Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Caroline Dinenage]

The hon. Gentleman is right: we do have a number of vacancies—a large number of vacancies—in adult social care. That is why, earlier in the year, the Government announced a recruitment campaign, “Every day is different”. It ran for a few months, with enormous success. There have been 14% more apply clicks on the relevant Government jobs site as a result, so we have just announced that we are going to expand and extend that recruitment campaign, with an additional £4 million of funding.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Among those most affected by lack of access to social care are the 2,300 autistic people and people with learning disabilities stuck in inappropriate in-patient units because of a lack of funding for community placements. Labour, my party, has pledged to spend £350 million per year to support moving as many of those people as possible into community placements. I note that the Health and Social Care Secretary actually pledged extra funding for social care if he became Prime Minister, so will the Care Minister tell us if he now promises to match Labour’s pledge and ensure that autistic people and people with learning disabilities can live in homes, not hospitals?

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 18th June 2019 Commons Chamber

[Caroline Dinenage]

The hon. Lady has often spoken very movingly in the House about her personal experiences, and she is absolutely right: abuse of vulnerable people is absolutely abhorrent. We are very determined to stop it, and we want to prevent it from happening in the first place through the tough inspection regime. We want to shut down poor-quality homes and, most importantly, we have made sure that across the country, police, councils and the NHS work together to help to protect people in the long term.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The integrity of CQC ratings was dealt a mortal blow by the uncovering of abuse at Whorlton Hall by BBC “Panorama”. Watching the abuse on that programme is made worse by the knowledge that the abuse may have started five years ago. The unpublished inspection report from August 2015 described allegations of assaults on patients, the undocumented use of a seclusion room and the use of rapid tranquilisation not backed by an organisation policy. I do not have any confidence that the review called by the CQC will uncover the truth behind that abuse. Will the Minister agree to set up an inquiry into this matter, so that we can establish whether the care regulator is fit for purpose?

[Caroline Dinenage]

The hon. Lady is absolutely right: abuse of any kind must not be tolerated, and we have heard horrific accounts of abuse that must be tackled. That is why in May, we announced much stronger commissioning oversight arrangements, where people are put in place out of area. Local commissioners must visit regularly. The CQC has commissioned two independent reviews, and the findings and recommendations of both will be published. The point is that opportunities to intervene have been missed, and we must be open and transparent in getting to the bottom of what happened.

Whorlton Hall

Baroness Keeley Excerpts

Thursday 23rd May 2019 Commons Chamber

[Caroline Dinenage]

The Care Quality Commission is taking the situation incredibly seriously. Some massive concerns were raised last night, and Paul Lelliott from the CQC apologised and said that the matter would be very thoroughly addressed and investigated by its team.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I appreciate the Minister’s response, but the Secretary of State really should be here to deal with this. The abuse shown on the BBC “Panorama” programme last night was appalling, and it should never have been allowed to happen. The fact that it is eight years since the Winterbourne View scandal and nothing has changed should be a source of shame for the Government. Rather than warm words—the Government seem to be getting good at warm words these days, but little else—will the Minister take personal responsibility and tell us what she is doing to ensure that this never happens again?

The abuse that was shown was tantamount to psychological torture, with residents sworn at, threatened and intimidated. Other residents were violently restrained or deliberately hurt by care staff. As the Minister has mentioned, other cases—such as Mendip House and Thors Park—show that this is not an isolated incident; it is part of a pattern of cruel and callous behaviour in such institutions. There is only one sure way to end this abuse, and that is to close down the institutions and move people into supported placements in the community.

Many of the people who were abused at Whorlton Hall were hundreds of miles from their families. Does the Minister recognise that cutting people off from their support networks allows such abuse to carry on without anyone noticing? Labour has pledged £350 million extra per year to ensure that people can move from such institutions and be supported in the community instead. Will the Minister match that commitment?

In 2011, the Government pledged to end the use of units such as Whorlton Hall. Eight years later, however, there are still more than 2,200 people detained in inappropriate institutions. More recent targets, which were less ambitious, were also missed. After years of broken promises, autistic people, people with learning disabilities and their families cannot trust the Government to deliver on their promises. Is it not time the Government brought in an independent commissioner to oversee the closure of such units?

[Caroline Dinenage]

I do not agree with the hon. Lady that what I have said today is about warm words; it is about action. The CQC report that came out on Tuesday was commissioned by our Secretary of State to really shine a light on the matter. We are shining a light on some of the most distressing information so that we can address it—so that we cannot brush it under the carpet and speak warm words about it. Not only did we accept all the CQC’s recommendations, but we made more recommendations of our own that we intend to put into practice.

In answer to some of the hon. Lady’s questions, I am very clear that as far as possible, people should be treated in a community setting. If they have to go into an in-patient setting, they should be as close to home as possible and they should be there for the shortest possible time, with a very clear route out and plan for their future. To help to deliver that, we have committed £4.5 billion to community funding as part of the NHS long-term plan, and I expect a good proportion of that money to be spent on investing in the community settings that we need.

[Barbara Keeley]

Why not close them?

[Caroline Dinenage]

The hon. Lady is saying from a sedentary position that we should close settings, but we are talking about very vulnerable people who have complex needs and require special care, and we need to make sure that there are sufficient services in the community to support them. It would be a complete dereliction of our duty and responsibility to take people out of one setting that is not working for them and put them into another setting that will be as bad, or worse.

National Marriage and Mental Health Awareness Weeks

Baroness Keeley Excerpts

Thursday 16th May 2019 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in this debate with you in the chair, Sir David. I congratulate the hon. Member for Congleton (Fiona Bruce) on securing the debate, and I thank hon. Members who have contributed to mark this unusual mix of Mental Health Awareness and National Marriage weeks.

Many points have been made on the value of marriage and family life, including in the excellent opening speech by the hon. Member for Congleton and by the hon. Member for Strangford (Jim Shannon)—I think I beat him by two years in how long I have been married. Happy anniversary for each of our relationships. The hon. Member for South West Bedfordshire (Andrew Selous) focused on family relationship issues and poverty, and the role of family breakdown.

