Points of Order
Wednesday 19th July 2017
(7 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text
Paul Flynn (Newport West) (Lab)
On a point of order, Mr Speaker. Yesterday’s Order Paper said that the debate on drugs could continue until 7 o’clock. The final speaker sat down four minutes early. The normal practice in this House is then to use that time for other speakers to contribute. It was particularly interesting that the final speaker, the Minister, had denied interventions on the grounds that she did not have enough time to finish. The Standing Orders are not clear on this point. Is it not right that we get some definition of past practice in relation to cases where speakers do not have anything else left to say and other Members can contribute to what would then be a full debate?
Mr Speaker
I am very grateful to the hon. Gentleman for his point of order and for his characteristic courtesy in giving me advance notice somewhat earlier of his intention to raise it. I am loth to quibble with the hon. Gentleman, who is a considerable authority on matters parliamentary, as evidence by the well-thumbed tome on how to be a Back Bencher of which he is the distinguished author. That said, I am inclined slightly to quibble with him on his proposition that it is normal or commonplace, if a ministerial wind-up concludes early, for other Members to be invited to contribute. In my experience, that is not commonplace. I would not say that it never happens, because you can almost always find an example of something if you try hard enough, but certainly when I am in the Chair I tend to work on the assumption that the ministerial wind-up is indeed the conclusion of the debate.
I note what the hon. Gentleman says about the conclusion of this debate taking place earlier than listed on the Order Paper, although I am sure that he will readily accept that the Official Report—that is to say, the verbatim account of what was said; there is no question of misleading anybody—will show that the debate concluded a little early. The Chair does not normally allow a further Back-Bench speech, and—this is not directed at the hon. Gentleman; it is just a wider point—certainly not from a Member who had already made a substantial speech in the debate.
As for interventions, the hon. Gentleman, as the author of “How To Be An MP”—available in all good bookshops, and of which I am myself a noted admirer, as he knows—he will appreciate that a Member is free to take interventions or not. I note what he tells me—that the Minister said, “No, I can’t take interventions because I haven’t time”—but that is not something on which the Chair can rule. Sometimes Ministers can be a tad neurotic in these circumstances, it is true, as can sometimes, perhaps, shadow Ministers, but that is not a matter for the Chair. Whether the Member seeking to intervene likes it or not, the situation is as I have described.
Let me take this opportunity, in a positive spirit, to encourage all new Members—I am not sure the Whips would agree about this—to read the hon. Gentleman’s books on being a good parliamentarian. [Interruption.] “No!” says a Government Whip, chuntering from a sedentary position, in evident horror at what bad habits new members of the flock might pick up. I think that they are fine tomes. The hon. Gentleman has used his position as a Back-Bench Member to stand up for his constituents and to fight for the principles in which he believes. That has sometimes pleased his party and sometimes not, but that is what we are supposed to get here—Members of Parliament who speak to their principles and their consciences. That is a good thing, and, as he knows, I like to encourage it. In fact, when I was a Back Bencher, I had a relationship with my Whips characterised by trust and understanding—I didn’t trust them and they didn’t understand me.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
On a point of order, Mr Speaker. Yesterday, the Department of Health accounts were finally laid before the House, after a week of to-ing and fro-ing that prompted no actual changes, as I understand it, to them. The Comptroller and Auditor General has raised some concerns about the accounts. I seek your guidance on two points, Mr Speaker. First, the accounts have again been laid late. Last year, they were laid on the final day on which Parliament sat; this time, they were laid only a couple of days before the final day. Secondly, what can we do to ensure that a Minister turns up to the House to explain the Department of Health accounts and address the financial concerns that many Members of the House, and not least the Public Accounts Committee, have about the Government’s handling of health finances?
Mr Speaker
I am very grateful to the hon. Lady, who has put her concern on the record. It will have been heard by those on the Treasury Bench, and I suspect that the contents of her point of order will wing their way to Health Ministers ere long. The truth of the matter is that there is no resolution of her grievance available from the Chair. The Select Committee on Health may wish to return to this matter if it is dissatisfied, and the Public Accounts Committee, of which the hon. Lady is herself the distinguished Chair, may wish to pursue this matter further. Realistically, I fear that that will have to wait until September, although if the hon. Lady—she is of course a London Member, and a very assiduous attender—is present in her place tomorrow for the summer Adjournment debate and wishes to expatiate further on her concerns, she may well find she is able to catch the eye of the Chair.
If there are no further points of order—I think that there are none—we come now to the presentation of Bills.
Bills presented
Assaults on Emergency Workers (Offences) Bill
Presentation and First Reading (Standing Order No. 57)
Chris Bryant, supported by Holly Lynch, Stephen Crabb, Mr Graham Brady, Ms Harriet Harman, Mr Dominic Grieve, Jo Stevens, Diana Johnson, Tulip Siddiq, Lilian Greenwood, Carolyn Harris and Philip Davies, presented a Bill to make provision about offences when perpetrated against emergency workers, and persons assisting such workers; to make certain offences aggravated when perpetrated against such workers in the exercise of their duty; to require persons suspected of certain assaults against such workers which may pose a health risk to provide intimate samples and to make it an offence, without reasonable excuse, to refuse to provide such samples; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 20 October, and to be printed (Bill 7).
Mental Health Units (Use of Force) Bill
Presentation and First Reading (Standing Order No. 57)
Mr Steve Reed, supported by Norman Lamb, Mr Charles Walker, Jim Shannon, Keith Vaz, Sarah Jones, Mr David Lammy, Dr Rosena Allin-Khan, Marsha De Cordova, Caroline Lucas, Clive Lewis and Heidi Allen, presented a Bill to make provision about the oversight and management of the appropriate use of force in relation to people in mental health units and similar institutions; to make provision about the use of body cameras by police officers in the course of duties in relation to people in mental health units; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 3 November, and to be printed (Bill 8).
Parliamentary Constituencies (Amendment) Bill
Presentation and First Reading (Standing Order No. 57)
Afzal Khan, supported by Joanna Cherry, Hannah Bardell, Mr Alistair Carmichael, Liz Saville Roberts, Lady Hermon and Caroline Lucas, presented a Bill to amend the Parliamentary Constituencies Act 1986 to make provision about the number and size of parliamentary constituencies in the United Kingdom; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 1 December, and to be printed (Bill 9).
Homes (Fitness for Human Habitation and Liability for Housing Standards) Bill
Presentation and First Reading (Standing Order No. 57)
Ms Karen Buck, supported by Luciana Berger, Jess Phillips, Matthew Pennycook, Shabana Mahmood, Heidi Allen, Marsha De Cordova, Andy Slaughter, Alex Sobel, Kate Green, Diana Johnson and Clive Efford, presented a Bill to amend the Landlord and Tenant Act 1985 to require that residential rented accommodation is provided and maintained in a state of fitness for human habitation; to amend the Building Act 1984 to make provision about the liability for works on residential accommodation that do not comply with Building Regulations; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 19 January 2018, and to be printed (Bill 10).
Mr Speaker
Friday 19 January is a splendid day—it is my birthday.
Civil Partnerships, Marriages and Deaths (Registration Etc.) Bill
Presentation and First Reading (Standing Order No. 57)
Tim Loughton, supported by Mr Graham Brady, Dame Caroline Spelman, Mrs Anne Main, Frank Field, Heidi Allen, Caroline Lucas and Antoinette Sandbach, presented a Bill to provide that opposite sex couples may enter a civil partnership; to make provision about the registration of the names of the mother of each party to a marriage or civil partnership; to make provision about the registration of stillborn deaths; to give coroners the power to investigate stillborn deaths; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 2 February 2018, and to be printed (Bill 11).
Organ Donation (Deemed Consent) Bill
Presentation and First Reading (Standing Order No. 57)
Mr Geoffrey Robinson, supported by Paul Flynn, Sir Vince Cable, Caroline Lucas, Michael Fabricant, Liz Saville Roberts, Dr Philippa Whitford, Kate Green, Sir Oliver Letwin, Jim Shannon, Angela Rayner and Crispin Blunt, presented a Bill to enable persons in England to withhold consent for organ donation and transplantation; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 23 February 2018, and to be printed (Bill 12).
Refugees (Family Reunion) (No. 2) Bill
Presentation and First Reading (Standing Order No. 57)
Angus Brendan MacNeil, supported by Stephen Twigg, Robert Neill, Stuart C. McDonald, Tulip Siddiq, Tim Farron, Jim Shannon, Caroline Lucas, Anna Soubry, Ian Blackford, Stella Creasy and Hywel Williams, presented a Bill to make provision for leave to enter or remain in the United Kingdom to be granted to the family members of refugees and of people granted humanitarian protection; to provide for legal aid to be made available for such family reunion cases; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 16 March 2018, and to be printed (Bill 13).
Parental Bereavement (Leave and Pay) Bill
Presentation and First Reading (Standing Order No. 57)
Kevin Hollinrake, supported by Will Quince, Sir Nicholas Soames, Craig Tracey, Carolyn Harris, Antoinette Sandbach, Jeremy Quin, Huw Merriman, Victoria Prentis, Diana Johnson and Rebecca Pow, presented a Bill to make provision about leave and pay for employees whose children have died.
Bill read the First time; to be read a Second time on Friday 20 October, and to be printed (Bill 14).
Representation of the People (Young People’s Enfranchisement and Education) Bill
Presentation and First Reading (Standing Order No. 57)
Vicky Foxcroft, on behalf of Jim McMahon, supported by Jeremy Corbyn, Tom Watson, Peter Kyle, Diana Johnson, Lucy Powell, Sir Peter Bottomley, Stephen Gethins, Jo Swinson, Jonathan Edwards and Caroline Lucas, presented a Bill to reduce the voting age to 16 in parliamentary and other elections; to make provision about young people’s education in citizenship and the constitution; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 3 November, and to be printed (Bill 15).
Overseas Electors Bill
Presentation and First Reading (Standing Order No. 57)
Glyn Davies presented a Bill to make provision extending the basis on which British citizens outside the UK qualify to participate in parliamentary elections; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 23 February 2018, and to be printed (Bill 16).
Parking (Code of Practice) Bill
Presentation and First Reading (Standing Order No. 57)
Sir Greg Knight, supported by Kevin Brennan, Pete Wishart, Mr Jacob Rees-Mogg, Daniel Zeichner and Graham Jones, presented a Bill to make provision for and in connection with a code of practice containing guidance about the operation and management of private parking facilities; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 2 February 2018, and to be printed (Bill 17).
Mr Speaker
I think the nation should be aware that, perhaps because the right hon. Gentleman’s Bill relates to parking, he is sporting a notably colourful tie, which features a very large number of cars. Knowing his penchant, I assume that they are classic cars.
Sir Greg Knight (East Yorkshire) (Con)
They are, indeed.
Unpaid Trial Work Periods (Prohibition) Bill
Presentation and First Reading (Standing Order No. 57)
Stewart Malcolm McDonald, supported by Ian Murray, Lady Hermon, Caroline Lucas, Christine Jardine, Patricia Gibson, David Linden, Alison Thewliss, Chris Stephens, Patrick Grady, Carol Monaghan and Martin Whitfield, presented a Bill to prohibit unpaid trial work periods in certain circumstances; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 16 March 2018, and to be printed (Bill 18).
Prisons (Interference with Wireless Telegraphy) Bill
Presentation and First Reading (Standing Order No. 57)
Esther McVey, supported by Andrew Selous, David T. C. Davies, Kirstene Hair, Trudy Harrison, Philip Davies, Mr Jacob Rees-Mogg, Mr Christopher Chope, Paul Farrelly, Mr Kevan Jones, Mr Stephen Hepburn and Sir Edward Davey, presented a Bill to make provision about interference with wireless telegraphy in prisons and similar institutions.
Bill read the First time; to be read a Second time on Friday 1 December, and to be printed (Bill 19).
Stalking Protection Bill
Presentation and First Reading (Standing Order No. 57)
Dr Sarah Wollaston, supported by Mrs Cheryl Gillan, Ms Harriet Harman, Alex Chalk, Antoinette Sandbach, Luciana Berger, Richard Graham, Victoria Prentis, Maria Caulfield, Mims Davies, Jess Phillips and Vicky Ford, presented a Bill to make provision for protecting persons from risks associated with stalking; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 19 January 2018, and to be printed (Bill 20).
Mr Speaker
Friday 19 January—I do hope I am here.
Employment and Workers’ Rights Bill
Presentation and First Reading (Standing Order No. 57)
Stephanie Peacock, supported by Louise Haigh, Rachel Reeves, Dan Jarvis, Ellie Reeves, Clive Lewis, Lisa Nandy, Jo Stevens, Ian Mearns, Mike Amesbury, Laura Smith and Chris Stephens, presented a Bill to make provision about employment conditions and workers’ rights; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 27 April 2018, and to be printed (Bill 21).
Licensing of Taxis and Private Hire Vehicles (Safeguarding and Road Safety) Bill
Presentation and First Reading (Standing Order No. 57)
Daniel Zeichner presented a Bill to make provision about the exercise of taxi and private hire vehicle licensing functions in relation to persons about whom there are safeguarding or road safety concerns; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 2 February 2018, and to be printed (Bill 22).
Freedom of Information (Extension) Bill
Presentation and First Reading (Standing Order No. 57)
Andy Slaughter, supported by Dan Jarvis, Jo Stevens, David Hanson, Ian C. Lucas, Ruth Cadbury, Christian Matheson, Clive Efford, Stephen Timms, Ms Karen Buck, Louise Haigh and Kate Green, presented a Bill to make providers of social housing, local safeguarding children boards, Electoral Registration Officers, Returning Officers and the Housing Ombudsman public authorities for the purposes of the Freedom of Information Act 2000; to make information held by persons contracting with public authorities subject to the Freedom of Information Act 2000; to extend the powers of the Information Commissioner; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 15 June 2018, and to be printed (Bill 23).
Representation of the People (Young People’s Enfranchisement) Bill
Presentation and First Reading (Standing Order No. 57)
Peter Kyle, supported by Nicky Morgan, Norman Lamb, Sir Peter Bottomley, Rachel Reeves, Ruth Smeeth, Wes Streeting, Anna Turley, Holly Lynch, Conor McGinn, Caroline Lucas and Jim McMahon, presented a Bill to reduce the voting age to 16 in parliamentary and other elections; to make provision for auto-enrolment onto the electoral register for people aged 16 to 24; to make provision about the use of educational establishments as polling stations; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 11 May 2018, and to be printed (Bill 24).
Physician Associates (Regulation) Bill
Presentation and First Reading (Standing Order No. 57)
Anne Marie Morris presented a Bill to make provision for the regulation of physician associates; to make physician associate a protected title; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 26 October 2018, and to be printed (Bill 25).
National Living Wage (Extension to Young People) Bill
Presentation and First Reading (Standing Order No. 57)
Holly Lynch, supported by Chris Bryant, Jo Stevens, Anna Turley, Wes Streeting, Jess Phillips, Tulip Siddiq, Ruth Smeeth, Gareth Snell, Conor McGinn, Naz Shah and Graham Jones, presented a Bill to extend the National Living Wage to people aged 18 to 24.
Bill read the First time; to be read a Second time on Friday 6 July 2018, and to be printed (Bill 26).
Mental Health Units (Use of Force) Bill
Friday 3rd November 2017
(7 years ago)
Commons ChamberRead Full debate Mental Health Units (Use of Force) Act 2018 Read Hansard Text Read Debate Ministerial Extracts
Mr Steve Reed (Croydon North) (Lab/Co-op)
I beg to move, That the Bill be now read a Second time.
Seni Lewis was a young graduate embarking on his life, aged 23, and living with his parents in Thornton Heath, when he suffered his first ever mental health episode. His parents recognised what was happening and took him to their local hospital. Seni ended up in the Bethlem Royal mental health hospital in Croydon. His parents stayed with him all day, but had to leave at 8 o’clock in the evening. Seni became very agitated when he realised they had gone, and he tried to leave, too. According to the coroner, the staff lacked the training to deal with him, and although there are no allegations that he attacked anyone, they called the police. Eleven police officers took Seni into a seclusion room and, using pain compliance techniques—the kind used against violent criminals—they took it in turns to hold him face down on the floor for 30 minutes in total. His hands were cuffed behind his back, and his legs were in restraints. They held him like that until he could no longer breathe, and he suffered a heart attack. He went into a coma, and four days later Seni was dead.
The coroner criticised Seni’s treatment as “disproportionate and unreasonable”. No patient entering a hospital for care should suffer and die in the way that Seni did. But the family’s agony did not end there. It took seven years of struggle by Seni’s grieving parents until an inquest was finally opened only this year. The coroner found severe failings by the police and the mental health services, and she gave the stark warning that
“there is a risk that future deaths will occur unless action is taken.”
That action is this Bill. What happened to Seni Lewis is not an isolated incident. According to the Independent Advisory Panel on Deaths in Custody, 46 mental health patients died following restraint between 2000 and 2014.
Nick Thomas-Symonds (Torfaen) (Lab)
I am grateful to my hon. Friend for bringing forward this very important Bill. Many families in my constituency have contacted me, including some affected by autism, and they are very concerned about the kind of face-down restraint that he has described so movingly in talking about this case. Does he agree that it is very important to have boundaries on the use of this restraint, and that families have some certainty about what can and cannot happen in such facilities?
Mr Reed
I completely agree, and I am delighted that the National Autism Society fully supports the Bill and its provisions.
I was talking about the number of patients who have died following the use of restraint, and the many more who have been seriously injured. Government guidelines say that face-down restraint is so dangerous it should not be used at all, but it was used over 9,000 times in the last year alone, including 2,500 times against children as young as seven. People who have been restrained talk about the experience with horror. They say that it is frightening, painful and humiliating, and they feel stripped of their dignity. In the words of one woman:
“It made me feel like a criminal, like I had done something wrong, not that I was ill and needed to get better.”
Statistics from the campaign group Agenda show that women are more likely to be restrained face down on the floor than men. Up to half of all women in mental health hospitals have been physically or sexually abused by men. Subjecting these women to face-down restraint by groups of men adds to the trauma that in many cases led to their mental illness in the first place.
It is difficult to understand clearly from the existing data what exactly is going on. There is no standardised way of recording why, when or how restraint is used. However, from their own data, there appear to be wide discrepancies between mental health providers. Some restrain as few as 5% of patients, while others restrain over 50%. There is no good reason for that variation.
Wera Hobhouse (Bath) (LD)
Does the hon. Gentleman agree that it is now time for each provider to publish, correctly and robustly, the data available, and should not the Minister make a commitment to the publication of the data?
Mr Reed
I agree, and I very much hope that the Minister will make such a commitment today.
There are fears about unconscious bias in the mental health services. The Angiolini review, a very important review published earlier this week, notes how a disproportionate number of people from black, Asian and minority ethnic communities have died after the use of force in custody more generally. Black people are four times more likely to be sectioned than white people. If we look at the faces of the people who have died after severe restraint in a mental health hospital, we see many more young black faces than in the population as a whole. We need to understand the extent to which assumptions based on stereotypes are causing that, but to do so we need standardised data recording.
What the Bill proposes is simple, but it will make a big difference. It will standardise the way in which the data on every instance of the use of force are recorded, so that we can better understand where force is being used unnecessarily, and the extent of any bias and disproportionality in the system. It will improve arrangements between the police and mental health services, and require the police to wear body cameras when carrying out restraint, unless there are good operational reasons not to do so.
David Hanson (Delyn) (Lab)
I support my hon. Friend’s Bill, particularly clause 13 on police body cameras. Is he aware that that provision applies to England only? Police body cameras are a slight anomaly in that they cannot be used by units in Wales because that matter is devolved to the Welsh Assembly. Once the Bill has been given a Second Reading, will he look at that and discuss it with the Welsh Assembly?
Dr David Drew (Stroud) (Lab/Co-op)
I congratulate my hon. Friend on the Bill. I declare a non-pecuniary interest in that my son is a community psychiatric nurse, although not a practising one. Does my hon. Friend agree that we need to look at the wider process of how people are taken into care? The sectioning process under the Mental Health Act 1983 does not allow any accountability to the victim. Does he agree that while the Bill is important, it needs to be seen in the wider context of how we deal with someone—at their most vulnerable—when they have been sectioned?
Mr Reed
I very much agree with my hon. Friend. The Government are commissioning a much wider review of mental health services. I hope it will encompass the points he raises, but that would be for the Minister to clarify.
The Bill will make sure that every mental health provider has a policy in place governing the use of force, including a clear deliverable plan for reducing its use, and ensuring that staff are properly trained in equalities and the de-escalation techniques needed to avoid the use of force. It will speed up justice and allow learning to take place by making sure that any non-natural death in a mental health unit automatically triggers an independent investigation, and making sure that recommendations from investigations and inquests are taken into account when improving mental health services in ways that currently do not happen.
The Bill is a significant step forward for our mental health services, moving them from the containment of patients to the care of patients. It will make sure that people with mental ill health are treated with compassion, not cruelty. There is overwhelming support for the Bill across the mental health sector. I am grateful for the practical support I have received from INQUEST, in particular its director Deborah Coles, and from Raju Bhatt, the widely respected solicitor who has represented so many bereaved families following deaths in custody. I am grateful to YoungMinds UK, Mind, Rethink Mental Illness, Agenda, the Labour Campaign for Mental Health, my hardworking staff and the Croydon North Ethnic Communities Forum. Also, 38 Degrees hosted an online petition that has been signed by over 60,000 people to demand this change.
Mr Jim Cunningham (Coventry South) (Lab)
More broadly, having watched documentaries on this issue, does my hon. Friend agree that there is an argument for providing the police with better training, so that they understand the difficulties facing people with mental health issues?
Philip Davies (Shipley) (Con)
I am grateful to the hon. Gentleman for the time he gave me to discuss the Bill a few weeks ago. He talks about mental health professionals supporting the Bill. I have spoken to my local care trust in Bradford, which, while it supports much of what is in the Bill, has concerns about some aspects. I therefore wonder how receptive the hon. Gentleman would be to amendments, either in Committee or on Report, that try to address those concerns, or is he determined that the Bill must end up in its current form?
Mr Reed
I thank the hon. Gentleman for his very helpful intervention. The only way to go forward with the Bill is through consensus. I have made it absolutely clear to both Ministers sitting on the Government Front Bench that I want to work with them constructively in Committee, as they have worked with me so far, so that we can secure an outcome that is supported by both sides of the House and right across the profession.
This week, the chief executives of 29 mental health organisations published a letter urging Parliament to back the Bill. It is supported by the Royal College of Nursing, the Royal College of Psychiatrists, the Care Quality Commission, NHS England and trade unions representing staff who do such an incredible job working in the mental health services. I must add my thanks to the Minister, the Under-Secretary of State for Health, the hon. Member for Thurrock (Jackie Doyle-Price), for working with me so constructively; as well as my right hon. Friend the Member for Islington North (Jeremy Corbyn), who supported the campaign long before he became the Leader of the Opposition.
Ruth George (High Peak) (Lab)
I congratulate my hon. Friend on bringing forward the Bill. Seni Lewis was a young man who grew up in my constituency of High Peak. His cousin was telling me yesterday what a lovely young man he was, that he was never in trouble with the law, and what a loss to society he is. Does my hon. Friend agree that his family should not have had to fight for six years to get an inquest? Will he pay tribute to them for all they have done to make sure that this never happens to another family?
Mr Reed
I absolutely agree. There is an old line that justice delayed is justice denied. No family who have lost their child in these circumstances should then have to fight the state to find out what went wrong, or to secure a modicum of justice for what happened.
Before I continue, I want to put on record my thanks also to the Prime Minister, who has met the Lewis family on more than one occasion and who I know supports the objectives of the Bill.
I have come to know Seni Lewis’s parents, Aji and Conrad, very well over the past few years. They are two of the most dignified and inspirational people I have ever met, but they have suffered pain and anguish that no parent should ever have to face. When I asked Aji and Conrad what they hoped for after all they have been through, they told me that they do not want Seni’s death to be in vain. They do not want any other family to suffer as they have suffered. I say to this House now, and to his parents, that Seni Lewis did not die in vain. We can honour his memory by making sure that no one else suffers the way he did, and by making our mental health services equal and safe for everyone. I dedicate this Bill to Seni Lewis. This is Seni’s Law. I commend it to the House.
Several hon. Members rose—
Mr Speaker
I was going to call Mr Malthouse, but although he is on the list he is not standing up. He is showing an unaccustomed reluctance to favour the House with his views.
Kit Malthouse (North West Hampshire) (Con)
I think there has been an error, Mr Speaker. I am here for the second debate, not the first.
Mr Speaker
I thought the hon. Gentleman wanted to speak on this Bill, but if I am mistaken and he wishes to preserve his thunder then so be it. We will hear from him at a later stage.
Several hon. Members rose—
Mr Speaker
Gosh, what a delightful choice awaits me. I call Victoria Prentis.
Victoria Prentis (Banbury) (Con)
I am most grateful to have been called first, Mr Speaker, out of the smorgasbord of choice available to you.
It gives me genuine pleasure to rise to support the Bill and to be the first to congratulate the hon. Member for Croydon North (Mr Reed) on his hard work. The Bill stems from great tragedy, but it is always good to see a piece of constituency casework come to fruition and get as far as the Floor of the House. I have enormous respect for the hon. Gentleman, and the all the work he has done with people across the House and outside to get this far. I wish him all the best.
Wera Hobhouse
Is it not also time to pay tribute to my right hon. Friend the Member for North Norfolk (Norman Lamb), who as Health Minister introduced the “Positive and Safe” guidelines, a two-year programme with funding to end the deliberate use of face-down restraint in all health and care settings? Unfortunately, those guidelines have not always been followed.
Victoria Prentis
I thank the hon. Lady for her intervention. It is very important in these cases to congratulate Members from across the House and to work together on cross-party lines to achieve the consensus needed, so we support those in our communities who need laws like this to keep them safe.
Michael Tomlinson (Mid Dorset and North Poole) (Con)
May I add my voice to my hon. Friend’s in congratulating the promoter of the Bill on not just bringing it to the House but gathering a consensus? Does she, like me, welcome the fact that he is willing to look at constructive suggestions in Committee to ensure the Bill is in a proper and fit state?
Victoria Prentis
I thank my hon. Friend for his intervention. We have begun to understand and talk about mental health only very recently. As we do so, we learn both from those patients who have suffered tragedies and those who have had better experiences with law enforcement agencies. It is important that we learn and listen as the debate progresses. Issues may well come up in Committee that nobody has given a moment’s thought to. A constituent will have a story to tell and we can learn from it as we go forward.
From my own constituency casework, I know that for those at the point of crisis the use of restraint can be both humiliating and traumatising. I discussed this issue with the Causeway Carers, a great organisation comprised largely of parents and other family members of victims with very severe mental health problems. They meet in Bicester once a month. Many have first-hand experience of sectioning and restraint, which they shared with me. That was a great privilege and I do not feel able to share any of those stories with the House today. From what we have heard about Seni, we can all imagine the sort of stories that are taking place even on the high street in Bicester from time to time, often at night. They are also taking place in all our communities. They are not isolated stories, and none of us can feel that we are untouched by them.
These families are suffering enormously because they are dealing with a very ill family member, often a child, and restraint is added to that dreadful suffering that they already have to cope with. I recognise that the use of police cells in England as places of safety under the Mental Health Act 1983 is declining, and that more cases than ever are now referred to health-based places of safety, which is real progress. We should also welcome the significant reduction in the number of deaths in, or following, police custody since 20 years ago. I imagine that this reflects improved training, guidance and practices in a number of areas, most significantly in suicide prevention. My background is as a lawyer for the Prison Service, and it strikes me that this is in sharp contrast to the dramatic and worrying rise in suicide rates recorded in the last 20 years in prisons.
Clive Lewis (Norwich South) (Lab)
We are being consensual across the House, and I would like to retain that spirit, but would also make the point that one of the linking factors in terms of both prisons and mental health is funding for the institutions. Staff and service users at the Norfolk and Suffolk mental health trust, which is in special measures, are concerned that a reduction in the number of staff—nurses and doctors—over the past five years means they have less ability to watch and monitor patients, so it is more likely that those patients are using medication, and that means restraint is more likely to be used, so we end up with the situation that the Lewis family were in. Will the hon. Lady comment on that?
Victoria Prentis
Rather than get too party political, I think it is appropriate to talk about other difficulties that have led to reductions in staffing in real terms in the Prison Service, because we on this side of the House can give lots of facts and figures about how much more is being spent. The difficulty that I know about personally now in my Banbury constituency is in recruiting and retraining staff—not with the money to pay for them, but with finding the right people. I pay tribute to all who choose to work in the very difficult mental health sphere, with patients who suffer from dreadful illnesses; the House should pay tribute to the work they do day in, day out with people who are often very difficult to deal with while they are ill.
One matter on which I am sure we can agree is the importance of reducing further the number of black, Asian and minority ethnic people detained for mental health reasons in police cells. The figures are disproportionately high. It simply cannot be right that black people are four times more likely to be detained under the 1983 Act than white people. The hon. Member for Croydon North mentioned the Angiolini review and the importance of standardised data recording. I apologise for again referring to my Prison Service experience, as the mental health system is completely different from the criminal justice system, but there are themes that run through the way BAME people are treated in both systems which we increasingly find utterly unacceptable.
Victoria Atkins (Louth and Horncastle) (Con)
I pay tribute to the hon. Member for Croydon North (Mr Reed) for bringing the Bill to the House. Does my hon. Friend join me in welcoming clauses 8 and 9 requiring mental health units to record the relevant characteristics of the patient on every occasion in which force is used, and to submit an annual report to the Secretary of State, so that health units and also the Secretary of State can review and understand where there are patterns of behaviour?
Victoria Prentis
I could not agree more. The provision of statistics and retention of figures and then the crunching of them is vital. It might not sound exciting, but it is the only way to deal with the big problem of racial imbalance in both the mental health and the criminal justice system. It sounds absurd to say that figures are what will push through action on racial imbalances, but I truly believe that facts and figures—such as those provided recently in the report on the Prison Service, where we learned that 277 black women are in prison for every 100 white women—will help achieve that. Such figures are unacceptable on any level. The more we can talk about such figures, backed up by good evidence, the better. A civilised society cannot put up with such things.
I have strayed far from my brief. I am proud that the Government have committed to addressing the disproportionately high rates of BAME people detained for mental health reasons, and I am proud of the work the Government have done generally on mental health.
We all know that the 1983 Act is outdated, and it will be reformed to make it fit for the modern era. In October 2017, the Prime Minister announced a comprehensive review of the Act, with a planned end date for the report of autumn 2018. I am pleased that the review is being led by Professor Simon Wessely, former president of the Royal College of Psychiatrists. I worked closely with him in my previous role. We were working on a case concerning the pardoning of first world war prisoners who had been shot for cowardice, and he was able to recreate their mental health states from the limited records we had available and give invaluable evidence to the court. He is a great man and I am sure he is the right person to lead this review. He has said that he expects some of the solutions to the difficulties in the mental health system to lie in practice, leadership and culture, as well as in potential legislative change.
I have been encouraged by the work on mental health in my constituency, including in the veterans support group. It meets at Behind the Wire in Heyford Park, next to my constituency office, about once a month. It is a former military establishment and the veterans who access it feel very comfortable in that environment. It is well known that veterans as a group are more prone to experience mental health issues. This particular group offers drop-ins for veterans living in the local area so they can meet organisations including the Support, Empower, Advocate, Promote service, Help for Heroes, the Royal British Legion, Veterans UK and Rethink Mental Illness, which the hon. Member for Croydon North mentioned, and which does a great deal of good work across the country.
I have other local organisations who are doing great things in supporting my constituents, including Restore in Banbury, which I was also lucky enough to meet recently. I visited the local branch of Mind in September, which has contacted me in recent days urging me to support the Bill. Its letter said that
“the proposals in this Bill are crucial to protecting people experiencing a mental health crisis...With your support this Bill would lead to better training for staff, better data, improving transparency and highlighting problem areas”.
It therefore gives me great pleasure not only to support the hon. Member for Croydon North, but to stand up for those of my constituents who have asked me to attend this debate and to speak in it.
As a former civil servant, I cannot emphasise enough how important it is that we have a joined-up approach across Departments. It is very much not just a matter for the Department of Health; the Ministry of Justice is also involved. I speak to it frequently about mental health and prisoners and the use of restraint in the criminal justice system, and I hope that the Minister will reaffirm the importance of cross-governmental co-operation, including work with NHS England, on the delivery of reforms to detention.
Oliver Dowden (Hertsmere) (Con)
Thank you very much for calling me to speak so early in the debate, Mr Speaker. I should like to begin by paying tribute to the hon. Member for Croydon North (Mr Reed) for bringing forward this legislation, which I very much support. In common with most Members, I am sure, I find that mental health is a rising issue in my constituency. Many of my constituents frequently contact me about it and many have particularly asked me to speak in this debate. I want to talk about two provisions in the Bill that I think are important. First, it is important to have transparency. As someone once said, sunlight is the best form of disinfectant. If people can see what is going on, they are much less likely to behave in an inappropriate fashion. The use of body cameras in many other areas of police work has done a great deal of good, so their introduction in this area, through the Bill, is to be welcomed.
Secondly, I welcome the provisions in the Bill on effective recording. One of the frustrations of my constituents who have mental health problems or whose family members have mental health problems is that the information on their interactions with public bodies—whether the police, local authorities or schools—is not properly collated or shared. Patients and their families therefore feel that they are constantly going round in circles repeating information. The more we can do to retain that information effectively, the better treatment those affected will receive. The root of all this lies in the need for a change in attitudes towards mental health; my constituency is emblematic of the changes that have taken place over the past 30 or 40 years.
Ms Karen Lee (Lincoln) (Lab)
Does the hon. Gentleman agree that, no matter what equipment we have, the root of the problem is not having enough staff to deal with these situations? I am a nurse, and I know that we do not have enough nurses. It is as easy as that, and we need to address the problem.
Oliver Dowden
I quite agree that we need to have the right levels of staff, and that is why I am so pleased that the Government have protected police funding. I was going to come on to this point, but I will raise it now. In the health service, we are moving towards achieving parity between mental and physical health. Some of the stats on this are very welcome. We are now spending £11.6 billion a year on mental health, for example. I believe that that is more than we have ever spent before. Also, the Health and Social Care Act 2012 is giving parity of esteem.
Victoria Atkins
Does my hon. Friend agree that this is not just about the numbers of staff but about how well they are trained to work in the particularly difficult circumstances of a mental health unit? The pressure on members of staff is particularly acute in such an environment. Clause 5 requires training in the appropriate use of force, which will provide positive benefits for members of staff.
Oliver Dowden
My hon. Friend is absolutely right. I do not think anyone is suggesting that police officers are actively seeking to treat mental health patients in an incorrect fashion, but there is a need for training so that they understand the correct way to behave.
Clive Lewis
We on the Opposition Benches do not think that this is only about the money that is going in now. If we look at the figures, we can see that there has been an increase in recent years, but the fact is that the years of cuts that went before have had an impact on staffing levels. In my trust, the Norfolk and Suffolk mental health trust, we have seen a 20% drop in the number of doctors and nurses on the payroll in the past five years. We can train up a lower number of doctors and nurses in restraint techniques, but the fewer there are, the more risk there will be of a need to restrain. We cannot get away from that fact.
Oliver Dowden
I am not sure that I entirely agree with the hon. Gentleman. Of course there have been historical problems with the funding of mental health. I hope that Opposition Members will recognise, as we do on the Government Benches, that over the decades there has not been enough funding going into that area. On the question of the NHS, however, despite this Government inheriting the largest budget deficit in our peacetime history and an appalling fiscal situation in which we were spending £4 for every £3 we earned, we made a decision to prioritise health. Health spending has risen every year under this Government and we are committed to implementing Simon Stevens’ recommendations. He, after all, was a Labour special adviser who advised this Government, and he recommended £8 billion of additional funding. I am very pleased that we have been able to do that.
Oliver Dowden
I would be delighted to give way to my hon. Friend on the other side of the House, if I may call her that.
Ms Rimmer
When public services are stretched and under-resourced, and with rising demands, it is more important than ever that we have the correct processes in place. Our public services do an exemplary job, and the Bill is not about criticising them. It is about having a regulated, transparent process so that we can minimise harm to staff and the people they care for. I have been contacted by many of my constituents on this matter. Indeed, there is widespread public concern about it. Does the hon. Gentleman agree that we should not turn this into a debate on another issue? Please let us stick to what we are here to talk about today.
Mr Speaker
Order. I am immensely grateful to the hon. Member for St Helens South and Whiston (Ms Rimmer), but may I gently point out that interventions must be brief? I recognise the sincerity and seriousness of what she said, but there is huge pressure on time in respect of this Bill and of what might follow, so a certain self-denying ordinance is needed.
Oliver Dowden
I thank the hon. Lady for her intervention. I know that she, like me, greatly values the work of our public sector workers. With respect, I was seeking to respond to interventions from other Opposition Members, and if they will refrain from making political interventions, I will happily refrain from rebutting them.
The root of this can be traced back to my constituency of Hertsmere, which I proudly represent and in which I was born and grew up. I remember the way in which mental health was treated during my childhood. We are on the edge of London, and London was historically surrounded by very large mental health institutions. In my own constituency, we had facilities such as the very large hospitals at Harperbury and Shenley. In many ways, those institutions had a positive ethos. I am fortunate to represent many mental health nurses who worked in those institutions and who still live in the constituency, and there was certainly a positive ethos of rehabilitation and providing a safe, calm space for people. However, the flipside of that was a tendency to put people in those institutions, shut them away and never think about the problem again. It is absolutely right that, under successive Governments, we have sought to change that approach. We now mainstream mental health problems, certainly in my own constituency and I am sure in many others.
Helen Hayes (Dulwich and West Norwood) (Lab)
I believe it is important for the hon. Gentleman to acknowledge that there are still far too many young people with autism and learning disability living for the long term in hospitals. Does he acknowledge that that problem is related to the resources available for their care and how those resources are spent? I believe that we need a shift towards properly resourced community settings for people with autism and learning disability, who really should not be in hospital for the long term.
Oliver Dowden
The hon. Lady makes an important point. The closer to the community the treatment can be given, the better the treatment will be. I see this with my own constituents. If they are having to travel long distances, particularly with younger children, to access mental health care facilities, that can only add to the disruption in their lives. However, I believe that a journey is taking place in all of this, and I am glad that the Government are addressing the need for that journey.
The experience of many of us is that mental health is now delivered at the primary care level. From speaking to GPs in my constituency, I know that they are now on the frontline of the process. What is the answer? The first thing is to ensure that we have parity of treatment between mental and physical health. A broken limb is a serious injury and the patient is patched up and treated properly—no one doubts that they have had an injury. However, it has been the case for too long that if people have a mental health condition, it is not immediately treated with the same seriousness, and there is a sense that the person concerned has to prove that they have a problem in the first place.
Wendy Morton (Aldridge-Brownhills) (Con)
My hon. Friend is making an important point. In addition to parity of esteem, we need greater understanding of what it really means to live with a mental health illness, and Bills such as this are important for raising awareness of what can be a sensitive issue.
Oliver Dowden
My hon. Friend is absolutely right. This is about not just understanding the experience of the person who is suffering from mental health, but the knock-on effect on the entire family. One thing that my constituents frequently raise is the impact on other siblings when one child in the family has mental health issues and ensuring that the others do not feel neglected or disadvantaged when one sibling necessarily gets more attention.
Not only do we need to change cultural attitudes towards mental health, we need to look at the legislative framework. Most of us would agree that 1983 was the last time we had a serious, large-scale piece of legislation and, in 1983, the old model that I was discussing earlier was the prevalent model. There is a pressing need for a larger piece of legislation that can build upon on the measures in this Bill and ensure that we take a more comprehensive look at things.
Kevin Foster (Torbay) (Con)
I am enjoying listening to my hon. Friend’s speech. Does he agree that the use of police cells is a big area for review? While we have seen a welcome decline in the use of police cells as places of safety, it is unacceptable that someone can end up in a cell not because they are suspected of a crime, but because they have been unwell.
Oliver Dowden
My hon. Friend makes an important point and that is something that we are waking up to. As Home Secretary, my right hon. Friend the Prime Minister made great strides to seek to change the approach taken by the police so that people are not automatically put in a cell. If somebody is already suffering from a mental health condition, the worst possible thing for them is a night in the cells, the conditions of which we have all seen as constituency MPs.
Kevin Foster
My hon. Friend is being extremely generous. The situation is ironic, because we have strict time limits for detention without a magistrate’s warrant due to the mental health impact on criminal suspects, yet we do not have the same for mental health. That could be looked at in future legislation.
Oliver Dowden
Again, my hon. Friend makes an important and interesting intervention, which comes back to the wider question of how we achieve parity. Parity is about not just funding or treatment by GPs, but all these other forms of, for want of a better phrase, micro-discrimination.
Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)
I agree with the hon. Gentleman that parity is not necessarily achieved just through funding, but what does he think about the data collected by my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger)? Through FOI requests, she was able to demonstrate that half of all clinical commissioning groups are looking to reduce the amount of money they spend on mental health provision in their communities, so that they can put more money into acute pressures, with which they are struggling due to other funding arrangements.
Oliver Dowden
I thank the hon. Gentleman. That goes back to my earlier point that the funding is there. We are increasing funding for the NHS, and CCGs should not be seeking to cut mental health services in order to cross-subsidise acute services. That is certainly not the case with my local CCG.
Hon. Members on both sides of the House have made important points, and I hope that the mental health review that the Government announced in the Queen’s Speech will take all considerations into account. Mental health really encompasses every area of Government activity, and a holistic approach is important.
I am conscious that I have taken up a little too much time, so my final point is about co-ordination. When sufferers of mental health find themselves in contact with the police, it is often due to more severe mental health episodes, and there is sometimes a frustration about which agency will take responsibility. If the police recognise a mental health problem, they will often get in contact with mental health services in the NHS, which may then get in contact with mental health services at the local council, and the patient and their family can feel that they are being pushed from pillar to post with no individual seeking to take responsibility. Returning to the provisions in the Bill about the collection of data, it needs not only to be collected but shared effectively among institutions. I hope that the review, which will hopefully lead to fresh legislation, will look at how to provide some co-ordination, so that there is somebody who can be a champion for people with mental health conditions and bring together the experiences of all the different institutions. At a time when families and individuals feel under so much pressure, if they can see that there is one person to whom they can relate, instead of having to negotiate with different bodies, that could provide much better outcomes.
In conclusion, I again pay tribute to the hon. Member for Croydon North for bringing this important issue to the House. I hope that this private Member’s Bill will complete its stages and make its way on to the statute book, but I also hope that it will mark the beginning of a wider process that will feed into fresh legislation covering all the different areas where we need to ensure genuine parity between mental and physical health. I hope that all hon. Members agree that that is the ultimate goal.
Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
It is a pleasure to follow my hon. Friend the Member for Hertsmere (Oliver Dowden), and I congratulate the hon. Member for Croydon North (Mr Reed) on all his work in bringing this Bill to the Floor of the House which, as my hon. Friend the Member for Banbury (Victoria Prentis) highlighted, is an extraordinary feat. I have only been in the House for two years, but it is evident that to beat the systems of the parliamentary process and bring together so many voices to ensure that an important gap in our legislation can be addressed is really impressive, so I am delighted to speak in support of his Bill.
How we view, diagnose and treat mental health has changed dramatically over the past few years. I am delighted that our Conservative Government have taken a lead on this matter now, but we still have a long way to go. Excellent work by health professionals, the royal colleges, many excellent charities, many parliamentarians and citizens from right across society is starting to ensure that mental health is, at last, right up at the top of the Government’s and society’s priorities. Bearing in mind just how much the picture has changed in recent years, it seems somehow incomprehensible that the Mental Health Act has remained unchanged since it was enacted in 1983, which was when I started secondary school—and I am definitely not one of the younger Members in the House.
To think how policy has changed, even over the past decade, reminds us of just how an Act passed three decades ago can no longer be anywhere near fit for purpose. In some ways, it is a good thing that we have moved so far in understanding what mental health means—and, in fact, what mental ill health means. I often find it a strange use of language to talk about mental health when we mean that somebody is unwell, because it is a moment in an otherwise healthy person’s life when they are unwell. As my hon. Friend the Member for Hertsmere said, it is an invisible part of our health and ill health through, for most of us, our now fortunately very long lives.
It is great news that the Mental Health Act review is ongoing, and I look forward to continuing to work with the Government and Ministers to ensure that we get effective reform across the board. This Bill will allow us to address the use of force in mental health units, about which I have had a substantial amount of correspondence from concerned constituents and, interestingly, more widely from family and friends who often say, “I don’t want to bother you, Anne-Marie, because you are very busy in Parliament,” because this is something that really bothers people, and they have dropped me a line to highlight the fact that they want me to speak out.
Sarah Jones (Croydon Central) (Lab)
I congratulate my hon. Friend the Member for Croydon North (Mr Reed) on introducing the Bill, which is important for the country and for Croydon. Seni died in Bethlem Royal Hospital, which is on the border of my constituency, and my love and support go to his family and friends for what he suffered.
A constituent came to me this week who had had a bipolar episode, ended up in a prison cell, and been assaulted. He said that “a police cell is often the first port of call for people with mental health issues, especially those unfortunate folk who, for one reason or another, end up on the streets like I had to go through.” He went to a solicitor to ask whether he should take action, and he was advised not to do so. Does the hon. Member for Berwick-upon-Tweed (Mrs Trevelyan) agree that the Bill will change practice within mental health units and will also hopefully encourage people, when things go wrong, to speak out, to take action and to feel that they will be supported in doing so?
Mrs Trevelyan
I thank the hon. Lady for her intervention, with which I absolutely agree. I am pleased that the number of people being held in police cells has fallen dramatically in the past few years, but, as we have seen this week, if people feel that they are suffering injustice, they should always take it to the police or, if that is where the problem or inappropriateness lies, find another outlet to be heard and to get redress. Every citizen of our country should always feel able to stand up and say, “This was wrong, and I am seeking redress for what was done to me.” I encourage the hon. Lady to support her constituent in seeking redress.
Many constituents have written to me with deep concerns about the effect that the undue use of force might have had on their child—and, in three harrowing cases, the effect that it has indeed had. One constituent detailed how the use of unreasonable restraint had a lasting effect on the health not only of the particular family member but on the whole family, which created years of trauma and ongoing illness. The use of excessive force can lead to long-term damage, and, as in the tragic case highlighted by the hon. Member for Croydon North, a death is an absolute travesty. We can never allow such abuses to take place in our civilised society.
It is good that cases of such terrible treatment are rare and that the numbers are coming down, but if we ever treat with force and brutality people who desperately need our help and support when in a state of mental ill health and distress, it is time for those voices to be heard and for action to be taken. These abuses cannot go unanswered or be tolerated any longer. The movement towards understanding mental ill health is progressing, and the Bill will help to change practice.
With that in mind, I will address two specific issues that are extremely close to my heart: autism and young people. There has previously been a lack of cross-Government co-operation on mental health issues. If we are to make a real impact on this issue and to change cultural norms, we need to ensure that the Department of Health, the Home Office, the Ministry of Justice and NHS England have closer working practices to deliver the necessary detention reforms. I hope the Minister will confirm that to the House later today.
The Bill could make a real difference in tackling the inappropriate force that is too often used against patients, many of whom are on the autism spectrum. A recent freedom of information request discovered that there were 66,681 recorded instances of restraint in England in 2015-16, an increase on the previous year. The use of physical, mechanical or face-down restraint can undermine an individual’s recovery and increase their risk of injury and long-term harm. As a society, we should be charged with protecting and helping those people to get well again.
I would hope that many in this House have read the National Autistic Society’s recent report “Transforming Care: our stories”. The report follows 13 families with a family member who is on the autistic spectrum or who has a learning disability and who is at risk of being admitted to an in-patient mental health hospital, of which there are still 2,500 across the country. One story spoke of a boy who was, according to a serious case review, “completely failed”:
“A very vulnerable young man suffered a sequence of traumatic experiences which may adversely affect him for…years.”
I am the mother of an autistic young adult—he has just turned 18—and I have other family members who are now diagnosed, and I am constantly concerned that the invisibility of autism in so many sufferers means that their mental health, or mental ill health when it hits them, has completely failed to be understood or, indeed, identified in crisis situations.
I used to have to ask teachers at my son’s school who did not understand how his Asperger’s affected him, “If he had a broken leg, would you ask him to run up the stairs or to join in a football match?” They would look a little bemused, and I would say, “He is in a state of deep stress and trauma at this point. You are expecting him to sit quietly in a classroom and pay attention, as when he is in a state of wellness. This is not possible.”
Teachers committed a huge amount of time to helping him to be in the mainstream system, and it took two or three years to understand that the invisibility not only of autism but often also of mental ill health until a crisis hits means that society cannot see it. Unless we are particularly attuned to the individual sufferer, or indeed to a wider understanding and identification of what that means, we cannot help them. It is important that people charged with looking after those who may be in need have rigorous frameworks and training. Just as we would not ask a boy with a broken leg to play in a football match, we must not have similar expectations of those in mental health crisis.
What can we say when we hear such harrowing stories, which are much more tragic than we should ever have to hear, and have to imagine the tragedy that those families have had to go through? How do we react? The instinct can no longer be to allow things to continue. We need things to improve, but we cannot just make tweaks here and there. The House cannot ignore issues that need urgent attention and reform. I am glad the Government recognise that and are supporting the Bill.
These isolated cases are sadly too common, and NHS Digital figures show that autistic young people still have an increased risk of being unnecessarily and frequently restrained because they cannot express their anxieties and crises in the way that neurotypical people more often can. We cannot continue with outdated practices and restraints that severely endanger the most vulnerable, who need considerate, appropriate and constructive treatment programmes that meet the autistic individual’s needs.
The Bill includes provisions to turn that into reality and to reform practices in mental healthcare, and it highlights a number of concepts that our constituents expect of us, of the Government and of our public services right through the system. I will cover a couple of those concepts.
