Amendment 155

Domestic Abuse Bill - Committee (5th Day) – in the House of Lords at 9:45 pm on 8 February 2021.

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Lord Ramsbotham:

Moved by Lord Ramsbotham

155: After Clause 72, insert the following new Clause—“Screening for acquired brain injury in domestic abuse cases(1) A woman who has been the subject of domestic abuse shall, with her consent, be screened for traumatic brain injury, and other forms of brain injury, including concussion.(2) For the purposes of this section a woman has been the subject of domestic abuse if—(a) she is the person for whose protection a domestic abuse protection notice or a domestic abuse protection order has been issued, or(b) she is the person against whom it is alleged the domestic abuse has been perpetrated, when the accused is charged with an offence that amounts to domestic abuse within the meaning of section 1 of this Act.(3) In the case of subsection (2)(a), the screening shall take place within two weeks of a domestic abuse protection notice or a domestic abuse protection order being issued.(4) In the case of subsection (2)(b) the screening shall take place within two weeks of a charge being made for an offence, where the behaviour of the accused amounts to domestic abuse within the meaning of section 1 of this Act.”

Photo of Lord Ramsbotham Lord Ramsbotham Crossbench

My Lords, in moving Amendment 155 and speaking to Amendment 156 standing in my name, I must declare two interests: first, I am chairman of the Criminal Justice and Acquired Brain Injury Interest Group; secondly, I am a vice-chairman of the All-Party Parliamentary Group for Acquired Brain Injury.

The chairman of the APPG, Chris Bryant MP, unsuccessfully tabled these two amendments in Committee in the other place. Since then, he and I have had a discussion with Victoria Atkins MP, Minister for Safeguarding, during which she assured us that the Government recognised the impact of acquired brain injury on victims of domestic abuse. Since then, she has forwarded a copy of the draft guidance to be issued to the police on domestic abuse protection notices and orders. Both are mentioned in Amendment 155, which includes referral to an independent domestic violence advocate, who can advise a victim on a range of issues, including healthcare. That has been forwarded to noble Lords by the noble Baroness, Lady Williams of Trafford.

These two amendments are linked in that both are to do with assessing whether a victim of domestic abuse is suffering from an acquired brain injury. I will speak first to Amendment 156, which covers prisoner victims of domestic abuse. It was the assessment of their needs conducted by the Disabilities Trust at HMP Drake Hall, a women’s prison in Staffordshire, that first alerted us to the added problems faced by victims suffering from an acquired brain injury.

The trust, which is a member of the interest group that I chair, had carried out an assessment of head injury at HMP Leeds, finding that over 40% of male prisoners were suffering from an acquired brain injury that affected their behaviour. The trust introduced a link worker scheme, in which someone who had worked with a prisoner while he was in prison supported him for six months when he was released into the community. The trust then carried out a similar assessment at HMYOI Wetherby, finding that a similar percentage of young offenders were suffering from an acquired brain injury.

Turning to women, the Ministry of Justice funded the trust to conduct a two-year specialist link worker scheme at Drake Hall. The trust found that 64% of the prisoners reported having suffered a brain injury, 98% of which were traumatic. Forty per cent of those suffering from a traumatic injury had a mental health diagnosis, and 62% of the women reported that they had received their injury during domestic abuse. For some, this was the first realisation that the injury was the cause of their behavioural symptoms.

In that connection, I have mentioned before in this House my disappointment that Theresa May, when Prime Minister, dropped the prisons part of David Cameron’s Prisons and Courts Bill. A number of us had hoped to use it to make statutory certain initial assessments on being received into prison, including an assessment of head injury. I hope that this Bill will provide the opportunity to make that good.

We have also corresponded with Alex Chalk MP at the Ministry of Justice regarding the follow-up to the Disabilities Trust report on Drake Hall. He confirmed that work was under way to improve the identification of individuals with an acquired brain injury and ensure that prison and probation staff were better informed and trained to understand and support the behavioural challenges of those with an acquired brain injury.

I shall move on, or rather backwards, to Amendment 155. In addition to the draft guidance for the police about domestic abuse protection notices and orders, I should draw attention to the inclusion of a time factor. Early assessment is of the essence in understanding the effects of an acquired brain injury no less for the victims than for those responsible for treating them. I beg to move.

Photo of Baroness Finlay of Llandaff Baroness Finlay of Llandaff Deputy Chairman of Committees, Deputy Speaker (Lords)

My Lords, the noble Lord, Lord Ramsbotham, has raised an important issue and outlined the size of the problem. Brain injury can arise from many different causes such as violent trauma, lack of oxygen to the brain or self-medication with alcohol and drugs. Sadly, brain injury is in large part irreversible, although sometimes the brain has the ability to relearn under intense rehabilitation, which is why rehabilitation services are so important.

