There have been 14 exchanges between Sir Christopher Chope and Department of Health and Social Care
|Tue 13th October 2020||Public Health: Coronavirus Regulations||9 interactions (590 words)|
|Tue 6th October 2020||Public Health||15 interactions (879 words)|
|Mon 28th September 2020||Covid-19||6 interactions (754 words)|
|Tue 19th May 2020||Coronavirus and Care Homes||3 interactions (54 words)|
|Tue 5th May 2020||Covid-19 Update||3 interactions (62 words)|
|Wed 30th January 2019||World Cancer Day (Westminster Hall)||2 interactions (21 words)|
|Tue 4th September 2018||Derbyshire CCGs’ Finances (Westminster Hall)||3 interactions (22 words)|
|Fri 6th July 2018||Mental Health Units (Use of Force) Bill||6 interactions (353 words)|
|Fri 15th June 2018||Mental Health Units (Use of Force) Bill||92 interactions (3,437 words)|
|Wed 6th June 2018||Health and Social Care (National Data Guardian) Bill (Public Bill Committees)||12 interactions (425 words)|
|Mon 21st May 2018||Health and Social Care (National Data Guardian) Bill (Money)||10 interactions (448 words)|
|Tue 6th February 2018||Oral Answers to Questions||3 interactions (53 words)|
|Wed 13th September 2017||Corby Urgent Care Centre (Westminster Hall)||2 interactions (33 words)|
|Thu 6th July 2017||Adult Social Care Funding||3 interactions (49 words)|
Just yesterday the Prime Minister and the Government unleashed a new package of restrictions and tiers in order to tackle the transmission of the coronavirus. Yesterday afternoon, in a meeting with west midlands MPs, the Secretary of State for Health and Social Care told the MPs present that all bar two areas—Dudley and Coventry—will be placed on tier 2 restrictions. When I asked him whether he could let me know the scientific basis for Coventry and Dudley being on tier 1 restrictions, and what could trigger a move to tier 2, my question was ignored and unanswered. When I asked how soon after a governmental decision has been made to move a constituency from one tier to another Members and community leaders would be alerted, I received no answer.
This is utterly unacceptable. My constituents in Coventry North West deserve better. They are doing everything they can to hold up their end of the bargain to ensure that transmission is low and stays that way. They deserve more clarity on the evidence behind the Government’s decisions. Clarity ensures adherence. Without it we are flailing in the wind, and people are suffering. Right now, the Government risk losing confidence in their ability to see us through this crisis. They have wasted months of precious time and millions of pounds of taxpayers’ money, and are still not getting it right. Will the Minister let us know just how much notice each local area will be given if a change in its restriction level occurs, and how local communities and local leaders will be told of these decisions?
To borrow a phrase that we are all too familiar with, winter is coming. It is imperative for the Government to be better prepared to tackle the virus, and equip our hospitals and care sectors with the resources they need to handle the second wave. I fear that the Government have not learnt lessons from spring, and that our care sector will be under-protected. I fear that our hospitals will be ill prepared to cope, and that non-covid patients will once again be relegated to the back burner, because the right precautions and planning are not in place to deal with what may come.
Will the Minister let the House know what the Government are doing to prepare for the pressures on our NHS that winter will bring, in particular for cancer patients? What plans will be in place clearly to address sprawling waiting lists for cancer services, and what additional support have the Government given to the many thousands of people who have had their cancer treatment disrupted over the course of the pandemic? These are pertinent question that we have asked the Government time and again, but yet again they are providing us with little clarity and no answer—on the back foot, as usual.
This is an opportunity for the Government to do better, and, in the interests of the country, I really hope they do.
Does my hon. Friend trust the prognosis of Professor Ferguson, whose estimates have been proved wrong again and again and are wildly exaggerated?
Clearly, if we are going to live with this virus, which we obviously will at least until—if ever—a vaccine is found, we need to influence individuals to behave in a way that not only keeps them safe, but makes them discharge their responsibility to keep safe other people in society and in their families. There are many tools that Governments can use to do this. They include rules, regulations and restrictions on activity. They also include messaging. We must give positive incentives to do these things, as well as negative consequences if the rules are not followed. However, I have to say to the Government that more rules will just mean that the compliant, who are not engaging in risky behaviour, will continue to comply, but that those who are reckless will find ways round the rules.
There is no better example of that than the curfew. We know that there is no scientific basis for doing it to protect people’s wellbeing. We have penalised restaurants, which now have to close at 10 pm and cannot do two sittings in an evening, although they have made massive investments to make their premises covid-secure. We are punishing the compliant. Meanwhile, publicans in the high street can comply with the rules and close at 10, but they are offering take-outs at 9.45 to the massive crowds of people spilling out of the pubs. That is reckless behaviour, and I really think the Government need to take stock. It is clear that this is not a good measure to influence behaviour in any positive way. There are much better ways of doing it. Considering the powers that the Government have already taken, I think we should look at more enforcement of fewer rules and regulations, rather than creating new ones when there are issues.
In the time I have left, I want to pay tribute to my community and to the local authority officials and health officials in Thurrock for the fantastic effort they have made in tackling this virus. We are currently 134th out of 149 local authorities in terms of cases. We have a local contact tracing capability that has kept rates down, and we have had no deaths since July, so it has come as some surprise that Public Health England has been lobbying my local authority to move from tier 1 to tier 2. That makes an absolute nonsense of this tiering policy, because we should be asking for additional restrictions only where there will be a material benefit to public health. My director of public health advises me that further restrictions will actually jeopardise public health, and that there will be no benefits from them. We must not be complacent, given the current rise in cases, but please will the Minister resist any attempt to put Thurrock into tier 2?
