Winterbourne View
Norman Lamb Excerpts(11 years, 9 months ago)
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The Minister of State, Department of Health (Norman Lamb)
With permission, Mr Speaker, I wish to make a statement about Winterbourne View.
The scandal that unfolded at Winterbourne View was devastating. We were all rightly shocked, angered and dismayed by the appalling abuse uncovered by the “Panorama” programme in May 2011. Straight after the programme was aired, my predecessor, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), commissioned an in-depth review to ensure that we learned the lessons and took action. Today, I am publishing the review’s final report.
The abuse at Winterbourne View was criminal. Staff whose job was to care for people instead routinely mistreated and abused them. Management allowed a culture of abuse to flourish. Warning signs were not picked up by health or local authorities, the residents’ families were not listened to, and the concerns raised by a whistleblower went unheeded. The fact that it took a television documentary to raise the alarm speaks volumes.
The abuse that was uncovered at Winterbourne View is only part of the story. This case has made us look again at how we care for one of society’s most vulnerable groups. Winterbourne View hospital provided care for people with either learning disabilities or autism, together with either mental health problems or challenging behaviour. Around the country, at any one time, there are about 15,000 people with similar needs, about 7,000 of whom live with their families. Of the remainder, many live in the community, but about 3,400 are in in-patient settings. Their behaviour can sometimes pose a risk to themselves, and sometimes also to others. There will therefore be times when they require intensive treatment and support.
However, hospitals are not where people should live. There are far too many people with learning disabilities or autism in hospital, and they are staying there for too long—sometimes for years. We should no more tolerate people being placed in inappropriate care settings than we would people receiving the wrong cancer treatment. What is necessary is nothing short of a fundamental change of culture.
We have known for more than a decade that, with the right support, the vast majority of such people can live happy, fulfilled lives, close to their families and in their own communities. I saw that at Tower Hamlets just this morning. Much of what we know works in this area is based on the pioneering work of Professor Jim Mansell. Professor Mansell helped to set up our review and supported us right up until his death in January this year. I pay tribute to him for his tireless work in this area and for the huge contribution that he has made to improving people’s lives.
We know what change is needed; it is now time to ensure that it happens. Today, we are setting out how we will address poor care and abuse, and ensure that excellent care becomes the norm. First, we need to send a clear message to those who provide care. Owners, boards of directors and senior managers must take responsibility for the quality and safety of their services. When they fail, they should feel the repercussions.
A number of front-line staff at Winterbourne View rightly received criminal convictions, but the case revealed weaknesses in our ability to hold to account those who are higher up. We will address that. We will examine how corporate bodies and their boards of directors can be held to account under law for the provision of poor care and for any harm that is experienced by people using their services. We will also explore whether we can ensure that directors are “fit and proper persons” to oversee care, including through consideration of their record with other providers.
We will also tighten regulation. The Care Quality Commission will include reference to the best model of care in its revised guidance about compliance, and will consider it as part of the regulation and inspection of services from April next year. The CQC will also check whether all providers are following the established national guidance or similar good practice, including by carrying out unannounced inspections involving people with learning disabilities or autism and their families. Where standards are not met, it will take enforcement action.
Secondly, we will tackle the wider failings. We must stop people being placed in hospital inappropriately and ensure that services are commissioned which properly meet people’s needs. That requires the NHS and local government to work together.
All current hospital placements will be reviewed by 1 June 2013, and everyone who is there inappropriately will be moved to community-based support as quickly as possible and no later than June 2014. We will also ensure that in future health and care commissioners design services that allow people to live safely with support in their communities, with the individual and their family included in the development of their care plan. By April 2014, every area will have developed an agreed plan to ensure that that group receives high-quality care. As a result, we expect to see a dramatic reduction in hospital placements.
The report sets out specific actions that we will take to support that high-quality care, including tackling the excessive use of physical restraint, addressing concerns about the over-use of antipsychotic and antidepressant medication, and improving safeguarding arrangements. We will support a positive and open culture in which staff provide excellent care but feel able speak out when care is poor. We will support providers to achieve that, including in relation to staff training.
Creating a positive culture means listening to and involving people and their families. At Winterbourne View, families’ concerns were ignored. However, we must go further than heeding warnings or complaints and ensure that people and their families are involved at every stage of their care, and that they get the support they need, including advocacy support. We will make these changes as quickly as possible.
The organisations responsible for delivering change share our commitment to making it happen and are working nationally and locally across health and social care. A concordat signed by more than 50 organisations sets out the specific actions that each organisation commits to deliver. The NHS Commissioning Board and Local Government Association will come together to lead a joint improvement programme, with financial support from the Department of Health, to ensure delivery of the changes. I will chair a programme board to oversee that progress is made.
Winterbourne View fills us all with sorrow and anger but we are using it as a spur to make things better. Some places are already getting things right—I have seen some of them for myself, including at Tower Hamlets this morning, and the report discusses many more. They show what can, and should, be done for all, and that a better life for people with learning disabilities and autism is possible. I regard it as a national imperative that we transform care for those with learning disabilities or autism and behaviour that challenges, and I commend this report to the House.
Liz Kendall (Leicester West) (Lab)
I would like genuinely to thank the Minister for advance sight of his statement and the briefing I received earlier today. Members on both sides of the House were appalled and angered by the terrible incidents at Winterbourne View, and we share a determination to ensure that all necessary steps are taken to prevent a similar tragedy from happening again. Our goal must be to ensure that everyone with a learning disability or autism, including those with challenging behaviours, receives high-quality, decent and humane care and support, and that we finally end the practice of sending people to long-stay institutions, far away from their family and friends.
The Minister has announced a number of welcome measures that are a step in the right direction, but I remain concerned that some of the proposals are not clear or strong enough to guarantee the fundamental changes that people with learning disabilities urgently need. The NHS mandate published two weeks ago states there should be
“a substantial reduction in reliance on inpatient care.”
Can the Minister give a figure for that reduction? Without one, that laudable aim will be open to such wide interpretation that it risks appearing meaningless. Similarly, the Government say they want every local area to provide “appropriate” care and support. Will the Minister tell the House who will define what care is “appropriate” and how that will be measured?
How will the Minister ensure that all local commissioners have the necessary skills to make these changes? That was a problem with 150 primary care trusts, yet in future there will be 212 clinical commissioning groups. Those can, of course, draw on expertise in local councils, but the authorisation process for CCGs does not even mention learning disabilities as an area in which competence is required. If this is such an urgent national imperative for the Government, will the Minister explain why that is the case?
Some parts of the country continue to use long-stay institutions because they have not developed alternative care in the community and at home. In a time of constrained resources, when we need to make the best use of taxpayers’ money, there should be one budget for people with learning disabilities, not separate budgets for NHS and council care. Will the Minister explain how he will make that happen on the ground? For example, will he require the NHS Commissioning Board to instruct CCGs to provide funding to local councils if they are slow to do so or if they refuse?
The serious case review of Winterbourne View said that light-touch regulation by the Care Quality Commission was not appropriate for closed establishments, and that they should be treated as high-risk institutions, requiring frequent, unannounced probing investigations. The review says that the investigations should involve speaking to residents’ families and patients, and in particular to people who have left the institution, who may feel more able to speak out. The CQC recently completed a focused programme of inspections of long-stay institutions. Will that specific programme continue along the lines the serious case review recommends? Will the Government, in their review of the use of restraint, consider banning t-supine restraint, as the serious case review recommends?
One of the most disgraceful aspects of Winterbourne View is that vulnerable people were neglected and criminally abused while the hospital’s owners, Castlebeck, charged huge fees and made huge profits. The serious case review says that Castlebeck made decisions about profitability, including shareholder returns, over and above decisions on the effective and humane delivery of treatment. The average weekly fee for residents at Winterbourne View was £3,500—the fee rose to £10,000 for one patient. The review could not determine how much of that money went back into the hospital and how much was creamed off for profit because of the company’s complex financial structure—Castlebeck is owned by private investors based in Jersey and Geneva. That has made it virtually impossible to hold the company to account. Will the Minister confirm that the company has so far failed to meet two of the serious case review’s key recommendations —that it should fund therapeutic services for all ex-Winterbourne View patients, and that it should pay for the costs of the serious case review, which have so far been borne entirely by the taxpayer?
I welcome the Government’s commitment to examining how corporate bodies and their boards of directors can be better held to account. As a first step, will the Minister consider requiring private companies to publish the names of their owners, the members of their boards, and the details of their financial structures, before they can be licensed and registered to provide publicly funded care? The excuse that such information is too commercially sensitive should not be acceptable when the care of vulnerable people is at stake, and when it is paid for using substantial amounts of taxpayers’ money.
How we care for the most vulnerable people is the hallmark of a decent society. I do not doubt the Government’s commitment to addressing this issue. I hope they listen to our concerns and strengthen their proposals, so that people with learning disabilities get the decent and humane care and support we would all wish for our families and friends.
Norman Lamb
I thank the shadow Minister for her contribution and appreciate the welcome she gives for the main thrust of the Government’s response. This is a moment when everybody must come together to be clear that a change of culture is necessary from top to bottom. This is not a party political issue. The culture must change, and everyone within the system—from top to bottom—must recognise their personal responsibility to achieve that.
The shadow Minister raised a point about the mandate. One very good thing about the mandate is that it gives us accountability and transparency in the system for the future, and enables us to hold the NHS Commissioning Board and other parts of the system to account on delivering what is in it.
The hon. Lady asked how we will measure success in relation to the reduction in numbers in long-stay institutions. There must be a focus on assessing an individual’s personal care needs—that is what counts. The arbitrary setting of a target on numbers would be completely inappropriate when we should be focusing on the needs of individuals. The guidance we have received is that while there are 3,400 people in in-patient facilities of one sort or another, we are talking about probably reducing that down to 300 or 400 people. That is the best assessment that has been made, but I stress again that it must be based on assessment of individual needs.
The hon. Lady rightly makes the point about the skills of commissioners. One of the big failures has been that of commissioners properly to look after the interests of highly vulnerable people. The programme, which will be led by the Local Government Association and the NHS Commissioning Board and funded by the Department with between £2 million and £5 million of support, will be there to provide support and guidance to ensure that local commissioners get this right. We should applaud the parts of the country where this is being done brilliantly at the moment. They can demonstrate best practice to areas that need to change.
The hon. Lady asked whether the Commissioning Board will hold CCGs to account. The answer is, absolutely. This is part of the transparency of the new system and they must deliver on what they will be required to do.
I agree with what the hon. Lady said about the budget. The report makes it clear that the starting point should be that pooled budgets are the appropriate way forward. This is patchy at the moment. If there are not pooled budgets, they should explain why. In my view, there is no good justification for not pooling the resources of the NHS and social care to ensure the best and most appropriate care for individuals. There is also a duty for the two sides—social care and NHS—to work together. The health and wellbeing boards help to bring them together, and that is valuable.
The hon. Lady asked about Care Quality Commission inspections. Unannounced visits will continue, and they will include people with learning disabilities and their families, so that their perspective is gained. This is not a time-limited programme—it will continue. I think that the CQC recognises that this is an area that requires focus because of the vulnerability of the individuals concerned.
On physical restraint, we will look at all elements, including those mentioned by the hon. Lady, so that the best possible guidance is given to ensure that the excessive use of restraint, which currently happens in too many places, comes to an end.
On Castlebeck, I absolutely agree that it should consider financial support for the costs incurred following the scandals uncovered in its care settings. The hon. Lady rightly points out the responsibility that goes with charging an average of £3,500 per week per patient. One of the great failures of the current system is that there is not sufficient corporate accountability to ensure that people are held to account when things go wrong. When we consider proposals to address that lack of corporate accountability, we will look at the hon. Lady’s transparency proposal on publishing a lot more information about financial structures. Indeed, in the consultation we announced a fortnight ago on the follow-up to Southern Cross, we are proposing that there should be transparency regarding financial structures and that that information is shared to ensure that we avoid being caught by surprise, which is what happened under the system in operation when Southern Cross crashed, leaving many people in an unacceptable state of anxiety.
