© PROMISE 2016 - All Rights Reserved | Em@il:promise@cpft.nhs.uk


PROactive Management of Integrated

Services & Environments



Sarah Rae

Expert by Experience, NED, CLAHRC EOE, Co Founder, PROMISE Global

Sarah is a joint lead for PROMISE. She has accessed secondary mental health services intermittently since her early 20s. She has also received treatment as an inpatient and has witnessed the use of restraint on several occasions. Sarah trained 6 years ago as Expert by Experience with the Cambridge and Peterborough Foundation Trust (CPFT). This led to new opportunities including the chance to become involved in Trust research projects and working groups. She also works a Trustee of national Mind and as a Lay Patient and Public Advisor to the CLAHRC (Collaboration for Leadership in Health Research and Care) East of England board. Sarah is married with 4 children, has 4 much adored Siamese cats and often gets roped into helping out with her daughter’s horse.  

Raod So Far

The exercise of force is incompatible with a vision of recovery. A caring response to distress underpins dignity and respect and paves the way for true enablement so people with mental health challenges can lead a life they want to lead and be self-determining. This ethos is the cornerstone of PROMISE (PROactive Management of Integrated Services and Environments). PROMISE began as an initiative to support staff and service users on a journey towards eliminating reliance on force in mental health services. Our vision, mission and values are:

Vision: Promote dignity by eliminating force in mental health

Mission: Create a global knowledge network for proactive practice


Following publication of the MIND report on Crisis Care in June 2013, PROMISE was conceived with a clear focus on understanding the scale of the problem as regards to Physical Intervention (PI) within Cambridgeshire and Peterborough NHS Foundation Trust (CPFT). So at inception the focus was on setting up systems around incident reporting and continuous auditing i.e. quantitative service evaluation. Qualitative research into positive and proactive care grew quickly into a new strand following publication of Department of Health guidance in April 2014. Since then PROMISE has expanded in its scope and has branched out considerably. Underlying this are some key insights that we have gained along the way.

The insights from our journey have been integrated with contemporary leadership and management theory into a co-produced model called PROCESS (PROduce Creative Effective Simple Solutions). It maps out the PROMISE change paradigm and provides a framework for leadership to lean on while navigating through the complex maze of service transformation. There has also been extensive work on the governance framework: PROGRESS (PROactive Governance of Recovery Settings and Services). PROGRESS provides board to ward visibility of all restrictive practices and quality assurance across a whole host of parameters. We are working steadily towards eliminating all prone restrains by April 2016. PROGRESS shows that most of the recent prone restrains have happened due to the patient putting themselves in a face down positon rather than due to staff intervention. Almost all the adult wards (barring one) have been prone restrain free for the last two months and many have been full physical interventions free as well. In August 2015 there were only four prone restrains in the entire trust. Within PROMISE we also listed over 200 bottom up initiatives in 2014, an association can be drawn with the consistent 90%+ scores on patient experience. We are currently in the process of organising the innovations from the frontline into a coherent tool kit, The SPACE Programme, that others can replicate and contribute to.

PROMISE Local has taken the aspirations from within CPFT into the local health and social care economy. We are now bringing together organisations to commit to a change agenda that involves:

We are working towards the 9th October to sign the PROMISE charter. At every level there are unique opportunities to work across statutory and 3rd sector, primary and secondary care, commissioners and providers, health and social care and so on. Education and training regionally could be changed to reflect these aspirations. We are in the process of aligning organisations across these fields.

PROMISE Global hopes to scale up and replicate these local solutions internationally. Cross-pollination between Cambridge, Yale, Brisbane,  Prague and Cape Town has helped PROMISE grow in its aspirations to create and share knowledge to ensure that every person receives positive, proactive and truly person-centred care. We hope our efforts will blossom into a global vision for local agendas. The various shapes and guises this might take will provide a rich kaleidoscope of experiential journeys to learn from. We will share and learn from each other’s efforts, struggles and successes and we will challenge the status quo and be a catalyst for a new discourse that redefines frontiers of humane care.