Health and Social Care

Nadine Dorries Excerpts

Thursday 3rd December 2020 Ministerial Corrections

The following is an extract from the debate in Westminster Hall on deaths in mental health care on 30 November 2020.

[Ms Dorries]

Matthew Leahy took his own life while he was in the care of the NHS.

[Official Report, 30 November 2020, Vol. 685, c. 18WH.]

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

An error has been identified in my response to the debate.

The correct response should have been:

[Ms Dorries]

Matthew Leahy died by hanging while he was in the care of the NHS.

Deaths in Mental Health Care

The following is an extract from the debate in Westminster Hall on deaths in mental health care on 30 November 2020.

[Barbara Keeley]

The point has been made that Melanie Leahy has campaigned on this for eight years and has done a wonderful job. I understand the reasons for trying to do this quickly, but it is too hasty for the Minister to move ahead and appoint a chair unless she is clear that the families, and particularly Melanie Leahy, are happy with that. The chair has to be seen to be independent. I am not sure that I am particularly happy with what the Minister is outlining.

[Ms Dorries]

We will go through the processes that we have been through within the Department of Health and Social Care. They are set in law and abided by during every inquiry; that has included all the past inquiries such as the Dixon inquiry, the Paterson inquiry and the Morecambe Bay inquiry. The same protocols and the same process will be adhered to.

[Official Report, 30 November 2020, Vol. 685, c. 20WH.]

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

An error has been identified in my response to the hon. Member for Worsley and Eccles South (Barbara Keeley)

The correct response should have been:

[Ms Dorries]

We will go through the processes that we have been through within the Department of Health and Social Care. They are set in precedent and abided by during every inquiry; that has included all the past inquiries such as the Dixon inquiry, the Paterson inquiry and the Morecambe Bay inquiry. The same protocols and the same process will be adhered to.

Deaths in Mental Health Care

Nadine Dorries Excerpts

Monday 30th November 2020 Westminster Hall

[Mike Hill (Hartlepool) (Lab)]

I beg to move,

That this House has considered e-petition 255823, relating to deaths in Mental Health care.

It is an honour to serve under your chairmanship, Mr Stringer. I, too, received that advice not long ago, and sought advice on behalf of the petitioner in regard to anything that I have to say. I will navigate through my speech, bearing in mind that legal statement. I apologise in advance if I stray into such territory, simply because to do justice to this petition I have for the most part chosen to reflect the words of the petitioner. That is only right and just. More than 100,000 people have signed the petition. It is a very personal case, and it is personal for other families whose relatives have died in such horrendous circumstances.

The petition attracted 105,580 UK signatories in support, despite the fact that it was curtailed by the Government closure of Westminster Hall last November due to covid. I will read the text of the petition to put it on the record and inform hon. Members fully. I have spoken to the petitioner, Melanie Leahy, on a number of occasions, and I pay tribute to her for starting the petition. She wrote:

“I request a full public inquiry into death of my son, Matthew Leahy. (20 yrs.)

Matthew was taken to ‘a place of safety’, and died 7 days later. 24 others died by the same means, dating back to the year 2000. An indicator that little was done to address the growing problems. Something went terribly wrong with the NHS Mental Health Services provided to my son.

There really is no way that public concern can be allayed, short of an Inquiry. All investigations to date, including police and inquest proceedings, have been based on a Trust Serious Incident Investigation. A four and half year Parliamentary Health Service Ombudsman Report has now concluded that this investigation was not adequate and lacks credibility.

There has been an inadequacy of investigation. A human rights violation. New evidence has been uncovered and I request a statutory inquiry, that compels witnesses to give evidence on oath.

Matthew is not alone. Many others have died”—

in the same institution—

“whilst ‘In The Care Of The State’.”

The petition ends with a link to a press report dated November 2018 detailing how a two-year police investigation sparked by Matthew’s death six years earlier, into the corporate manslaughter of 24 further patients, was dropped, leaving families without “accountability or recourse”, for their loved ones’ deaths.

In opening the debate on behalf of the Petitions Committee I want to begin with some background. On 15 November 2012, Melanie, Matthew’s mother, received the call that no parent wants to receive: “Matthew has been found hanging and it’s not looking good,” was the quote. It came to light that Matthew had already been dead for more than an hour when that call was made. Melanie described it to me as the first lie of many more that she would uncover after his death. I will share the background of Matthew’s short life, how he ended up in the care of the Essex mental health system, what went wrong, the journey that his mother has been on since his death to get to any form of truth or accountability, and her continued fight for truth, justice, accountability and change for others. I have received a letter from the right hon. Member for Harlow (Robert Halfon) in support of the case. He has had a case of someone dying in similar circumstances in the same place.

The account is quite long, but that is understandable as Melanie’s fight has taken eight years to date, and has encompassed many trials in getting to this point. I have a statement from Melanie that she would like to have been able to read herself. Obviously that is not allowed in this place, so I will read it for her:

“I write these words not just to represent my son, but to represent the multitude of lives that have been affected by the inadequate care offered by mental health services across our nation.”

Mr Stringer, almost within the last 10 minutes I received a statement from families, who asked for it to be read out. I do not have time to do that, but I ask the Minister to accept it if I forward it to her .

The Minister for Patient Safety, Mental Health and Suicide Prevention (Ms Nadine Dorries) indicated assent.

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

indicated assent.

[Mike Hill]

The statement reads:

“I am mum to Matthew James Leahy, born December 1991. He was a beautiful soul. He understood compassion and he cared for others. He was generous, he was kind, he was smart. He was funny and in his younger years he wanted to be a comedian. He was quite shy in large groups, and was a loyal friend. He was never one to encourage a fight but he would stand up for himself and the ones he loved. And I’m proud to say my son was honest, not a liar, not like some I’ve come across on this journey.

He loved the outdoors, loved anything water sports related and was a fantastic skier. Having left Grammar school, where he excelled in mathematics and computer science, he set up his own computer business, travelling between clients on his motorbike and was doing really well. He had a natural talent for swimming. He actually saved two ladies from drowning and when 18 he became a qualified life guard.

Aged 19 Matthew was having trouble sleeping and complaining of pains in his stomach and having stomach cramps. He was also hallucinating. When Matthew became poorly we turned to so called professionals for help, to help us to understand what was happening with our son. He was sectioned for care and treatment. This sectioning and the failings in care at that time, although noted briefly in the inquest verdicts, have never been investigated.

After Matthew’s death medical records showed that the first psychiatrist involved in his care picked up a B12 and folate deficiency and possible coeliac disease, combined with a thyroid issue. However, these discoveries were never addressed, as a new psychiatrist took over Matthew’s care and put him straight on to anti-psychotic medication. Any further physical checks were minimal.

On 7 November 2012, Matthew was placed under section 3 of the Mental Health Act and admitted to the Linden Centre in Chelmsford, Essex. By 15 November, some seven days in the ‘care of the state’, my son was dead. The last days of his life in a place he called ‘Hell’. And I now believe it truly was a hell on earth.

Alone, malnourished, over-medicated, scared, bleeding, bruised, reportedly raped, injected multiple times, ignored, and frightened. No records of any staff in those last seven days of his life offering him any comfort. I had been advised not to visit and to give him time to settle on the ward. I will live with the guilt for the rest of my life that I listened to so-called professionals and I was not there when my son needed me the most.

An inquest into my son’s death was held in January 2015. An open narrative verdict was reached, which concluded that my son, ‘Matthew James Leahy was subject to a series of multiple failings and missed opportunities over a prolonged period of time by those entrusted with his care. The jury found that relevant policies and procedures were not adhered to, impacting on Matthew’s overall care and wellbeing leading up to his death.’

How the inquest concluded I will never know. Staff were not interviewed by police after Matthew’s death. An internal investigation was carried out, which the Parliamentary and Health Service ombudsman has deemed flawed and not fit for purpose. This flawed investigation formed the basis of every investigation actioned after Matthew’s death.

The ligature was destroyed, the defibrillator was destroyed. Door logs were not downloaded. CCTV was hidden for over seven-plus years, and parts of it either not retained or deleted. So, so many more issues exist.

I have not been able to determine or control any of this—investigations, reviews, reports etc—all processes that have happened around me, with me being entitled to some information and some explanation, but little voice, little influence and little power.

I did think that the system would be open and honest, would explain what went wrong, hold to account those responsible for any failings and afford justice for failing my most precious son. However, I have discovered a deeply troubling mismatch between what I expected and what I found. In any other walk of life, if there had been failings, heads would roll. This has never happened, despite criminal offences being proved.

If the tragedy of losing Matthew hasn’t been bad enough, to not know the full circumstance that led to his death ‘whilst in the care of the state’ is unforgiveable. I still do not have full disclosure and have never seen internal statements. ‘Duty of Candour’ went out of the window the moment Matthew died.

It came to light after Matthew died that paperwork had been falsified, backdated and slipped into his files. It took me four-plus years to finally persuade Essex Police to register this falsification of mental health documents as a crime. I thought, ‘At last, they are listening to me.’ Then the bomb dropped. ‘We won’t be prosecuting, as it’s not in the public interest.’

The Trust has failed to take steps to protect patients in their care. The question remains why no individual has been held to account and why some staff involved in failing my son and other patients have actually been promoted to high-ranking positions within the NHS.

The Coroner called for a Public Inquiry after the inquest in 2015. There have also been multiple calls from various MPs in the last five years. The Parliamentary and Health Service Ombudsman went on national television after ‘The Missed Opportunities Report’ was published to say that if he had the power to, he would call a Public Inquiry.

In October last year, the Public Administration and Constitutional Affairs Committee held an evidence session on the Ombudsman’s Report into the failed care of Matthew and of Ben Morris. (Ben died in the Linden Centre in 2008 aged 20 years).

During the session, the Minister for Patient Safety, Mental Health and Suicide Prevention explained, ‘that Public Inquiries do not happen for individual cases. In this case, a Public Inquiry is not an appropriate response because we are talking about two cases’.

I have now been joined in this fight calling for a Statutory Public Inquiry into Essex Mental Health Services by multiple bereaved and failed families. (55 families and growing). How multiple deaths can have gone on unchallenged for so many years and so many people in official positions, not involved with this scandal, have entrapped themselves by collaboration the moment they came across it has baffled me. How the system did not prevent these deaths or at the very least detect the failings/changes needed earlier I’m sure is a question in many failed families’ minds, not just mine.

Where is the Government’s anger? Its thirst for Truth and Justice? Its commitment to getting answers and ensuring it never happens again?

Many families are losing loved ones while under the care of state mental health system. Whether that be due to mental illness, additional vulnerabilities such as autistic and/or learning disabled individuals, those misdiagnosed, or dementia...it does not discriminate.”

The Government are now officially, in Melanie’s words,

“on notice of…Gross and systemic Neglect (resulting in multiple avoidable deaths)…Physical, sexual, and emotional abuse and exploitation of the vulnerable—most of them young, historical and sadly, ongoing.

