Hospital restraint probe reveals lack of basic safeguards

Following the suspension of 20 members of staff from the Westwood Centre at West Lane Hospital in Middlesbrough, Article 39 submitted a freedom of information request to gain details of restraint techniques authorised for use on children there. The staff were suspended after using unauthorised restraint methods.

The FOI response from Tees Esk and Wear Valleys NHS Foundation Trust reveals an alarming lack of accountability, reporting and sparse information sharing with child patients and their parents/carers.

Westwood Centre cares for just 12 children at a time. Our FOI request reveals that:

  • In 2013/14 two formal complaints were made by children and young people and/or their parents;
  • This rose to 10 complaints in 2017/18; and
  • Eight complaints have been lodged from 2018 to date.

No written information was given to us about approved restraint techniques, and in the FOI response the Trust said no information is provided to children and parents.

The Mental Health Act 1983 grants children detained in the Westwood Centre the right to an independent mental health advocate when they make a complaint.

However, we’ve been told no child received assistance from an independent advocate when making a complaint between 2013/14 and 2016/17.

In 2017/18 only two children received support (when 10 had made complaints). Similarly, just two of eight complainants have received help from an advocate from 2018 to date.

Helen Donohoe, Article 39’s Assistant Director, said:

“A child or young person’s right to an independent advocate in settings such as the Westwood Unit is an essential safeguard against poor and dangerous practice, including the use of excessive restraint. We are alarmed that so many complaints could occur without children and young people receiving assistance from independent advocates, to make sure they are heard and their rights upheld. We are seeking assurance that the current investigation will address that now, and for future practice.”

The CQC inspected the NHS Foundation Trust in 2018 and found that:

The trust had made improvements since the last inspection as continued to monitor the use of restraint on Newberry and Westwood wards. The numbers of restraint on both wards have increased which management attributed to the acuity of patients. However, in 2015 prone restraint was 25% and 50% of total restraints on the respective wards however this had reduced significantly to the current figures of 3% and 6% of all restraints on these wards. Staff understood that the use of restraint was a last resort. They used de-escalation and low levels of restraint to manage incidents of aggression wherever possible. Staff ensured they documented episodes of restraint, and rapid tranquilisation in accordance with trust policy.

Extract from CQC inspection report, 2018

Article 39 is now seeking further information, including:

  • What was done in the five years before the staff suspensions to address the rise in complaints.
  • What restraint methods were approved for use on children, and why is information about authorised techniques not given to children and their parents.
  • Why is there a seemingly low use of independent advocates? Has material been produced especially for children about their right to an independent advocate? Who is responsible for making sure children and young people detained in the Centre are heard and their rights upheld?
  • How the perspectives of children and young people and their parents were considered during the CQC inspection in 2018; and how they they will be included in the current investigation.