Domestic Abuse Bill

Debate between Lord Ramsbotham and Baroness Finlay of Llandaff

Committee stage & Committee: 5th sitting (Hansard) & Committee: 5th sitting (Hansard): House of Lords
Monday 8th February 2021 Lords Chamber

[Lord Ramsbotham (CB) [V]]

My Lords, in moving Amendment 155 and speaking to Amendment 156 standing in my name, I must declare two interests: first, I am chairman of the Criminal Justice and Acquired Brain Injury Interest Group; secondly, I am a vice-chairman of the All-Party Parliamentary Group for Acquired Brain Injury.

The chairman of the APPG, Chris Bryant MP, unsuccessfully tabled these two amendments in Committee in the other place. Since then, he and I have had a discussion with Victoria Atkins MP, Minister for Safeguarding, during which she assured us that the Government recognised the impact of acquired brain injury on victims of domestic abuse. Since then, she has forwarded a copy of the draft guidance to be issued to the police on domestic abuse protection notices and orders. Both are mentioned in Amendment 155, which includes referral to an independent domestic violence advocate, who can advise a victim on a range of issues, including healthcare. That has been forwarded to noble Lords by the noble Baroness, Lady Williams of Trafford.

These two amendments are linked in that both are to do with assessing whether a victim of domestic abuse is suffering from an acquired brain injury. I will speak first to Amendment 156, which covers prisoner victims of domestic abuse. It was the assessment of their needs conducted by the Disabilities Trust at HMP Drake Hall, a women’s prison in Staffordshire, that first alerted us to the added problems faced by victims suffering from an acquired brain injury.

The trust, which is a member of the interest group that I chair, had carried out an assessment of head injury at HMP Leeds, finding that over 40% of male prisoners were suffering from an acquired brain injury that affected their behaviour. The trust introduced a link worker scheme, in which someone who had worked with a prisoner while he was in prison supported him for six months when he was released into the community. The trust then carried out a similar assessment at HMYOI Wetherby, finding that a similar percentage of young offenders were suffering from an acquired brain injury.

Turning to women, the Ministry of Justice funded the trust to conduct a two-year specialist link worker scheme at Drake Hall. The trust found that 64% of the prisoners reported having suffered a brain injury, 98% of which were traumatic. Forty per cent of those suffering from a traumatic injury had a mental health diagnosis, and 62% of the women reported that they had received their injury during domestic abuse. For some, this was the first realisation that the injury was the cause of their behavioural symptoms.

In that connection, I have mentioned before in this House my disappointment that Theresa May, when Prime Minister, dropped the prisons part of David Cameron’s Prisons and Courts Bill. A number of us had hoped to use it to make statutory certain initial assessments on being received into prison, including an assessment of head injury. I hope that this Bill will provide the opportunity to make that good.

We have also corresponded with Alex Chalk MP at the Ministry of Justice regarding the follow-up to the Disabilities Trust report on Drake Hall. He confirmed that work was under way to improve the identification of individuals with an acquired brain injury and ensure that prison and probation staff were better informed and trained to understand and support the behavioural challenges of those with an acquired brain injury.

I shall move on, or rather backwards, to Amendment 155. In addition to the draft guidance for the police about domestic abuse protection notices and orders, I should draw attention to the inclusion of a time factor. Early assessment is of the essence in understanding the effects of an acquired brain injury no less for the victims than for those responsible for treating them. I beg to move.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, the noble Lord, Lord Ramsbotham, has raised an important issue and outlined the size of the problem. Brain injury can arise from many different causes such as violent trauma, lack of oxygen to the brain or self-medication with alcohol and drugs. Sadly, brain injury is in large part irreversible, although sometimes the brain has the ability to relearn under intense rehabilitation, which is why rehabilitation services are so important.

