Mental Health Units (Use of Force) Bill

Christopher Chope Excerpts

Report stage: House of Commons
Friday 15th June 2018 Commons Chamber

[Sir Christopher Chope (Christchurch) (Con)]

I am grateful to the hon. Gentleman for his indication of support for these amendments. When the Government have explained to him why they cannot deal with them, have they explained how the objections he has raised do not occur where the treatment is provided in part by the NHS but not in toto?

[Mr Reed]

As the Minister is present, it is probably best to allow her to speak for herself, rather than for me to attempt to interpret this on her behalf.

I wish to turn next to the amendments tabled by the right hon. Member for North Norfolk, many of which I support in principle, having raised a number of them myself at previous stages. I am broadly satisfied that many, if not most, of the points will be dealt with through guidance issued by the Department after the legislation, but I look forward to the Minister’s further comments and explanations on those points.

Important additions have been made to what falls under the definition of “use of force” as this Bill has developed. One is the use of “chemical restraint”, which amendments 88 to 91, standing in the name of the hon. Member for Christchurch, would remove from the Bill. I am afraid that I cannot support those amendments, because the potential effect is that the Bill could limit the use of physical restraint, only to lead instead to an increase in the use of medication—for example, rapid tranquilisation. It is important therefore that the Bill covers all forms of restraint, both physical and chemical.

[Sir Christopher Chope]

I tabled these amendments on the basis of a sad, current constituency case involving the parents of a very ill young man of 25. He is in and out of a mental health unit, and normally he is in there because he has failed to take his medication. It is designed to reduce the need for force, because he would be violent without it. Surely, the giving of such medication to a person in the circumstances I have described should not be regarded as “force” under the Bill.

[Mr Reed]

I hear what the hon. Gentleman is saying, but the point remains: if we take measures to deal with only physical restraint but not chemical restraint, we may simply push the services to use chemical restraint, such as rapid tranquilisation, more frequently and we would not wish to see that as an unintended consequence of amending the Bill further.

On the nature of the use of force, the hon. Member for Shipley has tabled amendments 44 to 78, which would replace the word “force” with the term “ restraint” throughout the Bill. I do not wish to pre-empt his reasons for doing that, and I suspect he will explain himself well later this morning, but let me say that we used the term “restraint” rather than “force” during an earlier draft of the Bill, so I agree with the general intention behind these amendments. I was persuaded, however, that the current wording ensures greater consistency with other legislation and therefore that the Bill does not run the risk of adding confusion into how the professionals interpret the language used.

The right hon. Member for North Norfolk has tabled a number of amendments dealing with the information provided to patients. Amendment 38 would include in the information given to patients details of their right to independent advocacy, which would help the patient to make the right decisions about their care and involve, where appropriate, carers and families. I certainly agree on the need to give more power to service users, so I would gently encourage the Minister to set out how those objectives might be achieved.

The Bill, as amended in Committee, says that information does not need to be provided where it would “cause the patient distress”. I understand that the hon. Member for Christchurch also has concerns about that, which is why both he and the right hon. Gentleman have tabled amendments to remove that potential loophole. I agree on this, and following discussions with the Minister, I am happy to accept Government amendments 1 to 3, which remove this “distress” loophole.

On staff training, the hon. Member for Shipley has tabled amendments 11 and 12, which seek to strengthen the Bill by adding usefully to the list of training topics. I know that he has discussed the Bill with his local care trust, and I welcome that spirit of engagement and representation. Amendment 11 would require training to be given on “roles, responsibilities and procedure” if the police are called to a mental health unit, as happened in the case of Seni Lewis and in many others. That strikes me as a sensible addition to the Bill, ensuring a more joined-up approach between police officers and staff in mental health units. Amendment 12 would also strengthen the Bill. It would add

“awareness of acute behavioural disturbance”

to the list of training topics. That is clearly a valuable thing for staff to be aware of in terms of how restraint may affect someone displaying behavioural disturbance. I support amendments 11 and 12, but before accepting them, it is important to hear whether the Government intend to deal with them through guidance.

There are, however, amendments that I am not happy to accept. Amendment 9 would remove the need for training on diversity, but that is a crucial part of the improved training and it goes to the heart of the Bill’s purpose in ensuring equal treatment for everybody by identifying those areas where treatment is not being delivered equally to everybody, whether because of ethnicity, type of disability or gender. If we do not capture that data, we cannot see the problem, and if we do not recognise the problem, we cannot put in place the measures to deal with it. Therefore, I cannot support that amendment.

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[Philip Davies]

I am grateful to the Minister for that. I appreciate that we are in a strange situation in which the Government do not have time to decide whether to agree with the amendments, but they certainly have time to write speeches on why they will disagree with them because they are not in a position to accept them. We have got ourselves into a completely farcical situation. The Minister is going to read out the speech that has been prepared to say why she cannot accept the amendments, but we all know that the reason why she cannot accept the amendments is that she does not have the Department organised to get things decided within eight days. As I said, that gives the impression that the Government have been taken hostage by the civil service. The Department of Health and Social Care is probably one of the worst offenders for being taken hostage by its civil servants. I am being charitable in saying that, because I presume that that is why so many socialist, nanny-state proposals come from the Department. I cannot believe that the Ministers actually believe in all that rubbish, so it must be the civil servants who are running the Department if those things are coming forward.

With this Bill, it seems that the civil servants, who never want to accept any amendments tabled by anybody other than themselves, are doing their best to try to stop any improvements to the Bill. It is a shame that we have got ourselves into a farcical situation. The Minister is absolutely right: there is nothing to prevent Members from tabling amendments—we know that because we have tabled them, and we are grateful to you for selecting them, Mr Speaker—but we have got ourselves into a rather farcical situation in which we have done an awful lot of work, and my staff have done an awful lot of work, I might add, to try genuinely to improve the Bill, and then we come across this ridiculous bureaucratic situation, about which I have only just found out with this Bill but which no doubt applies to every Bill. It is important that everyone knows that if Members table amendments at this stage of a Bill, they are wasting their time. It is a completely pointless exercise.

[Sir Christopher Chope]

I do not think that we are wasting our time when we table amendments. Contrary to what my hon. Friend says, I still have faith in the Minister, as I think she believes she is in charge. I believe she comes to this debate with an open mind, and, if, having heard the merits of a particular amendment, she decides that she will allow it, then she will say so from the Dispatch Box.

Let me mention another issue. We often find that because of the constraints on private Members’ business, people say, “We’ll amend it in the Lords.” If the Bill is amended in the Lords, its progress is jeopardised because it then has to come back here again for us to consider the Lords amendments. So in fact the Government should be more assiduous and quick in dealing with amendments to private Members’ Bills than amendments to their own legislation.

[Philip Davies]

My hon. Friend is absolutely right, but he is being slightly naive in thinking that we will get some rapid decision making. As, I think, Mr Speaker, you were alluding to in your response to my point of order, the only time that the Government appear to be able to act with speed is when they think they are going to lose a vote. At that point, they seem to be able to react with miraculous speed. We do not seem to need any write-arounds at that point, or eight days of write-arounds; they appear to be able to cobble something together within seconds, particularly if my right hon. and learned Friend the Member for Beaconsfield (Mr Grieve) clicks his fingers. They then appear to swoop into action in no time whatsoever. It seems to me that if hon. Members actually want to improve the Bill, they should be busily telling their Whip that if we put these amendments to a vote, they will vote for them—I hope, Mr Speaker, that you will allow some of them to be put to a vote, particularly where the hon. Member for Croydon North says that he actually agrees with them. Perhaps then we might have some rapid decision making after all. We will see, but it has been yet another depressing morning in the history of Parliament for me. I have been here 13 years, but have found out only today how these things work. I started off cynical and I have become even more cynical as time has gone on.

I shall go through the farce of speaking to my amendments, even though we cannot actually make any headway on them. As the hon. Member for Croydon North alluded to, amendments 44 to 78 apply throughout the Bill and change the wording from “use of force” to “use of restraint”. I was encouraged to hear him say that he had originally believed that the term should be the “use of restraint”, but had been persuaded to change it to “use of force” by, I think, the Government.

The comments I make here largely come after consultation with my local Bradford District Care NHS Foundation Trust. The amendments that I have tabled would ensure that the terminology used in the Bill was correct and in line with that commonly used by mental health trusts. The term “use of force” is predominantly used by police forces in reference to the use of physical force while carrying out their duties. It is important to note that, although the police do play a part in the restraining of patients, it appears that the Bill’s primary focus is on the restraint methods used by staff in a mental health unit. Although we must not forget that the police are on occasion called to assist in the physical restraint of patients, it would be more appropriate to adopt the correct mental health terminology for actions used predominantly by mental health staff in a mental health setting. Not only that, but the use of the word “force” in this regard is somewhat misleading and suggests that the restraint being used on patients is being conducted with a degree of aggression, violence or excessive force, which is simply not the case.

I am told that restraining a patient, particularly in a mental health unit, often involves little to no use of actual force in the sense that most of us would understand it. The term “restraint” has been adopted as common terminology within mental health trusts and covers varying degrees of interaction with a patient. It can be applied, for example, to a person simply holding out a hand to stop someone advancing towards them, or to methods of calming such as simply talking to a patient. They are examples of the use of restraint.