First, on transparency, every time restraining force is used in a mental health unit it will be recorded and fully detailed. This would allow people to know that if this happened when they were in a state of mental ill health, it would be recorded; often people are not able to think clearly in these situations. Where someone has a broken leg or a broken arm, their mental capacities are still functioning fine and they will remember if the cast was put on the wrong arm—they would notice that. However, people in a state of deep mental ill health are not always able to see the world clearly at that point, so to have that fully detailed record will make a big difference to empowering those sufferers to know that they are being properly looked after.
In all our major institutions, such as the police or the NHS, we need accountability in everything that is done for our constituents. That is no mean feat in practice. This Bill will mean that every institution will have to have a named individual responsible for policy on the use of force and implementation. Given the discussions this week in the House, it is perhaps prescient to have a named person to whom those in distress can go, safe in the knowledge that they will be supported, understood and given a fair hearing. That is so important.
Dr Drew
Does the hon. Lady accept that the named individual must be able to prove that they have been trained in handling these incidents responsibly and, particularly, that they have been retrained on a regular basis? One weakness of the units is that there is not only a lack of training, but certainly a lack of updating of people’s training.
Mrs Trevelyan
I thank the hon. Gentleman for his intervention, and I agree absolutely that we need to get the training right in the first place; understand unconscious bias, which we all invariably suffer from, not only in general life, but within the complex environment of mental ill health; and ensure that de-escalation techniques are learned and constantly reiterated. Such an approach would allow the extraordinary people who work in this sector to be supported, constantly reminded of things and given the right tools to ensure that they can look after our family members and our constituents when they are in these crises.
Helen Whately (Faversham and Mid Kent) (Con)
One notable thing in the evidence about this is a huge variation in the use of restraint: in similar settings with similar groups of patients far more restraint is being used in some areas than others. Getting to the bottom of that when trying to improve the standards in all settings is surely part of the key to solving this problem.
Mrs Trevelyan
I thank my hon. Friend for that intervention. She is right: so often the circumstances of patients in the units has meant that people have been able to develop more sophisticated techniques and de-escalation programmes, and this best practice needs to be shared. That is the great challenge, as it so often is in education and in other parts of our public services. We need to find an effective way to share these best practices, so that we can help people who are doing their best in units across our constituencies but who are not necessarily using the most effective tools to help patients recover and restore their stability.
These two key policy areas, transparency and accountability, will protect patients, and promote dignity and respect. Everyone who passes through our mental health system should receive dignity in their care and respect for them as an individual in our society. I had a lovely chat with a gentleman on the street last night, not far from here. He was asking for money because he needed £35 for his bed and breakfast last night—this was going to be his night of luxury—and he had with him a sign saying, “This can happen to anyone.” That always makes me stop to chat. His life story was just unfortunate, with a series of unfortunate events, and there he was on the streets. Mental ill health can strike everyone, so to suggest that not everyone is entitled to that dignity would be wrong.
Oliver Dowden
My hon. Friend raises an important point. Does she agree that we must be careful not to judge people in that situation? There is always a temptation to think that there could be other reasons for it, but often they come from terrible circumstances, for example, having been the victims of child abuse and so on. There still needs to be a change in society’s attitudes, as we see when we look at some of these appalling cases of these people being abused by other members of the public.
Mrs Trevelyan
My hon. Friend is exactly right. It is incumbent on us as we go forward with this Bill to set these new markers to ensure that we get a cultural change; we need that understanding that mental ill health is part of our life experience and most of us may well suffer from it in one form or another. For those who are the most vulnerable we absolutely need to ensure that the practices are the best they can be, so that dignity and respect is afforded to every person who needs that support.
Transparency and accountability will also allow health professionals and emergency staff to manage the risks, protecting not only the patient, but our public servants. This can protect them from false allegations and allow us to have that evidence should things go wrong. Body-worn cameras are so important in this regard. The prison in my constituency, HMP Northumberland, was one of the prisons where body-worn cameras were trialled. This has been running for nearly two years now and there has been a dramatic drop not only in the reported cases of argy-bargy between prison officers and inmates, but in poor behaviour, because inmates who might have decided to have a go cannot be bothered anymore because they know it is going to be filmed; the relationship has improved so much as a result. This has created the same thing as we see where a teacher has good discipline in the classroom, understanding that if we provide a framework everyone within it works in a more conciliatory and more constructive fashion.
Victoria Atkins
I am a huge supporter of body-worn cameras on police officers and on prison officers, because I believe it protects not only them, but members of the public. Does my hon. Friend agree that just as—I hope—body-worn cameras will help victims of domestic violence who perhaps do not have the confidence to give evidence against their assailants, or cannot face the consequences of doing so, the same thing may apply in respect of prisons?
Mrs Trevelyan
My hon. Friend is absolutely right. Interestingly, even in the social media world we all live in, a storm of anonymity allows a level of poor behaviour. If the body-worn camera empowers people to remember that anything from good manners and good behaviour to constructive dialogue rather than more violent interventions is the way forward, this must be a tool we should be encouraging across the board. One hopes that behaviour can improve once people remember how these things can be done more constructively and with less violent interventions.
Kevin Foster
Does my hon. Friend also agree that one bonus of footage from body-worn cameras is that people have to go through a less lengthy investigation? Such investigations take the police officer off duty and put them on gardening leave. Having the certainty these cameras provide means that for both sides a quick resolution can be reached, and the organisation can then move on.
Mrs Trevelyan
My hon. Friend is exactly right. These common-sense measures could have a dramatic impact on the way our mental health units work, and for the well-being of both staff and those who are there receiving treatment.
Another important aspect of the Bill is the proposal that justice for a potential victim would now become possible. Our country and our values are based on the rule of law, but for justice to be done we need a new and open approach which would allow our public services to learn from past mistakes and ensure that no family or individual has to suffer the tragedy of loss or injustice that has too often been experienced by patients and their families. I have a constituency case in which a young girl had been put in restraint, not within a mental health unit, but within a special school environment, and, as a result of the fits from which she suffered, she hit her head and lost her sight. That is truly tragic, and the family has fought and fought to find a way to get redress and a better educational framework for this child to learn, having developed this entirely avoidable blindness. There is a great challenge in ensuring that we have a system that is open and transparent, and that families can be heard and do not have to fight for years.
Helen Whately
My hon. Friend just mentioned a case in a special school. I know we are talking about mental health units, but I wish to raise in the House the concern that exists about restraint in special schools. A case in my constituency involves some autistic boys having gone through some really concerning restraint when they were quite young, which gave them serious bruising. They have now been taken out of that setting, but we have never really got to the bottom of what happened there. This feels like something that needs to be looked into.
Mrs Trevelyan
I would be happy to work with my hon. Friend on that. Perhaps it is something we need to look at more widely. The extraordinary staff at special schools look after children with a breadth of needs that are never the same for two days running or for any two children. We must ensure that they are empowered with the right skills and techniques to support these children, who can lead fulfilling and full lives if we can get them through the education system. As I used to say to my son—I shall namecheck him again; he hates it when I do this, but tough, it is too late—it is really difficult for a child who sits outside the norms to be in the mainstream education system, but if they can make it to adulthood, they are free to be whoever it is that God created them to be and can really flourish. The challenge for our public services, whether for those who suffer from ill health or for children in special needs schools, is not only to ensure that we have a framework that supports them and wraps them with the skills and techniques needed to help them to develop and get well, but to ensure that they are treated with the dignity that everyone would expect for a family member who was in hospital for any other physical ailment.
The proposals in the Bill are really important to me personally and profoundly important to so many of our constituents who have experienced restraint and whose families have lacked a voice on the protection of children or relatives in these situations. Indeed, many have been unable to get any form of justice or restitution for damage to their family members. Legislation can change our practices and, in turn, our attitude towards how we care for those who need it the most. I am delighted that the Bill has been introduced and give it my wholehearted support.
Justin Madders (Ellesmere Port and Neston) (Lab)
I thank my hon. Friend the Member for Croydon North (Mr Reed) for introducing the Bill; he certainly made a powerful case for it. Everything we have heard has made it clear why the Bill is necessary. I congratulate Opposition and Government Members for the constructive way in which they have contributed to the debate so far. There is broad support for the measures in the Bill and I hope that if there are disagreements, they can be ironed out in Committee.
My hon. Friend the Member for Croydon North spoke movingly about the case of Seni Lewis, who, as we heard, tragically died after being restrained face-down in a mental health hospital. We have heard other examples of the issues that the Bill is designed to address. Sadly, Seni’s case was not an isolated incident. Restraint is still used far too regularly, despite Department of Health guidelines that state it should be used only as a last resort. Guidelines state that the dangerous practice of face-down restraint should be phased out, but unfortunately the technique is still used widely. There is significant variation in the use of restraint on mental health patients.
Justin Madders
I am not going to give way. Many other Members wish to speak and there are other items of business that we want to get to.
As Members have highlighted, there is an issue with unconscious bias. Young black men are statistically more likely to be seen as having psychosis or schizophrenia, and are at risk of being subject to inappropriate use of force, as are women.
Justin Madders
No, I have already made the point that many Members wish to speak so I shall not be giving way.
Metropolitan police figures show that in London, 36% of the 12,605 uses of force between April and June involved black people, despite the group accounting for just 12% of London’s population. Research has shown that women, who make up 46% of patients, are subject to more than half of all incidents of face-down restraint. Women and girls’ mental health conditions are often related to experiences of violence or abuse. The use of physical restraint on a survivor of sexual or physical abuse risks re-traumatising the patient.
It is essential that we take steps to reduce the use of force and address the unconscious bias currently reported in the system. My hon. Friend’s Bill seeks to do that in four key ways: through transparency, evidence, accountability and justice. The Bill will increase transparency. Currently, data are not collected uniformly so accurate data on how often restraint is used, and on how restraint is used disproportionately against certain demographics, are hard to collate. The Bill requires a registered provider to keep a record of any physical restraint of a person at any of its mental health units. That will include the place, time and duration of the restraint, the gender, age and ethnicity of the person who has been restrained and, critically, justifications for the use of restraint. Recording in a uniform way when, how and why restraint is used, who it is used on and what steps were taken to avoid its use, will increase transparency. It will allow us to take steps to improve the system where issues of unconscious bias or the overuse of restraint occur.
The Bill introduces steps to build and improve the evidence available when force or restraint are used. Currently, many forces require officers to wear operational body cameras, but not all. The Bill will require all police officers to wear such a camera when they are called to a mental health unit for any reason, unless there are clear operational reasons for not doing so. Research carried out at the University of Cambridge found that the use of police body-worn cameras made the use of force 50% less likely. Furthermore, the research found that the number of complaints filed against officers reduced tenfold. The evidence shows us that body-worn cameras work. They increase public trust in the police and protect our police officers from spurious complaints. The Bill would therefore improve overall accountability.
The Bill creates two further duties: it requires the responsible person to make and maintain a written policy for the use of physical restraint and take steps to ensure that physical restraint is used only in compliance with that policy, and it requires training to be provided to all frontline staff.
The Bill also seeks to improve access to justice. We want to ensure that tragedies such as those we have heard about today do not happen again. The bulk of the Bill works towards that goal. When tragedies such as what happened to Seni occur, we need to make sure that they are properly investigated and that the families of the victims receive justice. The Bill makes it compulsory for an independent investigation to be carried out whenever a death occurs in a mental health unit and the person has been physically restrained. This will end the scandal of families not knowing the circumstances of their loved one’s death.
The Bill is a step towards a model of care, rather than one of containment. Its measures will support mental health patients, their families, and emergency service workers. It will increase public trust in the emergency services and promote dignity and respect in mental health services. Restraint is used too often and disproportionately in certain sections of society. This cannot be allowed to continue. When she responds, I hope the Minister will support the Bill and allow it to be sent to Committee.
Rishi Sunak (Richmond (Yorks)) (Con)
It is a privilege to be called to contribute on this important topic. Many constituents wrote to ask me to participate in this debate, so they will be delighted that I have the opportunity to highlight some of the issues they raised. I commend the hon. Member for Croydon North (Mr Reed), not only for securing this debate and championing the Bill but for the constructive and consensual way he has gone about it.
So much has changed about our understanding of mental health. There was a time when we thought of mental health problems as something that happened to other people, away from ordinary life. Now, how many of us have a friend, a colleague or a family member who we know has suffered from mental ill health? That is because more people rightly no longer feel any shame about a mental health problem. Because society is on a journey of understanding, attitudes are changing and stigmas are breaking down.
We all recognise that good mental health is no less important than good physical health, but there is still so much more for us to do. The Bill is the next step in our national journey towards ending the injustices that those who experience mental health problems still face. It is for that reason that I congratulate the hon. Member for Croydon North, who has spent many years working with the family of the late Seni Lewis as they fought for the truth about what happened to their son. It is crucial that we learn the right lessons from what happened to Seni, which is why I am pleased to be able to discuss the important changes that the Bill will make to transparency in mental health units.
I wish to highlight three issues: first, I shall discuss how young people in particular are affected by mental ill health; secondly, I shall discuss some of the measures that the Government have already put in place to improve diagnosis and treatment; and lastly, I shall touch on just a few of the vital changes that the Bill will introduce.
I shall start with the topic of mental health and young people. I am passionate about helping young people to get the best possible start in life. Children and young adults should face no barrier to making the most of their unique talents and enjoying their lives to the full. Often in this Chamber, we think of the obstacles that young people may face in terms of social mobility, access to a good job or apprenticeship, or getting the right education. We are right, however, to highlight today that mental health merits no less of our attention. If we are to ensure that young people can make the most of the opportunities they have and deserve, mental health provision for them must be as accessible and high quality as possible.
The sad truth is that mental health issues disproportionately affect young people. Many of us in the Chamber are all too familiar with the negativity and hurtful comments that some people choose to spread via social media. I ask hon. Members to put themselves in the shoes of a young impressionable teenager or primary school student. One in 10 young people say they have been a victim of cyber-bullying. It is hard to imagine how difficult it might be for a young person when their smartphone or social media become ways for bullies to reach them.
I commend Google, with which I recently participated in a workshop in my constituency talking to primary school children about internet safety and how young people can protect themselves online from unwanted and hurtful attention. Google, I believe, is rolling out this project across the country, and I would urge hon. Members on both sides of the House to work with it when it comes to their constituencies, visits their schools and talks to young people about the importance of protecting themselves online.
Bob Stewart (Beckenham) (Con)
That is fascinating. Will parents be able to put some sort of inhibitor on Facebook, or just the child?
Rishi Sunak
My hon. Friend makes an excellent point. The workshops provide packs for teachers to give to children to take to their parents so that parents become much more engaged with their children’s online presence, which is something that I, as a parent of young children, am becoming more aware of, as I am sure many others in the House are. We all must be aware of what our children do online, just as we are careful when they cross the street or go to the park.
Alex Chalk (Cheltenham) (Con)
My hon. Friend is right to draw attention to the sensible measures being put in place to help potential victims, but we have to go beyond that: perpetrators of vile abuse have to understand that there will be consequences for them. The onus should not always be put on the victim: the perpetrator must expect to be punished too.
Rishi Sunak
My hon. Friend makes an excellent point—and one he has spoken about before. My hon. Friend the Member for North West Hampshire (Kit Malthouse) has also spoken passionately in the House about what more we need to do to protect children online and ensure they have a safe space to play and learn about the world around them.
Oliver Dowden
My hon. Friend rightly pays tribute to the work of our hon. Friend the Member for North West Hampshire and makes an important point, which pertains to mental health, about children needing a safe architecture in which to grow up. Just as we, as parents, give them safety and security in the physical world, so they must have safety and security in the online world, where they spend increasingly more of their time.
Rishi Sunak
My hon. Friend is absolutely right and puts it better than I could myself, so I will move back to the physical world, if I may.
Sadly, the evidence is that self-harm among young people is on the rise. It is right, therefore, that the Government have responded by improving mental health training in schools. Many colleagues have already mentioned the importance of appropriate training for those dealing with children—or adults—with mental health issues. This vital training will help teachers and staff at schools not just to identify but to assist at-risk children.
Helen Whately
My hon. Friend is talking about mental health treatment for children and young people, where we know a huge amount of work is needed to improve services and meet rising demand, but does he welcome, as I do, the fact that last year an extra 21,000 children were treated by children and young people’s mental health services? We are making progress in this area.
Rishi Sunak
I thank my hon. Friend for her comment, and I know that she is a tireless advocate for healthcare services, especially mental health services, in this place. I did not know that particular statistic, but it is indeed very welcome and will be welcomed, I am sure, by hon. Members on both sides of the House.
Furthermore, it should be our aim that children are not sent out of area to be treated for general mental health conditions. Representing a large and sparsely populated rural constituency, I am particularly focused on this issue of accessibility. Right now, the local mental health trust is looking to shift in-patient services away from our excellent local hospital, the Friarage, in Northallerton, to places as far afield as Darlington, Middlesbrough and Bishop Auckland, which will mean more than an hour and a half’s drive for some patients. This is of considerable concern to me and no doubt an issue that other colleagues will have experienced themselves. Against that background, we owe it to young people to ensure that mental health services are safe and transparent, so that when young people seek help, as Seni and his family did, they will receive it, secure in the knowledge that they will receive the high standard of care we all expect.
Secondly, I turn to the action that the Government are already taking on this important topic. Legislating for parity of esteem was a landmark step in the journey to tackling the injustices faced by people suffering from mental health problems. As we all know, however, making this parity of esteem a reality in everyday life will require not just effort but determination. We cannot, however, be in any doubt about the Government’s efforts, led by a Prime Minister passionate about this issue and determined to do more than ever before to bring about real change and to tackle what has aptly been described as a burning injustice.
The Prime Minister has overseen a £1 billion increase in the funding available for mental health and, as my hon. Friend the Member for Torbay (Kevin Foster) mentioned, championed a reduction in the number of people suffering a mental health crisis who end up in a police cell rather than a place of safety in the healthcare system. The whole House eagerly anticipates the conclusion of the review led by Professor Sir Simon Wessely, who is looking at why detention rates under the Mental Health Act are increasing.
Afzal Khan (Manchester, Gorton) (Lab)
I congratulate my hon. Friend the Member for Croydon North (Mr Reed) on bringing the Bill, which I support, to the House. I wish to make two points. First, constituents of mine, including professionals working in this field, have pointed out to me that racism causes people from black and minority ethnic backgrounds to experience mental health issues. We have heard statistics today showing that BME groups—especially black Caribbean people, who are also over-represented in hospitals and as detained patients—are more likely to be admitted to hospital. Secondly, unconscious bias among clinical professionals affects how mental health services respond to and meet the needs of people from different racial and religious backgrounds. Does the hon. Gentleman agree that it is right that the Bill will increase data and transparency on this issue?
Rishi Sunak
The hon. Gentleman’s intervention was timely, for I was just about to say that we should examine the important, complex and sensitive issue of whether minorities are disproportionately suffering poor mental health treatment or outcomes. We should be careful, however, about reaching for the knee-jerk—and potentially mistaken—conclusion and labelling the problem as one of institutional racism.
In that regard, I hope that Sir Simon Wessely takes note of the arguments made forcefully by Munira Mirza, the former Deputy Mayor of London, who has cited Professor Swaran Singh, a social and community psychiatrist with, I think, 30 years of clinical experience in this area, who has argued that institutional racism in his profession is not the primary cause of BME communities’ being disproportionately affected by these issues. He cites academic studies showing that BME communities and migrant groups are more exposed to mental health risk factors. We should tackle those underlying risk factors as a matter of priority. They include things such as family breakdown, substance abuse, poverty, living in areas with low social cohesion and, of course, the personal experience of migration and prior instances of racial prejudice. It is a sensitive area. The headline numbers obviously pose difficult questions for our public services, but we should get to grips with the underlying data before reaching for conclusions that may well be incorrect and that may not pay tribute to the work that people are doing with the best of intentions.
We must be more ambitious and use every opportunity available to further our efforts. Programmes such as mental awareness courses in the National Citizen Service or the £150 million that the Government are investing to support teenagers with eating disorders are practical, and will ensure that discussing mental health is not something that we do only in isolation or that happens only in a clinical setting.
Helen Whately
Does my hon. Friend agree that the recent announcement that 1 million people will be trained in mental health first aid is a huge step forward in raising the skills and awareness of those who help people with mental health issues?
Rishi Sunak
As ever, my hon. Friend makes an excellent point and displays her knowledge of this area. It is absolutely right that we bring help to people wherever they need it and in as many settings as possible. I very much welcome the extraordinary increase in the number of people being trained.
Indeed mental health provision needs to be part of an ongoing conversation about the development of young people and the issues that they face. I am confident that we as a society are now heading in the right direction. However, as I have noted, despite that substantial progress, we can in no way believe that the job is done. That is why I will now turn briefly to a few provisions in the Bill and say why they will make a real difference to the transparency in treatment of young people across the country.
The Bill will establish the requirement that mental health units must publish how and when they use force. That appears to be an eminently sensible change. All of us will be familiar with the detailed reports from Ofsted and the Care Quality Commission. The information that they publish gives us a window into how our public services are being run. Making information available about the strengths and weaknesses of organisations gives us the transparency that is needed to know what improvements need to be made. I see no reason why this should be any different with data on the use of force. This transparency is needed not just by the general public, but by the families of patients against whom force has been used. Of course, sometimes, health professionals will make the difficult judgment to use proportionate force in certain circumstances, but it took seven years for the Lewis family to get the full truth about the event that led to their son’s death. No family should be put in that position ever again.
The Bill also establishes a duty on the service provider of a mental health unit to record any instance of the use of force on a patient, in addition to recording several demographic characteristics. Added together with the requirement for police officers attending units to wear a body camera, the Bill will help us to be much clearer about how force has been used, against whom and why.
I wish to highlight the provision which says that, in the event of the death of a patient who was subject to the use of force, the Government will appoint an independent investigator who will produce a report on the incident in a timely fashion. Families who undergo such a tragic loss will have the official help that they need to get to the truth about what happened to their loved one. Those are essential changes that I hope will ensure that, in future, no family will have to fight as hard as the Lewis family did to get the truth that they deserve.
In conclusion, as many as one in four of us will experience mental ill health at some point in our lives. This is an issue that is simply too profound for us not to ask ourselves as legislators in this place, “What more can we do to prevent injustice occurring? What barriers must the House help to break down?” That is why, once again, I commend the hon. Member for Croydon North for his long-standing efforts on behalf of both the Lewis family and, more broadly, the many people across the country who suffer from mental health problems. The provisions in this Bill will give families and the public the transparency that is needed to ensure that force is used only when necessary. It is part of the journey that we are on as a nation to ensure that people with mental ill health are viewed no differently to those with physical ill health. I commend the Government for backing this vital piece of legislation, and I have been delighted to speak in favour of it today.
James Heappey (Wells) (Con)
May I add my congratulations to the hon. Member for Croydon North (Mr Reed) on bringing forward this Bill? I warmly support it and applaud his willingness to work with people across the House to ensure that the Bill fully meets the concerns of Seni’s parents and family and others who have been in such circumstances—I will share another story with Members on behalf of one of my constituents shortly—and works properly for those who are involved in mental healthcare in our country and who, like our police, will occasionally have cause to restrain those who are mentally ill. Those people work in very challenging circumstances and it is important that the Bill fully reflects that and is workable and fair to them as much as it is fair and transparent for those who are on the receiving end of its provisions.
I wish to discuss three areas, the first of which is the story of my constituent, James Herbert, who died in police custody in 2010. He was mentally ill and had been restrained shortly before his death. Secondly, I wish to look at how this Bill might have helped in that situation and how, in so many ways, it will certainly help to ensure that those sorts of events do not happen again. Thirdly, I will consider what additional training we might offer not only to our police, but to those who work in mental health. We need to make sure that, yes of course, there are safer techniques for restraint, but that there is also a much greater understanding of how we de-escalate those circumstances so that restraint might not be necessary.
James Herbert was known to the Avon and Somerset police, particularly those serving locally in and around Wells, as being mentally ill. Over the course of the day on which he died, there were a number of occasions when the police had had cause to observe his behaviour. On the evening after a hot June day, he was detained by the police. In the process of that detention, he was restrained. He was then put into a police van and driven for 45 minutes to a custody suite where he was stripped naked and put into a police cell. He died later that night of a cardiac arrest. The Independent Police Complaints Commission has looked in full into his death in the seven years since, and its report “Six missed chances” is rightly very critical of what happened that night. It is important to note that the police officers involved—one of whom is still a constituent of mine; the other, very sadly, took his own life a year or two ago—have not been held personally responsible for what happened. The failings that were identified were systemic, institutionalised failings—that sort of misunderstanding of mental health and the way that the processes were handled.
The Bill brings forward a very important aspect of how we deal with those with mental ill health. Sometimes, restraint is unavoidably necessary, but how that is done can have a profound impact on people such as the constituent of the hon. Member for Croydon North and my constituent, James Herbert.
Undoubtedly, the Bill will help. Staff not deliberately restraining people in a way that constrains an airway is clearly a very important and necessary provision, so, too, is restricting the intervention of a restraining technique that causes pain. Similarly, people should always seek to use the least restrictive method of restraint possible. Those are necessary de-escalatory measures, which in themselves could help, not quite to calm the person but at least not aggravate them further, which happens so often. The more that I have spoken to police officers about James Herbert’s case, the more they tell me that their concern to get their job done and retain the person means that they find themselves naturally going up through their levels of force and the application of their physical power. As both sides seemed to rub off of one another, they both got more and more aggravated, and the use of force became all the greater. The police reflected afterwards that they might have approached the situation differently in the first place.
James Cleverly
I do not know the ethnicity of the constituent who died in custody, but does my hon. Friend agree that it can be intimidating for police and medical professionals when the person they are dealing with is physically big and robust? As well as the measures in the Bill, they need our support to ensure safety for them and for the people for whom they are caring.
James Heappey
My hon. Friend, as ever, makes an excellent point. These are highly challenging, confrontational situations. James Herbert was white, but he was a big guy. As his anger and emotions built, so did the efforts of the police officers who were trying to restrain him for his own safety. My hon. Friend is right to observe that there some people who require restraint are physically very intimidating. The police officers or mental health workers involved in the restraint often fear for their own physical safety, which may lead them to use overly aggressive techniques. They may really be focusing on self-preservation, instead of on de-escalation. A great confidence is required in the techniques that have been taught for restraint, and in understanding how to deal with those who have acute mental health challenges. That confidence is absolutely necessary so that people are able to apply the right skills in the right way to bring about the right outcome, instead of fearing the physical situation in which they find themselves.
I agree very much with some of the other provisions in the Bill. Seclusion should be an absolute last resort. It is an alienating and escalatory measure. Then there is the immediate, confident and sympathetic engagement of other people involved in the care of the mental health patient. When the police were detaining James Herbert, they phoned his mother to talk to her about something very different, rather than to ask her about James’s condition and what she might be able to share with them in order to manage him much more appropriately in the situation.
I agree passionately with the use of body cameras. I have seen the profound impact of James Herbert’s case not only on his own family and friends, but on the careers, lives and mental health of those involved in his detention and, sadly, his death. Body cameras would have made an enormous difference in this case.
Mrs Sheryll Murray (South East Cornwall) (Con)
I welcome body-worn cameras. However, when someone is subjected to immediate harm in an emergency case, the absence of a body-worn camera should not prevent someone from coming in to address the situation. Does my hon. Friend agree?
James Heappey
I accept that there are situations that require immediate intervention. As a former soldier who was used to working on immediate notice to move at times, I suggest that the solution is that there must always be somebody in a custody suite or a mental health ward who is wearing the right kit and is on immediate notice to move. It should be a requirement, and it should be a simple drill for those managing the facilities. That is not to say that everybody needs to be sat around at all times, wearing their stab vest and their camera. But one person in a custody suite should be required to be wearing the appropriate kit at all times. Perhaps that is something to include in the Bill. The cameras are a great addition to what police officers wear. In fact, they are a de-escalatory measure in themselves. Away from cases of people suffering with mental health issues, I have been told by the local police commander for my part of Somerset that the simple act of turning them on has such an effect. People on the high street who have had a few too many drinks see themselves on the screen and know that their behaviour is being recorded; things immediately start to calm down and responsibility returns.
Mr Reed
I am grateful to the hon. Gentleman for raising this important point and I agree with the point made by the hon. Member for South East Cornwall (Mrs Murray). The hon. Gentleman will be interested to know that there is a weight of published academic evidence showing that the mere presence of police wearing body cameras reduces the likelihood of force being used in these circumstances by nearly 50%. That alone is reason enough to require police to wear body cameras.
James Heappey
The hon. Gentleman is absolutely right. It is great on days like today when the House is in such violent agreement. The cameras really are a great addition for our police forces. They give transparency for those who want to complain about perceived unfair treatment. But they also give a protection as important as the stab vest, by reassuring police officers that they will have a video record of what they did.
Will Quince (Colchester) (Con)
I accept points from both sides of the House on body-worn cameras. The Bill makes it clear that the officer has to turn the device on as soon as practically possible from the point at which they are called. Does my hon. Friend think that it would be more practical to say that that should be at the point they attend the mental health unit, not the point at which they take the call? Is not that a little too onerous for the officers? I am just posing the question.
James Heappey
From discussions with local police constables and with the police commander, it seems that police officers have an instinct for when they are going into certain types of situation. One would imagine that if an officer were on the custody desk and heard that something required their intervention, they would obviously flick on their camera as a matter of drill while they were going down to the cell or wherever something was happening. That is assuming what we were just discussing—that it should be standard practice that somebody in those circumstances is always fully kitted out.
Kevin Foster
The requirement in the Bill is for officers to wear body-worn cameras when attending a mental health unit. My understanding is that that means that the unit has an issue and has called the police to attend. In many instances, custody suites have cameras, even though they may not be body-worn. The real solution is that response officers—those who are deployed ready to attend 999 calls—should have body-worn cameras. That would help not just in these instances, but in many other circumstances.
James Heappey
My hon. Friend is right, but whenever attending a call-out to a mental health unit—just as in attending any other event in the community—the police officer would have deployed in their patrol car wearing their full kit. They would already have been wearing the camera and would have switched on it on as they were entering the situation, if they thought that were necessary. The much more likely scenario, as perhaps would have been the case with James Herbert, is of people being called into a situation when they are not out on the street, but are just nearby and lending a hand. The fixed cameras in the building may be obscured by those doing the detention, so I also see real merit in body-worn cameras being used in those situations.
This is not just about how to ensure that acute, immediate interventions are handled properly. It is also about the additional training that might be offered to police and mental health workers to make sure that these situations do not arise in the first place. Training is key. That goes without saying for mental health workers, who, by vocation, understand this stuff very well indeed, but the police are much less confident in dealing with people with mental health issues than they should be.
Training for the police so that they can spot those signs and intervene appropriately with concern and care would be helpful and would prevent a large number of the instances that we are debating. There are techniques for reassuring people, for de-escalating, and for managing the anxiety that often manifests itself in people with mental illness. Equipping police with those skills would be very welcome indeed.
James Cleverly
A number of years ago, when I served on the London Assembly, I visited Feltham young offenders institution. I cannot help but think that there are a number of young men in Feltham who had mental health problems but whose interactions with the police and authority during mental health episodes reached a stage at which they became violent and ultimately found themselves incarcerated, perhaps at least in part because of that lack of understanding and training on the part of the police. It is not a moral criticism but an observation that training could help the police officers and some of those young men, who were ultimately incarcerated in what was not necessarily the most appropriate institution.
James Heappey
I very much agree. It is interesting to reflect on conversations I have had with police and community support officers in my constituency. The nature of their job means that they understand or know more intimately the community they serve. Very often they have an insight into the mental health of people they routinely see around town who are on the edges of antisocial behaviour or even breaking the law. They can often deal with them very differently because they understand who they are dealing with. The PCSO job description is such that PCSOs naturally seek to de-escalate and deter, rather than enforce the law. My hon. Friend makes an interesting observation, and I certainly agree that it is possible to avoid these circumstances arising as often as they do.
Wera Hobhouse
The hon. Gentleman has pointed out the importance of PCSOs, but many police authorities are having to cut those services. Does he not agree that it is regrettable that police services have been cut and that important PCSO services have been taken away from the community?
James Heappey
My near neighbour, with whom I share probably the most beautiful diocese in the country, makes an interesting point, which she and I might jointly take up with the police and crime commissioner for Avon and Somerset. The decisions on how PCSOs are allocated are hers. It is not my experience in my constituency that PCSO numbers have been cut. In fact, I have been impressed by the service that we have received from PCSOs in Somerset during my time as MP for Wells. The Bill is not exclusively about the police—it is about the way in which we deal with people with mental health challenges.
Kelly Tolhurst (Rochester and Strood) (Con)
It is really good that my hon. Friend has highlighted the role of PCSOs. In January, we will increase the number of PCSOs who police our communities in Kent, because we recognise that they play a key role in the transition from meeting people with mental health issues on the streets to being able to direct them to the right care at local level, rather than getting police officers directly involved at the first point. Does my hon. Friend agree that that is a good thing, and we must recognise that we are increasing numbers in some places?
James Heappey
I very much agree. I have no first-hand experience of policing in Kent, my hon. Friend will be pleased to know, but I certainly agree that PCSOs are important. I do not see them in any way as a poor substitute for police officers. The way in which PCSOs carry out their job is excellent. I am fortunate to have some excellent PCSOs serving towns and villages in my constituency, and they make a big difference by intervening and making sure that crime levels stay low.
We have spoken a lot about the police—inevitably so in my case, because my experience has come about as the result of a death in custody, and I wanted to share that with the House. This is really about a wider way in which we care for people with mental health conditions. Mental health is something I am passionate about, and I learned a great deal about it while serving in both Iraq and Afghanistan. Before doing so, I was very much a member of the club that said that people should just pull themselves together. The reality is that when you see people who are absolute heroes—strong, strong people—who have served in the Army for 20 years, and you see their head break, you stop making the distinction between someone having their leg blown off and someone having their head break because they have witnessed a trauma that was so profound that it did something to them and over which they had no more control that someone who has lost a limb. That led me to look keenly at what mental health provision looks like in my community.
I had quite an epiphany when I realised how important mental healthcare is. Today we are discussing how to deal with people in the moment of most acute crisis. That is a necessary discussion, but it must not distract us from the urgent need to discuss how to stop people getting to crisis point in the first place. Somerset’s mental health provision is quite hollow. We have more than adequate provision of acute mental health beds, and we have reasonable provision of community nursing, but we do not have the stuff in between: the crisis houses—the step-up, step-down facilities—that can help people to find a bit of space to avoid or see off the imminent danger of a critical episode. That could prevent their having to go to an acute facility where things might escalate even further and might stop the horrible situations we have been discussing arising.
We must also look at how we do much more upstream prevention involving mental health charities in particular. Their role is enormously important. In Wells, Heads Up, of which I am a patron, and Charley’s Memory in Burnham-on-Sea—again founded as a result of a real tragedy to do with mental health—do amazing work in our communities. They work voluntarily and charitably, but they do something that should be a really important part of a broad, deep network of mental health provision that helps to manage people through mental illness at the appropriate level and prevent their slipping into crisis as much as possible.
We must push even harder to break the taboo on mental health in our communities. If there were greater acceptance of mental health conditions and people were more willing to be open and to talk about the issue and support people with mental illnesses, fewer people would find themselves in crisis because they had become isolated and their vulnerability had become such a problem that they made a big cry for help or their illness escalated to crisis point. Parity of esteem is not just about money, although in Parliament the debate often focuses on that. It is about attitudes and acceptance too. We need a mental health system that has real depth so that we can make sure that people who are living with mental health conditions can do so with dignity, not being unnecessarily aggravated because they have unreasonable waiting times for mental healthcare, but supported by an understanding and supportive community.
Mental health workers do amazing things, and so do the police who have to work with those who are suffering from mental illness. Nothing that we are discussing today should be seen a criticism of what they do. They should understand that we understand, fully, the extraordinarily challenging circumstances in which they work day in, day out. I thank them for the extraordinary hard work that they do.
Edward Argar (Charnwood) (Con)
Like other hon. Members, I pay tribute to the work of the hon. Member for Croydon North (Mr Reed) in bringing forward this Bill. As someone who was lucky enough to get drawn in the private Members’ Bill ballot last year, I know that luck plays a part but, more importantly, so does passion. He has shown that in talking very movingly today about his constituent and what has motivated him to take forward this important Bill. I think his constituents will rightly be very proud of the work he is doing on it.
I very much welcome and support the Bill. I know from my casework and more generally that it will be welcomed in my constituency and more broadly across the country. The tone in which this debate has been conducted reflects very well on our proceedings in the House today, as does the fact that on such an important issue, hon. Members who wish to speak are having the opportunity to do so. Our constituents would expect no less. They would expect all of us who wish to speak to have the opportunity to put our views on the record about this important issue.
As the shadow Minister made clear, this Bill is about transparency and accountability. It is also about changing attitudes, and about risk. Most importantly, it is focused on making the processes involved in our treatment of those who are detained in mental health units more people-centric. As my hon. Friend the Member for Richmond (Yorks) (Rishi Sunak) said, the circumstances that can lead to someone being detained in a mental health unit could happen to anyone. Mental ill health can happen to anyone, and it is important that we remember that. We are talking about people at their most vulnerable in these situations. As my hon. Friend the Member for Hertsmere (Oliver Dowden) pointed out, we are very good as a society at understanding physical ill health because we can see it, but less good at understanding mental ill health because it is more intangible and much harder to see. The hon. Member for Croydon North said that this is about compassion, not cruelty. At times, given the nature of the circumstances, restraint may be needed at a moment of crisis, but it must be applied in the right way and it must be minimal. We must always focus on dealing with such incidents in the right way and doing what we can to assist people in their recovery.
It is important that we highlight—as hon. Members have done, most recently my hon. Friend the Member for Wells (James Heappey)—the debt of gratitude that we owe to all those working in the emergency services, including in the mental health setting, for the incredibly difficult job they do with an amazing degree of professionalism, compassion and care. In that context, I very much welcome clause 5, with its emphasis on the provision of training. This is about protecting and supporting not just those who are detained in mental health units, but those who may have to intervene in applying restraint. The hon. Member for Stroud (Dr Drew) referred to the need for those workers not only to be trained at the induction stage but to have the training refreshed throughout their careers. That is an important point.
This Bill is about reducing the use of restraint where possible, but, as I said, it is also about risk. Too often in our society, be it in the private sector or in the public sector, there is an understandable desire to eliminate risk. The reality is that that simply cannot be done. Instead, we must seek to understand and mitigate risk, and ensure that that understanding drives the right behaviours. The data that the Bill will provide, the transparency it brings, and the understanding of how restraint operates in these settings will all feed into a better understanding of risk that will hopefully improve the way in which we treat those detained in mental health units. Of course, as the hon. Member for Croydon North made clear, this is about justice. In the tragic cases—I hope they are few in number, but they do occur—in which someone dies, it is important that the evidence exists to facilitate justice for that person and to ensure that we learn the lessons of the incident.
Finally—conscious of the importance of giving all who wish to speak the opportunity to do so, because that is what our constituents would expect—I turn to the point about changing attitudes. Attitudes to mental health in this country are changing, but there is still a long way to go. Every time we talk about mental health in this Chamber, we help to change attitudes and reduce any stigma attached to mental ill health. It is right that we continue to do so. We are on a journey, on which this welcome Bill is a hugely important step. A similar step will be the review that is under way of the Mental Health Act. The legislation may be of its time, but it is certainly not fit for our time. In that context, in addition to what we are discussing today, we must seek to create a mental healthcare system of which we can be proud, and which is fit for the 21st century. It is a pleasure to support the Bill.
Will Quince (Colchester) (Con)
I add my congratulations to the hon. Member for Croydon North (Mr Reed), who is not in his place, on introducing the Bill and on the emotive and heartbreaking story that he shared with the House.
The Bill is an important part of a wider issue. We need to improve our approach to mental health. Without question, mental ill health carries a stigma and a taboo, and Members from both sides have played a huge role in tackling that. One of my passions is campaigning on baby loss, which has a similar stigma and taboo attached to it. We do not talk enough about it, and that has led many people to stay silent. If we are to tackle the stigma and taboo, we have to raise these issues as much as possible and ensure that people feel able to talk about them openly. There is no greater place to do so than on the Floor of the House of Commons Chamber.
The Mental Health Act has remained unchanged since it was first published in 1983, and many consider it to be no longer fit for purpose. As a comparison, when the legislation was introduced, the Diagnostic and Statistical Manual of Mental Disorders, which is known as the DSM, existed in its third edition. Since then, it has undergone multiple revisions, and it is now in its fifth edition. The research into mental health conditions and our understanding of them have developed, particularly over the last three and a half decades, but our legislation has not changed. That is not good enough.
The Bill is one important step among many towards ensuring that people with mental health conditions are treated appropriately. I want to make it clear that there will be circumstances in which restraint is required in mental health units. That is, sadly, inevitable. Staff in such units have an incredibly challenging job. We would all agree, however, that restraint should be the last resort, not the first. I pay tribute to Mind, which launched its campaign in 2011 to reduce the use of restraint in healthcare settings. It has made fantastic progress so far.
In 2014, the coalition Government published guidance in this area following investigations into abuses at Winterbourne View hospital and a report published by Mind, which found that restrictive interventions were not being used as a last resort. The guidance made it clear that staff must use such actions only if they represent the least restrictive option for meeting the immediate need. The guidance also made it clear that staff must not deliberately restrict people in such a way as to impact on their airway, breathing or circulation. That includes face-down restraint on any surface, not just on the floor.
I continue in the spirit of the coalition Government by paying tribute, as my friend the hon. Member for Bath (Wera Hobhouse) has done—she is currently looking at her phone on the other side of the Chamber, and I cannot attract her attention—to the right hon. Member for North Norfolk (Norman Lamb) for the work that he did as a Minister. I know that this is an issue that he cares deeply about. I know that the right hon. Gentleman is not in the Chamber at the moment, but I certainly want to put that on the record—the hon. Lady still has not realised that I am complimenting her colleague—because he did a huge amount of work in this area.
Later in 2015, the Mental Health Act 1983 code of practice was revised, and NICE updated its guidance on violence and aggression, both of which put the emphasis on prevention and advised against the use of prone restraints. What all this recognised is that the solution is not to blame the staff, but to give them the skills and confidence to deal with some incredibly challenging situations.
In September, I visited the Lakes mental health unit in Colchester to see at first hand what a mental health unit is like. I initially had a brief meeting with senior managers, including Sally Morris, the chief executive of the Essex Partnership University NHS Foundation Trust—the names of NHS trusts always seem to be a bit of a mouthful—which manages the Lakes unit in my constituency. I was then given a tour of Ardleigh ward and Gosfield ward, and we discussed many issues. Restraint was not one of the issues we discussed, but following the debate on this extremely important Bill—the hon. Member for Croydon North, who introduced it, is now in his place—I will definitely be asking questions about the use of restraint in that unit.
I support what the Bill is seeking to achieve on training, especially as set out in clause 5(1). In many ways, it strikes me as remarkable that frontline staff would not already be given such programmes, but this is a good way of ensuring that staff, particularly new staff, are aware of best practice and guidance on the use of force. I suggest, however, that the Committee looks at whether the provision should be wider than just induction, so that existing members of staff are also given this training. In any workplace environment, it is incredibly important for people to be given refreshers to ensure that training remains fresh and at the front of their mind.
Another area I want to touch on is the mandating of body cameras for any police officer who attends a mental health unit. A number of colleagues have already raised this issue, but I want to focus on one particular area. It is important to mention from the outset that the use of body-worn cameras is ultimately a decision for local police and crime commissioners. Police forces are at different stages in this process: some are just investing now; and others are looking at new equipment, because they have used body-worn cameras for some time and are now in the second phase of procurement.
I suggest—I mentioned this in an intervention on my hon. Friend the Member for Wells (James Heappey)—that clause 13(2)(a) is perhaps a little too eager in expecting officers to turn on their cameras. It states:
“The police officer must ensure that his or her body camera is recording…from as soon as reasonably practicable after the officer receives the request to attend the mental health unit”.
That might be looked at in Committee, because the focus should perhaps be on ensuring that there is a recording of their attending the mental health unit, rather than from the point at which they get such a request.
Kevin Foster
My hon. Friend is making some very interesting points. Does he agree that the presumption is that an officer who is on duty and using a body-worn camera should have it switched on? Only when an officer has a specific reason to turn it off—for example, when dealing with a vulnerable witness who is uncomfortable talking while the camera is on—should it be switched off.
Will Quince
My hon. Friend raises a very good point. I come back to what I said earlier about body-worn cameras, which is that police forces are at different stages in the evolution of these pieces of kit. Their cameras have different battery lives and different download capabilities—some recordings take several hours to download, but more modern functionality means that that can be done quite quickly—so it depends where police forces are with their procurement and how long they have had the equipment. I totally agree with him, however, that the presumption is that this piece of equipment should be on, and that is and should certainly be standard practice for newer cameras.
Mrs Murray
My hon. Friend mentions a point I was about to raise. A battery could expire or there could be a software glitch, so maybe the clause needs to be tweaked in Committee. I wonder whether the hon. Member for Croydon North will consider that carefully if the Bill reaches the Committee stage.
Will Quince
My hon. Friend raises a very good point. I think we are all largely in agreement about the use of body-worn cameras, and I think we all think they are an excellent evolution in policing that protects both the public and police officers. I hope the hon. Member for Croydon North does consider that carefully in Committee, working with senior police officers who use the equipment on the ground to work out how the proposed legislation should be worded to ensure it is exactly right on this point.
Essex police works in partnership with the NHS in a county-wide street triage programme that helps to provide the best possible care to people with mental health issues. This trailblazing idea works brilliantly and I will come on to mention some of the statistics relating to it. Four street triage cars, staffed by trained officers and mental health professionals from the South Essex Partnership University NHS Foundation Trust and the North Essex Partnership NHS Foundation Trust, are available to Essex police. They operate seven days a week, from between 10 am and 2 am, and are based in Harlow, Colchester, Basildon and Rochford. Officers and mental health professionals attend incidents across the county if an individual is thought to be suffering a mental health crisis and is in urgent need of support or an intervention. The person is assessed by the officers and the mental health professional, who then gets them the assistance they need if it is appropriate to do so.
The programme follows the success of a four-month pilot that ran three nights a week. During that time, 269 individuals were assessed, of whom 11 were required to be detained under the Mental Health Act 1983. Others were referred to the appropriate services and given guidance from the mental health professional who was present. This initiative has been funded by the police and crime commissioner. The scheme has proved instrumental in reducing, by nearly a quarter, the number of people across Essex detained unnecessarily by the police under section 136 of the Mental Health Act 1983. It has also ensured that those with acute vulnerability are given the care and support they need.
In summary, I very much welcome the Bill. It will ensure that staff working in mental health units are given the training that will enable them to give patients the best possible level of care; training that I believe, having met staff at The Lakes mental health unit, they want to receive. There are a couple of areas in the Bill that need tweaking—I would be very happy to work with the hon. Member for Croydon North in Committee—but nothing should stop it from being given a Second Reading. I will be supporting the Bill.
Helen Whately (Faversham and Mid Kent) (Con)
I congratulate the hon. Member for Croydon North (Mr Reed) on introducing the Bill. I welcome the opportunity to speak on this important subject and I am pleased that the Government are supporting the Bill.
The more we speak about mental health—privately, publicly and especially here in Parliament—the more we wear away the stigma that surrounds it. As chair of the all-party group on mental health, I often speak to service users, professionals and campaigners from organisations such as Rethink Mental Illness, Mind and the Royal College of Psychiatrists. They tell me there has never been a better time to be a mental health campaigner. We have the five year forward view for mental health, a truly comprehensive and widely supported strategy to improve mental health care; a Prime Minister who is committed to fighting the injustice of inadequate treatment; and a Government who are spending record amounts on improving mental health care.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
The hon. Lady has highlighted the commitment made by the Government, but does she share my concern that commitments of money that have been made are not actually reaching the frontline and there is a wealth of evidence showing that many CCGs are diverting funds intended for mental health to other parts of our NHS?
Helen Whately
I have enormous respect for the hon. Lady; she is doing a huge amount of work campaigning on mental health. I have looked into the question she raises about finances getting to the frontline, and 85% of CCGs are spending at the level they should be on mental health, so the majority are meeting their obligation of increasing their mental health spend. I agree that a minority are not, and they are rightly being looked at and questions are being asked about what is going on there and why they are diverting money away from mental health, but the majority are doing so. The rate of spending on mental health is going up faster than the rate of extra money going to the CCGs—so the rate of spending on mental health is increasing faster than the increase in other parts of health. That is the right thing to do, as we must improve the status of mental health in our healthcare system and achieve parity of esteem, an ambition that I know the hon. Lady shares.
All of us have been moved by the awful story of Seni Lewis, who died after being restrained face down. As we have heard, that was not an isolated case. Those awful cases are happening despite the fact that there are strong guidelines even now on the use of restraint. The Mental Health Act code of practice states that restrictive practices should be used only when there is a possibility of real harm to the patient or other people. There is also National Institute for Health and Care Excellence guidance that states that staff should be trained to avoid or minimise restrictive practices on children and young people. Despite that, instances of restraint have been going up: 17% of girls and 13% of boys admitted to child and adolescent mental health services were restrained in 2014-15. The hon. Member for Croydon North is nodding as I say that. So the use of restraint is going up and is being used when there are better alternatives.
Restraint should be a last resort. It does enormous physical and psychological damage at times to the individual being restrained, and, as others have said, there are similar implications for those applying the restraint. So the Bill is badly needed and I welcome it, in order to put in place the right systems to train staff, create proper oversight of when restraint is used, and make the system more transparent and accountable.
Luciana Berger
Does the hon. Lady share my concern about not only the number of times people are being restrained, but the number of times particular individuals can be restrained? In the summer, we heard the example of girl X: Sir James Munby, the most senior family court judge in our country, wrote to the Government to raise the example of this girl, who was restrained 117 times because there was not an adequate place fit for her care. Does the hon. Lady agree that that is totally inadequate—in fact, horrifying?
