Oral Answers to Questions

Ann Coffey Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Jane Ellison]

We had an excellent debate. An extraordinary number of colleagues turned up in Westminster Hall, a debate of just half an hour, demonstrating how many people are interested in this important subject. I outlined in my response to the debate the fact that we have the bowel scope screening programme and the bowel cancer programme in England, which complement each other. The result, particularly of bowel scope screening, is that we can actually make a huge impact on mortality rates for people who are caught. I went into that in more detail in my response to the debate, but that is the key to making sure we identify more people and stop them dying from this dreadful disease.

[Ann Coffey (Stockport) (Lab)]

2. What recent representations he has received on the effect on health budgets of the administration of deprivation of liberty safeguards.

[The Minister for Community and Social Care (Alistair Burt)]

I have received a range of representations on the effect of the deprivation of liberty safeguards, including on the impact that the current system has on health and care budgets. The hon. Lady is a respected voice on the challenges that these safeguards pose, and I can reassure her and the House that there is ongoing work to address those challenges.

[Ann Coffey]

I thank the Minister for his reply. Deprivation of liberty assessments are costing Stockport Council £1.2 million this year, as a result of the Cheshire West judgment. Not one single penny of that is providing social care. This is clearly unsustainable at a time when social care budgets are under intense pressure. Something needs to be done now; we cannot wait for the Law Commission. Will the Minister consider, as a small step forward, scrapping costly automatic annual reassessments and the necessity to reassess every time an elderly person leaves a care home to go into hospital?

Cities and Local Government Devolution [Lords] Bill

Ann Coffey Excerpts

Wednesday 21st October 2015 Commons Chamber

[Nigel Mills]

It is a pleasure to speak in the debate, and I shall speak to amendment 39 in my name. The purpose of the amendment is not to divide the Committee, but to ask how these devolution deals will work in areas that have a partly unitary and partly two tier authority structure. It is not clear that that is an effective or desirable situation for various reasons.

The reason for proposing a consultation with local people is that I am not sure there will be much enthusiasm among local people to pay for three different tiers of local government. It is confusing. They have no idea now which council does what. In Heanor in my constituency, for example, people elect 21 town councillors, they elect councillors to a borough council that has 45 councillors, and county councillors to a county council that has 64 members. How many more people do they need to represent them on these issues?

It is worth having an open consultation. There has been too little information and consultation with the public on the Government’s proposals, and I fear that my constituents will wake up one morning and find that they are part of an elected mayor area, together with the constituents of the hon. Member for North East Derbyshire (Natascha Engel), who is chairing this debate, and of the hon. Member for Nottingham North (Mr Allen), without any of those constituents realising that that was going to happen.

I am not sure many people feel there is a natural community that covers the whole of those two counties or that they wish to be part of such a local government unit. I suspect that paying for three tiers, plus town and parish councils, will not be popular, so before the proposals are implemented people ought to have a say about whether they would rather have only one of the two existing tiers. That would be a more easily understood and more cost effective local government structure.

The reason for proposing a consultation, rather than an absolute condition that devolution could not take place and elected mayors could not be introduced without moving to unitary authorities, is that I feared that the pearl-handled revolver that the previous Secretary of State still has in his desk drawer might be drawn out and fired at me in this debate if I suggested compulsory local government reorganisation. But if we are saying to local areas, “You can choose whether you want to be part of devolution and whether you want an elected mayor,” we should allow them to choose what unitaries they want. That is the next step. Three tiers of local government are not sustainable. That would focus the mind on what local government would look like and how we could best deliver these important services to our local people.

As a matter of fairness, I am not sure how a city of 300,000 people can have one leader at the table, and a county which has, say, 700,000 or 800,000 people can have nine people at the table, all with a veto and a combined authority on certain issues. If I were a member of a city council, I do not think I would see that as fair. We have a multi-level local government system which looks a bit odd. It does not help, for example, with the new homes bonus. I am not sure how business rate setting can be devolved to a two-tier area with questions over who gets to set what and who gets to keep what. There is a need to look at how local government works, and this would be the perfect time to do it. We can say to local people before they get their devolution and their elected mayor, “You tell us what you want. Do you want unitaries or do you want to keep the existing structure, with the advantages of a very local council, but with the extra cost that that brings?”

[Ann Coffey (Stockport) (Lab)]

In Greater Manchester work on the devolution proposals is very advanced. Amendment 51, tabled by the hon. Member for Hazel Grove (William Wragg), would put that work on hold until a referendum was held to determine whether the public supported having an elected mayor. It would also require 50% of the population to vote yes before a mayor could be introduced, which is a high bar. The turnout in the 1998 referendum on establishing the Greater London Assembly and the Mayor of London was 34.6%. Although the turnout in the 1997 referendum on Scottish devolution was higher, the percentage of the total electorate who voted yes was less than 50%, and the same goes for the 1997 referendum on Welsh devolution.

[William Wragg]

I think that the hon. Lady has mistaken the explanatory statement, which refers to the 50% threshold, for the amendment itself. Perhaps she should pay a little closer attention to the wording of the amendment, rather than the explanation provided by the office.

--- Later in debate ---

[Ann Coffey]

The hon. Gentleman will appreciate that when I read an explanatory statement that says:

“The intention of this amendment is that elected mayors will be introduced only if that proposal has been endorsed, in a referendum, by 50% of the population”,

I am likely to believe the Clerks.

[Andrew Gwynne]

My hon. Friend will know that the Greater Manchester devolution settlement came from the bottom up, from the 10 councils of Greater Manchester, and the 10 leaders always intended to appoint an 11th member of the combined authority to act as full-time chair. The mayor merely becomes that 11th member.

[Ann Coffey]

I thank my hon. Friend for that intervention—his knowledge in this area is comprehensive.

As I was saying, 50% is a very high bar that is unlikely to be reached, so amendment 51 is, in effect, a wrecking amendment intended to stop the devolution of decision making from Whitehall to Greater Manchester. It is a kick in the teeth for the people of Greater Manchester.

The population of Greater Manchester is 2.7 million, and we have a shared sense of identity, even if, at the very minimum, it is, “We’re different from London.” Surely it is right that services to meet the needs of local people should be designed locally. Local people care about that much more than they do about esoteric arguments about organisational arrangements. Greater Manchester comprises 10 local authorities, 11 police divisions and 12 clinical commissioning groups. We have an opportunity to bring those resources together. Too often there are barriers to working together and sharing information and the delivery of services because of boundaries between councils and, for example, health agencies. The combined authority would bring together the strength, competence and experience of the existing local authorities and other agencies in Greater Manchester under the leadership of an elected mayor, which is supported by the 10 local authorities, so that the public can see the public face of that new devolved authority.