The right people in Government need to understand the full extent of the Essex Trust’s Failures and I have every faith that once the Government commits to a Full Statutory Public Inquiry into Essex Mental Health, the fundamental truth of what and still is going wrong will be revealed.

Through that knowledge I hope justice and accountability are afforded and that necessary change is made for others who, like I and many others did, look to services when they need safe, compassionate care for their loved ones.”

I have to echo that point in respect of some horrendous cases in the Tees Valley, my own patch.

I will conclude with the following words:

“I offered the Government Matthew’s sad death to be a catalyst of learning and change months ago. Please call a Public Inquiry into Essex Mental Health Services without further delay. Make the changes in Essex and send the learning across the country. I hope then that I can start to grieve the loss of my son and Matthew will be able to then rest in peace.”

I know I have kept my speech narrow, but I felt it appropriate to reflect the true voice of the petitioners. Thank you, Mr Stringer, for allowing me to do that.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship once again, Mr Stringer. I congratulate the hon. Member for Hartlepool (Mike Hill) on securing such an important debate on the e-petition calling for a full public inquiry into the tragic circumstances surrounding the death of Matthew Leahy, and the wider issue of deaths in mental health in-patient settings.

I thank all hon. Members present for making such valuable and powerful speeches on such an important issue. I am going to make quite an important announcement. Therefore, if anybody feels the need to intervene, could they wait until I have finished so that there is no ambiguity on the part of the relatives who may be listening, and so that they fully understand what I am saying and the reasons why I am saying it? In this case, that is quite important, particularly for Mrs Leahy and the relatives.

Matthew Leahy took his own life while he was in the care of the NHS.[Official Report, 3 December 2020, Vol. 685, c. 3MC.] His death was avoidable, as were the deaths of a number of other people in the same facility. While nothing that I or any of us can say today can ease the pain of their families and friends, I am determined that we learn the lessons of these tragic events.

[Barbara Keeley]

I should like to raise a question with the Minister. She said that Matthew took his own life. Melanie Leahy does not accept that, and I think it would be easier if we used the words “he was found hanging”. The inquest recorded an open verdict, so I do not think it is appropriate in this debate to say that he took his own life.

[Ms Dorries]

Until we have proceeded a bit further, there is a form of words that I have to use at the moment, and that is the form of words. There is absolutely no contention about how Matthew died or the appalling circumstances in which he was found, but I have to use a particular form of words at this point.

As I said, nothing can ease Melanie’s pain, or that of the relatives of others who were found in similar circumstances in the Linden Centre. Matthew died in November 2012 while he was in the Linden Centre, a mental health facility in the former North Essex Partnership University NHS Foundation Trust. I understand the devastating impact that that has had on Matthew’s family, especially Melanie, whom I have spoken to twice. My heartfelt condolences go out to them now, as was the case when I spoke to them and will continue to be so.

The petition we are debating today calls for a public inquiry into the death of Matthew Leahy on the grounds that past investigations have been inadequate. I first met Melanie last year and I was deeply moved by her story. I took that story away and have continued to work since I first spoke to her. I have since met her again and I have met some of the other families whose loved ones have died at the Linden Centre, and my thoughts are equally with them.

As a result of what I have heard from both Melanie and other relatives, I can confirm today that there will be an independent inquiry into the events at the Linden Centre, covering the period from 2000 to the present day, as requested in Mrs Leahy’s petition. This will mean that all the tragic events are given the attention they deserve to ensure that lessons are learned. The scope will not go earlier than 2000 or later than 2020, in order to keep the inquiry focused and to have it report in a timely manner. I consider that 20 years is a more than adequate timeframe to enable us to understand what happened at the Linden Centre and to learn from it.

I am in the process of appointing an independent chair, and I am considering half a dozen leading candidates at present. They will need to be robustly independent and command the confidence of the families. I have chosen to go down the route of an independent inquiry rather than a public statutory inquiry so that we can move quickly. To inform its findings, the inquiry will be able to call witnesses and undertake a close examination of what actually happened to patients who died at the trust. I will also appoint a barrister—a QC—to assist the chair in their investigations, along with a full secretariat. The inquiry will be independent and will consult families on the specific terms of reference. As an independent inquiry, it can determine how it wishes to work with the families so that they are able to give their accounts.

I will not pull any punches. Hon. Members will be aware of the report of the inquiry into the life and death of baby Elizabeth Dixon, published last week, which set out the details behind what it described as a “20-year cover-up”. I can cite two more inquiries: the Morecambe Bay investigation and the Paterson inquiry, both of which were independent inquiries commissioned by my Department. They left no stone unturned and were frank in their criticisms.

I expect witnesses to come forward irrespective of the type of inquiry. While public inquiries can compel witnesses to appear and give evidence under oath, importantly, they do not have to give evidence that would incriminate them. However, it is incumbent on all holders of public office, and on health professionals, to demonstrate their fitness by voluntarily co-operating with independent inquiries that seek to protect future patients and offer closure to families.

[Barbara Keeley]

Will the Minister give way?

[Ms Dorries]

I will when I have finished this point.

The independent Paterson inquiry—this is an important point—referred to the General Medical Council two doctors who had refused to give evidence to the inquiry, and they are being investigated. It is not the case that if someone in a professional capacity refuses to give evidence to an independent inquiry, they are not held accountable. That is patently demonstrated by the case of the doctors who are being investigated by the GMC.

With the timeframes that we originally set, I had hoped that the inquiry might report within 18 months. As I have today extended its scope to cover a 20-year span from 2000 to 2020, it will take longer, but I hope that it will report its findings within two years. I hope to announce the chair and outline the terms of reference in a written ministerial statement—

[Barbara Keeley]

Will the Minister give way?

[Ms Dorries]

I will.

[Barbara Keeley]

I think it would be easier if the Minister just let me ask the question. It was clear from what my hon. Friend the Member for Hartlepool (Mike Hill) said that Melanie Leahy is not necessarily happy with an independent inquiry. We should be clear about that. There is the question of compelling witnesses to attend.

The Minister is talking about appointing the chair. It is important that, for complete independence, any inquiry has the support of families such as Matthew’s. Can she tell us whether she will consider having the position of chair approved by an independent body or, for instance, the Health and Social Care Committee? I do not think people will be comfortable with her appointing the chair. As other hon. Members have said, there has been too much of people appointing other people, and saying, “You review me and I review you.” That is an important point.

[Ms Dorries]

I would like to get the inquiry going. As in all other inquiries, I believe it is the case—I will come back to the hon. Lady with the reasons why—that ministerial responsibility has to be taken.

As I was about to say, I want to get the inquiry under way before Christmas. I would like to make a written ministerial statement to the House before the Christmas recess to set out the terms of reference of the inquiry and to name the chair, with the provision that the inquiry will commence in the second week of February.

[Barbara Keeley]

The point has been made that Melanie Leahy has campaigned on this for eight years and has done a wonderful job. I understand the reasons for trying to do this quickly, but it is too hasty for the Minister to move ahead and appoint a chair unless she is clear that the families, and particularly Melanie Leahy, are happy with that. The chair has to be seen to be independent. I am not sure that I am particularly happy with what the Minister is outlining.

[Ms Dorries]

We will go through the processes that we have been through within the Department of Health and Social Care. They are set in law and abided by during every inquiry; that has included all the past inquiries such as the Dixon inquiry, the Paterson inquiry and the Morecambe Bay inquiry. The same protocols and the same process will be adhered to.[Official Report, 3 December 2020, Vol. 685, c. 4MC.]

[James Cartlidge]

I am grateful for what the Minister has said. I know that she has battled to get this through because she sincerely believes in the cause and in bringing justice. In my view, it is important that it happens quickly, as I said earlier. My worry is that a statutory inquiry would take months and months to set up. For my constituents the Wades, the key thing is time. The semantics do not matter, as long as what we do finds the truth and probes further. That is exactly what happened with the Dixon inquiry.

[Ms Dorries]

My hon. Friend is absolutely right that no stone was left unturned in the Dixon inquiry. It took 20 years to conclude, and the summary was devastating in terms of what happened. A nurse can no longer practise in this country, and it was revealed that the trust, doctors and medical staff had engaged in a cover-up for 20 years. It took 20 years of probing, but the inquiry happened. It might be thought that a public inquiry would find out more, but one of the advantages of an independent inquiry is that it can work much more closely with families and take their considerations into account by talking to them and involving them, whereas that would not happen with a public inquiry. As has been demonstrated by each one that has been conducted, an independent inquiry benefits from the relationship built with families and the information that families have been able to input. It is important that families’ stories are heard, because some of them are complex, painful and detailed.

Extending the inquiry from 2000 to 2020, as I have done this morning, incorporates both the former trust and the existing trust. A situation occurred recently within the new trust, and we are able to incorporate both trusts and even more families.

[Catherine West]

The Minister is being generous in giving way. The people running the inquest certainly say that they think a statutory inquiry would be best. Over a 20-year period, many of us have received emails from constituents whose children are now in social care—for example, a young woman who spent time in 11 different hospitals first went in when she was 14. She is still there at the age of 22, at a cost of £700,000 per annum. What learning is there at an interim level? Will the inquiry allow for learning as we go, rather than our waiting five years for the report? In those five years, we could lose another 10 or 15 patients each year, so what are the interim milestones that could give us support?

[Ms Dorries]

The hon. Lady is absolutely right, and we would hope for an interim report, but it would depend on the chair. Once we have appointed a chair and secretariat and have the ability to appoint a QC, as required for interviewing witnesses, we will have as a Department, as Ministers and as MPs—independent means independent. Nobody can have any influence on the inquiry, but we would ask for an interim report, particularly if there were findings. However, we have to be aware that findings could prejudice something that might come as a result of the inquiry. Learning is absolutely the key, which is why we have established the Healthcare Safety Investigation Branch.

This is an important point at which to mention medical examiners. In April 2019, we introduced medical examiners into hospitals. If there is a death of a patient today, a medical examiner will examine the death certificate—the hon. Member for Tooting (Dr Allin-Khan) will know this, as she is a practising doctor—look into the circumstances of the death and liaise with the bereaved family. We would hope that the circumstances surrounding a death are already improved by the medical examiner system, which incorporates learning too.

It has been some considerable time since there has been any kind of inquiry into a mental health setting, so it is important that we have an inquiry in order to have a 20-year window. We can take those examples, look at the report and take away the learning. If that can be introduced in an interim report that we can take away, that would be excellent. I cannot guarantee that, however, because we do not know what the chair or secretariat will find once the inquiry begins.

I did not finish replying to an earlier intervention. I hope the inquiry will commence in the second week of February, but the chair and secretariat will be appointed before the December recess.

[Kevin Hollinrake]

Assuming that the independent inquiry finds that somebody is culpable within the management, will the Minister set out what sanctions might be available to her or to the inquiry to hold those people to account?

