Oral Answers to Questions

Dan Carden Excerpts

Tuesday 11th July 2023 Commons Chamber

[Dan Carden (Liverpool, Walton) (Lab)]

17. What steps he is taking to ensure that people in care settings are permitted family visits.

[The Minister for Social Care (Helen Whately)]

I know how important it is for people in care homes, hospitals and hospices to see their family and friends. The majority of health and care providers follow national guidance. I do not want anyone to worry about not being able to visit a loved one, which is why in June we launched a consultation to change the law on visiting.

[Dan Carden]

As the Minister knows, last month I introduced my ten-minute rule Bill, the Care Supporters Bill, to make sure that we recognise in law the value of the care of a loved one. Will her consultation differentiate between a care supporter and a visitor? Currently, the Care Quality Commission does not investigate individual cases. Will it have the power to do that in future?

[Helen Whately]

First, I commend the hon. Member for his campaign on this issue. He has been a powerful advocate and draws on his own experience, as do I. He is probably asking me to pre-empt the outcome of the consultation. I encourage him and others concerned about this matter to put their views into that consultation, and we will respond once it is closed.

Mental Health Treatment and Support

Dan Carden Excerpts

Wednesday 7th June 2023 Commons Chamber

[Dr Allin-Khan]

I will take no lectures from the hon. Member, because he proudly sat as a Member of a Government who oversaw hundreds of thousands of unnecessary deaths. Families are still feeling the ongoing mental effects of losing loved ones because of the mishandling of the pandemic by his then Government.

My right hon. and learned Friend the Member for Holborn and St Pancras (Keir Starmer), the Leader of the Opposition, launched Labour’s mission for health in May. He said:

“Suicide is the biggest killer of young lives in this country, the biggest killer. That statistic should haunt us, and the rate is going up. Our mission—must be and will be—to get it down.”

He is right. Across the House, we are increasingly hearing brave, moving and revealing testimonies about our own experiences and struggles. It is vital that we challenge the stigma and talk openly about mental health.

[Dan Carden (Liverpool, Walton) (Lab)]

My hon. Friend and I have worked on these issues over the last couple of years. She knows that 70% of people who enter treatment for alcohol issues also experience trouble with their mental health. The Public Accounts Committee recently released a report on alcohol treatment services, and recommendation 4 called on the Government to set out, without delay

“what it is doing to help improve integrated care for people with co-occurring alcohol and mental health problems.”

Will she use her position today to encourage the Government to act on that recommendation?

[Dr Allin-Khan]

I could not be more proud to work with my hon. Friend in this space. He is a powerful advocate and I wholeheartedly support all his efforts, and those of Members across the House, to support people who are living with alcoholism, and their families. I thank him; we will continue to support his work.

Covid Pandemic: Testing of Care Home Residents

Dan Carden Excerpts

Wednesday 1st March 2023 Commons Chamber

[Helen Whately]

My hon. Friend is 100% right. The context is absolutely important as part of this conversation. It was a global pandemic about which very little was known and about which we worked incredibly hard to find out more, and on which we continually made the best possible decisions in the light of the information that we had. At all times, we prioritised protecting people and saving lives, particularly those who we learned would be most vulnerable. It is extremely disappointing to see an attempt to play politics with this issue.

[Dan Carden (Liverpool, Walton) (Lab)]

Care home residents and their families were failed not just at the beginning of the pandemic but in the months and years that followed, as families and loved ones were prevented from visiting. The leaked WhatsApps show that the Minister was arguing against the ban on visiting. Can she say why the ban was sustained for so long throughout the pandemic, and what plans she has to ensure that families with loved ones in care homes have the right to visit if this ever happens again?

[Helen Whately]

I know how strongly the hon. Member feels about this. Clearly, we are having ongoing conversations about visiting in care homes at the moment. As is evident in the WhatsApps, I was concerned during the pandemic about ensuring that families were able to see loved ones in care homes. As I have said in response to a number of questions, public health advice had to be taken into account all the way through the pandemic. Getting the right balance between protecting people from the risk of covid being taken into care homes and seeing friends and family will, I am sure, be looked into as part of the public inquiry discussions to answer questions such as his about the decisions taken on visiting. I will continue to work with him here and now to ensure that those who are currently in care homes get the visiting that they need.

Contact in Care Settings

Dan Carden Excerpts

Thursday 27th October 2022 Commons Chamber

[Dan Carden (Liverpool, Walton) (Lab)]

I beg to move,

That this House has considered the matter of guaranteeing the right to maintain contact in care settings.

After much delay due to circumstances out of our hands, I am grateful that we now have the opportunity in this Chamber to debate this incredibly important issue. I thank the Backbench Business Committee for its efforts in finding us time to speak about this in the Chamber today. I also want to extend my gratitude to the hon. Members for Chatham and Aylesford (Tracey Crouch) and for St Albans (Daisy Cooper) and the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) for their steadfast and resolute support and advocacy on this matter throughout.

People across the United Kingdom are still having to face their time in hospitals, care homes and other care settings completely alone and detached from the people they hold dearest. They are some of the most vulnerable and frail people in our society; some of them will be nearing the end of their lives. The devastating impact of this isolation and of denying contact with loved ones affects those in receipt of care and also their loved ones. It is difficult to imagine, unless we have personal experience, the anguish, pain and stress of not knowing when we will next see our loved one—our husband, wife, mother or father—and repeatedly asking ourselves, “Are they okay? Are they comfortable? Do they even know that I care?”

That same anguish and pain is experienced by the individual receiving care, not understanding why family or loved ones are not able to visit. Shirley from my constituency said:

“My father forgot I was his daughter during the period I was unable to visit. When I was finally able to visit, my dad was unrecognisable. It broke my heart. He has never recovered.”

The support and care given by partners and by parents and children is not an optional extra: contact with loved ones is absolutely vital to dignified care. This point was also made by the 363 members of the public who in the last few days alone provided written evidence for this debate, and I want to thank them for their brave contributions and the Chamber engagement team for collecting them.

Throughout today’s debate we will hear further personal experiences from across the Chamber, but I hope the House will not mind if I take a moment to talk about my own family’s experience last year. My mother and brother contributed a few words, too, and I am grateful to have the opportunity in the Chamber to express them.

My father, Mike, died last year: he was diagnosed with lung cancer in February and died in December. Like many people undergoing cancer treatment, one evening he suddenly became unresponsive and we had to rush him to A&E. At the hospital, it was confirmed that he had sepsis, and he was therefore isolated in a side room on the A&E ward, which was overrun with patients on beds or trollies in the corridor. My dad was in an A&E side room for three days, during which time he did not receive any hot food, he was not showered or washed, nor assisted to change his clothes, and he was unable to get help to go to the toilet. Instead, he was given cardboard containers which were often left full on his bed table for days despite regular requests that they be taken away and replaced. Throughout this time, he had no means of contacting us, because there was no phone signal where he was and he could not access the wi-fi despite repeated attempts.

There were other occasions: once he had to be moved to a ward, when he was left with his emergency buzzer out of his reach; and one time he could not breathe and began to panic, and he phoned my mum, who was unable to get through to the ward by phone and therefore rushed to the hospital. After these experiences he told us that he had felt so lonely and neglected, and unable to alert anyone to his basic needs, and my dad was a man who never liked to make a fuss.

The hospital policy at the time was that visitors were only allowed for patients in end of life care. The NHS website defines that as follows:

“End of life care is support for people who are in the last months or years of their life.

End of life care should help you to live as well as possible until you die and to die with dignity. The people providing your care should ask you about your wishes and preferences and take these into account as they work with you to plan your care.

They should also support your family, carers or other people who are important to you.”

However, at the time, the hospital defined end of life care differently and restricted visiting rights to those patients who were “actively dying”. In other words, they were displaying the physical symptoms of dying.

My mum said:

“This meant that instead of being able to focus on caring and supporting my husband through his final weeks, we had to battle with the hospital to see him. The trauma of my husband’s death—and in particular the neglect he experienced in his final weeks of life—remain with me. It is almost exactly one year since Mike was admitted to hospital, where he spent the last month of his life, and I am still overwhelmed each time I attempt to talk about what he went through.”

