Mental Health In-patient Services: Improving Safety
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The Secretary of State for Health and Social Care (Steve Barclay)
With permission, Mr Speaker, I would like to make a statement on improving safety in mental health in-patient services across England. Before doing so, I want to thank all the right hon. and hon. Members from across the country who have campaigned tirelessly on behalf of their constituents to improve mental health care. Too many people have experienced care in mental health in-patient settings that has been well below the high standard that we all deserve when we are at our most vulnerable. I would also like to put on record my sincere condolences to the families and friends of those who have lost their lives.
First, I will update the House on the independent inquiry into mental health in-patient care across NHS trusts in Essex between 2000 and 2020. I thank my right hon. Friend the Member for Chelmsford (Vicky Ford) for tabling a Westminster Hall debate on the Essex mental health inquiry earlier this year. She and colleagues, including our hon. Friend the Member for Rochford and Southend East (Sir James Duddridge) and our right hon. Friends the Members for Witham (Priti Patel) and for Maldon (Sir John Whittingdale), all spoke passionately about the need to get justice for patients and their families. I know that my hon. Friend the Member for South Suffolk (James Cartlidge) also tabled an Adjournment debate on mental health in-patient care in Essex before the independent inquiry was launched in 2021.
I also pay tribute to my right hon. Friend the Member for Saffron Walden (Kemi Badenoch) and my hon. Friends the Members for Clacton (Giles Watling), for Brentwood and Ongar (Alex Burghart), for Castle Point (Rebecca Harris), and for Southend West (Anna Firth) for their determined campaigning on behalf of their constituents. Of course, we should all remember the important contribution of the former Member for Southend West, and a great friend to many across this house, the late Sir David Amess. He tabled a Westminster Hall debate on mental health services in Essex back in 2014, and he was a passionate campaigner for improving mental health care. I know he is very much in our thoughts.
In 2021 we launched the independent inquiry to investigate the deaths of mental health in-patients across NHS trusts in Essex between 2000 and 2020. The Government appointed Dr Geraldine Strathdee, a former national clinical director for mental health for NHS England, to chair the inquiry. I want to place on the record my thanks to Dr Strathdee and her team, because a lot of good work has been done. I applaud the bravery of all the victims and their families who have come forward to tell their stories.
I also recognise the work that the Essex Partnership University NHS Foundation Trust—EPUT—has done to assist with the inquiry. The trust has been in the spotlight, and progress has already been made to learn lessons and improve in-patient mental health care. EPUT’s chief executive, Paul Scott, joined in 2020, and since then the trust has invested £20 million in its mental health in-patient wards and a further £20 million in community services. Compared with 2019, patients absconding from care has decreased by more than 60%, and the use of inappropriate restraint has fallen by 88%.
However, in January Dr Strathdee raised concerns with me about a lack of engagement with the inquiry by current and former EPUT staff. I know that many right hon. and hon. Members share her concerns. Since then, the inquiry and the trust have worked together in a concerted effort to increase staff engagement. None the less, I have listened to Dr Strathdee’s concerns that the inquiry still needs further staff engagement to get victims’ families the answers they deserve. In a letter to me in March, she said that
“30 percent of named staff, those essential witnesses involved in deaths we are investigating, have agreed to attend evidence sessions. In my assessment, I cannot properly investigate matters with this level of engagement.”
She has also raised with me concerns about ongoing safety issues at the trust. To quote from her letter once again, she said:
“I am very concerned that there are serious, ongoing risks to patient safety. Due to the nature of these issues, I am confident that these cannot be properly investigated by the Inquiry without statutory powers.”
The Government take both concerns extremely seriously, and I agree with Dr Strathdee that we have now reached the point where the only appropriate course of action is to give the inquiry statutory powers.
Statutory inquiries do take longer, but this does not mean that work will start from scratch. Dr Strathdee’s existing findings will inform the next phase of the inquiry. She has informed me that, owing to personal reasons, she will not be continuing as the inquiry’s chair, so I want to thank her once again for all her commitment and hard work. I am sure the House will agree that she is a true public servant. Our work to find her successor is proceeding at pace, and I will update the House on the progress of setting up the inquiry in due course.
I recognise that Members’ concerns about mental health in-patient facilities are not confined to Essex. The Government are committed to improving mental health care across England, which is why we are boosting mental health funding by at least £2.3 billion this year compared with four years ago, why we are making urgent mental health support available through 111, and why we are delivering three new mental health hospitals to provide specialist care and cut waiting lists.