[Andrew Gwynne]

Of course, the point is that the Greater Manchester combined authority already exists in statute; it is a body corporate. The Bill will allow the 11th member, who chairs the combined authority, to be directly accountable to the 2.7 million people who live in Greater Manchester. Surely that is a good thing.

[Ann Coffey]

My hon. Friend is absolutely right; it is a good thing. When people talk to me—and, I am sure, when they talk to him—and ask who they can go to, to them having a mayor makes perfect sense.

Of course, there are outstanding issues with regard to health, but there is nothing in the Bill that will take away from the people of Manchester the right to national health services enjoyed by people elsewhere. The problem in Greater Manchester is the fragmentation of health, so it is good that these proposals will help reduce the number of commissioning organisations and allow providers to work together in a more collaborative way for the benefit of local people. However, we need a funding settlement that gives greater flexibility in developing high-quality health and social care services in the community across Greater Manchester as an alternative to hospital admissions, and at the moment it is difficult for each clinical commissioning group to free up resources in order to do that. Without that investment, the demand for expensive hospital care will continue. The authority cannot simply be a bank that hands out money under the current funding arrangements.

There has been a lot of talk about accountability, but in my experience accountability is at its best when well-informed elected representatives, such as my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), demand answers and are willing to make their case loudly and publicly. No complexity in the arrangements for governance can take the place of that, and that is the accountability that the public expect us to ask for.

Last year I did some work looking into child sexual exploitation across Greater Manchester, at the request of the police and crime commissioner, Tony Lloyd, and following that I published my report “Real Voices” last October. Talking to children at risk of child sexual exploitation, it is absolutely clear that they do not observe local government boundaries, health boundaries or police boundaries, and neither do their predators. The digital age has redefined boundaries. A lot of progress on that has already been made across Greater Manchester. In particular, I want to congratulate Project Phoenix, a cross-boundary, multi-agency response to child sexual exploitation across the whole of Greater Manchester, which is working to ensure that child victims receive the same standard of response regardless of where they live. It has also initiated a very successful “It’s not okay” campaign to build public awareness of child sexual exploitation and help young people recognise when they are being groomed. It is clear that work on this crucial agenda will be enhanced by more devolution powers for Greater Manchester. We must overcome the silos and boundaries that prevent people working together to protect children from abuse.

Amendment 51, if passed, would be a kick in the teeth for the people of Greater Manchester and their children, who have felt for years that their voices have been ignored by Whitehall and Westminster. Devolution and the creation of a mayor offer the opportunity to the people of Greater Manchester to develop services that reflect their priorities and needs. We should take that opportunity and be positive about the opportunities we are being offered.

[Mr Brady]

I am pleased to have an opportunity to participate in this brief debate in Committee. We have already had some useful exchanges, and my hon. Friend the Minister has, as usual, been courteous and helpful—I am sure that he will be even more helpful before the end of our proceedings.

The hon. Member for Stockport (Ann Coffey) spoke with obvious passion, and we all very much appreciate the work she did on child sexual exploitation, but I want to pick up on the point she made right at the end of her speech, despite my hon. Friend the Member for Hazel Grove (William Wragg) making it clear that amendment 51 would require a simple majority in the referendum, whatever the explanatory statement might say. I think that she can relax about the prospect of any kick in the teeth for local people.

[Ann Coffey]

I understand from my hon. Friend the Member for Nottingham North (Mr Allen), who is very knowledgeable in these matters, that it is the Member who writes the explanatory statement for an amendment, not the Clerks.

Dementia Care Services

Ann Coffey Excerpts

Wednesday 9th September 2015 Westminster Hall

[Ann Coffey (Stockport) (Lab)]

It is a pleasure to serve under your chairmanship again, Mr Davies. I congratulate the hon. Member for Charnwood (Edward Argar) on securing this important debate and on his commitment to making life better for dementia sufferers and their relatives. I will not take up much time, and my observations are probably from a more personal point of view.

I completely support the Government’s objective to be a world leader in fighting dementia, but it is a challenging objective at a time of cuts in social care and given the difficulties in recruiting people to work in jobs that have traditionally been poorly skilled and badly paid. Social care is fundamentally task-orientated. It best supports people with physical disabilities and frailty, but it is not necessarily the best way to help people who have dementia.

In an area in which I have some personal experience, I know that the quality of the relationship between the carer and the dementia sufferer is vital in enabling the dementia sufferer to feel reassured and cope with anxiety, which is a common consequence of the illness. One of the symptoms of dementia is a complete loss of short-term memory, which results in the inability to do simple tasks. For example, a dementia sufferer may see a cup, a tea bag and a kettle, but not the connection among them. Making the cup of tea is, of course, an important task to ensure that the person does not become dehydrated. However, once the tea is made, the elderly person may be reluctant to drink it and may need continuous prompting. If the carer is new and does not know the person, and can spend only 15 minutes with them, the cup of tea may never get drunk.

A person’s relationship with their carer and the amount of time they can spend together is vital. It is sometimes forgotten how important relationships, emotional support and encouragement are to people with dementia, and how vital it is not to add to their confusion with multiple carers. Particularly when a person has no near relatives, the carer has to get to know them to understand when something is wrong with them, because a person with dementia cannot tell the carer themselves that their dentures are too tight.

Dementia sufferers need good quality care, and carers must have good antennae to be able to spot, for example, the signs of a urinary tract infection by changes in the person’s behaviour or level of confusion. We therefore need to move from a task-centred social care system in which multiple carers make short visits to a system that involves skilled care in which continuity of care and carers’ skills are a high priority. Simply integrating the health and social care system does not necessarily do that, as my experience in Scotland shows.

Of course, we cannot produce a vast army of skilled carers now or in the near future, particularly given population changes, so we need to look at how we can better use existing resources, including relatives, who at the moment seem to spend most of their time negotiating the system. The constant rounds of phone calls to doctors, nurses, occupational therapists and social workers leave relatives exhausted and with less time to spend with family members on social activities. There needs to be more support for relatives, who are important for ensuring the continual wellbeing of their family members.

We also need to be more imaginative about using technology to help people with dementia to free up the time for relatives and carers to build those important, high-quality relationships. We still tend to think of aids in practical terms, such as hand rails, bath mats or clocks with large faces, but I am interested in how we can use new technology to promote emotional wellbeing. For example, carers could help people to communicate with their relatives via Skype or smartphones, or set up digital photo frames that can be programmed to show photographs, which can help spark memories and support conversations. Relatives can link cameras to their smartphones and computers to check whether the person is all right at home, and they can use technology such as personal alarms and health monitoring devices. For example, bed pressure sensors can help reassure from a distance that the person has got out of bed, and a front door sensor can ensure that they have not left the house.

