Joint Committee On Human Rights Third Report


9 Staffing and training

258. Failures in the assessment of healthcare needs and the provision of healthcare, and excesses in the use of restraint, raise questions about the training provided for those with responsibility for ensuring the safety of detainees. Inadequacies of training have been found to contribute to breaches of the Article 2 positive obligation to take preventative measures to protect those whose lives are at risk. In Edwards v UK,[258] which concerned the murder of a remand prisoner by his mentally ill cellmate, the European Court of Human Rights' finding of a violation of Article 2 was based in part on the screening of prisoners by a health worker who was inadequately trained for that purpose. This, combined with defects in information provision to the prison on arrival of prisoners, led to a breach of Article 2.

Staffing of police custody suites and staff training

259. We have already referred to concerns about the adequacy of training for police custody officers (see paragraphs 155 et seq). The extent and quality of such training appears to vary considerably as between police forces, despite the existence of a CENTREX national training programme for custody officers.[259] Implementation of this national programme is a matter for individual police forces. Although the Home Office stated that many forces provide two to three weeks' training before officers are appointed to custody duties,[260] it conceded that this was not consistent across all forces. We were told that some custody officers began work before they had received any training at all in custody officer duties.[261]

260. The dearth of training for custody officers does not appear to reflect any lack of demand for training from custody officers themselves.[262] A pilot programme in the Metropolitan Police Service's Professional Standards Directorate, on the Prevention and Reduction of Death Following Contact with the Police, whose work has included a series of seminars for police custody officers and other staff, reported a demand for improved training amongst police officers working in custody suites.[263]

261. Evidence to the inquiry put forward proposals for establishing high and consistent standards of custody officer training. The Police Federation considered that—

    the only way to ensure this acute under-investment in training is properly addressed is to make training part of the national competency framework and accredit custody sergeant training … custody training is a prime example where there should be no variation between forces.[264]

Furthermore the Police Federation strongly supported "the introduction and monitoring of compulsory refresher and re-qualifying training for police officers working in custody suites".[265]

262. ACPO considered that—

    The introduction of a requirement to use and follow a structured, centrally produced training programme addressing core and critical competencies for the roles of Constable Gaoler, Designated Detention / Escort Officer and Custody Officer would promote a common approach, with common standards … The transference of knowledge could be done through a nationally recognised accreditation programme, through a recognised body, with in built quality and content controls, inspections and audits … [266]

263. In our view, the significant responsibilities of custody officers, not least their responsibilities under the Human Rights Act, and the skilled nature of their work, should be recognised. Expecting inadequately trained or wholly untrained staff to take responsibility for the custody of detainees who may be physically or mentally ill, disturbed, violent, or affected by a range of drug or alcohol addiction, places detainees at most risk, and may lead to breaches of the police force's positive obligations to protect Convention rights under Articles 2, 3, and 8, through failure to identify risk, to ensure the provision of appropriate and adequate healthcare, or to prevent suicide or self-harm. Management of police custody should be supported by a more reliable training structure than the present model. As a minimum requirement to ensure Human Rights Act compliance, we recommend that police forces should ensure that no custody officer should start work without training for this specialised role. Reliable human rights protection and the safety of detainees requires a standardised training programme for custody officers, consistently applied across all police forces, and including regular follow-up training. This could be facilitated by a national accreditation scheme for custody officers. Training should cover first aid and control and restraint, identifying and responding to drug and alcohol intake, and identifying and responding to mental disorder, risk of suicide and self-harm. It should also include training on cultural awareness, in fulfilment of police forces' obligations under the Race Relations (Amendment) Act, as well as under the Human Rights Act.

Prison officer training

264. Concerns have also been expressed to us about training for prison officers. We were particularly concerned to learn that there is no requirement for prison staff to undergo ongoing suicide prevention training. At Pentonville, we were told that although there was now some suicide awareness training for the new intake of officers, there was no refresher training for these or other officers. We were told of the difficulties in finding staff time for training, given the pressures on the prison and prison staff, in a prison that was overcrowded and had a very high turnover of prisoners. In discussion our experience has been that many prison officers would appreciate the opportunity for more and better training. We are also concerned that the quality and depth of suicide prevention training is insufficient to equip prison officers with the skills they need.

265. Helen Shaw of Inquest told us that at inquests—

266. We recommend that both initial and ongoing training in suicide prevention, including first aid, resuscitation, and mental health awareness should be made mandatory for all prison staff, along with regularly updated training on the use of control and restraint and on cultural awareness.