I turn to the words of one dementia sufferer, who said:

“I’d forget that I had an allergy, but my daughter was there to correct me. If alone, I would simply have said I didn’t have an allergy—that could be so dangerous.”

The lack of input from the family and friends of those receiving care—the people who know them best—leads to much worse outcomes.

In March, we invited affected constituents to an event where they could share their experiences with parliamentarians on the estate. The testimonies that we heard were harrowing, and the collective trauma was palpable. To give just one of the contributions from that day:

“Sitting with my mother’s body was the longest time I had been allowed to spend with her since she had entered the care home 16 months before.”

That powerful event left those hon. Members present united in the view that a legal right was needed to secure the right of care users to nominate an individual to provide support or care in all circumstances. Many of us at the event were disappointed by the response of the Government and the Minister for Care.

Since the event, 60 Members sent a letter to the right hon. Member for Bromsgrove (Sajid Javid), who at that point was Secretary of State for Health and Social Care, pushing for codification—a legal right to be put into law. We were again left disheartened by the Minister’s response. While we were told that the Government were committed to ensuring that care home residents had access to the support and companionship that loved ones bring, there was no answer to our request for a meeting or consideration of our proposals. Understandably, the campaign groups felt ignored once more. I hope that the Minister will not leave those affected feeling the same way.

The problem is not exclusive to the coronavirus pandemic. There are still rigid restrictions on visiting as well as shocking instances of denying contact. Another of my constituents reported:

“My family and I have never been allowed into the care home that he now resides in. Restrictions have caused unnecessary stress and anxiety to my family and I.”

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

The hon. Member is making an excellent speech. Does he agree that now is exactly the time that we should be considering this matter, because, as we go into the winter, many care settings will be considering the option of imposing restrictions, and guidance alone has proven insufficient? That is among the lessons that we should have learned over the last two years. The Government should now be acting.

[Dan Carden]

I am grateful to the right hon. Member for that intervention. The Government have previously pointed to guidance as a defence against bad practice, and we have enough evidence to show that that is not good enough. Indeed, while there are excellent examples of good practice across the sector, significant levels of uncertainty and variability throughout the system seriously undermine the rights of individuals. The guidance leads to a postcode lottery as separate settings interpret guidance differently.

That difference is compounded by the response of the Care Quality Commission, which is an organisation that many have had difficult and negative interactions with. The Government encourage those affected to report care providers who do not meet the guidance to the CQC, but by then it may be too late. The poor response is not because the CQC ignores complainants, although there was evidence of that as well, but that it simply does not have the proper powers or data to support people who have their access rights compromised. In the CQC’s own words:

“We do not have the power to require care homes to report live data on levels of visiting, neither do we have the power to take action against those care homes that are not reporting changes to their visiting status to us.”

The CQC, which regulates all health and care services in England, bases its enforcement action on the capacity tracker. However, providers are not obligated to use the tool—they are merely encouraged. That has led to very little, if any, clarity on the true extent of the problem.

By comparison, in Scotland, the National Care Service (Scotland) Bill, places a duty on Ministers to require providers to comply with any direction made regarding visiting. What assessment has the Department made of the Bill and would it be minded to introduce similar provision in England? The evidence suggests that the only way to guarantee contact in care settings is a legal right to an essential care supporter. An essential care supporter would be able to visit or accompany a person in any health and care setting to help communicate their wishes and needs, and to ensure they receive the correct care. If the Government are serious about their support for these calls, if they are serious about acting in the interests of families and loved ones, if they are serious about balancing clinical restrictions with the impact of restrictions on residents’ health and human rights, then I ask the Minister to immediately consider how to put that into law.

I cannot think of any other issue that commands such unanimous cross-party support. Indeed, as my right hon. Friend the Member for Leeds Central (Hilary Benn), who I know supports these calls wholeheartedly, said at our meeting in Parliament:

“How can anyone be opposed to this?”

There are also 35 organisations in this area who support these calls, including Mind, Mencap, Disability Rights UK and Dementia UK. The new Secretary of State for Health and Social Care, the right hon. Member for North East Cambridgeshire (Steve Barclay), has previously signalled support for this right. We are ready and willing to work with the Government to make this legal right a reality as swiftly as possible. The Joint Committee on Human Rights has also been unequivocal in its call for legislation in this area. In its report from July this year, “Protecting human rights in care settings” it stated:

“The Government must introduce legislation to secure to care users the right to nominate one or more individuals to visit and to provide support or care in all circumstances, subject to the same infection prevention and control rules as care staff.”

We have not yet had a response from the Government to that report, so may I ask the Government Minister to take that up? We have opportunities in the draft Mental Health Reform Bill and the Bill of Rights to codify this right. The Government could also introduce secondary legislation, which I know campaigners are in favour of. Will the Minister meet me, others and the affected families as soon as possible to discuss making this right as strong and effective as possible? The Government have previously said that legislative options are under active consideration, so please can the Government give much more specific detail on what that actually means?

I want to finish by paying tribute to the tireless campaigning of organisations in this area, in particular the Rights for Residents campaign group, the Relatives and Residents Association and John’s Campaign. The work of Jenny Morrison, Diane Mayhew, Helen Wildbore, Julia Jones, Nicci Gerrard and Kate Meacock has been absolutely inspirational, and they are all in the Public Gallery today watching this debate. Their dedication to this campaign has been phenomenal. I pay tribute to them. In the face of immense loss and personal grief, they have shown incredible selflessness and service to guarantee that no other family member will have to endure the pain of being denied contact again.

Families do not deserve any further delay; they have suffered enough. We must learn from this trauma and bring in legislation. I hope that when the Minister rises to give the Government’s response, she will agree and set out the steps that we can take to get this right.

[Mr Deputy Speaker (Mr Nigel Evans)]

Deepest condolences on your loss, Dan.

I call the debate’s co-sponsor, Tracey Crouch.

--- Later in debate ---

[Dan Carden]

I am grateful to you, Mr Deputy Speaker, for chairing the debate. I was watching the faces of the campaigners in the Gallery, who I am sure wish they had a voice in the Chamber. Having said that, I will take the Minister at her word. It may have been a bit much to ask that, on her first day, she would commit to legislation, but she knows that the campaigners will not be going away and that I and other hon. Members will continue to make their case.

We must put right what has gone wrong during covid. Loved ones are an essential part of care and, as many colleagues have said, there is an easy solution: essential care givers and loved ones should be treated in the same way as staff. The only way to resolve the situation is for this place to put a right in law through legislation. I think that we can all agree on the principle that, whether it is the state, a privately run care home or a hospital, it does not have the right to separate family and loved ones. The right to visit a loved one in a care setting is one that we should all enjoy across the country.

[Mr Deputy Speaker (Mr Nigel Evans)]

It has been a privilege to chair this emotional and effective debate.

Question put and agreed to.

Resolved,

That this House has considered the matter of guaranteeing the right to maintain contact in care settings.

Government Action on Suicide Prevention

Dan Carden Excerpts

Wednesday 8th June 2022 Westminster Hall

[Kerry McCarthy]

I thank my hon. Friend for his intervention. I know there was a very good debate in this Chamber yesterday morning, which unfortunately I could not attend, where such issues were raised. There are some discrete areas where a specific intervention suggests itself, such as gambling addiction, alcohol abuse, post-natal depression, or veterans’ mental health. I certainly feel that such risk factors ought to be reflected in the suicide prevention plan.

A quick win would be to obstruct people from accessing the means to die by suicide, with obstacles placed in their way. A lot of suicides are opportunistic. For example, the British Transport Police is very good in terms of how it polices stations and watches out for signs that somebody might be thinking of jumping in front of a train, and helplines can be flagged up at places such as the Humber bridge and the Clifton suspension bridge, but there are also physical measures that would make suicide more difficult. People might say, “Well, perhaps people will just go somewhere else,” but it does not always happen like that. If the moment is lost, there is a good chance a life will be saved.

Will the Minister tell us a little bit about the plans for the revised suicide prevention plan? Will it have clear priorities, with an evidence-based, tailored plan in each case for how we will bring rates down, and then targets set on that basis? One organisation described the current approach as very much a “throw everything at the wall and hope something sticks” approach. We need a far more tailored approach.