Hopefully, a cure will be found for this devastating illness, but until then we need to use the resources that are currently available better. In particular, we should develop technology, which, if it can free social carers from monitoring and supervision, would be very helpful in freeing up resources. We also need to use the resources of relatives, neighbours and the community. I hope that in the future we will be able to look at what the whole system can provide.

--- Later in debate ---

[Dr Whitford]

I absolutely would. In my previous life as a breast cancer surgeon, when I was also doing breast cancer immunology research, I watched what became Herceptin go from its development on the bench-top into common use. That took 21 years. This is something we often do not recognise when we moan about big pharmaceutical companies: they are investing in something that may turn out to be a mirage. The more that we can look at supported or shared R and D, the cheaper the drug will be when it finally comes to market. I would commend something like that.

The current problem is that most patients face living with dementia, and we must think about how we help them and their families to do that. We should be challenging ourselves to make dementia-friendly our surroundings and all the agencies that sufferers may interact with, whether through visual aids, through other people recognising them or, as the hon. Member for Stockport (Ann Coffey) said, through technology. The eHealth programme in Scotland is working on that, including devices in patients’ homes that it can interact with and establish whether the person is okay. Much of the care that people receive is the 15 minutes that the hon. Lady mentioned. How can we improve that? How can we ensure that the faces are not different every day? Some patients and families report 100 carers in a year. We should look at how we organise the care and remember who the real carers are: the family.

It is predicted that one in three of us will be carers for someone with dementia. We have a vested interest in ensuring that we look after them. The carer’s allowance is currently £60 a week, which does not even match jobseeker’s allowance, for a job that could be 164 hours a week, so we need to think of how we support carers and the work that they do. In Scotland, things are slightly different as we have free personal care, so the family does not pay for the carer who comes into the home. If that person has to go into a care home or nursing home, they do not pay for the personal care. The system has been expanded and deepened and actually allows us to keep more people at home for longer.

One problem is that care jobs attract lower earners. How can we motivate people and attract high-quality candidates if they are being paid the lowest possible amount?

[Ann Coffey]

On free personal care, the budget in Scotland is capped. Free personal care is probably welcome, but the problem is that sufferers do not necessarily get the required level of care because demand is managed by stopping the supply. That is the problem with a capped budget. Free personal care is not really a panacea for families seeking the care that their relatives need.

[Philip Davies (in the Chair)]

Order. Before I call Dr Whitford, may I ask that she bring her remarks to a close?

Deprivation of Liberty Safeguards Assessments

Ann Coffey Excerpts

Wednesday 17th June 2015 Westminster Hall

[Ann Coffey (Stockport) (Lab)]

I beg to move,

That this House has considered deprivation of liberty safeguards assessments.

It is a great privilege, Mr Davies, to serve under your chairmanship.

I am highlighting an expensive bureaucratic nightmare that is engulfing councils up and down the country. Local authorities are struggling to cope with the tenfold increase in applications for deprivation of liberty safeguards, known as DOLS, which is not only costing millions of pounds and tying up countless police and other resources, but causing untold distress to relatives of dementia sufferers who are treated when they die as if they had died in state detention.

We need first to look at how we arrived at such an unsustainable position. DOLS were introduced by the Department of Health in 2009 under the Mental Capacity Act 2005. They were intended to comply with articles 5.1 and 5.4 of the European convention on human rights to ensure that appropriate safeguards were in place to protect adults deprived of their liberty. DOLS provide a procedure for authorising any deprivation of liberty in care homes, hospitals and supported living arrangements. I am particularly interested in the increase in applications for DOLS assessments from care homes.

If DOLS were working effectively, the system would prevent potentially abusive restraint and sedation. It would also help to ensure that day-to-day practice in a care home did not restrict a person’s liberty—for example, people with dementia should be able to move around as they wish, as long as it was safe, and should not be required to stay in one place simply because that was easier for the staff.

In March 2014, the UK Supreme Court handed down two judgments, commonly known as Cheshire West, which outline the test that must be used in determining whether arrangements made for the care of an individual lacking capacity amount to a deprivation of liberty. The key test is whether the person concerned is “under continuous supervision” and “not free to leave”. The judgments in effect lowered the threshold and resulted in the colossal increase in the number of DOLS applications to local councils.

The situation was first brought to my attention by GPs in my constituency, council officers and distressed relatives of dementia sufferers living in local care homes. To get an overview of the national picture, I tabled a parliamentary question in March asking, with reference to the Supreme Court judgment, how many requests for DOLS assessments there had been in each local authority area. The answer revealed massive increases. In 2012-13, there were only 11,887 applications for the year, but the latest figure, for only the three months January to March this year, was 36,000, and of those, two thirds—68%—had not been processed. The numbers are rising every month and the Local Government Association estimates that an additional £136 million is needed this year to cope with the additional applications.

Between 1 April 2014 and the end of January 2015, Stockport received 612 applications. It now has about 230 cases that have not yet been processed. All cases agreed will be reassessed automatically in 12 months’ time. Stockport council is now spending almost £1.2 million a year on DOLS assessments and employing six new social workers, a special DOLS co-ordinator and a part-time solicitor. The council has also had to draft in a private agency, because each average assessment takes about nine to 12 hours. That is a lot of time and money when social care budgets are being squeezed.

One of the main aspects worrying me on behalf of my constituents is the consequences of guidance issued by the Chief Coroner to local coroners in December 2014, subsequent to the Supreme Court judgments. The guidance stated that all deaths of people subject to a DOLS order must be investigated by the coroner, whether the death was from natural causes or not, and that such people were deemed to be “in state detention”.

As a result, when a dementia sufferer subject to a DOLS dies in a care home, GPs have to notify police, who must come and sit with the body until it is collected by the coroner’s mortician to be taken to the hospital mortuary, where it has to be formally identified before a formal inquest process starts. That system is causing untold distress to relatives and leading to an increased workload throughout the public sector. I understand that Peter Fahy, the chief constable of Greater Manchester police, has written to adult social care teams looking for information amid concern about how the changes will impact on police time and resources.

One lady contacted me about her 86-year-old husband, who has Alzheimer’s and lives in a care home. She was very distressed about what would happen when he died and to learn that he was classed as being in state detention:

“He’s not a prisoner just because he has a lockable door. He is not in prison—he has done nothing wrong.”

The couple have been married for 60 years and she visits him every day.

Another lady, whose father lives in a care home, told me:

“I am absolutely appalled at the ruling that residents in a care home with dementia and their families, need to be put through so much after death. Not only will it be a drain on public services that are already stretched to the limit but it will also prolong the agony of the grieving families at a really stressful and upsetting time.”

