Government's Alcohol Strategy

Anna Soubry Excerpts

Monday 17th September 2012 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

We are today laying before Parliament the “Government Response to the House of Commons Health Committee Report of Session 2010-12: Government’s Alcohol Strategy” (Cm 8439).

The Committee gave a positive welcome overall to the Government’s alcohol strategy and welcomed in particular the decision to introduce a minimum unit price for alcohol. The Committee made some important points about the need to set out the evidence behind this policy and its implementation. We will address these points when we consult on the level of minimum unit price and other proposals set out in the strategy during the autumn.

We welcome the Committee’s argument that the alcohol industry’s participation in the responsibility deal is “intrinsic to responsible corporate citizenship”. We fully agree with the Committee that it is not a substitute for Government policy.

We are committed to reversing the long term rise in both health and social harms from alcohol misuse and have set out in the strategy a number of challenging ambitions by which our success will be judged.

We welcome the Committee’s support for effective local action, such as that in Birmingham, and the opportunity they recognize for local authorities and others, supported by Public Health England, to address the serious problems caused by alcohol misuse in local communities.

Today’s publication is in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

NHS Cancer Services

Anna Soubry Excerpts

Friday 14th September 2012 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate my hon. Friend the Member for Basildon and Billericay (Mr Baron) on securing the debate. I am aware of the excellent work that he has done with the all-party parliamentary group and with cancer charities to promote the inclusion of relevant cancer indicators in the NHS, public health and commissioning outcomes frameworks.

As you will know, Mr Deputy Speaker, there is a lot of terminology in the Department of Health—to which I am very pleased to have been appointed—and I apologise at the outset for any jargon that is used. One thing is certain: my hon. Friend will be more than familiar with it. However, I hope to explain the position in as much plain language as possible.

I am fully aware of the frustration felt by my hon. Friend, his all-party group and the cancer charities over the recommendations from the National Institute for Health and Clinical Excellence about the indicators for the commissioning outcomes framework and the difficulties that are likely to occur in 2013-14, but I can assure him that a methodology for possible one-year and five-year survival rate indicators for potential inclusion in COF is under way. I hope he will accept that that is good news, as is the fact that work is also under way to investigate composite cancer survival indicators at both national and clinical commissioning group level. I will say more about that, but I wanted to begin by reassuring my hon. Friend that we had taken his previous points fully on board.

As my hon. Friend knows, the Government published “Improving Outcomes: A Strategy for Cancer” in 2011. It set out our ambition to halve the gap between England’s survival rates and those of the best in Europe. My hon. Friend spoke of the disappointment that many people feel about our survival rates, and said that everyone wanted them to improve. It is estimated that halving that gap would save 5,000 more lives every year by 2014-15. The strategy is intended to reflect the importance of improving outcomes through the five domains—or areas, as I would call them—of the NHS outcomes framework: preventing people from dying prematurely, improving the quality of life for people with long-term conditions, helping people to recover from illness or injury, ensuring that people have a positive experience of care, and treating and caring for people in a safe environment and protecting them from avoidable harm.

In recognition of the fact that cancer is a big killer—more than 130,000 people die of the disease each year—we have included seven cancer indicators in domain 1 of the NHS outcomes framework. They cover the under-75 mortality rate from cancer and one and five-year survival rates for three major cancer killers, namely colorectal, breast and lung cancer. In addition, two overarching indicators will include cancer data: potential years of life lost from causes considered amenable to health care, and life expectancy at 75.

My hon. Friend has urged us previously to consider other indicators that would reflect improvements in survival rates for rarer cancers, and he mentioned them again today. I can confirm that we have asked the London School of Hygiene and Tropical Medicine to develop composite indicators that might allow improvements in survival rates across all cancers to be assessed. We hope to be able to make a decision in time for the NHS outcomes framework for 2013-14, which is due to be published later in the autumn.

[Mr Baron]

I am heartened by what the Minister is saying, but does she appreciate our view that a composite index should complement the one and five-year survival indicators rather than replace them? We fear that a composite index will mask bad news on rarer cancers with improvements on the more common cancers, which would have greater force in the index because they are more numerous.

[Anna Soubry]

I thank my hon. Friend for making that point, and I certainly take it on board. If there is anything that I am not able to cover in the short time that is available to me today, we will write to him; and, as he knows, my door is always open so that we can continue the debate. It is important, and it is especially important that we do things right.

