Pembrokeshire County Council

Independent Review Pupil Referral Unit

January 2010

Pamela Munday Sheila Booth
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Independent investigation Pembrokeshire Pupil Referral Unit
Introduction
Background to the Independent Investigation 1. In June 2009, an independent advocate, who was working with a previous pupil of the Pembrokeshire Pupil Referral Unit (PRU), reported to Pembrokeshire Child Care Services that he and other pupils at the unit had been locked in a room (called the time-out room) when they were out of control. 2. A strategy meeting was held with the police the same day and the police agreed to undertake a single agency investigation the following day (a Saturday). The young man and his family were interviewed. The PRU was visited the following Monday, 15th June 2009, and files and CCTV footage taken. The manager was interviewed about processes and the ‗time-out‘ room viewed. It was quickly decided at a Senior Management level that the time-out room would not be used and the room was locked and the keys returned to senior officers. 3. While initially it was agreed that the enquiries would be conducted under the procedures for professional abuse, within a short time it was agreed to move to the procedures for multiple and organised abuse. meetings were held. Enquiries were undertaken. 4. By September 2009, it was agreed that no further action should be taken with regard to the criminal investigation. However, at a Senior Strategy meeting held on 10th September 2009, it was decided that the educational Directorate would link with the Personnel Service in order to initiate a ‗without prejudice‘ investigation of the issues raised so far. Whilst this internal investigation would be led by an A series of Senior Strategy

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independent educationalist, that person would be supported by an independent person with safeguarding experience. The Investigators and their Brief 5. Pamela Munday, the retired head of Milford Haven Comprehensive School and Sheila Booth, a previous Head of Children‘s Services with Merthyr Tydfil County Borough Council, agreed to undertake a joint investigation. Their brief was to look at leadership and governance matters, relevant operational policies and practices of the Pupil Referral Unit and safeguarding arrangements. The brief specifically asked them to:  Investigate further the specific use of the time-out room and any further operational practices that have a bearing on safeguarding issues.  Analyse the evidence and garner any further information they may need to draw reliable conclusions – including interviewing staff.  Examine processes and procedures so as to ensure that any policy or practice deficiencies are identified and, where necessary, improvements can be put in place.  Identify any appropriate conclusions – including recommendations for action.  Interview any further personnel as necessary. Methodology 6. All relevant and available staff at the PRU and Child Care Services were interviewed. Senior managers from both departments and the Detective Inspector in the Police Protection Unit with responsibility for children‘s safeguarding were also seen. Relevant legislation and guidance was consulted, children‘s files in both the PRU and Child Care Services and minutes of meetings were read. Policies and procedures were examined and CCTV footage viewed. The Welsh Assembly Government were contacted for advice and clarification.

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Legislation and Guidance
7. It is important that the relevant legislation and guidance and the confusion that exists is understood. Education legislation and guidance in relation to the management of behaviour in schools is not clear. 8. The Education Act 1996 (as modified by the Education Act 1997) is the only certain piece of legislation implemented in Wales. The 1997 Act, in Section 4 says: After section 550 of the [1996 c. 56.] Education Act 1996 there shall be inserted— Power to restrain pupils 550A Power of members of staff to restrain pupils (1) A member of the staff of a school may use, in relation to any pupil at the school, such force as is reasonable in the circumstances for the purpose of preventing the pupil from doing (or continuing to do) any of the following, namely— (a) (b) committing any offence, causing personal injury to, or damage to the property of, any person (including the pupil himself), or (c) engaging in any behaviour prejudicial to the maintenance of good order and discipline at the school or among any of its pupils, whether that behaviour occurs during a teaching session or otherwise. (2) Subsection (1) applies where a member of the staff of a school is— (a) (b) on the premises of the school, or elsewhere at a time when, as a member of its staff, he has lawful control or charge of the pupil concerned; but it does not authorise anything to be done in relation to a pupil which constitutes the giving of corporal punishment within the meaning of section 548.