One can see the motivation behind the amendment, but I fear that it may be difficult to have it in the Bill. In acute head injury, haemorrhage, usually a subdural haematoma, needs to be detected rapidly and the clot removed neurosurgically. If missed, the injury may become a chronic subdural as the clot acts like a wick, drawing fluid into it so that it slowly expands in the fixed box that the skull provides.

The other main category is that of repeated impact injury, sometimes associated with episodes of concussion as classically seen in boxers, which can lead to dementia. The part of the brain that is damaged determines the clinical signs exhibited. If the frontal lobes or some of the main nuclei of the brain are damaged, there can be profound personality and behavioural changes, while in others, speech and movement are affected. It can be very variable. Sadly, although supportive care can help a person to cope with deteriorating brain function and slow its effect, it is not reversible.

A possible difficulty with the amendment is that it requires a two-week timeframe for assessment, given that there are already waiting lists for MRI machine time for those with symptoms indicating brain pathology, such as cancers that need urgent treatment. Awareness of head injury is gained first and foremost from the patient history, followed by appropriate physical examination, after which further investigations may or may not be indicated. It is the history of the injury and the clinical signs that may indicate brain injury; the screening itself can establish only that the findings and type of injury described are, on the balance of probabilities, likely to be causally linked. This well-motivated amendment should raise awareness of head injury so that women are asked about the type of injury, including how it happened and when. A high index of suspicion of head injury is needed, but I fear that the amendment as worded would not be workable in practice.

Photo of Baroness Burt of Solihull Baroness Burt of Solihull Liberal Democrat

I support the amendments in the name of the noble Lord, Lord Ramsbotham, which he spoke to so convincingly. Amendment 155 deals with screening for traumatic brain injury for female domestic abuse victims who choose to have it within two weeks of a domestic abuse protection notice or order, or when the abuser has been charged. This should provide valuable evidence of abuse for the court and possibly a diagnosis that could help health authorities to treat the injuries that have arisen both physically and mentally. We heard from the noble Baroness, Lady Finlay, about the harm to victims that acquired brain injury can cause; they are complex and worrying.

Amendment 156 relates to female prisoners. As the noble Lord, Lord Ramsbotham, confirmed, many prisoners of the male variety have been knocked around and may well have brain injuries, although I would suggest that that does not happen very often as a result of domestic abuse.

As we have been told, the amendment is based on research by the Disabilities Trust which shows that nearly two-thirds of offenders at Drake Hall had had a brain injury, of whom 62% claimed that the injury was a result of domestic abuse. Of those diagnosed as having a brain injury, nearly all of them had suffered traumatic brain injury, potentially leading to very serious health consequences, as we have heard.

The amendment provides for all female prisoners to be screened within two weeks of starting their sentence. While they are inside, remedial treatment can be started, I hope, although I accept the very informed and concerning comments of the noble Baroness, Lady Finlay.

Photo of Lord Ponsonby of Shulbrede Lord Ponsonby of Shulbrede Shadow Spokesperson (Justice) 10:00, 8 February 2021

My Lords, I support both these amendments. The noble Lord, Lord Ramsbotham, has had a long-standing interest in these matters, as he explained to the Committee, and he spoke with great authority, as he usually does. He also explained that he had had recent conversations with the Minister, Victoria Atkins, and I was pleased that he explained that she is taking this problem very seriously.

The noble Baroness, Lady Finlay, gave a very sobering medical explanation of brain damage and brain injury. In my understanding, she said it is a difficult thing to assess, but it is a very real issue. I too got the review of the Disabilities Trust report on Drake Hall from 2016-18, and we have heard a number of the statistics from the noble Baroness, Lady Burt, and the noble Lord, Lord Ramsbotham.

One particular statistic that was not repeated, and which I thought was particularly revealing, was that 33% of women with a brain injury sustained their injury before committing their first offence. That shows that brain injury can, and often does, lead to life-changing behaviours, which can and do mean that, disproportion-ately, people with brain injuries end up in prison—both women and men.

The noble Lord, Lord Ramsbotham, did not actually say that this was a probing amendment, but whether or not it is, I am happy to support it. I hope to hear from the Minister that the Government are taking these sources of injury and changes in behaviour very seriously within the prison estate.

Photo of Lord Parkinson of Whitley Bay Lord Parkinson of Whitley Bay Lord in Waiting (HM Household) (Whip)

My Lords, I am grateful to the noble Lord, Lord Ramsbotham, for setting out the case for these amendments, which, as he explained, follow similar suggestions from Chris Bryant MP when the Bill was debated in another place. I am pleased that my honourable friend the Minister for Safeguarding was able to meet Mr Bryant and the noble Lord, and that their discussions were—as the noble Lord said—helpful.

Amendment 155 seeks to introduce screening for acquired brain injury for female victims of domestic abuse within two weeks of a domestic abuse charge being made, including those victims to be protected by a domestic abuse protection order. Amendment 156 seeks to introduce screening for brain injury for all female prisoners within two weeks of starting their sentence, with a subsequent assessment to take place if an injury is found.

