Essex Mental Health Independent Inquiry

Tuesday 31st January 2023 Westminster Hall

11:00

[Geraint Davies (in the Chair)]

I will call Vicky Ford to move the motion. John Whittingdale will also speak for two minutes before the Minister responds.

[Vicky Ford (Chelmsford) (Con)]

I beg to move,

That this House has considered the Essex Mental Health Independent Inquiry.

It is a pleasure to serve under your chairmanship, Mr Davies. Today’s debate is important for the future of mental health services across the country and ensuring that the tragic stories that I and many of my Essex colleagues have heard from the families affected by the failings in mental health services in Essex are not repeated. This is not the first time that mental health in Essex has been debated, and I pay tribute to my hon. Friend the Member for South Suffolk (James Cartlidge) for his previous Adjournment debate. Before I start, I ask everyone to take a moment to think about all those who have died, those who have suffered, those who love them and those who care for them.

As well as other in-patient facilities, many concerns have been raised about the Linden Centre in Chelmsford, where there have been a significant number of in-patient deaths, both on the wards and while vulnerable patients were on section 17 leave or had absconded. The Linden Centre lies just outside the boundary of my constituency, but the patients treated there come from across Chelmsford and, indeed, Essex. For example, Jayden Booroff was suffering from acute psychosis and known to be at high risk of absconding. In October 2020, he was killed by a train just a few hours after he had been able to tailgate a staff member out of the Linden Centre. The inquest concluded that Jayden died following inconsistencies in care at the Linden Centre run by Essex Partnership University NHS Foundation Trust, or EPUT. Jayden’s mother, Michelle, is one of my constituents. She has told me of her wish to achieve accountability, for responsibility to be accepted and for long-term lasting improvements to services.

I and many of my Essex colleagues represent family members of mental health in-patients who have died under the care of EPUT, which is responsible for the provision of adult NHS mental health services in Essex. Many inquests and investigations have taken place, but it has been very clear for a long time that a fuller inquiry was necessary to understand why so many deaths have occurred and to try to prevent future tragedies.

In January 2021, the Government set up an independent inquiry, to be chaired by Dr Geraldine Strathdee, to investigate matters surrounding the deaths of mental health in-patients in Essex between 2000 and 2020. At the time, when local MPs were briefed on the issues, Ministers believed that a non-statutory inquiry was more appropriate, more likely to get to the truth and more likely to make recommendations for improvement in a timely manner, whereas a statutory inquiry was likely to take much longer to set up and report. It was made clear that, while the inquiry did not have statutory powers, witnesses were expected and would be encouraged to come forward and give evidence.

On 12 January 2023, I and many other Essex MPs were deeply concerned to receive the open letter published by the inquiry chair, Dr Strathdee, stating that she felt that the non-statutory inquiry into EPUT was unable to fulfil the terms of reference due to the extremely low engagement of EPUT staff. We also heard that rather than the 1,500 deaths we had been informed of, close to 2,000 fall within the scope of the inquiry. It is incredibly disappointing that, of the 14,000 members of EPUT staff whom the inquiry had written to, only 11 had agreed to give evidence. In the specific cases that the inquiry is investigating, only one in four responded. That is a shockingly low figure. It is abundantly clear that, with this extremely small pool of staff witnesses, it is highly unlikely that the full truth would be heard.

Upon receipt of Dr Strathdee’s letter, my right hon. Friends the Members for Maldon (Sir John Whittingdale) and for Witham (Priti Patel) immediately wrote to the Health Secretary to raise their serious concerns that the powers available to the inquiry did not go far enough. I have also written to the Health Secretary to underline my agreement with all the points they raised. Dr Strathdee’s unequivocal view, as stated in her open letter, is that the inquiry will not be able to meet its terms of reference with a non-statutory status. I want to put it on the parliamentary record that I join those calls for this to be converted into a statutory inquiry, which will compel witnesses to give evidence, to ensure full transparency and greater public scrutiny of its progress.

[Sir James Duddridge (Rochford and Southend East) (Con)]

My hon. Friend knows that I did not support a public inquiry—I thought it would take a long time and be an expensive distraction from spending money on the service—but the approach we have taken simply has not worked. Unless the Department and EPUT transform miraculously over the next four weeks, the only real option is a statutory inquiry, for which she has our full support.

[Vicky Ford]

I thank my hon. Friend for his words, which are absolutely spot on, and for emphasising the support among Essex colleagues on this matter.

Having said that, I also recognise the points made to MPs in a letter from the chief executive of EPUT on 19 January. He points out that a public inquiry could bring consequent delays and costs, and the trust needs to be focused on continued improvement to services at a time of rising demand, both in numbers and complexity of cases.

