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.
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.
Order. It will be obvious to the House that we have very little time left. I hope that we can manage without a formal time limit, if everyone speaks for approximately five minutes.
It is a pleasure to follow the right hon. Member for North Norfolk (Norman Lamb) and to work with him to try to resolve this problem—a problem that need not exist at all.
We hear the phrase “safeguarding children” all the time, but words mean nothing if they are not matched by commensurate actions. We all know that looking after our children well, getting to know them as they grow and finding ways to make their lives safe, happy and fulfilled, are what every parent aspires to—and, indeed, I hope, every teacher when they embark on their careers. It is not always easy: children can be stubborn, petulant and anxious, much like their parents, probably.
Children have a natural curiosity to discover, to learn, to play, and every good parent or teacher enjoys nothing more than fuelling those interests and having the wonderful satisfaction of watching the child blossom, discover new things, learn about their unique character and gifts, and start their life’s journey with pleasure and excitement. Sadly, for vulnerable children, those with physical, neurological or emotional higher needs than most, that vision of a healthy and nurturing childhood can only be a dream. The reality is that many of those most in need of nurture and care find that they get none of that. By their particular difference, they struggle with the “normal” learning environment, and as those around them fail to realise that their charges are in distress, the children use the only tools they have to demonstrate their anxieties, fears, or even terrors, and display what we call “challenging behaviour”.
I am not a fan of politically correct language, but what does “challenging behaviour” mean? It means lashing out or perhaps hiding away: it means a child has been put under too much stress and so the most basic survival instincts kicked in. The child, fearful of whatever it is that is going on around them or happening to them, tries to protect themselves with the limited tools available to them. As the mother of a now nearly 20-year-old university student, whose Asperger’s was undiagnosed until he was nearly nine years old, learning to provide a world around him so that he could thrive, rather than struggle and suffer from profound anxiety attacks because of the normal environment around him, was a learning curve. But once we found an intervention that worked, having identified the source of the distress, his anxiety and “challenging behaviour”, as it is now called, simply fell away. A bright boy, a happy child, reading for hours at a time; other children near him—not so good. People touching his food—profoundly upsetting; bright lights or unexpected loud noises—meltdown guaranteed.
I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this important debate, and on the powerful case that he made. I am sure the whole House would pay tribute to him for the progress that he has led in improving conditions for people with mental ill health over many years. Personally, I thank him for the support and advice that he so generously gave me during the passage of Seni’s law last year.
The use of restraint and excessive force is one of the most pressing issues for children who have experience of secure mental health units. Restraint is humiliating and degrading for children, as it is for adults. It can undermine their recovery and can make the child’s mental health condition worse.
There have been too many tragic incidents where children and young people have been seriously injured—even killed—because of excessive restraint. Seni’s law came about in response to the horrific death of my constituent, Seni Lewis. Seni, who was just 21 years old, died following severe and prolonged face-down restraint in a seclusion unit in a mental health hospital, when up to 11 police officers took it in turns to pin him face-down on the ground with his hands cuffed behind his head and his legs in shackles. That triggered a heart attack, which put him into a coma, and he was left to die all alone in a room, tied up face-down on the floor. Seni’s tragic story is just one of too many deaths and scandals, including Winterbourne View, Southern Health, St Andrews and many others that Members will be familiar with.
It is shocking that children are more likely to be restrained than adults. According to the leading mental health charity Young Minds, children under the age of 20 are four times more likely than adults to be restrained face-down, three times more likely to be tranquilised and twice as likely to be put in handcuffs or leg braces. Although children are less likely than adults to be secluded, it is surely unacceptable that any child with mental ill health is ever locked up all alone in a seclusion room.
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.
It is a pleasure to follow my hon. Friend the Member for Hornsey and Wood Green (Catherine West). I was very glad to support the right hon. Member for North Norfolk (Norman Lamb) in securing this debate, and I pay tribute to him for his commitment to safeguarding the human rights of people with learning disability, autism or both.
It is important that we debate this matter in this place because it affects the most vulnerable people in our society—children and young people, and most especially children and young people who have learning disability, autism or both, and who are often less able to communicate their thoughts and feelings, or to describe and bear witness to what has happened to them. As a consequence, there is an enormous imbalance of power between children and young people, who often cannot speak for themselves, and the adults into whose care they are placed, whether in a school, healthcare or residential setting. That imbalance of power confers a clear and important responsibility on the staff who work with those young people, but also on the Government to ensure a system that is transparent, accountable and properly resourced and equipped to provide the best possible care, education and support.