The NHS Commissioning Board will translate the national outcomes goals for the NHS into measures that are meaningful at a local level in the commissioning outcomes framework. The board authority is now working with clinical commissioning groups and other stakeholder organisations to discuss the shape of the commissioning outcomes framework for 2013-14 and beyond. COF will play an important role in driving up quality in the new system. Covering £60 billion in services commissioned by CCGs across the NHS, it will translate the NHS outcomes framework into clear, comparative data on the quality of services that CCGs commission for their local populations and the outcomes achieved for patients.

Concerns have been expressed that the NICE COF advisory group recommended only one indicator for inclusion in COF and, in particular, that the group recommended no survival rate indicators. NICE’s advisory group is independent of both the Department and the NHS Commissioning Board. NICE was asked to give advice on potential measures to include in the framework, based on the best available evidence. It is now for the NHS Commissioning Board to decide on its final shape for 2013-14.

The NHS Health and Social Care Information Centre has been asked to work with the London School of Hygiene and Tropical Medicine and the Office for National Statistics to develop a methodology for one-year and five-year survival rate indicators for potential inclusion in COF. These will be composite indicators, because of the difficulties associated with getting statistically valid indicators for individual cancers at CCG level.

[Mr Baron]

The national one-year and five-year figures for the three main cancers have been calculated. They must have been drawn from local figures. Experts in this area tell me that once the boundaries are known, it should be possible to slice those figures to show the one-year and five-year picture at a local level.

[Anna Soubry]

The difficulty is that the numbers in each CCG might be very small indeed, and therefore the statistical benefit will be limited. It may well be possible to look at the situation in respect of the health and well-being boards, however; we might be able to look at this at a local authority level.

[Mr Baron]

The Minister is being very generous in giving way, and one of the purposes of Adjournment debates is to enable us to have a bit of a discussion. I take on board her point, but the CCGs are larger than was originally estimated. I would also say that we have suggested the use of proxy measures such as staging and accident and emergency admissions figures to complement, but not replace, the one-year and five-year figures, because they would give a more complete picture at the local level.

--- Later in debate ---

[Anna Soubry]

We will certainly examine the points my hon. Friend raises. A letter or meeting between us may be the best way to resolve things.

Further work is required, and work is being undertaken to look at the feasibility of developing other measures, such as patient experience of cancer services, for possible inclusion in COF for 2014-15. We would expect the board to work with NICE and other stakeholders to establish priorities for development for the 2014-15 COF and beyond.

We recognise that the challenge of cancer is huge. Over 250,000 people in England are diagnosed with cancer every year, and currently about 1.8 million people are living with, and beyond, a cancer diagnosis. It is fair to say that cancer touches all our lives; if not our own individual life, then that of someone we know in our family, our circle of friends or the people we work with. Like many hon. Members, no doubt, I lost a member of my family: my father died of cancer many years ago. It is a pernicious disease, but great strides are being made all the time. However, despite improvements in the quality of cancer services, more can and should be done to improve outcomes for those afflicted by it. Regardless of the shape of the NHS and the commissioning outcomes frameworks in 2013-14, we are committed to delivering improvements in cancer survival rates, as set out in our strategy.

Finally, I again pay tribute to my hon. Friend, his all-party group on cancer and the various charities for all their work and their great contribution to the debate, including this debate. I look forward to continuing that debate and speaking with him so that I can answer all his questions and discuss all his ideas in full.

Question put and agreed to.

Health Select Committee’s Report on Education, Training and Workforce (Government Response)

Anna Soubry Excerpts

Thursday 6th September 2012 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

The House of Commons Health Select Committee published its report on education, training and workforce planning on 23 May 2012. We have today laid before Parliament the “Government response to the House of Commons Health Select Committee First Report of Session 21012-13: Education, Training and Workforce Planning” (Cm 8435).

The Committee welcomed the overall direction of the Government’s reforms in this area, including the establishment of Health Education England and Local Education and Training Boards, though it called for more detail and clarity on particular aspects. The Government’s response highlights a great deal of progress that has been made in establishing the new system of education and training since the publication of the Committee’s report.

Community Hospitals

Anna Soubry Excerpts

Thursday 6th September 2012 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Let me begin by congratulating my hon. Friend the Member for Totnes (Dr Wollaston) on securing the debate, and congratulating not just those who added their names to her motion but all who have spoken in what has been a very interesting and, indeed, passionate debate. In fact it has not really been a debate, because there has been an outbreak of agreement, certainly on the Government Benches, as so many speakers have spoken with such passion about the community hospitals in their constituencies.

