Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 29th October 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

Absolutely; I thank my right hon. Friend for putting it so eloquently. This just shows what can be achieved. We have seen great results from the soft drinks industry levy. The average sugar content of drinks subject to the levy decreased by 28.8% between 2015 and 2018, so we have been able to make significant investments in activity and healthy eating in schools.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Mr Speaker, as this is the last time that we will have Health questions with you in the Chair, I want to thank you for being a fantastic Speaker—particularly through your support for Back Benchers and ensuring that we can be heard through urgent questions.

Last week, we found that the number of people receiving publicly-funded social care has fallen by 15,000 in the past year. We know that 95 people a day die while waiting for care and that cuts of £7.7 billion have been made from social care budgets since 2010. Older and disabled people are paying the price. Labour has set out our plans to deliver free personal care for people aged over 65 who need it. We are providing dignity in old age. When will the Secretary of State give people the dignity and care they deserve, and bring forward the Government’s plans for social care?

[The Minister for Care (Caroline Dinenage)]

The hon. Lady will be aware that the Queen’s Speech announced a Bill to tackle the cost of adult social care. She will also know that the Prime Minister said on the steps of Downing Street that the Government will set out plans to fix the social care crisis once and for all. We need to get through Brexit, and Labour Members need to vote for the methods that will help us to deliver that, because we can then get on to the things in life that really matter, such as ensuring that no one will ever have to use their home to pay for their care.

The National Health Service

Baroness Keeley Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Matt Hancock]

This is another incredibly important point. I will be working with the new Minister for Defence People and Veterans, as well as the Minister for Mental Health, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), to address exactly that sort of concern. This is a long overdue—

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Before the Secretary of State leaves mental health, will he address this issue of the 2,300 autistic people and people with learning disabilities who are in in-patient units, as it has been around for far too long? Last week, the Care Quality Commission announced that one in 10 of those units was inadequate. He knows—and I have written to him about it—that Bethany, a young woman, is in seclusion and still in a locked cell. When will he do something about those 2,300 people?

Social Care Funding

Baroness Keeley Excerpts

Tuesday 1st October 2019 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in a debate with you in the Chair, Sir Charles. I think that this is the first time I have done so. I join others in congratulating the right hon. Member for Twickenham (Sir Vince Cable) on securing this important debate.

The number of Members contributing in this debate makes clear the appetite to speak on the matter, and it is a pity that more Government time—or even an Opposition day debate—has not been allocated. It is appropriate that on this International Day of Older Persons we have talked largely, though not entirely, about older people. That should remind us all that growing old with dignity is a fundamental right that we should all enjoy.

By my count we have heard 12 Back-Bench speeches and six interventions, and by the time we get to the Minister we will have heard three Front-Bench speakers. Many have rightly focused on the cuts to social care budgets and the harm caused to people who rely on and need social care. We have heard powerful examples of the impact of those cuts. That harm, however, is not inevitable. If social care is properly funded and delivered well, it can be life changing. My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) gave an example of how life can be changed in the wrong way if social care is not available.

Social care can keep someone connected to their community rather than isolated and lonely. It can support people to live the lives they want to live, rather than just survive from day to day—sometimes not even that—when the care disappears. But that is not what our social care system looks like today. Over the past nine years nearly £8 billion has been taken out of local councils’ social care budgets as a result of cuts. Hon. Members have mentioned the swingeing cuts experienced by many local authorities. As a result, hundreds of thousands fewer people are receiving the care they need. That is the straightforward result of the cuts.

Age UK tells us that 1.4 million older people in this country are struggling with everyday activities. Whether that means getting washed or eating a meal, they are not getting the help they should be getting. Older people are being left trapped in bed all day and perhaps going unwashed all week because their children can visit them only on weekends. They are having only microwave meals, because that is all their neighbours or family friends have the time to buy in for them. That is not what this country’s older and disabled people deserve.

I am glad that many hon. Members have mentioned the immense pressure that the state of our care system puts on unpaid carers. Wherever the Government pull back from funding social care properly, the UK’s millions of unpaid carers have to step in. As we have heard, that includes young carers in the constituency of my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard). It is very important to identify and support those young carers. I have tried three times to bring in legislation, including to identify young carers. The Minister’s predecessor did not support it, but we could still do it. I might give the Bill to my hon. Friend so that he can resurrect it.

It is a dire picture, including for young carers. Half of unpaid carers now spend 50 hours a week providing care, while 38% spend 100 hours of every week caring. One quarter of carers have not received any support, either for themselves or for the person they care for. Two thirds of carers say that they do not get as much social contact as they would like with other people. More than eight in 10 say that they cannot spend time doing things that they enjoy or value, and 40% of carers say that they have not had a day off for more than a year. In fact, a recent Carers UK report noted carers saying that if they had a respite care break, they would use it to visit their own GP for a medical appointment, which is very sad.

Even for the smaller number of people who manage to get a social care package, cuts mean that the care provided will not be of the quality expected. One in five social care services has been rated by the Care Quality Commission as either “inadequate” or “requires improvement”. The number of complaints to the local government ombudsman about social care provision has trebled since 2010, rising to more than 3,000, and two thirds of those complaints are upheld. There is very much wrong with our system. I find it deeply concerning that one in five care homes, housing as many as 9,000 older and disabled people, are now rated as unsafe.

These are not services that any of us would like a family member to have to rely on. The situation can mean care homes that are so unclean that residents are at risk of infection, or residents being at risk of malnutrition because nobody is monitoring what they are eating. Care in one’s own home can mean visits by staff who have not been subject to basic checks or who have not completed any training. It can mean staff being so rushed that they do not have time to take off their coat while they are getting people up and dressed. The reality is that some care providers cannot provide high-quality services with the funding available; sadly, other providers choose to protect profit margins rather than the people who use their services.

That issue is clearest in the social care workforce. There are 1.4 million people—or there would be, if the vacancies were filled—working in social care. These people provide vital support day in, day out, but they simply do not get the respect they deserve for the work they do. More than a quarter of those care staff work for a minimum wage, and the same proportion of the workforce are on zero-hours contracts. It is no surprise therefore that there are 110,000 vacancies in the care sector. Those important issues have been touched on by many Members in this debate.

Rather than providing the empathetic care that they want to offer, care staff are often reduced to visits lasting 15 minutes or less. They must rush through their tasks with barely any time to talk to the person they are visiting. This deterioration in the quality of care is the result of nearly a decade of cuts, care staff stretched to breaking point and services that barely deserve to be called “care”. Hundreds of thousands of people have to go without basic support.

[Melanie Onn (Great Grimsby) (Lab)]

My hon. Friend is making an excellent speech and paints a picture of social care in this country. On 15-minute visits, does she agree that the issue is not just the time limit but the ever-changing individual presence? With vulnerable people, consistency of care and the ability to build up a relationship are equally important.

--- Later in debate ---

[Barbara Keeley]

My hon. Friend is absolutely right. For people with dementia and learning disabilities, seeing a familiar face every day can be crucial.

We cannot allow this crisis to continue. We must see action to ensure that everyone is able to access the care that they need to live with dignity. That is why Labour has announced that we would introduce free personal care for all older people who need it and expand such provision to working-age adults as soon as possible. That would end the scandal of people having to sell their home to pay for basic care. We will fund social care in the only fair, sustainable and understandable way—through general taxation. That is how we fund our NHS and our schools, and it is how Labour will fund our national care service.

Before we can build this new system, we must also repair the damage caused by years of budget cuts. We will invest £8 billion in more care packages, in improved training and in better community support. The apprenticeship levy is not enough for training; skills for care should be better funded.

[Kevin Hollinrake]

Will the hon. Lady give way?

[Barbara Keeley]

I do not have time.

A few months ago, we pledged £350 million a year for community resources, aimed specifically at helping to bring autistic people and those with learning disabilities out of in-patient units—over 2,000 of them—in which they are trapped. It is a scandal that we do not have the social care and community resources that are needed to prevent people being trapped in abusive care. Time and again, the reason given for people being in those units is that there is no resource in the community. My hon. Friend the Member for Plymouth, Sutton and Devonport has spoken about the burden that falls on social care authorities if they end up with a very expensive case. We have to get round that.