Jack Lopresti (Filton and Bradley Stoke) (Con)
May we have an assurance, first, that local agencies, such as the police and local government, have to take a large chunk of responsibility for this situation occurring in the first place and, secondly, that there will never be a repeat of the situation where the local council can fail to pick up on up to 40 alerts over several years? That could have avoided much of the pain and suffering at Winterbourne View.
Norman Lamb
I agree absolutely. One of the great scandals of this whole saga has been the extent to which local authorities and primary care trusts let people down. The father of a patient at Winterbourne View told me how the concerns he raised were ignored, how he watched as his son became more zombie-like because of the use of antipsychotic drugs and how he felt guilty himself—how shocking that a parent ends up feeling guilty through no fault of his own. He was powerless to do anything. It is shocking that public authorities let people down in that way. That is why I say that everyone in the system has to step up to the plate and recognise the need for a complete change of culture to recognise that everyone with learning disabilities has exactly the same rights as the rest of us.
Grahame M. Morris (Easington) (Lab)
I thank the Minister for his statement and hope that he will reflect on some of the questions posed by my hon. Friend the Member for Leicester West (Liz Kendall), who made a powerful case for private providers being subject to freedom of information requests—I draw his attention to early-day motion 773, which embodies that principle.
On the failings that brought about this terrible tragedy, the Care Quality Commission was overly concentrating on process rather than its main job of ensuring that the required standards were met and looking at quality and risk profiles. There was a big disconnect between the perceptions of carers and families and the views of the CQC. Fundamentally, unless we address the lack of resources, will we not see a series of these disasters in the future?
Norman Lamb
In the aftermath of Southern Cross, we have seen the need for much greater transparency in these large corporate bodies to ensure that we know exactly what their financial structures are like and where the risk exists. The hon. Gentleman mentioned funding. The great scandal is that we are spending vast sums of public money putting people at risk and into inappropriate care settings. Visiting places such as Tower Hamlets, we discover that the right care package for individuals—most often, supported living in their own community—is much cheaper and gives them a quality of life they never experienced in these institutions. This is not about money, therefore, but about the system stepping up to the plate and ensuring that individuals are respected in their own right.
Paul Burstow (Sutton and Cheam) (LD)
The Minister is absolutely right that transparency is essential, but there is also a recognition—I think—that that is not sufficient; accountability is essential as well. In this case, the company, Castlebeck, has hidden in the shadows and left everyone else to take the blame. I welcome what he has said about corporate responsibility, therefore, but I urge him—and commend to him—to make a much closer examination of the corporate legal framework to ensure that there is a corporate legal offence. It is not good enough for the thugs who did this to be in the dock and receive a criminal conviction; the company itself has a criminal responsibility, and it should be held to that standard and brought to court as well.
Norman Lamb
I commend my right hon. Friend for the work he did on this subject. When I started this job, it struck me that there was an absence of effective corporate accountability in the law and that that had to be addressed. I was determined to ensure that the Government response addressed that issue head on. In doing that, we need to look both at the regulatory framework—issues such as whether there could be a fit-and-proper persons test for those on the boards of companies—and at the criminal law. It is striking that in the Winterbourne View case the authorities determined that it was not possible, under existing law, to bring prosecutions. I am absolutely clear, however, that responsibility rests at the top of the company for facilitating this sort of outrage. That is why the law needs to change. We need to look both at criminal offences and the regulatory framework.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
May I press the Minister on one aspect? Will he look much more closely at the role of the third sector, particularly charities, in providing services? Hollybank school and community in Mirfield in west Yorkshire, close to my constituency, does a brilliant job. Does he recognise that, in considering the report, it is the quality of management that one worries about and the fact that the most vulnerable people in our society are so often looked after by poorly trained people on the minimum wage working 12-hour shifts? That is often at the heart of the problem.
Norman Lamb
I thank the hon. Gentleman for that question and completely agree that we have to address the issue of skills. It is worth pointing out that there are some fantastic providers in the voluntary sector, and in the private sector as well. We should applaud that and recognise that there are many well trained people on low wages providing a fantastic quality of care, but there are also places where that is not the case. That needs to be addressed.
I absolutely agree with the hon. Gentleman that we should look closely at the voluntary or not-for-profit sector. I had a meeting recently with the head of Shared Lives, an organisation that places people with learning disabilities into people’s homes. Surprise, surprise—when people are treated with dignity and treated as human beings, their behaviour improves and sometimes all the complex problems subside. There is an awful lot we can do. In the new year I will bring together the providers of the best care available so that we can learn the lessons from them.
Sir Tony Baldry (Banbury) (Con)
As patients had come from different parts of the country to Winterbourne, there was a sense that they had got lost in that locality. Whatever happens, it is a tragedy that it took a television programme to discover all this. We are now going to have health and wellbeing boards and HealthWatch. Can my hon. Friend tell the House how, between them, they can ensure that they inspect and have a grip to ensure that something like this never happens in my county of Oxfordshire? It has never happened there because the structures of local government and health and social services are constantly monitoring and inspecting whatever is happening in our areas, irrespective of whether they are delivering health or social care.
Norman Lamb
I thank my hon. Friend for his question. He is absolutely right. The new structure provides far greater local accountability than we have ever had. One of my great criticisms of the old primary care trusts is that they are, in effect, completely unaccountable to their local communities. Health and wellbeing boards scrutinising what clinical commissioning groups and the local authority are doing can be very powerful. He also mentioned HealthWatch. Like its predecessor organisations, the local involvement networks or LINks, it will have the power to go into all care and health settings and inspect what is going on, often behind closed doors. We encourage HealthWatch to use those powers to shine a light on what is happening in some of those places.
Helen Jones (Warrington North) (Lab)
The Minister has rightly referred to the amount of money paid for patients in Winterbourne View, but does he also recognise that good-quality care in a community is also expensive and requires a lot of highly trained staff? Given the cuts to local authority budgets, is he convinced that sufficient resources are available, even if budgets are pooled? When he knows how many patients need to be transferred back into the community, will he commit to come to the House to make a statement on whether the right resources are available?
Norman Lamb
I thank the hon. Lady for that question. What was striking when I visited Tower Hamlets this morning and talked to the leaders on the health and local authority sides was that, despite being the third most deprived borough in the country, Tower Hamlets is one of the lower spenders on institutional care because it is doing things the right way. Tower Hamlets has not referred a single person from the borough to an assessment and treatment centre for three whole years. Tower Hamlets has demonstrated not only that that is possible, but that it often ends up costing much less to provide the right care in the community—[Interruption.] Well, that is what the borough leaders find. That is what I have been told by them and by many other people in the sector. An individual should have the care that they need, and if the cost of that package in the community is substantial, it should be met. We should never compromise on that. All I am saying is that the overall cost of providing the right kind of care in the community often looks lower, when compared with those institutions in which the cost is extraordinarily high—as much as £3,500 per week per patient.
Rehman Chishti (Gillingham and Rainham) (Con)
The Minister mentioned unannounced inspections. Will they involve speaking at random to patients at the centres? Linked to that point, some hospitals around the country have a whistleblower policy that allows people who work in them and others to take their concerns to senior officials in confidence.
Norman Lamb
I thank my hon. Friend for his question. I am quite sure that those inspections will involve talking to the people in those settings. The fact that the Care Quality Commission is saying that it will involve people with learning disabilities and their families in those inspections will help to ensure that they have a human face. My hon. Friend also mentioned whistleblowing. It is essential that individuals feel able to blow the whistle when they see examples of abuse or neglect. Indeed, the Government have funded a helpline for any whistleblower in either the health or the care setting to ensure that people can always get access to guidance on how to go through the proper process of blowing the whistle on unacceptable standards of care.
John Healey (Wentworth and Dearne) (Lab)
I welcome many of the steps that the Minister has announced today in response to the shameful scandal at Winterbourne View. He says that he wants those who are high up in the organisations to be held to account. Does he therefore accept the argument put forward by my hon. Friend the Member for Leicester West (Liz Kendall) that now is the time to regulate for the best business standards, as well as for the best care standards? He also says that he wants to use regulation to secure higher and tighter standards. Will he ensure that, in putting those standards in place, any regulation of physical restraint deals not only with the excessive use of such restraint but with the appropriate use of the best techniques and with the best training?
Norman Lamb
I thank the right hon. Gentleman for his welcome for the broad thrust of my proposals, and for his questions. On standards of business in the sector, it strikes me that the levels of corporate accountability seem to be significantly lower in this sector than in many others. How bizarre is that, in a sector in which the protection of individuals is absolutely vital? In our response to Southern Cross and to this case, we will require owners to adopt a much more transparent approach and to disclose details of their financing arrangements. We are introducing that level of engagement and transparency as well as addressing the need for accountability. The right hon. Gentleman also asked about restraint, and we will certainly look at the appropriate methods of restraint. It should really be used only for the protection and safety of an individual or of others. It should not be used for chastisement or punishment, as appears to have been the case in some locations. That is completely unacceptable.
John Pugh (Southport) (LD)
One of the big problems is the fact that many local authorities house vulnerable people at a considerable distance from their families. What element of the proposals will constrain that unfortunate practice?
Norman Lamb
I thank my hon. Friend for that question. He is absolutely right that one thing uncovered, both at Winterbourne View and in the Care Quality Commission survey of similar institutions, was that people were sometimes placed hundreds of miles away from their families. That still continues; that is what we have to address. My hon. Friend asks about what in the proposals will address that and ensure that it does not happen. Every part of the system is signed up through the concordat to changing what has been an unacceptable practice. People will be held to account. I said in my statement that I will chair a programme board throughout this period of change, and we will publish regular updates so we can, in a sense, hold to account every primary care trust or clinical commissioning group and every local authority that fails to change in the way expected.
Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)
I welcome the Minister’s pledge—made twice during his statement—that the Government will go ahead with a review of those “inappropriately placed” and to make it available by 2014. Will there be any element of advocacy during the review, including that endorsed under the Disabled Persons (Services, Consultation and Representation) Act 1986? Finally, do the Government think it possible—if not by this means, by other means—to consider the fairly large number of people inappropriately placed in prison?
Norman Lamb
I thank the right hon. Gentleman for his important questions. First, we want to ensure that advocacy is available to help those families and individuals, ensuring that they are placed in appropriate settings and away from these long-stay institutions that we all find completely unacceptable. I very much agree with him on that, and I find myself in agreement with him again on prisons. We shall come forward next year with some clearer proposals on approaches to diversion—assessing someone’s needs before they end up in prison, diverting them, if at all possible, to much more appropriate settings.
Andrew Selous (South West Bedfordshire) (Con)
I was not sure I heard the Minister correctly when he said that the average fee was £3,500 a week, which is £182,000 a year. Is it not possible to pay some of the caring staff slightly more and demand not only the highest level of skills, but the highest level of compassion for that level of fee from the state?
Norman Lamb
I thank my hon. Friend for that question. He is absolutely right that an extraordinarily high sum was being paid to put people at risk of abuse —and to be abused, as it turned out in Winterbourne View. Pay rates are not ultimately the responsibility of Government, but one would hope that responsible organisations look to train their staff to a high standard—that is absolutely a prerequisite and they will be held to account by the Care Quality Commission for proper training—and, wherever possible, to provide better pay rates so as to ensure that people are rewarded for the incredibly important work in our care sector.
Mrs Anne McGuire (Stirling) (Lab)
Before I became an MP, I worked with parents of learning disabled adults to establish supported community care homes, as those parents would have done anything rather than allow their adult children to go into institutional care. I welcome the Minister’s comments today. There is an emphasis on process, which is important, but does he agree that there is a challenge in the wider cultural sense? As long as we do not give those with learning disabilities the respect to which they are entitled as equal members of society, we almost create an environment in which people think they can with impunity do the sort of things they did in Winterbourne. Will the Minister work with the Minister for Disabled People, the Under-Secretary of State for Work and Pensions, the hon. Member for Wirral West (Esther McVey) and look at how we can challenge those attitudes, which are sadly still around in the 21st century?