I should also say thank you to all who have congratulated me on my appointment, and have said some rather kind things. I am sure that normal service will soon be resumed. Sadly, my right hon. Friend the Member for Chelmsford (Mr Burns), the former Minister with responsibility for health services, has now departed from that post and gone to another place, as it were—to another Department. We all miss him and thank him for his great service and his commitment to the national health service. He explained to the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) during a debate in June about community hospitals in the north-east that this Government support improvements in community hospitals across the country. That is because we know that community hospitals make it easier for people to get care and treatment closer to where they live. They allow large hospitals to discharge patients safely into more appropriate care. They free hospital beds for people who need them. Community hospitals allow many patients to avoid travelling to large hospitals—and many of those large, acute hospitals are in cities, with all the attendant problems of transport, parking and so forth.

Our community hospitals provide a wide range of vital services, including minor injury clinics and intensive rehabilitation, on patients’ doorsteps. They can also help save the local NHS money by moving services out of acute hospitals and closer to the people who use them. People are often rightly very protective of their community hospitals, as we have heard from many Members this afternoon. They deliver essential services, and provide employment for people who live nearby and spaces for community groups. It is therefore understandable that community hospitals are fiercely defended and inspire such loyalty.

If I am to retain responsibility for community hospitals, I shall be a busy Minister. I shall be going up to the north-east to Middlesbrough and Cleveland, to South East Cornwall, Bracknell, Newton Abbot, Cannock Chase, West Worcestershire, South Dorset, Penrith and The Border, Halesowen and Rowley Regis, Hexham, North Dorset, Wells, Tiverton and Honiton, including Seaton, and Denton and Reddish—although not to Southport as it does not have a community hospital. I am grateful for all those invitations, and if I can, I certainly will accept them.

My hon. Friend the Member for Totnes delivered a speech that was, as ever, thoughtful, inspiring and well-informed, and she asked a number of questions of me. If I do not answer all the points she raised, I hope she will forgive me, and she will certainly get a letter from me answering all of them. Let me state at the outset, however, that she has made a very powerful case in relation to the Community Hospitals Association and its database. Funding for that database was stopped. I cannot promise that it will be restored, but I can say this: I have asked my officials to look at that decision again with great care.

I anticipate that we will not have a vote on this motion, and it is of interest that the two Opposition Members present will abstain if there is a vote, because we have rightly heard a cacophony of voices from the Government Benches in support of community hospitals.

My hon. Friend asked about tariffs, as did the hon. Member for Denton and Reddish (Andrew Gwynne). It may be of some assistance, especially to my hon. Friend the Member for Penrith and The Border (Rory Stewart), for me to state that work is under way in the Department, looking at a payment system for patients suffering from long-term conditions. That includes services delivered in community settings. I trust that provides some hope. From 2013 and into 2014, tariff settings will be decided by Monitor and the NHS Commissioning Board. My hon. Friend the Member for Totnes made a powerful point about the potential importance of tariffs in ensuring the future of our community hospitals.

A good point was made about the decline in the number of GPs in some areas. I hope my hon. Friend will take comfort from the fact that my information is that there is a 50% target in respect of medical trainees going into general practice—I do not much like targets, but this could be a good one—and a taskforce has been set up to try to achieve that.

The future of community hospitals will, I hope, be secure in many of our communities, but it has to be said that many of the concerns Members have raised relate to local decisions, and it would not be right for me, as the Minister, to interfere in any of those decisions. My door is always open and I am always happy to meet hon. Members and any of their constituents. I may not be able to help in Cannock Chase, in Rowley, where there is difficulty, in Wells or in some other places, but I am happy to provide such support, assistance or advice as I am able to give.

Hon. Members have rightly discussed the future of the estate. I am conscious of the time, Madam Deputy Speaker, so I hope you will forgive me if I read out this part of my speech. It is important that hon. Members know and understand that the Health and Social Care Act 2012 required new ownership arrangements for current PCT estates. That means that providers such as community foundation trusts, NHS trusts and NHS foundation trusts will be able to take over those parts of the PCT estate that are used for clinical services. That includes the community hospital estate, but—this is an important but—we have put safeguards in place so that providers cannot just sell off newly acquired land and make a quick profit. Estates must be offered back to the Secretary of State for Health if, for example, the provider fails to keep the service delivery contract associated with the property or if the property becomes vacant. In addition, where any former estate becomes surplus to NHS requirements 50% of any financial gain made by the provider must be paid back to the Secretary of State and will go straight to front-line NHS services.