One can see the motivation behind the amendment, but I fear that it may be difficult to have it in the Bill. In acute head injury, haemorrhage, usually a subdural haematoma, needs to be detected rapidly and the clot removed neurosurgically. If missed, the injury may become a chronic subdural as the clot acts like a wick, drawing fluid into it so that it slowly expands in the fixed box that the skull provides.

The other main category is that of repeated impact injury, sometimes associated with episodes of concussion as classically seen in boxers, which can lead to dementia. The part of the brain that is damaged determines the clinical signs exhibited. If the frontal lobes or some of the main nuclei of the brain are damaged, there can be profound personality and behavioural changes, while in others, speech and movement are affected. It can be very variable. Sadly, although supportive care can help a person to cope with deteriorating brain function and slow its effect, it is not reversible.

A possible difficulty with the amendment is that it requires a two-week timeframe for assessment, given that there are already waiting lists for MRI machine time for those with symptoms indicating brain pathology, such as cancers that need urgent treatment. Awareness of head injury is gained first and foremost from the patient history, followed by appropriate physical examination, after which further investigations may or may not be indicated. It is the history of the injury and the clinical signs that may indicate brain injury; the screening itself can establish only that the findings and type of injury described are, on the balance of probabilities, likely to be causally linked. This well-motivated amendment should raise awareness of head injury so that women are asked about the type of injury, including how it happened and when. A high index of suspicion of head injury is needed, but I fear that the amendment as worded would not be workable in practice.

Armed Forces Bill

Debate between Lord Ramsbotham and Baroness Finlay of Llandaff

Monday 10th October 2011 Lords Chamber

[Baroness Finlay of Llandaff]

My Lords, I am most grateful to the Minister and officials for the time they have spent looking at all aspects of the Bill and the amendments we have just debated are most welcome. I now want to return to the question of including the operation of inquests in the annual report on the Armed Forces covenant. This would be incorporated into the new wording of the Bill.

It is important to consider that in this part of the Bill “service people” means,

“members of the regular forces and the reserve forces … members of British overseas territory forces who are subject to service law … former members of any of Her Majesty’s forces who are ordinarily resident in the United Kingdom … and relevant family members”.

I welcome the Minister’s comments that the report must be open and inclusive and I would hope that the operation of inquests could therefore also be included. The covenant report is to be about the effects of membership or former membership of the Armed Forces on service people. The reference group would steer and guide the detailed content of the report in relation to healthcare, education and housing and in such other fields as the Secretary of State may determine.

Why do we need the operation of inquests in the Bill? I suggest it is needed because the quality of civilian inquests is very variable and there is no office of chief coroner to address that. This amendment would complement such a post whenever it comes into being. Currently, the narrative verdict is used differently by different coroners and the information in the narrative verdict is not collated. However, it is important data, particularly in relation to former members of Her Majesty’s forces. For example, self-harming behaviours that are fatal may be linked to previous trauma. The long-term effects of emergency resuscitation techniques in the battlefield or from the use of equipment may as yet be unknown but they will emerge with time. Of course, many ex-service personnel die and there is no inquest—they die in civilian life and die of diseases like everybody else.

However, sometimes there is an inquest. I take asbestos as a specific example from history. The family of someone with mesothelioma may develop it from inhaling asbestos fragments that were on the clothing of the person exposed. As asbestos-related death has to be related to a coroner, such data were picked up. A current example that may be pertinent is those with Gulf War syndrome. I know that these personnel are being followed, but when they die, inquest data will become important.

The long-term sequelae of battlefield injuries may result in early deaths in civilian life. Cataloguing these can provide information for trauma management in future and the information will not be captured unless inquests into deaths of ex-service personnel are specifically catalogued. I am aware that many do not want to be followed up when they return to civilian life. They want to get on with their lives and put the past behind them. That makes health follow-up particularly difficult and is precisely why unnatural and untimely deaths, as would be referred to a civilian coroner, may represent the only point at which long-term sequelae of active service could be picked up.