In line with my brief, I want to bring this debate back to mental health, because it is Mental Health Awareness week and we could explore some issues there, too. I feel that, no matter how strong a family are, there will be times when they need support from outside—when they need the services that the state can provide to help them to cope. If those services are not there when they need them, it can cause immense strain for everyone involved. This is every bit as true for mental health as it is for physical health services.

We do not expect families to cope with a broken leg or a cardiac problem on their own, so we should not expect them to cope with depression or an eating disorder without professional support. I want to question whether we really are doing all we can for families where one child is living with a mental health condition and they need help. Whatever our best intentions, the fact is that we are not yet doing the best we can for children and families.

According to the British Medical Association, spending on mental health care equates to only 11% of our UK NHS budget, despite accounting for 23% of the burden of disease in the UK. As we know, there is increasing demand for mental health care, with patient numbers increasing across a range of conditions. It might be time to look at that number and decide whether it should be greater, particularly for children and young people. We know that one in eight five to 19-year-olds has at least one mental disorder, but that only 6% of the mental health budget is spent on services for children and young people. I believe it is time we questioned that, because such a gap has serious consequences for children and young people with mental health conditions.

Some 400,000 children and young people who have a mental health condition do not get to see a professional at all. Instead, they have to cope with informal support. More than one in four of the children and young people referred to specialist child and adolescent mental health services in 2016-17 did not have their referral accepted. As the Children’s Society analysis showed us last year—it is a very disturbing statistic—a quarter of 14-year-old girls and nearly one in 10 boys had self-harmed in a year.

I commend Sky News and their reporter Paul Kelso for a great piece of investigative work that sheds light on the experiences of children and young people in private mental health units, many of which take young people hundreds of miles from their homes and families. The report of this work was shown yesterday. One such young person is Natasha, who is now rebuilding her life after a lost decade spent in such units. Natasha has anorexia and escalating self-harm, and she hit crisis point when she was only 12. She then spent 10 years in private mental health units dotted around the country. She says she reached her lowest point in a mental health unit in a privately run hospital in Maidenhead. In that unit, she experienced brutal restraint, which she describes as follows:

“They would pin you up against the wall, smack your head against the wall, drag you across floors, wrap you round doorframes...People sat on your head and on your legs…this would be big men, not women.”

That was the unit where she said she did

“the worst amounts of self harm”

that she had ever done in her life. Despite Natasha’s history of self-harm, she was left unattended with razors and cut herself 26 times. She needed 200 stitches.

The constant threat of self-harm is a massive strain and worry for parents when their daughter is hundreds of miles away. A mother with a daughter in one of the units that was shown in the Sky News film described how when she wakes up she thinks, “Is she all right? Will she manage to achieve her self-harm aim today?” She added, “You are hundreds of miles away. If anything happened, you would not get there on time.” As the Sky News report showed, the toll of self-harm and suicide in these units is too high. Natasha explained how she lost 24 of her friends to suicide in such mental health units, including three or four in one unit alone.

Hon. Members here today will know how it feels when a desperate constituent tells us about their child’s mental health condition and the struggle they face being unable to get their child access to the services they need. This is intolerable. We have seen mental health services being underfunded—I know the Minister will tell me about the future funding that is coming in, but we have to think about where we are today—and we know that mental health budgets fell by nearly 8% between 2010 and 2015. Sadly, we are still seeing one in 10 commissioning groups unable to meet the investment standard expected of them by the Government, which means they are failing to give mental health services the funding priority they need. We must do better than that.

In 2017, Labour set out a clear plan for how we would do better than that. I want to touch on those points. Over the past decade, mental health spending has been a part of broader NHS budgets, but as budget pressures emerged, NHS trusts and commissioning groups raided their mental health budgets to prop up services elsewhere. To that end—I know the Government have not been keen on this—Labour would ring-fence mental health budgets, which is important to ensure that the money that those services need is not siphoned off to fill gaps elsewhere.

As we think about children, young people and their families, it is important that we question why only 6% of mental health spending goes to services targeted at children and young people, despite them making up some 22% of the population. Labour would dramatically increase the proportion of the mental health budget spent on children and young people.

Following on from what I said about yesterday’s Sky News programme, we would end the disgraceful practice of sending people hundreds of miles for mental health treatment when there is no good reason to do so. In the past year, sadly we have seen the number of inappropriate out-of-area placements rise from 640 to 720, despite a Government pledge to reduce their use. I see these out-of-area placements as a tragedy for families. They jeopardise the recovery of people receiving treatment and force parents and other family members to travel long distances to support the young person. With Mental Health Awareness Week, let us not persist in treating mental health as the Cinderella service of the NHS, and children and young people’s services as the Cinderella service inside that Cinderella service.

My plea is this. Let us help children and young people in need at the time of their need, rather than making them wait 18 months to get specialist support or letting them end up in very long-term placements in locked mental health units far from home. Let us do something about the fact that the number of autistic people detained in inappropriate in-patient facilities on dubious mental health grounds remains stubbornly high, and includes a rise in the number of children in what have been seen as modern-day asylums. Let us do better. We can do better than this for our children and young people and their families.

[Sir David Amess (in the Chair)]

Just before the Minister responds, I should have announced at the start that, because the second debate was cancelled, this debate could actually continue until 4.30 pm. I will leave it with hon. Members.

--- Later in debate ---

[Jackie Doyle-Price]

That is a very good point. We can expect employers to start doing things when they can see a return for themselves. It is interesting also that, as we reach higher levels of employment and as an appropriately skilled workforce is harder to come by, employers see the advantage of giving more help and support to their staff in order to retain them and keep them productive. We look forward to seeing more of that. Certainly our work through “Thriving at Work” with Mind, Paul Farmer and Lord Stevenson is designed to share best practice and encourage more.