Norman Lamb
I thank the right hon. Lady for that. She is absolutely right in what she says about institutional care. I keep mentioning Tower Hamlets, as it was rather inspirational to visit and see how things are done there. I was told that Tower Hamlets has one of the lowest rates of children going into care because of the support for families that it provides, preventing that from ever being necessary.
As for the right hon. Lady’s second point, she is absolutely right: this is moment that demands a change of culture, not just in the health and care system but in society as a whole. There must be a change in all our attitudes. We will make progress only if we understand the fundamental point that someone with learning disabilities has exactly the same rights as anyone else, and should be treated with dignity and respect.
Glyn Davies (Montgomeryshire) (Con)
We are for ever reading in reports such as this about poor behaviour in social care. In the last year or so, we have had Southern Cross and then Winterbourne View, which is probably the most shocking example of all. We greatly welcome the measures that the Minister has announced, but can he tell us what arrangements exist to enable us to share the knowledge that we have gained and the lessons that we are learning with the Welsh Government? I am sure that there are very good examples that we can pass over Offa’s Dyke, and that Wales has very good examples from which we can learn.
Norman Lamb
I know that some people from Wales were placed in Winterbourne View. This issue is important and relevant to Wales, Scotland, England and Northern Ireland. I would encourage officials of the devolved Administrations and the United Kingdom Government to liaise closely in order to ensure that the lessons that we are learning here can be applied elsewhere, and that good lessons from Wales and elsewhere can be learned in England.
Mr George Mudie (Leeds East) (Lab)
The Minister is a very humane man, and I entirely accept the fine things that are in the report. However, we are ultimately responsible for the proper treatment of vulnerable people, both in hospitals and in care homes, and fine words go only halfway. We have seen people in that sector take advantage of and abuse vulnerable people who cannot speak or fight back.
One of the key points raised by my hon. Friend the Member for Leicester West (Liz Kendall) concerned unannounced inspections, which the Minister seemed to suggest were a matter for local authorities or other public bodies. Can he tell us whether real resources will be put into that part of the operation? Whatever has been signed up to, vulnerable people have been treated so badly that we should be ashamed. If we do not provide resources that will enable us to know that someone independent has the power to enter premises at any time or on any day and inspect the treatment of vulnerable people who are in our care, we cannot be taking this issue seriously.
Norman Lamb
Let me respond first to the hon. Gentleman’s observation about fine words by saying that this is just the starting point. It does not do the job; it merely sets out the scale of the ambition that is necessary to address a national scandal. It is good that all parts of the system are signed up to it, because that gives it a better chance of success. I will chair a national programme board that will keep a close watch on what goes on and hold every part of the system to account.
The hon. Gentleman spoke of the horrors of what goes on in some care homes and in hospitals, but we must remember the horror of family members who went to local authorities or the NHS to complain and were ignored. That, in a way, is just as scandalous, and it must be addressed.
I have talked to the chief executive of the Care Quality Commission, David Bearn, who has confirmed that he has enough resources to maintain a programme of unannounced inspections. They will continue; they must continue, and they must include people with learning disabilities and their families. I mentioned the role of HealthWatch earlier. In every local area, its representatives will have the power to go into these places to see for themselves what is going on behind closed doors. That too will introduce a new accountability.
The final point I would make is that we are developing the idea of online quality indicators for every care and health setting, with user reviews so that individuals who have been in those care settings and their families can give their views. That scale of transparency can be transformational in driving up standards.
Schizophrenia Care
Norman Lamb Excerpts(11 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister of State, Department of Health (Norman Lamb)
I sincerely congratulate my hon. Friend the Member for Broxbourne (Mr Walker) on securing this debate on an incredibly important subject. It is good that in this House today we have debated people with learning disabilities and how they get treated by the system, and now we are debating people with schizophrenia. In the past, those two very important groups of people have often been rather neglected, and it is good that Parliament is focusing on them and how the system treats them. I pay tribute to my hon. Friend’s work as an advocate in mental health. It is very important that people speak up for those with mental health problems, and he and one or two other MPs have done us a good service by being prepared to talk about it openly. I pay great tribute to his work in this field.
This is a timely debate. The premature mortality that my hon. Friend mentioned, the stigma, the human cost and the statistics are as well known as they are shocking. Together they add up to a compelling call for action, and that makes the recent report, “The Abandoned Illness”, very important. It sets out how things must change, how services have to be more accessible, how staff have to be fully supported, how integration of services can change lives, and, of course, how people’s mental and physical health must be treated equally. Too often in the past, mental health has been seen as the poor relation. The Government have established the principle of parity of esteem, and we now have to make it a reality. This debate is an important moment at which to consider that.
The Government have published a mandate for the NHS Commissioning Board which sets out our key priorities for the service. The mandate goes further than ever before in setting out the priority that the Government give to mental health, and it makes it very clear that mental and physical health problems should be treated in a co-ordinated way with equal priority. We expect the NHS to demonstrate real progress on this by March 2015. We have also tasked the NHS with making progress in specific areas. Accessing care and treatment should be as easy for people with mental health conditions as for those with physical conditions, so we have asked the NHS Commissioning Board to consider new access standards, including waiting times, for mental health services. It is remarkable that in the past decade we have introduced waiting time standards for physical health—the 18-week wait—and yet in mental health there is no comparable standard. That has to change.
The NHS outcomes framework includes four measures that relate specifically to mental health. Three of those focus particularly on patients with severe mental illness: premature mortality in people with serious mental illness; the employment of people with mental illness, which my hon. Friend spoke about very movingly; and patient experience of community mental health services. Many other outcomes that we are measuring will be as relevant to people with mental health problems as to people with physical health problems. There is no magic bullet, but I think that this will help to kick off the drive towards real parity of esteem, just as it says in “The Abandoned Illness”.
On top of that, a lot more needs to be done to improve access to psychological therapies for people with severe mental illness. Much of the consideration of the improving access to psychological therapies project has focused on anxiety and depression, but we know that psychological therapies can also be very effective for those with a severe mental illness.
Six local projects, backed by £1.2 million of Government funding, are working on demonstrating the benefits of IAPT in treating people with a severe mental illness or personality disorder. Over the next five months, these organisations will share what they have learned about how best to deliver evidence-based treatments. The work will include demonstrating how this group can get better access to psychological therapies, spreading good practice to other services, and providing good quality data—this has so often been missing in the past on mental health—on how services can be improved for patients.
One of the report’s main findings was that there are far too many people with a mental illness in in-patient wards—my hon. Friend made this exact point—who do not need to be there. Furthermore, many wards are not the calm therapeutic environments that are conducive to improving patients’ well-being. Everyone in the House knows how much of a problem this is. It is not good for patients, families or the staff who work there.
The mandate of the NHS Commissioning Board sets out plans to introduce the friends and family test for all NHS services, including those for mental health in-patients. This will allow people to feed back their experience by saying whether they would recommend a particular service to their loved ones. I should also say that I am looking into the issue of the Care Quality Commission survey. I understand that it was terminated because of concerns about its accuracy and value, but the fact is that it applies in other parts of the health service and I am concerned that mental health services lack such a survey.
Our cross-Government mental health strategy, “No health without mental health”, also recognises the problem. Among its core objectives it lays out, first, that people who are acutely ill need to get safe, high-quality care in an appropriate environment when they need it and, secondly, that following acute illness people should be helped and supported to recover. This will mean different things to different people, but for many it will mean services working together to help people live independently, to find work and to play an active role in society. That means people moving from in-patient wards into the community, with support. This same service is integrated with early intervention, which my hon. Friend has also mentioned, and crisis teams can also support people early in their illness or during an episode of illness, so that they do not progress to needing in-patient care.
Our implementation framework sets out specific actions that local organisations can take to make that a reality. The framework was co-produced by five leading mental health organisations, including Mind and Rethink. In addition, we are already measuring employment for this group as part of the NHS outcomes frameworks for public health and for adult social care.
Mr Newmark
On the subject of Rethink, which does a tremendous job, will my hon. Friend join me in congratulating my constituent, Trina Whittaker, and Braintree Rethink on doing a tremendous job for those with schizophrenia and other mental illnesses?
Norman Lamb
I absolutely join my hon. Friend in applauding Trina Whittaker and the work of the local Rethink group. I met the national group last week to discuss this very subject. It does tremendous work around the country and I applaud it.
On personal budgets, we know that people want more control over their own care. For instance, patients often do not like the drugs that they are being prescribed—they might make them overweight or have other detrimental effects. It would be far better to move away, if possible, from that paternalistic, disempowering model towards a system in which patients have much more say.
We are already taking steps to help make that happen. The draft Care and Support Bill, published in July, places personal budgets on a legislative footing for the first time. It specifies that everyone eligible for ongoing social care, including those who are mentally ill, will get a personal budget as part of their personalised care and support plan by April 2013. On NHS services, the mandate sets out that patients with mental health conditions will be able to have an agreed personalised care plan, which they must be involved in preparing; it will not be imposed on them. Those plans will lead directly to people with mental illnesses getting the help that they want, and not being directed to a one-size-fits-all service.
Listening to people with mental illnesses is particularly important because of the huge stigma—my hon. Friend the Member for Broxbourne talked about this—that they endure throughout almost every sphere of their lives. Stigma features heavily in the report and I welcome the clear message that it gives us: we will not tackle stigma by burying our heads in the sand. It goes without saying that schizophrenia is an immensely complex condition, and it is made even more difficult when people characterise it as simply a split personality.
We are listening to service users who tell us of the appalling discrimination that they suffer. Many people tell us that the discrimination they face is often worse than the condition itself. That is why the Government are joining forces with Comic Relief to tackle mental health stigma. We are giving up to £16 million, alongside the £4 million that Comic Relief is providing, to Time to Change, the brilliant anti-discrimination campaign run by Mind and Rethink Mental Illness, so that it can continue its work through to March 2015. My hon. Friend and others who have spoken out about their own mental health problems are helping to address the stigma and make mental conditions more acceptable.
I should also say a word about black and minority ethnic service users, because they are over-represented in in-patient care and often stay longer than people from other ethnic groups. We are discussing those long-standing issues with a range of leaders and organisations from BME communities with a view to tackling them.
There is a clear need for organisations outside Whitehall to work much better together. The NHS, social care and other services need to work hand in hand to ensure that patients with mental health problems get effective, safe and streamlined treatment. Together, they need to identify the risks and manage them appropriately. The NHS Commissioning Board will directly commission specialised services, including secure mental health services. That is a great opportunity to ensure that there is high-standard, recovery-oriented and consistent practice across the country, with clear transitions for patients between different parts of the mental health system.
The Department of Health funds a wide range of research on schizophrenia and other psychoses. We have awarded nearly £49 million over five years to the biomedical research centre for mental health, based at the South London and Maudsley NHS Foundation Trust. It collaborates with the Institute of Psychiatry to translate promising research into effective practice. Psychoses are a major focus of its work. The National Institute for Health Research funds a clinical research network, which allows patients across England to take part in trials and other types of clinical study. The network is currently setting up and recruiting patients to about 90 projects to study schizophrenia and psychoses. Through the “Strategy for UK Life Sciences” the Government will provide an environment and infrastructure that supports pioneering researchers and clinicians to bring innovations to market earlier and more easily, making the UK the location of choice for investment.
The Government believe that people with schizophrenia, and indeed any severe mental illness, have a right to the care and support they need in a safe and comfortable environment where they are treated with the dignity and respect they deserve. They have as much right as anyone else to a fulfilled and productive life, free from discrimination and stigma. The coalition is making valuable changes from the centre, but this cannot be the Government’s responsibility alone. We need everyone everywhere to take what responsibility they can, including the commissioners who must purchase the care that meets people’s needs, the providers who have a duty of care to each and every individual for whom they are responsible, and the regulators who are responsible for ensuring the quality of that care. I have set out some of the recent developments at government level that will improve services for people with schizophrenia. However, I acknowledge that we are still some way from where we want to be. We must not relent in our pursuit of that.
