In speaking today, including about the amendments I have tabled, I take a different view from that of the hon. Member for Shipley (Philip Davies), in that I want the Bill to proceed. It is not perfect—there are things that I think should be included, which is why I have tabled amendments—but it is more important to get on the statute book this very important staging post in changing the culture in many mental health trusts than to delay it further.
I congratulate the hon. Member for Croydon North (Mr Reed), who has done a brilliant job in advocating the case for this reform, as he has in his advocacy on behalf of Mr and Mrs Lewis. It is an enormous pleasure to support him today in that endeavour. I particularly note the role that Mr and Mrs Lewis, who are present in the Gallery today, have played in all of this. They have fought their campaign with enormous dignity and with absolute determination to secure justice for the loss of their dear son. They have had a willing Member of Parliament working with them, but if the Bill reaches the statute book, it will be to their enormous credit for the battle they have fought, and we should all applaud them for the contribution they have made in achieving that.
I met Mr and Mrs Lewis when I was the Minister responsible for mental health. I remember a debate in this place in which the hon. Gentleman raised their case. I was horrified by what I heard while sitting on the
Front Bench, and I agreed to meet them. I met Mr and Mrs Lewis in my parliamentary office, and I took up their concerns with the Independent Police Complaints Commission, because the case did not appear to me to have been properly investigated. They have continued to fight stoically for justice, and I pay enormous tribute to them for doing so.
My interest in this issue as a Minister arose back in 2013, when Mind did a survey showing that the use of force—I use that term advisedly—was endemic across in-patient mental health settings around the country. Not only that, but the use of force varied incredibly from one unit to another, without any apparent justification. As a result of the Mind survey, I decided that we had to review the guidance. In due course, that led to the non-statutory guidance on “Positive and Proactive Care”, which was issued in 2014.
The purpose of the guidance was to end the use of face-down restraint, which was the sort of restraint used on Seni Lewis. At the time, I was confronted by a lot of people in the sector who said, “You’re not being realistic. You can’t reduce force. You can’t stop the use of face-down restraint, because we deal with very difficult circumstances.” Yet when I listened to progressive practitioners who had worked in such units, they demonstrated that we could end the use of inappropriate forms of restraint. Tim Kendall, national clinical director for mental health, announced that his unit in Sheffield would end the use of face-down restraint, and it did. If those progressive practitioners can do that, others can as well. I was frustrated that guidance issued by the National Institute for Health and Care Excellence in 2015 in some ways contradicted the 2014 guidance by not ruling out the use of face-down restraint. I think that was a big mistake by NICE. I realise its independence, but I question its methodology in reaching that conclusion.
Why is this issue so important? It is because many people, not only Olaseni Lewis, have lost their lives as a result of the use of face-down restraint in mental health settings. Along with those awful losses of life, too many people who experience the use of restraint see and feel it as an assault on them. In many cases, people have experienced abuse earlier in their lives, including sexual abuse, sometimes as children. For a woman in a mental health setting, to be held to the floor by several men who are acting to restrain her is likely to make her experience an extraordinary sense of trauma. In many cases that results in a loss of trust between staff and patients. Units that have confronted the culture of a heavy use of force have found that when time is used for creative activity, that reduces the need for force to be used in the first place. Staff end up being safer, as well as patients in their unit, and the unit becomes a more therapeutic environment and everyone benefits.
The bottom line is that since the 2014 guidance there has been very little change—that is why the Bill is so important. The use of face-down restraint is down a little, but the overall use of restraint appears to be at pretty much the same level. That may in part be due to better recording, but the report in The Observer on Sunday suggested that injuries are up. In 2016-17, 3,652 patients and 2,600 staff were injured as a result of the use of force. In many cases, units have close to 100% occupancy and a heavy use of agency staff. They are under enormous strain and stress, which is not a therapeutic environment for patients, and the use of
force becomes almost inevitable because of the strain that everyone is under. That is why training is so important in changing the culture.
