Children and Young People: Restrictive Intervention

Catherine West Excerpts

Thursday 25th April 2019 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House calls on the Department for Education to urgently issue guidance on reducing the use of restrictive intervention of children and young people; and further calls on Ofsted to change its guidance to inspectors to recognise the importance of seeking to avoid the use of those interventions with children and young people.

I will start by thanking the hon. Members for Dulwich and West Norwood (Helen Hayes) and for Berwick-upon-Tweed (Anne-Marie Trevelyan) for joining me in applying for this debate. I pay tribute to the hon. Member for Croydon North (Mr Reed) for taking through the Mental Health Units (Use of Force) Act 2018 to significant advance. He deserves enormous credit. I also pay tribute to Olaseni Lewis, who tragically lost his life through the use of restraint, and to his parents, who fought so hard for justice. Finally, let me pay tribute to the brilliant Challenging Behaviour Foundation and Viv Cooper, who runs it, and to Positive and Active Behaviour Support Scotland and its founder Beth Morrison for the brilliant work of that organisation.

[Catherine West (Hornsey and Wood Green) (Lab)]

Would the right hon. Gentleman accept an intervention?

[Norman Lamb]

I am not going to take interventions, because I am under strict instructions to keep to time. I hope that Members will accept that, with my apologies.

This is a debate about the human rights of children. I am afraid to say that abuse of children is endemic throughout the system, and I am also afraid to say that the Government are complicit in the abuse of children for failing to get to grips with it and for not issuing guidance, which is now five years overdue. I will develop my points in due course. What are we talking about? Well, the restrictions imposed on children include: physical restraint such as prone restraint, whereby an individual—in this case, a child—is held to the floor with their face down to the floor; seclusion, whereby a child is locked in a room, and these are often children with acute and complex autism, who will be in a state of acute anxiety; mechanical restraint, whereby a child might be tied to a chair or a bed, for example; blanket restrictions, which might involve preventing children from going outside; and chemical restraint. The settings that we are talking about include residential schools, special schools and, incidentally, mainstream schools, as well as children’s homes, assessment and treatment centres, and hospitals within the NHS.

By way of example, when I was Minister I visited a girl called Fauzia, who was admitted to St Andrew’s Hospital in Northampton at the age of 15 and was there for nearly two years. When I visited her, her family told me that she had been subjected to the constant use of restraint, was prevented from going outside most of the time and was often secluded in a room that was, frankly, like a prison cell. I visited her two years after we had got her out of that institution, when she was being cared for by an organisation which understood that staff have to be trained in how autism affects an individual. In the period from the day that she was discharged from St Andrew’s to the day that I visited her two years later, she had not been restrained on a single occasion; we have to read something quite profound into that.

I also met Leo, the mother of Stephen, who has autism and a learning disability. Leo told me the harrowing story of a child subject to prone restraint in a special school. Stephen was referred to a residential school in Norfolk, but prone restraint was again used. Serious medical conditions were ignored and not properly addressed, which ended up with Stephen being rushed to hospital because a bump on his head actually turned out to be a brain haemorrhage that had been ignored for several weeks.

I have also been contacted by Deidre Shakespeare, whose son Harry has been subject to mechanical restraint—being tied to a chair, with his legs also tied to the chair. Deidre and her son live in Tyrone in Northern Ireland, and her concern is that, given the collapse of power sharing, there is simply no authority in Northern Ireland to address these very serious concerns, which in my view amount to human rights abuses.

On the scale of the problem, as I said at the start, it is endemic in the system. The Challenging Behaviour Foundation carried out a survey with 204 respondents: 88% of families said their disabled child had experienced physical restraint; 35% reported it happening regularly; 71% said their child had experienced seclusion; in over half the cases of physical intervention or seclusion reported, the child was between the age of five and 10—these are small children being treated in an entirely inappropriate way; 58% said their child had experienced restraint that had led to an injury; and 91% reported an emotional impact on their child. Radio 5 Live, which I applaud for featuring this issue, made a freedom of information request in 2017—only a fifth of authorities responded—and identified 13,000 physical restraints in the previous three years and 731 injuries. We are talking about children placed in these organisations by the state. It is shocking and scandalous.

Here’s the thing: it does not need to happen in most cases. In most cases, it is avoidable with the proper culture and training of staff. In a report commissioned by the Government, Dame Christine Lenehan, a leading expert in this field, quotes a local authority officer who said:

“There can be a vicious circle occurring within the ASD cohort”—

people with autism. It continues:

“A poor provider triggers challenging behaviour or physical meltdowns (or fails to prevent such events), often exacerbating this with their reactions e.g. restraint, punishment or confinement. Good providers in whose care this behaviour may not have occurred will now not accept the child due to their history and pattern of risk. Therefore, the child is placed in a more restrictive or secure setting which can result in a worsening situation. Eventually, the child reaches a secure NHS setting which often is wholly inappropriate for their ASD needs. In different circumstances, a good specialist day placement could have worked for this child.”

That is really shocking, because so often children who end up in a secure setting never escape from it again and spend their lives in an institution. This is happening within our society behind locked doors, and it is wholly unacceptable.