Break in Debate
Mr Deputy Speaker, you may well think that over 37 years, you have heard enough from me, so let me read out a letter that happened to arrive this morning from a constituent. It says:
“I am 67 years old and for the first time in a long time I am scared. Not of the virus, which, let’s be honest, is proving to be no more deadly than the flu”—
that is his opinion; I do not necessarily share it.
“I am scared of the damage being deliberately caused to the economy and our freedoms by this Government in the name of covid-19. It isn’t the virus closing businesses and causing job losses, it’s the actions of the Government. It isn’t the virus stopping people getting treatment and operations, it’s the actions of the Government. It isn’t the virus preventing pupils and students getting the education they are entitled to, it’s the actions of the Government.”
So speaks my constituent in a letter that arrived this morning.
Another letter arrived this morning from a constituent telling me that they were having doorstep services very successfully over recent months attended by six to 16 people in place of going to church if that was not possible. That, of course, now breaks the rule of six, so they have had to stop.
I follow my hon. Friend the Member for Christchurch (Sir Christopher Chope) in posing some serious questions to Government that have to be answered. On positive test results—I ask the Government to write back to me if they cannot answer in the winding-up speech—what percentage do they estimate are false positives? Of covid hospitalisations, what is the breakdown between those in hospital who happen to have tested positive and those who are in hospital because of their covid symptoms? Given the disparity between the number of cases and the number of deaths, are we not wrong to react to the rate of infection, rather than hospitalisations and deaths? There are many, many other questions that need answering.
Following my hon. Friend, what is the evidence that we are saving lives by throwing people out of pubs at 10 o’clock into the street? They can go and buy lager in the shops. They can go back to their student digs.
My hon. Friend makes his point. We are a Parliament and we are entitled to express our opinion and hold the Government to account, and that is what we are trying to do this afternoon.
The trouble with the Health Secretary’s arguments is that he is always raising up Aunt Sallies and pretending that some of us want to let this thing rip. We are simply trying to ask questions of the Government and hold them to account. No Member of Parliament wants to let this thing rip, but what we do say is that the real danger of the disease is to people over 80. The average age of death is 82, and the vast number of them are over 80. It is up to the older population and those who care for them to take self-responsibility—masked by all means, taking great care and shielding even in places of multiple occupation. We have to shield elderly people—they are the people at risk—but we have to get the country back to work. We simply cannot go on bailing out businesses. We are going bankrupt, as I said to the Chief Secretary to the Treasury earlier this afternoon.
With the economy, we are hoping to pull ourselves up by the hair. We cannot do it. We have to allow people to work, and therefore the whole approach needs to change. We need to emphasise the need to shield the elderly population and those who care for them and we need people to take back control of their own lives. I repeat—I will say it again and again—that if we go on cancelling cancer operations and heart operations, if we drive people into mental health difficulties and if we close down businesses, we are paying a terrible price, and there has to be a balance.
I feel I have taken quite a number of interventions, so it is time that I moved on, if that is all right.
Let me talk through some further changes that have come into effect since the regulations were made. On 21 September, following the advice of the four chief medical officers, the UK’s covid alert level was raised from 3 to 4, which is the second most serious stage, meaning that transmission is high or rising exponentially. The Prime Minister outlined to Parliament on 22 September that we were at a “perilous turning point”, and needed to act to save lives, protect the NHS and the most vulnerable, and shelter the economy from far sterner and more costly measures that would inevitably become necessary.
As a result, further restrictions came into effect from 24 September. These included: rules on the closure of certain businesses selling food or drink between 10 pm and 5 am; measures to require hospitality venues to provide food and drink for consumption on the premises by table service only; the doubling of initial fines for individual breaches of the above measures; and new fines for businesses that do not adhere to the new requirements, starting at £1,000, up to a maximum of £10,000 for repeated breaches. The rules also change the exemptions to the six-person gathering limit to restrict attendance at wedding ceremonies, receptions and support groups to 15, and remove the exemption for stand-alone religious or belief-based lifecycle ceremonies and adult indoor sports apart from indoor disabled sports. We are working through the normal channels to schedule debates for these regulations as soon as possible.
I recognise that people have had to make significant sacrifices to suppress the first wave, and these restrictions are not measures that any Government would want to introduce, but the threat of the virus very much remains. With winter approaching, we must do whatever it takes to keep it under control and protect the NHS so that it can, in turn, look after us.
I am sorry but I was closing my speech, not taking an intervention. That was the end of my speech. [Interruption.]
Break in Debate
I certainly do not think my constituents are stupid, and I hope that the right hon. Gentleman does not either. A very important point has already been made about children, and I will return to that later. We have not yet had a convincing explanation why they are included in the six.
Even with the best of intentions, concerns and questions remain, not least about the way in which these regulations were introduced, how effective they are, how the Government communicated them and how they will be enforced. The timeline of these regulations is the perfect demonstration of the lack of transparency, strategy and accountably, which has been the hallmark of this Government. Following media briefings the night before, the Prime Minister made an announcement about the rule of six on 9 September, not to this place, as it should have been, even though he was in the House that day to answer Prime Minister’s questions. I call that a discourtesy to this place, and I hope we see and end of that. It shows not only a lack of respect to all Members and our constituents but a lack of confidence in what is being proposed and a lack of commitment to scrutiny. Most of all, the way that these regulations were introduced shows a lack of thought about the practicalities of enforcing them.
How can we expect anyone to adhere to the minutiae of these regulations if they appear for the first time only a quarter of an hour before they become law—at quarter to midnight on a Sunday evening? How were the police meant to enforce that? Are they supposed to google the regulations as they walk around on their beat? Brian Booth, the chair of the West Yorkshire Police Federation, said:
“Everybody is in the dark, it shouldn’t be like that…If the government says they’re going to infringe on people’s lives, they have to tell them how.”