We can fix the crisis in social care only by properly funding the system, as the Labour plans will do. Two years after the Conservatives’ disastrous 2017 manifesto plans, which were later dropped, we are still waiting to hear what they will do. The Government’s promised Green Paper has been delayed and delayed, and now it looks to many—including many in this Chamber—as if it has been dropped altogether. The hon. Member for St Ives (Derek Thomas) mentioned how embarrassing that was. It is not just embarrassing; people lose hope waiting for the care they need.

A cap on care costs, which would stop people facing catastrophic costs, and for which we legislated, was ditched by the Government in December 2017. I am sorry to say that instead the Government have provided only small, one-off cash injections—sticking plasters—rather than the long-term funding settlement that social care needs. Will the Minister tell us where the Government’s proposals on social care are? If the Government want to resolve the crisis that their funding cuts have created, as I hope they do, why have they constantly kicked social care funding reform into the long grass? It is time for a solution to the crisis that this Government have created. Labour Members have pledged a way to solve the crisis, which in itself gives hope to many people who need social care.

Mental Health Act 1983

Baroness Keeley Excerpts

Thursday 25th July 2019 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hanson, as it was to serve under Ms Buck earlier. I join others in congratulating my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) on securing this debate and echo their comments about the moving way in which he opened the debate. He started with his own family experience and then made a very powerful speech. I am sorry that you missed it, Mr Hanson. We heard contributions from the right hon. Member for New Forest East (Dr Lewis) and the hon. Member for Plymouth, Moor View (Johnny Mercer), as well as my right hon. Friend the Member for North Durham (Mr Jones) and my hon. Friends the Members for Bristol East (Kerry McCarthy) and for Stockton North (Alex Cunningham). I am sure we all want to thank Sir Simon Wessely and his team for their work in reviewing the Mental Health Act.

The wide range of perspectives in the debate is welcome. It shows how wide-ranging the work is and how it touches on so many different aspects. One thing on which we can all agree is that the current Mental Health Act is not working. It is too often overly restrictive and fails to give people the support they need, as we have heard. Before I discuss the contents of the review, I want to mention why it is so important that we get this right, because being detained under the Mental Health Act, although it is sometimes life-saving, can be immensely damaging if it goes wrong, and we have heard already about how it can go wrong. I, too, am going to talk about a case: the case of Matthew Leahy.

On 7 November 2012, Matthew was admitted to a mental health hospital under the Mental Health Act. On 15 November, he hanged himself in his room at the hospital. The Parliamentary and Health Service Ombudsman has identified failures in Matthew’s care that may have led to his death, but they have taken seven years to come to light. My hon. Friend the Member for Croydon North (Mr Reed) talked about delays. They are exasperating, concerning and impossible for families who have to live with the loss of a loved one. Some of the failures in Matthew’s case were truly shocking. He complained that he had been raped in the mental health hospital. The ombudsman found that had Matthew not phoned the police himself, it is not clear that staff on the unit would have done so. Anyway, the police failed to take action.

My hon. Friend the Member for Bermondsey and Old Southwark referred to the level of sexual assaults on patients—an appalling record, as reported by the CQC. It should be of deep concern to us that that is happening. Staff also failed to act when Matthew reported, and he had physical injuries that could have been caused by rape, which should have been a major cause of concern. It is also deeply concerning that his care plan was falsified and other paperwork was lost. Although he had a care plan for his first 72 hours in the unit, staff produced a fuller care plan only after he died. That that should have happened when he was apparently under the protection of the state is unacceptable. We must ensure that we know what went wrong in his and other cases of death so that we can act to prevent it from recurring.

There have also been issues with the subsequent investigation. The initial report by the NHS partnership contained inaccuracies about how Matthew’s care had been planned. Across the board, the partnership failed to learn the lessons of Matthew’s death, which compounds the tragedy of that young man taking his own life while he was in the care of the state. As my hon. Friend the Member for Croydon North has said, there should be independent investigations of deaths that occur in mental health hospitals. I know that the Minister has been asked before to set up an inquiry into Matthew Leahy’s death. I ask her to commit to doing so now, so that we can learn the lessons from that tragic event and prevent such a thing from happening again.

Sir Simon’s recommendations will not solve every problem with our in-patient mental health services, but the Opposition believe that they would improve them, and would remove many of the major issues with the Mental Health Act. Although we have a little time, we cannot focus on all 154 of the recommendations. I just want to discuss the principles that he felt should be central to the operation of the Act. My hon. Friend the Member for Bermondsey and Old Southwark outlined those four principles in his opening speech.

The first principle is choice and autonomy. Of course, it should go without saying that, wherever possible, we give people control over what is happening to them. I am glad that the Government have committed to introducing advance choice documents. Those will be central to ensuring that people can exercise choice over what happens to them. We have heard in many of today’s speeches why that is important. I ask the Minister to confirm today, if she can, when those plans will be brought forward. There will be instances when people cannot exercise the choice themselves, so Sir Simon’s proposals for the new nominated person role and increased use of advocates will ensure that in those circumstances people are still able to influence their care.

During the passage of the Mental Capacity Act 2019 there was a great deal of discussion, involving my hon. Friend the Member for Stockton North, about advocacy. We must ensure that local authorities are fully funded to provide those vital services. It would be a travesty if someone were denied a voice because of budget constraints at their local council. Can the Minister tell us whether the Government will provide additional funding for advocacy to ensure that that does not happen?

The second principle is that of least restriction. It seems self-evident that we should try to ensure that people retain as much of their freedom as possible, but we have heard of the number of ways in which that does not happen. It might mean supporting people to enter mental health hospitals voluntarily rather than their being detained, or ending the use of seclusion and segregation and the terrible cases of restraint that we heard about.

The third principle is therapeutic benefit. Again, it should be self-evident that everything done under the Mental Health Act should be clearly aimed at helping the person in question to recover. If it is not, what is the justification for detaining them? My hon. Friend the Member for Bristol East talked about people with autism and learning difficulties in mental health hospitals, and we have to question how often their detention for periods of five years, or five and a half years, helps them at all, and whether any of what happens to them could be talked about as treatment.

Finally, Sir Simon emphasised the importance of treating the person as an individual. In particular, that section of the review focused on the current experiences of young people and people from BAME communities in mental health facilities. We have heard about that in speeches today. My hon. Friend the Member for Bristol East talked about the lack of support for families of children with out-of-area placements. Sir Simon recommends that, while those still exist—my party pledges to do away with them—financial assistance should be available when a young person is admitted to a placement away from their family. We are committed to ending inappropriate out-of-area placements, but my hon. Friend the Member for Bristol East talked about a case where, if a facility was the only one that would be able to provide the care, a parent would choose it. However, that support and financial assistance must be available. It is not right to cut off a young person’s support network when they need it most.

My right hon. Friend the Member for North Durham also talked about why the powers under the Act are being used more with people from BAME communities, and we must focus relentlessly on the facts.

[Mr Kevan Jones]

Does my hon. Friend agree that we cannot leave the matter where it is? We need an inquiry into it. Sir Simon calls for more research, but unless we have an inquiry we will not be able to get the policy changes to identify what is, clearly, going wrong.

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[Barbara Keeley]

Indeed, and what my hon. Friend the Member for Croydon North has said, today and in speaking about the Mental Health Units (Use of Force) Act 2018, has helped us to focus on the issue of the number of times when young people—particularly from BAME communities—are subject to the Mental Health Act, segregation and restraint. It is not acceptable. None of those cases is acceptable, but it is totally unacceptable if one group seems to be singled out in society for such measures—particularly tragically in the case of Seni. I applaud my hon. Friend the Member for Croydon North for taking that one case and pushing it through to legislation, and the Minister for supporting it.

All the principles I have outlined are important. It is only by following them that we can ensure that a reformed Mental Health Act will work in the interest of those it is designed to help: people with mental health conditions. Will the Minister confirm whether the Government will accept recommendation 1 of the review, that the four crucial principles be put on the face of the Act? We had a bit of a battle during the passage of the Mental Capacity Act 2019 in getting the Minister to accept that things should be on the face of the Bill, but things such as advocacy are pretty important, and it will not be acceptable if they can be overlooked or treated as a budgetary problem.

