Children and Young People: Restrictive Intervention

Nadhim Zahawi Excerpts

Thursday 25th April 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Education (Nadhim Zahawi)]

I thank all colleagues who have contributed to the debate, including my hon. Friend the Member for Berwick-upon-Tweed (Anne-Marie Trevelyan), who offered a very personal story, and the hon. Members for Croydon North (Mr Reed), for Hornsey and Wood Green (Catherine West), for Dulwich and West Norwood (Helen Hayes), for Strangford (Jim Shannon) and for Dundee West (Chris Law). I commend the Challenging Behaviour Foundation, which has been mentioned several times, and Positive and Active Behaviour Support Scotland for all the work they do, and Dame Christine Lenehan for the work she has done for my Department. I also congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this important debate.

As has already been noted during the debate, any use of restrictive intervention is, quite rightly, always a sensitive issue. Restrictive intervention can have long-term consequences for the health and wellbeing of children and young people, and the right hon. Member for North Norfolk really brought that to life with the story of Fauzia, Stephen and Harry. It can also have a negative impact on the staff who carry out such interventions. It is never something to turn to unless there are very good reasons to do so. As colleagues have so eloquently said, the preferred approach should always be to use positive behaviour support and other alternatives that can de-escalate challenging behaviour and tackle the reasons for it at source.

I want to start by highlighting the guidance that is already in place for teachers around the use of reasonable force. The law and our guidance are clear that there are situations where using reasonable force is necessary in a school environment, to make schools safe places for pupils and staff. For example, force can be used to prevent pupils from hurting themselves or others, from damaging property or from causing disorder. However, the law is absolutely clear that force can never be used as a punishment. Any policy on the use of reasonable force should also acknowledge any duties in relation to disabled children and children with special educational needs.

There are times when the only realistic response to a situation is restraint or restrictive intervention—for example, when a young child is about to run into a busy road, or when a pupil is hurting a teacher or child and refuses to stop when asked. The same would be true in a hospital if a child were hurting staff or other patients. Our starting point on any use of restrictive intervention is that every child and young person has a right to be treated with respect and dignity, to have their needs recognised and to be given the right support.

We also fully appreciate that some children and young people with conditions such as learning disabilities, autistic spectrum conditions or mental health difficulties may react to distressing or confusing situations by displaying behaviours that may be harmful to themselves and others. My hon. Friend the Member for Berwick-upon-Tweed eloquently described the situation of her own son. Restrictive intervention may be needed to minimise the impact of their behaviour on themselves or on other people, but it should only be what is reasonable to deal with the situation, and proportionate to the circumstances.

Restrictive intervention should be avoided wherever possible. Instead, proactive, preventive, non-restrictive approaches should be used in respect of the challenging behaviour to tackle the issues early. Examples include providing an environment that does not overwhelm the child with noise or other stimulation, putting the right special educational provision in place to enable the child to learn effectively, and developing an appropriate behaviour management plan.

As the right hon. Member for North Norfolk knows from his time in government, guidance is in place to support health settings in helping to care for someone who displays behaviour that might be considered challenging. I would like to commend him for his contribution in this area. The Department of Health’s positive and proactive care guidance, published in 2014, sets out how restrictive interventions should be used appropriately in health settings where there is a real possibility of harm to the person, to staff, to the public or to others.

I know that there has been deep concern in response to media reports in recent months about the use of restrictive interventions in mental health hospitals. My right hon. Friend the Secretary of State for Health has asked the Care Quality Commission to review and make recommendations about the use of restrictive interventions in settings that provide in-patient and residential care for those who have, or might have, mental health problems, learning disabilities or autism. We will be following the progress of this review closely.

Through our new compulsory health education, all children will be taught how to look after their mental wellbeing and to recognise when classmates are struggling. In addition, we recently updated our mental health and behaviour advice, which provides signposting and information on how schools can identify pupils whose behaviour may result from underlying mental health difficulties, adapt the approaches outlined in their relevant policies and, of course, adjust policies as appropriate to support pupils.

Positive and proactive care has been important in setting expectations about the use of restrictive interventions in health settings, but there were concerns that the policy did not say enough about children and young people and about settings beyond health. That is why the Department for Education and the Department of Health and Social Care have consulted on new guidance to help with the prevention and management of challenging behaviour of those with autism, mental health difficulties or learning disabilities. We worked closely with a range of special educational needs and disability organisations in drawing up the draft guidance for consultation. We are working through some of the complex issues raised in the consultation responses and will, as many colleagues have requested today, announce our next steps shortly. The right hon. Member for North Norfolk and other Members, including the shadow Minister, asked about the delay, but the guidance addresses some sensitive issues, so it is only right that we have taken the time to engage with the education and health settings where it will apply.

We were clear in our consultation paper that restrictive intervention should be used only when absolutely necessary, in accordance with the law and clear ethical values and principles that respect the rights and dignity of children and young people, and in proportion to the risks involved. Restrictive intervention can never be a long-term solution, and we are particularly concerned about long-term or institutionalised uses of restrictive interventions, which several colleagues have described so harrowingly. We are aiming to support settings and services to develop their practice so that they have confidence to provide better support for children and young people with challenging behaviours and provide safe environments in which they can thrive.

While the guidance was written for special schools and specialist colleges, and focuses on students who have learning disabilities, mental health difficulties or autism, other settings may wish to use the guidance if they would find it helpful. The guidance is consistent with Ofsted’s expectations of schools and care settings in relation to the use of restraint and restrictive intervention. Last year, Ofsted published guidance to inspectors entitled “Positive environments where children can flourish: a guide for inspectors about physical intervention and restriction of liberty”, the thrust of which relates to the importance of proactive approaches to behaviour management and minimising the use of restrictive intervention. The fact that Ofsted developed the guidance is evidence of how importantly they take the issue.

I am enormously grateful to the right hon. Member for North Norfolk for raising such important issues today, and I hope that he is somewhat reassured that the Government recognise them. In making our final decisions on the guidance, we will consider the points made in the debate today, and I am grateful for the contributions of many colleagues. We have a real opportunity here to make a difference to the lives of some of our most vulnerable children and young people and of those who work with them, and it is crucial that we get it right.