In January, we commissioned a rapid review of how data is used in in-patient mental health settings in England. More effective use of data has the potential to reduce duplication, ensuring that healthcare professionals can spend more of their valuable time with patients. The review team—well led again by Dr Strathdee—heard from more than 300 people representing every part of the in-patient mental health sector, including former patients and frontline staff. Dr Strathdee has made recommendations for how data and evidence can be used to identify risks to patient safety and failures in care more quickly and effectively. The findings and recommendations of the rapid review will be published today, and I will deposit a copy in the Libraries of both Houses. The Government will consider its findings carefully and respond in due course.
We recognise, however, that patients and families want to know how their concerns will be taken forward as soon as possible, and I also recognise that a wide-ranging statutory inquiry relating to other settings, or covering multiple patient safety issues, would not deliver those answers quickly. My Department has therefore agreed to work alongside the Healthcare Safety Investigation Branch to prepare for the launch of a national investigation of mental health in-patient services, which will commence in October, when the HSIB receives new powers under the Health and Care Act 2022.
The new Health Services Safety Investigations Body will investigate the following themes: how providers learn from deaths in their care and use that learning to improve services, including post-discharge services; how young people are cared for in mental health in-patient services and how that care can be improved; how out-of-area placements are handled; and how to develop a safe staffing model for all mental health in-patient services. Across all those areas, it will explore the way in which providers use data. I want to reassure the House that the new body will have teeth and will work at speed, that it will have the power to fine those who refuse to give evidence when they are required to do so, and that its predecessor’s investigations were typically concluded within a year.
I hope that today’s announcements will be of some comfort to the bereaved families who have done so much to raise awareness of the failings of mental health care in Essex and elsewhere. I want them to know that the Government are committed to obtaining for them the answers that they deserve, and to improving mental health across the country. I commend this statement to the House.
Dr Rosena Allin-Khan (Tooting) (Lab)
I thank the Secretary of State for advance sight of the statement. However, it beggars belief that it has taken the Government so long to address the House on this matter. It seems that every month there are new scandals regarding needless loss of life and dehumanising behaviour in in-patient mental health settings. That must be stamped out now—these are people’s lives.
That brings me to the subject of Essex Partnership University NHS Foundation Trust. I welcome the announcement today that the inquiry will be given vital statutory powers, because for several years families who have lost loved ones at the trust have been calling for the inquiry to be given those powers. The grieving families I have spoken to have told me about the pain and anguish they have felt during their fight for answers, and that has only been compounded by an inquiry that lacked the necessary powers to seek the truth.
I must pay tribute to those families for their tireless campaigning and effort. In particular, I thank Melanie Leahy, who has fought for too long to achieve the announcement that has finally come today. I hope that Melanie, and every other family, will now start learning the truth.
Dr Strathdee has been a powerful advocate for the Essex inquiry, and we want to express our thanks to her for the work that she has already put in. The next inquiry chair must continue her work, and hold the confidence of the families who have been impacted in Essex.
I have repeatedly called on the Secretary of State to give the Essex inquiry statutory powers, and I am pleased to see that he has finally listened to our calls, but why were families left in the lurch for so long? Following months of scandals in in-patient mental health hospitals, public confidence is falling. More than one in three people say that they do not have faith that a loved one would be safe if they needed hospital mental health care, but every patient must be treated with dignity. I have repeatedly asked Ministers whether they have visited failing trusts. The Minister refused to answer, so will the Secretary of State commit himself to greater transparency? The Secretary of State has announced that urgent mental health support will be made available through 111, but 1.6 million people have been left languishing on waiting lists for mental health treatment, their condition deteriorating and reaching crisis point.
It is welcome that we will finally see the publication of the rapid review today—better late than never—but Labour has been calling for in-patient mental health settings to be reviewed in the light of these serious failings, and any rapid review should have had patient voices at its centre rather than being simply the data exercise that the Government commissioned. When we look at the planned national investigation into in-patient services that they will conduct alongside the Health Services Safety Investigations Body, we see that, yet again, there is no mention of working with patients and their families. Where is the learning? Where is the focus on what staff need in these settings? Are the Government looking at additional training needs, given that mental health care relies on staff and not simply on shiny equipment?