I return to the operation of the inquests themselves. Those who die on active service are subject to support from the Defence Inquest Unit of the Ministry of Defence. It provides coroners in the civilian world with a summary of the incidents in which people have died on active service and suggests who to call as witnesses. The unit meets the pledge in the covenant to support the bereaved, but it is involved in the inquests only on those on active service, including those who die in training. Sadly, year on year, there are deaths in training; one man died very recently. The tragedy is that the number of deaths in training really does not seem to be falling year on year; it seems almost to be flat-lined.

The Armed Forces covenant document requires that help and support are given to the bereaved families, as is done by the Defence Inquest Unit, but it does not specifically state that the operation of inquests themselves will be monitored. Yet some bereaved report experiences at these inquests that were unexpected and deeply traumatic. The waiting time for inquests has only recently fallen and has not yet reached the target time of nine months. Bereaved families often feel unable to grieve properly awaiting the inquest, and my concern is that unless we maintain a spotlight on inquests themselves the timing may slip. In civilian life we know that some people are waiting up to seven years for an inquest.

Currently, the quarterly reports to Parliament are a very important catalogue of deaths, but the reports will cease when we are no longer in the theatres of war. The reference group for the report on the covenant will include the Royal British Legion, which has been very active in campaigning for a chief coroner. Despite all the discussions since the Public Bodies Bill, no development has obviated that need. To have the operation of inquests on the face of the Bill will complement such an office; it will not replace it.

This amendment will not incur expenditure; it will ensure joined-up government between the Ministry of Defence and the Ministry of Justice, the latter having responsibility for inquests. The report can incorporate the current quarterly reports on military deaths and any other reports that get laid before Parliament. But when the frequency goes down, it will ensure that military deaths continue to be monitored, reported and catalogued. It will ensure that there is a record of inquests held on those actively serving, respecting their memory, and will allow collation of deaths of those who died after leaving the forces and whose deaths, for whatever reason, were the subject of an inquest, thereby providing important epidemiological data in the long term.

These annual reports, as they are proposed and as I hope they become, will be a historic document of our forces’ health and welfare. I suggest that we must also record their sacrifices of life through active service. I beg to move.

[Lord Ramsbotham]

My Lords, I support my noble friend Lady Finlay in this amendment, having also supported her in the campaign to get the chief coroner into post as part of the Public Bodies Bill. She has already mentioned that. I mention this because it has been 149 years since the coroners legislation was last updated, and it is now not fit for purpose. Those constituents who are finding it so are the families of those armed servicemen who are killed overseas. They have to wait an inordinately long time now for the inquest. This adds to their distress and is the very antithesis of everything that the Armed Forces covenant is all about. Therefore I hope that by putting this in the Bill and having it included in the annual report on the covenant, we will put pressure on those who ought to see that the coroners regulations and way of operating is updated and made fit for purpose, particularly for our servicemen and their families.

Armed Forces Bill

Debate between Lord Ramsbotham and Baroness Finlay of Llandaff

Tuesday 6th September 2011 Grand Committee

[Baroness Finlay of Llandaff]

My Lords, this is a very important amendment because of what has happened to the Public Bodies Bill. As has been said by the noble Lord, Lord Rosser, the new Chief Coroner would have had a role in monitoring investigations into deaths of service personnel and in ensuring that coroners were suitably trained to conduct such investigations. However, that is not the situation at the moment.

The requirement in the Bill is that the Armed Forces covenant report includes information on the effects of membership or former membership of the Armed Forces on servicepeople, or descriptions of such people. It is really important to be aware in our deliberations that, while there are quarterly reports on those who die on active service overseas, a large number of serving personnel die on active service but not overseas. I have the data from 2000 to 2009. In 2009 there were 59 deaths during hostile action and 47 other deaths: four violent, four suicides, 22 accidents and 19 that were disease-related. The important point is that these deaths are not being catalogued anywhere. I am glad that the Government are continuing to produce quarterly reports on the inquests of service personnel who died overseas. The latest report was on 19 July 2011. A total of 476 inquests had been held into the deaths of service personnel who had lost their lives in Iraq and Afghanistan, including 12 service personnel who died of their injuries in the UK.

