The Minister of State, Department of Health (Mr Paul Burstow)
I congratulate my hon. Friend the Member for Broxtowe (Anna Soubry) on securing what I think is her first Adjournment debate. Adjournment debates provide an opportunity for issues such as this to be debated in the House, and for the Government to account for what they are responsible for and ensure that others do the same. It is entirely appropriate for such a tragic and distressing case to be raised in an Adjournment debate.
Our thoughts must go first to the family whose lives have been turned upside down by this devastating incident. I offer them my deepest sympathies. As my hon. Friend said, members of the family are in the Gallery listening to the debate, and I look forward to meeting them afterwards and discussing the case with them directly. I fully understand their desire to ensure that something positive comes out of this terrible tragedy. As my hon. Friend said, our priority now is to ensure that the NHS learns from the incident, at a local and also, where appropriate, at a national level. I have asked my officials to look carefully at the issues raised by the case as they consider the future direction of mental health policy.
I shall say a little more about the national context later, but let me begin by focusing on the local issues. As my hon. Friend explained, Nottinghamshire Healthcare NHS Trust launched an internal investigation, which reported in April. It is a frank and honest account of what went wrong, and it gives the local NHS a good basis on which to improve the safety and effectiveness of its mental health teams. All that precedes the full external and independent investigation that the strategic health authority will commission in the near future. The trust has assured me that since the internal report came out it has taken active steps to address the weaknesses identified. It tells me that it is improving records management, strengthening communication between teams and reviewing its policy and procedures for assertive outreach. It is also addressing the way that mental health teams assess and manage risk, as well as looking at leadership issues and how they manage a patient's condition over the long term.
In addition, the trust has reviewed the cases of every patient using assertive outreach services to ensure that their care is not being compromised by the same failings. It has commissioned an external review of its assertive outreach teams, which is due to report in a fortnight. I have been reassured that the trust's board will examine the findings and respond swiftly and diligently to them. My hon. Friend and I would agree that all that work must feed directly through into better and safer practice on the ground. Crafting objectives and principles is one thing; achieving tangible improvements to practice is quite another.
My hon. Friend is absolutely right to emphasise the issues of strong leadership and clear lines of responsibility in assertive outreach teams. I can tell her that what should happen is that every assertive outreach patient has a named care co-ordinator. The co-ordinator takes overall responsibility for the appropriate assessment, care and review of the patient. There is no nationally prescribed model for who must take on that responsibility. I do not think that it is sensible to start prescribing how local teams are structured or run through a mandatory code. After all, patients’ needs will differ, and so will local circumstances.
However, there must be clarity. Everyone should know who is responsible for what, and people should be properly qualified, skilled and supported to discharge their responsibilities. The trust accepts that point. It tells me that it has set out a clear process for responding to service users who have not adhered to the agreed level of contact. Team managers are now responsible for monitoring that. I also understand that a risk assessment expert has spent a week with the assertive outreach team and is now developing a risk training programme for all staff. That training will be delivered in October.
Building on that point, I have also asked the trust about its quality assurance procedures. Assertive outreach obviously depends on strong relationships across different teams. That can be hampered if people change jobs, or if the continuity is broken in some other way, so the right quality assurance process is vital. Change has to be embedded within the organisation through regular and robust assessment of the competency of assertive outreach teams. In this regard, the trust tells me that it has improved clinical and managerial supervision as well as its performance management arrangements. For instance, attendance at multidisciplinary team meetings is now compulsory for anyone involved in a patient's care. Team managers now carefully monitor attendance at these meetings, and ensure that all actions coming out of the meetings are properly followed up.
I am keen that lessons from this tragedy are shared and absorbed by the rest of the NHS. In our White Paper, we talk about an NHS freed from the endless succession of top-down mandates and departmental circulars. That is the right approach. We want to replace command and control with much stronger local accountability, with councils in particular taking a much stronger role in working with the NHS and holding it to account. We have also said that the NHS will focus much more on achieving better outcomes; there is a debate to be had about what those outcome measures will be. A consultation is happening over the summer, and outcomes for mental health patients will form part of those discussions.
However, cutting the Whitehall apron strings does not mean abandoning our duties to look at local incidents and consider national repercussions. I will not pre-judge the external investigation. My hon. Friend would not expect me to do that, but I can tell her that the external investigation will be sent to the National Confidential Inquiry into Suicides and Homicides by People with Mental Illness as a matter of course. The inquiry team will consider the findings as part of its regular reviews of homicide investigations. The National Patient Safety Authority would respond to any points of national concern raised by the independent investigation.
In addition, my hon. Friend may be aware that the NHS already flags patient safety incidents via the NPSA’s national reporting and learning service, and if a trend or pattern emerges the NRLS can issue an alert to all relevant providers. Those alerts would give advice to the NHS on how to prevent such events from occurring.
My officials have contacted the NPSA about the specifics of this incident and it says no similar problems affecting other assertive outreach teams have been reported to it. Therefore, I will be particularly interested to see the dossier of evidence and I will follow that through.
Mary Macleod (Brentford and Isleworth) (Con)
This incident was very movingly described by my hon. Friend the Member for Broxtowe (Anna Soubry), and I do not think it is an isolated incident—I think it has happened elsewhere around the country. Can the Minister give an assurance that the lessons from this case will be learned across the country and that it will change the way things are done in the future?
Mr Burstow
In terms of the systems as they work now, we will do all we can to make sure that that learning is embedded, but I am concerned that my inquiries today have shown that the NPSA was not aware of this dossier and I will therefore look into that, and look at the dossier itself in order to see what it can teach us.
However, I want to reassure both hon. Ladies—and other Members—that if the independent investigation were to make recommendations with national implications, we would look at them very closely and make sure they were translated into action and learning around the country.
Let me end by saying that mental health professionals have an extremely difficult and challenging role; the hon. Member for Broxtowe was right to acknowledge that. The judgments they make are often finely balanced, and the risks they shoulder are considerable. Most professionals are doing an excellent job, and we ought to acknowledge that while also being concerned where practice falls short, but sometimes there are failures in care that could and should have been avoided. Tragedies like the case of John McGrath demonstrate the need for constant vigilance, scrutiny and self-improvement.
When such tragedies do happen, it is vital that all responsible authorities, both local and national, are honest about the weaknesses and diligent about putting things right for the future. Like the hon. Lady, I will take a close personal interest in the independent investigation and the coroner’s report. I want to ensure that this incident leads to improvements, because that is probably the only consolation that can come from such a tragedy.
That is my message to the McGrath family and the hon. Lady who has secured the debate tonight. I look forward to meeting the family shortly to discuss these matters further and to working with colleagues across the House to make sure our mental health services protect and give good quality care for people with mental health needs.
Question put and agreed to.