No Force First – Mersey Care NHS Foundation Trust

No Force First, developed by Recovery Innovations, is a restraint-reduction strategy and quality improvement programme that was piloted by Mersey Care in 2013. This has since been rolled out to all wards across adult mental health and secure wards and more recently, has started in specialist learning disability services. The programme promotes the reduction of conflict and aims to improve staff engagement and capability by establishing a recovery-focused and supportive culture and environment.

Co-Production

  • From start: No
  • During process: Yes
  • In evaluation: No

Evaluation

  • Peer: Yes
  • Academic: Yes
  • PP Collaborative: No

Find out more

Mersey Care NHS Foundation Trust provides specialist mental health services in North West England and beyond. It provides specialist inpatient and community mental health, learning disabilities, addiction and acquired brain injury services for the people of Liverpool, Sefton and Kirkby, in Merseyside. It also provides secure mental health services including high secure and specialist learning disability services.

No Force First, developed by Recovery Innovations, is a restraint-reduction strategy and quality improvement programme that was piloted by Mersey Care in 2013. This has since been rolled out to all wards across adult mental health and secure wards and more recently, has started in specialist learning disability services. The programme promotes the reduction of conflict and aims to improve staff engagement and capability by establishing a recovery-focused and supportive culture and environment. These goals are in line with the national guidance and requirements of the Care Quality Commission to reduce restrictive interventions.

Data from the pilot study identified more than a 50% reduction in physical and medication-led restraint in the first year. Service user experience feedback saw a positive improvement and staff morale and satisfaction was enhanced. Additionally, staff sickness on pilot wards fell by 25% in 2 years. Independent projections of the benefits of implementing a No Force First strategy predicts significant savings from reduced staff sickness and absence due to fewer assaults and injuries.

The aim of the programme was to inspire dedicated ward teams to make small measurable changes on the ward that improve recovery pathways and reduce distress. The trust has successfully implemented No Force First across all adult mental health and secure wards and by linking the programme to the trust’s Perfect Care strategy and ensuring that staff at all levels have been engaged in continual quality improvement. Enhanced use of incident data has underpinned this commitment to change and innovation. The trust also involved experts by experience in the co-production and delivery of the strategy. This engagement meant that staff developed emotional engagement with No Force First and were helped to break down any cultural barriers. A guide has been developed for staff to address some of the challenges and successes of replicating the initial results at scale across the whole organisation.

Mersey Care’s No Force First programme has been internationally recognised. It has won the Changing Culture Award at the 2015 Patient Safety Awards and has been runner up in the Sustainable Healthcare Awards at the Kings Fund.

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