My hon. Friend also talked about the long waits for children’s mental health services, which the hon. Member for Worsley and Eccles South (Barbara Keeley) also talked about. We have to concede that, historically, children’s mental health services have been very poorly funded and supplied, and we are dealing with the aftermath of that now. Everyone knows the extent of our ambition to deliver much improved mental health services to children and young people. However, we still have to properly address the situation that we have inherited. We are playing catch-up, but we will push forward and make sure that children have access to services. The mental health support teams are the first point of contact for children, helping them look after their own wellbeing.

[Barbara Keeley]

One interesting point, which I did not make, from the piece of work that I referred to from yesterday is that placements for children and young people in private units of the type that I talked about are more expensive. They can be £500,000, £600,000 or £700,000 a year, whereas support in the community would doubtless not be as much as that. They would not be 200 miles away from the families, and they would have the support that they need.

[Jackie Doyle-Price]

I agree completely. The reason why we have so many children in out-of-area placements—which, as the hon. Lady says, are expensive—is that there has not been sufficient support in the community. Nor has it been available early enough to give the children support. They have been badly failed. It has done them harm and made them more ill. The issue of out-of-area placements is of massive concern to me. I am making it a personal priority to fix it. I am concerned that, because it is seen as a specialised area of commissioning for NHS England, it commissions a quantum of beds, but that is what leads to them being out of area, and children are referred to them. We all know that their recovery will be much better if they are in their support networks near their friends and families.

When the system works well, it is absolutely inspirational. I visited an intensive care unit in east London last year. A young lady had come out the other side, having gone in for treatment for self-harm and anorexia. She was very clear that being able to undergo treatment while still being able to attend school was crucial to her recovery. To me, that seems compelling. I am deeply unhappy at the extent to which out-of-area placements are still being used. I am afraid there will probably be a need for them until we can be properly confident in our community services to work more effectively, but I am sure we all agree that we need to tackle it as soon as we can.

I enjoyed listening to the observations of the hon. Member for Strangford (Jim Shannon) about what makes a happy marriage. He is right that hard work is a big part of it.

The hon. Gentleman also shared the length of marriage in his family. This year, my parents are celebrating 50 years of marriage. Having lived with them for 21 of those, I have to say that that is quite an achievement. Obviously, it takes real work. As he says, quite often we do not like our partners, but clearly, notwithstanding the difficulties, they give us comfort and security. Not having a support network to rely on, whether that is a partner, wider family or friends, makes life a lot more difficult. I recognise that some relationships will be rollercoasters. Pressures, such as financial debts, can cause untold difficulties in relationships. There will be times when people need support and we need to make it easy for them to ask for it. We have heard several references to organisations that try to give support to couples, such as Relate. A problem shared is a problem halved—we need to encourage more of that.

I was horrified by the story that the hon. Gentleman shared of the couple neither of whom wanted custody of their children. That suggests that they were the product of dysfunctional families, which is another thing to consider. If we leave children to grow up in dysfunctional families, they will repeat that experience. We need to try to do better to improve the quality of family relationships, because that would be good for society. When we look at the back stories of people who end up in prison, we see that there were no end of opportunities where they came into contact with the state, either at school or in other ways. That is a failure for us and we need to tackle it.

It is always a pleasure to listen to my hon. Friend the Member for South West Bedfordshire, who really is a social justice warrior. Again, he brought home clearly the effect of the state applying process to everything and forgetting the humanity of people. We need to be more sensitive about how we intervene supportively. The institutions and the way we organise society can be excessively intimidating and formal, which is not the way to deal with people who need more emotional support. We need to think carefully about what sort of agencies should do that. The beauty of schools, and directing support via schools, is that they are not intimidating or formal institutions. Parents and children have peer support there, over and above their actual attendance, from friends and other people attending and taking their children.

We need to look at the avenues for engagement with people and make sure that they are fit for purpose, and to recognise that all Departments have a role in that. We siloise that contact. Mrs Bloggs takes little Jimmy to school, has a nice relationship and feels that they are being supported, but when she goes to the Department for Work and Pensions, she is treated as an operational performance and it is dehumanising. That is where we need to be more joined-up in the support that we are giving to families. There is a lot to learn. State institutions rely on process to ensure uniformity and fairness, but that does not always lead to good outcomes.

As my hon. Friend said, Governments are expected to do everything, but for the reasons I have outlined they are not always best placed to do that. Sometimes, rather than inventing processes and grand programmes, we should look more actively at letting 1,000 flowers bloom. Where third-sector organisations bring value, we should look at directly commissioning more services from them. That is the case in respect of mental health, because not all support for people suffering mental ill-health is clinical. Quite often, they will benefit from support that just helps them to get through life. That is something that third-sector organisations can do well. I have challenged clinical commissioning groups to look more actively at what they can do, because they will be able to deliver more care by not always relying on clinical staff.

I greatly enjoyed listening to the hon. Member for Glasgow North (Patrick Grady). He is wearing a fetching tartan and I am jealous that we have only the green ribbons. I will think about how we can outdo the Scottish tartan for Mental Health Awareness Week next year. He reminded us that it has been quite a week for mental health and mentioned the axing of “The Jeremy Kyle Show”. The incident that preceded that axing is a wake-up call; it shows that dysfunctional families have become entertainment. What does that say about how we operate as a society? I hope this gives everybody an opportunity for some self-reflection; it is not something that we should use for entertainment.

[Barbara Keeley]

I wanted to refer to what the hon. Member for Glasgow North (Patrick Grady) said about detoxifying issues, which is important. The worst thing that I have read about “The Jeremy Kyle Show” is not that it focused on dysfunctional families, but that it set people against each other in an aggressive way, so it needed bouncers and security staff on hand to part people. The programme seems to have used a toxic formula, which is something that the House could look at through an inquiry, because that could persist in other types of filming. Clearly, it has had a tragic outcome, which, given the Minister’s brief, we have to take seriously.