Let me turn briefly to the planned consultants’ strike, about which the Health Secretary has said absolutely nothing. Yet again he has been missing in action. For my consultant colleagues to have voted to strike is extraordinary, and the risk to patients of seven days of strike action is intolerable. Next week marks the 75th anniversary of the NHS, and it has never been in a worse state. The country is clear about who is to blame. It is not nurses, it is not junior doctors, it is not consultants, and it is not paramedics; it is this Conservative Government. They have lost control of the NHS, they have lost the confidence of NHS staff, and they have lost the support of the British people. The only ballot that we need now is a general election.
Steve Barclay
It is a shame that the hon. Lady chose to conclude her remarks in such a way. Let me address that head-on. It is bizarre to accuse a Minister who is literally at the Dispatch Box of being missing, particularly when the shadow Health Secretary, having managed to turn up for Prime Minister’s Question Time, has failed to turn up for this statement. It is even more bizarre that, although we are constantly told that the Labour party sees parity between mental health and physical health as a key priority, when it actually comes to debating the issue, the contrary is clearly on show.
This debate is not about the issues normally raised during Prime Minister’s questions about the politics of the day; it is about the families who have tragically lost loved ones, about how we can learn the lessons from that, and about how we can ensure that we get the data right, get the support for staff right, and get the procedures right so that other families do not suffer loss. We have responded to the excellent points made by Dr Strathdee through her rapid review about data. There are two elements to that: there is data that is collected that does not add value, is often duplicative and takes staff away from giving care—that is somewhere that we can free up staff—but there is other data that is needed to better identify issues early, and we need to look at how we improve that data. Specific issues arose in respect of engagement by staff, and we have actively listened and responded to the concerns raised by families and by many Members of the House, particularly about the Essex inquiry. I will come on to those as I go through the wider issues.
The shadow Minister mentioned speed. Of course, there is a balance to be struck between the completeness of a statutory inquiry and the greater speed that is often offered by other independent inquiries. Indeed, the Paterson inquiry was a non-statutory inquiry commissioned through the Department, and that is another vehicle that is often successfully used. There are also inquiries commissioned through NHS England, such as the Donna Ockenden review. There is often a balance to be struck between those inquiries, given the speed at which they can proceed, and a statutory inquiry, which has wider powers but often takes longer.
It was because of our desire to move at pace to get answers to families that we initially commissioned a non-statutory inquiry, in common with Bill Kirkup’s inquiry into Morecambe Bay and inquiries into many other instances in the NHS. However, we have listened to families and to right hon. and hon. Members who have raised concerns about the process and, in particular, the engagement by staff, and decided to make it a statutory inquiry.
The shadow Minister asked about our commitment to transparency. The very reason that we set up the rapid review in January was to bring greater transparency to the data. That is why I will be placing in the Libraries of both Houses the outcome of the rapid review. That speaks to the importance of transparency as we learn the lessons of what went wrong in Essex and in other mental health in-patient facilities.
The shadow Minister made a fair point about waiting times. We are committed to cutting waiting times, including in mental health. That is why we are spending £2.3 billion more on mental health this year than four years ago, we have commissioned 100 mental health ambulances, we have 160 different schemes looking at things such as crisis cafés to support people in A&E, and we have schemes such as the review through 111 and the funding the Chancellor announced in the Budget for mental health digital apps to give people early support. Of course, that sits alongside other mental health interventions, such as our programme to train more people to give mental health support in schools.
The shadow Minister made an important point about working with families. I agree with her about that. HSIB will be meeting families—indeed, Ministers have been doing likewise—and we are keen that that should feed into the terms of reference, both for the statutory inquiry and for the HSIB review.
We have touched on consultants, but let me make a final point on that. As far as I am aware, the Opposition do not support a 35% pay rise, whether for junior doctors or for consultants, but if that is their position, perhaps they will tell us whether this is yet another area that the stretchable non-dom contribution will reach to. Exactly how will it be funded?
This is a serious issue. The measures that we are taking address the concerns of families who have suffered the most tragic loss. It is important that we learn the lessons, both in Essex and more widely. We have actively listened to the points raised by Dr Strathdee, who has done a fantastic job. It is right that the work moves on to a statutory footing, but it is also right that we look more widely at the lessons from other mental health in-patient facilities. That is exactly what we intend to do.
