Why You Should Consider Not Training With Us
Nailing the colours (also nailing the colours to the mast or nailing the flag) is a practice dating back to the age of sail that expresses a defiant refusal to surrender, and willingness to fight to the last man.
During the Age of Sail, ships would legally fight only while flying their national flag.
‘Striking the Colours’ – meaning lowering the flag (the “colours”) is a universally recognized indication of surrender, particularly for ships at sea.
For example, if cannon shots fell a ship’s flag, her opponent would cease firing and inquire whether she was capitulating.
In contrast, fixing the battle ensign with nails would prevent it from being removed easily, and effectively prevented the surrender. It became an expression of defiance and willingness to force oneself to fight up to the bitter end.
Now Let’s Talk About Olaseni Lewis
Olaseni Lewis died as a direct result of being restrained by 11 police officers in Bethlem Royal Hospital, Beckenham.
Olaseni Lewis attended Bethlem Royal hospital for an overnight stay as a voluntary patient, but when he tried to leave a doctor called police to ask for their assistance in detaining him under the Mental Health Act.
The reasons the doctor felt the need to call for police assistance was because the staff did not feel that they had the necessary restraint skills or the training to enable them to safely restrain Olaseni Lewis.
So, the police responded and used their training to restrain Mr. Lewis, and at the inquest into Mr. Lewis’ death the coroner found that the force used on him was excessive, disproportionate and that is what ultimately led to his death.
The inquest jury also unanimously condemned police and healthcare staff actions in relation to the death of 23-year-old Olaseni Lewis.
Their highly critical narrative made a number of damning criticisms, including the statement that “Multiple failures at multiple levels within Bethlem Royal Hospital meant that the hospital staff had to call upon the assistance of the police when Seni became unwell.
Even Lewis’ parents, Conrad and Ajibola Lewis recently made a statement outside court via their solicitor that said: “We had taken Seni to hospital because we thought it was the best place for him when he became ill,” the statement said. “But instead of receiving the help and care he needed, he met with incompetence, hostility and worse: from the management and staff at the hospital, who were so poorly trained that they felt it necessary to call the police to deal with him when he was agitated; and even more so from the police officers who answered that call.
So, just to summarise so far, poorly trained NHS staff felt the need to call for police assistance because they didn’t have the necessary skills to safely restrain Mr. Lewis and it was the police officers use of force that ultimately killed Mr. Lewis.
As a result of all of the above, a new law was proposed which came into effect on November 2018 called the Mental Health (Units) Use of Force Act 2018.
Part of the new Act states that ‘Mental health unit staff must be provided with training on appropriate use of force’, and that would seem to make sense considering that it was the lack of appropriate training on the use of force that led to NHS staff having to call the police.
For clarification here, the legal definition of “Must” means that something is mandatory. So, under the Mental Health (Units) Use of Force Act 2018, the training must be appropriate, which to me means that it must be fit for the purpose for which it is intended.
This must mean that any use of force training ‘must’ be ‘appropriate’ enough to control the risks that are likely to be presented.
New PI Accreditation
Then, on the back of all of this, a new non-statutory PI Accreditation scheme has been devised that is due to come into effect in April 2020.
The aim of the scheme should be consistent with what the new Act requires, which is to ensure that mental health unit staff must be provided with training on the appropriate use of force.
And if it is to be of any practicable benefit it should be primarily aimed at keeping vulnerable patients and staff safe.
But let’s take a serious look at it.
This new PI accreditation is based on ISO/IEC 17065: The Standard for Certification Bodies.
I spoke to UKAS about this new PI accreditation scheme and in one of the emails I received back UKAS stated:
“The RRN standard is focused on providing training in mechanisms and processes to reduce the need to use physical intervention.
The standard requires the Training Provider in conjunction with the Service to identify and justify which restraint techniques it will use. The standard then has requirements on how this training is delivered. As a result, the Assessment of the training provider does assess the applicability and suitability of the training in physical interventions and there is a requirement for the assessors to observe this in practice.”
However, what the scheme fails to do is consider the individual techniques that make up the training. So, provided the training complies with the standards, with the odd exception (i.e. to discourage pain, prone etc) the specific techniques are not examined too closely.
So, What Does This Mean?
Well, it means that someone passing the accreditation could look good on paper but could be actually teaching or using physical restraint techniques that are in fact quite dangerous which could lead to someone being seriously injured or dying.
That seems to fly in the face of what the legislation states ‘must’ be done?
In addition, according to our initial research, an organisation would fail the accreditation process is they admit to be teaching or using any technique that may cause pain (intentionally or unintentionally) or any form of prone/face-down technique. But after much opposition, they will now consider these skills provided that they are used for emergency “escape and rescue” purposes.
