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Lord Ramsbotham
Main Page: Lord Ramsbotham (Crossbench - Life peer)Department Debates - View all Lord Ramsbotham's debates with the Home Office
(3 years, 9 months ago)
Lords ChamberMy Lords, in moving Amendment 22 I will speak also to Amendments 92, 105, 110 and 187, which are in my name and those of the noble Baroness, Lady Andrews, my noble friend Baroness Finlay of Llandaff and the noble Lord, Lord Shinkwin. In doing so, I declare my interest as co-chair of the All-Party Parliamentary Group on Speech and Language Difficulties. Unfortunately, I was unable to trail these amendments at Second Reading, for which I apologise to the Committee.
My co-chair, Geraint Davies MP, and I wrote to the Home Secretary in June, appealing to her to place a duty on the domestic abuse commissioner and local authorities to ensure that good practice should include the identification of, and appropriate support for, communication needs. We also appealed to her to allow victims of abuse, with communication disabilities and needs, to be allowed to give evidence in court in private. We also asked that speech and language therapists should serve on domestic abuse local partnership boards. We received a reply to this in September from Victoria Atkins MP, the Minister for Safeguarding, in which she said that the Government continued to prioritise improving speech and language outcomes, based on early identification and targeted support.
I well remember being introduced to the importance of having communication needs addressed by two cases when I was Chief Inspector of Prisons. The first was a woman who had been beaten into dumbness by her abusive partner. The creative writer at her prison encouraged her to express her feelings in poetry, which she then gave to other women to read out. One day the creative writer asked the woman herself to read her poem, and she found that she was able to. Her dumbness having been cured, the authorities could work with her. The same thing happened to a young offender who had been beaten into dumbness by his abusive father. Thanks to a speech and language therapist, the authorities were then able to plan a future that did not include return to his family.
I return to the amendments, which seek to flesh out the contents of our letter to the Home Secretary. Amendment 22 seeks to put the identification of and response to speech and communication needs into the Bill. Amendment 92 seeks to introduce local authority responsibility. Amendment 105 seeks to include speech and language therapists in domestic abuse local partnership boards, while Amendment 110 seeks to ensure that those with communication needs are provided with appropriate support in court. Amendment 187 adds the impact on children of witnessing domestic abuse to the importance of assessing the communication treatment that a victim may need. I beg to move.
My Lords, I have signed this group of amendments, introduced by the noble Lord, Lord Ramsbotham, with such conviction, because this area of domestic abuse is even more hidden from outside view than is normally the case.
The ability to defend oneself depends so much on the ability to use language—to express grief and hurt and to offer explanation and defence. We know that, for young people and children in particular, communication difficulties—difficulties in being understood and in understanding—can lead to invisibility as well as inaudibility. At worst, they lead to bullying in school and throughout life. These young people live at the heart of a perfect storm. Disabled people, shamefully, as we have learned throughout this debate, experience disproportionately higher and more prolonged abuse. They cannot as easily protect themselves or find protection. Their children, even if not directly abused themselves, will observe all of this—and, equally shamefully, disproportionately. Witnessing a parent being abused is itself the most hideous form of abuse. The children live with this violence and misery as victims and observers, silently and alone.
We can all understand that, but research underpins it and shows categorically that abused children are likely to have poor language and social skills. As research by Refuge has also found, they become afraid of the very people they count on to love them. It is no wonder that pre-school children shrink away into silence. While their disabilities grow worse, other children exposed to domestic violence are likely to be at risk of developing significant speech and language problems. Again, research documents a significant difference in hearing and speech development.
If that is combined with learning difficulties, as is often the case, children neither know what is happening to them, nor can they explain to other people what it feels like, except that many must feel that it is all their fault. The impacts are deep and lifelong. It is hard to imagine the mental torture for a child seeing a parent being violently hurt, and having to stand by, imprisoned by fear and locked in silence. Lifelong impacts must be at least loss of confidence in all relationships, as well as on learning.
