Mental Health Bill [HL]

Baroness May of Maidenhead Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Baroness May of Maidenhead (Con)]

My Lords, it is a great pleasure to be able to contribute to the Second Reading of this very important Bill, albeit, as other speakers have already said, a Bill that has been too long coming. I wholeheartedly welcome this Bill and I thank the Government and commend them for bringing it forward so quickly in their term of office. I also thank the noble Baroness the Minister and the Secretary of State for the meeting that they held with me earlier today. Like others, I also want to look back and thank Professor Sir Simon Wessely and his team—including, not least, the noble Baroness, Lady Neuberger—for the invaluable work that they did that has led to the Bill before this House today. I want to say a particular thank you to those with lived experience who were willing to come forward and inform and advise the review panel, but also the pre-legislative scrutiny work and at other stages too, so that the Bill could be based on real experience, not just on what politicians and, dare I say it, the civil servants thought would be the right thing to do. So I welcome this Bill.

When in October 2017 Sir Simon Wessely was commissioned to undertake the review, there were a number of reasons that led to that. The first was the one that the Minister has already referred to: the Mental Health Act 1983, which was in place for over 30 years, had had some amendments subsequently but was felt to be out of date. Society and clinical treatments had moved on, so there was a need to look at it. But, for me, there was a more fundamental issue, which was the fact that so many people who found themselves in mental health crisis felt that, somehow at those points of crisis, they were people to whom things were done, to whom society did things, rather than people who were able to be part of and involved in that decision-making—they lost their human dignity in the processes that they went through. There were also issues about family members who were concerned that they were not listened to, when they felt that they knew when people were coming to points of crisis, or family members who felt that they were shut out from the discussions about their relative who was potentially at a point of crisis.

Then there was the overuse of detention. Reference has already been made, and I am sure will be made by others in this debate, to the racial disparity in the use of detention, a matter which should concern us all. There was also the question of the use of detention for those with autism and learning disabilities. All those issues underpinned the reason for looking at reviewing the Mental Health Act 1983.

The first point has been that issue about the loss of dignity and the way in which people in mental health crisis are treated. I hope that will be dealt with by those very first principles that appear in Clause 1. I draw particular attention to the fourth of those:

“The person as an individual”.


Under “Matters to be addressed”, it says:

“treating patients with dignity and respect and considering their attributes and past experiences”,

although I accept, as the noble Baroness, Lady Murphy, just said, that it is not enough simply to put it on a page of legislation. For that to be enacted requires changes of culture and attitude from all those who deal with people in mental health crisis.

Part of this sense, though, of people being able to feel that they are making decisions for themselves is the advance choice document enshrined in this legislation. I am sure that the Government will want to think carefully about the matters that it might encompass, and about its interaction with potential future legislation.

I want to pick up the issue of the nominated person. I mentioned families feeling that they are sometimes cut out but of course, as we know, sometimes for the individual with mental illness or mental health problems the nearest relative—that family member—might not be the most appropriate person to be their nominated individual. That individual may actually be somebody with whom—how can I put it?—the tensions can lead to increased difficulties for the person with mental illness, rather than reducing them. That ability to nominate somebody else as the person who someone wants to be there is critical. The noble Baroness, Lady Watkins, referred to this in relation to children but I think that, in general, it could create some tensions with family members who feel that it is their right to be that person alongside the individual in mental health crisis. Having said that, I believe that the nominated person point in the Bill is absolutely appropriate.

I want to focus also on the questions of detention. I have referenced how we need to look carefully at the inappropriate racial disparity in detention, but I also want to comment on the police issue. I am pleased to see the outlawing in the Bill of the use of police cells and prisons as first places of safety. This is of course the culmination of work in progress. There was voluntary work with the police and the health service, in 2012 and subsequently, to encourage and help them to ensure that the first person who someone in mental health crisis saw was not a police officer, and that they were not taken to a police cell as a place of safety. We then ensured that work in the Policing and Crime Act 2017, so that police cells could not be used as places of safety for those under the age of 18. The Bill takes it that bit further and it is absolutely right that it does—and right to do it for the individual who is in mental health crisis.

It is also right to do that for the police, because one issue that police officers themselves constantly made reference to me about was their fear and concern about being expected to deal with somebody who was in mental health crisis, when they had no training and no capability of knowing what to do in those circumstances. Of course, it is bad for the individual too if they are faced with somebody who has no actual understanding of what their condition is or how they should be dealt with.

Perhaps I may gently say to the Minister that in 2015 we put £15 million into providing alternative places of safety and in 2017 the Government put £30 million into providing them. This Government are now putting £26 million into providing those alternative places of safety. It is easier to say this from this side of the House, but the Government might wish to consider those figures, if I can put it like that. I also suggest to the Government that they consider alternative places of safety as not necessarily being a healthcare facility. Many places in the third sector are able to provide those facilities and the Government should look at that as well.

Finally, we also need those facilities to try to ensure that people are less likely to get to the point of crisis. If they are less likely to get to that point, they are also less likely to turn up at A&E because they are in crisis. That would be a win-win for the individual concerned, for the Government and for the health service.

Overall, I welcome the Bill. There are some very good provisions in it. As we have heard, it will be subject to detailed scrutiny in this House but it is no bad thing—I can say this now—that it started in this House. I welcome it and look forward to its passage.

Draft Mental Health Bill

Baroness May of Maidenhead Excerpts

Monday 27th June 2022 Commons Chamber

[Sajid Javid]

I thank the hon. Lady, particularly for her remarks at the start of her response about my personal experience.

I think the hon. Lady agrees with me, as does everyone in this House, that the 1983 Act is outdated. Society has learned since then, rightly, that people’s mental and emotional wellbeing is as important as their physical wellbeing. That was recognised in the Health and Care Act 2022, which came before Parliament recently, and this draft Bill does a lot to change the situation as well.