To that end, I am convening a round-table meeting on schizophrenia next week with leading charities, members of the Schizophrenia Commission, the Royal College of Psychiatrists and others. My hon. Friend the Member for Broxbourne is welcome to attend if he is available. The aim of the meeting is to identify the further practical actions that key players can take to improve the quality of life of people with schizophrenia and other severe mental illnesses.
Question put and agreed to.
Personal Health Budgets
Norman Lamb Excerpts(11 years, 10 months ago)
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The Minister of State, Department of Health (Norman Lamb)
I am announcing the publication of the final independent evaluation report on personal health budgets, which have been piloted in the national health service since 2009 as a way to give people more choice and control over their care.
In summary, the results show that:
personal health budgets are cost-effective when implemented as the policy intended and patients have genuine control;
they improve people’s quality of life, well-being and feeling of being in control—but do not generally have any statistically significant effect on health status or clinical measures such as blood sugar levels for diabetics;
they may be more effective for people who are higher users of NHS services (such as people receiving NHS continuing health care) and those with mental health needs; and
they may reduce use of NHS services indirectly—particularly by reducing hospital admissions.
These are positive findings, which provide evidence for rolling out personal health budgets beyond the pilot programme. However, there is still much to learn about implementing personal health budgets for large numbers of people. This argues for a measured approach: setting a clear strategic direction of travel and supporting further learning as personal health budgets are scaled up.
In the light of the evidence, I can make a number of commitments.
First, the Government can confirm the ambitious objective set in the mandate to the NHS Commissioning Board, that
“patients who could benefit will have the option to hold their own personal health budget, subject to the evaluation of the pilot programme, as a way to have even more control over their care”.
Secondly, we also reaffirm our commitment to introduce a right, from April 2014, for people receiving NHS continuing health care to ask for a personal health budget; the evaluation clearly suggests that personal budgets have benefits for this group of people.
Thirdly, we want to enable NHS commissioners across the country to offer personal health budgets, including through the option of a direct payment. Direct payments for health care are currently only lawful within pilot schemes, but the Health Act 2009 gave power to extend them nationally by order, with the approval of both Houses of Parliament under the affirmative resolution procedure. We intend to bring forward proposals for this. To help inform the process, we will be launching a public consultation later this year on updating the regulations for direct payments. Meanwhile, existing pilot sites will still be able to offer direct payments, and will be able to act as early leaders in rolling out personal health budgets more widely.
Fourthly, we will be providing additional support to nine areas that are “Going Further, Faster”, pushing ahead with implementation on a larger scale and demonstrating how personal health budgets can be extended beyond NHS continuing health care. The Department will provide £1.5 million of funding to support early roll-out of personal health budgets in the period until April 2013, when responsibility will transfer to the NHS Commissioning Board.
Finally, we have also today launched a toolkit that is available to everyone who has an interest in personal health budgets. It contains a wide range of learning from the pilot programme, including practical advice and information to support the implementation of personal health budgets.
More information on personal health budgets, including the toolkit and stories of people who have budgets can be found on the personal health budgets learning network at: www.personalhealthbudgets.dh.gov.uk.
The evaluation report has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Oral Answers to Questions
Norman Lamb Excerpts(11 years, 10 months ago)
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Paul Burstow (Sutton and Cheam) (LD)
3. What plans he has to improve the quality and quantity of mental health crisis care services.
The Minister of State, Department of Health (Norman Lamb)
Mental health is a priority for this Government. That is reflected throughout the first mandate to the NHS Commissioning Board. The quality of all services, including crisis mental health, must improve. It is for the Commissioning Board, working with local commissioners and partners, to commission services in response to need.
Paul Burstow
I welcome that answer, particularly as regards the strengthening of the NHS constitution. My hon. Friend will accept that a mental health crisis is a very frightening thing to happen to a person and can be life threatening. The charity Mind has shown that there is unacceptable variation across the country in the quality and accessibility of crisis services. Does the Minister agree that just as the Government have rightly shone a light on the variability of physical health services, we need to do the same for mental health services? We need an atlas of variation for mental health services that hon. Members and others can use to challenge local commissioners to improve.
Norman Lamb
I am grateful to my right hon. Friend for that question. Atlases of variation are an important way of raising standards and we will be discussing their future use with the new commissioning organisations. He is also right to highlight the absolute importance of having parity of esteem between physical and mental health. The Government’s mandate makes it absolutely clear that there must be parity between mental and physical health services.
Hazel Blears (Salford and Eccles) (Lab)
There are 800,000 people in this country who are living with the effects of Alzheimer’s and dementia. For some of those people, challenging behaviour is a serious issue. Will the Minister ensure that every clinical commissioning group has a lead for dementia in the mental health field so that that can be taken seriously in every community in the country?
Norman Lamb
That is absolutely a priority for the Government and the right hon. Lady is right to highlight its importance. The NHS Commissioning Board will work with local clinical commissioning groups to ensure that we raise the standards of health and care services, but she is absolutely right to highlight the importance of substantially improving access to dementia services.
Rehman Chishti (Gillingham and Rainham) (Con)
Can the Minister clarify how often mental health centres and hospitals are inspected and how often patients are spoken to to help improve the service?
Norman Lamb
The Care Quality Commission inspects all services. Of course, there is now a registration system for such services. The hon. Gentleman is absolutely right to highlight the importance of ensuring that mental health services are regarded as just as important as physical health services, which has not always been the case.
Bridget Phillipson (Houghton and Sunderland South) (Lab)
Does the Minister agree that when people are experiencing a mental health crisis, the initial response that they receive when seeking help is vital? What steps are he and his Department taking to make sure that staff in accident and emergency departments are able to respond appropriately?
Norman Lamb
I am grateful to the hon. Lady for raising that important point. A fortnight ago I visited Heartlands hospital in Birmingham, where the RAID—rapid assessment, interface and discharge—team provides brilliant access for people arriving in accident and emergency who have a mental health problem, and ensures that they get immediate access to mental health services. That sort of best practice not only improves health and well-being for those individuals, but saves the system money. We need to spread that best practice across the country. I am very grateful to the hon. Lady for raising it.
Mr David Amess (Southend West) (Con)
13. What recent representations he has received on strategies to support patients with osteoporosis.
The Minister of State, Department of Health (Norman Lamb)
The Department of Health has received no recent representations on strategies to support patients with osteoporosis. From April this year, osteoporosis was included in the quality and outcomes framework, giving GP practices financial incentives for diagnosing and treating osteoporosis in their patients.
Norman Lamb
I very much welcome the establishment of the alliance, and I applaud the work of the National Osteoporosis Society, Age UK, and the all-party group of which I think the hon. Gentleman is a member. We know that if we follow the evidence, we can substantially reduce the number of falls and fractures, thereby increasing health and well-being and reducing the cost to the system.
Simon Hughes (Bermondsey and Old Southwark) (LD)
14. What the process is for deciding the future of health care provision in south-east London; and if he will make a statement.
Chris Ruane (Vale of Clwyd) (Lab)
15. What recent assessment he has made of the treatment of repeat episode depression by (a) drugs and (b) mindfulness-based intervention.
The Minister of State, Department of Health (Norman Lamb)
The National Institute for Health and Clinical Excellence has evaluated and recommended the use of mindfulness-based therapies as a psychological intervention for the prevention of relapse, within its guideline, “Depression: the treatment and management of depression in adults”. Drug treatment is also useful in the management of enduring depression.
Chris Ruane
The number of prescriptions issued for anti-depressants has gone from 9 million to 46 million in the past 10 years. NICE has recommended mindfulness as a better treatment than drug therapy for repeat episode depression, but it has not been taken up by the NHS. Will the Minister meet a delegation of MPs and mindfulness experts from across the UK to discuss how mindfulness can play its full role in helping the NHS and people with mental health problems?
Norman Lamb
I acknowledge the hon. Gentleman’s work on promoting the case for psychological therapies, including mindfulness, and would be happy to meet him and a delegation of experts. The Government have massively increased psychological therapies—nearly 1 million people in the past two years accessed psychological therapies through the improving access to psychological therapies programme. We are totally committed to improving access to psychological therapies to cure the imbalance in access to services for people with mental health problems that has existed for a very long time.
Lisa Nandy (Wigan) (Lab)
16. What assessment he has made of the possible effect on patient safety of reductions to ambulance trust budgets.
Sir Tony Baldry (Banbury) (Con)
T2. The new mandate for the NHS includes a very welcome objective for it to be a world leader in end-of-life care. Can we have an indicator in the commissioning outcomes framework on deaths in preferred places of care to ensure that new commissioning groups prioritise better end-of-life care, and to ensure that those who want to die peacefully at home have the best opportunity to do so?
The Minister of State, Department of Health (Norman Lamb)
I thank my hon. Friend for that question. The NHS outcomes framework includes an indicator on the quality of end-of-life care as it is experienced by patients and carers, which is based on the VOICES survey of bereaved relatives. The proposals for reform to the NHS constitution include a right for patients and families to be involved fully in discussions, including at the end of life.
Graham Stringer (Blackley and Broughton) (Lab)
T3. What action does the Minister intend to take to reduce the number of unplanned emergency admissions to hospital by sufferers of muscular dystrophy and other neuromuscular conditions?
Lilian Greenwood (Nottingham South) (Lab)
T8. A recent Schizophrenia Commission report highlighted catastrophic failings in the care of people with severe mental illness. We know that suicide rates rise during times of economic hardship and that record numbers of people are being detained under the Mental Health Act. The Government have said that mental health should have parity with physical health, so why has funding for mental health services been cut for the first time in a decade?
Norman Lamb
Whenever the NHS is under financial pressure, there is the risk that mental health services will get squeezed. As the Health Select Committee identified, that is exactly what happened under the last Labour Government in 2006. I share the hon. Lady’s concern, however, about the report on schizophrenia highlighting how money is used: too many people in in-patient facilities and not enough prevention work. I am committed to working with others to ensure that we use the money more wisely to get better care for those patients.
Tessa Munt (Wells) (LD)
T7. Since the Prime Minister made his radiotherapy promise to current and future cancer patients last month, cancer centres all over the country have been telling me that it cannot be delivered, because there is not enough investment in new radiotherapy machines and in the recruitment and training of staff to operate them. Will the Secretary of State give the same financial commitment to the annual radiotherapy fund as he is giving to the cancer drug fund, and will he meet me to discuss the matter?
Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)
The Minister will be aware that the process of making Kalydeco available to people with cystic fibrosis in England is much further advanced than in Scotland, where the G551D gene is two to three times more prevalent—a point highlighted by the Daily Record yesterday in respect of seven-year-old Maisie Black from Burnside in my constituency. Will the Minister clarify that the roll-out in England will not be restricted, so that young children, who have the least accumulated lung damage and therefore most to benefit, do not lose out on the chance of benefiting from this transformational drug?
Norman Lamb
The specialised commissioning groups will receive advice at their December board meetings and are expected to finalise their advice on the clinical and cost-effectiveness of Kalydeco early in the new year. The aim is to provide consistent national advice on the use of the drug for a sub-group of patients with cystic fibrosis.
Steve Baker (Wycombe) (Con)
Aylesbury constituent Mrs Evans-Woodward is a young woman who has had five heart attacks. One evening her husband drove her to Wycombe’s heart attack unit with a racing pulse, but she was turned away to the minor injuries unit, which again turned her away to the accident and emergency unit in Stoke Mandeville, before suggesting that she sit outside and call an ambulance, which she duly did—all of this with a racing pulse of 180. This is not good enough. It is an appalling prioritisation of bureaucracy over simple human care and compassion. Does it not show that the NHS needs to become much more accountable to patients?
NHS Consultation
Norman Lamb Excerpts(11 years, 11 months ago)
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The Minister of State, Department of Health (Norman Lamb)
I have launched a public consultation on proposals to strengthen the NHS constitution. These changes include:
strengthening patient involvement and shared decision making;
making clear the importance of patient and staff feedback;
setting out a new duty of candour;
emphasising the importance of integrated care;
clarifying patients’ rights for making complaints;
making clear how patient data is protected and used;
emphasising the importance of valued, empowered and supported staff to the delivery of high quality patient care; and
strengthening commitments to dignity, respect and compassion.
