Consultation on Use of Force in Mental Health Units

Nadine Dorries Excerpts

Tuesday 25th May 2021 Written Statements

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

Today, I am pleased to announce the launch of the Government’s consultation on the statutory guidance for the Mental Health Units (Use of Force) Act 2018.

The Mental Health Units (Use of Force) Act 2018, also known as Seni’s Law, was introduced into the House of Commons by the hon. Member for Croydon North (Mr Reed) in July 2017 and received Royal Assent in November 2018. The Act is named after Mr Olaseni Lewis, who died as a result of being forcibly restrained while he was a voluntary patient in a mental health unit.

The purpose of the Act is to clearly set out the measures which are needed to both prevent the use of force and then ensure accountability and transparency about the use of force in mental health units. By promoting good practice, identifying poor practice, and through a greater understanding of where there are problems or issues for specific groups, we can address this nationally as well as locally. The statutory guidance sets out how we expect mental health units to meet the requirements of the Act. This consultation will seek views on the clarity, content and approach of the proposed guidance.

This is vitally important to minimise restrictive interventions in mental health units which affected 12,000 individuals in 2019-20, and disproportionately those with protected characteristics under the Equality Act 2010.

This is a landmark piece of legislation which enjoys the support of patients, people with lived experience, voluntary and charitable sector organisations and the NHS. Today’s launch represents a significant step forward in our efforts to prevent the use of force in mental health units which would not have been possible without the tireless campaigning of the hon. Member for Croydon North and the Lewis family.

This consultation is part of the Government’s wider reform agenda to improve support for individuals with severe mental illnesses. The Government published their Mental Health Act White Paper on 13 January 2021, which sets out proposals for once in a generation reforms to the Mental Health Act, responding to and building on Sir Simon Wessely’s review of the Act. We are also working hard to achieve our NHS long-term plan commitment to give 370,000 adults and older adults with severe mental illnesses greater choice and control over their care and support them to live well in their communities by 2023-24.

The consultation will conclude on 17 August 2021. The Government’s intention is to publish the final statutory guidance and begin commencement of the Act in November 2021.

[HCWS55]

Black Maternal Healthcare and Mortality

Nadine Dorries Excerpts

Monday 19th April 2021 Westminster Hall

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

I thank all Members of the House who have taken the time to attend and speak in today’s debate, and particularly the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for having secured the debate. Along with everyone else, I also thank the co-founders of the Five X More campaign, Clo and Tinuke, for their incredible work. Their petition to Parliament has generated a huge amount of interest and support, and their work to improve maternity mortality rates and healthcare outcomes for black British women is inspiring and brings this deeply important issue the attention it deserves.

Every woman deserves to have safe care, to feel that her voice has been heard and to be an informed decision maker in her own care. The NHS is one of the safest places in the world to have a baby. Few women in the UK die during childbirth. Between 2016 and 2018, 217 out of 2.2 million women died during, or up to six weeks after, pregnancy from causes associated with their pregnancy. That equates to 9.7 maternal deaths per 100,000 pregnancies. We also know from the MBRRACE-UK maternal mortality reports that some of these deaths could have been prevented. Sadly, evidence shows that, currently, there remains a more than fourfold difference between maternal mortality rates among women from black ethnic backgrounds and among white women in England. There also remains an almost twofold difference between women from Asian ethnic backgrounds and white women. Those disparities are worrying and must be addressed, and I have heard all of the calls to do that today.

However, let me address the points that have been raised by speakers today—many of which have been raised repeatedly—beginning with the right hon. and learned Member for Camberwell and Peckham (Ms Harman). We need to fundamentally understand why this issue occurs and why we have these disparities. The statistics tell only part of the story: the lived experiences of black women need to be understood, appreciated and heard for us to really gain an understanding of the full picture. I think it was the hon. Member for Liverpool, Riverside (Kim Johnson) who read out some of the reasons for these disparities that are given in the report. As we know, and as we could tell from that report and from the list that she read, which was just the tip of the iceberg, the reasons are incredibly complex.

That is why, last month, I announced that the Government are embarking on the first women’s health strategy for England. That strategy is, first and foremost, about listening to women’s voices. The call for evidence that launched on International Women’s Day seeks to understand women’s experience of the health and care system, and we have already seen an incredible response to it. Many thousands of women across the country have come forward to share their experiences through the online survey, which takes just a few minutes to complete, so I will unashamedly make another call in this debate for any woman who has not yet completed the online survey to do so.

However, women from black and other ethnic minority groups are under-represented in the responses we have received so far, and today’s debate has reiterated just how important it is to ensure that the health and care system is listening to women of all backgrounds. I encourage any woman listening to this debate, and in particular women from black and ethnic minority groups, to come forward and have their voice heard. By better understanding women’s experiences, we can ensure that the health system truly meets the needs of women as they should be met. The complaint that women’s voices are not heard—that women are not listened to and are spoken down to in the healthcare sector—is a common one across the board from women, and was highlighted in Baroness Cumberlege’s recent “First Do No Harm” report.

Disparities in maternal mortality rates among women from different ethnic groups have been well documented for many years. The numbers are just not acceptable, and the Government are committed to reducing those inequalities. The charity Five X More has campaigned to make the NHS commit to a target to reduce inequalities and close the current gap in maternal mortalities. There are considerable limitations on producing an England-level indicator of maternal mortality by ethnicity. Many Members raised that point. The fact is that maternal deaths are rare, even among women from black ethnic groups. Because of the very low numbers, even a large reduction in mortality rates for a particular ethnic group would not necessarily be attributable to a genuine improvement in the quality of care.