We want to take the opportunity in the Bill not just to recognise the particularly vulnerable and dangerous situation that those children and young people face but, through these amendments, to build in agency and capacity for change. The first step must be, as set out in the amendment, to recognise and articulate the issue. The amendment would place a legal duty on the domestic abuse commissioner to ensure that the good practice that the commissioner must encourage has to include the identification of and appropriate support for communication needs. Given that there is no reason on earth why the Government should not accept the amendment, in all humanity, we ask the Minister how she sees this operating in good practice.
Amendment 92 and subsequent amendments in the group would embed agency at the level of local authority and practice, so that the needs of those children are made explicit in the local strategy, ensuring that they have a champion and advocate, a speech and language specialist. Such services are reflected in later amendments dealing with the courts. The Royal College of Speech and Language Therapists put it powerfully, stating:
“It would help support not just those affected by domestic abuse, but also the other professionals working with them to understand the links between domestic abuse and communication needs, how the latter may present and their impact, and how to respond appropriately”.
As with so much in this Bill, every aspect of every abuse that we are seeking to correct has taken on more complexity and urgency. However, this group of amendments has a particular moral force. It is primarily about victims of domestic abuse and their children, who are already at a great disadvantage and not well served by present services. They need extra help in this Bill. Your Lordships can make sure that they get it.
My Lords, I have received no requests to speak after the Minister, so I call the noble Lord, Lord Ramsbotham.
My Lords, I thank the Minister for his response and all those who have spoken so movingly in support of the amendments. The importance of communication for victims of domestic abuse and their children cannot be overemphasised. The Minister for Safeguarding having emphasised the importance that the Government attach to improving speech and language outcomes, I had hoped that the Government would consider including some of the contents of these amendments in the Bill. Until then, I beg leave to withdraw my amendment.
Lord Ramsbotham
Main Page: Lord Ramsbotham (Crossbench - Life peer)Department Debates - View all Lord Ramsbotham's debates with the Home Office
(3 years, 9 months ago)
Lords ChamberMy Lords, in begging leave to move Amendment 90—which I am most grateful to the noble Lord, Lord Rosser, for trailing and which might, with advantage, have been included in the group containing the other amendments on speech, language and communication needs that we considered in Committee last Wednesday—I declare my interest as co-chair of the All-Party Parliamentary Group on Speech and Language Difficulties.
Since our considerations in Committee last Wednesday, I have studied in great detail the responses of the noble Lord, Lord Parkinson of Whitley Bay, on some of which I shall now comment. The Minister said, inter alia:
“Those facing communication barriers are, arguably, some of the most vulnerable victims of domestic abuse … there is an important balance to strike between providing local authorities with the flexibility to meet particular local needs and … a consistent approach to the provision of support.”
He sought to reassure the Committee that
“the Bill already provides a framework to ensure that the speech, language and communication needs of victims are addressed.”—[Official Report, 27/1/21; cols. 1635-37.]
The provision of information in an accessible and inclusive format is one item that would benefit from a consistent approach to the provision of support. Because I am not reassured that the Bill covers this, I beg to move Amendment 90.
My Lords, following the helpful debate on the associated amendments last Wednesday, it is quite useful that we now have this debate on Amendment 90, specifically on how to support people with disabilities, particularly speech and language difficulties, with practical support for communication at the point at which they are seeking help.
With the best will in the world, there is little point in the agencies that are there to support them—whether they are specialist charities or local authorities—if those who are at greatest risk do not know, cannot follow or act on, cannot understand, cannot access and cannot make use of who can help them and how. The amendments debated last week had the powerful support of the UK Says No More campaign. This amendment is no exception, because it holds the key to getting help when it is most needed.
I am afraid the predictable response from government may be to say that information is available in different languages and sign language, but I say what the specialist groups in the field say: this simply does not go far enough. A leaflet, no matter how plain the language, would never be a substitute for the sort of help that can be provided only by a sympathetic advocate who takes the person by the hand along the pathway to safety. That is why we have given such priority to the service itself employing speech and language specialists.