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(3) Subsection (1) shall not be taken to prevent any person from relying on any defence available to him otherwise than by virtue of this section. (4) In this section— ―member of the staff‖, in relation to a school, means any teacher who works at the school and any other person who, with the authority of the head teacher, has lawful control or charge of pupils at the school; ―offence‖ includes anything that would be an offence but for the operation of any presumption that a person under a particular age is incapable of committing an offence. 9. This was clearly implemented in Wales. There is a later Act, the Education and Inspection Act 2006, which in Section 93 outlines the powers of members of staff to use force. There is very little difference to the wording of this section, which is attached in full as appendix 1. It was clearly intended that this act be implemented in Wales. However, the Welsh Assembly Government has confirmed that no commencement order was made for Section 93 of the Act and it is therefore not implemented in Wales. It is planned to begin consultation in the near future with an intention to implement Section 93 for the school year 2010/2011, when new guidance will also be issued. 10. Guidance, The Use of Reasonable Force to Control or Restrain People, was issued by the then Welsh Office under Circular 37/98 in December 1998. The Welsh Assembly Government have confirmed that this guidance is still in force in Wales. The guidance uses the legal framework that is found in Section 550A of the Education Act 1996 (as amended by the Education Act 1997). It goes on to say that there is no legal definition of ‗reasonable force‘ and what is reasonable will always depend on particular circumstances. The circumstances of the incident must warrant it, the degree of force must be proportionate and ‗reasonableness‘ may also depend on the age, understanding, physical maturity and sex of the pupil. It gives a list of situations where the use of reasonable force may be

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appropriate. It also lists some examples of the form of physical intervention which may be applicable which include:  Staff physically interposing themselves between pupils or blocking a pupil‘s path.    Holding, pushing, pulling, leading by the arm. Shepherding a pupil away by placing a hand in the centre of the back. Using classroom furniture to restrict movement.

11. It also lists unacceptable practices. Nowhere is there a reference to the use of seclusion or locked doors, (unlike the Department For Education and Skills guidance referred to below). 12. In March 2005, Welsh Assembly Government issued guidance, Framework for Restrictive Physical Intervention Policy and Practice. The guidance was issued for professionals who worked with children, young people, adults and older people in health, education and social care settings. However, enquiries have established that this was not issued under Section 7 of the Local Government and Social Services Act 1970 and therefore is not statutory guidance. The authors of this report understand that it had been the intention of Welsh Assembly Government to issue detailed and specific guidance but this has yet to be done. In this guidance the term restrictive physical interventions is defined as: direct physical contact between persons where reasonable force is positively applied against resistance, either to restrict movement or mobility or to disengage from harmful behaviour displayed by an individual. 13. There were a number of guidance documents issued by the Department for Education and Skills including Guidance on Restrictive Physical Interventions for People with Learning Disability and Autistic Spectrum Disorder, in Health, Education and Social Care Settings. It is worth repeating the first paragraph of this guidance.

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This guidance on the use of restrictive physical interventions in special schools, care and health settings, is issued jointly by the Department for Education and Skills/Department of Health. It stands as guidance under Section 7 of the Local Authority and Social Services Act 1970; and as advice to support the implementation of Section 550A of the Education Act 1996, in particular in special school settings catering for pupils with severe behavioural difficulties associated with learning difficulties and/or autistic spectrum disorders. Additionally, this guidance will have relevance for working with pupils with severe emotional and behavioural difficulties. Whilst the principles that underpin this guidance will have wider relevance and implications for children in mainstream schools (and LEAs may wish to bring the guidance to the attention of mainstream schools within their area), this guidance is not intended to cover all forms of extreme behaviours in all schools. 14. The guidance focused on the need for provider agencies to have effective policies, procedures and training for staff who work with people who may have behavioural episodes where restrictive physical intervention is necessary for their safety and the safety of others. Significantly, this guidance defined the term restrictive

physical intervention in a very specific way and it includes the use of forcible seclusion and/or a locked door. 15. There appears to be a convention among educationalists in Wales that, if there is no similar guidance in Wales, then the Guidance issued in England can be implemented. However, recent Welsh Assembly Government advice indicates that this is not the case and their view is that the guidance issued in Wales in 1998 and 2005 should be followed. This leaves some lack of clarity over the definition of restrictive physical intervention and advice from Welsh Assembly Government is that this will depend on what has been agreed by the educational establishment and the LEA. 16. The situation for children‘s services is significantly different. Under the Children Act 1989, any practice or measure, such as ‗time out‘ or seclusion, which prevents a 7

child from leaving a room or building of his own free will, may be deemed a ‗restriction of liberty‘. Under this Act, restriction of liberty of children being looked after by a local authority or accommodated by NHS establishments is only permissible in very specific circumstances, for example when the child is placed in secure accommodation approved by the Secretary of State or where a court order is in operation. 17. Other relevant legislation includes the Human Rights Act 1998 which enshrines in Article 5 the right to liberty and personal freedom and the European Convention on the Rights of the Child which include the prohibition of inhumane or degrading treatment or punishment by any public authority. Finally, false imprisonment is the unlawful physical interventions of freedom of movement which does not fall within the realms of reasonable parental discipline. 18. The legal situation is thus confused and contributed greatly to some of the difficulties faced by the authority in their response to the allegations made.