[Marsha De Cordova]

The issue is that there is a need for a target. When a target is set, work can take place towards a reduction. The Minister says it might be difficult to record the figures by ethnicity. Could she explain why it would be difficult?

[Ms Dorries]

I will go further and explain what we are hoping to do to make a difference. We know that for every woman who dies, 100 women have a severe pregnancy complication or a near miss. That has been mentioned a number of times. When that woman survives, she will often have long-term health problems. Disparities in the number of women experiencing a near miss also exist between women from different ethnic groups. Because near misses are more common than maternal deaths, we can investigate those disparities at local and regional level, to better understand the reasons for disparity, to assess local variation and to identify areas with less disparity and, hence, best practice.

[Wera Hobhouse]

Is it not clear from everything we hear that black women and women from ethnic minorities feel that the health system does not communicate appropriately, so they do not understand all the choices available to them? Is that not a way of getting to the bottom of what is going wrong?

[Ms Dorries]

That is certainly one of the many issues highlighted in the report, but it is not the only one. We have commissioned the policy research unit in maternal and neonatal health and care at the University of Oxford to undertake research into the disparities in the near misses, and to develop an English maternal morbidity outcome indicator. The research will explore whether the indicator is sufficiently sensitive to detect whether the changes made to clinical care are resulting in better health outcomes. Five X More called for that in its list of 10 requests.

We are putting the research in. We have found a way to look at the research in order to make the differences that need to be made. We can do that by examining the near misses. What happened in those cases and in those women’s experiences? What went wrong? Do the women feel that they were not listened to? Was it a matter of treatment? Was it a lack of understanding? We need to understand that by looking at the near misses. The research is being undertaken, but it will take some time. Hopefully, when that is reported, we will be able to make progress on the issue of setting targets.

This Government are no strangers to setting targets. On the very sad issue of baby loss, we set a target to reduce neonatal stillbirth and neonatal mortality rates by 20% by 2020. We have reached almost 25%. We have smashed that target and are still pushing forward to improve that situation even more. We are not afraid of setting targets, but when we are setting them we have to know how to achieve better outcomes. The hon. Member for Battersea (Marsha De Cordova) mentioned continuity of carer. She is absolutely right about those figures. We know that continuity of carer works incredibly well, particularly for black women and women from ethnic minorities. Having the same midwife throughout the process of pregnancy makes a huge difference. That is being rolled out across the country. I am sure that the hon. Lady has spoken to the chief midwifery officer, who is a huge supporter of the policy. We are continuing to roll it out and make progress with it. It has been slightly more difficult during the 12 months of the covid pandemic, particularly because many trusts did not continue with home births.

We are not afraid of setting targets, however. Setting targets in maternity units is what we are about, to make them safer places in which to give birth and in order to reduce both neonatal and maternal mortality rates, but we need to do the research on the near misses, to understand what the problems are. We cannot set targets until we know what we are trying to achieve through those targets and what we need to address. Five X More has asked for that research to be done. It needs to be done, and it will be done.

We are committed to reducing inequalities and to improving outcomes for black women—we work at that daily. I established the maternity inequalities oversight forum to focus on inequalities so that we in Government understand what the problems are. The forum also brings together experts from across the UK—we have met MBRRACE-UK and Maternity Voices—who have done their own research and studied this problem, to hear their findings and recommendations. Professor Jacqueline Dunkley-Bent, the chief midwifery officer for England, is leading the work to understand why mortality rates are higher, to consider the evidence on reducing mortality rates, and to take action to improve the outcomes for mothers and their babies.

NHS England is working with a range of national partners, led by Jacqueline Dunkley-Bent and the national speciality adviser for obstetrics, to develop an equity strategy that will focus on black, Asian and mixed-race women and their babies, and on those living in the most deprived areas. The Cabinet Office Race Disparity Unit has also supported the Department of Health and Social Care in driving positive actions through a number of interventions on maternity mortality from an equalities perspective. The Royal College of Obstetricians and Gynaecologists has established—

[Sir Gary Streeter (in the Chair)]

Order. Will the Minister kindly leave two minutes for Catherine McKinnell at the very end?

[Ms Dorries]

I will end there, but if any hon. Members wish to speak with me about the work we are doing and the research we have undertaken with Oxford University, we are happy to share more. I say in response to the hon. Member for Luton North (Sarah Owen) that very few personal meetings have taken place, but I would be happy to meet her and her constituent.

[Sir Gary Streeter (in the Chair)]

Thank you very much, Minister. It is very important that Catherine McKinnell has the final word.

Oral Answers to Questions

Nadine Dorries Excerpts

Tuesday 13th April 2021 Commons Chamber

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

In October 2020, I commissioned the Care Quality Commission to review how do not attempt cardiopulmonary resuscitation decisions were taken throughout the covid-19 pandemic and whether they had been inappropriately applied. We welcome the CQC report, which was published on 18 March, and we are committed to driving forward delivery of the recommendations through a ministerial oversight group, which I will chair, to ultimately ensure that everyone experiences the compassionate care that they deserve.