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[Philip Davies]

I understand the points that my hon. Friend makes, and I will come on to some of them later on, as they probably sit better with other amendments that have been tabled. I certainly accept his point, and as always, he makes it well.

I am also concerned that using the word “force” might worry people who are thinking about seeking treatment for mental health conditions. If they see that, it might scare them into wondering what may happen to them in some mental health settings. My view is that the word “force” in this case is not appropriate, not sensible and not actually what is generally used. Of course an element of force is used at times to carry out some methods of restraint, but common sense would suggest that the terminology used in the Bill should be what the sector uses.

[Sir Christopher Chope]

When one looks at the drafting of clause 1 (6), references to the use of force are to

“the use of physical, mechanical or chemical restraint”.

Force is being limited there to restraint, except that there is also,

“the isolation of a patient.”

Is it not the case that the drafting is really confusing? It suggests that the only difference between force and restraint is the addition of the isolation of a patient in the definition of use of force.

[Philip Davies]

My hon. Friend is absolutely right. He has made the point that I was literally just about to make. The use of force is defined as being physical restraint, mechanical restraint and chemical restraint. I reiterate my earlier point that, quite clearly, the most appropriate term to use is “use of restraint”. That is what the definition of the use of force is in the Bill. It sounds more sinister than it actually is, and that is clearly more appropriate terminology. I have tabled more than 60 amendments, but that point deals with more than 30 of them—about 35—in one fell swoop. I hope that other Members will accept that “use of restraint” is the more appropriate terminology.

Let me move on now to my other amendments. Amendment 9 to clause 5, which is about training on the appropriate use of force, would remove paragraph (c), which is about

“showing respect for diversity generally”.

The hon. Member for Croydon North mentioned that earlier. Restoring the faith of the public in their services is a key element and purpose of this Bill, and why not? We should all have the confidence and reassurance of knowing that when we go to any public service, we will be treated properly. However, when it suggests that illnesses are not diagnosed in proportion to the demographics of our society, I question whether people will draw the wrong conclusion from that. We could question whether anything in our daily lives mirrors social demographics. Of course it does not; it would be absurd to think that it does. What we need to keep in mind is that any illness, and specifically mental illness, is not selective in whom it touches and the outcomes that it can cause. It does not discriminate by people’s ethnicity, sexual orientation, religious belief or gender or in any other way. Mental illness is a very complicated and personal experience, which—as is well documented—can have a harrowing and life-changing effect on those who are directly affected by it, and on the people and families around them.

It has been argued that different ethnic groups have different rates and experiences of mental health problems, with people from black, Asian and minority ethnic groups in the UK more likely to be diagnosed with mental health problems and more likely to experience a poor treatment outcome. It is documented that for every 1,000 people of the black/black British population, approximately 41 are in contact with secondary mental health services. What is not mentioned so much is that for every 1,000 people of the white British population, approximately 37 are in contact with the same level of service. In actual numbers, 1.3 million of the total 1.5 million patients in contact with this service are of a white ethnicity, so the use of the ratio format instead of the actual figures over-exaggerates a point that is already not entirely convincing. For example, for every 1,000 people of the Asian/Asian British population, approximately 26 are also receiving secondary mental health care. In actual numbers, this is approximately 69,000 patients—higher than the total of mixed ethnicity and other ethnic groups combined, and 16,000 patients more than the black/black British category.

I do not want to make it sound like a competition for numbers; it clearly is not. These numbers represent people. But the Bill currently makes it appear as though this is an issue that only affects one ethnicity, when that is quite clearly far from the case. The suggestion that there should be a conscious overview of regulating the diagnosis and treatment of a patient not according to their symptoms, but according to their ethnic background, may result in turning it into a competition. By putting in place such measures, the good intentions of stopping ethnic discrimination—the existence of which is already questionable—would instead create discrimination against those who are not of a BAME background or, more specifically, not of black/black British ethnicity. This would therefore generate another problem altogether. In the simplest of terms, asking to provide further intensive training on unconscious bias and diversity, on top of what has already been established at the core of the service that is currently being provided, not only creates an unnecessary segregation among patients but is patronising towards staff to an unwarranted level.

I draw a parallel with the stop-and-search issues in London. It seems to me that a very well-meaning intention to stop a disproportionate number of black people being stopped and searched has led—directly or indirectly—to an increase in the amount of knife crime in London and in the number of people who are dying as a result of knife crime in London. I might add that it is largely young black men who have been the victims of that well-meaning policy.

I fear that mental health staff, rather than being asked to treat people exactly the same irrespective of their backgrounds, may well—directly, indirectly or because they feel some pressure—start to treat people differently as a result. That will have serious consequences. I fear that it is some people from black and minority ethnic backgrounds will who suffer most and not get the treatment they should as a result.

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[Philip Davies]

The hon. Gentleman’s motives are entirely honourable and decent, and I support them 100%. My fear is about what will happen in practice, because of the evidence of what happened with stop and search in London, to be perfectly honest. Exactly the same thing happened in that case, so it is not as if we have no evidence on which to base this fear. If the hon. Gentleman speaks to police officers, they will tell him that they were petrified of stopping people from a particular ethnic background because they feared they would be castigated for being racist. That is absolutely what happened. All I am saying is that my fear is that that may well happen as a result of this legislation, although I accept that it is not the hon. Gentleman’s intention.

[Sir Christopher Chope]

My hon. Friend is making an excellent point. Is it not also the case that substance and drug abuse has developed enormously, particularly in urban areas, as a result of this misguided policy on stop and search? It is then drug and substance abuse that so often leads to mental health issues.

[Philip Davies]

My hon. Friend is absolutely right to draw that comparison. It goes to show that well-meaning initiatives can often have the exact opposite result to what was intended.

In addition, diversity training programmes do not show any particular progress in the area that they are trying to improve. In fact, they have often proved to have the opposite effect. In a 2016 edition of the Harvard Business Review, an article entitled “Why Diversity Programs Fail” states:

“It shouldn’t be surprising that most diversity programs aren’t increasing diversity. Despite a few new bells and whistles, courtesy of big data, companies are basically doubling down on the same approaches they’ve used since the 1960s—which often make things worse, not better.”

The article says that companies have been heavily reliant on diversity training to reduce workplace bias, and bias during the recruitment process and employee promotions. It also says that studies have shown that this consistent and forceful approach to tackling diversity can

“activate bias rather than stamp it out.”

The article points out that social studies have found that people too often rebel against rules in a bid to assert their autonomy, and argues that companies—in our case, public services—will see far better results when they drop control tactics to make people conform. Even eminent people at Harvard are not particularly convinced that such a measure would have the result that the hon. Member for Croydon North intends.

On top of that, there are so many variations of diversity these days that there is a vast array of specifics to cover. For example, to my knowledge there are at least 71 variations of gender. I have a list here, but I will not test the patience of the House by reading them all out. Hon. Members who thought that there were only two genders are, I am afraid, well behind the times; there were 71 at the last count. I am sure that my hon. Friend the Member for Walsall North (Eddie Hughes) knows about this, as an esteemed member of the Women and Equalities Committee. I am sure that he can reel them all off from the top of his head, but most people could not.

Then we get on to the variations of religion that could be discussed. There are estimated to be approximately 4,200 different religions around the world, going far beyond those commonly observed in the UK. They include beliefs such as mysticism, paganism—which has, I think, 47 variants within it—Raëlism, Judaism, the ghost dance movement, chaos magic, and the happy science movement. The one that I personally liked most of all—I had not heard of it before but I am thinking about becoming a convert to it—is the Prince Philip movement. Being a great fan of Prince Philip, that sounds to me like a marvellous organisation.

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[Philip Davies]

I cannot accept that at all, Madam Deputy Speaker—it is a delight to see you in the Chair. My amendment is clearly pertinent to the Bill given that I am trying to remove something that is in it. If it was not pertinent, no doubt Mr Speaker would not have selected it. I am afraid that I cannot accept my hon. Friend’s challenge to the authority of the Chair. I am sure, Madam Deputy Speaker, that were I to be out of order, you would be the first to leap to your feet and put me right.

Will all these different religions, genders and all the rest of it be covered in the diversity training that I am trying to remove from the Bill? We cannot ignore the fact that they exist and therefore have as much right, presumably, to be detailed in diversity training as anything else. Let us not forget diversity of ideological beliefs. Will that be covered too? This is a throwaway phrase—one of those things that everybody puts into everything. It is meaningless. There are lots of meaningless things in political discourse: social justice—nobody knows what it is but everyone is in favour of it; sustainable development—we are all in favour of it, but nobody has ever been able to tell me what it actually means; diversity training—let us shove it in as a little part of our Bill, but nobody really knows what it is trying to achieve. I am not entirely sure that there is any point to it, and if there is any point, it will be counterproductive. I cannot accept this aspect of the Bill, and that is why my amendment 9 tries to remove it.

Amendment 10 to clause 5 is about training on appropriate use of force. It would remove paragraph (k) on training on

“ethical issues associated with the use of force.”

