Suicide

Lord Bishop of Exeter Excerpts

Tuesday 23rd April 2013 Grand Committee

[The Lord Bishop of Exeter]

My Lords, I, too, am grateful for this debate. There are just two aspects on which I shall comment. The first is the issue of suicide prevention among people in contact with the criminal justice system—something that concerned me greatly in my early years as Bishop of Exeter. In the three prisons in the Exeter diocese, 20 men committed suicide between 2001 and 2011. Of these, 14 were at Exeter prison—a figure which reflects the higher incidence of suicide in local prisons, especially during the early days of imprisonment. Half of these deaths, though, were between 2001 and 2004, and I note that the number of suicides in prison nationally has also fallen steadily since 2004, apart from a spike in 2007. Hopefully this is a sign that measures taken under the NOMS suicide prevention strategy are having an effect. However, with 57 suicides in prison in 2011, there is still real cause for concern.

I am also aware that on 6 March this year, the Prisons and Probation Ombudsman published a “Learning lessons” bulletin, following investigation of the apparently self-inflicted deaths of three teenagers in young offender institutions. Each of these children was extremely vulnerable and the lessons learnt included better responses to bullying and a greater focus on the involvement of families and outside agencies. This is where I come to my second area of concern and the main subject of this debate. From this month, local authorities have new responsibilities for co-ordinating and implementing work on suicide prevention. It will be for local agencies, including working through health and well-being boards, to decide the best way to achieve the overall aim of reducing the suicide rate. However, while there are clearly opportunities here for local initiatives in co-ordinating and commissioning work, there is also a risk that, especially where there is no local suicide prevention plan, this priority may be overlooked in the allocation of funds.

The findings of the All-Party Group on Suicide and Self-Harm Prevention have already been referred to by the noble Baroness. Only half of local authorities have a local suicide prevention group, while a quarter said that there was no local suicide prevention plan, even where there is a local suicide prevention group. Often there is no formal mechanism for such groups to report directly to health and well-being boards. Only one-third of respondents mentioned specific suicide prevention programmes. Yet the report also mentioned the key role of third sector groups. Many suicide prevention actions contained in local plans involve the voluntary sector in delivering programmes such as support services for people bereaved by suicide. From the available evidence, the majority of groups had voluntary sector membership, underlining their importance to suicide prevention and the heavy reliance on them.

However, within the voluntary sector there are real concerns about the responsibilities placed upon them and the resources that enable them to respond. Take the example of just one not-for-profit, open-access counselling service in Devon. It sees around 160 clients a week. These are self-referring adults who pay according to means. Work is with individuals, couples and family groups. There are no paid employees and all are qualified volunteers. The work of such groups is really important, because the potentiality of suicide often does not appear as a presenting issue, but rather through other therapeutic work, revealing, for example, patterns of isolation, self-harm and despair. However, the sustainability of such a model of group work is increasingly a challenge in the current economic climate. Average client contributions have fallen and margins are tight. Yet the self-funding model still seems to be the only viable way of securing an effective service. Counselling services are notoriously difficult to fund. Counselling does not constitute a “charitable purpose”—something at which Her Majesty’s Government need to take a look—and thus many funders exclude counselling services as recipients.

Where funds are available, such as lottery funding, they can amount to the kiss of death for a service as they are often short-term. Culturally, funders tend to favour innovation and new services in preference to tried, tested and researched ways of working, and funding projects rather than vital revenue costs. In my own areas, the combination of these facts has led to the closure of numerous local services over the years, revolving door-style, including high-quality and relatively inexpensive services for young people at high risk. The fact is that this very important voluntary sector, of which much is expected, suffers from gross systemic underfunding, is too often neglected for its experience and understanding, and thus such funding as there is may often be misdirected and unwisely spent. I think, for example, of the privileging of short-term cognitive behavioural therapy over person-centred and psychodynamic approaches, which evidence shows have a greater longer-term effect.

If Her Majesty’s Government’s well intended suicide prevention strategy is to really work, more attention needs to be given to just how the voluntary sector is most effectively supported and engaged. This also means rectifying the fact that, while much of this work in the third sector is underpinned by a strong faith base, and a great deal of work is being done by faith groups in supporting those at risk of suicide and self-harm, I find it concerning that there is so little reference to faith groups in any of the official documents underpinning the structures and strategies that we are debating today.

NHS: Liverpool Care Pathway

Lord Bishop of Exeter Excerpts

Tuesday 15th January 2013 Lords Chamber

[Earl Howe]

I am grateful to my noble friend for drawing attention to a very important point. It has always been emphasised in connection with the LCP that to ensure that it is used properly it is important that staff receive appropriate training and support, and that relevant education and training programmes are always in place. In view of the degree of staff turnover to which my noble friend refers, I am confident that the noble Baroness, Lady Neuberger, will have that fact in her sights.

[The Lord Bishop of Exeter]

My Lords, does the noble Earl agree that if there is to be full confidence in what is undoubtedly a useful clinical tool that has helped many thousands of people to experience better care in the last hours and days of their life, non-clinical priorities in the use of the pathway, especially financial priorities, must be eradicated, and every patient should be treated solely according to their needs? Does he further agree that it would be far better to link CQUIN payments to staff training in the use of the pathway, rather than the numbers of patients being placed upon it?

[Earl Howe]

My Lords, once again, I am sure that the noble Baroness, Lady Neuberger, will wish to look at that very issue. The CQUIN payment framework that the right reverend Prelate mentioned was designed to incentivise good practice, and the LCP is considered internationally to be best practice. In one sense, it is therefore logical that the two should be combined. It is equally important for me to emphasise that the Department of Health has not attached any set financial targets to the LCP; on the other hand, some commissioners in the NHS have introduced local incentives. The way in which those incentives have been applied should be the subject of close attention.

Older People: Health and Social Care

Lord Bishop of Exeter Excerpts

Monday 18th June 2012 Lords Chamber

[Earl Howe]

The noble Baroness makes a very fair point. As I made clear last week, our aim has been and remains to legislate in this Parliament to create a fairer, more just and better funding system for social care.

[The Lord Bishop of Exeter]

Given that Delivering Dignity recommends that,

“All hospital staff must take personal responsibility for putting the person receiving care first”,

and that staff “should be urged” to challenge practices that they believe are not in the best interests of residents, what measures have Her Majesty’s Government taken to support staff who whistleblow in this respect?

[Earl Howe]

My Lords, the right reverend Prelate draws attention to an area that we have focused on quite hard in recent months, and the NHS constitution has been changed to strengthen the areas around whistleblowing. In the care home context, often the care home is looking after someone who is not publicly funded and the arrangements there are often ones that the care home itself has put in place. We believe that the CQC needs to focus carefully on the arrangements in the care homes that it inspects to ensure that staff feel free to speak up if they are aware of any problems of maltreatment or anything of that kind.