Pupil Referral Unit
Background 19. As with all Pupil Referral Units, Pembrokeshire PRU is not designated as a school but is part of the behaviour support service. This means that it is not required to have a Board of Governors. Instead the LEA has appointed a Management Committee, being one of the first to have done this, with representatives from the LEA, local secondary head teachers and appropriate agencies such as Social Services, SNAP, Educational Psychology Service, Special Educational Needs, etc. Unfortunately this group has not met consistently and there was no clear remit over the matters that should be reported to the group or to the extent of their involvement in the management of the PRU. 20. The PRU was set up in 1995 with 16 children, who could not easily be accommodated in mainstream school because of behaviour difficulties. It has gradually been built up over 15 years to its present size, with 130 children based 8

on three sites. In addition, it supports a further 170 out in schools, across Key Stages 2 and 3 and 14 sixth formers. 21. The Neyland site is home to the KS3 PRU, the KS4 PRIDE provision, and the sixth form. KS2 children too challenging for Portfield Special School, attend the Penally site, and those who would formally have been sent out of county, are catered for at The Elms. Some pupils are on individual programmes, which include home tuition and attending Prince‘s Trust courses. 22. The Head of the Behaviour Support Service is Mrs Judy Jones. She has overall responsibility for providing behaviour support, including all units of the PRU and the team of Behaviour Support teachers attached to each family of schools. She sits on the Inclusion Panel and provides support and training for teachers and Learning Support Assistants in behaviour management, including the use of restraint techniques, across Pembrokeshire. 23. Although not officially classed as a school, the PRU is allowed to run as one, with its own budget, for which Mrs Jones has responsibility and uses as she sees fit, with reference to senior managers of the County Council Education Service but without reference to the Management Committee. The Management Committee provides an advisory and support role relating to the provision needed to cope with the increasing number of children coming under its auspices. 24. Since Mrs Jones‘ job remit extends much wider than the PRU at Neyland and requires her to be often off site, there is also a Head of School, Mrs Jan Cannon. Under her is a Head of KS3, Head of KS4 and a Business Manager. General staffing includes dedicated KS3 teachers and Learning Support Assistants, KS4 teachers and LSAs, administrative assistants, home tutors and a Pupil Support Officer. 25. All staff are supposed to undergo Level 1 Safeguarding immediately, though this does not always happen as soon as it should, and Restraint Techniques and Behaviour Management training as soon as possible. They are encouraged to gain

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further qualifications and two teachers have recently gained Masters degrees in Social, Emotional and Behavioural Difficulties. Suitably qualified staff are difficult to recruit but the PRU has an excellent track record in training its own, including the placing of newly qualified teachers in schools to run nurture groups before bringing them back on site on completion of their probationary year.. 26. Schools can self-nominate pupils for the initial six week KS3 Phoenix class. From there pupils either return to mainstream school or move over into the two term assessment programme depending on progress and identified needs. After a period of ongoing assessment they either return to mainstream or gain a permanent placement in the PRU, from which they mostly transfer to the KS4 Pride Programme at the appropriate age. Some will move to the Elms provision and others will be placed on individual programmes involving home tuition, often delivered on the Neyland site. The Time-out Room (TOR) 27. A newly refurbished, lockable, TOR, with a light switch in the next room, has been in place since Easter 2009. It was constructed in its present form, on advice from the Clerk of Works, by a firm which provides such facilities nationwide and has been used in another Pembrokeshire school. It is designed to be completely safe, with padding on the walls, floor and ceiling. 28. The previous TOR, which was vandalised by a pupil with complex challenging behaviour, had no lock and a light switch in the corridor. Damage to ceiling tiles, window, door, lighting and furniture prompted the search for a safe room. The light was intended to be kept on unless the pupil requested otherwise because it was too bright. The switch is in the adjoining room because other pupils were known to turn the light on and off when they knew someone was inside. Some pupils state that the room was dark. CCTV images are clear. There is no furniture, staff and pupils have to sit on the padded floor. It is very small. There is no ventilation, despite it having been requested at the planning stage. There is a very definite presence of fumes coming from the material padding the walls, ceiling and floor. 10