Control and restraint training

IN HOSPITALS

267. Comprehensive training in control and restraint does take place for staff in some secure hospitals.[268] But research indicates that significant numbers of mental healthcare staff, including nurses, had received no training in control and restraint as part of their undergraduate training; many had received no in-service training and no refresher training, and those staff who had been trained had little confidence in their ability to use restraint safely or to manage violence without recourse to restraint.[269] The Report into the Death of David Bennett found a "serious failure of training" in control and restraint techniques, which contributed to the excessive and dangerous level of restraint used against Mr Bennett, and recommended that there should be a national system of training in control and restraint.[270]

268. Draft NICE Guidance states that all service providers must have a policy for training employees and staff-in-training in relation to the short-term management of violence, and that training relating to the management of violence should be subject to the national accreditation and regulation scheme being established by the National Institute for Mental Health in England (NIMHE) and the Security Management Service (SMS).[271] It also provides that there should be an ongoing programme of training for all staff in racial, cultural, spiritual and social issues.[272]

269. It is vital that staff should be qualified to assess risk accurately and respond proportionately to it. As a basic principle, and in order to ensure compliance with Article 2, no member of staff should be involved in the use of control and restraint unless they have been trained in its use. There should be a statutory obligation on health authorities to ensure that all staff who may be involved in control and restraint are trained in its use, and to provide mandatory annual refresher training for all staff. Training should be carried out using nationally accredited trainers. It should include cultural awareness and gender issues, and should include an explanation of the obligations imposed under the Human Rights Act.

IN POLICE CUSTODY

270. There is no statutory regulation of police powers of control and restraint. A training manual, the Personal Safety Manual of Guidance, produced by ACPO and CENTREX, lays down a national basis for training in control and restraint, but the extent to which this model is adopted is a matter for individual police forces. The decentralised nature of the policing system means that there is little consistency in practice of control and restraint, or in training of police officers in control and restraint, across different police forces. This is a feature of a number of aspects of police custody practice, as we discuss further below. A number of witnesses expressed specific concern about the variation of training in control and restraint.[273]

271. ACPO confirmed that there was no consistent monitoring or recording across all police forces of the use of control and restraint.

272. However, ACPO stated—

    There is specific guidance and training for all officers, with refresher training on a regular basis, that actually identifies issues such as positional asphyxia and problems in relation to excited delirium, and all officers are made aware of this from their initial training and right through their refresher training, and also the problems … in relation to the way that people should not be held in prone positions.[274]

273. However, the Home Office conceded that, although the ACPO/CENTREX Manual of Guidance provided a basis for restraint training nationally, the extent of training on the basis of the manual was a matter for individual police forces, and the amount of time allocated to restraint training varied considerably between police forces, "from as little as 4 hours annually to up to 4 days annually."[275]

274. The recent Report of the Inquest into the Death of Roger Sylvester expressed concern that, in relation to the training offered by the Metropolitan Police Service "there does not appear to be any specific training or any specific procedures for continuing to restrain a non-compliant person with ABD [Acute Behavioural Disturbance] on their side or in a kneeling or sitting or in a standing position" despite the increased risk of asphyxiation that resulted from restraint of such a person in a prone or semi-prone position.[276] The Coroner also concluded that police officers needed training in the specific techniques appropriate to restraint of persons arrested under section 136 of the Mental Health Act.[277]

275. ACPO noted that under the Police Reform Act 2002 there was potential for guidance to be developed across the police service on key issues, in the form of codes of practice. The under-regulation of control and restraint, and inconsistency in its practice raise concerns of human rights compliance similar to those that arise in the mental health context. In our view, there should be a national Code of Practice on restraint in police custody, which takes account of the Convention rights. The Code of Practice should be backed up by statutory obligations which mirror those we have recommended in relation to Mental Health Act detention: to record all incidents of the use of force, and to train on the basis of the Code of Practice. Training, including mandatory annual refresher training, which reflects human rights standards, should be conducted by nationally accredited trainers. Police policy and training on control and restraint should draw on experience and standards in the mental health sector.

Co-ordination of policy and training on restraint

276. The circumstances in which restraint is used vary, and the techniques used to ensure safety in one custodial environment are not necessarily directly or universally applicable in another. Nevertheless, there are common issues in the use of restraint in all forms of detention,[278] in particular the use of restraint against disturbed and mentally ill people, and the possibility of disproportionate use of restraint against people of particular ethnic groups. The recent death in a juvenile detention centre following restraint has highlighted the need for review of prison service policy and training on restraint. In this, the prison service might benefit from discussions on training and techniques with the police and healthcare sectors.

277. Practice and policy in restraint techniques appears to vary widely between different forms of custody—for example, whilst we understand that mechanical restraints are regularly used in police custody, the practice in Mental Health Act detention is to use such restraints only in the most exceptional situations, if at all. Special hospitals may however rely on restraint through medication, or on seclusion.