[Alex Cunningham]

Does my hon. Friend agree that one of our particular concerns was the way that the proposals related to young people and the fact that although there appeared to be safeguards that might look after adults, the protection for young people, and provision to give their families the necessary help to support them, was thin?

[Barbara Keeley]

Indeed, and we did try valiantly to get the Minister to accept amendments, but she would not. There is concern. It is a good thing to include 16 and 17-year-olds in the legislation, but not if there are no safeguards. There are real worries. In many cases that I have looked at, and where I continue to try to support families, parents feel ignored and helpless. They feel that mental health hospitals act without reference to the people who know the young person best.

One area in which Sir Simon did not make recommendations was the definition of a mental disorder. Specifically, he concluded that it was not appropriate for his review to decide whether autistic people should remain within the scope of the Act purely because of their autism. I agree with Sir Simon that that is a complex topic, but we should not let it be an excuse for inaction. Autism is not a mental health condition, but the Mental Health Act treats it as though it is. As a result, there are 1,150 autistic people in in-patient mental health facilities. A proportion of them will have mental health conditions that require treatment, but it should never happen that someone is detained purely because they are autistic or because they present with behaviour that could be challenging. I know of many cases where that is happening.

We all saw the deeply disturbing BBC “Panorama” programme on Whorlton Hall, which revealed the shocking treatment that autistic people were subjected to while detained in mental health hospitals. I am sure we would all agree that that treatment is simply unacceptable, but we must do more to prevent it. The best way of doing that is to ensure that people are not put into in-patient environments unnecessarily. If someone does not have a mental health condition that is being treated, they should not be held under the Mental Health Act. Can the Minister confirm that when the Government bring forward the proposals in the review, they will go further than Sir Simon and commit to ending the outdated practice of treating autism in the same way as mental health conditions?

It is eight months since Sir Simon’s final review was published, although it does not seem like it. He made more than 150 recommendations. We did not expect the Government to respond to all of them straightaway, but in eight months they have responded to fewer than a dozen recommendations. The other 140 apparently have to wait for the White Paper. We have heard about more reviews from the new Prime Minister this morning. All we seem to get is more rounds of consultation and more reviews, but Sir Simon consulted widely during the review. His review was informed by the experiences of 988 people, including 467 service users—the inclusion of service users is praiseworthy—and evidence from 75 organisations and 90 professionals working in the field. I hope that that included social workers. I thank my hon. Friend the Member for Stockton North for making such a strong case for the involvement of social workers; I agree with him.

The only reason I can see for further consultation would be if the Government were planning to go further on some of the recommendations than Sir Simon did—for example, in removing autism from the scope of the Act. Can the Minister confirm whether that is the case? If not, can she tell us why she feels that the consultation that Sir Simon carried out is insufficient? Surely it would be better to publish a draft Bill and carry out pre-legislative scrutiny in the normal way than to do what has become known as kicking the can down the road. Six months ago we were promised a new set of guidance on the Mental Capacity Act, but that has not been mentioned at all since then. Those are the things that should be coming forward.

We have also been told that there will be a mental health White Paper to implement the findings of the review—we find ourselves waiting for Green Papers and White Papers. Someone could be forgiven for looking at that and thinking that the Government simply do not care about people waiting for much-needed reforms. I know that the Minister cares, but do her Government care? Can she give us a date for the publication of the Government’s mental health White Paper? It is popular to say a season or the end of the year, but a date is more useful to work with. I realise that it is a time of great uncertainty for Government Ministers—I hope that we will see this Minister in her place in future—but a firm date would help us to hold the Government to account should they let their focus slip.

People with mental health conditions have been let down for too long. The review represents a rare opportunity to make changes that have cross-party support—the consensus in this debate has been encouraging—to a system that does not work properly. I hope that the Minister, and the incoming Government, do not waste this opportunity by delaying it further, which would leave people stuck in a system that is harming, not helping, them.

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[Jackie Doyle-Price]

On mixed-sex wards specifically, I cannot tell my right hon. Friend what the proportion is, but we are ensuring that the guidance on sexual safety on mental health wards is being rolled out. I will write to him specifically on that, if he will indulge me.

[Barbara Keeley]

An important point is that Matthew Leahy phoned the police to report the rape, but they concluded that it was part of his delusion—that was the reason they gave for not taking action. In the case of Whorlton Hall, the police also did not act on reports of assault, although assault was clearly going on. The Minister needs to take that problem up with the Policing Minister. It is not acceptable that what someone says is ignored if they are autistic or detained under the Mental Health Act 1983, because the level of sexual assault is disturbing, as my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) said.

[Jackie Doyle-Price]

That is an excellent point, and it plays into a general prejudice that people who are in detention are just an inconvenience to be managed. In the context of Sir Simon’s review, the whole ethos that any reform we make should be about empowering patients brings with it obligations to challenge other aspects of the system, not just the care providers. The hon. Lady is right to say that I need to take that up with the Policing Minister, which I will do as part of rolling out our preparations for the White Paper. I understand the hon. Lady’s lack of confidence when I say that the White Paper can be expected before the end of the year, but that is certainly my ambition, notwithstanding the fact that I know she has been waiting rather a long time for another paper that she was promised.

I can reassure the hon. Lady on the extent of the work that Sir Simon has done and the engagement we have had, especially with service users. Rather like the hon. Member for Bermondsey and Old Southwark, those service users shared with us their personal experiences, often reliving significant distress. Given that they have participated and that we have raised their expectations, we would, to be frank, be letting them down if we did not address that. I do not think that would be in any way forgivable, so, as long as it is on my watch, we will be pushing ahead.

As the hon. Member for Bermondsey and Old Southwark said, we are dealing with legislation passed in 1983, so although this appears to be a once-in-a-generation opportunity to reform this legislation, I hope that that is not the case. The situation is probably more symptomatic of the fact that we have not given this matter as much attention as it deserves, but clearly that has changed. The world has changed in terms of how we debate mental health, and that is welcome. Chiming in with the discussion we have had today, I am keen that we take this matter forward with consensus.

I pay tribute to the leadership that Sir Simon has shown in this review. As well as not ducking the controversial aspects of examining the legislation, he has engaged in dialogue and dealt with them in such a way that it is accepted that Members, peers, service users and professionals need to consider them. I am incredibly grateful for what he has done.

We talk more about mental ill health now, but when it comes to severe mental illness—the hon. Member for Bermondsey and Old Southwark spoke about schizophrenia —that is something that reveals incredible prejudice in people. As we have heard, if someone is able to manage their condition, they can live a full and independent life, but the key is being able to manage the condition with the appropriate support. We still have a lot to do in educating the public and society about the real impact of severe mental illness.

There are so many issues, but I will try to address them all in the time I have. The hon. Member for Bristol East (Kerry McCarthy) asked about out-of-area placements for people with autism and learning disabilities. I must say that this is something that really bothers me. Far too many people remain in institutional care and in out-of-area placements, and nowhere is that more true than in the field of learning disabilities and autism.

It is interesting, once we dig under the issue, to see that we have been very successful in getting people with learning disabilities out of in-patient care and into the community. However, that has been matched by a bigger increase in the number of people with autism finding their way into in-patient care. That tells me—I do not think this will be a surprise to anyone in the Chamber—that we are not doing enough to diagnose autism early enough, and as a consequence we are not equipping people with the skills to be able to live independently.

The ultimate result is that we end up putting people in in-patient care. Quite often, those people are forgotten about and it becomes very expensive to keep them there, so not only are we failing people by not having services for them early enough, but we are adding significant cost to the taxpayer and, frankly, doing harm, because the longer those people stay in in-patient care, the more their ability to live independently diminishes. As far as I am concerned, that is a major failing that we need to address.

[Jackie Doyle-Price]

I agree with every word that the hon. Lady says. One of our expectations of the new mental health support teams that we are rolling out into schools is that they will be able to work with schools and to spot people who might be in trouble. She is right that, with girls particularly, autism is under-diagnosed, and by the time the challenges start to have an impact on mental health, it is much more difficult to give people appropriate support. Early diagnosis is key.

I am pleased that we are now setting up a unit within the Department of Health and Social Care to look at neurodiverse conditions and what more we can do to improve service provision for them. I am also pleased that NHS England shares my concern about this and that we can expect more work on it, but there remains a lot to do and I do not shirk from admitting that.