I am trying to make sure that legal issues are the focus of the training, not ethical issues. How does one go about taking account of ethical issues in the use of force or restraint? As I said earlier, staff have a very difficult job as it is. When they are focusing on whether they should be using restraint with a particular patient, are we seriously saying that they have to start considering, at that moment, the ethical issues associated with it? Surely this House is about making sure that people act within the framework of the law, not about what I, the hon. Member for Croydon North or somebody else thinks are the relevant ethical issues. How do we decide what the ethical issues are that people should be considering? The ethical issue that I might think is particularly pertinent may be different from the one my hon. Friend the Member for Christchurch (Sir Christopher Chope) or the hon. Member for Croydon North thinks pertinent. What sort of a situation are we putting staff in when they have to be thinking about the ethical issues, as intended in this Bill? I would not be able to explain that to them. We should be removing these bits of flim-flam from the Bill and making sure that we are instead asking people to follow a legal framework.

[Sir Christopher Chope]

As always, my hon. Friend is making an excellent point. In his extensive research, has he been able to ascertain the source of the support for the flim-flam that he is describing with regard to the use of the word “ethical”? The Minister said earlier that the Bill has the support of all stakeholders—I do not think she used that word, but she might have chosen to do so. Where is the evidence that the stakeholders are behind the use of ethical issues being part of the training?

[Philip Davies]

I am afraid I cannot answer my hon. Friend’s question. I do not know. The Minister was absolutely right to highlight the fact that although stakeholders do welcome this Bill, it would be wrong to say that they welcome every provision within it. That is certainly the feedback that I have had from my local care trust. While it certainly agrees with the thrust of the Bill and many of its provisions, there are still some it is not comfortable with. I cannot tell my hon. Friend about the genesis of this or any widespread level of support for it, because I am not aware of it. Perhaps the hon. Member for Croydon North or the Minister can help out. All I can say is that that definition of “ethical” is

“relating to moral principles or the branch of knowledge dealing with these”.

I am not sure whether my hon. Friend is any more enlightened by that definition that members of staff may have to take into account. I have no idea what it all means, to be perfectly honest, and yet we are expecting members of staff who are dealing with patients in difficult situations to be weighing up all these things.

I think it can be established that everyone has their own individual take on morals, but surely we cannot start applying ethical and moral views in serious situations such as these. This will end up being the beginning of a long list of other factors that it will be demanded people be mindful of. My view is that healthcare should be provided in a legal and law-abiding way, and not with the addition of anybody’s personal, individual ethical take on what is moral and not moral.

[Philip Davies]

My hon. Friend may well be right; I do not know. I have not been able to find any evidence for that, but it may exist somewhere. Perhaps the promoter of the Bill or the Minister will be able to enlighten us. If my hon. Friend has any evidence, I would be very happy to change my mind, but as it is, I cannot see any purpose to the provision.

The general thrust of my argument is that while this Bill should indeed be making staff and institutions accountable, it should also be helping them in their daily job, but it is making their life far more difficult than need be. I do not see that it is helping to protect the rights of patients, which is at the heart of what it is supposed to do.

[Sir Christopher Chope]

My hon. Friend has referred to the definition of “ethics” and “ethical”. Paragraph (k), to which he is addressing his remarks, talks about the “principal” ethical issues—not all ethical issues but the “principal” ones. Does he have any insight into which ethical issues are “principal” and which are not?

[Philip Davies]

My hon. Friend makes a good point. I do not know the answer to that—who knows? It is a mystery to me, and therefore it will almost certainly be a mystery to any institutions trying to implement these measures. We have to bear in mind that this is not just meaningless. This will be the law of the land. Institutions and members of staff could well be taken to court over whether they have sufficiently taken into account these “principal” ethical issues. Surely it would be intolerable to put people in that legal uncertainty. I am not entirely sure that we, the people who are passing this piece of legislation, have any idea what it means ourselves, so how on earth are the people who are supposed to implement this meant to?

Surely laws have to be fit for purpose. I know that my hon. Friend the Member for Christchurch is an eminent lawyer by background, and no doubt his profession will be dancing in the aisles at the prospect of all this uncertainty, because they are the only people who will benefit. The patients will not benefit, the staff certainly will not benefit, and the institutions will not benefit, because they will probably find themselves facing expensive legal suits. Unless this is simply a benefit for the legal profession, I cannot see any point to it whatsoever.

I am confident of scoring a few more runs on amendment 11, because the hon. Member for Croydon North indicated that he supported it. As I indicated to Mr Speaker at the start, I may wish to press the amendment to a Division and test the will of the House on this matter. The amendment would insert new paragraph (l) in clause 5(2), which relates to training in the appropriate use of force, to include training for mental health staff about who is responsible, and the roles and procedure when the police are called to assist.

Some people may say—I would not necessarily dismiss this out of hand—that clause 5 is already too prescriptive. There is an argument for saying that we should take out this detailed list of things that people should be trained in and effectively leave it to institutions and local experts to sort out training for themselves, rather than putting every little element of what that training should consist of in statute. There is certainly an argument for saying that we should get rid of all these areas of training that are prescribed. Of course, the problem with prescribing everything is that what will happen is that everything prescribed will be covered, but nothing else will be. Something may well have been missed out from the list, but if it is not on the list, institutions will not bother with it. That is my problem. Given that we are prescribing so much, it is essential that we get those things right, otherwise important things will be missed in the training. It seems to me that we go one of two ways: either we do not prescribe any of it; or we prescribe everything, because otherwise things will be missed out.

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I hope that the Government make sure that the amendments are included, and I am grateful that the hon. Gentleman accepts that they should be. Our job in this House is to make sure that the Government put them in the Bill, given that, I suspect, if they had had the time to consider it, they would have agreed to do so. Let us force them to do it. I hope that the Minister, having listened to those cases, will decide that never mind the write-rounds, these things need to go in the Bill today.

[Sir Christopher Chope]

I certainly agree with my hon. Friend about the necessity of putting the two amendments in the Bill, and I think that everybody who has been listening to his speech will be of the same opinion. I wonder whether he would be able to tempt the Minister to intervene now and say that, having heard my hon. Friend’s compelling case, the Government will indeed accept amendments 11 and 12.

[Philip Davies]

I am grateful to my hon. Friend. If the Minister wishes to intervene, I will not stop her.

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[Philip Davies]

There you go, Madam Deputy Speaker. What can you say? The civil service script has been brandished. There is always a reason in the civil service why anything should not be done, but all I can say to the Minister is that, to be perfectly honest, the idea that it is not necessary could apply to every single individual thing that is already listed. If we wanted to go down that line, we could say that all these things are being done anyway individually by this person or that person. Either there has to be a comprehensive list of things that the Government feel are essential, which must be covered in the training, or they do not. How on earth, knowing what happened to Mr Lewis and in the other cases that I have mentioned, can anybody stand up and say, “Having listened to that, we do not think these things are absolutely necessary.”? It is literally beyond belief. We literally could not make it up. It is a shameful situation that we have got ourselves into, to be perfectly honest. I will let people decide which side they are on. I hope that we can test the will of the House on those amendments, so we can see what people make of them and whether they want to be in the civil service box of deciding that nothing needs to be done, having listened to those cases. We will let the House make its mind up, and that is that.

[Sir Christopher Chope]

Looking at the amendments on what should be in the training, has my hon. Friend had a chance to look at my amendment 98? It would introduce into clause 5(2)(a) the involvement of “patients” and “their families” in the planning, development and delivery of care and treatment. It seems that with the cases that he has cited, family involvement can be crucial, and this should also be part of the training.

[Philip Davies]

The answer to my hon. Friend’s question is yes—I have looked at his amendment and agree with it. If he would allow me, I had planned to go through my amendments first, before moving on to other people’s. I have his amendment in my sights and I will come to it later. I have read it and very much agree with him.

My next amendment—amendment 14—moves us on to clause 7(2), which states that reporting the use of force

“does not apply…where the use of force is negligible”.

My proposal would amend it to include restraint that does not include physical contact. The amendment would ensure that there is a not a series of pointless recording of every interaction with a patient that falls under the category of restraint. I am still using the word “restraint”, but I am appreciate that I am in danger, at the end of these amendments, of losing the battle, and that it will be called “force”. However, for the purposes of putting forward my amendments, I will still call it “restraint”, as I am seeking to do. Restraint is defined in the dictionary as the

“deprivation or restriction of liberty or freedom of action or movement”.

It must be reiterated, however, that it can be conducted in the most subtle of ways. The law entitles people to freedom of movement provided that they are not harming others or themselves while exercising that right. The policies of NHS services vary between trusts. Overall, the guidance for all medical staff follows the same basic principles, but specific details are more varied.

It would be fair to say that health trusts across the board consider physical restraint to be a last resort that should be used only following the exhaustion of all other methods. Staff are advised to call for the assistance of security when physical restraint is considered, as they will have been trained in restraint techniques. Bradford District Care Trust advises that the assistance of police be called upon only as a final resort when usual restraint methods have failed and there is a serious concern for the safety of the patient, staff or other patients on the ward. I have been told that as a general rule a patient would have to be exhibiting sustained high levels of physical aggression, often involving some kind of weapon, before the police were called.

