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.

Medway child prison will be site of experimental secure school, despite history of failure to protect children

Last month, Article 39 and 35 others wrote jointly to the Ministers responsible for child protection and child prisons urging them to abandon plans to open an experimental secure school on the site of Medway secure training centre.

A serious case review showed substantial failure both within the institution, and among local and national agencies, to keep children safe. This was followed by an inspection report, published on 29 January 2019, which revealed children had been recently unlawfully inflicted with pain as a form of restraint. The secure training centre transferred from G4S to Ministry of Justice management in July 2016.

We received a letter this week – see below – from Edward Argar MP, responsible for child prisons. He said he was also replying on behalf of Nadhim Zahawi MP, whose Ministerial portfolio includes child protection and safeguarding vulnerable children.

Given our joint letter was wholly about the safety and welfare of very vulnerable children, many of them in the care system, it is very disappointing that Minister Zahawi did not, at the very least, countersign the letter.

But the most astonishing part of the response is the Government’s explanation for using Medway secure training centre as its first experimental secure school:

“Medway STC stood out for several reasons – including location, our ownership of the site and the absence of any need to go through a potentially protracted and expensive planning application.”

Edward Argar MP, Youth Justice Minister

On location, official data published by the Ministry of Justice shows 58 children from the South East region of England were detained in December 2018. However, 228 children were detained within the region – meaning that 170 children were from outside the area. Over a quarter (27%) of children in custody are sent to the South East region. The Government’s own data therefore shows that extra provision is not required in this location.

Moreover, one of the documents produced by the Ministry of Justice to encourage companies to apply to run the first experimental secure school notes that there are no secure settings in England’s Eastern region – yet 77 children from that area are detained, according to latest figures.

That the Ministry of Justice owns the prison site has no credibility as a reason for choosing it as the place to pilot an institution meant to be completely different from existing child prisons.

There is a very long history of the prison service’s ownership of land, as opposed to children’s needs, determining where institutions are built. The location of Medway secure training centre itself was selected in the late 1990s because the prison service ran the nearby Cookham Wood young offender institution and Rochester prison.

Prior to its opening in 1998, Medway secure training centre was known as Cookham Wood secure training centre – showing its links to the adjacent prison. Its other neighbouring prison, Rochester, was once called Borstal prison, and was the site of the first ever experimental child prison – which opened in 1902.

Similarly, the Government’s avoidance of having to “go through a potentially protracted and expensive planning application” makes no sense if Ministers genuinely want to abandon penal institutions for children. Whenever a local authority or health body wishes to open a new residential service, for children or adults, they must go through the planning process.

Article 39’s Director, Carolyne Willow, said:

“The Minister’s response signals his department continues to be trapped in a cycle of failure with the perpetual remodelling of child prisons. The first experiment in child prisons started in the same geographical location as the planned secure school. That was 117 years ago.

“If Ministers are truly behind replacing young offender institutions and secure training centres, they must surrender their dependence on prison land and prison property.

“And if they genuinely want secure schools to be secure children’s homes, as their promotional literature says, then why not build upon and develop the best of existing provision run by local authorities as part of their wider services to children and families?”

The Minister’s letter can be read here.
Our joint letter to the minister can be read here.

In December 2016, the Government announced it shares the long-term vision of Charlie Taylor (Chair of Youth Justice Board) to replace juvenile young offender institutions and secure training centres with secure schools.

Pain-inducing restraint of vulnerable children: legal challenge on hold

Adam Rickwood photograph
Adam Rickwood hanged himself in 2004, aged 14, after Serco officers unlawfully restrained him – including by striking him in the nose. The ‘nose distraction’ was then an authorised restraint technique.

Article 39’s application for permission to apply for judicial review of the authorisation of pain-inducing restraint on children has been stayed pending the Charlie Taylor Review and the report of the Parliamentary Joint Committee on Human Rights.

This means we can return to court should children’s human rights continue to be breached after both investigations have concluded.

With financial backing from 196 donors, we have been challenging the Ministry of Justice’s authorisation of pain-inducing restraint during detained children’s journeys to and from secure children’s homes. GEOAmey holds the contract for prisoner and secure escorts. 

We have argued that the Government’s policy breaches children’s rights to protection from inhuman and degrading treatment or punishment, and to protection from discrimination, under Articles 3 and 14 of the European Convention on Human Rights. Pain-inducing restraint within secure children’s homes is banned. 

We are also pressing for clear and public rules setting out when children may be restrained during their journeys to and from places of detention. 

Our challenge led the Ministry of Justice to review its policy on pain-inducing restraint during children’s journeys to and from custody. It then committed to a much wider review of pain-inducing restraint across young offender institutions, secure training centres and secure children’s homes – as well as the escorting process. This is being undertaken by Charlie Taylor and is expected to report no later than Summer 2019.

Parliament’s Joint Committee on Human Rights is also conducting an inquiry into the solitary confinement and restraint of children in custody. The Committee recommended the abolition of pain-inducing restraint techniques in children’s custodial institutions in 2008 and 2009. Since then the European Committee for the Prevention of Torture, the UN Committee on the Rights of the Child and the UN Committee Against Torture have all urged the withdrawal of these harmful techniques.

