John Pugh (Shadow Minister, Health; Southport, Liberal Democrat)

I beg to move, That the clause be read a Second time.

The new clause should prompt a brief but useful debate about physical restraint and its use within the mental health service. It is about the use of seclusion, other forms of behaviour management, mechanical restraint and other interventions managing disturbed behaviour and the removal of a patient from normal levels of association and freedom—in other words, locking them away or keeping them in some very controlled environment. The new clause endeavours to specify certain purposes for which that may be done, suggesting that there should be regulations defining the circumstances in which any form of intervention might be used; reporting requirements for the use of such interventions, which obviously at times involve quite fraught methods of physical restraint; a review of such interventions, to find out how common they are; scrutiny of their use; and also a record of the circumstances under which patients subject to interventions are visited.

This is really the most troublesome of all ends of mental health care. More than 35 years ago, I think, I had my only experience of showing somebody into what was then a padded cell, in an old-fashioned,  locked refractory ward. Even today I remember the episode very vividly. The individual was terribly distressed, standing out from all the other patients in many ways, and many of the patients were in a very severe state indeed. He was routinely excluded. He seemed to have some sort of immunity to drugs like Stelazine, the psychoactive then available. Therefore, he lived in a deeply troubled world, tortured by hallucinations. To this day I wonder what on earth could have happened to him.

My point is about what was done to him, however, which was not by and large therapy, but an act of therapeutic desperation. The only alternative was to over-sedate him, which is equally undesirable. Given that that is what happens in such extreme—I accept that it is quite rare—circumstances, it is entirely appropriate for us to have reports, reviews, scrutiny and a visit in order to minimise such episodes, because more sophisticated interventions might be able to prevent some cases happening. I accept that in modern medicine this procedure is rarely used and that there are alternatives. The more normal form would not be physical restraint, but some injection—forcibly delivered into the backside in all probability. Insofar as this happens at all, we need to record and regulate it as a precursor to minimising it.

Rosie Winterton (Minister of State (Health Services), Department of Health; Doncaster Central, Labour)

The new clause certainly raises an important issue. I appreciate the concerns that exist around the use of interventions such as seclusion and mechanical restraint in managing disturbed behaviour. I know that the subject concerns my hon. Friend the Member for Norwich, North as well, obviously because of the very distressing case of Rocky Bennett and the following inquiry.

Many issues have come to the Government’s attention in the past few years. I can assure the Committee that we share the common objective of ensuring that there is no inappropriate use of seclusion, restraint or similar interventions. We want to see such measures taken only when they are essential and used properly, and that patients have adequate safeguards.

However, I must tell the hon. Member for Southport that new clause 5 is not the best way in which to address those concerns. It would not be practical to define in regulations all the situations in which disturbed behaviour may need to be managed and the range of techniques that may be used and it would limit the ability of staff to respond flexibly to the wide range of situations that they may face. There are circumstances in which restraint will be the only action available to make a dangerous situation safe. Also, regulations run the risk of inhibiting the development of new and improved techniques for managing difficult behaviour. We have to be careful not to do that.

The management of disturbed behaviour and the techniques involved are not regulated specifically by the Mental Health Act, but they are subject to general criminal and public law, including the Human Rights Act 1998. They are also subject to the professional duties and obligations of the practitioners involved. We have reflected the 2004 guidance from the National  Institute for Mental Health in England in the code of practice, which also advises adherence to the National Institute for Health and Clinical Excellence guidelines, which were issued in 2005. That guidance addresses the issue of the management of aggression and violence, including restraint.

The Healthcare Commission and the Health Inspectorate Wales will be mindful of the guidance when they visit hospital units—they would wish to be satisfied that it is being followed.

Tim Boswell (Daventry, Conservative)

I am following the Minister’s argument with quite a lot of sympathy. I understand the case for flexibility and the difficulty of covering everything in regulations. There was a trainee in a secure training centre in my constituency who sadly died. A restraint lock was used on him, in accordance with Home Office guidelines, but he collapsed and died. We need not expand on that now. Does the Minister agree that it is terribly important that less invasive and aggressive techniques are developed and brought forward and communicated as best practice as soon as possible? The fact that we have set guidance in the past, perhaps because a practice was acceptable at the time, does not mean that we so much as tacitly accept that it is the way forward. As soon as we know a better way, we should avoid old practices.

Rosie Winterton (Minister of State (Health Services), Department of Health; Doncaster Central, Labour)

The hon. Gentleman is absolutely right. One of the reasons why we do not want to accept the new clause is that the spreading of best practice in the way in which he described might be hampered. Hospital managers also have responsibilities for best practice. They should regularly review the use of seclusion. Providers should have clear written policies on the use of restraint, which should include provision for review and for the application of restraint to be audited and reported to hospital managers.

The “Count Me In” census collects and publishes information about periods of seclusion during an in-patient’s stay in hospital. It also records incidents of hands-on restraint, which it defines as the physical restraint of an in-patient by one or more members of staff in response to aggressive behaviour or resistance to treatment.

We will, however, consider how information on the use of seclusion and restraint may be reported to the new regulator for England. That will also be a matter for Welsh Ministers, and it will be an important step forward. The guidance on seclusion and restraint has been revised and updated during preparation of the draft illustrative code of practice for England to accompany the Bill, and it will be further developed in the new code, on which consultation will take place.

The Government completely understand the concerns that underlie the new clause, but we oppose it for the reasons that I have stated. I can give a commitment to hon. Members that we shall continue to work to ensure that restraint and seclusion are used only when they are essential.

John Pugh (Shadow Minister, Health; Southport, Liberal Democrat)

I thank the Minister for that enlightenment and range of assurances. I beg leave to withdraw the motion.