She added:

“I would like the guidance to be looked at again with more compassion towards grieving families.”

Nationally, there have been reports of relatives of dementia sufferers who pass away in care homes being forced to wait months to bury loved ones because of the rules.

In addition to individual constituents, I have been approached by the local GP practice in Brinnington, Stockport, an area in which there are 234 elderly care beds and five care homes, most of whose residents have some form of dementia. The GPs have said that they are worried that the Chief Coroner’s advice will have an enormous and far-reaching impact across a great many services,

“not least affecting patients and grieving relatives.”

Their main concern is that those subject to DOLS must have their death reported to a coroner. They pointed out that, technically, that could involve every single care home resident in Stockport: all care homes have lockable doors to help to protect resident welfare, so every resident could be liable to a DOLS assessment.

Nationally, doctors are unhappy. The British Medical Association is calling for an urgent review of DOLS to simplify the system, which it says is a time-consuming and cumbersome process that will divert resources from front-line services.

I wrote to the Chief Coroner, Judge Peter Thornton QC, to express my concerns. He confirmed in a reply in March that, in his view of the law,

“and as I set out in the Guidance, persons who die in a hospital or care home subject to an authorised DoLS die ‘in state detention’. Their death must therefore be referred to and investigated by the Coroner.”

He said that that interpretation of the law was shared by the Ministry of Justice and the Department of Health, and was also the view of the Labour Government during the passage of the Coroners and Justice Act 2009. However, he accepted that

“the consequences of the law… may not have been appreciated at the time of enactment. They involve consideration by Coroners of all DoLS cases even where the death was from natural causes. That is unfortunate and may cause extra distress to the bereaved families, which should be avoided if at all possible.”

He went on:

“Within the framework of the law at present, I am therefore considering ways of easing the burden of such cases on families and easing the extra burden of work for coroners (an additional expense for local authorities). But this in itself may require a change in the law which will be a matter for Parliament.”

I understand that the Law Commission is reviewing DOLS following a critical report by a House of Lords Select Committee in March 2014—ironically, a few days before the Supreme Court ruling that said DOLS were “not fit for purpose”. However, the Law Commission’s recommendations are not due until 2017 and there might be no change in practice until 2020.

The setting up of the post of Chief Coroner was quite controversial. There were concerns that trying to introduce uniformity to the system would take away discretion from experienced local coroners, and it would appear that that is exactly what has happened in this regard. Local coroners, who make decisions every day about whether to have inquests, now feel obliged to have an inquest on someone because they were subject to a DOLS even though their death was entirely expected. The need for an inquest is being determined not by the nature of the death, but by a person’s status of being in state detention when they died.

I have been told about a case of a lady who died of natural causes in a care home and was cremated, only for it to be discovered afterwards that she was subject to a DOLS. The coroner then had to get permission to carry out an inquest in the absence of a body. The family were very upset because they had to revisit the death. Another elderly gentleman subject to a DOLS died of a type of cancer of the lung often linked to exposure to asbestos, and there now has to be an inquest with a jury because that is an unnatural cause of death for someone subject to a DOLS. That all takes time and money.

The Chief Coroner’s guidance, however, is essentially his opinion. Paragraph 46 of the guidance states:

“The Chief Coroner, who sits in the High Court on coroner cases, is not providing a judgment or ruling. This guidance is no more than the expression of an opinion, subject to the ruling of the High Court. Coroners, who are of course entitled to make their own independent judicial decisions, will do as they see fit in any particular case. But they are invited to take this guidance into account.”

The Chief Coroner may argue that it is therefore up to local coroners to make decisions, but the last sentence of the paragraph has been interpreted by local coroners as an order rather than guidance. The Chief Coroner, of course, has the authority of a judge. If that last sentence was removed, local coroners might feel they had more discretion over when to hold an inquest.

In reference to state detention, the Chief Coroner says in his guidance that there are two alternative views. The first is that the death of a person in hospital or a care home who was subject to a DOLS would not automatically require a coroner’s investigation. Indeed, in most cases there would be no need for an investigation, although the coroner would have to decide case by case whether one was necessary. However, the Chief Coroner has taken the second view, which is that a person subject to a DOLS

“falls squarely within the 2009 Act’s definition of ‘in state detention’.”

Given the distress caused to relatives, the diversion of resources from front-line care and the Chief Coroner’s stated objective of easing relatives’ suffering, it is time for him to reconsider his position on state detention.

Without a shadow of a doubt, that phrase, “state detention”, is causing great upset to relatives who, on top of their grief, have to cope with all the additional formality of process accompanying a state detention, such as, for example, the attendance of the police and an inquest. Further, if all the applications for 2014-15 had been processed, we would have had an additional 142,902 people in state detention. That could give rise to a misunderstanding among the international community, which might think that we were approaching the levels of detention in North Korea.

Although DOLS were introduced with good intentions, the situation is now out of control. The police, GPs and coroners are overloaded, local authorities are spending millions of pounds from reserves, grieving relatives are in terrible distress and two thirds of all applications are not being processed, meaning that some people are not being protected by a DOLS and could be having their liberty curtailed unnecessarily. Frankly, this is a tsunami and it is fast sweeping over us. We cannot wait until 2017 for the Law Commission review. We need a solution urgently.

There is also concern that some applications are unnecessary. Care home residents have differing capacities and the fact that a care home has some locked doors does not mean that every resident, as a matter of course, should be referred for a DOLS. The Care Quality Commission has an important role to play as an inspectorate to ensure that there is proper understanding of the Mental Capacity Act and DOLS among care providers, as well as an understanding that they need to provide environments that are flexible to residents’ needs, so as to ensure the greatest liberty consistent with their capacity. I welcome the CQC inspection regime of adult care that began in April 2014.

Care England represents independent care providers. Its main concern is the time it takes to process assessments, which has led to many providers being placed in a position in which their services are being inspected by the CQC yet they do not have DOLS authorisations in place for all the residents who should have them. Care England also stresses that the delay in burials caused by waiting for inquests is upsetting cultural norms. For example, there are care homes solely for members of the Jewish faith, whose beliefs require a quick burial after death. If the coroner has to carry out a full investigation, that will preclude the family from being able to carry out a quick burial.

I suggest the following way forward to the Minister. The Law Commission review should be speeded up and conducted urgently, before 2017. In the meantime, opportunities should be taken to change the law to make it clear that not all deaths need an inquest. The Chief Coroner should be invited to look again at his guidance and review it in relation to state detention and automatic inquests. The Minister could consider mounting a legal challenge to the Chief Coroner’s guidance on behalf of all those adversely affected by the administration of DOLS, including those residents in care homes whose applications have not yet been processed. Perhaps the Government might consider whether state detention should now be statutorily defined and finally conduct an urgent review of the DOLS regulations to simplify this bureaucratic and time-consuming system—for example, the fact that DOLS have to be reassessed automatically every 12 months.