Helen Whately
That is a shocking example, and I agree that both the general issue of the use of restraint and cases when particular individuals are having to be restrained multiple times need to be looked at.
I should provide some balance and say that I recognise that there are times when restraint is necessary. That has been made clear by the people providing mental health care whom I have talked to, but it is vital that the staff who restrain are properly trained, and the provisions of clause 5 of the Bill address that. By being properly trained, they will also be able to help protect patients from trauma and injury as a result of restraint, and it will also protect staff from possible litigation when things go wrong, which would of course be bad for staff who are trying to do a good job in providing mental health care. As others have said, this is a very tough and challenging, as well as a very rewarding, sector to work in, and I, too, thank that workforce.
I have also been told that at present anyone, no matter what their background and experience is, can offer their services as a restraint trainer. It seems strange that a certain standard is not required of the trainers who train people in restraint methods. Some kind of accreditation is surely required to ensure that the training is of an appropriate standard. I find it astounding that that is not the case, and that definitely needs to be looked into.
We need to get restraint right and ensure that the use of restraint techniques follows medical evidence. I want to put on record that, while the Mental Health Act code of practice says that there should be no planned or intentional use of restraint due to the risk of restricted breathing, the Royal College of Psychiatrists has warned me that the current medical evidence does not support the use of one type of restraint over another. This is clearly an incredibly difficult area to talk about, but we need to ensure that when restraint is used, the least harmful and least dangerous methods are employed.
It is certainly true to say that the level of restraint overall is too high across the system. The level of variation that exists between mental health units indicates that there are times when restraint is not always necessary. The Care Quality Commission has published a report, “The state of care in mental health services 2014 to 2017” in which it picks up on that particular point. The report states that the CQC is
“concerned about the great variation across the country in how often staff physically restrain patients whose behaviour they find challenging. This wide variation is present even between wards that admit the same patient group.”
The fact that similar patients are being admitted but receiving different treatment in different parts of the country indicates that something is going wrong. Those who are carrying out more restraint should surely work out how they can emulate those who manage to carry out less. The CQC also noted that
“those wards where the level of restraint is low or where they have reduced it over time have staff trained in the specialised skills required to anticipate and de-escalate behaviours or situations that might lead to aggression or self-harm.”
That points to the fact that training is part of the key to reducing that worrying variation.
The Bill will introduce extra monitoring. There is often a resistance to extra monitoring because of concerns about box-ticking and form-filling, but the professionals are actually supporting it in this case. The Royal College of Psychiatrists is backing the Bill, and it recognises the need for the right regulations and for proper oversight to reduce the use of restraint in mental health units. In fact, it has gone further and signed a memorandum of understanding with the College of Policing and the Royal College of Nursing on the use of restraint in mental health and learning disability settings. So the agenda is already moving on, and the Bill is helping to focus minds on what can be done straightaway, before it even becomes law, to improve the use of restraint.
I reiterate that we need to look at the use of restraint in special schools. There was a case involving some autistic children in my constituency who were restrained in a really shocking way. No one has ever got to the bottom of what happened in that situation. I will work with my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan), who has suggested that we should work together to take action on these problems as well.
As those of us who are active in campaigning on mental health will know, a major reform of the Mental Health Act 1983 is coming our way. That is very welcome and much needed. The reform will, for example, tackle the rise in sectioning and bring mental health legislation up to date. It might also have looked into the question of restraint, but it is a large piece of work. It is therefore absolutely right that, in the meantime, this Bill will take action quickly to improve the use of restraint in these difficult circumstances. Once again, I congratulate the hon. Member for Croydon North on bringing in the Bill, and I look forward to supporting it.
James Cleverly (Braintree) (Con)
I am conscious that it can sometimes be a blight on a Member’s political career to have someone from the other side of the Chamber lavish praise upon them, so I apologise in advance to the hon. Member for Croydon North (Mr Reed) because the opening comments of my speech could hang like a political albatross around his neck for some time. I hope he recognises, however, that even if that is the case—I suspect it will not be—the work he has done in bringing forward this private Member’s Bill will more than offset any detriment.
I suspect that when the Bill makes its way through the House and is enacted, people will look back at this as a tipping point. That is exemplified by the first few names on the list of sponsors. It is of great credit to the hon. Gentleman, both as an individual and a parliamentarian, that he is able to get support from all the parties in England and from both sides of the House. The Bill is drafted in a way that makes gaining cross-party support as easy as possible and gives it the best chance of being enacted. At a time of ultra-partisan politics around the globe and when things are proposed specifically to create division and to play games, it is refreshing to see a Bill that is clearly designed to improve and, in many instances, save lives, so I thank him for that.
The Linden Centre in Chelmsford serves my constituency, and I regularly have meetings with its management and with the Essex Partnership University NHS Foundation Trust. It is clear that the management of that mental health centre are passionate about protecting service users and improving the mental health of the people under their responsibility. I also have a close working relationship with Essex Police, whose officers are also passionate about protecting people. Before I go on, I want to echo the words of my right hon. Friend the Member for Wells (James Heappey)—[Interruption.] He is not yet a right hon. Member.
James Cleverly
It is inevitable. I echo the thanks that my hon. Friend the Member for Wells put on the record to the medical professionals, police and others who work so hard to try to protect people who have either acute or chronic mental health episodes. I would not want any of the conversation about deaths and restraint in mental health units and by police officers and others to be in any way seen as an implicit criticism of them. They do incredibly important work, often in the most difficult and challenging of circumstances.
Bob Stewart
My hon. Friend has close links with the police and with medical professionals. Do they use the same approach to restraining people? I would have thought that the police might be harder than nurses; do they use the same techniques and just apply different sections of the techniques?
James Cleverly
I only really have detailed experience of medical and policing practices from my time on the Metropolitan Policy Authority in London and now, as the representative of Braintree, from the Essex Police and my local mental health trust, so I cannot talk about the universality of the situation. However, without a shadow of a doubt, the message that I am picking up is that there is huge variation across and within constabularies and trusts.
The group of clauses relating to accountability is one of the most significant parts of the Bill, and my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) touched on this. I am one of those gruff and grumpy old Tories—[Interruption.] At this point, Members are supposed to join in a chorus of “You’re not that old.”—[Hon. Members: “You’re not that old!”] I thank hon. Members, although no one cried, “You’re not that grumpy.” Clause 7 is incredibly important. I am a gruff and grumpy old Tory, and my instinct is to take away as much red tape and administrative burden as possible but, as my hon. Friend the Member for Faversham and Mid Kent highlighted, this modest additional administrative burden is welcomed by the profession.
There is an old saying in management consultancy, “If you want to change something, measure it”—[Interruption.] I can see my hon. Friend the Member for Faversham and Mid Kent nodding. It is important to register the use of force whenever it is applied, because that will do two things. It will prompt a small pause for reflection if someone knows that they will have to justify the use of force, and it is inevitably a good thing if they recognise in that moment of pause that the use of force is not appropriate. Perhaps more importantly, if the decision is made that force is the appropriate action, clause 7 will mean that there is a record of all the times that force has been used, including the times when that force does not lead to injury or, in the most tragic cases, death. That will enable us to get an accurate understanding of how many times the use of force unfortunately leads to injury or fatality, which is important because it will remind us of the difficulty faced by many professionals.
Mr Reed
I am grateful for the hon. Gentleman’s generous comments earlier. I should make it clear that it is not my intention that the Bill should impose any additional administrative burden. Institutions already collect data on the use of force, but they do not collect it in the same way, so it cannot be compared. The Bill will simply standardise what currently happens to allow greater scrutiny, rather than imposing a new burden.
James Cleverly
That is a fair and balanced intervention. In my next sentence—honestly, this is true—I was going to list some things that, if they are not already collected, really should be collected. It is not a bad thing if the Bill creates a standardisation so that we can see the differentials between forces and trusts.
One of the most difficult and contentious points—this goes to the heart of my opening remarks about the impact the Bill could have on British society—is that, without a shadow of a doubt, we know that examples of huge community friction, of civil disorder and of further injury and loss of life have been caused when families, friends of families and wider communities feel that the use of force has led to an unnecessary death. I will be as cautious as I can with my words because of the sensitivities, but it is particularly acute in Britain’s black communities.
There is huge disproportionality between the black community in Britain and the rest of the communities in Britain—and it cannot possibly just be chance—in the rate of death and injury in custody of people suffering mental health episodes. That has to be addressed. No single Bill can solve the situation, as it has been long in the making and will take a very long time to resolve, but this Bill could be a big step in the right direction.
If, as I suspect it will, the Bill reduces the incidence of serious injury or fatality among people suffering mental health episodes, that will in itself have a knock-on effect in reducing some of the community friction and disorder that we have seen in the past. Unfortunately, I suspect there will be further cases where a black man is detained and dies after contact with the police, but if it can be evidenced that in all instances force is applied modestly, minimally and only when absolutely necessary, that might help to defuse some of the tensions that have in the past led to further difficulties.
In conclusion, I thank the hon. Member for Croydon North, and the other hon. Members who have supported this Bill, for introducing to this place a Bill that makes it easy for those of us who want to see genuine improvement both in mental health and community cohesion to support it. I commend it to the House.
Mike Wood (Dudley South) (Con)
Like other hon. Members, I wish to start by congratulating the hon. Member for Croydon North (Mr Reed) on introducing such an important Bill. I know from my own experience two years ago of being drawn high up in the private Members’ Bill ballot that it can feel a bit of a mixed blessing. There are a few days in the lead-up to publishing the Bill when they are probably among the most popular Members of Parliament; telephone lines and email inboxes are rarely idle. Of course once the simple step of presenting the Bill is done, the really hard work begins, not only in producing the Bill and the explanatory notes, but in starting to build the consensus that allows the Bill to have a reasonable chance of progressing into legislation. The hon. Gentleman has done that exceptionally well to this point, and I know he will be proceeding as he has begun.
I also wish to thank my constituents who have contacted me, some with their own experiences and others with their own views of the current use of force in mental health units. I also thank West Midlands police and the range of organisations with an interest in mental health policy which have briefed us all, shedding new light on both the scale and nature of the problems in the system.
In recent years, mental health has come to the fore in public policy, and much of that is due to the outstanding work done by a number of right hon. and hon. Members who have a real passion for improving the way mental health is treated and ensuring that parity of esteem is not just a catchphrase but rather that it reflects the way mental health is treated, not only in the NHS, but across public policy and society more widely. In particular, I am thinking of the excellent work done by my hon. Friend the Member for Halesowen and Rowley Regis (James Morris), when he chaired the all-party group on mental health; by the Secretary of State for Health; and by my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and, of course, the right hon. Member for North Norfolk (Norman Lamb), when they were Ministers responsible for mental health.
We have seen the changes in the guidelines and the way sections 135 and 136 of the Mental Health Act 1983 are handled, and the new provisions that will be brought in through the Policing and Crime Act 2017, which gained Royal Assent earlier this year. The political consensus that there is a need to do more is being matched with real progress in both policy and legislation. All of us have welcomed the prominent place mental health reform has had, not just in the Conservative manifesto ahead of the general election, but in its being reflected in the Queen’s Speech and in the Prime Minister’s announcement that the Government would begin a comprehensive review of the Mental Health Act. Public servants who work in the police, the NHS and the justice system are often on the frontline of dealing with people with mental ill health, particularly those affected by acute episodes of mental ill health. My hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) was, though, right to question why we always talk about mental health in terms of mental illness, because it is also important to talk about mental wellness and consider how we support, develop and improve people’s positive mental health.
A lot of the changes in the public policy framework in recent years have been driven by innovation in public services. I think in particular of the excellent work done by Inspector Michael Brown, who blogs as Mental Health Cop. He previously worked for West Midlands police, and I think he now works for the chief constable of Dyfed-Powys police. It is largely because of his work that the need to address sections 135 and 136 came to the fore of the public policy agenda. In recent decades, section 136 has set the framework within which people suffering from mental ill health are treated in the police and criminal justice system. Although it is part of legislation that is nearly 35 years old, it is barely different from equivalent measures in the Mental Health Act 1959. That was 60 years ago, when there were still asylums in Britain and the whole approach to mental health was completely different. Thankfully, we no longer have asylums and we make huge efforts to treat people in the appropriate settings and in the community. We need to ensure that we adapt not only public policy but a legislative framework that was designed for a completely different society with a completely different outlook on and approach to mental healthcare. The Bill has an important part to play in changing the legislative framework.
In my area, West Midlands police have made substantial progress in how they deal with people suffering from mental illness. In July, the office of the West Midlands police and crime commissioner and the West Midlands combined authority provided an update on and summary of some of their innovations, particularly the model of mental health triage that has been operating for the past few years. A successful model for mental health triage is being rolled out across the force, throughout the Black country, Birmingham and Solihull. The model relies on an ambulance vehicle, a mental health nurse and a paramedic being available between 10 o’clock in the morning and 2 o’clock the following morning, so that when there is a call-out and it is thought there might be mental health issues to consider, there can be an appropriate health response and health assessment, alongside and as part of the police response. Shortly before I was elected to Parliament, I had the privilege of joining a triage team on a call-out in Birmingham. I saw how it worked and the difference it made compared with the old model of police officers being deployed and, more often than not, somebody suffering from a serious episode of mental ill health ending up in a police cell or another custodial setting.
Let me give an example of how the system has worked. When the police and ambulance services received a report of a 19-year-old female self-harming in the street and threatening to kill herself, a check on the mental health systems was able to establish quickly that she had an extensive history with mental health services. The paramedic had wanted to take the female to an acute hospital immediately, but the deployment of the street triage team meant not only that her wounds could be dressed by the paramedic in the car at the scene, but that the mental health nurse could carry out a face-to-face assessment and make an urgent referral to the home treatment team. As a result, she got crisis access to services overnight and then home treatment the next day, which was a much more appropriate response for somebody going through a crisis. Ultimately, she was safeguarded with a friend for the evening, who took her home and stayed with her through the night, and the whole incident lasted 45 minutes, compared with the many hours it would have taken had she gone to A&E and then other more conventional settings.
The triage teams in the west midlands have treated about 9,000 people in the last year, and as a result—despite the worrying figures we have heard from around the country—the use of section 136 powers in the west midlands has been reduced by about a third over the last five years, from typically 1,200 to 1,300 a year to 852 last year. Remarkably, in the first half of the year, nobody at all in the west midlands was detained in police custody under section 136 of the Mental Health Act—the first time this has ever happened in the west midlands. Instead, more than 8,000 people have received alternative outcomes, including referrals to a GP or other partners, to ensure they get mental health care rather than have their case treated as a purely criminal justice matter.
Although significant progress has been made, and continues to be made, the Bill will help to make further progress, especially through the way it addresses the use of force and restraint against people suffering from mental ill health. Currently, the code of practice clearly states that restrictive practices should only be used where there is a real possibility of harm, either to the patient or to someone else, and should not be used either to punish or inflict pain or suffering, and should be used with minimum interference to autonomy, privacy and dignity. In the case of children and young people, it should not be used at all. Staff should always ensure that restraint is used only after taking into account an individual’s age, size, physical vulnerability and emotional and psychological maturity.
Although the guidelines exist, further openness around the use of force and restraint is not only welcome and progressive but absolutely necessary for the individuals involved and if our public service workers are to have confidence that their actions are reasonable and defensible. That is why clause 5, which requires that registered managers have a training programme for frontline staff, is particularly important. “Frontline staff” would include all registered managers who might reasonably expect to use force or authorise its use on patients. The proposal to guarantee that staff use the latest and safest procedures should be an opportunity to build on previous learning, not only on mental health care and proportionate use, but on wider issues of equality and necessity.
Clause 6 deals with the requirement on all mental health providers systematically to record information on their use of force. As has been said, if we can measure it, we can track progress and drive changes in behaviour. Including records on the gender, age and ethnicity of patients will help to improve our understanding and, more importantly, the understanding of public services about the use of restraint, particularly on the basis of gender and race.
Let me turn now to body-worn video. Clause 13 provides that on-duty police officers who are called to a mental health unit for any reason must wear body cameras that start recording from as soon as is reasonably practicable. The west midlands, which is within my own force area, is now rolling out body cameras to all its response officers. The kind of body cameras it is using can be automatically triggered by a siren or a blue light, or if airbags are deployed and firearms are drawn. We should consider how these body cameras can be automatically deployed and, without having to think about human error, can automatically stay on until they are manually turned off.
Kevin Foster
Does it make sense that, if a police officer is on duty in a response role, the presumption should be that the camera is on? We see that in other walks of life—for example, it is the case with ticket inspectors, so it should not be that difficult to apply this practice to on-duty, on-call police officers.
Philip Davies
I agree with everything that my hon. Friend has said, but my understanding is that, in some areas—certainly with some police forces—the issue is that the battery life on some of these cameras is not all that it could be, which means that the cameras might not last long enough in all these circumstances. Does he agree that we need better technology for the battery life before we start insisting on these things being used in all circumstances?
Mike Wood
It is extremely important that we have adequate and appropriate technology. Of course the battery life of these cameras on the frontline is a key part of that. Police using the system being rolled out in the west midlands, which is partly funded through the Home Office, are confident that they can use the cameras from when they are automatically triggered through to when the footage can be uploaded back at the station. As has already been pointed out, research strongly suggests that the use of force is reduced by about half if body cameras are worn. Attacks on police officers are also reduced. In the west midlands, harm to police officers has been reduced by about three quarters since body cameras started being routinely used, and complaints against police officers have fallen by more than 90% when evidence from a body camera is used.
There has been great progress in the area of mental health, but there is still much more that needs to be done. We need a greater focus on mental wellness, prevention, early intervention and ensuring that primary care is in a position to support and treat our patients at an early stage. There will always be occasions when restraint is appropriate and even a small number of circumstances in which the use of force is necessary. That use of force must be properly regulated, registered, controlled and used as a last resort—when no other adequate course of action is available.
Kelly Tolhurst
There has been increased police use of body-worn cameras in Kent and it has been going quite well. Will my hon. Friend give me slightly more information about what has been happening in Dudley South?
Mike Wood
In the first year of general use, there has been a sharp fall in the number of assaults against police officers. There are also fewer complaints against police officers, and the time it takes to handle responses has fallen. It used to take many of hours of investigating and phone calls; now, in some cases, it takes barely minutes of reviewing clear body camera evidence.
The measures in the Bill are necessary and welcome, so I wholeheartedly support it today and look forward to supporting it in its passage through this place.
The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
I join Members across the House in congratulating the hon. Member for Croydon North (Mr Reed) on bringing the Bill before us today. I thank him for the constructive way in which he has engaged with me and my officials. I look forward to taking this Bill further—hopefully completing its journey—so that we can bring Seni’s law to the statute book.
The death of the hon. Gentleman’s constituent, Seni Lewis, was a tragedy. I know that the hon. Gentleman has been deeply touched by the incident—so touched that he has brought forward this Bill, with an impressive coalition of interests behind it. May I send my very best wishes, through the hon. Gentleman, to Seni’s family? It must be an incredibly difficult time for them and I extend my deepest sympathies to them.
As we have heard, the Bill seeks to reduce the inappropriate use of force or restraint against people with mental ill health, to allow greater scrutiny of the use of force in mental health units, and to ensure that police officers use body-worn video cameras in the course of their duties in relation to people in mental health units. It also seeks to guarantee that the mental health system learns from and applies appropriate lessons in relation to the use of force. For too long, restrictive interventions have been accepted as the norm in health and mental health care settings, and we want to change that culture. That is why the Government support the principles set out in the Bill.
Eddie Hughes
It is important to note that there were 67,864 incidents against NHS staff in 2015, 67% of which took place in a mental health setting. We need to appreciate that there is a need for force, because staff working in these situations sometimes need to be protected.
Jackie Doyle-Price
My hon. Friend makes a valid point but I think that we are all agreed in this House—certainly in this debate—that we need to balance rights and liberties with the need to achieve safety. I can say, quite categorically, that this Bill goes a long way towards achieving that.
The Government support the principles set out in the Bill, but we accept—as I think the hon. Member for Croydon North would—that there is still some work to do on the detail regarding the right mechanisms and processes. We can explore those matters in Committee and we are fully behind the Bill’s Second Reading.
Tom Pursglove (Corby) (Con)
Does the Minister agree that the thrust of the Bill is about accountability, and that the measures provide protection for the individual patient and for the professionals working around them?
Jackie Doyle-Price
I agree with that point very ably made by my hon. Friend. The Bill brings real accountability and transparency, which will protect everyone in the system.
I welcome the opportunity to debate the Bill, and to highlight some of the progress we have already made on some of the provisions that the Bill seeks to introduce and strengthen. First, we should examine the issue of restrictive restraint. It is not a great picture, to be frank. Information from NHS Digital shows that more than 6,000 people who spent time in hospital in 2013-14 were subject to at least one incident of restraint. Collectively, these people experienced more than 23,000 incidents of restraint, with 960 people having been restrained five or more times in a year. As colleagues across the House have said, that can cause real trauma and should be avoided at all costs. The group who experienced the highest proportion of restraint per 1,000 inpatients was the category labelled “mixed ethnic group”, with 101 incidents of restraint per 1,000 in-patients. We need to get to the bottom of why that is the case. There is a link between the use of restraint and particular points in the patient pathway. For example, in 2015, the survey of restraint commissioned by the Government found that 23.6% of restraint incidents occurred in the first week of admission. We have discussed gender, and I can confirm that 54.7% of people who were restrained were men, compared with 42.5% being women. That clearly does not reflect the gender balance of people in detention.
Members have referred to the fact that on Monday the House welcomed the publication of Dame Elish Angiolini’s independent review of deaths and serious incidents in police custody, and the Government response. The report is thorough and identifies room for improvement at every stage in procedures and processes surrounding deaths in police custody. It makes 110 recommendations on the use of restraint, on training for officers and on making it easier for families facing an inquest into a death in police custody to access legal aid. The hon. Member for Croydon North is concerned about that issue.
The extent to which restraint techniques contribute to a death in custody and whether current training is fit for purpose is a crucial aspect of Dame Elish’s report. Police training and practice emphasise that under certain circumstances any form of restraint can potentially lead to death, so the National Police Chiefs Council and the College of Policing continue to ensure that legal, medical and tactical advice are embedded in the national personal safety manual, especially in relation to the challenges of prone restraint and mental health issues.
Members have expressed views on the use of restraint, particularly prone restraint, with some of them suggesting that that type of restraint should be banned altogether. I was at Broadmoor yesterday, and I was told about a man who had experienced a head injury and needed stitches. Because of the challenges of his behaviour and mental health condition, prone restraint was used. I am not condoning the use of prone restraint in that situation or in any other, but I will say some words of caution. We need to understand restraint and define it clearly before introducing an outright ban. The guidance says that prone restraint should be used only as a last resort, and we must be careful not to put staff at risk by introducing a blanket ban without understanding more about the circumstances in which that type of restraint might be necessary.
In August this year, the CQC published its report, “The state of care in mental health services 2014-2017”, which identified variations in the frequency with which staff used restrictive practices to manage people with challenging behaviour. It is looking at the issue more closely, and it has committed to reviewing how it assesses the use of restrictive interventions, including developing and regularly updating tools for inspection teams to ensure consistency of assessment and reporting. We believe that the variations are as much due to the principles behind the making of reports as differences in behaviour.
As part of its annual report, “Monitoring the Mental Health Act”, the CQC is developing a publication to highlight areas of good practice in reducing the need for restrictive interventions. Colleagues at the CQC have indicated that they support the principles of better reporting, improved training and accountability, and greater transparency under the Bill, and it is vital that we engage with that as we take this forward.
Turning to the measures in the Bill, there is provision for front-line staff to receive training in equality and non-discrimination, as well as awareness of conduct prohibited under the Equality Act 2010; a trauma-informed approach to care; and, critically, techniques to avoid and reduce the use of force. Individual providers are expected to ensure that all their staff are appropriately trained in the use of force, and there are many training programmes available to health service providers The Bill will help us to address the variation across the system in the training received by staff. Healthcare providers are encouraged to focus training on de-escalation and on understanding the causes of challenging behaviour, and to reflect on incidents of restraint to see how they can be reduced or avoided for both the individual concerned and for all service users.
Treating and caring for people in a safe, compassionate environment both for patients and staff is a priority for this Government. We know that restrictive physical interventions are risky for all individuals involved and that they have a negative impact on patients’ dignity and their trust in services. We have made progress since the publication of “Positive and proactive care: reducing the need for restrictive interventions” in April 2014. This guidance focuses on the use of preventive approaches and de-escalation for managing behaviour that services may find challenging. It also recommends that all restrictive interventions should be for the shortest time possible and use the least restrictive means to meet the immediate need. The guidance introduced an expectation that services develop restrictive intervention reduction plans. These plans, along with organisations’ relative use of restraint in comparison with other organisations, form a key focus of the CQC inspections. We expect the CQC to use its regulatory powers to ensure that services minimise the use of force and other restrictive interventions, including face-down restraint.
Our colleagues in the police are training officers on how to respond to calls that relate to those with mental health conditions and people with learning difficulties. The revised national police guidance on authorised professional practice on mental health was published by the College of Policing in October last year. It aims to give officers the knowledge they need to resolve situations and ensure that the public get the most appropriate service. While the police are not, and are not expected to be, mental health professionals, they are often first on the scene at incidents involving those experiencing a mental health crisis. The aim is therefore to ensure that officers can respond appropriately.
On data collection, the Bill seeks to gain more detailed information in relation to incidents of force used in mental health settings. From January 2016, NHS Digital has collected information about the use of face-down restraint as part of the mental health services dataset. There is still a lot of work to be done on the quality of the data, as the hon. Member for Croydon North said, as they do not currently go into the amount of detail that the Bill would require. However, we are confident that we can make changes to improve the transparency of the information that we collect.
Mr Alan Campbell (Tynemouth) (Lab)
claimed to move the closure (Standing Order No. 36).
Question put forthwith, That the Question be now put.
Question agreed to.
Question put accordingly, That the Bill be now read a Second time.
Question agreed to.
Bill read a Second time; to stand committed to a Public Bill Committee (Standing Order No. 63).
Mental Health Units (Use of Force) Bill (First sitting)
Wednesday 28th March 2018
(6 years, 7 months ago)
Public Bill CommitteesRead Full debate Mental Health Units (Use of Force) Act 2018 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 28 March 2018 - (28 Mar 2018)
The Chair
Good morning. Welcome to the Public Bill Committee on the Mental Health Units (Use of Force) Bill. I remind everyone to turn off their electronic devices. Tragically, tea and coffee are not permitted.
Ordered,
That, if proceedings on the Mental Health Units (Use of Force) Bill are not completed at this day’s sitting, the Committee shall meet on Wednesdays while the House is sitting at 9.30 am.— (Mr Reed.)
The Chair
On the basis of the motion just agreed, and given that the required notice period in Public Bill Committees is three working days, amendments should be tabled by 3 pm on Fridays for consideration on Wednesdays. I encourage Members to submit amendments earlier, if they can. I advise Members that, as a general rule, I do not intend to call starred amendments, which have not been tabled with adequate notice.
Mr Steve Reed (Croydon North) (Lab/Co-op)
I beg to move,
That the Bill be considered in the following order, namely, Clauses 1 to 6, Clauses 9 to 11, Clauses 7 and 8, Clauses 12 to 20, new Clauses, new Schedules, remaining proceedings on the Bill.
It is a pleasure to serve under your chairmanship, Ms Buck. We have finally got the Bill to Committee, and I am delighted that we are all here. The Committee has been delayed for four weeks in a row, because of the Government’s failure to lay a money resolution, which would allow us to consider the Bill in its entirety and all the amendments. Even this morning we will not be able to consider several amendments because a money resolution has still not been laid, despite the fact that the Bill enjoys the support of the Government and received the unanimous support of the House on Second Reading. When I asked the Government why the money resolution had not been laid, they said it was not possible because of the heavy schedule of business going through the Chamber, but both yesterday and last Tuesday the Adjournment was early because of insufficient business going through the House.
I want to register my disappointment that the money resolution has not been laid at this stage, and I urge Government and other Members to use their influence with the Whips to encourage the Government to do so as soon as possible. The Bill contains an important reform that will dramatically improve safety for many highly vulnerable people using mental health services, and I see no reason for it to continue to be delayed in such a fashion.
The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
It is a pleasure to serve under your chairmanship this morning, Ms Buck. I thank the hon. Gentleman for the points he has made. He is absolutely right to say that the Government support the measure. We support it very much because of the co-operative discussions that we have had, to get it to a place where everyone can agree. I fully endorse his point that the Bill is an important social reform; it is an important ingredient in our broader agenda to improve the treatment of people with mental health problems and illness.
The hon. Gentleman made his point about the need for a money resolution robustly. I will relay his representations to the House business managers, so that we can proceed without delay, as we all want such an important reforming measure to be on the statute book as soon as possible.
Question put and agreed to.
Clause 1
Key definitions
Mr Reed
I beg to move amendment 2, in clause 1, page 1, line 5, leave out subsection (3) and insert—
‘(3) “Mental health unit” means—
(a) a health service hospital, or part of a health service hospital, in England, the purpose of which is to provide treatment to in-patients for mental disorder, or
(b) an independent hospital, or part of an independent hospital, in England—
(i) the purpose of which is to provide treatment to in-patients for mental disorder, and
(ii) where at least some of that treatment is provided, or is intended to be provided, for the purposes of the NHS.’
This amendment replaces the definition of “mental health unit” with a new definition which clarifies that a unit may form part of a hospital. The amendment also removes care homes and registered establishments from the definition, and includes mental health units in an independent hospital within the definition only where the unit provides NHS treatment.
The Chair
With this it will be convenient to discuss the following:
Amendment 3, in clause 1, page 1, line 8, leave out subsection (4) and insert—
‘( ) In subsection (3) the reference to treatment provided for the purposes of the NHS is to be read as a service provided for those purposes in accordance with the National Health Service Act 2006.’
This amendment ensures that “treatment for the purposes of the NHS” is read in accordance with the National Health Service Act 2006. It also makes a change which is consequential on the removal of care homes from the definition of “mental health unit” (see Amendment 2).
Amendment 4, in clause 1, page 1, line 12, leave out subsection (5) and insert—
‘( ) “Patient” means a person who is in a mental health unit for the purpose of treatment for mental disorder or assessment.’
This amendment provides a new definition of “patient”. This definition makes clear that a patient includes a person who is in a mental health unit in order to be treated for mental disorder or to be assessed in the unit.
Amendment 6, in clause 1, page 2, line 1, leave out subsections (7) and (8) and insert—
‘(7) References to “use of force” are to—
(a) the use of physical, mechanical or chemical restraint on a patient, or
(b) the isolation of a patient.
(7A) In subsection (7)—
“physical restraint” means the use of physical contact which is intended to prevent, restrict or subdue movement of any part of the patient’s body;
“mechanical restraint” means the use of a device which—
(a) is intended to prevent, restrict or subdue movement of any part of the patient’s body, and
(b) is for the primary purpose of behavioural control;
“chemical restraint” means the use of medication which is intended to prevent, restrict or subdue movement of any part of the patient’s body;
“isolation” means any seclusion or segregation that is imposed on a patient.’
This amendment provides a revised definition of “use of force” which uses simpler language. It also removes threats from the definition and includes the isolation of a patient in the definition.
New clause 7—Interpretation—
‘In this Act—
“health service hospital” has the same meaning as in section 275(1) of the National Health Service Act 2006;
“independent hospital” has the same meaning as in section 145(1) of the Mental Health Act 1983;
“the NHS” has the same meaning as in section 64(4) of the Health and Social Care Act 2012;
“responsible person” has the meaning given by section 2(1);
“relevant health organisation” means—
(a) an NHS trust;
(b) an NHS foundation trust;
(c) any person who provides health care services for the purposes of the NHS within the meaning of Part 3 of the Health and Social Care Act 2012;
“staff” means any person who works for a relevant health organisation that operates a mental health unit (whether as an employee or a contractor) who—
(a) may be authorised to use force on a patient in the unit,
(b) may authorise the use of force on a particular patient in the unit, or
(c) has the function of providing general authority for the use of force in the unit.’
This new clause compiles various definitions for terms that are used throughout the Bill.
Mr Reed
I thank the Minister for her earlier comments. It has been a great pleasure to work with her and her team in such a constructive manner. I said in the Chamber that we would pursue the Bill in a constructive, co-operative and cross-party manner, and that is what all Members have tried to do so far. I suspect that we will not detain the Committee for too long this morning, such is the level of consensus on the amendments, so perhaps I should get on with it without any further ado.
Clause 1 sets out some of the important terms used throughout the Bill. The amendments are minor and aim to ensure that those terms are clearly defined. Amendment 2 strengthens the definition of “mental health unit” to make clear that any such unit may form part of a hospital. Amendment 3 ensures that “treatment provided” is read in accordance with the National Health Service Act 2006. Amendment 4 defines what the Bill means by “patient”, which is someone in a mental health unit who is there to be treated or assessed for mental ill health. Amendment 6 clarifies the definition of “use of force”, using more straightforward language, and it includes “isolation” as part of that definition. New clause 7 compiles and explains various other definitions used throughout the Bill.
Jackie Doyle-Price
I confirm that the Government entirely support these amendments, which make the language in the Bill consistent with the 2015 code of practice under the Mental Health Act 1983, and with broader guidance. That makes for a much tidier way of achieving the objectives of the Bill.
Amendment 2 agreed to.
Amendments made: 3, in clause 1, page 1, line 8, leave out subsection (4) and insert—
‘( ) In subsection (3) the reference to treatment provided for the purposes of the NHS is to be read as a service provided for those purposes in accordance with the National Health Service Act 2006.’
This amendment ensures that “treatment for the purposes of the NHS” is read in accordance with the National Health Service Act 2006. It also makes a change which is consequential on the removal of care homes from the definition of “mental health unit” (see Amendment 2).
Amendment 4, in clause 1, page 1, line 12, leave out subsection (5) and insert—
‘( ) “Patient” means a person who is in a mental health unit for the purpose of treatment for mental disorder or assessment.’—(Mr Reed.)
This amendment provides a new definition of “patient”. This definition makes clear that a patient includes a person who is in a mental health unit in order to be treated for mental disorder or to be assessed in the unit.
The Chair
With this it will be convenient to discuss the following:
Amendment 7, in clause 2, page 2, line 26, leave out subsections (1) to (3) and insert—
‘( ) A relevant health organisation that operates a mental health unit must appoint a responsible person for that unit for the purposes of this Act.
( ) The responsible person must be—
(a) employed by the relevant health organisation, and
(b) of an appropriate level of seniority.
( ) Where a relevant health organisation operates more than one mental health unit that organisation must appoint a single responsible person in relation to all of the mental health units operated by that organisation.’
This amendment replaces the requirement for mental health units to have a “registered manager” with a requirement to appoint a “responsible person”. That person must be employed by a relevant health organisation and be of an appropriate level of seniority. If an organisation operates multiple units, only one responsible person needs to be appointed in relation to those units.
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 60, in clause 7, page 4, line 38, leave out “registered manager” and insert “responsible person”
This amendment is consequential on Amendment 7.
Mr Reed
The clause establishes a named accountable individual in a mental health unit who will be responsible for a reduction in the use of force. It seeks to create established, clearer lines of accountability for the existence of appropriate policy, and for when things go wrong, so that it will be possible to find somebody who can explain exactly what circumstances might have led to any problems or failings with the use of force.
Amendment 7 replaces the phrase “registered manager” with “responsible person”. The change in language avoids confusion with existing Care Quality Commission regulations that use the phrase “registered manager”, but the intention remains the same. By introducing the legal concept of a responsible person for mental health units, the Bill increases accountability and leadership. Ultimately, the responsible person will be accountable for the requirement that the Bill places on mental health units, so it is important properly to define them as a senior officer in the organisation. They will set the organisation-wide direction for a reduction in the use of force. The responsible person will be at board level, with more detail about who is appropriate set out in guidance by the Secretary of State under clause 6. Amendments 5, 11 and 60 are consequential on changes of the phrase “registered manager” to “responsible person”.
Jackie Doyle-Price
The Government support the amendments. Perhaps one of the most important aspects of the Bill is that it enshrines accountability for ensuring that any institution fulfils its responsibilities. The buck needs to stop somewhere, and it is important that happens with someone at board level. The amendments are important for improving leadership, governance and accountability for the use of force. The amendments were drafted in line with the existing positive and proactive care guidance. It is also worth emphasising that this will not incur any additional burden on healthcare organisations; it will simply strengthen and enshrine accountability. On that basis, the Government are happy to approve the amendments.
Amendment 5 agreed to.
Amendment made: 6, in clause 1, page 2, line 1, leave out subsections (7) and (8) and insert—
‘(7) References to “use of force” are to—
(a) the use of physical, mechanical or chemical restraint on a patient, or
(b) the isolation of a patient.
(7A) In subsection (7)—
“physical restraint” means the use of physical contact which is intended to prevent, restrict or subdue movement of any part of the patient’s body;
“mechanical restraint” means the use of a device which—
(a) is intended to prevent, restrict or subdue movement of any part of the patient’s body, and
(b) is for the primary purpose of behavioural control;
“chemical restraint” means the use of medication which is intended to prevent, restrict or subdue movement of any part of the patient’s body;
“isolation” means any seclusion or segregation that is imposed on a patient.’—(Mr Reed.)
This amendment provides a revised definition of “use of force” which uses simpler language. It also removes threats from the definition and includes the isolation of a patient in the definition.
Clause 1, as amended, ordered to stand part of the Bill.
Clause 2
Mental health units to have a registered manager
Amendment made: 7, in clause 2, page 2, line 26, leave out subsections (1) to (3) and insert—
“( ) A relevant health organisation that operates a mental health unit must appoint a responsible person for that unit for the purposes of this Act.
( ) The responsible person must be—
(a) employed by the relevant health organisation, and
(b) of an appropriate level of seniority.
( ) Where a relevant health organisation operates more than one mental health unit that organisation must appoint a single responsible person in relation to all of the mental health units operated by that organisation.”.—(Mr Reed.)
This amendment replaces the requirement for mental health units to have a “registered manager” with a requirement to appoint a “responsible person”. That person must be employed by a relevant health organisation and be of an appropriate level of seniority. If an organisation operates multiple units, only one responsible person needs to be appointed in relation to those units.
Clause 2, as amended, ordered to stand part of the Bill.
Clause 3
Policy on use of force
Mr Reed
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.
The Chair
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.
Mr Reed
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.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
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.
Mr Reed
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.
Jackie Doyle-Price
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
Information about use of force
Mr Reed
I beg to move amendment 84, in clause 4, page 3, line 12, leave out subsections (1) to (3) and insert—
‘(1) The responsible person for each mental health unit must publish information for patients about the rights of patients in relation to the use of force by staff who work in that unit.
(1A) Before publishing the information under subsection (1), the responsible person must consult any persons that the responsible person considers appropriate.
(1B) The responsible person must provide any information published under this section—
(a) to each patient, and
(b) to any other person who is in the unit and to whom the responsible person considers it appropriate to provide the information in connection with the patient.
(1C) The information must be provided to the patient—
(a) if the patient is in the mental health unit at the time when this section comes into force, as soon as reasonably practicable after that time;
(b) in any other case, as soon as reasonably practicable after the patient is admitted to the mental health unit.’
This amendment replaces Clause 4(1) to (2) with a duty to publish information about the rights of patients in relation to the use of force in a mental health unit. Before publishing the information, a consultation must be carried out. The published information must be given to patients in the mental health unit and to new patients admitted to the unit, and to any other person considered appropriate if in the unit.
The Chair
With this it will be convenient to discuss the following:
Amendment 19, in clause 4, page 3, line 24, leave out from “provided” to “in” in line 27.
This amendment removes the requirement that the Secretary of State must prescribe the form that information under Clause 4 must be provided.
Amendment 20, in clause 4, page 3, line 27, leave out “with regard to” and insert “having regard to”.
This amendment is a drafting change to Clause 4(4)(b).
Amendment 21, in clause 4, page 3, leave out line 28.
This amendment removes a paragraph that deals with providing information under Clause 4 that has regard to the patient’s communication needs because that paragraph is unnecessary.
Amendment 22, in clause 4, page 3, line 29, leave out “capacity” and insert “ability”.
This amendment is a drafting change to avoid confusion with the terminology of the Mental Capacity Act 2005.
Amendment 23, in clause 4, page 3, line 30, leave out subsection (5).
This amendment is a drafting change linked to Amendment 22.
Amendment 24, in clause 4, page 3, line 31, at end insert—
‘( ) The responsible person must keep under review any information published under this section.
( ) The responsible person may from time to time revise any information published under this section and, if this is done, must publish the information as revised.
( ) If the responsible person considers that any revisions would amount to a substantial change in the information, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised information.’
This amendment requires the responsible person to keep information published under Clause 4 under review. If the responsible person intends to make substantial changes to the information published under that clause, then a consultation must be conducted.
Amendment 85, in clause 4, page 3, line 31, at end insert—
‘( ) The duty to provide information to a patient under subsection (1B) does not apply if—
(a) the patient refuses to accept the information, or
(b) the responsible person considers that the provision of the information to the patient would cause the patient distress.
( ) The duty to provide information to another person under subsection (1B) does not apply if—
(a) the patient requests that the information is not provided to the person, or
(b) the responsible person considers that the provision of the information to the person would cause the patient distress.’
This amendment provides exceptions to the duties to provide information under Clause 4. It provides that a patient can refuse to accept the information or request that it is not provided to another person, and the information does not need to be provided if it would cause distress to the patient.
Mr Reed
The amendment deals with the requirement to provide patients with information about their rights. Many patients entering a mental health unit will be in a state of considerable distress. Many of them will be unaware of their rights regarding the use of force. Currently it is not universal practice that those patients are informed about what those rights are so that they can ensure that those rights are not infringed.
It is important that any patient entering a mental health unit is aware of what may or may not be done to them regarding the use of force, so that if people in the unit seek to do things to them that go beyond their rights, they are able to call it out and stop it. This applies not just to the individual concerned, but to their carers, family members or close relatives who might be there with them, who are often unfamiliar with mental health units and have equally high levels of concern. It is important that they, too, are aware of what their loved one’s rights are.
Jackie Doyle-Price
I said at the beginning of today’s proceedings that I view the measures enshrined in the Bill as an important social reform. These amendments and this clause go to the heart of that, in the sense that it is all about empowering patients and enshrining their rights. That is very much the spirit in which we are embarking on the review of the Mental Health Act, so we completely support the clause and the amendments.
The amendments ensure that other appropriate people, such as patients’ carers and relatives, will normally receive information about use of force, which is key for patients who do not always understand the information that is given to them, as the hon. Gentleman suggested. It is also important to understand that sometimes too much information can cause patients further distress at a difficult time. In those circumstances, a good relationship with relatives and carers is extremely important. That can be as much about empowering the patients as furnishing the individual with such information.
On the specific concern that amendment 85 might cause a loophole, I must emphasise that the exception is not about letting any unit off, but about recognising when it might be appropriate so that information will not cause further unintended distress and ensuring that patients’ interests are protected. Different patients will require different approaches, and a one-size-fits-all approach does not count.
When the measure is set alongside the other provisions in the Bill, we are satisfied that we have the right balance between protecting the rights of patients and empowering them—and empowering their carers and relatives to look after them—while having appropriate safeguards to prevent further distress. I support the amendments.
Amendment 84 agreed to.
Amendments made: 19, in clause 4, page 3, line 24, leave out from “provided” to “in” in line 27.
This amendment removes the requirement that the Secretary of State must prescribe the form that information under Clause 4 must be provided.
Amendment 20, in clause 4, page 3, line 27, leave out “with regard to” and insert “having regard to”.
This amendment is a drafting change to Clause 4(4)(b).
Amendment 21, in clause 4, page 3, leave out line 28.
This amendment removes a paragraph that deals with providing information under Clause 4 that has regard to the patient’s communication needs because that paragraph is unnecessary.
Amendment 22, in clause 4, page 3, line 29, leave out “capacity” and insert “ability”.
This amendment is a drafting change to avoid confusion with the terminology of the Mental Capacity Act 2005.
Amendment 23, in clause 4, page 3, line 30, leave out subsection (5).
This amendment is a drafting change linked to Amendment 22.
Amendment 24, in clause 4, page 3, line 31, at end insert—
“( ) The responsible person must keep under review any information published under this section.
( ) The responsible person may from time to time revise any information published under this section and, if this is done, must publish the information as revised.
( ) If the responsible person considers that any revisions would amount to a substantial change in the information, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised information.”.
This amendment requires the responsible person to keep information published under Clause 4 under review. If the responsible person intends to make substantial changes to the information published under that clause, then a consultation must be conducted.
Amendment 85, in clause 4, page 3, line 31, at end insert—
‘( ) The duty to provide information to a patient under subsection (1B) does not apply if—
(a) the patient refuses to accept the information, or
(b) the responsible person considers that the provision of the information to the patient would cause the patient distress.
( ) The duty to provide information to another person under subsection (1B) does not apply if—
(a) the patient requests that the information is not provided to the person, or
(b) the responsible person considers that the provision of the information to the person would cause the patient distress.’—(Mr Reed.)
This amendment provides exceptions to the duties to provide information under Clause 4. It provides that a patient can refuse to accept the information or request that it is not provided to another person, and the information does not need to be provided if it would cause distress to the patient.
Clause 4, as amended, ordered to stand part of the Bill.
Clause 5
Training in appropriate use of force
Mr Reed
I beg to move amendment 86, in clause 5, page 3, line 33, leave out subsection (1) and insert—
‘(1) The responsible person for each mental health unit must provide training for staff that relates to the use of force by staff who work in that unit.
(1A) The training provided under subsection (1) must include training on the following topics—
(a) how to involve patients in the planning, development and delivery of care and treatment in the mental health unit,
(b) showing respect for patients’ past and present wishes and feelings,
(c) showing respect for diversity generally,
(d) avoiding unlawful discrimination, harassment and victimisation,
(e) the use of techniques for avoiding or reducing the use of force,
(f) the risks associated with the use of force,
(g) the impact of trauma (whether historic or otherwise) on a patient’s mental and physical health,
(h) the impact of any use of force on a patient’s mental and physical health,
(i) the impact of any use of force on a patient’s development,
(j) how to ensure the safety of patients and the public, and
(k) the principal legal or ethical issues associated with the use of force.’.
This amendment replaces Clause 5(1) with a revised duty on the responsible person to ensure that training is provided for staff that covers a wide range of topics relating to the use of force in mental health units.
The Chair
With this it will be convenient to discuss amendment 87, in clause 5, page 3, line 39, leave out subsection (2) and insert—
‘(2) Subject to subsection (2A), training must be provided—
(a) in the case of a person who is a member of staff when this section comes into force, as soon as reasonably practicable after this section comes into force, or
(b) in the case of a person who becomes a member of staff after this section comes into force, as soon as reasonably practicable after they become a member of staff.
(2A) Subsection (2) does not apply if the responsible person considers that any training provided to the person before this section came into force or before the person became a member of staff—
(a) was given sufficiently recently, and
(b) meets the standards of the training provided under this section.
(2B) Refresher training must be provided at regular intervals whilst a person is a member of staff.
(2C) In subsection (2B) “refresher training” means training that updates or supplements the training provided under subsection (1).’.
The amendment sets out when training under Clause 5 should be given to staff. A definition of “staff” is given in NC7.
Mr Reed
These amendments are to the clause relating to improving training for staff working in mental health units before they are able to use force of any description against patients. It is clearly better for patient safety that any staff administering force should be properly trained, but it is worth noting that it is also important for staff safety that they are properly trained before they engage in administering force to patients.
Helen Hayes (Dulwich and West Norwood) (Lab)
I commend my hon. Friend for introducing the Bill. On the need for training, I want to flag my experience of young patients with autism being held in secure psychiatric units. In my experience, there is a lack of expertise and training across the board for staff treating young people with autism, so they fail to understand that much challenging behaviour arises from the intense levels of anxiety experienced by young people with autism. In such circumstances, the use of force further compounds that anxiety, and indeed traumatises those young people. I ask the Minister whether, when laying down guidance to accompany the Bill, specific regard will be given to the lack of training and understanding of autism within our mental health services?
Mr Reed
I am grateful to my hon. Friend for making that important point and I look forward to hearing the Minister’s comment. That point has been made to me by many service users and advocacy groups, including Rethink Mental Illness, YoungMinds and others.
Many of the approaches outlined in the Bill ought to be applied more widely for people who experience mental ill health in many other circumstances. I hope that the Government’s ongoing review into mental health will do that. I hope that some of the principles in the Bill will take us forward and allow that review, when it reports back, to make a bigger impact than it perhaps might have made otherwise.
Moving back to the principles of training in general, the Bill includes provisions on training to recognise the Equality Act 2010 and de-escalation techniques that reduce the need for force to be used in any circumstances. The amendment will also strengthen the requirement for trauma-informed care. It is important to include in the Bill that staff are trained in the impact of further traumatising patients, whose mental ill health may have already been exacerbated by forms of trauma.
I am informed by Agenda that more than 50% of female patients in mental health units have experienced physical or sexual abuse by men, which in most cases contributes significantly to their mental ill health. After those experiences, being forcibly restrained—generally by groups of men—can further traumatise those women and make their mental health conditions even worse, so it is very important that staff are fully aware and trained in the risks of re-traumatising patients who have already been traumatised.
It is also important that training takes full account of the risks of unlawful discrimination regarding race. Dame Elish Angiolini’s report last year into deaths and serious incidents in police custody found that:
“The stereotyping of young Black men as ‘dangerous, violent and volatile’ is a longstanding trope that is ingrained in the minds of many in our society.”
