HOPE(S) Model :: Mersey Care NHS Foundation Trust

What is HOPE(S)

The HOPE(S) model is an ambitious human rights based approach to working with individuals in segregation developed from research and clinical practice.

The clinical model was developed by Mersey Care NHS Foundation Trust. It reduces the use of long term segregation sometimes experienced by autistic adults, adults with a learning disability and children and young people.

Mersey Care has wide experience of good practice in complex care settings and continues to collect clinical evidence as part of our commitment to learning. We were commissioned by NHS England to deliver a national programme over two years. This enabled specially trained practitioners to work with service users and staff at sites across the country. The national rollout concluded on 31 March 2025 and it is now for local service providers and commissioners to choose if they wish to continue to use practitioners in their area.

The programme was funded by NHS England to roll out the model across services in England. It was subject to national scrutiny and an oversight group chaired by Gavin Harding MBE and Sir Norman Lamb, both experts by experience. Mersey Care has worked closely with Manchester Metropolitan University to provide academic oversight and research into the success of the model. So far, over 2400 clinical staff have been trained by Mersey Care in the use of this model. There has been significant learning in how to do this, not just in the NHS, but also for our partners in community services and the programme won a major award from the Restraint Reduction Network.

We have held events to hear from people with lived experience, directly recounting their stories, senior healthcare leaders and our research partners at Manchester Metropolitan University and thanks to everyone who attended, supported or contributed to their success. Colleagues and partners continue to meet in their communities of practice, sharing ideas and giving space to hear diverse views and experiences.

The HOPE(S) clinical model has what is described as “a relentlessly positive” approach to supporting people in long term segregation.

The model describes:

It encourages teams to Harness the system through key attachments and partnerships
Create Opportunities for positive behaviours, meaningful and physical activities;
Identify Protective and preventative risk and clinical management strategies;
Build interventions to Enhance the coping skills of both staff and people in services
Whilst engaging in these tasks clinical teams and the System needs to be managed and developed to provide support throughout all stages of the approach.

HOPE(S) supports the compassionate trauma-informed care with service offers in different parts of England. Commissioners can contact Mersey Care for further details and guidance.

The team are commissioned to deliver a programme of secure avoidance specifically to help people with learning disabilities and autism in hospital settings avoid unnecessary transfer to or within secure services.

Through the nationally recognised HOPE(S) model, this pathway brings together specialist assessment, trauma-informed practice and practice leadership to reduce unnecessary restrictions in care. It empowers teams, transforms culture and creates real, sustainable change for people who need it most.

They support people with complex trauma histories, high levels of distress or with experience of long term segregation.

HOPES Qualification graphic.jpg The Diploma provides the foundation of the key principles of the HOPE(S) model and equips clinicians with the core skills required to administer the Barriers to Change Checklist and formulate key intervention targets to reduce long-term segregation. In addition, it covers human rights-based practice, trauma informed care, Positive Behavioural Support and other frameworks to reduce restrictive practice and associated harms.

The qualification aims to provide a learning and skills development pathway enabling people to become effective practice leaders.

The Diploma Practice Leadership in the HOPE(S) model is delivered by the Restraint Reduction Network (RRN).

Find out more online.

The HOPE(S) model is led by Mersey Care. Clinical psychologist Dr Jennifer Kilcoyne is the co-author and Director.

Lead nurse Danny Angus is the co-author and Associate Director. In the below film from Mersey Care, Dr Jennifer Kilcoyne and Danny Angus, along with Lead Practitioner Dr Leanne Franks, introduce the programme:

Some of our practitioners tell us about their roles and early successes.

July 2026

Reports relating to the Independent Care (Education) and Treatment Reviews (ICETRs) and Long-Term Segregation (LTS) which contain a number of important and encouraging messages for the HOPE(S) programme and the wider agenda of reducing restrictive practice have been published.

In the reports listed below, the HOPE(S) approach created by Mersey Care is recognised, particularly within the Oversight Group’s report, where there are references to the programme, and its evaluation, alongside recommendations linked to the Select Committee findings. This represents important national recognition of the contribution that HOPE(S) has made in supporting human rights-based, person-centred alternatives to long-term segregation and restrictive care.