The system takes a sledgehammer approach, which is not remotely sensitive, and the issue has aroused widespread concern. My concern, on behalf of my constituents, is that when their loved ones die in a care home they should not have their grief exacerbated. They have often spent months deliberating about admitting their relatives to a home and feel guilty that they cannot care for them themselves. The process now surrounding the death of a person subject to DOLS adds immeasurably to their distress. When someone asks, “How did your mother die?”, who wants to reply, “In state detention.”? The situation must be resolved.

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to serve under your chairmanship once again, Mr Davies. I thank the hon. Member for Stockport (Ann Coffey) not only for raising an issue that she is closely involved in and has a great deal of knowledge about, but for kindly sending my office a copy of her speech to enable us to give the best possible response. I appreciate both that and the detailed but measured way in which she presented what has become a very difficult situation. She quoted the Chief Coroner as saying that

“the consequences of the law, however, may not have been appreciated at the time of enactment.”

If we all had £1 for every time that phrase was uttered, we would all be fairly rich. In answer to his quote, I would say, “You bet they weren’t,” but let me develop my argument further.

I welcome the opportunity to provide clarity and more information about what my Department is doing to support professionals in relation to DOLS. DOLS derive from the simple premise that a person who may lack capacity through a mental health disorder and is receiving care and support from the state has as much right to freedom of movement and choice as someone with full capacity. The background to DOLS is not always appreciated, but it is important, and I doubt that there is any difference between the hon. Lady and I on that point.

The phrase “deprivation of liberty” is, like “state detention”, an emotive one and derives from the legal framework. It may seem counterintuitive, but in some circumstances, a deprivation of liberty can be entirely appropriate in providing care and treatment for an individual who may lack capacity. Furthermore, it is worth emphasising that DOLS are firmly based within the Mental Capacity Act and, as such, reflect the Act’s core principles: namely, that a person’s wishes and feelings must be central to the decision-making process, and that the least restrictive form of care and treatment should be pursued wherever possible.

I stress that DOLS are a positive tool in that the assessments undertaken ensure that when a person is—in the legal sense—deprived of their liberty, it must be in their best interests. I entirely agree with the hon. Lady that where DOLS are working effectively, they can prevent unnecessary restrictive measures and prevent people with dementia from being required to stay in one place simply because it is easier for staff.

As the hon. Lady said, until March 2014 the number of DOLS assessments a year was approximately 13,000. The Care Quality Commission noted in its annual reports that that figure seemed low. Then, in March 2014, in the case of Cheshire West, the Supreme Court clarified the law on what constitutes a deprivation of liberty by setting out a so-called acid test. I will not repeat that test now because the hon. Lady and the House know it well, but it is clear that the effect of the Supreme Court judgment has been to lower the threshold for what constitutes a deprivation of liberty when compared with previous standard professional practice. Official statistics from the Health & Social Care Information Centre have borne that out, showing that there have been 113,000 applications in 2014-15—roughly a tenfold increase on the previous year.

I will turn to the wider issues related to that in a moment, but let me concentrate first on the implications for coroners, which the hon. Lady spent the majority of time dealing with in her speech. The Supreme Court’s judgment had a number of unforeseen implications. One, which I know to be of particular concern to her, is the rise in coroners’ investigations.

The Chief Coroner for England and Wales has provided guidance to coroners in which he states his view that, under the Coroners and Justice Act 2009, the death of a person who is subject to a DOLS authorisation is regarded as a “death in state detention” and, as such, should be subject to a coroner’s investigation. Helpfully however, the Chief Coroner states that coroners are able to make their own judgment on that matter. He also states that, where appropriate, any inquest could be paper-based and certainly that neither a jury inquest nor a post mortem is required. None the less, I have heard distressing reports of coroners’ investigations leading to unforeseen delays in funeral arrangements and causing great anguish for relatives.

The Department has issued guidance urging local authorities to work closely with their coroner to develop a proportionate response. I am aware that many have done so and, for the time being, that may be the way through the difficulties. I can tell the hon. Lady today that my Department will issue further guidance on this specific matter in the next few weeks. Furthermore, I commit to writing to the Chief Coroner to ensure that we are doing all we can to encourage an approach that minimises the potential distress to relatives.

[Ann Coffey]

As I think I said in my speech, part of the problem is that the Chief Coroner is a judge and his guidance is seen as a question of law. If he could perhaps make it clearer that he is giving discretion to coroners, that might also help move things forward. Might the Minister take that up with the Chief Coroner?

[Alistair Burt]

The hon. Lady, in her concluding remarks, suggested that there might be a legal challenge to the Chief Coroner, but at this stage, I am not persuaded that that would be the best way forward. Perhaps we might leave it at this: depending on the Chief Coroner’s response to my letter, I might seek a meeting with him, so that I might have the opportunity to talk to him in a slightly different manner about some problems that the hon. Lady has raised and get an opportunity to take things further. I ought to get the Chief Coroner’s written response in the first place, but I appreciate her point of view.

We want to encourage an approach that minimises relatives’ potential distress, which, as the hon. Lady set out, can be severe. The key to best practice is good communication and information exchange between partners in the system. Leicester City Council is indicative of a local authority that has worked closely with its local coroner. Together they have designed a shared protocol that includes the clear steer that, unless there are suspicious circumstances, notification of a death can wait until office hours, negating the need for distressing out-of-hours visits from uniformed police officers. In the vast majority of those cases, police involvement will not be necessary. Certainly, 999 calls are not appropriate.

I am grateful to the hon. Lady for stressing the importance of this issue. The Law Commission, which I will refer to in a second, is also looking at the issue of coroners’ investigations, and I want to see the results of that.

Let me say more about the Law Commission, having dealt with coroners to an extent. The Government’s policy is twofold in dealing with the significant challenge that has been given to local authorities and health and care providers now charged with implementing DOLS. First, we seek to understand whether legislative change can provide a system that is sustainable in the long term and that better balances the protection of individuals against the need for minimum bureaucracy to ensure that existing limited resource is maximised. Secondly, we are seeking to provide practical support and guidance to manage the challenges in the interim.

The case for a thorough review of the legislation in this area is unambiguous. The legislation underpinning DOLS was introduced by the then Government in 2007. It was criticised by Select Committees of both Houses, even before the implications of the Supreme Court judgment became clear. Following the judgment, the Government are funding the independent Law Commission to review the legislation underpinning DOLS. It will launch a four-month public consultation on a proposed new scheme on 7 July 2015.