Once again, there is no impact assessment for these regulations. Surely some thought was given to the practicalities, so what discussions did the Minister have with her counterparts in the Home Office and with police forces around the country prior to the introduction of these regulations?
The way that regulations are introduced matters. They are too important not to be debated and given full and timely parliamentary scrutiny before they become law. Since March, more than 70 health protection statutory instruments have been introduced in this way, with no debate and no vote before they come into force. We recognise that, in the early stages, there was a need to act quickly under the emergency procedures, and we acknowledge that that may still be the case at times, but more and more of the regulations that are being introduced do not meet the test of urgency. The Government have slipped into bad habits. They treat this place as an afterthought—an inconvenience, an optional extra—and not as the cornerstone of the democratic process that it should be. Surely they can do better than that. Do they not realise that scrutiny, debate and challenge in the making of our laws means that, in the long run, laws are more robust, more effective and have greater public acceptance?
I repeat once again and for the record our offer to meet at short notice to debate and vote on regulations before they become law. I appreciate that that might be inconvenient for some, but, to be frank, we are in a pandemic so a bit of inconvenience should be the least that we have to put up with to ensure that democracy still functions.
Regrettably, I am not one of the business managers of the House, so I cannot advise on that, although I expect that we will have an answer during the business statement on Thursday. I note what Members have said about national regulations being debated on the Floor of the House before they become law, if possible—obviously, that will still be after the event, but we really need to start doing a lot better in that area.
There is rightly a concern across the House and among the population that we do not have control of the virus. A central part of regaining control is ensuring that there is robust scrutiny of the regulations and their effectiveness. The Government need to stop reacting to situations too late—that is how the virus has run out of control. They need to look ahead, plan, prepare and act now to get a grip on test and trace, to have a clear and consistent message on what the public need to do and to ensure that there is widespread compliance with the rules. The latter two go hand in hand and are very much connected to the regulations that we are debating today.
As we heard from the Minister, the regulations amend the Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations for the fourth time. The regulations restrict social gatherings to six people, unless an exemption applies. We have heard a little about some of those exemptions, so I will not list them all, but they are where the good intentions behind the regulations depart from the clear and consistent messaging that we need. For example, there is an exemption in the regulations for gatherings of up to 30 persons for a marriage or civil partnership; as Members will already be aware, that has been reduced to 15. Yet again, as with a whole host of other restrictions, we are debating regulations that are, in part at least, out of date.
The wedding industry has been decimated this year; I do not know what repeatedly inviting and uninviting people to a wedding does for family relations—maybe people could ask everyone to wear tweed to the wedding and combine it with a grouse shoot so that they could keep numbers at 30. However, this is a health debate, so I will focus on the health aspects. To that end, I would like the Minister to spell out very clearly the rationale for this decision. The limit of 30 at a wedding lasted for just two weeks before it was reduced to 15. Either a specific piece of evidence emerged during that fortnight that required the limit to be reduced for weddings but not for funerals, or the limit should never have been 30 in the first place. Which one is it?
The regulations also provide that the restrictions in private dwellings in the regional lockdown regulations remain in place; it is notable that the rules for the rule of six vary across the devolved nations, as we have already heard. Far from us having an easy-to-remember set of rules that apply to everyone, it seems that the rule of six is the baseline for around only half the UK.
In Wales, as we have heard, primary-age children are not counted in the six. The Welsh Assembly took that decision based on the evidence that it has, which shows that children are far less likely to have the most serious symptoms and are less likely to pass on the virus. The question, which has already been put today, is about how the Government have come to a different conclusion on that point. Why are younger children included in the rule of six in England, but not in Wales—or in Scotland, for that matter?
Break in Debate
There are eight people on the call list, and I will get everyone in if it kills me. To do so, I am introducing a rule of six. It is not an arbitrary figure; I have divided the time left by how many people want to speak. The rule of six could become the rule of five or the rule of four if there are a lot of interventions.
I am sure the Minister really appreciated that warm welcome from her colleagues—so different from those horrid breakfast-time interviews that she is occasionally trapped in.
I would like to make three very quick points. I want to ask, first, about this rule of six. If it is a purely arbitrary figure and it has no scientific basis at all, does the Minister accept that she is being quite unfair to those with larger extended families, and how does she justify that?
Secondly, we need clarity on the question about police powers of entry. It is quite ridiculous for the Minister to come to the Dispatch Box and tell us that the police can level fines and that they can do this or that enforcement, only for us to discover that, if they are standing outside a property where there is a party of 40, 50 or 60 going wild, they have no room to enter. It would be useful, if we are being asked to renew these powers, to know what powers the police have.
Finally, is there a numerical point of reference—an R number, say, or a number of cases—for when these restrictions will be revised in either direction? If that is the case, surely we should know, and surely the public should know.
Break in Debate
I have only three minutes left, so I am keen to cover a few more points that have been made in the debate.
Colleagues have spoken about children and the rule of six. As I have said, I am acutely mindful of this point as I have a family of five. I am well aware that Wales and Scotland, where health is devolved, have made their own decisions, including a slightly different decision on this issue. Of course, we will learn from the other parts of the United Kingdom. There are regular conversations between the devolved authorities and the UK Government.
On the matter of extended families and larger households, there is an exemption for larger households—clearly, they can gather—but in some areas there has been a particularly rapid spread when larger households of extended families come together. That can be a particular source of the spread, so it is much harder for larger households wanting to socialise. This is a difficult balance to strike, but we want to ensure that we are suppressing the virus because it is such a cruel thing.
Let me turn to policing. The police approach is one of engage, explain, encourage and enforce. I can confirm that they do not have power of entry, but my understanding of the feedback that we have received from the police is that they feel that they do not need further powers to enforce these measures.