Let me deal briefly—briefly!—with my amendments. I tabled them because I wished these important issues to be included in the Bill, and it is a pity that they are not. I do not want to delay the passage of the Bill, so I will not seek to divide the House, but I hope that the Minister will give the strongest possible indication that she supports the issues I seek to raise—I think she probably does.
Clause 1 includes a definition of the “use of force”, and it is important to extend that to cover threats of the use of force, and coercion, which means
“the use or threat of force, with the intention of causing fear, alarm or distress to control a patient’s behaviour or elicit compliance with the application of the use of force”.
Such coercion can be enormously traumatic for individuals who have experienced trauma in their lives, and it is important for that to be recognised in the Bill.
Amendment 37 to clause 3 states that the policy on the use of force
“must set out that the use of force will only be used without the sole intention of inflicting pain, suffering or humiliation, or subjecting patients to tortuous, inhumane or degrading treatment, or without inflicting punishment or intimidation.”
That is in line with the Mental Health Act code of practice and the UN convention against torture. I am pleased that the Minister has indicated that she will deal with that in guidance, but I hope very much that it will be very clear in that guidance. If it had been on the face of the Bill, it would have helped to address the concerns of the special rapporteur on torture.
Amendment 36 would ensure that mental health units committed to reducing the overall use of force—surely that is ultimately the central purpose of the Bill—and it would increase transparency about how they intended to achieve that and what types of force were permissible in the unit. All that is absolutely essential to more personalised care whereby people are informed about what might happen to them in in-patient units.
Amendment 38 to clause 4 would ensure that people’s legal rights to advocacy were properly communicated to them in relation to the use of force. People often simply do not know what their rights are, and the amendment would assist by ensuring that they did.
Amendment 79 to clause 5 addresses the importance of training in the appropriate use of force. It makes it clear that the
“Secretary of State must publish quality standards for training”.
That is important because training practices are variable around the country. My preference would be for accredited trainers, so that we know that they meet the right standard and are training staff in the right way. My proposal would at least ensure that there was a national standard that people should abide by.
Amendments 80 and 81 are intended to ensure that training requirements for staff include training in trauma-informed care. That comes back to the absolute importance, when we are caring for people, of recognising the impact that trauma has had on people’s lives. It is great that clause 5(2)(g) covers training on experience of trauma, but it should be strengthened to cover not only the
impact of trauma on patients’ mental and physical health, but how the use of force itself can re-traumatise people—the very opposite of what should be happening when they are receiving mental health care and treatment. Trauma-informed care is a model of care that is
“grounded in and directed by a complete understanding of how trauma exposure affects”
a person’s
“neurological, biological, psychological and social development”.
In clause 7, on the recording of the use of force, amendment 39 would improve the transparency and accountability about the use of force by ensuring consistency in the recording of all uses of force, not just those above a threshold set in statutory guidance. The Bill as it stands states that records should not have to cover the “negligible” use of force. I understand entirely why that is in the Bill, but the concern is that guidance will be interpreted differently. That is why the way the guidance is framed will be of critical importance. There is a risk of low-level micro-aggressions—uses of force in a minor way but on a continuing basis below the radar—which can have an impact on people’s wellbeing and their potential for recovery, which is out of step with the Mental Health Act code of practice.
Clause 9 is on the annual report by the Secretary of State. According to the related amendments, the annual report should
“make reference to the annual statistics”
published by NHS Digital, including relevant characteristics, so that we can monitor the ethnicity of people against whom force is used, and they state that the Secretary of State should report on that and that there should be a statement to Parliament.
I do not want to take up any more time. I will end by saying that I absolutely hope that the Bill gets on to the statute book as quickly as possible. I hope that the Minister will respond to it becoming law by going on a drive nationally to proselytise and make the case for a change of culture, so that we can see a radical reduction in the use of force across mental health settings. There are very many inspiring practitioners who have demonstrated how that is possible, but we need to make sure that it is the standard and not the exception. The Minister could go down in history for achieving a dramatic cultural change if she takes the Bill, when it is passed, and really goes out and makes the case for it.
12.45 pm