[Ms Dorries]

As a Minister, it is not my role to issue sanctions, but if the chair discovered anything even remotely untoward during the inquiry, it would be referred to the police. The inquiry does not cover up criminal activity—that is the case for any inquiry, not just this one. There would be accountability.

[Barbara Keeley]

I want to touch on inquests. Given the new evidence in Matthew’s case and many others, does the Minister think it would be appropriate to revisit inquests that returned open or narrative verdicts? That can be important to the families.

[Ms Dorries]

I cannot comment because, as the hon. Member knows, inquests and coroners are under the jurisdiction of the Ministry of Justice. Coroners are almost in the vein of judges, so that is a legal question for the MOJ to answer; it is not within the jurisdiction of the Department of Health and Social Care. Our job is to launch an inquiry, ensure that it has a robust, independent chair, that it is fully funded and staffed, that it establishes terms of reference in consultation with as many families as possible as soon as possible, and that it commences as soon as possible.

As hon. Members will be aware, the Health and Safety Executive has investigated how the trust managed environmental risks from fixed potential ligature points in in-patient wards between 25 October 2004 and 31 March 2015. As a result of the investigation, the Health and Safety Executive has brought a prosecution against the Essex Partnership University NHS Foundation Trust, which was formed following the merger of the North Essex Partnership University NHS Foundation Trust with the South Essex Partnership University NHS Foundation Trust. I am sure hon. Members will understand that I cannot go into the details of those proceedings as they are before the courts.

I could say quite a bit about the petition and the cases, but I will conclude to let the hon. Member for Hartlepool have the final say. I thank Melanie Leahy for her years of campaigning. I hope she will understand that a robustly independent inquiry that is unafraid to turn over stones and work with the families, calling those it sees fit to give evidence, is a way to discover what has happened at the Linden Centre over the past 20 years, including what culture developed, what practices were in place and what happened to those young boys who died there. As my hon. Friend the Member for South Suffolk (James Cartlidge) said, what is important is that we get to the truth. It does not matter what the framework or structure is; what matters is the truth, knowing how those young boys died, what happened and what we can learn from those dreadful mistakes.

Elizabeth Dixon Investigation Report

Nadine Dorries Excerpts

Thursday 26th November 2020 Written Statements

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

Today we have published the report into the events surrounding the death of Elizabeth Dixon—a baby who sadly died in December 2001 from asphyxiation resulting from a blocked tracheostomy tube and while under the care of a private nursing agency.

I offer my heart-felt condolences to Elizabeth’s family, to Anne and Graeme Dixon for their loss, compounded by the length of time—the passage of 20 years—before the facts of this case have been brought to light.

The investigation led by Dr Bill Kirkup was tasked with reviewing the care given to Elizabeth Dixon between her birth on 14 December 2000 and her death on 4 December 2001—and the response of the health system to a catalogue of errors and serious failings in that care.

This report describes a harrowing and shocking series of mistakes associated with the care received by Elizabeth and a response to her death that was completely inadequate and at times inhumane. Elizabeth and her family were let down by a failure to diagnose or respond to her underlying condition, to put in place the care she required, to acknowledge the circumstances of her death or provide her parents with an honest account of these failings.

The investigation sheds light on what the report describes as a “20 year cover up”. It alleges that some individuals have been persistently dishonest in accounting for their actions or inaction.

Underlying all of this was the acceptance of a flawed prognosis that influenced the future course of events. It created a situation in which

“facts were wilfully ignored, and alternatives fabricated”.

Shocking too is the implication in the report’s recommendations that the presence of her physical and mental health needs may have been used to justify or excuse the inadequate care she had received.

On behalf of Government and the health system I would like to say I am truly sorry for the devastating impact this must have had upon the Dixon family.

Individuals made mistakes and acted unprofessionally, but the system allowed it. The report makes it clear that

“clinical error, openly disclosed, investigated and learned from, should not result in blame or censure; equally, conscious choices to cover up or to be dishonest should not be tolerated”.

It is also unacceptable for patients ever to be exposed to unsafe or poor care, and I remain fully committed to ensuring we provide the highest standards of quality and safe services to all patients.

I am grateful to my right hon. Friend the Member for South West Surrey (Jeremy Hunt) for commissioning this investigation in June 2017 when he was Secretary of State for Health and bringing these events into the open. I would also like to thank Dr Bill Kirkup and his team for the diligence and hard work that has informed their report.

Particularly, I would like to pay tribute to Anne and Graeme Dixon who have fought so hard for answers. I hope this report is the beginning of a process that will bring some closure for the family. They should not have had to wait for so long.

This report shines a light on a culture of denial and cover up 20 years ago that left a family with little choice but report their concerns to the police. Families should not have to fight a closed system for answers and I will not hesitate to expose this sort of behaviour whenever it appears today. Indeed, Elizabeth’s legacy should be that other families will always be told the truth.

Relevant organisations will need to consider and reflect carefully on the report’s recommendations. There is no room for complacency. The continual appearance of shocking reports about patient safety—historical or more recent—implies there is much for the NHS to focus on. My Department will therefore have oversight of their responses and report back to the House. There needs to be learning and implementation, but above all I want to be assured that we are doing all we can to make sure such events cannot happen again.

No other family should ever again have to go through the heartache and frustration experienced by the Dixons and I apologise again for the failings set out in this report.

Copies of the report have been laid before the House.

[HCWS607]

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Nadine Dorries Excerpts

Committee stage & Committee Debate: House of Commons
Wednesday 25th November 2020 Public Bill Committees

[Carolyn Harris]

Thank you, Ms Rees. I am not being presumptuous by sitting in the shadow Minister’s seat; I am merely observing social distancing. I would not presume to elevate myself to such great heights.

I would first like to congratulate the hon. Member for Sevenoaks on having secured parliamentary time to debate this important issue, and I welcome the Bill’s principle of protecting vulnerable young people. The amendments I have tabled are simply intended to improve the Bill. They aim to ensure that no person under 18 years of age receives a non-surgical cosmetic procedure unless it is deemed medically necessary, and medical advice has previously been sought.

As the co-chair of the all-party parliamentary group on beauty, aesthetics and wellbeing, alongside my hon. and dear Friend the Member for Bradford South, I recognise the importance of this Bill and its aim of protecting our young people. The APPG is currently conducting an important inquiry into non-surgical cosmetic procedures, and we have found that all representatives from the beauty industry and beyond are united in supporting a restriction on all persons under 18 years of age.

I am concerned that the Bill, as it is currently worded, would allow registered medical practitioners, as well as regulated health professionals under the direction of a registered medical practitioner, to carry out procedures on any person under the age of 18 without needing to provide medical evidence. I want to be absolutely clear: no practitioner should be exempted from this measure simply because of their qualification level.

It is important to make the case for rare exceptions, as non-surgical cosmetic procedures have uses outside aesthetics: for example, when treating certain muscle conditions such as dystonia, which is a type of uncontrollable muscle spasm. At the beauty, aesthetics and wellbeing APPG session yesterday, on ethics and mental health, it was emphasised by our expert witnesses that medical exemptions must be at the discretion of medical professionals such as psychologists, not left to the devices of the practitioner. One thing I found very disturbing is that we were given evidence by eminent experts in this field who told a story of some medical practitioners seeking excuses to carry out procedures during lockdown that would have justified them being able to practise. I felt that the Minister should know that.

I know that the hon. Member for Sevenoaks accepts the principle of these amendments, and I urge the Minister to consider how to protect vulnerable groups in our society, especially young people who are influenced by social media, peers, and in some cases the industry itself. I know that the hon. Lady will keep us informed about progress, and I urge the Government to make sure that we find a way to protect these young people going forward.

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

It is a delight to serve under your chairmanship, Ms Rees. I pay tribute to my hon. Friend the Member for Sevenoaks for all the hard work and commitment she has put into bringing the Bill forward. She had the delight of being drawn first in the ballot, but the passion and commitment she has shown to this issue, which is close to all our hearts, is second to none.

I thank the right hon. Member for North Durham and the hon. Member for Swansea East. Since I took up this post, the right hon. Gentleman has contacted me, written to me, spoken to me personally, and cornered me in the Tea Room and the corridors to talk to me about this subject many times. I know that he is passionately committed to the subject and the amendments that we are here to talk about. He has been relentless in his pursuit, letter writing and lobbying on the issue.

The hon. Member for Swansea East never rises to speak unless she firmly believes in what she is saying. She is an MP of principle and belief. It is a delight to have her in the House and we are the better for her presence here.

Can I clarify something, Ms Rees? Do you want me to make my comments now or are we going to the hon. Member for Swansea East first?

[The Chair]

We are going to the hon. Member for Swansea East after you, Minister.

[Ms Dorries]

Thank you, Ms Rees.

The hon. Member for Swansea East has tabled her amendments. I wish again to reiterate the Government’s support for this legislation. On amendments 1 and 2, I should say that the Government are responsible for understanding the impact of any regulatory policy through the completion of a post-implementation review within the first five years following implementation. The review should assess whether the objectives of the regulation have been achieved and are still relevant, the cost of the policy and any wider unintended effects of the policy.

The indicators of the success of this policy would be a reduction in the numbers of businesses offering or performing treatments on under-18s. That may assessed through means such as measuring public, practitioner and stakeholder awareness and experience of the policy, to understand the policy’s reach and effectiveness, and gathering intelligence on the level of enforcement by the police and local authorities.

I was concerned to hear the hon. Lady’s comments about practitioners who were finding reasons and excuses to continue practising. That is something that I know my hon. Friend the Member for Sevenoaks has been made aware of, and we will keep it under review.

[Laura Trott (Sevenoaks) (Con)]

It is honour to serve under your chairmanship, Ms Rees. Before I start, I thank everyone in the room today. This has long been an overlooked area of policy, but with the work of everyone here, perhaps that will not be the case for much longer. As the right hon. Member for North Durham has said, it is a welcome first step.

I pay particular tribute to the work of the hon. Members for Swansea East and for Bradford South, and the all-party parliamentary group on beauty, aesthetics and wellbeing that they lead. The group’s findings have underpinned the substance of the Bill and I thank them for sponsoring it.

I completely agree with the sentiments behind the amendments. It is right that we should restrict these treatments for under-18s to only where it is absolutely medically necessary. The advice I have received is that that is covered in the Bill, inasmuch as UK doctors must be registered and hold a licence to practise with the GMC. The GMC publishes specific ethical guidance that says that doctors performing cosmetic interventions can provide treatment to children only when it is deemed to be medically in the best interests of the patient.

I accept that, as the right hon. Member for North Durham said, in some cases at the moment this is not happening correctly when it comes to botox, but to create a new legal precedent around the wording “deemed medically necessary” would add a layer of complexity, given that it is generally for the GMC to decide what is in the best interests of the patient. As he also mentioned, it would also produce two different authorities—the GMC and the court—which would then opine on the same issue. That could cause confusion.

I understand the thrust of the amendments, but if the hon. Member for Swansea East is content to withdraw them, I will work with hon. Members on some form of strengthened wording, which we can bring forward on Report.