[Jackie Doyle-Price]

I share that view. By definition, if people are making TV that is designed to be entertaining, it will be manipulative and exploitative. A good friend of mine went on “I’m a Celebrity…Get Me Out of Here!”—not the person who was an hon. Member, but someone else. He told me in great detail about how situations were manipulated to generate conflict. Because he is already a celebrity, he is resilient and well equipped for that, but we can imagine that for people who are not, and for whom being in the public eye is new, the risk of harm is significant. I understand that the Digital, Culture, Media and Sport Committee will be looking at the issue, and I welcome that inquiry. If someone switches on the TV, there will be any number of reality TV shows on—often because, in truth, they are cheap to make. Given their proliferation, perhaps we ought to have some standards that producers should respect.

Another example—this shows how much rubbish I watch on TV—is the axing of “Celebrity Big Brother” earlier this year, or perhaps last year, because of an incident between two celebrities on it. I think the public showed such revulsion because they were celebrities whom the public perceived they knew. If it had been the non-celebrity version and they were two strangers, I doubt that there would have been the same reaction. That tells us that, actually, we have all been manipulated by it. It is only when something terrible happens that we stand back and think, “Hang on a minute, we shouldn’t be doing this.” But here we are.

The hon. Member for Worsley and Eccles South made some very fair criticisms about the challenges to children and young people’s mental health. I agree that one of the reasons that we are where we are is that, historically, child and adolescent mental health services have been far less effective than they ought to have been. I watched the Sky film that the hon. Lady referred to, and I have to say that some of the practices that were referred to in it are utterly unacceptable.

I have been very clear with the CQC that institutions that apply restraint to the extent that the hon. Lady described are totally unacceptable, and it is now being much more aggressive in implementing inspections. We will hold organisations to account. In that respect, the Bill in the name of the hon. Member for Croydon North (Mr Reed) will be a great help. We are in the process of agreeing guidance to deliver that. It will require a real cultural change, but I often say that sunlight is the best disinfectant. The best led institutions are open about when they have to use restraint and fully document it; the worst do not report it at all, and that really has to change. That is something that the CQC challenges now when it visits organisations. I want the number not only out-of-area placements, but of in-patient placements more generally, to come down. That will be a mark of success and a sign that we really are investing in improved community services for our children and young people.

The hon. Lady also referred to the appalling extent to which the young lady in the film had come across people who had engaged in suicide and self-harm. I am pleased that we now have the Zero Suicide Alliance, which is led by the fabulous Joe Rafferty, the chief executive of Mersey Care. Our ambition is to have zero suicides as a consequence of any NHS-funded care. That was launched at the end of last year, and we need to use it as a tool to drive improvements in this area.

As the hon. Lady said, we have the mental health investment standards, whereby we expect local trusts and CCGs to spend more of their budgets on mental health. She suggested that funding should be ring-fenced. I have always felt that ring-fences can be seen as ceilings. However, we are committed, through the long-term plan, to ensuring that all local commissioners abide by those standards, which are a ring-fence in all but name. We are closer than we have been on that issue.

I again remind hon. Members about the troubled families programme, which has been dealing with 400,000 families. It will be revisited next year, and we would welcome any representations from hon. Members about how we can learn from it and improve how we help families with complex needs. Obviously, we need to develop better outcomes for all family members.

Coming back to Marriage Week, we know that good quality relationships are critical for all of us, as they add to our overall happiness. As my hon. Friend the Member for South West Bedfordshire said, some people do not necessarily want their relationship to be recognised as a marriage. None the less, we all benefit from stable, loving and supportive relationships. With my suicide prevention hat on, I will say that relationship breakdown is the biggest driver of suicide. That is another reason why we should always enable people to find help when they need it.

As far as the impact on children and their life chances is concerned, we know that by the age of five, almost half of children in low-income households have seen their families break apart, compared with only 16% of children in higher-income households. As my hon. Friend said, we must address that social injustice because when relationships break down, there is a risk of poor outcomes in the long run.

I see health visitors as very important partners—I always refer to them as my army. They are on the frontline, and their contact with people is less formalised. They are the one group of people who can engage with the entirety of the family. They look not just at the baby and mum, but at dad and the siblings, too. We need to take advantage of those interventions to do better for families in general.

We are spending £39 million on the reducing parental conflict programme, which is designed to reduce conflict between parents who are still together, and work with them to strengthen their relationship, exactly as my hon. Friend the Member for Congleton wants, to help them to stay together if that is what they want. We should also recognise that separation can sometimes be the best option, particularly if there are other factors involved that can cause distress for the children. Even in the event of a separation, continued co-operation and communication between parents and their children will give advantage to the child.

Although the Government will continue to support and champion marriage, we will not discriminate against other types of families who require our support. We will ensure that parents can access help when they need it, whether they are already married and need help to sustain their partnership, are not married and wish to improve the health of their relationship, or have chosen to separate.

I turn to what we are delivering through the NHS long-term plan. The improvement in perinatal mental health services will help us to engage people when they are at risk, assess people’s circumstances, give peer support and perhaps just make a decisive intervention at a time of real stress for families, where either the mother or the father becomes ill.

The theme of this year’s Mental Health Awareness Week is not marriage but body image. The two are not entirely unconnected, because how we think and feel about our bodies obviously affects how we engage with other people. Just as we need to get real and think about working harder, not everything will be ideal. We are not all going to have a marriage that is like a fairy tale 100% of the time, and we are not all going to look like Claudia Schiffer. That is okay—that is normal—and we just need to be aware of that.

It is worrying that, according to the Mental Health Foundation, 39% of children feel shame in relation to body image. We ought to think about the causes of that stark statistic. People are bombarded with images via social media, and so on, so we need to encourage parents to spend time with their children and make sure that children know what they can realistically expect. They cannot expect to look like the doctored images that they are being shown.