We are debating serious concerns about the use of restraint and seclusion, and there are gaps in the regulatory and training framework in some settings, particularly education. Before I set those out, I wish to pay tribute to the many dedicated, highly skilled and tireless staff who work in schools, healthcare and residential settings with children and young people who have learning disabilities, autism or both. I pay particular tribute to the fantastic Turney School in my constituency, and to Marilyn Ross and her exceptional team at the Michael Tippett School. Her visionary work in establishing the Michael Tippett College has enabled 19 to 25-year-old students with learning disabilities, autism or both to remain in education.
I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this debate. We have heard some truly excellent speeches from right hon. and hon. Members.
Like other Members, since I was first elected, I have been inundated with schooling issues. Those include parents trying to secure special educational needs assessments, or those whose children have been diagnosed with special educational needs but are not getting the help they need. There are schools that cannot afford to provide the help that is needed, and teachers who struggle to cope with the number of children who need more from them. I must have dealt with thousands of such cases over the years. The reason why is that education for children matters. It matters that children get the support they need to achieve a rounded education and that schools receive the funding they need to provide it. It matters that parents know that their children will get the best chance at life in the future, and that is critical to this debate.
With that in mind, it is little wonder that there are times when restrictive intervention is needed—an overworked teacher might be attempting to deal with a child who is misunderstood, frustrated and unable to bond with the teacher or classroom assistant as there are too many in the class. That frustration turns to violence, and the child is in danger of hurting themselves or someone nearby. In such cases, action is needed. However, there are limits on restraint, which must always be the last available option and fully considered.
Everyone who has spoken so far has referred to the need for training and resources and to the capability of the schooling system to respond to this issue. Teachers must have the knowledge and training on how and when other methods can be employed and, if there is no option, how to restrain safely. It is my belief that, due to a lack of guidance, there is a lot of confusion about the best and appropriate use. I join with colleagues in asking for that guidance to be released, as the guidance for restrictive intervention for adults has also been released.
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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.
My son was lucky beyond words. We had teachers who were always willing to learn how to support him, so that he could enjoy school. A beanbag hidden behind a teacher’s desk, to escape to if a lesson was too noisy. An agreement that he only ate certain foods, and an explanation to the other children as to why. Extraordinary staff who learned, with us and with him, how to provide a positive environment. In so doing, they allowed my son to thrive and succeed within mainstream school. Not every child with special needs is so lucky.
I first met the wonderful Ella, one of my younger constituents, when her mother, Elly, contacted me shortly after I was first elected, in a state of profound distress and anger at the long-term physical damage caused to her daughter by the use of physical restraint, leading to violent reactive behaviour which left her with permanent physical damage. There seemed to be no way to empower Ella’s parents to challenge the school, nor to ask for justification for the use of restraint. That family are extraordinary. Nothing—although so many brick walls have been put in their way—has stopped them battling to drive change for their daughter and other vulnerable children.
The school did not help. The council did not really get as stuck in as it should have done to meet its duty of care to this bright young girl. Only Ella’s parents and friends really fought to effect change for their girl, and for others they know need better support and the enactment of what having a duty of care actually means.
We need the Government to help us change the existing—inadequate at best—systems, from basic national guidance for teachers and support staff to evidence-based early intervention support for families. Learning what works for your child’s health and wellbeing is not easy, and every parent is always a novice, so let us share the evidence and best practice, to help each other most effectively. In doing so, positive behaviour support training in schools will quickly change the challenges into good environments for these children, and the adults in loco parentis for them while in their care, from whence reductions in cost to the state and, most important, the reduction of—and hopefully an end to—the unnecessary, unacceptable, irreparable damage to these young people. Be it physical or emotional damage, so much can be avoided with intelligent and supportive environments.
All children are born with great potential, and I always say it is the adults around them who either help them to thrive or allow them to fail. We can do so much better to get this right early on—support parents and thereby help each child to reach their potential. To ensure that we get this right, we need a safeguarding system that is fit for purpose. Ofsted needs to be inspecting specifically for safeguarding outcomes for disabled and special needs children, and for that all schools must have a robust, mandatory recording system of all interventions with their pupils, so that parents, councils and Ofsted can see what is actually going on and hold them to account.
In my work on children’s services on the Public Accounts Committee, I continue to be dismayed that Ofsted seems to have little guidance to inspect the outcomes for our most vulnerable children. In this area of restraint usage and oversight of special needs management, through to foster and kinship care, we need to see clearer inspection rules and a much stronger accountability system, which includes the recording and reporting of restrictive interventions and actions, so that harm to our most precious children can be held to account.
I was grateful for the huge support from across the House for Seni’s law, which became an Act of Parliament last year. It introduced some important principles into law that now need to be extended to protect all people with mental ill health, including children, in every setting, not just mental health units, to which that piece of legislation applied. Those principles are intended to reduce the use of restraint, so that it is only ever used as a very last resort and face-down restraint is never used at all.