Article 39’s Director, Carolyne Willow, said:

“With the Charlie Taylor Review, this is the first time Ministers have commissioned a stand-alone investigation of the deliberate infliction of pain on vulnerable children. This has only happened because of our legal challenge, and we are extremely grateful to all those who donated funds and to our excellent legal team.  

“This year is the fifteenth anniversary of the death of Adam Rickwood, a 14-year-old boy who hanged himself after officers deliberately assaulted him in the nose – which was then an authorised method of restraint. A second inquest into his death found he had been unlawfully restrained. 

“It’s been a very long wait to get this basic child protection, where members of staff are not allowed to strike a child in the name of restraint, but we are now the closest we have ever been.

“There is no question that we will return to court should the Charlie Taylor and Joint Committee on Human Rights’ reviews not result in children receiving the protection to which they are entitled.”

Article 39 is represented by Mark Scott, Partner at Bhatt Murphy Solicitors, and Dan Squires QC and Tamara Jaber from Matrix Chambers.

Joint call for closure of Medway secure training centre & secure school

With 35 others, yesterday Article 39 sent a joint open letter to the Justice and Children’s Ministers urging them to close Medway secure training centre and discontinue plans to make it the country’s first experimental secure school.

The move comes after the publication of a serious case review into the centre, and last week’s Ofsted inspection report which revealed children are still being unlawfully restrained there.

Article 39’s Director, Carolyne Willow, said:

“Whenever there is institutional failure stretching back many years, there comes a point when someone in charge has to take decisive action and say ‘enough is enough’. The serious case review and the latest inspection report show deep fault lines in protecting children.

“If this child prison was a children’s home or a school, its gates would have been closed shortly after the shocking BBC Panorama exposé of physical and emotional abuse three years ago.

“Ministers must stand up to the false optimism that the institution can reform itself, and local and national agencies will properly scrutinise and protect children. The continuing revelations show that this is not possible. A change of name to secure school and a small refurbishment is not going to address the systemic failings. The centre must be closed for good.”

 

Systemic and serious child protection failures – G4S and Medway Safeguarding Children Board

Medway Safeguarding Children Board has this afternoon published the serious case review it commissioned into the abuse of children in G4S-run Medway secure training centre, which was exposed by a BBC Panorama programme in January 2016.

Carolyne Willow, Article 39’s Director, said:

“This review confirms what millions of us watched on the BBC Panorama programme: that G4S failed to protect children from staff violence and cruelty. The new revelation is that the local systems for protecting children in this institution were utterly ineffective and at times expressly working against keeping children safe. 

“The extent to which local authorities are left to create their own arrangements for responding to institutional abuse allegations cannot be right. Nor is it acceptable that so much onus is placed on children to know they are being mistreated and to seek help.

“The serious case review highlights that children’s past experiences can affect their recognition of abuse, and their confidence in speaking out. But there are also very powerful institutional factors which influence both children’s and adults’ perceptions of what is tolerable or not, and the actions they take.

“There is a compelling and urgent need for government guidance on keeping children safe in institutions.

“Much is missing from the serious case review, including the alleged sexual abuse found by the local authority and submitted to the Independent Inquiry into Child Sexual Abuse last summer. Only a small number of children were interviewed and parents appear not to have been involved at all. The police went back to 1998 in their investigation, and the Guardian newspaper reported abuse claims going back to at least 2003, yet the serious case review only starts at 2014. Given the very serious and systemic local failure to protect children, Ministers must now revisit their decision to convert Medway secure training centre into their first experimental secure school.”   

The serious case review commenced in July 2017, 18 months after the Panorama programme and a year after management of the secure training centre was transferred from G4S to Her Majesty’s Prison and Probation Service. Its time-frame was 2014-2017.

The serious case review shows:

Excessive physical restraint and victimisation of especially vulnerable children
The small number of children who were interviewed as part of the review (13 by telephone and 7 face-to-face) reported “excessive” physical restraint; staff deliberately using physical restraint out of sight of CCTV; and some staff more frequently using restraint which deliberately inflicts pain on children. Children who were especially vulnerable were victimised by staff. The serious case review states: “staff had picked on children who appeared vulnerable. This included children who did not speak English or were comparatively young or withdrawn or had no extremal family support”.  Barking and Dagenham local authority reported to the serious case review that one of its children detained at Medway secure training centre had been stopped from seeing their social worker alone.

Reporting of crimes against children “stymied”
Before the police investigation set up after the Panorama programme, “the reporting of crimes committed against children at Medway STC can be described as “stymied” in that their progress had been prevented/hindered”. There was a “limited police response to previous allegations from or about children at the STC”.

Children regularly taken to A&E
90 children were taken to A&E from Medway secure training centre during the three-year period under review (the review does not state whether this was as a result of injuries from restraint or self-harm, or other reasons). A&E staff did not contact children’s next of kin or social workers in respect of children in care; this was left to custody officers to do.