The hon. Lady talked, rightly, about the importance of mental health services. The NHS is putting record funding into NHS services. Some 1.25 million people were seen through the NHS talking therapies service, despite the pressures of the pandemic, and an additional £500 million of resources was put into mental health services because of the pandemic.

On the workforce, today in the NHS, we have around 129,000 health professionals focused on mental health. That is the highest number ever, and the number has gone up by some 20,000 since March 2016. As for the NHS’s strategic workforce plan—the 15-year plan on which it is currently working—having the correct provision for mental health will, of course, be a very important part of that.

[Mrs Theresa May (Maidenhead) (Con)]

I commend my right hon. Friend for his statement and thank him for his kind comments. I also join the Opposition Front Bencher, the hon. Member for Tooting (Dr Allin-Khan), in commending him for sharing his family’s experience. It shows that this is not just a piece of legislation from a Secretary of State; it comes from somebody who understands the issue.

I welcome the publication of the draft Mental Health Bill. While it is necessary for it to be given proper scrutiny, does my right hon. Friend join me in believing that we need to get these new provisions on the statute book as quickly as possible, to ensure that all those who are going through a mental health crisis can indeed be treated with the dignity and compassion that they deserve?

[Sajid Javid]

Let me thank my right hon. Friend again for the crucial role that she has played in getting the House to this point today with the publication of the draft Bill. It was her commitment to giving mental health parity with physical health that has led us to this important point. I agree absolutely with her. The draft Bill is before the House today. No doubt there will be prelegislative scrutiny, which I strongly welcome, to have the Bill ready as quickly as possible for First Reading in this House and to make sure that it becomes legislation as quickly as possible.

Health and Social Care Leadership Review

Baroness May of Maidenhead Excerpts

Wednesday 8th June 2022 Commons Chamber

[Sajid Javid]

I am not surprised by the typical response from the hon. Gentleman: not really engaging with the real issues and showing once again that he is more interested in theatrics than in the real issues facing our NHS. He started his comments by trying to make some kind of joke about the leadership news this week, but we all know that he is only interested in one leadership review in a political party in this House, and it is not the Conservative party’s.

Let us look at the issues that the hon. Gentleman raised. He rightly talked about the importance of the workforce overall and how we need more doctors and nurses. He should know that we have more doctors and nurses than ever before and that we are recruiting at a faster rate than ever before, with 10,000 more nurses and over 4,000 more doctors in the past year, and more in training than ever before. However, he will know that dealing with the challenges of getting more workers and building those hospitals, all of which are on track, requires proper funding, yet he and his party voted against the funding that the NHS needed to achieve that.

The hon. Gentleman is right to talk about when things go wrong in the NHS. Of course they need to be properly investigated, as they were in Telford and Shropshire, when we learned about the terrible things that had been going on under successive Governments in that trust. When there is a need for other investigations to take place, including independent ones, such as the one I have just asked for in Nottingham, that will be done. But the hon. Gentleman should understand that the best thing, which is far better than doing a review when things go wrong, is not having things go wrong in the first place. That is why he should have welcomed this report.

[Mrs Theresa May (Maidenhead) (Con)]

This is an important review. There have been regular radical changes in the management of the NHS throughout my 25 years in this House, so may I suggest that my right hon. Friend proceeds with care? He rightly says that good leadership of the NHS is important, for example, to ensure that we can deal with the covid backlogs, and that includes consultants. Too many experienced consultants are leaving the NHS because of problems with their pensions, so will he now commit to an urgent review of this issue, including looking at the change in the abatement scheme?

[Sajid Javid]

I thank my right hon. Friend for her comments. I always listen carefully to what she has to say, given her important experience. On the pension issue, she will know that in the 2020 Budget, I believe it was, significant changes were made, especially to where the taper rate kicks in—it went from £110,000 to £200,000. That benefited the top 5% of earners in this country, but it was the right thing to do to encourage and incentivise doctors, in particular, to work more. She is right to talk about what more we can do. We are looking precisely at what further flexibilities we can offer on pension arrangements.

Cumberlege Report

Baroness May of Maidenhead Excerpts

Thursday 3rd February 2022 Westminster Hall

[Mrs Theresa May (Maidenhead) (Con)]

As others have said, it is a privilege to serve under your chairmanship, Mr Rosindell. I add my congratulations to my hon. Friend the Member for Elmet and Rothwell (Alec Shelbrooke) on having secured this important debate. We are here for a significant reason, which is, frankly, to hold the Government’s feet to the fire and press them on why they have not made more progress on this issue. As others have said, it was debated some months ago in the Chamber of the House of Commons, and the cross-party support for Government action was absolutely clear, as the presence here shows, yet we have had to come back to ask the Government why they are not making more progress.

The independent medicines and medical devices safety review was absolutely clear about the damage done by the three medical devices and medicines that it considered: Primodos, mesh—not only vaginal mesh—and sodium valproate. As my hon. Friend the Member for Elmet and Rothwell—

[Alec Shelbrooke]

Right honourable.

[Mrs May]

I am so sorry; that must have changed after my time. My right hon. Friend set out very clearly how people’s lives have changed. The hon. Member for Blaydon (Liz Twist) has just done that as well.

Lives have been not just changed, but significantly damaged. People have suffered physically, mentally, socially and, in many cases, economically. As well as suffering the direct impact of what was done to them and, in the case of Primodos, to the babies born with defects as a result of their mothers taking it, they suffered constant rejection by the state—by the NHS and the Government, the very bodies that should have been there to protect and support them. The longer it takes the Government to fully implement the recommendations of the Cumberlege report, the more rejection these people suffer. Every week that goes by is a further rejection, because the report was very clear: action needs to be taken.