That comes back to the issue of quality time. Smartphones have been absolutely revolutionary for our society. Is it not fantastic that we can find information about anything we want and contact people at any time? However, face-to-face engagement, especially between parents and their kids, is really important. I pay tribute to Frankie & Benny’s, the restaurant chain, which has said that to encourage parents to speak to their children while they are having a meal, it will give them a discount if they hand their phone over.

We are so easily distracted by time spent on a phone. The first thing I do in the morning when I wake up, and the last thing I do at night, is to look at my phone. It is not very healthy, to be honest. We need to encourage our children to have a healthy relationship with their smartphones, and the same is true for ourselves. There is no substitute for some good parent-child conversation, and that does not need to take place via WhatsApp or text.

Broader mental health support is available to people who suffer from mental health problems. IAPT provides couples therapy for depression, which is available through the NHS. That directly helps relationships.

This debate has been interesting and thought provoking, and it has highlighted many issues that, although we may agree about them, we perhaps need to be more proactive about properly addressing. They are not the easiest things to deal with, because they are about human failings, but it is good to hear that so many colleagues are bothered about them and actively think about them.

Mental health problems can affect anyone, any day of the year. Those problems have a bearing not only on the wellbeing of the individual, but on marriages, relationships and children. We must continue to work together, across Government and with our partners, to address some of those issues. As a society, we all need to be more sensitive about the stresses of particular times, such as when people experience job loss, debt or relationship breakdown, to ensure that we give people appropriate support.

I am sure we can all agree that Marriage Week and Mental Health Awareness Week provide us with excellent opportunities to bring those subjects together. I am very grateful to my hon. Friend the Member for Congleton for bringing those subjects forward for debate.

Learning Disabilities Mortality Review

Baroness Keeley Excerpts

Wednesday 15th May 2019 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the learning disabilities mortality review.

[The Minister for Care (Caroline Dinenage)]

I would like to start by restating our commitment to reducing the number of preventable deaths among those of our population with a learning disability and to addressing the persistent health inequalities that they experience. It is completely unacceptable that people in our country with a learning disability, and indeed autism, can expect a shorter life than the population as a whole.

Each and every death that might have been prevented is an absolute tragedy, and we must not compound that tragedy by failing to learn any lessons we can that might improve the care that is provided in the future. That is why the Government asked NHS England in the first place to commission the learning disabilities mortality review programme, known as LeDeR. The principle behind it is a relentless determination to learn from these deaths and to put in place changes to the way care is organised, provided and experienced, to make a real difference locally and nationally. It means challenging often deep-rooted, systematic or cultural issues that have existed for decades. It is driven by the fact that we are clear that the quality of care offered to people with a learning disability sometimes falls very short of the standards we expect, and that is simply not good enough. The existence of the LeDeR programme testifies to our commitment to address this issue so that people with a learning disability can access the best possible care and support. The annual reports published by the LeDeR programme and the recommendations it makes are all part of this.

Over the weekend, the media reported on the findings of a draft of the third annual LeDeR report, which is due to be published shortly. In making this statement, I would like to record my deep regret at this apparent leak. It is also a regret that Her Majesty’s Opposition should table an urgent question based on leaks and, indeed, that the Speaker’s Office should see fit to grant it. More generally, the House—

--- Later in debate ---

[Caroline Dinenage]

Thank you, Mr Speaker.

With regard to the LeDeR programme, I have committed in the past and will commit once again to bringing the final report before Parliament on the day of publication, which we are told by NHS England will be in the next few weeks. Members will feel as concerned as I do about some of the things in the report that have been leaked, and I will be happy to discuss the more detailed information when the report is fully published.

[Barbara Keeley]

Well, this is a mess, isn’t it? Last year, the first report from this important review was sneaked out on a Friday, in the middle of the local election results, and this year we have read about it through leaks to The Sunday Times and the Health Service Journal. The Minister says that it is a draft that is going to be published shortly; I understand that the authors handed it over on 1 March. How long does it take the Department to turn round a draft? Clearly, somebody somewhere thinks it should be out there, because somebody somewhere is leaking it. Will the Minister take responsibility for this process and ensure that future reports are published in a timely manner? I am not happy with “shortly” or “in a few weeks”; will she tell us when the full copy of the report—not just what was leaked, first in the Sunday papers and now in the Health Service Journal—will be available?

It appears from the leak that the review has been able to consider only a quarter of the premature deaths reported to it, leaving more than 3,000 families waiting for closure—it is those 3,000 families on whom we should be focusing—and that well over a third of cases do not even have a reviewer assigned to them. That shows that, as we suspected last year, the LeDeR programme is significantly under-resourced, so will the Minister pledge now to ensure that the review has the resources it needs in future?

Last year, the Government made 24 specific commitments relating to the annual report, and 15 of them were due to be completed by now. Will the Minister update the House on the progress on those commitments?

The leak tells us that the review found that in 8% of cases the care given

“fell so short of good practice that it significantly impacted on their wellbeing or directly contributed to their cause of death”.

What is the Minister doing now to ensure that no more people with learning disabilities die early because of poor care?

Lastly, and most disgracefully—I am certainly going to mention this from the leaked report—the report says that over a period of two years, at least 19 people with learning disabilities who died had “learning disabilities” or “Down’s syndrome” given as the reason not to resuscitate them. A patient having a learning disability or Down’s syndrome is not a reason to put a “do not resuscitate” order on their care. Does the Minister agree that such an approach, if it exists, smacks of eugenics and is completely unacceptable? What action will she take to ensure that it does not continue?

[Caroline Dinenage]

This is not a mess; the Department of Health and Social Care requested that NHS England commission the whole LeDeR programme. The report is an independent document, which is very important because we are talking about people’s lives and about deaths that could have been prevented. It is really important that the work is done by an independent group and that it is carefully scrutinised, and that that scrutiny and work to look at the recommendations—[Interruption.] If the shadow Minister would like to bob up and ask some questions, I will happily answer them, but if she is going to keep murmuring from a sedentary position, I will not be able to address anything that she says.

