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Secure Training Centres (Restraint)
12.30 pm
Ms Sally Keeble (Northampton, North) (Lab): I am pleased to have secured this Adjournment debate on the use of restraint in secure training centres. The well-being of young people in the care of the state has to be a major concern for all of us who are elected to public office. The safety of children is a priority for me, as it is for most if not all hon. Members. When the well-being of a child, especially a child in the care of the state, is at risk, everything else stops, so the events of last April triggered alarm bells.
However, the events of last April are not the subject of the debate, as that matter is still sub judice. In this debate I am looking at the wider issue of the use of restraint in secure training centres. I am not dealing with overall secure training centre policy, the quality of education services in them, the reoffending rate or any other wider policy matters; I am concentrating on the use of restraint. My information is taken from official sources, including the many parliamentary questions I have tabled, and also from the people to whom I have spoken over the past 18 months.
Any residential institution needs strategies for securing the safety of staff and residents. In a secure training centre it is inevitably going to be a complex task managing some difficult challenging behaviour by people who, although they may be young, may be physically strong and also difficult. Many people would concede that, regrettable though it might be, any strategy for behaviour management in such institutions would have to address the need for physical restraint. The question is what sort of restraint, at what stage it should be applied, for how long, with what checks, and what else should be tried beforehand in terms of de-escalation and prevention.
My contention is that the present regime in the four secure training centres is unacceptable. I will set out the extent of my concerns, and what I believe the Government need to do. The Minister's predecessor—her fellow Under-Secretary of State, my hon. Friend the Member for Wythenshawe and Sale, East (Paul Goggins)—indicated in a written response that the restraint techniques in question, including distraction techniques, are supposed to be used as a last resort. However, Home Office figures show that the use of restraint in secure training centres is routine.
In 2002, restraint was used on 2,461 occasions; in 2003 it was used on 3,289 occasions; in the first few months of 2004 it was used 1,228 times. That means that in 2002 and 2003 it was used an average of four times a year on each resident or trainee accommodated during the course of the year in each secure training centre. To put it another way, across the whole establishment restraint was used between seven and nine times a day in 2002 and 2003, and in each of the secure training centres, restraint was used about twice a day, each and every day of the year. That is not a technique of last resort. That is routine use of physical control, sometimes involving the inflicting of pain on young people, day in and day out.
It is often assumed that those are the most severely disturbed, challenging and violent young people. Again, the reality is somewhat different. The median age of the young people in secure training centres in 2002 and 2003
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was 14. Increasingly, they had not been convicted of anything at all. In 2002 almost one third of them were being held on remand, and in 2003 that figure had risen to almost half of them. What on earth does anyone think happens to a 14-year-old being held on remand when day in and day out—they may have been there for a month or longer—they witness the consistent use of physical force to control other young people?
A report that I received stated that on her first night in one of the secure training centres, a girl who witnessed one of those incidents, in which another young girl was held in the restraint position for some time, then went into her room, curled into a ball and cried all night. After April 2004 a number of reviews were set up, including a review of the use of physical control in care, and a summary of the conclusions was posted on the Youth Justice Board website. As my hon. Friend the Minister knows, the use of the seated double embrace has been banned.
My hon. Friend said in a written answer today that figures were not held centrally on the number of times that the seated double embrace had been used in secure training centres. However, I understand that that information is recorded by each secure training centre, so it should be possible to provide it to the Home Office. The statement on the Youth Justice Board website restricted the use of other restraints, but allowed the continued use of many, including nose distraction. The review carried out by a team of experts showed, however, that many more restraint techniques should be scrapped—about 20 in total, including the nose distraction technique. This is the technique described by the Howard League for Penal Reform as being a kind of karate chop. It puts staff at risk of being bitten, and young people at risk of nose bleeds.
Another technique recommended for abolition was thumb distraction. It is described as follows:
"This is another pain compliance technique which causes pain by stretching the joint capsule and ligaments of the thumb. It has a relatively high injury potential in youngsters. The mechanical disparity delivered by the force of an adult hand on a child's thumb has the potential to deliver more injury than other joint stretch pain compliance techniques"
How on earth are we, in the 21st century, managing to run a regime for young people that includes the equivalent of thumbscrews?
