Care Inspectorate on restrictive practice

Charlotte Wilson, the Chief Inspector for Children and Young People at the Care Inspectorate shares the scrutiny body's work around restrictive practice.

The promise was clear that Scotland must strive to become a nation that does not restrain its children. Restrictive practices relate to different types of restraint. This can be physical, mechanical, chemical, cultural, environmental or psychological restraint, surveillance or blanket rules. Restrictive practice is defined as making someone do something they do not want to do or stopping them from doing something they do want to do, by restricting or restraining them, or depriving them of their liberty.

The Care Inspectorate is committed to upholding and promoting human rights and the rights of the child. These rights may only be restricted as a last resort, including in the use of restraint.

The use of restrictive practices, including physical restraint, must be considered within a context of the conflict in the promotion of rights, independence and choice for children and young people, versus promoting and maintaining our duty of care. In law, the use of force in any form is required to be justifiable, reasonable and proportionate. Practitioners may be required to take protective action to keep children and young people safe from harm that may affect rights, including choice, dignity and freedom. However, this must be delivered within a context of positive risk taking and compassionate care.

One of the recommendations of the promise relates to the recording and reporting of both restraint and seclusion. This recommendation was made with the intention of better understanding how often these restrictive practices were used and monitoring the progress towards stopping them.

As the body that collects data from Scottish care services on the use of restraint and restrictive practices, the Care Inspectorate has undertaken a number of strands of work to progress towards meeting these recommendations. 

The Care Inspectorate has been a member of the Scottish Physical Restraint Action Group (SPRAG)  since its inception in 2019. One of the early workstreams of the group was to give consideration to the data that is held on the use of restraint. Following a presentation on the existing Care Inspectorate data to SPRAG in 2020, we learned about the importance of clarity in definitions and reporting parameters. This led to the group focusing on developing consistent definitions with the aim of informing more accurate reporting.

The Care Inspectorate have since used these definitions in their revised version of Children and young people's care services: Guidance on records you must keep and notifications you must make. Alongside this, they developed  a Self-evaluation tool: The use of restrictive practices and piloted it with volunteer services from SPRAG at the end of 2021. The tool was launched in early 2022 with support from the sector and the Centre for excellence for Children’s Care and Protection (CELCIS), and some awareness raising webinars for providers where those who had piloted the tool shared their learning. The tool was updated in 2024, in consultation with the sector. Robust self-evaluation of restrictive practices plays a key role in the journey of reducing the use, and eliminating the misuse, of restrictive practices.

Care Inspectorate notifications are a requirement for all care services to report specific significant events, incidents, and changes to their service. These notifications help the Care Inspectorate monitor the quality and safety of care being delivered, identify potential risks, and take action where needed. The Care Inspectorate used the revised definitions to create a new notification on the use of restraint and restrictive practices.  They worked collaboratively with SPRAG members to develop the content of this.  The new notification was launched in May 2022, and updated in 2024 to take account of reflections on learning from the sector. The new notification has provided the Care Inspectorate with better access to, and analysis of, the data provided by care services.

Care Inspectorate annual returns are yearly reports that care services complete to provide information about their service and the people experiencing care. The information helps the Care Inspectorate assess risk, plan inspections, and understand the national picture. The Care Inspectorate used the new definitions to revise the content of the annual returns for residential childcare services to ensure consistency, and this was included in the annual returns from 2022/23. 

SPRAG has been a great example of collaborative working, as the sector journeys together to implement the changes called for in the promise.

There is learning in this on how to approach change management on a national level, as SPRAG has facilitated a partnership working approach that has been led by the sector rather than the regulator. You can see the Care Inspectorate sharing the progress in SPRAG at SIRCC videos in 2021 and 2022. 

In 2024, the Care Inspectorate began publishing annual data on the use of restrictive practices in residential childcare services in a statistical bulletin. This was followed by a similar publication in 2025. This has provided enhanced transparency on the direction of travel for the sector, young people experiencing care, and other interested stakeholders. The data is included in the Promise Story of Progress as one of the indicators of how well Scotland is doing in its progress towards keeping the promise.

In early 2025, the Care Inspectorate published their Policy position on the use of restrictive practices. This applies to all people experiencing care from infants and children, through to young people, adults, and older people. 

More recently, the Care Inspectorate has been meeting with Education Scotland and Scottish Government colleagues to explore a consistent approach to the reporting of restrictive practices for education settings that are connected to care settings, such as school care accommodation services and secure accommodation services.  They hope to be able to progress further with these conversations in 2026. In the interim, the Care Inspectorate has worked collaboratively with the Scottish Physical Restraint Action Group to co-create Incident Reporting Scenarios.

Learning from this journey over the past seven years, and in particular the recent focus on practice and reporting discrepancies between care, education, and mental health settings, has helped to inform Plan 24-30's Route map: Rights and Restraint. By continuing to take incremental steps towards developing practice in this area, the route map will guide Scotland in keeping the promise to “become a nation that does not restrain its children unless the only option is to ensure their safety…”