[Judith Cummins (Bradford South) (Lab)]

I beg to move amendment 3, in clause 1, page 1, line 23, after “age,” insert “including by requiring and recording proof of this information,”.

It is a pleasure to serve under your chairmanship, Ms Rees. First, I thank the hon. Member for Sevenoaks for introducing this Bill and successfully bringing it to Committee. It is long overdue. I thank her from the bottom of my heart.

I stand in support of the Bill’s principles and I want to reiterate a point made by my hon. Friend the Member for Swansea East. My amendments seek to enhance the Bill and close the gaps in the wording. This amendment is a probing amendment and it deals with ensuring that a framework for age identification is present when practitioners are assessing a client for a non-surgical cosmetic procedure.

I am concerned that, as currently worded, the Bill leaves open to interpretation what reasonable steps a practitioner must make to establish the age of the person receiving the procedure. I want the Bill to make it clear that practitioners must request proof of age before any procedure is undertaken, verify the authenticity of that document and ensure that it is recorded, to ensure that there is no doubt about a client’s age. We need clear and explicit guidelines to ensure that vulnerable young people do not fall through the net.

My hon. Friend the Member for Swansea East and I established and became the co-chairs of the all-party parliamentary group on beauty, aesthetics and wellbeing. I am worried about how few protections there are for children under 18 years of age when it comes to non-surgical cosmetic procedures.

I was also in attendance at our inquiry into ethics and mental health. It will be no surprise that all our expert witnesses agreed that young people are at their most vulnerable in their teenage years. They are faced with many pressures, including societal pressures, which make ideal beauty standards the norm, especially in this age of social media. We must ensure we put safeguards in place to protect our young people.

I ask the hon. Member for Sevenoaks and the Government to consider this amendment to ensure that proper mechanisms are in place to strengthen the process of age verification for non-surgical cosmetic procedures and to improve the accountability of all practitioners. The amendment requires the practitioner to formally log and prove a client’s age.

Like my hon. Friend the Member for Swansea East, I welcome the opportunity to adapt the wording of the amendment should the hon. Member for Sevenoaks be unable to accept it. I ask that this amendment be considered.

[Ms Dorries]

Again, I thank the hon. Lady for moving the amendment. I understand that it will not be pressed to a Division, but I give her my absolute assurance that all comments made in the Committee today will be taken away and reviewed by my hon. Friend the Member for Sevenoaks and me before we move forward on to the next stage of the Bill. I thank all hon. Members for their contributions today.

[Laura Trott]

Again, I agree entirely that we must ensure providers have proof of age before carrying out treatments. However, I worry that the amendment is too narrow, in that it is for the defendant to establish the steps that they took to evidence proof of age. It is already implicit that that could and should include recording information, but it should not be limited to that. For example, it should be for them to establish the veracity of the documents produced, rather than just recording them.

While I completely agree with the intent of the amendment, I argue that it is not needed on the face of the Bill and would be more appropriately contained in guidance, which I would expect professional bodies to produce when the Bill becomes law. I would like to continue discussions with the hon. Members on the topic.

--- Later in debate ---

[Mr Jones]

I agree. There are adverts on Amazon in this sector, and treatments offered include fillers, although certain other terms are used. People are not allowed to advertise botox, but they get around that by advertising consultations. In response to the question, many practitioners are not qualified at all and hold no medical qualifications, so how do they get access to botox? They do so because people are signing prescriptions. I fear that a situation may arise in which that practice continues, although it needs to stop.

Another issue is that under the definition the botox can be bought because this is basically a free market, as I see it. A practitioner could then administer the botox to a young person with no regard to that individual’s medical history. A medical practitioner, under the definition, could even be defined as a dentist. That needs tightening up. I do not think that would be onerous for doctors, who are quite rightly prescribing botox injections and other things for perfectly legitimate medical use. Doctors and patients are protected when those uses are laid out.

If I had more faith in the GMC to clamp down, I would be content to leave the situation as it is. I am sorry, but having seen the way the GMC operates, I see that the organisation is not friendly to the complainant or to the patient organisation. It protects the doctor. We took self-regulation away from solicitors, and I have concluded that self-regulation should be taken away from doctors. I did not start with that position, but have come to it.

The Minister promised a Bill on GMC reform in the last Parliament, and one is certainly needed, because frankly, the patient is at a disadvantage in a host of areas, not just this one. It cannot be right that it took my constituent’s case five years to reach the GMC, with huge hurdles to overcome to get there. I hear what the hon. Member for Sevenoaks says, but we should try to tighten things up a bit. The Bill will certainly be improved if we can.

[Ms Dorries]

Again, I thank my hon. Friend the Member for Sevenoaks. Many points have been made today and throughout the passage of the Bill that will give us plenty to consider and review.

The GMC publishes guidelines on the ethical obligations of doctors undertaking cosmetic procedures, including guidance on responsible advertising. There is no question as to the GMC’s performance and it being fit for purpose as an organisation. The GMC maintained its track record of meeting regulation standards last year, and it met those standards amid a surge in demand for registration.

The performance review of the GMC for 2018-19 by the Professional Standards Authority, the body that oversees the healthcare regulators, found that good practice was upheld in all 24 standards of good regulation across education, registration standards and fitness to practise. The review confirmed an effective approach to managing a rise in registration applications, progress with the credentialing framework and work to promote fairness in fitness to practise processes.

[Mr Kevan Jones]

I hear all that, but I think what needs to happen—I offer this to the Minister—is for her to meet my constituent, Dawn Knight, so she can explain to the Minister the agony that she went through to get justice. The GMC is not user-friendly to patients. The fact of the matter is that, in her case, a doctor was allowed to remain on the register for five years, even though there was clear evidence from multiple women that he had undertaken operations that were, in some cases, life-threatening. Frankly, that is appalling.

[Ms Dorries]

The right hon. Gentleman does Dawn great credit by raising that case again, and his words have been noted. He is a tireless advocate. The GMC publishes guidance on ethical obligations for doctors undertaking cosmetic procedures, as it does with all procedures that doctors undertake, which includes guidance on responsible advertising, as I have said. There is another opportunity to continue to raise this matter: I will take his comments away and, as I have a patient safety meeting later today, I will raise them in that forum as well, since this is ultimately a patient safety issue.

[Sarah Owen (Luton North) (Lab)]

First, I want to say a massive well done and thank you to the hon. Member for Sevenoaks for bringing this important Bill to us and getting it in Committee. The question is not necessarily about the existing guidance, but around the enforcement of that guidance—I think that is what my right hon. Friend the Member for North Durham is saying. It is not just about saying that the guidance is there; we need to see strengthening of that enforcement.

[Ms Dorries]

The most I can say at this point—Dawn is a case in point—is that I will take away the comments made by the right hon. Member for North Durham, and I know my hon. Friend the Member for Sevenoaks has also heard them. We will consider those comments. It might be that this matter cannot continue within the scope of the Bill, but we will look to continue it. This does not stop here: my hon. Friend the Member for Bosworth (Dr Evans) is introducing the Digitally Altered Body Images Bill under the ten-minute rule, so there will be another opportunity to raise these points. Within the confines of patient safety, this is an issue that we need to continue reviewing.

[Mr Kevan Jones]

Will the Minister look at prescriptions for botox as well? There is clearly a market out there and there are medical professionals signing prescriptions and then selling them on, fuelling this market and leading to people who are not qualified giving that botox. Could she look at that?

[Ms Dorries]

Of course. I heard that comment in the right hon. Gentleman’s initial remarks. This is a difficult market to police—it is regulated, but it is difficult to police and to know who those practitioners are and where they are selling prescriptions on to. If he knows of any practitioners who are doing that, or is aware of any practitioner who is writing out bulk prescriptions for botulinum toxin and selling them on to other, more ruthless practitioners, or to people who are not even registered to practise, I ask him to please let us know, then we can take that forward.

[Mr Kevan Jones]

May I suggest another way of doing this? If the Minister speaks to the prescription licensing body, it will know exactly who is signing huge amounts of botox prescriptions, and one possible way to investigate large numbers of botox prescriptions is to ask whether those people can justify what they are doing. If we go online, we see umpteen adverts for botox treatments, and those people who are doing this are not doctors, so where are they getting them from?

[Ms Dorries]

Again, the right hon. Gentleman has done his cause justice by raising those concerns and saying what he has in Committee. We will have a look at that.

--- Later in debate ---

[Mr Jones]

That is the point. Part of this is about a process of education to teach people what the dangers are. These products are marketed and sold to people—especially young people—as if they are just like make-up.

Well, they are not make-up—this is a medical procedure that can have life-threatening consequences if it goes wrong. It is clear that some of the advertising on Facebook and other sites is directed at under-18s. The Minister mentioned body image, and the Mental Health Foundation’s report from last year on that issue shows that the marketing is for young people.

This is a probing amendment to get this issue on the record. We need to look at ways to ensure that young people are protected from advertising. It is not newspaper advertising; that is for old-fashioned people like me. It is advertising on Facebook, Instagram and elsewhere. I have raised this issue with Facebook. Of course, we get the usual guff from Facebook: “Oh well, we take them down.” I have even written to Sir Nick Clegg asking whether he will do anything about it. Getting an audience with or response from the Pope would be easier than getting a response from him. Those platforms are making money out of this, and they are targeting their adverts at young people, not older people.

Do not get me started on the Advertising Standards Authority, which is a completely toothless, useless tiger, frankly. It takes down some adverts, but they keep proliferating. The social media companies need to do something about it, because young people are being put at risk and because there is a market. Botox is supposed to be a medically controlled substance, but it is not; it is advertised. The way the companies get around that is that, although they cannot advertise botox, they can advertise a consultation, which just happens to be for botox. Facebook, Instagram and others could take down those adverts overnight and just stop them, but they are not doing that because there is clearly money to be made in this sector. Some of those issues will come out in the private Member’s Bill of the hon. Member for Bosworth on body image, but if we do not tackle them, this Bill could be enacted and the Facebooks of this world could still make money on the back of this sector.

The purpose of new clause 1 is to ensure some oversight over the effectiveness of the Bill. It calls for a report when it is under way so that we can assess whether it is effective. It also relates to advertising and promotion. By raising this issue with the Minister, I want to put on the record that there is an issue. I accept that advertising is not directly within her remit as Public Health Minister, but I want to see what more can we do not just on the targeting of under-18s, but on the broader issue of the way in which big business is trying to circumvent the law—advertising botox is supposed to be illegal.

There are two ways of doing that. The first is to stop the supply of botox from prescribers, and the second is to crack down on it very heavily. The Mental Health Foundation’s report on body image shows that, in this age of the internet and the internet of things, young people are in a terrible situation and are suffering due to their body image. That is reinforced by advertising. Botox is seen as a quick fix, but it is potentially dangerous. We need to try to stop this danger to our young people.