[Karin Smyth [V]]

I welcome the Minister’s comments. It is over a decade since I worked with clinicians on how to communicate end-of-life care, so I was shocked by some of the reports and by reading the CQC and Compassion in Dying reports. The lessons learned from coronavirus can and should be seen as a catalyst to having more open and honest conversations about this decision making and advanced care planning. Will the Minister commit to a public awareness campaign, including groups such as Compassion in Dying, Marie Curie and Hospice UK, to ensure that patients are fully aware and at the heart of these decisions?

[Ms Dorries]

I thank the hon. Lady for her question. That is exactly what we are trying to do at the moment. We have posted a public-facing message on the nhs.uk website, which informs the public about how DNACPR decisions should be taken and the process involved. There should be no blanket application of DNACPR notices. Every patient should be involved in the decision when a notice is applied, as well as the family, relatives and care workers, and where possible it should be signed by a clinician. This engagement with the NHS, the wider public and the voluntary and care sectors is ongoing, and we continue to monitor it.

[Antony Higginbotham (Burnley) (Con)]

What steps he is taking to support integration within the health and social care system.

--- Later in debate ---

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

What assessment he has made of the effect of the covid-19 outbreak on bereavement services.

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

The Government recognise that the effects of covid-19 have increased the demand for bereavement services and highlighted the complexity of grief that these services support. In response, since March 2020, we have given more than £10.2 million to support mental health charities, including bereavement services, to support adults and children struggling with mental wellbeing due to the impact of covid-19.

[Seema Malhotra]

Last year, along with the Co-operative party, I called for a proper plan for bereavement to ensure that everyone who has experienced loss during this difficult period has the support that they need. Awareness of the services available is vital if people are to get this help. The Good Grief Trust, with which I have been in contact, has said that too many people simply do not know where to turn. What steps is the Minister taking to help signpost families to bereavement charities and support and to increase awareness of the support available to families in need, which also includes support that can be signposted from hospitals when loved ones die?

[Ms Dorries]

I thank the hon. Lady for her important question. The mental health and wellbeing recovery action plan published on 27 March this year aims to respond to the impact of the pandemic on people’s mental health, specifically targeting groups that have been most impacted. She mentioned the Good Grief Trust, and I mentioned the £10.2 million of funding that we have allocated recently. That is on top of the £2.3 billion a year for general mental health, which includes bereavement counselling, and the £500 million additional spending that we received in the spending review. Some of that money did go to the Good Grief Trust, which has done a fantastic job. It has been signposting services by putting cards in doctors’ surgeries and in A&E departments in hospitals so that people have immediate access to a line, but there are 700 other charities across the UK that are providing bereavement and grief counselling services to many members of the public. We recognise that the demand is high, but the services are there and available.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

With your permission, Mr Speaker, I will pay a tribute to my father, Mohammad Aslam Khan, who passed away a few days ago. Not only was he a keen cricketer and an amazing dancer, he was also a champion of equality. He was incredibly strong and brave until his very last breath and he shall be missed beyond measure. I extend a huge thank you to all the team at St George’s, especially the marvellous team on Dalby ward, also to Victor and the incredible staff and carers at Ronald Gibson House and to a wonderful nurse called Anne Wheeler. My brother and I saw at first hand that not all angels have wings.

Covid-19 has stripped the humanity out of grieving, with millions being unable to attend funerals, say final goodbyes, or be with loved ones following a death. Last year, the Government provided £10.2 million to mental health organisations to ensure that services could continue during the pandemic. Many people have been relying on the support of dedicated bereavement organisations to help them cope, yet the extra financial support ended on 1 April. Will the Minister please consider reviewing this vital funding immediately to ensure that no one has to go through bereavement alone?

[Ms Dorries]

I pay tribute to my hon. Friend and her brave words about her much missed father. Politics divides us, but grief, for many reasons, unites us across this House. I have personally declared to my hon. Friend that I am here should she need me. I pay tribute to her for her bravery, being here today so soon after the loss of her wonderful father. I hear her request; it is constantly under review. Bereavement services are incredibly important to me personally and to many of us. She mentioned the £10.2 million. There are 700 bereavement charities, including the Good Grief Trust. We monitor carefully how people access bereavement services. We know that there is an increased need at the moment and that is being watched very carefully. My hon. Friend is incredibly brave.

[Paul Holmes (Eastleigh) (Con)]

What steps he is taking to improve the understanding and treatment of long covid.

--- Later in debate ---

[Christian Wakeford (Bury South) (Con)]

What progress he has made on implementing the recommendations of the independent medicines and medical devices safety review.

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

A written ministerial statement was published on 11 January 2021, updating Parliament on the Government’s current progress on each of the nine recommendations. The Government will respond in full to the report later this year. It took more than two years to produce the report and we therefore consider it vital, for the sake of patients and especially those who have suffered greatly, to give this independent report the full consideration it deserves.

[Christian Wakeford]

Baroness Cumberlege’s respected report makes it clear that those harmed by sodium valproate have suffered great and irreparable harm for many decades and that redress is needed. The patient reference group adds more delay for people who have waited long enough already. Will my hon. Friend commit to doing the right thing today and take up this issue of redress and give those harmed the support they have waited so long for?

[Ms Dorries]

I would like first to convey my most sincere sympathies to anyone who has suffered as a consequence of taking sodium valproate during pregnancy. It remains still the only drug that some women who suffer from epilepsy can take to control their epilepsy. As set out in the recent written ministerial statement, the Government will carefully consider the recommendations and make a full response to the whole report later this year.

[Claire Coutinho (East Surrey) (Con)]

What progress his Department has made on increasing the recruitment of nurses to the NHS.