Mersey Care sees research as central to improving healthcare. We commissioned Manchester Metropolitan University (MMU) to conduct an independent rigorous research evaluation for the HOPE(S) programme.

Central to their 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. This provided a rich narrative account of the issues of long term seclusion and the perceived impact of the HOPE(S) programme. The mental health team at MMU used a mixed-methods design to address these objectives, including:

i. narrative and semi-structured interviews;

ii. focus groups;

iii. co-design/service improvement events; and

iv. secondary analysis of routinely collected anonymised clinical data.

Involving people with lived experience of learning disabilities, autism or long-term segregation and their families is central to the conduct and dissemination of this research. This includes producing an accessible version of the findings. The research team worked closely with people with lived experience part of the HOPE(S) steering groups and their networks. This made sure that recruitment to the research was appropriate and participation was accessible and supported.

The evaluation provided evidence-based research findings and recommendations to inform practice and policy in this area. It was published in the summer of 2025. The key recommendations from MMU include:

Standardising definitions and language across systems
Mandate transparent national monitoring and reporting
Embed mandatory training on LTS and right-based practice
Shift to proactive prevention
Centre families in care planning a service design
Expand and invest in HOPE(S)

The full report is available from the University and is summarised on our webpage.

March 2026

Cambridge University Press have published a new study of long-term segregation from different perspectives and examined its impact, with qualitative data from more than 70 people with lived experience, staff, commissioners and regulators. The authors conclude that “LTS is not a therapeutic intervention and is associated with profound psychological harm”.

Mersey Care has welcomed a delegation from Ukraine and the World Health Organisation (WHO) to share learning on human rights-based mental health care and how services can support people with dignity, compassion and hope.

The June visit brought together representatives from the Ukrainian Ministry of Health, clinical professionals and experts by experience as part of the WHO’s QualityRights programme, supporting Ukraine’s ongoing mental health reform.

Dr Noir Thomas, Mersey Care’s Chief Medical Officer, said “We’re delighted to welcome colleagues from Ukraine and the WHO to share learning about compassionate care that puts people first, protects human rights and supports recovery. Dr Thomas added: “The best way to keep improving healthcare standards is to learn from each other, share best practice and hear different perspectives so, as health professionals, we can keep pushing the boundaries and help our communities across the world.”

The visit took place against the backdrop of the ongoing war in Ukraine, which has placed sustained pressure on health services and reinforced the need for mental health care that is trauma-informed, community-based and grounded in human rights.

Anna-Maria Breysacher, mental health specialist at the WHO, said: “Our delegation included the Ministry of Health, mental health professionals, people with lived experience, lawyers and managers, were impressed by the practice they saw. She added: “We experienced a culture of transparency and trauma-informed care on the wards where patients are involved in their care. Co-production and the involvement of people with lived experience in their own care is most important for any transformation. We’ll reflect on what we’ve learned and what can be taken into our own practice in Ukraine.”

During the visit, delegates took part in a programme of learning and engagement, including:

Leadership discussions with Trust executives including the Chief Executive and WHO representatives
Workshops on the WHO QualityRights programme and cultural transformation
Visits to inpatient and community services to meet practitioners and patients at Mossley Hill, Aspen Wood and The Life Rooms
Examples of day to day care that reduces restrictive practice, promotes recovery and values lived experience
Discussion with Dr Jennifer Kilcoyne and the leads in the HOPE(S) programme

The visit highlighted the importance of mental health care that puts the person at the centre, supporting people with dignity, compassion and hope.

The opening of the 2024 HOPE(S) conference in central Liverpool.

Sir Norman Lamb, former Health Minister and Co-Chair of the National HOPE(S) Steering Group, also spoke at last year’s conference.

HOPES model graphic.jpg

External research findings

Click on the image below to see it in full size.

Download the HOPE(S) model clinical guide

Learn more about the project from people with direct experience:

High Secure Commissioner Alison Cannon details the benefits of the scheme.

Hear from Sir Norman Lamb, co-chair of the national HOPE(S) steering group on the occasion of the July 2025 report.

Fiona Ritchie OBE is a senior intervener for NHS England. She is a hugely experienced leader and has held a variety of strategic positions nationally. Here she describes how HOPE(S) practitioners are vital role models.