[Barbara Keeley]

There is also the financial difficulty that my hon. Friend the Member for Bristol East (Kerry McCarthy) referred to. Private hospitals that autistic people and people with learning disabilities end up in tend to be very expensive—we know that the placements can be as much as £730,000 a year. The answer is to fund placements in the community. Years ago, when we were moving people out of long-stay mental health institutions, there was a dowry system. The Government do not have a dowry system to help with this, so Transforming Care failed because there was no mechanism to transfer funding from the NHS, which is taking the hit on cost, to cash-strapped local authorities. If local authorities are to continue being cash-strapped, and I hope they are not, some mechanism is needed there. My party has pledged to put in £350 million a year of transfers to make that happen. Does that idea recommend itself to the Minister? I know she is bothered about this.

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[Jackie Doyle-Price]

It is a fantastic school. It was amazing how the principle of mental wellbeing ran through the whole school from walking in to the point where the kids pick up a sticker that reflects their mood and put it on the whiteboard, so straightaway the teacher could look out for those who were feeling a bit distressed. The other amazing thing was the teaching assistants, who instead of being based in each classroom all had specialisms and did lots of one-to-one activities outside the classroom. Even more importantly, there was a facility to reach out to parents pre-birth—obviously families tend to go and see schools. I was hugely impressed, and that goes to show how we should be encouraging innovation and imagination with regards to these services. In fact, it is probably the poster organisation to show that mental health is not everybody else’s problem; it is all our problem. The ability for such engagement in school is fantastic, so well done Charles Dickens Primary School.

Members will be pleased to know that Sir Simon Wessely has worked with the sector, and interest groups in the sector, in coming up with his proposals. I am also in regular dialogue with them to discuss the principles. In the spirit with which we all approach reform of the Mental Health Act, we obviously want to keep people safe, so there needs to be the power for potential detention, but most importantly we need to protect the rights of patients and empower them. That is the principle that I really want to underline.

[Barbara Keeley]

We have moved past the point of discussing people with autism and learning disabilities. I take on board the Minister’s concern, but I wonder whether she could answer my question. Under a reformed Mental Health Act, is she looking at—or minded to look at—changing how people with autism are included as if they have a mental health condition? That is important to a lot of people, and Sir Simon did not rule on it.

[Jackie Doyle-Price]

We need to look at issues about autism in the round. The hon. Lady is right that it is currently treated as a mental health issue for the reasons outlined by the hon. Member for Bristol East: it is not diagnosed until a mental health issue materialises. That is really the issue. I would like us to use the 10th anniversary of the Autism Act 2009 to reboot our approach to ensuring that we are looking out for people with autism. In a way, we must go through the same journey with autism and learning disabilities as we have with mental health. That does not really answer the question from the hon. Member for Worsley and Eccles South.

[Barbara Keeley]

It is about the legislation.

[Jackie Doyle-Price]

As far as legislation is concerned, ultimately people with autism who are suffering from mental ill health will be detained under the Mental Health Act. Perhaps we ought to pick up how that interacts with other legislation as we develop the White Paper. The overlap is a clear problem.

I have paid tribute to Sir Simon Wessely. We are all about making sure that our reforms deliver genuinely person-centred care. We should be removing coercion and control as far as we can.

My hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) talked about Georgi Lopez, who addressed the all-party group and whom I had the pleasure of meeting. She tells a compelling story about her contrasting experiences. She readily concedes that on one occasion being detained under the Act was the best thing that could have happened to her, but on another occasion it did her genuine harm. In fact, Members who read Frank Bruno’s book will find exactly the same story. It is almost as if once someone is on that pathway and under detention, they will always be seen through that prism. We need to tackle the underlying prejudice. People who are suffering from mental ill health are vulnerable; they are not an inconvenience. Any services provided by the state need to be working with them to support them, not to do them harm.

Our overall objective when we asked Sir Simon to look at the Act was to reduce the rising number of people detained under it. I hope that underlines the spirit with which we are approaching the inquiry. We also asked him specifically to address the disparities in how the Act is used, highlighting in particular the impact on black and ethnic minority groups, but also on women. It is of great credit to him that he went much further than that and led a full review of the entire Act. Again, that raises the expectations on me to deliver fundamental reform—but that is fine; it is what I am here to do. He did so with such speed, and having taken so many with him, that he has provided exactly the right conditions to approach reform.

Sir Simon built relationships with service users and carers, and I am riding on the back of them. I meet those people regularly to hear directly from them about their responses to his recommendations. We will continue with that. I have been struck by some of the experiences shared with me by service users and family members, which bring home how disempowering it can be. I often talk about the arrogance of medical professionals who, when someone turns up and says, “Fix me,” send them along. That dismissiveness can be more so in mental health than anywhere else. We need to ensure that we put in a regime that treats people with dignity and respect.

At the heart of this issue, the current Act has much too big a disempowering effect, which does too much to remove people’s autonomy and not enough to support their decision making and influence over their own care. It is dehumanising. We should look at detention as the last resort, because it does genuinely do harm. That is not to be critical: staff will act with the best of intentions, but a lot of it depends on culture. When Georgi Lopez shared her experiences, she talked about the two very different cultures of the organisations in which she was detained. When the CQC visits such places and assesses whether they are well led, it must assess the culture and whether patients are genuinely empowered.

I do not think we should duck the fact that sometimes we will have to detain people for their safety and that of others, but we need to ensure that we have the right guarantees in place. I am struck by something that Sir Simon always says: from the moment of detention, release planning should start there and then. A credible care plan is all about getting people back out and re-empowered. It should be based on consent and empowering the patient.

As has been mentioned, Sir Simon’s report contains 154 recommendations. I will work with the Ministry of Justice on a joint White Paper from both Departments, which will come forward by the end of the year. We have already started to implement the recommendations that we can, and I hope that Members are reassured by how, last week, the previous Prime Minister re-emphasised her commitment to making sure that we tackle the issues regarding black and ethnic minority detainees. I know she will continue to have a full interest in these issues from the Back Benches. I reassure the hon. Member for Worsley and Eccles South that if she sees no sign of a White Paper, she has a good ally on the Government Benches to hold the Government’s feet to the fire. I look forward to engaging with all hon. Members on those recommendations when we come forward with our White Paper, for which we should also consider the issues that have been highlighted during the debate.

As I have said, we want to modernise and ensure that people who are detained under the Act receive better care by improving patient choice and autonomy in their treatment. We will introduce statutory advanced choice documents to enable people to express, in advance of detention, their view on the care and treatment that works best for them.

It is important to talk about the role of family, because we have agreed that patients should be able to identify a nominated person who will have the power to look after their interests under the Act. At the moment, the next of kin is the default. I have heard compelling evidence from patients who have said that that is not always appropriate. Family members can often be a source of abuse or additional pressure and harm, so patients want to be able to nominate someone, which seems extremely sensible. I recognise that that will cause some controversy.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Caroline Dinenage]

The hon. Gentleman is right: we do have a number of vacancies—a large number of vacancies—in adult social care. That is why, earlier in the year, the Government announced a recruitment campaign, “Every day is different”. It ran for a few months, with enormous success. There have been 14% more apply clicks on the relevant Government jobs site as a result, so we have just announced that we are going to expand and extend that recruitment campaign, with an additional £4 million of funding.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Among those most affected by lack of access to social care are the 2,300 autistic people and people with learning disabilities stuck in inappropriate in-patient units because of a lack of funding for community placements. Labour, my party, has pledged to spend £350 million per year to support moving as many of those people as possible into community placements. I note that the Health and Social Care Secretary actually pledged extra funding for social care if he became Prime Minister, so will the Care Minister tell us if he now promises to match Labour’s pledge and ensure that autistic people and people with learning disabilities can live in homes, not hospitals?