Cardiopulmonary Resuscitation in the Pandemic

Nadine Dorries Excerpts

Tuesday 13th April 2021 Commons Chamber

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

I thank my hon. Friend the Member for Devizes (Danny Kruger) for securing this debate on the important issue of the use of “Do not attempt cardiopulmonary resuscitation” orders and the decisions that were taken during the pandemic.

We remain crystal clear that the blanket application of DNACPR decisions is unacceptable, and that standards and quality of care should be maintained even in pressurised circumstances such as we have had over the past year with the recent pandemic. Reports of inappropriate or blanket application of DNACPR decisions across groups of people, particularly our most vulnerable, have been—I think my hon. Friend used this word himself—shocking, and failure to consult people and their families on decisions around CPR causes significant distress.

My hon. Friend mentioned that the review undertaken by the CQC also saw examples of good practice. Much work has taken place over the past year, and I would like to take this opportunity to update the House on the action that the Department, the NHS and clinical leaders have taken to tackle this issue and to ensure that excellent patient-centred care is maintained.

In April and May last year, clinical leaders issued a number of joint statements and letters to health and care providers and professional bodies, making it clear that there has never been an instruction or a directive issued by the NHS to put in place blanket DNACPR orders. Those communications also directly addressed and clarified best practice around the use of DNACPRs for people with learning disabilities, and rightly challenged assumptions about clinical frailty regarding that particular group of people.

Clear messages on the use of DNACPR decisions were also reinforced in our adult social care winter plan in September last year. We made it crystal clear that any advanced care decision, including DNACPR decisions, should be fully discussed with the individual and their family, where possible and appropriate, and signed by the clinician responsible for their care.

I have personally been through this process recently. It is true, as my hon. Friend mentioned, that every end-of-life scenario is different. No two cases are ever the same. In my particular case, it was someone with very late stage 4 cancer, and the discussion was very simple and very easy and took a matter of moments. It involved family and clinician, but the person making that decision was very precise about what they wanted. That scenario exists frequently, but there are also people who may not have the full capacity or may require further input and discussions around the decisions that are being taken.

To ensure that we could take early learnings and address directly concerns about inappropriate DNACPR decisions, because we are aware of the variation, I commissioned the CQC to review how DNACPR decisions were being made during the pandemic. The CQC worked at pace to gather insight from across the health and care system. It took in views from experienced staff, and from patients, their families and representatives, to produce an in-depth thematic review of such an important yet complex—and it is complex—issue. I thank the CQC once again for its work, which was speedily and efficiently completed, as well as all those who participated in the review and shared their valuable insight and experience.

The review shone a light on what good conversations around end-of-life care should look like, illustrating examples of clinicians and care staff going above and beyond to deliver these conversations in a caring and compassionate way, despite the pressures posed by the pandemic. However, it also drew a worrying picture of the reasons that some of those conversations fell short of the high-quality and personalised care that people deserve. As my hon. Friend mentioned, the report identified three key areas where improvements must be made.

First, the CQC found a greater need for information, training and support for health and care professionals to hold DNACPR conversations. In particular, the report raised concerns that a range of equality groups, including

“older people, people with dementia and people with a learning disability,”

were not being supported in the right way.

Secondly, the report found that there lacked a consistent national approach to advanced care planning. The language used in holding DNACPR conversations was often complex, with many different types of advanced care plans in use. Clearly, this lack of consistency runs the ongoing risk of affecting the quality of care that people receive.

Finally, the report found that the right processes were not always in place to ensure that people experienced personalised, compassionate care in relation to DNACPR decisions. Poor record keeping and inconsistency in how DNACPR decisions were reviewed, as well as a lack of system oversight, meant that it was not always possible to understand how effective these conversations actually were.

Over the last year, our NHS and adult social care sectors have truly been the backbone of our nation, and staff have worked tirelessly to deliver outstanding care. Nevertheless, we must use these learnings as an opportunity to do better in areas where we can do more. Going forward, we must ensure that staff across health and social care have the tools required to hold these conversations appropriately and compassionately. We must also begin the journey towards normalising these conversations and giving patients, their families and representatives the knowledge to truly be equal partners in their care.

When staff, patients and their families have concerns, we must put in place the best processes to ensure that people feel supported to speak up. That is why we strongly recommend the findings of the review and, as the Minister responsible for this, why I am personally committed to driving forward its recommendations. To that end, I will be heading up a ministerial oversight group that will bring together partners from across the health and social care system, as well as the voluntary and advocacy sector, ultimately to ensure that everyone experiences the compassionate care that they deserve.

Sensitive and well communicated DNACPRs can and should be an important part of patient care. I am not sure whether my hon. Friend is aware that nhs.uk has now put up a public facing message to explain the process of DNACPRs, how those decisions should be taken and how those conversations should happen, so that everybody who wants to know what the process is can go to the website and see it for themselves. We deliberately made it a public facing message and wanted it to be part of the general conversation around this issue. We are committed to taking continued action to ensure that these decisions are managed and communicated well in all settings.

Question put and agreed to.

9.3 pm

House adjourned.

