Restrictive Practice Reduction Through Reviewing Waiting Restrictions in PBS

May 15, 2026

Positive Behaviour Support requires providers to review restrictions that occur when people are made to wait for access, support, information or ordinary routines. The Positive Behaviour Support hub for rights, behaviour and restrictive practice reduction supports services to connect proactive planning with dignity, autonomy and safer everyday support.

In specialist services, restrictive practice review and reduction should include delays before meals, outings, personal care, medication support, staff responses, activities, visitors, phone calls and access to preferred spaces.

This reflects PBS principles around predictability, rights and person-led support, because waiting can become restrictive when people are left without explanation, choice or meaningful control.

Concept Explained Clearly

Waiting restrictions happen when a person’s access to something important is delayed by service routines, staffing patterns, unclear communication or informal rules. Waiting itself is not always restrictive. The concern arises when the person has little information, no influence and no reliable way to understand when access will happen.

This may include waiting for staff to unlock a room, waiting for transport, waiting for a preferred activity, waiting for a drink, waiting to make a phone call, or waiting for reassurance after asking a question. For some people, waiting without structure can quickly increase anxiety and distress.

PBS requires services to understand the function of waiting-related behaviour. The aim is not to remove all delay from life, but to support people to understand, tolerate and influence waiting in ways that are fair, respectful and least restrictive.

Why It Matters in Real Services

Waiting restrictions can create repeated flashpoints. A person may knock on doors, ask the same question many times, become verbally distressed, attempt to leave, or refuse later support because the original delay felt unfair.

Services may respond by increasing control: closing doors, reducing access, limiting requests or telling the person to wait without explanation. This can make the cycle worse. Commissioners and CQC will expect providers to evidence that delays are understood, communicated and reviewed where they contribute to restriction or distress.

What Good Looks Like

Strong services make waiting understandable. Staff explain what is happening, how long it may take, what the person can do while waiting and how they can ask for help.

Providers should be able to evidence waiting plans, visual supports, communication scripts, staff guidance, incident trends and outcome records. This creates a clear line of sight from waiting-related distress to support action, and from support action to reduced restriction and improved confidence.

Operational Example 1: Reducing Distress While Waiting for Community Transport

Step 1 – Context: A person became distressed most mornings while waiting for transport to a community activity. Staff often asked them to sit in the hallway until the vehicle arrived.

Step 2 – Support approach: Review showed the person found the hallway noisy and unpredictable. The issue was not the activity, but waiting without clear timing or a calming routine.

Step 3 – Day-to-day delivery detail: Staff introduced a transport countdown card, a quieter waiting space, a preferred magazine and a clear phrase used only when the vehicle was five minutes away.

Step 4 – Restriction reduction: The person no longer had to wait in the hallway and was supported to remain in a preferred space until transport was genuinely close.

Step 5 – How effectiveness was evidenced: Morning incidents reduced, departures became calmer and attendance improved. The provider evidenced that changing the waiting environment reduced restrictive staff direction.

Deepening the Approach

Waiting-related restriction often reflects a mismatch between the service timetable and the person’s processing needs. Staff may think they have explained the delay, but the person may need visual time cues, repeated reassurance, clearer sequencing or a meaningful alternative activity.

Strong teams analyse what happens before, during and after waiting. Using ABC data to understand behaviour patterns in PBS can help services identify whether distress relates to uncertainty, staff tone, blocked access, sensory pressure or previous experiences of promises not being kept.

Operational Example 2: Reviewing Waiting Before Personal Care Support

Step 1 – Context: A person repeatedly knocked on the office door when waiting for evening personal care support, and staff began asking them to remain in their bedroom until called.

Step 2 – Support approach: PBS review found that the person became anxious when support times changed. Being told to wait in their room felt like exclusion rather than reassurance.

Step 3 – Day-to-day delivery detail: Staff introduced a visible evening sequence, offered two care-time windows and agreed that staff would update the person if delayed by more than ten minutes.

Step 4 – Restriction reduction: The instruction to stay in the bedroom was removed and replaced with clearer information and proactive staff updates.

Step 5 – How effectiveness was evidenced: Office-door knocking reduced, personal care started more calmly and the person used the visual sequence to check timing. The provider evidenced that information reduced the need for restrictive direction.

Systems, Workforce and Consistency

Waiting support must be consistent. If one staff member gives clear timing and another says “in a minute” without meaning it, the person may lose trust in all staff communication.

Supervision should review whether staff understand how waiting affects the person and whether common delays are being managed fairly. Handovers should include what waiting strategies worked, what caused distress and whether any access delay needs management review. Strong services demonstrate that waiting is treated as a support issue, not simply a behaviour problem.

Operational Example 3: Reducing Restrictions Linked to Waiting for Shared Spaces

Step 1 – Context: A person became distressed when waiting to use a sensory room, so staff restricted requests to one planned session per day.

Step 2 – Support approach: Review found that the distress was greatest when the room was occupied but no one explained when it would be free. The daily limit reduced access without solving uncertainty.

Step 3 – Day-to-day delivery detail: Staff introduced a simple booking board, a waiting activity box and a clear “available next” card for the person to hold.

Step 4 – Restriction reduction: The one-session limit was removed, and access was managed through transparent booking and preparation.

Step 5 – How effectiveness was evidenced: Sensory room conflict reduced, requests became calmer and the person accepted short waits when timing was visible. The provider evidenced that transparent access reduced restrictive limits.

Governance and Evidence

Governance should show how waiting-related restrictions are identified, reviewed and reduced. Providers should be able to evidence PBS plan updates, incident analysis, access delay reviews, staff supervision notes, communication tools, quality-of-life outcomes and feedback from the person.

Strong governance creates a clear line of sight from behaviour to waiting barrier, from waiting barrier to support adjustment, and from support adjustment to outcome. Providers should be able to evidence that waiting-related distress is not managed through unnecessary control, but through better communication, timing and access design.

Commissioner and CQC Expectations

Commissioners expect providers to understand everyday causes of distress and reduce avoidable restrictions. They need assurance that people are not waiting unnecessarily because of poor planning, unclear staffing arrangements or service-led routines.

CQC will expect care to be person-centred, responsive, respectful and least restrictive. Inspectors may review whether people understand routines, whether staff communicate delays properly and whether restrictions are used to manage frustration. Strong services demonstrate that waiting support is part of PBS governance and daily practice.

Common Pitfalls

Using vague phrases such as “soon” or “in a minute” without clarity.
Making people wait in areas that increase sensory or emotional distress.
Restricting requests instead of improving information and access systems.
Failing to record waiting as a trigger for behaviour.
Allowing different staff to give inconsistent timing messages.
Measuring success by reduced requests rather than reduced anxiety and increased trust.

Conclusion

Restrictive practice reduction through reviewing waiting restrictions helps PBS services recognise how delays can affect autonomy, trust and emotional safety. Waiting should be supported, explained and reviewed when it contributes to distress.

Strong providers evidence how waiting barriers are understood, how communication improves and how unnecessary access controls reduce. This gives commissioners and CQC confidence that PBS is improving everyday experience in practical, measurable ways.