There have been 20 exchanges between Christopher Chope and Department of Health and Social Care
|Wed 30th December 2020||Public Health||11 interactions (134 words)|
|Tue 15th December 2020||Healthcare Support Services: Conception to Age Two (Westminster Hall)||3 interactions (39 words)|
|Tue 1st December 2020||Cancer in Teenagers and Young Adults (Westminster Hall)||3 interactions (14 words)|
|Thu 19th November 2020||DHSC Answers to Written Questions (Urgent Question)||4 interactions (232 words)|
|Wed 18th November 2020||Covid-19||3 interactions (686 words)|
|Thu 22nd October 2020||Covid-19||7 interactions (512 words)|
|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)|
I hear my hon. Friend’s point, and I share his view that throughout this pandemic the vast majority of people have behaved with great responsibility. I know that people in tiers other than tier 4 thought very hard about whether they should gather with relatives, even within the easing that was allowed during the Christmas period, and rightly so. We must all play our part in controlling the virus and stopping its spread.
I will make some progress.
At the time of these provisions we were seeing an exponential rise in cases in London, Kent, and some other parts of the south-east, and it was clear that the tier 3 restrictions were not sufficient. We identified the existence of a new variant in those areas, and further analysis showed us that the new variant was driving the steep trajectory of infections. The new and emerging respiratory virus threats advisory group—NERVTAG—tells us that the new variant demonstrates a substantial increase in transmissibility, compared with other variants, and that the R value appears to be significantly higher, with initial estimates suggesting an increase of between 0.4 and 0.9.
There is no evidence to suggest that the new variant of the virus is more likely to cause more serious disease, but increased infections lead to increased hospital admissions and, sadly, increased loss of life. These winter months already pose great challenges for our NHS. That is why we had to take the action that we took before Christmas, and the further steps announced today to control the relentless spread of the virus. However, it is not all bad news.
I am making some progress and I am mindful that many Members want to speak this evening.
The roll-out of the Pfizer vaccine is happening at pace, with more than 600,000 people receiving it between 8 and 20 December. Vaccinations in care homes started on 16 December, and the NHS has already been getting the vaccine to those who are most vulnerable, and the care workers who look after them. Now, the Oxford-AstraZeneca vaccine has been approved, and it is much easier to get out to people and into arms. There is every reason for optimism, but we are not there yet. We must suppress the virus now and in the weeks ahead.
On the specific measures in these regulations, in response to the greatly increased risk, the addition of tier 4 stay-at-home measures will be familiar to people from the November national restrictions. Tier 4 involves minor changes to those national restrictions. As of November, people in tier 4 areas must stay at home and not travel out of tier 4. They may only leave for a limited number of reasons such as work, education, or caring purposes. We are advising that clinically extremely vulnerable people in tier 4 areas should do as they did in November and stay at home as much as possible, except to go outdoors for exercise or to attend health appointments. The regulations contain the same exemptions as other tiers for childcare and support bubbles. We advise that people elsewhere avoid travelling into a tier 4 area, unless they need to do so for work, education or health purposes.
One thing that I will do when I have finished speaking is see whether I can look up the specific data for the hon. Member’s constituency. In general, however, the announcements made today, just as with previous announcements, are based on the data that we are seeing, which includes rapidly rising rates of infection in certain areas, the level of new infections, the trajectory and hospital pressures.
The tier 4 regulations require all non-essential retail, indoor entertainment, hairdressers and other personal care services to close. International travel is also restricted to business trips only. However, we have listened to hon. Members and the public about what is most important to people in their daily lives so, unlike in the November restrictions, communal worship and a wider range of outdoor recreation are still permitted. We also recognise the restrictions’ impact on businesses and continue to provide them with ongoing support to help get through the crisis.
We know that these measures are hard. We know that they keep families and friends apart, yet we also know that they are necessary for us to get through this situation and to prevent the loss of lives as we do so. This virus thrives on the things that make life worth living, such as social contact, but that means we can all play our part in stopping the spread—as I said, if not for ourselves, then for others. The end is in sight, but for now it is our duty here in Parliament to put in place these restrictions—onerous though they are—to control this virus. I commend the regulations to the House.
Break in Debate
This House legislated explicitly for specific arrangements to govern the celebration of Christmas, and no sooner than the House had risen itself for Christmas, the Government, by ministerial fiat, changed those arrangements. We are asked this evening to give retrospective legislative approval to the changes that they made. We are in the absurd position of being asked to vote for the ghost of Christmas past.
Sometimes in a democracy, process has an importance. I am constantly—daily— confronted by individuals and businesses facing ruin, notwithstanding the huge investment that they made in covid-secure premises and procedures. What we have never had, and what we have always been asking for, is the cost-benefit analysis that the Government made on each of the restrictive measures that make up the menu of their tier system. I do not for one moment question the motives of Ministers. I do, however, question their ability, in exactly the way that I question my own ability.
When the House rose, the lobby of Government scientific advisers—a lobby, we should remember, that had already publicly expressed their frustration that their earlier strictures on how Christmas should be celebrated had not been fully taken on board by the Government—announced that they had discovered a new strain of the disease so much more transmissible than the earlier one. They bounced the Government. I have to accept, of course, the possibility that they may be absolutely right, but I know this: were I presented by such a lobby of eminent scientists—eminent people leading in their field—and told that they had discovered this new emergency, and that so many more people were going to die, and unless I did what they said, I would be responsible for their deaths, I would find great difficulty in having the wherewithal to identify and ask the right questions to be sure that they were on the money, or 100 miles from it.
What I would certainly want, and what I believe the Government need, is an alternative source of expertise—a competitive source of expertise—particularly statisticians leading in their fields, who would be able to furnish me, to arm me, to arm Ministers, with the right questions to ask about the validity of the modelling and the data. It can only improve the decision-making process. But what is really galling in all this is then to hear on the airwaves Professor Ferguson being interviewed, giving his wisdom to the nation once again, to all intents and purposes as if he were still a key Government adviser. I do hope that the Minister winding up the debate will be able to assure us that that is most certainly not the case.
I was always rather jealous of Poole, Christchurch and Bournemouth, because our infection rate in the New Forest was substantially lower than theirs, but they turned out to be in tier 2 and we were in tier 3. Now we are all together in tier 4.
It is a pleasure to serve under your chairmanship, Sir Christopher, and a great pleasure to be speaking in a debate secured by my very old, wise and aged colleague, my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom)—the high priestess of early years. As she said, I speak as the chair of the all-party parliamentary group on the first 1,001 days. I also recently stood down as chair of the Parent-Infant Foundation, the charity that she founded and that is having such an important effect on the whole movement for 1,001 days. I have been very proud to chair that charity for the past six years.
It is great to see this subject coming into the mainstream. We have had a number of Westminster Hall debates, including on the impact of covid on maternity, families and children in lockdown. Before the general election, I held a debate on health visitors. Since “The 1001 Critical Days” manifesto, the important document produced about eight years ago by my right hon. Friend, we have had various reports, including “Babies in Lockdown”, “Rare Jewels” by the Parent-Infant Foundation, “Building Great Britons”, and several Select Committee reports, including by the Health and Social Care Committee and the Science and Technology Committee, all of which were serious, heavyweight studies of the first 1,001 days.