The mental health system needs to be fully transparent. There is wide regional variation in the use of restraint against children, but we do not know why, and data is not available for us to interrogate. The campaigning charity Agenda reports that in some mental health trusts, three quarters of children are restrained, while in others it is none at all. If some trusts can completely avoid the use of restraint against children, why can every trust not do so? We need a standardised national system for recording the use of restraint, so that we can compare like with like, identify best practice and ensure that it is shared, and allow us and other observers to fully interrogate and scrutinise the system to ensure that it is supporting and not harming some of the most vulnerable children in our society.
Half of all girls with mental ill health have experienced some form of abuse, either physical or sexual, that affected their mental health. The use of restraint against them—especially being pinned face down on the floor by men—reawakens the horrific abuse that made them ill in the first place, which can mean that they leave care with worse mental ill health than they arrived with. That surely cannot be acceptable.
The second important principle is accountability. All mental health settings need a policy in place for restraint reduction, with appropriate training to ensure that restraint is avoided whenever possible. They need a named senior person who is publicly accountable for how restraint is used, so that there is clarity about who is ultimately responsible for what happens in that setting.
Despite Government attempts to discourage it, the most dangerous form of restraint—face down on the floor—was used against children more than 2,500 times in the most recent year for which data is available, yet that form of restraint is not supposed to happen at all. The current system clearly is not working. The deaths, injuries and psychological damage that excessive restraint causes to children must stop. I hope the Government will ensure that the important principles enshrined in Seni’s law and the important work undertaken by Sir Simon Wessely’s mental health review are used to protect every child who experiences mental ill health.
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?
Recent research by the Challenging Behaviour Foundation and Positive and Active Behaviour Support Scotland found that nearly 90% of parents of children with SEN or behavioural needs, including autism, reported that their child had been physically restrained. Some 35% said that that happened regularly, and more than half those cases involved children aged between five and 10. Only one in eight parents said that restraint was discussed with families in advance, and just 17% said there were discussions after the event to help prevent it from happening again. Some 50% of parents reported the use of medication to manage challenging behaviour; 58% of children or young people were injured; and 91% reported emotional impacts, including PTSD, heightened anxiety and insomnia.
We know that such restraint is not necessary, and with a little education and training in those settings, proven alternative forms of behaviour management can almost eliminate the need for restraint. Guidance and regulation on the use of restraint in healthcare settings is much more stringent than it is for education settings. Ofsted makes clear that it is good practice to record incidents of restraint and inform parents, but there is no requirement on schools to do so. That is problematic, because it is precisely those schools that already model good practice and have the best leadership and governance that will abide by that advice, while those schools with problems will be less likely to do so.
In 2014, the Government promised new guidance on reducing restrictive intervention in schools, but more than five years later that guidance is still to be introduced. That is not acceptable. No parent or carer should have to worry that their loved one will suffer violence, injury or psychological distress as a result of restraint in an education, health or care setting, yet that is the reality for too many families. The gaps in the current legislative and policy framework are glaring, but they are straight- forward to fill, and the delay by the Government who promised new guidance in 2014 is simply inexcusable. New legislation and guidance must be supported by appropriate training and resources. I call on the Government to introduce that new guidance and regulation as soon as possible and to ensure that all staff working with the most vulnerable children in our society are properly equipped and resourced to implement it.
Before the debate, I mentioned to the right hon. Member for North Norfolk that I was at a school before Christmas where a young fellow was “difficult”, shall we say? It took two teachers to supervise and restrain him, and a degree of violence did take place. I mention that to illustrate the need for schools to have the necessary teachers, training and resources. They did have that in that school and that was good to have.
I read a briefing supplied to me by one concerned body called the Challenging Behaviour Foundation, whose research has thrown up a few surprising statistics that are certainly worth quoting today. The main source of data is a “5 Live Investigates” freedom of information request to local authorities in England, Scotland and Wales that revealed 13,000 physical restraints over the previous three years, resulting in 731 injuries. Only a fifth of authorities replied, so the information presented might not be the whole picture. Another source of data was a survey conducted by the Challenging Behaviour Foundation. Some 88% of the 204 respondents said their disabled child had experienced physical restraint, with 35% reporting that it happened regularly. Some 71% of families who completed the survey said their child had experienced seclusion, with 21% reporting that it was taking place on a daily basis.
Those figures are challenging and they tell us the real story. I believe there is a better way to prevent these kinds of issues. Issuing guidance is certainly one step, but it is not the whole answer. Classrooms must have sufficiently trained staff members to deal with these scenarios without disrupting the other 29 children in a class. Children who need additional help need assessments, and those assessments must result in extra help and support. Parents must understand what is happening and be able to provide a helpful insight into the best ways to understand a child. There are so many factors, but the guidance that has been on the cards since 2014 must instead be off the cards and taken into schools urgently as the first step to ensuring that the education of every child is the best that it can be.