Priti Patel (Witham) (Con)
First, let me put on the record my personal thanks to the Secretary of State and Ministers for their honest and frank engagement with colleagues and with bereaved families, whose concerns they have listened to. It was my constituent Melanie Leahy, who was at one stage a constituent of my right hon. Friend the Member for Maldon (Sir John Whittingdale), who brought the issue to our attention and to the attention of the Secretary of State. She deserves a lot of support for the way she has conducted herself. None of us would want to go through the sheer anguish and personal trauma that she has experienced. We owe a lot to her and to others who have come forward.
There are still 80-plus families who did not engage with the inquiry led by Dr Strathdee, to whom I pay tribute. The statutory inquiry will give them the confidence and courage to come forward, speak up and share what will be—we should be frank about this—deeply harrowing evidence. Will the Secretary of State expand on how evidence received by Dr Strathdee’s inquiry will be treated? I know that he said he will come back to the House on the processes. We are interested, in particular, in the inquiry’s terms of reference. Importantly for bereaved families, what measures will be in place to support people to come forward and give evidence? There have been too many barriers in that regard for families and, if I may say so, those who have been employed by EPUT. What involvement will the families have in drawing up the terms of reference? They are the ones that need confidence in the process. Again, I thank Dr Strathdee, and I thank the Secretary of State and Ministers for their engagement.
Steve Barclay
In my discussions with my right hon. Friend and colleagues, I found the compassion that they showed and the way they championed the family voice compelling. I absolutely agree that it is important that families take confidence from the decision to move the inquiry on to a statutory footing and come forward with their evidence. I know that she plays an active part in that. Of course, we want families to be part of the discussion on the terms of reference. I know that, with her significant experience, my right hon. Friend is keen to be part of that too, and we are keen to engage with her on it.
My right hon. Friend is right to highlight the evidence that has already been gathered through the excellent work of Dr Strathdee. I had a meeting with her yesterday to ensure that we capture that as part of the work that is moving forward. I hope—I reinforce my right hon. Friend’s point—that families will take confidence from today’s announcement and that those families who have not come forward to date will be able to do so. I know that in my right hon. Friend they will have a resolute champion supporting them to do so.
Rachael Maskell (York Central) (Lab/Co-op)
I, too, welcome the Secretary of State’s statement, but I am disappointed that he did not say more about the serious risks that we have raised in the House—not least about timely access to services and the significant risk that many of my constituents have faced out in the community—in respect of Tees, Esk and Wear Valleys NHS Foundation Trust, which serves York. I wonder whether he can expand on that, and on his proposals for taking things forward at the trust. I am meeting one of his Ministers next month, but I would like to hear his position on addressing the serious concerns that have been raised.
Steve Barclay
The hon. Lady raises a very valid point. There are real concerns about Tees. We considered that when considering the scope of the statutory inquiry. Given that significant work had been done in Essex, we decided to strike the balance by putting that on a statutory footing but enabling work to proceed at pace through HSIB on Tees and some other areas. The hon. Lady will know that the Care Quality Commission prosecuted the trust in May for a regulation 12 breach, and that significant work has already gone in; the report of the system-wide independent investigation was published last March. They are very serious issues on which I think there is concern across the House, and we stand ready to work with her and other elected representatives from that area as part of the wider work.
Vicky Ford (Chelmsford) (Con)
It is a deep, deep tragedy that, over the 20-year period, around 2,000 people lost their life under the care of mental health services in Essex. Families and survivors are right to want transparency and accountability. Given the slow progress of the independent inquiry, it is right that it now moves to a statutory basis.
When I spoke in Westminster Hall, I shared the testimony of a constituent who had been an in-patient in the early 2000s. She described being raped by another patient and being laughed at by staff when she asked for support. She described being able to make many suicide attempts, absconding from the ward and overdosing. She described how staff refused to treat her self-harm injuries and how she was repeatedly restrained and forcibly injected. I put on record my incredible respect for the people who are coming forward to relive their horrors and share their testimony. They are doing this because families and survivors want to know that change is embedded so that lives are safeguarded now and in the future. Will my right hon. Friend give assurance to my Essex constituents that mental health services in Essex will now be given the support they need to keep vulnerable people safe?