In addition, the Department of Health proposes some minor technical changes to the NHS constitution that are necessary to ensure it reflects legislative changes introduced since its launch in January 2009. This includes making clear that the constitution extends to local authorities in the exercise of their public health functions as set out in the Health and Social Care Act 2012.
The changes proposed in the consultation respond to the recent recommendations of the NHS Future Forum working group on the NHS constitution, which was tasked in March 2012 with advising the Secretary of State for Health on whether there was scope for strengthening and reinforcing the constitution. The Government accepts the forum’s recommendations in full.
Following the forum’s conclusion that awareness of the NHS constitution remains too low and should be increased, the consultation document sets out the Department’s commitment to work collaboratively with the NHS Commissioning Board, clinical commissioning groups, and Health Education England to promote and raise awareness of the constitution.
The consultation seeks views on how the NHS constitution can be given greater traction, so that patients, staff and the public know what to do if their expectations are not met. The Department will establish an expert group, which I will chair, to develop proposals to do this. We will consult on these separately in the spring following the report of the public inquiry into the events at Mid Staffordshire NHS foundation trust.
The consultation will run until 28 January 2013. The Government intend to publish the revised NHS constitution, together with updated supporting documents—the Handbook to the Constitution and Statement of NHS Accountability—by 1 April 2013.
“A consultation on strengthening the NHS constitution” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Winterbourne View
Norman Lamb Excerpts(11 years, 11 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Liz Kendall (Leicester West) (Lab)
(Urgent Question): To ask the Secretary of State for Health to make a statement on the steps the Government have taken to ensure the safeguarding of former Winterbourne View residents.
The Minister of State, Department of Health (Norman Lamb)
The review into the abuse at Winterbourne View hospital, established by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), set out 14 actions to transform care and support. Central to the review is ensuring the safety and well-being of these very vulnerable people. I shall publish the final report before the end of November.
When Winterbourne View closed, NHS commissioners put in place independent clinical and managerial supervision and commissioned an independent assessment of every patient. The Care Quality Commission worked with commissioners to relocate Winterbourne View patients to suitable alternative placements.
In March, the Department of Health review team commissioned NHS South of England to follow up the 48 patients who had been in Winterbourne View, and there was a further review in September. The first review in March revealed that 19 former patients were the subject of safeguarding alerts. In response to this, officials asked commissioners to take appropriate action and confirmed that a follow-up would take place in six months’ time. I was extremely concerned to be informed that this follow-up had revealed that there are current safeguarding alerts for six former patients. I am assured that these are all being followed up to ensure the safety and well-being of the individuals concerned. That is extremely important. Furthermore, the September follow-up exercise revealed that 32 Winterbourne patients were now living in the community in their own family homes, in supported living or in a residential care home, with 16 still living in hospital settings.
The priority is to improve commissioning to develop the good local services that will prevent people from being sent to hospital inappropriately. We are working closely with the NHS Commissioning Board, the Local Government Association and directors of social services on what support local services need. Although a small number of people will need hospital treatment, we expect to see—and, indeed, must see—a substantial reduction in the number of in-patients.
We intend to strengthen safeguarding arrangements to prevent and reduce the risk of abuse and neglect of adults in vulnerable situations. Where there are safeguarding concerns, the local safeguarding adults boards need to be closely involved. The boards will be placed on a statutory footing for the first time, ensuring a co-ordinated approach to local adult safeguarding work.
The Government will put in place the necessary legislation for safeguarding adults boards, and local councils should bring clarity to their roles and responsibilities, but it is the responsibility of the care provider—we must remember this—to ensure a culture of safety, dignity and respect for those in their care, including stopping abuse before it happens. Those providers must be held to account for the care that they provide.
Liz Kendall
I thank the Minister for his statement, but there remain serious concerns about whether the Government have taken all necessary steps to ensure that the former patients of Winterbourne View are now receiving safe and effective care. Last night’s “Panorama” programme revealed that 19 patients have been subject to safeguarding alerts since leaving Winterbourne View. Not all those alerts mean that someone has been harmed, but “Panorama” said that one was due to an incident of assault and another had resulted in a criminal investigation. Is that an accurate reflection of the picture?
Have the families of all patients with a safeguarding alert been given the full details? What specific action has been taken as a result of the alerts, and can the Minister guarantee that the patients in question are all no longer at risk? Can he also guarantee that all local commissioners responsible for all the former Winterbourne View residents now have a proper plan in place to ensure that they receive good-quality care?
Has the Care Quality Commission recently inspected all the providers that former Winterbourne View patients were moved to, and are the Government confident of the CQC’s findings? Last night’s programme raised particular concerns about Postern House, which the CQC inspected in January this year following the Winterbourne View scandal. The CQC said that it met all the essential standards of quality and safety, and that suitable arrangements were in place to ensure that people were safeguarded against the risk of abuse, yet “Panorama” revealed a number of problems at Postern House over several years and the fact that a former Winterbourne View patient had a safeguarding incident there in June this year. Is the Minister confident that all patients currently in Postern House are safe from the risk of abuse?
The Minister rightly said that responsibility for the care of people with learning disabilities lies with providers, commissioners and the CQC, but it is Ministers who set policy and have responsibility for ensuring that it is implemented. The Government have a particular responsibility to ensure that former Winterbourne View patients never have to suffer from such appalling abuse again. Organisations such as Mencap are also very concerned that the Government are not moving quickly or strongly enough to end the practice of sending patients with learning disabilities to long-stay institutions far away from their family and friends.
The Minister must answer our questions about whether former Winterbourne View residents are all now guaranteed safe care, and he must urgently bring forward proposals to reform learning disability services properly for the future.
Norman Lamb
I thank the shadow Minister for asking the urgent question. The view is shared on both sides of the House that what “Panorama” exposed is utterly intolerable and has to come to an end. I am absolutely determined that when I make the Government’s final response by the end of November, it will be robust and clear so that everybody understands what has to happen.
When I came into my job, I heard briefings about the whole saga and how long it has gone on. For years and years, public money has been spent on putting people into inappropriate settings, often putting them at risk of abuse. That is a national scandal, and it has to end. I will be very clear about ensuring that we take robust and effective action.
The hon. Lady is absolutely right that Ministers are here to set policy, and that is what I intend to do. Since my appointment, I have been working to ensure that we set the right policy to protect vulnerable individuals. She is right that they must never suffer from abuse. Of course, there is always the risk of rogue individuals who behave very badly, and they must be dealt with through the criminal law, as has been seen with Winterbourne View staff. I have also made the point that the corporate owners of such organisations must be held to account for things that go on in their homes if those homes have been neglected. I want to meet the parents of those who were at Winterbourne View to hear from them directly, and I will seek to make arrangements for that.
The hon. Lady mentioned the 19 safeguarding alerts. In fact, that intolerable figure was in March but by September, the number was down to six. She is right, of course, that not every safeguarding alert means that something awful is happening. It means that concerns have been raised, and it is important that people raise their concerns. I assure her that I will do everything I can to end this scandal and ensure that we have proper safeguarding arrangements in place.
Jack Lopresti (Filton and Bradley Stoke) (Con)
Will my hon. Friend assure the House that the alerts are being actioned and dealt with? We know that on previous occasions, South Gloucestershire council and Avon and Somerset police received countless alerts, but if it had not been for the BBC and “Panorama”, we would never have found out about this issue. When I saw the programme last night, I was appalled that patients can be moved hundreds of miles without their families—and their parents in particular—being told. I thought that was an outrage.
Norman Lamb
My hon. Friend raises extremely important points. First, we must ensure that the alerting system works effectively. We are putting safeguarding boards on a statutory basis. That is important and means that all key players will have a part in ensuring that adults in vulnerable situations are kept safe. We must ensure that alerts always work effectively in the future.
My hon. Friend’s point about individuals being placed a long distance away from home is of absolute concern. It strikes me that if someone is placed far away from their community, in what is effectively a closed setting, conditions are created for potential abuse to take place. That has to stop.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Does the Minister agree that there can be no excuse for abuse in any setting at any time? Is there not a profound problem that many of our most vulnerable citizens up and down the country are looked after by people who are poorly trained, poorly qualified and paid the minimum wage for 12-hour shifts? Is that the underlying root of this problem?
Norman Lamb
First, it is important to make it clear that many highly dedicated care workers provide fantastic quality care for elderly people and other adults in vulnerable situations. However, the hon. Gentleman is right to address the fact that we need to raise standards across the board. We are working with Skills for Care to ensure there is a code of practice to implement proper standards, and that minimum training standards apply across the sector. We must also ensure that we keep people in good health and well-being in their own homes as much as possible, reducing the number of people who go into care and nursing homes. That will make it possible to spend more on those people who do need to go into a home, and ensure that standards are maintained at the right level.
Paul Burstow (Sutton and Cheam) (LD)
As we learnt from Winterbourne View, the absence of safeguarding alerts is not necessarily a sign that everything is okay. Winterbourne View was receiving £3,500 a week for some of its residents, yet it was delivering very poor care and allowing its staff to abuse. In future, can we ensure that the contracts let by social service departments and the NHS are written not by the provider, but by those who are buying the service in the first place to get the right quality of care?
Norman Lamb
I pay tribute to my right hon. Friend for his work in this area. He draws attention to the fact that there is a serious issue about the quality of commissioning and the work done by primary care trusts and, in some cases, local authorities. Too often, people seem to be placed in those settings and then to all intents are purposes forgotten about, which is not acceptable. Standards of commissioning and ensuring that contracts contain the right terms are extremely important.
Mr Andrew Smith (Oxford East) (Lab)
Does the Minister agree that this whole dreadful saga—which he rightly describes as a national scandal—underlines the importance of self-advocacy for vulnerable people? In his legislation and any guidance that may follow from it, will he take steps to ensure that the voices of these most vulnerable people will be heard directly wherever possible?
Norman Lamb
The right hon. Gentleman makes an extremely valuable point, and I would be happy to discuss that with him further. Too often in the past there has been a paternalist approach in which others have decided what is best for individuals. Hearing the voice of people with learning disabilities is absolutely central to getting this matter right.
Claire Perry (Devizes) (Con)
People who watched “Panorama” will know that a tall, flame-haired young man named Simon Tovey was one of the patients who suffered horrific abuse. His mother, Ann Earley, is my constituent, as is Simon, who has now returned to a lovely community care home in West Lavington. Mrs Earley believes that the views of parents in particular were not heard under the system—they knew for years the problems pertaining to Simon’s care. What reassurance can the Minister give to Mrs Earley, and the House, that the views of parents and other responsible adults will be included when seeking to avoid these tragedies in the future?
Norman Lamb
It struck me when I listened to the story of that family that I would like to meet them if they are interested in having that discussion. Just as it is essential that people with learning disabilities have their say, it is critical that the family is involved in the discussions before the commissioning takes place, so that they are partners in the decisions that are taken in respect of those individuals.
Mr Dave Watts (St Helens North) (Lab)
Can the Minister reassure the House that there are sufficient inspectors to go around those establishments during the day, during the evening and at night to ensure that standards are maintained?
Norman Lamb
Inspections are essential to ensure that we identify where problems exist. The role of the Care Quality Commission is critical in that respect. We need to do more to open up those establishments to public view. One role that the new local HealthWatch can take is to go into care homes, nursing homes and so on to see for itself. The more there is a culture of openness, the less likely it is that abuse will take place.
Mr Robert Buckland (South Swindon) (Con)
I commend to my hon. Friend the work of organisations such as the Swindon Advocacy Movement, which does so much work not only to advocate for service users, but to train volunteers, so that more adults with learning difficulties can stay in the communities in which they live, work and thrive. In that way, the nightmare scenario of Winterbourne View can be avoided in future.