This is, at last, not a new subject. I come to this debate much in the mode of Elizabeth Taylor’s sixth husband: knowing what was expected of him, but struggling to make it new and fresh. But we will give it a go.
Children, particularly very young children, have been the forgotten element in the whole pandemic lockdown; so too have parents of very young children. The lockdown, the regulations, and the alienation from or unavailability of family member support networks—which many of us, as early parents, took for granted—have had mental health impacts on new parents and single parents in particular. We should not underestimate that. It will be a long time before we can get back to a degree of normality and start to see the impact that missing out on those important contacts and support mechanisms in those crucial early months has had and will have for many years to come.
Early years has for too long been forgotten when it comes to Government spending. Many of us have been going on about that for a long time, and it is worth repeating. Work done a few years ago estimated that the cost of perinatal mental illness is £8.1 billion each and every year. The cost of child neglect in this country is £15 billion each and every year. That means that we are spending more than £23 billion on getting it wrong for parents and very young children in those crucial early years. If we were to spend a fraction of that amount on greater preventative intervention measures for those who most need it in those crucial early years from conception to age two, that bill would be reduced significantly and it is a false economy not to be doing that.
It was disappointing to see just £300 million in additional funds being given to the social care sector—that is, the adult and children’s social care sector—in the spending review, even though there is a shortfall of some £3 billion in local authority children’s social care alone, not to mention all the problems with public health and the shrinking numbers of health visitors, which I will come back to in a moment.
Why is that important? My right hon. Friend the Member for South Northamptonshire has given us some of the figures. Up to 20% of women experience mental health problems in pregnancy or the first 12 months after birth, and 50% of all maltreatment is related to children under the age of one. It has been estimated that 122,000 babies under the age of one live with a parent who has a mental health problem. One third of domestic violence begins during pregnancy—a figure I could not believe when I first came across it. The Government are doing good work with domestic abuse legislation, but we need to be addressing the problem at source. If domestic violence is happening in a household, what sort of physical and psychological message is that sending to the newborn child? The same applies to even before it is born as well: there are signs that communication within the womb itself is a factor. Suicide is one of the leading causes of death during the period of pregnancy to one year after the birth of a child. That is a deeply tragic figure, but it preventable if proper systems and checks are in in place.
About 40% of children in the UK have an insecure attachment to a parent or carer by the age of 12 months. The figure that I have always used—this is, I think, the killer point—is that for a child at the age of 15 or 16 who is suffering from some form of depression or low-level mental illness while at school, there is a 99% likelihood that his or her mother suffered from some form of depression or mental illness during or after pregnancy. It is as direct a correlation as that. If we do not do something within those first 1,001 days, we will reap the consequences, as will children, not just during childhood but into adulthood as well.
Child obesity rates are all connected to what happens in the first 1,001 days. Last year we also had worrying figures—this is particularly topical now—about the dwindling vaccination rates in England. In particular, only 86.5% of children had received the full dose of the measles, mumps and rubella vaccine. We have effectively lost our immunity status, because the World Health Organisation target to protect a population from a disease is 95%. One hopes that parents in particular will take up the covid vaccination as it is rolled out, because we have seen the effects on the children’s population of not having vaccinations in recent years.
The Children’s Commissioner estimates that 2.3 million children are living with risk because of a vulnerable family background and that more than one third within that group are invisible—they are not known to services and are therefore not getting any support. That is why it is crucial, particularly before those children present at school and come on the radar, that health professionals at various levels are having contact with those children and families to ensure that everything is all right. They can give that help and support and that tender affection and empathy, but they are also an early warning system for when things are going wrong, right up to safeguarding issues. The one thing that all those ailments have in common—there are a lot more that I have not mentioned—is that they come under the remit of the health visitor to a varying extent. I will come back to the importance of health visitors.
The impact of covid is great, as I have said, and I will not go over that again, but more families with babies and young children under five have been tipped into vulnerability due to the secondary impacts of the lockdown. At a time when families, and particularly families from deprived communities and single-parent families, need face-to-face contact with people like health visitors the most—I also refer to health visitors as the trusted uniform services who are usually welcomed over the threshold, whereas with social workers and others a barrier goes up instantly—more than 70% of health visitors have been repurposed to other aspects of the health service to deal with covid. That really is a false economy.
I pay tribute to Cheryll Adams, the chief executive of the Institute of Health Visiting, who is standing down from the outstanding role she has played for the cause of health visitors and their importance in the first 1,001 days. She will be greatly missed, but I am sure she will not quit the scene altogether, because of her dedication to the cause. Her report showed that 82% of health visitors reported an increase in domestic violence and abuse; 81% an increase in perinatal mental illness and poverty; 76% an increase in the use of food banks and speech and communication delay among children; 61% an increase in neglect; and 45% an increase in substance abuse. Finally, 65% of health visitors have a case load of more than 300 children under the age of five.
Is that sustainable? My worry is that even in the good times without a pandemic, health visiting was greatly stretched. One of the great achievements of the coalition Government was the delivery of a promise to institute 4,200 additional health visitors, based on the Kraamzorg system in Holland, which we visited and saw. It was a huge achievement—I think we were just a few dozen short of 4,200 by the time we got to 2015—and yet I fear that those numbers have dwindled back almost to the level that was inherited. That is such a false economy. Health visitors are a critical part of a universal offer to all families in the first 1,001 days. The report by the First 1001 Days Movement says:
“It is essential that governments invest in the delivery of the Healthy Child Programme and that this programme supports babies’ emotional wellbeing and development. We believe that all families should be able to access care from a named health visitor who offers them a high-quality service that is proportionate to their needs.”
I wholeheartedly concur.
What should be done? Many suggestions have been made. The LGA recently brought out a report saying that the Government should
“properly resource councils to enable investment in preventative universal and early help services to ensure that children, young people and their families receive the practical, emotional, education and mental health support they need”.
That is absolutely right. The Parent-Infant Foundation, in its “Babies in Lockdown” report, recommended funding for a
“Baby Boost to enable local services to support families who have had a baby during or close to lockdown.”
As my right hon. Friend said, more than half a million babies were born in that period. The report also said we should have a
“new Parent-Infant Premium providing new funding for local commissioners, targeted at improving outcomes for the most vulnerable children.”
I obviously agree with that.
Finally, I will go back to the “Building Great Britons” report, which was produced back in 2015 and made nine main recommendations: that a 1,001 critical days policy should be a mainstream undertaking by central Government; that all local authorities should be required to produce and implement a 1,001 days strategy within the next five years; that national Government must establish a 1,001 days strategy blueprint; that local health and wellbeing boards should demonstrate delivery of a sound primary prevention approach; that the early help recommendations from the Munro review, which I commissioned back in 2010, should be picked up and carried; that we should have a Minister for families, either close to or at Cabinet level, to carry the banner for the importance of the early years and family contexts, which are so important to the social policy of any Government; that we should have more inter-agency training on the importance of the early years; that children’s centres should be repurposed to be these family hubs, which this Government have committed to and which should be a Piccadilly Circus of these services available to all families; and that we should have the research evidence to go with all of that.