I was pleased to set up the report, and I commissioned it largely out of the concern I had about Primodos, which had been raised with me by my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning), but also by our former colleague Seema Kennedy, who took up this issue as well. The aim of the review was not just to get to the truth, but to identify what needed to be done to redress the problems that had occurred, to provide support to those who had suffered, and to ensure that it could not happen again.

There are two glaring aspects to these issues. The first is that the natural reaction of the NHS and the medical establishment was—and, I fear, continues to be—to defend themselves, rather than to admit to mistakes, ensure that those who suffered were given the support they needed, and take action to ensure that those mistakes could not happen again. That is still happening.

I spoke to a constituent earlier this week who had an operation a number of years ago, and is still having operations to correct problems that arose from a mistake made in that operation. My constituent Hugh Whitfield, a former consultant surgeon who runs the Independent Medical Negligence Resolution, spoke to me before Christmas about the large sum of money the NHS spends on litigation and on trying to defend cases in court, when a better system would be to just accept that mistakes were made. I have constituents who just wanted an apology. They just wanted to know that somebody had accepted that something had gone wrong, and to be shown that it would not be allowed to happen again. Instead, the NHS spends significant sums of money trying to defend itself in court cases when there is a better solution. That is slightly aside from the main point I want to make about the Cumberlege review, but it shows that the NHS’s attitude is to defend itself, rather than accept that mistakes were made.

I want to pick up on a point made by the three Members who have spoken. Sadly, when we look at the three issues that the Cumberlege review considered, we see a patronising attitude towards women—a pat-you-on-the-head attitude. “There, there. This is the sort of thing you can expect. You’re in pain? Oh well. You’re a woman.” I am afraid that that was the attitude taken on some of these issues—and it was not just that: it was a female doctor, Isabel Gal—a woman who had survived Auschwitz—who first identified the problems with Primodos, but she was dismissed and ignored, and sadly her career was damaged as a result. She eventually left the medical profession. What comes through in the report is that there is an attitude of not being willing to listen to women’s voices, and of not accepting it when women say, “Actually, what you have done to me is causing me extreme pain and difficulty.” Instead of saying, “You know what? I do this, and I get it right. Go away, dear,” professionals should say, “Let’s look into this and find out exactly what happened, and whether we made a mistake.”

I come to three of the specific recommendations, one of which is to appoint a patient safety commissioner. Reference has already been made to this, and it is good that the Government have accepted the recommendation, although they needed a bit of a nudge in the House of Lords to do so. What concerns me is the need to ensure that this patient safety commissioner is not in hock to the Department of Health and Social Care.

My right hon. Friend the Member for Elmet and Rothwell spoke about the NHS. Yes, these are the actions of the NHS, but behind it lies the Department of Health and Social Care, which consistently resisted properly looking into these issues over a significant period. I do not want a patient safety commissioner to be taken over by the Department of Health and Social Care. It has to be somebody who can be independent and can genuinely give patients a voice.

On the recommendation to establish a redress agency, my right hon. Friend the Member for Hemel Hempstead is right that under its terms of reference, the Cumberlege review was not able to look at compensation for individuals, but it was asked to look at wider redress measures, and it proposed the redress agency—a proposal that, sadly, the Government have not been willing to accept. I know the Treasury will have heard the proposal as, “Ding, ding, ding! Pounds!”—I have dealt with the Treasury, and we all know what happens—but the agency would have a wider remit than that. The Treasury often thinks these things are just about funding and monetary compensation, but people who have suffered as a result of these issues need other sorts of support given to them—for example, support for children with special educational needs. Redress is wider than monetary compensation, which is often what Government think about.

Recommendation 9 is to set up a taskforce. The patient reference group is a good idea but, as the hon. Member for Blaydon (Liz Twist) said, where now? The taskforce would have the job of gripping this issue and pressing down on the accelerator for action. I ask the Minister: who in Government is gripping this issue and pressing the accelerator for action? As I am sure she will gather, most of us here think that nobody is doing that, and that the issue is being allowed to drift. It is important that these recommendations be followed up on.

My final thought is about levelling up—a term that some of us in politics like to use at the moment. The victims of these three issues need to have their lives levelled up with those of people who did not suffer as a result of this. Above all, NHS treatment given to women needs to be levelled up with that given to men, to ensure that women are not just patted on the head and told to go away.

--- Later in debate ---

[Maria Caulfield]

There are absolutely processes in place, including bodies such as the Care Quality Commission, which audit and inspect to ensure that the processes that have to be in place are being used. NHS Resolution is clear about the work it does, and its chief executive also gave evidence to the Select Committee this week on how the process should work. Of course, if patients feel that it is not working for them, we need to hear about it. We set up these mechanisms specifically to make compensation easy, quick and representative of the needs of those who are claiming, to make sure that they get the compensation they need as quickly as possible. That has not happened in the past; we fully acknowledge that.

The Secretary of State will announce a consultation on wider reforms to clinical negligence very soon, because we recognise that the system has not worked for people. It has been too bureaucratic, and the legal position and fear of going to court has put many people off. It does not need to be like that. We want to make it as easy as possible for people, whatever their clinical negligence claim.

[Mrs May]

I want to press the Minister. I apologise about that, but she will recognise from the debate that there is real concern about this. I have concerns about NHS Resolution and the way it operates. There are systems elsewhere, in countries such as Australia and Canada, where, at a very early stage, an independent medical expert, who is completely separate from the institution where the negligence has taken place, is brought in, and there is much more of a sense of no-fault compensation and of not needing to go to litigation. NHS Resolution gets involved in litigation, and it can take many years before that is resolved.