It is so important to do this process in an independent way, because we are talking about people’s lives. NHS England says that the LeDeR report has not been published yet because it contains some serious recommendations, as have other such reports, and NHS England needs to make sure that the correct people will be responsible for implementing those recommendations and that the document can be scrutinised in the correct way before it is published. I understand that the shadow Minister is always keen to get things published as quickly as possible, and not always with the benefit of their being done as thoroughly as possible, but in this case we will not be pushed. This is an independent document and I cannot control when it will be published, but the shadow Minister can rest assured that when it is published, I will be happy to answer any questions that arise from it.

Members will feel, as I do, that recent press reports are a clear indication that we need to do more on this, and I assure the House that we recognise that. The LeDeR programme confirms how seriously we take the issue of premature mortality and differences in life expectancy. We will continue to work with partners across Government and throughout the health and social care system to consider any recommendations that improve care for people with learning disabilities and autism and address the shameful inequalities that they experience. Everybody has a right to expect effective, compassionate and dignified care. If someone has a learning disability, their expectations should be no different.

I have already stated that I do not intend to comment on the specifics of the leaked bits of the document, which is independent and has not yet been published. However, like other Members, I am particularly concerned about any suggestion that doctors have recorded learning disability or Down’s syndrome as the reason for a “do not attempt cardio-pulmonary resuscitation” order—a DNACPR, as they call it. People with a learning disability have exactly the same right to enjoy a meaningful life as everyone else, and their disability should never, ever be used as an acceptable reason for a “do not resuscitate” order. We are taking immediate steps to ensure that doctors are reminded of their responsibilities and avoid any form of discrimination. [Interruption.] The shadow Minister says from a sedentary position that doctors should not need reminding. That is the whole point of commissioning the LeDeR review. Sometimes there are systematic or cultural ways of going about things in everyday life, whether in the medical profession or anywhere else, that mean people are not treated with the dignity and respect that they deserve. The whole point of the LeDeR review is to learn from every single preventable death and to make sure that no one else suffers in the same way.

The LeDeR programme published its second annual report in May 2018, and the Government’s response, which we published in September 2018, set out a range of actions for the Department of Health and Social Care, NHS England and other national partners to help to reduce premature mortality and improve outcomes for people with learning disabilities. Many of those actions have now been completed—for example, we recently closed our consultation exercise on plans to introduce mandatory training in learning disability and autism awareness for health and care staff, and we will set out plans to move forward on that later in the year.

The latest report will no doubt reinforce what we already know: that the Government and our health and care system need to do more to ensure that people with a learning disability receive good-quality, informed and safe care. There has been a significant improvement—there has been a tenfold increase in the number of LeDeR review cases that have been covered, the backlog has improved, and in 2018-19 NHS England invested an additional £1.4 million to support the local teams to accelerate the process, as well as to train 2,100 experts to carry out reviews. The process is new, but we are pushing forward and putting in the necessary resources to make sure that we deliver on time. The LeDeR programme is there to help to achieve what we have set out, which is to make sure that those with a learning disability should never expect to receive worse health outcomes. We will respond to the full version of the report as soon as it is published.

Health

Baroness Keeley Excerpts

Tuesday 14th May 2019 Commons Chamber

[Mr Speaker]

The hon. Member for Scunthorpe (Nic Dakin) does not need to raise his hand as though he were in a classroom. I can see him clearly, he is unmistakeable and we will come to him ere long.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

On a point of order, Mr Speaker. I raised a point of order yesterday highlighting the fact that the annual report of the learning disabilities mortality review has not been published despite its being handed over by its authors on 1 March and being leaked in The Sunday Times this week. Now we have leaks not only of details from the report about the deaths of people with learning disabilities who had a do not resuscitate order placed on their care, but of the full recommendations of the report in the Health Service Journal.

It is a pity that the Under-Secretary of State for Health and Social Care, the hon. Member for South Ribble (Seema Kennedy), has left her place before I have finished this point of order. Ministers do not seem to care about this report, which deals with the deaths of 4,300 people with learning disabilities.

Have you had notification that the Secretary of State has finally decided that this vital report is too important to have published by selective leaks, or has he indicated that he will come to the House tomorrow, as he should, to make a statement on this report?

[Mr Speaker]

I am grateful to the hon. Lady for her point of order. The short answer is that I have received no indication from any Minister of an intention to come to the House to make an oral statement on this matter. I note what she says about leaks to the media of sections and parts, even substantial elements of the report. That is not conducive to the best public debate, it has to be said. I know not how those leaks occurred: it is not the first time and it will not be the last.

If the hon. Lady is concerned that these matters should be aired in the Chamber, there are options open to her and she will have to reflect on that. I certainly have no aversion whatever to a proper focus on that important matter, affecting very many vulnerable people indeed, in the Chamber. Knowing her as I do, I have a feeling that I will probably hear further from her.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 7th May 2019 Commons Chamber

[Caroline Dinenage]

That is a really good point. We all know that access to respite care can be incredibly valuable, both for autistic people and their carers and their loved ones. That is why we are supporting CCGs that want to invest in respite care, and we are looking more carefully at how we can direct funding to these important services.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Eight years after the Government pledged to move autistic people out of in-patient units following the Winterbourne View scandal, there are still 2,260 people in such units, many of whom are subject to restraint, over-medication, seclusion and even neglect. Rather than reviews and warm words, will the Secretary of State now act to change things by matching Labour’s pledge of £350 million of extra funding to move autistic people and people with learning disabilities back into the community where they belong?

[Caroline Dinenage]

Of the original 2015 cohort that the hon. Lady mentioned, 6,325 people have been discharged and 476 beds have been decommissioned, but the thing is that people are still coming in. The only way we can achieve permanent, long-term cuts is if we invest in community health. That is why the long-term plan commits to an extra £4.5 billion a year for community health. Local providers are expected to use some of that to develop the right specialist services in the community to reduce avoidable admissions.