Some services, such as the London Ambulance Service, apply a different approach and advise that police be called at the earliest sign of physical restraint being required. That is due to the service not providing its staff with training in physical restraint and therefore leaving them vulnerable without the back-up of police services. In all cases of restraint, staff are required to apply the principle of using the least restrictive and most proportionate option to control behaviour, for the least time possible. Again, the word “proportionate” is reiterated through the guidelines on restraint, which reminds us that it is consistently a consideration when restraint is conducted.

The types of restraint fall into three categories: low-level restraint—interventions that prevent a person from behaving in a way that threatens to cause harm to themselves, others or trust property and/or equipment; physical restraint—any manually applied method, be it physical, mechanical, material or equipment, that immobilises or reduces the ability of a person to move their arms, legs, body or head freely; and chemical restraint—a drug or medication used to manage a patient’s extremely violent or aggressive behaviour that can be administered, if necessary, against the patient’s wishes. Such drugs might, of course, also be used when the threat of harm is less immediate, with the patient’s consent, or if it is in the assessed best interests of a patient who lacks capacity.

Low-level or psychological restraint methods are the initial exercises conducted to try to prevent a situation from escalating quickly. Most often, this will be a variation of calming methods, which are less restrictive than methods in other categories, and which can ultimately allow the patient to have a timeout in isolation to calm down. Essentially, that can be as simple as telling someone not to do something or depriving them of equipment or possessions that may enable them to do what they otherwise would do—for example, removing glasses, hearing aids and mobility aids. It is less invasive and more frequently used with those who suffer with dementia.

Those less invasive approaches to patients allow them to retain a certain element of control over the outcome, but it is precisely those approaches that I fear will fall through the loophole of being constantly recorded, which will take the time of carers and care trusts away from the patients who actually need help. The key restraint methods the Bill is concerned with are those that require an element of physical contact, which should be reported appropriately. It is important that we remove the need to report minor interventions, which are not really at the heart of the Bill.

In the interests of time, I will group the next few amendments together. Amendment 15 to clause 7, on recording the use of force, would remove paragraph (k). Amendment 17 to the same clause would remove subsections (9) and (10), which require the recording of relevant characteristics of the patient—race, sexuality and so on. Amendments 21 to 30 are to clause 7 and amendment 31 is to clause 8, on statistics prepared by mental health institutions. Amendment 21 would insert new paragraph (q), which would add

“the relevant characteristics of the staff involved (if known)”

to the list of relevant characteristics in subsection (9). The other amendments would change the list to include the relevant characteristics of both patients and staff, make the list plural to cover both patients and staff and include the relevant characteristics of the staff involved.

Amendments 32 to 35 to clause 7 would remove paragraphs (c), (e), (f) and (h), which deal with a patient’s marriage status, race, religion and sexual orientation. Those amendments would remove such unnecessary labelling of patients. I am not one for putting people into categories, and I am not a fan of labels. All these things are irrelevant to the treatment of people with mental health problems, and we should not be getting bogged down listing everybody’s gender, race, sexual orientation, marital status and so on. It is all irrelevant to the treatment of people with mental health problems, and we should not be bogging down the staff with all this political correctness.

[Sir Christopher Chope]

Is it not extraordinary that the list to which my hon. Friend refers makes no reference to whether the patient has any family or relatives?

[Philip Davies]

Again my hon. Friend is absolutely right. One could argue that that is important and should be logged. I am sure we would all want to involve the family in discussions about the treatment of family members. That might well have helped in the case of Mr Lewis. Yes, it is extraordinary that the bit that could actually be relevant to the treatment of the patient is not included and all this other stuff, which is completely irrelevant to their treatment, is included. It seems like unnecessary political correctness.

In recording the use of force, the inclusion of race to help tackle racism, of sexuality to tackle homophobia, and of gender to avoid sexism, will do nothing to aid the patients. Surely, if we believe in equality, all those things are irrelevant. We should not be pointing out people’s differences. Those things cannot be changed and are not relevant, and we should not be passing legislation that tries to make them an important part of treating people with mental health conditions.

If we will insist on going down this route, however, I am confused about why the Bill requires only the recording of the patient’s characteristics, and not those of the person giving out the treatment. If there is institutional racism, or whatever it is that people try to hang a hat on, surely the characteristics of the person using the force must be relevant. Surely a complete picture can never be grasped only by recording the characteristics of the patient. If we are trying, as I think the hon. Member for Croydon North is, to uncover unconscious bias, institutional racism, or whatever he wants to call it—people have their different terminology to hang their hat on—surely it cannot be done without amendment 21. He indicated in his opening remarks that he had sympathy with it, and I am grateful to him for that. I hope he agrees that it is not just useful but essential if we are going down this route.

The Bill also asks that the police wear body-worn cameras so as to literally give a full picture of their involvement in these cases. Why are we only reporting one side of the story when the police are not there? If the relevant characteristics of the staff are included in the report, the recorded statistics might give a better representation of the matter. I feel that the provision I suggest in the amendment was not originally added because it might highlight a very different narrative from that which some would like to present. One particular concern I have is that these reports will be used to try and back up the questionable argument of institutional racism in the health service, despite studies showing a lack of early diagnosis of mental health illness and psychosis because of a lack of trust in mental health services among people from BAME communities.

It is consistently documented that BAME patients, particularly those with African and African-Caribbean backgrounds, are more likely to be diagnosed with a form of psychosis, and to enter the mental healthcare system via a more confrontational approach than would be the case through a routine appointment with a GP. That is the basis for the institutional racism argument. However, it should be considered that the suggestion of institutional racism in the mental healthcare system is what is preventing people from seeking early medical help in the first place. It is not helping the situation; it is making the situation worse. People are being told, “Don’t enter these services, because there is institutional racism”, and that is not helping anyone.

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It is worth bearing in mind that a key argument in favour of the Bill is that there is currently no consideration of whether a patient has experienced a history of abuse or violence, and whether there are therefore some forms of restraint to which he or she should not be exposed. The one thing that is missing in the middle of all the reporting, statistic taking and analysis is the patient’s care plan. The purpose of restraint techniques is to prevent patients from causing harm to themselves and others around them when they are experiencing what could arguably be a very dark and turbulent period of their lives. Those methods are being branded tactics to control and humiliate patients, when in fact they are part of a broader care plan to protect the patient. That often seems to be forgotten. To put it in simple terms, they can form part of the patient’s overall treatment. I find it astounding that unless the Government change their mind, these instances will not be documented in individual medical notes as they should be.

[Sir Christopher Chope]

I think we have all encountered constituency cases in which people suffering from mental illnesses are shifted from one location to another—from one clinical commissioning group area to another, or from one part of the country to another. In one of my constituency cases, someone is being told that they must go up to Manchester to be treated for a mental condition. If people are being dealt with in different locations, it is all the more important for there to be one set of medical notes that records everything that has happened.

[Philip Davies]

That is a very good point. I had not mentioned that people might be moved from one institution to another, but that, of course, makes the amendment even more important. I am not in favour of excessive bureaucracy, but that strikes me as being an essential part of what the Bill is intended to achieve. The purpose of my amendment 16 is to deliver the Bill’s original aim. In fact, that is the theme of all my amendments. They are certainly not intended to weaken the Bill; if anything, they are intended to encourage the hon. Member for Croydon North to go further. The amendment is not just something nice to tag on to the Bill. I think that it goes to the heart of what the Bill should be about. Restraint techniques should be documented in medical notes to provide other medical practitioners who are treating the same patient with an overview of how that individual patient responds to the use of that form of restraint. I cannot see why that should not be part of the Bill.

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[Philip Davies]

As I said at the start, I genuinely appreciate the constructive way in which the hon. Gentleman has approached the Bill, and he has just given another indication of that. The question is—this is the dilemma that we always seem to have on a Friday—whether we should rush through legislation that we know is not as it should be, and try to patch up little defects with a bit of sticking plaster here and a bit of sticking plaster there, or whether we should make an effort to ensure that the Bill is in a fit state in the first place.

The hon. Gentleman is arguing—it is a perfectly respectable position to hold—that it is all right to gloss over the fact that lots of really important things are missing and to provide a big sticking plaster called guidance, telling people, “Here is some guidance. We forgot to put this in the Bill, by the way. It should have gone in, but we did not sort it out in time. Parliament couldn’t be bothered to do its job properly, so here is a list of all the things that you should and should not be doing.” That is a perfectly reasonable case to make, but I take the view that when we pass legislation in the House, we should be a bit more mindful of the people who will have to implement it, and make sure that it is fit for purpose the first time round.

It seems to me that it is possible for everyone to be satisfied. The last thing that we want is for the Bill not to go on to the statute book. It is broadly a good piece of legislation—although, as I have explained, I have reservations about it—but I think that we have an opportunity to make it better. We have three options. The first, which is the ideal option, is for the House to put the Bill into proper shape and accept some of my amendments, which I think are clearly necessary. The hon. Gentleman himself accepts that some of them should have been in the Bill originally. Secondly, we can opt for the sticking plaster route: we can cock it all up ourselves, then put a sticking plaster called “guidance” over it and hope that someone will be responsible for sorting it all out. Thirdly, we can give the Bill another slot at a future date so that the Government have time to consider and do their write-rounds, and the hon. Gentleman can do a bit more consultation. Hopefully we can deal with the Bill later in the year, along with some of these amendments—either agreed or not agreed—on the basis of the write-rounds and the consultation. That seems to me to be the most sensible way of going about it.

