Mental Health Budget: Domestic and Sexual Violence

Debate between Lord O'Shaughnessy and Baroness Hollins

Thursday 22nd November 2018 Lords Chamber

[Lord O’Shaughnessy]

I am grateful to the noble Baroness for her recognition of the work that is going on in funding. It is important to point out that NHS England published a sexual assault and abuse strategy this April. That involved funding for sexual assault referral centres and a range of other innovations, including an Identification and Referral to Improve Safety project, which has now been rolled out in 800 GP practices. So work is going on not only to roll out these kinds of services but to make sure that many more victims are coming through to them. I know that the Women’s Mental Health Taskforce is due to report later this month and I will speak to my colleague, Jackie Doyle-Price, who is the lead Minister, to find out if we can give more specificity on how we track the number of users of these kinds of services.

[Baroness Hollins (CB)]

My Lords, we know that sexual violence in childhood, whether as a victim or secondary victim, correlates closely with mental illness in adulthood. Will the Government make childhood trauma a local commissioning priority and invest in trauma-informed models of care?

[Lord O’Shaughnessy]

The noble Baroness is right and I can reassure her that some of the additional £100 million of funding that the Government are providing for this issue is going on children who have been victims of abuse. Indeed, the draft domestic abuse Bill that we look to bring forward this Session will propose tougher sentences when a child has been involved in domestic abuse.

Mental Capacity (Amendment) Bill [HL]

Debate between Lord O'Shaughnessy and Baroness Hollins

Committee: 3rd sitting - (Hansard): House of Lords
Monday 22nd October 2018 Lords Chamber

[Baroness Hollins]

My Lords, these amendments are examples of the long and complicated amendments which I think could end up going wrong, because they are trying to cover quite a lot, which will probably become gold-plated and give rather too much weight to the legal profession. I do not think that what Sir Simon Wessely planned to do is relevant here, because it is not really about mental illness but about dementia. If that is the case, people may not be in a position to change their mind at a later date, so these amendments are very complicated and probably rather unwise.

[Lord O’Shaughnessy]

I am grateful to the noble Baroness, Lady Thornton, for introducing this clause stand part debate. We had a chat earlier, so I shall not formally respond to her but instead deal with the amendments as laid, if that is all right with everybody. Clearly, these are very important issues that need to be dealt with properly.

Amendment 84 would allow individuals to provide advance consent to arrangements enabling care or treatment that would otherwise amount to a deprivation of liberty. As noble Baronesses have commented, the Law Commission recommended that provision should be made in the Bill to allow this. This would mean saying that cared-for people entering certain settings, such as hospitals and end-of-life care, where the arrangements are predictable and time limited, would not be required to undergo additional assessments if they needed to be deprived of their liberty. In the Government’s response to the Law Commission, we agreed that people should have choice and control over future decisions being made on their behalf, but we said that we needed to look at the detail of this specific proposal. I understand that there is enthusiasm among some noble Lords for such a recommendation, particularly, as has been said, as a way of alleviating unnecessary assessments for those in palliative and end-of-life care.

On palliative care, before I get on to more general concerns, I think it is important to note that the Government have issued some guidance about consent in the context of palliative care in the last few weeks of life. I realise that this talks only about one part of the time period that we might be talking about. The guidance says that if an individual has capacity to consent to arrangements for their care at the time of their admission, or at a time before losing capacity, and does consent, this consent would cover the period until their death, hence there is no deprivation of liberty. However, the guidance is also clear that this consent would no longer be valid if significant extra restrictions were put in place, after this point, to which the person had not consented. So there is a situation that pertains to people right at the end of life and provides some opportunity for challenge if restrictions change.

If we extend that time period out, not just to weeks but to months and years, it has been brought to light in this debate that, while there is a desire to make sure that a person’s advance consent is taken seriously and given legal force, concerns have also been raised, not least by the noble Baroness, Lady Finlay, about extending the application in such a way that it could actually deprive people of their protections and human rights. These are clearly concerns that we need to take seriously.