A Department of Health-owned limited company called NHS Property Services Ltd, to which reference has been made, will take on the remaining estate, as announced in January this year. Its key objective will be to provide clean, safe and cost-effective buildings for use by community and primary care services. I would like to assure every hon. Member, and every member of the public, that any community hospital building taken on by this company will be well looked after. Local clinicians will decide how those estates are used; whether new buildings are built or existing ones are closed will be up to them, as will all decisions about local patient services. As I have said, it is right that these decisions are taken locally. In reality, patients and the public will not notice any difference, at least in the short term. In the longer term, they will see that the NHS estate is managed more efficiently, by people who know what they are doing; that money will go to improve properties and front-line services.

NHS Property Services Ltd will own and manage buildings that are needed by the NHS. However, it will also be able to release savings from its properties that are declared surplus to NHS requirements. That money will be used further to improve property provision in the NHS. All PCT properties will transfer to either NHS providers or NHS Property Services Ltd on 31 March 2013. Until the provisional lists of property transfers have been finalised later in the year, I cannot confirm whether any particular community hospital will transfer to either an NHS provider or NHS Property Services. In the latter case, the community hospital services provider will become a tenant of NHS Property Services, in the same way that it is currently a tenant of the PCT.

[John Pugh]

Should the tenant, be it a community hospital or whatever else, seek to expand and should it need further facilities, is there a dialogue it will be able to have with the company to get it to extend the premises?

[Anna Soubry]

I am grateful for that question, but I shall be blunt and say that I do not know the answer. I will make inquiries and I will certainly make sure that the hon. Gentleman gets a full report in response.

Under the statutory provisions, while a building is needed to deliver NHS services, no NHS organisation will be allowed to sell it off, so there is no question of useful NHS property being sold to or transferred to organisations outside the NHS. At the same time, this means that a league of friends—a number of hon. Members have spoken with great fondness and admiration in support of leagues of friends, and I am sure that they will relay this to their local league of friends and their community hospitals—is unable to own the freehold of an operational NHS property. A league of friends is able to bid to become an owner of a community hospital only when it is declared surplus to NHS and public sector requirements. Current Government policy is that surplus property should normally be sold by auction or competitive tender. In such cases, the hospital league of friends would be given the opportunity to bid for the property along with all other interested parties. A league of friends could form a social enterprise to compete to provide services from a community hospital but, even then, as a social enterprise rather than an NHS body it could not take ownership of the assets of the community hospital. That might disappoint some, but I hope that in many ways it will give people comfort for the future and go some way towards addressing many of the points raised by my hon. Friend the Member for Totnes.

In conclusion, the Government have taken steps to secure the assets of community hospitals and ensure they are used for the benefit of their community. Those decisions will be made by people qualified to do so. That is the best thing for the hospitals and it is certainly the best thing for the communities that they serve. It is quite clear why so many people speak out so strongly and forcefully about community hospitals; it is because of the great work that they do. On behalf of the Government, I want to pay tribute to everybody who works in community hospitals and all the organisations that support them. I thank everybody who has contributed to the debate, which has been a very good exposition of the fine qualities of our community hospitals and, in particular, the organisations, such as the leagues of friends, that do so much to make them the great hospitals that they invariably are.

Health and Social Care Bill

Anna Soubry Excerpts

Tuesday 20th March 2012 Commons Chamber

[Andy Burnham]

No, I do not, is the answer—[Interruption.] Well, what has that proved? We had trusts earning income, but the foundation trust legislation set a cap: it allowed the principle but tightly controlled it for the vast majority of hospitals. That was its purpose. This Bill removes those tight controls. This Bill, supported all the way on that point by Liberal Democrats, now allows hospitals completely to change character over time. In time they can turn to US-style hospitals and devote half their facilities to the treatment of private patients—

[Anna Soubry (Broxtowe) (Con)]

That is rubbish.

[Andy Burnham]

It is not rubbish. They can earn 49% of their income, according to this Bill, from the treatment of private patients. That is a fact, and why the hon. Lady shouts “rubbish” I have no idea.