Norman Lamb
I absolutely commend the work of the organisation to which the hon. Gentleman refers and would be interested to hear more about it. The scandal is that so many people over so many years have been put into institutions and ended up there for years when their care would be much more appropriate for their needs if it took place in their communities through supported living or in a care home. As my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) mentioned, the extraordinary thing is that we were spending public money—on average, £3,500 per patient in Winterbourne View—to put people at risk of abuse. Often, an appropriate care package costs less than that, and gives the individual the care they need in their own community.
Fiona Mactaggart (Slough) (Lab)
I have raised with the Minister and his predecessor the problem that, often, the responsible authority does not know where people are placed. Families might have died since the placement, and yet there is no national audit of placements of people with learning disabilities, who are often placed a long way from their home. When the Minister returns to the House in November, will he ensure that there is an audit of where people are placed so that we can track them properly?
Norman Lamb
I shall certainly consider the hon. Lady’s point and am happy to discuss it further with her. At the end of the day, we must ensure that people in highly vulnerable situations are adequately protected. I want to ensure that all the steps we take are aimed at that goal.
Chris Skidmore (Kingswood) (Con)
The Minister has mentioned raising the standard and quality of care providers. Will he consider the introduction of a starred grading system for care providers, so that we have absolute transparency on how well they are performing, and so that we know the most excellent care providers and the worst?
Norman Lamb
My hon. Friend raises an important point. One thing we are doing on the NHS Choices website is having quality indicators for every care home, nursing home and so on. That means that any individual looking for a care home for a loved one will be able to find out much more about the quality of the care that an organisation provides. In due course, the website will include user reviews, so that people who have experienced care in those homes will have their voices heard. That openness of information could have a transformational effect in driving up standards.
Emma Reynolds (Wolverhampton North East) (Lab)
It beggars belief that some of the vulnerable adults who were subjected to the most appalling and horrific abuse at Winterbourne View were moved to other providers where they were either abused—according to the “Panorama” allegations—or at risk of further abuse. Will the Minister reassure me that all local commissioners responsible for each of the former Winterbourne View residents have a proper plan in place to guarantee that they are now receiving safe and effective care?
Norman Lamb
I share the hon. Lady’s view on what has happened. We must make absolutely certain that every commissioner is held to account. My understanding is that proper arrangements are in place for all those individuals, but I will continue to monitor the situation to ensure that that remains the case. We must be alert to the interests of the 48 residents who were in Winterbourne View, but we must also focus our minds on the 1,500 people who are in settings of that sort—assessment to treatment centres—often for years. The interests of all those individuals are important.
John Pugh (Southport) (LD)
To put it bluntly, after all this, is the Minister still confident in the CQC and does he believe that it is fit for purpose?
Norman Lamb
I tend to the view that we have had too many changes of regulator over a number of years, and that continuity would be a good thing. An assessment of the CQC earlier this year indicated that it was on the right track. I have met the new chief executive and am reassured by the plans he has in place. It is seductive to believe always that it is an attractive proposition to abolish an organisation and set up a new one, but is there any more chance that a new organisation will be better? Let us therefore make the CQC work properly.
Grahame M. Morris (Easington) (Lab)
I welcome the Minister’s response—he is sincere in his desire to address these issues. Does he recognise the important role of whistleblowers? Does he have any information on concerns raised by whistleblowers in respect of the alternative provision before Winterbourne View patients were transferred?
Norman Lamb
The role of whistleblowers is central. Importantly, the Government have funded a whistleblowing helpline, which is available to any worker in the care sector—it covers all care homes. It is important that any worker at any stage feels they can raise their concerns with the relevant authorities so that they are properly investigated. What happened with the whistleblower at Winterbourne View was not acceptable, because their concerns were not taken up effectively.
Rehman Chishti (Gillingham and Rainham) (Con)
I welcome the Minister’s statement. On inspection, can he clarify what provision exists for inspectors to speak to patients? How will that be further enhanced?
Norman Lamb
I am sure that inspectors can speak to patients, and that they routinely do so, but I will check on the important point the hon. Gentleman makes. We mentioned earlier the views of those with learning disabilities and their families, but it is essential that the regulator hears directly from them of their potential concerns.
Steve McCabe (Birmingham, Selly Oak) (Lab)
I am not sure that the Minister has made his position clear. Is it his intention to end the appalling practice whereby vulnerable people can be transported to establishments hundreds of miles away from their home town at the whim of the authorities and without the knowledge and consent of their families?
Norman Lamb
I have tried to be clear on my views on what has been happening—it has been going on for years. As I have said, the fact that someone is sent 200 miles away from home creates the conditions in which abuse is more likely than if they are in their own community. I want that to end—I want to be as clear as I can that that is a national scandal that needs to be brought to an end.
Jim Shannon (Strangford) (DUP)
I thank the Minister for his comments. I also watched the “Panorama” programme last night and was horrified. According to the local council and the Minister, changes have been made. Will he confirm that the lessons learned will be conveyed to the devolved Administrations in Scotland, Wales and Northern Ireland to ensure that this terrible abuse never happens again anywhere in the UK?
Norman Lamb
The hon. Gentleman makes an essential point. Wherever people are, they must be protected from potential abuse and benefit from high standards of care. I will give him my absolute assurance that we will work closely with the devolved Administrations to ensure that people receive that benefit, wherever they are in the UK.
Bridget Phillipson (Houghton and Sunderland South) (Lab)
I heard the Minister’s earlier answer on the importance of whistleblowing, but will he set out what further steps he will take to encourage staff to whistleblow and to ensure that, when they come forward with concerns, they do not suffer retribution as a result?
Norman Lamb
The legal framework is satisfactorily in place to protect whistleblowers who raise their concerns with the relevant authorities, but this is about culture. We must do everything we can to ensure that providers encourage their staff to raise concerns—internally first, if possible, but with other authorities, if necessary—whenever they see abuse or neglect taking place. We must also encourage individuals to feel safe about raising concerns. The framework of protection is there for individuals to do that.
Chris Bryant (Rhondda) (Lab)
There are two problems. First, the “out of sight, out of mind” mentality has meant that thugs have been able to get away with terrible behaviour in care homes. Secondly, despite the enormous advances in ischaemic heart disease, cancer and diabetes, for example, the amount of money invested every year to find solutions and treatments for mental health conditions remains very poor.
Norman Lamb
On the first point, I agree with the hon. Gentleman that these closed settings and institutions too often create the conditions for abuse to take place. It is all the more important, then, to get the regulation right for the sake of those individuals who have to be in such institutions—a minority have to be there for their own safety or that of the public. On the second point, he raised the general issue that for a long time—probably, it has always been the case—mental health has been a poor relation to physical health in terms of the amount of money spent on research and how the money flows within the NHS. I seek to address that.
Kerry McCarthy (Bristol East) (Lab)
In Bristol, we face the closure of care homes, while south Gloucestershire is outsourcing the in-house home care teams. Following the case of Winterbourne View, which is just outside my constituency, there is a lack of confidence in the area in the private sector. What can the Minister do to reassure people that it is safe to place vulnerable relatives in private sector care homes?
Norman Lamb
First, abuse is unacceptable and horrifying wherever it takes place, whether in the public sector or the private sector. The review that followed Winterbourne View being exposed revealed poor standards of care in too many places in both the public and private sectors. We need to be clear on that. Secondly, I have questioned whether there is adequate corporate accountability and whether adequate rules and regulations are in place to ensure that accountability. If people are making a profit out of providing care, they have to be held to account for the standards of that care.
Diana Johnson (Kingston upon Hull North) (Lab)
May I raise with the Minister my concerns about the relaxation of checks on people who work with vulnerable adults and children, as set out in the Protection of Freedoms Act 2012? As a new Minister, will he undertake to look at the specific provisions in that Act and see whether he is satisfied that our most vulnerable people are protected?
Norman Lamb
I am happy to discuss the matter further with the hon. Lady. It is clear, though, that when a care home provider seeks to recruit a member of staff to work with people in a care home setting, they have to—[Interruption.] They are obliged in law to carry out criminal records checks on people who work within that setting. I repeat, however, that I am happy to discuss the matter with the hon. Lady and to look again at the issues.
Ian Lucas (Wrexham) (Lab)
As the Minister has made clear—his commitment is coming through—the care provider is key. As he moves forward, will he look at whether there is any disparity between private and public sector provision? In cases that I am aware of, there has been a qualitative difference: vulnerable individuals are not being looked after as well as they ought to be by some private sector providers.
Norman Lamb
We probably all know from our constituencies of fantastic private sector care providers that provide a fantastic quality of care to older or younger adults with disabilities and so on, so we must be careful not to condemn the whole sector. My clear view is that wherever there are low standards of care it is unacceptable. But let us remember Mid Staffordshire hospital, where hundreds of people lost their lives unnecessarily owing to poor standards of care. It can happen in both public and private sectors. We must find it intolerable in both.
Mental Health (Approval Functions) Bill
Norman Lamb Excerpts(11 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister of State, Department of Health (Norman Lamb)
I beg to move, That the Bill be now read a Second time.
The purpose of the Bill is simple, but urgent. The Secretary of State described to the House yesterday how the need for it arose and came to light, and I hope that hon. Members will bear with me if some of what I say today repeats what he said then. May I begin by reiterating my gratitude to Opposition Members for the highly constructive approach that they are taking to the issue, without which we would not be able to respond with the necessary speed?
Detaining a mentally ill person in hospital and treating them against their will is clearly a matter of the utmost seriousness, and it is treated as such by the law and by health and social care practitioners. The statutory framework is contained in the Mental Health Act 1983, which sets out that, for assessments and decisions under certain sections of the Act, including detention decisions under sections 2 and 3, three professionals are required to be involved: two doctors and an approved mental health professional, usually a social worker. One of the two doctors must be approved under section 12 of the Act. When strategic health authorities came into being in 2002, the Secretary of State at the time quite properly and lawfully delegated to them his function under the 1983 Act of approving the doctors able to be involved in making these decisions.
Early last week, the Department of Health learned that, in four out of the 10 SHAs—North East, Yorkshire and the Humber, West Midlands and East Midlands—the authorisation of doctors’ approval was further delegated by the SHAs to NHS mental health trusts over a period extending, in some cases, from 2002 to the present day. The issue was identified as a result of a single doctor querying an approval panel’s processes. I was informed later in the week, as soon as the extent of the issue became clear, and since then, the Secretary of State and I have been kept informed of, and involved in, the action being taken.
Emma Reynolds (Wolverhampton North East) (Lab)
This is an issue of great concern. Can the Minister reassure the House that the four areas that he has identified are the only areas in which this has happened, and that it has not taken place in other regions?
Norman Lamb
I can assure the hon. Lady on that point. All SHAs have undertaken an assessment of the position, and the position has been regularised for future cases in those four SHAs. Of course, individual patients may be moved to different parts of the country, but the problem relates to those four SHA areas.
Hywel Williams (Arfon) (PC)
Rampton and Ashworth are involved, and patients from Wales travel to those hospitals. Have there been any discussions between the Minister’s Department and the Wales Office or the Welsh Government on the implications of this for patients from Wales?
Norman Lamb
Yes, I can confirm that that is the case. The Secretary of State spoke to the relevant Health Ministers this morning. I hope that that gives the hon. Gentleman reassurance.
Jim Shannon (Strangford) (DUP)
Following on from what the hon. Member for Arfon (Hywel Williams) has asked, may I ask the Minister, in relation to Northern Ireland, what investigations have taken place to ensure that no one was detained illegally, and whether there are likely to be challenges from people who have been sectioned? I am afraid that they might have reason to claim against the Government for that purpose, given that no legislation was in place. Please excuse the condition of my voice, by the way.
Norman Lamb
I am grateful to the hon. Gentleman for that intervention, but I am afraid that I struggled slightly to hear all the points that he was making. Perhaps the best way of dealing with all this is to ensure that I respond in writing to all his questions. I can also assure him that the Secretary of State spoke to the Northern Irish Minister yesterday and briefed them fully on the situation. There is good liaison there.
