RRN Standards and BILD Act Certification – Is It Mandatory or Not?
Many of you will be aware of the recent letter sent out by the RRN, CQC, HEE and Skills for Care, dated the 18th November 2020 and entitled ‘RE Certification of Training in Restrictive Practices’.
I have received quite a few messages from people who have concerns regarding the letter and one such message (included below with the senders permission) echoes the concerts of a number of people who have contacted me regarding this proposed ‘certification scheme’.
The message I received is as follows:
I only use NFPS trainers, normally [names redacted], I have seen your videos on the new CQC regs for restraint, and I just came across the post” – The content of which reads as follows:
“The Restraint Reduction Network (RRN), Care Quality Commission (CQC), Skills for Care (SfC) and Health Education England (HEE) issue [sic] a letter of clarification to all regulated services on the RRN training certification scheme and the action that your organisation will need to take as the requirement for certified training is introduced from April 2021
From April 2021 CQC all services across health and social care will be expected to only use training in restrictive practices that is certified as complying with the Restraint Reduction Network training standards.”
The link in the post goes to this letter issued on the 18th November – https://restraintreductionnetwork.org/wp-content/uploads/2020/11/Letter-restraint-training-certification-ALBs-2020.pdf
“I keep being asked by a company “do my trainers meet these standards”, and I say yes. They then ask are they BILD accredited or CQC approved……….
Can you shed some light on this for me on how I can respond to them please as I am genuinely worried that many trainers are going to be out of work through no fault of their own.
My Response Post Legal Advice
My response to the above message, post having taken the appropriate legal advice, is as follows:
Hi [Name Redacted]
Thank you for your message and I am aware of the letter that you linked to, a previous version of which was distributed in July 2019.
In the letter linked to in the post it states:
“From April 2021 CQC will expect all services across health and social care to only use training in restrictive practices that is certified as complying with the Restraint Reduction Network training standards.”
There are two points to consider here:
One is that these standards are not mandatory because the parts of the Mental Health Units (Use of Force) Act 2018 that relates to what the Restraint Reduction Network (RRN) Standards and BILD Act certification is offering has not as yet been forthcoming from the Secretary of State for Health.
Therefore, the current situation is that compliance with the RRN standards is not a legal mandatory requirement as can be seen by the word ‘Prospective’ next to the relevant section of the Act here if you view ‘Latest available (Revised)’ version – (see here- https://www.legislation.gov.uk/ukpga/2018/27)”. Note the image below with a red arrow pointing to what version to view.
Furthermore, The Mental Health Units (Use of Force) Act 2018 is
“An Act to make provision about the oversight and management of the appropriate use of force in relation to people in mental health units;……”
As stated right at the top of the Act itself.
Therefore, the provisions of the Mental Health Units (Use of Force) Act 2018 only apply to the following institutions (as taken directly from the Act itself)::
“Mental health unit” means—
1. a health service hospital, or part of a health service hospital, in England, the purpose of which is to provide treatment to in-patients for mental disorder, or
2. an independent hospital, or part of an independent hospital, in England—
(i) the purpose of which is to provide treatment to in-patients for mental disorder, an
(ii) where at least some of that treatment is provided, or is intended to be provided, for the purposes of the NHS.”
Any organisation that falls outside the scope of the definition of a mental health unit provided by the Mental Health Units (Use of Force) Act 2018 is not affected by this law because it doesn’t fall within the scope of what the Act requires.
Secondly the letter states that: “Commercial training provider: Where service provider organisations commission training from a commercial training organisation they must ensure that the commercial training provider has been certified (with a link to this page – https://bildact.org.uk/certified-organisations/)”.
This is a Condition of Contract – Not a Legal Requirement
That requirement was decided on the basis of an NHS standard contract only and not by law. That means that the requirement has been set as a condition of contract.
With regards to what, if anything the Secretary of State for Health’s guidance will require is as of yet not known because no guidance has been forthcoming by the Secretary of State for Health as yet. But once again, I stress that at this present moment in time this requirement is a contractual requirement only and not a legislative mandatory one.
Currently however, quite a lot of agencies are not happy with this and are quite prepared to use their preferred training provider/s even if they do not have the BILD Act certification, as long as they can evidence that they can meet or exceed the RRN standards to satisfy CQC’s requirement.
In short, they are willing to override the ‘contractual’ condition if they are happy with the training provider they are currently using or are intending to use.
Also, a number of trusts are now asking CQC what legitimate sanctions CQC can impose on them if they choose not to get the BILD Act certification or use a training provider certificated under the BILD Act certification scheme.
The reason they are asking that question is because there are no legitimate sanctions that can be imposed and if any illegitimate sanctions were unfairly imposed that had a negative or disproportionate and adverse effect on the service, the service users, staff and someone’s business then that would possibly leave CQC open to a range of legal challenges.
An Alternative to The BILD Act Scheme & The 20% Royalty Rate
Interestingly a professional colleague of mine approached UKAS to set up an alternative option for certification so that there would be an alternative option to just the BILD Act scheme with university backing.