Since the double seated embrace was banned, increased use of handcuffs is reported. As my hon. Friend will know, I have tabled a question about that. In at least one of the institutions, in place of the double seated embrace a standing hold is used, but it has been reported to me that children are still being bent over—and it is the bending that is so dangerous, because that is what prevents breathing. During the course of my investigations I had some of these holds demonstrated to me, and the risks are evident.
There is also a real problem of churn among both staff and trainees in secure training centres. Medway, with 76 places, had a total of 322 residents or trainees in 2003 and Rainsbrook, which is the same size, had 289. Meanwhile, staff figures show that often there is a turnover of 20 to 25 per cent. of staff leaving in a year. At Medway, 101 of 256 staff left in 2003.
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Questions have been raised with me about the qualifications and training of staff. Are psychologists suitably qualified and registered? Have nursing staff who are supposed to be present and observe—and, indeed, video—the use of physical control been trained to know what they are looking at? Do then know when things become risky, and when to intervene? How many staff have higher education qualifications? How many staff have qualifications in child care or social work? What about training and procedures in relation to gender, such as the impact of male staff using physical restraint techniques on vulnerable young girls?
Questions have also been raised about the appropriateness of the use of restraint, and whether physical control is being used not just to protect the safety of staff and residents, but to achieve compliance with instructions, which is not supposed to be allowed. There have also been questions about the quality of the guidance and the manuals on the use of restraint provided for staff. For example, in the central police training manual on the use of control techniques, police officers are told they should
"pay close attention when they recognise the following symptoms, taking immediate action to remedy them and apply emergency aid",
I understand that there is no such caveat in the training manual for secure training centre staff, although one might have prevented the tragedy of April last year.
There has been criticism of the length of time for which children are held in these positions of restraint. In one institution staff reported recently that they thought it reasonable to hold them for up to 40 minutes. Questions have also been raised about the monitoring and reporting arrangements, and about the sharing of information and skills across the different private companies which run these institutions. There has been criticism of the way in which the complaints systems operate in one of the institutions, on the ground that the complaints procedure was too internally focused.
It is completely wrong that it should take 18 months and an Adjournment debate to get the full statement from the Home Office on the use of restraint in secure training centres. The short statement posted on the Youth Justice Board website does no justice at all to the concerns that have been voiced and the reviews that have been carried out in this difficult policy area. The fact that after repeated concerns were raised in Parliament by me and by other hon. Members it was sneaked out during the recess is woeful.
During that 18 months of delay, hundreds of other children and young people have passed through those institutions. There are two actions that the Government should take, bearing in mind the fact that those four institutions—the only ones in the secure training centre programme—are all in the private sector, and not open to the controls that might apply to public sector institutions. There is sufficient ground for concern at Hassockfield and Oakhill for the Home Office to conduct a stringent review of the contracts with the companies involved, to ensure that they are capable of complying with what is required to provide a safe regime for young people and staff, and that any penalties for non-performance are applied.
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At Medway and Rainsbrook, however, the position is more serious. Those are the two secure training centres with the greatest use of restraint. One of them was also the scene of the serious incident last April. In addition, I understand that those centres did not allow admission to the consultants employed by the Home Office to carry out the review of physical control in care. In those circumstances, the contract with the private company responsible for these two centres should be terminated, because they have not shown that they have provided, or indeed are able to provide, a regime that is either appropriate for the staff or safe for the young people.
Terminating the contract would leave the front-line staff in place, but ensure that a management structure and team that could instigate the changes in procedures and policies needed in these institutions to protect both staff and residents was put in position. In the past 18 months, I have looked at many reports and spoken to many people about what happens in the secure training centres, and the problems associated with their use of restraint exceed my worst fears. For the Government to fail to act on this matter would be a complete dereliction of duty.
12.43 pm
The Parliamentary Under-Secretary of State for the Home Department (Fiona Mactaggart) : I congratulate my hon. Friend the Member for Northampton, North (Ms Keeble) on raising this important matter, which we have spoken about before. The use of restraint on young people in secure training centres is rightly a matter of concern, and I welcome this opportunity to discuss it.
It may help if I begin by saying something about the role of the centres, which are a relatively recent addition to the youth justice system. The first centre, Medway, opened in 1998 and three more are now operating. The most recent, Oakhill, came into operation in August last year. The aim of the centres is to provide high-quality education and care for young people between the ages of 12 and 17 who have been sentenced to custody. As my hon. Friend said, they also accommodate some young people who have been remanded in the care of a local authority with a requirement that they be kept in secure conditions.