I would like to reiterate the Government’s commitment to working with Parliament and to debating regulations such as these and others. I should say that we absolutely recognise the impact of these restrictions on people’s lives, and that it is with great reluctance that we bring them in. None the less, as I have said, the alternative is not suppressing the rate of the virus, and, as I have mentioned, it is not always a mild illness. We are seeing cases of long covid. There is also a health impact on our hospitals: if they become too full treating people with covid, they will struggle to treat people with other illnesses. That has its own health implications, and cannot be the right strategy. The strategy has to be to control this virus and to suppress it with the rule of six and all the other things that we as individuals can do, including our own compliance with the social distancing measures. We must take this approach, and I thank everybody for all that they are doing. I know that the public face the implications of these restrictions day in, day out, as we do ourselves, but we must do it, because it is the way that we get back to normal as soon as possible.
I have to admit that I have had to rewrite my speech in the light of the events that have occurred today in my area, Cleveland, with respect to covid-19.
I thank and pay tribute to all the NHS workers, care workers and key workers who keep the people of my constituency, Hartlepool, safe, well, protected and fed. I also pay tribute to all the local volunteers who have been relentless in their efforts to keep our communities going, to keep them together and to keep our citizens supported. I am very pleased—so pleased—that one of the national vaccine trials is taking place at our very own University Hospital of Hartlepool, which deserves much more Government investment to protect operational services. It is playing its part in this national crisis and I am proud of the people who work there.
I have changed my speech because of the Secretary of State’s announcement from the Dispatch Box of local restrictions for the Cleveland and Tees Valley area. On the letter written by the hon. Member for Middlesbrough South and East Cleveland (Mr Clarke), who is not present to hear this speech, and his fellow Conservative MPs in the area—they are known as the Cleveland Conservative collective of MPs—to all local authorities in the Tees Valley area to say that they feel the authorities should not proceed with voluntary local restrictions, it would have been much better for them to have spoken to all Tees Valley MPs, rather than construct what is little more than a local, party political and divisive missive at a time when we should all be working together for the greater good in the Tees Valley. I am sorry that the hon. Gentleman is not present to hear me say that.
Local restrictions are the last thing we want—they hurt business and keep families and loved ones apart—but where the R rate is so high, protective measures and local restrictions are put in place to protect people and stop the spread of virus, as we have seen in other areas. I have often disagreed with my local council—for example, it has a bizarre plan to stop traffic going up and down a local high street known as the York Road but it cannot explain why; it just says that it is because of covid-19 reasons. I will disagree with bizarre local plans like that and be vocal about them, but I have spoken to the council today about local restrictions and I have listened to our local public health authorities, and I understand why they feel that more resources and more support is needed to get Hartlepool through this crisis.
Until now, Hartlepool has been given only ad hoc provision, yet we persistently sat at the bottom of the fatalities league in the north-east—something we should rightfully be proud of. Even so, we had been in the red zone—the watch zone—for more than two weeks before routine testing materialised. I am no apologist for my council, which is a Conservative-backed collective, but in order to get a grip of this virus, and with a distinct lack of direction and leadership from the other side, on balance taking local control appears to be the way forward. People in Hartlepool—or anywhere else, for that matter—should not be made to drive miles just to get a test. It is absolutely ridiculous and my constituents rightly feel outraged by it. We need Government leadership and positive direction from the Government; unless we get that, the local option is the better option.
Coronavirus presents a very real threat to the health of our constituents and must be controlled, but we must also recognise that measures to control its spread are having a huge impact on our constituents’ lives and those impacts are not evenly felt. They have a disproportionate impact on particular groups, particular places and particular sectors. There is only a short time available, so I intend to restrict my remarks to three matters.
The first is the system for test and trace. If this is not working effectively, there is a likelihood of further restrictions, which none of us wants to see, yet we know that, over the last few weeks, many of our constituents who are unwell and who suspect they have contracted the virus have faced huge problems in accessing a test. When they do get a test, results are too slow. Last week, fewer than one in three people tested in person got their results back within 24 hours, and that proportion was lower last week than the week before. Once positive cases were identified, only around three quarters of those they were in close contact with were asked to self-isolate—again, a smaller proportion than in previous weeks.
The Prime Minister might say that testing and tracing has “nothing to do” with the spread of the disease, but everybody else understands that rapid testing, effective contact tracing and self-isolation are absolutely vital to identifying and containing any outbreak. The Government must acknowledge that there are problems, identify the source of those problems and then take swift action to fix them. Please can we get the Department of Health and Social Care to start working with others that can help? Numerous universities, including the University of Nottingham, are undertaking asymptomatic testing to control outbreaks on university campuses and protect the wider community. Those universities are now working together to share information, but the Government have gone AWOL. Where is the strategy?
That brings me to the second issue I want to raise—the need for Government support for universities and their students. The Government of course have had to act fast on some issues, but when it comes to universities, their action has been glacial. I asked for a statement from the Universities Minister on 9 July, and we still have not had one. Tomorrow, I understand, we are going to have an urgent question, but only because there are serious problems. Young people who are starting university this autumn were promised a mixture of online and face-to-face learning, but an increasing number of students want or need to study remotely, and to do so they need access to the right equipment and connectivity. We know that students from disadvantaged backgrounds already face a digital divide, so what are the Government doing to bridge that divide and ensure that every student can access high-quality education, whether they are on campus or at home in self isolation?