Our current assessment is that about 2,000 doctors were not approved properly in line with the provisions of the 1983 Act, and that those doctors have participated in the detention of between 4,000 and 5,000 of the patients currently detained in NHS or independent sector hospitals. There are two important points that I would like to make clear now. First, the decision to detain a patient under the Mental Health Act is primarily a clinical one. There is no suggestion, and no reason to believe, that the irregularity of the approval process for these doctors has resulted in any clinically inappropriate decision being made, whether the decision was to detain or not to detain. Nor is there any suggestion that the doctors approved by mental health trusts are anything other than entirely properly qualified to make these recommendations.
All the proper clinical processes were gone through when these patients were detained. There is no reason why the irregular approval process should have led to anyone being in hospital who should not be—or vice versa—and no patients have suffered because of this. The doctors had no reason to think that they had not been properly approved; they acted in total good faith and in the interests of the patients throughout this period. As of Friday last week, the SHAs concerned had corrected their procedures and all the doctors involved had been properly approved. I hope that that addresses the question raised by the hon. Member for Wolverhampton North East (Emma Reynolds).
Hywel Williams
This may be a naïve question, but will the Minister tell us whether doctors approved in one SHA area are then approved automatically for other parts of England or possibly parts of Wales, or is the approval confined to the particular SHA area?
Norman Lamb
My understanding is that people are approved for the SHA in which they work, but it is an important question and I will happily confirm the position to the hon. Gentleman in writing.
In the light of our legal advice, we do not believe that any decisions made about patients’ care and detention require review because of this irregularity. Doctors should continue to treat patients who are currently detained under the Mental Health Act in the usual way.
My second point is that we have been advised by First Treasury Counsel that there are good arguments to show that the detentions involving these particular approval processes were, and are, lawful. Given the seriousness of the issues, counsel also argues the need for absolute legal clarity and advises that this is most safely resolved through emergency retrospective legislation. We are taking that advice. As soon as the irregularity was identified, the Department moved swiftly to identify the best course of action and to put the necessary preparatory work in place. Officials immediately sought initial legal and clinical advice, and then swiftly analysed the options, including the reassessment of all the potentially affected patients, working with the health leads in the regions involved and clinical experts from the Royal College of Psychiatrists.
When I was briefed on the situation, I asked for detailed information on the time it would take—the Secretary of State has also sought and obtained this advice—and the clinical risks involved in reassessing all potentially affected patients. Last Friday, the Secretary of State asked for an emergency Bill to be drafted over the weekend as a matter of contingency, and he briefed the Prime Minister personally the following day. Following further discussions and analysis over the weekend, the decision to introduce emergency legislation was taken on Sunday.
At all times, the Secretary of State’s priority—and, indeed, mine too—has been to resolve this in a way that follows clinical advice. That is the most important thing. In the interests of a group of highly vulnerable individuals, it is important to do this in the most sensitive way. It would not have been feasible quickly to reassess all the patients and it may well have caused great distress to them and their families.
We have worked to remedy the problem as it relates to current and future detentions. The accountable officers for the four SHAs in question have written to Sir David Nicholson, chief executive of the NHS, to confirm that they have made the necessary changes to their governance arrangements. Furthermore, the accountable officers in the other six SHA areas have written to Sir David to confirm, in the light of this issue, that they have reviewed their own arrangements and are in full compliance with the Mental Health Act. That directly addresses the question asked by the hon. Member for Wolverhampton North East. I can confirm, incidentally, that approval in one SHA applies elsewhere in England. The Bill will put right those doctors’ approvals wherever they are now practising. That again gives complete clarity to that particular point.
Although we believe that there are good arguments that past detentions under the Mental Health Act were and are lawful, it is vital that doctors, other mental health professionals and, most importantly, patients and their families have absolute confidence in the decisions made. That is why, in relation to past detentions, we have decided that the irregularity should be corrected by the Bill.
Mr Andrew Smith (Oxford East) (Lab)
On this serious matter, will the Minister give a fuller explanation of why, given that the proper procedure was not followed, making it irregular, it is none the less his advice that it remained lawful?
Norman Lamb
I cannot provide full detail, but I can repeat that the legal advice received by the Department was that there are good reasons to believe that the detentions are, and remain, lawful. Absolute certainty is essential in the interests of the patients concerned, whose care is paramount, and indeed of their families. That is why it is so important to proceed straight away with this retrospective legislation.
Although we are only aware of the problem in the four areas going back to 2002, the Bill applies in principle to the approval of all doctors under the Mental Health Act since its introduction in 1983. It retrospectively validates the approval of clinicians by those organisations to which responsibility was delegated, up to the point when all the relevant doctors were fully re-approved and their status put beyond doubt. The Bill will not deprive anyone—this is a really important point—of any of their normal rights of redress if they have been detained for any reason other than the narrow issue of the delegation of authority to approve by the SHAs. All the other rights remain exactly as they are. The provision addresses only the narrow issue of the nature of the authorisation. Nor will it affect any future detentions or legitimise any similar failures in the future—again, an incredibly important issue.
Necessary as it is to address the issue in that way, it is also important that we get to the bottom of how this happened. The Secretary of State has asked Dr Geoffrey Harris, chair of NHS South and former chair of the Buckinghamshire mental health trust, to undertake an independent review to look at how the responsibility was delegated by the four SHAs and, more broadly, the governance and assurance processes that all SHAs use for delegating any responsibilities. The Secretary of State will ask him to look at that in the context of the new NHS structures that come into force from next April to see whether any lessons need to be learned.
It is imperative that that review is swift. The Secretary of State has asked Dr Harris to report to him by the end of the year with recommendations to ensure that every part of the system employs the highest standards of assurance and oversight in the delegation of any functions.
In conclusion, I stress that both the Secretary of State and I have reviewed thoroughly with lawyers, clinicians and NHS managers all possible alternatives to introducing this retrospective legislation. The Secretary of State has been advised that all alternatives would be highly disruptive to the welfare of many of the most vulnerable patients in the mental health system, and would also deprive many other patients—another critical point—of the care they need while any action is undertaken. That is why, in such exceptional circumstances, we are proposing this retrospective legislation.
Mental Health (Approval Functions) Bill
Norman Lamb Excerpts(11 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
I want to raise two specific points. Opposition Members are concerned that the concept of “Any person” in clause 1 is too broad, because it appears to legalise approvals by anybody. Why does the clause not refer specifically to North-East, Yorkshire and the Humber, West Midlands and East Midlands?
Secondly, where is the provision for the doctors who have been approved by a trust according to what we now understand was a defective process to be re-approved by the correct process? As the clause stands, it seems—I am happy to be put right on this—that doctors approved previously by the trust will be able to continue to section patients without re-approval under the correct process.
The Minister of State, Department of Health (Norman Lamb)
I will first set out what the clause seeks to do and then respond to the shadow Minister’s questions.
The clause directly addresses the issue that the Bill intends to resolve. Between 2002 and 2012, four strategic health authorities delegated to mental health trusts the function of approving doctors with responsibilities under the Mental Health Act 1983. The legal advice that we have obtained is that there are good arguments, as we have already discussed, that decisions to detain made by doctors who were approved in that irregular way are nevertheless lawful. The clause removes any doubt—that is its purpose. It clearly spells out that when mental health trusts gave approval in the past they are to be treated as having had the power to do so.
The clause has the effect of eliminating any irregularity from decisions made in complete good faith, and in the best interests of the patient, by doctors fully qualified to make them. It does so in a way that is fully consistent with the legal and clinical advice that we have received on the issue, and means that patients and their families do not have to undergo the process of assessment for detention under the Act again solely for the purpose of correcting a technical error made by a strategic health authority.
The hon. Lady asked why the clause was so broad as to refer to “Any person”. I understand her concern, but the point is that we do not yet know whether there were other issues before the establishment of the SHAs. Obviously, that is part of the work that the review will undertake, but to ensure that we resolve the problem absolutely and that all those patients have clarity the decision was made for the clause to refer to “Any person” in order to avoid any risk of our uncovering another problem that might need a separate resolution. This deals with the whole problem of the approval process for the doctors who made those decisions.
The hon. Lady then asked, correctly, whether decisions will be taken properly as we progress. I can confirm that all the doctors have already been re-approved according to a proper process, so every decision that is taken from hereon in cannot be challenged. As we have said, any patient who wants to question the clinical judgement can do so and their rights remain the same as they have always been. This simply addresses the technical issue that we have been debating today.
Andy Burnham (Leigh) (Lab)
The clause refers not only to “Any person” but one who
“has done anything in the purported exercise of an approval function”.
On both counts, it is incredibly widely drawn and could take us into the territory of other elements of the approval process that may have been defective. Will the Minister assure the Committee that the clause is as narrow as it needs to be? It seems to be uncomfortably wide and may well restrict somebody’s ability to challenge an element of their section other than the fact that the doctor was not approved by the SHA. It is very loose in its current form.
Norman Lamb
I am grateful to the shadow Secretary of State for that intervention. We have gone through a very careful process and have followed legal advice on what is necessary to regularise the position. This relates specifically to the approval function, which is defined in clause 1(2). As I have said, the legal advice is that this is the best way to regularise the issue that has been uncovered.
Mr Andrew Smith (Oxford East) (Lab)
Before the Minister responded to the intervention by my right hon. Friend the Member for Leigh (Andy Burnham), he told my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) that if mistakes had been made before the establishment of the SHAs, some of the doctors who had not been properly approved previously may not have been approved by the executive action that the Secretary of Sate referred to earlier. Will the Minister assure the Committee that, should such instances come to light, those doctors will also be subject to a re-approval process?
Norman Lamb
The first thing I want to clarify, again, is that the clause ensures that if any previous authorisations were not done in accordance with the statutory provisions, the clause regularises that process, full stop. Of course, if we go back a long way, that may apply to people who have long since been discharged from their section. This regularises the situation for all. It also ensures that the detention of anyone who continues to be sectioned is regularised, because the original authorisation is deemed to be acceptable under the Bill and in accordance with parliamentary intent, as the Secretary of State said earlier.
Mr Smith
I am grateful to the Minister, but he has not fully answered my question. The Secretary of State has now properly given approval to those who were previously improperly approved. The Minister is right that many of the people in question may have retired or left, but some may still be practising. If further instances come to light, will they too be subject to a new scrutiny process?
Norman Lamb
I absolutely take the right hon. Gentleman’s point, and I am grateful to him. We must be absolutely certain that everybody is now properly authorised to make decisions. We know that everybody outside the four affected SHAs has been properly authorised—that has been checked and confirmed by SHAs, which have undertaken a proper check of their procedures. We also know that the four affected SHAs have already regularised the position of all their authorised practising doctors. We therefore know that across the whole system, doctors who undertake sectioning from now onwards will be properly authorised in accordance with the Mental Health Act 1983. The Bill addresses the previous problems with the authorisation process, and we have addressed the problem for the future by ensuring that everybody is properly authorised. I hope that deals with that point.
Norman Lamb
It does not entirely seem to deal with it, so I give way to the shadow Secretary of State.
Andy Burnham
I am grateful. It is important to get clarity before we leave this clause.
I know that the Government have not yet undertaken a full case-by-case review of the up to 5,000 cases involved. That prompts the question how the Government can be sure that the whole team involved in each case was qualified to a suitable level, and that there were not some instances of under-qualified people making decisions. That gives rise to concern that we may be retrospectively approving processes that were defective.
Norman Lamb
I do not think there is any suggestion that any of the people who undertook sectioning were not medically qualified to do so. The issue is simply with the body that undertook the authorisation and the fact that SHAs delegated that responsibility to mental health trusts, which was not in accordance with the law. The Bill is intended to regularise the position of every clinician who was not properly authorised because of that flaw.
Andy Burnham
I do not want to detain the Committee unnecessarily, but because the clause is drawn so widely it will possibly take away some people’s right to challenge whether there was a deficiency in the process or whether someone involved in the sectioning decision was under-qualified. Given that the Government have not undertaken a case-by-case review, I wonder how we can have absolute confidence that the power in the Bill is not too widely drawn.