UK Rare Diseases Framework

Nadine Dorries Excerpts

Wednesday 24th March 2021 Westminster Hall

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries) [V]]

It is a pleasure to serve under your chairmanship, Mrs Miller. I am afraid that I have been asked a huge number of questions. The shadow Minister just said he hoped I could answer them, but I am afraid that is not going to be possible. However, I will write to the hon. Member for Blaydon (Liz Twist) and answer her questions in detail. I congratulate her on securing this important debate. I think someone described her as a doughty campaigner, and I pay tribute to her tireless work championing the rare disease community as chair of the all-party parliamentary group on rare, genetic and undiagnosed conditions. I will try to answer a few of the points in the short time that I have and I will write on the rest.

First, I will answer a more general point. Many hon. Members brought up the drug Kuvan, which is indicated to reduce blood phenylalanine levels in patients with phenylketonuria. PKU is an inherited metabolic disorder. NICE published draft guidance on 25 February recommending Kuvan for people with PKU who are under 18. Hon. Members have quite rightly acknowledged that when children and young people reach the age of 18, that is a problematic step.

NICE’s draft guidance is a huge step forward for children who stand to benefit from Kuvan as a treatment, but I understand that it will be disappointing for adults. It is important to stress that this is not the final guidance. NICE will carefully consider all comments received during the recent consultation. The Government encourage the company to continue working with NICE, NHS England and NHS Improvement to ensure that Kuvan is priced affordably, so that more patients may benefit. That is a sort of round-robin answer to a number of the questions that have been asked.

I would like to pick up the first question that the hon. Member for Blaydon asked about the report to be published on the outcomes of the UK strategy for rare diseases. We have published yearly updates on the UK strategy for rare diseases implementation plan. Those updates highlight areas of progress and ongoing action against the commitments described in the strategy. The Department is constantly engaging stakeholders to learn what has worked in the strategy and the implementation plan.

We are constantly engaging and looking for areas of improvement, and we took the learnings into consideration when we developed the UK rare diseases framework. The framework builds on the previous strategy, outlining clear, concise and actionable priorities that were developed in close collaboration with the rare diseases community, including patients themselves.

The shadow Minister asked about screening newborns in the UK. As part of our screening improvement programme, the Department is considering how better to integrate targeted screening of high-risk groups in our population-based screening programmes. The chief medical officers of the UK have established a screening advisory working group to consider the scope and remit of the single screening advisory body proposed by Professor Sir Mike Richard. We have committed to making better use of technology to develop a more personalised screening offer, including important genetic testing, inter-screening and diagnostics. In the 2019 report, “Generation genome and the opportunities for screening programmes”, the UK National Screening Committee concluded that there is “clear potential” for genomics in the testing for many of the conditions currently included in the blood spot test. I think that all of us here today would agree on one fact: screening and medical science are moving forward at a rapid pace.

Only last month, we marked Rare Diseases Day. We have heard many touching stories today from Members, but last month we also heard many touching stories and how rare diseases, including PKU, can have an impact on patients and on their family members. As many Members of this House know, while rare diseases are individually rare, they are collectively common: one in 17 people is affected by rare disease at some point in their lifetime. In the UK, that amounts to more than 3.5 million, which is a significant group of people.

I am sure that the hon. Member for Blaydon would like to respond to the debate, so I will end. We will write to her with detailed responses to her thoughtful and detailed questions. I hope she will be able to share that information with the rest of the people who have spoken.

Independent Inquiry into Issues Raised by Paterson

Nadine Dorries Excerpts

Tuesday 23rd March 2021 Written Statements

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

It is now 12 months since the independent inquiry into the issues raised by the convicted breast surgeon, Ian Paterson, published its report. The report made for difficult reading and describes the terrible harms that can occur when the malpractice of an individual, rogue surgeon goes unchecked.

In my statement to Parliament on 28 April 2020 I reluctantly announced a delay in our work to respond to the report. The covid-19 pandemic has continued to exert unprecedented pressures on the health system, and this has necessitated a pragmatic response to the recommendations of the Paterson inquiry.

The independent sector has stepped up and supplied much needed additional capacity for the NHS in its treatment of NHS patients during the response to the pandemic.

We have taken stock of all the recommendations and engaged with stakeholders across the system to gather views on the best way forwards. As part of this we have listened carefully to former patients of Ian Paterson through regular conversations with representatives of the three main patient groups and a bespoke event to ensure their voices are heard.

The immediate safety of patients has been our top priority and we have sought and received reassurance that the recalls of patients by University Hospitals Birmingham NHS Foundation Trust and Spire Healthcare have proceeded as quickly as possible.

When the recommendations have provided a clear way forward, we have worked with our system partners to put in place, or require, effective action. We will continue to consider all the recommendations and produce a full response to the inquiry’s 15 recommendations during 2021.

Today I am able to update the House on the Government’s initial response to the following five recommendations of the independent inquiry into the issues raised by Paterson, and update on three other developments.

Recommendation 2—Information to patients: We recommend that it should be standard practice that consultants in both the NHS and the independent sector should write to patients, outlining their condition and treatment, in simple language, and copy this letter to the patient’s GP, rather than writing to the GP and sending a copy to the patient.

NHS England and NHS Improvement will examine how current guidance published by the Academy of Medical Royal Colleges (AoMRC) in 2018 on writing outpatient clinical letters addressed to patients (and copied to their GP) using simple, appropriate language can be incorporated into the requirements of the NHS standard contract.

Recommendation 4—Consent: We recommend that there should be a short period introduced into the process of patients giving consent for surgical procedures, to allow them time to reflect on their diagnosis and treatment options. We recommend that the GMC monitors this as part of “Good medical practice”.