Having seen some of the very worrying reports this weekend, what are the Government doing to ensure that students are properly supported at university, particularly if they are required to self-isolate? Many young people already experience anxiety and poor mental health. What are the Government doing, alongside universities, to ensure that young people—many away from home for the first time and now experiencing extra pressures as a result of restrictions—can access mental health support, and can the Minister assure us that there are systems in place to ensure their well-being? Will she also assure us that students will not be forced to remain in student accommodation, away from their families, when it comes to the end of term?
Thirdly, Nottingham does not just benefit from having two universities—it is a regional centre with a rich and diverse cultural sector and a thriving night-time economy, sectors that are vital to the city’s economy and provide employment for thousands of people. I am deeply concerned that the Chancellor’s economic plan simply ignores the disproportionate impact on these sectors. Pubs, bars and nightclubs are either still shut down or operating at reduced capacity, and the 10 pm curfew has made things even more difficult. Our theatres, arts venues and cinemas are reopening, but at far reduced capacities.
These businesses and the people who work in them need and deserve Government support, but the job support scheme simply does not provide it. If a business remains closed, it is impossible to access. For businesses that can access the scheme, it is cheaper to have a fewer number of full-time staff than to keep more people on in part-time work. My Labour colleagues have repeatedly called for a more targeted approach for a job recovery scheme that incentivises bringing more staff back part time and includes a training component. Of course it is welcome that the Chancellor has finally accepted the need to move away from the furlough cliff edge, but he is still letting down those sectors and those workers who most need support. Without a further change of direction, we can only see further job losses hitting my city hard.
I rise to do three things. The first is to praise the Government for everything they have achieved on PPE, on testing and on the track and trace app. In my libertarian soul, and in my instinct, my heart and my reason, I consider the Government’s track and trace app to be the very apotheosis of my worst fears. Yet over the weekend I studied what the Government have done. They have moved away from the first version, to the Apple and Google-distributed model, with all the private data remaining on the user’s phone. They have released a source code, both for the server side and for the client, which I very much welcome as a software engineer, although I doubt I shall be grinding through it. Against all my instincts—and in the knowledge that I am not the Member of Parliament for dogmatic libertarians across the country, with whom I generally agree, but in fact the MP for Wycombe—I have done the right thing: I have, against my expectations, installed the contact tracing app. I ran out of excuses, I have installed it, and I am allowing it to run even as we speak. I hope that will be of some reassurance, even to those libertarians who might condemn me for it.
Secondly, I want to say something about the science. I am not going to engage in amateur epidemiology, much as I have been enjoying picking it up, but I will praise my constituent and friend, Dr Raghib Ali, who is an epidemiologist. Unusually, he is an academic epidemiologist and also an acute medicine consultant who works in Oxford, so he is perhaps uniquely positioned to comment on the disease. He has been tweeting and writing about the disease. He is a very reasonable man. He has really helped me to keep my feet on the ground. I say to all Members who, like me, really hate and despise these restrictions on our freedom to look at what Dr Raghib Ali is writing. He has helped to keep me anchored in the truth that this is a very dangerous disease for people who are older and people who have pre-existing conditions, and we have just got to deal with it.
On the science, I wish my right hon. Friend the Secretary of State were present. As he framed the problem between either suppression or letting it rip, I thought that our friend Mr Osborne was back framing the issue in terms of what I think is a false dichotomy. I think we need to take another look at the scientific advice. There are professors out there telling us that this is an optimisation problem—we need to maximise the lives saved and minimise harm. There is, I think, going to turn out to be a third way that enables us to minimise harm. The Department’s own figures have shown, as reported in The Daily Telegraph, that the cost of lockdown in quality adjusted life years, adjusted for comorbidities, was greater than the cost of the disease thus far. So if we wish to maximise human flourishing and save lives, we have to look extremely carefully at the science.
I am working with my friend Professor Roger Koppl, from Syracuse University and author of a book titled, perhaps unfortunately, “Expert Failure”, looking at what actually happens with expertise. I wrote a brief for the Prime Minister, which I have also tweeted. My covering letter points out:
“Pandemic policy making has been asking the impossible of scientists, economists and politicians. There are solutions and they are fundamental to the success of a free society in an era of accelerating complexity and change.
There is a structural problem rooted in the division of labour which, when combined with bad incentives, causes inevitable failures of expert advice. The problems are acute, delicate, dangerous and long-standing. They do not arise from faulty expertise or bad actors.”
I am not going to call for anyone to be sacked.
So I hope people will look at the brief I have put out, which includes concrete suggestions. I will put on the record the Harold Macmillan quote with which the brief leads:
“We have not overthrown the divine right of kings to fall down for the divine right of experts”,
however brilliant they may be.
I do not know the facts about meningitis, but I am grateful to my hon. Friend for his point. I particularly welcomed the debate between scientists on this Sunday’s Ridge programme. We have seen that the science actually involves a great deal of uncertainty and debate, as brilliant people, well versed in their lifetime’s work, try to make their way through uncertain knowledge, to predict the future. We must all proceed with great care if we are to be concerned for our constituents’ wellbeing.
In a sense, what I am saying to the Government today is that we need to fix two parts of this process. We need to change the structure within which expert advice is provided. I have provided a brief to the Minister. I have tweeted it out and would happily give it to the Minister. We also need to deal with the problem that has been the subject of so much news this week. We need to deal with the issue of this House voting on restrictions of the people’s liberty before it is taken away. That is surely the fundamental point about democracy. I can say, hand on heart, that all Members of this House appreciate that, in an emergency, it is necessary for Ministers to use the powers they have to protect life, liberty and property and I do not condemn anyone, but we are now into a different phase of the disease. It really is time to reach an agreement—I am happy to say that we have just had a constructive meeting with the Secretary of State, the Chief Whip and the Leader of the House—and to reach a constructive way forward. I know it is inconvenient for Ministers to come to the House before they take away people’s liberties, but I say to Ministers: it is supposed to be. It is what keeps us a free people.
