External research findings :: Mersey Care NHS Foundation Trust

Independent Evaluation by Manchester Metropolitan University

Manchester Metropolitan University (MMU) was commissioned by Mersey Care NHS Foundation Trust to undertake an independent research evaluation of the National HOPE(S) programme. Funded by NHS England’s Learning Disability and Autism Programme, the HOPE(S) national rollout concluded on 31 March 2025. This implementation and outcome evaluation represents the first large-scale, mixed-methods research study to systematically examine the impact of LTS in mental health settings and evaluate a dedicated intervention designed to reduce and prevent its use.

Central to the evaluation were in-depth interviews and focus groups with 73 key stakeholders including individuals with lived experience, family members, clinical staff, those delivering the intervention, commissioners, regulators and system leaders, providing a rich narrative account of the harms of LTS (long-term segregation) and the perceived impact of the National HOPE(S) programme. These qualitative insights were complemented by outcome data gathered by service providers and HOPE(S)/Respond practitioners between May 2022 and March 2025.

The findings from this evaluation offer a stark confirmation of what people with lived experience, families, and advocacy organisations have long described: (LTS is profoundly harmful, both to the people subjected to it and to those who care about them. They face significantly compromised quality of life, heightened risks to their physical and mental health, and a significant erosion of their rights, dignity and autonomy. The psychological and emotional toll of LTS also extends beyond the individual. This is the first study to extensively document the impact on family members, many of whom described persistent trauma, helplessness, and isolation. Families reported feeling excluded from care planning, disbelieved by professionals, and stigmatised by association.

LTS Reduced Significantly:129 people supported since May 2022; 86 (67%) exited LTS, and 40% of these were discharged into the community.
National Reach:88 people supported out of LTS across 71 hospital sites and 42 NHS organisations engaged.
Training Delivery:Over 3,800 staff trained, including 1,685 clinicians and 2,184 awareness attendees. Training extended to CQC inspectors, NHSE case managers, IC(E)TR chairs, and community providers.
KPI Achievement:Met the target reduction in LTS from baseline cohort. New KPI frameworks and performance contracts are in place for future commissioning.
An independent evaluation by Manchester Metropolitan University, the largest of its kind to date on people in LTS in inpatient services indicated the following outcomes:

Clinical and wellbeing outcomes

Engagement in meaningful activity up 109%, fresh air/exercise up 84%.
Restraint down 21%, seclusion down 33%, chemical restraint down 12% monthly.
Staff burnout and trauma decreased, while compassion satisfaction increased.

Thematic analysis from 73 stakeholders highlighted:

LTS causes significant trauma and harm.
HOPE(S) improves care quality and culture.
It is scalable and should expand beyond its original scope.
Systemic challenges remain, but HOPE(S) is a credible solution.

The programme has had a measurable, life-changing impact. Two-thirds of those supported have exited LTS, and over a third of those who are out of LTS have returned to their communities. The reduction in restrictive practices is matched by an increase in meaningful engagement and staff wellbeing.

The independent evaluation confirmed the programme’s credibility and the urgency of expanding it. The programme has earned recognition nationally and globally, a testament to its robust design and impactful outcomes.

An independent Return on Investment (ROI) analysis of the HOPE(S) programme was carried out by a specialist in Return on Investment for change projects and programmes. The analysis of the cost impact of the HOPE(S) intervention indicated a significant financial saving and Return on Investment (ROI) ratio of over 12:1 for every pound spent.

National and international recognition

HOPE(S) is evolving into new areas, both domestically and internationally.

Commended by WHO: Included as part of the WHO’s Quality Rights training for Europe.

Endorsed by CQC & Baroness Hollins:

Cited in House of Lords discussions and Secretary of State responses.

Awards and acknowledgement:

Shortlisted for three national awards: Highly Commended by HSJ for Innovation and patient safety. Winner RRN best initiative award 2023.

LTS is not a therapeutic intervention, but a practice that strips people of their dignity, identity, and hope...

HOPE(S) has proven that compassionate, skilled, and rights-based care can transform lives.

This is not just effective, it is urgent, ethical, and just.”

– Manchester Metropolitan University Evaluation, 2025

Read the full report or the executive summary.