278. There is a strong case for exchange of expertise and good practice on restraint between the police, prison service and NHS. This is particularly so given the wealth of recent initiatives to improve safety in the use of restraint, in particular in mental health settings. Exchange of information will assist in the development of consistent guidance across all settings where restraint may be used, and in the development of consistent and comprehensive training models to a high standard. It should also assist in devising proportionate and flexible responses to violence, which are human rights compliant. INQUEST proposes that—

    [t]here should be national training standards across different agencies and the establishment of an inter-agency group to share best practice and, working with the health and safety executive, to set up and monitor standards for the validation of training modules and courses.[279]

279. We understand that some of this joint development is already taking place, in particular within the cross-government group on the management of violence, which is working towards the production of joint guidance applicable across prison, police, and mental health act detention. The guidance is to cover local protocols and will address training needs in relation to restraint. We welcome the establishment of the cross-government group on the management of violence. We recommend that further joint working should take place to ensure that high standards of safety are set and maintained wherever restraint is used against detainees. A permanent body should be established to ensure that these standards are maintained and kept under review.

280. Ensuring the safety of detainees also requires that detainees who must be restrained are restrained in the environment and by the people who are best qualified to protect them from harm. This is a particular issue in relation to highly mentally disturbed people who are detained in police custody, in particular under section 136 of the Mental Health Act 1983. The Report into the Death of Roger Sylvester addressed this issue and concluded that NHS bodies should give priority to treatment of patients with acute behavioural disturbance who are being restrained by the police, and that local protocols should reflect this. It emphasised that an acutely disturbed and non-compliant detainee in restraint constituted a medical emergency, and should be treated as such and be given priority in transfer to hospital.[280]

Staffing Levels

281. On visits to a number of institutions, and in written evidence and discussions, we have seen that serious understaffing is hindering capacity to protect vulnerable people, in many prisons, special hospitals, and police custody suites. At Broadmoor, for example, we were told that staff shortages were a chronic problem, a product of both lack of resources and problems in recruiting, which gave rise to concerns about both staff and patient safety. On several of our prison visits we were told that staff shortages made observation of prisoners more difficult, and prevented staff from being released for training. We were also told in evidence that staff shortages were a problem in some police cells. Detention and care of people at risk of self-harm and suicide is inevitably resource intensive. Chronically understaffed detention facilities create conditions in which deaths in custody can more easily occur. In our view, adequate staffing is a necessary precondition to safety and Article 2 protection.


258   Edwards v UK (2002) 35 EHRR 19 Back

259   Q 139 Back

260   Ev 96 Back

261   Q 426 and Q 379 Back

262   QQ 428-429 Back

263   Meeting with the Metropolitan Police Service Professional Standards Directorate, 7 July 2004 Back

264   Ev 163 Back

265   Ev 164 Back

266   Ev 134 Back

267   Q 11 Back

268   Meeting with staff at Broadmoor hospital, where training for all staff in the use of restraint, and annual refresher training, is compulsory. Training included 5 days of training in using restraint as part of a team of three people, and training in "breakaway" techniques to allow staff to disengage from an aggressor. Back

269   UK Central Council for Nursing Midwifery and Health Visiting, The Recognition, Prevention and Therapeutic Management of Violence in Mental Health Care, February 2002 Back

270   Norfolk, Suffolk and Cambridgeshire Strategic Health Authority, Independent Inquiry into the Death of David Bennett, December 2003, p 29 Back

271   National Institute for Clinical Excellence, Draft guidelines on the short term management of disturbed (violent) behaviour in in-patient psychiatric settings and accident and emergency settings, July 2004, para. 1.3.2 Back

272   ibid., para. 1.3.5 Back

273   Ev 163-164 (Police Federation), Ev 133-134 (ACPO) and Ev 190 (Professor Gournay) Back

274   Q 421 Back

275   First Report of Session 2003-04, op cit., Ev 8 Back

276   Inquest into the Death of Roger Sylvester, Section 2, pp. 7-8. Following this the Metropolitan Police Service published a Report on restraint and Mental Health, September 2004, which recommended, amongst other things, that the Department of Health should commission research to provide practical guidance on restraint of people with Acute Behavioural Disturbance (Recommendation 8) Back

277   ibid., Section 2, p. 18; Section 3, p. 6  Back

278   The report of the coroner in the inquest into the death of Roger Sylvester suggested that police officers could usefully learn from the experiences of psychiatric nurses in using de-escalation techniques to avoid physical restraint. This would particularly be so in respect of persons detained under section 136 of the Mental Health Act (p. 18). Back

279   First Report of Session 2003-04, op cit., Ev 93 Back

280   Inquest into the Death of Mr Roger Sylvester, op cit., p. 16 Back


 
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