I say from the outset that we want to make sure that we provide healthcare and support that meets the specific needs of all victims of domestic abuse, and female offenders too, including those with acquired brain injury. We have carefully considered these amendments, and while we appreciate their overarching intent, we feel that legislating would not be the appropriate course of action. The noble Baroness, Lady Finlay of Llandaff, set out clearly the clinical difficulties that would be involved if we were to put this in the Bill.

The National Health Service is there to provide appropriate care and treatment for everyone who needs it, based on clinical need. This key principle on which the NHS operates means that anyone who needs a certain diagnostic test based on clinical need should receive it. The healthcare needs of victims of domestic abuse will vary greatly based on their individual circumstances and experiences but, if they need urgent assessment or treatment, they will receive this from the National Health Service.

Moreover, as we have heard throughout the scrutiny of the Bill so far, domestic abuse can manifest itself in many ways, including—as in the group of amendments we have just discussed—through coercive control or financial abuse, and it would be inappropriate to invite victims of these forms of domestic abuse for brain injury screening. That is why we do not consider that testing all female victims of domestic abuse, as this amendment suggests, would be an effective use of NHS resources or provide the personalised care they need.

Nevertheless, we believe that improvements can be made to existing screening processes through non-legislative measures. I will provide some background to that. All people entering prison receive an early health assessment within the first 24 hours. This initial assessment is comprehensive so that their health needs can be identified and addressed at an early stage. It includes a standard requirement to undertake a screening questionnaire for head injury and loss of consciousness, which focuses on issues with memory or concentration. As noble Lords have said, these can be important signs.

We acknowledge that more could be done during this screening process to identify and address specific circumstances where head injury or loss of consciousness has resulted from domestic abuse. I am pleased to say that NHS England and NHS Improvement have confirmed that they would be happy to add further questions to the existing screening tool to ascertain, where an acquired brain injury has been identified, whether that acquired brain injury occurred as a result of physical injury related to domestic abuse, sexual violence or another form of abuse.

The national screening tool is reviewed and updated by NHS England and NHS Improvement on an annual basis to allow for any changes in NICE guidance or any recommendations arising from a coroner’s report to prevent future deaths. To amend the existing screening tool, NHS England and NHS Improvement will need to agree the precise questions to be asked and how these will be reported. I am pleased to say that the initial screening questions on domestic violence and the coding that is required have already been agreed and will be implemented by April this year.

Alongside this, NHS England and NHS Improvement are continuing to work with the Disabilities Trust on a training package for healthcare practitioners to increase effectiveness when supporting people with impaired neurological functioning, either as a result of domestic abuse or for other reasons, and also to support them by providing practical steps to those working with patients and self-help tools for the patients themselves to reduce and overcome the impact of any brain injury.

In so far as Amendment 155 seeks to link screening to the making of a domestic abuse protection order, it is important to recognise that, like other protective orders, these are designed to impose requirements on the perpetrator. They cannot impose requirements on the person to be protected by the order, such as requiring them to undertake a screening for an acquired brain injury.

We will, however, use the statutory guidance to the police to recommend that they refer victims to an independent domestic violence adviser, or another specialist advocate, who will be able to advise victims of their options on a whole range of issues, including healthcare. In addition, we will include information on where to go to seek medical attention in the advice materials provided to victims which we will be producing ready for the pilots of the orders.

I hope that these non-legislative measures reassure the noble Lord, Lord Ramsbotham, that we are acting to support women with acquired brain injury and that putting this in the Bill is therefore not necessary. I am glad to repeat our thanks to him and to Mr Bryant for the discussions we have had on this important issue. I hope that the noble Lord will be willing to withdraw his amendment.

Photo of Lord Ramsbotham Lord Ramsbotham Crossbench

My Lords, I thank the Minister for that considered response and the noble Baroness, Lady Burt, and the noble Lord, Lord Ponsonby of Shulbrede, for their support. I am particularly grateful to my noble friend Lady Finlay of Llandaff for drawing on her considerable medical expertise to point out the practical medical difficulties with the timeframe proposed in Amendment 155. I majored on Amendment 156 and the assessment of victims of domestic abuse when they are received in prison, which has been proved to be so important. I will examine in detail what the Minister and my noble friend Lady Finlay said and decide what to do on Report. I beg leave to withdraw the amendment.

Amendment 155 withdrawn.

Amendments 156 and 157 not moved.

Photo of Lord McNicol of West Kilbride Lord McNicol of West Kilbride Deputy Chairman of Committees

We now come to the group consisting of Amendment 158. I remind noble Lords that anyone wishing to speak after the Minister should email the clerk during the debate. Anyone wishing to press this amendment to a Division must make that clear in debate.