Concerns have also been expressed to the department, in engagement with stakeholders, that the inclusion in statute law of advance consent to being deprived of liberty might imply that there is an expectation that people should have an advance statement of wishes in place, and that people may be pressured into making an advance statement. I take the point made by the noble Baroness, Lady Murphy, that in some ways planning for the future may be a good thing but, equally, we do not want to force people to plan for the future when their desire is not to. We protect the right of people to make bad decisions; that is an important part of a person having a sense of agency and autonomy. Concerns have been expressed that that would be put in danger and people would feel pressured to do something that they might not wish to do.

Clearly, the Law Commission made this recommendation with highly laudable aims. However, we have concerns and are not yet convinced of the merits of the amendment. We have tried to deal with some of the issues around integrating planning through the creation of a system based on the production of a care plan. We have talked about the inclusion of a statement of wishes. I would like to know more about the proposal of the noble Baroness, Lady Barker, about advance statements of wishes. I would like to follow that up and understand it a bit better. The process we are envisaging would allow the inclusion of advance decisions to refuse treatment as part of future care planning. That is not affected by what we are discussing here but that would be allowed. We are not convinced of the merits of the amendment—indeed, we have some concerns about the implications of it—but I would be keen to understand a bit more about previous discussions of this topic and whether there are other ways to provide that sense of agency for the person who will be cared for without producing undue pressure on them or legal force in a way that would go against their interests and, in legal terms, their human rights.

Amendment 85 would create a new civil court remedy against some private care providers, including non-NHS hospitals and private care homes, if they have deprived someone of their liberty unlawfully. Again, this provision was proposed by the Law Commission. However, we do not believe that a new legal remedy is required. There is already an ability to seek damages under the Human Rights Act on the basis of a breach of Article 5 and usually Article 8. This is available in private cases, where a private care provider is depriving a self-funder of their liberty unlawfully. A remedy could be sought against the public authority responsible for the deprivation. Obviously, we need to hold private care providers to the same standards that we hold public care providers to. There are already a number of mechanisms that allow for this, and the law provides for them. There is the criminal offence of false imprisonment, as well as the existing law of false imprisonment for civil claims. So people can already bring legal action against private care providers.

On top of this, the Care Quality Commission in England and the Care Inspectorate Wales would also ensure compliance with the liberty protection safeguards. Clearly, they have a range of enforcement actions available to them that apply to the public and private sector alike. Furthermore, as commissioners, local authorities will—and do—have a role in ensuring that private care providers fulfil their legal duties. The Government believe that sufficient levers are already in place and that the creation of an additional civil route could increase care providers’ insurance costs at a time when, as we all know, we are working hard to make sure that there is funding in the system to provide adequate and good-quality social care to everybody who needs it.

I understand and agree with the desire to hold private providers to the same standards that we hold public providers to, but we believe there are existing remedies within the system and there is no need to require or implement new ones. On that basis, I hope the noble Baroness will not move her amendments.

Mental Capacity (Amendment) Bill [HL]

Debate between Lord O'Shaughnessy and Baroness Hollins

Committee: 2nd sitting (Hansard - continued): House of Lords
Monday 15th October 2018 Lords Chamber

[Baroness Hollins]

My Lords, these amendments in the name of the noble and learned Lord, Lord Mackay, and myself are about mediation, conflict and decision-making. It is a complex area and made more complicated now that the Bill is being extended to 16 and 17 year- olds. Rather than taking time in your Lordships’ House this evening, I believe the noble and learned Lord, Lord Mackay, would prefer to discuss this matter with the Minister and decide whether the Bill is the right place to progress this issue. I am grateful to the Minister for already having agreed to discuss it. I reserve the right to return to this on Report if no progress is made.

[Lord O'Shaughnessy]

We have had a discussion about the issues under consideration here, which are in some ways prompted by the experience of the Gard family and their son Charlie; we are all aware of the tragic circumstances at the end of his life. We agree with the noble Baroness and my noble and learned friend that these are incredibly important issues, and we are grateful to them for tabling the amendment. However, I think this would be best pursued outside of the confines of the Bill. I give her my commitment to do that; I am keen to work with her and with all noble Lords who have a particular interest in this issue, to ensure we come to the right conclusion. On that basis, I am sure she will withdraw the amendment.