[Ms Dorries]

The right hon. Gentleman has made wide-ranging and important comments. I am not sure it was any easier to speak to the former right hon. Member for Sheffield, Hallam when he was in this place than it is now—there is not much change there—but I thank the right hon. Member for North Durham on all our behalf for his efforts to do so. Outside of the Committee and official channels, he still keeps batting away and trying to get results. We thank him for that.

I believe everyone has the right to make informed decisions about their bodies and our role in Government is to support young people in making safe, informed choices and, where necessary, to protect them from the potential harm that cosmetic procedures can do to their health. This Bill is a really important step on that path and in that process.

On indemnity, the Government passed legislation in July 2014 requiring all practising regulated healthcare professionals to have appropriate indemnity arrangements in place as a condition of registration with the regulatory body and, therefore, their ability to practise. For doctors, those regulations came into force in August 2015. Failure to comply may mean that they are dealt with under fitness-to-practise procedures. That means that all practising surgeons are affected by the legislation, including overseas surgeons practising in the UK. I hope that information helps.

[Mr Kevan Jones]

I am not against the cosmetics industry. I agree with what the Minister just said—it is about informed choice—but it has to be done safely. I welcome her comments on professionals. The big grey area, which this Bill cannot cover but which needs covering, is those who administer botox and fillers. Most of those people are not medical professionals. They have done “a course” in injections, which in some cases I have seen is just a tick-box exercise. That is the area we need to move on to next—not only who can prescribe, but who can inject these fillers and botox.

[Ms Dorries]

As the right hon. Gentleman notes, those matters are not within the scope of the Bill and the Bill will not seek to achieve the points he has made. As I have said before, I will take the comments away and will continue to work on them and review them.

[Laura Trott]

I thank the right hon. Member for North Durham for all his work in this area. On amendment 4, the pressure that young people are put under by social media is undoubtedly a motivating factor behind many of them seeking out these cosmetic treatments. That was discussed at length on Second Reading by the hon. Member for Clwyd South, among others. In many case studies that we have heard, discounts were one of the reasons that a young person went to have one of these treatments.

I note that there is a lot more work going on this area, which is welcome. In January, the Committee of Advertising Practice and the Medicines and Healthcare Products Regulatory Authority issued an enforcement notice to the beauty and cosmetics industry and have started to use monitoring tools to take down posts on social media, which is a welcome development, although obviously we need more.

I completely agree that further work is needed in this area. However, as the right hon. Gentleman rightly notes, it is outside the scope of the Bill. I will be making those points in the debates on forthcoming online harms regulations. I imagine he will be doing the same.

[Mr Kevan Jones]

These were probing amendments. I took the opportunity to get them on the record, as it is important to ensure that we tackle this area. I welcome the Minister’s comments on this being an area that we need to look at further. I know the Department of Health and Social Care does not like to bring legislation forward because it is still suffering from the Care Act 2014—

[Ms Dorries]

Nonsense.

[Mr Jones]

Well, I was told that by a Minister in her Department. One simple thing we could do is to regulate those who administer these fillers and botox. That would be a huge step forward. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

--- Later in debate ---

Clause 5 enables amendments to be made that are consequential on the Bill. Clause 6 sets out the territorial extent of the Bill. The Bill does not impose any requirement on bodies within Scotland, Wales and Northern Ireland that regulate and enforce the supply and administration of botox and cosmetic fillers.

[Ms Dorries]

My hon. Friend the Member for Sevenoaks has said everything that needs to be said about these clauses.

[Mr Kevan Jones]

Are we now debating whether the rest of the clauses stand part of the Bill?

Health and Social Care

Nadine Dorries Excerpts

Tuesday 24th November 2020 Ministerial Corrections

The following is an extract from the debate on covid-19 on 22 October 2020.

[Ms Dorries]

… My hon. Friend the Member for Christchurch (Sir Christopher Chope) mentioned Sweden, but an article in The BMJ—a research study—concluded that Sweden and the US are the only two countries that are failing to reduce their numbers of deaths. In fact, it is far more accurate to compare Sweden with its Nordic neighbours. Sweden has 586 deaths per 1 million people, while its neighbour Norway has 279, so I am not quite sure why Sweden would be cited as a country of success.

[Official Report, 22 October 2020, Vol. 682, c. 1337.]

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

An error has been identified in the response I gave to my hon. Friend the Member for Christchurch (Sir Christopher Chope).

The correct response should have been:

[Ms Dorries]

… My hon. Friend the Member for Christchurch (Sir Christopher Chope) mentioned Sweden, but a JAMA research letter referred to in the BMJ concluded that Sweden and the US were among eight countries that were failing to reduce their excess mortality numbers. In fact, it is far more accurate to compare Sweden with its Nordic neighbours. Sweden has 582.3 covid-related deaths per 1 million people, while its neighbour Norway has 52.5 covid-related deaths per 1 million people, so I am not quite sure why Sweden would be cited as a country of success.

Draft Coronavirus Act 2020 (Expiry of Mental Health Provisions) (England and Wales) Regulations 2020

Nadine Dorries Excerpts

Wednesday 18th November 2020 General Committees

[The Chair]

Before we begin our debate, I thank Members for observing the social distancing regulations. Hansard colleagues would be grateful if any speaking notes could be sent to [e-mail].

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

I beg to move,

That the Committee has considered the draft Coronavirus Act 2020 (Expiry of Mental Health Provisions) (England and Wales) Regulations 2020.

It is a pleasure to serve under your chairmanship, Mr Davies. I am pleased to speak in support of the draft statutory instrument, which was laid before the House on 21 October. The Government have committed to keeping all elements of the Coronavirus Act 2020 under close review and to sunsetting any provisions that are no longer necessary. The Act expires two years from when it was passed, but it contains a power to bring forward the expiry date of any of its provisions.

My right hon. Friend the Secretary of State for Health and Social Care told the House in September, during the debate on the six-month review of the Coronavirus Act, that the emergency provisions of schedule 8 in England are to be sunsetted as they are no longer necessary. The regulations enact that decision. The regulations expire the provisions in schedule 8 to the Coronavirus Act 2020, which allowed for a temporary change to the operation of certain sections of the Mental Health Act 1983.

The emergency provisions that the regulations remove were included in the Act to protect the safety of patients and to maintain access to essential care. They were designed to enable mental health services to continue to provide vital care and treatment to patients in the event of the pandemic having a drastic impact on staffing levels. These were always powers of last resort; they have not been commenced and have never been used, because they have not been required. They were designed so that the emergency changes would be switched on by the Secretary of State only if staffing shortages in the mental health sector due to the pandemic were so severe that patient safety was significantly compromised.

I will briefly remind the Committee of the provisions we are seeking to expire in the draft regulations. The provisions would have enabled an approved mental health professional to apply to detain someone on the advice of one registered medical practitioner rather than two, if securing two recommendations was considered impractical or would lead to undesirable delay. They would also have allowed extensions to the time that individuals who were already hospital in-patients could be temporarily detained, pending an application for longer term detention under the Mental Health Act.

For individuals accused of crimes, defendants and prisoners with a mental health condition, the provisions would have extended the amount of time they could be remanded to hospital. The provisions would have allowed an accused person, convicted person or prisoner to be sent to hospital on the recommendation of just one registered medical practitioner rather than two. They would also have extended the procedural time limits for transferring a prisoner to hospital.

We are highly conscious of the gravity of the effects of these provisions, should they be commenced, and the need for them has been kept under continual review. We are pleased that, due to the resilience and ingenuity of NHS England, the provisions have not been needed and have never been used. We are removing them because we have listened to stakeholders and to Parliament. Three separate Select Committee reports have recommended that we take this step.

The Joint Committee on Human Rights reported on the Government’s response to covid and argued that, if enacted, the provisions would weaken the protections available for people subject to the Mental Health Act. The report also highlighted the concerns of stakeholders, including Mind, the Royal College of Nursing and the National Survivor User Network. The Public Administration and Constitutional Affairs Committee report on the Government’s response to covid and the Coronavirus Act 2020 also noted the concerns of the mental health charity Mind and its call for the removal of these temporary powers. Further to this, the Women and Equalities Committee highlighted that evidence suggests that the measures are unlikely to be needed. The Committee noted concern that the provisions

“went against the direction of travel in Mental Health Act reform”

and most notably the need for

“a more balanced system with more safeguards, more choice and less restriction”,

as set out in the independent review of the Mental Health Act 1983 chaired by Sir Simon Wessely. The Committee stressed that the measures should not be kept available on a “just in case” basis. The same report noted that the Royal College of Psychiatrists had emphasised to the Committee that any use of the emergency mental health provisions would have an unequal effect on black people, whose contacts with mental health services are disproportionately based on detention orders requiring them to stay in hospital.

The announcement of the decision to expire these provisions has been positively received across the House and by a wide range of stakeholders. Rethink Mental Illness said that the decision came as a relief to many people living with mental illness and their loved ones. I am pleased to reiterate the Government’s commitment to publish a White Paper setting out our priorities for reform to address inequalities in the existing system, strengthen patients’ rights and enhance protections within the Act. We will do this as soon as possible. The Secretary of State was not persuaded even during the initial covid peak that these powers were necessary, because our mental health services had shown incredible resilience and ingenuity. These powers are no longer required, so the regulations seek to expire them. It should be noted that the regulations do not expire the transitional provisions in schedule 8 to the Act; however, these will have no legal or practical effect.

In relation to Wales, the regulations expire only matters that are not devolved to the Welsh Government—those which relate to patients under the Mental Health Act involved in criminal proceedings or under sentence. Provisions under schedule 8 to the Act devolved to the Welsh Government relating to health services remain in the Coronavirus Act, with an exception for provisions relating to the Welsh mental health review tribunal. None of these provisions has been commenced. Should it ever be deemed necessary to return these provisions, we will introduce new legislation.

Mental health services were able to continue to support people detained under the Mental Health Act despite the pressures resulting from the pandemic. The Government and NHS England and NHS Improvement have taken measures to support mental health services to continue to offer vital care and treatment to individuals despite ongoing workforce pressures resulting from the covid-19 pandemic.

The Department and NHS England and NHS Improvement issued legal guidance for mental health, disability and autism, and specialised commissioning services supporting people of all ages during the coronavirus pandemic. The guidance set out how the Act’s code of practice may be interpreted during this period, including, for example, allowing the delivery of statutory forms electronically to allow mental health staff to work more flexibly and reduce risk of covid-19 infection. The guidance also set out how video technology can be used for medical assessments to be carried out remotely under the Act; this is to make it easier to have two doctors examining a patient during the pandemic. The Department has also supported the Care Quality Commission in bringing in a modified second-opinion appointed doctor or SOAD service, which allowed the service to work remotely. This enabled procedures around assessing and improving the medical treatment of patients detained under the Act to continue as normal, rather than enacting powers that would lessen this safeguard.