However, the way in which those inquests were handled raises some questions. There were 75 open inquests to be concluded into the deaths of service personnel in Iraq and Afghanistan: 21 involved deaths in the previous six months. The Wiltshire and Swindon coroner had retained 28 of the remaining open inquests, but there were 54 outstanding inquests, which meant that relatives had waited for more than six months. Thirty-five inquests were being conducted by coroners closer to the next of kin. That group becomes really important because, when one looks through the list of inquests from 2002 to August 2009, some were held by coroners who did more than five inquests a year but, in 2009, half of them were conducted by coroners who did fewer than five military inquests in their whole working lifetime. Sometimes the list may include one inquest done by one coroner over the whole period of the list being available. The problem is that those coroners may have no training in military inquests. The questions they ask may not collate the important and relevant information. That is because the role of the coroner’s inquest is to determine the cause of death and potentially make recommendations, but a lot more information needs to be gained.

The other concern is the experience of the bereaved families. I will quote one bereaved relative who said that when her sister died outside the military the police advised that they should get legal representation. She said that such advice was small comfort to the family at the time. That was in 2009. When a young man in the family lost his life on active service, the family went into the inquest blind and totally unadvised about the process.

In 2009, the Royal British Legion facilitated a meeting of bereaved families. The comments from that meeting are horrific. One woman said:

“Listening to your husband’s final words or viewing images on screen of his partial burial site is a very personal, emotional and private time. One should not have to see this for the first time in a court room”.

Another bereaved person said:

“Had we known before we went to the inquest, the agenda and the proceedings would have been entirely different and we could have provided more assistance to the coroner”.

The way that these inquests are currently being handled is excellent in some cases, but I am afraid that in others it is not good at all, but lamentable. That is despite the Ministry of Defence having published in 2008 the Boards of Inquiry and Coroners’ Inquests Information for Bereaved Families booklet. That booklet is not providing any support to these bereaved families.

The proposed Chief Coroner would have provided leadership over the way in which the inquests are conducted, the information to be collated from them and central information about all other military deaths which do not occur overseas. The problem is that when a body is repatriated to the UK, if only one person has died in that incident, the coroner—it has been the coroner from Swindon and Wiltshire—can allocate the inquest to the local coroner wherever that person is to be buried or cremated and have their final resting place. It is because of that that we have this lack of expertise across the whole country.

The other reason that it is important carefully to collect information from military inquests relates to a previous amendment that we discussed in the names of my noble friends Lord Kakkar and Lord Patel. It is important to do this because battlefield tactics change rapidly and therefore a coroner with relevant experience will have conducted inquests into contemporary military fatalities and will ask more pertinent questions and collect more appropriate data. The other problem is that when a coroner gives a narrative verdict, others with a legitimate interest may never see it. A coroner’s verdict will represent a summary of the evidence and ought to be a matter of written record but is currently not collated. Unless we include a requirement to report on the operation of inquests and not merely to collate their outcome, we will do a major disservice to those who have lost their lives while on active service for this country and to troops currently serving whose lives remain at risk because we are not collating information and learning lessons from deaths that have occurred, quite apart from not doing the right and best thing by those who are bereaved and left behind.

[Lord Ramsbotham]

My Lords, I will add one thing to what the noble Baroness has said. One of the bodies taking most action against the Government as regards the Chief Coroner is the Royal British Legion. It has worked with the charity Inquest, which looks after bereaved families, and has presented a powerful case. That case would be a great deal more powerful if the Ministry of Defence took as strong a line on behalf of serving people affected by this matter as the Royal British Legion is taking on behalf of veterans.