Policy on use of force

Mental Health Units (Use of Force) Bill – in a Public Bill Committee at 9:25 am on 28 March 2018.

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Photo of Steve Reed Steve Reed Shadow Minister (Digital, Culture, Media and Sport) (Civil Society) 9:25, 28 March 2018

I beg to move amendment 8, in clause 3, page 2, line 36, leave out subsection (1) and insert—

‘(1) The responsible person for each mental health unit must publish a policy regarding the use of force by staff who work in that unit.’.

This amendment replaces Clause 3(1) and provides a clearer duty for the responsible person to publish a policy regarding the use of force in mental health units.

Photo of Karen Buck Karen Buck Labour, Westminster North

With this it will be convenient to discuss the following:

Amendment 9, in clause 3, page 2, line 37, at end insert—

‘( ) Where a responsible person is appointed in relation to all of the mental health units operated by a relevant health organisation, the responsible person must publish a single policy under subsection (1) in relation to those units.’.

This amendment provides that if there is a single responsible person for all of the mental health units operated by a relevant health organisation, the person needs to provide a single policy for those units.

Amendment 10, in clause 3, page 2, line 37, at end insert—

‘( ) Before publishing a policy under subsection (1), the responsible person must consult any persons that the responsible person considers appropriate.’.

This amendment requires the responsible person to consult before publishing the policy under Clause 3.

Amendment 12, in clause 3, page 2, line 38, leave out second “the” and insert “any”.

This amendment is consequential on Amendment 13.

Amendment 13, in clause 3, page 2, line 40, leave out subsections (3) and (4) and insert—

‘( ) The responsible person may from time to time revise any policy published under this section and, if this is done, must publish the policy as revised.

( ) If the responsible person considers that any revisions would amount to a substantial change in the policy, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised policy.’.

This amendment requires a further consultation under Clause 3 if the responsible person intends to make substantial changes to the policy published under that clause. Amendment 12 is consequential on this amendment.

Amendment 14, in clause 3, page 3, line 2, leave out “minimise and”.

This amendment removes the requirement that the policy under Clause 3 must minimise the use of force. Instead it will require the policy to reduce the use of force.

Amendment 15, in clause 3, page 3, line 2, leave out

‘at the mental health unit’ and insert

‘in the mental health unit by staff who work in that unit’.

This amendment ensures consistency with Clause 3(1) as amended by Amendment 8.

Amendment 16, in clause 3, page 3, line 3, leave out subsection (6).

This amendment removes the requirement for the registered manager to take all reasonable steps to ensure compliance with the policy published under Clause 3.

Amendment 17, in clause 3, page 3, line 6, leave out subsection (7).

This amendment removes a consultation requirement that is superseded by the changes made by Amendment 10.

Photo of Steve Reed Steve Reed Shadow Minister (Digital, Culture, Media and Sport) (Civil Society)

This is a very important clause, because it establishes the requirement for mental health units to have in place a policy regarding the use of force in that unit. That requirement does not currently exist, so there is wide divergence and variation between procedures, practice and means for controlling and managing the use of force in different health units, which can be detrimental to the safety of patients.

A written policy will effectively govern the use of force within the units, and there is a real opportunity for NHS trusts to work with service users and their families to formalise and replicate the best of what many are already doing to reduce the use of force. The use of force varies enormously across NHS trusts. Some already have robust policies in place to minimise the use of force but others do not. The amendment will put an end to the regional disparity between trusts. Based on currently available figures, the variation can be as wide as between 5% and 50% of patients being subject to the use of force while attending mental health units for treatment.

Photo of Luciana Berger Luciana Berger Labour/Co-operative, Liverpool, Wavertree

I congratulate my hon. Friend on bringing forward the Bill, which is a fantastic achievement. The fact that he has used his private Member’s Bill slot for this Bill is to be highly commended. My local mental health trust, Mersey Care, adopts the “no force first” approach, which is very important. I just wanted to shine a spotlight on the fact that some trusts adopt that approach. I welcome the fact that the Bill seeks to eradicate the differences in approach across the country.

Photo of Steve Reed Steve Reed Shadow Minister (Digital, Culture, Media and Sport) (Civil Society)

I thank my hon. Friend for her intervention. Mersey Care is well known to me and to many others in the room as a fine example of the best practice that we wish to replicate everywhere across the country, so that patients, wherever they are, can enjoy the very best levels of service, to which they ought to be entitled.