He made a number of recommendations, including an increase in resources and expertise available to the inquiry chair, and ensuring appropriate information-sharing protocols. He also suggested a number of practical steps to drive better staff engagement with the inquiry. He has informed me that, since 2019, absconsions have decreased by more than 60%, the use of prone restraint has reduced by 88% and fixed ligature incidents have reduced by 32%. He has told me that many staff are scared to come forward, and that all board members will come forward now, as an example to others.

Given that, I can understand that Ministers might be tempted to give those suggestions a short period of time, to see if they bring improvements. However, I make two points. First, it is two years since the independent inquiry was announced. EPUT has already had a long time to take action and to support staff to engage. Secondly, given how incredibly low the engagement has been to date, I have serious doubts about whether the process would be effective. Therefore, I suggest that, if Ministers decide to take this option, they should set a deadline of no more than one month, making it clear that if there is not a massive material change in staff engagement, the statutory route will be actioned. They should also make it clear that the statutory route is likely to include some staff being named, and being compelled to give evidence in public.

[Priti Patel (Witham) (Con)]

I thank my hon. Friend for securing this debate and for her contribution. I also want to pay tribute to the families who are here today. We support the point she makes about a statutory inquiry. I want to thank the Minister for his engagement on that. Alongside that, does my hon. Friend have any thoughts on the role of an independent public advocate for family members? Perhaps the Minister could also comment on that. Their voices are simply not being heard. At the end of the day, we are here to represent them against institutional state failure. Duty of candour for stuff to come forward is important, but the time has now come for an independent public advocate for family members.

[Vicky Ford]

I thank my right hon. Friend for making that point. It is important that the voices of the families are heard. I am about to come on to the point that it is also important that the voices of the survivors are heard. Anything we can do to help to ensure that those voices are heard is vital. In calling for a statutory inquiry, I am not just supporting the calls of the bereaved families, but those of the group that I strongly feel has not, until now, been mentioned often enough. That is the group who, although they did not lose their lives, have been victims of appalling care: they are the survivors. That group also falls within the scope of the inquiry, which is investigating issues beyond in-patient deaths, including the management of self-harm and suicide attempts, sexual safety on the wards, the use of restraint and restrictive practices with in-patient units, medication practices and management, and various other issues, as outlined in the inquiry terms of reference, which were published in May 2021.

One of my constituents shared with me the testimony that she has given to the inquiry. She describes how during her time at the Linden Centre in the mid-2000s, she was raped by another patient, and when she asked for support, she was laughed at by staff members. She describes being able to make suicide attempts, including absconding from the ward and overdosing, as well as being able to ligature on the ward. She has told me of times when staff refused to treat her self-harm injuries and how she herself treated her own serious injuries and the injuries of others. She has also described to me how she was repeatedly restrained, often held on the floor by a number of staff, and forcibly injected.

This survivor reflected to me that she had hoped things might have changed in the years since she was an in-patient, but the recent “Dispatches” documentary suggests to her and many others that that is not the case. This is just one of the appalling stories shared by survivors of the horrific treatment they suffered while in the care of mental health services in Essex. This survivor is absolutely clear about the need to establish answers and uncover the truth of the situation to ensure that nobody else has to suffer the trauma she faced, which will live with her for the rest of her life. This survivor and others who have worked with the inquiry simply want to ensure that this never happens again.

Before Christmas, I spoke in the Chamber of the House of Commons about my own lived experience. I explained that it is very hard to talk about one’s own experiences of mental illness. It brings back all the horrors. The survivors who have shared their testimony are extraordinarily brave. I have asked what support is available for them, and I understand a contract is in place with Hertfordshire Partnership University NHS Foundation Trust, while psychological support is available to anyone involved in the inquiry. I understand also that some survivors might not be aware of that. EPUT has promised to publicise it, and I will ask the inquiry to ensure that it publicises it too.

Based on all that I have said, the words of the chair of the inquiry herself, and the devastating testimony of bereaved families and survivors, I believe that there is an urgent need to revisit the powers available to the inquiry and reconvene it on a statutory footing to ensure accountability and learning, and, most importantly, to embed long-lasting changes to safeguard lives in the future.

[Geraint Davies (in the Chair)]

Thank you, Vicky. I invite John Whittingdale to speak for two minutes.

11:12

[Sir John Whittingdale (Maldon) (Con)]

I start by thanking my right hon. Friend the Member for Chelmsford (Vicky Ford) for securing the debate and for allowing me to make a brief contribution.