Mental Capacity (Amendment) Bill [Lords]

Baroness Keeley Excerpts

Ping Pong: House of Commons
Tuesday 2nd April 2019 Commons Chamber

[Caroline Dinenage]

The code of practice is being worked on as we speak. It is very important that we take it forward in partnership with all the key stakeholders and those who are involved at the front end implementing the liberty protection safeguards. Once we are all content that the code of practice is robust and fully covers everything that we want it to it will then be presented to both Houses of Parliament.

This will mean that the definition will be considered regularly. It will remain up to date with evolving case law. It means that we are laying a report of the review before Parliament and that there will be a review within three years of the measure coming into force to ensure that it is working as intended. The review will extend to all the guidance related to the liberty protection safeguards contained in the code of practice and not just the definition. By regularly reviewing the code in this way, we will ensure that there is up-to-date guidance for people and practitioners and this will support the successful operation of the liberty protection safeguard system.

The amendment will ensure that the code clarifies when a deprivation of liberty does or does not apply and provide useful guidance for families, carers and professionals while also ensuring that we do not put a definition in statute that conflicts with article 5 of the convention and I ask the House for its support in this.

I shall briefly turn to Lords amendment 25A, which was tabled in the other place with the admirable aim of ensuring that the authorisation record is provided to the individual and other relevant persons in a timely manner. This followed the Government amendment that clarified the responsible body’s duty to provide information to the person and other relevant persons. Noble lords amended the Bill to specify that a record must be kept if the authorisation record is not provided immediately. If the authorisation record is not provided to the person within 72 hours then a review must be conducted.

The Government agree that it is very important to make sure that the authorisation process record is provided quickly. However, there are some issues with Lords amendment 25A that need to be addressed before it can be put into statute. For example, it does not make a specific person or organisation responsible for recording that an authorisation record has not been provided for completing a review, so the duty cannot be enforced. Government amendment (a) in lieu of Lords Amendment 25A states:

“After authorisation arrangements, the responsible body must, without delay, arrange for a copy of the authorisation record to be given or sent.”

Government amendment (b) in lieu will ensure that if the responsible body has not done this within 72 hours of the arrangements being authorised, it must review and record why this has not happened. Providing information, including in the authorisation record, is so important to ensure that people are able to exercise their rights. The Government have listened and reflected on the concerns of the other place and have brought forward this amendment. I ask that the House supports it.

Finally, I take this opportunity to put on record my thanks to the Members of both Houses. We set out to consult very widely on this piece of legislation and to listen very carefully to the concerns of both Houses. Both Houses have very carefully scrutinised this crucial piece of legislation. I also thank many of the stakeholders who have supported its development. I thank the Bill team, particularly the Bill manager Sharon Egan, and officials across the UK and Welsh Governments who have worked with the team to deliver this reform. I thank, too, the legal team and my private secretary Flora Henderson. It is through a great deal of dedication and hard work that we will be able to rectify a failing system and provide protections to the 125,000 vulnerable people for whom it currently falls well short.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

When we last debated this Bill, I was clear that Labour did not think that the Bill was adequate to become law. The Minister has just expressed her thanks, but we did make it clear that it contained a number of serious flaws and this still remains the case. While improvements have been made in the House of Lords, they do not fix many of the concerns that we still have with this Bill.

The Bill still places more power than it should in the hands of care home managers. From organising assessments to carrying out consultations with the cared-for person, the Bill means that an untrained, or an ineffective, care home manager could end up carrying out the process in a flawed or improper way.

Recently, there was a focus on the scandal of abuse that happened at the Mendip House Care Home in Somerset, with six autistic residents with complex needs. The Safeguarding Adults Review carried out by the Somerset safeguarding board revealed a host of management failures by the National Autistic Society. The registered manager of that particular care home did not address the unprofessional behaviour of a thuggish gang of male staff. This resulted in the following abuse being meted out to the residents of Mendip House: they were “ridden like horses” by staff; forced to crawl on all fours; made to eat raw chillies; and, in one horrific instance, forced to eat food spiked with mustard, which caused the resident to vomit. The resident was then made by a member of staff to drink that vomit.

People living in Mendip House had complex needs and all would have lacked capacity to make certain decisions and all required deprivation of liberty safeguards. The Care Quality Commission had not receive any notifications that DoLS had been authorised. On care planning and recording, the review report on Mendip House states:

“Care plans were very poor with no mental health or Best Interests assessments recorded... DoLS not being followed.... recording poor, plans out of date...”

The Minister has previously said that, through this Bill, the Government

“are ensuring that people’s wishes are always considered and respected, and that people are safe, cared for and looked after.”—[Official Report, 18 December 2018; Vol. 651, c. 757.]

But I have just cited a case where the care home manager neglected both care planning and safeguarding, so what steps will the Minister take to investigate what happened at Mendip House? Will she ensure that such behaviour does not continue under the provisions of this Bill, given that so much power is given to care home managers? Today is World Autism Awareness Day, and we must do more than pay lip service to showing solidarity with autistic people.

--- Later in debate ---

I listened carefully to the shadow Minister, who discussed how to regulate care homes and to ensure that standards are applied. I am not suggesting that every consultation should be carried out by someone from the local authority. Indeed, as I said at an earlier stage of the Bill, it may be more appropriate for a carer who knows the person well to carry out part of the consultation rather than having someone turn up from the council. Again, this is about how to ensure that appropriate standards are maintained. I will keep to the amendments, but we could have a longer debate about how to ensure that regulatory standards are where they need to be.

[Barbara Keeley]

In the example I gave, residents who had lived in a care home for a long period had a manager who did not keep their care plans or any documentation, and they suffered terrible abuse. Such things do go on, and I am still concerned that we are giving responsibility to people who are already overstretched and may not be doing or may be unable to do a good job.