[Maria Caulfield]

Yes, absolutely. Part of the consultation we will announce shortly will look at international comparisons. One concern we have about some of the no-fault schemes is the caps on the amount of compensation that can be given. I think some countries have a £1 million cap. I am not an expert on how much compensation these ladies should be due, but we want to make sure that, if we set up systems like that—we are not closed to those ideas—they actually address the issues that these specific women face. We will look at those options in the round.

--- Later in debate ---

[Alec Shelbrooke]

I thank all hon. Members who have contributed this afternoon. Even though many Members have given me apologies for not being able to be present, we have covered the wide-ranging aspects of the review concerning Primodos, sodium valproate and mesh. I thank and congratulate the Minister, who showed in her response that she understands her brief. I will come on to some of the issues we disagree on, but she did not just read out what has been written for her. She has taken the issue seriously and has taken the debate on board. That is a refreshing change from her predecessor.

Let me move on to some of the specific comments. I welcome the hon. Member for Chesham and Amersham (Sarah Green), with whom I have not had the privilege of being in a debate before. She made an important point when she said that we need to listen to victims. That is the point of the report: the need to listen to victims. We have to be very careful about how we proceed. The report was trusted because the victims felt that they were finally and properly listened to. That is why it matters so much.

Let us be blunt: it does not matter which side we are on, we in this place are all getting a bit of a bad press at the moment. The report is an opportunity to show people that they can have faith in this place and trust it. When we go out, listen to victims, take their views on board and, as a Parliament, say, “The adversarial side of politics can be parked over there, because on these really important issues, we all get together and we can make things happen,” we can do things. I thank the Minister for the progress that she is making on the recommendations, and for giving us the update.

The hon. Member for Livingston (Hannah Bardell) gave us a shocking revelation. Records were destroyed, rather than people admitting the mistakes that had been made. That is why redress, the databases and all the other things that we want to introduce are so important.

We come back to this point. I thank my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) for her reference to the analogy I gave her about the aircraft industry. The Minister used the word “whistleblower”, and that is the wrong word. We are talking about cultural change, and it follows on from what the hon. Member for Livingston and my right hon. Friend the Member for Romsey and Southampton North said. We have to develop a culture in which it is natural for anybody working in a system to feed in, “This is going wrong” or “There has been some evidence of this.” There should be no blame for anybody and no comeback for their careers.

I am a great fan of the TV programme “Air Crash Investigation”—my wife cannot watch it—especially as I spend my life in the air. It is absolutely clear when people watch that programme how the airline industry is now at a point at which it is really unusual for a plane to drop out of the air, because of the no-blame culture. If somebody leaves a spanner somewhere, that gets reported. The tiniest things are reported, which is how that industry’s safety has improved.

[Mrs May]

Will my right hon. Friend give way?

[Sir Graham Brady (in the Chair)]

Order. I am terribly sorry to interrupt the right hon. Lady, but we cannot have interventions during what should be a very brief winding-up speech.

Covid-19 Update

Baroness May of Maidenhead Excerpts

Monday 6th December 2021 Commons Chamber

[Sajid Javid]

First, let me thank the hon. Lady for her support for vaccination in general. Right across the UK, it is really making a difference, and I thank her for her comments on that, and especially on the importance of the booster programme.

On testing for this variant, she talked about the proxy measure, which is the S-gene dropout. There are other methods being deployed alongside that, which stop short of sequencing, but they take much longer, and the capability is not universal. Between these two proxy methods, the majority of testing centres can pick up the potential marker for omicron, but we are expanding that so that all testing centres will be able to do it very soon.

The hon. Lady talked about the restrictions. I point her to one of the important points that I made earlier, which is that the restrictions are temporary. As soon as they can be removed, we will remove them, and that is what industry and others want to see—as soon as we do not need them, we will remove them without any delay.

The UK can be proud of its commitment to vaccine donations to the developing world. We have a commitment of 100 million by June 2022. We have already delivered 22 million to COVAX and bilaterally. Another 9 million are on their way in the next couple of weeks, and we will meet our commitment.

[Mrs Theresa May (Maidenhead) (Con)]

The early indications of omicron are that it is more transmissible, but that it potentially leads to less serious illness than other variants. I understand that that would be the normal progress of a virus. Variants will continue to appear year after year. When will the Government accept that learning to live with covid, which we all have to do, means that we will most certainly have an annual vaccine and that we cannot respond to new variants by stopping and starting sectors of our economy, which leads to businesses going under and jobs being lost?

[Sajid Javid]

My right hon. Friend makes a very important set of points. She is right about what the early data suggests about transmissibility. We are certainly seeing that here in the UK, and we are also seeing it in the reports from our friends across the world.

On the severity of the variant, we should not jump to any conclusions. We just do not have enough data. Most of the data that is available at this point in time is coming from South Africa. That is where most of the world’s cases are, but it is important to remember that it has a younger population. South Africa also had the beta wave, and beta as a variant is much closer to the omicron variant. While it is quite possible that there will be a difference in clinical outcomes from infection, it is too early to jump to conclusions.

None the less, my right hon. Friend is right in her final point. Of course we must learn to live with this virus; it is not going away, as she says, for many, many years, and perhaps it will lead to annual vaccinations. We have to find ways to continue with life as normal.

Health and Care Bill

Baroness May of Maidenhead Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Justin Madders]

My hon. Friend is right that one of the criticisms we have levelled against the Bill is that it does not address the issues and challenges facing the NHS. I will take no further interventions, because I am conscious that many Members have contributions to make.