Following the hon. Lady’s intervention, it has occurred to me that she and other parliamentary colleagues may appreciate a dedicated consultation event with the Law Commission on the parliamentary estate. If she agrees, I shall endeavour to make arrangements for that. I will contact the Law Commission to suggest such an event and I hope that it might want a session here so that it can listen to the expertise of colleagues. I am sure the commission would benefit from such expertise, and I will write to her and let her know what it makes of that suggestion.

Given the criticism of the current DOLS legislation, and bearing in mind the likelihood of unintended consequences, I strongly believe that it is important for the Law Commission to be given the time to consider the entire legislation in the round and, if appropriate, propose a comprehensive solution. It would be unwise to rush into specific legislative changes, the repercussions of which might not be clear, so I am not tempted at the moment to make any changes to the regulations.

However, I agree with the hon. Lady on greater urgency. The Law Commission’s review was scheduled to be completed, in the form of detailed policy proposals and a draft Bill, in the summer of 2017. I think, having taken up my duties, that that needs to happen quicker. Accordingly, I have proposed, and the Law Commission has agreed, an acceleration of the review to ensure that it will now be completed, in the form of detailed policy proposals and a draft Bill, by the end of 2016. I know that that is still some time away, but bearing in mind the complexity of the issue, I do not think we can afford to get the next bite at this wrong, so I hope that the hon. Lady welcomes that news.

In the interim, my Department has been working with various partners to support the system’s response to the Supreme Court judgment. I reiterate now that the response to that judgment must be rooted in the principles and values of the Mental Capacity Act. Our efforts have to be focused primarily on realising real benefits for individuals. DOLS are about people, not paperwork. My Department has issued clear guidance that has emphasised the importance of a proportionate Mental Capacity Act-centred approach, and emphasised that so-called bulk applications for all the residents of a care home are not acceptable. DOLS apply only to those who lack the specific capacity to consent to their accommodation. Many in care homes and hospitals will have that capacity and so not be eligible for DOLS. That must be made clear.

We recognise that the scale of the challenge set by the Supreme Court means that some local authorities will be unable to process DOLS applications within the 21-day legal timeframe. The Care Quality Commission has been clear that providers will not be unfairly punished for such technical breaches. However, the CQC has been equally clear, quite rightly, that a do-nothing approach is unacceptable, so providers and local authorities must have a plan in place for ensuring that those who stand to benefit most from a DOLS assessment receive one in a timely manner.

The Department has funded a reduction in the non-statutory bureaucracy accompanying the DOLS process, reducing the number of application forms from 32 to 13. The Association of Directors of Adult Social Services, which delivered that project, deserves particular praise for the support it has provided to its member organisations since the Supreme Court judgment.

The Department has funded the Law Society to produce excellent comprehensive guidance, in collaboration with practitioners, to assist in identifying a true deprivation of liberty, and in March this year, the Government announced that they would provide local authorities with an extra £25 million to support their efforts on DOLS in 2015-16.

I reassure the hon. Lady that I understand the concerns that some local authorities have about the cost of DOLS, and I praise the hard work of local DOLS teams. However, I am aware that there is considerable variation among local authorities as regards the number of applications that they have been able to process. Clearly, it is important that we identify and learn from current best practice, so my officials are in close contact with providers and local authorities, and I have instructed them to make further visits across England this summer to continue to understand the local response.

Although some may baulk at the idea of 100,000 DOLS applications a year, we should remember that every one of those applications represents a person having their care independently scrutinised. DOLS can help to shine a light on care that is unnecessarily restrictive and does not put the person’s views first and foremost. Therefore, we should strongly back the principles of DOLS. Our shared challenge now is, through the Law Commission review, to understand how those principles can be better applied in the day-to-day reality of the health and care system and after the unintended consequences of the judgment.

I thank the hon. Lady for raising these important issues. My Department and I would be grateful for any further insight she may have, conscious as we are of her expertise in the social care field. I hope that we have touched this afternoon—

NHS (Five Year Forward View)

Ann Coffey Excerpts

Monday 1st December 2014 Commons Chamber

[Ann Coffey (Stockport) (Lab)]

I welcome any extra funding for the NHS, but will the Secretary of State ensure that it is fairly distributed, as on the current funding formula, Stockport is 4.9% from target, and that is affecting the ability of the clinical commissioning team to develop health services in the community as an alternative to emergency admissions to Stepping Hill hospital?

[Mr Hunt]

I recognise the hon. Lady’s concern about the way funding is allocated, and it is a concern that is shared in all parts of the House. It has been very difficult to get that right in a period when NHS funding has not been going up by large amounts, but that matter is now decided at arm’s length from Ministers by NHS England. It will make its decisions at a board meeting on 17 December, and I will make sure that I relay to it her concerns.

Oral Answers to Questions

Ann Coffey Excerpts

Tuesday 25th November 2014 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for his question. After the Francis report, we now have 5,000 more nurses on our hospital wards. The scores that patients themselves are giving for whether they are treated with dignity and respect are up by 10%. We want to put poor care behind us and behind the NHS. It is time that Labour got on board with this agenda instead of constantly saying that we are running down the NHS by sorting out poor care.

[Ann Coffey (Stockport) (Lab)]

T5. Recent reports indicate that the extent of child sexual exploitation and abuse is more widespread than previously recognised. The trauma of sexual abuse can have massive, life-long consequences on the physical and mental health of victims. Will Ministers consider designating child abuse and child sexual exploitation as a public health priority in the same way as smoking, alcohol, drug use and obesity?

[Jane Ellison]

The hon. Lady is quite right to say that those are incredibly important issues, and we do see this as an important public health issue. We are committed to tackling child sexual abuse. In May the Department published its response to the recommendations of the independent health working group report on child sexual exploitation and we accepted the recommendations in full. We are taking this very seriously.

NHS Investigations (Jimmy Savile)

Ann Coffey Excerpts

Thursday 26th June 2014 Commons Chamber

[Mr Hunt]

I am afraid that I do not know the details of that particular case, but I will look into it and write to the hon. Gentleman.

[Ann Coffey (Stockport) (Lab)]

Is not one of the wider problems our perceptions of how a sexual predator looks and acts? When men like Savile are arrested, the usual reaction is shock that such a nice man could abuse children, but sex predators are not men in dirty raincoats; they come from all walks of life and all professions. That perception means that children are not being heard. Will the Secretary of State make preventing as well as detecting child sexual abuse a public health priority? It is only through a better informed public, more aware of how predators such as Savile behave, that we will be able to protect children from abuse.