Use of Time-Out Room 29. The concept of using time-out to give children space, privacy and opportunity to regain self-control, and therefore avert a more serious situation, is well recognised as good practice. Pupils would be asked to make use of this facility (or other facilities such as the corridor) voluntarily, and mostly they did so. Sometimes the request came from the pupil who recognised their own need to take a few minutes to calm down. One pupil regularly asked to sleep in there. In these situations the pupil was free to decide to leave the room at any time. 30. There is specific reference in the individual education plans (IEPs) for some pupils, referring to the use of voluntary time out as a means of learning better self-control. This was agreed by parents. Instances of this kind were only very occasionally recorded since they were not regarded as significant incidents. 31. Where a pupil refused to go to the TOR voluntarily and staff judged it necessary for the safety and well-being of others, they would be placed there. This sometimes required the use of physical restraint and the locking of the door. Pupils were given to understand that they could come out as soon as they had calmed down sufficiently to be of no danger to others. On average they were in there between 15 and 35 minutes, although it could be longer, especially if awaiting the arrival of the police. 32. Although senior staff including the Head of Service, believed that the door was only locked in exceptional situations, interviews with staff showed that locking of the door was common practice when pupils were placed in the room against their will. Again, it was expected that there would always be a member of staff within earshot and that pupils could request to come out by knocking on the door. In reality the practice differed considerably. Some staff did monitor outside the door or in the corridor but others went back to the classroom and returned periodically to monitor the situation. There tended to be a reliance on other staff in the vicinity or monitoring of the CCTV by business staff but no process to check that they

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were available to monitor the situation. These incidents were usually recorded in pupils‘ files. Findings 33. Legislation is difficult to locate, with little having been produced by the Welsh Assembly Government. However, DFES policy and guidance states clearly that it is reasonable to use a locked room in extreme circumstances where a child is violent and therefore a danger to themselves or others. This is at variance with legislation for children‘s homes. (See Education Act 1997 and DFES Guidance 2002) 34. There was no written policy specifically for the use of the TOR, but all staff were aware of what was generally agreed to be good practice. A policy is currently being produced, with a draft version now available. Whilst all teaching staff believe they have used the TOR in line with accepted policy and in everyone‘s best interests, it appears that some have made more use of it than others. It is universally regarded as a much safer and more comfortable place than the previous room. 35. There are discrepancies between some pupil accounts given to Social Services and PRU staff recollections. There is also confusion in some pupils‘ memories as to which room they were in as descriptions of the room match the current provision which was installed after they left the unit. 36. There are some full accounts of incidents involving the TOR, but not all records have been dated and signed. Not all incidents are recorded, and not all details of methods of restraint included. There was no specific log book for the TOR, but one is in place now. 37. Staff felt supported by their colleagues and senior staff and there were opportunities at the end of each day for staff to discuss incidents that had occurred. However, there was little evidence of more formal and individual

opportunities to debrief after an incident.

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38. Comprehensive risk assessments are carried out on all pupils attending the PRU. These focus largely on behaviour difficulties, and do not contain references to health or emotional issues that might have a bearing on decisions regarding the use of the TOR. 39. Since it has been out of use pending investigation, the lack of a TOR has led to pupils being left on corridors, in offices and in reception. This has been far from ideal and certainly not safe. Discipline has also been more difficult to maintain since it was necessary for Social Services to visit and write to parents. 40. Although parents were not aware of the changes made to the TOR since Easter, in particular the facility to lock it, there is evidence that parents still broadly support the use of a TOR for the right reasons. There have been no formal complaints made despite the very clear opportunity to do so. There are currently vulnerable pupils in the PRU with extreme difficulties and for whom the current provision is not adequate. This puts staff and other pupils at risk. There has been an unusually high incidence of assaults on staff reported to the police. 41. All PRU staff were clear as to who to speak to if they had concerns, but not all understood what is meant by whistle blowing. All said they had no concerns. However, the authors of this report understand that a degree of unease about the use of the room did exist, but it was not felt possible to raise this concern with management or the authority. 42. Too much time has passed since the original referral, putting PRU staff under unnecessary strain. Relationships between them and Social Services staff have become very strained. Conclusion 43. Use of a TOR is not illegal. It can be used in the interests of safety for the young person concerned, and other pupils and staff. PRU staff believe that they have only ever acted in everyone‘s best interests. They were not aware that they were opening themselves up to allegations of false imprisonment. They looked upon the

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use of time out as a way of giving pupils the opportunity to regain self-control. Occasionally they found it necessary to protect other pupils and staff when a pupil was clearly out of control. On the whole this policy was adhered to, but it was open to temptation to use it more frequently than was perhaps strictly necessary.