I, too, represent several family members of those who lost their lives while in the care of EPUT. The matter has been continuing for a long time, and the inquiry is considering 20 years of NHS provision for people suffering from mental illness in Essex. We have had a number of inquests for those who died, and we have had Care Quality Commission investigations and police investigations, but there are still unanswered questions. For that reason, I agreed with and supported the establishment of the mental health inquiry by my right hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who was then a Health Minister.

As my right hon. Friend the Member for Chelmsford has said, real concerns were expressed to us about the fact that the inquiry would not be statutory, but we were assured by the Minister that a non-statutory inquiry could reach conclusions faster than a statutory one and that there were other advantages to such an inquiry, which might lead to people being more willing to come forward than if the inquiry were under statutory control. I listened to the concerns expressed by my constituents who felt strongly that the inquiry should be statutory, but I accepted the assurances of the Minister. I want to say to the families that they were right and we were wrong, and I am sorry that that was the case. I was therefore greatly concerned when I saw the letter from the chair, who says that she has now concluded that statutory powers are needed owing to the lack of co-operation from staff and former staff, although initially she, too, had thought that a non-statutory inquiry was correct.

I have had a long conversation with the chair of the inquiry. I am impressed by her absolute determination to get to the truth and her independence. As my right hon. Friend has said, the chair still hopes very much that not only staff members, but all family members who have evidence to give will come forward, particularly as there will be support available. I understand that the family members still believe the inquiry should be statutory. Therefore, I agree with my right hon. Friend that we have reached the point at which, unless we receive co-operation in a very short time, statutory powers are needed.

We need to get to the bottom of this. A figure of 2,000 deaths has mysteriously and suddenly appeared from the trust, and we need to find out what happened to those people. I say to the Minister that I understand the wish of the Government and the inquiry to obtain testimony from all those concerned, but if it cannot be achieved by the present arrangement, we will move to statutory powers.

11:15

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank my right hon. Friend the Member for Chelmsford (Vicky Ford) for securing this important debate, and I thank her and all the local MPs—my right hon. Friend the Member for Witham (Priti Patel), my hon. Friend the Member for Rochford and Southend East (Sir James Duddridge) and my right hon. Friend the Member for Maldon (Sir John Whittingdale)—for their dogged work over a long period in trying to get justice both for those in the Public Gallery and for all the others who are unable to be present this morning.

I know that Members have raised a lot of concerns about the progress of the inquiry, and I want to take this opportunity to make clear our strong commitment to this absolutely vital work. The speech made by my right hon. Friend the Member for Chelmsford was stark, and I know that some of the victims, survivors, and friends and families of people who have been affected are in the Public Gallery. It is a powerful reminder of why the inquiry is so important: it has to get to the truth.

The Government are committed to improving mental health services across the country, which is why we launched the independent inquiry in January 2021, covering a 20-year period from 2000 to 2020. Obviously, it is a complex inquiry. Like Members present, I am pleased with the hard work of Dr Geraldine Strathdee, the inquiry chair, since the inquiry started its work. However, I am concerned about the level of co-operation that the inquiry has received, which was set out clearly by my right hon. Friend the Member for Chelmsford. It is not good enough, and Dr Strathdee has recently raised concerns about this. She met the Secretary of State and has since published an open letter in which she stated that

“in the event that staff engagement remains very poor, it is my view that the inquiry will not be able to meets its terms of reference with a non-statutory status.”

We take those concerns very seriously.

Dr Strathdee has raised two particular concerns. The first is about the participation of current and former staff, and the second is about the availability of documents for the inquiry. As a result of Dr Strathdee’s concerns, the Secretary of State met Paul Scott, the chief executive of Essex Partnership University NHS Foundation Trust, to better understand how the trust will support the inquiry. The Secretary of State sought assurance on two key issues. The first is what actions the trust will take to encourage more staff engagement with the inquiry, and the second is assurance that the trust will provide all the evidence and information requested by the inquiry, to enable it to fulfil its terms of reference. I know that Mr Scott has also written to local MPs setting out the steps that he thinks necessary to improve engagement, and he feels confident that progress can be made.

On staff participation, I remind the House that it is incumbent on all holders of public office and all health professionals to demonstrate their fitness for office by voluntarily co-operating with independent inquiries. In their guidance on the duty of candour, professional regulators advise that health and care professionals must be open and honest with their colleagues, employers and relevant organisations, and take part in reviews and investigations when requested. Similarly, they must support and encourage each other to be open and honest. I therefore hope that anybody who is asked to contribute evidence will co-operate fully with the inquiry in the public interest and in fulfilment of their professional obligations. The Department is also working closely with the inquiry and NHS England to look at what more can be done.