We only have to look at pictures of the faces of people who have died in state custody, including in mental health custody, to see how severe the risk of unconscious bias in the system is. A much higher proportion of those faces will be of young black men than the proportion present in the population as a whole. In order to ensure that staff will not be acting out of prejudice against people who enter a publicly funded health service for treatment on equal terms with everyone else, it is important that staff are trained to be fully aware of the risks of unconscious bias and racism in that service.
Putting anti-discrimination training into legislation is a move towards ending such unlawful discrimination, as is the overall aim of the Bill, and towards exposing the use of force to much closer scrutiny by standardising data recording across the whole country, so that it is possible to compare performance in mental health units on the same basis in different parts of the country. That is not currently possible, and it is a loophole that was pointed to by Dame Elish Angiolini in her report. I am pleased that the Bill will close the loophole.
Crucially, staff must also be trained in the use of techniques to avoid or reduce the use of force—essentially de-escalation. That makes the situation safer for everyone involved. It is critical that anything that might trigger behaviours in a patient that could lead to their being restrained should be avoided, if at all possible, so that the use of force can be minimised.
Amendment 86 sets out a revised duty on the responsible person to ensure that training is provided for staff in mental health units. Amendment 87 sets out when training should be provided to staff. It should be provided as soon as the provision comes into force, and there should be refresher training at regular intervals. That will build the institutional knowledge needed to ensure that force will only ever be used as a genuine last resort.
Luciana Berger
My hon. Friend, and many other Members, will probably have seen the “Dispatches” programme last month, in which a temporary member of staff went to work in a privately owned but NHS-funded mental health unit. That undercover report revealed scenes that were difficult to watch. Part of the challenge was that the individual was not given any appropriate training when she was asked to care for some very unwell people in secure parts of the accommodation. I want to reinforce what my hon. Friend has been saying: the issue is critical for existing and new staff, and often there are too many temporary staff working in such units.
Mr Reed
My hon. Friend makes an important point, clearly and eloquently. There are no circumstances in which an untrained member of staff, whether full-time or not, should be able to use force—effectively violence—on a patient. If they have not been properly trained, that should be an absolute no.
Jackie Doyle-Price
The clause relates to ensuring that all members of staff are appropriately trained on when it is appropriate to use force. It is worth emphasising that it will make any institution or organisation safer for patients, but also for staff. It is important to prioritise and enhance training in de-escalation techniques. That will make for a safer environment for everyone, with less harm to patients, and will probably help to some extent with their continuing care and recovery. I totally endorse the clause, and the amendments, which will make it more effective. Clearly these measures are important for a Government whose approach to leadership in health involves prioritising patient safety.
We see the provisions as an opportunity to build on the positive and proactive care guidance. The amended clause will now go much further to address the points made by the hon. Members for Croydon North and for Liverpool, Wavertree. Only people working in a professional capacity would be able to use force on patients; any volunteers would not be able to do so. In that sense, it is a much stronger measure, because we are giving a clear view that the use of force is not something that volunteers should be involved in.
The Chair
With this it will be convenient to discuss the following:
Amendment 29, in clause 6, page 4, line 3, leave out “registered managers” and insert
“responsible persons and relevant health organisations”.
This amendment is consequential on Amendment 7 as well as including relevant health organisations as subjects of the guidance published under Clause 6.
Amendment 30, in clause 6, page 4, line 3, at end insert—
‘(1A) In exercising functions under this Act, responsible persons and relevant health organisations must have regard to guidance published under this section.’
This amendment places a duty on responsible persons and relevant health organisations to have regard to the guidance published under Clause 6.
Amendment 31, in clause 6, page 4, line 3, at end insert—
‘(1B) The Secretary of State must keep under review any guidance published under this section.’
This amendment places a duty on the Secretary of State to review any guidance published under Clause 6.
Amendment 32, in clause 6, page 4, line 3, at end insert—
‘(1C) Before publishing guidance under this section, the Secretary of State must consult such persons as the Secretary of State considers appropriate.’
This amendment imposes a duty onto the Secretary of State to consult before publishing guidance under Clause 6.
Amendment 33, in clause 6, page 4, line 4, leave out subsection (2).
This amendment removes Clause 6(2) which is legally unnecessary.
Amendment 34, in clause 6, page 4, line 10, leave out subsection (3) and insert—
‘(3A) The Secretary of State may from time to time revise the guidance published under this section and, if this is done, must publish the guidance as revised.
(3B) If the Secretary of State considers that any revisions would amount to a substantial change in the guidance, the Secretary of State must consult such persons as the Secretary of State considers appropriate before publishing any revised guidance.’
This amendment places a duty onto the Secretary of State to consult before publishing revised guidance under Clause 6 where the revisions to the guidance are substantial.
New clause 3—Delegation of responsible person’s functions—
‘(1) The responsible person for each mental health unit may delegate any functions exercisable by the responsible person under this Act to a relevant person only in accordance with this section.
(2) The responsible person may only delegate a function to a relevant person if the relevant person is of an appropriate level of seniority.
(3) The delegation of a function does not affect the responsibility of the responsible person for the exercise of the responsible person’s functions under this Act.
(4) The delegation of a function does not prevent the responsible person from exercising the function.
(5) In this section “relevant person” means a person employed by the relevant health organisation that operates the mental health unit.’
This new clause gives a power to the responsible person to delegate functions under the Bill subject to the limitation that the person to whom functions are delegated is of an appropriate level of seniority. The obligations associated with the functions remain with the responsible person despite any delegation.
Mr Reed
Rather than including too much prescriptive guidance in the Bill, we have decided that it is best dealt with through statutory guidance, so that it can always be kept up to date with the latest best practice or other information and can be changed more quickly than legislation. Clause 6 sets out the requirements for guidance to be issued to set out compliance with the various requirements of the Bill. Amendment 28 places a duty on the Secretary of State to produce that guidance. That is a more appropriate level at which to produce the guidance than the CQC, although the CQC will have an important role to play in monitoring and regulating compliance with the Bill. The guidance will be statutory, so a failure to have regard to it will be a breach of a statutory duty. The amendments provide me with the assurance that operators of mental health units will be fully aware of their duties and the requirements under the Act.
New clause 3 gives the responsible person the power to delegate their functions under the Bill to another employee of appropriate seniority, but it does not mean that the responsible person will no longer be accountable for that function. It is important that in every unit there is always a named individual who is responsible for compliance with the provisions of the Bill and accountable, should there be any failure to comply with the provisions.
Jackie Doyle-Price
I agree that it is more appropriate for the Secretary of State to produce the guidance under the clause. The guidance will provide mental health units and the healthcare organisations that operate them with a detailed explanation of the requirements of the Bill. That will help to ensure that they understand the obligations they are under and, in turn, help them reduce the use of force so that it is only ever used as a last resort and carried out appropriately.
I want to clarify something I said earlier, in case I gave a slightly wrong impression when I referred to volunteers. We do not expect volunteers to use force and, accordingly, we do not expect them to be given training. There will not be an outright ban, but clearly the emphasis in the Bill means that only appropriately trained professional staff will be involved.
The duty to consult will ensure that there is input from a wide range of partners and stakeholders, so that the guidance is well received within the health service. On that basis, the Government are content to support the amendments. We are also content to support the new clause, which will allow a responsible person to delegate some of their functions to the right person within the organisation, but still retain overall accountability for compliance with the requirements of the Bill.
Amendment 28 agreed to.
Amendments made: 29, in clause 6, page 4, line 3, leave out “registered managers” and insert
“responsible persons and relevant health organisations”
This amendment is consequential on Amendment 7 as well as including relevant health organisations as subjects of the guidance published under Clause 6.
Amendment 30, in clause 6, page 4, line 3, at end insert—
‘(1A) In exercising functions under this Act, responsible persons and relevant health organisations must have regard to guidance published under this section.’
This amendment places a duty on responsible persons and relevant health organisations to have regard to the guidance published under Clause 6.
Amendment 31, in clause 6, page 4, line 3, at end insert—
‘(1B) The Secretary of State must keep under review any guidance published under this section.’
This amendment places a duty on the Secretary of State to review any guidance published under Clause 6.
Amendment 32, in clause 6, page 4, line 3, at end insert—
‘(1C) Before publishing guidance under this section, the Secretary of State must consult such persons as the Secretary of State considers appropriate.’
This amendment imposes a duty onto the Secretary of State to consult before publishing guidance under Clause 6.
Amendment 33, in clause 6, page 4, line 4, leave out subsection (2)
This amendment removes Clause 6(2) which is legally unnecessary.
Amendment 34, in clause 6, page 4, line 10, leave out subsection (3) and insert—
‘(3A) The Secretary of State may from time to time revise the guidance published under this section and, if this is done, must publish the guidance as revised.
(3B) If the Secretary of State considers that any revisions would amount to a substantial change in the guidance, the Secretary of State must consult such persons as the Secretary of State considers appropriate before publishing any revised guidance.’
This amendment places a duty onto the Secretary of State to consult before publishing revised guidance under Clause 6 where the revisions to the guidance are substantial.—(Mr Reed.)
Clause 6, as amended, ordered to stand part of the Bill.
Clause 9
Annual report by the Secretary of State
Mr Reed
I beg to move amendment 70, in clause 9, page 5, line 39, leave out subsections (1) to (4) and insert—
‘(1) As soon as reasonably practicable after the end of each calendar year, the Secretary of State—
(a) must conduct a review of any reports made under paragraph 7 of Schedule 5 to the Coroners and Justice Act 2009 that were published during that year relating to the death of a patient as a result of the use of force in a mental health unit by staff who work in that unit, and
(b) may conduct a review of any other findings made during that year relating to the death of a patient as a result of the use of force in a mental health unit by staff who work in that unit.
(1A) Having conducted a review under subsection (1), the Secretary of State must publish a report that includes the Secretary of State’s conclusions arising from that review.
(1B) The Secretary of State may delegate the conduct of a review under subsection (1) and the publication of a report under subsection (1A).
(1C) For the purposes of subsection (1)(b) “other findings” include, in relation to the death of a patient as a result of the use of force in a mental health unit, any finding or determination that is made—
(a) by the Care Quality Commission as the result of any review or investigation conducted by the Commission, or
(b) by a relevant health organisation as the result of any investigation into a serious incident.’
This amendment replaces the provisions of Clause 9 with a duty imposed on the Secretary of State to review reports each year made by coroners under the Coroners and Justice Act 2008 (often referred to as “regulation 28 reports”). The Secretary of State can also review other findings. After the review, a report must be published that includes the Secretary of State’s conclusions arising from the review.
This clause is very important. When there has been a fatality in a mental health unit, a coroner investigates the circumstances and the causes of that death and produces a report. I sat in for part of the coroner’s hearing following the death of Olaseni Lewis in Croydon. The coroner’s findings in that case were very damning of failures that had occurred leading up to that young man’s death, which were certainly avoidable, had lessons from previous coroners’ inquiries been properly learned and applied.
The purpose of the amendment and the clause is to ensure that all findings from coroners’ reports over a year are collated by the Secretary of State and published in an annual report, with the Secretary of State’s conclusions on how the state is learning from any incidents that occurred during that year.
That is an important step towards transparency and a culture in which lessons are learned quickly and effectively. A striking element of the findings in coroners’ reports over the years is how frequently the same recommendations are made again and again. If there was learning in the system and those lessons were being applied, that repetition would be far less likely to occur.
The proposal is to ensure that when those findings are made, they do not vanish into the ether; they must to properly understood and incorporated into the future development of best practice, to keep mental health patients safe. Amendment 70 would make the necessary provisions for the Secretary of State to carry out the publication of the reports.
Jackie Doyle-Price
Transparency is such an important ingredient in ensuring that we strengthen the rights of patients in mental health settings, and ensuring the accountability of organisations that are discharging their responsibilities at the behest of the state. That is why transparency is at the heart of the measures in the Bill.
Having read more than my fair share of coroners’ reports since taking this job, I fully endorse the provisions in the clause and the amendment. It is important that the broader system learns lessons when things go wrong. If we learn lessons when things go wrong, the chances that they will not happen again are much stronger. It is very important that the healthcare system is able to learn lessons from any death of a patient in a mental health unit that results from the use of force.
Drawing together the lessons learnt from a variety of sources into one report will allow greater transparency and shine a light on the issues that need to be tackled by organisations, and it will ensure that the learning from these tragic events is not lost. For that reason, the Government support the amendment.
Amendment 70 agreed to.
Clause 9, as amended, ordered to stand part of the Bill.
Clause 10
Requiring information regarding the use of force
Question proposed, That the clause stand part of the Bill.
Mr Reed
This will be brief. I am asking the Committee to vote against clause 10, because the provisions that were originally included in it have now been placed in clause 7, where they have also been strengthened, so the clause is no longer required.
Question put and negatived.
Clause 10 accordingly disagreed to.
Clause 11
Duty to notify Secretary of State of deaths
Question proposed, That the clause stand part of the Bill.
Mr Reed
Similarly, I am asking the Committee to vote against clause 11, because it duplicates existing duties in regulations 16 and 17 of the Care Quality Commission (Registration) Regulations 2009, so it is no longer required.
Question put and negatived.
Clause 11 accordingly disagreed to.
The Chair
We have made very good progress this morning, but we can go no further with the line-by-line consideration until the House has passed a money resolution for the Bill. I invite Steve Reed to move the Adjournment motion.
Ordered, That further consideration be now adjourned. —(Mr Reed.)
Mental Health Units (Use of Force) Bill (Second sitting)
Wednesday 18th April 2018
(6 years, 7 months ago)
Public Bill CommitteesRead Full debate Mental Health Units (Use of Force) Act 2018 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 18 April 2018 - (18 Apr 2018)
The Chair
Before we begin, can everybody have their electronic devices switched to silent, please?
As the Committee cannot consider the remaining clauses of the Bill until the House has agreed to a money resolution, I call Steve Reed, as the Member in charge of the Bill, to move that further consideration of the Bill be adjourned.
Mr Steve Reed (Croydon North) (Lab/Co-op)
It is a pleasure to serve under your chairmanship this morning, Ms Buck, however briefly. I thank Members for coming—I wish we were going to spend more time together, but it seems we are not.
I will just make a few points before I formally move the Adjournment. This is the fifth successive week the Committee has been unable to complete its work, and that is excluding the two weeks of recess. The reason is that the Government have not yet laid a money resolution, so we are not allowed to consider the remaining clauses. I have raised this directly with the Opposition Whips, who have raised it with the Government Whips. I have raised it in a direct question to the Leader of the House in business questions, and I pursued it in a letter to the Leader of the House, from whom I had a very charming reply that does not shed any further light on why the delays may be happening.
After five weeks, I am starting to feel that this is a little disrespectful to members of the Committee and to the Bill’s many supporters outside this House. I do not doubt for a moment the support of the Minister, or indeed the Government, who have consistently reiterated their support for the reform we are trying to get through, but it would be nice if the Government were able to let the Bill Committee get on with its work. With great respect, I would ask the Minister whether she has had any conversations with the Government Whips or Government business managers, what they may have said and when we might expect to have the money resolution.
The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
I share the hon. Gentleman’s impatience with the current state of affairs, not least because I really do believe that this is a very important reform, and the sooner we get it on the statute book, the better. However, as he alluded to, such matters are for the Government business managers. I am pleased that he has kept the pressure up at his end and raised this with the Leader of the House, and I know that those discussions are continuing.
I would remind the Committee that we have just had two weeks of recess and a very intense few days in terms of other business, which has perhaps dominated the business managers’ thinking this week. However, I hear the hon. Gentleman’s message completely, and I completely understand where he is coming from. Following this meeting, I will resume my conversations with the Government business managers so that we can make very fast progress.
Ordered, That further consideration be now adjourned.— (Mr Reed.)
Mental Health Units (Use of Force) Bill
Friday 15th June 2018
(6 years, 5 months ago)
Commons ChamberRead Full debate Mental Health Units (Use of Force) Act 2018 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 15 June 2018 - (15 Jun 2018)
13:52 - The House divided: - Ayes: 8 / Noes: 47 - Question accordingly negatived.
14:04 - The House having divided: - Ayes: 3 / Noes: 49 - Question accordingly negatived.
Mr Steve Reed (Croydon North) (Lab/Co-op)
I beg to move, That the clause be read a Second time.
Mr Speaker
With this it will be convenient to discuss the following:
New clause 2—Independent investigation of deaths: legal aid—
‘(1) Schedule 1 to the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (civil legal services) is amended as follows.
(2) After paragraph 41 (inquests) insert—
“41A Investigation of deaths resulting from use of force in mental health units
(1) Civil legal services provided to an individual in relation to an investigation under section (independent investigations of deaths) of the Mental Health Units (Use of Force) Act 2018 (independent investigation of deaths) into the death of a member of the individual’s family.
(2) For the purposes of this paragraph an individual is a member of another individual’s family if—
(a) they are relatives (whether of the full blood or half blood or by marriage or civil partnership),
(b) they are cohabitants (as defined in Part 4 of the Family Law Act 1996), or
(c) one has parental responsibility for the other.”
Amendment 86, in clause 1, page 1, line 13, leave out sub-paragraph (ii).
Amendment 87, page 1, line 15, leave out subsection (4).
Amendment 44, page 2, line 3, leave out “force” and insert “restraint”.
Amendment 40, page 2, line 4, after “use” insert “or threat ”.
This amendment, together with Amendments 41 to 43, would extend the definition of the use of force for the provisions in the Bill to cover threats of the use of force and coercion.
Amendment 88, page 2, line 4, leave out “mechanical or chemical” and insert “or mechanical”.
Amendment 89, page 2, line 5, leave out paragraph (b).
Amendment 41, page 2, line 5, after “isolation” insert “or threat of isolation”.
See explanatory statement for Amendment 40.
Amendment 42, page 2, line 5, at end insert “or
(c) the coercion of a patient.”
See explanatory statement for Amendment 40.
Amendment 90, page 2, leave out lines 14 and 15.
Amendment 91, page 2, leave out lines 16 and 17.
Amendment 43, page 2, line 17, at end insert—
““Coercion” means the use or threat of force, with the intention of causing fear, alarm or distress to control a patient’s behaviour or elicit compliance with the application of a use of force.”
See explanatory statement for Amendment 40.
Amendment 92, in clause 2, page 2, line 20, leave out “a relevant” and insert “any”.
Amendment 93, page 2, line 23, leave out “relevant”.
Amendment 94, page 2, line 25, leave out “relevant”.
Amendment 45, page 2, line 30, clause 3, leave out “force” and insert “restraint”.
Amendment 95, page 2, line 32, leave out “relevant”.
Amendment 37, page 3, line 2, at end insert—
‘(6A) A policy published under this section must set out that the use of force will only be used without the sole intention of inflicting pain, suffering or humiliation, or subjecting patients to tortuous, inhumane or degrading treatment, or without inflicting punishment or intimidation.”
This amendment would prevent the use of force with the sole intention of causing suffering or harm to a patient, in line with the Mental Health Act code of practice and the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.
Amendment 36, page 3, line 3, leave out from “out” to end of line 4 and insert—
“(a) a description of each of the methods of restraint that may be used in the mental health unit;
(b) what steps will be taken to reduce and minimise the use of force in the mental health unit by staff who work in the unit;
(c) a description of the techniques to be used for avoiding or reducing the use of force in the mental health unit by staff who work in the unit; and
(d) a commitment to reducing the overall use of force in the mental health unit.”
This amendment would require mental health units to commit to reducing the overall use of force, and increase transparency about how they intend to achieve this and what types of force they permit.
Amendment 46, page 3, line 4, leave out “force” and insert “restraint”.
Amendment 47, in clause 4, page 3, line 7, leave out “force” and insert “restraint”.
Amendment 38, page 3, line 8, at end insert—
‘(1A) Information under subsection (1) must include a patient’s right to advocacy and how to access an advocate.”
This amendment would ensure that people’s legal rights to advocacy, under existing provisions, are communicated to them in relation to the use of force.
Government amendment 1, page 3, line 16, at end insert—
“unless the patient (where paragraph (a) applies) or the other person (where paragraph (b) applies) refuses the information.”
This allows for cases where a person refuses the information provided, and supersedes subsections (9)(a) and (10)(a).
Government amendment 2, page 3, line 22, leave out subsection (5) and insert—
‘(5) The responsible person must take whatever steps are reasonably practicable to ensure that the patient is aware of the information and understands it.”
This expands the duty to provide information accessibly so that it requires the responsible person to take whatever steps are reasonably practicable to ensure the patient understands.
Government amendment 3, page 3, line 33, leave out subsections (9) and (10).
Subsections (9)(a) and (10)(a) are superseded by Amendment 1. Subsections (9)(b) and (10)(b) are unnecessary as the information will not be of a nature that would cause distress.
Amendment 96, page 3, line 36, leave out “the responsible person considers that”.
Amendment 97, page 3, line 42, leave out “the responsible person considers that”.
Amendment 48, in clause 5, page 4, line 3, leave out “force” and insert “restraint”.
Amendment 79, page 4, line 3, at end insert—
‘(1A) The Secretary of State must publish quality standards for training provided under subsection (1).
(1B) The Secretary of State may delegate the publication of quality standards for training under subsection (2).”
This amendment would require training on the use of force to comply with quality standards.
Amendment 98, page 4, line 6, after “patients” insert “and their families”.
Amendment 9, page 4, line 9, leave out paragraph (c).
Amendment 49, page 4, line 11, leave out “force” and insert “restraint”.
Amendment 50, page 4, line 12, leave out “force” and insert “restraint”.
Amendment 80, page 4, line 13, at beginning insert “trauma-informed care, including”
This amendment, together with Amendment 81, would ensure that training requirements for staff include training on trauma-informed care.
Amendment 81, page 4, line 14, at end insert
“and the impact of the use of force on a patient who may have experienced violence and abuse.”
See explanatory statement for Amendment 80.
Amendment 51, page 4, line 15, leave out “force” and insert “restraint”.
Amendment 52, page 4, line 16, leave out “force” and insert “restraint”.
Amendment 99, page 4, line 18, leave out “the principal”.
Amendment 10, page 4, line 18, leave out “or ethical”.
Amendment 53, page 4, line 18, leave out “force” and insert “restraint”.
Amendment 11, page 4, line 18, at end insert—
“(l) the roles, responsibilities and procedure in the event of police involvement,”
Amendment 12, page 4, line 18, at end insert—
“(m) awareness of acute behavioural disturbance.”
Government amendment 4, page 4, line 30, leave out “meets the standards of” and insert
“is of an equivalent standard to”
This is a small drafting change that clarifies that training does not need to be provided under Clause 5 if training that was recently provided was of an equivalent standard to the training provided under that Clause.
Amendment 13, page 4, line 31, leave out subsections (5) and (6).
Amendment 100, page 5, line 8, clause 6, at end insert—
‘(7) Guidance under this Act shall be published no later than six months after this Act is passed.”
Government motion to transfer clause 6.
Amendment 101, in clause 7, page 5, line 11, after “any” insert “significant”.
Amendment 54, page 5, line 12, leave out “force” and insert “restraint”.
Amendment 39, page 5, line 13, leave out subsections (2) and (3).
This amendment would improve transparency and accountability about the use of force by ensuring consistency in the recording of all uses of force, not just those that are above a threshold to be set in statutory guidance.
Amendment 102, page 5, line 13, leave out subsection (2).
Amendment 55, page 5, line 13, leave out “force” and insert “restraint”.
Amendment 14, page 5, line 13, at end insert
“or does not involve physical contact”.
Amendment 103, page 5, line 14, leave out subsection (3).
Amendment 56, page 5, line 14, leave out “force” and insert “restraint”.
Amendment 104, page 5, line 17, leave out subsection (4).
Amendment 57, page 5, line 20, leave out “force” and insert “restraint”.
Amendment 58, page 5, line 21, leave out “force” and insert “restraint”.
Amendment 59, page 5, line 22, leave out “force” and insert “restraint”.
Amendment 60, page 5, line 23, leave out “force” and insert “restraint”.
Amendment 61, page 5, line 25, leave out “force” and insert “restraint”.
Amendment 62, page 5, line 26, leave out “force” and insert “restraint”.
Amendment 63, page 5, line 28, leave out “force” and insert “restraint”.
Amendment 64, page 5, line 31, leave out “force” and insert “restraint”.
Amendment 15, page 5, line 33, leave out paragraph (k).
Amendment 65, page 5, line 36, leave out “force” and insert “restraint”.
Amendment 66, page 5, line 38, leave out “force” and insert “restraint”.
Amendment 67, page 5, line 39, leave out “force” and insert “restraint”.
Amendment 68, page 5, line 40, leave out “force” and insert “restraint”.
Amendment 21, page 5, line 41, at end insert—
“(q) the relevant characteristics of the staff involved (if known)”
Amendment 16, page 5, line 43, at end insert—
‘(6A) Records must also be kept in the patient’s medical notes.”
Government amendment 5, page 6, line 5, leave out
“made by or under the Data Protection Act 1998”
and insert
“of the data protection legislation”
Amendments 5 and 6 are consequential on the Data Protection Act 2018.
Government amendment 6, page 6, line 6, at end insert—
‘( ) In subsection (8) “the data protection legislation” has the same meaning as in the Data Protection Act 2018 (see section 3 of that Act).”
Amendments 5 and 6 are consequential on the Data Protection Act 2018.
Amendment 17, page 6, line 7, leave out subsections (9) and (10).
Amendment 22, page 6, line 7, leave out from “(5)(k)” to “mean” and insert
“(5)(k) and (q) the ‘relevant characteristics’ in relation to a patient and member of staff”
Amendment 23, page 6, line 8, leave out “the patient’s” and insert “their”.
Amendment 24, page 6, line 9, leave out “the patient has” and insert “they have”.
Amendment 32, page 6, line 11, leave out paragraph (c).
Amendment 25, page 6, line 11, leave out “the patient’s” and insert “their”.
Amendment 26, page 6, line 12, leave out “the patient is” and insert “they are”.
Amendment 33, page 6, line 13, leave out paragraph (e).
Amendment 27, page 6, line 13, leave out “the patient’s” and insert “their”.
Amendment 34, page 6, line 14, leave out paragraph (f).
Amendment 28, page 6, line 14, leave out “the patient’s” and insert “their”.
Amendment 29, page 6, line 15, leave out “the patient’s” and insert “their”.
Amendment 35, page 6, line 16, leave out paragraph (h).
Amendment 30, page 6, line 16, leave out “the patient’s” and insert “their”.
Amendment 69, in clause 8, page 6, line 21, leave out “force” and insert “restraint”.
Amendment 70, page 6, line 22, leave out “force” and insert “restraint”.
Amendment 31, page 6, line 26, leave out “and (n)” and insert “(n) and (q)”.
Amendment 71, in clause 9, page 6, line 33, leave out “force” and insert “restraint”.
Amendment 72, page 6, line 35, leave out “force” and insert “restraint”.
Amendment 82, page 6, line 39, at end insert—
‘(2A) The report published under subsection (2) must make reference to the annual statistics published under section 8.”
This amendment, together with Amendments 83 to 85, would improve accountability and transparency in the progress towards reducing the overall use of force.
Amendment 83, page 6, line 39, at end insert—
‘(2B) The Secretary of State must make a statement to Parliament, as soon as practicable following the publication of report under subsection (2).”
See explanatory statement for Amendment 82.
Amendment 84, page 6, line 41, leave out “and”.
See explanatory statement for Amendment 82.
Amendment 85, page 6, line 41, at end insert
“and the statement under subsection (2B).”
See explanatory statement for Amendment 82.
Amendment 73, page 7, line 2, leave out “force” and insert “restraint”.
Amendment 18, in clause 12, page 7, line 38, leave out “must take” and insert “should consider taking”.
Amendment 19, page 8, line 2, leave out “must wear it and” and insert
“should wear it and try to”
Amendment 20, page 8, line 6, leave out subsections (4) and (5).
Government amendment 7, in clause 13, page 8, line 32, leave out
“has the meaning given by section 2”
and insert
“means a person appointed under section 2(1)”
This improves the drafting of the definition of “responsible person”.
Amendment 74, page 8, line 42, leave out “force” and insert “restraint”.
Amendment 75, page 8, line 43, leave out “force” and insert “restraint”.
Amendment 76, page 8, line 46, leave out “force” and insert “restraint”.
Government motion to transfer clause 15.
Amendment 77, in clause 17, page 9, line 24, leave out “Force” and insert “Restraint”.
Amendment 78, in title, line 2, leave out “force” and insert “restraint”.
Government amendment 8, line 2, leave out “and similar institutions”.
This removes from the long title a reference to “similar institutions” as these are not covered by the Bill.
Philip Davies (Shipley) (Con)
On a point of order, Mr Speaker. I am sorry to interrupt the hon. Member for Croydon North (Mr Reed), but I want to raise a matter of some importance. Also, I am sorry that I have not given you advance notice of this.
Mr Speaker, you are well regarded for your reputation of championing the rights of Back Benchers, but it has become apparent over the past few days that the rights of Back Benchers in this House are being massively curtailed. The deadline for tabling amendments for Fridays is Tuesday evening, which gives people the opportunity to consider the amendments that have been tabled. The timescale is the same for every Bill’s Report stage.
It has become apparent over the past day or so that the Government have a policy of saying that they will not agree to any amendments tabled unless they have at least eight days in which to consider them and to do a write-round of all Departments. That means that no Back Bencher has an opportunity to have any amendments that they table on Report accepted—the Government will automatically not accept those amendments because they have not had time to consider them. This means that the rights of Back Benchers are being massively curtailed, and also that laws will be passed that are not fit for purpose, because amendments that would otherwise have been accepted by the Government will not have been accepted. Will you look into this matter, Mr Speaker?
It seems to me that if Back Benchers are to have the opportunity to get their amendments accepted, we will need a new regime under which they will have to be tabled at least eight days before a Bill is considered; otherwise, we will have no chance. That would mean that the business of the House would have to be brought forward. Can you also confirm that, for anyone who has taken the time to table amendments to improve this Bill, the only way to have their amendments properly considered would be to ensure that we did not get to the end of our debate on these amendments today, meaning that proceedings would have to be rescheduled for a subsequent day, as that would give the Government time to consider whether to accept the amendments? Is that the only course of action open to a Back Bencher who has spent lots of time trying to improve the legislation?
Mr Speaker
I am grateful to the hon. Gentleman for his point of order, which is a source of some concern to me. Off the top of my head, it seems important to distinguish between two not altogether unrelated but, in important senses, separate matters. One is the question of the selection of amendments; the other is the question of the House’s treatment of them and the opportunity for treatment of them.
So far as selection is concerned, that is, as the hon. Gentleman knows, a matter for the Chair, and I will go about my duty in this matter the way that I have always done. I hope that I do this dispassionately but with a regard for Back Benchers. He and other colleagues will have discovered over the years that the views of the Government are not a matter of any particular interest or concern to me. If I think something should be selected, it will be selected.
Secondly, the hon. Gentleman will probably not be entirely surprised to know that I was not aware of any new intended arrangements being drawn up for the administrative convenience—I use that term non-pejoratively—of the Executive branch. That is not something of which a Whip has notified me. The Government might well think it most convenient to have rather longer, for the reasons that the hon. Gentleman has adduced, but it is not something of which I have been made aware. I think it would be useful to have knowledge of such a matter, but I do not think that anything can be done today. However, it would be a pity if Back Benchers were hampered in any way.
I would just add that in my limited experience—like the hon. Gentleman, I have never served in government, which I say as matter of some considerable pride—Governments are perfectly capable of operating quickly when it is convenient for them to do so, and of operating at a more leisurely pace when it is convenient for them to do so. If the hon. Gentleman is asking whether I have managed to discern the mindset of the Treasury Bench, I can say only two things. First, I have been here only 21 years, which is quite a short time in which to try to discern the mindset of those on the Treasury Bench. Secondly, if the hon. Gentleman were to think that I did understand fully the mindset of those on the Treasury Bench, he would be attributing to me an intellectual weight that I do not claim for myself.
If there are no further points of order for now, perhaps we can proceed with the oration of Mr Steve Reed.
Mr Reed
Thank you, Mr Speaker. I have sympathy for what the hon. Member for Shipley (Philip Davies) said, but I hope that during today’s debate we will find ways of achieving the objectives of his constructive amendments.
The Bill is known as Seni’s law after Seni Lewis, a young man from Thornton Heath in my constituency who died in 2010 after a period of severe and prolonged face-down restraint. Seni is one of too many people who have suffered unnecessary and avoidable deaths in our mental health services, and that comes alongside any number of unnecessary and avoidable injuries. Following the inquest into Seni’s death, the coroner’s verdict was clear that, without change, what happened to Seni will happen again, and it has already happened to others. That change is this Bill, and I am grateful for support from Members on both sides of the House, the Minister and every single professional and patient advocacy group working in the sector.
New clause 1 is probing. It arises from the fact that Seni Lewis’s parents, having suffered the trauma of the loss of their child in completely avoidable circumstances in 2010, had to fight the state for seven years simply to obtain an inquest to find out how their previously healthy 21-year-old son ended up dead on the floor in hospital. The coroner pointed to severe failings by the mental health trust, the police and the Crown Prosecution Service that led to delays in that inquest opening. The root cause of the problem was the insufficiently independent investigation conducted by the mental health trust into its own failings. The answer is to ensure that any death in such circumstances automatically triggers a fully independent investigation into the circumstances and causes of that death, with legal aid provided to the families of the deceased persons so that there is a level playing field for all parties taking part in the inquest.
Currently there is a huge disparity between how investigations are conducted for deaths in mental health units and those in other forms of state detention. When somebody dies in police custody, an external investigation by an independent national body happens automatically, but the same does not happen in a mental health setting. If a patient dies, the trust or private provider investigates itself or appoints another trust or individual to do so. That lack of accountability means that reports can be delayed or kept quiet, and can lack the necessary independence and rigour.
Jeremy Quin (Horsham) (Con)
I congratulate the hon. Gentleman on the progress of the Bill, which I hasten to say that I support, but I have a concern about new clause 1. I appreciate that he has tried to address it in subsection (7), which aims to avoid conflict with the coroners, and he may have dealt with my concern, but I was worried about the interaction between the new independent report, the coroner’s work and the work of the police, if that is relevant. The hon. Gentleman referred to the external reports produced in other custodial circumstances, so is he able to reassure the House that, were this proposal to go ahead, there would be no conflict between the different authorities: the coroner, the police and the author of the independent report that goes to the Secretary of State?
Mr Reed
The hon. Gentleman raises an important point, and I look forward to the comments of the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price). It is important that there is consistency across all forms of state detention so that those who suffer traumatic circumstances, or even death, are treated in the same way.
If lessons are not learned from such incidents, the chance to prevent further deaths is missed, and we end up with a series of what look like isolated tragic incidents, such as Seni’s death, that are actually part of a wider institutional problem that has not been recognised and therefore not dealt with. It is unacceptable that institutions responsible for the care of patients suffering from mental ill health are subject to less scrutiny than institutions that detain criminal suspects and prisoners. It is no wonder that the casework of the campaigning charity Inquest, which works with bereaved families, shows that so many people who rely on such services no longer have confidence in them.
Another barrier to justice for families is funding for legal representation. Dame Elish Angiolini’s excellent report concluded last year that
“families face an intrusive and complex mechanism for securing funding”,
because there
“is no legal aid for inquests other than in exceptional circumstances”.
The Angiolini report recommended that legal aid should be awarded to families in the case of deaths in police custody. The Government have accepted that there is a need to look at that in the Lord Chancellor’s review and, in the spirit of consensus that has characterised the development of the Bill, I would welcome an update from the Minister on what work is being done on that. It makes little sense not to extend legal aid to situations in a mental health unit, because we need consistency across all forms of state custody. The families of patients should certainly not be disadvantaged compared with other bereaved families, and new clause 2 would ensure that legal aid is available to family members in relation to an investigation of an unnatural death in a mental health unit.
I will briefly address some of the amendments tabled by the Government, the hon. Members for Shipley and for Christchurch (Sir Christopher Chope), and the right hon. Member for North Norfolk (Norman Lamb). I welcome their efforts to strengthen the Bill, which has progressed through the Commons with a real sense of consensus, both from the Minister, and from every professional body and patient advocacy active in the sector. It is important that such work continues during the Bill’s remaining stages and beyond.
On the scope of the Bill and which mental health units it applies to, the hon. Member for Christchurch tabled amendments 86, 87 and 92 to 95, which would extend the Bill’s scope to cover all independent providers of mental health care. The principle behind the amendments seems sound, because every patient, whether NHS or private, should be protected by the same rights. However, I know that the Minister has some concerns about the practicalities of extending the Bill’s scope in that way, not least about how wholly private providers would report data through NHS Digital and the limits of statutory guidance in that respect, so I look forward to her comments.
Norman Lamb (North Norfolk) (LD)
Does the hon. Gentleman share my view that whether the measure gets into the Bill or not, we need to reach a point at which data is provided from private providers and from the NHS in exactly the same way so that we can compare how people are treated on both sides of the divide?
Sir Christopher Chope (Christchurch) (Con)
I am grateful to the hon. Gentleman for his indication of support for these amendments. When the Government have explained to him why they cannot deal with them, have they explained how the objections he has raised do not occur where the treatment is provided in part by the NHS but not in toto?
Mr Reed
As the Minister is present, it is probably best to allow her to speak for herself, rather than for me to attempt to interpret this on her behalf.
I wish to turn next to the amendments tabled by the right hon. Member for North Norfolk, many of which I support in principle, having raised a number of them myself at previous stages. I am broadly satisfied that many, if not most, of the points will be dealt with through guidance issued by the Department after the legislation, but I look forward to the Minister’s further comments and explanations on those points.
Important additions have been made to what falls under the definition of “use of force” as this Bill has developed. One is the use of “chemical restraint”, which amendments 88 to 91, standing in the name of the hon. Member for Christchurch, would remove from the Bill. I am afraid that I cannot support those amendments, because the potential effect is that the Bill could limit the use of physical restraint, only to lead instead to an increase in the use of medication—for example, rapid tranquilisation. It is important therefore that the Bill covers all forms of restraint, both physical and chemical.
Sir Christopher Chope
I tabled these amendments on the basis of a sad, current constituency case involving the parents of a very ill young man of 25. He is in and out of a mental health unit, and normally he is in there because he has failed to take his medication. It is designed to reduce the need for force, because he would be violent without it. Surely, the giving of such medication to a person in the circumstances I have described should not be regarded as “force” under the Bill.
Mr Reed
I hear what the hon. Gentleman is saying, but the point remains: if we take measures to deal with only physical restraint but not chemical restraint, we may simply push the services to use chemical restraint, such as rapid tranquilisation, more frequently and we would not wish to see that as an unintended consequence of amending the Bill further.
On the nature of the use of force, the hon. Member for Shipley has tabled amendments 44 to 78, which would replace the word “force” with the term “ restraint” throughout the Bill. I do not wish to pre-empt his reasons for doing that, and I suspect he will explain himself well later this morning, but let me say that we used the term “restraint” rather than “force” during an earlier draft of the Bill, so I agree with the general intention behind these amendments. I was persuaded, however, that the current wording ensures greater consistency with other legislation and therefore that the Bill does not run the risk of adding confusion into how the professionals interpret the language used.
The right hon. Member for North Norfolk has tabled a number of amendments dealing with the information provided to patients. Amendment 38 would include in the information given to patients details of their right to independent advocacy, which would help the patient to make the right decisions about their care and involve, where appropriate, carers and families. I certainly agree on the need to give more power to service users, so I would gently encourage the Minister to set out how those objectives might be achieved.
The Bill, as amended in Committee, says that information does not need to be provided where it would “cause the patient distress”. I understand that the hon. Member for Christchurch also has concerns about that, which is why both he and the right hon. Gentleman have tabled amendments to remove that potential loophole. I agree on this, and following discussions with the Minister, I am happy to accept Government amendments 1 to 3, which remove this “distress” loophole.
On staff training, the hon. Member for Shipley has tabled amendments 11 and 12, which seek to strengthen the Bill by adding usefully to the list of training topics. I know that he has discussed the Bill with his local care trust, and I welcome that spirit of engagement and representation. Amendment 11 would require training to be given on “roles, responsibilities and procedure” if the police are called to a mental health unit, as happened in the case of Seni Lewis and in many others. That strikes me as a sensible addition to the Bill, ensuring a more joined-up approach between police officers and staff in mental health units. Amendment 12 would also strengthen the Bill. It would add
“awareness of acute behavioural disturbance”
to the list of training topics. That is clearly a valuable thing for staff to be aware of in terms of how restraint may affect someone displaying behavioural disturbance. I support amendments 11 and 12, but before accepting them, it is important to hear whether the Government intend to deal with them through guidance.
There are, however, amendments that I am not happy to accept. Amendment 9 would remove the need for training on diversity, but that is a crucial part of the improved training and it goes to the heart of the Bill’s purpose in ensuring equal treatment for everybody by identifying those areas where treatment is not being delivered equally to everybody, whether because of ethnicity, type of disability or gender. If we do not capture that data, we cannot see the problem, and if we do not recognise the problem, we cannot put in place the measures to deal with it. Therefore, I cannot support that amendment.
Jeremy Quin
I wonder whether the hon. Gentleman has any thoughts on amendment 113, which I do not think will be debated. It was tabled by my hon. Friend the Member for Witney (Robert Courts) and it seeks to define what “regular intervals” are and whether there should be annual training. At the moment, the training is to be given at “regular intervals”, so does the hon. Gentleman have any thoughts on how regular those intervals should be and whether there should be an annual stipulation?
Mr Reed
I agree with the sentiment, but I do not think that the Bill should be too prescriptive. It is for the Government, working with professionals in the field, to determine the appropriate period within which refresher training should take place. However, it should definitely take place, because training done several years previously can easily be forgotten or the circumstances can change. There is always a need to keep professional practice absolutely up to date.
Research shows that there are real fears about unconscious bias in our mental health services. The Angiolini review, published by the Government last year, shows how a disproportionate number of people from black, Asian and minority ethnic communities have died after the use of force in custody. Black people are four times more likely to be sectioned than white people. Training must reflect those challenges and consideration must be given to the effects of that kind of unconscious bias.
There are also concerns, as shown in amendment 13, proposed by the hon. Member for Shipley, about the frequency with which staff receive training—indeed that point has just been made in this debate. The principle of refresher training is important and the Bill deliberately does not specify how often it is provided, as that needs to be up to the Government, in consultation with professionals. I welcome and accept Government amendment 4, which ensures that training need not be undertaken by a member of staff if they have recently been trained to an equivalent standard.
Turning to the recording of data, the Bill sets out what should be recorded by mental health units when using force, and this is how trusts will be held accountable for the types and frequency of restraint used, as well as which patients they use it on. A number of amendments have been tabled on this issue, and I will deal with a few of them. I appreciate that there is concern about the provision in clause 7(2), which provides that the use of “negligible” force does not have to be recorded; amendments 102, 103 and 39 seek to remove the subsection. I shared similar concerns at an earlier stage of the Bill because I, too, feared that this might be a loophole. The reason this provision is in the Bill is that we want to avoid unnecessary burdens on staff, who might feel otherwise that they have to record every physical contact, such as guiding a patient through a door by the elbow. Such recording would be unnecessary and it is important that the Bill does not set up such circumstances.
I welcome the Minister’s assurance that the definition of “negligible” will be very tightly defined in the guidance, and I hope that gives the proposers of those amendments reassurance on the point that was behind them. The Minister has shown real commitment to building consensus on this Bill as it is has developed and I am sure she will do the same on the guidance. I hope that that encourages those Members not to press those amendments to a vote.
On what data should be recorded and why, I note that the hon. Member for Shipley proposes that the characteristics of staff who carry out restrain should also be recorded. That makes sense to me in principle, and the point has been made to me by people who work in the sector. There are real concerns about pre-existing prejudice against people with mental ill health, which might lead to inappropriate behaviour by some staff if it is not identified and corrected. However, up to this stage in the Bill’s development, there has been no engagement with the sector on this point, and the opinions and experience of those who work in the sector must be taken into account before we legislate. I look forward to hearing the Minister’s views on that, but my preference is for the issue to be considered through consultation, after legislation, and to be dealt with through guidance, if necessary.
Philip Davies
May I start by commending the hon. Member for Croydon North (Mr Reed), who is an excellent Member of this House? We clearly do not agree on a lot of things, but he really is an excellent MP. I commend him for two things. First, he has introduced legislation that is of particular interest to him, not least because of what happened to his constituent. He should be commended for doing that, and it goes to show the kind of local MP that he is. It is absolutely right that the tragic case of Olaseni Lewis has prompted him to introduce this legislation, the thrust of which I absolutely support, as he well knows.
Secondly, unlike many Members who promote private Members’ Bills, the hon. Gentleman has engaged in a rather constructive manner with everybody who has tabled amendments. I wish it were always like that—as we know, it often is not—but he has certainly engaged, and I absolutely commend him for that. The way in which he has conducted himself throughout the Bill’s passage through the House does him an enormous amount of credit, and I am grateful to him.
Having said that, there are parts of the Bill on which the hon. Gentleman and I disagree, as he alluded to in his speech. I absolutely support the thrust of what he is trying to achieve, and a great many parts of the Bill will make a considerable difference, but, as with most pieces of legislation, it would be naive to think that it could not be improved. As I said in the point of order that I made earlier, I fear that we are in danger of passing a piece of legislation that everybody in the House knows is not as good as it could and should be, largely because of the paralysis in Government decision making, which means that they do not seem to be able to assess and agree amendments with the speed with which the hon. Gentleman appears to have been able to do so. I suspect that is partly because the civil service appears to have taken the Government hostage in the running of public policy.
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
My hon. Friend is perhaps one of the most passionate Members about defending and championing the interests of Back Benchers, but I remind him of what the hon. Member for Croydon North (Mr Reed) has just said. The Government have worked with the hon. Gentleman to get his private Member’s Bill into a shape that they can support, while recognising that it is his Bill, and it has been taken forward in consultation with the sector. Rather than blame civil servants and processes, my hon. Friend could acknowledge that we want to take the whole sector with us on this Bill.
Philip Davies
I am sure we do, which is why I have consulted my local trust, Bradford District Care NHS Foundation Trust, about the Bill’s merits, and why I have tabled some amendments as a direct consequence of the discussions that I have had with the trust. I find the idea that only the Government are interested in moving forward with consensus rather offensive. I have been trying to move forward with consensus, too, as the hon. Member for Croydon North knows only too well. We have reached the stage at which the Government are saying, “I wish we’d known about some of these amendments earlier, because in that case we may well have been able to accept them.” What on earth is the point of having a deadline for the tabling of amendments three days beforehand if the Government cannot organise themselves to decide within that timescale whether those amendments should be agreed to? They should operate like most organisations and business do: if they have a timescale to meet, they should meet it, rather than pretend that the timescale is of only passing interest to them.
Jackie Doyle-Price
This is great fun. I come back to the point that this is a private Member’s Bill and the Government have agreed their position on it. We are not getting in the way of Back-Bench MPs tabling amendments, because although I will articulate the Government’s view on those proposals, it will be for the House of Commons to decide.
Philip Davies
I am grateful to the Minister for that. I appreciate that we are in a strange situation in which the Government do not have time to decide whether to agree with the amendments, but they certainly have time to write speeches on why they will disagree with them because they are not in a position to accept them. We have got ourselves into a completely farcical situation. The Minister is going to read out the speech that has been prepared to say why she cannot accept the amendments, but we all know that the reason why she cannot accept the amendments is that she does not have the Department organised to get things decided within eight days. As I said, that gives the impression that the Government have been taken hostage by the civil service. The Department of Health and Social Care is probably one of the worst offenders for being taken hostage by its civil servants. I am being charitable in saying that, because I presume that that is why so many socialist, nanny-state proposals come from the Department. I cannot believe that the Ministers actually believe in all that rubbish, so it must be the civil servants who are running the Department if those things are coming forward.
With this Bill, it seems that the civil servants, who never want to accept any amendments tabled by anybody other than themselves, are doing their best to try to stop any improvements to the Bill. It is a shame that we have got ourselves into a farcical situation. The Minister is absolutely right: there is nothing to prevent Members from tabling amendments—we know that because we have tabled them, and we are grateful to you for selecting them, Mr Speaker—but we have got ourselves into a rather farcical situation in which we have done an awful lot of work, and my staff have done an awful lot of work, I might add, to try genuinely to improve the Bill, and then we come across this ridiculous bureaucratic situation, about which I have only just found out with this Bill but which no doubt applies to every Bill. It is important that everyone knows that if Members table amendments at this stage of a Bill, they are wasting their time. It is a completely pointless exercise.
Sir Christopher Chope
I do not think that we are wasting our time when we table amendments. Contrary to what my hon. Friend says, I still have faith in the Minister, as I think she believes she is in charge. I believe she comes to this debate with an open mind, and, if, having heard the merits of a particular amendment, she decides that she will allow it, then she will say so from the Dispatch Box.
Let me mention another issue. We often find that because of the constraints on private Members’ business, people say, “We’ll amend it in the Lords.” If the Bill is amended in the Lords, its progress is jeopardised because it then has to come back here again for us to consider the Lords amendments. So in fact the Government should be more assiduous and quick in dealing with amendments to private Members’ Bills than amendments to their own legislation.
Philip Davies
My hon. Friend is absolutely right, but he is being slightly naive in thinking that we will get some rapid decision making. As, I think, Mr Speaker, you were alluding to in your response to my point of order, the only time that the Government appear to be able to act with speed is when they think they are going to lose a vote. At that point, they seem to be able to react with miraculous speed. We do not seem to need any write-arounds at that point, or eight days of write-arounds; they appear to be able to cobble something together within seconds, particularly if my right hon. and learned Friend the Member for Beaconsfield (Mr Grieve) clicks his fingers. They then appear to swoop into action in no time whatsoever. It seems to me that if hon. Members actually want to improve the Bill, they should be busily telling their Whip that if we put these amendments to a vote, they will vote for them—I hope, Mr Speaker, that you will allow some of them to be put to a vote, particularly where the hon. Member for Croydon North says that he actually agrees with them. Perhaps then we might have some rapid decision making after all. We will see, but it has been yet another depressing morning in the history of Parliament for me. I have been here 13 years, but have found out only today how these things work. I started off cynical and I have become even more cynical as time has gone on.