I think that what is important is for a sensible piece of legislation to go on to the statute book. There are plenty of days left in the current Session on which we could deal with the Bill. Putting everything that should be in the Bill in guidance at the end does not really do it for me. It might do it for the hon. Gentleman, it might do it for the Minister, and it might get us over a little hurdle, but I do not really think that it is the best way to pass legislation in the House.

[Sir Christopher Chope]

My hon. Friend sets out the three options very clearly, and if we went for the last of them that would give the Government an opportunity to produce the draft guidance so we can see what will be in it. What has concerned me so far is that the Minister has said that quite a lot of the things my hon. Friend and I think should be in the Bill are not necessary, and the Minister is not even saying they should be in the guidance. If we get the draft guidance, we will be able to see where we stand.

[Philip Davies]

My hon. Friend is right. The Minister is doing her best; she does not decide the Government’s bureaucratic nonsense of decision-making strategies and all the rest of it. This is not her fault; she is left in a difficult situation, and I am the first to appreciate that. But as my hon. Friend says, at present we are not even getting a guarantee that these things will be in the guidance; we are being told they might be dealt with in the guidance, and even that there is an expectation that they might be. But I have been here long enough; I have been shafted before on private Members’ Bills where I have been promised that an amendment will be tabled in the Lords to deal with something and then it never arrives. So a bird in the hand is certainly worth more than two in the bush, particularly when it comes to Government promises on amendments and guidance in my experience. That is not a party political point; both sides have been guilty of that in the past. I am therefore looking for a bit more than a waft here and a waft there suggesting this might be covered in guidance; I am looking for something a bit more concrete than that. Indeed, I do not think it does the Bill justice if it goes through Parliament when it is not in a fit in a state; we all want to see it in a fit state.

My amendments 18 to 20 to clause 12 relate to police body cameras. I propose to change subsections (1) and (2) to say that police “should…try to”, rather than “must”, take a video recording. I also want to remove subsections (4) and (5) which make police “liable to criminal…proceedings” if they fail to take a video.

As the College of Policing has stated, it is an indisputable fact in today’s society that law enforcement officers carrying out their duties, and the tactics they use, are under greater scrutiny than ever before. That is a good thing, and I am a massive fan of police body-worn cameras; they are fantastic for the interests of justice, and they safeguard the interests of police officers, who often face vexatious complaints. The footage can be produced to show that what they did was absolutely right, which is almost always the case. That is fantastic for the courts, too, because they can see at first hand what actually happened, rather than have to deal with conflicting accounts and have to choose to believe one witness over another and so forth. I am therefore a big fan of body-worn video cameras, and they are often the modern method of detailing interactions with the public by the police. Their aim is to improve the accountability and transparency of police conduct when police officers encounter the public. This is a move that the Home Office highlighted at the time of their launch as being the technology of the future, and as a means to help save police time and improve working practices.

General procedure for using the devices is that they are to be used only for recording encounters with the public and are not to be constantly recording for the duration of a shift. The policy of West Yorkshire Police, which covers my area, on body-worn camera video advises that it is to be used where a degree of investigation or exercising police powers is required unless there is a good reason not to. The rationale for not using body-worn video cameras may need to be explained at a later stage, and justified to a supervisor and/or during court proceedings. The recording must be proportionate, and the effect it may have on individuals and their privacy must be taken into account. It is advised that the cameras be switched on the moment the incident becomes apparent, and in some cases this may be en route for the incident. However, it is stated that officers must announce that they are using the recording equipment in clear wording: for example by saying, “I am wearing and using body-worn video. I just need to tell you that; you are being videoed and audio recorded.” The recordings taken are stored on the camera until they are returned to their docking station at the police station. From there, clips are downloaded and sent to the central system for viewing. These clips cannot be altered, changed or deleted by the officer in any way, which keeps them completely authentic for evidence purposes.

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[Philip Davies]

I am grateful to the Minister for that, and I am sure that police officers will be grateful, too. However, I just feel that there are occasions when it may be practicable to wear a camera, but for whatever reason—the pressure, time or the heat of the situation—they forget, and I wonder what will happen in such cases. There could be a situation in which it is practicable for them to wear a camera but, owing to the noises they make and the flashing lights or whatever, they think, “You know what? In this circumstance, I’m unsure I’m going to do that, because it might make this patient worse.” I worry that there are insufficient loopholes, so to speak, for police officers who are trying to do the right thing in difficult situations and that we are in effect trying to make things more difficult for them. I fear that, as a result of this Bill, criminal proceedings will be brought against a police officer that never should have been brought. It is all right to say, “We don’t think that that will happen,” but these things do happen. I want the law to be worded to make that as unlikely as possible. That is my only concern, and we will see whether my fears are realised.

[Sir Christopher Chope]

Is there any evidence to suggest that the police will not want to protect themselves by taking body-worn cameras to such incidents? Why do we need this measure in the Bill at all?

[Philip Davies]

My hon. Friend makes a good point. The evidence is that police officers are the biggest supporters of body-worn cameras. They are crying out for them and want to use them more often, and they want the cameras to have a longer battery life. I agree that it is entirely unnecessary, so do we need to go down the road of criminalising police officers because they forgot to wear a camera? It might have been entirely practicable, but they may have simply forgotten. Should that really be a criminal offence? I am dubious. We ought to be giving our police officers more support, not trying to make their lives harder.

I have been discussing my amendments, but other right hon. and hon. Members have tabled several amendments, and I want to start on those by discussing new clauses 1 and 2, tabled by the hon. Member for Croydon North. I understand what he is seeking to do, and it was perfectly reasonable for him to say that if there is death at the hands of the police, the Independent Police Complaints Commission—although I think it has a new title these days—will get involved and all the rest of it, so why should other deaths not be subject to a similar procedure? That is a perfectly respectable point, and I have every sympathy with that view.

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[Philip Davies]

We have been around that issue, so I do not intend to revisit it again. The fundamental amendments 11 and 12, which I have addressed at some length, go to the heart of what happened to Mr Lewis on that terrible occasion. They would ensure that training was given to staff to ensure that those things could not happen again. It is therefore essential that those amendments are made to the Bill and that these things are not just dealt with as part of guidance, which may or may not then be covered off by individual trusts. We have a duty to make sure that the things that happened to Mr Lewis are absolutely covered in the training given to staff.

[Sir Christopher Chope]

My hon. Friend is absolutely right not to fall foul of the scaremongering, because we are fortunate to be in a much longer Session than usual, and the Government are still to announce the extra Fridays that will be available to discuss private Members’ Bills. If a Bill such as this is supported by everybody in the Chamber—by the Government and the Opposition—but there is need for further improvement, why not improve the Bill, rather than putting it on the statute book in an imperfect state, given that we know jolly well how difficult it would be to amend it later through a further private Member’s Bill? Let us make this a good Bill.

[Philip Davies]

The Bill will definitely conclude its Report stage at some point, but if it does not pass today, it will not be my fault. For goodness’ sake, we still have two and a half hours to go. The Government still have plenty of opportunity to say that they will accept amendments 11 and 12, and if they do so, the Bill will go through today. If they need more time to do a write-around before those amendments can be agreed, that is literally in not my hands, but the Government’s. If they want the Bill to get through today—

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[Philip Davies]

But we do not know what will be in this guidance. I am making the case that it is absolutely essential that amendments 11 and 12 are made to the Bill. The hon. Member for Croydon North said quite clearly that he agreed with them and that he also thought they should be made to the Bill. I appreciate that he is trying to find a compromise but, strictly speaking, he would be happy for the provisions to be in the Bill. I think they should be in the Bill; he thinks they should be in the Bill. The Minister has not even made a commitment that these specific amendments would be reflected in the guidance. I am literally being offered nothing, apart from her saying, “Oh, we know this Bill is not good enough. We will try to sort out a bit of guidance here and there. It’s not perfect, but just let it through because it has a worthy sentiment behind it.” We must start treating legislation with a bit more respect in this place. The Minister says that the Bill has gone through parliamentary scrutiny, but this is parliamentary scrutiny. This is the Bill’s Report stage for goodness’ sake.

[Sir Christopher Chope]

The Government’s line seems to be that this legislation is an urgent measure. If it is so urgent, may I ask the Minister—through you, Madam Deputy Speaker—what state the guidance has reached?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The hon. Gentleman is making an intervention on the hon. Member for Shipley (Philip Davies), not the Minister.

[Sir Christopher Chope]

I invite my hon. Friend the Member for Shipley (Philip Davies) to ask the Minister whether she agrees that, because of the urgency of this legislation, the guidance is ready in draft form in her office and can be laid before the House tomorrow or in the next couple of weeks. I suspect that the Government have not even begun to draft the guidance, but we need the guidance before this legislation would ever be able to take effect.