Steve Barclay
Having discussed that harrowing evidence with my right hon. Friend, I do not think any Minister could either forget it or not be moved. I found it an extremely moving experience to hear her talk about the experiences of a number of her constituents. She is right to praise those who come forward, and to recognise that it is often a difficult ask to relive the most awful circumstances, but it is important that families come forward so that we learn lessons and ensure this is not repeated.
My right hon. Friend is also right to highlight the two broad elements of learning the lessons of what happened in the past and maintaining services for the future. I am therefore happy to give her an assurance that we will work closely with her on support for Essex as lessons are learned through the statutory inquiry and as services continue to be delivered. We are working closely on that with the chief executive.
Daisy Cooper (St Albans) (LD)
My thoughts are, first and foremost, with the bereaved families and all those involved, because this process must be utter agony for them. It is right that the inquiry is put on a statutory footing.
In his statement, the Secretary of State quoted from a letter he received from Dr Strathdee, in which she said:
“I am very concerned that there are serious, ongoing risks to patient safety.”
The Secretary of State did not expand on that, and I do not know whether he is able to do so. If I may extrapolate, we know that, more broadly, there are risks to patient safety when there is not enough workforce and when there are not enough beds. Hertfordshire is the most under-bedded area of the country. When we see the workforce plan, potentially this week, will it include estimates of the number of qualified mental health staff we need in in-patient settings, NHS community settings and schools? Will he meet me and my local mental health trust to discuss the number of beds we have in the county and our plan to expand them?
Steve Barclay
Dr Strathdee did not particularly focus on staffing numbers, as far as I recall; she focused on some of the issues with care from staff. That was the nature of the concerns. On the ongoing risk, part of the reason why we commissioned the rapid review was to look, in particular, at the quality of data. There was a quantity of data that was not effective, and that often distracted staff from spending time with patients. There were also gaps in the quality of data that needed to be filled, and the document that will be placed in the Libraries of both Houses speaks to that point. That is why we are so keen to move at pace on learning lessons.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
I welcome that sentence and the seriousness and speed with which this is being taken forward.
As a now non-practising consultant psychiatrist, I have a variety of declarations in this area, which are best summarised in the pre-legislative scrutiny report on the draft Mental Health Bill. My constituents are waiting for the rebuild of the Abraham Cowley unit in my constituency, but the framework under which patients are looked after is very important. People in in-patient settings are, by definition, some of the most vulnerable people looked after by the NHS, and a fair proportion are a detained population. Could the Secretary of State update the House on how soon we will see the Government’s response to the pre-legislative scrutiny Committee report on the draft Mental Health Bill and when we expect the proper Bill to be brought forward?
Steve Barclay
My hon. Friend is right to highlight the importance of pre-legislative scrutiny, into which he had a personal input. I am hugely grateful for his work and the work of Baroness Buscombe and others. I met Baroness Buscombe some months ago to discuss the outcome of that pre-legislative scrutiny. I do not have a date to share today, but I am happy to write to my hon. Friend with a further update.
Florence Eshalomi (Vauxhall) (Lab/Co-op)
Many of my constituents depend on mental health services provided by the South London and Maudsley NHS Foundation Trust, which provides a range of services for very vulnerable people across a large part of south London. The in-patient service includes cleaning and catering facilities, and it is vital that those services are run well so that well-trained professional staff are able to treat mental health patients. Some of the trust’s staff are contracted to a company called ISS, and they have been on strike. Does the Secretary of State agree that ISS should come to the table and discuss the issues of the pay dispute so that staff can provide the cleaning services for mental health professionals to continue with their vital jobs?
Steve Barclay
We are investing more in mental health services as a whole, and that includes the important area of cleaning and catering services. Obviously, it would be inappropriate for me to comment on that specific contractual dispute, but industrial action, in its wider sense, is clearly disruptive and I am very keen for it to be resolved as quickly as possible, whether in the context of consultants or cleaning and catering services.
Stephen Metcalfe (South Basildon and East Thurrock) (Con)
I welcome my right hon. Friend’s statement and the move to put the EPUT inquiry on a statutory footing. He mentioned that putting it on a statutory footing means it will take longer. On behalf of constituents and those who are keen to get closure on these important issues, can he give any kind of indication of when the findings might be available?
Steve Barclay
The chair is to be appointed, and given that statutory basis and the independence of the chair, it would be wrong for me to pre-empt the terms of reference. People can look to other statutory inquiries and come to a conclusion. The inquiry is not starting from scratch, and part of the reason we originally went with a non-statutory inquiry was because of the desire for speed. Of course, Dr Strathdee has done a huge amount of work and it will be available to the new chair of the statutory inquiry. One can look to other inquiries and draw conclusions, but I would expect it to move more quickly in this instance because a significant amount of work has already been done.
Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)
I welcome the statutory inquiry, which is a step in the right direction. I also welcome the Secretary of State’s focus on families. Ensuring family involvement in the care of mental health in-patients not only improves patient outcomes but enables proper scrutiny and questioning of care. In regions such as the south-west, many patients facing the most serious mental health crises receive care outside the region, which is often a long way for families to travel. Is he considering the increased commissioning of local provision so that families can know their loved ones are being well cared for? Many families will be concerned about the statement and the experiences of patients in Essex. The right care and the best care for many patients is closer to home.
Steve Barclay
The hon. Gentleman raises an extremely important point, and he is right that a particular downside of out-of-area placements is often the distance from families. Indeed, one can see in the data that there is often a corresponding uptick in issues of harm. The crux of his point is very valid. That is why we are committed to building new facilities, with three new hospitals for mental health announced in the statement I gave on the new hospitals programme; that included three new mental health ambulances. This is also about preventing people from needing in-patient care through our crisis cafés, our earlier intervention in community services and the interplay with 111. More fundamentally, it is about giving greater power to commissioners on a place-based basis. The reforms through integrating health and social care, having fewer targets from the centre and allowing more devolved decision making mean that those areas that want to put more money into in-patient mental health, for example, have greater flexibility to do so. The point the hon. Gentleman raises is extremely important and it is exactly what we are facilitating.
Jackie Doyle-Price (Thurrock) (Con)
As my right hon. Friend observed, a non-statutory inquiry is generally more fleet of foot than a statutory one. It is so disappointing that the failure of staff to engage in that process has brought us to where we are now. That would indicate a very poor culture and sets the tone for how this inquiry will be taken forward. Let me remind him that one reason we are so anxious to get the Mental Health Act reformed is that kind of behaviour towards patients. Too many in-patient settings see patients as an inconvenience to be managed, rather than having their real welfare at heart. Will he therefore redouble his efforts to make progress on this, because many people who have been through the other side want to see that progress?
Steve Barclay
First, I do not want to wait for legislation before we make changes. Indeed, under the leadership of Paul Scott, who joined EPUT in 2020, investment has been made, with an extra £20 million being put into the in-patient wards and a further £20 million into community services. We are keen to make further progress on that. On the wider issue of legislation, I know that my hon. Friend, as a former Government Whip, is particularly acquainted with how the legislative process works, but the Government take her comments, and those of the House, on engaging staff in this process seriously, and we are working very actively on that.
Charlotte Nichols (Warrington North) (Lab)
It is vital that the Government work with sector experts and those with lived experience of in-patient mental health services in getting this vital area of policy right. As someone who spent almost a month as a psychiatric in-patient back in 2021, I know at first hand how difficult, disorientating and dehumanising these settings are, at a time when you are at your most vulnerable, and how easily things that are well-intentioned can and do go wrong. Will the Secretary of State therefore commit to working with Mind and other organisations giving patients and their families a voice to shape these improvements, to ensure that any changes happen with patients and their families, and not to them?
Steve Barclay
I very much agree on that. The hon. Lady speaks powerfully of the importance of engaging with those with experience—the charity sector, the families and those directly impacted by the decisions taken in in-patient mental health facilities. She makes an extremely pertinent point and it is very much part of the approach we are taking.
Mr Mark Francois (Rayleigh and Wickford) (Con)
I thank the Secretary of State for mentioning our great friend Sir David Amess. I am sure that, if he were still with us today, he would welcome this statement, as do I, as does his successor and, as is clear, as do all other Essex MPs. The Secretary of State has done the right thing and should be commended. EPUT has been a troubled organisation for some time, although I believe that its chief executive, Mr Paul Scott, is genuinely trying to turn it around. As we look back to find out what went wrong—some things clearly went very badly wrong—will the Secretary of State work with the chief executive, providing support and resources, not just to make sure this does not happen again, but to try to help EPUT improve in the future as well as examine the past?
Steve Barclay
I know that my right hon. Friend was particularly close to Sir David and is uniquely qualified to speak of his interest and involvement in these issues. I am happy to give him the reassurance that he seeks on working closely with the chief executive and the leadership team there. I know from my engagement with colleagues across the House that they will be closely involved in this in the weeks and months ahead.