The Investigation Relevant Legislation
44. Child Care Services in Pembrokeshire have a responsibility to make enquiries about children who are believed to be suffering significant harm. The primary legislation is the Children Act 1989 Section 47 which says (1) (a) Where a local authority— are informed that a child who lives, or is found, in their area— (i) is the subject of an emergency protection order; or (ii) is in police protection; or (b) have reasonable cause to suspect that a child who lives, or is found, in their area is suffering, or is likely to suffer, significant harm, the authority shall make, or cause to be made, such enquiries as they consider necessary to enable them to decide whether they should take any action to safeguard or promote the child’s welfare. New Guidance was issued by the Welsh Assembly Government in 2007, Safeguarding Children - Working Together under the Children Act 2004, 45. Local education authorities, schools and further education institutions have responsibilities to ensure that they are promoting and safeguarding the welfare of children. This is to be found in Section 175 of the Education Act 2002, which imposes a duty on LEAs, the governing bodies of maintained schools, and the governing bodies of further education institutions to make arrangements with regard to the welfare of children. LEAs must make arrangements to ensure that

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their functions in the capacity of an LEA are exercised with a view to safeguarding and promoting the welfare of children (i.e. persons under 18 years of age). Similarly governing bodies must make arrangements to ensure that their functions relating to the conduct of the school, or institution, are exercised with a view to safeguarding and promoting the welfare of children who are pupils at the school, or who are receiving education or training at the institution. New guidance was issued by Welsh Assembly Government in 2009 entitled Safeguarding Children In Education – The Role of Local Authorities and Governing Bodies under the Education Act 2002. 46. There are also a number of procedural and practice issues that are relevant. The Framework for the Assessment of Children in Need and their Families 2001 clearly sets out how children‘s services should deal with referrals. When it is likely from the information received that the referral will lead to a strategy discussion or strategy meeting followed by Section 47 investigations, the All Wales Child Protection Procedures 2008 are also relevant as is the 2007 edition of Working Together to Safeguard Children. 47 On the afternoon of Friday 12th June, Child Care Services in Pembrokeshire received a referral from an advocate working with a former pupil of the PRU. This advocate had recently attended safeguarding training and had realised that she had been told information which should be referred to social services. The

information related to the use of a locked room at the PRU, which it was alleged was used for children whose behaviour was out of control. It was alleged that children were left in this room on their own until they calmed down. 48. In line with the All Wales Child Protection Procedures, a strategy discussion was held that day between the Child Care Assessment Team and the Police. As it was late on Friday afternoon, it was agreed that the police would interview the young person concerned and his family over the weekend. This was done and the young person confirmed that he had been placed in a room at the PRU against his will. He (and his parents) also named other children who had been placed in the room. 15

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An initial strategy meeting was held the following Monday, 15th June at 9am, in compliance with the All Wales Procedures for Professional Abuse. The police confirmed that the agreed interview had taken place for the purpose of clarifying information. The young person concerned had not been interviewed under Achieving Best Evidence procedures as his parents did not wish to make a formal complaint. The strategy group was also told that some adults had also expressed concern about the escalating use of the room as ‗punishment‘.

50. Decisions were made to continue a Section 47 child protection enquiry on the basis that there were alleged offences of unlawful imprisonment committed regarding vulnerable children/young people with emotional difficulties and there were risks of significant harm. A joint investigation was agreed between child care services and the police. An outline action plan was agreed and the meeting was to be reconvened at the end of the day or early the next day. 51. Investigations took place that day and the PRU was visited by child care services, the police and the Head of School Improvement and Inclusion. The time-out room was examined and photographed. The head of behaviour support was interviewed about the arrangements for using the time-out room and asked about policies, procedures and recording of incidents. Arrangements were made for the collection of the files of pupils identified as having used the time-out room and for copies of the CCTV coverage. It was also established that there may be other similar facilities in Pembrokeshire schools. A further action plan was agreed and this included seeing all the children, who had been identified as having used the room. The joint investigation was to continue with all the named children to be interviewed. 52. The families of the children were contacted and arrangements made to visit although not all the families responded. The police wished to distance themselves from these interviews in case there was a later criminal investigation. A decision was made by child care managers not to deal with this as Section 47 enquiries but as part of an initial assessment. A ‗script‘ (a series of questions) was agreed with 16

the police and a group of workers briefed to undertake the interviews. Apart from one newly qualified social worker, these were unqualified social work assistants and one student social worker. They had clear instructions to stick to the ‗script‘ and not to embark on any ‗fishing expeditions‘. The two members of staff interviewed were clear that they had adhered to the brief. The visits were recorded on all the children‘s files. This will be returned to in the conclusions below. 53. The chair of the strategy meetings made the decision to move the investigation from one of allegations of professional abuse to one of multiple and organised abuse. Multiple and organised abuse is described in Working Together to

