Restrictive Practice and Restraint in Care: What CQC Expects and How to Reduce It
What counts as restraint and restrictive practice, when it can lawfully be used, what CQC requires of providers and how to monitor and reduce it.
Restrictive practice is any action that restricts a person’s movement, liberty or freedom to act independently, including physical, mechanical or chemical restraint. CQC Regulation 13 requires a zero tolerance approach to unlawful restraint, and says any restraint must only be used when absolutely necessary, be proportionate to the risk of harm, take account of the person’s needs and capacity and follow current legislation and guidance. Providers must monitor and review its use regularly.
Restrictive practices are among the most serious issues in care and among the most closely scrutinised. This guide explains the definitions CQC uses, what Regulation 13 requires, how the Mental Capacity Act and Deprivation of Liberty Safeguards fit in, and practical steps to monitor and reduce restrictive practice. It is general guidance and does not replace specialist advice for services supporting autistic people, people with a learning disability or people with mental health needs.
Key takeaways
- Regulation 13 defines control or restraint as using or threatening force, or restricting liberty of movement, including by physical, mechanical or chemical means.
- Restraint must be a last resort, necessary, proportionate, lawful and based on assessment and capacity.
- Staff must be trained, and providers must monitor and review restrictive practices regularly.
- Where a person lacks capacity, follow a best interests process and use DoLS where appropriate.
- Record every use, review it and look for ways to reduce it.
In this guide
What Counts as Restraint and Restrictive Practice
Regulation 13 says a person controls or restrains a service user if they use, or threaten to use, force to secure the doing of an act which the person resists, or restrict the person’s liberty of movement, whether or not they resist, “including by use of physical, mechanical or chemical means”. CQC’s guidance covers restraint and restrictive practices together, and improper treatment includes unlawful restraint, which includes inappropriate deprivation of liberty under the Mental Capacity Act 2005 (CQC: Regulation 13). Examples include physical holds, locked doors, bed rails or lap belts used to restrict movement, sedating medicines used to control behaviour and seclusion. Which practices are lawful depends on the circumstances.
What Regulation 13 Requires
CQC says providers must have a zero tolerance approach to abuse, unlawful discrimination and restraint, and that unnecessary or disproportionate restraint and inappropriate deprivation of liberty are forms of abuse or improper treatment. If restraint is used, providers must make sure it:
- is only used when absolutely necessary;
- is proportionate to the risk of harm and the seriousness of that harm;
- takes account of the assessment of the person’s needs and their capacity to consent;
- follows current legislation and guidance.
Staff must receive induction training relevant to their role so that control, restraint or restrictive practices are only used “when absolutely necessary, in line with current national guidance and good practice, and as a last resort”, and providers should keep staff up to date. Providers and staff “should regularly monitor and review the approach to, and use of, restraint and restrictive practices”.
Capacity, Best Interests and DoLS
CQC says where a person lacks capacity to consent to arrangements for their care, including depriving them of their liberty, providers must follow a best interests process under the Mental Capacity Act 2005, including the Deprivation of Liberty Safeguards where appropriate. Restrictions should be the least restrictive option. See consent in care, MCA and DoLS in practice and the DoLS tracker.
Your Restraint Policy
CQC asks some services, including specialist services for autistic people and people with a learning disability, to send a restraint policy with their registration application. It says the policy shows how and when restraint may be used, must be lawful, ethical and in the person’s best interests, and must show a commitment to least restrictive practice with restraint only ever as a last resort (CQC: Restraint policy). Even if you are not required to submit one, having a clear policy helps staff and inspectors. See also our guide to Right support, right care, right culture.
Monitoring and Reducing Restrictive Practice
- Record every use: what, when, why, who, how long, the effect and the alternatives tried.
- Review each episode and look for triggers, patterns and ways to prevent recurrence.
- Review the overall picture at your governance meeting: numbers, trends and any unmet needs. See governance meetings.
- Train and assess competence in de-escalation and, where relevant, positive behaviour support.
- Involve the person, their family and advocates in reviewing plans.
- Consider safeguarding: unnecessary or disproportionate restraint is a form of improper treatment. See safeguarding adults.
Keeping the Records
CQCLogic includes a DoLS/MCA tracker with authorisation expiry alerts and a mental capacity log, an incident log with flags for CQC and safeguarding notifications and a safeguarding log for referrals. It does not hold restraint-specific forms, so keep your monitoring records in a format that works for your service and link them to these logs.
Keep capacity, incident and safeguarding records connected
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Frequently Asked Questions
What is restrictive practice?
Any action that restricts a person’s movement, liberty or freedom to act independently, including physical, mechanical or chemical restraint, as described in CQC Regulation 13 guidance.
What does CQC say about restraint?
Providers must have a zero tolerance approach to unlawful restraint. If restraint is used it must only be when absolutely necessary, be proportionate, take account of the person’s needs and capacity, follow current guidance and be regularly monitored and reviewed.
Is restraint ever allowed in care?
Only when absolutely necessary, proportionate to the risk of harm, lawful and as a last resort. Unnecessary or disproportionate restraint is improper treatment.
What is the difference between restraint and deprivation of liberty?
Restraint is using or threatening force or restricting movement. Deprivation of liberty is a legal concept under the Mental Capacity Act, and inappropriate deprivation of liberty is unlawful restraint. Use the Deprivation of Liberty Safeguards where appropriate.
Do staff need training on restrictive practices?
Yes. CQC guidance says staff must receive training relevant to their role so restrictive practices are only used when absolutely necessary, with updates at appropriate intervals.
How can providers reduce restrictive practice?
Record and review every use, look for triggers, involve the person and advocates, train staff in de-escalation and positive behaviour support and review trends at governance level.
Sources: CQC: Regulation 13, Safeguarding from abuse and improper treatment · CQC: Restraint policy