[Mr Hunt]

I completely agree, and that is one of the big lessons. The shadow Home Secretary was absolutely right to say that this issue raises serious questions about the nature of celebrity in our society. One of the reasons that totally inexcusable things happened—such as being given the keys to Broadmoor—was that somehow on the basis of Savile’s image people made wrong assumptions about him. The hon. Lady is absolutely right. One of the things that will change as a result of this investigation is that people will be more willing to challenge those who previously were not challenged. But there is a long way to go.

Oral Answers to Questions

Ann Coffey Excerpts

Tuesday 1st April 2014 Commons Chamber

[Dr Poulter]

These are questions that the Opposition should have thought about—the hon. Lady was a Minister in the previous Government—when they negotiated the redundancy terms. They are Labour’s redundancy terms, which we are changing. When we look at the figures, under the previous Government’s NHS reorganisation in 2006 to 2008, we see that the NHS spent more than £360 million on redundancy and early retirement alone, which compares with only half that—£178 million from 2011 to 2013—under the current Government. How much more money would have been available for staff pay had the previous Government got that right?

[Ann Coffey (Stockport) (Lab)]

4. What representations he has received on community pharmacies.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

We receive a number of representations about community pharmacies over any period. Of course, they play a vital role in their local area, providing high-quality care and support and improving people’s health, especially in hard-to-reach communities. For example, more than 5,000 pharmacies assist with smoking cessation work.

[Ann Coffey]

I thank the Minister for her reply. With GPs managing demands on their time by operating longer waiting lists for appointments, to the increasing frustration of my constituents, is it not time for a more radical change in the role of community pharmacists in primary care? Does the Minister agree that any proposals to reorganise health services in Greater Manchester should fully explore the contribution that pharmacists can make—for example, in supporting people with long-term conditions or prescribing for minor conditions?

[Jane Ellison]

The hon. Lady is right to say that pharmacists have a great role to play, and she has given a good example of their helping people to manage long-term conditions and helping people with their medication. NHS England’s community pharmacy call to action has stimulated the debate about where community pharmacies should sit. We see them as a vital part of front-line services, and I am glad that the NHS is looking at their role in the round, because it is a really important one.

Sexual Health Data

Ann Coffey Excerpts

Thursday 13th December 2012 Commons Chamber

[Ann Coffey (Stockport) (Lab)]

Over the past 20 years, we have seen numerous high profile inquiries and serious case reviews after children have been harmed and abused. Each one has said that failures in data sharing and ineffective inter-agency working played a significant role in the child’s injury or death. Lord Laming’s progress report on child protection in 2009 following the Victoria Climbié and baby P inquiries stated:

“Despite the fact that the Government gave clear guidance on information sharing in 2006 and updated it in October 2008, there continues to be a real concern across all sectors, but particularly in the health services, about the risk of breaching confidentiality or data protection law by sharing concerns about a child’s safety. The laws governing data protection and privacy are still not well understood by frontline staff or their managers. It is clear that different agencies (and their legal advisers) often take different approaches.”

Disappointingly, that was echoed nearly three years later in the recent report by Sue Berelowitz, the deputy Children’s Commissioner, into sexual exploitation in gangs and groups. She highlighted the difficulties that she had experienced in collecting data from health agencies.

The overarching aim of year one of her inquiry was to identify the prevalence of child sexual exploitation and the warning signs that victims present, and to quantify the number of children at risk. She identified 16,500 children as being at high risk, using multiple indicators, and said that the figure would have been higher if the inquiry’s attempt to obtain health data had not been frustrated by “patchy” and “inconsistent” responses.

Of the 14 “signs” or behaviours generally seen in children who are already being sexually exploited, six relate to data collected by health organisations. Those health signs are: physical injuries; drug or alcohol misuse; repeat sexually transmitted infections, pregnancy and terminations; poor mental health, and self harm and thoughts of suicide. It was therefore important for the purposes of her inquiry that the deputy Children’s Commissioner was able to access that information.

Initially, it was her intention to collect individual level data in relation to children who have repeatedly attended clinics with sexually transmitted diseases and had had more than one abortion. The intention was to share the data with other known CSE indicators to assess the prevalence of child sexual exploitation.

However, because of current regulations it was not possible to get individual data on terminations. On sharing sexual health data, there were different legal opinions from the Department of Health, the Office of the Children’s Commissioner and individual primary care trusts. The Department took the position that it would share its legal counsel and direct areas to not share that data. Aggregate national data provided by the Health Protection Agency and the Department of Health showed that 11,800 children had presented at a sexual health clinic on more than one occasion, 900 of whom had a repeat sexually transmitted infection, and 1,193 children under the age of 16 had an abortion who had also had at least one earlier termination. Those numbers indicate how important it is to have individual sexual health data to identify children at risk of child sexual exploitation.

The Department said a decision on substance misuse/mental health data could be made at a local level. Services operating in 41% of primary care trusts around mental health provided individual level data, while services operating in 30% of PCTs around substance misuse provided it. Those differences in data provided by PCTs indicate the wide variation in interpretations of existing law, regulations and guidance. A central request to the National Treatment Agency for Substance Misuse, which collects individual data on people accessing substance misuse units nationally, was also refused due to concerns about breaching the Data Protection Act 1998 and health regulations. In the end, the National Treatment Agency provided aggregate level data that was not possible to match with the other indicator data obtained at an individual level.

In answer to my parliamentary question last week, I am aware that the Minister has commissioned Dame Fiona Caldicott to lead a review on the sharing of health data that strikes an appropriate balance between the protection of confidential and identifiable information, and the use and sharing of that information for research and a range of other purposes. Given the extent of the numbers of children attending sexual health clinics, it is crucial that, for example, the frequency of visits to a sexual health clinic, which may be an indicator of sexual exploitation, is capable of being shared alongside other health data at a local children’s safeguarding board level if we are serious about better protecting children from child sexual exploitation. The problem is not only confined to the health professional sharing information with non-health professionals, but it seems that there are problems with health professionals sharing information with each other.

Anecdotally, the other day I was told by a GP that he had contacted a health visitor to discuss an issue relating to a family he was concerned about, and was told by the health visitor that he had to get the patient’s permission to do so. The General Medical Council issued guidance to doctors in July 2012 on information sharing, but of course this was not issued to health visitors. Unless we resolve the confusion about data sharing, it is going to result in different practices in different areas. In some areas, emphasis on confidentiality may mean that a child is continuing to be exposed to risk of child sexual exploitation because data that could identify the risk are not being shared, while in another areas, because of different practices, appropriate interventions are being made.