Health and Social Care Bill

Anna Soubry Excerpts

Tuesday 13th March 2012 Commons Chamber

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

I welcome today’s motion on the Health and Social Care Bill, because I know how precious the NHS is. We must do everything possible to protect it. I am proud of the fact that the Labour party founded the NHS. In 1997, when we took over from the previous Government, we had to rebuild a health service that was under-invested in and turn it into a world-class health service, which is what it is today. We reduced waiting times and invested in creating a health care system that delivered for patients. On our watch, there were 33,000 fewer deaths from heart disease each year, and we achieved the highest ever level of patient satisfaction. In my constituency we have seen real improvements locally and real successes in Tower Hamlets, with the highest childhood vaccination rates in London, improved health for those with chronic diseases such as diabetes, and reduced mortality rates from cancer and heart disease, although there is much more to do.

The Labour party has always been at the forefront of reform where it is needed and where it would benefit people on the ground. As my hon. Friends have already pointed out, we are talking about the difference between good reform and bad reform. My party will always support reform that is good for patients, but the Government’s plans do not offer that kind of reform. I have had thousands of letters and e-mails from constituents—

[Anna Soubry (Broxtowe) (Con)]

Thousands?

[Rushanara Ali]

Yes, thousands. I have had thousands of letters and e-mails from constituents—members of the public, as well as professionals—who oppose the Bill.

NHS Risk Register

Anna Soubry Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Andy Burnham]

My right hon. Friend eloquently makes the point I made at the beginning of the debate: people with long-term conditions, such as diabetes, who depend utterly on the NHS have a right to know whether there is any risk to the continuity or integration of the care they receive. I understand that representatives of patient groups, who perhaps have not been heard enough in this debate, made that point directly to the Prime Minister on Monday. It is absolutely essential that their voice is heard. They say that the Bill represents a danger to the integrated care that they receive and depend upon. It seems pretty clear to me that the Government are not following their own policy—[Interruption.]

[Anna Soubry (Broxtowe) (Con)]

indicated dissent.

[Andy Burnham]

I quoted from the policy, but the Secretary of State is not publishing the risk register—

--- Later in debate ---

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

It really does not matter what vote the Government Whips are able to secure tonight, because the truth is that the Government have lost the argument. The Secretary of State has squandered whatever political capital the Prime Minister was able to accumulate on the NHS and lost the trust and confidence of the public and professions with this Bill. There cannot be a single person in the country who does not understand that there is secret information, pertinent to the passage of the Bill, that he is determined to withhold from Parliament and the public. That is the position we are in.

The vote does not matter, but I would not like to be a Government Back Bencher having to go back and explain the matter to my constituents. I certainly would not like to be one of the Lib-Dem Members having to do so, because whatever the arguments and posturing here in the Chamber today, they will not cut any ice with a public who know that the facts are being withheld and feel they are being conned over a measure that they were promised would never be introduced by this Secretary of State.

I do not say this with any malice, but I think that it is too late to restore the Secretary of State’s reputation. Even at this late stage he could agree to release the information, but more importantly he should pause again and, this time, really listen to what people are saying about the NHS. He is probably not keen to take advice from me, but I have consulted my constituents in Selly Oak quite extensively on the Bill, and it is important that he knows that 76% of the people whom I consulted said that it is the wrong priority at the wrong time. Their concerns are about faster diagnosis and treatment and shorter waiting times.

The Secretary of State cited waiting times earlier in his speech, and he will know that the 18-week waiting time in south Birmingham is rising steadily. In fact, I think it has gone up—

[Anna Soubry]

You think?

[Steve McCabe]

Off the top of my head. I can check the figure, because the Secretary of State wants to be accurate, but I think it is 36%—since he became Secretary of State. It is going up, and he must know that, because he was quite happy to cite other figures earlier.

The money should be spent on reducing waiting times; it should not be withheld by the SHAs to cover the cost of the reorganisation. The Minister of State says that that is not happening, but his own operating framework shows perfectly well that that is exactly what the money is being withheld for. It is spelt out in black and white in his own documents, and that is what is wrong at the moment.

The public feel that waiting times are rising, they have difficulty accessing GPs and they are worried about the confusion surrounding the measure. As my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) said earlier, in some parts of the country it is already destabilising the NHS, but what we have today is the Government dismissing all those arguments while hiding behind a cloak, saying, “Everything’s going to be okay, but we’re not going to tell you the facts of the matter.” It is disgraceful, and the Secretary of State knows perfectly well that during the years that he spent in opposition he would never have tolerated such behaviour. His behaviour since taking office has been to undermine the NHS and to waste every bit of political capital that the Tory party accumulated during its years in opposition.