It was then that we were presented with a document that states the following:
“The Restraint Reduction Network owns the Restraint Reduction Network Training Standards 2019 and the Certification Scheme (as agreed by UKAS and HEE). The Restraint Reduction Network licences the Standards to certification bodies, subject to agreement to the scheme rules. The scheme rules are outlined in this handbook and licence agreement includes:” and bullet point 3 reads: “Certification bodies licence the standards from Restraint Reduction Network for agreed royalty rate (of 20%)”
In short, any alternative option to the BILD Act certification would need to pay them twenty percent of all income.
The fact is, in most other professional industry sectors, as long as an organisation can show that they have met and complied with the necessary regulatory standards, by whatever means, where it is a legal requirement to do so, that is all that matters.
With regards to the BILD/RRN process it has been set up (as is clear by the twenty percent royalty rate issue) to make it less attractive and to prohibit other agencies from being in competition in the marketplace.
UKAS Response To My Enquiry
As this was agreed by UKAS and HEE (Health Education England) I spoke to UKAS about this and the response I got contained the following statement:
“UKAS is the national accreditation body who accredits Certification Body’s to offer accredited certification for different products/processes and services. The accreditation process provides confidence to many stakeholders over the competence of a Certification Body to certify a specific product or service. Therefore in context of training involving physical restraint practices, a certification body could certify a training provider for the provision of a service which meets a specified criteria (e.g. contains required course content, verification of TNA, competence of trainers). This provides assurance to stakeholders that the service being delivered meets the standard. UKAS then accredits the Certification Body to provide assurance that the certification body is competent in undertaking a reliable certification process. With regards to the specified criteria this could be the BILD RRN standard or any standard produced.”
On UKAS’ website it states:
“UKAS accreditation provides an assurance of the competence, impartiality and integrity of conformity assessment bodies. UKAS accredited certification, testing, inspection and calibration reduces the need for suppliers to be assessed by each of their customers.”
However, in correspondence to me they have also stated this:
“UKAS has not offered accreditation in the area of restraint reduction training services before”.
So the ‘certification’ scheme is nothing more than an internal quality assurance programme designed by and for BILD that meets certain quality assurance standards, similar to an ISO 9000 quality assurance process. What that means is that it is written around what an organisation wants to achieve. It is nothing more than a UKAS certificated in-house training programme. This is unlike an ‘accredited qualification’ programme delivered through an Awarding Organisation like Pearsons, Highfields, or QNUK (for example), which is regulated by Ofqual and involves strict internal and external verification and quality assurance practices to be in place that meet nationally regulated requirements.
Furthermore, because UKAS has never been involved with this area of expertise before, it is taking advice from the very organisation that has approached it for certification. Now I’m not the cleverest person on the planet by far, but isn’t this akin to a person taking their driving test telling the examiner what they have to do to pass them?
In short, anyone can apply to UKAS to get anything ‘certificated’, but it is not an Awarding Organisation, Ofqual Regulated qualification or accreditation.
It Is Also Very Expensive
Another problem with this ‘certification’ scheme is that it is very expensive, involves a lot of work, increases training requirements and costs, will possibly reduce compliance and add further logistical costs to an already cash-strapped NHS.
And what is equally important is that it will intentionally put some training providers out of business, when many are already struggling due to the financial impact that covid has already had on their businesses.
Will It Keep People Safer?
The bottom line is will it keep staff and patients safer? I don’t think so. Anytime bureaucracy (an excessively complicated administrative procedure) is implemented, the focus ends up on the process of administration and not the outcome.
Interestingly in a HSJ publication on the 18th December 2019 entitled ‘Staff assaults and killing spark investigations of 20 providers’, it highlighted that “Safety inspections have been carried out at 20 health and care providers after three health workers have been killed by patients in the last five years.”
It went on to stat that HSE has said it inspected “a mixture of acute and mental health care providers” in the first half of 2019-20” and added that around “22 percent of non-fatal incidents reported to HSE between 2015 and 2018 in health and social care were attributed to acts of violence, which is three times as high as in all industries”.
Most interesting of all was that it stated that HSE inspectors “observed significant contraventions of the law”.
Does our Training Meet The RRN Standards?
We have mapped our training over the the RRN standards and our training definitely meets the standards.
In fact, we have been committed to restraint reduction for many years now and in February 2019 I reported on how we had managed to reduce restraint in one very large healthcare organisation by seventy-nine-percent. You can read that blog post here – https://www.nfps.info/achieving-a-seventy-nine-percent-reduction-in-prone-restraint-video/
I was actually told at the time that it would have possibly been an over ninety percent reduction, but the organisation had acquired another company that was using a different system of PMVA, who were co-incidentally looking to become BILD accredited!
Will We Be Seeking BILD Act Certification?
The short answer to that is no, we will not be seeking BILD Act certification and if you wish to know more about that then you can read the following blog posts that make our position on this very clear:
I hope that helps clarify the situation for some of you from our understanding of the situation based on the correspondence and evidence we have acquired.
Director, NFPS Ltd.