Lord Ramsbotham:

Moved by Lord Ramsbotham

77: 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, including female prisoners and those awarded community sentences under probation supervision, must, with her consent, be screened for traumatic brain injury, and other forms of acquired 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 has been alleged that domestic abuse has been perpetrated when the accused is charged with an offence within the meaning of section 1 of this Act.(3) The purpose of screening under subsection (1) is to assist in the determination of whether a woman has been the subject of domestic abuse.(4) If screening under subsection (1) shows that there is an acquired brain injury—(a) an assessment must be made of whether such an injury has been acquired as a result of domestic abuse, and(b) the woman must be given appropriate rehabilitation treatment and advice.”Member’s explanatory statementThis Amendment seeks to improve the state’s understanding of the prevalence, causality and impact of brain injuries sustained during incidents of domestic abuse. It seeks to ensure that this is done quickly and thoroughly in order to start rehabilitative treatment.

Amendment 77, in my name and that of my noble friend Lady Finlay of Llandaff, is an amalgam of the two amendments I tabled in Committee. It is also an amalgam of the amendments tabled in the other place by Chris Bryant MP, chairman of the All-Party Parliamentary Group on Acquired Brain Injury, in which I should declare an interest as a vice-chairman. I should also declare an interest as chairman of the Criminal Justice and Acquired Brain Injury Interest Group, which consists of a number of practitioners in the field and officials from the Department of Health and the Ministry of Justice.

In Committee, I outlined just why it was so important that all victims of domestic abuse should be screened and assessed for any acquired brain injury as quickly as possible after the event, and was very happy that the draft guidance to be issued by the Home Office to the police contains just such an instruction. I am keen that such an instruction should also be issued to the Prison and Probation Service, I hope statutorily, based on evidence produced by one of the members of the interest group the Disabilities Trust at HMP Drake Hall, a women’s prison in Staffordshire.

After Committee, I wrote to Ministers appealing to them to adopt my amendment as a government one, and I am most grateful to the noble Lord, Lord Parkinson of Whitley Bay, for seeing me to discuss that. I am still hopeful and will not decide whether to divide the House until I have heard what he says in response.

Noble Lords often raise matters that they think should be in legislation during the detailed scrutiny that all Bills receive in this House, which Bill teams almost invariably brief their Ministers to turn down, but there is often method behind the apparent madness of the mover of a particular amendment, because officials simply cannot be expected to know as much detail as professionals in the field, and their successors may one day be grateful that they included a particular reminder or nuance.

I admit that I had not realised the importance of domestic abuse victims being screened for an acquired brain injury before I was educated, any more than did some of the victims screened at Drake Hall. Some of them realised that an injury had been inflicted during the abuse only when the reason for some of their symptoms was explained.

My Lords, I am not getting any messages through on my iPad or my phone, so if there is anything I need to know I hope the Whip will let me know. I call the noble Lord, Lord Naseby. The noble Lord has scratched, so I call the noble Baroness, Lady Finlay of Llandaff.

My Lords, this Amendment is important and it has been carefully worded to cover all the suggested improvements, as my noble friend Lord Ramsbotham said. It must be incorporated into guidance to prisons. The victim of a domestic abuse brain injury, normally a woman, may suffer memory loss, get confused and her speech become slurred because of brain injury. There is no physical wound or bruise; the damage is internal and invisible. Some in the criminal justice system doubt her because she appears confused and disorganised through loss of some executive functions. The brain injury remains unrecognised, and most victims will never have consulted a doctor, often through fear of talking about the abuse.

The Disabilities Trust’s work in Drake Hall prison which my noble friend Lord Ramsbotham referred to found that 64% of women prisoners coming on to the secure estate for the first time had a brain injury, and almost two-thirds were from a domestic violence incident. Some 40% of the women had a traumatic injury labelled as a mental health diagnosis, and for many this was the first time anyone realised the cause of their behavioural symptoms. Similar work with male prisoners has verified exactly the same situation.

Women who have experienced domestic abuse need treatment. They may need surgery to remove a chronic clot on the brain, and they certainly need neurorehabilitation services to understand the condition and cope with it. As I said, the data from male prisoners is similar, and it is similar in young offenders too: around 40% have an acute brain injury affecting their behaviour.

We cannot ignore the size of the problem, with almost two-thirds of women having a brain injury that came about from domestic abuse. This must be incorporated into guidance. I feel that if the Government will not agree to do that, my noble friend will be forced, unfortunately, to divide the House.

My Lords, it is a pleasure to follow the noble Baroness, Lady Finlay, who is so immensely knowledgeable in these matters. I recall clearly the debate we had in Committee and what we learned about the shocking prevalence of acquired brain injury among prisoners and domestic violence victims alike.

As regards this Amendment, women victims should be screened if they have been subject to domestic abuse, including women in prison. The amendment sets out quite strong qualifying criteria for screening and treatment for whether the woman qualifies as a domestic abuse victim.

In Committee, the noble Baroness, Lady Finlay of Llandaff, expressed concern about the practicality of being able to perform scans within two weeks, given the large waiting lists, which have been made appreciably worse by the pandemic. She also cast a depressing light on the fact that much acquired brain injury is irreversible. Therefore, I believe it is a balance between what is practical and what is desirable.