That is what is fundamentally wrong with the measure. It does not matter how many times people try to deal with the minutiae of the risk register; the reality is that the report is there and the information is there. There is only one person hiding it, and he is sitting opposite me on the Government Front Bench at the moment. That is what the public know. This is no longer an argument confined to what happens in this Chamber; it has gone way beyond that. It has got to the stage where the Secretary of State’s credibility is on the line, and I am afraid that it has been lost.

NHS (Private Sector)

Anna Soubry Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

My hon. Friend anticipates me. I shall come to precisely that point in a moment, and it will backs up his point that the Bill is akin to the privatisations of the 1980s.

[Anna Soubry (Broxtowe) (Con)]

What?

[Andy Burnham]

Just hang on and listen. Nothing has been done to the Bill to bring together the Prime Minister’s and Deputy Prime Minister’s promises that there would be no privatisation. There has been no substantial change since the pause.

Let me come directly to whether the Bill represents a privatisation of the kind that we saw in the 1980s. In doing so, I shall refer to a report from the King’s Fund, which I recommend to the hon. Lady. The Government have failed to introduce measures that they promised, months after the pause, so it is still considered appropriate for a body as respected as the King’s Fund to make a fairly shocking comparison that, indeed, the Bill is similar to the privatisations of the Thatcher Government. The report says:

“The Government’s proposals draw heavily on the regulatory framework developed in telecoms and utilities regulators …Interestingly, Secretary of State for Health Andrew Lansley’s own ideas for the reform of the NHS, developed while in opposition, were born out of his experience of the privatisation and regulation of utilities in the mid-1980s when he was Principal Private Secretary to Norman Tebbit.”

There we—[Interruption.] Okay, there we have it. That is the view of the King’s Fund—this is a privatisation along the lines of those we saw in the 1980s.

To back up that point, the King’s Fund quotes from a speech that the Secretary of State gave in 2005 to the NHS Confederation. He said this of the 1980s privatisations:

“The combination of the introduction of competition with a strong independent regulator delivered immense consumer value and economic benefits.”

There are two problems with that statement. First, there are real questions about whether gas, electricity, water and rail customers feel that they have had immense value. Secondly, it is troubling that the Secretary of State for Health, of all people, considers the delivery of health care directly comparable to telecoms and utilities.

Oral Answers to Questions

Anna Soubry Excerpts

Tuesday 7th September 2010 Commons Chamber

[Mr Lansley]

My hon. Friend and I have had a conversation in Burnley about emergency and children’s services at Burnley hospital. I was not aware of the position that he has just described, but I will ensure that any reconfigurations that have taken place in the past and are still being reviewed, or that are currently being proposed or acted on, comply with the criteria that I set out in May, and I will write to him.

[Anna Soubry (Broxtowe) (Con)]

15. What mechanisms are in place to assess the effectiveness of assertive outreach teams in providing support for people with severe mental illness; and if he will make a statement.

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

The Department of Health has issued guidance on the key components of an effective assertive outreach team. It is for each local trust to put in place robust quality assurance arrangements to ensure that it delivers the high-quality and effective service that the public expect. That is further underpinned by the work of the Care Quality Commission.

[Anna Soubry]

I am grateful to the Minister for his response. One of my constituents, William Barnard, who was profoundly mentally ill, went on to kill his grandfather as a result of the poor system that was operating in relation to his care. What progress has been made in ensuring that other teams do not suffer from the same failings in their systems?

[Mr Burstow]

The hon. Lady and I debated this issue in the Chamber back in July. One of the most concerning aspects of the case of William Barnard was a singular failure to listen to the concerns expressed by family members and carers on the part of those who could have taken the necessary action to improve matters. I continue to take a close interest in the investigations being undertaken by the local NHS. We want to ensure that when lessons can be learned nationally, they are reflected in the Government’s forthcoming mental health policies.

John McGrath

Anna Soubry Excerpts

Thursday 22nd July 2010 Commons Chamber

[Anna Soubry (Broxtowe) (Con)]

Before I begin the Adjournment debate I will let hon. Members leave, as I anticipate and understand they will, given the hour.

As you will know, Mr Deputy Speaker, I bring to the House’s attention a very serious and tragic matter. It is almost a year to the day since John McGrath was killed by his grandson, William Barnard. John McGrath’s wife, Mabel, was seriously injured in that unfortunate incident. William Barnard was sentenced last month and is now in Rampton secure hospital, where he will be, no doubt, for a considerable time, because at the time of the incident he was seriously ill, suffering from paranoia and schizophrenia. Those who were supposed to be in charge of his care in the mental health services team available to him have helpfully provided a report that goes into considerable detail about the events that led up to that dreadful incident.