I say happy birthday to my hon. Friend and pass on the best wishes, no doubt, of the whole House. The question he raises is a difficult one, because in many cases, the best place for somebody is not in a hospital. Indeed, people can catch diseases in hospital, so it needs to be done on a clinical basis. That is why we have put in place the testing, isolation procedures and infection control of people who are leaving hospital to go into care homes.
One of the five tests that we have set out before the restrictions are eased is that the number of deaths should be falling consistently. Indeed, the Scottish Government’s document includes a similar proposal, and we are working to ensure that the UK is as aligned as possible.
I beg to move,
That this House has considered World Cancer Day.
It is a pleasure to serve under your chairmanship, Sir Christopher. I am grateful to right hon. and hon. Members for being here to debate an important issue that sadly affects too many of our constituents.
This debate comes ahead of what will be the 20th World Cancer Day, which will take place on Monday 4 February. I am delighted that following a suggestion from Elaine Monro, who is a constituent of mine and a Cancer Research UK volunteer, the Palace of Westminster will mark World Cancer Day by lighting up in pink. As far as I am aware, this will be the first time that Westminster will be illuminated for World Cancer Day, so I would like to place on the record my thanks to the Speaker and the Lord Speaker for agreeing to that request.
World Cancer Day is an initiative led by the Union for International Cancer Control. Each year, the global cancer community is united in seeking to raise awareness about cancer prevention and treatment, and about the importance of Governments’ working together, tackling cancer globally. Last year’s World Cancer Day involved more than 1,000 activities in 139 countries, culminating in half a million social media mentions and over 14,000 press articles and broadcasts in 145 countries worldwide.
Cancer is a global problem. Last year, more than 18 million people worldwide were diagnosed with cancer, but the story of those patients varies hugely depending on where they were born; many countries have no access to basic treatments, such as radiotherapy. This is all about working together—a global push to tackle a global issue. As Cancer Research UK has put it:
“No single person, organisation, or country is going to beat cancer on its own. We must all work together.”
In the UK, a number of charities mark World Cancer Day through campaigns or fundraising activities. Cancer Research UK and CLIC Sargent both sell wristbands, which I am pleased that I and colleagues are wearing today, to raise funds and awareness about the day. Children with Cancer UK and the Institute of Cancer Research are also running campaigns to coincide with World Cancer Day and in previous years many other charities, including Macmillan Cancer Support, Marie Curie, Breast Cancer Now and Anthony Nolan, have also marked the day. Events are taking place across the United Kingdom, from the Scottish cancer prevention conference in Edinburgh to Cancer Research UK’s winter run in London.
I pay tribute to each and every one of those charities, their staff and volunteers; they do incredible work. They are truly a credit to our country and contribute significantly to the global effort to tackle cancer, doing hugely valuable work with global partners. Cancer Research UK is the largest independent funder of cancer research in the world and it has played a role in developing eight of the world’s top 10 cancer drugs. Can the Minister touch upon how the Government support this work and how they help the UK to continue to contribute to the global effort to tackle cancer? I know that some charities have concerns about the impact that Brexit may have on the UK’s continued contribution to this work.
There is some great work being carried out in my constituency; I shall mention a few examples. The Cancer Research UK team from Selkirk, led by Elaine Monro, has developed an official tartan scarf, which is produced in the Borders by Lochcarron and continues to sell like hot cakes, not only in Selkirk and Scotland, but throughout the United Kingdom. The Marie Curie team in the Borders, who now help patients with terminal illnesses generally, not just cancer, do some incredible work caring for people in their final days. I must not fail to mention that I will be running the London marathon in a few weeks to help raise funds to support my local Marie Curie nursing team. I hope that by raising £5,000 I shall be able to support their work in caring for people with terminal illness in my constituency.
In partnership with Macmillan, NHS Borders runs a dedicated, world-leading cancer centre at the Borders General Hospital, which pulls together specialist staff and treatments all in one location. NHS Borders is very good at meeting its cancer treatment waiting times, as well as targets for cancer screening, not least because of that Macmillan centre.
Although World Cancer Day is focused on tackling cancer globally, we are understandably focused on the UK’s record. Like most other developed nations, the UK has higher rates of cancer, but we also have quite high mortality rates—just above the average, according to the 2018 Global Cancer Observatory figures, and higher than many other developed nations. Given that the UK leads the way in vast amounts of cancer research, and that we have some of the world’s best cancer professionals and a universal health service, our mortality rates are simply too high.
Cancer continues to affect far too many people in the UK. More than 360,000 Brits are diagnosed with cancer each year, and that is expected to rise to the equivalent of one new case every minute by 2035. Every day, 12 children and young people are diagnosed with cancer, which remains the biggest killer of children by disease in the United Kingdom.
Actually, the alternative is correct. The CCGs in Derbyshire were managing absolutely fine until the five-year forward review in 2016-17. They were making surpluses, and there was no problem—particularly with North Derbyshire CCG, which covers my area and the hon. Gentleman’s area. It had surpluses and hit the 1% target underspend—[Interruption.]
The figures speak for themselves, as do the cuts to the county council, and as do all the other cuts that the CCG has had to make since the reduction in its funding increase in 2017, which I will set out in detail.
Last year, just after I was elected, our local dementia assessment and support ward in Buxton was axed. It was a gold-standard service that took the most difficult patients with dementia and helped them back into care in their own home in an average of less than six weeks. Our rehabilitation and support ward at Buxton, Fenton ward—the only place where acute patients in High Peak can be sent, as we have no nursing homes at all—is due to lose more than half its beds, despite the fact that a waiting list of patients in our acute hospital need those beds, even during the summer.