I will move swiftly on to our two amendments dealing with inequality and to new clause 64 in the name of my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams). To show that this is an NHS and social care Bill, not just an NHS Bill, local authorities need to be more involved and more emphasis must be placed on wellbeing and better outcomes. We support the NHS triple aim—improving health, quality of care and cost control are, of course, important functions. Nevertheless, we live in a country where significant inequalities remain, and narrowing those gaps should be a national priority.

Research from the IPPR last month highlighted the 10-year gap in life expectancy between a person living in the poorest community and a person in the best off. That gap doubles when we talk about healthy life expectancy. Tackling that disparity must be a priority in the Bill. The Secretary of State for Health and Social Care said in his first speech that said he wanted to tackle the “disease of disparity”, so why is that missing?

Turning to clause 39—one of my favourites—why it remains in the Bill is a mystery given that the previous Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), who requested these powers, is no longer in the role. Perhaps he will give us his insight into that later on. It is the absolute antithesis of the Lansley view that politicians should be distanced from NHS operational issues and makes a mockery of the overall thrust of this Bill, which is about encouraging local decision making. It is no exaggeration to say that, taken literally, clause 39 and its accompanying schedule 6 require the Secretary of State to be told if there are, or even if there might be, proposals to vary service—even moving a clinic from one location to another nearby.

As has been pointed out by wise heads, the power is not one that many Secretaries of State should want to get involved in. A Secretary of State who used it could be accused of favouring certain areas or decisions for political purposes. The well-articulated fear is that it will be used to block necessary but unpopular changes and that expediency will rule. Such decisions should be left to the clinicians or maybe the health economists but not politicians. Labour opposes this new power and would gently say to the Minister, “Be careful what you wish for.”

Finally, the issues around discharge to assess are complex. As we worked our way through in Committee, we heard evidence from many stakeholders, and it is fair to say that views on the matter were polarised. We are led to believe, and have some confirmation, that this development is working well for some acute settings, helping ease the perennial and disruptive issues around delayed transfers of care, but in other places we hear voices calling for much greater caution and for tougher safeguards or even, as amendment 60 requests, to stop it altogether. While we have sympathy with amendment 60, it would only pose more problems for the NHS if it was passed, so we have opted in our amendment 73 just to tighten up on safeguards.

Of course the real solutions are far more complex and would require higher investment both in the NHS and in social care. It should be mandatory that all aspects of ongoing care have been properly discussed and agreed with the patient and carers prior to discharge. An assessment should include carers with special attention if a child carer is involved, and there is a concern that unpaid carers will not be identified and consulted at the point of discharge.

The system for step-down care outside acute hospitals must be adequate, and there must be sufficient high-quality and funded places in care settings of all kinds. We are literally a whole generation away from having that kind of system, even if the funding started to become available today. On a related point, new clause 63 from the hon. Member for St Albans (Daisy Cooper) also deserves support.

I will leave my comments there, as I know many hon. Members want to speak.

[Mrs Theresa May (Maidenhead) (Con)]

I rise to speak in support of amendments 93 to 98, whose purpose is very simple.

The Health and Social Care Act 2012 established parity of esteem between physical and mental health in their treatment in the national health service. The Bill is silent on the issue. I know that Ministers have given assurances, in a variety of ways, that it is not the Government’s intention to move away from that parity of esteem, but if that is the case, the answer is simple: accept the amendments. The Government do not even have to write them; they have been written for them. There would then be absolutely no doubt about the continued commitment to ensuring parity of esteem between physical and mental health.

Mental health was clearly in the long-term plan for the national health service that I was pleased to see introduced. It was there because of the need to accept, as Members across the House do, that for too long mental health has not been given the attention that it deserves. People who were suffering with mental health problems were not getting the services that they need.

It will take time to ensure that we can provide for all, but sadly the issue has been exacerbated by the pandemic. In March 2021, there were 26% more referrals for mental health services than in March 2019, before the pandemic. The Centre for Mental Health reckons that 10 million additional people will need mental health care as a result of the pandemic. I am particularly concerned about the impact on young people; I am sure that Members across the House are seeing young people in their constituencies whose mental health may have been suffering anyway, but has suffered even more as a result of the pandemic.

More people now require mental health services. The Government talk a lot about dealing with the backlog that is a result of the pandemic, but it is only ever spoken about with reference to surgery or operations. The great danger is that in their focus on dealing with that backlog, which we all accept is necessary, the Government will push the issue of mental health services to one side.

The amendments stand in the name of my hon. Friend the Member for Broxbourne (Sir Charles Walker), in my name and in the names of Members across the House—there is cross-party concern. I say to the Minister once again: it is very simple. If the Government wish to maintain parity of esteem between physical and mental health and ensure that people with mental health problems are given the services and care that they need, they must put uncertainty to one side, accept the amendments and make it clear that physical and mental health will be treated with parity of esteem in our national health service.

[Dr Whitford]

I rise to speak to my amendment 82, which is on legislative consent if the Bill is used in the devolved aspects of healthcare in future. The bulk of healthcare—certainly its delivery through the Scottish NHS—is devolved. Having been on the Bill Committee, I was surprised that in the original version of the Bill there was not one mention in that context of the word “consultation”, let alone the word “consent”.

I do welcome amendments 118 and 121. I recognise that the Minister is trying to work constructively with the devolved Governments, but health is devolved. I am sorry, but after the United Kingdom Internal Market Act 2020, because of how the funds to replace EU funding post Brexit are being used to cut the devolved Governments out of decision making, there is a real fear among the public in Scotland that their health services could be changed in future. I ask anyone who supports devolution in principle to support amendment 82.

Independent Medicines and Medical Devices Safety Review

Baroness May of Maidenhead Excerpts

Thursday 8th July 2021 Commons Chamber

[Mrs Theresa May (Maidenhead) (Con)]

I join the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) in thanking the Backbench Business Committee for enabling this important debate.