In short, we need a full “team around the family” approach; we need to invest in health visitors and other health professionals, including GPs and mental health specialists, particularly around attachment issues. We need them to work with all of those in the early years setting, alongside social workers and others with safeguarding responsibilities—supporting, not supplanting parents, but signposting them to the most appropriate services and ensuring that they are accessible when needed. We need a national roll-out, national guidance and national scrutiny to ensure that it is being delivered, but it should be implemented locally and governed by local circumstances. To not do that is a false economy, and children in future generations will pay the price.
Thank you, Sir Christopher. I thank the right hon. Lady for South Northamptonshire (Andrea Leadsom) for setting the scene so well, and to all those hon. Members who have made contributions.
As the grandfather of five grandchildren, this is an issue that is close to my heart. There is little that brings me as much joy as seeing my grandchildren—though that has not happened as often over the past few weeks because of the lockdown—and knowing that they are healthy and happy. Katie, Mia, Austin, Rhea, and Max, who is just eight weeks old, are bright and happy and in these dark days. That brings so much joy and I thank God daily for them.
I thank the Duchess of Cambridge, to whom the right the hon. Lady referred in her introduction, for the wonderful work she has done. She came to my constituency but unfortunately I was unable to be there. She visited the Ark Open Farm in Newtownards, and the results of what was done that day are clear.
Early years matter a great deal and the overarching response to the questionnaire undertaken is that more support must be given to young mums and families. Over the pandemic, many of us have realised how much we underestimated the support and help provided by the mums and toddlers groups in the local church or community centre. We had not understood that talking to another mum about their horrific day with their wee toddler—even if it was never really all that horrific—and exchanging viewpoints about how they felt made coping that little bit better. We have learned, more than ever, that it takes a village to raise a child, and so it does. It is little wonder that dedication and christening services highlight that a mum and dad cannot and should not do it alone.
When my parliamentary aide was pregnant with her daughter, one of the first signs I noticed was that her 10 cups of coffee per day were reduced to zero. She had read that caffeine would make her baby’s heart beat up to six times as fast; she loved her coffee, but she loved that unborn child even more. Mothers all through this nation make changes before a baby arrives, including eating more healthily, taking vitamins, stopping drinking. There are no laws that say they must do these things, but the mother knows to do it. Prenatal support for mum at this time is essential, and I believe that we need to give more advice, more listening ears and more communication for those who worry at this stage.
Together for Short Lives contacted me and asked me to briefly highlight a number of issues, as not all pregnancies end in the dream photo-op at the end of labour. Some have a much sadder story to tell—that is a fact of life. The majority of child death occurs in the first 28 days of life—the neonatal period. Every year, over 100,000 babies are admitted to neonatal intensive care in the UK. While many of these babies will only need to receive treatment for a few days or weeks before being discharged home, a minority will need more intensive care. The “Make Every Child Count” study, published this year, found that the prevalence of life-limiting conditions is highest in the under-one-year age group, at 226.5 per 10,000. That is the point that the right hon. Member for South Northamptonshire is making, and the very point of this debate. On average, there are 1,267 neonatal deaths each year from causes likely to require palliative care.
With this in mind, Together for Short Lives has highlighted the importance of the specific challenges faced by babies and children with life-limiting conditions and their families; they are not forgotten. The NHS England children’s hospice grant will increase to £25 million per year by 2023-24. It will be reallocated equitably to children’s hospices and there will be £7 million funding for children’s palliative care.
In conclusion, Sir Christopher, I briefly highlight the phenomenal work done by the WAVE Trust and Alex Williamson, and their 70/30 Campaign, which is about reducing the number of children who experience maltreatment by at least 70% by 2030. It is difficult to argue against their proposals or those of Together for Short Lives.
I look to the Minister, as I always do, to confirm that pregnancy and early years matter; if we want to see a generation of well-adjusted and happy youth it must be not simply because their parents have invested time and love. It has to be more than that. Our Government have to understand that funding for early years is not a grant of money, but an investment in our future—one certain to return a great yield. As the good book says, as you diligently sow, so you will reap. We must sow good for our children to get good from them as adults, and that must begin today.
I agree that is arguably one of the opportunities of a more cashless society. If people are making a payment, the gift aid opportunities are potentially easier to access than with putting money in a box.
I appreciate that healthcare is a devolved matter, but I am still looking forward to hearing the Minister’s response because I am sure these challenges exist throughout the UK. Indeed, that is why the hon. Member for Strangford is the person who has secured this debate. We can also achieve much by pooling our healthcare expertise across the four nations. We should be making sure that in Scotland, Wales, Northern Ireland and England that we are following the best possible practice, which means raising awareness of symptoms, enabling swift diagnosis and ensuring that children, young people and their families are properly supported.
It is, as always, a pleasure to see you in the chair, Sir Christopher. I very much miss serving on the Procedure Committee with you all those years ago, but it is a pleasure none the less to see you this morning.
I congratulate the hon. Member for Strangford (Jim Shannon) on securing and opening the debate, and to see him back in his place after his period of self-isolation last week. He was very much missed last week in the debate that he had secured on the persecution of religious minorities. It is good to see him back in that seat—which I am sure he has probably got title deeds for now given that he is there so often.
This has been a very short but very enjoyable debate. The hon. Member for Strangford opened with a very passionate speech, as we would always expect from him, but in particular he spoke about that very poignant testimony from Alex. The hon. Member for Wakefield (Imran Ahmad Khan) spoke about young Daniel and that relationship that was struck by his father in hospital. I think hearing about three-year-old Ellis really moved us all. I cannot begin to imagine how difficult it must be for Ellis’s family as they work through losing a loved one. The hon. Gentleman has spoken very eloquently on behalf of his constituents and they should be incredibly proud to have him in here to be raising those issues, as he sits alongside the Minister.
Finally, the hon. Member for North East Fife (Wendy Chamberlain) talked about Toby’s Magical Journey in Cupar. I, too, pay tribute to Richie, Alison and Toby for that remarkable figure of raising £50,000 pounds, and it was great to hear that Toby got the all-clear in 2018. She raised an important point about the impact that the transition to a cashless society will have on charities. I hope that is something that we can tease out in the debate in Westminster Hall on Thursday afternoon about transitioning to a cashless society, particularly in the light of the covid pandemic.
On that point, covid-19 has dominated so many aspects of our lives. Much of the discussion around public health shows that it is still so vital to look after other aspects of our health and wellbeing during this time. That very much includes checking for symptoms and signs of cancer.
