Building Strong PBS and Clinical Governance in Transforming Care Services

Positive Behavioural Support (PBS) is central to Transforming Care — but commissioners increasingly look beyond the behaviour plan itself. They want assurance that your service has clinical governance to keep PBS live, responsive and accountable.

This means linking your PBS model to clear MDT structures, risk processes and learning loops. If your service supports step-downs from inpatient units or ATUs, you may also find our article on safe step-down transitions useful alongside this piece.

1. PBS as a whole-service framework, not a document

Commissioners are wary of services where PBS exists only as a folder on the shelf. Strong providers show that PBS:

  • Shapes the environment — low arousal spaces, predictable routines, clear visual structures.
  • Guides staff practice — proactive, relational, de-escalation first.
  • Drives data collection — tracking functions, triggers and outcomes.
  • Underpins review cycles — plans updated in response to lived data, not just annual reviews.

2. Clear PBS leadership and MDT integration

Commissioners look for visible PBS and clinical leadership. Effective models typically include:

  • A named PBS Lead (internal or external) with protected time for observation, coaching and review.
  • Regular MDT meetings with psychology, psychiatry, SALT and OT, aligned to individual needs.
  • Clear decision-making routes: who can modify plans, authorise restrictions or agree de-escalation strategies.
  • Links to wider clinical governance — incident review meetings, safeguarding processes and quality dashboards.

3. Competence, not just attendance at PBS training

In tenders, it’s no longer enough to say “all staff receive PBS training”. Commissioners want to see how you:

  • Assess competence post-training (observations, competency checklists, reflective accounts).
  • Coach staff in real time during transition phases and high-risk periods.
  • Use supervision and debriefs to embed PBS language and analysis.
  • Refresh training after incidents or changes in presentation.

4. Data that tells a story — and informs decisions

Good PBS and clinical governance turn raw data into narrative. Consider how you will:

  • Track incidents by function, time of day, setting and staff mix.
  • Monitor use of PRN, physical interventions or environmental restrictions.
  • Link data to meaningful outcomes — community access, independence skills, relationship quality.
  • Present this information in commissioner-friendly dashboards or reports.

5. Proportionate restrictions with clear review cycles

Transforming Care is underpinned by the reduction of unnecessary restrictive practice. Commissioners expect:

  • A clear least-restrictive-first approach in all plans.
  • Documented rationales for any environmental or procedural restriction.
  • Time-limited restrictions with planned review dates.
  • Co-production with the person and, where appropriate, their family or advocate.

6. Learning from incidents — not repeating them

High-quality governance treats incidents as opportunities for systemic learning, not fault-finding. Strong services:

  • Hold structured debriefs with staff and, where possible, the person themselves.
  • Identify themes across incidents: what keeps happening and why?
  • Update PBS plans, risk assessments and staff training in response.
  • Share learning with commissioners in a balanced, non-defensive way.

7. Assuring commissioners and families

Finally, governance must be visible. Providers can build confidence by:

  • Sharing a clear governance chart in tenders — who leads what, where and how often they meet.
  • Providing anonymised examples of PBS reviews and data-driven changes.
  • Offering regular quality and outcomes reports to commissioners and families.

In Transforming Care, PBS is the “how”, but clinical governance is the “why and so what”. Providers who can describe both — clearly, simply and with evidence — are far more likely to be trusted with complex step-down pathways.

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Written by Impact Guru, editorial oversight by Mike Harrison, Founder of Impact Guru Ltd — bringing extensive experience in health and social care tenders, commissioning and strategy.

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