I will go through the amendments in the grouping. Collectively, they are intended to add greater clarity and consistency to the policies. Amendment 9 provides that, for relevant organisations that operate a number of health units, the responsible person needs to publish only one policy to cover all staff in all those units. Amendments 10 and 13 ensure that the policy is consulted on when it is first published and when changes are made. It is important that the responsible person considers and consults the views of current and previous service users to ensure that their experiences form part of improving policy and guidance into the future.

Amendment 14 requires the policy to include reducing the use of force, which is a key purpose of the Bill, and a key commitment that the use of force should only ever be used as a genuine last resort, as indeed it is in Mersey Care and other mental health trusts. We should be clear that this is only a start—we would like the use of force to be minimised and not just reduced—but this puts into legislation the Government’s intention to reduce the use of force, and we will be holding them to that.

Amendment 16 places into statutory guidance a requirement on the responsible person to take all reasonable steps to ensure compliance with the policy, and makes a failure to have regard for the guidance a breach of the statutory duty.

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care

The Government entirely support the need for every institution to which the Act will apply to make a policy on the use of force. Central to that is the concept of accountability; having a named person, as we have already discussed, plus a policy for an organisation to be held to account to, is clearly important to achieve that. The Government support these amendments and see them as important ingredients in reducing the use of force overall in mental health units. We will ensure that any guidance produced under this clause gives further detail about what policies should include. We expect that to look like what is already set out in positive and proactive care guidance. We expect it to say that responsible persons will have a duty to have regard to this guidance in the development of their organisation’s policy, which will help ensure that each policy meets the same basic criteria as well as allowing for local flexibility.

I associate myself with the comments of the hon. Members for Liverpool, Wavertree and for Croydon North on Mersey Care, which offers a good example. The culture of transparency in itself generates sensible use of force, and only when appropriate. It is a truism for everybody in this room that we want to see minimal use of force. There are occasions when, for the safety of both patient and staff, it sometimes needs to be used, but the way to be sure that it is only used appropriately is to have that culture of accountability. Many organisations could learn from Mersey Care in that regard. We support these amendments.

Amendment 8 agreed to.

Amendments made: 9, in clause 3, page 2, line 37, at end insert—

‘( ) Where a responsible person is appointed in relation to all of the mental health units operated by a relevant health organisation, the responsible person must publish a single policy under subsection (1) in relation to those units.’.

This amendment provides that if there is a single responsible person for all of the mental health units operated by a relevant health organisation, the person needs to provide a single policy for those units.

Amendment 10, in clause 3, page 2, line 37, at end insert—

‘( ) Before publishing a policy under subsection (1), the responsible person must consult any persons that the responsible person considers appropriate.’

This amendment requires the responsible person to consult before publishing the policy under Clause 3.

Amendment 11, in clause 3, page 2, line 38, leave out “registered manager” and insert “responsible person”.

This amendment is consequential on Amendment 7.

Amendment 12, in clause 3, page 2, line 38, leave out second “the” and insert “any”.

This amendment is consequential on Amendment 13.

Amendment 13, in clause 3, page 2, line 40, leave out subsections (3) and (4) and insert—

‘( ) The responsible person may from time to time revise any policy published under this section and, if this is done, must publish the policy as revised.

( ) If the responsible person considers that any revisions would amount to a substantial change in the policy, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised policy.’

This amendment requires a further consultation under Clause 3 if the responsible person intends to make substantial changes to the policy published under that clause. Amendment 12 is consequential on this amendment.

Amendment 14, in clause 3, page 3, line 2, leave out “minimise and”.

This amendment removes the requirement that the policy under Clause 3 must minimise the use of force. Instead it will require the policy to reduce the use of force.

Amendment 15, in clause 3, page 3, line 2, leave out

“at the mental health unit”

and insert

“in the mental health unit by staff who work in that unit”.

This amendment ensures consistency with Clause 3(1) as amended by Amendment 8.

Amendment 16, in clause 3, page 3, line 3, leave out subsection (6).

This amendment removes the requirement for the registered manager to take all reasonable steps to ensure compliance with the policy published under Clause 3.

Amendment 17, in clause 3, page 3, line 6, leave out subsection (7).—(Mr Reed.)

This amendment removes a consultation requirement that is superseded by the changes made by Amendment 10.

Clause 3, as amended, ordered to stand part of the Bill.

Clause 4