With your forbearance, Sir Christopher, I want to pay tribute to my colleague and my hon. Friend the Member for East Dunbartonshire (Amy Callaghan), who has been a tireless campaigner on the subject of cancer and young people. She is not just one of my colleagues in this place and my constituency; she is one of my closest friends. I congratulate her on her election as chair of the all-party parliamentary group on children, teenagers and young adults with cancer. I also pay tribute to this young woman who has survived cancer twice. As has been well documented this year, she has also been through other health challenges. This House is stronger for having the experience of people like her. I look forward to her coming back and, arguably, making a much better speech than I could ever do. I hope to do this justice on her behalf.
I also want to pay tribute more broadly to the work of the APPG. It has done fantastic work in raising awareness of the issues affecting young people with cancer and their families. The 2018 report published by the APPG, “Listen Up! What Matters to Young Cancer Patients”, looked into cancer patient experience for children and young people across the UK. That report found that 64% of respondents did not think enough was being done to create a positive experience for children, teenagers and young adults with cancer. It also discovered that 82% of young people and parents responding to the survey did not think that Government listened enough to the experiences of young people with cancer and their families.
The report offered several recommendations for helping teenagers and young people understand the symptoms of cancer, as well as for those facing cancer treatment. Those include compulsory lessons in secondary school on spotting the signs of cancer; designated hospital parking for children and young people with cancer; an agreement by the Government to meet yearly with young cancer patients to discuss their experiences; and offering access to free fertility treatment to survivors of childhood cancer, who are not offered fertility preservation before receiving cancer treatment. That report highlights that not enough has been done to support young people and their families through a challenging diagnosis.
It is important that young people know the signs and symptoms of cancer, although they may differ from person to person. The common symptoms are lumps, unexplained tiredness, mole changes, pain and significant weight change. For more information about the different symptoms and where to seek help, I advise people to go the NHS website, the CLIC Sargent website and that of the Teenage Cancer Trust.
A lot of young people have expressed worry that they are wasting doctors’ and nurses’ time, particularly during the coronavirus pandemic. I get incredibly frustrated, as a constituency MP, when people say, “I don’t want to bother the NHS or go to my GP, because they are really busy.” One of our privileges in this place is to have the voice to get this message out to our constituents: “If you are experiencing any of those symptoms, please do not worry about bothering your GP or the health service, but go and get it checked out.”
I want to reassure young people that if they have any of those symptoms or if they are worried about their health, they will be listened to and taken seriously. The NHS, in whatever part of the United Kingdom, is and always will be there for everyone. That is something we have certainly learned during the course of the pandemic. Despite the pandemic, the NHS continues actively to encourage people to contact their GP if they are worried about possible cancer symptoms. If the symptoms lead to a diagnosis, early diagnosis and treatment are really important and can improve the outcome for many young people.
I want to highlight the fantastic work of CLIC Sargent and the Teenage Cancer Trust, both of whom act jointly as the APPG’s secretariat. Understandably, for many families, when a young person receives a cancer diagnosis, it can be a very scary and confusing time. From doctor’s appointments to new treatments, the process can be overwhelming for young people. Those organisations offer advice to help young people and families to adjust to the cancer diagnosis and the treatment that follows. The Teenage Cancer Trust offers people advice on how to speak to doctors if they are feeling nervous, details of the different symptoms and case studies of teenagers and young people who have experienced treatment during the pandemic. CLIC Sargent is also a great resource, providing guidance for navigating clinical care, granting financial support and helping young people with the emotional impact of illness. Both organisations have new information around how to manage cancer during the covid-19 pandemic. Clearly, the public health crisis creates new challenges for patients, but there is still support available to help young people through this challenging time.
This year, the covid-19 pandemic has thrown unprecedented challenges at us all. From facing the virus itself to the huge financial insecurity that many people have experienced, to the restrictions and lockdowns taking us away from our loved ones, it has undoubtedly been a tough year for many of us. I say that after my grandfather was cremated yesterday. One of the hardest things that I have experienced during this pandemic was limiting the number of people at his funeral to 20. It has been incredibly, incredibly cruel from a public health point of view, and I think we would all agree that this has been such a difficult year for us.
This debate has highlighted that the teenagers and young people facing a cancer diagnosis and treatment during this time are facing even more challenges, but support is out there. Whether it be from the APPG, the NHS, CLIC Sargent or the Teenage Cancer Trust, there are people out there to offer information and guidance. It is vital that all young people check for the signs and symptoms of cancer. To reiterate, they are: lumps, unexplained tiredness, mole changes, pain and significant weight change. If a young person is experiencing these symptoms, I urge them to contact their GP. An early diagnosis will lead to the best outcome. Facing cancer as a young person can be incredibly scary and overwhelming and I pay tribute, above all, to all the young people undergoing treatment for cancer diagnoses. I thank their families, their carers and the NHS, who are working so hard to support them.
Parliamentary questions are a key element of Parliament’s ability to scrutinise Government on behalf of the people of the United Kingdom. As the House would expect, we take them very seriously, and as you, Mr Speaker, and hon. Members will know, I take seriously all aspects of my and the Government’s accountability to this House. Prior to the pandemic, my Department had an exemplary record of providing accurate and timely answers. In the last full parliamentary Session, despite receiving more PQs than any other Department, we had the highest response rate in Whitehall. However, as hon. Members will be aware, DHSC, its Ministers and officials have been at the forefront of responding to this pandemic, with the attendant additional workload that has brought.
As such, it is a matter of regret that we have been unable to sustain previous PQ performance, for which I rightly apologise to you and the House. However, it is explicable in the face of a trio of concurrent challenges. The first is volume: between March and October this year, we received over 8,000 written parliamentary questions across both Houses. This compares with 4,000 for the equivalent period last year. The second challenge is timeliness: we have met a rapidly, almost daily, changing situation, and answers drafted by officials are sometimes out of date shortly after they are drafted. We have been prioritising accuracy of response to Members over speed, but this can mean that responses have to be redrafted, with attendant delays.
The third challenge is policy input: despite increasing the administrative resources to respond to parliamentary questions, it remains the same policy officials who are responding to the pandemic operationally and drafting regulations and are the only people with the requisite policy expertise to input into parliamentary questions and responses.
That said, Mr Speaker, although we continue to field exceptional volumes of parliamentary questions, I want to reassure you and the House that we are not making excuses in providing these explanations, and are taking every possible step to recover our performance. We have instituted a parliamentary questions performance recovery plan and are delivering against it by increasing resource where we can and clearing the backlog, focusing on the oldest parliamentary questions first.
More broadly, throughout this challenging time the Secretary of State and Ministers have sought to make themselves regularly available in the House to be questioned and held to account. Between March and October, the Secretary of State made 18 statements and answered seven urgent questions. We have also seen seven general debates on covid since March, and that is not including junior Ministers’ appearances in the Chamber. This is not an alternative to written parliamentary questions, but it is an important reflection of our accountability to this House.
To conclude, written parliamentary questions will continue to be a top priority on which I am briefed weekly. I thank you, Mr Speaker, and hon. Members for your and their patience and recognition of the exceptional circumstances of recent months. In the weeks and months ahead, we will work hard to restore our leading performance, which hon. Members have a right to expect.