From a modest start—Medway originally held 40 trainees—the secure training centres now provide 274 places for young people. Placement is, in most cases, decided by the Youth Justice Board and takes account of the young person's age, sex and assessment of vulnerability, and where he or she lives. STCs seek to combine the high staff-trainee ratio that is also a feature of secure children's homes, with the benefits of a larger establishment—in particular, the ability to run a wider range of programmes, with an emphasis on education.
Those young children do not only have the problem of lack of educational achievement; they frequently have a range of other difficulties, including unstable family relationships, substance and alcohol misuse and mental health problems. Many have poor social skills and little understanding of the distinction between acceptable and unacceptable behaviour, so for those who run STCs, maintaining good order is necessarily a high priority.
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That has become more problematic as the average age of trainees at STCs has increased. Originally, the centres held only 12 to 14-year-olds under secure training orders. After April 2000, when the secure training order was replaced by the detention and training order, the centres began to take older, and therefore physically more developed, children. As my hon. Friend admitted, such children can be very strong. The reality is of physically well developed but socially unskilled young people who, often for the first time in their lives, are expected to adapt to the standards of behaviour that the rest of us think of as normal. There is bound to be some resistance, and staff need to be skilled in dealing with that. The guiding principle is that physical methods of restraint should be used only as a last resort; other methods of behaviour management should be used to resolve incidents whenever possible.
The Youth Justice Board has been consulting on a draft code of practice for managing children's and young people's behaviour in the secure estate. The code places very strong emphasis on maximising the use of non-restraint methods of behaviour management, in order to minimise the need for physical intervention. I expect to receive the final version of the code for approval in the near future. The YJB is also seeking to develop guidance on and training in behaviour management techniques as part of the follow-up to its review of physical restraint in care.
Regrettably, however expert STC staff are at managing behaviour, on some occasions physical restraint will have to be used. Staff may need to act quickly to prevent trainees from harming themselves, another trainee or a member of staff. It may also be necessary to restrain a trainee from damaging property or escaping from custody. Use of restraint must, of course, be lawful, and the use of restraint is authorised for those strictly limited purposes by rule 38(1) of the STC rules, which are a statutory instrument laid before Parliament.
A system of physical interventions known as physical control in care—PCC—was developed in the late 1990s for use in STCs. It was approved by the Secretary of State on the advice of a panel of experts, including medical experts. It was designed to be non-pain-compliant, although, as my hon. Friend said, it includes certain distraction techniques that involve the brief infliction of pain. Those techniques may be used where necessary for safety reasons. PCC may be used only by staff who have received the proper training. There are strict guidelines about how incidents involving the use of restraint are managed, and each incident must be properly recorded within 12 hours of its occurrence.
PCC has recently been reviewed by a panel of experts, again including medical experts. The review began in March 2004. Following the death the next month to which my hon. Friend referred, the use of one type of hold previously approved as part of PCC has been discontinued, and others have been modified. My noble Friend Baroness Scotland has approved the new arrangements, and the YJB published a summary of the panel's recommendations in September this year. My hon. Friend suggests that it was sneaked out during the recess, but I believe that that is a misrepresentation. It would have been utterly wrong of Ministers to delay until Parliament had returned the production of such important information about the way in which physical control in care is managed.
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The YJB plans to publish a full report of the review in the fairly near future. The reason for delaying the full report is that the follow-up review covers a number of other matters, including the recommendations of the expert panel that focus on more general issues of behaviour management. If we are to ensure that physical restraint is in practice a last resort, we must ensure that behaviour management techniques that do not rely on physical restraint are well developed and effective.
My hon. Friend expressed particular concern about the Rainsbrook centre. It would be helpful for her to visit the centre, and I understand that the operators have invited her to do so. I have suggested that she also discuss her concerns with the chief executive of the Youth Justice Board. She is aware that I have spoken to him and to the deputy chief executive about the full range of those concerns.
The most recent inspection of Rainsbrook was carried out by the Commission for Social Care Inspection in January 2005. It found that monthly meetings were held at which the quality assurance and information officer presented an analysis of the data on the use of physical restraint, single separations and sanctions applying to young people. All the senior managers at the meeting considered in detail the information—including trends over time—on young people, the staff involved and the location of incidents. A young person was invited to the final part of the meeting to provide feedback on his experience of being subject to control.