I shall go through the farce of speaking to my amendments, even though we cannot actually make any headway on them. As the hon. Member for Croydon North alluded to, amendments 44 to 78 apply throughout the Bill and change the wording from “use of force” to “use of restraint”. I was encouraged to hear him say that he had originally believed that the term should be the “use of restraint”, but had been persuaded to change it to “use of force” by, I think, the Government.
The comments I make here largely come after consultation with my local Bradford District Care NHS Foundation Trust. The amendments that I have tabled would ensure that the terminology used in the Bill was correct and in line with that commonly used by mental health trusts. The term “use of force” is predominantly used by police forces in reference to the use of physical force while carrying out their duties. It is important to note that, although the police do play a part in the restraining of patients, it appears that the Bill’s primary focus is on the restraint methods used by staff in a mental health unit. Although we must not forget that the police are on occasion called to assist in the physical restraint of patients, it would be more appropriate to adopt the correct mental health terminology for actions used predominantly by mental health staff in a mental health setting. Not only that, but the use of the word “force” in this regard is somewhat misleading and suggests that the restraint being used on patients is being conducted with a degree of aggression, violence or excessive force, which is simply not the case.
I am told that restraining a patient, particularly in a mental health unit, often involves little to no use of actual force in the sense that most of us would understand it. The term “restraint” has been adopted as common terminology within mental health trusts and covers varying degrees of interaction with a patient. It can be applied, for example, to a person simply holding out a hand to stop someone advancing towards them, or to methods of calming such as simply talking to a patient. They are examples of the use of restraint.
Norman Lamb
I am grateful to the hon. Gentleman for giving way. In my experience both from my time as a Minister and from talking to many people in mental health, restraint covers an enormous range of circumstances, from the very light-touch to very considerable force, including pinning people to the floor with face-down restraint, which was the action that led to the tragic death of Olaseni Lewis. It is not right to say that it cannot involve considerable force; it often does.
Philip Davies
The right hon. Gentleman certainly knows more about this subject than I do, and probably more than anybody in this House, and I commend him for that. Absolutely—I am certainly not saying that the use of restraint never involves the use of excessive force; it absolutely does. My point is that it often does not. To throw all these things in together by using the word “force” is not only not within the terminology generally used in mental health trusts, but slightly misleading given what the norm in this area is.
Kevin Foster (Torbay) (Con)
I am listening with some interest to my hon. Friend’s speech. The purpose of his amendments, as he has said, is to replace the word “force” with “restraint”, and he has just given quite a strong list of things that could be restraint. However, surely the whole purpose of this Bill is to focus on force as we see it defined in other legislation. I know from his doughtiness on issues such as nanny state and cotton wool-style politics that the prospect of talking to people with smiles, which he says could be restraint, is the last thing that we want in this type of Bill.
Philip Davies
I understand the points that my hon. Friend makes, and I will come on to some of them later on, as they probably sit better with other amendments that have been tabled. I certainly accept his point, and as always, he makes it well.
I am also concerned that using the word “force” might worry people who are thinking about seeking treatment for mental health conditions. If they see that, it might scare them into wondering what may happen to them in some mental health settings. My view is that the word “force” in this case is not appropriate, not sensible and not actually what is generally used. Of course an element of force is used at times to carry out some methods of restraint, but common sense would suggest that the terminology used in the Bill should be what the sector uses.
Sir Christopher Chope
When one looks at the drafting of clause 1 (6), references to the use of force are to
“the use of physical, mechanical or chemical restraint”.
Force is being limited there to restraint, except that there is also,
“the isolation of a patient.”
Is it not the case that the drafting is really confusing? It suggests that the only difference between force and restraint is the addition of the isolation of a patient in the definition of use of force.
Philip Davies
My hon. Friend is absolutely right. He has made the point that I was literally just about to make. The use of force is defined as being physical restraint, mechanical restraint and chemical restraint. I reiterate my earlier point that, quite clearly, the most appropriate term to use is “use of restraint”. That is what the definition of the use of force is in the Bill. It sounds more sinister than it actually is, and that is clearly more appropriate terminology. I have tabled more than 60 amendments, but that point deals with more than 30 of them—about 35—in one fell swoop. I hope that other Members will accept that “use of restraint” is the more appropriate terminology.
Let me move on now to my other amendments. Amendment 9 to clause 5, which is about training on the appropriate use of force, would remove paragraph (c), which is about
“showing respect for diversity generally”.
The hon. Member for Croydon North mentioned that earlier. Restoring the faith of the public in their services is a key element and purpose of this Bill, and why not? We should all have the confidence and reassurance of knowing that when we go to any public service, we will be treated properly. However, when it suggests that illnesses are not diagnosed in proportion to the demographics of our society, I question whether people will draw the wrong conclusion from that. We could question whether anything in our daily lives mirrors social demographics. Of course it does not; it would be absurd to think that it does. What we need to keep in mind is that any illness, and specifically mental illness, is not selective in whom it touches and the outcomes that it can cause. It does not discriminate by people’s ethnicity, sexual orientation, religious belief or gender or in any other way. Mental illness is a very complicated and personal experience, which—as is well documented—can have a harrowing and life-changing effect on those who are directly affected by it, and on the people and families around them.
It has been argued that different ethnic groups have different rates and experiences of mental health problems, with people from black, Asian and minority ethnic groups in the UK more likely to be diagnosed with mental health problems and more likely to experience a poor treatment outcome. It is documented that for every 1,000 people of the black/black British population, approximately 41 are in contact with secondary mental health services. What is not mentioned so much is that for every 1,000 people of the white British population, approximately 37 are in contact with the same level of service. In actual numbers, 1.3 million of the total 1.5 million patients in contact with this service are of a white ethnicity, so the use of the ratio format instead of the actual figures over-exaggerates a point that is already not entirely convincing. For example, for every 1,000 people of the Asian/Asian British population, approximately 26 are also receiving secondary mental health care. In actual numbers, this is approximately 69,000 patients—higher than the total of mixed ethnicity and other ethnic groups combined, and 16,000 patients more than the black/black British category.
I do not want to make it sound like a competition for numbers; it clearly is not. These numbers represent people. But the Bill currently makes it appear as though this is an issue that only affects one ethnicity, when that is quite clearly far from the case. The suggestion that there should be a conscious overview of regulating the diagnosis and treatment of a patient not according to their symptoms, but according to their ethnic background, may result in turning it into a competition. By putting in place such measures, the good intentions of stopping ethnic discrimination—the existence of which is already questionable—would instead create discrimination against those who are not of a BAME background or, more specifically, not of black/black British ethnicity. This would therefore generate another problem altogether. In the simplest of terms, asking to provide further intensive training on unconscious bias and diversity, on top of what has already been established at the core of the service that is currently being provided, not only creates an unnecessary segregation among patients but is patronising towards staff to an unwarranted level.
I draw a parallel with the stop-and-search issues in London. It seems to me that a very well-meaning intention to stop a disproportionate number of black people being stopped and searched has led—directly or indirectly—to an increase in the amount of knife crime in London and in the number of people who are dying as a result of knife crime in London. I might add that it is largely young black men who have been the victims of that well-meaning policy.
I fear that mental health staff, rather than being asked to treat people exactly the same irrespective of their backgrounds, may well—directly, indirectly or because they feel some pressure—start to treat people differently as a result. That will have serious consequences. I fear that it is some people from black and minority ethnic backgrounds will who suffer most and not get the treatment they should as a result.
Mr Reed
Surely the point about an unconscious bias is that it is unconscious. If we do not collect the data and evidence to show what is happening to a particular group, it will continue to happen because no one has interrogated the data to understand what the problem is. For instance, women are more likely to be restrained than men in mental health services. More women are restrained than men, even though there are more men present in mental health services. If we do not understand why that is happening, we cannot do anything to correct it.
Philip Davies
I understand the hon. Gentleman’s point and I am not totally unsympathetic towards it. My fear is what will happen as a result of such a measure and the impact on staff, who have a very difficult job. Their job is difficult enough as it is and they do a great job. When we are passing legislation like this, it is important to say—at least in passing—how much we appreciate what staff do in many of these places. They are doing their best, often under difficult circumstances and with limited resources. I do not want these people, who are working their socks off, to think that we are trying to kick them in the teeth and tell them that they are not doing a good job. On the whole, they are doing a very good job.
My point is that their job is difficult enough as it is and I fear that it will be made even harder when, in effect, they are subconsciously given the message, “Oh, you’ll want to be careful what you do with different minority groups, because you may be accused of being racist if you’re using restraint on too many people from a particular background.” That is exactly what happened to the police with stop and search, when they were told, “Even though you should be stopping and searching people, don’t bother doing it with somebody from a particular ethnic background, because you might be accused of being racist if, when it’s all totted up, you’ve stopped more black people than white people.” We should not put people in that kind of situation.
Philip Davies
The hon. Gentleman’s motives are entirely honourable and decent, and I support them 100%. My fear is about what will happen in practice, because of the evidence of what happened with stop and search in London, to be perfectly honest. Exactly the same thing happened in that case, so it is not as if we have no evidence on which to base this fear. If the hon. Gentleman speaks to police officers, they will tell him that they were petrified of stopping people from a particular ethnic background because they feared they would be castigated for being racist. That is absolutely what happened. All I am saying is that my fear is that that may well happen as a result of this legislation, although I accept that it is not the hon. Gentleman’s intention.
Sir Christopher Chope
My hon. Friend is making an excellent point. Is it not also the case that substance and drug abuse has developed enormously, particularly in urban areas, as a result of this misguided policy on stop and search? It is then drug and substance abuse that so often leads to mental health issues.
Philip Davies
My hon. Friend is absolutely right to draw that comparison. It goes to show that well-meaning initiatives can often have the exact opposite result to what was intended.
In addition, diversity training programmes do not show any particular progress in the area that they are trying to improve. In fact, they have often proved to have the opposite effect. In a 2016 edition of the Harvard Business Review, an article entitled “Why Diversity Programs Fail” states:
“It shouldn’t be surprising that most diversity programs aren’t increasing diversity. Despite a few new bells and whistles, courtesy of big data, companies are basically doubling down on the same approaches they’ve used since the 1960s—which often make things worse, not better.”
The article says that companies have been heavily reliant on diversity training to reduce workplace bias, and bias during the recruitment process and employee promotions. It also says that studies have shown that this consistent and forceful approach to tackling diversity can
“activate bias rather than stamp it out.”
The article points out that social studies have found that people too often rebel against rules in a bid to assert their autonomy, and argues that companies—in our case, public services—will see far better results when they drop control tactics to make people conform. Even eminent people at Harvard are not particularly convinced that such a measure would have the result that the hon. Member for Croydon North intends.
On top of that, there are so many variations of diversity these days that there is a vast array of specifics to cover. For example, to my knowledge there are at least 71 variations of gender. I have a list here, but I will not test the patience of the House by reading them all out. Hon. Members who thought that there were only two genders are, I am afraid, well behind the times; there were 71 at the last count. I am sure that my hon. Friend the Member for Walsall North (Eddie Hughes) knows about this, as an esteemed member of the Women and Equalities Committee. I am sure that he can reel them all off from the top of his head, but most people could not.
Then we get on to the variations of religion that could be discussed. There are estimated to be approximately 4,200 different religions around the world, going far beyond those commonly observed in the UK. They include beliefs such as mysticism, paganism—which has, I think, 47 variants within it—Raëlism, Judaism, the ghost dance movement, chaos magic, and the happy science movement. The one that I personally liked most of all—I had not heard of it before but I am thinking about becoming a convert to it—is the Prince Philip movement. Being a great fan of Prince Philip, that sounds to me like a marvellous organisation.
Matt Warman (Boston and Skegness) (Con)
I too am obviously a great fan of Prince Philip. In talking about his fears, my hon. Friend is, while of course still being orderly, discussing matters that go some way from the central intention of this Bill. Does he share my fear that some of his concerns might risk derailing what is, at its heart, a very important and sensible measure that we all surely, as he has said, support?
Philip Davies
I cannot accept that at all, Madam Deputy Speaker—it is a delight to see you in the Chair. My amendment is clearly pertinent to the Bill given that I am trying to remove something that is in it. If it was not pertinent, no doubt Mr Speaker would not have selected it. I am afraid that I cannot accept my hon. Friend’s challenge to the authority of the Chair. I am sure, Madam Deputy Speaker, that were I to be out of order, you would be the first to leap to your feet and put me right.
Will all these different religions, genders and all the rest of it be covered in the diversity training that I am trying to remove from the Bill? We cannot ignore the fact that they exist and therefore have as much right, presumably, to be detailed in diversity training as anything else. Let us not forget diversity of ideological beliefs. Will that be covered too? This is a throwaway phrase—one of those things that everybody puts into everything. It is meaningless. There are lots of meaningless things in political discourse: social justice—nobody knows what it is but everyone is in favour of it; sustainable development—we are all in favour of it, but nobody has ever been able to tell me what it actually means; diversity training—let us shove it in as a little part of our Bill, but nobody really knows what it is trying to achieve. I am not entirely sure that there is any point to it, and if there is any point, it will be counterproductive. I cannot accept this aspect of the Bill, and that is why my amendment 9 tries to remove it.
Amendment 10 to clause 5 is about training on appropriate use of force. It would remove paragraph (k) on training on
“ethical issues associated with the use of force.”
I am trying to make sure that legal issues are the focus of the training, not ethical issues. How does one go about taking account of ethical issues in the use of force or restraint? As I said earlier, staff have a very difficult job as it is. When they are focusing on whether they should be using restraint with a particular patient, are we seriously saying that they have to start considering, at that moment, the ethical issues associated with it? Surely this House is about making sure that people act within the framework of the law, not about what I, the hon. Member for Croydon North or somebody else thinks are the relevant ethical issues. How do we decide what the ethical issues are that people should be considering? The ethical issue that I might think is particularly pertinent may be different from the one my hon. Friend the Member for Christchurch (Sir Christopher Chope) or the hon. Member for Croydon North thinks pertinent. What sort of a situation are we putting staff in when they have to be thinking about the ethical issues, as intended in this Bill? I would not be able to explain that to them. We should be removing these bits of flim-flam from the Bill and making sure that we are instead asking people to follow a legal framework.
Sir Christopher Chope
As always, my hon. Friend is making an excellent point. In his extensive research, has he been able to ascertain the source of the support for the flim-flam that he is describing with regard to the use of the word “ethical”? The Minister said earlier that the Bill has the support of all stakeholders—I do not think she used that word, but she might have chosen to do so. Where is the evidence that the stakeholders are behind the use of ethical issues being part of the training?
Philip Davies
I am afraid I cannot answer my hon. Friend’s question. I do not know. The Minister was absolutely right to highlight the fact that although stakeholders do welcome this Bill, it would be wrong to say that they welcome every provision within it. That is certainly the feedback that I have had from my local care trust. While it certainly agrees with the thrust of the Bill and many of its provisions, there are still some it is not comfortable with. I cannot tell my hon. Friend about the genesis of this or any widespread level of support for it, because I am not aware of it. Perhaps the hon. Member for Croydon North or the Minister can help out. All I can say is that that definition of “ethical” is
“relating to moral principles or the branch of knowledge dealing with these”.
I am not sure whether my hon. Friend is any more enlightened by that definition that members of staff may have to take into account. I have no idea what it all means, to be perfectly honest, and yet we are expecting members of staff who are dealing with patients in difficult situations to be weighing up all these things.
I think it can be established that everyone has their own individual take on morals, but surely we cannot start applying ethical and moral views in serious situations such as these. This will end up being the beginning of a long list of other factors that it will be demanded people be mindful of. My view is that healthcare should be provided in a legal and law-abiding way, and not with the addition of anybody’s personal, individual ethical take on what is moral and not moral.
Eddie Hughes (Walsall North) (Con)
My hon. Friend is making a fascinating speech that seems to be very well researched. Given that he considers this to be flim-flam, if there were other elements of law surrounding this topic that included the use of the term “ethics” or “ethical”, might this need to be included in order to satisfy some type of uniformity across different pieces of legislation?
Philip Davies
My hon. Friend may well be right; I do not know. I have not been able to find any evidence for that, but it may exist somewhere. Perhaps the promoter of the Bill or the Minister will be able to enlighten us. If my hon. Friend has any evidence, I would be very happy to change my mind, but as it is, I cannot see any purpose to the provision.
The general thrust of my argument is that while this Bill should indeed be making staff and institutions accountable, it should also be helping them in their daily job, but it is making their life far more difficult than need be. I do not see that it is helping to protect the rights of patients, which is at the heart of what it is supposed to do.
Sir Christopher Chope
My hon. Friend has referred to the definition of “ethics” and “ethical”. Paragraph (k), to which he is addressing his remarks, talks about the “principal” ethical issues—not all ethical issues but the “principal” ones. Does he have any insight into which ethical issues are “principal” and which are not?
Philip Davies
My hon. Friend makes a good point. I do not know the answer to that—who knows? It is a mystery to me, and therefore it will almost certainly be a mystery to any institutions trying to implement these measures. We have to bear in mind that this is not just meaningless. This will be the law of the land. Institutions and members of staff could well be taken to court over whether they have sufficiently taken into account these “principal” ethical issues. Surely it would be intolerable to put people in that legal uncertainty. I am not entirely sure that we, the people who are passing this piece of legislation, have any idea what it means ourselves, so how on earth are the people who are supposed to implement this meant to?
Surely laws have to be fit for purpose. I know that my hon. Friend the Member for Christchurch is an eminent lawyer by background, and no doubt his profession will be dancing in the aisles at the prospect of all this uncertainty, because they are the only people who will benefit. The patients will not benefit, the staff certainly will not benefit, and the institutions will not benefit, because they will probably find themselves facing expensive legal suits. Unless this is simply a benefit for the legal profession, I cannot see any point to it whatsoever.
I am confident of scoring a few more runs on amendment 11, because the hon. Member for Croydon North indicated that he supported it. As I indicated to Mr Speaker at the start, I may wish to press the amendment to a Division and test the will of the House on this matter. The amendment would insert new paragraph (l) in clause 5(2), which relates to training in the appropriate use of force, to include training for mental health staff about who is responsible, and the roles and procedure when the police are called to assist.
Some people may say—I would not necessarily dismiss this out of hand—that clause 5 is already too prescriptive. There is an argument for saying that we should take out this detailed list of things that people should be trained in and effectively leave it to institutions and local experts to sort out training for themselves, rather than putting every little element of what that training should consist of in statute. There is certainly an argument for saying that we should get rid of all these areas of training that are prescribed. Of course, the problem with prescribing everything is that what will happen is that everything prescribed will be covered, but nothing else will be. Something may well have been missed out from the list, but if it is not on the list, institutions will not bother with it. That is my problem. Given that we are prescribing so much, it is essential that we get those things right, otherwise important things will be missed in the training. It seems to me that we go one of two ways: either we do not prescribe any of it; or we prescribe everything, because otherwise things will be missed out.
Norman Lamb
I suspect that the hon. Gentleman and I agree that it is really important to protect the individual against the overbearing power of the state, and the Bill is primarily about achieving that—protecting individuals who are often in very vulnerable positions against the potential misuse of power. Giving some detail about what the training must cover, so as to ensure that people are treated with respect and dignity, and their rights are protected, is surely something that he agrees is rather important.
Philip Davies
Absolutely I do—I am not sure that anyone would disagree with that. The issue is how we best ensure that the training is comprehensive and covers the necessary areas. My point is that there are two ways of doing that in law. One option is to simply say that training should be given and effectively leave it to the experts in the field to determine what that should cover. The Bill has gone a different way—I am not saying that it is necessarily wrong; we can argue it both ways—by literally prescribing in law what should be covered in that training.
Given that we are going down that route, it is essential that we include the things that are missing from that list, because if we do not include them, institutions will look at what it is their legal responsibility to cover, and then cover all those things, and that will be it. They will not cover anything else, because they will presume, not unreasonably, that what has been produced for them is an exhaustive list of what should be covered. My amendments 11 and 12 merely highlight that essential things to cover have been missed off the list.
When the hon. Member for Croydon North opened the batting, he kindly agreed that the things specified in amendments 11 and 12 are important and should be included in the training, and that he therefore supported them. His issue with including them in the Bill arose from the suggestion that they could be simply covered in guidance. The Minister might have something to say about that, but I do not understand this. It appears that the Government do not have the authority to agree to put these things in the Bill, but miraculously do have the authority to agree that they should go into guidance. If they have the authority to agree that these things should go into guidance, why on earth do they not have the authority to agree that they should go in the Bill? It makes no sense to me, but that is the beauty of the establishment.
Jackie Doyle-Price
I advise my hon. Friend that the guidance we will issue on the Bill will be subject to consultation. I fully anticipate that we can pick up the themes mentioned in his amendments as part of that consultation.
Philip Davies
I am grateful to the Minister. As I suggested, the Government have the authority to put these things in guidance, but not in the Bill. I do not understand that, but there you go, Madam Deputy Speaker—that is the vagaries of the establishment and the Executive for you.
The point that I want the hon. Member for Croydon North to note, given that this is his Bill, is that if we have 11 things in statute, putting two others in guidance does not really cut the mustard, because they will not be statute but guidance. Institutions will focus on what is in the law and what they can be taken to court for if they do not act properly. We cannot have a pick-and-mix effort, with some of these things in law and some in guidance because, by definition, the things that are in guidance are clearly not as important as those in law. My contention is that the matters specified in amendments 11 and 12, with which the hon. Gentleman said he agreed, are so important that they should be part of the list that goes into law. Guidance just is not good enough; it is not acceptable.
Amendment 11 would include in the Bill training for mental health staff on who is responsible, and on roles and procedures when the police are called to assist. The amendment would ensure that we have a structured approach regarding the involvement of the police when restraining a patient, and it goes to the heart of one of the purposes behind the Bill. This is one of the reasons why the hon. Member for Croydon North brought forward the Bill in the first place, in my opinion, so it would be extraordinary if the Bill did not include training on the thing that is central to it. The amendment stems from that inspiration.
The hon. Gentleman has detailed on several occasions in the Chamber the case of his constituent, Olaseni Lewis, and the treatment he received in the lead-up to his death. On reading through the inquest into Mr Lewis’s death, alongside the coroner’s report, a number of things stood out to me, but predominantly the fact—I believe it can be agreed—that the entire scenario that took place on the evening of his death was a mess. It was a shambles, and it should not have happened. There seemed to be a sudden shedding of responsibility from the medical staff to the police, which I believe caused the quality of medical care that Mr Lewis received to be compromised.
What I find most disturbing is that the police seem to be blamed for Mr Lewis’s death, yet his cause of death was identified by the coroner as medical negligence. I therefore ask what responsibility medical staff have in such events and what responsibility the police have. That is fundamental to this particular case behind the Bill. Common sense suggests that if a patient is in a medical unit and experiencing an episode of mental illness, the priority is for medical staff to control the situation, due to the cause of the situation being medical, and the police are purely there to assist in giving someone appropriate medical care and treatment.
An interesting case is that of the former premier league footballer, Dalian Atkinson, who died in the early hours of Monday 15 August 2016. Police were called to attend a report of concern for safety. Neighbours had reported that Mr Atkinson was banging on and kicking his father’s front door after
“flying into a booze-fuelled rage”.
They had also reported that Mr Atkinson was trying to enter his father’s property because he claimed that he was homeless. Mr Atkinson’s father, who was not the person who called the police, stated of his son:
“I don’t know if he was drunk or on drugs but he was very agitated and his mind was upset…He was threatening and very upset.”
At the time of the incident, Mr Atkinson was reported to have been suffering for some time from a series of illnesses that left him in a fragile state, with a weakened heart. Alongside pneumonia and liver problems, Mr Atkinson was also said to have undergone dialysis for kidney failure and to be battling depression. Mr Atkinson’s brother Kenroy stated that, on the night of his death, Mr Atkinson
“had a tube in his shoulder for the dialysis”,
which he had removed himself, leaving him “covered in blood”. He also said that his brother had attacked their father, who was 85, and held him by the throat, telling him that he was going to kill him. He told their father that he had already killed his sister and another of his brothers, which was not true.
What makes Mr Atkinson’s case different from Mr Lewis’s is that, instead of force from person-to-person contact, Mr Atkinson was subject to the use of a Taser gun. With a combination of multiple health issues and a weak heart, this caused him to suffer cardiac arrest, which subsequently caused his death. In the days following his death, Mr Atkinson’s nephew, Fabian Atkinson, said of his uncle:
“He had some health issues that he was trying to get through and that’s why his heart was weak. When a Taser is deployed, as soon as a Taser is deployed, they need to automatically call an ambulance. How do they know the health of the guy or the girl that they are affecting?”
That is exactly my point.
When the police are called to an incident, they are not aware—they cannot possibly be aware—of a person’s medical history. There is no briefing beforehand, because that is simply not possible when they are put into an urgent situation. Training is designed to help them attend incidents and de-escalate them quickly and efficiently. The question is: how is it possible for this to be done and for them also to be able to take on the additional task of medical assessment?
It might be assumed, from the medical setting, that there is the reassurance of a medical professional being present to monitor the person’s health. In the Royal College of Emergency Medicine’s best practice guidance, the advice is that when a patient is restrained in the emergency department, even if the police are providing that intervention, the ultimate responsibility for the patient’s safety and wellbeing rests with the doctors and nurses of the emergency department. I think that that is absolutely crucial.
I appreciate that those guidelines are for a patient who is taken to an accident and emergency department, while Mr Lewis was in a specialist mental health unit where there were medically trained staff who should have been well versed in such situations. From reading the reports, it seems to me—other people may have a different interpretation—that the staff felt it appropriate to pass responsibility for Mr Lewis’s medical wellbeing to police officers, who are not of course medical professionals. I believe that that was the most detrimental aspect of the last moments of Mr Lewis’s life. That is why this matter should be one of the key focuses of the Bill.
In its memorandum of understanding, “The Police Use of Restraint in Mental Health & Learning Disability Settings”, the College of Policing states:
“People who talked to us wanted mental health staff to be proactive and use their therapeutic skills to de-escalate situations and only call on the police when absolutely necessary…Each situation where the police are called for emergency assistance should be properly assessed on its merits…The police role is the prevention of crime and protection of persons and property from criminal acts.”
This provides a very clear distinction between the responsibilities of the services. In case it was not already apparent, the police are responsible for crime, and the medical staff are responsible for health.
I do not want the police to have to be given a full medical briefing before assisting with the restraint of a patient—in most cases, there simply will not be time—so there needs to be understanding about the co-operation of the medical services and the police, with the medical staff giving direction to the police. I ask that amendment 11 be made to ensure that staff are given clear training to alleviate the possibility of a similar chaotic scenario arising when the police are involved in restraining a patient, and so that they are fully aware that the police are there to assist, not to take over additional responsibilities that the medical staff would otherwise have.
It seems to me that amendment 11 goes to the heart of what the Bill is trying to achieve: to prevent anyone from suffering in the same way as Mr Lewis suffered on that particular occasion. I do not understand how the Bill can be fit for purpose unless it specifically puts that aspect of the training into statute. If it does not cover that, I do not think we are being diligent in making sure that what happened to Mr Lewis is prevented. The hon. Member for Croydon North is quite right to bring that terrible situation to the attention of the House and to try to prevent such a scenario, but the provision in my amendment is what would most help to achieve that, and it is not right that it is not in the Bill. I hope that hon. Members will overcome the bureaucratic nature of the Government and insist that the amendment goes into the Bill. I would like to see that, and the promoter has said that he would also like to see that. It is our job to make the Bill fit for purpose.
Amendment 12 to clause 5—“Training in appropriate use of force”—relates to the same area. It would insert another new paragraph—paragraph (m)—with regard to training on acute behavioural disturbance, which is another really important thing that has been missed out of the list of areas that must be covered in training. The amendment would ensure that there was staff awareness training on acute behaviour disturbance, which can be life threatening when paired with restraint techniques on a patient.
I will again refer to the case of Olaseni Lewis, whose cause of death was detailed by the coroner as hypoxic brain injury caused by restraint in association with acute behavioural disturbance, or ABD. It states in the circumstances of death that Mr Lewis became agitated and fearful, resisting efforts to leave him alone in the seclusion room. Officers restrained him but were unable to regain control. Eventually, Mr Lewis became unconscious and suffered cardiac arrest.
Hypoxic brain injury, or hypoxia, is caused by an interruption to the constant flow of oxygen that the brain requires. The brain uses 20% of the body’s oxygen intake to survive, and that is needed to make use of glucose, which is its main energy source. Interruption of the oxygen supply causes a disturbance in the brain function and will therefore cause immediate and irreversible damage. A person can take as little as 15 seconds to fall unconscious due to a lack of oxygen, and damage begins to take place after four minutes.
Hypoxia is not easily identified at the beginning of an examination since the primary cause is often unrelated to the brain. Common causes can be low blood pressure, heavy blood loss such as a haemorrhage, suffocation, choking, strangulation, asthma attack, drowning, exposure to high altitudes, smoke inhalation, carbon monoxide inhalation, poisoning, drug overdose, electric shock, and predominantly—as was the case with Mr Lewis—cardiac arrest and heart failure. It is the acute behavioural disturbance element, which was referred to by the coroner in Mr Lewis’s case, that I feel would be most beneficial to add to the training, and I want to explore it further.
According to guidelines written by the Faculty of Forensic & Legal Medicine, acute behavioural disturbance may occur secondary to substance misuse, such as intoxication and withdrawal; physical illness, such as following head injury or hypoglycaemia; and psychiatric conditions, including psychotic and personality disorders. Of all the forms of acute behavioural disturbance, excited delirium is the most extreme and potentially life threatening. Similar to abnormal brain function, it can cause a loss of consciousness, confusion, stupor and agitation, which is the contributing factor to causing the characteristic outburst of violence.
The agitation element of the symptoms can stem from several causes, as stated in module 4 of the College of Policing’s personal safety manual. The causes are acute brain inflammation such as meningitis; limited oxygen supply to the brain, such as through acute pneumonia or heart attack; metabolic problems, as diabetes can cause high or low blood sugar levels, both of which can cause severe changes in personality and behaviour—from sleeping to agitation—and can be lethal if untreated; and general illness, in that severe sepsis can cause confusion.
It then goes on to list the symptoms associated with more severe agitation, which are as follows:
“Psychiatric illness…
Acute intoxication with a broad range of drugs or withdrawal from them”
or an
“Acute brain injury (such as a ‘stroke’”
Aside from violent behaviour, other clinical symptoms may include impaired thinking, disorientation, hallucinations, acute onset of paranoia and panic, shouting, unexpected physical strength, sudden tranquillity after frenzied activity or vice versa, high mental and psychological arousal, aggression and hostility, and insensitivity to pain and incapacity.
Sir Christopher Chope
I certainly agree with my hon. Friend about the necessity of putting the two amendments in the Bill, and I think that everybody who has been listening to his speech will be of the same opinion. I wonder whether he would be able to tempt the Minister to intervene now and say that, having heard my hon. Friend’s compelling case, the Government will indeed accept amendments 11 and 12.
Philip Davies
I am grateful to my hon. Friend. If the Minister wishes to intervene, I will not stop her.
Jackie Doyle-Price
I am happy to give some clarification on the Government’s position on this issue. When I discussed the amendments with my hon. Friend, I emphasised to him that we did not feel that his amendments were necessary. I advise him that a memorandum of understanding about police involvement is already in existence. The Mental Health Act 1983 has been amended to emphasise that people in mental health settings should be in clinical settings with clinical care. The Angiolini report states specifically that agreement should be in place between health partners and police, which emphasises that health takes the lead on the use of force, in line with the principles of the already existing national memorandum of understanding. I say again that I do not believe that my hon. Friend’s amendments are necessary.
Philip Davies
There you go, Madam Deputy Speaker. What can you say? The civil service script has been brandished. There is always a reason in the civil service why anything should not be done, but all I can say to the Minister is that, to be perfectly honest, the idea that it is not necessary could apply to every single individual thing that is already listed. If we wanted to go down that line, we could say that all these things are being done anyway individually by this person or that person. Either there has to be a comprehensive list of things that the Government feel are essential, which must be covered in the training, or they do not. How on earth, knowing what happened to Mr Lewis and in the other cases that I have mentioned, can anybody stand up and say, “Having listened to that, we do not think these things are absolutely necessary.”? It is literally beyond belief. We literally could not make it up. It is a shameful situation that we have got ourselves into, to be perfectly honest. I will let people decide which side they are on. I hope that we can test the will of the House on those amendments, so we can see what people make of them and whether they want to be in the civil service box of deciding that nothing needs to be done, having listened to those cases. We will let the House make its mind up, and that is that.
Sir Christopher Chope
Looking at the amendments on what should be in the training, has my hon. Friend had a chance to look at my amendment 98? It would introduce into clause 5(2)(a) the involvement of “patients” and “their families” in the planning, development and delivery of care and treatment. It seems that with the cases that he has cited, family involvement can be crucial, and this should also be part of the training.
Philip Davies
The answer to my hon. Friend’s question is yes—I have looked at his amendment and agree with it. If he would allow me, I had planned to go through my amendments first, before moving on to other people’s. I have his amendment in my sights and I will come to it later. I have read it and very much agree with him.
My next amendment—amendment 14—moves us on to clause 7(2), which states that reporting the use of force
“does not apply…where the use of force is negligible”.
My proposal would amend it to include restraint that does not include physical contact. The amendment would ensure that there is a not a series of pointless recording of every interaction with a patient that falls under the category of restraint. I am still using the word “restraint”, but I am appreciate that I am in danger, at the end of these amendments, of losing the battle, and that it will be called “force”. However, for the purposes of putting forward my amendments, I will still call it “restraint”, as I am seeking to do. Restraint is defined in the dictionary as the
“deprivation or restriction of liberty or freedom of action or movement”.
It must be reiterated, however, that it can be conducted in the most subtle of ways. The law entitles people to freedom of movement provided that they are not harming others or themselves while exercising that right. The policies of NHS services vary between trusts. Overall, the guidance for all medical staff follows the same basic principles, but specific details are more varied.
It would be fair to say that health trusts across the board consider physical restraint to be a last resort that should be used only following the exhaustion of all other methods. Staff are advised to call for the assistance of security when physical restraint is considered, as they will have been trained in restraint techniques. Bradford District Care Trust advises that the assistance of police be called upon only as a final resort when usual restraint methods have failed and there is a serious concern for the safety of the patient, staff or other patients on the ward. I have been told that as a general rule a patient would have to be exhibiting sustained high levels of physical aggression, often involving some kind of weapon, before the police were called.
Some services, such as the London Ambulance Service, apply a different approach and advise that police be called at the earliest sign of physical restraint being required. That is due to the service not providing its staff with training in physical restraint and therefore leaving them vulnerable without the back-up of police services. In all cases of restraint, staff are required to apply the principle of using the least restrictive and most proportionate option to control behaviour, for the least time possible. Again, the word “proportionate” is reiterated through the guidelines on restraint, which reminds us that it is consistently a consideration when restraint is conducted.
The types of restraint fall into three categories: low-level restraint—interventions that prevent a person from behaving in a way that threatens to cause harm to themselves, others or trust property and/or equipment; physical restraint—any manually applied method, be it physical, mechanical, material or equipment, that immobilises or reduces the ability of a person to move their arms, legs, body or head freely; and chemical restraint—a drug or medication used to manage a patient’s extremely violent or aggressive behaviour that can be administered, if necessary, against the patient’s wishes. Such drugs might, of course, also be used when the threat of harm is less immediate, with the patient’s consent, or if it is in the assessed best interests of a patient who lacks capacity.
Low-level or psychological restraint methods are the initial exercises conducted to try to prevent a situation from escalating quickly. Most often, this will be a variation of calming methods, which are less restrictive than methods in other categories, and which can ultimately allow the patient to have a timeout in isolation to calm down. Essentially, that can be as simple as telling someone not to do something or depriving them of equipment or possessions that may enable them to do what they otherwise would do—for example, removing glasses, hearing aids and mobility aids. It is less invasive and more frequently used with those who suffer with dementia.
Those less invasive approaches to patients allow them to retain a certain element of control over the outcome, but it is precisely those approaches that I fear will fall through the loophole of being constantly recorded, which will take the time of carers and care trusts away from the patients who actually need help. The key restraint methods the Bill is concerned with are those that require an element of physical contact, which should be reported appropriately. It is important that we remove the need to report minor interventions, which are not really at the heart of the Bill.
In the interests of time, I will group the next few amendments together. Amendment 15 to clause 7, on recording the use of force, would remove paragraph (k). Amendment 17 to the same clause would remove subsections (9) and (10), which require the recording of relevant characteristics of the patient—race, sexuality and so on. Amendments 21 to 30 are to clause 7 and amendment 31 is to clause 8, on statistics prepared by mental health institutions. Amendment 21 would insert new paragraph (q), which would add
“the relevant characteristics of the staff involved (if known)”
to the list of relevant characteristics in subsection (9). The other amendments would change the list to include the relevant characteristics of both patients and staff, make the list plural to cover both patients and staff and include the relevant characteristics of the staff involved.
Amendments 32 to 35 to clause 7 would remove paragraphs (c), (e), (f) and (h), which deal with a patient’s marriage status, race, religion and sexual orientation. Those amendments would remove such unnecessary labelling of patients. I am not one for putting people into categories, and I am not a fan of labels. All these things are irrelevant to the treatment of people with mental health problems, and we should not be getting bogged down listing everybody’s gender, race, sexual orientation, marital status and so on. It is all irrelevant to the treatment of people with mental health problems, and we should not be bogging down the staff with all this political correctness.
Sir Christopher Chope
Is it not extraordinary that the list to which my hon. Friend refers makes no reference to whether the patient has any family or relatives?
Philip Davies
Again my hon. Friend is absolutely right. One could argue that that is important and should be logged. I am sure we would all want to involve the family in discussions about the treatment of family members. That might well have helped in the case of Mr Lewis. Yes, it is extraordinary that the bit that could actually be relevant to the treatment of the patient is not included and all this other stuff, which is completely irrelevant to their treatment, is included. It seems like unnecessary political correctness.
In recording the use of force, the inclusion of race to help tackle racism, of sexuality to tackle homophobia, and of gender to avoid sexism, will do nothing to aid the patients. Surely, if we believe in equality, all those things are irrelevant. We should not be pointing out people’s differences. Those things cannot be changed and are not relevant, and we should not be passing legislation that tries to make them an important part of treating people with mental health conditions.
If we will insist on going down this route, however, I am confused about why the Bill requires only the recording of the patient’s characteristics, and not those of the person giving out the treatment. If there is institutional racism, or whatever it is that people try to hang a hat on, surely the characteristics of the person using the force must be relevant. Surely a complete picture can never be grasped only by recording the characteristics of the patient. If we are trying, as I think the hon. Member for Croydon North is, to uncover unconscious bias, institutional racism, or whatever he wants to call it—people have their different terminology to hang their hat on—surely it cannot be done without amendment 21. He indicated in his opening remarks that he had sympathy with it, and I am grateful to him for that. I hope he agrees that it is not just useful but essential if we are going down this route.
The Bill also asks that the police wear body-worn cameras so as to literally give a full picture of their involvement in these cases. Why are we only reporting one side of the story when the police are not there? If the relevant characteristics of the staff are included in the report, the recorded statistics might give a better representation of the matter. I feel that the provision I suggest in the amendment was not originally added because it might highlight a very different narrative from that which some would like to present. One particular concern I have is that these reports will be used to try and back up the questionable argument of institutional racism in the health service, despite studies showing a lack of early diagnosis of mental health illness and psychosis because of a lack of trust in mental health services among people from BAME communities.
It is consistently documented that BAME patients, particularly those with African and African-Caribbean backgrounds, are more likely to be diagnosed with a form of psychosis, and to enter the mental healthcare system via a more confrontational approach than would be the case through a routine appointment with a GP. That is the basis for the institutional racism argument. However, it should be considered that the suggestion of institutional racism in the mental healthcare system is what is preventing people from seeking early medical help in the first place. It is not helping the situation; it is making the situation worse. People are being told, “Don’t enter these services, because there is institutional racism”, and that is not helping anyone.
Sir Christopher Chope
I think we have all encountered constituency cases in which people suffering from mental illnesses are shifted from one location to another—from one clinical commissioning group area to another, or from one part of the country to another. In one of my constituency cases, someone is being told that they must go up to Manchester to be treated for a mental condition. If people are being dealt with in different locations, it is all the more important for there to be one set of medical notes that records everything that has happened.
Philip Davies
That is a very good point. I had not mentioned that people might be moved from one institution to another, but that, of course, makes the amendment even more important. I am not in favour of excessive bureaucracy, but that strikes me as being an essential part of what the Bill is intended to achieve. The purpose of my amendment 16 is to deliver the Bill’s original aim. In fact, that is the theme of all my amendments. They are certainly not intended to weaken the Bill; if anything, they are intended to encourage the hon. Member for Croydon North to go further. The amendment is not just something nice to tag on to the Bill. I think that it goes to the heart of what the Bill should be about. Restraint techniques should be documented in medical notes to provide other medical practitioners who are treating the same patient with an overview of how that individual patient responds to the use of that form of restraint. I cannot see why that should not be part of the Bill.
Mr Reed
I am sorry to intervene on the hon. Gentleman—I know that he is trying to be as brief and succinct as he can possibly be. [Laughter.] I take his point about medical records. I—like him, I suspect—believe strongly in patient empowerment, and I think that there is a case for the inclusion of records of restraint in patients’ medical notes. However, I am loth to support changes in the Bill when we have not consulted either patient groups or medical professionals. Given that it is possible to make this change through guidance after the Bill is enacted, if the Minister will give an assurance to that effect, I shall be content to deal with the issue in that way, because that would meet the objective for which the hon. Gentleman is arguing.
Philip Davies
As I said at the start, I genuinely appreciate the constructive way in which the hon. Gentleman has approached the Bill, and he has just given another indication of that. The question is—this is the dilemma that we always seem to have on a Friday—whether we should rush through legislation that we know is not as it should be, and try to patch up little defects with a bit of sticking plaster here and a bit of sticking plaster there, or whether we should make an effort to ensure that the Bill is in a fit state in the first place.
The hon. Gentleman is arguing—it is a perfectly respectable position to hold—that it is all right to gloss over the fact that lots of really important things are missing and to provide a big sticking plaster called guidance, telling people, “Here is some guidance. We forgot to put this in the Bill, by the way. It should have gone in, but we did not sort it out in time. Parliament couldn’t be bothered to do its job properly, so here is a list of all the things that you should and should not be doing.” That is a perfectly reasonable case to make, but I take the view that when we pass legislation in the House, we should be a bit more mindful of the people who will have to implement it, and make sure that it is fit for purpose the first time round.
It seems to me that it is possible for everyone to be satisfied. The last thing that we want is for the Bill not to go on to the statute book. It is broadly a good piece of legislation—although, as I have explained, I have reservations about it—but I think that we have an opportunity to make it better. We have three options. The first, which is the ideal option, is for the House to put the Bill into proper shape and accept some of my amendments, which I think are clearly necessary. The hon. Gentleman himself accepts that some of them should have been in the Bill originally. Secondly, we can opt for the sticking plaster route: we can cock it all up ourselves, then put a sticking plaster called “guidance” over it and hope that someone will be responsible for sorting it all out. Thirdly, we can give the Bill another slot at a future date so that the Government have time to consider and do their write-rounds, and the hon. Gentleman can do a bit more consultation. Hopefully we can deal with the Bill later in the year, along with some of these amendments—either agreed or not agreed—on the basis of the write-rounds and the consultation. That seems to me to be the most sensible way of going about it.
I think that what is important is for a sensible piece of legislation to go on to the statute book. There are plenty of days left in the current Session on which we could deal with the Bill. Putting everything that should be in the Bill in guidance at the end does not really do it for me. It might do it for the hon. Gentleman, it might do it for the Minister, and it might get us over a little hurdle, but I do not really think that it is the best way to pass legislation in the House.
Sir Christopher Chope
My hon. Friend sets out the three options very clearly, and if we went for the last of them that would give the Government an opportunity to produce the draft guidance so we can see what will be in it. What has concerned me so far is that the Minister has said that quite a lot of the things my hon. Friend and I think should be in the Bill are not necessary, and the Minister is not even saying they should be in the guidance. If we get the draft guidance, we will be able to see where we stand.
Philip Davies
My hon. Friend is right. The Minister is doing her best; she does not decide the Government’s bureaucratic nonsense of decision-making strategies and all the rest of it. This is not her fault; she is left in a difficult situation, and I am the first to appreciate that. But as my hon. Friend says, at present we are not even getting a guarantee that these things will be in the guidance; we are being told they might be dealt with in the guidance, and even that there is an expectation that they might be. But I have been here long enough; I have been shafted before on private Members’ Bills where I have been promised that an amendment will be tabled in the Lords to deal with something and then it never arrives. So a bird in the hand is certainly worth more than two in the bush, particularly when it comes to Government promises on amendments and guidance in my experience. That is not a party political point; both sides have been guilty of that in the past. I am therefore looking for a bit more than a waft here and a waft there suggesting this might be covered in guidance; I am looking for something a bit more concrete than that. Indeed, I do not think it does the Bill justice if it goes through Parliament when it is not in a fit in a state; we all want to see it in a fit state.
My amendments 18 to 20 to clause 12 relate to police body cameras. I propose to change subsections (1) and (2) to say that police “should…try to”, rather than “must”, take a video recording. I also want to remove subsections (4) and (5) which make police “liable to criminal…proceedings” if they fail to take a video.
As the College of Policing has stated, it is an indisputable fact in today’s society that law enforcement officers carrying out their duties, and the tactics they use, are under greater scrutiny than ever before. That is a good thing, and I am a massive fan of police body-worn cameras; they are fantastic for the interests of justice, and they safeguard the interests of police officers, who often face vexatious complaints. The footage can be produced to show that what they did was absolutely right, which is almost always the case. That is fantastic for the courts, too, because they can see at first hand what actually happened, rather than have to deal with conflicting accounts and have to choose to believe one witness over another and so forth. I am therefore a big fan of body-worn video cameras, and they are often the modern method of detailing interactions with the public by the police. Their aim is to improve the accountability and transparency of police conduct when police officers encounter the public. This is a move that the Home Office highlighted at the time of their launch as being the technology of the future, and as a means to help save police time and improve working practices.
General procedure for using the devices is that they are to be used only for recording encounters with the public and are not to be constantly recording for the duration of a shift. The policy of West Yorkshire Police, which covers my area, on body-worn camera video advises that it is to be used where a degree of investigation or exercising police powers is required unless there is a good reason not to. The rationale for not using body-worn video cameras may need to be explained at a later stage, and justified to a supervisor and/or during court proceedings. The recording must be proportionate, and the effect it may have on individuals and their privacy must be taken into account. It is advised that the cameras be switched on the moment the incident becomes apparent, and in some cases this may be en route for the incident. However, it is stated that officers must announce that they are using the recording equipment in clear wording: for example by saying, “I am wearing and using body-worn video. I just need to tell you that; you are being videoed and audio recorded.” The recordings taken are stored on the camera until they are returned to their docking station at the police station. From there, clips are downloaded and sent to the central system for viewing. These clips cannot be altered, changed or deleted by the officer in any way, which keeps them completely authentic for evidence purposes.
Kevin Foster
I thank my hon. Friend for giving way. It is always a pleasure to have an extended opportunity to hear him speak on a Bill. His amendment proposes to replace “must take” with “should consider taking”, when the words “if reasonably practical” are already in the Bill. Similarly, his amendment 19 would introduce the rather vague concept of trying to do something. Hon. Members are usually rather doughty in wanting to take vague provisions out of legislation, but in this case my hon. Friend wants to put some in.
Philip Davies
I understand the point that my hon. Friend is making. Equally, I am not keen on unnecessarily criminalising decent police officers. My fear, which I know my hon. Friend does not share, is that that could well happen. It could also be the case that the officer would be acquitted following a long disciplinary process and trial. That often happens to police officers, but we should not underestimate the hurt that results from their having to go through all that. I am trying to prevent unnecessary disciplinary and criminal proceedings being taken against police officers.
Kevin Foster
I thank my hon. Friend for giving way again. He gave the example of the pilot schemes, and body-worn cameras have led to a reduction in complaints against police of over 90%, which deals with the point he makes.
Philip Davies
I made it clear that I support and encourage the use of such cameras, but there may be occasions when, for whatever reason, they cannot be used, and the wording says “must”.
Jackie Doyle-Price
I completely agree with my hon. Friend’s points. It was precisely to address such concerns that the phrase “if reasonably practicable” was placed on the face of the Bill. To clarify, we do not want the fact that a police officer is not wearing a camera to impede them from doing what is right in this context. My hon. Friend raises concerns about the potential for the criminalisation of police officers, but that is not our intention. The subsections to which he refers are consistent with those in the Police and Criminal Evidence Act 1984, and they are there just to remind the police of their obligations. He rightly draws attention to the fact that cameras protect police officers as well as patients. As a force for transparency, they are an effective tool. I reassure my hon. Friend that his concerns are addressed in the Bill.
Philip Davies
I am grateful to the Minister for that, and I am sure that police officers will be grateful, too. However, I just feel that there are occasions when it may be practicable to wear a camera, but for whatever reason—the pressure, time or the heat of the situation—they forget, and I wonder what will happen in such cases. There could be a situation in which it is practicable for them to wear a camera but, owing to the noises they make and the flashing lights or whatever, they think, “You know what? In this circumstance, I’m unsure I’m going to do that, because it might make this patient worse.” I worry that there are insufficient loopholes, so to speak, for police officers who are trying to do the right thing in difficult situations and that we are in effect trying to make things more difficult for them. I fear that, as a result of this Bill, criminal proceedings will be brought against a police officer that never should have been brought. It is all right to say, “We don’t think that that will happen,” but these things do happen. I want the law to be worded to make that as unlikely as possible. That is my only concern, and we will see whether my fears are realised.