We want to see any kind of communication in an easy-read format, obviously, but also made accessible on augmentation and alternative communication devices. But the idea that all problems can be solved by the written word, however plain the language—that is, of course, the first and most basic requirement—or even sign language, is simplistic and out of date.
Many people with speech and language difficulties are capable of—and even more dependent than the rest of us on—using technology, but emails, advice and all communications need to be jargon free. Where possible, signs and symbols can be used. It requires knowledge and empathy to get this right, but they are not in short supply and the Bill can benefit from them.
I have received no requests to speak after the Minister, so I call the noble Lord, Lord Ramsbotham.
My Lords, I thank the Minister for that response and all noble Lords who spoke to this amendment. We shall carefully consider all that Ministers have said during the passage of the Bill and decide before Report whether it strikes a balance between providing local authorities with the flexibility to meet local needs and ensuring a consistent approach to the provision of support. Until then, I beg leave to withdraw the amendment.
Lord Ramsbotham
Main Page: Lord Ramsbotham (Crossbench - Life peer)Department Debates - View all Lord Ramsbotham's debates with the Ministry of Justice
(3 years, 9 months ago)
Lords ChamberMy 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.
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.
My Lords, I am grateful to the noble Lord, Lord Ramsbotham, for setting out the case for these amendments, which, as he explained, follow similar suggestions from Chris Bryant MP when the Bill was debated in another place. I am pleased that my honourable friend the Minister for Safeguarding was able to meet Mr Bryant and the noble Lord, and that their discussions were—as the noble Lord said—helpful.
Amendment 155 seeks to introduce screening for acquired brain injury for female victims of domestic abuse within two weeks of a domestic abuse charge being made, including those victims to be protected by a domestic abuse protection order. Amendment 156 seeks to introduce screening for brain injury for all female prisoners within two weeks of starting their sentence, with a subsequent assessment to take place if an injury is found.
I say from the outset that we want to make sure that we provide healthcare and support that meets the specific needs of all victims of domestic abuse, and female offenders too, including those with acquired brain injury. We have carefully considered these amendments, and while we appreciate their overarching intent, we feel that legislating would not be the appropriate course of action. The noble Baroness, Lady Finlay of Llandaff, set out clearly the clinical difficulties that would be involved if we were to put this in the Bill.
The National Health Service is there to provide appropriate care and treatment for everyone who needs it, based on clinical need. This key principle on which the NHS operates means that anyone who needs a certain diagnostic test based on clinical need should receive it. The healthcare needs of victims of domestic abuse will vary greatly based on their individual circumstances and experiences but, if they need urgent assessment or treatment, they will receive this from the National Health Service.
Moreover, as we have heard throughout the scrutiny of the Bill so far, domestic abuse can manifest itself in many ways, including—as in the group of amendments we have just discussed—through coercive control or financial abuse, and it would be inappropriate to invite victims of these forms of domestic abuse for brain injury screening. That is why we do not consider that testing all female victims of domestic abuse, as this amendment suggests, would be an effective use of NHS resources or provide the personalised care they need.
Nevertheless, we believe that improvements can be made to existing screening processes through non-legislative measures. I will provide some background to that. All people entering prison receive an early health assessment within the first 24 hours. This initial assessment is comprehensive so that their health needs can be identified and addressed at an early stage. It includes a standard requirement to undertake a screening questionnaire for head injury and loss of consciousness, which focuses on issues with memory or concentration. As noble Lords have said, these can be important signs.
We acknowledge that more could be done during this screening process to identify and address specific circumstances where head injury or loss of consciousness has resulted from domestic abuse. I am pleased to say that NHS England and NHS Improvement have confirmed that they would be happy to add further questions to the existing screening tool to ascertain, where an acquired brain injury has been identified, whether that acquired brain injury occurred as a result of physical injury related to domestic abuse, sexual violence or another form of abuse.
The national screening tool is reviewed and updated by NHS England and NHS Improvement on an annual basis to allow for any changes in NICE guidance or any recommendations arising from a coroner’s report to prevent future deaths. To amend the existing screening tool, NHS England and NHS Improvement will need to agree the precise questions to be asked and how these will be reported. I am pleased to say that the initial screening questions on domestic violence and the coding that is required have already been agreed and will be implemented by April this year.