I am grateful to my hon. Friend. As he will be aware, other Departments, while they have heavy workloads, are not leading the response to the pandemic. In response to his final point, he will not be surprised that I do not characterise it in that way. Instead, I would characterise it as the Department of Health being in the lead in saving lives and protecting the NHS in this country.
My hon. Friend asked two other substantive questions. I think his language was a little intemperate in respect of the serious efforts that officials undertake every day to try to provide accurate and timely answers. There is no suggestion that they seek to stonewall or to avoid responding. They do their best, but it is difficult and the situation changes day by day. Where answers are deemed to be inadequate, hon. Members often revert to me directly or table their questions again, and we endeavour to fulfil our obligation to provide accurate answers.
On my hon. Friend’s question about recovery, we have set a trajectory for each month in order to recover performance over the coming months. Of course, that depends to a degree on the workload of officials in responding to the pandemic, as well as in providing answers, but I do not see it as an either/or; we intend to recover performance in parallel with tackling the pandemic.
I am delighted to start my contribution to this debate by paying tribute to the key workers on the frontline of this pandemic. Their commitment to public service and their selflessness in the face of the most severe of circumstances set an example to us all.
I am deeply concerned by the dangerous polarisation on public health measures that have been implemented to save lives, and that is what I want to focus on. I am sure that Members across this House have been inundated with correspondence from constituents sharing very legitimate concerns about restrictions that have been imposed in order to protect the NHS, keeping us agile enough to deal with covid, while thousands of elective care patients have had procedures and treatments delayed. This suffering is real. The diversity of the issues raised is phenomenal, spanning mental ill-health, business support, attendance at funerals, redundancies, access to universal credit, and care home closures. We also receive correspondence from constituents reasonably seeking to clarify the rules in respect of their own actions.
On the other side of the coin, we have all received correspondence from angry constituents—on occasion aggressive, even abusive—about the restrictions that this Parliament has collectively implemented, under great duress and with an increasingly heavy heart. Aggression and abuse are never acceptable, but the anger is justified, and it is not taken lightly; neither is it dismissed by anyone in this place, especially coming from those many constituents who have fallen on hard times.
However, I want to shine a spotlight on some of the more sinister and fringe drivers of that anger. A cause for growing apprehension is the misinformation, the fake news and the dismissal of science in the post-truth world that a small number of hardened minds occupy. Assertions are made, social media lies are repeated, and distrust in our institutions, our scientists and our elected representatives is sown in reference to their motives. That translates into real-world consequences. This ugly underbelly has seen a small number of aggressions against those in Liverpool waiting patiently in line to be tested. There have been megaphones outside school gates screaming at parents and pupils about testing, confrontation sometimes of those wearing masks, and the outright dismissal of the growing prospect of a vaccine—a prospect that is giving so much hope to a beleaguered population who yearn to return to some normality.
It is apparent that much responsibility for such behaviour lies with social media platforms: most people receive their information through that medium. People currently have many insecurities, both health and economic, and the misinformation plays into these deeply held fears and is easily shared at the click of a button. My colleagues on the Front Bench are right: the producers of such material should be denied a stage to peddle these lies and myths that have no basis in truth. Ahead of the delivery of a vaccine, we cannot let the naysayers spread further mistrust when so much is at stake for all our people.
The hon. Gentleman, as ever, makes a valid point. That is why I have been calling for additional support, whether signposting or helplines. We actually need a cross-Government strategy on mental health going forward.
On those who have been excluded from financial support, as the Chancellor remains intransigent on that point, I urge the Minister first to speak to her Treasury colleagues and ask them yet again to think again. Will she also step up mental health support for those who have been excluded? The mental health impacts will cost us a lot down the line.
The other very important group is the more than 9 million unpaid carers who are the forgotten heroes in our society. I hope the Minister agrees when I say that our health and care systems would be overwhelmed if it were not for the work of unpaid carers in our society. The Exchequer saves billions thanks to their work. Four out of five unpaid carers have taken on more caring responsibilities during lockdown, and almost two thirds have seen their mental health worsen during the pandemic. Many have lost their access to respite care, which has affected their ability to earn money. She will be aware that carer’s allowance is pitifully low at £67 a week.
One thing that would help respite care and day care centres to reopen—Homelink in my constituency is taking all sorts of safety measures and is desperate to reopen—is access to regular testing. I raised that in the Chamber with the Secretary of State for Health on 7 July. He told me that a plan was in place and he would write to me about it. He never wrote to me, but I did not chase him about it because I heard that testing had been made available to day centres—briefly; I have now heard that it is no longer available. My council has spoken to colleagues in the Department of Health and Social Care, who say that they cannot offer tests to respite care day centres. Those officials say that they are following SAGE priorities, and that suggests to me that there never was a plan. I would be grateful if the Minister could clarify that point. This is an issue for the Department, and I urge her to address it urgently, because respite care is a lifeline to so many unpaid carers. I also ask the Minister to speak to her colleagues in the Department for Work and Pensions about addressing the woeful level of carer’s allowance. How can anyone be expected to survive on the equivalent of £1.91 an hour?
The Chancellor previously said to the public,
“you will not face this alone”.
Can we say, hand on heart, that unpaid carers and those whom the Chancellor has excluded from financial support have not been left alone? They feel abandoned and their mental health is suffering, so I urge the Minister to address these injustices.
I draw Members’ attention to my membership of trade unions and to donations from Unite the union, as outlined in my entry in the Register of Members’ Financial Interests.
I welcome this debate on covid-19. Stockport and Greater Manchester have been hard hit by this pandemic. I pay tribute to the leader of Stockport Council, Elise Wilson, and to the Mayor of Greater Manchester, Andy Burnham, for all they have done. Stockport Council has much to be proud of in its response to date. The transfer of many council functions to home working has gone well, which is a credit to all the staff involved. Stockport was one of the most effective authorities in Greater Manchester in distributing covid grants to local businesses. Our council workers do a very important job in difficult circumstances, and I speak on behalf of my constituents when I thank them from the bottom of my heart.
I believe that Members on both sides of this House will agree that the hospitality sector has been particularly hard hit in recent times. My trade union Unite has published a hospitality and tourism rescue plan this week. The hospitality and tourism sector is the third-largest employer in the UK and Northern Ireland, creating one in six of all jobs and employing 6 million people, 3.2 million directly. The hospitality industry has lagged behind many other sectors in terms of good working practices, with average pay of just £8.84 per hour and more workers employed on zero-hours contracts than in any other sector. I urge all Members to look up Unite’s hospitality and tourism rescue plan, as it is an important document. The recommendations include extending the sector-specific job retention scheme for six months, adequate sick pay and routine testing for hospitality workers, and a call for the Government to work with Unite’s proposed hospitality commission to retrain workers who lose their jobs.
The Test and Trace system has been a national disgrace. The Labour party’s analysis shows that the Government’s contact tracing is going backwards across England, with just over half of contacts—57.7%— reached last week. In my region of the north-west, more than 26,000 people were not contacted. I urge the Government to give local communities additional resources to carry out door-to-door testing and contact tracing and to check in on people to ensure that they are able to self-isolate in areas such as mine that face additional restrictions.