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 18th June 2019 Commons Chamber

[Caroline Dinenage]

The hon. Lady has often spoken very movingly in the House about her personal experiences, and she is absolutely right: abuse of vulnerable people is absolutely abhorrent. We are very determined to stop it, and we want to prevent it from happening in the first place through the tough inspection regime. We want to shut down poor-quality homes and, most importantly, we have made sure that across the country, police, councils and the NHS work together to help to protect people in the long term.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The integrity of CQC ratings was dealt a mortal blow by the uncovering of abuse at Whorlton Hall by BBC “Panorama”. Watching the abuse on that programme is made worse by the knowledge that the abuse may have started five years ago. The unpublished inspection report from August 2015 described allegations of assaults on patients, the undocumented use of a seclusion room and the use of rapid tranquilisation not backed by an organisation policy. I do not have any confidence that the review called by the CQC will uncover the truth behind that abuse. Will the Minister agree to set up an inquiry into this matter, so that we can establish whether the care regulator is fit for purpose?

[Caroline Dinenage]

The hon. Lady is absolutely right: abuse of any kind must not be tolerated, and we have heard horrific accounts of abuse that must be tackled. That is why in May, we announced much stronger commissioning oversight arrangements, where people are put in place out of area. Local commissioners must visit regularly. The CQC has commissioned two independent reviews, and the findings and recommendations of both will be published. The point is that opportunities to intervene have been missed, and we must be open and transparent in getting to the bottom of what happened.

Whorlton Hall

Baroness Keeley Excerpts

Thursday 23rd May 2019 Commons Chamber

[Caroline Dinenage]

The Care Quality Commission is taking the situation incredibly seriously. Some massive concerns were raised last night, and Paul Lelliott from the CQC apologised and said that the matter would be very thoroughly addressed and investigated by its team.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I appreciate the Minister’s response, but the Secretary of State really should be here to deal with this. The abuse shown on the BBC “Panorama” programme last night was appalling, and it should never have been allowed to happen. The fact that it is eight years since the Winterbourne View scandal and nothing has changed should be a source of shame for the Government. Rather than warm words—the Government seem to be getting good at warm words these days, but little else—will the Minister take personal responsibility and tell us what she is doing to ensure that this never happens again?

The abuse that was shown was tantamount to psychological torture, with residents sworn at, threatened and intimidated. Other residents were violently restrained or deliberately hurt by care staff. As the Minister has mentioned, other cases—such as Mendip House and Thors Park—show that this is not an isolated incident; it is part of a pattern of cruel and callous behaviour in such institutions. There is only one sure way to end this abuse, and that is to close down the institutions and move people into supported placements in the community.

Many of the people who were abused at Whorlton Hall were hundreds of miles from their families. Does the Minister recognise that cutting people off from their support networks allows such abuse to carry on without anyone noticing? Labour has pledged £350 million extra per year to ensure that people can move from such institutions and be supported in the community instead. Will the Minister match that commitment?

In 2011, the Government pledged to end the use of units such as Whorlton Hall. Eight years later, however, there are still more than 2,200 people detained in inappropriate institutions. More recent targets, which were less ambitious, were also missed. After years of broken promises, autistic people, people with learning disabilities and their families cannot trust the Government to deliver on their promises. Is it not time the Government brought in an independent commissioner to oversee the closure of such units?

[Caroline Dinenage]

I do not agree with the hon. Lady that what I have said today is about warm words; it is about action. The CQC report that came out on Tuesday was commissioned by our Secretary of State to really shine a light on the matter. We are shining a light on some of the most distressing information so that we can address it—so that we cannot brush it under the carpet and speak warm words about it. Not only did we accept all the CQC’s recommendations, but we made more recommendations of our own that we intend to put into practice.

In answer to some of the hon. Lady’s questions, I am very clear that as far as possible, people should be treated in a community setting. If they have to go into an in-patient setting, they should be as close to home as possible and they should be there for the shortest possible time, with a very clear route out and plan for their future. To help to deliver that, we have committed £4.5 billion to community funding as part of the NHS long-term plan, and I expect a good proportion of that money to be spent on investing in the community settings that we need.

[Barbara Keeley]

Why not close them?

[Caroline Dinenage]

The hon. Lady is saying from a sedentary position that we should close settings, but we are talking about very vulnerable people who have complex needs and require special care, and we need to make sure that there are sufficient services in the community to support them. It would be a complete dereliction of our duty and responsibility to take people out of one setting that is not working for them and put them into another setting that will be as bad, or worse.

National Marriage and Mental Health Awareness Weeks

Baroness Keeley Excerpts

Thursday 16th May 2019 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in this debate with you in the chair, Sir David. I congratulate the hon. Member for Congleton (Fiona Bruce) on securing the debate, and I thank hon. Members who have contributed to mark this unusual mix of Mental Health Awareness and National Marriage weeks.

Many points have been made on the value of marriage and family life, including in the excellent opening speech by the hon. Member for Congleton and by the hon. Member for Strangford (Jim Shannon)—I think I beat him by two years in how long I have been married. Happy anniversary for each of our relationships. The hon. Member for South West Bedfordshire (Andrew Selous) focused on family relationship issues and poverty, and the role of family breakdown.

In line with my brief, I want to bring this debate back to mental health, because it is Mental Health Awareness week and we could explore some issues there, too. I feel that, no matter how strong a family are, there will be times when they need support from outside—when they need the services that the state can provide to help them to cope. If those services are not there when they need them, it can cause immense strain for everyone involved. This is every bit as true for mental health as it is for physical health services.

We do not expect families to cope with a broken leg or a cardiac problem on their own, so we should not expect them to cope with depression or an eating disorder without professional support. I want to question whether we really are doing all we can for families where one child is living with a mental health condition and they need help. Whatever our best intentions, the fact is that we are not yet doing the best we can for children and families.

According to the British Medical Association, spending on mental health care equates to only 11% of our UK NHS budget, despite accounting for 23% of the burden of disease in the UK. As we know, there is increasing demand for mental health care, with patient numbers increasing across a range of conditions. It might be time to look at that number and decide whether it should be greater, particularly for children and young people. We know that one in eight five to 19-year-olds has at least one mental disorder, but that only 6% of the mental health budget is spent on services for children and young people. I believe it is time we questioned that, because such a gap has serious consequences for children and young people with mental health conditions.

Some 400,000 children and young people who have a mental health condition do not get to see a professional at all. Instead, they have to cope with informal support. More than one in four of the children and young people referred to specialist child and adolescent mental health services in 2016-17 did not have their referral accepted. As the Children’s Society analysis showed us last year—it is a very disturbing statistic—a quarter of 14-year-old girls and nearly one in 10 boys had self-harmed in a year.

I commend Sky News and their reporter Paul Kelso for a great piece of investigative work that sheds light on the experiences of children and young people in private mental health units, many of which take young people hundreds of miles from their homes and families. The report of this work was shown yesterday. One such young person is Natasha, who is now rebuilding her life after a lost decade spent in such units. Natasha has anorexia and escalating self-harm, and she hit crisis point when she was only 12. She then spent 10 years in private mental health units dotted around the country. She says she reached her lowest point in a mental health unit in a privately run hospital in Maidenhead. In that unit, she experienced brutal restraint, which she describes as follows:

“They would pin you up against the wall, smack your head against the wall, drag you across floors, wrap you round doorframes...People sat on your head and on your legs…this would be big men, not women.”

That was the unit where she said she did

“the worst amounts of self harm”

that she had ever done in her life. Despite Natasha’s history of self-harm, she was left unattended with razors and cut herself 26 times. She needed 200 stitches.

The constant threat of self-harm is a massive strain and worry for parents when their daughter is hundreds of miles away. A mother with a daughter in one of the units that was shown in the Sky News film described how when she wakes up she thinks, “Is she all right? Will she manage to achieve her self-harm aim today?” She added, “You are hundreds of miles away. If anything happened, you would not get there on time.” As the Sky News report showed, the toll of self-harm and suicide in these units is too high. Natasha explained how she lost 24 of her friends to suicide in such mental health units, including three or four in one unit alone.

Hon. Members here today will know how it feels when a desperate constituent tells us about their child’s mental health condition and the struggle they face being unable to get their child access to the services they need. This is intolerable. We have seen mental health services being underfunded—I know the Minister will tell me about the future funding that is coming in, but we have to think about where we are today—and we know that mental health budgets fell by nearly 8% between 2010 and 2015. Sadly, we are still seeing one in 10 commissioning groups unable to meet the investment standard expected of them by the Government, which means they are failing to give mental health services the funding priority they need. We must do better than that.

