Children and Young People: Restrictive Intervention

Debate between Norman Lamb and Catherine West

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.