The General Medical Council (GMC) published its revised good practice guidance on consent on 30 September 2020. This came into effect on 9 November 2020 and sets out seven principles of decision making and consent, including giving patients the information they need to make a decision and the time and support they need to understand it. The GMC will work with organisations across the UK’s health services to support doctors to embed this into their everyday practice.

Recommendation 5—Multidisciplinary team (MDT): We recommend that CQC as a matter of urgency, should assure itself that all hospital providers are complying effectively with up-to-date national guidance on MDT meetings, including in breast cancer care, and that patients are not at risk of harm due to non-compliance in this area.

Specific questions relating to MDT are already included in appropriate CQC service frameworks. As part of a longer-term strategy (based upon a short and medium term action plan that includes) this recommendation the CQC will work to ensure these become mandatory elements of its assessment and inspection approaches and communicate its expectations to service providers.

Recommendation 7—Patient recall and ongoing care: We recommend that the University Hospitals Birmingham NHS Foundation Trust board should check that all patients of Paterson have been recalled, and to communicate with any who have not been seen.

University Hospitals Birmingham NHS Foundation Trust (UHB) contacted 4,394 patients between May and August 2020. This has given rise to 355 enquiries. Following receipt of each enquiry, the patient/relative was contacted directly by a member of a dedicated team to ensure that the trust was responding in a way that was respectful and responsive to individual patient preferences. For patients who underwent a breast procedure, care was reviewed by a consultant breast surgeon who was independent from the trust. For patients who had a general procedure e.g. hernia repair or a varicose veins/other vascular procedure, care was reviewed by a consultant from UHB.

Recommendation 8—Patient recall and ongoing care: We recommend that Spire should check that all patients of Paterson have been recalled, and to communicate with any who have not been seen, and that they should check that they have been given an ongoing treatment plan in the same way that has been provided for patients in the NHS.

By December 2020 Spire Healthcare had contacted all known living patients of Ian Paterson for whom they had addresses (approximately 5,500). Spire Healthcare is currently ensuring that those patients’ care has been fully reviewed, that the outcome of the reviews has been fully communicated to them and that, if required, they are getting the support and care that they needed. Additionally, several hundred people have contacted Spire as a result of the letters sent out last year. A proportion of these are having their care reviewed by an independent consultant surgeon and some have been referred for counselling, follow up support or, where clinically appropriate, treatment. Spire Healthcare will continue their review of patients’ care during 2021.

In addition, we are taking three legislative actions to drive up patient safety and ensure care provided by the independent sector is closely scrutinised.

First, prior to the publication of the recommendations of the Independent Medicines and Medical Devices Safety Review the Government acted in June last year to amend the then Medicines and Medical Devices Bill to create the power to establish a UK-wide medical device information system. This system will mean that in future, subject to regulations, we can routinely collect medical device, procedure and outcome data from both NHS and private provider organisations across the UK, ensuring that no patient in the UK falls through the gaps. The Government are also considering how best to supply patients with the details of any device that has been implanted, to ensure they can continue to access that information in the future.

Secondly, following the Independent Medicines and Medical Devices Safety Review the Government are establishing a patient safety commissioner (PSC) for England with responsibility for medicines and medical devices. The main duties and powers of the PSC are detailed in the Medicines and Medical Devices Act which achieved Royal Assent on 11 February 2021 and establishes the commissioner role. The PSC for England will be able to exercise their powers in both the independent sector and the NHS.

Thirdly, the White Paper, published in February 2021 setting out legislative proposals for the Health and Care Bill, announced our intention to extend the remit of the Health Service Safety Investigation Branch to private providers.

The report of the Paterson inquiry shone a light on a set of harrowing events over many years and recommended a way forward to improve safety and quality in both the NHS and the independent sector. I believe it is right that we have taken urgent action where we can, and we will respond in full to the inquiry during 2021.

[HCWS869]

Health and Social Care

Nadine Dorries Excerpts

Friday 12th March 2021 Ministerial Corrections

The following are extracts from the statement on women’s health strategy on 8 March 2021.

[Ms Dorries]

I reiterate that what we are announcing today is a call for evidence from women everywhere in the UK: from every organisation and every friend, every partner, every family of every woman.

[Official Report, 8 March 2021, Vol. 690, c. 539.]

Letter of correction from the Minister for Patient Safety, Suicide Prevention and Mental Health, the hon. Member for Mid Bedfordshire (Ms Dorries).

An error has been identified in my response to a question arising from the statement.

The correct response should have been:

[Ms Dorries]

I reiterate that what we are announcing today is a call for evidence from women everywhere in England: from every organisation and every friend, every partner, every family of every woman.

[Ms Dorries]

I hope that, as we do on all issues related to health, we and the devolved nations will share data and the methods of collecting it, experience and the evidence to develop a women’s health strategy, which will one day be rolled out across the UK.

[Official Report, 8 March 2021, Vol. 690, c. 540.]

Letter of correction from the Minister for Patient Safety, Suicide Prevention and Mental Health, the hon. Member for Mid Bedfordshire (Ms Dorries).

An error has been identified in my response to a question arising from the statement.

The correct response should have been:

[Ms Dorries]

I hope that, as we do on all issues related to health, we and the devolved nations will share data and the methods of collecting it, experience and the evidence to develop a women’s health strategy, which will one day be rolled out across England.

[Ms Dorries]

My hon. Friend is absolutely right that working with charities, organisations, the third sector and all women, and their families and friends, across the UK is really important.