Mental Capacity (Amendment) Bill [HL]

Debate between Lord O'Shaughnessy and Baroness Hollins

Committee: 1st sitting (Hansard - continued): House of Lords
Wednesday 5th September 2018 Lords Chamber

[Baroness Hollins]

I asked about the difference between care homes and supported living and just that conflict.

[Lord O’Shaughnessy]

I will briefly come to that. In supported living arrangements, the local authority, the CCG or the local health board would arrange the assessments. It would automatically be that body, as opposed to the supported living provider. I hope that will provide the reassurance the noble Baroness is looking for. It would be the commissioning body in that case.

[Baroness Hollins]

It may be that a lot of the thinking has been done around elderly people and people with dementia as opposed to people with learning disabilities. In the learning disability world, there has been such encouragement towards supported living that they are often within the same organisation, even within the same setting. It seems very strange that you would have a manager who ends up being responsible for a care home, where they have the responsibility, and for supported living, where somebody else has the responsibility.

[Lord O’Shaughnessy]

I am grateful to the noble Baroness for clarifying that. I will seek to understand the implications of the Bill for those cases, and I will make sure that I write to her and all noble Lords with an explanation of what is envisaged.

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[Lord O’Shaughnessy]

There is a useful flowchart that exemplifies it and brings it to life. I will make sure that it is shared. I agree that we need to find ways of bringing it to life, and that is something we can do outside this Chamber.

[Baroness Hollins]

My Lords, I am most grateful to the Minister for his reassurance that the care home manager’s responsibility is only to arrange the assessments. The Mental Capacity Act is so important that we have to be sure that we do not make it worse. It is a good Act, and the main problem identified in the Post-legislative Scrutiny Committee was that it was not well understood. It is emerging that the stakeholders are not understanding what is intended. We should be trying to make it easier to understand and operate, not more complicated.

The noble Lord spoke of trying to legislate for a streamlined process. I am rather worried about legislating for some of these matters, and I am beginning to think that some aspects need to be in regulations rather than in the Bill, just to make things as simple as possible, but also amendable without having to come back to primary legislation. I beg leave to withdraw my amendment.

NHS: Brexit-related Risks

Debate between Lord O'Shaughnessy and Baroness Hollins

Thursday 5th July 2018 Lords Chamber

[Lord O'Shaughnessy]

I am very pleased to do so. The Windrush generation has made a fantastic contribution to our NHS and caring services.

[Baroness Hollins (CB)]

My Lords, I am glad that contingency plans are being made. The British public voted to leave the EU because of the promise of £350 million a week to save our NHS. We now hear, however, that Brexit could have catastrophic consequences for the NHS in areas such as staff recruitment and essential supplies and for the adequate resourcing of the NHS to the standard of our EU partners—a standard that we do not yet reach. Will the Minister admit that these promises were wrong and tell the British people that we may need to think again?

[Lord O'Shaughnessy]

It would be a big mistake for anybody to tell the British people that they voted the wrong way. I point out to the noble Baroness, however, that, whatever was on any side of the bus, as a result of the funding plan announced by the Prime Minister there will be £394 million a week more in real terms for the NHS by 2024. I am also pleased to say that there are more EU staff working in the NHS today than two years ago.

National Health Service: Mental Health Funding

Debate between Lord O'Shaughnessy and Baroness Hollins

Wednesday 20th June 2018 Lords Chamber

[Lord O’Shaughnessy]

Although the particular funding the noble Baroness is talking about is a Home Office issue, I can say that £100 million is available until 2020 to support the victims of domestic violence. From the health service perspective, obviously we are increasing the amount of money spent on treating those with mental illness, regardless of the cause that gave them their illness in the first place.

[Baroness Hollins (CB)]

My Lords, does the Minister agree that more oversight is needed—not just through the mental health dashboard—of how and how well clinical commissioning groups meet the mental health investment standard, previously known as parity of esteem? Can he also explain why the mental health investment standard does not include people with learning disabilities who have mental health needs? Further, what assurances are there that clinical commissioning groups will continue with their current level of investment once the national sustainability and transformation fund finishes?