I decided that the independent medicines and medical devices safety review should be set up because I was deeply concerned about the impact, which had been raised over many years, of the use of certain medicines and medical devices on women, and in particular the use of pelvic mesh, sodium valproate and hormone pregnancy tests, predominantly Primodos.

I would like to take this opportunity to commend all Members of the House who have campaigned on these issues over the years. I would also like to add my thanks to the noble Baroness Cumberlege for the work she did in chairing the review, and in producing such a no-holds-barred and absolutely-to-the-point review, which made very clear for the Government the problems that had occurred and what needed to be done.

I will also take this opportunity to say to the Minister that I would like to thank the Government for their decision to establish a strategy for women’s health, which I think is important. But that is for the future; what we are talking about now, of course, are problems that occurred in the past but also problems that are still occurring, as we have just heard in relation to mesh, and indeed as with sodium valproate, which I will refer to later.

What was clear to me when these issues were raised with me is that over decades women had suffered, children had suffered and families had suffered, and the impacts are still being felt today. What was also clear was that the voices of patients, of women and of others had been raised and had consistently been ignored. There had been a sort of attitude that said, “There, there. You’re a woman; you just have to put up with it.” The unwillingness to listen and act had occurred under successive Governments, through the Department of Health and various aspects of the national health service.

I have to say to the Minister that sadly such an approach is perhaps not unexpected by Members of the House. I am sure that other Members will, like me, have had constituency cases in which there has been a problem with the treatment an individual received from the NHS, and they want an apology and to know that someone will ensure that it does not happen again to somebody else, but they come up against a brick wall, because the natural inclination is to defend the institution, rather than address the issue that has been raised.

[Jim Shannon]

Some of the ladies in Northern Ireland who have contacted me want more than apologies. Some of them have not been able to work—they cannot work and will never be able to work—not because of anxiety and depression but because of the physical difficulties they have. Does the right hon. Lady agree that this is also about making sure that people have the benefits that the Government can make available? We also need to address the breakdown in their marriages and the help we can give. Those are some of the things that my constituents want to see, as well the things that the right hon. Lady has referred to.

[Mrs May]

The hon. Gentleman is absolutely right and I shall come to the issue of redress in relation to these particular aspects of pelvic mesh, sodium valproate and Primodos and other HPTs. I was making the general point that I see constituency cases of individuals where a mistake has been made by the NHS. They want an apology and to know that change is going to take place, but they come up against a brick wall and sometimes find themselves battling and ending up in court to try to get some redress—with all the problems that that creates—because the institution has defended itself, rather than taking the patient’s voice seriously.

Our NHS does amazing work day by day and it has done amazing work during the pandemic, but, sadly, when mistakes are made, it does not always respond in the right way. The report of the independent review made this very clear:

“There is an institutional and professional resistance to changing practice even in the face of mounting safety concerns. There can be a culture of dismissive and arrogant attitudes that only serve to intimidate and confuse. For women there is an added dimension—the widespread and wholly unacceptable labelling of so many symptoms as ‘normal’ and attributable to ‘women’s problems’.”

It went on:

“Mistakes are perpetuated through a culture of denial, a resistance to no-blame learning, and an absence of overall effective accountability.”

It was apt that the report was called “First Do No Harm”; as the noble Baroness Cumberlege said:

“It is a phrase that should serve as a guiding principle, and the starting point, not only for doctors but for all the other component parts of our healthcare system. Too often, we believe it has not.”

Like the hon. Member for Kingston upon Hull West and Hessle, I am concerned that the Government have not responded to and accepted the recommendations of the review in full. The recommendations were not made lightly; they were made after listening to considerable evidence and hearing the voice of people who had suffered for years as a result of the use of these medicines or medical devices. The report identified where changes needed to be made. Of course responses take time and of course the Department has been dealing with the pandemic, but I hope that the Government are going to respond properly on all the issues raised.

The Government have agreed to set up an independent patient safety commissioner—partly, I have to say, because of the action in the House of Lords in relation to amendments to a Bill—and they are now consulting on the position, but we do not know when the commissioner is going to be in post. The commissioner is important, because it is the commissioner who will enable the user’s experience—the patient’s voice—to be heard. By hearing that voice, it will be possible to detect and stop the use of medicines and medical devices that lead to avoidable harms.

[Hannah Bardell]

The right hon. Lady has made the point about institutional cultures, defensiveness and the culture of litigation that it feels like we have now got into, particularly in respect of some aspects of the health service. Does she agree that the patient safety commissioner must have teeth and must be able to help us—I think there would be agreement across this House and in the other place on this—to try to move away from that culture so that we can learn from mistakes?

[Mrs May]

I absolutely agree about the importance of the patient safety commissioner; they have to be able to do the job that is intended and set out for them to do. I know that there will be those who will be concerned that their sponsoring Department is the Department of Health and Social Care. It is natural because this is a health issue, but I hope that the Department will make every effort to ensure that it cannot be accused of trying to water down the role of the independent safety commissioner, because, as we are saying, it is important for the user’s experience to be heard. This is not about trying to get at the Department of Health or the NHS or anything. It is about people who are suffering real-life experiences and impacts as a result of the use of medicines and medical devices; it is about identifying those situations and ensuring that action is taken to stop them happening so that others can be protected.

The issue of redress was mentioned by the hon. Member for Kingston upon Hull West and Hessle and the hon. Member for—I apologise, because the hon. Gentleman is in the House so frequently, but I have forgotten his constituency—[Interruption.]. Strangford, thank you. The issue was also mentioned by the hon. Member for Strangford (Jim Shannon). The Government have said that an agency is not needed, yet time and again the only redress for patients is through recourse to the courts. That is expensive and stressful. It is also expensive for the national health service; in 2018-19, the NHS paid £2.4 billion in clinical negligence claims. But redress is about far more than compensation. It is about relating to the real impact that the use of these medicines and medical devices has had on people, such as the need for special education for children who have been affected because their mothers have taken sodium valproate when pregnant. There are many other examples. I urge the Government to look again at that issue.