[Philip Davies]

Absolutely. It appears, to me at any rate—I do not know about anyone else—that the Government are just making things up as they go along, desperately trying to get this Bill through in any form whatever. Whether it is good, perfect or indifferent is neither here nor there. They just want to get it through, presumably so that they can say at next questions, “We got the Mental Health Units (Use of Force) Bill through Parliament.” Well, perhaps they just want to pass any old legislation, include a few decent clauses and hope that it will do the job, but I am afraid that is not what this House should be about. It is about saying that we have identified areas where the Bill should be strengthened, and we therefore have a duty to find a way to do that. If the Government will not agree to do it today, I am afraid that we will have to try to ensure that they do it in the future.

I am determined that the Bill will go through in a proper form that will help to stop what happened to Mr Lewis ever happening again. We have to get back to the central reason for the hon. Member for Croydon North introducing this Bill in the first place. The points on which I am focusing are not just useful add-ons here and there; they are at the very heart of the purpose behind the hon. Gentleman’s Bill. I do not really see why he should be so complacent about letting it through without these things being included.

Anyway, hon. Members have tabled amendments that deserve to be scrutinised. The right hon. Member for North Norfolk has tabled quite a few. With amendment 40, he wants to include the threat of force as part of the use of force, so that the threat of restraint would be considered the same as the use of force. I am afraid that I cannot agree with that. We do not want to deter people from warning of the threat of force, when warning of the threat of force may actually stop them having to use it in the first place. I do not really see how the threat of force can be treated in exactly the same way as the use of force. Often, threat of force seems to be a legitimate restraint technique. If staff are not threatening to use force before they actually use it, the use of force might become more likely. I do not agree with that amendment.

[Sir Christopher Chope]

And, of course, every threat of the use of force would have to be recorded, would it not? The threat of force was actually included in the original drafting of the Bill and was taken out in Committee, so I do not understand why the right hon. Member for North Norfolk (Norman Lamb) wants to include it again.

[Philip Davies]

I agree. The same applies to amendment 41 —also in the name of the right hon. Member for North Norfolk—which would include the “threat of isolation” alongside isolation itself, and to his amendment 42, with which he wants to include the “coercion of a patient”. I am not entirely sure why such an amendment is needed, to be perfectly honest. He includes a definition of coercion in amendment 43, as

“the use or threat of force, with the intention of causing fear, alarm or distress to control a patient’s behaviour or elicit compliance with the application of a use of force.”

I am not really sure what that adds to the Bill, to be perfectly honest. I do not think that anything it does add to the Bill is something that I could support anyway. I think that he is taking these definitions a bit too far given the Bill’s purpose.

The right hon. Gentleman’s amendment 37 would insert into clause 3:

“A policy published under this section must set out that the use of force will only be used without the sole intention of inflicting pain, suffering or humiliation, or subjecting patients to tortuous, inhumane or degrading treatment, or without inflicting punishment or intimidation.”

With regard to using force with

“the sole intention of inflicting pain, suffering or humiliation”,

I look to people who are more legally qualified than me, but surely that must already be illegal. I cannot believe that that can already be lawful in this country. Therefore, this amendment is not necessary either.

Amendment 36 refers to a

“description of each of the methods of restraint that may be used…what steps will taken to reduce and minimise the use of force”

and

“a description of the techniques to be used”.

Paragraph (d) is the worst bit. It refers to

“a commitment to reducing the overall use of force in the mental health unit.”

Would that potentially mean that restraint and force is not being used when it should be used because somebody had a commitment to reduce its overall use? Surely, we should be seeking to make sure that restraint and force are used appropriately—at the right times, in the right situations, with the right patients. As long as that is being done, the number of cases is neither here nor there. It is the appropriateness that matters, not the numbers. This amendment would mean that restraint would not be used when it should be used. The lack of trust in staff in this is something that I cannot possibly support.

Amendment 38 says that

“subsection (1) must include a patient’s right to advocacy and how to access an advocate.”

Again, this may deter staff from using restraint even when it is necessary, thinking that they are going to get into a compensation culture with vexatious legal claims being made against them. We should not be passing laws that encourage that.

Amendment 79 says:

“The Secretary of State must publish quality standards for training”

and

“The Secretary of State may delegate the publication of quality standards for training”.

There is already a requirement to have standards for training; the right hon. Gentleman seems just to want to add the word “quality”. I am not sure that there is any indication that the standards for training would not be of quality anyway. It goes without saying that we want quality standards of training; we do not need to put that into the Bill.

Amendment 80 refers to “trauma-informed care”. I do not have a particular problem with that. Again, it is an issue of how prescriptive we should be in relation to the training. I have already spoken at length about that. The right hon. Gentleman makes some fair points.

The right hon. Gentleman’s other amendments include amendments 83, 84 and 85. Amendment 83 says:

“The Secretary of State must make a statement to Parliament, as soon as practicable following the publication of report under subsection (2).”

It is difficult to disagree with that, to be honest. I do not see why that should not happen. I would be perfectly happy about it.

My hon. Friend the Member for Christchurch has also tabled some amendments. His amendment 88 would

“leave out ‘mechanical or chemical’ and insert ‘or mechanical’.”

I think that he wants to get rid of the chemical type of restraint from the Bill. A chemical restraint can be described as a medical restraint to restrict the freedom of movement of a patient. Such chemical restraints can sometimes also be used to sedate a patient if necessary. I think that his amendment is understandable. My only concern is whether it might lead to perverse outcomes whereby chemical means of force are used more often than they should be to get round the Bill. I am a bit nervous that that may happen. I would therefore deter him from pressing ahead with it, although I certainly understand where he is coming from.

Amendment 90 to clause 1 seems to be a consequential amendment, so we do not need to deal with that. Amendment 89 would leave out paragraph (b) from clause 1(6), to remove the isolation of a patient from the list of things referred to by “use of force”. I am much more sympathetic to this amendment, because my hon. Friend makes a good point. I am sure he will express his own opinion when the time comes on why he feels so strongly about that, but my view on first reading is that it is perfectly sensible. Amendment 91 is consequential to that.

Amendment 98 is one to which my hon. Friend referred in an earlier intervention. It would insert the words “and their families” after “patients”, to allow patients and their families to plan, develop and deliver their care and treatment in a mental health unit. This is an excellent amendment. It is essential that families are involved in the treatment of their family members. In many cases, if the family could have been more involved from the start and been able to help and warn what the situation was, such problems and terrible situations would not have happened. It is a very sensible amendment, and I hope that he will pursue it with vigour, because it is really important that we involve family members in treatment.

Amendment 100, which would ensure that guidance is published no later than six months after the Act is passed, is particularly pertinent to the discussions we have been having. My only quibble is that six months may be too long, but I certainly agree with the thrust of it, which is that there should be a time limit.

[Sir Christopher Chope]

It all depends on when the draft guidance is produced. My amendment is referring to the guidance that emerges after any consultation. As I said earlier, I think that the consultation should take place very early, but six months is a maximum.

[Philip Davies]

My hon. Friend is on to something with that, and I certainly agree. It is quite extraordinary that we do not have the draft guidance already, but I will not go over that again.

Amendment 101 is sensible. It would insert the word “significant” after “any”, to require a record to be kept of any significant use of force on a patient by a member of staff. That is sensible because we do not want to include other things that should not be included. The point I make is that the word “significant” is rather subjective. One person’s “significant” may not be another person’s “significant”, and it might be a bit difficult for trusts and staff to understand what counts as “significant”. My only concern is whether that adds confusion.

[Sir Christopher Chope]

At the moment, clause 7(2) states that subsection (1) does not apply to cases where the use of force is “negligible”. That is refined in subsection (3). I am effectively saying in my amendment that “significant” is non-negligible.

[Philip Davies]

I hope that my hon. Friend will expand on that later. He makes a good point, and I am broadly sympathetic to it.

I have now gone through the amendments on the amendment paper. Different Members have tabled quite a few amendments, and therefore it takes a bit of time. I would like to think that, like the hon. Member for Croydon North, people have been convinced of the necessity of amendments 11 and 12, which go to the heart of what the Bill is supposed to be about.

[Sir Christopher Chope]

Some people looking at today’s proceedings may say that my hon. Friend has been speaking for a long time, but we need to remember that when Bills are considered, the amendments are often grouped so that we do not consider all amendments in one discussion. Today, we are considering all the amendments to the Bill in one group, which I think explains why he has spoken for a bit longer than he might sometimes do.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. May I just say that we do not need to be reminded of how long the hon. Member for Shipley (Philip Davies) has spoken? All that does is use up precious time, and I know you would not want to do that, Sir Christopher.

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[Jackie Doyle-Price]

This is an important reform that will considerably alter the balance of the scales of justice in favour of patients and bereaved families. I want it to make rapid progress, and the specific case of how long it took for Seni’s family to get a resolution in relation to his death is the inspiration for this Bill.

[Sir Christopher Chope]

Will my hon. Friend expand a little more on the timescale within which an independent forensic pathologist must reach a conclusion following a death? The husband of a constituent of mine died more than nine months ago, and the coroner ordered a pathology report but that still has not been carried out, causing enormous distress to everybody involved.