In the absence of any form of effective test and trace, frontline staff, including all key workers at hospitals, schools and local authorities, must be provided with access to personal protective equipment. I used to work as an industrial organiser for Unison North West and often went into hospitals and care homes to recruit union members. Sadly, care home residents and staff have suffered badly due to the mismanagement by the Department of Health and Social Care. Weekly testing of care home residents and staff is critical to saving lives, yet there have been repeated delays to the rolling out of testing, and care homes have waited days for their results. There are also serious concerns about vacancies in the care sector during the months ahead.
The Government must provide an immediate plan to better support care workers in all settings, including the 9 million unpaid carers across our country. That includes covid-19 test centres, which is why I have recently highlighted concerns that my constituents have raised about the lack of PPE at Tiviot Dale church test centre in my constituency. I have received a letter from a secondary school teacher, who informed me that the only protective measures in place were disposable face masks for staff and visitors, and that the manager had informed them that they did not need them. This is deeply concerning, given that a large number of staff were from an ethnic minority, who, as we know from the first wave of the pandemic, suffered disproportionately. Our test centres should be the first step towards controlling this disease, not hotbeds for its spread. I have written directly to the Health and Social Care Secretary on this issue, but I have yet to receive a response. It is simply not good enough, with Stockport and Greater Manchester facing sharp spikes in infection rates and cases rapidly spiralling out of control.
We are reaching a crisis point with the virus, and we badly need the Test and Trace system fixed and adequate support for all workers and businesses.
Break in Debate
Possibly; the hon. Gentleman is in a very difficult position now. I say well done to him for taking apart the Great Barrington declaration. I will now not go into it, as he did an excellent job.
Turning to herd immunity, without a vaccine how do we attain herd immunity? With no knowledge of immunity from coronavirus, how do we obtain herd immunity? I will share with the House that I was diagnosed with coronavirus on 7 March, I had a severe dose and my antibodies had disappeared 12 weeks later. I am no longer immune to coronavirus. That is not just my story; it is the story of many, many people. Many people who were donating their plasma post-coronavirus for convalescent therapy were told quite quickly, “We no longer need your plasma because you do not have any antibodies left.” Work is going on into immunity, and we have not reached a conclusive position yet, but I can speak from my own experience and from the experiences that we are hearing about, and if people do not have long-term antibodies and we have no vaccine, there is no such thing as herd immunity. I say that again because it is the truth.
On the comments about the measures we are putting in place, how restrictive they are and social distancing, all I can say—and this relates to the number of deaths in hospitals—is that back in March no one was wearing face coverings and no social distancing was being complied with by the public, and the rate of infection was doubling every three to four days. Now, it is doubling every seven to 14 days, because the public are wearing masks, they are hand washing and they are socially distancing, and that means that when someone contracts coronavirus, they contract a smaller viral load, which is enabling doctors to treat those patients once they reach an intensive care unit. In ICUs, people are now living, not dying, but we still need the ICUs and we still need the ICU beds in which to treat those people in order that they can live. The fundamental purpose of every measure we take is to protect the NHS and to keep those beds in ICUs, so that they are there to treat people and to keep people alive.
I described this to someone today who argued with me that face masks and coverings are unnecessary. If people are in the space of someone with no facemask—I will use a scale of one to 100—they will breathe in 100 droplets and a full viral load, but when someone has a mask on it is much less. This is not a scientific experiment; it is my own analogy, but the figure is probably 10. The hon. Member for Tooting (Dr Allin-Khan) knows this much better than I do, and can confirm or deny it. Therefore, with a mask, people’s viral load is lower and it is far easier to treat them once they arrive in hospital at A&E and are transferred to an ICU, and there is a huge chance of success. That is what we are seeing in action now in our hospitals. If we all abandon our face coverings, stop social distancing and stop hand washing, we will be back to where we were in March, when the virus was doubling every three to four days.
My hon. Friend the Member for Christchurch (Sir Christopher Chope) mentioned Sweden, but an article in The BMJ—a research study—concluded that Sweden and the US are the only two countries that are failing to reduce their numbers of deaths. In fact, it is far more accurate to compare Sweden with its Nordic neighbours. Sweden has 586 deaths per 1 million people, while its neighbour Norway has 279, so I am not quite sure why Sweden would be cited as a country of success.
No, there is no time—I am sorry—because I want to go on to what other Members have said.
I want to talk about mental health and just correct a few points, particularly on frontline workers. On the evidence we have at the moment, the two groups of people who are suffering with their mental health as a result of this pandemic are those people who had pre-existing mental health conditions and frontline workers who are suffering from post-traumatic stress disorder. For those frontline workers, a package was put in place straightaway by the NHS, which provided each frontline worker with three counselling sessions, numerous apps and the ability to have a contact and to receive immediate counselling, as well as a website where they could go through the tools used to work through their feelings. Almost every trust manager put in place a support package for frontline workers in their hospitals, and yesterday the NHS announced a further £15 million to support the mental health of frontline workers.
For those with pre-existing mental health conditions—and I would like to pay tribute to Claire Murdoch, who is responsible for mental health delivery in the NHS—trusts across the UK put in place 24-hour mental health crisis helplines in a matter of weeks, and they have had a huge impact. The Government have committed the £2.4 billion; we have accelerated the long-term plan; we have accelerated the trailblazer schemes in schools; we have introduced the wellbeing package in schools for children returning to school, and we have supported the third sector financially to deliver additional mental healthcare to almost every sector of society, including on eating disorders. I always say that is one of the worst mental health conditions because it has a high rate of morbidity, and it too has received additional funding. We have put a huge amount of work into mental health, and I know that Claire Murdoch and others are proud of what the NHS has done in terms of the mental health services that it has delivered.
I cannot answer anybody else, but I will write to people. This has been an important debate in the middle of one the greatest public health emergencies that this country has faced, and I would like to end by again thanking everyone across the country for playing their part to reduce the rate of transmission and to protect their loved ones and our local communities.
Question put and agreed to.
That this House has considered covid-19.
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.
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.
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.
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.
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.
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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.
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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.
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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.
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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.
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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.
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That is a very good point. I had not mentioned that people might be moved from one institution to another, but that, of course, makes the amendment even more important. I am not in favour of excessive bureaucracy, but that strikes me as being an essential part of what the Bill is intended to achieve. The purpose of my amendment 16 is to deliver the Bill’s original aim. In fact, that is the theme of all my amendments. They are certainly not intended to weaken the Bill; if anything, they are intended to encourage the hon. Member for Croydon North to go further. The amendment is not just something nice to tag on to the Bill. I think that it goes to the heart of what the Bill should be about. Restraint techniques should be documented in medical notes to provide other medical practitioners who are treating the same patient with an overview of how that individual patient responds to the use of that form of restraint. I cannot see why that should not be part of the Bill.
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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.