Dame Christine Lenehan in her report says:

“Strategies such as positive behaviour support (PBS) can also be effective for managing challenging behaviour. PBS assesses the relationship between environmental events and behaviour, identifies what can cause the behaviour and uses proactive strategies to prevent it. One respondent to our call for evidence noted that using a PBS-informed strategy had coincided with an almost 90% reduction in the use of physical restraints.”

If it is possible to avoid it, to use it is an abuse of that child’s human rights—full stop. There can be no compromise on this. We have to end it, and that is why it is so important that the Department for Education takes notice.

I want to contrast the approach between the Department of Health and Social Care and the Department for Education. As a Minister in the Department of Health, I issued guidance in 2014 for adults designed to radically reduce the use of restraint and to end the use of prone restraint. Now we have a provision, which will be introduced into the formal NHS contract, requiring that certified providers of training meet a standard of training that avoids the use of restraint in the first place, rather than training staff how to use restraint. That is the key difference. It will be embedded in how the NHS works and will be part of the Care Quality Commission framework.

By comparison, the Department for Education seems like a wholly different culture. The child is seen as the problem, interfering with education and therefore disciplined, with no attempt to understand their needs. We have a responsibility to understand what causes the behaviour in the first place, but there is no promotion of positive behaviour support or any other preventive approach. What a bizarre situation we have, when children are less well protected from abuse than adults. That is surely unacceptable.

There is no obligation to collect and report data on the use of restraint or seclusion, and parents do not even have to be told when their child has force used against them. The guidance offered by Ofsted is weak and needs to be reformed and reinforced. There is now a plan for legal action by 600 parents whose children have suffered physically or psychologically, with crowd-funding under way. The claim will be based on age and disability discrimination, and the Human Rights Act.

I have the following questions for the Minister. When will the guidance be published? We have been waiting for five years for it. How many children have suffered abuse in the meantime? Will it take a human rights-based approach? Will it include training at a certified standard as a requirement? Will the training be funded by the Government to ensure that it happens across the country? Will the same approach apply whatever setting the child is in?

Staff need support, training and guidance, but the bottom line is that the abuse of children must stop and the Government must act. We, and especially children, have waited far too long.

--- Later in debate ---

[Catherine West (Hornsey and Wood Green) (Lab)]

First, I pay tribute to the work of Inquest and Deborah Coles, who has worked in this field for many years and has a great deal of expertise. She continues to support families through very difficult processes, including inquests, which we know, as constituency MPs, can be extremely testing times for families. I also want to thank the right hon. Member for North Norfolk (Norman Lamb) for securing the debate and for his expertise in this matter.

It is 15 years since Gareth Myatt died in a child prison. That is a terrible anniversary, when we think of how little has changed in the human rights picture. Adam Rickwood sadly hanged himself following restraint, also by people much bigger and older than he was, yet we still hear the sorts of figures mentioned by my hon. Friend the Member for Croydon North (Mr Reed).

I want very briefly to put on record my thanks for what I learned as a Member of Parliament from listening to the passage of the Bill and from Seni’s family. They were suffering, but how generous they were to allow their own family experience to teach us, as Members of Parliament, the meaning of what we do and how we can press the human rights of all those young people—not just those under 18, but those in their early 20s—who end up in these terrible situations.

It is clear from the Joint Committee on Human Rights report that there is insufficient oversight and accountability in many of our settings—mental health settings, child prison settings or child training centre settings. For example, there is the tragic case of Amy El-Keria, who died at the Priory some time ago. We know that much of what happened to her before she tragically died involved inadequate staffing levels, failures to share key risk and care information with staff and inadequate systems for identifying and managing ligature risk, such as placing Amy in an unsuitable room containing high-risk ligature points and missed opportunities to remove a scarf in Amy’s possession. There were failures adequately to address the bullying of Amy by her peers or to follow the Priory’s anti-bullying procedures, and failures to pass on key information about Amy’s increased suicide risk on the day of her death. Finally, there was the delay in undertaking the final observation during which Amy was found hanging. To add to that, as I know from reading the paperwork that came out at the inquest, not one member of staff accompanied her to the hospital when, tragically, she was pronounced dead.

We must all remember these terrible incidents. Small numbers of people are in care in some form, but these individual stories do tell a tragic truth. In these individual cases of when things going wrong, there must be much quicker action by those working in child and adolescent mental health services and various other mental health systems. I would also like to see much more supervision of staff, particularly agency staff and new staff coming in on overnight shifts, when so much of this tends to happen.

In summing up, I merely want to put on record two key points. First, the Government must comply with international law and end the restraint techniques that we know, both from the passage of Seni’s law and from the work that the right hon. Member for North Norfolk has emphasised today, are unlawful and contrary to the human rights of children. Secondly, the solitary confinement of children in detention should be completed phased out as a practice.

I will reiterate the very useful points that the right hon. Gentleman made in his opening speech. When will the Government publish guidance on this important area? When will the training requirements be clarified for providers who are paid by the public purse to look after children with severe mental health problems, developmental problems and other sorts of difficulties? Will the funding be adequate for those training requirements and for the providers, and will these apply to all settings in which children, sadly, are virtually imprisoned, including both children’s social care and mental health settings?

[Several hon. Members rose—]