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[Jackie Doyle-Price]

The right hon. Gentleman is right about that, so let me go through the provisions we think are in place to protect patients from exactly that circumstance. The care quality regulations—the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014—clearly set out the types of behaviours that are prohibited and create an offence of failing to comply with the requirement to protect service users from those behaviours. We are satisfied that those provisions would be an appropriate tool with which to tackle this issue. Clearly, we will be relying on guidance to implement much of this Bill, and I can give him every assurance that these issues will be very much part of that guidance; this process will be consultative and I am sure he will want to remind me of the undertaking I have just given him as and when that comes through.

My hon. Friend the Member for Shipley has discussed his amendments 44 to 78, providing us with his understanding of the use of the terms “force” and “restraint”. The point he made was that he wanted the Bill to be consistent with language used elsewhere in mental health settings. It is important that we make sure the language we use is consistent. The term “force” is a more overarching description of what is happening to a patient, and the individual elements that the definition needs to cover are the types of restraint. In the context of this Bill, those are physical, mechanical and chemical restraint, along with isolation. We have chosen to use the term “force” because it works alongside the Mental Health Act 1983 code of practice, with which practitioners are familiar, and it reduces any risk of confusing the drafting due to the use of similar terms, where that can be avoided. This approach has very much been accepted in our consultation with the sector. I heard my hon. Friend say that he had received representations to suggest the opposite, so I would be pleased to take that up with him offline, in order to satisfy his local care trust that what we are doing is consistent with other law, because it is important that we take everyone with us.

My hon. Friend the Member for Christchurch has tabled amendments that would remove certain types of force from the Bill, particularly chemical restraint and isolation, which covers segregation and seclusion. I am grateful to him for testing our conscience via these amendments, because it is entirely legitimate for him to worry that practitioners might be impeded from administering medication to their patients, as, obviously, that would be harmful if those patients needed it. I can give him the assurance that when we talk about “chemical restraint”, we are not considering a patient’s normal medication. The type of medication used for chemical restraint would usually be different from that used as part of a patient’s normal medication to control or treat their mental health condition. As part of a chemical restraint, patients would not simply be given more of their medication. The types of medication used in chemical restraint are a particular kind of product, lasting for only a short period and not having the effect of over-medicating a patient. It is important that we record and receive national data on the use of those products so that we understand their use and shine a light on areas where they might not be used appropriately. I hope that gives him some comfort.

[Sir Christopher Chope]

Will the Minister make a statement on which products would be covered by the Bill and which would not? From talking to my constituent, I had the impression that the products used in his case would be covered.

[Jackie Doyle-Price]

I will commit to writing to my hon. Friend with details of the products licensed by the National Institute for Health and Care Excellence for the purpose of restraint, if that would be helpful.

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My hon. Friend the Member for Christchurch has tabled amendments that would make the legislation cover independent hospitals that treat wholly private patients. I understand the intent behind that, but he will be aware that we have been taking the Bill forward very much in the spirit of consensus, and to avoid a big consultation with the sector, we have framed the legislation around services that the NHS commissions. To give my hon. Friend some assurance, the NHS will clearly place patients only where there are the best possible services. We think that that will guarantee that the legislation will apply in all cases. That is very much consistent with how we would apply the law.

[Sir Christopher Chope]

Would the Bill cover situations in which the NHS is paying for private services in mental health units?

[Jackie Doyle-Price]

It would; indeed, to be more explicit, any service with which the NHS commissions mental health services would be expected to have procedures that comply with the Bill. That will cover non-NHS patients in those institutions as well.

My hon. Friend the Member for Shipley asked some testing questions about training. I really want to say that from my perspective the detail of what will be covered in training will be taken forward through statutory guidance that will be subject to consultation. He has made it clear that he believes that the training of police forces and training on acute episodes need to be factored into that. That is something that we will take forward as part of that consultation. In all honesty, I do not believe that his amendments will be necessary; in any case, we will take that forward as part of the consultation.

On police roles and responsibilities, my hon. Friend will know now that, as I have mentioned, we have a memorandum of understanding that governs how the police and health services interact in these circumstances. That is owned and taken forward by the College of Policing, and I am sure that he will agree that they are the right people to own that. If a provision affects the police in that way, I cannot make any decision without further consultation with colleagues across the Government.

I hope that I can assure my hon. Friend that I fully take on board his points; indeed, the hon. Member for Croydon North supports the inclusion of those issues in training. We will take forward that proposal as part of the consultation process that will develop the guidance. I hope that that is enough to persuade my hon. Friend to withdraw his amendments.

On enforcement, there have been representations such that the guidance should be published within six months of the Bill being passed. Again, I do not want to prejudge Parliament’s decision. We will take forward the consultation as and when the Bill is passed. These are significant issues and a 12-month process would be more appropriate in the context. It is better to get it right than to be guided by speed, however impatient we are to achieve the desired outcomes.

[Sir Christopher Chope]

My hon. Friend is being very generous. Will she tell us the current state of the guidance? Can it be published for consultation immediately this Bill attains Royal Assent?

[Jackie Doyle-Price]

We will undertake it speedily and it will be made public, but, as my hon. Friend will appreciate, the whole purpose of consultation is that it consults and we want to ensure that we are taking everybody with us. Personally, I will want to do it in an extremely timely fashion.

There are many amendments to go through, but I hope that I have articulated the Government’s overall support for this measure and what we are trying to achieve in terms of supporting the hon. Gentleman’s Bill. Central to all this is the need to underline transparency and to strengthen accountability so that patients are protected. Clearly, we desire to minimise the use of force. The best way that we can achieve that is by shining a light on those incidents. We will continue to take this forward in the spirit of openness, and the Secretary of State will be producing reports on how this is being implemented.

Let me turn now to my final point. I have already addressed this in response to the remarks of my hon. Friend the Member for Shipley. On police body cameras, I can give him this assurance: the proposal does not create a criminal offence for not wearing a body camera. We have been very deliberate in our language to say that it is practicable to make sure that we do not get in the way of the police doing what is right in these situations. The references he makes to the law are consistent with the Police and Criminal Evidence Act 1984, but this would not raise any issue of a police officer being faced with criminal prosecution for not wearing a camera. I hope that that gives him some satisfaction.

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[Mr Deputy Speaker (Sir Lindsay Hoyle)]

If it goes wrong, it is obviously going to come back on me. In the end the right hon. Gentleman must make the decision, but overall I would say yes; my view is that the actions he mentioned would lead to more time for a better debate.

If there are no further points of order, I call Sir Christopher Chope to speak—briefly, I presume, because I know that he wants to get on with the amendments.

[Sir Christopher Chope]

There is only a bare hour left, Mr Deputy Speaker.

[Mr Deputy Speaker]

Twenty-five minutes will do you, then. Come on, Sir Christopher!

[Sir Christopher Chope]

It is a pleasure to follow the Opposition spokesman. He was right to pay tribute to the work of the hon. Member for Croydon North (Mr Reed), because this is a really good example of how somebody who is successful in the private Members’ ballot can bring forward a Bill that is to the benefit of their constituents and arises from a constituency case. The right hon. Member for North Norfolk (Norman Lamb) put the issue in context by saying that in the last year for which figures are available, more than 3,500 patients and more than 2,500 staff were injured in mental health units. It is therefore an issue of quite considerable significance.

I intervened on the Minister when she was dealing with new clause 1, and I want to say a little more about timescales for the independent investigation of deaths. As I said, I have a constituency case in which the coroner ordered an investigation that went out to an independent forensic person, who then became ill and has not been able to complete her work. It has not been possible, for all sorts of reasons that I cannot really fathom, to get anybody else to take over the responsibility for that work, with the result that my constituents—and, indeed, other families in Dorset—are waiting for results of post-mortems in respect of loved ones’ deaths many, many months ago. That is intolerable.

I therefore tabled some questions to the Ministry of Justice. In fact, they were among the last questions answered there by my hon. Friend the Member for Bracknell (Dr Lee). He said that there was a provision in the Coroners (Investigations) Regulations 2013 that reports must be made as soon as practicable after the examination, but there is no absolute time limit. He also said that he would raise the question of timeliness with the Department of Health and Social Care and write to me. I hope that that question of timeliness will be on the Minister’s desk soon and that she will then also be able to write to me to explain what could be done to ensure that there is a finite period for these very sensitive post-mortems, and the investigations that flow from them, to be carried out. It would be very useful if we can achieve some progress on that.

The hon. Member for Croydon North says at paragraph (5) of his new clause:

“A person appointed under this section must provide a report within three months of that appointment.”

That is a clear time limit. If the Minister thinks that that is reasonable, then there is no reason why it should not be applied more widely. That could certainly address the problem that I have identified.

I now turn to my amendments. I am grateful to my hon. Friend the Minister for responding, in anticipation, to some of them. Amendment 86 is designed to extend the operation of the Bill to all mental health units in England and Wales, not just to those that in national health service hospitals or those where treatment is provided, or is intended to be provided, for the purposes of the NHS. I still do not understand this: my hon. Friend seems to be saying that she would like to extend these provisions to the independent sector—to all mental health units—but is inhibited in being able to do so because of the constraints of the need to consult on the legislation. Is that correct?

[Jackie Doyle-Price]

My hon. Friend, as a good small state Conservative, will appreciate my desire not to put burden on business. When we bring forward regulations that will introduce additional burdens, we go through a consultation process to take business with us. I am satisfied that the Bill will affect all patients, because the NHS commissions services from independent mental health care providers, and any institution where the NHS is commissioning services will be captured under the Bill. It will benefit private patients in private settings where those institutions provide services to the NHS.