In 2017, Labour set out a clear plan for how we would do better than that. I want to touch on those points. Over the past decade, mental health spending has been a part of broader NHS budgets, but as budget pressures emerged, NHS trusts and commissioning groups raided their mental health budgets to prop up services elsewhere. To that end—I know the Government have not been keen on this—Labour would ring-fence mental health budgets, which is important to ensure that the money that those services need is not siphoned off to fill gaps elsewhere.

As we think about children, young people and their families, it is important that we question why only 6% of mental health spending goes to services targeted at children and young people, despite them making up some 22% of the population. Labour would dramatically increase the proportion of the mental health budget spent on children and young people.

Following on from what I said about yesterday’s Sky News programme, we would end the disgraceful practice of sending people hundreds of miles for mental health treatment when there is no good reason to do so. In the past year, sadly we have seen the number of inappropriate out-of-area placements rise from 640 to 720, despite a Government pledge to reduce their use. I see these out-of-area placements as a tragedy for families. They jeopardise the recovery of people receiving treatment and force parents and other family members to travel long distances to support the young person. With Mental Health Awareness Week, let us not persist in treating mental health as the Cinderella service of the NHS, and children and young people’s services as the Cinderella service inside that Cinderella service.

My plea is this. Let us help children and young people in need at the time of their need, rather than making them wait 18 months to get specialist support or letting them end up in very long-term placements in locked mental health units far from home. Let us do something about the fact that the number of autistic people detained in inappropriate in-patient facilities on dubious mental health grounds remains stubbornly high, and includes a rise in the number of children in what have been seen as modern-day asylums. Let us do better. We can do better than this for our children and young people and their families.

[Sir David Amess (in the Chair)]

Just before the Minister responds, I should have announced at the start that, because the second debate was cancelled, this debate could actually continue until 4.30 pm. I will leave it with hon. Members.

--- Later in debate ---

[Jackie Doyle-Price]

That is a very good point. We can expect employers to start doing things when they can see a return for themselves. It is interesting also that, as we reach higher levels of employment and as an appropriately skilled workforce is harder to come by, employers see the advantage of giving more help and support to their staff in order to retain them and keep them productive. We look forward to seeing more of that. Certainly our work through “Thriving at Work” with Mind, Paul Farmer and Lord Stevenson is designed to share best practice and encourage more.

My hon. Friend also talked about the long waits for children’s mental health services, which the hon. Member for Worsley and Eccles South (Barbara Keeley) also talked about. We have to concede that, historically, children’s mental health services have been very poorly funded and supplied, and we are dealing with the aftermath of that now. Everyone knows the extent of our ambition to deliver much improved mental health services to children and young people. However, we still have to properly address the situation that we have inherited. We are playing catch-up, but we will push forward and make sure that children have access to services. The mental health support teams are the first point of contact for children, helping them look after their own wellbeing.

[Barbara Keeley]

One interesting point, which I did not make, from the piece of work that I referred to from yesterday is that placements for children and young people in private units of the type that I talked about are more expensive. They can be £500,000, £600,000 or £700,000 a year, whereas support in the community would doubtless not be as much as that. They would not be 200 miles away from the families, and they would have the support that they need.

[Jackie Doyle-Price]

I agree completely. The reason why we have so many children in out-of-area placements—which, as the hon. Lady says, are expensive—is that there has not been sufficient support in the community. Nor has it been available early enough to give the children support. They have been badly failed. It has done them harm and made them more ill. The issue of out-of-area placements is of massive concern to me. I am making it a personal priority to fix it. I am concerned that, because it is seen as a specialised area of commissioning for NHS England, it commissions a quantum of beds, but that is what leads to them being out of area, and children are referred to them. We all know that their recovery will be much better if they are in their support networks near their friends and families.

When the system works well, it is absolutely inspirational. I visited an intensive care unit in east London last year. A young lady had come out the other side, having gone in for treatment for self-harm and anorexia. She was very clear that being able to undergo treatment while still being able to attend school was crucial to her recovery. To me, that seems compelling. I am deeply unhappy at the extent to which out-of-area placements are still being used. I am afraid there will probably be a need for them until we can be properly confident in our community services to work more effectively, but I am sure we all agree that we need to tackle it as soon as we can.

I enjoyed listening to the observations of the hon. Member for Strangford (Jim Shannon) about what makes a happy marriage. He is right that hard work is a big part of it.

The hon. Gentleman also shared the length of marriage in his family. This year, my parents are celebrating 50 years of marriage. Having lived with them for 21 of those, I have to say that that is quite an achievement. Obviously, it takes real work. As he says, quite often we do not like our partners, but clearly, notwithstanding the difficulties, they give us comfort and security. Not having a support network to rely on, whether that is a partner, wider family or friends, makes life a lot more difficult. I recognise that some relationships will be rollercoasters. Pressures, such as financial debts, can cause untold difficulties in relationships. There will be times when people need support and we need to make it easy for them to ask for it. We have heard several references to organisations that try to give support to couples, such as Relate. A problem shared is a problem halved—we need to encourage more of that.

I was horrified by the story that the hon. Gentleman shared of the couple neither of whom wanted custody of their children. That suggests that they were the product of dysfunctional families, which is another thing to consider. If we leave children to grow up in dysfunctional families, they will repeat that experience. We need to try to do better to improve the quality of family relationships, because that would be good for society. When we look at the back stories of people who end up in prison, we see that there were no end of opportunities where they came into contact with the state, either at school or in other ways. That is a failure for us and we need to tackle it.

It is always a pleasure to listen to my hon. Friend the Member for South West Bedfordshire, who really is a social justice warrior. Again, he brought home clearly the effect of the state applying process to everything and forgetting the humanity of people. We need to be more sensitive about how we intervene supportively. The institutions and the way we organise society can be excessively intimidating and formal, which is not the way to deal with people who need more emotional support. We need to think carefully about what sort of agencies should do that. The beauty of schools, and directing support via schools, is that they are not intimidating or formal institutions. Parents and children have peer support there, over and above their actual attendance, from friends and other people attending and taking their children.

We need to look at the avenues for engagement with people and make sure that they are fit for purpose, and to recognise that all Departments have a role in that. We siloise that contact. Mrs Bloggs takes little Jimmy to school, has a nice relationship and feels that they are being supported, but when she goes to the Department for Work and Pensions, she is treated as an operational performance and it is dehumanising. That is where we need to be more joined-up in the support that we are giving to families. There is a lot to learn. State institutions rely on process to ensure uniformity and fairness, but that does not always lead to good outcomes.

As my hon. Friend said, Governments are expected to do everything, but for the reasons I have outlined they are not always best placed to do that. Sometimes, rather than inventing processes and grand programmes, we should look more actively at letting 1,000 flowers bloom. Where third-sector organisations bring value, we should look at directly commissioning more services from them. That is the case in respect of mental health, because not all support for people suffering mental ill-health is clinical. Quite often, they will benefit from support that just helps them to get through life. That is something that third-sector organisations can do well. I have challenged clinical commissioning groups to look more actively at what they can do, because they will be able to deliver more care by not always relying on clinical staff.

I greatly enjoyed listening to the hon. Member for Glasgow North (Patrick Grady). He is wearing a fetching tartan and I am jealous that we have only the green ribbons. I will think about how we can outdo the Scottish tartan for Mental Health Awareness Week next year. He reminded us that it has been quite a week for mental health and mentioned the axing of “The Jeremy Kyle Show”. The incident that preceded that axing is a wake-up call; it shows that dysfunctional families have become entertainment. What does that say about how we operate as a society? I hope this gives everybody an opportunity for some self-reflection; it is not something that we should use for entertainment.

[Barbara Keeley]

I wanted to refer to what the hon. Member for Glasgow North (Patrick Grady) said about detoxifying issues, which is important. The worst thing that I have read about “The Jeremy Kyle Show” is not that it focused on dysfunctional families, but that it set people against each other in an aggressive way, so it needed bouncers and security staff on hand to part people. The programme seems to have used a toxic formula, which is something that the House could look at through an inquiry, because that could persist in other types of filming. Clearly, it has had a tragic outcome, which, given the Minister’s brief, we have to take seriously.