Community hospitals across Derbyshire are facing the loss of 84 beds. Bolsover Hospital and Bakewell have already closed, and staff at Clay Cross and Ilkeston hospitals are living with a threat to their wards. Anyone would think we were seeing a reduction in the number of patients with dementia, or elderly and frail people who need rehabilitation to get them home from hospital. Of course we are not. Instead, there has been an explosion in the need for those services at a time when our NHS is being forced to make short-term cuts that will have long-term implications for the care of our patients and for the skilled staff we need to keep in the NHS.
I had thought that the Government’s aim was to keep our long-term health costs down. Instead, cut after cut is forcing up costs—not just in the long term but immediately. The hours have been cut at our minor injuries units at Buxton and in Erewash. Our local A&E had an immediate increase in patients, which is costing the NHS even more. That A&E department, which usually sees 200 cases a day on average, rising to 250 in winter, has been seeing 300 patients a day over the summer. There has not been a spate of accidents; those patients have long-term illnesses that are not being managed because our local health services cannot keep up with the increased demand as they are not now being funded to do so.
It seems that, whichever service that helps people to stay out of hospital or long-term care one thinks of, it is being reviewed or cut. Our respite care for people with severe learning disabilities is one of the services that patients have been told is being reviewed due to the challenges it faces. My constituent Christine told me that her daughter Julie, who is 38 but has a mental age of eight, receives four or five days of respite care a month, and that is all that enables Christine and her husband to continue to care for her at home, as Christine is 62 and her husband 75. The alternative of permanent residential care would be far more expensive for the state to provide.
Specialist nurses who help people to manage very serious long-term conditions, including heart failure, diabetes and Parkinson’s disease, are also proposed for cuts. After more outcries, especially from the GPs who would be shouldering that huge extra burden, those cuts have been put on hold until next year. The threat, however, is still there, and the specialists and the committed staff who run the service do not feel secure in their jobs.
Even funding for wound dressings has been removed. After suture removal and the first dressing, GPs are supposed to send patients with suppurating wounds to clinics many miles away, although often those patients have no transport. Otherwise, GPs have to pick up the burden themselves to prevent their patients from suffering serious infections, ending up in constant pain and back in hospital. In the case of our average small rural GP practice, that is 1.5 days of practice-nurse time a week. To keep that up is not sustainable.
Given all the rhetoric from the Department of Health and Social Care about sustainability, why is that happening? Why are short-term financial decisions impacting so hard on our frontline health services, on our voluntary services—which are vital as part of a long-term sustainable service—and on the frail and vulnerable people who need them? The short answer is finance. Finance has become the be-all and end-all for decisions on healthcare in Derbyshire. It is not an unusual area and we do not have particularly unusual health needs, apart from being more rural and having a slightly older age profile. The cost of our health needs, as in most areas, increases by about 3.5% a year.
Our CCGs were doing absolutely fine—meeting all their targets, delivering the required underspends and building up reserves—until the funding formula changed in 2016. North Derbyshire, for example, had a reserve of £20 million until, instead of the average CCG increase of 3.75%, North Derbyshire received only 1.6%. With a flat budget for 2017-18 and only a 2% increase for 2019-20, that is disastrous. The CCG was told by NHS England to find £16 million in cuts over six months during 2016-17. When that did not happen, it was placed in special measures and told to find cuts of 7% in 2017-18. However, long-term services with loyal staff cannot be cut that quickly, so again the deficit mounted.
Now Derbyshire’s four CCGs are applying to merge so that they can achieve the required efficiencies of scale and organisation. However, their combined deficit is now £95 million. NHS England has stipulated that if they can make £51 million of cuts, the other £44 million will be written off. That is all well and good, but it is dependent on those £51 million of cuts being made in just seven months. If the CCGs cannot make those cuts, they will have to find not only the £51 million but another £44 million. That is on top of the unmet extra costs of services next year of a further £21 million.
The Government claim that they are increasing spending on the NHS, but that is not what we see locally. Our communities see cut after cut after cut. Even the long-promised uplift of 3.5% a year from 2020 will only meet that one year’s increase in need; it will do nothing to deal with the huge backlog of cuts from a decade of austerity for our NHS.
Healthwatch Derbyshire has challenged the legality of the cuts, because they are being made at such speed that there is little assessment of the impact, let alone proper consultation. Much of the problem is that the benefits of the services that are being cut will not be measured financially—only their immediate cost. As far as NHS England is concerned, as long as £51 million of cuts are made, it does not matter that those cuts will increase costs by £151 million next year and every year thereafter. Furthermore, in the case of our voluntary sector and of our skilled specialist staff, when they are gone, they are gone. Voluntary services such as ours in Derbyshire take years of building up, of working with volunteers and of recruiting staff who are often prepared to be paid for only a few hours a week but who show absolute commitment to looking after their clients and volunteers. No one wants to make those cuts, but as the chair of one of our CCGs said:
“I wish that we had a regulator who would walk the path with us, and would look at the impact of these cuts, instead of simply demanding savings.”
That brings me to my question for the Minister. We should be nurturing our voluntary services and supporting our hard-working NHS staff, whose pay has been declining while their workloads have soared. We should be protecting our ever-growing numbers of frail, elderly and disabled patients, who have seen huge cuts to their social care and become ever more reliant on the health service, and working to integrate our health and social care budgets properly so that we do not see one service making cuts that cost the other even more. We should be building a sustainable health service fit for the 21st century. Please will the Minister tell me that NHS England will enable that to happen in Derbyshire?
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.
Has the hon. Gentleman completed his remarkably brief oration?