Another hurdle here is that NHS England has now also made it a condition of contract that anyone providing PI training to an NHS Hospital in England, under a standard contract, must hold the new certification by April next year.
So How Does An Organisation or Training Provider Then Deal With This?
How do they attain the accreditation to allow them to continue to deliver training in an NHS hospital in England if the system they teach provides instruction in techniques that may cause pain (intentionally or unintentionally) or any form of prone/face-down technique?
Even if (in some cases, based on an individual patients behavioural care plan and restraint risk assessment) those techniques are needed to reduce the risk to the patient and also the staff, which makes them legally ‘appropriate’ by default?
Well, it seems the answer lies in three basic options:
- Simply remove the offending techniques from the system and syllabus.
- Keep the techniques in, but tell or encourage staff not to report the use of the offending techniques, or
- Change the names of the offending techniques so that they are intentionally disingenuously not recorded accurately.
Surely, this is illegal or at best (if it is allegedly happening) dishonest and fraudulent?
What is The Likely Net Effect Of This on NHS Staff?
It would de-skill and de-motivate an already stressed NHS workforce. It would discourage staff to use physical intervention to protect their patients or other staff for fear of being disciplined, ostracized or worse.
In some cases, if staff were bullied (and I’m not going to dress this up because that it what is probably [allegedly] happening already) into either not reporting or being made to change their reported statement of events, it will take away their confidence to use a system of intervention that may be inherently flawed. Another allegation being made is that pain compliance techniques and prone restraints no longer appear as recording options on use of force forms meaning that they will no longer be recorded.
How Is this Legislatively ‘Appropriate’?
Interestingly, one of the ‘opportunities to improve practice’ that has been stated on a Restraint Reduction Network slide is:
“Reduce the prevalence of trauma caused by restraint”.
It May Also Expose NHS Staff To The Risk of PTSD
Yet, what I am describing above is very likely to expose NHS staff to the risk of PTSD.
The American Diagnostic and Statistical Manual of Mental Disorders (DSM) (The Bible of Psychiatry and Psychology), has highlighted the fact that anytime the causal factor of a stressor is human in nature, the degree of trauma is usually more severe and long-lasting. The manual states that although post-traumatic stress disorder is comparably rare and mild in response to natural disasters and traffic accidents when it is another human being that causes our fear, pain and suffering, it shatters, destroys and devastates us.
In short, human aggression towards another human being can lead to PTSD, especially if the recipient of that has not had the appropriate training to effectively deal with is or, worse still, is made to feel that they are part of the problem.
So, lets recap:
- Olaseni Lewis died because he was restrained by 11 police officers.
- The police were called because the NHS staff were so poorly trained that they felt it necessary to call the police to deal with him.
- As a result of that The Mental Health Units (Use of Force) Act 2018 came into force.
- One aim of the new Act is to ensure that ‘Mental health unit staff must be provided with training on appropriate use of force’.
- On the back of that new PI accreditation is now due to come into effect in April 2020 for the NHS in England, which NHS England have now made a condition of contract.
- The new PI accreditation, however, does not deal with the physical techniques, so an organisation can pass the certification process but could still be teaching techniques that either may not work or are dangerous.
- The higher-level and more restrictive techniques (prone and pain-compliance) have to be either removed, not reported or disengenuinely reported (allegedly) for an organisation to achieve certification.
- This means that a system of PI in an NHS hospital may be accredited on paper but is flawed if it doesn’t meet the requirements of a risk assessment in terms of what should actually be provided.
- Net result, staff feel even more de-skilled and de-motivated as well as possibly scared, frustrated and stressed at using something they feel will not work.
- This will lead to either a real or perceived lack of capability to use the skills they are taught, so the trust will probably end up having to call the police, who are exempt from this new PI accreditation and will probably end up using the very techniques that the NHS staff are discouraged from using.
The fact is this. Olaseni Lewis died following restraint by police officers, not NHS staff and this new accreditation will not prevent another death due to restraint. In fact, I actually think it will increase the risk.
It also seems that this new PI accreditation is taking us back to the dark ages of restraint, to a time when staff were too scared to report, yet this is being done in an age where (post Winterbourne View and other abuse scandals) the need to be ‘transparent’ is always waved around like a rallying call.
I genuinely feel for the parents of Olaseni Lewis. No one should lose a son. But the focus of this new PI accreditation scheme is way off the mark.
So, if you are looking for a training provider to train your staff who is certificated under this new scheme please do not come to me as we cannot help you because we have no intention of signing up for something that is inherently flawed.
21st November 2019
PS: If you do want to find out more about our BTEC Level 3 Restraint Instructor Award Course then you can do so here – https://nfps.info/physical-intervention-trainer-course/
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