[Kevin Foster]

I accept the point. However, the hon. Lady’s example is not just about standards being ignored, because there was a raft of, bluntly, criminal behaviour and abuse. If we were having a longer debate about care homes and the regulatory system, we could look at whether having the Care Quality Commission cover such a wide range of areas is the best way of ensuring that such things do not happen, but Mr Deputy Speaker is always keen for us to stick to the topic of the debate.

The amendments relating to Lords amendment 1B are appropriate and slightly better than the original, and the amendments relating to Lords amendment 25A make eminent sense. It makes sense to record why something has not happened, because if there are concerns about the management of a care home, there should be a duty to record why something was not done, not just to review it. The management could in theory say, “I’ve reviewed it, but I didn’t record what I’ve concluded,” or try to come up with a conclusion later.

--- Later in debate ---

[Helen Whately (Faversham and Mid Kent) (Con)]

It is always a pleasure to follow the hon. Member for Strangford (Jim Shannon), who makes such thoughtful contributions. I will be brief, as we appear to have a large amount of consensus on this piece of legislation.

First, I want to pay tribute to my hon. Friend the Minister for the work she has done on the Bill, her extremely consensual approach to it and the way she has listened to concerns from Members on both sides of the House and consulted stakeholders widely. It has been a real pleasure to work with her on the Bill, and I thank her for that.

This Bill is critical because it concerns some of the most vulnerable people in our society. We have talked about the fact that there are 125,000 people waiting to be processed for deprivation of liberty orders, and the system is not working, but there are 2 million people who have impaired mental capacity in the country, and we need to get the system right for all of them, not just the 125,000 who are being let down by the current system.

It is also important to say that the Bill builds on more than three years of work and the recommendations of the Law Commission. It has been fully scrutinised by the Joint Committee on Human Rights, and the other place has contributed to it, as have members of the Bill Committee. I have received many emails in support of the fact that it introduces a better system, gets rid of the bureaucratic box-ticking exercises in the old system and should be better for both the individuals who are deprived of their liberty and their families.

[Barbara Keeley]

The work that was done for three years was on a 15-clause Bill that is not this Bill. We discussed that plenty of times in Committee. I think it only fair to be accurate. This five-clause Bill is not the Bill that was consulted on, and it is not the Bill that had three years of work. It is not correct to claim that it is. We spent a lot of time in Committee trying to put right the things that were missing and taken out of the earlier 15-clause Bill, and it is better to be accurate about that.

[Helen Whately]

I thank the hon. Lady for her intervention. Broadly, I was attempting to say that a significant amount of work has gone into this. I have heard overwhelmingly from those working in the sector about the importance of doing something about the current situation, because it is not working and cannot be allowed to continue. This is urgent.

It is right that the NHS and social care providers will be given a bigger role in the decision-making process, so that people under their care receive better care and their rights are protected. The fact that we have people outside the system unprotected at the moment clearly cannot be right and cannot continue. During the passage of the Bill, I raised concerns about how it will work for people with fluctuating conditions, and I have been reassured by the Minister that responsible bodies will be required to keep individuals’ circumstances under review. I welcome the fact that there is further detailed guidance on fluctuating conditions in the code of practice.

I turn to the amendments and particularly the debate about the best way to define “deprivation of liberty”. It feels like a sensible conclusion has been reached in order for us to move forward, with a plan to develop the definition further through the code of practice. These things evolve and are extremely complex, and we need a flexible system that meets the needs of our society.

To sum up, the old system is not fit for purpose. The Bill makes important and timely amendments. It is better for individuals and all those around them to ensure that they have appropriate protections for the very serious matter of depriving individuals of liberty.

Question put and agreed to.

Resolved,

That this House does not insist on its amendment 1 to which the Lords has disagreed, and disagrees with Lords amendment 1B proposed in lieu, but proposes amendment (a) to the Bill in lieu of the Lords amendment.

Resolved,

That this House disagrees with Lords amendment 25A proposed to its amendment 25, but proposes amendments (a) and (b) to its amendment 25 in lieu of the Lords amendment.—(Jo Churchill.)

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 26th March 2019 Commons Chamber

[Matt Hancock]

My right hon. Friend is absolutely right to raise this. There has been a rise in opioid-related deaths, and we need to work across government to tackle the problem. Public Health England is reviewing prescription drug dependence, including opioid dependence, and we recently announced a review of over-prescription in the NHS to make sure patients are taking the right medicines for the right amount of time.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

There are still 2,295 patients who are autistic or who have learning disabilities in hospital in-patient settings, despite a Government pledge in 2012 that no one would be in inappropriate settings by 2014. In 2015, the Government said they would close up to 50% of these in-patient places, and they failed to meet that pledge, too, because of a lack of social care funding. Will the Secretary of State now commit to proper social care funding for this programme and renew the pledge to end the misery of these placements by 2022?

[The Minister for Care (Caroline Dinenage)]

The NHS long-term plan has made it clear that learning disability and autism are one of the key clinical pillars in its absolute priorities. This transforming care work is incredibly important. Where people need access to in-patient services for assessment and treatment of their needs, it has to be for as short a time as possible, it has to be as close to home as possible and it has to be with a very clear discharge plan in place.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 19th February 2019 Commons Chamber

[Caroline Dinenage]

First, I welcome the hon. Gentleman to his new location in the Chamber. From that location, he might recognise that actually, there has been a failure of successive Governments to get to grips with this very thorny issue of the long-term funding of adult social care. We are the Government who have decided to tackle the issue. We will no longer put it in the “too difficult” pile, and we will be publishing this document shortly.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

But the Government are not tackling the problem of the long-term funding of social care, are they? Age UK found that 50,000 people who had applied for social care had died waiting in vain for that care in the 700 days after the Government first announced their Green Paper. How many more people will have to die waiting in vain for social care before the Government fix the crisis they have created?

[Caroline Dinenage]

I cannot stress enough how much money we have made available. The Government have given councils access to almost £10 billion—a 9% increase—to address this issue. Local authorities have a statutory duty to look after the vulnerable, the elderly and the disabled people in their area, and we have given them access to the funding to do it.