Improving safety with ‘No Force First’

Secondary Care | Service Users


Following the publication of reports such as Winterbourne View and Mental Health Crisis Care: Physical Restraint in Crisis, Mersey Care NHS Foundation Trust wanted to improve patient safety and quality of care by reducing the number of occasions of physical restraint or increased medication was used as a response to incidents. 

Who and where?

Iris Benson, Katharine Tyrer and Lynn King from Mersey Care NHS Foundation Trust.


The Trust had a long-standing commitment to a recovery-focused care and piloted the use of No Force First on three wards – adult mental health acute, learning disability and medium secure. Peer support workers were recruited, language was fundamentally changed and care was individualised. Risk assessments were replaced with patient safety plans. Education and training was designed to promote and develop the concepts of No Force First.


The wards involved were encouraged to develop their own changes using driver diagrams and PDSA cycles to identify priority interventions and measure improvement. Small, simple, improvements in quality were implemented and measured for effectiveness. Baseline data on restraint was collated for twelve months prior to implementation and monthly progress was monitored using statistical process control (SPC) run charts.

The project illustrates the importance of wider organisational culture. Support was provided by Mersey Care’s Centre for Perfect Care and Wellbeing  and the Advancing Quality Alliance (AquA).  

Organisational commitment to recovery principles was important, for example staff briefing sessions were co-produced and delivered.

Our success

All  three wards reduced physical and medication-led restraint by 50%. Balancing measures showed seclusion use, service user satisfaction and staff sickness were not negatively impacted by changes. One ward experienced a significant reduction in work-related sickness.

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