Will the Minister also tell us where the boundary falls between what is in the remit of the Department of Health and Social Care and work that requires action by other Departments? We have already talked about gambling, and the debate yesterday was answered by the Under-Secretary of State for Digital, Culture, Media and Sport, the hon. Member for Mid Worcestershire (Nigel Huddleston). The Online Safety Bill is another example of where another Department is taking the lead, and I am worried that the Government will not fully seize that opportunity to crack down on sites promoting suicide and self-harm. I gather there is a bit of a difference of opinion between the two Departments, which is particularly disappointing given that the current Secretary of State for Digital, Culture, Media and Sport, the right hon. Member for Mid Bedfordshire (Ms Dorries), was the first Minister for Suicide Prevention. Does the Minister agree that we need to strengthen the Bill’s provisions on this issue, or has she lost the battle with the Secretary of State for Health and Social Care? I hope not, and I hope that, if the Bill is not strengthened in Committee, we can improve it on Report.

The review of special educational needs and disability is another potential missed opportunity. It is meant to be a joint effort by the Department for Education and the Department of Health and Social Care—there is a joint foreword—but there is very little in it on child and adolescent mental health services. Given the overlap between children struggling at school who cannot get the right diagnosis and cannot get a timely education, health and care plan and children who end up in the mental health system, joint working is really important.

Obviously, it is not just children with SEND who struggle. One in six children are now said to have a probable mental health condition, up from one in nine in 2017. More than 400,000 under-18s were referred for specialist mental health care between April and October last year. These are children at the more severe end of the spectrum—those who presented with suicidal thoughts, self-harming or eating disorders. The number of attendances at A&E by young people with a diagnosed psychiatric condition has tripled since 2010.

We know that CAMHS is at breaking point. There are huge waiting lists, and severely mentally ill children are being cared for in inappropriate settings or being sent hundreds of miles away from home for treatment. It is said that half of all mental health problems are established by the age of 14, rising to 75% by the age of 24. If we do not want today’s children to be tomorrow’s suicide statistics, we need to do much more, much faster, to help them now, and I just do not see that sense of urgency from the Government. This consultation is all wrapped up in a 10-year plan, but we need a 10-day plan. We need action now.

One issue we discussed at the event in Speaker’s House was how schools could better nurture children’s creativity and give them an outlet for their emotions through music and art. We also talked about whether the current trajectory of education, with schools very focused on grades—someone described them as “exam factories”—places undue pressure on children. I agree with that to a large extent and worry about cuts to things like music education, which mean that creatively inclined children do not have that outlet. It is not plain sailing for the other 50%, the academic ones, either. Just because a child does well in education does not mean that they are set up for success in the wider world, whether that means higher education or the world of work.

I am sad to say, as a Bristol MP, that Bristol University has become known for the number of student suicides in recent years. It is obviously not the only university to have experienced this, but it has come to particular attention. There needs to be a constant process of reflection and review. We have just had the court ruling in the tragic case of Natasha Abrahart. She was a very able student at Bristol University, but she suffered terribly from social anxiety and just could not handle the oral side of her course and having to do presentations. Rather than trying to force all young people into one model of what success and achievement look like, institutions need to adapt to them. I hope that Natasha’s parents will be able to pursue their campaign to ensure that that happens in the future.

I have also spoken to various groups about data sharing, which I appreciate is a complicated area. When should parents of university students, who are adults, after all, be informed? What are the boundaries of patient confidentiality? Some students might be deterred from speaking to mental health services at uni if they think that their parents might be told, particularly if they are grappling with something like their sexuality or if they have become involved with drugs. There are all sorts of things that young people would not want their parents to know about. Some might come from abusive family backgrounds and their parents would not be helpful or supportive, but in many cases the parents would have desperately wanted to know that their child was struggling to the extent that they were.

Steve Mallen from the Zero Suicide Alliance thinks that more could be done within data protection laws to protect students, and I hope that that is under active consideration.

[Dan Carden (Liverpool, Walton) (Lab)]

I was at the Speaker’s House reception, and one of the most shocking things I heard was that two thirds of people who commit suicide have never sought any support for their mental health. What does my hon. Friend think are the consequences of that, and how should we be trying to deal with it? I think that we need to ensure that we have a holistic approach that offers support, because we all have mental health needs; we all need support. What does she think?

[Kerry McCarthy]

I thank my hon. Friend and agree with him, but I have some reservations about going down that path. A lot of the conversation about mental health in recent years has focused on the importance of getting people to open up and talk about their problems, and an obstacle in the way of doing that is that it can be very difficult for people to access GP appointments or to get the help that they need. I very much support Labour’s policy of publicly accessible mental health hubs in every community, as well as mental health support in every school. There needs to be swift and easy access to talking therapies or even to something less formal—just to someone who will sit there and be prepared to talk to the person. There is also campaigning to try to get people just to ask others how they are feeling, and that would help. I am a bit worried because there is a danger that we will focus totally on the softer end of things and talk a lot less about the more difficult areas, where people are well past the point where a nice cup of tea and a friendly chat would make a difference. At the moment, there certainly seems to be a huge problem where people are considered to be past the point where talking therapies would help. It might be that they are too high risk or too unwell to benefit from primary mental health services but not quite ill enough to access secondary services, such as the community mental health teams; they are not totally at crisis point. Often, they are left to fester somewhere in the middle, and when they reach crisis point, they finally get help, but that is too late in many cases to actually turn their mental health around. Too many people fall by the wayside because the right pathway is not available.

Currently, 40% of patients waiting for mental health treatment are forced to contact emergency or crisis services before they receive treatment. One in 10 of them ends up in A&E, and I have real concerns about whether A&E is appropriate, particularly if someone has experienced psychotic episodes. I cannot think of anything worse for them than being in an A&E department, with the sirens, flashing lights and people who have probably turned up there because they have drunk far too much or are off their heads on something or other and have got into fights on a Saturday night. Some hospital trusts are experimenting with trying to triage people very quickly away to mental health provision in A&E, which I think is a very good move.

We have waited a long time for the Government to bring forward the mental health reforms outlined in the Queen’s Speech. We are right to be concerned about the misuse of powers under the Mental Health Act 1983. We have heard terrible stories of people with autism being detained long term against their will, and the disproportionate use of those powers against people from ethnic minority backgrounds, particularly young black men. I hope that, as part of that debate, we can also talk about how the system fails people who do need to be in hospital, whether by voluntary admission or being sectioned, because a lot of people would benefit.

We see people on the streets talking to themselves, heads bowed, and everybody side-steps them. Sitting on public transport next to someone who is clearly unwell can be uncomfortable. If people have physical health problems, the expectation is that the health service is there to treat them. I know there is a question of capacity and whether people consent to treatment, but I feel we write people off when their mental health reaches a certain state, unless it gets so bad that they are a danger to themselves or others. The system needs to gear up to help people who are broken to that extent. It might not be possible to fix them, but their lives could be made better.

The number of beds in NHS mental health hospitals has fallen by a quarter since 2010, with almost 6,000 beds lost in England alone, despite big increases in the number of people needing mental health support, and cases where people are sectioned under the Mental Health Act. Figures obtained through freedom of information requests show that on a single day in February this year, all of England’s high and medium-security hospitals were operating above the Royal College of Psychiatrists’ maximum bed occupancy rate of 85%. The NHS pays £2 billion a year to private hospitals for mental health beds because it does not have enough of its own. Nine out of 10 mental health beds run by private operators are occupied by NHS patients.

It was also revealed last month, again through FOI requests, that over a five-year period from 2016 to 2021, more than half of the 5,403 prisoners in England assessed by prison-based psychiatrists as requiring hospitalisation were not transferred from prison to hospital. Those were not people with what might be called run-of-the-mill mental health concerns; they had major psychotic illnesses or chronic personality disorders. They needed to be in hospital, not in prison, but they did not get those transfers. We can only speculate on the problems that might store up for the future.

