Suicide Risk Assessment Tools in the NHS

(Limited Text - Ministerial Extracts only)

Wednesday 4th September 2019 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

It is a pleasure to serve under your chairmanship, Sir Christopher. After 10 years of being a Chair myself, I hope I do not incur your wrath today.

I thank my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) for securing this important debate. It is an honour for me to take up the position as Minister with responsibility for suicide prevention. My predecessor, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), did a commendable job when she held this position and I am determined that we continue to do whatever we can to reduce the devastating impact of suicide.

I offer my sincere and heartfelt condolences to the family of my hon. Friend’s constituent. I welcome Robert Bellerby to Westminster Hall and thank him for coming today. These will continue to be difficult times for the Bellerby family. I know from personal experience how devastating it is to lose someone you love and someone who is close to you through suicide. It is inspirational for me to see the courage and determination of those, such as Mr Bellerby, who manage to bring about positive action from such tragic circumstances. By their actions, Mr Bellerby and others like him will help to prevent others from going through the same deep and lasting loss.

I will now turn to the specifics raised by my hon. Friend about the use of risk assessment tools for patients at risk of suicide. He raised the specific case of Andrew Bellerby, who sadly died in 2015. I understand that at the time of Andrew’s attendance at hospital, it was practice at the Sheffield Health and Social Care NHS Foundation Trust to use a crisis triage rating scale tool. It was used to assess Andrew before he was discharged. Sadly, he took his own life shortly after. The trust conducted a serious incident review to learn the lessons from this tragic case.

It is clear that the care Andrew received leading up to his death was not satisfactory, and I understand that a comprehensive action plan was developed and fully implemented by the trust following the serious incident review. I have also been reassured that the trust has stopped using the crisis triage rating scale tool, following a report published by the national confidential inquiry into suicide and safety in mental health in 2018, which recommended that the risk assessment tools should not be used as a way of predicting future suicidal behaviour.

I recognise and share my hon. Friend’s concerns about the use of risk assessment tools across the wider NHS. He is right that guidelines published by the National Institute for Health and Care Excellence make clear recommendations that NHS professionals should not use risk assessment tools and scales to predict future suicide or repetition of self-harm, or to determine who should be offered treatment and who should be discharged. Each NHS trust is responsible for the care it delivers and the safety of its patients. but NICE guidelines are clear on the use of risk assessment tools, and we expect the NHS to implement the guidelines. Clinical guidelines represent best practice and should be taken fully into account by clinicians.

The national confidential inquiry into suicide and safety in mental health has published “Safer services: a toolkit for specialist mental health services and primary care”, which presents 10 ways to improve safety. NHS England has supported all mental health trusts to access the toolkit, which includes guidance for trusts on the use of risk assessment tools and highlights NICE guidance. The toolkit specifically states:

“All patients’ management plans should be based on the assessment of individual risk and not on the completion of a checklist.”

The hon. Member for Blaydon (Liz Twist) was absolutely right that the situation should be put in its context as it presents at that moment. Everything, including the history of physical and mental health, should be considered when assessing and evaluating a patient when they present with a potential suicide.

[Liz Twist]

I am pleased to hear that the Minister is focused on ensuring that NHS trusts apply the guidance. What steps will she take to ensure that that happens across the board?

[Ms Dorries]

I am delighted to inform the hon. Lady that just this week, NHS England has written to all mental health trusts to make clear that they should be adhering to NICE guidelines on the use of risk assessment tools. My hon. Friend the Member for Thirsk and Malton mentioned a trust that is still using the old method. As a result of this debate, we have ensured that the letter is going out to tell NHS trusts that they should not be using the tools any longer and should be implementing the NHS guidelines.

[Jim Shannon]

I congratulate the Minister on her appointment. When intervening on the hon. Member for Thirsk and Malton (Kevin Hollinrake), I referred to the 20% increase in suicides in Northern Ireland. I did so because it is factually correct, and because in Northern Ireland we have a policy and strategy in place to address those issues. Has the Minister, in her short time in her role, had the opportunity to discuss those matters with, for instance, the Northern Ireland Department of Health?

[Ms Dorries]

I am afraid I must disappoint the hon. Gentleman. This is my third day in, and I have not yet had a chance to discuss Northern Ireland in detail, but as a result of his intervention I will ensure that we do that, and it will be on tomorrow’s agenda.

The letter that NHS England sent out highlights the report from the University of Manchester on “The assessment of clinical risk in mental health services”, and asks trusts to ensure that their risk assessment policies reflect the latest evidence from the university, as well as best practice. I am pleased that NHS England and NHS Improvement have committed to working with trusts to improve risk assessment and safety planning as part of future quality and safety work on crisis care and suicide prevention.

My hon. Friend the Member for Thirsk and Malton asked specifically about the role of the Care Quality Commission in ensuring that trusts are adopting best practice in respect of risk management processes. The CQC has assured me that risk management processes are a key feature of every CQC inspection. I hope that that assurance from the CQC, along with the letter that NHS England sent out this week, will go some way to reassure my hon. Friend.

[Kevin Hollinrake]

I am sure that the work that the Minister has already done to raise the issue with trusts is very positive news for the family. On the basis that people do not do what is expected but what is inspected, it is good to hear that some processes are already in place in the CQC. Will new processes be added? Presumably checks were happening when the situation occurred, so we need something else to ensure that best practice is properly adopted.