I also want to raise the issue of the patient’s voice, because this has all been about an unwillingness in the past to listen to the patient’s voice. Setting up the patient reference group was fine, but I understand that it is due to publish findings shortly, and nobody knows whether the patient’s voice is going to be taken into account or how it can be in the future. I urge the Government to ensure that patients are part of the implementation; it is their experience that we are talking about, so it is so important that they are included.

My final point relates to sodium valproate and it partly comes from constituency experience. This medicine has a one in two risk of causing harm to a baby if a woman is taking it while she is, or becomes, pregnant. What lies behind this issue is information and education, but it took a year for the Government to write to women to raise awareness of the risk. I hope that the Government do not think that that is job done, because this is an ongoing issue that has to be addressed. It is not just about providing information to women; it is also about ensuring that their clinicians are well informed when they are prescribing and dealing with their cases.

Women suffered considerably from the use of pelvic mesh, from hormone-based pregnancy tests, predominantly Primodos, and from sodium valproate, but they and their children are still suffering today. At the heart of this situation lay a health system that, in the words of the report, is

“not good enough at spotting trends in practice and outcomes that give rise to safety concerns. Listening to patients is pivotal to that.”

The system did not listen. It saw real pain and debilitation as women’s problems. The service which at its heart has our safety and protection ignored concerns over safety for too many years. The independent report recommends steps for the system to change. I urge the Government to embrace the recommendations in full. That way, we will be on the way to ensuring that we have a system that genuinely first does no harm.

NHS Integrated Care System Boundaries

Baroness May of Maidenhead Excerpts

Tuesday 29th June 2021 Commons Chamber

[Mrs Theresa May (Maidenhead) (Con)]

I congratulate my hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin) on securing this debate, and thank him and the Minister for their courtesy in agreeing that I could speak briefly in it.

I want to focus, first, on my local integrated care system. The majority of my constituency is covered by the Frimley ICS, as is the rest of east Berkshire. I know that the comments I am going to make are supported by my hon. Friend the Member for Bracknell (James Sunderland), the hon. Member for Slough (Mr Dhesi) and my hon. Friend the Member for Windsor (Adam Afriyie). Frimley ICS is one of the best performing and most effective ICSs in the country—arguably, it is the best performing and most effective ICS in the country. That has been achieved by partnership working across county boundaries and across local authorities. It has been achieved by people coming together, working together in a network of partners whose aim has been to provide the best possible outcomes for our constituents. Yet now the Government want to break it up—why? It is because it is bureaucratically neater to align an ICS boundary with a local authority boundary. I understand that in this instance one local authority leader argued that his local authority should be covered by a single ICS and therefore the boundaries should be the same.

I refer the Minister to the White Paper, which says:

“Frequently, place level commissioning within an integrated care system will align geographically to a local authority boundary”.

It says “frequently”, not in every case, at every occasion or in every ICS we are looking at, so it is not necessary to align every ICS with a local authority boundary. Frimley ICS is supported by all the GPs and healthcare providers in east Berkshire, and by GPs and others in Hampshire and Surrey, which Frimley ICS also covers. Frimley ICS is supported by all the east Berkshire local authorities, all the east Berkshire MPs, who, as my hon. Friend the Member for Harwich and North Essex pointed out, were not consulted as part of these proposals going forward. Our message collectively to the Government is a very simple one: Frimley ICS is working well, it provides excellent services to our constituents, do not break it up. Far from breaking it up, Frimley ICS should be a template for ICSs across the rest of the country. The message can be put more simply: if it ain’t broke, don’t fix it. That is particularly important at this point in time. The NHS has been under intense pressure during the pandemic, but as we come out of the pandemic it is also under increased pressure with the backlogs in surgery and in the provision of other services, and with the increasing pressures there will be on mental health services. Are we to say at this time to people working in the NHS, “What we want you to do is to go away and break up this thing that you’ve brought together and worked very hard to ensure is working so well, and create entirely new ones.”? In the case of Frimley, three ICSs would probably be created as a result. That can only lead to a disruption in services. Who suffers from a disruption in services? The people who suffer will be our constituents.

As we heard from my hon. Friend the Member for Harwich and North Essex and in interventions, Frimley is not the only ICS that is under threat where Members of Parliament are concerned about the impact on their constituents. That brings me to the concept that underpins the White Paper—primacy of place. “Place” is not defined simply by a local authority boundary. A local authority boundary defines the area of the local authority, but primacy of place has a deeper meaning. It involves people’s behaviour and natural networks. In East Berkshire, our acute hospital is Wexham Park in Slough and is part of the NHS Frimley Health Foundation Trust. The natural geographical area for East Berkshire to be part of is the Frimley health trust area. That makes common sense to people—those working in the NHS and our constituents.

So much hard work has gone into ensuring that we have an ICS in our area that delivers for our constituents. I hear the same from other hon. Members in the debate this evening. I therefore ask the Minister to do what reflects the natural networks that define primacy of place and not to destroy the good will that has gone into making those partnerships work. Do not break up Frimley ICS. Just for once, let common sense prevail.

Mental Health Act Reform

Baroness May of Maidenhead Excerpts

Wednesday 13th January 2021 Commons Chamber

[Matt Hancock]

I thank the shadow Minister for her thoughtful approach. I agree with the way that she described the challenge, and with her insistence that we must not just improve the legislation—and we will—but improve and continue to strengthen service provision, in particular community service provision, as an alternative to admission. That is how we turn legislation from dry words on a page into real action on the ground.