Safeguard Children as: abuse involving one or more abuser and a number of related or non-related abused children and young people. The abusers concerned may be acting in concert to abuse children, sometimes acting in isolation, or may be using an institutional framework or position of authority to recruit children for abuse. 54. This necessitated the convening of a strategic management group to oversee the investigation and this was held on Tuesday 21 st July 2009 when all relevant senior managers were present. The meeting received a briefing report prepared by the Duty Manager Child Care Assessment Team on the investigation and also included a statement from the Head of Behaviour Support. At the meeting, the police outlined their position. They had not received any complaint but that would not have prevented them investigating further, if there had been evidence of false imprisonment. They were concerned that the absence of record keeping supporting the staff actions left them in a very vulnerable position. The police had made a decision not to be involved in any further investigation. 55. The following action was agreed to safeguard children.  All schools in Pembrokeshire had already been requested to stop the use of lockable ‗time-out‘ rooms.

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      

The group would act as steering group at a strategic level. Decisions to be made about what the parents were to be told. Legal advice to be available to the group. The police were willing to come back into a Section 47 enquiry if necessary. Independent review of PRU to be commissioned. Complaints route to be clarified. Personnel to be contacted to see if there are any staffing issues to be addressed.

Governance issues of PRU to be addressed.

56. The Customer Service Manager and the Duty Manager visited the families who were seen in the earlier visits to give the parents an update of the investigation and information regarding the possible outcomes. These meetings took place on 20th and 21st August 2009. Six sets of parents/carers were interviewed and five sets of parents/carers were written to but not seen. An analysis of the CCTV footage of the time-out room, the reports in the PRU files and what the children said in interview was completed. 57. A summary report was prepared for the second senior strategy meeting held on 10th September 2009. This report summarised the views of each of the families interviewed and set out a series of conclusions. These included comments that not all the relevant children were interviewed and that staff of the PRU had not been interviewed. 58. The meeting discussed the report. The police confirmed that the formal criminal investigation had been concluded with no further action. Actions arising from the meeting included:   A final strategy meeting to be held A report to be presented to cabinet 18

The British Institute of Learning Difficulties to provide a summary report on the governance and policy position within the PRU

   

An internal independent investigation to be commissioned Current TOR to be no longer used The complaints process be reviewed and advocacy considered Core assessments be undertaken for some young people identified as being children in need

Meeting to be arranged with all head teachers regarding safeguarding.

That appears to have been the end of the investigation. Conclusions 59. It was totally appropriate for child care services to commence Section 47 enquiries on receipt of the referral on 12th June 2009 and to deal with it under the All Wales Child Protection Procedures. The initial decision to use the procedures for allegations of professional abuse was appropriate in the early stages but, when it became clear that the allegations involved more than one professional and a number of children, it was equally appropriate to move to the procedures for multiple and organised abuse. The senior strategy meeting was convened with appropriate membership. 60. The investigation itself raises more concerns. The child care managers made the decision not to conduct the interviews with the children and their families as Section 47 enquiries but as initial assessments. This allowed them to use unqualified staff to carry out these interviews. It is clear that a ‗script‘ had been prepared and staff carefully briefed. However, a formal strategy meeting had been convened and decisions made to interview the appropriate children. This should have been under Section 47 and, certainly, given the potentially high profile of the case, it would have been more appropriate for registered, experienced social workers to conduct the interviews. This may have reduced the concerns that some 19

agencies had about the brief being overstepped and also about the recording of the interviews. There is anecdotal evidence that some of the staff overstepped their brief and advised families to complain. 61. Staff at the PRU were not interviewed. No clear reason has been established for this. At the early stages of the investigation, when it was unclear if there would be a criminal prosecution, it was appropriate not to interview staff. Once the police had confirmed that there was to be no criminal prosecution, there was no reason for staff not to be seen. Staff at the PRU felt excluded from the process, did not feel supported by the authority and felt that the investigation was one sided. They were anxious about their jobs and their futures in education. They also felt that there had been a presumption of their guilt. 62. While it is imperative to listen to children and hear what they have to say, this should be in a measured and sensitive way. There are discrepancies in what young people and their families said and what was recorded in the PRU files. This was inevitable. The recording of incidents did not always describe the build up to the incident, the decision making and the details of the restraint used. For the young people, who had been placed in the room on more than one occasion, the details of each episode would not always reflect what had actually happened. This does not imply that there was any attempt to deceive or distort what happened by the children, their parents/carers or the staff of the PRU. What also emerged was that child care services held information on children, which would have been very helpful to the Pupil Referral Unit in their risk assessments and decision making on the appropriate way to manage certain young people. 63. Some of the child care services reports were judgemental in their tone and reflected a lack of understanding of the complicated and contradictory legal situation. There also seemed to be little recognition or understanding of the

difficulties PRU staff faced in dealing with disruptive and at times dangerous behaviour in group situations with young people with a range of emotional and behavioural difficulties. 20