All that is part of the process, which is quite well developed, of ensuring that the implementation of policy is as close as possible to our ambitions to reduce the use of physical control, to improve other means of behaviour management and to ensure that things are monitored well. In practice, they are monitored well at individual centres, even if we do not always have the IT mechanisms to ensure that data collected locally can be centrally provided at reasonable cost. Each of the centres is inspected every year, and in addition to those regular CSCI inspections, there are a range of random inspections.
My hon. Friend expressed concerns about staff recruitment and retention. I hope that she will be aware that before commencing work, all staff must undergo a comprehensive vetting process that includes an enhanced Criminal Records Bureau check and employer vetting. The contracts with secure centre operators require that all successful job applicants should be vetted both by the employer and the authority—now the Youth Justice Board, but previously the Home Office. That consists of the CRB checks I have just referred to and the verification of the employment history of each applicant.
Before an individual commences employment in a secure training centre, the employer must verify that individual's employment over the previous five years. Within three months of their commencing work, the employer must verify their employment history over the previous 20 years, or from when they left school. Rebound, the operator of Rainsbrook, has assured the Youth Justice Board that no member of staff employed at the centre has been subject to disciplinary procedures, suspension or conviction for a criminal offence while employed at Northamptonshire social services department or any other such department.
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The Youth Justice Board is committed to working with the organisations that provide custody for children to make sure that the behaviour of young offenders is dealt with in a constructive and positive way whenever possible, and with minimum physical intervention. The way in which statistics are presented can imply a widespread and common use of physical restraint. However, our rigorous reporting requirements mean that such physical intervention as using an arm to encourage a child to behave in a particular way would be reported, because we need to be rigorous in ensuring that all incidents are reported.
My hon. Friend's focus on the most concerning aspect of physical control in care, which is the use of pain-compliant techniques—she is right to be concerned about that—implies that it is a frequent occurrence in our secure training centres. However, I agree that those techniques must be used only in a tiny number of exceptional cases, and in the context of the number of places available in each centre, the use of any form of restraint is reported less than twice a month per place in our centres.
We need to ensure that that such use is minimised and that our staff have the appropriate skills to manage behaviour without using physical restraint. However, in order to protect trainees as well as staff from potentially violent incidents, methods to distract children who behave dangerously are required. When essential, pain-distraction techniques are authorised, but I do not want this debate to leave the impression that they are a common feature of our restraint techniques.
The Youth Justice Board works with organisations that provide custody for children to ensure that young offenders' behaviour is dealt with constructively and positively wherever possible, and that physical intervention is kept to a minimum. For that reason the production of a full code of practice has been delayed, because it seems right to us that restraints should be used only as a minor part of a suite of behaviour-influencing tools. The YJB will produce the full report on behaviour management, which will be backed up with training and will include the full final report of the review of physical control in care.
We are determined to improve the systems of restraint used in custodial establishments. The YJB has completed its review; it is also working with the Prison Service to see whether the latter's system of restraint can be modified, so that it relies less on the controlled use of pain to achieve compliance.
My hon. Friend raised her concerns about the use of handcuffs. I approved an answer to her parliamentary question over the weekend, so it will probably be in her pigeonhole today. It appears to me that centres that use handcuffs can use them to reduce the incidence of other methods of physical control. There is often a trade-off. I would be interested to learn her comments when she views the figures.
Difficult choices must be made. The YJB is determined to learn from the best. That is why it is discussing with the Prison Service whether other adaptations can be made. The YJB is working with all the providers of custody for children to develop more consistent collection of information on restraints—a point that my hon. Friend raised—to ensure that it can identify where improvements need to be made.
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The death of any young person in custody is a tragedy. The Government are committed to doing everything that they can to prevent such deaths and to ensuring that young people are kept in safe, decent, secure and purposeful establishments, in which the causes of their offending are addressed. The safety of young people in our care is of the greatest importance. The Government and the Youth Justice Board are committed to doing everything possible to limit the use of physical restraint to circumstances in which there is no reasonable alternative. Where it has to be used—
Mr. Jimmy Hood (in the Chair): Order. It is time for the next debate.
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