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Driving quality forward

Peter Kinsey and Sarah Maguire explore the importance of positive behaviour support, how to take forward the Driving Up Quality Code and its relevance to all health and social care settings.

In the previous articles, we have explored the way that providers of learning disability services have embraced the Driving up Quality Code, and how they’ve implemented and assessed it to benefit their clients and business. In this article, we are taking things one step further and discussing the application of positive behaviour support across all sectors and plans to expand the use of the Driving up Quality Code to a more diverse range of health and social care providers.

The Driving up Quality Code was developed by the provider sector as a direct response to the terrible abuse at Winterbourne View. We know that people labelled as ‘challenging’ are at particular risk of abuse and poor treatment regardless of their age, condition or the setting they are in. As a result, we felt it would be useful to develop the Code, and particularly its self-assessment tool, a stage further to cover positive behaviour support.

Positive behaviour support

Many providers talk about positive behaviour support, but don’t necessarily understand what this means. By definition, Positive Behavioural Support is a holistic way of working with individuals whose behaviour may challenge. It is a values-based, person-centred way of working that promotes the use of non-aversive and non-punitive responses to behaviour. It is a proactive model of support that seeks to understand a person and the functions of their behaviour, marrying up ‘applied behaviour analysis’ and ‘a good life’.

Many providers talk about positive behaviour support, but don’t necessarily understand what this means.

In our experience, some providers implement strategies that fail to take account of the reasons behind an individual’s behaviour and implement approaches that are ineffective in supporting people to communicate their wishes.

Assessing positive behaviour support

The Driving Up Quality Alliance has developed a positive behaviour support self-assessment tool specifically for any providers who support people who present challenges. It asks providers to consider a range of questions, including:

  • What is your organisation’s approach to positive risk-taking?
  • How do you balance individual dreams versus organisational risk and/ or capacity in line with the Mental Capacity Act?
  • How are these risks discussed and explored with the person and their circle of support?
  • How do you ensure that staff understand about restrictive, aversive or exclusion practices, to ensure they are avoided when an individual challenges?
  • Are positive behavioural plans based on assessments and analysis by a ‘competent’ person?
  • How do you know that support staff implement and review strategies designed to support individuals such as communication strategies or behavioural plans?
  • What does your organisation do if it’s difficult to support someone?
  • Who do you seek advice and input from?
  • How do you learn what works for them?
  • How well understood are the principles of the Mental Capacity Act at all levels throughout the organisation?


This revised self-assessment tool is currently being piloted by a commissioner. The pilot is due to run until May 2016. Following the feedback from the pilot, we intend to roll out the new self-assessment tool across the provider sector in England and look to working with providers to create a suite of tailored self-assessment questions. There has been some interest in using the Driving Up Quality Code and selfassessment tool in Wales and we will encourage its dissemination in other parts of the United Kingdom.

The impact of implementing the Code and its self-assessment process has been understood by many learning disability providers. It has contributed to a ‘Good’ and ‘Outstanding’ rating under the Care Quality Commission’s ‘Well-led’ Key Line of Enquiry. The process of seeking feedback from key stakeholders and making changes that improve the quality of a service, as a direct result, fit very well with the principles of a ‘Well-led’ service.

In addition, providers are now required to demonstrate that they have implemented a ‘duty of candour’. The Driving Up Quality self-assessment process is a very effective way of demonstrating that an organisation is open, transparent and prepared to listen to the views of stakeholders, take them on board and act on them.

Applications across the sector

We believe that the principle of Driving Up Quality, using a transparent self-assessment process, involving the views of the people being supported, their families and staff, is relevant across health and social care. With that in mind, it is our intention to develop self-assessment tools across the sector, for providers of services to older people and people with mental health difficulties.

The Driving Up Quality Alliance is very keen to hear from providers interested in developing these self-assessment tools and would encourage you to get in touch and help to Drive Up Quality across health and social

Peter Kinsey is Chief Executive of CMG Ltd. Email:  Twitter: @PeterKinseyCMG

Sarah Maguire is Director of Quality and Safeguarding at Choice Support. Email: Twitter: @Choice_Support

You can find out more about Driving Up Quality at Twitter: @DrivingUpQualit


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