I speak briefly to confirm my very strong support for this Bill, to congratulate the hon. Member for Croydon North (Mr Reed) on pursuing it, and to pay tribute to the extraordinary stoicism of Seni’s parents, Mr and Mrs Lewis. I am not sure whether they are here today, but we owe it to them that something good comes from the tragedy of the loss of their son. When I was a Minister, I published new guidance aimed at ending the use of prone restraint—the sort of restraint used on Seni Lewis—and radically reducing the use of other restraint.
Depressingly, although it may in part be due to better reporting, the data shows very little change in the overall use of force in mental health units across the country. The truth is that force is endemic in many in-patient units. However, we also know that many units have managed to reduce the use of force substantially.
On therapeutic care and recovery, we have to confront, as a country, the use of force in our mental health units and, if we do not do that, we will never achieve the ambition of facilitating recovery for people who have experienced mental ill health. Frequently, people who find themselves in mental health units have suffered abuse in their life. For a woman who has suffered abuse, restraint, with many people holding her down to the floor, is just a repeat of that abuse. Such restraint destroys trust between staff and patient and completely undermines therapeutic care.
It is possible to achieve a much greater reduction in the use of force. This Bill, particularly through the transparency and accountability it brings, will be enormously beneficial in seeking to change that culture. I strongly support the Bill for that reason.
I absolutely agree. The Bill sets up a process and attempts to change the culture of the services, and I hope that the Bill’s successful passage will not be the end of that process. The right hon. Gentleman’s point needs to be taken into account.
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.
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.
Break in Debate
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.
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.
Break in Debate
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.
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.
Break in Debate
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.
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.
Break in Debate
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.
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.
Break in Debate
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.
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.
Break in Debate
I am grateful to my hon. Friend. If the Minister wishes to intervene, I will not stop her.
Break in Debate
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.
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.
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.
Break in Debate
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.
Break in Debate
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.
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.
Break in Debate
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.
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.
Break in Debate
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.
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—
Break in Debate
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.
Order. The hon. Gentleman is making an intervention on the hon. Member for Shipley (Philip Davies), not the Minister.
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.
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”
“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”
“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.
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.
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.
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.
Break in Debate
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.
I am grateful to my hon. Friend for making that point. As he says, the longer the answers take, the more distressing and dehumanising it is for the bereaved. I will come to the timescales later in my remarks, but one of the real achievements of the Bill is that it places clear expectations on the authorities in regard to investigations.
As I was saying, a police investigation could be carried out at the same time, depending on the type of incident involved. That was the case when Seni died. NHS guidance now clearly states that, whenever feasible, serious incident investigations must continue in parallel with police investigations. That is an important point, because what happened in Seni’s case was that the police investigation basically put a brake on the NHS investigation. We are clear that these investigations should take place in parallel. That is possible because the terms of reference for the investigations are quite different, and where this eventuality arises, it should be considered in close consultation with the police so that they can be clear about the purpose of the healthcare-led investigation and how it will be managed.
If, following discussions or a formal request by the police, coroner or judge, an application is made to suspend the NHS investigation, it could be put on hold. However, the family must be very much involved in that decision, and the commissioner must ensure that they can agree a date for completion once the investigation can recommence. It is very much down to the commissioner to establish that timeframe. Whether an investigation is put on hold or not, it is absolutely central to our proposals that families should be kept engaged and informed of when the investigation will start up again, and when it will be completed. We also have national guidance on learning from deaths, which was published in March 2017. That now sets out clear expectations of NHS organisations for engaging with carers and families in these circumstances. Dialogue is absolutely central and underpins everything we are doing in this space.
I want to provide some details about what happens if a death follows police contact, when that contact may have caused or contributed to the death, as this is particularly relevant to the events that followed Seni’s death. In such circumstances, the police are under a duty to refer the matter as soon as possible to the Independent Office for Police Conduct. Following an investigation, a report is sent to the police force. The report provides the IOPC’s opinion about what should happen to those involved in the incident. For example, it might recommend further training, a misconduct meeting or a gross misconduct hearing. The police force will then provide its own view about what should happen. If the IOPC disagrees with the force, it has the power to recommend that it should take appropriate action, such as holding a misconduct meeting or hearing. Ultimately, the IOPC can direct the force to do that.
Under the scheduled reforms, this process will be further streamlined so that the IOPC will make the decision on whether there is a case to answer for misconduct or gross misconduct, and decide what form the disciplinary proceeding should take. The IOPC will provide a copy of the investigation report to the relevant police force, and to the complainants and the family of the person involved, as well as to the coroner and the Crown Prosecution Service, which will consider whether any further action should be undertaken.
I want to return to concerns about the quality of investigations, and to briefly explain the role of the Healthcare Safety Investigation Branch. The Lord Chancellor is looking at how we support people going through an investigation, and the hon. Member for Croydon North has also raised the issue of legal aid. It is important that we ensure that families have appropriate support as they navigate this process. This is not just about the process of walking through the contacts with the NHS investigating bodies, which can be quite formal; they could end up in a situation involving legal action or criminal proceedings, at which point they would need that support.
Much reference has been made this morning to the Dame Elish Angiolini review, in which she was clear that all deaths in custody should be treated on an equivalent basis, and I can confirm to the House that the Lord Chancellor’s review into legal aid for deaths in custody will consider deaths in mental health settings on the same basis as deaths in prisons and other forms of custody. I can also advise the House that the ministerial board on deaths in custody constantly reviews what we are doing and how we are implementing the recommendations of the Angiolini review, so the review of legal aid for inquests will consider how it can be applied to deaths in mental health settings, too.
Break in Debate
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.
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.
Break in Debate
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.
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.
Break in Debate
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.
Twenty-five minutes will do you, then. Come on, Sir Christopher!
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.
Where that institution provides services to the NHS, it will, because we will only commission services in places that are compliant with the Bill.
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.
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.
Break in Debate