Sir Christopher Chope
Is there any evidence to suggest that the police will not want to protect themselves by taking body-worn cameras to such incidents? Why do we need this measure in the Bill at all?
Philip Davies
My hon. Friend makes a good point. The evidence is that police officers are the biggest supporters of body-worn cameras. They are crying out for them and want to use them more often, and they want the cameras to have a longer battery life. I agree that it is entirely unnecessary, so do we need to go down the road of criminalising police officers because they forgot to wear a camera? It might have been entirely practicable, but they may have simply forgotten. Should that really be a criminal offence? I am dubious. We ought to be giving our police officers more support, not trying to make their lives harder.
I have been discussing my amendments, but other right hon. and hon. Members have tabled several amendments, and I want to start on those by discussing new clauses 1 and 2, tabled by the hon. Member for Croydon North. I understand what he is seeking to do, and it was perfectly reasonable for him to say that if there is death at the hands of the police, the Independent Police Complaints Commission—although I think it has a new title these days—will get involved and all the rest of it, so why should other deaths not be subject to a similar procedure? That is a perfectly respectable point, and I have every sympathy with that view.
Mr Reed
I look forward to hearing the Minister address that point because I believe that she has proposals on how we take this forward. May I just take this opportunity to welcome to the Chamber Seni Lewis’s parents, Aji and Conrad Lewis? Following the tragic death of their son in 2010, they had to fight for seven years, because of a botched internal investigation, to secure an inquest to find out what had happened to their son and why he had died, and to secure the modicum of justice that surely they, as bereaved parents, deserved right from the start.
Philip Davies
I am very grateful for that intervention, and I also very much welcome them and salute them for everything they have done in Mr Lewis’s honour. I would just say two things to them. First, they have a fantastic Member of Parliament who has done a great job representing their interests in the House—they should be very proud of their Member of Parliament. Secondly, we are all agreed that it is essential that this House passes laws—through this Bill, we hope—that will ensure that what happened to Mr Lewis will never happen to anybody else ever again. That unites everybody in this debate, whatever our individual views on any particular amendment.
Norman Lamb
I am conscious of the fact that the hon. Gentleman has been speaking for two hours. He is raising legitimate points, but I feel passionately that the Bill has to be passed into law, and I know that many other hon. Members share that view. I have a real concern—I do not think this is his intention; I hope it is not—that we could end up with the Bill being talked out today, which would risk it being lost. It would be a tragedy if that happened, and I urge him to allow other Members to contribute to this debate so that we can reach a conclusion.
Philip Davies
I hear what the right hon. Gentleman says, but clearly he has not heard what I have said. The Bill would not be lost, as he well knows. He has been here long enough to know exactly how procedure works in the House. As the Bill has already started its Report stage, it would very easily slot to the top of the queue on a future date, when it could go through. I hope that it would go through in a better state, once the Government have had time to look at the amendments that they need to consider in order to make the changes to the Bill that the hon. Member for Croydon North has agreed should be made. All I am trying to do is to deliver what the hon. Gentleman wants in the Bill.
Philip Davies
We have been around that issue, so I do not intend to revisit it again. The fundamental amendments 11 and 12, which I have addressed at some length, go to the heart of what happened to Mr Lewis on that terrible occasion. They would ensure that training was given to staff to ensure that those things could not happen again. It is therefore essential that those amendments are made to the Bill and that these things are not just dealt with as part of guidance, which may or may not then be covered off by individual trusts. We have a duty to make sure that the things that happened to Mr Lewis are absolutely covered in the training given to staff.
Sir Christopher Chope
My hon. Friend is absolutely right not to fall foul of the scaremongering, because we are fortunate to be in a much longer Session than usual, and the Government are still to announce the extra Fridays that will be available to discuss private Members’ Bills. If a Bill such as this is supported by everybody in the Chamber—by the Government and the Opposition—but there is need for further improvement, why not improve the Bill, rather than putting it on the statute book in an imperfect state, given that we know jolly well how difficult it would be to amend it later through a further private Member’s Bill? Let us make this a good Bill.
Philip Davies
The Bill will definitely conclude its Report stage at some point, but if it does not pass today, it will not be my fault. For goodness’ sake, we still have two and a half hours to go. The Government still have plenty of opportunity to say that they will accept amendments 11 and 12, and if they do so, the Bill will go through today. If they need more time to do a write-around before those amendments can be agreed, that is literally in not my hands, but the Government’s. If they want the Bill to get through today—
Jackie Doyle-Price
My hon. Friend is again mischaracterising the Government’s position. Our position is that the amendments are not necessary. I have already outlined to the House that the specifics of the role and responsibility of police officers on these occasions are subject to a memorandum of understanding on which the College of Policing, which my hon. Friend has praised, has led. I ask him again not to press his amendments, because they are not necessary.
Philip Davies
Perhaps when the Minister responds to the debate she can tell us which amendments the Government would accept if they could get their write-around sorted out in time—[Interruption.] The Minister indicates “none” from a sedentary position, but that is absolutely not what the Government communicated to me yesterday. They said to me yesterday, “I wish we had seen these amendments earlier.” The Minister’s indication flies in the face of that.
Sarah Jones (Croydon Central) (Lab)
Members have had six months to table amendments, so perhaps the hon. Gentleman could have speeded up the tabling of his.
I support my hon. Friend the Member for Croydon North (Mr Reed) and his Bill, but there is a suggestion that it needs to be improved, and we must of course all look into what improvements could be made. I should point out, however, that the organisations that support the Bill in its current form include the Royal College of Psychiatrists, the Royal College of Nursing, the Care Quality Commission, NHS England, YoungMinds, Mind, Agenda, Rethink Mental Illness, Inquest, the GMB and Unison. With all those very good organisations supporting the Bill, perhaps we can try to make progress today.
Philip Davies
I do not believe the hon. Lady has been present throughout the debate; had she been, she would have appreciated that we all support the Bill. The hon. Member for Croydon North supports the Bill in its current form, but it has become apparent during the debate that he actually agrees that it would be improved by the inclusion of amendments 11 and 12. It is a question not of whether we support the Bill—we all support it—but of whether we get a Bill that is fit for purpose, and if we pass the best possible Bill. The point is that once these provisions have passed through the House, that will be it: the Bill will move off the House’s agenda, and we will not have another chance to do the great things that the hon. Gentleman is trying to achieve. We have to get it right this time, because otherwise the opportunity will pass. Those two absolutely key bits of training to prevent what happened to Mr Lewis from happening to other people need to be provided for in the Bill. To be perfectly honest, it is blindingly obvious to anybody that they need to be in the Bill.
Will Quince (Colchester) (Con)
Are we not in danger of allowing the perfect to be the enemy of the good?
Philip Davies
On that basis, my hon. Friend is basically saying, “Let’s get a Bill with a nice title, with any old nice-sounding provisions in it, and bang it on to the statute book without any scrutiny whatsoever.” The whole point of Report is to try to improve Bills. I am still confident that people will decide that what I am saying is sensible, because the amendments are sensible improvements to the Bill. It is not my fault that the Government cannot carry out their decision making in time. To address the point raised by the hon. Member for Croydon Central (Sarah Jones), the whole point of requiring amendments to be tabled by Tuesday evening prior to their being debated on Friday is to give people time to consider them.
Mr Reed
If the hon. Gentleman were generous enough to draw his remarks to a close within a reasonably short period of time, the Minister would be able to put on record how the Government intend to deal with some of the issues that he quite rightly and legitimately raises. My belief is that there are other ways of dealing with them that would allow the Bill to proceed today.
Philip Davies
Yes, that point has been raised. Basically, we are going to cover everything that is not in the Bill but should be in guidance. It seems that the Minister has made it abundantly clear that she is hardening her position as every minute goes by. We have gone from a situation of her saying, “If only we’d had the amendments earlier, we would have done something about them,” to, “They’re not necessary,” and now to, “We don’t agree with any of them.” The latest indication is that the Government do not agree with any of them.
Jackie Doyle-Price
Again, I would have appreciated sight of the amendments earlier, not least because we could have had a sensible discussion about how to achieve the outcomes that my hon. Friend wants. I am very clear that we can achieve that through guidance, which we will bring forward in consultation—we have consulted throughout the passage of the Bill—with the sector. I am talking about statutory guidance, and all institutions will need to have regard to it. We are in this position following dialogue with the sector and we have carried out parliamentary scrutiny. The Bill is not the only opportunity to bring forward legislation in this sphere because consultation on Healthcare Safety Investigation Branch legislation and the review of the Mental Health Act 1983 are taking place as we speak. This will not be the only opportunity for my hon. Friend to bring forward legislative proposals.
Philip Davies
Well, the only problem with that is that we will end up in the same game in which I table an amendment and the Government say that there is not time to do a write-around about it. I do not even follow the Government’s position any more. We have gone from them saying, “We wish we’d had these amendments earlier,” which the Minister has just reiterated, to then saying that they are not necessary—[Interruption.] The Minister says, “No they are not,” and then she says that they will be covered in guidance. Well, if they are not necessary, why would she put them in guidance? We will have to start getting our story straight. Are these things necessary or not?
Jackie Doyle-Price
My hon. Friend has been a Member of Parliament for a lot longer than I have, so he will be aware that Bills set out the principles of legislation, and it is standard practice for the detail under a Bill to be enshrined in guidance.
Philip Davies
But we do not know what will be in this guidance. I am making the case that it is absolutely essential that amendments 11 and 12 are made to the Bill. The hon. Member for Croydon North said quite clearly that he agreed with them and that he also thought they should be made to the Bill. I appreciate that he is trying to find a compromise but, strictly speaking, he would be happy for the provisions to be in the Bill. I think they should be in the Bill; he thinks they should be in the Bill. The Minister has not even made a commitment that these specific amendments would be reflected in the guidance. I am literally being offered nothing, apart from her saying, “Oh, we know this Bill is not good enough. We will try to sort out a bit of guidance here and there. It’s not perfect, but just let it through because it has a worthy sentiment behind it.” We must start treating legislation with a bit more respect in this place. The Minister says that the Bill has gone through parliamentary scrutiny, but this is parliamentary scrutiny. This is the Bill’s Report stage for goodness’ sake.
Sir Christopher Chope
The Government’s line seems to be that this legislation is an urgent measure. If it is so urgent, may I ask the Minister—through you, Madam Deputy Speaker—what state the guidance has reached?
Madam Deputy Speaker (Dame Rosie Winterton)
Order. The hon. Gentleman is making an intervention on the hon. Member for Shipley (Philip Davies), not the Minister.
Sir Christopher Chope
I invite my hon. Friend the Member for Shipley (Philip Davies) to ask the Minister whether she agrees that, because of the urgency of this legislation, the guidance is ready in draft form in her office and can be laid before the House tomorrow or in the next couple of weeks. I suspect that the Government have not even begun to draft the guidance, but we need the guidance before this legislation would ever be able to take effect.
Philip Davies
Absolutely. It appears, to me at any rate—I do not know about anyone else—that the Government are just making things up as they go along, desperately trying to get this Bill through in any form whatever. Whether it is good, perfect or indifferent is neither here nor there. They just want to get it through, presumably so that they can say at next questions, “We got the Mental Health Units (Use of Force) Bill through Parliament.” Well, perhaps they just want to pass any old legislation, include a few decent clauses and hope that it will do the job, but I am afraid that is not what this House should be about. It is about saying that we have identified areas where the Bill should be strengthened, and we therefore have a duty to find a way to do that. If the Government will not agree to do it today, I am afraid that we will have to try to ensure that they do it in the future.
I am determined that the Bill will go through in a proper form that will help to stop what happened to Mr Lewis ever happening again. We have to get back to the central reason for the hon. Member for Croydon North introducing this Bill in the first place. The points on which I am focusing are not just useful add-ons here and there; they are at the very heart of the purpose behind the hon. Gentleman’s Bill. I do not really see why he should be so complacent about letting it through without these things being included.
Anyway, hon. Members have tabled amendments that deserve to be scrutinised. The right hon. Member for North Norfolk has tabled quite a few. With amendment 40, he wants to include the threat of force as part of the use of force, so that the threat of restraint would be considered the same as the use of force. I am afraid that I cannot agree with that. We do not want to deter people from warning of the threat of force, when warning of the threat of force may actually stop them having to use it in the first place. I do not really see how the threat of force can be treated in exactly the same way as the use of force. Often, threat of force seems to be a legitimate restraint technique. If staff are not threatening to use force before they actually use it, the use of force might become more likely. I do not agree with that amendment.
Sir Christopher Chope
And, of course, every threat of the use of force would have to be recorded, would it not? The threat of force was actually included in the original drafting of the Bill and was taken out in Committee, so I do not understand why the right hon. Member for North Norfolk (Norman Lamb) wants to include it again.
Philip Davies
I agree. The same applies to amendment 41 —also in the name of the right hon. Member for North Norfolk—which would include the “threat of isolation” alongside isolation itself, and to his amendment 42, with which he wants to include the “coercion of a patient”. I am not entirely sure why such an amendment is needed, to be perfectly honest. He includes a definition of coercion in amendment 43, as
“the use or threat of force, with the intention of causing fear, alarm or distress to control a patient’s behaviour or elicit compliance with the application of a use of force.”
I am not really sure what that adds to the Bill, to be perfectly honest. I do not think that anything it does add to the Bill is something that I could support anyway. I think that he is taking these definitions a bit too far given the Bill’s purpose.
The right hon. Gentleman’s amendment 37 would insert into clause 3:
“A policy published under this section must set out that the use of force will only be used without the sole intention of inflicting pain, suffering or humiliation, or subjecting patients to tortuous, inhumane or degrading treatment, or without inflicting punishment or intimidation.”
With regard to using force with
“the sole intention of inflicting pain, suffering or humiliation”,
I look to people who are more legally qualified than me, but surely that must already be illegal. I cannot believe that that can already be lawful in this country. Therefore, this amendment is not necessary either.
Amendment 36 refers to a
“description of each of the methods of restraint that may be used…what steps will taken to reduce and minimise the use of force”
and
“a description of the techniques to be used”.
Paragraph (d) is the worst bit. It refers to
“a commitment to reducing the overall use of force in the mental health unit.”
Would that potentially mean that restraint and force is not being used when it should be used because somebody had a commitment to reduce its overall use? Surely, we should be seeking to make sure that restraint and force are used appropriately—at the right times, in the right situations, with the right patients. As long as that is being done, the number of cases is neither here nor there. It is the appropriateness that matters, not the numbers. This amendment would mean that restraint would not be used when it should be used. The lack of trust in staff in this is something that I cannot possibly support.
Amendment 38 says that
“subsection (1) must include a patient’s right to advocacy and how to access an advocate.”
Again, this may deter staff from using restraint even when it is necessary, thinking that they are going to get into a compensation culture with vexatious legal claims being made against them. We should not be passing laws that encourage that.
Amendment 79 says:
“The Secretary of State must publish quality standards for training”
and
“The Secretary of State may delegate the publication of quality standards for training”.
There is already a requirement to have standards for training; the right hon. Gentleman seems just to want to add the word “quality”. I am not sure that there is any indication that the standards for training would not be of quality anyway. It goes without saying that we want quality standards of training; we do not need to put that into the Bill.
Amendment 80 refers to “trauma-informed care”. I do not have a particular problem with that. Again, it is an issue of how prescriptive we should be in relation to the training. I have already spoken at length about that. The right hon. Gentleman makes some fair points.
The right hon. Gentleman’s other amendments include amendments 83, 84 and 85. Amendment 83 says:
“The Secretary of State must make a statement to Parliament, as soon as practicable following the publication of report under subsection (2).”
It is difficult to disagree with that, to be honest. I do not see why that should not happen. I would be perfectly happy about it.
My hon. Friend the Member for Christchurch has also tabled some amendments. His amendment 88 would
“leave out ‘mechanical or chemical’ and insert ‘or mechanical’.”
I think that he wants to get rid of the chemical type of restraint from the Bill. A chemical restraint can be described as a medical restraint to restrict the freedom of movement of a patient. Such chemical restraints can sometimes also be used to sedate a patient if necessary. I think that his amendment is understandable. My only concern is whether it might lead to perverse outcomes whereby chemical means of force are used more often than they should be to get round the Bill. I am a bit nervous that that may happen. I would therefore deter him from pressing ahead with it, although I certainly understand where he is coming from.
Amendment 90 to clause 1 seems to be a consequential amendment, so we do not need to deal with that. Amendment 89 would leave out paragraph (b) from clause 1(6), to remove the isolation of a patient from the list of things referred to by “use of force”. I am much more sympathetic to this amendment, because my hon. Friend makes a good point. I am sure he will express his own opinion when the time comes on why he feels so strongly about that, but my view on first reading is that it is perfectly sensible. Amendment 91 is consequential to that.
Amendment 98 is one to which my hon. Friend referred in an earlier intervention. It would insert the words “and their families” after “patients”, to allow patients and their families to plan, develop and deliver their care and treatment in a mental health unit. This is an excellent amendment. It is essential that families are involved in the treatment of their family members. In many cases, if the family could have been more involved from the start and been able to help and warn what the situation was, such problems and terrible situations would not have happened. It is a very sensible amendment, and I hope that he will pursue it with vigour, because it is really important that we involve family members in treatment.
Amendment 100, which would ensure that guidance is published no later than six months after the Act is passed, is particularly pertinent to the discussions we have been having. My only quibble is that six months may be too long, but I certainly agree with the thrust of it, which is that there should be a time limit.
Sir Christopher Chope
It all depends on when the draft guidance is produced. My amendment is referring to the guidance that emerges after any consultation. As I said earlier, I think that the consultation should take place very early, but six months is a maximum.
Philip Davies
My hon. Friend is on to something with that, and I certainly agree. It is quite extraordinary that we do not have the draft guidance already, but I will not go over that again.
Amendment 101 is sensible. It would insert the word “significant” after “any”, to require a record to be kept of any significant use of force on a patient by a member of staff. That is sensible because we do not want to include other things that should not be included. The point I make is that the word “significant” is rather subjective. One person’s “significant” may not be another person’s “significant”, and it might be a bit difficult for trusts and staff to understand what counts as “significant”. My only concern is whether that adds confusion.
Sir Christopher Chope
At the moment, clause 7(2) states that subsection (1) does not apply to cases where the use of force is “negligible”. That is refined in subsection (3). I am effectively saying in my amendment that “significant” is non-negligible.
Philip Davies
I hope that my hon. Friend will expand on that later. He makes a good point, and I am broadly sympathetic to it.
I have now gone through the amendments on the amendment paper. Different Members have tabled quite a few amendments, and therefore it takes a bit of time. I would like to think that, like the hon. Member for Croydon North, people have been convinced of the necessity of amendments 11 and 12, which go to the heart of what the Bill is supposed to be about.
Sir Christopher Chope
Some people looking at today’s proceedings may say that my hon. Friend has been speaking for a long time, but we need to remember that when Bills are considered, the amendments are often grouped so that we do not consider all amendments in one discussion. Today, we are considering all the amendments to the Bill in one group, which I think explains why he has spoken for a bit longer than he might sometimes do.
Mr Deputy Speaker (Sir Lindsay Hoyle)
Order. May I just say that we do not need to be reminded of how long the hon. Member for Shipley (Philip Davies) has spoken? All that does is use up precious time, and I know you would not want to do that, Sir Christopher.
Philip Davies
My hon. Friend the Member for Christchurch will have noticed that at no point did anybody in the Chair say that I was off-subject, and there were over 100 amendments to consider.
I would like the Government to take responsibility for my amendments 11 and 12, which the hon. Member for Croydon North, the promoter, wants to include in the Bill. I hope that we get the opportunity to test the will of the House on those amendments, especially if he supports them, and we will see what Members make of them. If we do not include amendments 11 and 12 in the Bill, we are doing a really big disservice to the people we are trying to help and we are doing a disservice to the honour of Mr Lewis, which is what the hon. Gentleman’s Bill is all about. Those two amendments go to the heart of what he is trying to achieve with his Bill, and I hope that Members will reflect on that before we vote on them.
Norman Lamb
In speaking today, including about the amendments I have tabled, I take a different view from that of the hon. Member for Shipley (Philip Davies), in that I want the Bill to proceed. It is not perfect—there are things that I think should be included, which is why I have tabled amendments—but it is more important to get on the statute book this very important staging post in changing the culture in many mental health trusts than to delay it further.
I congratulate the hon. Member for Croydon North (Mr Reed), who has done a brilliant job in advocating the case for this reform, as he has in his advocacy on behalf of Mr and Mrs Lewis. It is an enormous pleasure to support him today in that endeavour. I particularly note the role that Mr and Mrs Lewis, who are present in the Gallery today, have played in all of this. They have fought their campaign with enormous dignity and with absolute determination to secure justice for the loss of their dear son. They have had a willing Member of Parliament working with them, but if the Bill reaches the statute book, it will be to their enormous credit for the battle they have fought, and we should all applaud them for the contribution they have made in achieving that.
I met Mr and Mrs Lewis when I was the Minister responsible for mental health. I remember a debate in this place in which the hon. Gentleman raised their case. I was horrified by what I heard while sitting on the Front Bench, and I agreed to meet them. I met Mr and Mrs Lewis in my parliamentary office, and I took up their concerns with the Independent Police Complaints Commission, because the case did not appear to me to have been properly investigated. They have continued to fight stoically for justice, and I pay enormous tribute to them for doing so.
My interest in this issue as a Minister arose back in 2013, when Mind did a survey showing that the use of force—I use that term advisedly—was endemic across in-patient mental health settings around the country. Not only that, but the use of force varied incredibly from one unit to another, without any apparent justification. As a result of the Mind survey, I decided that we had to review the guidance. In due course, that led to the non-statutory guidance on “Positive and Proactive Care”, which was issued in 2014.
The purpose of the guidance was to end the use of face-down restraint, which was the sort of restraint used on Seni Lewis. At the time, I was confronted by a lot of people in the sector who said, “You’re not being realistic. You can’t reduce force. You can’t stop the use of face-down restraint, because we deal with very difficult circumstances.” Yet when I listened to progressive practitioners who had worked in such units, they demonstrated that we could end the use of inappropriate forms of restraint. Tim Kendall, national clinical director for mental health, announced that his unit in Sheffield would end the use of face-down restraint, and it did. If those progressive practitioners can do that, others can as well. I was frustrated that guidance issued by the National Institute for Health and Care Excellence in 2015 in some ways contradicted the 2014 guidance by not ruling out the use of face-down restraint. I think that was a big mistake by NICE. I realise its independence, but I question its methodology in reaching that conclusion.
Why is this issue so important? It is because many people, not only Olaseni Lewis, have lost their lives as a result of the use of face-down restraint in mental health settings. Along with those awful losses of life, too many people who experience the use of restraint see and feel it as an assault on them. In many cases, people have experienced abuse earlier in their lives, including sexual abuse, sometimes as children. For a woman in a mental health setting, to be held to the floor by several men who are acting to restrain her is likely to make her experience an extraordinary sense of trauma. In many cases that results in a loss of trust between staff and patients. Units that have confronted the culture of a heavy use of force have found that when time is used for creative activity, that reduces the need for force to be used in the first place. Staff end up being safer, as well as patients in their unit, and the unit becomes a more therapeutic environment and everyone benefits.
The bottom line is that since the 2014 guidance there has been very little change—that is why the Bill is so important. The use of face-down restraint is down a little, but the overall use of restraint appears to be at pretty much the same level. That may in part be due to better recording, but the report in The Observer on Sunday suggested that injuries are up. In 2016-17, 3,652 patients and 2,600 staff were injured as a result of the use of force. In many cases, units have close to 100% occupancy and a heavy use of agency staff. They are under enormous strain and stress, which is not a therapeutic environment for patients, and the use of force becomes almost inevitable because of the strain that everyone is under. That is why training is so important in changing the culture.
Let me deal briefly—briefly!—with my amendments. I tabled them because I wished these important issues to be included in the Bill, and it is a pity that they are not. I do not want to delay the passage of the Bill, so I will not seek to divide the House, but I hope that the Minister will give the strongest possible indication that she supports the issues I seek to raise—I think she probably does.
Clause 1 includes a definition of the “use of force”, and it is important to extend that to cover threats of the use of force, and coercion, which means
“the use or threat of force, with the intention of causing fear, alarm or distress to control a patient’s behaviour or elicit compliance with the application of the use of force”.
Such coercion can be enormously traumatic for individuals who have experienced trauma in their lives, and it is important for that to be recognised in the Bill.
Amendment 37 to clause 3 states that the policy on the use of force
“must set out that the use of force will only be used without the sole intention of inflicting pain, suffering or humiliation, or subjecting patients to tortuous, inhumane or degrading treatment, or without inflicting punishment or intimidation.”
That is in line with the Mental Health Act code of practice and the UN convention against torture. I am pleased that the Minister has indicated that she will deal with that in guidance, but I hope very much that it will be very clear in that guidance. If it had been on the face of the Bill, it would have helped to address the concerns of the special rapporteur on torture.
Amendment 36 would ensure that mental health units committed to reducing the overall use of force—surely that is ultimately the central purpose of the Bill—and it would increase transparency about how they intended to achieve that and what types of force were permissible in the unit. All that is absolutely central to more personalised care whereby people are informed about what might happen to them in in-patient units.
Amendment 38 to clause 4 would ensure that people’s legal rights to advocacy were properly communicated to them in relation to the use of force. People often simply do not know what their rights are, and the amendment would assist by ensuring that they did.
Amendment 79 to clause 5 addresses the importance of training in the appropriate use of force. It makes it clear that the
“Secretary of State must publish quality standards for training”.
That is important because training practices are variable around the country. My preference would be for accredited trainers, so that we know that they meet the right standard and are training staff in the right way. My proposal would at least ensure that there was a national standard that people should abide by.
Amendments 80 and 81 are intended to ensure that training requirements for staff include training in trauma-informed care. That comes back to the absolute importance, when we are caring for people, of recognising the impact that trauma has had on people’s lives. It is great that clause 5(2)(g) covers training on experience of trauma, but it should be strengthened to cover not only the impact of trauma on patients’ mental and physical health, but how the use of force itself can re-traumatise people—the very opposite of what should be happening when they are receiving mental health care and treatment. Trauma-informed care is a model of care that is
“grounded in and directed by a complete understanding of how trauma exposure affects”
a person’s
“neurological, biological, psychological and social development”.
In clause 7, on the recording of the use of force, amendment 39 would improve the transparency and accountability about the use of force by ensuring consistency in the recording of all uses of force, not just those above a threshold set in statutory guidance. The Bill as it stands states that records should not have to cover the “negligible” use of force. I understand entirely why that is in the Bill, but the concern is that guidance will be interpreted differently. That is why the way the guidance is framed will be of critical importance. There is a risk of low-level micro-aggressions—uses of force in a minor way but on a continuing basis below the radar—which can have an impact on people’s wellbeing and their potential for recovery, which is out of step with the Mental Health Act code of practice.
Clause 9 is on the annual report by the Secretary of State. According to the related amendments, the annual report should
“make reference to the annual statistics”
published by NHS Digital, including relevant characteristics, so that we can monitor the ethnicity of people against whom force is used, and they state that the Secretary of State should report on that and that there should be a statement to Parliament.
I do not want to take up any more time. I will end by saying that I absolutely hope that the Bill gets on to the statute book as quickly as possible. I hope that the Minister will respond to it becoming law by going on a drive nationally to proselytise and make the case for a change of culture, so that we can see a radical reduction in the use of force across mental health settings. There are very many inspiring practitioners who have demonstrated how that is possible, but we need to make sure that it is the standard and not the exception. The Minister could go down in history for achieving a dramatic cultural change if she takes the Bill, when it is passed, and really goes out and makes the case for it.
Jackie Doyle-Price
First, I thank and congratulate the hon. Member for Croydon North (Mr Reed) on his tireless work getting this important Bill to Report, and I hope it makes further progress. It is an important reform that will significantly enhance the rights of patients in mental health settings and will be a force for justice. We have had numerous references to its inspiration, and I pay tribute to the dignified and determined way in which Olaseni Lewis’s family have pursued an important reform that will materially improve the treatment of patients.
The Government welcome the measures on monitoring and reducing the use of force in mental health settings. The Bill will provide clarity in several areas, including on recording and reporting, and is very much in the spirit that sunlight is the best disinfectant—that transparency is the most effective tool for ensuring good treatment and performance. It will facilitate better and more consistent data collection, which in turn will give us better evidence by which to measure the success of the Bill and these reforms in minimising the use of force in mental health units. I take up enthusiastically the challenge from the right hon. Member for North Norfolk (Norman Lamb). We who believe strongly in these issues owe it to the public to campaign for the adoption of best practice and the minimisation of restraint. I will say more about his amendments later.
The Government have tabled amendments to clause 4 to remove an unintended consequence of amendments made in Committee, where we unwittingly inserted a loophole that might have enabled providers not to inform patients of their rights. We have made amendments to close that loophole, while still enabling an element of discretion in the system where advising patients might cause them further distress. I notice that my hon. Friends the Members for Shipley (Philip Davies) and for Christchurch (Sir Christopher Chope) tabled similar amendments. I hope they will support at least the action I have taken in response to those concerns.
The Government agree that it is important that patients have access to advocacy services, which are very much a part of the right to information on rights and something that the hon. Member for Croydon North and his stakeholders have repeatedly raised with me, but we do not want to put this provision in the Bill. That said, to reassure them about how we are treating the issue of advocacy, which we recognise is important, I remind the House that the independent review of the Mental Health Act 1983, which was set up to look at how its provisions were being used and how practice could be improved, will examine this issue. The interim report was published in May and the final recommendations will appear in the autumn. Following that, we will develop guidance through consultation. The report and recommendations will give us another opportunity to discuss this and ensure we are happy with the standards of advocacy in place. I hope the hon. Gentleman will understand why I cannot accept his representation.
I turn now to the hon. Gentleman’s amendments on the independent investigation of deaths and legal aid. I am grateful for the opportunity to address these points, which go to the heart of what he is trying to achieve in the Bill. The appalling, dehumanising experience suffered by Seni’s family during the investigation, which went on for an unacceptably long time, is really the test by which we should measure the effectiveness of the Bill.
Let me now explain why we would resist the amendment, describe the steps that we have taken to improve investigations of deaths in custody, and, hopefully, give the House some reassurance that the experience we are discussing today will not be repeated under the current regime. That is at the heart of the Bill: we want to ensure that what was experienced by Seni’s family is never repeated.
Clause 10 in its current form requires that when a patient dies or suffers a serious injury in a mental health unit, the responsible person must have regard to the relevant guidance relating to investigations of deaths or serious injuries, published by a list of organisations that are responsible for regulation: for example, NHS Improvement and the Care Quality Commission. That means that in the current NHS Improvement guidance, the NHS serious incident framework, which was last revised in 2015, will be put on a statutory footing. The framework outlines the process for conducting investigations of deaths and other serious incidents in the NHS for the purpose of learning to prevent recurrence. It requires the treating clinician to report an unexpected death when natural causes are not suspected. All deaths of detained patients must be reported to the coroner, the CQC and the provider’s commissioner as serious incidents. That will ensure that all deaths in custody are automatically reported.
If the death occurred in a mental health in-patient or hospital setting, NHS providers are responsible for ensuring that there is an appropriate investigation into the death of a patient detained under the Mental Health Act, or where the Mental Capacity Act 2005 applies. The death of a voluntary in-patient will also be investigated by the coroner, and under the NHS serious incident framework, if it was violent or unnatural. These are not inquiries into how a person died, as that is a matter for coroners, and they are not conducted to hold any individual or organisation to account. Other processes exist for that purpose, including criminal or civil proceedings, disciplinary procedures, employment law, and systems of service and professional regulation. That is an important point, because overlapping interests will need to be managed. I hope that I can give the hon. Gentleman some comfort, and reassure him that we are tackling the real problem that the Bill is intended to tackle.
Independent investigations within the framework are commissioned and undertaken independently of those directly responsible. I know that throughout our discussions on the Bill, the issue of independence was extremely important to everyone with an interest. It will be normal for the provider to conduct its own internal investigation, but that investigation will be reviewed by the relevant commissioner, and it will be for the relevant commissioner to commission an independent investigation. Commissioners must satisfy themselves that the investigation is clearly independent, and that there is no potential for conflicts of interests and no previous relationships. It will be their responsibility to establish that.
We expect commissioners to ensure that the family is properly informed throughout an investigation, and that all agencies involved in an investigation are held to account for their roles. We expect them to take the lead in commissioning an inquiry, and to take a number of steps including listing all the agencies that have had a stake in the care of those involved with the incident, and ensuring that they are aware of the process and their responsibilities in relation to the inquiry. It is up to them to identify all legal issues that may be relevant to the independent investigation or court proceedings and obtain appropriate legal advice. It is for them to co-ordinate meetings and discussions between the investigation team, the trust representatives, the police representatives and other agencies with an interest that have agreed to participate, so that all are agreed as to what their responsibilities are. They are responsible for early discussion with the local coroner. Crucially, they are responsible for informing the patients, carers and families about how the process will work and how they can be involved.
It is extremely important that as part of the investigation process the families’ needs and wishes are properly respected and they feel some ownership and accountability and can hold the process to account if dissatisfied with how things are progressing—that is extremely important. It will be for the commissioner as well to ensure they have access to the investigation team if they so wish. I also expect the commissioner to agree the timescale for the investigation together with timings and setting a date for the report. As much as I would like to be able to say that we will never have such a situation ever again, we can never say never, and if there were to be any delay the reasons must be clearly explained to the patients and families involved as part of keeping them fully informed and making sure they are fully supported.
The serious incident framework sets out clear guidance on who should be involved in the independent investigation team and that the healthcare commissioner is to identify a lead investigator who appoints the investigation team. The framework says the following, and I will quote directly again to underline the real independence of these investigations:
“In order to ensure independence and avoid any conflict of interest, no member of the independent investigation team can be in the employment of the provider or commissioner organisations under investigation, nor should they have had any clinical involvement with the individual(s) to whom the investigation relates.
Investigators must declare any connectivity that might, or might appear to, compromise the integrity of the investigation.”
I hope that is explicit and gives the hon. Member for Croydon North some comfort about what we are doing to establish that independence.
I should also mention that we have just completed a consultation on the serious incident framework, and independence of investigations was a key theme, so we will be continuing to review this to make sure we can guarantee that independence. We will be bringing forward our response to the consultation by the end of the year, so we have another opportunity to ensure that we are satisfied that what we have is fit for purpose.
Another complication in the case of Seni Lewis was the interaction with the police investigation. That is where there is still the possibility of delay, and again we need to do everything we can to ensure that families are supported in that context.
Michelle Donelan (Chippenham) (Con)
Does my hon. Friend agree that this Bill is vital and it is a testament to the work of Seni Lewis’s family? Is she as concerned as I am about jeopardising this Bill, because it is so important, not least to my constituents, that we tackle this important area?
Jackie Doyle-Price
This is an important reform that will considerably alter the balance of the scales of justice in favour of patients and bereaved families. I want it to make rapid progress, and the specific case of how long it took for Seni’s family to get a resolution in relation to his death is the inspiration for this Bill.
Sir Christopher Chope
Will my hon. Friend expand a little more on the timescale within which an independent forensic pathologist must reach a conclusion following a death? The husband of a constituent of mine died more than nine months ago, and the coroner ordered a pathology report but that still has not been carried out, causing enormous distress to everybody involved.
Jackie Doyle-Price
I am grateful to my hon. Friend for making that point. As he says, the longer the answers take, the more distressing and dehumanising it is for the bereaved. I will come to the timescales later in my remarks, but one of the real achievements of the Bill is that it places clear expectations on the authorities in regard to investigations.
As I was saying, a police investigation could be carried out at the same time, depending on the type of incident involved. That was the case when Seni died. NHS guidance now clearly states that, whenever feasible, serious incident investigations must continue in parallel with police investigations. That is an important point, because what happened in Seni’s case was that the police investigation basically put a brake on the NHS investigation. We are clear that these investigations should take place in parallel. That is possible because the terms of reference for the investigations are quite different, and where this eventuality arises, it should be considered in close consultation with the police so that they can be clear about the purpose of the healthcare-led investigation and how it will be managed.
If, following discussions or a formal request by the police, coroner or judge, an application is made to suspend the NHS investigation, it could be put on hold. However, the family must be very much involved in that decision, and the commissioner must ensure that they can agree a date for completion once the investigation can recommence. It is very much down to the commissioner to establish that timeframe. Whether an investigation is put on hold or not, it is absolutely central to our proposals that families should be kept engaged and informed of when the investigation will start up again, and when it will be completed. We also have national guidance on learning from deaths, which was published in March 2017. That now sets out clear expectations of NHS organisations for engaging with carers and families in these circumstances. Dialogue is absolutely central and underpins everything we are doing in this space.
I want to provide some details about what happens if a death follows police contact, when that contact may have caused or contributed to the death, as this is particularly relevant to the events that followed Seni’s death. In such circumstances, the police are under a duty to refer the matter as soon as possible to the Independent Office for Police Conduct. Following an investigation, a report is sent to the police force. The report provides the IOPC’s opinion about what should happen to those involved in the incident. For example, it might recommend further training, a misconduct meeting or a gross misconduct hearing. The police force will then provide its own view about what should happen. If the IOPC disagrees with the force, it has the power to recommend that it should take appropriate action, such as holding a misconduct meeting or hearing. Ultimately, the IOPC can direct the force to do that.
Under the scheduled reforms, this process will be further streamlined so that the IOPC will make the decision on whether there is a case to answer for misconduct or gross misconduct, and decide what form the disciplinary proceeding should take. The IOPC will provide a copy of the investigation report to the relevant police force, and to the complainants and the family of the person involved, as well as to the coroner and the Crown Prosecution Service, which will consider whether any further action should be undertaken.
I want to return to concerns about the quality of investigations, and to briefly explain the role of the Healthcare Safety Investigation Branch. The Lord Chancellor is looking at how we support people going through an investigation, and the hon. Member for Croydon North has also raised the issue of legal aid. It is important that we ensure that families have appropriate support as they navigate this process. This is not just about the process of walking through the contacts with the NHS investigating bodies, which can be quite formal; they could end up in a situation involving legal action or criminal proceedings, at which point they would need that support.
Much reference has been made this morning to the Dame Elish Angiolini review, in which she was clear that all deaths in custody should be treated on an equivalent basis, and I can confirm to the House that the Lord Chancellor’s review into legal aid for deaths in custody will consider deaths in mental health settings on the same basis as deaths in prisons and other forms of custody. I can also advise the House that the ministerial board on deaths in custody constantly reviews what we are doing and how we are implementing the recommendations of the Angiolini review, so the review of legal aid for inquests will consider how it can be applied to deaths in mental health settings, too.
Kevin Foster
The Minister is making some interesting points about the legal aid review. Will she confirm what groups she is considering talking to? I am thinking of third-sector groups, community groups and, potentially, law centres.
Jackie Doyle-Price
I thank my hon. Friend for that intervention. I hope that we will continue to consider everything that we can do to support people, and I welcome those suggestions. Ultimately, such people are facing massive injustice at the hands of the state, and we should never stop looking at what we can do to support people in those circumstances. The simple truth is that those people have put their trust in the institutes of the state, so there is double pain when they are failed by them, and we must ensure that we do everything possible.
I hope that what I have said about legal aid and the investigation process satisfies the hon. Member for Croydon North, so I hope that he will not press his amendments to a Division so that we can get the Bill into the other place and deliver the objectives that he and I both want.
To clarify something that I was saying about the Government amendments, we unwittingly included a loophole that would allow institutions not to provide patients with information, and I might have suggested that that was a matter of discretion. However, it is actually in the Bill that they must provide information unless “the patient refuses” to accept it. I just wanted to make that clear in case there was any misunderstanding. The remaining Government amendments are largely technical, linking the Bill with the Data Protection Act 2018, for example, and providing clearer definitions regarding mental health units. Those are very much drafting changes, and I hope that the House will approve them.
Turning to the amendments tabled by my hon. Friends the Member for Christchurch and for Shipley and the right hon. Member for North Norfolk, I have already discussed the Government’s view on such matters, but I will refer first to the right hon. Gentleman’s amendments in relation to threats and coercion. The Government’s main concern is that putting the use of threats of force and coercion on the face of the Bill might cause confusion for staff working in mental health units when we are trying to encourage them to use de-escalation techniques. We have the same objective as the right hon. Gentleman, which is to minimise restraint, but we are concerned that the amendments might act as an impediment to what we are trying to achieve.
Norman Lamb
Will the Minister look at whether the guidance will be clear about the importance of staff not inappropriately threatening force or coercion, because that all goes down to the culture of the organisation?
Jackie Doyle-Price
The right hon. Gentleman is right about that, so let me go through the provisions we think are in place to protect patients from exactly that circumstance. The care quality regulations—the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014—clearly set out the types of behaviours that are prohibited and create an offence of failing to comply with the requirement to protect service users from those behaviours. We are satisfied that those provisions would be an appropriate tool with which to tackle this issue. Clearly, we will be relying on guidance to implement much of this Bill, and I can give him every assurance that these issues will be very much part of that guidance; this process will be consultative and I am sure he will want to remind me of the undertaking I have just given him as and when that comes through.
My hon. Friend the Member for Shipley has discussed his amendments 44 to 78, providing us with his understanding of the use of the terms “force” and “restraint”. The point he made was that he wanted the Bill to be consistent with language used elsewhere in mental health settings. It is important that we make sure the language we use is consistent. The term “force” is a more overarching description of what is happening to a patient, and the individual elements that the definition needs to cover are the types of restraint. In the context of this Bill, those are physical, mechanical and chemical restraint, along with isolation. We have chosen to use the term “force” because it works alongside the Mental Health Act 1983 code of practice, with which practitioners are familiar, and it reduces any risk of confusing the drafting due to the use of similar terms, where that can be avoided. This approach has very much been accepted in our consultation with the sector. I heard my hon. Friend say that he had received representations to suggest the opposite, so I would be pleased to take that up with him offline, in order to satisfy his local care trust that what we are doing is consistent with other law, because it is important that we take everyone with us.
My hon. Friend the Member for Christchurch has tabled amendments that would remove certain types of force from the Bill, particularly chemical restraint and isolation, which covers segregation and seclusion. I am grateful to him for testing our conscience via these amendments, because it is entirely legitimate for him to worry that practitioners might be impeded from administering medication to their patients, as, obviously, that would be harmful if those patients needed it. I can give him the assurance that when we talk about “chemical restraint”, we are not considering a patient’s normal medication. The type of medication used for chemical restraint would usually be different from that used as part of a patient’s normal medication to control or treat their mental health condition. As part of a chemical restraint, patients would not simply be given more of their medication. The types of medication used in chemical restraint are a particular kind of product, lasting for only a short period and not having the effect of over-medicating a patient. It is important that we record and receive national data on the use of those products so that we understand their use and shine a light on areas where they might not be used appropriately. I hope that gives him some comfort.
Sir Christopher Chope
Will the Minister make a statement on which products would be covered by the Bill and which would not? From talking to my constituent, I had the impression that the products used in his case would be covered.
Jackie Doyle-Price
I will commit to writing to my hon. Friend with details of the products licensed by the National Institute for Health and Care Excellence for the purpose of restraint, if that would be helpful.
Sir Christopher Chope
Would the Bill cover situations in which the NHS is paying for private services in mental health units?
Jackie Doyle-Price
It would; indeed, to be more explicit, any service with which the NHS commissions mental health services would be expected to have procedures that comply with the Bill. That will cover non-NHS patients in those institutions as well.
My hon. Friend the Member for Shipley asked some testing questions about training. I really want to say that from my perspective the detail of what will be covered in training will be taken forward through statutory guidance that will be subject to consultation. He has made it clear that he believes that the training of police forces and training on acute episodes need to be factored into that. That is something that we will take forward as part of that consultation. In all honesty, I do not believe that his amendments will be necessary; in any case, we will take that forward as part of the consultation.
On police roles and responsibilities, my hon. Friend will know now that, as I have mentioned, we have a memorandum of understanding that governs how the police and health services interact in these circumstances. That is owned and taken forward by the College of Policing, and I am sure that he will agree that they are the right people to own that. If a provision affects the police in that way, I cannot make any decision without further consultation with colleagues across the Government.
I hope that I can assure my hon. Friend that I fully take on board his points; indeed, the hon. Member for Croydon North supports the inclusion of those issues in training. We will take forward that proposal as part of the consultation process that will develop the guidance. I hope that that is enough to persuade my hon. Friend to withdraw his amendments.
On enforcement, there have been representations such that the guidance should be published within six months of the Bill being passed. Again, I do not want to prejudge Parliament’s decision. We will take forward the consultation as and when the Bill is passed. These are significant issues and a 12-month process would be more appropriate in the context. It is better to get it right than to be guided by speed, however impatient we are to achieve the desired outcomes.
Sir Christopher Chope
My hon. Friend is being very generous. Will she tell us the current state of the guidance? Can it be published for consultation immediately this Bill attains Royal Assent?
Jackie Doyle-Price
We will undertake it speedily and it will be made public, but, as my hon. Friend will appreciate, the whole purpose of consultation is that it consults and we want to ensure that we are taking everybody with us. Personally, I will want to do it in an extremely timely fashion.
There are many amendments to go through, but I hope that I have articulated the Government’s overall support for this measure and what we are trying to achieve in terms of supporting the hon. Gentleman’s Bill. Central to all this is the need to underline transparency and to strengthen accountability so that patients are protected. Clearly, we desire to minimise the use of force. The best way that we can achieve that is by shining a light on those incidents. We will continue to take this forward in the spirit of openness, and the Secretary of State will be producing reports on how this is being implemented.
Let me turn now to my final point. I have already addressed this in response to the remarks of my hon. Friend the Member for Shipley. On police body cameras, I can give him this assurance: the proposal does not create a criminal offence for not wearing a body camera. We have been very deliberate in our language to say that it is practicable to make sure that we do not get in the way of the police doing what is right in these situations. The references he makes to the law are consistent with the Police and Criminal Evidence Act 1984, but this would not raise any issue of a police officer being faced with criminal prosecution for not wearing a camera. I hope that that gives him some satisfaction.
Norman Lamb
This is my very final point. Even if this is not in the Bill, does the Minister agree that it would be a good thing if the Secretary of State reported to Parliament annually on the basis of the data that was produced by NHS Digital?
Jackie Doyle-Price
That issue did come up in Committee. Although I appreciate the spirit with which the right hon. Gentleman makes that inquiry, we would not want to make a particular arrangement for one set of NHS data over another. Clearly, we need to explore this issue to make sure that there is some annual return on how this Bill operates when it becomes an Act.
I could say so much more, Mr Deputy Speaker, but I will not. Everybody in this House is very clear that they want this Bill to make progress. I appreciate that I cannot keep all Members happy all the time, but I do hope that I have been able to assure my hon. Friends the Members for Shipley and for Christchurch on how we will take forward their representations and that I can persuade them not to push their amendments to a vote.
Justin Madders (Ellesmere Port and Neston) (Lab)
May I start by congratulating my hon. Friend the Member for Croydon North (Mr Reed) on progressing this extremely important Bill to this stage? I had the pleasure of speaking to it on Second Reading back in November. I am sure that the past seven months have felt pretty long to him, particularly as there were delays outside his control with the money resolution, and I am sure that that feeling was present again at times this morning. I hope that his diligence and persistence will pay off. We all know how much it will mean to see this Bill finally enshrined in statute. Nothing can demonstrate better the positive impact that a constituency MP can have in such circumstances, where there are clearly shortcomings in the current law, which we hope to put right.
I congratulate all hon. Members who have contributed so positively to the progress of the Bill, and the Minister on her constructive approach. I also echo the tributes paid to the Lewis family for the dignified and helpful way in which they have assisted in shaping this legislation. It has been evident from contributions that hon. Members have made during the passage of the Bill just how united we all are in our determination to do something to ensure that the tragic case of Seni is not repeated.
It is shocking to hear that, according to the Independent Advisory Panel on Deaths in Custody, 46 mental health patients died following restraint between 2000 and 2014. Victims of restraint in these circumstances have said that face-down restraint by groups of men adds to the trauma that in many cases led to their mental illness in the first place. As well as bias towards women, there is evidence to suggest that members of the BAME community are disproportionately more likely to experience restraint, so we strongly support the Bill, which we hope will reduce the use of force and address the unconscious bias currently reported in the system, by increasing transparency, evidence, accountability and justice.
In terms of transparency, data is not currently collected consistently, so it can be hard to collate accurate data on how often restraint is used and on how restraint is used disproportionately against certain demographics. We hope that the Bill will create a level of uniformity that is currently missing. Recording how and why restraint is used, who it is used on and what steps were taken to avoid its use will inject much needed transparency and consistently into the system. We will then be in a much stronger position to tackle the issues of unconscious bias or overuse of restraint to which hon. Members have referred throughout the passage of the Bill.
We need to ensure that if tragedies of this nature occur again, they are independently investigated and that justice is not only done, but seen to be done. As my hon. Friend the Member for Croydon North has set out, new clause 1 would make it compulsory for an independent investigation to be carried out whenever a death occurs in a mental health unit. He set out the thinking behind the new clause very well. The Minister set out why it is not something that she can take on board, but she did give a clear view of some of the safeguards that will be needed regarding independence, particularly when it comes to potential conflicts of interest or, as she said, appearances of conflicts of interest. She was clear and strong about the need for the ownership and involvement of the families in any investigation. That is of paramount importance. I look forward to hearing whether my hon. Friend considers that a satisfactory response.
In conclusion, the Bill is a step towards a model of care, rather than one of containment. Of course, it does not have everything that we would want, but it is an important step in the right direction that will support patients, their families and emergency service workers. I commend my hon. Friend the Member for Croydon North on his hard work in reaching this stage and look forward to Seni’s Bill becoming Seni’s law.