Where there are hospital beds, the pressures on the wards and staff are immense. There are way too many tragic stories of patients being discharged too soon, being wrongly assessed as low risk, and not getting the help they needed, with inevitable results. For example, 22-year-old Zoe Wilson died at Callington Road hospital in my constituency in 2019. She was put on a low-risk ward, despite ongoing psychosis. In January this year, the inquest jury returned a narrative conclusion, having found that multiple failings contributed to her death. The prevention of future deaths reports—the regulation 28 reports—published with the latest coroners’ statistics, make very grim reading. So many of the reports point to failings such as those noted in Zoe Wilson’s case.

I am not convinced that lessons will be learned from these reports, because what is required in many cases is not actions by individual hospital trusts. I should explain what happens. The coroner notes that an institution—a university, or any organisation that might have had contact with the person prior to their death—should learn a lesson and do something in future to try to save a life. Those comments are usually directed at a hospital trust or another organisation, but I would like to know what notice the Government take. Patterns showing where there are failings in the system emerge in these reports. I would be reassured if I felt that, rather than just informing the actions of an individual institution, the reports also informed future suicide-prevention strategy. I am sure the Minister will tell us how much more is being devoted to mental health spending, but we need to acknowledge the simple fact that, despite any figures she might produce today, our mental health services are drastically underfunded, under-resourced and under-staffed, which is why they are at crisis point.

I want to finish today by paying tribute to people who have spoken up about their own family experiences, as Mr Speaker did at the event in Parliament. He spoke so powerfully, because he was clearly very upset about what had happened. I, too, lost someone to suicide last year, as many other people will have, including people who are listening today. I started off by talking about how Bernard and Stephen from Joy Division/New Order came to speak about how, even 42 years later, they are still affected by the death of their singer Ian Curtis. Another musical genius and a musical hero of mine, David Berman, took his own life a few years ago. His last album, “Purple Mountains”, was basically a suicide note. He can be very funny at times—he has this real lyrical genius—but listening back to the album now, you can see where he is going. He suffered from depression for a long time, and he has this song, “Nights That Won’t Happen”, which says,

“The dead know what they’re doing when they leave this world behind…

When the dying’s finally done and the suffering subsides

All the suffering gets done by the ones we leave behind.”

I will finish on that note, because that is very true. He felt that he was escaping from something. He escaped from it, but I hope that support services for people who have recently been bereaved by suicide is at the top of the Minister’s agenda, because those are the people who really need it.

--- Later in debate ---

[Dan Carden (Liverpool, Walton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate my hon. Friend the Member for Bristol East (Kerry McCarthy) on securing the debate, in which we have heard some really powerful contributions. I add my support to what has already been covered in the debate, including for a new suicide prevention plan. I will concentrate my remarks on suicide in the LGBT+ community, and on the important role of alcohol in this debate.

According to surveys, young LGBT+ people are three times more likely to self-harm, and twice as likely to contemplate suicide as their non-LGBT+ peers. Depending on the study we look at, gay people are between two and 10 times more likely as straight people to take their own life. We are twice as likely to have major depressive episodes. Surveys of gay men regularly find that three quarters of the community suffer from anxiety or depression, abuse drugs or alcohol, or are in abusive relationships. That is the case despite social progress and greater acceptance, and despite the fact that we have got rid of many discriminatory laws. Rates of depression, loneliness, substance abuse and suicide among gay men remain many, many times higher than for the general population.

A book that was very important to me was “The Velvet Rage: Overcoming the Pain of Growing Up Gay in a Straight Man’s World” by Alan Downs. The important message in that book is that when someone comes out about their sexuality or gender identity, the trauma is not overcome at that point. Growing up gay leaves trauma, so many people in the LGBT community require support to overcome trauma, shame and other issues of that nature. That is why counselling and therapy are important.

When we in this House talk about mental health, we rarely mention or acknowledge that addiction is a chronic mental health condition; addiction is an illness. Alcohol is a depressant that can exacerbate low mood and suicidal thoughts. It is probably the most normalised way of coping with mental health issues, trauma or suicidal thoughts; it is a fast-acting way to change how we feel. The relationship between alcohol and suicide is well established and a cause for great concern. Research by the Samaritans shows that people who are dependent on alcohol are two and a half times more likely to die by suicide. In England, nearly half of all patients who are in the care of mental health services and who die by suicide have a history of alcohol misuse. They account for almost 600 deaths a year on average.

Despite that harrowing evidence, there has been no national alcohol strategy since 2012. I welcome the Government’s recent efforts on tackling illicit drugs and gambling and tobacco harm. My question is: where is the effort on alcohol? To fully understand the current scale of alcohol harm, and to provide targeted recommendations to improve outcomes for people with co-occurring mental health and alcohol-use conditions, I would like to see the Government conduct a Dame Carol Black-style independent review of alcohol harm. I hope the Minister will respond to that point.

I will finish by mentioning a place in my constituency that I have visited over the years. Paul’s Place was set up by the parents of Paul Williams; Paul and I went to school together, and he took his own life in August 2015. Paul’s Place offers bereavement support to families who have lost members to suicide. I invite the Minister and the Opposition spokesperson to visit Paul’s Place to talk about the important work it does for communities across Walton, and how its funding can be sustained.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Bone. I start by thanking the hon. Member for Bristol East (Kerry McCarthy) and commending her work—she is an absolute champion for this matter. She spoke extremely powerfully on the need for data collection, which I think is the crux of taking good service delivery forward. She spoke very emotively about her own personal experience, and her words resonated with many people here when she advocated for services for those families who are left behind. I thank her for being a champion of this important issue. It is often neglected, and is something that for many years has been difficult for people to speak about. The more that it can be spoken about and raised in this place, the better for everybody right across the United Kingdom.

The hon. Member for Bradford West (Naz Shah) spoke about how difficult it is to access mental health services, particularly for children and young people. I think there are gaps—chasms, actually—in waiting times across the United Kingdom that need to be addressed. As chair of the all-party parliamentary health group, I hear about that constantly. No matter where someone lives, it is very difficult for them to access services. It takes far too long and people are falling through those gaps. The hon. Member for Blaydon (Liz Twist) spoke about the importance of levelling up regional and gender disparities. I am interested in the point she made about adult males being particularly at risk.

There has been good work going on across Scotland— I am sure these exist across the United Kingdom— through the Men’s Sheds developments. I have two in my own constituency that I have visited—one in Lesmahagow and Blackwood and one in the Stonehouse area. They are doing fantastic work to reduce loneliness and isolation, and to create environments where people can begin to speak about issues and receive important social support from like-minded people. We still have a society where there is more stigma for men who speak up about those issues, so such developments are crucial. The hon. Member for Blaydon is also an advocate for this issue in her role as chair of the all-party parliamentary group on suicide and self-harm prevention. She has made key recommendations for the Government to take forward.

The hon. Member for Liverpool, Walton (Dan Carden) spoke about the LGBT community and about alcohol-related harm. What is key—and I know this from my professional life prior to Parliament, working in psychology —is that often having an addiction diagnosis on someone’s medical records can make it more difficult for them to access mental health services. That just should not be the case because, exactly as he says, having alcohol or drug-related problems is, in itself, a risk factor for suicide. Therefore, it should be something that heightens people’s access to services, rather than diminishing it. I would therefore like to thank him once again for the work that he does on these matters.

The hon. Member for Strangford (Jim Shannon)—who is in his place in most of the debates that I happen to attend because he is such a strong advocate for his constituents—spoke about the devastating suicide rates in Northern Ireland, and something else that is very important, which was the impact of and bullying on social media. I think that that is something that really must be tackled. I know, from some work I have been doing with the Diana award in Parliament, that it has been supporting young people’s advocates across schools in the UK—anti-bullying ambassadors to give children and young people peer support—because often young people prefer to speak to peers than to parents. I know that myself, particularly from having adolescents at home who do not want to be seen with or speak to me at this stage in their life.

The hon. Member for Richmond Park (Sarah Olney) also raised an important constituency case—I am so pleased that the family is here today—that families are not listened to enough. Well, if we are not listening to families, who are we listening to? Families know people better than anybody else. I think that long gone is the time when we say, “Well, professionals know best.” It should be an assessment that involves everybody, wherever possible. Families who want to reach out to services are doing that because they have anxiety that something that is traumatic is going to happen in that case. They know that person better than anybody else, so they must be listened to.