[Jackie Doyle-Price]

I share that view. By definition, if people are making TV that is designed to be entertaining, it will be manipulative and exploitative. A good friend of mine went on “I’m a Celebrity…Get Me Out of Here!”—not the person who was an hon. Member, but someone else. He told me in great detail about how situations were manipulated to generate conflict. Because he is already a celebrity, he is resilient and well equipped for that, but we can imagine that for people who are not, and for whom being in the public eye is new, the risk of harm is significant. I understand that the Digital, Culture, Media and Sport Committee will be looking at the issue, and I welcome that inquiry. If someone switches on the TV, there will be any number of reality TV shows on—often because, in truth, they are cheap to make. Given their proliferation, perhaps we ought to have some standards that producers should respect.

Another example—this shows how much rubbish I watch on TV—is the axing of “Celebrity Big Brother” earlier this year, or perhaps last year, because of an incident between two celebrities on it. I think the public showed such revulsion because they were celebrities whom the public perceived they knew. If it had been the non-celebrity version and they were two strangers, I doubt that there would have been the same reaction. That tells us that, actually, we have all been manipulated by it. It is only when something terrible happens that we stand back and think, “Hang on a minute, we shouldn’t be doing this.” But here we are.

The hon. Member for Worsley and Eccles South made some very fair criticisms about the challenges to children and young people’s mental health. I agree that one of the reasons that we are where we are is that, historically, child and adolescent mental health services have been far less effective than they ought to have been. I watched the Sky film that the hon. Lady referred to, and I have to say that some of the practices that were referred to in it are utterly unacceptable.

I have been very clear with the CQC that institutions that apply restraint to the extent that the hon. Lady described are totally unacceptable, and it is now being much more aggressive in implementing inspections. We will hold organisations to account. In that respect, the Bill in the name of the hon. Member for Croydon North (Mr Reed) will be a great help. We are in the process of agreeing guidance to deliver that. It will require a real cultural change, but I often say that sunlight is the best disinfectant. The best led institutions are open about when they have to use restraint and fully document it; the worst do not report it at all, and that really has to change. That is something that the CQC challenges now when it visits organisations. I want the number not only out-of-area placements, but of in-patient placements more generally, to come down. That will be a mark of success and a sign that we really are investing in improved community services for our children and young people.

The hon. Lady also referred to the appalling extent to which the young lady in the film had come across people who had engaged in suicide and self-harm. I am pleased that we now have the Zero Suicide Alliance, which is led by the fabulous Joe Rafferty, the chief executive of Mersey Care. Our ambition is to have zero suicides as a consequence of any NHS-funded care. That was launched at the end of last year, and we need to use it as a tool to drive improvements in this area.

As the hon. Lady said, we have the mental health investment standards, whereby we expect local trusts and CCGs to spend more of their budgets on mental health. She suggested that funding should be ring-fenced. I have always felt that ring-fences can be seen as ceilings. However, we are committed, through the long-term plan, to ensuring that all local commissioners abide by those standards, which are a ring-fence in all but name. We are closer than we have been on that issue.

I again remind hon. Members about the troubled families programme, which has been dealing with 400,000 families. It will be revisited next year, and we would welcome any representations from hon. Members about how we can learn from it and improve how we help families with complex needs. Obviously, we need to develop better outcomes for all family members.

Coming back to Marriage Week, we know that good quality relationships are critical for all of us, as they add to our overall happiness. As my hon. Friend the Member for South West Bedfordshire said, some people do not necessarily want their relationship to be recognised as a marriage. None the less, we all benefit from stable, loving and supportive relationships. With my suicide prevention hat on, I will say that relationship breakdown is the biggest driver of suicide. That is another reason why we should always enable people to find help when they need it.

As far as the impact on children and their life chances is concerned, we know that by the age of five, almost half of children in low-income households have seen their families break apart, compared with only 16% of children in higher-income households. As my hon. Friend said, we must address that social injustice because when relationships break down, there is a risk of poor outcomes in the long run.

I see health visitors as very important partners—I always refer to them as my army. They are on the frontline, and their contact with people is less formalised. They are the one group of people who can engage with the entirety of the family. They look not just at the baby and mum, but at dad and the siblings, too. We need to take advantage of those interventions to do better for families in general.

We are spending £39 million on the reducing parental conflict programme, which is designed to reduce conflict between parents who are still together, and work with them to strengthen their relationship, exactly as my hon. Friend the Member for Congleton wants, to help them to stay together if that is what they want. We should also recognise that separation can sometimes be the best option, particularly if there are other factors involved that can cause distress for the children. Even in the event of a separation, continued co-operation and communication between parents and their children will give advantage to the child.

Although the Government will continue to support and champion marriage, we will not discriminate against other types of families who require our support. We will ensure that parents can access help when they need it, whether they are already married and need help to sustain their partnership, are not married and wish to improve the health of their relationship, or have chosen to separate.

I turn to what we are delivering through the NHS long-term plan. The improvement in perinatal mental health services will help us to engage people when they are at risk, assess people’s circumstances, give peer support and perhaps just make a decisive intervention at a time of real stress for families, where either the mother or the father becomes ill.

The theme of this year’s Mental Health Awareness Week is not marriage but body image. The two are not entirely unconnected, because how we think and feel about our bodies obviously affects how we engage with other people. Just as we need to get real and think about working harder, not everything will be ideal. We are not all going to have a marriage that is like a fairy tale 100% of the time, and we are not all going to look like Claudia Schiffer. That is okay—that is normal—and we just need to be aware of that.

It is worrying that, according to the Mental Health Foundation, 39% of children feel shame in relation to body image. We ought to think about the causes of that stark statistic. People are bombarded with images via social media, and so on, so we need to encourage parents to spend time with their children and make sure that children know what they can realistically expect. They cannot expect to look like the doctored images that they are being shown.

That comes back to the issue of quality time. Smartphones have been absolutely revolutionary for our society. Is it not fantastic that we can find information about anything we want and contact people at any time? However, face-to-face engagement, especially between parents and their kids, is really important. I pay tribute to Frankie & Benny’s, the restaurant chain, which has said that to encourage parents to speak to their children while they are having a meal, it will give them a discount if they hand their phone over.

We are so easily distracted by time spent on a phone. The first thing I do in the morning when I wake up, and the last thing I do at night, is to look at my phone. It is not very healthy, to be honest. We need to encourage our children to have a healthy relationship with their smartphones, and the same is true for ourselves. There is no substitute for some good parent-child conversation, and that does not need to take place via WhatsApp or text.

Broader mental health support is available to people who suffer from mental health problems. IAPT provides couples therapy for depression, which is available through the NHS. That directly helps relationships.

This debate has been interesting and thought provoking, and it has highlighted many issues that, although we may agree about them, we perhaps need to be more proactive about properly addressing. They are not the easiest things to deal with, because they are about human failings, but it is good to hear that so many colleagues are bothered about them and actively think about them.

Mental health problems can affect anyone, any day of the year. Those problems have a bearing not only on the wellbeing of the individual, but on marriages, relationships and children. We must continue to work together, across Government and with our partners, to address some of those issues. As a society, we all need to be more sensitive about the stresses of particular times, such as when people experience job loss, debt or relationship breakdown, to ensure that we give people appropriate support.

I am sure we can all agree that Marriage Week and Mental Health Awareness Week provide us with excellent opportunities to bring those subjects together. I am very grateful to my hon. Friend the Member for Congleton for bringing those subjects forward for debate.

Learning Disabilities Mortality Review

Baroness Keeley Excerpts

Wednesday 15th May 2019 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the learning disabilities mortality review.

[The Minister for Care (Caroline Dinenage)]

I would like to start by restating our commitment to reducing the number of preventable deaths among those of our population with a learning disability and to addressing the persistent health inequalities that they experience. It is completely unacceptable that people in our country with a learning disability, and indeed autism, can expect a shorter life than the population as a whole.

Each and every death that might have been prevented is an absolute tragedy, and we must not compound that tragedy by failing to learn any lessons we can that might improve the care that is provided in the future. That is why the Government asked NHS England in the first place to commission the learning disabilities mortality review programme, known as LeDeR. The principle behind it is a relentless determination to learn from these deaths and to put in place changes to the way care is organised, provided and experienced, to make a real difference locally and nationally. It means challenging often deep-rooted, systematic or cultural issues that have existed for decades. It is driven by the fact that we are clear that the quality of care offered to people with a learning disability sometimes falls very short of the standards we expect, and that is simply not good enough. The existence of the LeDeR programme testifies to our commitment to address this issue so that people with a learning disability can access the best possible care and support. The annual reports published by the LeDeR programme and the recommendations it makes are all part of this.