Conclusions and Recommendations
64. Child care services and the police had no alternative but to make enquiries following the allegations that were made. It is not possible to investigate such allegations without causing distress to the people concerned. Initially, when there was a likelihood that criminal proceedings may have ensued, it was necessary to exclude the staff of the PRU from the sharing of information. However, when this situation changed, they should have been interviewed and certainly kept informed about the progress of the investigation. 65. The authority needs to decide whether the time-out room, with the suggested adaptations and safeguards put in place, should re-open. If the decision is made to permanently close it, the authority will need to urgently consider what safeguards are to be put in place to protect children and staff at the PRU and to ensure that they meet their duty of care to both. 66. There are a number of recommendations for the PRU, Child Care Services and the Authority. Recommendations for the PRU 67. The PRU need access to a range of appropriate time-out facilities including the current TOR. The new policy for the use of the TOR needs to be completed and implemented, after consultation with staff, pupils, parents, and LEA. 68. Record keeping needs to be tightened up, with a specific separate record kept of incidents involving the TOR; reports of incidents must be dated and signed, an indication given as to whether or not the room was locked and why, and full details of any physical restraint or handling used. 69. Use of the TOR needs to be restored as soon as possible, with the following provision:   Adequate ventilation Control of light switch inside room 21

   

Soft, safe seating To be locked only in extreme circumstances for safety reasons A member of staff always outside the door CCTV watched continuously whilst a pupil is in the room

70. The current TOR should only be used for safety reasons. A separate, larger, pleasanter room should be provided as soon as possible for voluntary time out, or imposed time out for a pupil to regain self-control. There needs to be more training in the use of restraint and particularly in safe ways of moving pupils into the TOR when they are behaving dangerously. Recommendations for Child Care Services 71. All interviews and enquiries that are part of any Section 47 enquiry should be undertaken by registered and experienced social workers in line with the Victoria Climbé Enquiry Report recommendations. 72. Reports must be written in a non-judgemental way reflecting the enquiries that have been undertaken. While in no way suggesting that the safeguarding and wellbeing of children and young people should not be at the centre of every investigation, the wider circumstances should also form part of the discussion and decision making. 73. The Authority should consider establishing arrangements for independent investigation of complex internal safeguarding matters. Discussions should take place with the Welsh Assembly Government and with the neighbouring authorities, who are members of the Dyfed Powys Safeguarding Children‘s Forum, about a way forward. Recommendations for the Authority Legislative Matters 74. The legal position in Wales is very confusing and it is not acceptable for two agencies that work with children and young people to work to such different 22

legislation and guidance.

This leaves both services open to criticism and The

education, in particular, is left vulnerable to possible criminal charges.

authority should enter into urgent discussion with the Welsh Assembly Government to ensure that there is much greater clarity with regard to legislation and guidance. Governance Matters 75. The governance arrangements of the Pupil Referral Unit are not satisfactory. It is not a school but, in many ways, it is treated and viewed as a school. The establishment of a management group went some way to bridging the gap but it did not meet consistently and its remit was not clear. 76. The authority must make decisions about the governance arrangements. There must be proper governance arrangements with very clear terms of reference. These must include:  monitoring the management of behaviour within the unit, including the use of physical restraint,     assaults on staff, complaints, staff recruitment, training and development, support arrangements.

There should also be reporting mechanisms to senior management, cabinet and scrutiny. 77. It is also suggested that consideration be given to the establishment of an operational group as a subgroup of whatever governance arrangements are put in place. It should be made up of senior, but operational, staff from the PRU, the LEA, a schools representative, child care services, the YOT and health, particularly CAMHS. It could be used to:

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  

assist in the development of policies and procedures, audit practice in relation to behaviour management, act as a conduit for the sharing of information on all new admissions to the unit,

provide support in managing particularly difficult young people including accessing specialist services,

improve understanding and relationships between agencies and reduce the isolation of the PRU.