[Lord O’Shaughnessy]

I reassure the noble Baroness that there is independent audit of performance against the mental health investment standard. Anyone with mental health problems, whether they have learning disabilities or not, should certainly be included in the figures. I am alarmed by what she has said and obviously I will look into it and write to her. However, it is important to say that CCGs have been increasing their spending. In 2016-17 they were expected to deliver at least 3.7% growth in mental health spending, but the actual outturn was 6.3% growth, so that is a good story.

Long-term Plan for the NHS

Debate between Lord O'Shaughnessy and Baroness Hollins

Tuesday 19th June 2018 Lords Chamber

[Baroness Hollins]

My Lords, there is much concern in this House about social care. Can the Minister confirm that the now-promised social care plan will address not only the needs of older people but the needs of all vulnerable people of all ages? It is a little-known fact that the cost of meeting the needs of people with learning disabilities will soon overtake the cost of care of the growing number of older people. It is really important to address that.

[Lord O'Shaughnessy]

The noble Baroness is quite right to highlight the care for this vulnerable group of adults. As she knows, there has been a parallel work stream alongside the work for the Green Paper. Those are two allied but separate pieces of work. At this point in time I do not have a specific date for when that work will emerge into a report or a review, but I will write to her with the details because the Government agree with her that this issue is of equal importance.

Learning Disabilities Mortality Review

Debate between Lord O'Shaughnessy and Baroness Hollins

Wednesday 9th May 2018 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I declare my interest as the chair of a social enterprise that creates communication resources for people with learning disabilities. My own research more than 25 years ago uncovered very similar shocking inequalities. The noble Lord has responded to a question about education but is it not now time for there to be mandatory education for all healthcare professionals? This is not a specialist matter. Does he agree that such training should be co-delivered by people with learning disabilities in order to reduce the fear and lack of understanding among health professionals when it comes to making reasonable adjustments? What action will be taken now?

[Lord O'Shaughnessy]

The point that the noble Baroness makes about the involvement of people with learning disabilities in this process is critical. I did not respond to a question from the noble Baroness, Lady Jolly, about communications with people with learning disabilities. Having written a manifesto in the past and having had it translated into the Easy Read format, I know that this is critical. I know that there are attempts to make sure that communications are made in that format where it is helpful to do so.

On the noble Baroness’s question about training, we have a really good template which my honourable friend Caroline Dinenage mentioned in the other place yesterday, and that is dementia training. It is tiered, with tiers 1 and 2, and it has been rolled out very broadly across the health and care sectors with great success. Therefore, I think that we have a template for doing this, and I know that my honourable friend is taking that forward. It was a specific recommendation in the report by the University of Bristol. My honourable friend committed to take forward with NHS England all those recommendations, and that is what we will endeavour to do.

Health: Medical Respite for Children

Debate between Lord O'Shaughnessy and Baroness Hollins

Wednesday 21st March 2018 Lords Chamber

[Lord O'Shaughnessy]

Yes, I would be happy to do so. I am disturbed by the picture that the noble Lord has painted. He will know, I am sure, that the Government have set out our commitment to end the variation in end-of-life care, and of course this is a co-commissioned service. I would be very pleased to meet him to investigate that.

[Baroness Hollins (CB)]

My Lords, what measures are being taken by the NHS to check that CCGs have the range of specialist expertise available to be able to make assessments individual by individual? These children’s needs are complex. From my experience, often the assessors may be expert in one area but not necessarily that of the case they are assessing.

[Lord O'Shaughnessy]

The noble Baroness is quite right. Many of the children we are talking about are receiving continuing care to meet all their needs, and delivering that is very complex. A national framework for continuing care is being revised at the moment, and it will provide the picture for the skills mix that is needed at local level to ensure that these children are properly served.

Children and Young People: Mental Health Services

Debate between Lord O'Shaughnessy and Baroness Hollins

Thursday 8th March 2018 Lords Chamber

[Lord O'Shaughnessy]

These are interconnected but separate issues. Anyone can suffer from mental health problems, including a high propensity of children with learning difficulties. A separate line of work led solely by the DfE is providing specific educational support for children with learning difficulties. The point of having specialist staff in all primary and secondary schools is to spot any child, whatever their vulnerability, and signpost them to services.