“Erratic and ineffective” local authority oversight of child protection, with “serious and undetected deficiencies”
The local authority designated officer (LADO) function – responsible for monitoring and overseeing investigations of staff working with children – was “erratic and ineffective”. Referrals were not passed to the local authority’s child protection social workers to investigate; instead LADO staff carried out investigations themselves.

The focus “appeared to be proving if the allegation could be substantiated or not, rather than understanding the behaviour of the adult as possibly harmful, criminal or suitable and managing the potential risk of that behaviour towards children reoccurring and causing harm”.

This arrangement – known as the ‘Medway way’ – led to “few [child protection] strategy discussions, interviews with children were not undertaken by those professionals who best knew the child from their home authorities, management oversight and supervision were poor, policies were not followed, regular liaison meetings were not held and responses were slow and did not provide sufficient challenge to the staff and management at Medway STC. There was no operational practice guidance on the management of allegations in the procedures and the approach to the line management of the LADO who may have a specific expertise unfamiliar to most other staff including the line manager appears to have contributed to some serious and undetected deficiencies… It was not until 2016 that these began to be detected”.

Local Safeguarding Children Board did not act on Ofsted concerns from 2014 and 2015 and failed to challenge inadequate arrangements for protecting children in Medway secure training centre
Ofsted recommendations in respect of child safeguarding monitoring and oversight, in 2014 and 2015, “were not apparently followed up in a timely manner and the Medway Safeguarding Children Board did not challenge the quality of the LADO annual reports or other performance information it received”.  The “lack of proper analysis of allegations being presented to the [Medway Safeguarding Children Board] was a missed opportunity for challenge”.

Barnardo’s told it couldn’t refer child protection concerns to the local authority
Against requirements in government safeguarding children guidance, a contract between the Youth Justice Board and children’s charity Barnardo’s “expressly did not allow” independent advocates to refer concerns about child protection directly to the local authority. This was only rectified in July 2017 – 18 months after the Panorama programme. When Barnardo’s advocates supported children to make complaints about “how staff acted during restraints”, there was no requirement on G4S to inform the charity of the outcome of these complaints. Barnardo’s advocates were contracted to be in the centre 17 hours a week, yet they were not given a private office in which to meet children.

Barnardo’s advocates no longer see every child after they have been restrained
The year after the Panorama programme, the crucial safeguard of advocates meeting children after each restraint incident, to offer them help, was removed. This protection was first established following a coroner’s recommendation after 15 year-old Gareth Myatt died of positional asphyxia following restraint by three G4S officers in a different secure training centre. Since July 2017, advocates working in Medway secure training centre have not been required to be “physically present to offer advocacy” if a child has been previously restrained.

No recommendations for G4S
The individual management review undertaken specifically in respect of G4S identified not a single recommendation for the security company, which ran the centre between 1998 and 2016, and continues to run two other child prisons – Oakhill secure training centre in Milton Keynes and Parc young offender institution in Bridgend, Wales.

The serious case review makes a general recommendation “that G4S should consider the learning from their own IMR process and the overall learning in this SCR and consider implementation in its other service provision in the secure estate”.

G4S failed to hand over all of its staff records
When the prison service took over the running of Medway secure training centre, G4S failed to hand over “some locally stored staff records” and “local supervision records”. Although not mentioned in the serious case review, this echoes G4S’s failures to hand over information requested by the Independent Inquiry into Child Sexual Abuse last summer.

Youth Justice Board focused on contracts not children
Youth Justice Board monitors focused on contract compliance “as opposed to the safety and welfare of children” and “before December 2015, both internal monitoring and external reports on Medway STC had not signaled concerns about the treatment of children by staff”.

There are very significant omissions in the published serious case review:

  • There is no chronology showing when concerns were raised, and by whom; and the nature of concerns.
  • There is no overview of the children detained in Medway STC during the three-year time frame – their ages and other demographic information, a profile of their needs, and so on.
  • There is no data on child protection referrals, complaints, disciplinary action, restraint injuries and other serious incidents during the three-year time frame.
  • It lacks a full description of what was shown in the Panorama programme which led to the serious case review being commissioned, and the STC moving from G4S management.
  • We are not told what action the local authority and other agencies took immediately in response to the Panorama programme to safeguard and promote the welfare of the children who were shown on the programme being abused.
  • The review states there were no criminal convictions of G4S staff following the Panorama programme, but we are not told whether there was any disciplinary action taken by G4S, the local authority, the Youth Justice Board or any other agencies.
  • None of the evidence before the Independent Inquiry into Child Sexual Abuse last summer – including the very serious concerns reported by the social worker appointed by the local authority to, among other things, review the full Panorama footage – is mentioned in the serious case review, let alone considered. This is a very serious omission.

About serious case reviews
Serious case reviews are set up when a child has died or “has been seriously harmed and there is cause for concern as to the way in which the authority, their Board partners or other relevant persons have worked together to safeguard the child”.

Statutory guidance on serious case reviews for the time period stated: “when things go wrong Serious Case Reviews (SCRs) are published and transparent about any mistakes which were made so that lessons can be learnt” (Working Together to Safeguard Children, 2015).