Over the weekend, the media reported on the findings of a draft of the third annual LeDeR report, which is due to be published shortly. In making this statement, I would like to record my deep regret at this apparent leak. It is also a regret that Her Majesty’s Opposition should table an urgent question based on leaks and, indeed, that the Speaker’s Office should see fit to grant it. More generally, the House—

--- Later in debate ---

[Caroline Dinenage]

Thank you, Mr Speaker.

With regard to the LeDeR programme, I have committed in the past and will commit once again to bringing the final report before Parliament on the day of publication, which we are told by NHS England will be in the next few weeks. Members will feel as concerned as I do about some of the things in the report that have been leaked, and I will be happy to discuss the more detailed information when the report is fully published.

[Barbara Keeley]

Well, this is a mess, isn’t it? Last year, the first report from this important review was sneaked out on a Friday, in the middle of the local election results, and this year we have read about it through leaks to The Sunday Times and the Health Service Journal. The Minister says that it is a draft that is going to be published shortly; I understand that the authors handed it over on 1 March. How long does it take the Department to turn round a draft? Clearly, somebody somewhere thinks it should be out there, because somebody somewhere is leaking it. Will the Minister take responsibility for this process and ensure that future reports are published in a timely manner? I am not happy with “shortly” or “in a few weeks”; will she tell us when the full copy of the report—not just what was leaked, first in the Sunday papers and now in the Health Service Journal—will be available?

It appears from the leak that the review has been able to consider only a quarter of the premature deaths reported to it, leaving more than 3,000 families waiting for closure—it is those 3,000 families on whom we should be focusing—and that well over a third of cases do not even have a reviewer assigned to them. That shows that, as we suspected last year, the LeDeR programme is significantly under-resourced, so will the Minister pledge now to ensure that the review has the resources it needs in future?

Last year, the Government made 24 specific commitments relating to the annual report, and 15 of them were due to be completed by now. Will the Minister update the House on the progress on those commitments?

The leak tells us that the review found that in 8% of cases the care given

“fell so short of good practice that it significantly impacted on their wellbeing or directly contributed to their cause of death”.

What is the Minister doing now to ensure that no more people with learning disabilities die early because of poor care?

Lastly, and most disgracefully—I am certainly going to mention this from the leaked report—the report says that over a period of two years, at least 19 people with learning disabilities who died had “learning disabilities” or “Down’s syndrome” given as the reason not to resuscitate them. A patient having a learning disability or Down’s syndrome is not a reason to put a “do not resuscitate” order on their care. Does the Minister agree that such an approach, if it exists, smacks of eugenics and is completely unacceptable? What action will she take to ensure that it does not continue?

[Caroline Dinenage]

This is not a mess; the Department of Health and Social Care requested that NHS England commission the whole LeDeR programme. The report is an independent document, which is very important because we are talking about people’s lives and about deaths that could have been prevented. It is really important that the work is done by an independent group and that it is carefully scrutinised, and that that scrutiny and work to look at the recommendations—[Interruption.] If the shadow Minister would like to bob up and ask some questions, I will happily answer them, but if she is going to keep murmuring from a sedentary position, I will not be able to address anything that she says.

It is so important to do this process in an independent way, because we are talking about people’s lives. NHS England says that the LeDeR report has not been published yet because it contains some serious recommendations, as have other such reports, and NHS England needs to make sure that the correct people will be responsible for implementing those recommendations and that the document can be scrutinised in the correct way before it is published. I understand that the shadow Minister is always keen to get things published as quickly as possible, and not always with the benefit of their being done as thoroughly as possible, but in this case we will not be pushed. This is an independent document and I cannot control when it will be published, but the shadow Minister can rest assured that when it is published, I will be happy to answer any questions that arise from it.

Members will feel, as I do, that recent press reports are a clear indication that we need to do more on this, and I assure the House that we recognise that. The LeDeR programme confirms how seriously we take the issue of premature mortality and differences in life expectancy. We will continue to work with partners across Government and throughout the health and social care system to consider any recommendations that improve care for people with learning disabilities and autism and address the shameful inequalities that they experience. Everybody has a right to expect effective, compassionate and dignified care. If someone has a learning disability, their expectations should be no different.

I have already stated that I do not intend to comment on the specifics of the leaked bits of the document, which is independent and has not yet been published. However, like other Members, I am particularly concerned about any suggestion that doctors have recorded learning disability or Down’s syndrome as the reason for a “do not attempt cardio-pulmonary resuscitation” order—a DNACPR, as they call it. People with a learning disability have exactly the same right to enjoy a meaningful life as everyone else, and their disability should never, ever be used as an acceptable reason for a “do not resuscitate” order. We are taking immediate steps to ensure that doctors are reminded of their responsibilities and avoid any form of discrimination. [Interruption.] The shadow Minister says from a sedentary position that doctors should not need reminding. That is the whole point of commissioning the LeDeR review. Sometimes there are systematic or cultural ways of going about things in everyday life, whether in the medical profession or anywhere else, that mean people are not treated with the dignity and respect that they deserve. The whole point of the LeDeR review is to learn from every single preventable death and to make sure that no one else suffers in the same way.

The LeDeR programme published its second annual report in May 2018, and the Government’s response, which we published in September 2018, set out a range of actions for the Department of Health and Social Care, NHS England and other national partners to help to reduce premature mortality and improve outcomes for people with learning disabilities. Many of those actions have now been completed—for example, we recently closed our consultation exercise on plans to introduce mandatory training in learning disability and autism awareness for health and care staff, and we will set out plans to move forward on that later in the year.

The latest report will no doubt reinforce what we already know: that the Government and our health and care system need to do more to ensure that people with a learning disability receive good-quality, informed and safe care. There has been a significant improvement—there has been a tenfold increase in the number of LeDeR review cases that have been covered, the backlog has improved, and in 2018-19 NHS England invested an additional £1.4 million to support the local teams to accelerate the process, as well as to train 2,100 experts to carry out reviews. The process is new, but we are pushing forward and putting in the necessary resources to make sure that we deliver on time. The LeDeR programme is there to help to achieve what we have set out, which is to make sure that those with a learning disability should never expect to receive worse health outcomes. We will respond to the full version of the report as soon as it is published.

Health

Baroness Keeley Excerpts

Tuesday 14th May 2019 Commons Chamber

[Mr Speaker]

The hon. Member for Scunthorpe (Nic Dakin) does not need to raise his hand as though he were in a classroom. I can see him clearly, he is unmistakeable and we will come to him ere long.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

On a point of order, Mr Speaker. I raised a point of order yesterday highlighting the fact that the annual report of the learning disabilities mortality review has not been published despite its being handed over by its authors on 1 March and being leaked in The Sunday Times this week. Now we have leaks not only of details from the report about the deaths of people with learning disabilities who had a do not resuscitate order placed on their care, but of the full recommendations of the report in the Health Service Journal.

It is a pity that the Under-Secretary of State for Health and Social Care, the hon. Member for South Ribble (Seema Kennedy), has left her place before I have finished this point of order. Ministers do not seem to care about this report, which deals with the deaths of 4,300 people with learning disabilities.

Have you had notification that the Secretary of State has finally decided that this vital report is too important to have published by selective leaks, or has he indicated that he will come to the House tomorrow, as he should, to make a statement on this report?

[Mr Speaker]

I am grateful to the hon. Lady for her point of order. The short answer is that I have received no indication from any Minister of an intention to come to the House to make an oral statement on this matter. I note what she says about leaks to the media of sections and parts, even substantial elements of the report. That is not conducive to the best public debate, it has to be said. I know not how those leaks occurred: it is not the first time and it will not be the last.

If the hon. Lady is concerned that these matters should be aired in the Chamber, there are options open to her and she will have to reflect on that. I certainly have no aversion whatever to a proper focus on that important matter, affecting very many vulnerable people indeed, in the Chamber. Knowing her as I do, I have a feeling that I will probably hear further from her.