I will not go into the detail of that report. It is available for anybody to read if they contact me or Nottinghamshire Healthcare. However, it is clear from the report that there was a significant and serious failing in the care and supervision that should have been enjoyed by William. That is deeply regrettable, because this incident happened without that care and supervision. Had he had it, this tragedy would not have occurred. I am grateful that the Minister has come along today, and I know that, if time allows, he will meet the family. On their behalf, may I extend to you, Mr Deputy Speaker, their thanks for allowing me to address the House in this way? In short, they are very keen to ensure that John McGrath did not die in vain.

The report contains many recommendations. The NHS trust in Nottinghamshire, Nottinghamshire Healthcare, assures me that it has learned many lessons and has said the failings identified that will not happen again, as a result of the recommendations that it is determined to implement. However, through this debate, I want on behalf of the family to ensure that everyone—every team, every trust, every authority—not only reads the report, but understands the failings that it identified and is made aware of the recommendations that it contains, in order to ensure that such a tragedy never occurs again anywhere else in the United Kingdom.

I will quote from the report in time, but I would like to begin by talking briefly about John McGrath. John earned the nickname Dr John, because of his kindness and his willingness to help anyone who came his way, in any way that he could. At the time of his death he was almost 82, and he and Mabel lived in Stapleford, a small town in my constituency. William was the son of their youngest daughter Kathleen. The couple had three other children, all of whom are in the Public Gallery today, as is Mabel. Her other grandchildren, and William’s sister and her boyfriend are also here.

As the report says, William Barnard is part of a large and supportive extended family, who played a significant role in providing care for him under extremely difficult circumstances. I have met the family and they are remarkable. They are an example to us all of the sort of love and support that we wish we could all enjoy. They are good people. Indeed, it is perhaps testimony to the sort of people the family are that they have come to this place today with a file containing other cases—cases that I know will cause the Minister great concern, as they concern us all—cases of other people who were meant to be in the care of mental health teams and workers, but who unfortunately did not receive the care and support that they should have had, and either killed or injured other people. I know that the Minister will take that dossier and read it.

It is because of the love and support within that family that they have always had great concern for William, to whom I want briefly to turn. In his late teens, he began to exhibit signs of a serious mental illness. He spoke to his mother, who at that time was training to be a nurse. She knew that there was a problem, and together they engaged with mental health services. Again, I will not go into all the detail—the appendix to the report makes clear some of their dealings with mental health services—but it is clear that, from 2002, he exhibited many of the symptoms of a serious mental illness. That, if I may say so, was clear for all to see.

I am no expert, but if I may say so, in 2007 William was exhibiting some of the stereotypical behaviours of somebody in need of serious help and assistance. There were a number of unfortunately very typical symptoms shown by people who experience such an illness, but the important features included a non-engagement with, and suspicion of, mental health care workers and their team. There was also a lot of evidence that William was at great risk of inflicting serious harm to himself through self-neglect. I would say that there were also features—I have read about them in the appendix—that should certainly have caused those responsible for his care to be alerted to a potential risk to other people.

Today I was shown a photograph of Will, as he was known by his family, from when he was well. He was described by his family to me as a gentle giant, and in the photograph—I am sure that the family and he will forgive me for saying this—one can see a rather chubby-faced young man, and he is smiling. He looks happy, and he is clearly well. That stands in sharp contrast to the photograph that has appeared in some of the local papers—understandably so—of William on his arrest. In that photograph, he is a gaunt, haunted young man. That just shows how his illness had affected him.

In 2007 going into 2008, William was sectioned, which was largely due to the efforts of his mother. Again, it was clear that he had a problem, with a lack of engagement with, and a great suspicion of, those charged with his care. Indeed, he escaped from hospital in Derby. He was, in effect, captured—again, it is thanks to the family that he was detained—and he returned to hospital, before being discharged in due course from that Mental Health Act order and returning to Stapleford, into his loving and caring family.

