National Preventive Mechanism Fifth Annual Report 2013–14 Health Mental Health Act Commissioners raised concerns with restraint practice in hundreds of visits in England. In one example, CQC observed physical restraint being used by three members of staff against one patient. During a 15 minute period, the patient was placed in the prone position on her stomach on her bedroom floor, with her legs restrained by one of the members of staff while others held her arms. The patient protested about the pain to her legs and constantly requested staff to stop. CQC noted subsequently that the patient’s observation chart recorded little detail about the incident, nor did it record the views of the patient. In addition to their response to the individual incident, CQC took action to ensure training and monitoring improved adherence to the Code of Practice. Raising awareness The IMBs used their annual conference to raise awareness of restraint issues, with a presentation of the findings of the Independent Advisory Panel on Non-Compliance Management and some subsequent training provided to relevant monitors. ii. Preventing sanctions arising from NPM work The Optional Protocol to the Convention against Torture requires that sanctions (any punishment or prejudice resulting from a person or organisation’s contact with an NPM or its staff) should not be permitted or tolerated (Art. 21). As reported in the NPM’s Fourth Annual report, NPM members committed to take action to address this requirement and their own responsibility to prevent any sanctions arising from their work, and address any that came to light. In October 2013, HMI Prisons and the IMBs adopted a protocol,37 jointly with the Prisons and Probation Ombudsman, to guide joint work to protect any prisoner/detainee from sanctions or other prejudice. The protocol provides reassurance that prisoners/detainees should be able to freely communicate with each organisation without fear of sanctions or other prejudice, and sets out specific working arrangements to ensure that the three bodies follow up appropriately on any case that arises. Since the protocol was adopted, 10 alleged cases of sanctions – or concerns that they may arise – were reported and acted upon. The majority of allegations of sanctions arose as a result of a prisoner having spoken to a member of staff from HMI Prisons. The serious nature of a small number of some of the cases and allegations has led to relevant establishments conducting internal investigations in some instances, and the parties to the protocol have remained in contact to monitor the action taken and ensure it is appropriate. An initial evaluation of the implementation of the protocol identified its positive influence in raising awareness among NPM staff of their responsibility to prevent and act upon sanctions, which are unlikely to be overt, as well as demonstrating that such cases can be addressed. Further efforts to ensure all incidents of reported sanctions are followed up in line with the protocol will be pursued in the next reporting year, as well as efforts to extend this work across jurisdictions and types of detention. The NPM was able to share its experience of preventing and addressing sanctions at 37 http://www.justiceinspectorates.gov.uk/prisons/wp-content/uploads/sites/4/2014/02/hmip-imb-ppo-protocol.pdf 30