or upsetting

These steps create safer, more effective care environments for everyone.

Involving People Accessing Services

Genuine involvement of people who use services is a guiding principle in the framework. This means:

• Asking people about their preferences, including what helps and what does not
• Encouraging involvement in care planning and decision-making
• Listening to feedback following any incident, and acting on their insights

This co-production approach builds trust and helps services deliver care that works for each unique person.

Monitoring, Reporting, and Accountability

Transparency is central to the Positive and Proactive Care Framework. Organisations are expected to keep accurate records of:

• Each restrictive intervention used, including the reasons for it
• The duration and outcome of the intervention
• Reflections from everybody involved

This information helps organisations spot patterns, learn from what has worked well or gone wrong, and share good practice. Boards and regulators look at this data when checking on the quality of care.

Multidisciplinary Working

Working with colleagues from different backgrounds offers a range of expertise to support people well.

A multidisciplinary team typically includes:

• Nurses
• Psychiatrists
• Psychologists
• Occupational therapists
• Support workers
• Social workers
• Advocates

Each person brings their knowledge to design support plans and review practices regularly. Good communication within these teams is essential, as is valuing the input of the person and their family.

Working with Families and Carers

Families and carers have unique insights, which can help professionals understand the person better and spot early signs of distress.

Ways to involve families include:

• Regular, open conversations about care and support needs
• Sharing positive strategies that work at home
• Seeking feedback after incidents of restraint
• Informing families about their rights and options for raising concerns

This joined-up way of working keeps the person at the centre of all decision-making.

Trauma-Informed Care

The framework highlights the need for trauma-informed practice. Many people who use health and social care services have experienced traumatic events in their lives.

Key components of trauma-informed care:

• Recognising how past trauma may affect current feelings and behaviour
• Reducing triggers that might cause distress or flashbacks
• Supporting people with compassion and patience
• Avoiding practices that may re-traumatise individuals

Trauma-informed care builds safety and trust, creating the conditions for recovery.

Positive Behavioural Support (PBS)

PBS is an approach strongly encouraged by the framework. It is based on understanding why someone behaves in a certain way and helping them meet their needs in positive, safe ways.

The main steps of PBS:

• Understanding what triggers behaviour, using observation and discussion
• Developing support plans that focus on strengths and skills
• Teaching the person new ways to communicate or cope
• Adjusting the environment or routines to reduce stress
• Reviewing and adapting support regularly

PBS aims to reduce behaviours that challenge by meeting needs proactively, rather than reacting with restrictions.

Reducing the Use of Restraint

The framework sets a clear goal: restraint should be used only as a last resort, for the shortest time, and in the safest way possible. This is to prevent harm and respect every person’s right to freedom.

Reduction strategies include:

• Anticipating and addressing needs early
• Using de-escalation techniques, such as calm communication and offering choices
• Changing staffing or the environment so stress and risk are lower
• Involving the person in developing their own safety plans

As a last resort, if restraint is absolutely necessary to prevent harm, it must be done safely by staff who are confident and well-trained, with full recording and review.

Each Person’s Rights and Voice

A guiding principle of the Positive and Proactive Care Framework is respect for every person’s rights, independence, and inclusion. It recognises that each person has a unique set of needs and strengths, calling for support that fits them, rather than forcing people to fit a system.

Staff are expected to champion this approach:

• Respecting people’s dignity at all times
• Listening and acting on concerns or complaints
• Helping individuals to understand and exercise their rights

Upholding these ideals increases trust, satisfaction, and positive outcomes for all involved.

Final Thoughts

The Positive and Proactive Care Framework marks a major step in changing approaches to behaviour that challenges within UK health and social care. It places prevention, person-centred care, and rights at its core, moving from crisis and control to compassion and collaboration.

By fostering skills, support, and cultures that value each individual, this framework offers a better path for people who use services, for their families, and for staff alike. Reducing restrictive interventions is not only a matter of safety but of respect, dignity, and justice in care.