Those measures, coupled with mental health staff’s resilience and innovation, have been effective in mitigating pressure on mental health services, avoiding the need to commence the emergency powers. NHS mental health services have coped without needing to turn on these emergency powers through their hard work and innovative approaches, supported by the Department, NHS England and NHS Improvement,.

--- Later in debate ---

[Ms Dorries]

We recognise the immense strain that the pandemic and the measures to contain it have placed on everybody’s lives, particularly in-patients in mental health services and people who work for the NHS in such services. Mental health is critical in these unprecedented times, and we recognise how important it is that people get the support they need for their mental health.

We know that some people will experience exacerbated mental health problems as a result of the pandemic, and there are also issues with people’s wellbeing. I am probably accurate in distinguishing between wellbeing and mental illness—I think the hon. Member for Tooting used the term “mental illness” in her response. She was quite right to highlight that, during this pandemic, there has been pressure on people with pre-existing mental health problems and on the new cohort—frontline workers—who have been particularly susceptible during the pandemic.

Mental health continues to be our priority. We are doing our utmost to ensure that mental health services are there for everybody who needs them during the pandemic. As I said in my opening speech, that is thanks to the hard work and innovative approach of NHS workers, NHS England and NHS Improvement. We have recently announced our winter plan for mental health, in which we will outline the support that is available for people over the coming winter. I hope very shortly—within days—to be able to bring that plan forward. It is one element of our work to deliver a modern mental health service and to meet the demands created by the pandemic. The winter plan, which will be published imminently, is a demonstration of the Government’s firm commitment to supporting the mental health of everyone throughout this winter period and beyond.

We are absolutely committed to continuing our investment and to expanding the transformation plan for mental health services in England. As I have said many times, that amounts to an additional £2.3 billion of extra funding a year in mental health services by 2023-24. The Government are setting out clear commitments to support mental health services to manage pressures over the winter, and we will also do so during our winter plan. All health and social care staff, including those providing mental health services in hospitals, get priority access to testing when they show symptoms. Hospitals can test patients, including those admitted with mental health conditions, in areas with a higher prevalence of covid.

The NHS worked hard to keep mental health services going during the first peak, using technology where needed but also providing face-to-face appointments where appropriate. All mental health trusts have established a 24/7 urgent mental health helpline, where people experiencing a mental health crisis can access support and advice. We took up this idea in late March, when we realised that we were facing the full blast of the pandemic. We had a meeting on, I think, 4 April with NHS England and all the mental health trusts; the 24/7 crisis helpline rolled out across all mental health trusts at a rapid pace. and it has been there for anyone facing a mental health crisis to use.

The Government have committed more than £400 million over the next four years to refurbish mental health facilities, to get rid of dormitories in those facilities and to benefit the patients of 40 trusts across the country. We are committed to supporting NHS staff. The NHS is setting up staff mental health hubs to provide proactive outreach, in addition to the services we are already providing for NHS frontline workers. We are investing £50 million to ensure that all staff get rapid access to those expanded mental health services.

To bring us back to the core purpose of the Committee, the Government committed to keeping all elements of coronavirus under close review and to sunset any provisions that are no longer necessary. The emergency modifications to the Mental Health Act were designed as a backstop to support services if unprecedented constraints in the mental health sector put patient safety at risk during the pandemic, and the Government have remained conscious of the need to balance that with the rights of individuals who are detained under the Mental Health Act. Due to the resilience and the ingenuity of the NHS, we have not needed to switch on the provisions; now is therefore the right time to expire them.

This is an important milestone in our work to make much-needed reforms to the Mental Health Act, which will ensure that patients have greater autonomy and control over their care and treatment. The reforms will be set out in the Government’s White Paper on the subject, which will be published shortly. I commend the draft regulations to the Committee.

Question put and agreed to.

Oral Answers to Questions

Nadine Dorries Excerpts

Tuesday 17th November 2020 Commons Chamber

[Alison Thewliss (Glasgow Central) (SNP)]

What steps he is taking to support the healthcare needs of babies and families during the covid-19 outbreak.

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

The indirect impact of covid-19 has been significant for pregnant women and their young families. Support for families is a priority, and it means short-term and long-term harms can be prevented. Health visiting teams have continued to support and prioritise high-need families. We have also gone to great lengths to ensure that informal support networks that have been there in the past to support mothers and younger babies can remain and provide the support they were unable to give during the first wave.

[Andrea Leadsom]

I know that my hon. Friend is well aware of the desire of new families to return to face-to-face services as soon as is possible, but does she agree that the amazing work of so many in the early years sector to deliver online and digital services at this incredibly difficult time must not be lost? When we return to face-to-face services, we also therefore need to capture all the amazing learning on digital and make sure we can amplify support for new families in that way.

[Ms Dorries]

I absolutely agree with my right hon. Friend on that. First, may I pay tribute to her for the work she has undertaken throughout her career with families, parents and young babies, and on early years, particularly the first years of a child’s life? I am sure Members on both sides of the House are hugely anticipating and excited about receiving her review on early years and young families. She is right to say that using digital technologies has enhanced so many areas during the first lockdown and throughout our time with covid, not only in mental health, but with young families and children. In a way, it has been a catalyst whereby we have embraced technology in all areas across health service delivery. We are making sure that we continue to do that and we do not lose the moment.

[Alison Thewliss]

Many low-income families have struggled to make ends meet during lockdown. Families with babies under one are entitled to Healthy Start vouchers of only £6.20 a week, which is not enough to buy any infant formula that I can find on the market. By contrast, Scotland’s equivalent provides £8.50 a week for Best Start foods. The all-party group on infant feeding and inequalities, which I chair, produced a report on the cost of infant formula in 2018. It recommended the uprating of Healthy Start vouchers, because the cost involved in buying formula means that families are watering down formula or feeding their babies unsafe alternatives. Will the Minister urgently consider uprating Healthy Start vouchers, to ensure that low-income families can claim their entitlement, because many do not?

[Ms Dorries]

I will take away the hon. Lady’s comments and we will look at them.

Baby Loss: Covid-19

Nadine Dorries Excerpts

Thursday 5th November 2020 Westminster Hall

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

I definitely will. It is a pleasure to serve under your chairmanship, Ms Eagle. I thank the hon. Member for Tooting (Dr Allin- Khan) for doing the round-up and highlighting everybody’s speeches. I thank all hon. Members for being here today, and I particularly thank my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) for securing this debate. Her speech was a difficult and incredibly brave thing to do.

Normally this debate would be in the main Chamber—I responded to it last year—and were it not for the social distancing in this Chamber, other colleagues would have been here today giving their support, and telling their own difficult stories or sharing their experiences, which is so important in raising the issue. Let us hope that next year the debate will be in the main Chamber. I am disappointed that the debate taking place in the Chamber right now is not taking place here and that we are not in the Chamber. It has almost downplayed the importance of this subject. I want to put it on the record that this debate deserves its place in the main Chamber next year.

I want to pick up on a few of the important points that have been made before I get to the substance of explaining what the NHS is doing. The hon. Member for North Ayrshire and Arran (Patricia Gibson) raised the issue of the increased number of stillbirths from 24 to 40, and I want to use that to piggyback on the comments of my hon. Friend the Member for Guildford (Angela Richardson). This is a new virus. We do not know its full pathology or impact or what we will learn going forward, but the hon. Member for North Ayrshire and Arran is absolutely right that the number of stillbirths has gone up. The Healthcare Safety Investigation Branch has launched a thematic review into the reasons behind the change, and we hope it will report within the next few months. We want to unpack that—was it to do with the virus, or was it to do with circumstances?—and to know fully what those details were. She was quite right that the numbers have gone up, but we need to know why. It may not be the virus at all, but we absolutely have to know what it was, and that work is already under way. I just wanted to reassure colleagues on that.

I am delighted that a regular at these debates has just joined the Public Gallery—my hon. Friend the Member for Banbury (Victoria Prentis) has been instrumental in the APPG and in bringing forward this debate on a yearly basis. I am delighted that she has joined us, because it would not be quite the same if she was not here, and I thank her for that.

Before I move on to the substance, I will pick up the point raised by the hon. Member for Sheffield, Hallam (Olivia Blake). I thank her for sharing her story, because it was so raw and so new, and her experience was—there is no other way to put it—a dreadful one. However, as the Minister, I have to tread the line of balance, and I would like to say that, yes, on 8 September, along with the Royal College of Obstetricians and Gynaecologists, we agreed new guidance that would be sent out to trusts to allow, where possible, partners—and not just partners, but parents or friends—to go in for scans with sonographers and to be there for the mother, so that she has somebody with her to support her throughout all those appointments. Trusts that can do that are doing it wherever possible.

Of course, the answer is the testing, and a lateral flow test will be available for anybody who wants one in Liverpool from tomorrow. That is the key to the future. Those tests give the results in 15 minutes, so they are a bit like a pregnancy test, and the specificity is, I think, 99.9%, so we can be sure and confident in maternity units that parents and partners can go in and that it is a covid-secure place.

As we know, and as the hon. Member for Tooting can inform us all, when young babies are born, their immune systems are very compromised—almost non-existent, and there has been a balance in ensuring that the environments in maternity units are covid-safe. I just give one example of a birthing mother who had two partners accompany her for the birth, both of whom had tested positive for coronavirus within the previous few days.

There is that balance for the NHS staff and midwives as well, because NHS staff have gone down with covid themselves, and we need to keep our midwife workforce working as healthily as possible. Each trust, in conjunction with NHS staff, decides how to apply the guidance and how to make its areas safe and secure for pregnant mothers to go to.

I also mention the case of one sonographer, who does the scans, who told me that her room has no windows because of the glare on the screen. It is 6 feet by 4 feet, and it has a table, the ultrasound equipment, and room for one chair and the bed. There is no ventilation whatever; it is almost an extended cupboard on the inside of the hospital. There is no way that that room could be covid-secure for her for the amount of time it takes to do a scan. Again, we need to keep our sonographers working.

There is a balance. I know that some trusts have changed where the scans are done and that the NHS is trying its very best to ensure that situations such as the one the hon. Member for Sheffield, Hallam went through —it was just dreadful, and it was so brave of her to recount it so soon—are minimised as far as possible, but having the lateral flow test is the key, so that we know that people going in and out of the hospital are negative for coronavirus. That is the key to the future and to ending this particularly difficult problem.

I thank the charity Sands and the Baby Loss Awareness Alliance for making Baby Loss Awareness Week a success once again. This year, it focused on the feelings of isolation that many women, fathers, partners and other family and friends experience after pregnancy and baby loss. Those feelings of isolation have sadly been amplified by the covid-19 pandemic and the measures that have had to be put in place to keep healthcare workers, patients and the general public safe.

To mark the week, I met with the charities Sands, Bliss and Tommy’s, and hosted the first meeting of my new maternity inequalities oversight forum, a small group of clinical and academic experts and service users that will regularly discuss women and babies from black, Asian and other minority and ethnic backgrounds and those from lower socioeconomic communities. Every stillbirth or baby loss is a tragedy, and it is only right that we support, and remain absolutely committed to supporting, parents through any difficult situations that they may experience at that difficult time.