When I worked in mental health, the training and risk assessment were very clear; it is not a static assessment; it is dynamic—it changes. That is the thing about it. The British Psychological Society issued guidance on risk assessment. A risk assessment is not a questionnaire; it is a clinical judgment with tools that help that. However, it also must highlight risk indicators. Importantly, it is not just that an assessment is completed; it is that there is a risk-management plan as well—people are aware of their risk indicators, they know when risk is heightened, they know who to seek help from, and that there is a risk-management plan that can protect them and prevent harm coming from risk. The point made by the hon. Member for Richmond Park is key, and I wish her all the support that I can give for her campaign for these matters to be taken forward and for key frontline staff to be given adequate training in risk assessment.

As chair of the all-party parliamentary health group, I hear constantly that the bar is set too high for access to services. Some of the things said are that because someone might have a personality disorder, they could not benefit from treatment. Well, we know that people with personality disorder diagnoses still suffer from mental distress, so of course they should be able to access treatment for that mental distress. That should not be a barrier to treatment. There are also psychological therapies that have been shown to be clinically valid for use in those cases, but people cannot access them.

People who have drug or alcohol problems may present at accident and emergency and be told, “Well, you’ll have to deal with your addiction and then come back and deal with your mental health problem.” However, that is not right either, because we know about the risk and the importance of services being integrated and created for dual diagnosis. Where people have more than one clinical condition, it is very important that both are treated together because, as has been said, mental health might be one of the triggers for alcohol and drug use, which, of course, exacerbates it.

[Dan Carden]

It is really important that we send a clear message that it is absolutely nonsense to send people away to recover from their addiction without the mental health support they need, as happens up and down the country. We should send a clear message that the guidance needs to be rewritten, and that support for mental health and addiction services must be delivered.

[Dr Cameron]

I thank the hon. Gentleman for making that important point. I wholeheartedly agree. If we are serious about preventing harm and suicide, and about helping people, their care must be looked at holistically. We cannot syphon off parts of people’s diagnosis and say, “Deal with this first, then that.” People’s lives are not like that. As we know, the formulation means that it is interwoven, so both conditions must be dealt with simultaneously.

Other things I have heard include, “It is attention-seeking,” “It is a behavioural issue,” “It is not a psychiatric illness,” “There’s no diagnosis,” but surely people who suffer acute psychological distress should have access to services without having to qualify in diagnostic terms as having a major mental illness. Many people need help at such time, and it should not need to be exacerbated to the point of mental illness if we can use prevention. Equally, many people who go on to harm themselves and even commit suicide never have a diagnosis of a mental illness such as depression or schizophrenia, but they still deserve help, so there must be services for them.

GP access is very important, as has been said. I know from my constituents and from chairing the all-party parliamentary health group that that is another issue that must be dealt with. People find it very difficult to see GPs face to face, and if they are in mental distress, speaking to receptionists on the telephone is really not adequate. They must be able to sit down and speak to a GP they know. It is hard enough to open up at that point, but without that access, I am afraid that so many people will fall through the net.

The Scottish Government have committed £120 million for a recovery fund following covid. They are committed to doubling the current £1.4 million of annual funding for suicide prevention, and they have a new strategy coming out.

I thank the services in my constituency, which have been on the frontline when people have been languishing on waiting lists, including the Trust Jack Foundation, set up because someone lost their life. The lady in charge of it is a wonderful individual who has taken her personal tragedy and turned it into support for other people across our constituency. Victorious People in East Kilbride is providing counselling for young people, and Talk Now in East Kilbride is providing services for trauma survivors. That is just to name a few of the fantastic services that have been developed.

I plead with the Minister to fill those gaps and make sure there are services for people suffering acute mental distress, crisis and suicidal ideation. They should not have to have a mental illness diagnosis to access treatment. That is why we are losing people, and families are being hurt in the process.

Prison-based Addiction Treatment Pathways

Dan Carden Excerpts

Wednesday 2nd March 2022 Westminster Hall

[Dr Rupa Huq (in the Chair)]

I call Dan Carden to move the motion. The Minister will respond, but there is no right for the mover to respond at the end, as is the norm in 30-minute debates.

[Dan Carden (Liverpool, Walton) (Lab)]

I beg to move,

That this House has considered prison-based addiction treatment pathways.

It is a pleasure to serve under your chairmanship, Dr Huq. Too many people with drug dependency

“are cycling in and out of prison. Rarely are prison sentences a restorative experience. Our prisons are overcrowded, with limited meaningful activity, drugs easily available, and insufficient treatment. Discharge brings little hope of an alternative…life. Diversions from prison, and meaningful aftercare, have both been severely diminished and this trend must be reversed to break the costly cycle of addiction and offending.”

Those are the words of Dame Carol Black in her groundbreaking independent review of drugs—a damning observation.

The treatment system and effective recovery pathways from addiction in prisons are in desperate need of repair, yet the effectiveness of evidence-based, well-delivered treatment for drug and alcohol dependence is well established. When it is properly funded, it works: it cuts the level of drug use, reoffending, overdose risk and the spread of blood-borne viruses.

Analysis of Her Majesty’s inspectorate of prisons data from 2019 reveals that 48% of men surveyed by the inspectorate who reported having a drug problem said that it was easy to get drugs. The proportion of prisoners who said that they developed a drug problem while in custody more than doubled between 2015 and 2020.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing this debate. This is not the responsibility of the Minister, but in the papers last week it was reported that the drug uptake in prisons in Northern Ireland has risen to an astronomical height. It is therefore clear that what the hon. Gentleman is saying about the UK mainland also applies to us back home. Does he agree that the premise of prison is to rehabilitate and that addiction pathways are the absolute foundation for the rehabilitation that he and I want to see and that, to be fair, I think the Minister wants to see too? That can work only if funding is sourced and allocated UK-wide to make sure that it happens.

[Dan Carden]

The hon. Gentleman is spot on. I will come on to the function of prisons. Modern, progressive society should aspire to something more than having prisons there for punishment. The function of prison should be to rehabilitate, reduce reoffending and help those in prison to build productive and meaningful lives. I think the Minister will agree that without tackling drug dependence, that function cannot be fulfilled.

Part 2 of Dame Carol’s review calls for improved

“transparency and accountability of the commissioning and delivery of substance misuse services in prisons, including through publishing how much money is spent each year on these services”,

and ensuring that

“everyone leaving prison has identification and a bank account and that those who cannot claim benefits online get the opportunity, from the day of release, to access DWP’s telephony service.”

It calls for ending Friday release dates and for making sure that

“prisoners with drug dependence can access and receive drug treatment in the community as soon as possible after release.”

It also calls for additional prison staff to ensure that prisoners’ experience is improved, and for

“earlier interventions for offenders to divert them away from the criminal justice system, particularly prison.”

I am pleased that the majority of Dame Carol’s observations and recommendations have been embraced by the Government in the form of the 10-year drug strategy, “From harm to hope”, and the prisons strategy White Paper. Diversionary schemes are rightly encouraged by Dame Carol and endorsed by the drug strategy and the White Paper, despite the Government’s heavy “tough on drugs” messaging, because we cannot simply arrest our way out of the country’s addiction crisis, we cannot punish the already marginalised into recovery and we cannot end the pointless cycle of harm without evidence-based policy.

One in four people are placed in prison for committing an offence relating to their drug use. They are often given short custodial sentences of up to six months, most commonly serving as little as six weeks behind bars. Those on short-term sentences are the least likely to have access to drug and alcohol treatment, and prisoners serving seven-day sentences almost always pass through the system without support.

There are many innovative diversionary schemes and community sentences in use in different parts of the country. They reduce prison numbers, focus on treatment, recovery and rehabilitation, and stop small-time offenders losing access to housing, employment and family ties, which too often push them only further down the path of addiction, reoffending and homelessness, and exacerbate that vicious cycle of harm. I hope the Minister will touch on that in her reply.

For those who do reach the threshold of a custodial sentence and enter prison, the only answer to deliver change and break the cycle is to ensure there is access to treatment services within prison and on release. Sadly, the sharp decline in recovery services, particularly in prisons, mirrors the sharp decline in recovery services in the community. That has been further exacerbated by the pandemic, where prison regimes have entered strict lockdowns.