Alongside this, NHS England and NHS Improvement are continuing to work with the Disabilities Trust on a training package for healthcare practitioners to increase effectiveness when supporting people with impaired neurological functioning, either as a result of domestic abuse or for other reasons, and also to support them by providing practical steps to those working with patients and self-help tools for the patients themselves to reduce and overcome the impact of any brain injury.
In so far as Amendment 155 seeks to link screening to the making of a domestic abuse protection order, it is important to recognise that, like other protective orders, these are designed to impose requirements on the perpetrator. They cannot impose requirements on the person to be protected by the order, such as requiring them to undertake a screening for an acquired brain injury.
We will, however, use the statutory guidance to the police to recommend that they refer victims to an independent domestic violence adviser, or another specialist advocate, who will be able to advise victims of their options on a whole range of issues, including healthcare. In addition, we will include information on where to go to seek medical attention in the advice materials provided to victims which we will be producing ready for the pilots of the orders.
I hope that these non-legislative measures reassure the noble Lord, Lord Ramsbotham, that we are acting to support women with acquired brain injury and that putting this in the Bill is therefore not necessary. I am glad to repeat our thanks to him and to Mr Bryant for the discussions we have had on this important issue. I hope that the noble Lord will be willing to withdraw his amendment.
My Lords, I thank the Minister for that considered response and the noble Baroness, Lady Burt, and the noble Lord, Lord Ponsonby of Shulbrede, for their support. I am particularly grateful to my noble friend Lady Finlay of Llandaff for drawing on her considerable medical expertise to point out the practical medical difficulties with the timeframe proposed in Amendment 155. I majored on Amendment 156 and the assessment of victims of domestic abuse when they are received in prison, which has been proved to be so important. I will examine in detail what the Minister and my noble friend Lady Finlay said and decide what to do on Report. I beg leave to withdraw the amendment.
Lord Ramsbotham
Main Page: Lord Ramsbotham (Crossbench - Life peer)Department Debates - View all Lord Ramsbotham's debates with the Home Office
(3 years, 8 months ago)
Lords ChamberAmendment 92 is in my name and those of the noble Baronesses, Lady Finlay of Llandaff and Lady Whitaker, and the noble Lord, Lord Shinkwin. As in Committee, I declare an interest as co-chair of the All-Party Parliamentary Group on Speech and Language Difficulties.
In Committee, I tabled a number of amendments designed to have the speech, language and communication needs of victims of domestic abuse and their children included in the Bill. I am most grateful to the noble Lord, Lord Parkinson of Whitley Bay, for his response in Committee and for seeing me and a number of colleagues last week to discuss how this might be taken forward. I was particularly pleased to hear that officials were studying the issue, and I am pleased to learn from them that the Government are thinking of making revisions to the Bill before Royal Assent.
When moving a previous amendment, I reminded the House that many noble Lords often raised matters which they thought should be on the face of legislation during the detailed scrutiny that each Bill received in this House, which Bill teams almost invariably briefed their Ministers to turn down, but the method behind the apparent madness of the proposers of such amendments was that officials cannot be expected to know as much detail as professionals in the field, and their successors may well be grateful for having had their attention drawn to particular detail.
One example of this was quoted by the noble Baroness, Lady Newlove, very movingly on the first day on Report, when she referred to the traumas suffered by one of her daughters after witnessing the horrific murder of her father, following which she required speech therapy. If the traumatic effects on children of witnessing horrific events such as domestic abuse had been set down somewhere, officials might know what to advise the victims. It makes sense for a Government to draw on the advice of experts in drawing up a Bill and, as they draw up this piece of legislation, I appeal to them to listen to the expertise of the Royal College of Speech and Language Therapists, I CAN, the leading children’s communication charity, and the Association of Youth Offending Team Managers, all of which support the amendment.