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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.
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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—
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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.
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.
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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.
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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.
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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.
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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.
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.
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.
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I cannot pay tribute enough to the hon. Member for Croydon North (Mr Reed) for his incredible leadership in getting us to this point. He has made it extremely easy for me to work with him and to engage with the sector. I cannot overstate the signal that this reform will send both in terms of how we treat mental health and how we treat patients and enhance their rights; it will be extremely significant indeed. When, as I hope, the Bill gets on to the statute book, he can really be proud of a very significant achievement. I am very pleased that he was able to use his place in the ballot to bring forward such a progressive and important measure.
I could not disagree with a word the hon. Gentleman said as he introduced the Bill’s Third Reading. He was absolutely right. For too long, restrictive interventions have been accepted as the norm in health and in mental healthcare settings, as the right hon. Member for North Norfolk (Norman Lamb) said.
It has been great to have the right hon. Gentleman’s input into today’s proceedings. He is the one who blazed the trail that I am trying to follow, which is quite a tough act it has to be said, but we are all extremely grateful for the real efforts that he made while he was a Minister, and I hope to build on the change that he started to embed.
We must expect that restrictive interventions and the use of force must never be used for the purpose of punishment, or to degrade or to humiliate patients. Mental health settings are places where people should feel safe, and it is clear that the existing guidance is not having the impact that the Government expected, and that we must do more. This Bill will be a very important tool to achieve that.
I come back to why we are here today: the death of Seni Lewis. The measure of the Bill’s success will be in the strength of the independence of the investigations and in the support that bereaved families get should, unfortunately, any other family find themselves in this situation. That is the yardstick against which the Bill should be measured. We should be very sensitive to ensure that we all continue to do our best so that, when people are let down by organisations of the state, we in this House are at the front of the queue to see that they get justice—and justice promptly, because justice delayed is justice denied.
It is a great pleasure to serve under your chairmanship, Dame Cheryl. I welcome the Minister and shadow Minister to the Committee.
The purpose of the Bill is to put on to a statutory footing the office of the National Data Guardian for Health and Social Care, and to promote the provision of advice and guidance about the processing of health and adult social care data in England. It would be remiss of me not to mention the work of my hon. Friend the Member for Bury St Edmunds (Jo Churchill): she has worked hard for a long time to establish the position of the National Data Guardian for Health and Social Care, and her perseverance and tenacity have ensured that we are on track to deliver it.
I thank the Minister and shadow Minister for their help and support with the Bill—and special thanks, of course, go to Dame Fiona Caldicott, who has pioneered the work on ensuring that the NHS handles data properly. She has been very helpful to me in the preparation of the Bill.
Clause 1 creates the Office of the National Data Guardian for Health and Social Care, referred to in the Bill as the “Data Guardian”. It makes general provisions about the Data Guardian’s functions and the way in which they are to be carried out. Subsection (2) empowers the Data Guardian to publish guidance about the processing of health and adult social care data in England. I should like to make it clear that it also covers public health data.
Subsection (3) imposes a duty on certain organisations and individuals to have regard to the National Data Guardian’s published guidance. Comment has been made as to why the Secretary of State is not included in the list. However, the Department of Health and Social Care is already included in the definition of those who have to have regard to the National Data Guardian’s advice, so it would be superfluous to include the Secretary of State.
Subsections (4), (5) and (6) cover requirements in relation to the Data Guardian’s published guidance. Those subsections are intended to keep the guidance relevant over time and, if necessary, updated to reflect new evidence. It has been suggested that subsection (5) should add an obligation that organisations and individuals that process health and social care data should provide the Data Guardian with appropriate information. I argue that that would create a duplication of the remit of regulators that already exist in those sectors. The Data Guardian’s role is as an advocate for the patient and the public, to build and maintain public trust. The role is as much about supporting individuals and organisations to get it right first time as it is about commenting, advising and providing guidance. It is not the intention of this Bill to create another regulator, but that the National Data Guardian should work with the Information Commissioner’s Office and the Care Quality Commission.
It has also been suggested that subsection (6) should add a duty that all data controllers and their data processors must publish their response to all advice issued. That would be extremely burdensome on those organisations and individuals, and it would be toothless without sanctions. Accountability should be assessed through actions, not written responses; the existing regulators would be able to assess the adherence to guidance and would cite the National Data Guardian during any investigation.
Clause 1(7) allows the Data Guardian to give informal advice, assistance and information to anyone, as long as it is about or relates to the processing of health and adult social care data in England. Clause 1(8) gives the Data Guardian flexibility in how far any particular piece of advice, assistance, information or guidance may be extended. The effect is to clarify that the Data Guardian can publish guidance and give advice on specific topics or themes, and can target it to certain organisations, individuals or sectors as appropriate. Clause 1(9) provides that the duty to have regard to the Data Guardian’s published guidance applies only in so far as the guidance is relevant to the functions or services of the body or person.
Clause 1(10) introduces schedule 1 to the Bill. As clause 1 and schedule 1 are being debated together, I will make some brief comments on schedule 1. The schedule makes further provision for the establishment, maintenance and operation of the Office of the Data Guardian. It sets out the Data Guardian’s terms of appointment and covers a broad range of matters related to the Office of the Data Guardian. It includes its constitution, its financial and reporting framework, and how members of staff and advisers are reported and remunerated. I draw the Committee’s attention to paragraph 15 of schedule 1, which provides that the Secretary of State must pay to the Data Guardian the amount that he considers appropriate for the purpose of enabling the Data Guardian to carry out his or her functions.
The Committee will be aware that there was some debate about the cost during the money resolution debate. I thank hon. Members who are here today and those who took part in the debate. I want to make clear that, although the estimated cost is £725,000 per year, that is only an additional £225,000 per year and relates to putting the Data Guardian on a statutory footing. As the Committee will know, there is already a Data Guardian, which costs £500,000; we are just putting this on a statutory footing and saying it is the right thing to do.
I am grateful for my hon. Friend’s intervention and the fact that he is on the Committee; I know that all Committees welcome his membership.
The reason why we have a Data Guardian is to provide safeguarding and to make sure that the data is handled properly. Those costs can only be estimated; as my hon. Friend says, they could be more or less, depending on the requirements. That is exactly why we need a guardian. I would like the costs to be minimal, because that means that we are handling the guardian properly. But if there needs to be more, because there is a requirement to do more, there will be more cost.
I agree, but what we are not doing today is creating a regulator; I would not be likely to propose a Bill to create a regulator. The Data Guardian already exists and it is not a regulator—I specifically said that in my opening remarks. Although it is probably true that regulators do that, that is not what I expect to happen with the National Data Guardian.
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Christchurch and Rhondda speak as one, in a uniting of the Christophers, something that will not, I think, happen very often. It is a serious point; I understand that such clauses are a frequently used means of tidying up the process of a Bill coming into force. However, it adds cost, because the Government must go through an additional process; and frankly there is no reason why we should not just put in a date and tell the Government to get their act together—because everyone supports the measure.