The reason I established the inequalities oversight forum is that women from black, Asian and ethnic minority backgrounds suffer inequalities during birth. We need to find out the reasons why. We need to find out why black women are five times more likely to have a stillbirth or to die during childbirth. We need to get to the bottom of the reasons and to find out what we can put in place to ensure that, by addressing those issues, we reduce the number of stillbirths.

I was deeply affected by the heartbreaking photographs shared by Chrissy Teigen last month when she lost her son Jack around halfway through her pregnancy. It was incredibly brave, moving the debate out into the public arena again. Closer to home, one of our colleagues and friends, my hon. Friend the Member for Hexham (Guy Opperman), tragically lost his twin boys, Rafe and Teddy, shortly after they were born. I commend the bravery and strength of all those individuals who have come forward, as everyone in the Chamber has today, to open up the conversation about baby loss. For far too long it has carried a stigma, as we have heard, and has been treated as a taboo subject.

I would like to mention the death of Mary Agyapong, a pregnant nurse who died with covid after her baby was delivered at Luton and Dunstable University Hospital, where she worked. That deeply affected me, as the hospital serves my constituents. It is a tragic case, and our deepest sympathies remain with Mary Agyapong’s family.

It is one of the Government’s highest priorities to reduce the number of stillbirths and other adverse maternity outcomes, and to make sure that grieving families and friends have access to the support that they need.

[Sarah Owen]

On the point about the loss of Mary Agyapong, I would like to share my sadness, as she was a constituent of mine. I hope the Government will continue to support her family throughout this difficult period. As to the point about black, Asian and minority ethnic women suffering more stillbirths and miscarriages throughout pregnancy, that has been heightened throughout covid. What is being done to look into the situation, and how can this be improved for the future?

--- Later in debate ---

[Ms Dorries]

I apologise: I had not realised that Mary Agyapong was one of the hon. Lady’s constituents.

The situation that the hon. Lady describes is why we established the inequalities forum with a group of clinical experts, including National Maternity Voices, Jacqueline Dunkley-Bent and others. It was for exactly that reason: to try to find out why this is happening, to look at some of the myths around the reasons and to get down to the clinical reasons and to the changes we can implement to stop this. MBRRACE-UK, hon. Members, National Maternity Voices and Jacqueline Dunkley-Bent, as well as a number of other people known and recognised as leaders in this field, are trying to drill down into the reasons.

In a way, it is covid, and what has happened, that has made us drill down to focus on that. I hope that as we move a little further forward—we have had our second meeting—I will be able to report some of the findings back to the House. I particularly encourage the hon. Lady to read the MBRRACE-UK report, which focused on the issue. It contains some interesting reading and findings. That report also stimulated the need for the group to look at these issues.

[Ms Angela Eagle (in the Chair)]

Minister, in the light of the time—

[Ms Dorries]

Oh, gosh, I am sorry. I will just mention James Titcombe. It is the 12th anniversary of the death of his baby, Joshua. James has absolutely been an advocate of patient safety, and his work has influenced it. However, I want to give my hon. Friend the Member for Truro and Falmouth time to respond.

Covid-19

Nadine Dorries Excerpts

Monday 2nd November 2020 Commons Chamber

[Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)]

Dither, delay and disaster—that was the Prime Minister’s own word today—and, of course, it did not have to be this way. There has never been a starker contrast between the gross failings of the Prime Minister and the leadership shown by my right hon. Friend the Leader of the Opposition, my hon. Friends on the Labour Front Bench and our Welsh Labour First Minister, Mark Drakeford, in calling for action at the right time and taking action at the right time on a firebreak lockdown. Instead, we saw a Prime Minister who ridiculed the proposals, describing them as “the height of absurdity”. His office described the Leader of the Opposition as “an opportunist”. The Chancellor blocked those who wanted to act sooner, and now we are seeing the same mistakes repeated that we saw earlier in the year. Forty days have been wasted, with the consequence that England will now face a longer, harder lockdown and worse consequences.

What a contrast with Wales, where our First Minister set out a difficult but clear set of restrictions, with common-sense exemptions, when he announced our firebreak weeks ago. He has communicated throughout with, and engaged and listened to, our elected representatives, councils, businesses and trade unions—the hallmark of his approach throughout this crisis—bringing Wales together to tackle the tough reality that covid presents. Today, he has set out that on 9 November our firebreak will end, not in a free-for-all, but with a sensible, clear, national set of measures, where people will be encouraged to do the minimum, not the maximum, allowed and we will prioritise the safety of their families, their friends and our NHS as we continue to be led by the evidence and the threat of this virus.

The consequences of the wider approach taken by the Prime Minister could not be more serious for our collective health and the economy. As the Independent SAGE meeting last week suggested, over the next four weeks, we will now potentially see deaths locked in in their thousands in England if the trends continue, and the mental health and the economic impacts will be for longer and deeper. That is the cost of delay, and I have never known a more incompetent and reckless Prime Minister, Chancellor and Government.

Matt Chorley reported what Tory MPs tell him in private—they often tell us in private, too. There were comments such as:

“Shambolic. Rudderless ramblings. Constituents getting in touch furious or in tears”,

“Grim grim grim”

and

“I think it could be his Suez”.

At least they have the guts to be honest in private, but others, extraordinarily, would rather brazen it out in public. The Minister for Patient Safety, Mental Health and Suicide Prevention claimed that only a crystal ball could have predicted the need for a second lockdown—it is absolutely extraordinary. Has she even been reading her briefs? Anybody can see from the graphs, the trends or the historical examples—

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

Will the hon. Gentleman give way?

[Stephen Doughty]

No, I will not—the Minister made her comments very clear publicly. Of course, others were simply patronising. [Interruption.] Oh, go on then—I will give way to her.

[Ms Dorries]

I thank the hon. Gentleman for giving way. The cases of infections, particularly in the over-60s, and the demand on hospital beds far exceed the previous reasonable worst-case scenario.

--- Later in debate ---

[Dr Allin-Khan]

I have engaged with such serious subjects when undertaking all four of my science degrees.

Speculation that self-isolation could be reduced from 14 to seven days does nothing to clarify how people can keep their families safe. [Interruption.] I am enjoying hearing the chuntering; I would welcome anybody who wished to intervene on me because I am well up for it, as they say in Tooting. I do enjoy debates—in fact, I would welcome debate, because what always happens is that I make my comments from the Dispatch Box, sit down and listen to the Minister, for whom I have a great deal of respect, but then I have no ability to intervene, so bring it on.

The resilience that British people have shown over the past seven months has been remarkable. In the face of uncertainty and fear, our communities have come together to support one another time and again. Like everyone in the Chamber, I am so proud of all those who helped to deliver food and medicines to our most vulnerable at the height of the crisis, and I have been incredibly moved by all those businesses, struggling themselves, that provided free school meals locally when the Government failed to act. It touches me to witness the hope and humanity of our communities and of individuals such as Marcus Rashford, but it is shameful that that has been necessary as a result of this Government’s actions.

It breaks my heart that more children than ever will know the taste of hunger in 2020 and that they will feel the cold that comes from their parents being unable to pay the bills. The last Labour Government lifted more than 1 million children out of poverty. We need more action like that, not Conservative Members blaming chaotic parents for child hunger, alleging that free school meal vouchers go direct to crack dens and brothels, or spinning the narrative that it is the sole responsibility of local communities to ensure that no child goes hungry. Where is the compassion and humanity from the Government? I hope we do not have to continue asking ourselves that question throughout winter.

Certainly, across our communities, compassion and humanity are in no short supply among our frontline health and care staff—on that we can all agree. Those frontline staff have been placed in an impossible situation throughout the year. Will the Government commit to ensuring that those staff have adequate levels of PPE across the winter, and will they commit to frequent testing of our frontline staff, who put their lives on the line day in, day out? The impact of the neglect of our NHS staff is that almost 2 million days were lost to mental ill health during the first wave of the pandemic. I fear the effects of the second spike this winter. We can stand on our doorsteps and clap, but why can we not give them the support they truly deserve?

Will the Minister agree to meet to discuss our care for carers proposal to address the mental health needs of our 3 million health and care staff? Will the Minister agree to meet me to discuss the care for carers plan? Will the Minister agree to work cross-party together to support our frontline NHS and care workers?

[Ms Dorries]

Will the hon. Lady give way?

[Dr Allin-Khan]

Of course.

--- Later in debate ---

[Ms Dorries]

Obviously, I cannot answer from a sedentary position. On the care package, the hon. Lady will need to meet another Minister, but I will take her request on. I am the Minister for mental health, not for care workers, but I will pass that on for her.

[Dr Allin-Khan]

It is a package of mental healthcare for our frontline NHS and care workers, which I am sorry the Minister seems to have forgotten. I have raised it a number of times. Is she agreeing to meet me to discuss the care for carers mental health package for our frontline NHS and care staff?

[Ms Dorries]

I will provide a detailed explanation of what we are doing for frontline workers in my own speech.

[Dr Allin-Khan]

I take that as a no. I give the Minister the opportunity to give me a straight yes or no answer. Will she kindly agree to meet me to work cross-party together for the betterment of the mental health of our frontline NHS and care staff—yes or no?

[Ms Dorries]

Madam Deputy Speaker, this is a rather unusual way of closing a debate. We have a very comprehensive package in place for key workers, which has been provided by the NHS, and I am happy to detail that when I give my closing speech.

[Dr Allin-Khan]

I am very familiar with the detail, which the Minister uses every single time we have a debate, but I will take that as a hard no and continue with my speech.

For the mental health of people across the country—[Interruption.] The policy is very clear. The Minister is chuntering from a sedentary position; would she like to intervene?

--- Later in debate ---

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

One of the joys of being a Minister in Government is that we won an election and that gives us the right and the ability to decide policy. If the hon. Member for Tooting (Dr Allin-Khan) wishes to decide policy, the Labour party should try harder at the next election.

As we heard from so many hon. Members during the debate, the virus is a deadly adversary. The debate has been wide-ranging, and many points were raised. It is impossible to mention everybody who spoke, but there were several themes and I would like to group them. Obviously, because of my portfolio, I will start with mental health, which almost everybody mentioned.

We recognise that it is a difficult time for people and the immense strain that the pandemic and measures to contain it place on everyone’s lives. Recently, the president of the Royal College of Psychiatrists said that there were significant mental health consequences for people who contract covid and for the families of those who are affected or sadly lose their lives. He went on to say that mental health concerns as a result of lockdown were

“being weaponised by those with other political agendas”.

He added that there is increasing evidence that the virus directly attacks the central nervous system, which can affect mental wellbeing and mental health, let alone the post-traumatic stress that those who contract the virus and may end up on medical ventilation can experience.