[Sir Christopher Chope]

Will it apply to private patients in private institutions as well?

[Jackie Doyle-Price]

Where that institution provides services to the NHS, it will, because we will only commission services in places that are compliant with the Bill.

[Sir Christopher Chope]

Okay. That is very helpful. As my hon. Friend says, I am keen to avoid unnecessary burdens and regulation, so it is good to have clarification on that and to know that imposing fresh regulations purely on the private sector would trigger several regulations having to be repealed. Perhaps her Department’s list of regulations to repeal is running a bit short. I am grateful for her response.

Amendment 87 is consequential to amendment 86. I am grateful to the Minister for dealing with my amendment 88, which relates to chemical restraint, and for her offer to write to me with a list of the chemicals that satisfy the definition of “chemical restraint”. The Bill defines chemical restraint as

“the use of medication which is intended to prevent, restrict or subdue movement of any part of the patient’s body”.

However, that does not provide as much clarity as I would wish. My concern is that medication should not be given because it will result in less violence from a patient—for example, if a patient normally takes their medication but becomes more violent if they do not. That seems to be a regular pattern, and I would not want there to be any perverse incentive or disincentive to give people their medication.

Amendment 89 deals with isolation, which the Bill defines as

“any seclusion or segregation that is imposed on a patient”.

I still cannot get my head around why the isolation of a patient is deemed a use of force. Quite often, isolation can prevent a patient from causing physical harm to other patients or indeed staff. Can the Minister expand on that?

[Jackie Doyle-Price]

My hon. Friend is right, it can, but that should be a clinical judgment. We are trying to tackle the use of seclusion as a method of control where it can do harm, because there are clearly cases where it can, but that will be very much a clinical judgment.

[Sir Christopher Chope]

I am grateful to my hon. Friend for that clarification.

I tabled amendments 92 to 95 because I was concerned about the term “relevant” health organisations and felt that we should be referring to all health organisations, but the Minister dealt with that point in response to an earlier amendment, so I will not press it. As my hon. Friend said, some of the issues relating to the unintended consequences of the amendments made in Committee have also been addressed.

I turn now to clause 5, and particularly my amendment 98. Clause 5 has turned out to be the weakest part of the Bill. My hon. Friend the Member for Shipley (Philip Davies) made a stunning and really illuminating speech in support of his amendments 11 and 12, which I most heartily endorse. I do not see how anybody who listened to him could do anything other than reach the same conclusion, which I am glad to say is the conclusion reached by the promoter of the Bill. A lot of my hon. Friends were sitting in the Chamber and listening to my hon. Friend the Member for Shipley, and I think they were also in strong agreement with the sentiments he expressed.

The Minister’s response has very much been to say that such amendments are not needed. I do not know whether she will respond in the same way to my amendment 98, but that amendment makes it clear that the training provided under subsection (1) must include how to involve not just patients but their families in the planning, development and delivery of care and treatment in mental health units. The involvement and engagement of families is of absolutely fundamental importance. If the Government have chosen to set out a whole list of what they consider to be very important ingredients in any training course, I cannot understand why they have omitted any reference to the involvement of families in the planning, development and delivery of care and treatment.

In one of the constituency cases I mentioned earlier, the parents have had an incredibly distressing time not just because of their personal circumstances, but because of their son’s circumstances. They have experienced great frustration in trying to get proper contact with the people in the mental health unit where their son is a patient. It seems to me that families, who often care for 20 years or more for mentally ill children, are in a really strong position to know and understand their children’s needs. It is also very important that they should be informed about what is happening. For example, in this case, the young person concerned is sometimes suddenly discharged from the mental health unit at the weekend, and he then goes and makes a nuisance of himself and the police have to bring him back to his parents’ house many miles away. On one recent occasion, he proceeded to trash the whole place. We cannot allow such situations to arise, and it seems to me that there is a really important role for involving and engaging with the families. I hope that my hon. Friend will confirm that the Government really take seriously the involvement of the families.

[Jackie Doyle-Price]

The Government most certainly do. I mentioned earlier that we are currently undertaking a review of the Mental Health Acts. The involvement of families is a key part of what is coming out of that, and there will be recommendations on that when the report is completed in the autumn. There are also issues regarding mental capacity, so the review of the deprivation of liberty law raises issues about the role of families, and we need to provide greater clarity. However, this is very much part of what we need to get right. My hon. Friend is absolutely right to say that families not only have an interest in, but can do much to support their loved ones. There are also occasions when that can cause harm and families ought not to be involved, but, again, that is part of the clinical judgment. I come back to the fact that all of this will be addressed in the guidance, which we will take forward in consultation with the sector.

[Sir Christopher Chope]

I am grateful to the Minister, and to you for your indulgence, Mr Deputy Speaker. It shows your flexibility that you allowed one long response, rather than having more interventions flowing on from that. [Interruption.] Well, it was very welcome for its content, and I am grateful to the Minister for putting that on the record.

My final point concerns clause 5(2)(k) and what we mean by

“principal legal or ethical issues”.

It seems to me that “principal” is redundant. Why do we need to talk about “principal” legal issues unless we specify more clearly what we mean by that? Do we mean that some laws or legal issues are more important than others? What does it mean? We have not yet had an answer on that—I do not know whether the Minister has one readily to hand.

--- Later in debate ---

[Sir Christopher Chope]

I, too, pay tribute to the hon. Member for Croydon North (Mr Reed) for bringing forward this Bill. He has done a masterly job. I was also impressed by much of what the Minister said in response to concerns that have been expressed. None the less, there are still some unanswered questions, particularly around the implementation of the Bill.

The Minister has said that she will bring forward guidance as a substitute for some of the provisions that we think should have been included in the Bill. She said that we did not need other aspects that we thought should be included in the Bill because they were already in law. I hope that we will be able to keep up the pressure on the Minister to come forward with more precise answers regarding when she will publish the draft guidance.

On Report, I asked the Minister what state the draft guidance was in at the moment and if it was in a form in which it could be produced. I did not get an answer to that question. I also did not get an answer to the question of whether draft guidance would be published before the Bill goes to the other place. There is a lot to be said for the Government publishing the draft guidance tomorrow, say, or next week. One merit of doing that would be that if the Bill’s Third Reading debate does not conclude today, we would have the chance to look at that draft guidance before commenting on it during the remainder of the debate.

As the hon. Member for Croydon North said, the Bill is important because it introduces means by which we can measure lots of things that are happening in our mental health units about which we are not aware at the moment. As we know, what we cannot measure, we cannot control.

I remain concerned that some of the information that will be produced as a result of the Bill could lead to unintended consequences, as my hon. Friend the Member for Shipley (Philip Davies) also mentioned. We heard a reference to the fact that women in mental health units suffer more force against them than men, but that might be because only the most serious cases of women in mental units are brought before the—

Mental Health Units (Use of Force) Bill

Christopher Chope Excerpts

3rd reading: House of Commons
Friday 6th July 2018 Commons Chamber

[Sir Christopher Chope (Christchurch) (Con)]

I hope that my hon. Friend the Minister will be able to give us a little more information today on her plans on the issue of the code of conduct. The advisory code is key to the Bill, and when we discussed it last time she said that she would bring draft guidance forward. I hope she will be able to tell me today whether that will be done before the Bill reaches the other place, so that there can be a proper discussion of the contents of the draft guidance at the same time as the substance of the Bill is discussed. I will give her the chance to intervene when she has the answer to that question.

In the meantime, I thank the Minister for responding to the point that I made on Report, when I asked which products were licensed by the National Institute for Health and Care Excellence for the purposes of restraint. She has now written back to say:

“there are no products in the UK which are licensed for chemical restraint as defined in the Mental Health Units (Use of Force) Bill.

However, a number of psychiatric medications can be used for rapid management of acute agitation in psychiatric patients. Of these products, Haloperidol 5mg/ml Solution for Injection is indicated for rapid control of severe acute psychomotor agitation associated with psychotic disorder or manic episodes of bipolar I disorder, when oral therapy is not appropriate.

Clinicians in the UK are primarily guided by the advice about rapid tranquilisation given in the following documents: Maudsley Prescribing Guidelines; Rapid Tranquilisation Algorithm by the Royal College of Psychiatrists; and the Rapid Tranquilisation section from Restrictive Interventions for Managing Violence and Aggression, which is published by the National Institute for Care Excellence.”

I put that on record because it is relevant to our discussion on Report, and I am grateful to her for writing to me with those details. I will give way if she has any more news about the guidance.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

The guidance will be published and consulted on. Clearly, it would be inappropriate to propose guidance until Parliament has passed this legislation, but we fully undertake to consult all those with an interest. We expect that debate to take place so we can implement the Bill, if passed, within a year of its passage.

[Sir Christopher Chope]

I am grateful to my hon. Friend, and I hope that is the maximum timetable, rather than the minimum.

[Mr Speaker]

Has the hon. Gentleman completed his remarkably brief oration?

[Sir Christopher Chope]

I have indeed, Mr Speaker.