The shadow Minister is absolutely right, too, that service users must be at the heart of framing the legislation. If I may link that point to her question about the timeframe, the challenge of the timeframe is to ensure that we move fast enough to help people and get the new legislation on the statute book as quickly as reasonably possible, but at the same time continue with the consensus-based approach that we have taken.

I am very grateful, as I said, for the work of Sir Simon and the NHS team, and I am grateful that we have managed to develop this White Paper with broad consensus among those who provide mental health services and service users, and politically across the House. I think that is an important consensus to keep, and I want to try to keep it by ensuring that we take as open an approach as possible to the legislation. I am absolutely open to joint prelegislative scrutiny, and I am absolutely open to the publication of a draft Bill. Let us get the details right, and let us work together on this and keep it as consensual as possible.

I also agree with the hon. Member’s point about the need to tackle broader health inequalities, and covid has laid bare some of those. That is a core part of our levelling-up agenda, and it is an important consideration for both physical and mental health. I am glad to say that this landmark White Paper, which will lead to a once-in-a-generation Bill, is proceeding with the support of the Opposition. I am really pleased about that, because this is for everyone. It is to make sure that some of the most vulnerable people in our country get the support they need and deserve.

[Mrs Theresa May (Maidenhead) (Con)]

May I congratulate my right hon. Friend on this White Paper and also on his continued commitment to this issue during what have been really challenging times for him and his Department in dealing with the pandemic? I fear, though, that the legislation might not be on the statute book until 2023. Meanwhile, GPs and hospitals caring for my constituents tell me that there is an increasing problem of mental health and increasing numbers of people with mental health problems, particularly young people. So what steps can my right hon. Friend take to put in place the principles that underpinned the Wessely review—I thank Sir Simon Wessely once again and his team for their work—of less coercion, better choice and control for service users, better care, and a reduction in inequality and discrimination, while dealing with the growing number of people who have mental health problems, some as a result of the pandemic?

[Matt Hancock]

I put on record my gratitude to my right hon. Friend. Without her, I am not sure we would have reached this point. Her dedication to this topic, both as Home Secretary and then as Prime Minister and since, has been vital, and I am grateful for the advice that she has given me in the last few months as we prepared this White Paper. I am grateful to her for appointing Sir Simon Wessely, and I am grateful to her for appointing me as Health Secretary, too. [Laughter.]

My right hon. Friend is absolutely right about the urgent pressures right now in mental health services right across the country, so I am really pleased that during the pandemic we have been able to keep work going on the policy and the new legislation that we are proposing. At the same time, however, in hospitals and in GP surgeries right across this country, there is urgent pressure on mental health services, and we know that there are mental health impacts of the actions that we have to take to control covid.

As I said in my statement, we have put in more money in the short term, on top of the long-term plan that was agreed when my right hon. Friend was Prime Minister. We are committed to doing everything we can to support people with mental ill health and, crucially, to support people to keep their mental health strong, even if they do not have a mental illness, because these are difficult times. The good public health approach means that, just as looking out for our physical health and our mental health is important for all of us, so too is the provision of acute services for people with serious mental health conditions, which is under strain right now. We are willing to—and have—put the money in at the spending review, but we must also support the clinicians on the frontline who are working so hard right now.

Covid-19

Baroness May of Maidenhead Excerpts

Tuesday 12th May 2020 Commons Chamber

[Mrs Theresa May (Maidenhead) (Con) [V]]

First, I pay tribute to all those in the NHS, in care homes and in other settings for working so hard to save lives. But I also pay tribute to all those other workers—the people in local authorities and the emergency services, and others, as well as volunteers, including those in communities across my Maidenhead constituency, who are ensuring that the country can keep going.

Let me say to Ministers that having been there, I do not envy the Government the difficult decisions they have to take. There are no risk-free answers. It is not about eliminating risk, because that is not possible; it is about managing and mitigating risk. It is right that science should underpin decisions, but the science can only take us so far, because essential data is lacking. We do not know how many people have had covid-19 in the UK. Although the Office for National Statistics survey is building a better picture, the scientists are still making estimates and debating consensus. The Government are putting an emphasis on R—the rate of infection—but that varies across areas, across different parts of the UK, and across different settings. So there are no absolutes, and both scientists and Ministers have to exercise judgment.

As I say, it is not possible to eliminate risk, but in assessing the risk to be managed and mitigated, it is necessary to assess other risks to lives and livelihoods from covid-19. While the number of people dying from covid-19 has been falling, we see lives being lost prematurely not from covid but because people have not been going to hospital and treatments have been postponed that could impact their prognosis in future. And that is without thinking about all those whose mental health will be affected by this lockdown, increased domestic abuse, and the impact of loneliness. So dealing with covid has unintended consequences.

Protecting the NHS for the future, and protecting our public services for the future, means ensuring that we have an economy that can provide the taxes that pays for them.

Without that, as The Sun commented this morning, many more lives will be lost. As well as listening to the science, the Government need to apply common sense and, as I said earlier, judgment. To do that, I hope that alongside assessing the science and assessing the rate of infection, the Government are also looking closely every day and assessing the wider impact of the lockdown on lives and livelihoods.

This is about judgment. As we pull away from lockdown and as we take those steps to return to a more normal life, we need to ensure that we are being driven not just by an absolute science, which is not there, but by an assessment of the wider impact of covid on people’s lives and their livelihoods. I trust the Government are making those assessments, because it is only by making those assessments that we can ensure not only that we restore our economy to a normality that will supply taxes for our NHS and public services, but that people are able to return to a more normal life.