[Ms Dorries]

If I may continue my speech, I hope that I can reassure my hon. Friend on that point.

The Government are committed to a culture of openness, honesty and transparency in the NHS. The legal duty of candour means that trusts need to be open and transparent with patients or their families when something appears to have caused, or could lead to, significant harm. Trusts could face action from the CQC if they are seen to be failing to comply with that duty. I think that some good news will come out later in the year that will hopefully reassure my hon. Friend regarding a new culture that will develop within the NHS to encourage staff and clinicians to be more open about incidents as they happen, so that they share information and we can learn from such incidents.

Our national learning from deaths policy has introduced a more standardised approach to the way that trusts review, investigate and learn from deaths. The national guidance on learning from deaths, published in 2017, is about supporting trusts to become more willing to admit to and learn from mistakes, so that they reduce risks to future patients and prevent tragedies from happening in the first place. The guidance is clear that trusts must engage meaningfully and sensitively with bereaved families and carers as part of that process. I hope that, as a result of those measures, what the Bellerby family went through in 2015 will never be experienced by another family. To support our national policy, the CQC has strengthened its assessment of learning from deaths by trusts.

I will talk about what we are doing to reduce suicides across the NHS more widely. People in contact with mental health services account for around a third of all suicides in England, and arguably some of the more preventable ones. The overall suicide rate among people in contact with mental health services has reduced significantly over the last decade, but numbers remain too high. We must not lose sight of the fact that nobody under the care of NHS services should ever lose their life as a result of suicide. At the start of 2018, we therefore launched a zero suicide ambition, starting with mental health in-patients, but asking the NHS to be more ambitious and look to expand it to include all mental health patients.

[Andrew Griffiths (Burton) (Con)]

I know it is only the Minister’s third day, but the thing that we ask for more than anything else in a Minister is for somebody who cares about their portfolio. It is clear that my hon. Friend really cares about this issue. I am not unique in this, but as one of the few Members who has used NHS mental health services, I can attest to the real value and life-saving contribution that they make. I commend her decision to have that aspiration for zero deaths from suicide in the NHS.

In my constituency, there were 10 suicides last year. That is 10 families ripped apart and hundreds of lives broken as a result of those tragic decisions. Key to a brilliant service is the number of NHS nurses out in the community. Will the Minister, as she develops in her role, look at the numbers on the ground, so that we can be sure that everybody in our constituencies has access to mental health nurses, who can save lives?

[Ms Dorries]

I hope that I can reassure my hon. Friend on some of those points as I whizz forward. We have asked all mental health trusts to put zero suicide ambition plans in place. As already outlined, NHS England is providing funding for suicide prevention to every local area, which includes investment in a national quality improvement programme to improve safety and suicide prevention in mental health services across the NHS.

We are also investing £2 million in the Zero Suicide Alliance, which aims to deliver an NHS with zero suicides across the system and in local communities. It is doing that through improved suicide awareness and prevention training, and developing a better culture of learning from deaths by suicide across the NHS. In June, the then Prime Minister announced that we would encourage all NHS staff to undertake the Zero Suicide Alliance training, which makes all NHS staff more aware and gives them a basic understanding of how to recognise when somebody may be in the space of wanting to take their own life.

My hon. Friend the Member for Thirsk and Malton may be aware that yesterday the Office for National Statistics published the final suicide registrations data for 2018. Concerningly, there were substantial increases in the suicide rate amongst the general population, following three consecutive years of decreases. The latest figures are disappointing, but reinforce why suicide prevention continues to be a priority for the Government and for me personally.

Experts are clear that we need more data to draw firm conclusions from the latest data, and we will continue to work closely with academics and other experts to consider the data in more detail. There has also been an issue over the past two accounting periods surrounding coroners and the way the reporting of suicides takes place. We continue to take action to reduce the devastating impact of suicide. Every local area has a suicide prevention plan in place, and we are working with the local government sector to ensure the effectiveness of those plans. NHS England is also continuing to roll out funding to every local area to support suicide prevention planning.

We are continuing to improve mental health services. Under the NHS long-term plan published in January, there will be a comprehensive expansion of mental health services, with an additional £2.3 billion in real terms by 2023-24. Crisis care is a key element of the plan, which commits to ensuring that by 2023-24 anyone experiencing a mental health crisis can call NHS 111 and have 24/7 access to the mental health support that they need in their community.

We will set clear standards for access to urgent and emergency specialist mental health care. That will be supported by further mental health crisis care services by 2023-24, including 100% coverage of 24/7 crisis provision for children and young people, 100% coverage of 24/7 crisis resolution, and home treatment teams operating with best practice by 2021 and maintaining coverage to 2023-24. We are also investing £249 million to roll out liaison mental health teams in every acute hospital by 2020, which I hope addresses the question my hon. Friend the Member for Thirsk and Malton asked earlier, to ensure that people who present at hospital with mental health needs get the appropriate care and treatment that they need.

To conclude, I again extend my sincere and heartfelt sympathies to the Bellerby family and friends. I assure them that we are doing everything that we can to prevent further suicides, as we understand their devastating impact on families and the communities affected. I thank my hon. Friend again for raising this very important issue. I would be happy to meet him, and Mr Bellerby and his family, to discuss their concerns in more detail.

Question put and agreed to.