One practical challenge is that efforts to tackle drug use in prison are often undermined by the widespread availability of drugs across prison estates. Time, energy and resources end up being consumed by cracking down on the illicit supply. How can policy deal with that challenge, while also dealing with the demand for these substances and the root cause of that? Security can do only so much without a parallel commitment to reducing demand. The Government should ensure that they are committed to acting on both.

I am yet to meet anyone in addiction and recovery who has not experienced trauma. For those fortunate enough to have no personal experience of addiction, it is difficult to comprehend that the drug of choice is, at first, a solution, before it becomes a problem. Prisoners with drug and alcohol problems tend to have high rates of trauma, and trauma begets trauma.

Trauma has been shown to impact on cognitive functioning and on an individual’s ability to build and maintain social relationships. To be drug or alcohol dependent is a harrowing and hopeless ordeal; it is not a choice. To quote Dame Carol, a

“widespread sense of boredom, hopelessness and lack of purposeful activity in custody”,

coupled with little access to meaningful support in prison, is perhaps the worst possible environment the state could create to deal with this growing problem.

We know that, with access to properly resourced, person-centred, trauma-informed care, people can and do make positive changes to their lives. For prisoners, that care cannot stop when they walk from the prison gates. Many prisoners with drug problems are still being released on Friday afternoons, with nowhere to stay, no access to appointments at probation or drug services, no Naloxone and nothing but £46 in their pocket, with predictable results.

Transition between prison and the community must be prioritised to ensure a significant increase in engagement and community treatment on release. Every person in recovery is proof of the transformational change that is possible. For those who doubt whether someone in prison can address their addiction and make positive changes, I recommend taking the time to look at the fantastic “More Than My Past” campaign by the Forward Trust.

The sad reality is that the UK was once a leader in offering accredited addiction and recovery programmes in prisons. At the beginning of the last decade, there were over 100 programmes in England and Wales in prison settings, with over 10,000 prisoners participating. Today, access to accredited addiction and recovery programmes is a prison postcode lottery. There is no national standard, and the latest figures suggest that the number of people participating in accredited services in prisons is below 200 per year.

In 2012, the Rehabilitation for Addicted Prisoners Trust—now the Forward Trust—managed 14 intensive accredited addiction and recovery programmes in prisons across England, serving around 1,200 people per year. Independent evaluations showed that those programmes helped thousands of people into recovery from addiction, and that prisoners who completed those programmes were 49% less likely to be reconvicted compared with those who completed other programmes. By 2020, most of those programmes had closed due to lack of funding, and only around 300 people were able to access them. As it stands today, after two years of covid restrictions, only four programmes of this kind are still running, with only one currently operational. Despite the evidence, access is sparse, and prisoners have to transfer in order to access such services.

The Health and Social Care Act 2012 transferred responsibility for commissioning health services in custody from Her Majesty’s Prison and Probation Service to NHS England. Funding for prison healthcare and substance misuse services fared well compared with the local authority funded services in the community, but there have been other consequences. Physical healthcare services in prisons have improved, but as Dame Carol pointed out, the arm’s length approach to commissioning substance misuse services in prisons has been widely criticised. Contracts are often placed with general healthcare providers, then further subcontracted out, and the system becomes fragmented and unaccountable.

Since that transfer, there has been an alarming reduction in the range of provision in prisons, particularly in recovery-oriented services. Fewer than 200 prisoners are accessing accredited, structured addiction and recovery programmes, and in its “Alcohol and drug treatment in secure settings” report, the Office for Health Improvement and Disparities showed that there were 43,255 adults in alcohol and drug treatment in prisons and secure settings between April 2020 and March 2021—a drop of around 3,000 from the previous year. However, that figure of 43,255 prisoners accessing the treatment system does not tell us anything about how many were accessing recovery-oriented services. Can the Minister tell me what that treatment consists of, considering that accredited addiction and recovery course attendance has plummeted so drastically? With this new strategy, will the Minister also commit to restoring accredited addiction and recovery programmes to former levels and making them available in every prison?

When discussing addiction treatment pathways in community and secure settings, there is an unproductive and recurring debate: harm reduction versus abstinence. Each has its own set of benefits, yet they represent completely different approaches to recovery. Both approaches to treatment have their perceived pros and cons, but there is no right choice or correct pathway; after all, addiction has many causes, and recovery can be supported in a number of ways. Opiate substitute treatment, needle exchange, and the life-saving naloxone are important interventions—harm reduction saves lives, but so does recovery. It is time to take seriously the challenge of turning people away from drugs and crime.

I understand that the Secretary of State for Justice’s promotion of abstinence-based programmes in the prisons White Paper has caused confusion and some upset. Some believe that his approach goes against evidence-based research and the Government’s own 2017 “Drug misuse and dependence: UK guidelines on clinical management” document. The guidance is clear:

“any plan for reduction and cessation of OST should be based on the clinical judgement of the prescriber in collaboration with the prisoner and the wider team. Reduction and cessation should not be on an arbitrary or mandatory basis but rather requires careful clinical assessment and review…There should not normally be mandatory opioid reduction regimes for dependence…The purpose of healthcare in prison, including care for drug and alcohol problems, is to provide an excellent, safe and effective service to all prisoners, equivalent to that of the community.”

This should not be an either/or. When we think about recovery from any other health condition, that way of thinking would not be accepted. Clinicians would be focused on combinations that give people the best possible chance to make a full recovery. The Government say in their drugs strategy:

“We will treat addiction as a chronic health condition”.

I welcome that. As with many other health conditions, there needs to be a wide range of interventions and services that provide those in need with real choice.

For many people, harm reduction is the start of the recovery journey, but recovery is much more than, “Are you clean or not?” Recovery is not binary, recovery is not linear, but recovery is possible. To support it, there needs to be greater allocation of physical space on the prison estate to carry out therapeutic interventions that all people can access. That must include space for psychosocial, not just clinical, interventions. Well-designed recovery wings create a much less violent and more co-operative population who are focused on rehabilitation. Every prison should have recovery-focused wings. I wonder if the Minister is considering that possibility.

I welcome the commitment from the Ministry of Justice to expanding the use of recovery-focused areas in prison, which pointed to Her Majesty’s Prison Holme House as an example of good practice. The early outcomes from recovery wings have identified a reduction in violence and substance use, and a link to increased employment opportunities on release. Despite the support from addiction treatment charities for recovery wings, and despite their inclusion in the prisons White Paper, I have been made aware of a growing sense of open resistance in the Department of Health and Social Care to the expansion of recovery wings in prisons.

I would be grateful if the Minister could shed some light on those worrying reports. Is that the case, and if so, will she put a stop to it? Will her Department deliver on the reforms set out in the drugs strategy and the prisons White paper to improve addiction treatment in prisons and not stand in their way? Will the Minister tell us how the new spending allocation will reflect the priorities set out in both papers?

To conclude, I will quote Charlie Taylor, Her Majesty’s chief inspector of prisons:

“To lead successful, crime-free lives when leaving custody, prisoners must change the way they feel about themselves and develop a belief that they can take control of their future.”

I hope that officials in the Department of Health and Social Care take heed of the chief inspector’s words as the final decisions are made on what has the potential to be positive progress under this Government’s reforms. Lives depend on it.

Government Contracts: Randox Laboratories

Dan Carden Excerpts

Thursday 10th February 2022 Commons Chamber

[Mr Speaker]

It is Mr Bryant’s Committee, rather than mine.

[Dan Carden (Liverpool, Walton) (Lab)]

It really is quite remarkable: what the Minister has outlined in her response is what should have happened during the course of the pandemic and what has been proven not to have happened. Instead, the situation has been epitomised by Tory donors receiving billions of pounds in contracts, Ministers losing mobile phones when their Department and the law have tried to find out what has gone on, and decent companies with great experience in this field—I am thinking of Arco up in the north-east—being left with next to nothing. How can the Minister stand there and defend the indefensible?