[Official Report, 8 March 2021, Vol. 690, c. 547.]

Letter of correction from the Minister for Patient Safety, Suicide Prevention and Mental Health, the hon. Member for Mid Bedfordshire (Ms Dorries).

An error has been identified in my response to a question arising from the statement.

The correct response should have been:

[Ms Dorries]

My hon. Friend is absolutely right that working with charities, organisations, the third sector and all women, and their families and friends, across England is really important.

[Ms Dorries]

It is really important that BAME women understand that we want to hear their stories and birth experiences. BAME women are five times more likely to die in childbirth than white women. We need to know what those issues are, and it is important to get that message out to those women.

[Official Report, 8 March 2021, Vol. 690, c. 548.]

Letter of correction from the Minister for Patient Safety, Suicide Prevention and Mental Health, the hon. Member for Mid Bedfordshire (Ms Dorries).

An error has been identified in my response to a question arising from the statement.

The correct response should have been:

[Ms Dorries]

It is really important that BAME women understand that we want to hear their stories and birth experiences. BAME women are just over four times more likely to die from causes associated with their pregnancy and childbirth than white women. We need to know what those issues are, and it is important to get that message out to those women.

[Ms Dorries]

It is really important to us that as many women from as many backgrounds and as many geographical locations as possible across the UK respond to this call for evidence.

[Official Report, 8 March 2021, Vol. 690, c. 548.]

Letter of correction from the Minister for Patient Safety, Suicide Prevention and Mental Health, the hon. Member for Mid Bedfordshire (Ms Dorries).

An error has been identified in my response to a question arising from the statement.

The correct response should have been:

[Ms Dorries]

It is really important to us that as many women from as many backgrounds and as many geographical locations as possible across England respond to this call for evidence.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Nadine Dorries Excerpts

Report stage & 3rd reading
Friday 12th March 2021 Commons Chamber

[Alex Norris (Nottingham North) (Lab/Co-op) [V]]

I have been reassured by the answers given to the promoter of the Bill, the hon. Member for Sevenoaks (Laura Trott), so I do not intend to support either amendment or delay proceedings any further.

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries) [V]]

I congratulate my hon. Friend the Member for Sevenoaks (Laura Trott) on the outstanding work that she has done in introducing the Bill, and I reiterate the Government’s support for the legislation. I believe that everyone has the right to make informed decisions about their bodies, but our role in Government is to support young people in making safe, informed choices where necessary to protect them from the potential harm that cosmetic procedures can do to their health. The increasing popularity of cosmetic procedures and the pressures on our young people to achieve this aesthetic ideal are well documented, and I believe that the Bill is an important step in putting those necessary safeguards in place.

I acknowledge the intentions behind the amendment tabled in the Public Bill Committee by the hon. Members for Swansea East (Carolyn Harris) and for Bradford South (Judith Cummins) to introduce a medical necessity test on the face of the Bill, and I hope that they have taken assurances from the explanation by my hon. Friend the Member for Sevenoaks of the work that she has done to explore this. The standards set by the General Medical Council already require doctors to consider the best interests of the patient to cover the ethical treatment of under-18s.

It has been an absolute pleasure to work with my hon. Friend to take this step towards greater regulation of the cosmetic procedure industry. I look forward to the Bill’s successful passage through the Lords.

[Sir Christopher Chope]

Because time is running short, I thank those who have contributed to this short debate, and so that we can move on to Third Reading, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Third Reading

--- Later in debate ---

[Ms Dorries [V]]

I have nothing further to say due to the shortage of time. I just reiterate that it has been an absolute pleasure to work with my hon. Friend the Member for Sevenoaks (Laura Trott) to take these steps forward to the conclusion of the Bill, and I commend it to the House.

[Alex Norris [V]]

I add my congratulations to the hon. Member for Sevenoaks (Laura Trott). I know that this has been no mean feat, especially during the current challenging times, and there has had to be a lot of patience, but it has been rewarded today. It is important that we act to protect our young people, especially with the pressures that they face. This is one of those great bits of legislation where I think if we stopped our constituents in the street and asked them about it, they would think it was already like this. This is a common-sense, practical and proportionate way to protect our young people, and we give it our full support.

National Carers Strategy

Nadine Dorries Excerpts

Friday 12th March 2021 Commons Chamber

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries) [V]]

I congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on securing this debate on the important issue of unpaid carers. I am aware—I am sure everyone is—of her long-term campaigning on this issue. The Government recognise the vital role that unpaid carers play, especially given the difficulties that the coronavirus pandemic has placed on those caring for relatives and loved ones.

At the very beginning of her speech, the hon. Lady raised the support that carers have received during the pandemic. It has included funding through a number of charities to support carers and provide guidance tailored to them to help them self-identify and gain access to the support that they need. She also raised the issue of vaccines. We are aware of the issue she raised about GPs, but she may not be aware that this week we announced that carers are now in Joint Committee on Vaccination and Immunisation table 6 and will be called this week to go for their vaccinations. I take on board the issue with her constituent and the GP, and I will take that back to the Department to have a further look at it, but it is covered under the standard operating procedure and all carers should be receiving their vaccine now.

We are focused on supporting carers during the pandemic. As well as the measures I have just mentioned, our response has included free personal protective equipment for unpaid carers living separately from the people they care for, priority for vaccines in line with JCVI advice, as I have mentioned, funding through the charities for guidance, and £500,000 to the Carers Trust to provide support to unpaid carers experiencing loneliness during the pandemic. We have also provided £122,000 to Carers UK to extend its helpline opening hours and have funded the See, Hear, Respond service to provide support to children, young people and families who are affected by the coronavirus crisis, which includes a dedicated young carers hub.