Richard Benyon (Newbury) (Con)
On a point of order, Mr Deputy Speaker. I seek your advice, because I have heard conflicting views. It is quite clear that we are not going to get to my Armed Forces (Statute of Limitations) Bill today. Would I be right that, if I were to not move it today and were to go to the Public Bill Office to seek another date, we would then have a better chance of having a debate? Many Members on both sides of the House want to debate the Bill, and there are 250 veterans in Parliament Square who particularly want the matter aired on the Floor of the House. I seek your advice on the best way to make that happen.
Mr Deputy Speaker (Sir Lindsay Hoyle)
If it goes wrong, it is obviously going to come back on me. In the end the right hon. Gentleman must make the decision, but overall I would say yes; my view is that the actions he mentioned would lead to more time for a better debate.
If there are no further points of order, I call Sir Christopher Chope to speak—briefly, I presume, because I know that he wants to get on with the amendments.
Mr Deputy Speaker
Twenty-five minutes will do you, then. Come on, Sir Christopher!
Sir Christopher Chope
It is a pleasure to follow the Opposition spokesman. He was right to pay tribute to the work of the hon. Member for Croydon North (Mr Reed), because this is a really good example of how somebody who is successful in the private Members’ ballot can bring forward a Bill that is to the benefit of their constituents and arises from a constituency case. The right hon. Member for North Norfolk (Norman Lamb) put the issue in context by saying that in the last year for which figures are available, more than 3,500 patients and more than 2,500 staff were injured in mental health units. It is therefore an issue of quite considerable significance.
I intervened on the Minister when she was dealing with new clause 1, and I want to say a little more about timescales for the independent investigation of deaths. As I said, I have a constituency case in which the coroner ordered an investigation that went out to an independent forensic person, who then became ill and has not been able to complete her work. It has not been possible, for all sorts of reasons that I cannot really fathom, to get anybody else to take over the responsibility for that work, with the result that my constituents—and, indeed, other families in Dorset—are waiting for results of post-mortems in respect of loved ones’ deaths many, many months ago. That is intolerable.
I therefore tabled some questions to the Ministry of Justice. In fact, they were among the last questions answered there by my hon. Friend the Member for Bracknell (Dr Lee). He said that there was a provision in the Coroners (Investigations) Regulations 2013 that reports must be made as soon as practicable after the examination, but there is no absolute time limit. He also said that he would raise the question of timeliness with the Department of Health and Social Care and write to me. I hope that that question of timeliness will be on the Minister’s desk soon and that she will then also be able to write to me to explain what could be done to ensure that there is a finite period for these very sensitive post-mortems, and the investigations that flow from them, to be carried out. It would be very useful if we can achieve some progress on that.
The hon. Member for Croydon North says at paragraph (5) of his new clause:
“A person appointed under this section must provide a report within three months of that appointment.”
That is a clear time limit. If the Minister thinks that that is reasonable, then there is no reason why it should not be applied more widely. That could certainly address the problem that I have identified.
I now turn to my amendments. I am grateful to my hon. Friend the Minister for responding, in anticipation, to some of them. Amendment 86 is designed to extend the operation of the Bill to all mental health units in England and Wales, not just to those that in national health service hospitals or those where treatment is provided, or is intended to be provided, for the purposes of the NHS. I still do not understand this: my hon. Friend seems to be saying that she would like to extend these provisions to the independent sector—to all mental health units—but is inhibited in being able to do so because of the constraints of the need to consult on the legislation. Is that correct?
Jackie Doyle-Price
My hon. Friend, as a good small state Conservative, will appreciate my desire not to put burden on business. When we bring forward regulations that will introduce additional burdens, we go through a consultation process to take business with us. I am satisfied that the Bill will affect all patients, because the NHS commissions services from independent mental health care providers, and any institution where the NHS is commissioning services will be captured under the Bill. It will benefit private patients in private settings where those institutions provide services to the NHS.
Sir Christopher Chope
Will it apply to private patients in private institutions as well?
Jackie Doyle-Price
Where that institution provides services to the NHS, it will, because we will only commission services in places that are compliant with the Bill.
Sir Christopher Chope
Okay. That is very helpful. As my hon. Friend says, I am keen to avoid unnecessary burdens and regulation, so it is good to have clarification on that and to know that imposing fresh regulations purely on the private sector would trigger several regulations having to be repealed. Perhaps her Department’s list of regulations to repeal is running a bit short. I am grateful for her response.
Amendment 87 is consequential to amendment 86. I am grateful to the Minister for dealing with my amendment 88, which relates to chemical restraint, and for her offer to write to me with a list of the chemicals that satisfy the definition of “chemical restraint”. The Bill defines chemical restraint as
“the use of medication which is intended to prevent, restrict or subdue movement of any part of the patient’s body”.
However, that does not provide as much clarity as I would wish. My concern is that medication should not be given because it will result in less violence from a patient—for example, if a patient normally takes their medication but becomes more violent if they do not. That seems to be a regular pattern, and I would not want there to be any perverse incentive or disincentive to give people their medication.
Amendment 89 deals with isolation, which the Bill defines as
“any seclusion or segregation that is imposed on a patient”.
I still cannot get my head around why the isolation of a patient is deemed a use of force. Quite often, isolation can prevent a patient from causing physical harm to other patients or indeed staff. Can the Minister expand on that?
Jackie Doyle-Price
My hon. Friend is right, it can, but that should be a clinical judgment. We are trying to tackle the use of seclusion as a method of control where it can do harm, because there are clearly cases where it can, but that will be very much a clinical judgment.
Sir Christopher Chope
I am grateful to my hon. Friend for that clarification.
I tabled amendments 92 to 95 because I was concerned about the term “relevant” health organisations and felt that we should be referring to all health organisations, but the Minister dealt with that point in response to an earlier amendment, so I will not press it. As my hon. Friend said, some of the issues relating to the unintended consequences of the amendments made in Committee have also been addressed.
I turn now to clause 5, and particularly my amendment 98. Clause 5 has turned out to be the weakest part of the Bill. My hon. Friend the Member for Shipley (Philip Davies) made a stunning and really illuminating speech in support of his amendments 11 and 12, which I most heartily endorse. I do not see how anybody who listened to him could do anything other than reach the same conclusion, which I am glad to say is the conclusion reached by the promoter of the Bill. A lot of my hon. Friends were sitting in the Chamber and listening to my hon. Friend the Member for Shipley, and I think they were also in strong agreement with the sentiments he expressed.
The Minister’s response has very much been to say that such amendments are not needed. I do not know whether she will respond in the same way to my amendment 98, but that amendment makes it clear that the training provided under subsection (1) must include how to involve not just patients but their families in the planning, development and delivery of care and treatment in mental health units. The involvement and engagement of families is of absolutely fundamental importance. If the Government have chosen to set out a whole list of what they consider to be very important ingredients in any training course, I cannot understand why they have omitted any reference to the involvement of families in the planning, development and delivery of care and treatment.
In one of the constituency cases I mentioned earlier, the parents have had an incredibly distressing time not just because of their personal circumstances, but because of their son’s circumstances. They have experienced great frustration in trying to get proper contact with the people in the mental health unit where their son is a patient. It seems to me that families, who often care for 20 years or more for mentally ill children, are in a really strong position to know and understand their children’s needs. It is also very important that they should be informed about what is happening. For example, in this case, the young person concerned is sometimes suddenly discharged from the mental health unit at the weekend, and he then goes and makes a nuisance of himself and the police have to bring him back to his parents’ house many miles away. On one recent occasion, he proceeded to trash the whole place. We cannot allow such situations to arise, and it seems to me that there is a really important role for involving and engaging with the families. I hope that my hon. Friend will confirm that the Government really take seriously the involvement of the families.
Jackie Doyle-Price
The Government most certainly do. I mentioned earlier that we are currently undertaking a review of the Mental Health Acts. The involvement of families is a key part of what is coming out of that, and there will be recommendations on that when the report is completed in the autumn. There are also issues regarding mental capacity, so the review of the deprivation of liberty law raises issues about the role of families, and we need to provide greater clarity. However, this is very much part of what we need to get right. My hon. Friend is absolutely right to say that families not only have an interest in, but can do much to support their loved ones. There are also occasions when that can cause harm and families ought not to be involved, but, again, that is part of the clinical judgment. I come back to the fact that all of this will be addressed in the guidance, which we will take forward in consultation with the sector.
Sir Christopher Chope
I am grateful to the Minister, and to you for your indulgence, Mr Deputy Speaker. It shows your flexibility that you allowed one long response, rather than having more interventions flowing on from that. [Interruption.] Well, it was very welcome for its content, and I am grateful to the Minister for putting that on the record.
My final point concerns clause 5(2)(k) and what we mean by
“principal legal or ethical issues”.
It seems to me that “principal” is redundant. Why do we need to talk about “principal” legal issues unless we specify more clearly what we mean by that? Do we mean that some laws or legal issues are more important than others? What does it mean? We have not yet had an answer on that—I do not know whether the Minister has one readily to hand.
Mr Reed
I am grateful to right hon. and hon. Members across the Chamber for the constructive way in which they have engaged with this debate, and for the kind comments thrown my way. It is important to say, however, that this Bill is the work of many people who have contributed to its development and to getting it to its current stage. I hope that this debate is a further contribution to strengthening the Bill and the shape that we have it in now. That includes the many campaign groups and advocacy groups outside the Chamber that have been working with me and with the Government, as well as the Government’s officials, who have been extremely helpful all the way through.
The driving force behind this Bill is something that the coroner said when we held the inquest into the death of Seni Lewis. Seni died in 2010 but we only got the coroner’s verdict in June 2017, while the general election was under way. She said that if things did not change to address the failings that led to Seni’s death, there would be more deaths of that kind. Seni was one of many people who died unnecessarily because of failings in the system and many, many others have been injured because of those failings. Report after report coming out of inquiry after inquiry, and inquest after inquest, pointed to what the problems were, but they were not being picked up by the system, nor lessons learned to keep people safe in future. The coroner said clearly that change must come. That change is this Bill, and I am grateful to everybody who has brought us to this point today.
I have a couple of specific thank yous. I pay particular tribute to the Minister, who has been robust and clear in her support for the Bill right from the start. She has been absolutely clear about the commitments that she could make as a Minister and has delivered on those, so I am immensely grateful to her. In my opinion, we are very lucky to have her as the Minister.
Above all, I pay tribute to the family—to Seni’s parents, Aji and Conrad Lewis, who are with us today, because the real reason we are here is the profound depth of love that they have for their son, who was lost in such tragic circumstances. That love has driven them to campaign for justice, not just for their son, but for everybody using mental health services. Their profound wish is that Seni did not die in vain, so this Bill is dedicated to them and to Seni. It his legacy and his testament, and because of this Bill no one else will need to suffer in the way that Seni did.
On the basis of the Minister’s assurances at the Dispatch Box, I am happy to withdraw my new clause 1 and not to press new clause 2, and I look forward to the further progress of the Bill. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
Clause 4
Information about use of force
Amendments made: 1, page 3, line 16, at end insert—
“unless the patient (where paragraph (a) applies) or the other person (where paragraph (b) applies) refuses the information.”
This allows for cases where a person refuses the information provided, and supersedes subsections (9)(a) and (10)(a).
Amendment 2, page 3, line 22, leave out subsection (5) and insert—
“(5) The responsible person must take whatever steps are reasonably practicable to ensure that the patient is aware of the information and understands it.”
This expands the duty to provide information accessibly so that it requires the responsible person to take whatever steps are reasonably practicable to ensure the patient understands.
Amendment 3, page 3, line 33, leave out subsections (9) and (10).—(Jackie Doyle-Price.)
Subsections (9)(a) and (10)(a) are superseded by Amendment 1. Subsections (9)(b) and (10)(b) are unnecessary as the information will not be of a nature that would cause distress.
Clause 5
Training in appropriate use of force
Amendment proposed: 11, page 4, line 18, at end insert—
“(l) the roles, responsibilities and procedure in the event of police involvement,”.—(Philip Davies.)
Question put, That the amendment be made.
Mr Deputy Speaker (Sir Lindsay Hoyle)
I ask the Serjeant at Arms to investigate the delay in the Aye Lobby.
Mr Reed
I beg to move, That the Bill be now read the Third time.
Given that we have only nine minutes, I shall be extremely brief. I am grateful to Members from all parties for their support for the Bill’s intentions and ambitions. Having spoken to many advocacy and professional groups outside the House, I know that the Bill in its current state will, if passed, give the United Kingdom some of the best legislation in the world to protect mental health patients from abusive or excessive restraint. That is exactly as it should be.
The Bill will make a difference in four broad areas. First, on accountability, by requiring the appointment of a named senior manager in each mental health unit to be accountable for the existence and implementation of a policy governing the use of restraint and its reduction, the Bill will ensure clear and direct accountability for how restraint is used.
By standardising the reporting of incidents of restraint throughout the country so that they are recorded in exactly the same way against the same demographics, we will be able to see for the first time where the best practice really is, so that it can be spread. That will also allow us to scrutinise the data so that if particular groups—for example, women, BME people, young men and people with disabilities—are subject to more frequent or more severe forms of restraint than other groups, that can be corrected.
According to academic research, the requirement on the police, when operationally practicable, to wear body cameras in and of itself reduces the likelihood of restraint being used by the police by 50%. That alone makes it worth doing, but it also protects the police against vexatious complaints and provides evidence when things do go wrong so that lessons can be properly learned to prevent any repetition.
I am grateful for the Minister’s comments on Report about the investigation of deaths. It is important that those investigations happen immediately following a death or serious incident, and it is critical that they are sufficiently independent to allow people to learn what has gone wrong to prevent any repetition and deliver justice to the family of any victim. It is important, too, that there is consistency among all forms of state custody and that mental health custody is not treated disadvantageously compared with police or prison custody, so I welcome the Minister’s commitment to achieve that through the deaths in custody panel that she co-chairs.
I said that I would be brief, and I will to stick to my word. The Bill is an important step away from the containment of people who are mentally ill towards treating them with the care and compassion that their circumstances deserve. It will give this country mental health services that are fair and equal for everybody.
Jackie Doyle-Price
I cannot pay tribute enough to the hon. Member for Croydon North (Mr Reed) for his incredible leadership in getting us to this point. He has made it extremely easy for me to work with him and to engage with the sector. I cannot overstate the signal that this reform will send both in terms of how we treat mental health and how we treat patients and enhance their rights; it will be extremely significant indeed. When, as I hope, the Bill gets on to the statute book, he can really be proud of a very significant achievement. I am very pleased that he was able to use his place in the ballot to bring forward such a progressive and important measure.
I could not disagree with a word the hon. Gentleman said as he introduced the Bill’s Third Reading. He was absolutely right. For too long, restrictive interventions have been accepted as the norm in health and in mental healthcare settings, as the right hon. Member for North Norfolk (Norman Lamb) said.
It has been great to have the right hon. Gentleman’s input into today’s proceedings. He is the one who blazed the trail that I am trying to follow, which is quite a tough act it has to be said, but we are all extremely grateful for the real efforts that he made while he was a Minister, and I hope to build on the change that he started to embed.
We must expect that restrictive interventions and the use of force must never be used for the purpose of punishment, or to degrade or to humiliate patients. Mental health settings are places where people should feel safe, and it is clear that the existing guidance is not having the impact that the Government expected, and that we must do more. This Bill will be a very important tool to achieve that.
I come back to why we are here today: the death of Seni Lewis. The measure of the Bill’s success will be in the strength of the independence of the investigations and in the support that bereaved families get should, unfortunately, any other family find themselves in this situation. That is the yardstick against which the Bill should be measured. We should be very sensitive to ensure that we all continue to do our best so that, when people are let down by organisations of the state, we in this House are at the front of the queue to see that they get justice—and justice promptly, because justice delayed is justice denied.
Sir Christopher Chope
I, too, pay tribute to the hon. Member for Croydon North (Mr Reed) for bringing forward this Bill. He has done a masterly job. I was also impressed by much of what the Minister said in response to concerns that have been expressed. None the less, there are still some unanswered questions, particularly around the implementation of the Bill.
The Minister has said that she will bring forward guidance as a substitute for some of the provisions that we think should have been included in the Bill. She said that we did not need other aspects that we thought should be included in the Bill because they were already in law. I hope that we will be able to keep up the pressure on the Minister to come forward with more precise answers regarding when she will publish the draft guidance.
On Report, I asked the Minister what state the draft guidance was in at the moment and if it was in a form in which it could be produced. I did not get an answer to that question. I also did not get an answer to the question of whether draft guidance would be published before the Bill goes to the other place. There is a lot to be said for the Government publishing the draft guidance tomorrow, say, or next week. One merit of doing that would be that if the Bill’s Third Reading debate does not conclude today, we would have the chance to look at that draft guidance before commenting on it during the remainder of the debate.
As the hon. Member for Croydon North said, the Bill is important because it introduces means by which we can measure lots of things that are happening in our mental health units about which we are not aware at the moment. As we know, what we cannot measure, we cannot control.
I remain concerned that some of the information that will be produced as a result of the Bill could lead to unintended consequences, as my hon. Friend the Member for Shipley (Philip Davies) also mentioned. We heard a reference to the fact that women in mental health units suffer more force against them than men, but that might be because only the most serious cases of women in mental units are brought before the—
Mental Health Units (Use of Force) Bill
Friday 6th July 2018
(6 years, 4 months ago)
Commons ChamberRead Full debate Mental Health Units (Use of Force) Act 2018 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 15 June 2018 - (15 Jun 2018)
Sir Christopher Chope (Christchurch) (Con)
I hope that my hon. Friend the Minister will be able to give us a little more information today on her plans on the issue of the code of conduct. The advisory code is key to the Bill, and when we discussed it last time she said that she would bring draft guidance forward. I hope she will be able to tell me today whether that will be done before the Bill reaches the other place, so that there can be a proper discussion of the contents of the draft guidance at the same time as the substance of the Bill is discussed. I will give her the chance to intervene when she has the answer to that question.
In the meantime, I thank the Minister for responding to the point that I made on Report, when I asked which products were licensed by the National Institute for Health and Care Excellence for the purposes of restraint. She has now written back to say:
“there are no products in the UK which are licensed for chemical restraint as defined in the Mental Health Units (Use of Force) Bill.
However, a number of psychiatric medications can be used for rapid management of acute agitation in psychiatric patients. Of these products, Haloperidol 5mg/ml Solution for Injection is indicated for rapid control of severe acute psychomotor agitation associated with psychotic disorder or manic episodes of bipolar I disorder, when oral therapy is not appropriate.
Clinicians in the UK are primarily guided by the advice about rapid tranquilisation given in the following documents: Maudsley Prescribing Guidelines; Rapid Tranquilisation Algorithm by the Royal College of Psychiatrists; and the Rapid Tranquilisation section from Restrictive Interventions for Managing Violence and Aggression, which is published by the National Institute for Care Excellence.”
I put that on record because it is relevant to our discussion on Report, and I am grateful to her for writing to me with those details. I will give way if she has any more news about the guidance.
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
The guidance will be published and consulted on. Clearly, it would be inappropriate to propose guidance until Parliament has passed this legislation, but we fully undertake to consult all those with an interest. We expect that debate to take place so we can implement the Bill, if passed, within a year of its passage.
Sir Christopher Chope
I am grateful to my hon. Friend, and I hope that is the maximum timetable, rather than the minimum.
Norman Lamb (North Norfolk) (LD)
I speak briefly to confirm my very strong support for this Bill, to congratulate the hon. Member for Croydon North (Mr Reed) on pursuing it, and to pay tribute to the extraordinary stoicism of Seni’s parents, Mr and Mrs Lewis. I am not sure whether they are here today, but we owe it to them that something good comes from the tragedy of the loss of their son. When I was a Minister, I published new guidance aimed at ending the use of prone restraint—the sort of restraint used on Seni Lewis—and radically reducing the use of other restraint.
Depressingly, although it may in part be due to better reporting, the data shows very little change in the overall use of force in mental health units across the country. The truth is that force is endemic in many in-patient units. However, we also know that many units have managed to reduce the use of force substantially.
On therapeutic care and recovery, we have to confront, as a country, the use of force in our mental health units and, if we do not do that, we will never achieve the ambition of facilitating recovery for people who have experienced mental ill health. Frequently, people who find themselves in mental health units have suffered abuse in their life. For a woman who has suffered abuse, restraint, with many people holding her down to the floor, is just a repeat of that abuse. Such restraint destroys trust between staff and patient and completely undermines therapeutic care.
It is possible to achieve a much greater reduction in the use of force. This Bill, particularly through the transparency and accountability it brings, will be enormously beneficial in seeking to change that culture. I strongly support the Bill for that reason.
Philip Davies (Shipley) (Con)
I start by commending the hon. Member for Croydon North (Mr Reed) for his dedication to the Bill and, more importantly, for his dedication to his constituent Seni Lewis and his family, who have been through unimaginable tragedy.
The hon. Gentleman’s campaign to highlight the issues that the Lewis family have faced and to create a positive change in mental health practices is admirable and a true reflection of the care and compassion he applies to his role in his local community. As he knows, and as we have discussed on a number of occasions, I support the core principles of what he is aiming to do. The Bill is something of a curate’s egg, because some bits are very good, some bits are bad and, most frustratingly—this happens with virtually every Bill that comes before the House—some bits could have been much better, as he and I both agree.
As my hon. Friend the Member for Christchurch (Sir Christopher Chope) mentioned, the Minister said on Report that she could not agree to certain things being included in the Bill but that she wants them to be included in statutory guidance. I will outline my under-standing of the things that will go into statutory guidance, which the Minister will hopefully either confirm or correct. Hopefully, as I have always intended, the Bill will then be able to complete its passage in no time at all.
Clause 5, on training in appropriate use of force, is a positive step forward in the care of patients. It is an important change, as it centres on the very core of health services—the patient. Key elements of the training programme are listed in subsection (2). The use of techniques for avoiding or reducing the use of force, and the risk associated with the use of force are two fundamental points that are vital when restraint methods are part of a medical care plan.
It must not be forgotten that the most forceful restraint methods are advised to be used as a last resort. Medical staff should be fully versed in a wealth of techniques to avoid such restraints, where possible, but it must not be assumed that restraint should be banned altogether. Unfortunately, there are times when forceful restraint is necessary, but it is essential that such techniques are used with a full knowledge of the associated risks.
It is regrettable that my amendment 12, on introducing training on acute behavioural disturbance, was not accepted on Report, as it would have enhanced the Bill. I thank the hon. Member for Croydon North for supporting that amendment. I have been advised by the Minister that such training will be added to statutory guidance instead, and I thank her for sending me a letter on Wednesday to follow up on many of these points.
My concern, and I would like some clarification, is how the statutory guidance will be worded. In her letter to me, the Minister quoted the 2015 National Institute for Health and Care Excellence guidelines, which state that training on ABD
“should be included in staff training”.
The whole point of my amendment is that it would have ensured training on ABD must be included in staff training. My concern is that guidance is just that, guidance, rather than something that is mandatory. This is an opportunity to ensure the thorough education of staff on something we have established to be central to the Bill.
I therefore hope the Minister is able to confirm, whether today or in future, that training on acute behavioural disturbance must, rather than just should, be included in staff training. It must be mandatory.
Jackie Doyle-Price
I appreciate my hon. Friend’s frustration. One of the difficulties with clause 5, inevitably, is that a list of criteria could go on forever. He is right to highlight the issues of acute behavioural disturbance, which we consider already to be enshrined in guidance. I completely take his point, and I give him an assurance that we will use statutory guidance to make it very clear that staff need to be fully trained on acute behavioural disturbance, not least because, unless staff understand it, they cannot be proportionate when the use of force is, indeed, appropriate.
Philip Davies
I am very grateful to the Minister for that positive intervention, and we look forward to seeing that guidance when it is brought forward.
On clause 5, I am also supportive of the focus on involving
“patients in the planning, development and delivery of care and treatment”.
I would have preferred to see that extended to the patient’s family, as was proposed by my hon. Friend the Member for Christchurch, because, as we know, mental illness does not affect just the patient; it can affect those near and dear to them, too. Again, the Minister stated on Report that she would seek to put this into statutory guidance and I hope she intends to follow through with that, because many family members would think it is very important.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
As chair of the Westminster Commission on Autism, may I tell the hon. Gentleman that many people in the commission have a great interest in this Bill and support it? He has started off very reasonably in his remarks and I hope he will continue in that reasonable way, because the autism community want to see this Bill become law.
Philip Davies
Absolutely. The hon. Gentleman is not alone in that, and nor is the autism community—I want the Bill to become law, too. If he had not intervened on me, we could have completed this a bit sooner. I assure him that this Third Reading will complete very soon. I certainly do not intend to go on for long today and I do not think anyone else does. We want to complete this as quickly as possible and see the Bill on the statute book. I want to see that just as much as he does.
Clause 6 deals with recording the use of force and I am very supportive of having this in the Bill. It is right to record the carrying out of such practices on patients. The police have a system in place when using restraint as part of their role, so it is only right that medical staff should follow suit. I am advised by my local care trust that it does have some measures in place to record restraint of a patient, but this Bill will of course make it a legal requirement to do so, which is important and absolutely right. Again, I was disappointed that my amendment proposing that these records be added to the patient’s medical records was not accepted. As I have stated, restraint is considered to be a form of medical care and therefore should be documented in the patient’s medical notes. That would help people to know what reaction the patient had had when restraint had happened in the past. I hope the Minister will make sure that the statutory guidance can be used and updated to make sure that these things are added to people’s medical records at the same time. I hope she will be able to confirm that in the fullness of time, too.
On clause 6(5), the information listed to be included in the report is largely constructive. Where I feel it falls short is in insisting on adding what are referred to as “relevant characteristics”. As the hon. Member for Croydon North knows too well, I do not agree that that is necessary. I am of the opinion that including these “relevant characteristics” detailing race, sexuality, religion, marital status and so on is purely a politically correct gesture in order to be seen to be doing something to combat discrimination, when instead it causes the illusion of discrimination. There is a notion that this creates a more transparent mental health service, but that is not the case. For instance, the detailing of these “relevant characteristics” will extend only to the patient and not the staff. My amendment to say that staff members should be included in this was also supported by the hon. Gentleman, for which I am grateful. I hope that the Minister takes on board those points and will ensure that the statutory guidance she produces in conjunction with the Bill will set out that staff members’ “relevant characteristics” will be included alongside those of the patient.
Jackie Doyle-Price
I confirm to my hon. Friend that we will reflect on that when we come to discuss this matter with consultees. I want also to come back to the point he made earlier about families. On the face of it, we should be enshrining the rights of families in the Bill, recognising, as the hon. Member for Huddersfield (Mr Sheerman) said in regard to autism, that we often rely on families to protect individuals whose mental capacity is not enough to consent to treatment. However, we are also aware that patients suffering mental ill health can often not be best served by family members, so enshrining this in the Bill and in law could have unintended consequences. On the role of families, we strongly feel that statutory guidance gives us a better tool with which to manage both guaranteeing their rights and protecting individuals who might be vulnerable to their family under the law.
Philip Davies
Again, I am very grateful to the Minister for that and for her positive approach to ensuring that the points being raised here and that we raised on Report will be considered for the statutory guidance. We will therefore look forward to seeing it when it is published.
Finally, I wish to refer to clause 12, which deals with video recording and specifically details the police use of body-worn cameras when assisting in restraint at a mental health unit. Largely, police body cameras are used in this instance, unless there are special circumstances. I am a big fan of body-worn cameras, which are a beneficial tool for both officers, protecting them when complaints are made about them, and the public, in making sure that the true facts of a situation are seen by everybody. However, the Bill states that the police
“must take a body camera”
and
“must wear it and keep it operating at all times”.
It goes on to state that a “failure” to “comply” makes
“the officer liable to criminal…proceedings.”
As the Minister and the hon. Member for Croydon North know, I feel that that creates a severe disproportion of consequences between the actions of the police and the actions of the medical staff.
Chris Philp (Croydon South) (Con)
Clause 12(4) states:
“A failure by a police officer to comply with the requirements…does not…make the officer”
criminally liable. I think I am right in saying that such an officer would not be criminally liable. If I have misunderstood this, I am happy to be corrected.
Philip Davies
I am grateful to my hon. Friend for that intervention. I cannot recall whether he was here on Report, but we went through this in some detail then and so I do not wish to test the patience of the House by going through it all again this morning. If he looks back at the transcript of the debate, he might not be so confident in what he said. I think there is some doubt about this provision and it offers some doubt for police officers, who have also looked at the Bill. Notwithstanding that intervention by my hon. Friend, may I ask that the Minister takes this issue into careful consideration when creating the statutory guidance, if that provides an opportunity to look at this? I ask her to make sure that there are no unintended consequences. My hon. Friend the Member for Croydon South (Chris Philp) sums up exactly what is intended by the Government and the promoter of the Bill, but I hope that when the Minister brings forward her statutory guidance she will clarify the situation, because police officers are concerned about it.
Jackie Doyle-Price
Perhaps I can give my hon. Friend reassurance by saying that the College of Policing will be fully involved in the development of the statutory guidance.
Philip Davies
Again, I am extremely grateful for that and am pleased to hear it.
To conclude, I reiterate my support for the Member for Croydon North with his private Member’s Bill. As I have said on a number of occasions, I support the core principles of the Bill, although I feel that there have been some missed opportunities to achieve fully the objectives he set out. I hope that his constituents, the Lewis family, feel that the Bill is something they can proudly remember the life of Seni Lewis through, knowing that his death was not in vain. It was a terrible tragedy for the family, but it was not in vain, in the sense that they have worked very hard and constructively, and they have a fantastic Member of Parliament who has taken on board their campaign, on the back of which they have played their part in making sure that the terrible thing that happened to Seni Lewis does not happen to other families. On that basis, we should all be pleased that the Bill is passing its Third Reading today.
Catherine West (Hornsey and Wood Green) (Lab)
It is a privilege to contribute briefly to this Third Reading debate. I congratulate my hon. Friend the Member for Croydon North (Mr Reed) on getting the Bill to this stage, and hope that there will be sufficient support for it when we vote later.
As a patron of Mind in Haringey, I know that there is a real sense of urgency regarding the need to improve the quality of services in mental health provision, not only locally but nationally. Whether it is basic primary care assistance to prevent the decline in a patient’s mental health, or at peak crisis time when psychosis, mania or the depths of the lows for a bipolar sufferer strike, it is crucial that care is provided in a professional, sensitive and compassionate manner.
Tragically, the Bill does not reflect the fatal experience of just one 23-year-old young man from my hon. Friend’s constituency: Seni Lewis died following restraint by 11 police officers while he was in a mental health unit. That was not an isolated incident. Thousands of patients have suffered abusive restraint, with too little guidance and supervision for police and mental health professionals on how best to manage mental health crisis. The high number of injuries—3,652 this year, according to the women’s charity Agenda—has been compounded by the reduction in spending on mental health wards, the cuts to training budgets for support workers, and the increased social isolation experienced by people with poor mental health. All too often, the warning signs are not picked up until a patient is very ill. Because of the lax reporting requirements on the use of restraint in the sector, it is likely that the available statistics under-report the extent of poor practice.
In a similar case highlighted by the charity Inquest, Surrey dad Terry Smith suffered at the hands of those who owed him a duty of care and he died in an ambulance, following restraint. When his behaviour became worrying, Terry’s family knew that he needed an ambulance; instead, he was met by police who, rather than seeing a vulnerable man in crisis, pursued, restrained, bound and hooded him, and then took him to a police station rather than a hospital. They only called for an ambulance when it was too late.
Seni’s law will strengthen the guidance for police and mental health professionals so that medical emergencies are recognised as such and acted on speedily. The incident occurred before the introduction of body-warn cameras. It was pleasing to hear the hon. Member for Shipley (Philip Davies) speak about best practice for body-warn cameras. When the Bill passes into law, it will assist many of our constituents, but it will disproportionately protect the high number of young women who are restrained and the high number of black and ethnic minority patients who suffer the highest number of injuries in mental health facilities.
In my first Adjournment debate, shortly after I entered the House in 2015, I highlighted the desperate need for better resourced, higher-quality mental healthcare in my constituency. This Bill will go some way towards that by bringing more clarity and better reporting standards and it will set the bar higher for police and NHS staff, as well as for mental health advocates, but most importantly it will set the bar higher for those constituents whose pain is often invisible, inexpressible, frightening and overwhelming, and who sadly so often miss out on what we all expect from health carers: clarity of purpose, clear communication, understanding and compassion.
Scott Mann (North Cornwall) (Con)
I rise to speak in support of the Bill. I congratulate the hon. Member for Croydon North (Mr Reed) on getting the Bill to this stage and his work to make sure that people who are detained in mental health units have proper rights and are properly protected. I welcome the fact that the Government support the Bill and that reforms to mental health legislation are on their agenda.
Our understanding of mental health has progressed by leaps and bounds since the Mental Health Act 1983 was introduced. We need mental health legislation that is fit for purpose in our modern times and that gives better protection to people with mental health challenges, and we need better guidance and training for those who are there to help. That is why it is right that we introduce reforms and why I will support the Bill today. Although it focuses only on a specific part of mental health provision, it will nevertheless make sure that better protections are in place.
One big issue in recent years has been the detention of people with mental health problems in police station prison cells, where they do not have the appropriate level of support which they would have access to in a mental health unit. The problem is twofold: first, there are problems with the process and resources at police stations for looking after people with mental ill health; and, secondly, there is a lack of mental health beds in many local communities. Both issues are being addressed through increases in mental health funding, with the Government pledging an additional £1 billion between 2016 and 2021.
I was pleased to hear in March that the number of people being detained in police cells in Devon and Cornwall when suffering a mental health crisis was zero, and I hope that is still the case. I look forward to seeing the numbers and hope that they are still very low. Since 2013, the figures for the number of people put in a cell alongside offenders, under section 136 of the Mental Health Act, have steadily decreased, from 800 to just 31 in 2017.
I welcome clause 2, which will ensure that mental health units have registered managers, and clauses 3 and 4, which will ensure that those managers will publish a written policy regarding the use of force on patients and that there is information explaining patients’ rights in relation to the use of force. I am particularly pleased that clause 5 will ensure that the appropriate training is in place for staff who work in mental health units. That will include making sure that staff involve patients in the planning, development and delivery of care in the unit. The risk associated with using force, its effect on a patient’s mental and physical health, and any use of force could all affect a patient’s development.
I welcome the provisions in the Bill on the use of video recording in units to make sure that any use of force is transparent and accountable. In pursuit of a more transparent system, I support clauses 8 and 9, which legislate for the publication by the Secretary of State of statistics on the use of force and an annual review of any deaths that result from the use of force. It is important that we learn from tragic incidents such as those we have heard about during our consideration of the Bill. The publication of statistics and the review of incidents will make sure that the legislation continues to work properly into the future and that patients are protected.
Once again, I welcome the Bill and the reforms that it will introduce. I wish the hon. Member for Croydon North every success in getting it through Parliament.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
It is a privilege to be here today. Members from all parties are often in a quandary about whether and how to be here on a Friday when we also have constituency commitments, but it was important to me that I be here today to support my hon. Friend the Member for Croydon North (Mr Reed). He has been a shining example to us all—Opposition and Government Members—of how best to use a private Member’s Bill slot, particularly as a member of the Opposition. He has put forward a change to the law in a way that has essentially secured support from Members on both sides of the House, as we have heard from the speeches so far. He has not only carried Members with him but achieved the Government’s support. I do not want to jinx anything, but I anticipate and hope that, at the end of today’s deliberations, the Bill will progress to the other place.
It has been a privilege for me to play a small part in the process, having served on the Bill Committee. I also stand here on behalf of the Labour Campaign for Mental Health. Many people outside this place are following our discussions today and have followed what has happened to get to this point. People with lived experience, family members and clinical professionals are really pleased that we are working on something that is productive and positive. I believe, as does my hon. Friend the Member for Croydon North, that it will effect some change in our country.
I do not seek to speak for long, but wish to reflect on a few reasons why the Bill is so important. I hope that we will be joined by Mr and Mrs Lewis—I know that they are on their way—because it is a testament to them and to their courage and bravery that they have worked to ensure that, in the wake of the tragedy that they have experienced, some good will come from the tragic death of their son. Members from all parties have come together today to reflect on Seni’s death.
But it is not just Seni’s death; in fact, only this week we heard about some research done by the UK-based charity Agenda, which campaigns for women and girls at risk. That research shows that over the past five years, from 2012-13 to 2016-17, 32 women who were detained under the Mental Health Act died after experiencing restraint. That is another example of why the issues we are discussing are so important. Those 32 women lost their lives as a result of what happened to them in mental health units.
If we look a little more closely at the figures, we see that younger women made up the majority of those restraint-related deaths, and more than a fifth of them were from black, Asian and minority ethnic backgrounds. I listened very closely to the hon. Member for Shipley (Philip Davies), but I do think that it is important, in the context of what we are discussing today, to look very closely at defined and protected characteristics. We are seeing certain groups disproportionately affected by this action in more ways than others.
Many programmes have shone a spotlight on what happens inside some of our mental health services, in particular, the Dispatches programme “Inside The Priory”, which was shown on Channel 4 back in February. It had to use undercover cameras to expose what happened in one unit alone. It was particularly disturbing, because it showed the high-stress environments that exist in some, but certainly not all, of our mental health in-patient units. I have had the privilege of visiting a number across the country. However, when people find themselves in a crisis in such an environment, all too often, unfortunately, the staff are temporary, or they are bank staff or agency staff. To echo what others have said today, the fact that we have a recruitment crisis in this sector will have an impact on someone’s recovery. We should be doing everything possible to ensure that those environments are therapeutic and that they lead to someone’s recovery. I see this as something that is absolutely critical, but is it not a shame that we are discussing it today, and that we have to make this law? Actually, we should be doing everything possible to prevent people from getting into in-patient units in the first place, but if they are there, the settings should be right, the staff should be trained and full-time and the environment should be therapeutic. The fact that that is not the case is why this law is even more crucial.
We need to do everything possible to eradicate restrictive practices in in-patient care. This law is crucial in ensuring that when these things happen, everything possible is done to protect patients, to ensure that they are given a voice, and to ensure that they are not held or treated in a way that will exacerbate the very condition that saw them go into a mental health in-patient unit in the first place. Once again, I echo my thanks to my hon. Friend the Member for Croydon North for all the work that he has done to get us to where we are today.
Mary Robinson (Cheadle) (Con)
It is a pleasure to follow the hon. Member for Liverpool, Wavertree (Luciana Berger). I too add my congratulations to the hon. Member for Croydon North (Mr Reed) on introducing this Bill and on his tireless efforts to guide this important piece of legislation through the House. I was here last month, when this Bill was last discussed, but unfortunately I did not get an opportunity to contribute, so I am very pleased to be able to speak in support of it today.
This is a sensible Bill. It follows recent announcements by the Prime Minister and Ministers addressing mental health, and feeds into current initiatives on how best to improve current systems of support for people who face mental health problems. The figures on mental health are striking: every week, one in six adults suffers from some sort of mental health condition, such as anxiety, depression and suicide. Even more alarmingly, one in five has considered taking their own life at some point.
I am encouraged to see that the Government are taking the issue of mental health so seriously and as seriously as physical health. In my view, parity of esteem means far more than simply saying we value a person’s mental wellbeing. It must mean tackling mental health issues with the same energy and priority with which we tackle physical illness. It is about changing the experience for people who require help with mental health problems. In addition, we must aim to put the funding and training for mental health services on a par with those for physical health services.
Crucially, we must end what appears to be the criminalisation of mental health conditions. The tragic case of Olaseni Lewis highlighted for many how quickly the police can become involved in mental health situations in a way that they perhaps do not in physical heath cases. Indeed, the Metropolitan police force received a phone call relating to mental health every five minutes last year, an escalating level of demand which they have said could be caused by NHS services struggling to cope. The number of calls handled by the Metropolitan police in which someone was concerned about mental health hit a record 115,000 in the past year—on average 315 a day, or about 13 an hour.
In some cases, ill people struggling to find help have even committed crimes to obtain treatment, believing that that was the best way to get access to mental health services. The Met also expects to use powers to detain under section 136 of the Mental Health Act 1983 more often. Data from health partners in my own area of Greater Manchester indicate that around 1,000 people each year are detained under section 136.
However, some really good initiatives are being rolled out. I wish to highlight an initiative from my own force in Greater Manchester. It has collaborated with Greater Manchester West Mental Health NHS Foundation Trust to provide a training programme for staff that improves the understanding of mental health. For the past 12 months, staff and officers at Greater Manchester police have received comprehensive mental health training, delivered by mental health professionals. The scheme was originally designed for staff in the custody offices where people are detained, but I am delighted to report that it has proved so successful that it has now been incorporated in the training requirements for response officers, police community support officers and special constables. The eventual aim is that all workers complete the sessions.
The concept of parity of esteem, and indeed the wider issue of highlighting the importance of mental health, is especially vital, as we know, for young people. Some 75% of all chronic mental health problems start before the age of 18, yet currently only a quarter of children and teenagers under 15 with mental health problems get the help they need from public services. Since January 2013, there have been 17 deaths of patients under the care of young people’s mental health services. I know that the Government regard patient safety as a key priority, which is why my right hon. Friend the Secretary of State published national guidance on learning from deaths last year to improve the way the NHS investigates and learns from in-patient deaths and to prevent future tragedies. I also welcome the £25 million of investment to support mental health patients so that we can achieve what we want, which is a zero suicide ambition.
I wish to speak to clause 12, which covers police-worn body cameras. That is already becoming standard practice in Greater Manchester. GMP has the largest force of officers outside London using body cameras, with more than 3,000 staff equipped with video recording devices. The Crown Prosecution Service has endorsed the equipment as a critical piece of technology not only in reducing violence, but—and this is key for this debate—in improving transparency. As the evidence suggests, there is merit in applying this measure across England and Wales. Body cameras have dramatically reduced the number of complaints made against police officers. During a trial period of their use, complaints dropped by 93%. It is because of that record that I believe body cameras will be an effective tool not only in assisting on-duty hospital staff, but in instilling those important patient safeguards.
There are good measures in the Bill which, coupled with the duties of the “responsible person”, will make this a very important piece of legislation. I am very pleased to support it and wish it well on its passage through this House.
Chris Philp (Croydon South) (Con)
Let me start by congratulating my constituency neighbour, the hon. Member for Croydon North (Mr Reed), on piloting this piece of legislation through the occasionally shark-infested waters of the private Member’s Bill process. He has done a very good job in getting the Bill to this stage. It is a particular pleasure to support it because, of course, it was the terrible suffering of a Croydon resident, one of his constituents, that inspired and motivated him to bring forward this very important piece of legislation in the first place.
This Bill, which I hope shortly will become an Act, does a very important thing in emphasising that physical force in a mental health context should be used as an absolute last resort and only after very careful thought and with great restraint, which, clearly, was not the case in the tragic death of Seni Lewis. I have been encouraged by the declining use of police custody suites as places of safety under the Mental Health Act; it has roughly halved over the past five or six years, which is a very welcome trend. I would like to see that reduced to zero.
The hon. Member for Liverpool, Wavertree (Luciana Berger) also made a very important point when she said that the use of any sort of physical force in a mental health environment is a symptom of failure. No mental health case should ever be allowed to progress to the point where physical intervention is required, although it may sometimes be unavoidable. Therefore, an emphasis on prevention, early intervention and treatment long before any physical intervention is extremely important. I am pleased that the Government are spending more money in this area. The more we can do to make sure that patients are treated well before things escalate, the better the system will be.
The Bill as amended for our consideration today is a very good Bill. I strongly support it and look forward to voting for it shortly. However, I have a couple of comments and questions that I hope the hon. Member for Croydon North and the Minister might be able to comment on and answer. My first question relates to clause 3, which is about the requirement to publish a policy on the use of force. It requires “the responsible person” to publish a policy, but as far as I can see there is no prescription as to the contours or limits imposed on that policy. For example, one might have expected to see a requirement in the Bill that any such policy limits the use of force to reasonable force. That may be done in regulations, or perhaps there was another reason it was not considered appropriate to put it in the Bill, but one might have expected some explicit statement limiting force to reasonable force. I would be interested to hear from the hon. Gentleman and the Minister why that does not appear in the Bill.
My second point relates to clause 5 on training, about which I have two questions. The first concerns subsection (2)(c) on
“showing respect for diversity in general”.
I wonder whether the hon. Gentleman could amplify a little what that means in practice. I would have expected a requirement that everyone should be treated equally, regardless of their background. Perhaps that is what he means, but I am not sure whether “showing respect for diversity” quite conveys that meaning. I would be interested to hear his and the Minister’s comments on that.
My other question relates to subsection (5) on refresher training, which it specifies should take place “at regular intervals”. I wonder whether regulations would specify what is meant by “regular intervals”. Annually would be a sensible degree of regularity, but if someone was not being true to the spirit of the Bill, they might interpret “regular” as once every 10 years, which clearly would not be frequent enough. I would be interested to hear the hon. Gentleman’s and the Minister’s views on what is suitable regularity and how that will be enforced. My view is that such training should be annually or at least once every two years.
Jackie Doyle-Price
I appreciate the spirit in which my hon. Friend is making these points. We do not want to be too prescriptive by putting in particular timings on how often the training should be, because obviously that depends very much on the context of the facility and how much wider training there is. At the same time, however, we want to be very explicit that it is regular training so that there is no excuse for staff not being properly informed about best practice in this area.
Chris Philp
I thank the Minister for her helpful intervention. Of course, I entirely sympathise with the point that Parliament should not impose unduly onerous requirements on already very busy and possibly, in some cases, overstretched mental health units, but I am concerned to make sure that we have not left a little loophole that might, perhaps inadvertently, end up being exploited so that training is not being given the degree of regularity that perhaps the House intends.
My final point of detail is on clause 6(10), which specifies the “relevant characteristics” of a patient. My hon. Friend the Member for Shipley (Philip Davies) questioned whether we need to record these “relevant characteristics”, which are listed in quite some detail. If we are going to do so, and any inference is to be drawn from those characteristics in future, it is important to measure them against the same characteristics for the whole population treated in any particular mental health unit. If we are going to say, for example, that X% of people who have been subject to this procedure have a particular gender, sexual orientation, religion or ethnicity, then before drawing any inference from that, it is important to compare that statistic with the proportion of people in the unit with the same characteristic. One needs to use those statistics with of careful thought to make sure that inappropriate or inaccurate inferences do not end up being drawn.
I am, like my hon. Friend the Member for Shipley, a great supporter of the use of police body-worn cameras, which are a great innovation. They have been responsible for a huge reduction in the number of complaints against police officers, because the officer is aware that the camera is being worn and recording—that, I am sure, has some moderating influence—and the person the officer is dealing with is aware of the same thing. I am sure that that has also reduced the number of vexatious complaints against the police. It is a very welcome move.
I was not present for the lengthy debate that my hon. Friend mentioned about whether a failure to wear a body-worn camera might be considered unlawful in the light of clause 12. Personally, I draw comfort from subsection (4), which appears to say expressly that there is not criminal liability. However, I will certainly follow his advice and refer to the report of the previous proceedings on that point. In general, the use of body-worn cameras when the police are dealing with mental health cases is extremely welcome and will, I am sure, assist with the problems that have existed in this regard.
I reiterate my very warm congratulations to my constituency neighbour, the hon. Member for Croydon North, for his tireless work in this area. I am sure that not just the London Borough of Croydon but the whole House and the whole country are grateful for his work.
Jeremy Quin (Horsham) (Con)
I congratulate the hon. Member for Croydon North (Mr Reed) on this Bill, which I support. I have two concerns that I raised on Report, one of which relates to training, which was touched on by my hon. Friend the Member for Croydon South (Chris Philp). The promoter of the Bill dealt with those admirably on Report, as he has throughout the progress of the Bill, and that certainly settled my concerns.
Of course, we will have other concerns. We all know that legislating in this place is one thing, but ensuring the enforcement of that legislation is another. There are areas—social care and others—where we all have questions to ask ourselves about enforcement of stuff that gets through this House. However, I know that this Bill is sound, and it puts this country in the best place in the world for legislation on this area. I congratulate the hon. Member for Croydon North on what he has been doing. I know that he will be as doughty on ensuring that we have proper enforcement as he has been in promoting the Bill.
I echo the words of the hon. Member for Liverpool, Wavertree (Luciana Berger): this is a fantastic example of where a truly dreadful, appalling incident in an hon. Member’s constituency has provoked questions and led to an investigation, to thought, and ultimately to legislation. That is the purpose of private Members’ Bills, which, if properly scrutinised and if proper time is given, can really have a positive impact for our constituents. A dreadful incident has hopefully produced, via the work of the hon. Gentleman, a lasting legacy. I congratulate him once again on this Bill. I wish Seni’s law, as I hope it will soon become, Godspeed in its remaining stages.
Craig Tracey (North Warwickshire) (Con)
It is a pleasure to follow my hon. Friend the Member for Horsham (Jeremy Quin). I echo many of the points that have been raised by colleagues today and in the debate three weeks ago, at which I was present although unfortunately did not get the opportunity to speak.
I congratulate the hon. Member for Croydon North (Mr Reed) on the work he has done and the success he has had in gaining support not only across the House, but from Government, for this Bill, which I think we all agree is incredibly important.
I fully respect the intentions behind the Bill and the potential impact it could have for families affected by mental health. I would like to pay tribute to the hon. Gentleman’s endeavour to honour Seni Lewis’s memory in this way. I understand that Seni’s law, as the Bill is known, is personally important to the Lewis family, who have campaigned tirelessly on this issue with considerable success. These are important proposals for people in all our constituencies, and particularly those who have a family member or relative suffering with mental health issues. They need to know that the mental health units that their loved ones are in the care of are providing a safe and secure environment. That is a basic and fundamental right and expectation.
Around 9,000 people are restrained in mental health settings a year in England. The Bill is a significant piece of legislation, as it will serve as an important reform of the way in which we treat those detained under the Mental Health Act. It also represents significant progression in this area. It is about ensuring trust and accountability in the mental health system—something that tragic case studies have sadly shown is not always in place. I think every Member in the Chamber today would like to see a reduction in the use of force, and the Bill will help to provide that reduction.