Dr Strathdee has expressed her concern that an additional 600 cases were recently sent to the inquiry. The trust has advised that they were identified during a validation process. I appreciate that this is not ideal, but I understand that the trust has allocated appropriate staffing and resource to ensure the thoroughness of the searches requested by the inquiry.

As Members have mentioned, the participation of families is equally important to the work of the inquiry, and I am grateful to all who have provided evidence to date. I am disappointed that a number of families who have tragically lost loved ones have chosen not to participate and get their voices heard. I urge them to reconsider, so that the inquiry can be as thorough as possible.

Our view is that a non-statutory inquiry, if it is possible, remains the most effective way to get to the truth of what happens. It is quicker, and potentially involves not having to drag clinicians through the public processes of a statutory inquiry. When my right hon. Friend the Member for Witham was Home Secretary, she used the non-statutory process to protect those who did not want to be named and dragged through a statutory process. It is faster and more flexible, which is why it was chosen in the first place. Although statutory inquiries can compel witnesses to give evidence under oath, that does not necessarily mean that it will be easier to obtain the evidence we want. However, all that turns on people co-operating with a non-statutory inquiry, and we now need to see a quantum leap in the level of co-operation. We will not hesitate to move to a statutory inquiry if we do not see a dramatic increase in the level of co-operation. Given how long this has gone on, we cannot wait for a long period for a transformation in the level of engagement. While the approach remains non-statutory for now, we will not hesitate to change that approach if we do not see the change we need rapidly.

[Sir James Duddridge]

I have visited Essex Partnership University NHS Foundation Trust in Rochford a number of times and have been incredibly impressed with its work, notwithstanding its very real problems. What I cannot get over is why people have not come forward to give evidence in a non-statutory environment, because these are caring individuals who want to improve the service. I do not understand why only 11 people have come forward.

[Neil O’Brien]

That is a vital question. There is an excellent chair, and many publicly spirited individuals are already co-operating to get to the truth and improve services for the long-term. We are currently in this environment of the non-statutory inquiry, which allows an informal approach. People do not have to give evidence in the way they would if we went to a statutory approach. There is an opportunity for people to co-operate more with the inquiry, exactly as my hon. Friend says.

[Vicky Ford]

I understand that the Minister is asking for a quantum leap—that is a good phrase to describe the massive change we need—rapidly. Does he agree that rapidly should mean no more than one month?

[Neil O’Brien]

It is not for me to put a date on that in this setting. I have had conversations with a number of the hon. Members here, but my hon. Friend can rest assured from the tone of what I am saying that this will not be a long period of time. We are not kicking this into the long grass; we urgently need this change because, as numerous Members have pointed out, this has been going on for a long time and families who have been through the mill are waiting for justice.

[Sir John Whittingdale]

One of the problems with a non-statutory inquiry is people’s reluctance to come forward. If it becomes statutory, certain consequences obviously follow, including the publication of the names of those who are summoned to appear. Will my hon. Friend the Minister think about making his requirement that the co-operation be achieved in a short space of time more public, so that people understand exactly what will follow if they continue to fail to co-operate?

[Neil O'Brien]

This debate goes some way to achieving exactly that. My right hon. Friend is exactly right that the current non-statutory approach has the benefit that those who give evidence do not have to be named. That is why it would clearly be more desirable if we could make the non-statutory approach work, but that has not been the case to date and, unless that changes, something else will have to change too.

To continue making progress in how we address issues with mental health services, Members will be aware that we have recently announced a rapid review into patient safety in mental health settings across England. The review will focus on what data and evidence is available to healthcare services. I am pleased that Dr Strathdee will be leading the rapid review over the next couple of weeks, given her knowledge and experience. However, I assure hon. Members that the work of the inquiry in Essex will continue at the same time.

I firmly believe in the importance of transparency and accountability to improve patient safety, and I wish to take all action necessary to assist the inquiry in its work. This is absolutely the last chance to make progress. If staff engagement and access to documents remain unsatisfactory despite these actions, we will consider whether the inquiry should remain on a non-statutory footing. We simply cannot go on as we have, with inadequate co-ordination and documents not being forthcoming. Everyone in the inquiry knows the situation and that there is not a long period of time for things to change.

I thank hon. Members for bringing forward the debate, because it allows us to set out the situation clearly for the public. I thank all who are here today, all who have co-operated with the inquiry, and all who have lost loved ones or been personally affected by this matter and have had the bravery and grit to come forward and talk about their experiences. We are extremely grateful to them.

Question put and agreed to.

11:25

Sitting suspended.