Funding has also been made available through the infection control fund, some of which can be used by local authorities to reopen or reconfigure day care centres, which provide vital respite to carers and allow those they care for to meet others. We are helping to ensure the safe continuation and restarting of day services, and have worked with the Social Care Institute for Excellence to publish guidance to day care centres. We have also undertaken work with the Association of Directors of Adult Social Services and local authorities to understand the barriers to opening and reopening day centres.

On social care funding, which can be used to provide services for unpaid carers, as well as those with eligible needs, we are providing local authorities with access to more than £1 billion of additional funding for social care in 2021-22. That includes £300 million of new grant funding for social care, on top of the £1 billion social care grant announced in 2019, which is being maintained, in line with our manifesto commitment. The Government are also enabling local authorities to access up to £790 million of new funding for adult social care through a 3% adult social care precept. We are also providing local authorities with further packages of support worth an estimated £3 billion in 2021-22 to help manage the impact of covid-19 across their services and on income. Some £1.55 billion of the £3 billion is being provided as un-ring-fenced grant funding to directly address spending pressures on local authority services, including adult social care.

In 2019-20, more than 375,000 carers in England were supported by local authorities, with more than 315,000 carers receiving direct support, including information, advice and other services. In addition, in excess of 45,000 carers have received respite or other carer support delivered to the person they care for. Our funding continues to support local authorities in maintaining care services, while keeping up with the rising demand and the recovery from the impact of covid-19.

Let me turn to the two-year carers action plan, which was published in June 2018. The plan set out a cross-Government programme of targeted work to support all carers in England until the end of 2020. The action plan put a focus on practical actions to support carers, recognising and supporting unpaid carers to provide care in a way that protects their own health and wellbeing, employment and other life chances.

Good progress has been made towards fulfilling the commitments set out in the plan. In July 2019 we published the carers action plan one-year progress review, which showcases some of the key commitments we made within the action plan—for example, the Carer Confident benchmarking scheme, launched in January 2019, which aims to encourage workplaces to have policies to enable carers to stay in employment, and the carer passport scheme, which increases recognition of the carer’s role by connecting them to local support to make their lives a little easier.

In June 2019, the Social Care Institute for Excellence and Carers UK published new guidance to improve the provision of carers’ breaks. The Government are committed to the improvement of the adult social care system and will bring forward proposals in 2021. Our objectives for reform are to enable an affordable, high-quality and sustainable social care system that meets people’s needs, while supporting health and care to join up services around people. We want to ensure that every person receives the care they need and is provided with the dignity they deserve.

We recognise unpaid carers as a key part of our health and social care system and as part of ensuring the best outcomes for those they care for. That includes a wide range of people with different conditions and circumstances. We look forward to continuing to work with carer organisations and stakeholders across the public sector to help unpaid carers to gain access to the support that they are entitled to but often do not claim, and to build on the pandemic response.

Ensuring support for carers does not rely on one Department or on Government alone. We will continue to work with the public sector and carer organisations and across Government to understand the needs of unpaid carers and how best to support them to care as they would wish to care, balancing their caring role with their own health and wellbeing.

I conclude by extending my thanks on behalf of the country to unpaid carers for their invaluable support, and to those providing support to them for everything they do.

Question put and agreed to.

Independent Investigation into East Kent Maternity Services Trust: Terms of Reference

Nadine Dorries Excerpts

Thursday 11th March 2021 Written Statements

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

On 13 February 2020 I confirmed in Parliament that, following concerns raised about the quality and outcomes of maternity and neonatal care, NHS England and NHS Improvement (NHSEI) have commissioned Dr Bill Kirkup CBE to undertake an independent review into maternity and neonatal services at East Kent Hospitals University NHS Foundation Trust (the trust).

The review will be known as the “Independent Investigation into East Kent Maternity Services” (the independent investigation).

We take the patient safety concerns at East Kent maternity services very seriously. The independent investigation will provide an independent assessment of what has happened with East Kent Maternity and Neonatal Services and identify lessons and conclusions.

The terms of reference have been finalised now the views of the families affected have been taken into account and are published today on the independent investigation (Independent Investigation into East Kent Maternity Services: https://iiekms.org.uk/) and NHSE website (www. england.nhs.uk/publication/independent-investigation-into-east-kent-maternity-services-terms-of-reference). The terms of reference include the scope and arrangements that are to be put in place to support its functions and confirm the independent investigation will examine maternity and neonatal services in East Kent, in the period since 2009, when the trust came into being, until 2020. The terms of reference include the scope and arrangements that are to be put in place and confirm the independent investigation will examine maternity and neonatal services in East Kent, in the period since 2009, when the trust came into being, until 2020.

The independent investigation will draw conclusions as to the adequacy of the actions taken at the time by the trust and the wider system and will produce a report to be disclosed first to the affected families and then to NHSEI as the commissioning organisation, and then to the Department of Health and Social Care prior to publication.

The work of the independent investigation is expected to complete by the autumn of 2022 and arrangements will be made for the final report to be presented to the Secretary of State; Ministers will subsequently publish the report to Parliament, and a response will be provided in due course.

A copy of the terms of reference will be deposited in the Libraries of both Houses.

[HCWS840]