Abuse and Deaths in Secure Mental Health Units

Wednesday 9th November 2022 Lords Chamber

Statement

The following Answer to an Urgent Question was given in the House of Commons on Thursday 3 November.

“I am grateful to the honourable Lady for raising this important question. Everyone in any mental health facility is entitled to high-quality care and treatment and should be kept safe from harm. The findings from the investigation into the deaths of Christie, Nadia and Emily make for painful reading. The death of any young person is a tragedy, and all the more so when that young person should have been receiving care and support. My thoughts and, I am sure, the thoughts of the whole House are with their families and friends, and I want to apologise for the failings of the care that they received.

As I told the House on Tuesday, these incidents are completely unacceptable. The Secretary of State and I are working closely with NHS England and the Care Quality Commission, and they have updated us on the specific situation and the steps that the Tees, Esk and Wear Valleys NHS Foundation Trust is taking to improve the care at its services. Those include investing £5 million in reducing ligature risks across the estate; improving how it develops and implements care plans for young people; strengthening its policy on observation; and improving staff training and the culture that can exist within the trust.

I recognise that these worrying findings come in the context of broader concerns highlighted by other recent scandals. The Minister for Health and Secondary Care, my honourable friend the Member for Colchester (Will Quince), was at the Dispatch Box last month responding to an urgent question on the unacceptable abuses at the Edenfield Centre. These challenges are, rightly, the subject of sharp focus in my department, and we understand that every part of our system has a responsibility to keep patients safe. That is the driving motivation behind our new mental health safety improvement programme and the patient safety incident response framework.

I am not just the Minister for Mental Health; I am also responsible for patient safety, and I am not satisfied that the failings we have heard about today are necessarily isolated incidents at a handful of trusts. The Secretary of State and I are urgently meeting the national director of mental health to look at the system as a whole, the role of CQC inspections and the system for flagging concerns. I will also be meeting the new patient safety commissioner to seek her guidance, and based on that, we will make a decision on how we proceed in the coming days.”

12:15

[Baroness Merron (Lab)]

My Lords, week after week we return to this Chamber to hear of patients dying when their deaths could have been prevented and patients being bullied, dehumanised and abused, and their medical records falsified, in a scandalous breach of patient safety. This cannot continue. In reflecting that it feels as though it is being left to undercover reporters to expose such terrible failings in patient care, will the Minister action a rapid review of mental health in-patient services? What are the Government doing to ensure that patients’ complaints about their care are being taken seriously?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

I thank the noble Baroness. I first want to apologise for the failings in the care that Christie Harnett, Nadia Sharif and Emily Moore received. My thoughts, and I am sure the thoughts of this whole House, are with their families and friends. The death of any young person is a tragedy, all the more so when they should have been receiving care and support in a safe place.

The Minister in the Commons is looking much more towards a rapid review rather than a public inquiry, as the feeling is that rapid action is needed. We have seen some good examples of that recently, with Dr Bill Kirkup. It is very much at the top of the agenda and I agree with the noble Baroness; this is the third time I have spoken on similar incidents in the short time I have been here. We clearly need to make sure the proper action is in place to identify these issues.

[Baroness Tyler of Enfield (LD)]

My Lords, when this Question was answered in the other place on 3 November, the Minister said that

“staff shortages often contribute to some of the failings we have seen.”—[Official Report, Commons, 3/11/22; col. 1021]

These are some of the most horrific cases of abuse and death in so-called secure mental health units I have ever seen. Can the Minister say what emergency intervention funding will be made available, as happens with maternity services put into special measures, to ensure that every mental health patient in a secure unit is in a safe place?

[Lord Markham (Con)]

I agree, and I have been asking similar questions around whether we should be looking for a special measures-type regime in this space. To be fair to the new CEO, who has come in from 2020, he has set out a plan and progress is being made on many steps. It is the focus of the Minister to see whether that progress is quick enough. We understand that staffing is a key issue. We have increased the number of staff by 24,000 since 2016, and almost 7,000 in the last year alone. Clearly, part of this rapid review needs to be around staffing.