The ability to communicate is a vital life skill, and early speech and language training an important factor in every child’s health and development—which I am glad the Minister recognises. As I said in Committee, those victims of domestic abuse who also face communication barriers are arguably among the most vulnerable, given the added difficulties that they face in asking for help. This is why the Government should make it abundantly clear that local authorities should consider what additional barriers they may have erected, preventing victims seeking refuge or access to other, safer accommodation services.
I have gone on quite long enough. My amendment is designed to provide a new opportunity for the Government to set out how they propose to issue guidance to local authorities under Part 4 of the Act. There are four aspects to any guidance, which will each be covered by a following speaker. The first is the link between domestic abuse and speech, language and communication needs. The second is the impact of witnessing domestic abuse on children’s speech, language and communication needs. The third is the services available to support people with speech, language and communication needs who are experiencing domestic abuse; and the fourth is how support provided by local authorities can be made inclusive and accessible to people with speech, language and communication needs. I beg to move.
My Lords, it is a pleasure to follow the noble Lord, Lord Ramsbotham, and to support the work that he has done on this amendment from the start of the Bill. I will not repeat the arguments for the amendment because, frankly, I think the Government have got the point that children and adults with speech and language difficulties are at greater risk of abuse than others and are therefore among the most vulnerable victims of domestic abuse. They have asked for, deserve and should now be given extra protection. In the debate we have heard powerfully from many noble Lords how much support there is for action in this Bill which will help these children and adults, because they face not only physical abuse but collateral dangers such as other mental health issues, substance misuse, literacy difficulties, learning disabilities, brain injury, neurodiversity, cognitive issues and, for many, rough sleeping and homelessness.
Including references to speech, language and communication needs in the Bill’s statutory guidance is what we are after. If we do this, we can ensure that the issues can be properly addressed so that some of the most vulnerable people can access the support that they need. I think the Government will say this evening that they have listened, but what we are listening out for is assurances that the guidance itself will be explicit on this point.
To make the Government’s task easier, the Royal College of Speech and Language Therapists has done the hard work. The experts to which the noble Lord, Lord Ramsbotham, referred have suggested a few specific ways of strengthening the guidance, and we are all grateful to them for their thoughtful and expert help throughout this Bill. They suggest:
“The Draft Statutory Guidance Framework might be strengthened by specifically referencing speech, language and communication needs in the following ways”,
I ask the House to bear with me while I read what they said. In chapter 2, “Understanding Domestic Abuse”, they said:
“Referring to speech, language and communication needs as a separate and specific intersectionality, inserting in Paragraph 58 that they are one of the barriers to people leaving … inserting in Paragraph 79 that they are one of the specific impairments that may result in people experiencing abuse.”
In chapter 4, “Agency Response to Domestic Abuse”, they suggest:
“Inserting in Paragraph 176 that they are a specific vulnerability and a barrier to disclosing information and seeking support”.
Finally, in chapter 5, “Commissioning Response to Domestic Abuse”, they say:
“Inserting a reference in Paragraph 232 that they are one of the diverse needs to which local strategies and services have to respond … Inserting a reference in Paragraph 247 that they are an additional barrier that people experiencing domestic abuse face. The Government could also usefully commit to ensuring that the national statement of expectations, which is due to be published later this year, references speech, language and communication needs.”
I will press the Minister to give us an answer, because these are modest but powerful changes. They should be accepted and incorporated in the guidance. As I said, this hard work has already been done for the Government. It is the least that the Government can now do. Having recognised that there is a specific problem, it can be addressed here, even if not entirely solved. We seek the Minister’s assurances that he will absolutely do this.
My Lords, I thank the Minister for his considered response, particularly his assurance that the Government will be revising the guidance. I also thank all noble Lords who have spoken in support of the amendment, indicating as they did so their expertise in, and knowledge of, the issue. Ministers and officials are clearly seized of the need to satisfy speech, language and communication needs and, from that point of view, to include them in the statutory guidance to be issued to all local authorities. In that spirit, and in the hope that Ministers and officials will also study what has been said in this debate and earlier ones, I beg leave to withdraw my amendment.