Norman Lamb
I am told that we have dealt, doctor by doctor, with all the doctors in question who are currently practising. The problem relates to the doctor, not the patient, because it is about their authorisation to undertake the duties in the 1983 Act. The only people who undertake the actions referred to in the clause are doctors, who were authorised but unfortunately by the wrong body. That is what we are seeking to regularise.
Andy Burnham
We must have absolute clarity about this. In that case, why does the Bill mention “Any person” rather than “any doctor”? Our understanding is that a broader team of people can be involved in a sectioning decision, such as a social worker. If it is only doctors, the Bill should just say “any doctor”, but it does not.
Norman Lamb
We are talking about the approval function. Subsection (2) mentions
“practitioners approved to give medical recommendations”,
so it clearly deals with practitioners who have already been authorised, but by the wrong body.
John Pugh (Southport) (LD)
I am genuinely trying to understand this point and ensure that the Bill is as foolproof as possible. As I understand the Government’s case, the clinical need of people with mental health problems—the Bill clearly would not apply to people who did not have mental health problems—is trumping the absence of proper process, so the Bill is not an abuse of human rights.
The difficulty that I have with that argument—perhaps I ought not to have it, and maybe I am being particularly thick—is that the clinical need in question was established through a process that is acknowledged as formerly having been flawed. The clinical need is apparent only when a case has been heard and processed. The concept of clinical need here is certainly—
Norman Lamb
All that is being regularised is the power to approve a doctor, not whether a doctor is clinically sound. Any patient who challenges a judgment to section them either now or in the past will retain all their rights in law. We have acted on the advice of both lawyers and clinicians to ensure that we deal with the problem that has emerged in a way that respects patients’ clinical interests and considers them with the utmost seriousness. To go through a full reauthorisation process in every case could be incredibly damaging to individuals in potentially vulnerable situations. The Bill is based on the best clinical and legal advice that we have received on how to deal with the problem.
Ms Abbott
The Opposition have listened with great care to what the Minister has said. He has made a point of saying that his advice suggests that the Bill is the best way to deal with the situation. We argue that it is perhaps the most convenient way, but we know that the parliamentary draftsman has been under huge pressure to produce the Bill, and this would not be the first time that parliamentary draftsmen have come up with a form of words that is in some way defective. I repeat our concern about the broad nature of the clause, which states that “any person” who “has done anything” is to be “treated for all purposes”.
Winterbourne View
Norman Lamb Excerpts(11 years, 11 months ago)
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The Minister of State, Department of Health (Norman Lamb)
I wish to update the House about ongoing activity in relation to Winterbourne View private hospital.
The House will wish to be aware of two developments relating to Winterbourne View since the last written ministerial statement, issued on 25 June 2012, Official Report, column 2WS. First, the South Gloucestershire safeguarding adults board serious case review into Winterbourne View hospital was published on 7 August 2012 and can be found at:
http://www.southglos.gov.uk/Pages/Article%20Pages/Community%20Care%20-%20Housing/Older%20and%20disabled%20people/Winterbourne-View-11204.aspx.
Secondly, the House will wish to be aware that 11 former members of staff at Winterbourne View who were convicted of offences under the Mental Health Act 1983 and Mental Capacity Act 2005 received sentences on Friday 26 October. Six have been jailed, and five others given suspended sentences. I hope that these sentences will send a clear message that such criminal behaviour will not be tolerated and that there will be real consequences for the perpetrators.
This terrible case has revealed the criminal and inhuman acts some care workers and nurses are capable of. I want this case to reinforce to everyone, from front-line workers, to regulators, service commissioners, managers and board members, that they have a responsibility in preventing abuse of vulnerable people.
The abuse of patients at Winterbourne View hospital was horrifying. This was criminal behaviour—unacceptable in any part of our society, but particularly distressing given that these were people in vulnerable situations.
The BBC “Panorama” programme to be broadcast tonight continues to highlight inappropriate and poor quality care. There is no excuse for this.
The Department of Health review, set up by the former Minister of State, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), has found clear evidence that there are far too many people in specialist in-patient learning disability services (including assessment and treatment units) and many are staying there for too long. This must not carry on and must come to an end. People often end up in these facilities due to crisis which are preventable or could be managed if people are given the right support in their homes or in community settings.
Best practice and Department of Health guidance on this matter are clear—people with learning disabilities or autism and behaviour which challenges should benefit from local personalised services and should be supported to live in the community wherever possible. Only in very limited cases should in-patient services be used. This means that:
no one should be sent unnecessarily into in-patient services for assessment and treatment;
for the small number of people for whom in-patient services may be needed for a short period, the focus must be on providing good-quality care which is safe, caring and open to the community; and
people should move on from these services quickly—planning starts from day one to enable people to move on as quickly as possible to more appropriate care.
The key priorities are to address unacceptable failures of commissioning and to improve the capacity and capability of commissioning across health and care for people with behaviour which challenges with the aim of driving up the quality of care they receive, improving their lives and significantly reducing the number of people using inpatient services. This is best done through effective joint commissioning across health and social care and proper local planning.
I will publish the final report of the Winterbourne View review shortly. Alongside that final report, I will publish an agreement or concordat setting out the responsibilities of Government, commissioners, providers, professional bodies and regulators and the timetabled actions that each body commits to deliver.
We will continue to work with voluntary organisations, people with learning disabilities and their families so that they can hold health and social care bodies to account in making sure we deliver real change.
I will continue to update the House on this issue.
Oral Answers to Questions
Norman Lamb Excerpts(11 years, 11 months ago)
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Dr Sarah Wollaston (Totnes) (Con)
4. What his policy is on making available all information about the results of clinical trials to patients, doctors and medicine approval bodies.
The Minister of State, Department of Health (Norman Lamb)
The Government support transparency in publishing results of clinical trials, and they recognise that more can, and should, be done. In future, greater transparency and the disclosure of trial results will be achieved via the development of the European Union clinical trials register, which will make the summary results of trials conducted in the EU publicly available. Greater transparency can only serve to further public confidence in the safety of medicines, which is already robustly assured in the UK by the Medicines and Healthcare products Regulatory Agency. By law, the outcomes of clinical trials undertaken by companies must be reported to that regulator, including negative results.
Mr Speaker
Order. We are grateful to the Minister but some of these answers are simply too long. If they are drafted by officials, Ministers are responsible—[Interruption.] Order. I require no assistance at all from the Under-Secretary of State for Health (Anna Soubry). She should stick to her own duties, which I am sure she will discharge with great effect.
Dr Wollaston
I thank the Minister for his answer and for recognising that missing data from clinical trials distorts the evidence and prevents patients and their doctors from making informed decisions about treatment. Will the Minister meet a delegation of leading academics and doctors who remain concerned that not enough is being done to see how we can ensure that all historic and future data are released into the public domain?
Norman Lamb
My hon. Friend raises absolutely legitimate concerns, which have been raised by others, including Ben Goldacre. I am happy for my noble Friend Lord Howe or me to meet her and experts to discuss this important issue further.
Barbara Keeley (Worsley and Eccles South) (Lab)
7. What steps he plans to take to ensure that providers of domiciliary care employ staff who are properly qualified and security checked.
The Minister of State, Department of Health (Norman Lamb)
Providers of services are responsible for the safety and quality of the care they provide. All staff must be properly qualified and vetted, and the Care Quality Commission can and must take action against providers who fail in that regard. Action can range from a warning notice to, ultimately, cancelling a provider’s registration. The commission must be willing to take that action if necessary.
Barbara Keeley
But the Minister knows that a recent BBC programme showed that 217 providers of care at home use staff who are not properly qualified, and that dozens of people with criminal records have not been vetted and are working unsupervised in people’s homes. The Care Quality Commission has reached only just over one in four of its target inspections, with 40% of care at home providers never having been inspected by it. What will the Minister do to ensure that we can have more confidence in care provided at home to vulnerable people and that it is up to a better and safer standard?
Norman Lamb
I absolutely share the hon. Lady’s concern about this. It is intolerable that people receiving domiciliary care do not get high-quality care and that in some cases people are inappropriately employed. The Care Quality Commission must take action where there is evidence of employers not taking sufficient action to guarantee the quality of their staff. It is essential that the people who run those services are held to account if they fail in that regard.
Mark Pawsey (Rugby) (Con)
Will the Minister also consider the matter of the uniforms worn by staff in this sector? I understand that on occasions there has been confusion in members of the general public between such staff and qualified nurses.
Norman Lamb
It is absolutely essential that users of services know exactly who the staff are who are caring for them, and the issue of uniform is something that I would be happy to discuss further with the hon. Gentleman.
David Mowat (Warrington South) (Con)
8. What plans he has to review the health allocation formula.
Tim Loughton (East Worthing and Shoreham) (Con)
11. What steps he is taking to deliver better access to mental health services for school-age children.
The Minister of State, Department of Health (Norman Lamb)
The children and young people’s improving access to psychological therapies project, which we introduced in 2011, is about transforming mental health services for children and young people with mental health conditions. The Government’s mental health strategy implementation framework, published in July, suggests actions that schools, colleges and children’s services can take to provide better support.
Tim Loughton
The Government should be congratulated on tackling the stigma of mental health by their “No health without mental health” policy, but the growing problem of mental illness among school-age children is a concern and with the demise of the early intervention grant, which included the targeted mental health in schools funding, there is a worry that too many schoolchildren will be neglected. Will the Minister liaise with the Department for Education and with school nurses to make sure that appropriate and timely access to talking therapies and others are available for school age children rather than having to rely on the belated chemical cosh of powerful drugs?
Norman Lamb
May I first pay tribute to my hon. Friend’s work in this area? He has been really impressive and dedicated in his work. I absolutely agree with him about the importance of ensuring access to mental health services for children and adolescents. In fact, the Government are investing over £50 million over a four-year period through the children and young people’s improving access to psychological therapies programme and, critically, involving schools and colleges in that work. I would be very happy to work with my hon. Friend to improve access for children and young people.
Phil Wilson (Sedgefield) (Lab)
Will the Minister confirm that funding for children’s mental health services has actually been cut?
Norman Lamb
I repeat the point that we are actually investing more in a transformation of children’s and adolescents’ mental health services—and it is making a real difference. People within the service can see the benefits that it is bringing.
Mr William Bain (Glasgow North East) (Lab)
12. What recent representations he has received on regional pay in the NHS.
David Tredinnick (Bosworth) (Con)
Will my right hon. Friend extend the scope of personal budgets? They help not only patients, giving them wider choice, but carers, allowing them to leave their post.
The Minister of State, Department of Health (Norman Lamb)
My hon. Friend makes an extremely good point. This is all about giving power to patients. Personal budgets have already been very successful in social care, and there are pilots under way in health care; the indications are that they are proving very successful.
Jim Shannon (Strangford) (DUP)
The NHS has a responsibility for all patients in ill health, especially those who are elderly. Is the Minister aware of the information released last week that 3,000 general practitioners have drawn up a list of 7,000 patients who have less than a year to live—in other words, whose level of care is in question? Will the Minister condemn that list and take every possible step to ensure that every patient gets NHS care, irrespective of age?
Norman Lamb
The whole purpose of that approach is to ensure that patients get appropriate care at the end of their life. There is very strong consensus supporting that approach, including on the part of Marie Curie Cancer Care and Age UK. It is really important that all GPs and others involved in the care of people at the end of their life engage fully with the patient and the patient’s loved ones. That is the right approach.
Mel Stride (Central Devon) (Con)
My right hon. Friend will know that in this country, over 1,000 people a year die as a consequence of asthma. We have one of the highest prevalences of asthma in the world. Will he outline to the House what action we will take to get those mortality rates down?
Steve McCabe (Birmingham, Selly Oak) (Lab)
Further to the answer that the Minister of State gave to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), why do the Government not make it a criminal offence for those who recruit staff on the cheap not to bother checking employees’ employment records, qualifications or criminal records? Surely they are putting people’s lives at risk.
Norman Lamb
I absolutely share the hon. Gentleman’s concern. I am looking at the whole issue very closely. It seems to me that the fundamental point is to ensure that the people in charge at the corporate level are held to account for failures of care. We are very serious about ensuring that that happens.