Policies and Procedures 78. All the policies and procedures for behaviour management should be updated and formally ratified by the authority. These must include authority wide agreed

definitions of, and guidance on, the use of, reasonable force and restrictive physical intervention. Management and Education of Children with Educational difficulties 79. It is clear from this inquiry that the PRU has been successful with a substantial number of pupils. However, there were also a number of young people with very significant difficulties whose needs were not being met. Staff and parents had concerns about the considerable delays in obtaining assessments and, as a result, access to appropriate education for their children, particularly those on the autistic spectrum. This resulted in young people inappropriately remaining at the PRU until they were inevitably excluded. Some then had home tuition or, in the case of one young man, self education using the internet. address this issue. Advocacy 80. The authority should provide an independent advocacy service to all children and young people who are using the behaviour support service. This should be a The authority should urgently

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proactive service, well publicised, with children and their families being routinely informed about its work. Complaints and Representations 81. The Complaints and Representation policy and procedures should be reviewed and systems established for it to be managed independently of the behaviour management service. Again, it should be a proactive service, well publicised, with children and their families being routinely informed about how it works. There should also be regular information sought from children and their families about the service they are receiving and this should be reported to the governing body.

Training 82. The Head of the Behaviour Support Service is qualified at Masters level in Social and Behavioural Emotional Difficulties as are two of her senior staff. While staff at the PRU (and throughout the Behaviour Support Service) receive a range of appropriate training, training in the use of restrictive physical intervention, including restraint techniques has been very much left to the Head of the Behaviour While staff have been very complimentary about the

Support Unit to deliver.

quality of training delivered, she was not in fact qualified as a trainer in this aspect. 83. The authority needs to ensure that recognised and suitable training is delivered to all appropriate staff. This must include information on the factors contributing to emotional and behavioural difficulties and on alternative ways of managing such behaviour. There should also be more opportunities for joint training with other agencies in safeguarding and other aspects of children‘s behaviour. Support for the PRU 84. The PRU appears and feels to be isolated and staff are left very much on their own to manage some very difficult young people. The LEA needs to revisit the support it provides through a range of staff including the assistant director, educational

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psychologists etc. and to satisfy itself that this is sufficient. The operational group suggested above will also give a more informal support mechanism. 85. The authority should consider approaching health for the provision of some emotional health support to the unit. There should be discussion with the police about the management of very difficult/dangerous behaviour and consideration given to a protocol for their involvement. It would also be useful if more formal links could be forged with similar services in other local authorities. Whistle blowing 86. Staff in the PRU had differing knowledge of whistle blowing procedures and a varying level of confidence in the system. This has contributed to the authors‘ view that the unit has become quite closed and inward looking. Staff must be made aware of the authority‘s policies and procedures and must be afforded opportunities to discuss issues of concern without anxieties about their future. Improving Relationships 87. Opportunities should be made for staff from both child care services and the PRU to meet in a structured way to discuss the issues raised in this report. There needs to be a greater understanding of the differences in legislation and guidance. Staff from both services need to recognise that, while they are dealing with many of the same children, they work in different environments, with different expectations and responsibilities for these young people. Better working together can only be beneficial to these young people. 88. While much will depend on the development of personal relationships between services, this will be greatly assisted by the establishment of some formal mechanisms. Consideration should be given to establishing forums for staff to meet and for job shadowing which should also become part of induction for both services.

Pamela Munday 26

Sheila Booth 2nd January 2010

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Appendix 1
Education and Inspections Act 2006
Use of reasonable force 93 Power of members of staff to use force (1) A person to whom this section applies may use such force as is reasonable in the circumstances for the purpose of preventing a pupil from doing (or continuing to do) any of the following, namely— (a) committing any offence, (b) causing personal injury to, or damage to the property of, any person (including the pupil himself), or (c) prejudicing the maintenance of good order and discipline at the school or among any pupils receiving education at the school, whether during a teaching session or otherwise. (2) This section applies to a person who is, in relation to a pupil, a member of the staff of any school at which education is provided for the pupil. (3) The power conferred by subsection (1) may be exercised only where— (a) the member of the staff and the pupil are on the premises of the school in question, or (b) they are elsewhere and the member of the staff has lawful control or charge of the pupil concerned. Subsection (1) does not authorise anything to be done in relation to a pupil which constitutes the giving of corporal punishment within the meaning of section 548 of EA 1996. The powers conferred by subsection (1) are in addition to any powers exercisable apart from this section and are not to be construed as restricting what may lawfully be done apart from this section.

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In this section, ―offence‖ includes anything that would be an offence but for the operation of any presumption that a person under a particular age is incapable of committing an offence.

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