[Baroness Buscombe (Con)]

My Lords, I currently chair the Joint Committee scrutinising the draft mental health Bill. This is an important Bill and is the subject of both Houses on a cross-party basis. We hope to publish our recommendations in the middle of January. Will my noble friend reassure me and the whole House that great care will be taken to consider the recommendations we put to the Government and that an early response will be brought forward in the light of the fact that it is incredibly important that we see this legislation through as soon as possible?

[Lord Markham (Con)]

I thank my noble friend for the work that she and others are doing in this space. I agree that we need to respond rapidly. As I said, this is very high on Minister Caulfield’s agenda, and I assure my noble friend that we will be looking to respond quickly.

[Baroness Berridge (Con)]

My Lords, I am also serving on the Joint Committee mentioned by my noble friend. We received evidence that the highest rate of mortality for those held in custody between 2016 and 2019 was among those held under the Mental Health Act. If you die in a prison or an immigration centre, there will be an independent investigation under the Prisons and Probation Ombudsman, and if you die in police custody, the IOPC will investigate. There is no independent investigation should you die while detained under the Mental Health Act. Is that not a lacuna that the Government could look into in relation to deaths while being detained under the Mental Health Act?

[Lord Markham (Con)]

My noble friend raises a good point. My understanding is that the rapid review that we seek to put in place would involve an independent chair, because independence is key in this area. On the detail of whether that should be the case for every death, I will take back that point and respond to my noble friend.

[Lord Harris of Haringey (Lab)]

My Lords, following on from the noble Baroness, Lady Berridge, until 2015 I chaired the Independent Advisory Panel on Deaths in Custody. As she said, the largest number of deaths in custody were those in secure mental health units. There is no independent arrangement. It is all very well to talk about an independent chair, but, essentially, the assessment is being made by those in the same field—sometimes, indeed, in the same institution. The Government are failing their Article 2 obligations on the right to life. How frequently do the Minister and his colleagues in the department meet the Independent Advisory Panel on Deaths in Custody, and when did they last take note of, and act on, the recommendations it has made?

[Lord Markham (Con)]

I do not have the information to hand on when the last visit was, so I will write to the noble Lord on this. The substance of the question is good: clearly, we cannot have people marking their own homework—for want of a better phrase—in this situation, so I will take back this point. Again, I understand the importance of this; it is vital that these young people, and others in mental health institutes, are supported in the right way. We are spending about £400 million to eradicate dorms, which are often part of the problem, but that is not to say that more does not need to be done.

[Baroness Uddin (Non-Afl)]

My Lords, I declare my interest as a registered social worker. Last year, I had the opportunity to look at mental health services in east London, where the overrepresentation of black and Muslim men is absolutely horrific. Their experiences are vastly different, and there is no recognition of the fact that they are suffering not just bullying but racism and Islamophobia. As the Minister will be aware, the problem is that, as well as cases of bullying, these services are understaffed. More importantly, the staff who are supposed to be supporting these individuals who are very unwell are underqualified and severely underpaid. There is a great deal for us to be concerned about, including underresourcing and staff training. What is the Minister’s department doing about this? Having just announced one set of funds after another, which had no effect at all on the ground in those wards, can the Minister say what the reality is on the ground?

[Lord Markham (Con)]

We are investing, and I understand and agree with the point that training is key to this. We have committed to spend £2.3 billion more in 2023-24 in the mental health arena, exactly around this space. It is something that we are working on, and we understand that we need to ensure that the mental health of all our citizens, whatever their race or colour, is well served and looked after.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, as a member of the committee that the noble Baroness, Lady Buscombe, chairs, may I ask the Minister to especially note what she said about the importance of acting quickly on whatever recommendations come forward? Will he also acknowledge that mental health services, not just in secure institutions but across the country, are under very severe strain and that it is when people get into crisis that they are then put into secure units, often because they have not had the help they need before that crisis arrives? Will he please accept that there is a very serious shortage of mental health provision across the country? It would be interesting to know what real impact the numbers he has been able to tell us about today will have on that.

[Lord Markham (Con)]

As previously mentioned, we are investing to increase the provision—I believe it is £2.3 billion in 2023-24, which is a significant sum. We have increased the workforce by 7,000 in this last year alone, and there are plans to increase it further. Clearly, we need to keep that under review. I agree with the premise that prevention is always better than cure in these instances, and we need to make sure that mental health services, training and support are given at the point of need.