Neil Coyle (Bermondsey and Old Southwark) (Lab)
South London and Maudsley is the mental health trust that covers my constituency. This year, as a direct result of the Secretary of State’s wider policies, SLaM is cutting £45 million from services. He has said today that he wants to improve mental health care and that he takes safety concerns seriously, but when will those words be meaningful for mental health care for patients and their families in Southwark?
Steve Barclay
The meaningfulness of those comments can be seen in the fact that we are putting this inquiry on a statutory basis; the £2.3 billion additional investment compared with what we had four years ago; the crisis cafés and the other schemes we have, as part of the 160 schemes we are bringing forward; and our willingness to innovate in mental health through the use of mental health digital apps. There is a whole range of initiatives because that is the right approach. Across the House, it has been recognised that in the past mental health did not get as much focus as physical health, which is why we are investing more. Again, the House recognises that covid has brought more focus to these issues, which is why this is a priority for the Government. Today’s statement is a further continuum in that effort.
Sir James Duddridge (Rochford and Southend East) (Con)
I thank the Secretary of State for his attitude to this issue and the time he has put in. I fully support the points he has made about non-statutory and statutory inquiries. It was right to start off non-statutory and to change when the situation changed and we were not getting what we wanted.
I reflect on the comments of my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois) about, “Where did this go wrong?” Since I first visited Rochford Hospital, part of what is now EPUT, in my constituency, I believe we have had three Secretaries of State visit, as well as at least five Ministers responsible for these areas. What was the South Essex Mental Health Partnership grew to take in more of Essex, and it then reached across the border into Hertfordshire and, if I recall correctly, went further. It perhaps just got too big. Early on, the constituents I spoke to were concerned about getting in; they wanted their children to get in, but there were delays and this was about overall capacity. Now the issue is about the quality of what goes on. The hon. Member for St Albans (Daisy Cooper) mentioned beds and I can tell her that this is not a problem of beds, certainly in Rochford Hospital, where there are plenty of beds; it is about having the clinical psychiatrists specialised in children’s services and the supporting nurses to deliver. We should also pay attention to the fact that things are much better where people have simple mental health problems, but very few people have those. When these problems are combined with drug use or autism, particular challenges are presented while people are in these places and during discharge. I urge the Secretary of State to encourage the inquiry to look into all those issues.
Steve Barclay
My hon. Friend makes extremely important points, and I absolutely agree with him. Indeed, I will draw the inquiry’s attention to the points he raises. He is right about the trade-off between non-statutory inquiries giving speed and statutory inquiries having a wider range of powers. We have followed the evidence on that, which Dr Strathdee has shared. There is also a balance between the size of a facility and the quality of the care. Data is a key component within that and the rapid review was focused particularly on it. All of us are focused on, “How do we get the best patient outcomes? Where those have fallen short, how do we ensure the lessons of that?” That is what the statutory inquiry is absolutely focused on and it is important that families then engage with it.
Kerry McCarthy (Bristol East) (Lab)
The Care Quality Commission report at the end of last year said that workforce issues and staffing shortages are the greatest challenge facing the mental health sector. I am sure that that would not have come as a surprise to the Health Secretary. The Glenside campus, part of the University of the West of England, is in my constituency, and it runs mental health training courses for nurses. What conversations is he having with the sector about how we can ensure we get enough mental health nurses trained, so that we get the right people coming through and they are encouraged to stay the course?
Steve Barclay
The hon. Lady’s point is important, given that in the wake of the pandemic we have seen significant increases in demand, particularly for children’s and young people’s services. For example, in a year, the demand increased by 41%, so there is significant demand, which places pressure on the workforce. That is why the Prime Minister and the Chancellor have committed to the long-term workforce plan, which we will be bringing forward very shortly. We have been engaging with the sector, including the mental health sector, as part of that plan. NHS England has been doing significant work on that in recent months.
Dean Russell (Watford) (Con)
The background stories to today’s announcement are truly heartbreaking, and I welcome the statutory inquiry. The Secretary of State referred to recent announcements about funding and the 111 helpline. Will he expand on what support can be accessed by people, especially young people, if they are going through a crisis right now?