However, we know that productive discussions have been had by the Safeguarding Minister, with the noble Lord, Lord Ramsbotham, and Chris Bryant MP in the Commons. The noble Lord has done a great service to the House in raising this issue, and I greatly commend the work he has done over many years to raise awareness of the importance of acquired brain injury.

The noble Lord also secured a commitment from NHS England and NHS Improvement to add further questions to their existing screening tool to identify how an acquired brain injury occurred and whether violence was involved. He told the House about the extensive health examination given to new prisoners. That has certainly improved since my prison days. Much seems to be being done—or planned—by the NHS through non-legislative means. I agree with the noble Lord, Lord Ponsonby, who spoke in Committee, that it is not totally necessary to include this amendment in the Bill.

My Lords, I too pay tribute to the noble Lord, Lord Ramsbotham; he has a long-standing interest in this subject and I have heard him bring it up in other forums many times. As he said, he has worked constructively with Chris Bryant in Another place; they have worked in tandem in bringing this issue to the fore and to the attention of Ministers. I am glad that the noble Lord, Lord Parkinson, has met the noble Lord, Lord Ramsbotham, and maybe the noble Baroness, Lady Finlay, as well.

The noble Lord, Lord Ramsbotham, indicated that he is undecided about whether to divide the House on this matter, and it will depend on the Minister’s response. From my party’s perspective, I am not sure that this needs to be in the Bill, and we would abstain if the noble Lord were to press the matter to a vote.

I was also very persuaded, for a second time, by the noble Baroness, Lady Finlay. She made a very stark speech about the seriousness of these brain injuries and how they are potentially irreversible; she drew the problem even wider, saying that they are prevalent among male prisoners and those in young offenders’ residences.

I once again congratulate the noble Lord, Lord Ramsbotham, but I urge him not to press his Amendment.

My Lords, I thank the noble Lord, Lord Ramsbotham, for once again outlining the case for his Amendment. Along with Chris Bryant MP, he has raised the importance and profile of the issue of acquired brain injury and the importance of early screening, for which both he and Mr Bryant should be commended. I was grateful to have the opportunity to discuss the issue in greater detail with the noble Lord, as he mentioned. However, as I indicated in Committee, we remain of the view that legislation is not the right course of action, for the reasons that I will now set out.

The amendment would introduce screening for acquired brain injury for female victims of domestic abuse, including female prisoners and those to be protected by a domestic abuse protection order. It is important that the healthcare and support provided for victims of domestic abuse and female prisoners, including those with acquired brain injury, meets the healthcare needs which may result from their abuse. We believe that this Bill is transformational in the support that it will provide for victims of domestic abuse in bringing their perpetrators to justice and raising awareness of domestic abuse, including the impact it can have on survivors.

It is for the NHS to provide the most appropriate care and treatment, based on an individual’s medical history and clinical need. That is the basis on which the NHS operates, providing healthcare and diagnostic tests for those who need it, including urgent referrals.

As I mentioned in Committee, domestic abuse can manifest itself in many ways, not just through physical injuries but mental harm through coercive control and financial abuse. We do not think that such victims should be screened for brain injury, or that this would be an effective use of NHS resources. In addition, we would not want to deter women from coming forward to receive support if they are concerned about the possible outcomes of a brain screening.

I set out in Committee the improvements we have made to existing screening processes through non-legislative measures in prisons. This was in acknowledgement that more could indeed be done to improve current screening processes. The process I described will now identify and address specific circumstances where head injury or loss of consciousness has resulted from domestic abuse and other forms of violence. That is an important step forward.

As I explained, 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. NHS England and NHS Improvement have agreed the precise questions to be asked and how these will be reported against. The coding within the clinical system has been agreed, and we expect these changes to be implemented next month. I am sure noble Lords would agree that this is an important and significant step forward and a good demonstration of how we can make improvements without legislative measures.

In addition, 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 due to other reasons. This training is also designed to provide practical steps for those working with patients, and self-help tools for the individuals themselves to reduce and overcome the impact of any brain injury.

In his amendment, the noble Lord, Lord Ramsbotham, seeks to link screening to the issuing of a domestic abuse protection order against a perpetrator. It is important not to conflate the two issues. Domestic abuse protection orders, like other protection orders, 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. However, we can, and we will, use the statutory guidance to the police on DAPOs to recommend that the police refer victims to an independent domestic violence adviser or other specialist advocate who will be able to advise victims on their options on a range of issues, including healthcare. We will also include information on where victims can go to seek medical attention in the DAPO advice materials for victims which we will be producing ready for the pilots of the orders.

We remain of the view that these non-legislative interventions are the appropriate way forward to address the important issue that the noble Lord has again raised and will help improve screening for acquired brain injury. On that basis, I hope that the noble Lord, Lord Ramsbotham, will be reassured and will be content to withdraw his amendment.

My Lords, I thank the Minister for that considered response, and I also thank all noble Lords who have spoken in this short debate. I am very relieved to hear that NHS England and NHS Improvement are working with the Disabilities Trust, and on that basis I beg leave to withdraw the Amendment.

Amendment 77 withdrawn.

Amendments 78 to 81 not moved.

We now come to the group consisting of Amendment 82. Anyone wishing to press the amendment to a Division must make that clear in the debate.