I have come across similar barriers to data sharing as chair of the all-party group for runaway and missing children and adults. It seemed to us incredible that Ofsted was not able to share the names and addresses of children’s homes with the police because of existing regulations. I am pleased that the Government are now consulting on a change to the regulations that would allow this to happen. On the face of it, it seemed like a good principle to keep a child’s address secret. However, in trying to safeguard one piece of information about a child’s life, we were exposing that child to undue risk. It is the same with sharing sexual health data, where we are often looking at complex issues of confidentiality versus safeguarding. It is a shame that having sorted out data in one area, we still see barriers in another.

This is a difficult area, and it is made all the more difficult by the fact that there is separate guidance from the Department of Health and the Department for Education. To give one example, the Department of Heath guidance about patient confidentiality issued in 2003 says that NHS professionals must take all necessary steps to secure any information capable of identifying an individual examined or treated for any sexually transmitted disease, and that it shall not be disclosed except where there is consent to do so or to prevent the spread of the disease. The updated guidance on November 2010 says that decisions about disclosures of confidentially sensitive information must be made case by case. Having read both these sets of guidance, I find it easy to see how there can be widely differing interpretations of what data to share and with whom.

We also have statutory guidance from the Department for Education entitled, “Working Together to Safeguard Children”. It was published in 2010, but is currently being revised. The 2012 consultation paper stresses that partners and agencies should proactively share information with each other and with the local safeguarding children boards. It says that from 2010 to 2011, 615,000 children in England were referred to children’s social care services by individuals who were concerned about their welfare. The guidance goes on:

“A consistent message from research, which has been reinforced in every high profile inquiry on child protection, is that children are best protected when professionals are clear about what is required of them individually, and how they need to work together... It is important that children receive the right help at the right time. For that to happen, everyone who comes in contact with them has to play a role in identifying concerns early, sharing information, and taking prompt, informed action. This will involve a range of professionals - for example midwives, health visitors, GPs, early year’s professionals, teachers, police officers, youth workers voluntary workers and social workers. It will require all professionals to be vigilant and take prompt action when they suspect that a child is suffering harm.”

The guidance also points out that, under section 11 of the Children Act 2004, public heath and NHS organisations are among those key organisations that have a statutory responsibility to make arrangements to ensure their functions are carried out with regard to safeguarding and promoting the welfare of children. The Government are rightly urging local agencies to work together more effectively to safeguard children from child sexual exploitation, but the confusing and conflicting guidelines from the Department of Health and the Department for Education are creating barriers to effective data-sharing arrangements at a local level.

The confusion over current guidelines on sharing health data is giving rise to different interpretations and practices locally, which has led to a postcode lottery when it comes to safeguarding children. I have another anecdotal example. At a child sexual exploitation meeting in Greater Manchester where professionals were sharing data to try to assess the risk to a particular girl, it transpired that the girl had attended accident and emergency for treatment—a fact that had not been disclosed by the health worker present. She subsequently said that she thought that health information was confidential.

We are also facing big organisational change in the health service and in Greater Manchester. For example, several sexual health services run by different primary care trusts are due to be transferred to 10 local councils in 2013. I am pleased that Greater Manchester is trying to work towards a consistent interpretation of the different guidance from the Department of Health and the Department for Education for the whole of the Greater Manchester. It cannot be right that the safety of a child at risk of child sexual exploitation is dependent on where they live.

I hope that, in her review, Dame Caldicott will bring together existing guidance from both Departments that will allow local safeguarding children boards to share information in the best interests of the child. The importance of the proper collection of data and data sharing cannot be over-emphasised. The all-party group’s report in June emphasised the link between going missing and the risk of sexual exploitation, but no one fact will be enough and often something that does not seem significant to one agency might assume greater significance when placed with a fact picked up by another agency.

For example, a child who is reported missing for repeated periods, but not for any great length of time, might be the same child who visits a sexual health clinic with an older man. Those two factors being put together would set alarm bells ringing, whereas in themselves they would not seem significant. That is the value of sharing information. It is surely wrong that a child can walk out of a sexual health clinic back to a predator without alarm bells being rung. I am not advocating the routine sharing of every visit by every child to a sexual health clinic, but I believe that health and other professionals need better guidelines and training about when they should share information in the interests of safeguarding a particular child.

Given that identification practices of child sexual exploitation vary significantly across the country, with many areas adopting a reactive approach, accurate data are essential. That is particularly important in relation to black and minority ethnic victims. The Office of the Children’s Commissioner found it difficult to find information about that group of victims, although it established under-reporting of child sexual exploitation in BME communities. That information is significant, given that the general perception appears to be that sexual exploitation by gangs and groups is primarily a crime committed against white children. We have to be able to establish the true extent of sexual exploitation in BME communities, as well as understanding the underlying reasons for under-reporting. Those children have a right to our protection. That makes it even more critical that these sexual health indicators, which indicate risk, should be shared with other agencies.

Sharing data on health is vital in protecting children. These data will be of most value when matched with the data collected by police on missing incidents, by local authorities on absence from school and by youth offending teams, to identify and safeguard all children at risk of being sexually exploited. Lord Laming described the situation eloquently when he said:

“Whilst the law rightly seeks to preserve individuals’ privacy and confidentiality, it should not be used (and was never intended) as a barrier to appropriate information sharing between professionals. The safety and welfare of children is of paramount importance, and agencies may lawfully share confidential information about the child or the parent, without consent, if doing so is in the public interest.”

This week Sue Berelowitz summed up the problem when she told the Select Committee on Home Affairs that misunderstandings about the Data Protection Act were

“getting in the way of children being protected”.

It is surely time to ensure clearer guidance about the disclosure of health information in the interests of protecting vulnerable children, who should be the main focus of our concern. I hope the Minister will respond by sending out a strong message to that effect.

Oral Answers to Questions

Ann Coffey Excerpts

Tuesday 18th October 2011 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

My hon. Friend is absolutely right to highlight how well-intended regulation can sometimes be a way of blocking effective growth and the opportunities available for new people to set up businesses in the care sector. I would be very happy to meet my hon. Friend to discuss that matter.

[Ann Coffey (Stockport) (Lab)]

Stockport is one of only five PCTs in the country that does not provide any in vitro fertilisation treatment—in spite of recommendations from the National Institute for Health and Clinical Excellence. Does the Secretary of State think it fair that my constituents, who pay the same taxes as everybody else, do not get the same access to this treatment as people living elsewhere?

[Mr Lansley]

The hon. Lady will know, I hope, that the deputy chief executive wrote to primary care trusts a few weeks ago further to remind them of the need to respond to NICE clinical guidelines. It was the hon. Lady’s Secretary of State, John Reid who, when NICE published its guidelines, told PCTs in 2004 that they should not follow them.