Steve Barclay
It is extremely important that we get support to young people, because many mental health cases start at a young age. Indeed, data suggests that as many as 50% of mental health cases crystalise by the age of 15, so it is important that intervention is made early. Our programme in schools, for example, is focused on that. It is also important for us to have better community support, which is why we are looking at what mental health support can be offered when people phone 111 and at how we can better scale up the use of digital apps that offer support, given that people often access information through their phones or digital channels in a way that they did not five or 10 years ago.
Jim Shannon (Strangford) (DUP)
On behalf of my party, I express my sympathy to all the families who have been bereaved and hurt by what has taken place. I thank the Secretary of State for his announcement about the statutory inquiry and the new powers. It is clear to those of us in the House who listened to his statement that he is committed to making patients’ lives better; we thank him and I put it on the record that he deserves credit for that. I know that the Secretary of State is always keen to share progressive strategies and policies with the regional Administrations; he is on record as having said that. It is clear that many lessons can and will be learned, so does he intend to share them with the regional Administrations?
Steve Barclay
I am extremely keen to share our experience, so that we can learn from each other. As the hon. Gentleman knows, this is a shared challenge across our United Kingdom. The pandemic shone a spotlight on the mental health pressures that many people face, and I am extremely keen to work on a UK-wide basis with colleagues to ensure that we learn from each other as we take these measures forward.
Julian Sturdy (York Outer) (Con)
Given that a recent report into mental health services in York established that communication is a clear concern that is affecting mental health outcomes and safety locally, what specific steps would my right hon. Friend take to ensure better communication between primary and secondary care services? As we all know, that is vital in delivering faster and better outcomes for patients not only in York but across the country.
Steve Barclay
That is an extremely good point. In fact, a key element of the primary care recovery plan looks at the handover points between secondary and primary care, which are often the cause of significant additional work within primary care. We are keen to see where we can ease those pressures, which in turn frees up our experienced GPs to do those tasks that require more time, so that is part of the primary care recovery plan. Through the rapid review and the focus on data, we are better able to identify where there are gaps or areas of duplication that take clinicians away from spending time with patients. That matters both in secondary and primary care, and it is something that the rapid review has been addressing.
Peter Gibson (Darlington) (Con)
I welcome my right hon. Friend’s statement and the publication of the rapid review. While Essex is rightly getting its statutory inquiry, it appears that the situation in Tees, Esk and Wear Valleys NHS Foundation Trust will merely be covered by the new powers of the Healthcare Safety Investigation Branch. Will my right hon. Friend confirm that TEWV will be covered by the HSIB review? When can families expect to hear anything from that review? Will he keep the need for a statutory inquiry into TEWV under review?
Steve Barclay
It will be covered by the HSIB review. On how long that will take, investigations under the predecessor body typically took around a year, which is one of the advantages of the speed at which these things can be done. I hope my hon. Friend can see from the statement today that we will follow the evidence, given the decision we have taken to put the Essex inquiry on a statutory footing, but the HSIB approach has the benefit of speed. I hope that will benefit his constituents, as we learn the lessons.
It is worth clarifying that the new body will have much greater teeth, as a result of the reforms that were passed by the House in 2022. While it is not on a statutory footing, it actually has more power than was the case in the past. That is why we think it is the right approach for learning the lessons in his constituency and more widely.
Andrew Percy (Brigg and Goole) (Con)
The Secretary of State has rightly pointed to the £2.3 billion in extra funding and has reiterated from the Dispatch Box his belief that early support for children’s mental health is vital. Does he agree that this is sadly still patchy across the country? Early access to children’s mental health services needs to be a priority for all new care systems. I commend to him the approach being taken in north Lincolnshire, where that is absolutely the case and where it has been championed by the wellbeing boards and in all our health partnerships. That should be replicated across the country.
Steve Barclay
I commend my hon. Friend for the service he gives as a community first responder. Through that, I know he takes a huge interest in these matters. As with the point about data, I am extremely keen that where there is good practice, we are socialising that across the country as a whole, rather than having it in pockets. I would be extremely keen to work with him on the lessons coming out of north Lincolnshire and on how we scale that across the country, so that good practice can be adopted more widely. Indeed, the statement today is about how we will ensure that the lessons from Essex can be applied more widely, so that best practice is socialised across the country.
Madam Deputy Speaker (Dame Eleanor Laing)
I thank the Secretary of State for his statement, which will be welcomed by everyone across Essex.