Children and Young People: Restrictive Intervention Debate

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Department: Department for Education

Children and Young People: Restrictive Intervention

Nadhim Zahawi Excerpts
Thursday 25th April 2019

(2 years ago)

Commons Chamber

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Department for Education
Mike Kane Portrait Mike Kane (Wythenshawe and Sale East) (Lab)
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25 Apr 2019, 4:42 p.m.

I thank the Backbench Business Committee for granting this important debate. It was secured by the right hon. Member for North Norfolk (Norman Lamb)—who made an excellent speech—along with my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and the hon. Member for Berwick-upon-Tweed (Anne-Marie Trevelyan), who gave some powerful personal testimony, as did the hon. Member for Dundee West (Chris Law).

This is a difficult and, for some, very personal issue to talk about. I congratulate all the Members who have spoken, including my hon. Friend the Member for Hornsey and Wood Green (Catherine West) and the hon. Member for Strangford (Jim Shannon). I also pay tribute to my hon. Friend the Member for Croydon North (Mr Reed). Members will know that his private Member’s Bill, known as Seni’s law, was predicated on the devastating and inexcusable death of his constituent Seni Lewis in 2010. Seni had been restrained so excessively, so unreasonably, that he died. Seni’s law addressed the issue of prone restraint—the act of forcing someone’s face into the ground—and, as we know, Seni was not the first person to die in such circumstances. In 2014, during his time as a Minister in the Department of Health, the right hon. Member for North Norfolk issued guidance on the restraining of adults, with the intention that it should be followed by guidance on the restraining of children.

The national inquiry into child sexual abuse recently concluded that “pain compliance” was child abuse and should be outlawed, and the Equalities and Human Rights Commission has also argued that such methods should not be used on children. Article 19 of the United Nations convention on the rights of the child, which has already been mentioned today, states that Governments must do all they can to ensure that children are protected from all forms of violence, abuse, neglect and bad treatment by their parents or anyone else who looks after them. According to the BBC, these painful techniques were designed for prison riots, with the aim of forcing individuals to comply through the use of pain. I should not even need to say this, but we should not be using prison riot techniques on children.

What is also concerning, and constitutes the essence of the debate, is the continued absence of clear guidance from the Government. Although their consultation on draft guidance to reduce the need for the restraint of children took place between November 2017 and January 2018, we have still not received the results. Will the Minister tell us when they will be published?

Parents have argued that, in the absence of guidance and with the prevailing uncertainty, schools are using so-called restraint techniques against children with special educational needs and disabilities. That has occurred in an environment of austerity; one that has seen a crisis in funding for children with special educational needs. As we discussed in the previous debate, local authority children’s services are currently overspending by £800 million. It was reported last November, for instance, that council overspending on children’s special educational needs and disabilities has trebled in just three years.

The Minister might be aware that the Challenging Behaviour Foundation and Positive and Active Behaviour Support Scotland released a report in January on the use of restrictive intervention. The report found that 88% of parents surveyed said that their disabled child had experienced physical restraint, and 35% said that it happened regularly. Over half the cases of physical intervention or seclusion were of children between the ages of five and 10, with one case involving a two-year-old child. It should come as no surprise that this has had a negative effect on the children’s health. Over 90% of those surveyed said that restraint had emotionally impacted their child. That physical intervention was for cases of incontinence, meltdowns and shutdowns—situations that leave children unable to communicate as they are so overloaded with emotions.

I will return quickly to the Government’s own delayed guidance. When Ministers launched the consultation, they stated that any guidelines would not apply to mainstream schools. This is clearly illogical. Guidance must apply across the board, not just in specific settings. Otherwise, this suggests that mainstream schools are not safe spaces for children with special educational needs and disabilities. Will the forthcoming guidance be universal, so that all children are protected?

I would now like to move on to the treatment of young people who are autistic or have learning disabilities or mental health conditions. Across mental health, autism and learning disability services, over 1,000 young people were subject to a restrictive intervention in 2017-18. That accounted for 26,000 separate restrictive interventions. What is shocking is that the under-20s in these services who are subject to any restrictive intervention are, on average, subject to more than twice as many as those in any other age group. There are also hundreds of young people who are subjected to seclusion, segregation and—perhaps most worryingly—chemical restraint. We are drugging these young people because their behaviour is deemed to be too challenging. That is not acceptable. I know that the Care Quality Commission is currently carrying out a review of the use of restraint in these services, but it will not report until next year.

Currently 250 young people who are autistic or have learning disabilities are being detained in inappropriate care settings that were covered by the Transforming Care programme. That programme was intended to move people out of inappropriate settings and back into the community. Since 2015, however, the number of young people in such institutions has more than doubled. Some of these children have been sent more than 100 km from home. Ministers have recognised that this is wrong, but they have not yet done anything to stop it. Moreover, the programme expired last Sunday. Can the Minister therefore tell us what plans there are either to continue the work or to introduce a new programme to close inappropriate care settings? What funding will be made available in the next five years, given that the Government have committed to funding only an additional year of the programme?

What happens in early childhood has a defining impact on human development, affecting everything from educational achievement to economic security and health. Violence towards children can leave a long, irrevocable shadow over their lives. There can be no place for it anywhere. I therefore hope that the Minister will take the contributions made to heart.

Nadhim Zahawi Portrait The Parliamentary Under-Secretary of State for Education (Nadhim Zahawi)
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25 Apr 2019, 4:49 p.m.

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.

Norman Lamb Portrait Norman Lamb
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25 Apr 2019, 4:58 p.m.

I thank all hon. Members who have contributed to this debate, which included some powerful contributions. The personal testimony from the hon. Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) was telling, because the wonderful news is that her son is now at university. The Minister should note that, because not only will early intervention and positive behaviour support being embedded in the entire system give people the chance of a good life, but the state will save a fortune. That is why it is so important.

We need the guidance. It needs to have teeth and to be backed by proper accredited training and by mandatory recording and reporting across the system. The Government need to get on with that now, because we must end the scandal of children not being protected from abuse in the way that adults and those in health settings already are. It is unacceptable that children in residential schools and in other settings are not protected. As the shadow Minister said, the guidance must be comprehensive. There is no justification for leaving out some settings, such as mainstream schools. The guidance should apply to everyone.

Question put and agreed to.


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.