Because of the nature of William’s illness, he should have been looked after by the assertive outreach team. In my work as a criminal barrister, I have represented a number of people who have suffered from mental illness. I have come into contact with some of the people who work with people with mental health difficulties and serious mental illnesses, and I have not met one who did not have the most remarkable skills, and a commitment to the person in their charge. They perform a difficult job, and often struggle to resolve huge conflicts. The outreach team in this case was well staffed and well equipped. According to the report, its members were trained. So this was not one of those cases involving a pitiful lack of funding or staff, or any other such deficiency. There were enough people; that was not the problem. The problem was a lack of care and supervision. No one took responsibility for William’s care. According to the dossier that the family has handed to me, that is all too common a feature of these terrible tragedies.

In December 2008, William refused to take his medication. That is typical of people with these conditions. He did not take his medication for some seven months before the incident, and those charged with his care knew about that. There were 30 attempts to make contact, but they resulted in only four face-to-face meetings, some of which were only fleeting. For four months before the incident, he was not seen by any professional health team workers at all. There were, however, 11 recorded occasions on which the family contacted the assertive outreach team, and 13 other instances in which other people and agencies, including the pharmacist and even the police, contacted the team to express their genuine, well-founded concerns.

The report talks about an “excessive passivity” in the management of William’s case, and a lack of information and detailed knowledge. It describes a breakdown in the assertive outreach team’s function. Concern was expressed by some workers, and I do not seek in any way to go behind that. No doubt there were people who were there to look after William and who had concerns about him, but the lack of communication and the systemic failings meant that no positive action was taken. There was no proper analysis of the signs of William’s deterioration. According to the report, there was “confusion” and “inaction”, as well as ineffective leadership and absent leadership. The report is a damning indictment of what happened in this case. It reveals a systemic failure.

I want to give the House an example, which makes profoundly sad reading. On 20 April, a meeting was called to consider the information that had been placed before the team. It was decided that Will would be monitored for six weeks, after which time a further meeting would be held to reassess his case and to decide whether he should be sectioned under the Mental Health Act. No one made a proper note of what was to happen, however; certainly, no one carried out any work. No review date was set, and there is no record of any action being taken. Worse still, perhaps, was the fact that no attempt was made to see Will for a month.

On 15 June, reports were received from the police and from the pharmacist, who, according to the report, did a remarkably good job of trying to get this young man the help he needed. There were also reports from the family. All kinds of alarm bells should have been ringing loudly at this point, but again, nothing was done or planned. On 24 July, Will was deemed to be an acute risk, not only to others but—most importantly, it could be said—to himself. There was another failed visit. Those who attended his flat saw blood on a door handle, and strange writings and other things on his door. All that clearly indicated that this young man was in desperate need of assistance. Again, his family was spoken to, and his grandfather spoke of his grave concern for the grandson he loved so much. And that grandson loved him and saw him very much as a father figure. A request for a Mental Health Act assessment to be carried out that very day, as it should have been, was turned down, and a decision was made to wait until the following Monday. By then, of course, it was too late, for it was on that very day that this dreadful incident took place.

The real question to be asked is, “What is to be done, and why are we in the House of Commons raising this matter?” We know that there is to be a report from the strategic health authority, and we look forward to reading its comments and recommendations. We believe that there will also be a coroner’s inquest report, as well as the report to which I have referred.

As I have said, lessons must be learnt, not just by Nottinghamshire Healthcare NHS Trust—which has given me an assurance, for whose assistance I am grateful, and to whose representatives I have spoken at length—but throughout the country. We are keen to ensure that when reports such as this are produced, whatever tragedy they concern, it is not one of those cases in which all that happens is that someone says, “Yes, we will carry out all the recommendations.” Perhaps that is done for a short period, but there is no long-term, regular audit to ensure that everything that should have been put right has indeed been put right for the future.

The other thing that everyone wants is for families to be far more involved in the care of people like Will who mean so much to them. According to the report, there was a lack of interaction, and we want that to change. Of course there are some cases in which the family does not need to be involved, and of course there are real conflicts over the autonomy of a patient; but in this case, as in so many others, the people involved should have been listened to, and should have been involved to a greater extent. It could be said that William’s grandparents, Mabel and John, were themselves vulnerable people to whom a duty of care was owed. They should have been listened to, and they should have been involved.

As a result of an Act introduced by the last Administration, those who work with people who suffer from the sort of illness from which William Barnard suffered, and still suffers, have powers to enter homes. They also have powers to ensure that someone who should be taking medication and is not doing so can be “recalled”—a criminal barristers’ term—to hospital. I ask the Minister to ensure that everyone involved in local health services is aware of those powers and willing to use them, and that the assertive outreach teams that exist throughout the country do exactly what it says on the tin, and are assertive in their care and support.