[Maggie Throup]

As I said, we follow the Public Contracts Regulations 2015, and in procuring goods and services we are committed to fair and reasonable timetables and procedures, and encourage open competition wherever possible. However, we were in the middle of a pandemic.

Let me go through the process in a bit more detail. Awarding bodies use three main procurement routes in awarding contracts. First, there are direct awards without competition using emergency procurement rules, and I am sure hon. Members will appreciate that we were in an emergency situation. Secondly, there are direct awards using variations to existing contracts. The third route is awards from framework agreements—both direct awards and mini competitions—where suppliers have previously undergone a competitive process to be appointed to the framework. As we move out of the pandemic, we will obviously get back to business as usual and use these other mechanisms.

Oral Answers to Questions

Dan Carden Excerpts

Tuesday 18th January 2022 Commons Chamber

[Maggie Throup]

We are intent on making vaccines as accessible as possible, so there are now more vaccination sites than at any point in the programme. They operate 12 hours a day, seven days a week where possible, including at hundreds of walk-in and pop-up sites. In every community, there should be slots available at least 16 hours a day; in some places, that is extended to 24 hours a day to support workers such as those in the transport sector, who often work unsociable hours.

[Dan Carden (Liverpool, Walton) (Lab)]

The Secretary of State has introduced guidance for essential care givers so that family members can visit loved ones in care homes. Is he considering going further to guarantee the right to visit residents in care homes and patients in hospitals?

[The Minister for Care and Mental Health (Gillian Keegan)]

The hon. Member makes a very good point. It is important that people get the right to visit their loved ones in care homes. That is why we have introduced guidance that says that essential care givers should get access to care homes at all points, even during outbreaks. There is a process, which the Care Quality Commission manages, for reporting those that do not comply, but if there are specific examples, I am very happy for him to write to me with details and I will follow it up.

Dame Carol Black’s Independent Review of Drugs Report

Dan Carden Excerpts

Wednesday 27th October 2021 Westminster Hall

[Yvonne Fovargue (in the Chair)]

Before we begin, I encourage Members to wear masks when they are not speaking, in line with current Government guidance and that of the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test twice a week if coming on to the parliamentary estate. That can be done either at the testing centre in the House or at home. Please also give each other and members of staff space when seated, and when entering and leaving the room.

[Dan Carden (Liverpool, Walton) (Lab)]

I beg to move,

That this House has considered Dame Carol Black’s independent review of drugs report.

It is a pleasure to serve under your chairmanship, Ms Fovargue. I refer Members to my entry in the Register of Members’ Financial Interests. The damning conclusion of part two of Dame Carol Black’s review, setting out a way forward on drug treatment and recovery, was that

“the public provision we currently have for prevention, treatment and recovery is not fit for purpose, and urgently needs repair.”

I have called today’s debate because the report’s recommendations are too important to be left gathering dust on ministerial bookshelves. I want Dame Carol’s words ringing in ministerial ears. She says:

“Government faces an unavoidable choice: invest in tackling the problem or keep paying for the consequences. A whole-system approach is needed…This part of my review offers concrete proposals, deliverable within this Parliament, to achieve this.”

Of the review, Dame Carol says:

“It calls for significant investment, but the payoff is handsome: currently each £1 spent on treatment will save £4 from reduced demands on health, prison, law enforcement and emergency services. I am hopeful that the recommendations will be welcomed by this government as they strongly support its crime reduction and ‘levelling up’ agendas.”

The 32 recommendations are a gift to the Government, and should be a moment for change. It is fitting that the debate falls on Budget day. The economic cost of drug misuse is upwards of £20 billion each year; yet the spending on prevention and treatment stands at just £650 million. The recommendations give hope that real change is possible. Addiction is a national crisis. Drug and alcohol-related deaths are the highest on record, at the very moment that treatment services are most ill-equipped to deal with the soaring need.

Forward Trust estimates that more than 2 million people are in need of help with alcohol, drugs or gambling, and its recent YouGov poll showed that 64% of people said that they knew someone personally struggling with addiction. Since I talked openly about my personal experience of addiction and recovery, I have been over- whelmed by the thousands of people who have reached out to tell me their personal stories—of the horror of addiction, and the blessings of recovery. The tragedy is that addiction is everywhere, yet remains so hidden.

In 2019 Dame Carol was commissioned by the then Home Secretary, the right hon. Member for Bromsgrove (Sajid Javid), to independently review illicit drugs in England. I thank her for her commitment and dedication over the last few years, and all those who contributed to this groundbreaking report. Most of all, I hope that my contribution today does justice to the absolute clarity that Dame Carol brings to these incredibly complex matters. Part one of her review was published on 27 February, and made for uncomfortable reading. The unflinching analysis detailed the extent of drug-related harm and the challenges posed by drug supply and demand, including the ways in which drugs fuel serious violence.

The Department of Health and Social Care swiftly commissioned Dame Carol to produce part two of her independent review, which focused on how to improve the funding, commissioning, quality and accountability of drug prevention, treatment and recovery services in England. Part two of her report, published in July, pulls no punches either. It says:

“Funding cuts have left treatment and recovery services on their knees. Commissioning has been fragmented, with little accountability for outcomes. And partnerships between local authorities, health, housing, employment support and criminal justice agencies have deteriorated.”

The report goes on:

“The workforce is depleted, especially of professionally qualified people, and demoralised. Vital services have been cut back, particularly inpatient detoxification, residential rehabilitation, specialist services for young people, and treatment for cannabis and stimulant users.”

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for bringing this issue to Westminster Hall for debate and discussion. Does he agree that more should be done to ensure that alcoholism in particular is treated urgently, along with drugs, and that help needs to be given to families for rehabilitation, which he has referred to, not in a punitive fashion, which is how some would like to do it, but instead to help to draw people away from their addiction? That has to be done in such a way that people wish to get away from their addiction and try to move forward.

[Dan Carden]

Absolutely. That is a valuable intervention, and it is good that we have a Health Minister responding to this debate, because it is a health response, joined up across Government, that this issue calls for.

Part two of the report goes on:

“Areas of the country with the highest rates of drug deaths or the poorest treatment services are the very same areas where the need to level up is greatest. These communities want to see urgent and effective action to tackle the violent drugs market, alongside purposeful efforts to rebuild treatment services and recovery support so that people can get the help they need.”

[Tommy Sheppard (Edinburgh East) (SNP)]

The hon. Gentleman is making an excellent speech, and I very much endorse and support the recommendations of Dame Carol Black’s review. However, I have heard her present these reports, and she has been very clear that the framework that she was given—the parameters that she was allowed to look at—deliberately excluded any review of the legislation that frames this whole matter. Given that this is a unique health pandemic—because the victims of it are liable to criminal prosecution if they seek help, and many who would seek to help them would be liable to criminal prosecution if they tried to do so—is it not time for the Government to begin a review of the Misuse of Drugs Act 1971, to ensure a more up-to-date legal framework to deal with these problems? Would that not assist in the implementation of Dame Carol Black’s recommendations?

[Dan Carden]

The hon. Member makes an important point, although it is one that I will not get drawn into today.

A month after part two was published, the Office for National Statistics confirmed that drug-related deaths had hit an all-time high in England and Wales—the highest number of deaths since records began. Drug deaths have risen 60% in the last decade. In 2020, 4,561 people lost their lives to drugs. Each life lost represents years of pain and suffering; each life lost leaves a family devasted and shattered irreversibly; each life lost is evidence of a missed treatment opportunity; and, most importantly for us today, it is important to accept that each life lost is a failure of policy, too.

I want to make special mention of the stigma that surrounds addiction. Someone who finds themselves dependent on a substance deserves the evidence-based health treatment and support that works, yet stereotyping and prejudice remain all too common in our approach to addiction. It was disappointing to see the Government’s response to the review referring to addiction as a “scourge on society”. The dehumanisation of people who become drug-dependent feeds into the stigma that we must eradicate, so we must steer the discussion, the policies and the treatment towards a compassionate and person-centred health response.

Last week I joined the Forward Trust at the launch of its “Taking action on addiction” campaign, which aims to improve public understanding of addiction as a erious, chronic mental health condition. The Duchess of Cambridge, patron of the Forward Trust, spoke there. I want to quote her at length:

“Addiction is not a choice. No one chooses to become an addict. But it can happen to any one of us. None of us are immune. Yet it’s all too rarely discussed as a serious mental health condition. And seldom do we take the time to uncover and fully understand its fundamental root causes.