The result is that there are two mental health stories to the pandemic. We know that people will suffer exacerbated mental health problems as a result of the pandemic and that people with existing mental health conditions and frontline workers are particularly susceptible. However, there is another side to the story, which is long covid: young people who contract covid and consequently suffer mental illness. In the words of Dr Adrian James, the president of the Royal College of Psychiatrists:

“We need… to wake up to the very serious mental health consequences for people who get coronavirus and for the families of those who are disabled or killed by the disease.”

We are absolutely committed to continuing our investment in expanding and transforming mental health services in England. That will amount to an additional £2.3 billion of funding a year in mental health services by 2023-24. We are doing our utmost to ensure that our mental health services are there for everyone who needs them during the pandemic—for patients and our NHS colleagues. Thanks to the ingenuity of so many, we worked hard to keep all mental health services fully functioning during the first peak, using technology when required. All mental health trusts have established 24/7 crisis phone lines where people who experience a mental health crisis can access urgent support and advice. We have invested more than £10 million in supporting national and local mental health charities to continue their vital work in supporting people across the country.

It is a priority to keep services and support working and to provide full services throughout the winter months. I would encourage anyone who needs support to reach out for it so that the NHS can help them, just as we are together doing so much to protect the NHS. I would encourage everyone’s constituents to make use of the resources that are there and have been provided: for example, Every Mind Matters for frontline workers; online psychological first aid training has had 90,000 frontline worker users to date.

It is okay not to feel okay during this difficult time, and we will support everyone in getting the help they need. I am pleased to announce that the NHS will launch a major campaign to encourage people who may be struggling with common mental health illnesses to come forward for help. Talking therapy services will continue to be made available remotely, so that people can access help safely from home. While we know anecdotally that some people’s experiences of digital mental health services have been very positive, we also know that they do not work for everyone, particularly people with more serious mental health illnesses. The NHS will work to ensure that the option of face-to-face support is provided to people with serious mental health illnesses across all ages where it is clinically safe to do so, and people with serious mental health illnesses will continue to receive help from NHS volunteer responders to access essentials such as food and medication throughout the winter.

Overall, our response to the mental health impacts of the pandemic must be driven by the best possible evidence to help us access the data on the number of suicides. Public Health England is currently piloting a national surveillance system to monitor suspected suicide and self-harm by collecting data from local systems in near realtime. This will allow us to identify patterns of risk and inform national and local responses. I can also announce that we are developing a winter plan for wellbeing and mental health, and I hope to return to the House with more information on this shortly.

A number of Members have mentioned hospitals. It was lovely to hear my hon. Friend the Member for Warrington South (Andy Carter) talk about Warrington hospital, where I did indeed train as a nurse; I was there from 1975 until 1988, all those years ago. He spoke about the real pressures that hospitals are feeling at the moment, and while we have been having this debate the North West Ambulance Service has declared a major incident, owing to demand on ambulances tonight in the north-west of England due to covid. The pressures in Warrington hospital that my hon. Friend spoke about are being felt across the country.

We all stood and clapped for carers on a Thursday night during the first lockdown, and many of the comments tonight have talked about our frontline workers while, in the same speech, arguing against a second lockdown. What we are doing in arguing against a lockdown, or against the measures we are taking, is subjecting those frontline workers to the almost unimaginable and impossible stresses that they would have to experience, as they are in the north-west of England tonight. As someone said to me before this debate, the eerie sound of ambulances and sirens is noticeably more common across London tonight than it has been over the past week. It is our frontline workers who are dealing with those blue lights as they go into the accident and emergency departments in our hospitals across the UK. It seems impossible that we can clap for workers during one lockdown, then argue against protecting them through a second lockdown, because that is what the principle is: to protect our NHS, and to protect our hospital workers.

The pathway through a pandemic is never straightforward, and we have learned so much about this virus during these past few months, not least—as I said a few moments ago—the fact that it leaves young people with long covid and attacks the central nervous system, which in itself creates mental health problems. I reiterate that there are two sides to the mental health coin when it comes to coronavirus, and we need to protect families and those who have loved ones in hospital or who may end up in hospital and lose their lives. Bereavement brings with it its own mental health issues. All of us are required to make difficult decisions and tough sacrifices to bring this virus under control. We must persevere as we work so hard on the long-term solutions that will see us through and allow us to come together once again, so that we can look after the people and communities that we love.

Question put and agreed to,

That this House has considered covid-19.

Covid-19

Nadine Dorries Excerpts

Thursday 22nd October 2020 Commons Chamber

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

As my right hon. Friend the Secretary of State and others have made clear during this debate, although so much has been done to get this virus under control, the fight is not over. I thank all the Members who have spoken in this debate. It is clear that this pandemic has had a huge effect on everyone’s constituents, across the country. I wish to start by paying tribute to all the hard work of NHS workers, social care staff and volunteers throughout the pandemic. I also pay tribute to the British public for the sacrifices they have made to help us combat coronavirus and for observing the essential social distancing measures that have kept us all safe. Thanks to that hard work, we are able to protect the NHS, just as it is always there to protect us. As my right hon. Friend said, this has been an incredible national effort, and we are seeing the increasing effects of it today in the compliance with social distancing, particularly among young people, which is helping us very much to slow down the progression of the virus.

I wish briefly to outline to the House a few further areas to those set out by the Secretary of State where we have strengthened our response. I will go through these quickly because I want to answer some of the points raised today. We know that we have delivered more than 4.2 billion items of PPE since last February, and our adult social care winter plan, published in September, sets out the actions for the Government and every local care provider.

I want to get straight on to some of the points that have been raised, because some really important issues have been discussed today. I cannot mention everybody and every point, but some people will definitely be receiving a letter from me, particularly the hon. Member for Twickenham (Munira Wilson). I will write to you and answer your points, because you are always very constructive in the way you ask for information and I will make sure you get that information. The hon. Member for Rhondda (Chris Bryant) made the best speech I have ever heard you make in this House—

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. I am going to stop the Minister. I let her do it once; she called the hon. Member for Twickenham “you” and now she is calling the hon. Member for Rhondda “you”. Please call him “the hon. Gentleman”.

[Ms Dorries]

I do apologise, Madam Deputy Speaker, it is because I have not been here very often lately.

The hon. Gentleman made one of the best speeches I have heard him make in this House, probably because he agreed with every word I have been saying—indeed, I almost ripped up this speech. I applaud him for some of the comments he made.

[Chris Bryant]

I will have to resign now!

[Ms Dorries]

Possibly; the hon. Gentleman is in a very difficult position now. I say well done to him for taking apart the Great Barrington declaration. I will now not go into it, as he did an excellent job.

Turning to herd immunity, without a vaccine how do we attain herd immunity? With no knowledge of immunity from coronavirus, how do we obtain herd immunity? I will share with the House that I was diagnosed with coronavirus on 7 March, I had a severe dose and my antibodies had disappeared 12 weeks later. I am no longer immune to coronavirus. That is not just my story; it is the story of many, many people. Many people who were donating their plasma post-coronavirus for convalescent therapy were told quite quickly, “We no longer need your plasma because you do not have any antibodies left.” Work is going on into immunity, and we have not reached a conclusive position yet, but I can speak from my own experience and from the experiences that we are hearing about, and if people do not have long-term antibodies and we have no vaccine, there is no such thing as herd immunity. I say that again because it is the truth.

On the comments about the measures we are putting in place, how restrictive they are and social distancing, all I can say—and this relates to the number of deaths in hospitals—is that back in March no one was wearing face coverings and no social distancing was being complied with by the public, and the rate of infection was doubling every three to four days. Now, it is doubling every seven to 14 days, because the public are wearing masks, they are hand washing and they are socially distancing, and that means that when someone contracts coronavirus, they contract a smaller viral load, which is enabling doctors to treat those patients once they reach an intensive care unit. In ICUs, people are now living, not dying, but we still need the ICUs and we still need the ICU beds in which to treat those people in order that they can live. The fundamental purpose of every measure we take is to protect the NHS and to keep those beds in ICUs, so that they are there to treat people and to keep people alive.

I described this to someone today who argued with me that face masks and coverings are unnecessary. If people are in the space of someone with no facemask—I will use a scale of one to 100—they will breathe in 100 droplets and a full viral load, but when someone has a mask on it is much less. This is not a scientific experiment; it is my own analogy, but the figure is probably 10. The hon. Member for Tooting (Dr Allin-Khan) knows this much better than I do, and can confirm or deny it. Therefore, with a mask, people’s viral load is lower and it is far easier to treat them once they arrive in hospital at A&E and are transferred to an ICU, and there is a huge chance of success. That is what we are seeing in action now in our hospitals. If we all abandon our face coverings, stop social distancing and stop hand washing, we will be back to where we were in March, when the virus was doubling every three to four days.

My hon. Friend the Member for Christchurch (Sir Christopher Chope) mentioned Sweden, but an article in The BMJ—a research study—concluded that Sweden and the US are the only two countries that are failing to reduce their numbers of deaths. In fact, it is far more accurate to compare Sweden with its Nordic neighbours. Sweden has 586 deaths per 1 million people, while its neighbour Norway has 279, so I am not quite sure why Sweden would be cited as a country of success.[Official Report, 24 November 2020, Vol. 684, c. 8MC.]

[Sir Christopher Chope]

Will the Minister give way?

[Ms Dorries]

No, there is no time—I am sorry—because I want to go on to what other Members have said.

I want to talk about mental health and just correct a few points, particularly on frontline workers. On the evidence we have at the moment, the two groups of people who are suffering with their mental health as a result of this pandemic are those people who had pre-existing mental health conditions and frontline workers who are suffering from post-traumatic stress disorder. For those frontline workers, a package was put in place straightaway by the NHS, which provided each frontline worker with three counselling sessions, numerous apps and the ability to have a contact and to receive immediate counselling, as well as a website where they could go through the tools used to work through their feelings. Almost every trust manager put in place a support package for frontline workers in their hospitals, and yesterday the NHS announced a further £15 million to support the mental health of frontline workers.

For those with pre-existing mental health conditions—and I would like to pay tribute to Claire Murdoch, who is responsible for mental health delivery in the NHS—trusts across the UK put in place 24-hour mental health crisis helplines in a matter of weeks, and they have had a huge impact. The Government have committed the £2.4 billion; we have accelerated the long-term plan; we have accelerated the trailblazer schemes in schools; we have introduced the wellbeing package in schools for children returning to school, and we have supported the third sector financially to deliver additional mental healthcare to almost every sector of society, including on eating disorders. I always say that is one of the worst mental health conditions because it has a high rate of morbidity, and it too has received additional funding. We have put a huge amount of work into mental health, and I know that Claire Murdoch and others are proud of what the NHS has done in terms of the mental health services that it has delivered.

I cannot answer anybody else, but I will write to people. This has been an important debate in the middle of one the greatest public health emergencies that this country has faced, and I would like to end by again thanking everyone across the country for playing their part to reduce the rate of transmission and to protect their loved ones and our local communities.

Question put and agreed to.

Resolved,

That this House has considered covid-19.