[Baroness Hollins (CB)]

My Lords, have the Government done any analysis of the numbers? My daughter is a child psychiatrist working particularly with younger children. She points out to me that there is little attention given to the needs of nought to two year-olds and their mental health in the Green Paper. We know that interventions are important in those early years. For the prevention of adverse childhood experiences and interventions after adverse childhood experiences, does the noble Lord consider it wise to ring-fence funds to support prevention and early intervention at that stage?

[Lord O'Shaughnessy]

The noble Baroness makes an excellent point about the importance of that age group. I will write to her giving the specifics of the support available to children and families with children of that age. A significant amount of funding is going into specialist perinatal and mental health services for mothers, which is a big part of the picture, but not the whole. Health visitors are being trained in mental health support. I will write to the noble Baroness with more details but I am sure there is more to be done.

Dental Care

Debate between Lord O'Shaughnessy and Baroness Hollins

Thursday 1st February 2018 Lords Chamber

[Lord O'Shaughnessy]

I recognise the benefits of fluoridation that the noble Lord has pointed out. There is no question about that. But we know that this is a very difficult and vexed issue locally—there are strong feelings either way. That is why the position was reached in the 2012 Act. The noble Lord’s idea of a discussion is a good one. I should point out that it is not a policy area on which I lead so I will have to speak to my colleague in the department, but if we can get that going and think about ways to encourage more action it would be a very clever thing to do.

[Baroness Hollins (CB)]

My Lords, I am sure that the Minister is aware that adults with learning disabilities are also at considerable risk of tooth decay, in part because of difficulties in maintaining their dental health. What measures are being taken to improve their dental health? I declare an interest here because I published a book on the subject. I am concerned too about excessive sugar consumption as a major cause of tooth decay. This is a risk for children and adults with learning disabilities. Will the Government consider introducing a ban on advertising high-sugar products on television before the watershed?

[Lord O'Shaughnessy]

The noble Baroness might send me her book so I can get her ideas on reaching adults with learning difficulties. Most adults with significant learning difficulties are likely to be on a range of benefits. That means that their dental care is free, if not for all, I suspect, then for some. She is absolutely right to point to sugar. We now have the sugar levy, which has had a really big impact. About 50% of drinks that would have been affected have been reformulated to either reduce or remove the application of that levy. That is a really good impact. On her point on advertising, we have very tough advertising rules in this country, including the banning of advertising of sweet drinks, sugary products and so on in children’s media. That is one of the reasons why we are seeing some hopeful signs on, for example, the number of extractions falling in primary care year on year.

NHS: Winter Funding

Debate between Lord O'Shaughnessy and Baroness Hollins

Thursday 11th January 2018 Lords Chamber

[Lord O'Shaughnessy]

I think that the trust has been clear that there are not going to be delays. If the noble Lord is talking about the story on the front page of the Times yesterday, the trust has subsequently been clear that it will not delay or curtail its treatments. We know that more nurses are required. That is why, as I am sure he will be pleased to know, there have been around 11,700 more nurses on wards in the last seven years.

[Baroness Hollins (CB)]

My Lords, I have heard from clinicians, including an on-call psychiatrist working over Christmas at St George’s Hospital in south London, about the difficulties experienced and the teamwork displayed to manage the exceptional strain and capacity problems hospitals face. Particular concern was expressed about the pressure to discharge patients quickly and the possible impact on people with learning disabilities or serious mental illness, especially given similar pressures in social care. What steps are being taken to prevent this, for example, by targeting flu vaccination to these vulnerable groups, but also to monitor the impact on them?

[Lord O'Shaughnessy]

The noble Baroness is right to pay tribute, as we should all do, to the incredible work that NHS and social care staff are doing during winter. Of course there is a need to discharge patients, but that should be only when it is clinically appropriate. If she has seen or heard of instances in which she believes that that is not the case I urge her to write to me with them. On how we deal with vulnerable groups, one example is clearly flu vaccination. I point out, and this is important, that not only were flu vaccinations offered for all NHS staff for free this year, with 60% uptake, but for the first time they were also offered to care home staff. That is a really important point about making sure we go to the community to prevent infection.