“The journey towards addiction is often multi-layered and complex. But, by recognising what lies beneath addiction, we can help remove the taboo and shame that sadly surrounds it. As a society, we need to start from a position of compassion and empathy.”

As many as 80% of the public support more treatment and care for people struggling with addiction; less than 10% believe more punishment and condemnation would help. Intolerance, shaming, tougher punishments and denial will not rid society of addiction, because addiction is an illness. It is a matter of public health, and Dame Carol puts it best when she says,

“It must be recognised that addiction is a chronic mental health condition, and like diabetes, hypertension or rheumatoid arthritis, it will require long-term follow-up.”

Sadly, as things stand, I cannot think of another illness that causes so much harm to society, that is given so little, and the sufferers of which are treated with such contempt. It is the only illness in which blame is placed on the person suffering. Instead of blaming the individual for making bad choices, we need to ask why so many people are turning to substances in the first place.

Now to the prevention, treatment and recovery system as it stands: not fit for purpose, in urgent need of repair, years of austerity, continued disinvestment, fragmentation and a dire lack of accountability throughout. The Health and Social Care Act 2012 shifted addiction treatment out of the NHS mental health services on to local authorities, at the same time as their budgets were being slashed. On that matter, Dame Carol is clear:

“We recommend that funding for drug treatment be allocated to local authorities based on a needs assessment and then protected.”

We also urgently need to improve the situation for people suffering co-occurring mental ill health and drug or alcohol dependency. Too many people are being bounced between fragmented services and end up falling between the cracks. It is simply wrong that mental health services can require patients to reduce their alcohol or drug use, without providing the proper support to do so, before they can receive the treatment they need. Or that drug and alcohol services do not possess the competencies to support someone with significant mental health issues, thereby often leaving sufferers with no support whatsoever.

There must be a “no wrong door” policy. One young woman, whom I will call Jane, told me:

“It was as if I had to get more ill, drink and use more, until I got the right help and support. For 18 months, my mental health deteriorated. Mental health services couldn’t help me and addiction services struggled to support me because of my poor mental health. I was so frightened, I had to reach crisis point and rock bottom before I was able to be considered for residential treatment.”

Jane is now in recovery and leading a happy, healthy life, but she did not receive public funding. In fact, she was denied that. If it had not been for a chance meeting with Action On Addiction, which provided her with a bursary-funded bed, she would not be alive today. It should simply not fall to charities to catch the increasing numbers of people falling through the threadbare safety net. Access to treatment should not be about luck, only available to those who can afford it or those who live in a local authority that prioritises it.

Currently, the drugs treatment market operates in a similar way to that of adult social care. Providers are being squeezed and staff poorly paid. There is high turnover in the workforce and a depletion of skills. The number of medics, psychologists, nurses and social workers in the field is falling significantly.

It is time to repair that broken system and overhaul addiction treatment, and we have the road map for the future—the 32 recommendations of Dame Carol Black’s independent review of drugs. The scope of the recommendations is far-reaching and the solutions span many Government Departments, local government and other organisations.

Dame Carol’s review has pursued three main objectives: first, to increase the proportion of people misusing drugs who can access treatment and recovery support, including more young people, with earlier interventions to divert offenders away from the criminal justice system; secondly, to ensure that the treatment and recovery package offered is of high quality and includes evidence-based drug treatment, mental health and physical interventions, and employment and housing support; and thirdly, to reduce the demand for drugs and prevent problematic drug use, including use by vulnerable and minority groups and recreational drug users.

To achieve those objectives, significant changes need to be made in four areas: radical reform of leadership funding and commissioning; rebuilding of services; increased focus on prevention and early intervention; and improvements to research and how science informs policy, commissioning and practice. And the 32 recommendations cover a wide range of responsibilities.

The Government have already begun to set in motion some of the structural changes, which I welcome, and the policy commitments that will help to drive through the review’s recommendations. It is reassuring that Dame Carol herself will continue to act as an independent adviser to Government. However, the remaining recommendations are contingent on Government investment.

In January 2021, the Government announced £148 million of new money to cut crime and protect people from the harms caused by illegal drugs, which I also welcome, with £80 million of that money to be invested in treatment and recovery. That £148 million must be the first instalment of the £1.78 billion that Dame Carol has called for over the next five years and I hope that the Minister has come with hot-off-the-press Budget commitments. Dame Carol’s spending recommendation would restore addiction treatment to what it was before 2012. Although local authorities are well positioned to oversee services, drastic cuts to public health grants have led to cuts to addiction treatment services over many years. The Local Government Association has long argued that reductions to the councils’ public health grant, which is used to fund drug and alcohol prevention and treatment services, is a false economy, which will only compound acute pressures for criminal justice and NHS services further down the line.

I must stress to the Minister that if the Treasury is unable to find all the funding that the review calls for, the money it does find must not be thinly spread across the country. Instead, it should be targeted at those areas most in need, and efforts must be made at least to pilot the whole-systems approach that Dame Carol has called for. Small amounts of money given to each local authority will not bring about the long-term transformational change that the review demands.

There has simply never been the political will to act on prevention, treatment and recovery from drug and alcohol harm, but we have reached a crisis point, with record deaths, rising economic and social harms, and depleted treatment services. Dame Carol’s groundbreaking review, which was commissioned by this Government, is the moment for change, and the Government cannot meet their pledges to level up the deprived communities that they seek to represent, which are often found in the north, unless they recognise that. In the words of Dame Carol herself:

“The Government must either invest in tackling the problem or keep paying for the consequences.”

[Several hon. Members rose—]

--- Later in debate ---

[Dan Carden]

I thank the Minister and right hon. and hon. Members for their kind comments, particularly, the Opposition spokesperson, my right hon. Friend the Member for Leicester South (Jonathan Ashworth). I will hold the Government to account on this issue. I want to see regular reports back. I want to see how the Government intend to implement Dame Carol’s 32 recommendations. I share the cross-party spirit that has been expressed on this matter, because in the end, this is about families and people up and down this country who, when things go wrong with addiction and with drug and alcohol problems, lose loved ones, always in the most dramatic and unfortunate circumstances. I welcome the Minister’s comments and look forward to holding the Government to account on this in future.

Question put and agreed to.

Resolved,

That this House has considered Dame Carol Black’s independent review of drugs report.

Obesity Strategy 2020

Dan Carden Excerpts

Thursday 27th May 2021 Commons Chamber

[Dan Carden (Liverpool, Walton) (Lab)]

It is a pleasure to speak in this debate, which is covering a wide range of issues. At its heart, it is about trying to support a healthier British public, which I think the whole House genuinely cares about.

My reason for speaking in the debate relates to alcohol labelling; I am sure that the Minister remembers our recent Adjournment debate. We are in the incredible situation where a product such as non-alcoholic beer or wine may provide its calorie content, nutritional information and a lot more, but an alcoholic product need contain only three pieces of information by law: the allergens, the percentage of alcohol by volume and the amount of liquid in the container. That is quite a bizarre situation for us to be in, so I am pleased to hear that the Minister is pushing ahead with the consultation on alcohol labelling. There has been some confusion in recent weeks and months. Just a few weeks ago, we heard that the Government had ditched plans to force pubs to list calories as part of a drive to tackle obesity. That came from Downing Street. I hope that, given what the Minister said, the consultation will be kicking off some time soon.

I want to push the Minister once more on the need for a national alcohol strategy. We had the highest rate of deaths from alcohol on record this year. Alcohol-specific deaths are at an all-time high at a moment when drug and alcohol services are underfunded and mental health services are overstretched.

If this is all about supporting a healthier nation—we have the obesity strategy, Dame Carol Black’s review of drugs, a consultation on alcohol labelling, a review of the Gambling Act 2005, and a promised addiction strategy from 2019—I suggest to the Minister that that work needs to be pulled together. The issues that we have touched on in this debate, including mental health and poverty, which are drivers of addiction, really need to be focused on in the months and years ahead.