However, while targets are all well and good, in certain circumstances—for example, when a patient is violent—the people caring for a patient might need to be able to protect themselves from harm and might have to resort to some form of force to do so. Assuming that use of force is a last resort, proportionate and does not risk the patient’s health, it is reasonable that they are afforded that protection. I appreciate that this is a delicate area, but it is important that clarity is provided in the published policies and that balance is sought.
I think it is fair to say that we cannot foresee every violent and threatening situation that may arise. Clearly we want a reduction in the use of force, and we can question the frequency of its use, but we must also consider a mental health carer who may find themselves attacked by a patient who may not understand what they are doing. We do not want to put people off undertaking this important role, for fear of prosecution. While these are obviously courses of action that we hope will never be needed, it is impossible to rule out situations arising in which one of them is a necessary last resort, in the best interests of both patient and carer.
Mind, the mental health charity, which does such important work in this area, makes a useful contribution to this consideration, saying:
“Healthcare staff and police do a challenging job and sometimes need to make difficult decisions very quickly. Often they use force to control someone’s behaviour, which can include physically restraining someone against their will, injecting them with medication and using seclusion to confine and isolate someone on the ward. For the person in crisis, this can be humiliating, traumatising and even life-threatening.”
A balance must be found in the interests of the wellbeing and safety of all of those involved.
The Bill complements the real focus we have seen from this Government on mental health, and in particular the treatment, priority, stigma and people costs of mental health matters. In October 2017, the Prime Minister announced that the Government would embark on a comprehensive review of the Mental Health Act, with a final report later this year. I am encouraged that the review will examine existing practices and address the disproportionately high rate of detention of people from ethnic minorities. As a country, we have taken progressive steps to improve the mental health sector, and the Bill is another step in the right direction. The Parliamentary Under-Secretary of State for Health and Social Care summed it up pretty well in Committee when she said:
“Perhaps one of the most important aspects of the Bill is that it enshrines accountability for ensuring that any institution fulfils its responsibilities. The buck needs to stop somewhere, and it is important that happens with someone at board level.”––[Official Report, Mental Health Units (Use of Force) Public Bill Committee, 28 March 2018; c. 7.]
I wholeheartedly agree with that sentiment, so I am pleased to support the Bill today.
Mr Steve Reed (Croydon North) (Lab/Co-op)
I would like to make a few concluding remarks. I have already spoken on the Bill, so I am grateful for this opportunity but do not intend to speak at length.
Perhaps I could start by acknowledging the presence in the Chamber of Seni’s parents, Aji and Conrad Lewis—we are delighted and proud to have them here—and also Marcia Rigg, who lost her brother Sean in very similar circumstances. Although the Bill is called Seni’s law, in honour of Seni, it has affected many people beyond Seni who have lost their lives or been injured simply because they were unwell, and the purpose of the Bill is to make sure that that cannot happen again.
This week we have marked the 70th anniversary of the national health service—one of the greatest things this House has ever created. What better way to celebrate that occasion than by giving the NHS a birthday present to make it even better, creating some of the best protections anywhere in the world for people with mental ill health? That is a wonderful way to celebrate the 70th anniversary of an institution that everybody in this country is so very proud of.
My thanks go to the many people who have had a hand in the Bill, from the Minister to Members on both sides of the House, but most of all to the families who have led the campaign to get this law on the statute book. I cannot put it better than Seni’s father, Conrad, did three weeks ago, when we concluded the Report stage of the Bill. We were standing outside in the Members’ Lobby and somebody came up to Conrad and asked him, “How do you feel about today?” He said, “I bear a burden that I will have to carry for the rest of my life. It is a burden I wouldn’t wish on my worst enemy, and I don’t want any other parent to have to carry that burden.” This is our chance to make mental health services safe and equal for everyone. I am confident that the House will seize that chance, and in doing so, we will create a lasting and proud legacy for Seni Lewis.
Question put and agreed to.
Bill accordingly read the Third time and passed.
Mental Health Units (Use of Force) Bill
Monday 9th July 2018
(6 years, 4 months ago)
Lords ChamberRead Full debate Mental Health Units (Use of Force) Act 2018 Read Hansard Text Amendment Paper: Consideration of Bill Amendments as at 15 June 2018 - (15 Jun 2018)
Mental Health Units (Use of Force) Bill
Friday 7th September 2018
(6 years, 2 months ago)
Lords ChamberRead Full debate Mental Health Units (Use of Force) Act 2018 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 15 June 2018 - (15 Jun 2018)
Baroness Massey of Darwen
That the Bill be now read a second time.
Relevant document: 31st Report from the Delegated Powers Committee
Baroness Massey of Darwen (Lab)
My Lords, it is an honour to speak on this short but important Bill, and I am glad to see that the speakers here today all have experience of and commitment to mental health, young people, police systems and making systems better.
I shall illustrate why this short Bill is so important. In 2010, a young man, Olaseni Lewis, known as Seni, was a patient at the Bethlem Royal Hospital in Croydon. There was an incident in which Seni attempted to leave the hospital’s mental health unit and he was restrained face down by police officers. He suffered a heart attack and died four days later. He was a constituent of Steve Reed MP, who originally took this Bill through another place.
I thank Steve Reed and congratulate him on introducing the Bill with such passion and clarity. As he said at Third Reading, which was completed in July this year,
“the Bill in its current state will, if passed, give the United Kingdom some of the best legislation in the world to protect mental health patients from abusive or excessive restraint”.—[Official Report, Commons, 15/6/18; col. 1266.]
That is what we all want. It is not a party-political issue—all parties supported the Bill in another place. It is a matter of human rights and human dignity, and of how vulnerable people are treated in a system that should be there to protect them.
I thank Steve Reed for holding meetings with me, and I also thank Jackie Doyle-Price, the Minister for Public Health, and the noble Lord, Lord O’Shaughnessy, our Minister here today, for attending a very helpful meeting earlier this week. Both Ministers recognise the vital role that this Bill would play in getting more order into a system that is subject to so much criticism. In another place, Ms Doyle-Price stated that,
“the existing guidance is not having the impact that the Government expected, and … we must do more”.—[Official Report, Commons, 15/6/18; col. 1267.]
She has shown her determination and passion to make things better, and our deliberations today will, I know, contribute to that.
I also thank the numerous NGOs that have focused on this Bill with briefings and discussions—NGOs from mental health and disability organisations, the Restraint Reduction Network, the Crisis Prevention Institute and children’s organisations. Their work is, as ever, much appreciated. As we know, the voluntary sector is a highly respected force in our society for its critical judgments and for advocating change when needed.
I shall not go through the Bill in detail; I shall bring forward specific concerns and questions for the Minister later. I shall simply say that, as we know, Clause 1 deals with definitions such as “patient”; Clauses 2, 3, 4 and 5 discuss the duties of the responsible person in a mental health unit, including training; Clauses 6 to 9 relate to reporting incidents of the use of force and the investigation of deaths and record-keeping; and Clauses 7 and 8 require the Secretary of State to publish an annual report and to conduct a review of reports. Clause 9 refers to the investigations of death and serious injury in mental health units; Clauses 10 and 11 speak of the duties of the responsible person and of delegation; Clause 12 makes provisions related to wearing and operating body cameras when police attend a mental health unit; and Clauses 13 to 16 make provisions on the interpretation of the Bill and its financial implications. Finally, Clause 17 applies the extent of the Bill to England and Wales.
How big is the problem of the use of force in mental health units? The Crisis Prevention Institute found, from a series of information requests sent to mental health trusts in England in 2016-17, that 3,652 patients were injured while being restrained during NHS treatment, that 13% of trusts did not have a policy in place to reduce the use of restraint, that 97,000 restraints took place, with more than 2,600 staff assaulted by patients during interventions, and that 46 people have died. This is simply not good enough.
I want to probe five issues in relation to the Bill: guidance to the Bill, the issue of training of personnel working with people in mental health units, patient involvement, the treatment of children in mental health units and the disproportionate use of restraint.
First, guidance will be crucial to the success of the measures suggested. There is already statutory guidance but it is not working well enough. Guidance is essential because every nitty-gritty definition cannot be included in the Bill. Guidance must be clear and firm and must be monitored to check that it is actually working. Will the Minister tell us when new guidance will be issued? Will contributions from NGOs, parliamentarians, and staff and clients from mental health institutions be taken into account? How will that consultation work? I do not intend to move amendments to the Bill, but I hope we can be assured that the guidance will be detailed and strong.
The second issue is training, which is vital to deliver the outcomes that we all want. What kind of training are we talking about? Those of us who have delivered training know that it is not just about giving lectures and telling people what to do. It is about exploring feelings about issues; sharing experiences; getting below the surface of deep and fundamental problems that might exist; and using client groups to suggest recommendations about behaviour. In relation to the Bill, will a training manual be produced that includes case studies of good practice or will all this go into the guidance?
Thirdly, how will the views of patients be sought? Patients need to understand their rights and be able to contribute to decision-making about their treatment. If people feel respected, they are more likely to understand the issues and contribute to solving problems.
I come now to the fourth issue: disproportionate restraint. Among patients admitted to mental health units, there may be people of different races and faiths, and different ages and abilities, both physical and mental. Today, I received a letter from someone who works with people with Alzheimer’s who have suffered in these institutions. At the Second Reading of the Bill in another place, Steve Reed said:
“If we look at the faces of the people who have died after severe restraint in a mental health hospital, we see many more young black faces than in the population as a whole”.—[Official Report, Commons, 3/11/17; col. 1090.]
The same is of course true of the youth justice system. There is a huge need for training to understand and deal with the issue of bias and lack of recognition of race, culture and special needs. Units seem to act independently, and therefore standardisation on recording data is needed. How will guidance address this issue?
Finally, I have a particular concern about the treatment of children and young people in both the youth justice system and mental health units. Children are children first, and anyone under 18 is a child according to the United Nations Convention on the Rights of the Child, which we have signed. Children on the cusp of 18 are at particular risk: in institutions they are frequently treated as adults and are placed with adults. This is inappropriate and can place them in danger. How will guidance deal with the issue of children?
This is an excellent and much-needed Bill. I look forward to contributions from all colleagues and I hope to hear a satisfactory and positive response from the Minister. I beg to move.
Lord Harris of Haringey (Lab)
My Lords, I am grateful to my noble friend Lady Massey for bringing this Bill forward in your Lordships’ House. I am also grateful to my honourable friend Steve Reed for the work he did in bringing the Bill through the House of Commons following the death of Seni Lewis at Bethlem Royal Hospital in 2010. We should pay tribute to the persistence of the family of Seni Lewis in wanting to see positive change as a result of their truly traumatic experience. I talked to Steve Reed about what he wanted to achieve when he was at first successful in the ballot for Private Members’ Bills in the House of Commons and I am very pleased that we have reached this stage today.
This Bill is extremely important and valuable in its own right, but I am afraid that I do not want to talk about what is in the Bill itself, but about what is not in the Bill. I should also make it clear that I have no intention of moving amendments in Committee, because every effort should be made to get this Bill intact on to the statute book. I will raise in this speech issues that were raised in Committee in the House of Commons—along with a lot of other stuff, as it happens. I aim to get greater clarity from the Government and get the Minister to reflect on these points and take them back to his department.
I bring to this Bill my experience for a number of years as chair of the Independent Advisory Panel on Deaths in Custody. My panel was responsible for looking at deaths in the custody of the state and what more should be done to protect the lives of those to whom the state holds specific obligations in terms of Article 2 of the European Convention on Human Rights. Our remit covered deaths in prison and in police custody as well as the deaths of those detained under the Mental Health Act. If you die in prison, your death is automatically investigated by the Prisons and Probation Ombudsman, and the report of that ombudsman subsequently informs the inquest. If you die in police custody, the death is automatically referred to what is now the Independent Office for Police Conduct, formerly the IPCC, and again the report produced informs the inquest.
I am not pretending that either of those two processes—for prisons or for police custody—is in any way perfect. I certainly have many criticisms of them, and will continue to do so. But those are not a matter for today. The important issue of those processes is that they happened automatically and were both palpably independent of the institutions concerned. What is more, they were thorough enough to ensure that the coroners’ court had drawn to its attention the key issues of substance.
Another point is relevant to the Minister and the Department of Health and Social Care. Those two specialist bodies developed a level of expertise and experience through looking at those types of death that meant that not only could they be more effective in terms of their investigation, because they had seen similar things before and the investigators had worked on similar issues, but the Prisons and Probation Ombudsman or the IPCC could report thematic findings that could helpfully influence the practice across the police or prison services. Because of that expertise and the fact that they were looking repeatedly at similar types of incident, they could come back to the institutions as a whole or the relevant government departments and say, “This is a common theme. These are issues that need to be addressed across the system”. That is what is missing from the arrangements that we have at present, and even the arrangements that will exist after the passage of this Bill.
Like many noble Lords, I have received briefing from the charity Inquest, which I have known for many years and worked with in my work on the independent advisory panel. It has extensive casework involving families affected by deaths in state custody. Inquest believes that the current system of investigations following non-natural deaths in mental health settings is simply not sufficient. A system of truly independent, pre-inquest investigations, equivalent to others in detention settings, with a mechanism for national oversight and learning, is absolutely necessary to reduce the number of deaths and serious incidents such as those involving the use of force. But they will also illuminate other categories of death as well. Frankly, it is iniquitous that institutions that are responsible for the treatment and care of mental health patients should not be subject to the same scrutiny as other institutions of detention such as the police, prison and immigration detention. This risks leaving ongoing injustices for bereaved families.
I am sure that we will hear from the Minister about level 3 investigations as part of the 2015 serious incident framework. They are a step forward compared with what there was before, which I can—no doubt totally unfairly—characterise by saying that you would ask the guy sitting next to you in the office to investigate the failings of the service for which you were responsible. That was deemed a sufficient inquiry. Yes, there is an arrangement under the serious incident framework. It is the only mechanism for independent investigation and scrutiny prior to the coroner’s inquest. But the issues with the mechanism is that level 3 investigations are used inconsistently and rarely take place. Perhaps the Minister can do something about that. In many cases, given the seriousness of the death, you would have expected an independent investigation to take place within the framework, but there has been a failure to do so. This Bill looks specifically at restraint. I would have thought that any death involving restraint must automatically be one where serious questions are raised around wider issues of practice and should be subject to a full and proper level 3-type enhanced investigation.
While the serious incident framework may provide for an independent team to conduct an investigation, the commissioning and management of the independent process is not institutionally or practically independent as it continues to sit within the NHS management structures. There is also no oversight outside of the NHS on whether investigations should take place and no oversight or external assessment of the quality of those investigations. Moreover, the investigations that do take place under the serious incident framework are of varying quality. They are often deficient in terms of their scope, timeliness, quality, independence and family involvement. There are also concerns about the lack of publication of investigation reports and the methods of identifying learning beyond that of the individual trust or provider. That is a key point because we want to make sure that if there is relevant learning, it will almost certainly apply not just to the individual institution, but much more broadly than that. The internal nature of the investigations means that there is no visibility or oversight around the implementation of the recommendations or identification of common themes and issues which may be of relevance nationally.
I have heard it argued that such an investigation is not necessary because that is the job of the coroner’s court, but my experience of looking at coroners’ investigations is that they are always enhanced and facilitated by the receipt of an independent report setting out the key issues. That provides a scope for the coroner’s inquiry and investigations. This is something that has to be revisited in those terms. I would ask the Minister to take this aspect away and look at it again, although not in the context of this Bill. Is the Minister confident that he is really fulfilling his personal Article 2 obligations in the absence of a more robust and independent system? Can he say, hand on heart, that he believes that the systems which are currently in place will identify wider lessons and enable them to be disseminated throughout the mental health sector?
My second and final concern, for those who feel that I am going on for too long, is about the funding of the legal costs of inquests for the families of those who die in mental hospitals. One of my most vivid memories from the listening days that Inquest organised for my panel was an account of a family whose family member had died in a mental hospital. I do not know how many noble Lords have been to a coroner’s court, but they are often held in bleak environments without even the grandeur of a court setting. For a bereaved family, for whom the whole process is very emotional, the atmosphere is both bewildering and demoralising. This family found themselves having to share the rather small waiting area with not only those whom they felt might have been responsible for their loved one’s death but the large teams of lawyers, funded at public expense, representing each and every one of those people. The family described to me how they walked down the corridor, trying to get to this small waiting room first to get a seat, and heard the trundling of the lawyers with their wheelie suitcases full of papers coming down the corridor behind them. They had to walk faster and faster to make sure that they got three seats in the room. That is a graphic image and a reminder of how isolated the families concerned will feel.
The purpose of an inquest is to find out what happened and determine the cause of death, yet every person involved will be legally represented at our—the public’s—expense to put the position of the client’s actions in the best possible light. Only the family of the person who lost their life in such circumstances will not automatically be represented publicly. I have no problem with people engaged in the issue being funded and supported, but it is grotesquely inequitable and unfair that the family—unless they have substantial means—are not similarly represented to ensure that the coroner is able to pursue all the issues that need exploring. No doubt the Minister will have been briefed that families can obtain legal aid. In practice, this is unlikely and difficult. The income rules are onerous and the pot is already small.
At present, the legal costs of the trust, the commissioner, if it is a relevant party, the nurses, the doctors and the police—if they are involved—and so on are all covered by the public purse; all except the group of individuals who care the most about knowing what happened to their loved one. What is to stop the Minister saying today that in the interests of fairness, of justice and of making sure that lessons applicable elsewhere can be identified, he will instruct the trust responsible for the individual who has died to meet the legal representation costs of the bereaved family? In practice, this will only be a small proportion of the legal costs associated with the death. If he feels that this is too difficult and too onerous a burden on the trust concerned, perhaps those costs should be borne by his department or NHS England, which would incentivise both organisations to ensure that such deaths are minimised in future. I look forward to the Minister’s reply but in the meantime, I look forward to this valuable Bill passing through your Lordships’ House without amendment.
Lord Adebowale (CB)
I rise to put forward my view on the Bill. Before doing so, I congratulate Steve Reed in the other place and the noble Baroness, Lady Massey, on bringing the Bill forward. I agree entirely with the points made by the noble Baroness and the noble Lord, Lord Harris. I declare my interests as a board member of NHS England and the chief executive of Turning Point, which provides services to people with mental health challenges.
Before I begin, I want to raise an issue that came out of my work in 2012 looking at the Metropolitan Police’s response to mental health. I looked at 55 deaths associated with the police response to mental health before they got anywhere near a mental health unit. All of them involved the use of pain restraint, which has resulted in the deaths of too many individuals. I ask the Minister to take a look at that report in considering his approach to the Bill. The Bill is excellent and goes a long way to resolving some of the issues, but I do not feel that the concerns raised in bringing the Bill to the House will be fully addressed until we can look at the police response to mental health. I am more than happy to forward to him my commission’s recommendations.
As I said, the Bill is very welcome. It could take the next few steps to provide strong guidance; it would be a shame if it could not. It is very rare that the voluntary sector’s lobbying on these issues is so in tune with the Government’s support for a Bill, such that we should take into account almost word for word what it is saying in the Bill’s accompanying guidance. Its recommendations are sensible and clear on extending the definition of the use of force to cover threats of the use of force and coercion, which, as I have observed when talking to patients in mental health institutions, can be a real restriction on their ability to receive good care.
The guidance needs to clarify that force cannot be used with the intention of causing pain, suffering or humiliation, save for the purpose of lawful self-defence. That would also be helpful. It needs to ensure that a mental health unit’s policy includes a commitment to reducing the overall use of force and to clarify that the post-incident reviews need to take into account the patient’s perspective and that of their relatives. When you have looked into the eyes of relatives who have suffered the tragedies of deaths as a result of restraint, you can see how important that is. Ensuring that the patient’s legal rights advocacy relating to use of any force is communicated to them would also be sensible and entirely appropriate. Establishing proper standards of training in these units would also be useful.
We need to take into account two points. It is vital that we eliminate any loopholes in the recording of the use of force of any kind in units, such that we can have transparency. We have to ensure accountability and transparency in the use of force, in particular the disproportionate use of force on those people from black and minority ethnic communities. It is a burning injustice that this issue has been allowed to continue. The statistics tell the story but we do not react to them. We should publish those statistics so that we can see just how disproportionately it affects those people from minority ethnic groups.
This is a good Bill that is supported by expertise from outside the House. It would be a shame if were not to use that expertise to strengthen it and the guidance that supports its implementation.
Baroness Tyler of Enfield (LD)
My Lords, I strongly support the Bill and I know that it has strong support from Liberal Democrats generally. I pay tribute to Steve Reed, who introduced the Bill in the other place, and to the noble Baroness, Lady Massey, for the way she introduced it. To clarify, I too will not be bringing forward amendments. I fervently hope that the Bill reaches the statute book as quickly as possible.
The Bill is a major and much-needed step forward in reducing the use of force in mental health units across the country. I am pleased that we have cross-party support on this point. The provisions in the Bill for greater transparency, oversight and accountability will lead to vital improvements in the care and protection of children, young people and adults who are experiencing a mental health crisis, and to ensuring that their rights and protections are made as robust as possible.
When I looked at the evidence for the Bill to say why it is so timely, I looked at the figures about the use of restraint. They have been going up very significantly in recent years, despite statutory guidance saying that restraint should be used only as a last resort.
When I looked at the figures, I was perturbed to see that children and young people under the age of 20 seem to be subject to the use of force four times more than adults in mental health in-patient units—a point made also by the noble Baroness, Lady Massey. I was concerned, too, to read that girls and women are subject on average to double the number of restrictive interventions experienced by boys and men. Clearly, not only will such restraint be frightening and potentially dangerous but it can retraumatise women and children who may have experienced violence and abuse. I will return to that point later.
Above all, I hope that the Bill proves to be a fitting tribute to the life of Seni Lewis, a young man who tragically died following prolonged physical and mechanical restraint by 11 police officers called to assist healthcare staff back in 2010. Sadly, nothing can bring Seni back, but I hope that the passing of this Bill brings some meaning to those tragic events.
I was struck when reading about that dreadful incident to learn that Seni had been admitted as a voluntary patient, but, following his family’s departure and his becoming increasingly frightened and disoriented, the police were called by hospital staff but his family were not contacted. That is very concerning. Seven years later, an inquest jury unanimously concluded that multiple failures in care had led staff to call the police and that the restraint used by officers was excessive, unreasonable, disproportionate and therefore contributed to Seni’s death.
An issue that I want to highlight today, and which the Bill goes a long way to address, is patient awareness and involvement and the involvement of families. In reality, most patients and their families do not understand their rights in relation to the use of force or even what type of restraint may be used. In some settings, it is clear that force is routinely used without adequate involvement of the patient or their representative in decision-making. Advocates are not routinely involved in post-incident reviews. I hope that the Bill, through Clause 4 and, even more so, in guidance, will be able to rectify that.
Noble Lords have already referred to the inadequate training that currently takes place, with an emphasis on painful techniques rather than de-escalating a situation. Much can be done to improve training and to move away from using combative and uncompassionate approaches towards a much greater focus on de-escalation.
I look back at what the Care Quality Commission said about training in 2017:
“Wards where the level of physical restraint was low had staff trained in the specialised skills required to anticipate and de-escalate behaviours or situations that might lead to aggression or self-harm”.
Those are important points.
There are a number of other points that I want us to probe as the Bill goes through. As I said, we might be able to cover them in the guidance. The noble Lord, Lord Adebowale, has mentioned a number of them, so I do not want to repeat what he said. Ensuring that each mental health unit policy includes a commitment to reducing the use of force needs to be spelled out. Ensuring that a post-incident review occurs to establish the patient’s perspective following the use of force is incredibly important and has not happened nearly enough up to now. Ensuring that patients’ legal rights to advocacy are communicated to them and their families is also important. I also think that, in order to ensure accountability and transparency, parliamentary oversight is really important. We have a critical role if progress is to be made towards reducing the use of force through the annual statement. It is there in the Bill, but there is an issue about timing. It is really important that the annual statement that, as I understand it, the Secretary of State will be obliged to make will be so timed to include the annual statistics produced by, I think, NHS Digital, so that we can carry out good and proper scrutiny. I think that that is extremely important.
I shall finish by saying a few things about the situation for children, young people and women in particular. I have already made some reference to this. When I was looking at the statistics about the scale, the frequency and the impact, I was really alarmed. Frankly, I was very alarmed when I read that, back in 2016, more than one in six in-patient CAMHS providers did not know how often patients were being restrained and how this compared to benchmarks from previous years. If we do not even know that, that is really worrying. I was really concerned to see that children and young people seem to be subject to the use of force four times more than adults over 20. That seemed really alarming to me. Often, these incidents of restraint—I think this relates to adult patients—happen in the first week of admission, a long time before things have settled down.
In terms of gender, I have already mentioned my real concern over the figures for girls and women, who experience, on average, double the number of restrictive interventions. Again, I was frankly surprised to read that; I do not know why, but I was. I want to understand more about why that happens and what we need to do about it, because it seems to me that that is not a situation we should allow. I then looked at the impact of this and realised that it is happening in secure settings—non-mental health settings—in secure children’s homes, secure training centres and young offender institutions. So there is a lot for this Bill to address.
I looked back at what Ofsted had to say on the matter back in 2012. Ofsted made it clear then that restraint should usually be used as a last resort, never as a punishment; that staff should always be trying to calm things down, to de-escalate; that it should not be used by staff just to keep good order and control. Extremely importantly—this is the point I wish to emphasise—restraint should never be used on very young children, children who had only just come in to care, disabled children, children with mental health issues and children who have been sexually abused. That is one of the reasons why this report is so very important and why I feel so strongly about it. That was 2012. In 2016 and 2017, the Children’s Commissioner’s findings from her visits to medium, secure and forensic in-patient settings for children and young people were indicating high levels of restraint and seclusion in units with a learning disability specialism. She found:
“There is no evidence base for the effectiveness of prone restraint in reducing the frequency or intensity of behaviours that challenge. It is a hugely traumatic and damaging experience for children and their families”.
I hope that someone can give me reassurance on my final point, which has been raised by people who are working very hard to ensure that we get the Bill right. I hope that the Minister can give me explicit clarification and reassurance that the Bill applies to children—that it applies to all ages. If so, that is fine, we can all be reassured, but there seems to be an element of doubt and, for the reasons I have set out, I think it is terribly important that we know that children and young people are covered by the Bill.
Baroness Thornton (Lab)
My Lords, I congratulate my noble friend on her excellent introduction to the Bill and on this short but very expert debate.
I agree with my honourable friend in the Commons, Justin Madders, when he indicated the Opposition’s support for the Bill:
“I thank my hon. Friend the Member for Croydon North (Mr Reed) for introducing the Bill; he certainly made a powerful case for it. Everything we have heard has made it clear why the Bill is necessary. … Restraint is used too often and disproportionately in certain sections of society. This cannot be allowed to continue. When she responds, I hope the Minister will support the Bill and allow it to be sent to Committee”.—[Official Report, Commons, 3/11/17; cols. 1107-09.]
As we know, the Government are to be congratulated on their willingness to support the Bill.
As noble Lords have said, the purpose of the Bill is to improve,
“the oversight and management of the appropriate use of force in relation to people in mental health units”.
It aims to do this in various ways, including through extensive training and requiring police officers to wear body cameras while in mental health units.
The case that has been referred to, of Seni Lewis dying due to improper force, is not isolated or a rare mishap. The current reality is that there is a severe lack of trained workers, leaving it open for patients in these health units to be abused and mistreated. The Crisis Prevention Institute found that in 2016-17—other noble Lords have referred to this—3,652 patients were injured while being restrained during NHS treatment. This is widely recognised as unacceptable, as shown by the unanimous support the Bill gained as it went through the Commons.
I am going to refer particularly to women who die after being restrained. In July, the organisation that looks at the issues faced by women facing multiple deprivation and abuse, Agenda, published research which said that 32 women died after experiencing restraint over a five-year period. It continued:
“The data, on patients detained under the Mental Health Act, suggests women were more likely to have restraint-related deaths than men between 2012/13 and 2016/17. Younger women made up a large number of the restraint-related deaths – 13 were aged 30 and under, compared to 4 men in that age range. More than a fifth of women who died were from Black, Asian and Minority Ethnic backgrounds, according to the figures, which were originally gathered by the Care Quality Commission”.
The director of Agenda, Katharine Sacks-Jones, said at the time:
“It is a national scandal that so many women are dying in our hospitals after being subjected to restraint. Mental health units are meant to be caring, therapeutic environments for women and girls feeling at their most vulnerable, not places where their lives”,
should be,
“put at risk. This bill is a real opportunity to reduce the use of this potentially lethal practice”.
I hope that we will see it go through your Lordships’ House.
However, that issue of the gender-based and other equality-based issues is one that I would like the Minister to address because of those factors. The idea that a woman who may be suffering from mental health problems and has been abused should then be subject to restraint in a mental health unit is really unthinkable and cruel. The guidance that flows from this legislation really has to address those issues.
A whole series of amendments were tabled in the Commons, which we will probably not be discussing in your Lordships’ House because we want to get the Bill on the statute book and do not want to risk it. However, those amendments tabled to the Bill in the Commons raised some very important points. I hope that the Minister will address the issues they raised, many of which have been raised by noble Lords already. They include: that training for staff should include training on trauma-informed care to understand how trauma exposure can affect patients’ neurological, biological, psychological and social development; to ensure that staff are required to have training on a patient’s right to advocacy, so as to improve the legal rights of the patient and capability of the staff; to ensure that the training for staff includes training on safeguarding procedures, to increase the protections for patients and the knowledge and capabilities of staff; and to ensure that training on the use of force complies with the quality standards so that the Secretary of State can delegate the training standards to a different agency, for example Health Education England.
The noble Baroness has already mentioned the importance of recording and accountability. I want to raise the use of the word “negligible”. It seems to me that it provides a loophole and could decrease transparency. I hope the Minister will be able to address that issue because I would hate us to find ourselves back here in three or four years’ time discussing this issue again because we have managed to put on to the statute book something that creates a loophole which is then used to not solve this problem.
I agree with noble Lords that the Secretary of State coming to Parliament with the statistics about mental health units and the use of force is very important. Is the Minister confident that, if we put this legislation on the statute book, the legislation and the guidance will be sufficiently robust to achieve what my honourable friend Steve Reed wanted to achieve when he set off on this journey, which was to not allow these tragedies to happen again?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)
My Lords, I shall begin by thanking three sets of people for getting us this far. The first is the noble Baroness, Lady Massey, whom I thank for introducing this Bill and for the opportunity to respond and contribute to the Second Reading. The second is Steve Reed, the MP for Croydon North, who, as all noble Lords have said, has done much of the work to get the Bill to where it is today. We know how difficult the journey of a Private Member’s Bill is, but that it has got this far in this good shape and has this broad support shows not just how important this issue is, but what a fantastic job he has done. I congratulate him. The third set of people are the parents and family of Olaseni Lewis. They have been through a heartbreaking experience, but they have nevertheless fought and campaigned tirelessly for justice for their son. I join other Members of the House in expressing my admiration for them, their resolve and the work they have done to ensure that other families do not to suffer in the way they and their son sadly had to.
This is an emotive subject. It touches the lives of people when they are at their most vulnerable, but at the same time we need to be conscious of the fact that patients must have trust in all NHS services in whatever setting. In that context, the topic of restrictive interventions is always difficult. They are never without risk. Going through an intervention and, I believe, delivering one can be a frightening and traumatic experience for patients and staff at a time when those patients are unwell. The Government are clear that restrictive interventions should only be used as a last resort when all attempts to de-escalate a situation have been employed.
Noble Lords are aware that in April 2014 the Government launched the positive and safe programme, which aimed to reduce the use of these kinds of restrictive interventions in the health and social care sector. That included the non-statutory guidance, Positive and Proactive Care: Reducing the Need for Restrictive Interventions. It was intended to inform the Care Quality Commission’s programme of monitoring and inspections.
What has been identified not just in this debate but during the passage of the Bill in the other place and by my honourable friend the Minister is that the existing guidance is not having the impact the Government expected and that much more needs to be done. For that reason as well as others, the Government are in full support of this Bill.
The noble Baroness, Lady Massey, was right in saying that this Bill is a good example of cross-party collaboration. A number of changes have been incorporated since it was first introduced to respond to multiple concerns, many of which have been raised this afternoon and by other parliamentarians, campaigners and staff. I pay tribute to all those who have contributed to the improvement of the legislation in the other place.
I shall deal quickly with some of the amendments that were made in the other place because they demonstrate how the Bill has been improved and that it is in a good place now. First, we have included “isolation” and “segregation” in the key definitions of use of force to address stakeholder concerns that these commonly used techniques would not be recorded and reported on nationally if they were not included in the Bill. We clarified the role of the responsible person in Clause 2 so that a board-level or equivalent person has responsibility for reducing restrictive interventions.
We have added to Clause 3 so that the policy on the use of force must set out what steps will be taken to reduce the use of force in the mental health unit, something that has been mentioned many times today. We strengthened Clause 4 in relation to sharing information with the patient about their rights, so that the responsible person has to take whatever steps are reasonably practicable to ensure not only that a patient is aware of the information about their rights but that they understand it. Critically, on the point that was raised by the noble Baroness, Lady Tyler, it will ensure that every patient and their family members or carers understand what the patient’s rights are in relation to the use of force while they are in a mental health unit, a really important improvement.
In Clause 5 we have expanded the topics that must be covered in training courses to recognise the impact that trauma may have on a patient’s physical and mental health and, as the noble Baroness, Lady Thornton, said, what is known as trauma-informed care. I will return to the issue of training but I will say at this point that we have also now included a requirement for staff to receive refresher training as appropriate, so it is not just one-off training.
We have expanded the list of information that must be recorded in Clause 6 to include a description of how force was used and the outcome of that use of force to increase transparency and accountability, while also amending the time for which records must be kept so that it is proportionate and in line with data protection law.
In Clause 7 we have ensured that the responsibility for publishing annual statistics sits with the Secretary of State in order to enable NHS Digital to collect national data and produce and publish those statistics. Following this debate today, in response to the question from the noble Baroness, Lady Tyler, I will clarify the timing of the publication of the statistics so that it can be done in a way that shines the greatest light on that information. I shall write to her and all noble Lords with more details on that.
In Clause 8 we have further committed to an annual review of published reports by coroners under paragraph 7 of Schedule 5 to the Coroners and Justice Act 2009—more commonly known as regulation 28 reports—relating to the death of a patient as a result of the use of force, and any other findings made during that year. This will enable lessons to be learned across the system. This was one of the points made by the noble Lord, Lord Harris, and again, I will respond to that in a bit more detail in a moment.
Clause 9 is the result of much discussion about investigations, to ensure that mental health units have regard to any guidance relating to investigating deaths or serious injuries that is published by a range of organisations including the CQC, NHS Improvement and NHS England, as has been referenced. This puts the NHS Serious Incident Framework on a legal footing and gives strength to the requirement to carry out an independent investigation into an unexpected death, including the death of a patient following the use of force.
Finally on the improvements made in the other place, the clause on police body cameras was amended to ensure that the use of body-worn video is proportionate, legitimate, necessary and in line with the College of Policing guidance on its use. It was also amended to clarify that failure to bring or use body-worn video when attending an incident in a mental health unit is not in itself a criminal offence.
I thank noble Lords for indulging me in mentioning those points. I wanted to demonstrate the improvements that have been made in response to stakeholders from the charitable and voluntary sector. By virtue of those improvements, we can be confident that the Bill is in very good shape and, in response to the question from the noble Baroness, Lady Thornton, has the best possible chance of delivering the outcomes we want. We want to ensure that the Bill goes through in its current shape but, like my colleague Jackie Doyle-Price, I will be more than happy to meet any noble Lords who want further reassurance on any of the questions they have asked, although I shall try to deal with some of them as well as I can now.
I turn to some of the specific points and questions raised by the noble Baroness, Lady Massey, and other noble Lords. First, on the timing of the statutory guidance, calls to see drafts of it and the timetable for its publication, Jackie Doyle-Price in the other place accepted the need to move quickly and said that publication within 12 months of the Bill being passed would be appropriate in the context. I believe that this is reasonable, given the complexity of the guidance that we will need to consider. On the critical question of how it will be drawn up, we plan to establish and consult with an expert reference group, including experts in the field of restrictive interventions and people with lived experience, as well as carrying out a public consultation on the guidance before it is published. I reassure noble Lords that we will work closely with key stakeholders to take account of their contributions, and the discussions on the Bill in both Houses, in developing the guidance. I hope all noble Lords who have taken part in this debate will have the opportunity to contribute to the development of that guidance.
The issue of diversity and the disproportionate use of force for black and minority-ethnic groups was raised by the noble Lord, Lord Adebowale. Annual figures from the mental health services dataset showed that in 2017 the number of people subject to restrictive interventions was 9,771. Collectively, these people experienced more than 71,000 incidents of restrictive interventions. They also showed that they were disproportionately affecting patients from the BAME community, as well as women and children, as was mentioned by the noble Baronesses, Lady Thornton and Lady Tyler. This is clearly unacceptable, but we do not yet have a consistent and rich enough dataset to understand exactly where the problems in the disproportionate use of force take place, when they take place, in what settings, and so on. It is precisely for that reason that we want that rich dataset to inform practice and action, and to respond accordingly. I should be pleased to follow up our debate today with noble Lords, once data is available, to think about what action could be taken to address the discrepancies in performance.
The noble Baronesses, Lady Tyler and Lady Massey, asked about children. I can confirm that the Bill applies to all patients in a mental health unit, including children, for the purposes of treatment for a mental disorder. The children and young people who are being looked after in those mental health units are, of course, among the most vulnerable patients, and I absolutely acknowledge that staff will require a different skill set when looking after them. I will come to the issue of staff training in a moment, but Clause 5 sets out the requirements for staff training, including involving patients in their care, and this will be a different conversation for children and young people than for an adult. I reassure noble Lords that the statutory guidance that we produce will have specific examples and principles of good practice for how to carry out those conversations with young people and children, as well as with adults.
I should like to address some questions raised about the use of force. Although it has not been raised in this debate, it was asked in the other place whether the words “threat to use force” and “coercion” should be included. The reason for resisting that is that we believe that they can be useful terms when used properly as part of de-escalation techniques. As the noble Baroness, Lady Tyler, pointed out, those techniques are incredibly important in reducing the use of force wherever possible.
Nevertheless, we need to ensure that there is proper oversight to ensure that threats are not used improperly. That is part of the policy that we will expect the responsible persons to put in place to ensure proper responsibility, and proper accountability within the organisation for the reduction of the use of force and not merely substituting for it by other means.
Of course, as noble Lords have pointed out, staff must be properly trained. On those occasions where restrictive interventions are needed, we must feel confident that mental health unit staff have the techniques at their hands to use properly. In response to the question asked by the noble Baroness, Lady Massey, and other noble Lords, I say that Clause 5 sets out as a minimum the list of training topics which must be covered. The list in the Bill is not exhaustive, but covers the essential topic areas key to ensuring that, where necessary, force is used in a safe way using the least restrictive force. I mentioned that that will include ensuring that staff receive refresher training at regular intervals to ensure that they are up-to-date with the latest techniques and new approaches.
While we are on the topic of force, I shall address the question asked by the noble Baroness, Lady Thornton, about the use of the term “negligible”. As I have said, Clause 6 imposes a duty to keep a record of any use of force on the patient by staff who work in that unit. It sets out what information should be recorded and how long those records should be kept.
The clause also states that the duty to record does not apply to the use of negligible use of force. This is because, in consultation with our health partners, it was felt that staff should not be burdened with the need to record lower-level therapeutic activities, such as the use of a lap belt when moving someone in a wheelchair, or guiding someone by the arm down a corridor or through a doorway. These are activities that happen many times every day and, if we did not have this exception, staff would have to record such events as a use of force. This would significantly increase the time spent recording which would take staff away from caring for patients.
Baroness Thornton
Maybe that is the wrong word, then. Maybe the Bill should say “therapeutic” or something which does not allow a loophole which says: “Oh well, that slap was only negligible”. That might be the wrong word to use.
Lord O'Shaughnessy
The noble Baroness makes a good point, which is relevant to the point made by the Delegated Powers and Regulatory Reform Committee when it reported on the Bill, which I will use this opportunity to address. This was about our proposal that definitions should be within statutory guidance. This determines the appropriate mechanism for making the definition, to ensure that the kind of problems pointed out by the noble Baroness do not arise. The committee noted that the guidance under Clause 6(3) will determine whether a use of force is negligible, and thus affect the legal obligations of responsible persons in mental health units. The committee’s view is that this should be set out in regulations, in order to provide an appropriate level of parliamentary scrutiny. I have replied to the committee on this issue this morning and will share my letter with noble Lords.
We considered whether the meaning of a “negligible” use of force could be set out in regulations or, indeed, on the face of the Bill. However, the range of techniques that may be used for physical interventions alone is many and varied, from the most serious, such as prone restraint, to something as simple as guiding a patient by the elbow down a corridor or through a doorway. Furthermore, what is negligible will generally be a matter of degree rather than kind. It was concluded that the meaning would be more effectively illustrated through example case studies in guidance, which would also allow for more rapid revision to take account of changes in practice. The decision to require “negligible” to be determined in accordance with the guidance was taken to ensure consistency of approach to recording uses of force across the sector. Because the information recorded under Clause 6 will be used for the preparation of national statistics about the use of force under Clause 7, if responsible persons are taking a different approach to recording information—a current problem—that will affect the interpretation and value of the statistics.
The Government accept the committee’s concerns about the sensitive nature of the subject. This is why the Bill imposes constraints on the issue of guidance, one of which is to require the Secretary of State to consult any person he or she considers appropriate. In practice, that will mean consulting experts in the field of restrictive interventions and those with lived experience whom the Government consider appropriate for this type of guidance. It is not usually the case that we go against the advice of the committee, but in this instance we felt that the nuance required around the definitions of “negligible”, combined with the strength of force that is needed to provide consistency for statistics, meant that this particular definition within a form of statutory guidance was the appropriate way forward. I hope that noble Lords will accept that; if further discussion is warranted, I would be happy to follow it up.
My final point is on the issue of deaths of patients, which was at the heart of the questions asked by the noble Lord, Lord Harris. There was a lot of debate on Clause 9 in the other place and the clause was revised in Committee, but concerns remained about the timeliness, quality and independence of the investigations that would be made whenever a patient dies following the use of force. As Clause 9 is drafted, if a patient dies or suffers a serious injury in a mental health unit, the responsible person must have regard to any guidance relating to the investigation of deaths or serious injuries published by a list of organisations which are responsible for regulating and monitoring the NHS, such as the CQC. As I said, this means that the NHS serious incident framework is put on a statutory footing. The noble Lord, Lord Harris, gave some examples of how this would work in practice and talked about level 3 investigations. However, prior to that there is a legal duty, under the Mental Health Act, to report the death of a patient to the CQC. After that, an independent investigation should always be considered following the death of a patient in those circumstances.
As the noble Lord pointed out, level 3 investigations under the framework are those that will probably be most suited to these kinds of incidents, where the integrity of an internal investigation is likely to be challenged or where it will be difficult for an organisation to conduct such an investigation internally in an objective manner. I want to be clear that no one involved in the investigation process should be involved in the direct care of the patients affected, nor should they work directly with those involved in the delivery of that care. Following such an investigation, there would of course be an inquest, including a legal duty to report the death to the coroner, who has a duty to investigate violent or unexpected deaths. I hope that gives the noble Lord some reassurance about the objectivity and independence of the investigatory framework that would follow such a death. I am more than happy to discuss that further with him, and to make sure that the point he made is properly reflected: that there is an opportunity not just to investigate individual deaths but to look for thematic issues at a higher level—of the kind that he outlined and indeed used to be responsible for carrying out and which the IPCC used to carry out—which may be suitable for the new health services investigation board that we are introducing. That is something that I would like to discuss further with him.
The noble Lord also briefly asked about support for families. Legal aid is, I believe, the most appropriate way for that support to be offered. The Ministry of Justice has considered this in response to the Dame Elish Angiolini report and will also consider deaths in these settings on the same basis as deaths in prisons and police custody. Again, I hope that provides some reassurance, but if he wants to discuss that further I would be more than pleased to.
I hope that I have addressed all issues and questions raised in the debate today. I just finish by saying how important the Government consider this legislation to be and how much we support the noble Baroness in bringing it forward. Noble Lords have indicated that they do not intend to amend the Bill, and of course we are all conscious of time, but I am more than happy to speak to any noble Lords about remaining questions to make sure that we can put their minds at ease, provide the necessary reassurance and move ahead as quickly as possible.
Baroness Massey of Darwen
My Lords, I thank all noble Lords who have taken part in the Second Reading of this Bill. I have found the debate most moving, which cannot often be said about debates in your Lordships’ House. It has been both interesting and moving, and it is a pleasure to be in the midst of people who are so concerned about vulnerable people—children and adults. I hope that the family of Seni will consider this debate something of a tribute to him and to themselves for all their work in bringing this to our attention and the development of a Bill that could be a very significant piece of progress.
I shall just make a few comments about speeches that noble Lords have made. I liked the very incisive comments of my noble friend Lord Harris and his clarity in talking about the investigation of deaths in custody, based of course on his own vast experience of this. I learned a lot from his speech and I hope that the Minister will take that up further, as there was a lot in there that needs to be looked at again in writing, assessing how it could contribute to any possible future guidance. The noble Lord, Lord Adebowale, also has huge experience of working with vulnerable young people and with mental health issues. He emphasised the need to take account in the guidance of the work of NGOs, which I—and I think all of us—totally support. The noble Baroness, Lady Tyler, and I have worked for years on the issues relating to children and young people and I am glad that she reinforced comments on that, as did other noble Lords, and that she gave her support to the Bill. Her point about consultation with parents is important, as was the issue also raised by my noble friend Lady Thornton about the traumatisation of women who may have been subjected already to violence and be in distress. She also mentioned training in the prevention of the use of restraint.
My noble friend Lady Thornton raised many good points about equality. I think she said that it was “unthinkable and cruel” that people who have problems should be subject to more, and sometimes regular, violence. She recalled the amendments tabled in the other place and said that we should take account of them, and I agree. I am trying not to use the word “negligible” here. At least I can say it. I thank my noble friend for her comments in winding up.
The Minister made some helpful points about the importance of cross-party collaboration in the Bill, and said that more needs to be done. He covered many issues that have been raised today, and I know that he is passionate about this, because we have talked about it. It would be a good idea if we had a full meeting after this debate. Things have come up that we need to tease out the meanings of, like that terrible word “negligible”, and the word “patient” itself, including children in that. What is a child? We need a definition. Is a child someone under 18? In fact, some organisations use “child” to cover up to age 24. Let us get some correct definitions. Let us listen to what my noble friend Lord Harris said, to what all other noble Lords said, and to the NGOs. The Minister is generous to suggest a meeting, and it would be useful, just to tidy up some of the things we have talked about and to reinforce some of the issues. I would appreciate that, and perhaps we can talk about it afterwards.
Having said all that, I thank all noble Lords. I said I was moved by the debate, and I was. We have done justice to a serious and important issue here, and I hope that we will see it move forward a bit more rapidly than I heard the Minister say. I do not know whether that is possible, but we need guidance as quickly as possible, although not rushed guidance. However, with consideration, we can make this into good guidance that will have some impact on the ground where people work and are in mental health units. I also take the point that the people administering this violence may also be suffering somewhat. I am of the view that violence never solves anything at all; we need a different approach to this, which can come only from training, discussion and sympathetic listening to people who are in this position. I ask the House to give the Bill a Second Reading.
Mental Health Units (Use of Force) Bill
Tuesday 23rd October 2018
(6 years ago)
Lords ChamberRead Full debate Mental Health Units (Use of Force) Act 2018 Read Hansard Text Amendment Paper: Consideration of Bill Amendments as at 15 June 2018 - (15 Jun 2018)
Baroness Massey of Darwen (Lab)
My Lords, I understand that no amendments have been set down to this Bill and that no noble Lord has indicated a wish to move a manuscript amendment or to speak in Committee. Unless, therefore, any noble Lord objects, I beg to move that the order of commitment be discharged.
Mental Health Units (Use of Force) Bill
Tuesday 30th October 2018
(6 years ago)
Lords ChamberRead Full debate Mental Health Units (Use of Force) Act 2018 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 15 June 2018 - (15 Jun 2018)
Baroness Massey of Darwen (Lab)
My Lords, in moving that the Bill do now pass, I should like to sincerely thank several people, including the Minister and his counterpart in the other place, Jackie Doyle-Price MP, who have been so supportive and helpful on the Bill. I also thank the voluntary sector, which has been incredibly vigorous and thorough in making sure that the Bill is as close to perfect as it can be. Will the Minister confirm that there will be other, informal, meetings on the Bill, which will look at the guidance to the Bill, particularly on statistics, impact and measurements? I wish to say that the Bill should now pass.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)
I am very grateful to the noble Baroness for her question and, more importantly, for her steering the Bill to this point. I offer my thanks to her, her colleague Steve Reed in the other place and everybody who has been involved in this important piece of legislation. As she will know, my honourable friend Jackie Doyle-Price, the Minister for Mental Health, committed to the Government publishing statutory guidance within 12 months of the Bill being passed. I am happy to confirm to the noble Baroness that, in developing this guidance, the department will establish and consult an expert reference group, which will include experts on restrictive intervention as well as people with lived experience and, furthermore, that public consultation will take place before the publication of the final guidance. So I can absolutely reassure the noble Baroness and all noble Lords that we will consult widely with a broad set of stakeholders, as well as reflecting discussions in this House and the other place, to make sure that all those contributions are included in the guidance.
Royal Assent
Thursday 1st November 2018
(6 years ago)
Lords ChamberRead Full debate Read Hansard Text Amendment Paper: Consideration of Bill Amendments as at 15 June 2018 - (15 Jun 2018)