Social Care: Sleep-in Payments

Debate between Lord O'Shaughnessy and Baroness Hollins

Thursday 7th December 2017 Lords Chamber

[Baroness Hollins (CB)]

I beg leave to ask the Question standing in my name on the Order Paper, and I remind the House of my interests.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O’Shaughnessy) (Con)]

My Lords, we recognise that the historic liabilities associated with the national minimum wage for sleep-in shifts present a challenge to the financial position of many care providers. The Government have been working with representatives of the social care sector to understand how liabilities for back pay for sleep-in shifts impact on the provision of care for vulnerable people. We are exploring options to minimise any impact on individuals and the sector.

[Baroness Hollins]

The Minister will be aware of the considerable stress and anxiety faced by people with learning disabilities and their families about the likely loss of service providers. People with personal budgets who directly employ support staff fear being made bankrupt if they are found to owe arrears to them. We have been aware of this issue for some time now. Will the Government commit to funding these historical liabilities for sleep-in shifts and end the stress and anxiety which is now prevalent within this sector?

[Lord O’Shaughnessy]

We absolutely recognise the pressures that this has caused for providers of all kinds, whether they are large providers of social care or those with personal budgets in receipt of direct payments. I should point out that HMRC is working with local authorities where they are providing funding for direct care, so it is not just a discussion between individuals and HMRC. Local authorities are involved as well because they clearly need to look at the budgets they are providing to make sure they are adequate to pay for existing costs. We are looking at all the issues around historic liabilities, but I am afraid that I cannot give the noble Baroness the commitment she is asking for today.

Brexit: Mental Health Research Funding

Debate between Lord O'Shaughnessy and Baroness Hollins

Thursday 23rd November 2017 Lords Chamber

[Lord O'Shaughnessy]

In our future partnership paper we have set out that we want an ambitious agreement on science and innovation and that we will continue, albeit in a new form, to collaborate with the European Union on health research, including mental health research. On honouring the bids that were underwritten, I should point out that that applies not just to bids or projects that are taking place but to bids that have been submitted up until exit day, so there is a long lead time. It is also important to point out what the Government have been doing domestically. For example, the National Institute for Health Research has increased by over 50% the amount of funding that it puts into mental health research, so the Government have been going a long way in increasing the amount of funding in this area.

[Baroness Hollins (CB)]

My Lords, cancer research gets 25% of the UK’s annual research budget. The Minister mentioned that there has been an increase in the research money available for mental health but, as I understand it, mental illness gets only about 6% of the research budget. Why is that, and is there hope that that will be improved?

[Lord O'Shaughnessy]

In relation to the NIHR funding that I talked about and the specialist disease areas that receive funding, mental health is second only to cancer, so it is getting a great deal of funding. I could talk about the increase in the Medical Research Council’s budget and so on, but more funding is going in specifically to mental health research.

Health Workers: Training

Debate between Lord O'Shaughnessy and Baroness Hollins

Wednesday 18th January 2017 Lords Chamber

[Lord O’Shaughnessy]

I thank the noble Baroness for that question. We are recruiting and creating conditions for the recruitment of more nurses. Something like 37,000 applications were turned down for those wishing to take on nursing, midwifery and allied health professional degrees in 2014-15. That was one of the reasons for removing the cap and equalising the funding arrangement that goes to nurses on other courses within higher education. That will allow universities to provide more places for trainee nurses. We are still early in the cycle and are moving to a new system. I think the UCAS applications have just closed and it is certainly true that in the past when fees were introduced by whichever Government—Labour, coalition or whoever—there was sometimes a small dip in take-up in the first year. But following that, in all those cases across the system, there was a strong rebound in interest in higher education places.

[Baroness Hollins (CB)]

My Lords—

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[Baroness Hollins]

My Lords, my profession of psychiatry is the medical specialty which has recruited the most specialists from outside the United Kingdom, with 41% of trainees coming from overseas. It takes something like 14 years to train a consultant psychiatrist. Can the Minister confirm whether it is the intention of Her Majesty’s Government to allow doctors, nurses and other health and social care professionals to remain in the United Kingdom after Brexit?

[Lord O'Shaughnessy]

The Prime Minister has been incredibly clear on this point—and was again yesterday. It is our intention to do so, and to agree that early with our EU partners. But that is something that needs to be reciprocated.