I hope—I am sure—that the Minister will now say, “We intend to do it as soon as practicable after the Bill has been through both Houses,” and all the rest of it; but it would be better for the date to be in the Bill, because then she would not have to do anything later, and, to use a valleys word, it would be tidy. Let us be tidy.
Tempted as I am to engage in debate on the abuse or otherwise of statutory instruments, I prefer not to go down that road. Suffice it to say, we should put provisions into action only once they are tidy, to use the term suggested by the hon. Member for Rhondda. We should be governed by the integrity of the rules we pass rather than by speed, but I can confirm that it is the Government’s desire to implement the Bill, which we fully support, as soon as practicable. Clearly, we already have a National Data Guardian; the Bill would just put it on a statutory footing. It is in all our interests that we do that as soon as possible, so the Government are content with the clause.
I completely agree with everything my hon. Friend says. It is Ministers’ responsibility to ensure that the decisions made by Parliament are actioned as promptly and effectively as possible. I know him well enough to be sure that he will hold me to account on exactly that basis if he does not feel the Bill comes forward quickly enough. I would like to see it commenced by the end of the year, and I will work with my officials to ensure that that is the case. If we cannot achieve that, I will give him an explanation.
I am grateful for my hon. Friend’s intervention, but I would like to deal with that later in my remarks.
There is the following deferred Divisions motion on the Order Paper in the name of the Prime Minister:
“That, at this day’s sitting, Standing Order No. 41A (Deferred divisions) shall not apply to the Motion in the name of Mel Stride relating to the Health and Social Care (National Data Guardian) Bill.”
That is interesting because under Standing Order No. 49 automatically there has to be a debate of up to 45 minutes on a money resolution, so I am not sure why that motion is on the Order Paper. The new version of Standing Orders published on 1 May is in the Vote Office today, and consideration of such a resolution automatically can go through the moment of interruption.
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That is exactly what I am saying, because it would come on as a second Bill and therefore, as it is quite a complex Bill, would not get through. I think that some people who may have been involved in rearranging when money resolutions come through—this new idea of having a choice in relation to money resolutions—were aware of that fact, but I am not sure that everyone in this House was. I considered standing up and recommending that Members should not support this money resolution. However, if I did that, I would be playing into the Government’s hands, because that would stop a private Member’s Bill.
Absolutely. There was much discussion with the Clerks of the House on that point. As my hon. Friend knows, that money has already been expended on the system that we have. My Bill is actually not going to cost the public purse any more money than at present. I argued strongly that my Bill should not have a money resolution, but the Clerks persuaded me that it was the proper thing to do. I think they felt that, on balance, it was safer to do it like this.
I did not think I would be speaking about a money resolution for my Bill. I did not think that anyone would spend any time on this matter. What normally happens—[Interruption.] No, I think we need to scrutinise this properly—
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What a pleasure it is to take the House past 10 o’clock this evening.
It is quite interesting that schedule 1(15) to the Bill states:
“The Secretary of State must pay to the Data Guardian such sums as the Secretary of State considers appropriate for the purpose of enabling the Data Guardian to perform his or her functions.”
In addition, the motion we are discussing is not cumbersome and states:
“That, for the purposes of any Act resulting from the Health and Social Care (National Data Guardian) Bill, it is expedient to authorise the payment out of money provided by Parliament of any expenditure incurred under the Act by the Secretary of State.”
It would therefore not be a lot of work for the Government to bring forward a money resolution for the Parliamentary Constituencies (Amendment) Bill, too. Given that it has been easy tonight, I look forward the money resolution being passed for the Bill of the hon. Member for Wellingborough.
The Department wrote to all NHS and foundation trusts in September 2017 to remind them that tax avoidance schemes should not be entered into in any circumstances, but the hon. Lady makes a slightly strange point. She seems to be arguing that NHS hospitals are, in essence, paying too much tax to the Treasury, rather than having that money within the NHS. These subsidiaries are 100% owned by trusts themselves.
I admire how the VAT element of the original question was brought into a discussion of exit payments. As my hon. Friend will be well aware, I visited the issue of exit payments frequently as a member of the Public Accounts Committee, and I am happy to discuss it further with him.
Thank you, Mr Chope, for chairing the debate in your inimitable style. I was intrigued to learn that my hon. Friend the Member for Corby (Tom Pursglove) had not used the precincts of Westminster Hall to raise an issue before; I was somewhat surprised, because he is such an assiduous campaigner for his constituency and such a frequent contributor in the main Chamber. The reason may simply be that he does not manage to find time to get into Westminster Hall, so often does he raise his constituents’ interests on the Floor of the House. It is good to see him so well supported again today by his constituency neighbours from Wellingborough and Kettering.
We have discussed this matter privately and, to a limited degree, on the Floor of the House. My hon. Friend the Member for Corby referred to the Adjournment debate to which he contributed before Parliament rose for the summer recess. We have also discussed during the summer, as events unfolded in a more unpredictable way, what could be done to secure the future of the facility for which he has advocated so well today.
I feel reasonably up to speed with events in Corby; for the benefit of other Members present, I will rehearse a small number of them. I will not go into too much detail, not least because at the heart of the issue has been a contractual dispute, which has limited the ability of participants to describe the nature of it. That has, in itself, given rise to some problems in communicating to the local population what the problem has been. We remain bound by the confidentiality arrangements around the legal procedure, but suffice it to say that, as my hon. Friend correctly observes, we are close to a point where action has to be taken to maintain the facility from the end of this month.
From my conversations with the CCG leadership in preparation for this debate, I can assure my hon. Friend that on that side of the negotiating table they are determined to ensure that continuity of service is provided through the rolling four-month contract. They alerted him to that contract at the end of last month and are engaging with the provider, Lakeside Plus, to try to reach agreement. There is no doubt that without an agreement, some of the services would have to be provided in an alternative and less satisfactory way for the local population. That is inevitable, if it is put together in a short timeframe.
It is in everybody’s interest to make this work, but it will be a precursor to a longer-term solution, which is clearly required for the local population. I am pleased that my hon. Friend recognises that such a solution needs to be widely consulted on. Indeed, he is pressing for a more fulsome consultation than is perhaps typical. Given the circumstances surrounding this case, I will be urging the CCG regarding that full consultation. I have been alerted that it is due to start in November, and think that he has been given the same information.
I was not aware of a pre-consultation, and am not quite sure what it means. Hopefully, it means providing an opportunity to ensure that the full consultation is as detailed as necessary. I am quite sure that my hon. Friend will encourage all those who have been in touch with him to participate in that consultation when it gets under way. I was pleased to learn from him about the cross-party nature of the support and full engagement that he has been working, alongside the action group, to generate. I am sure that all those taking an interest will participate in the consultation.
To touch on the substance of the issue, I should say that the GP practice co-located with the urgent care centre has the largest patient list of any GP practice in the midlands, certainly, and possibly across NHS England’s footprint, so it has some unusual characteristics. One of the pressures on that practice, which my hon. Friend alluded to, is access to that GP surgery. Pressure is put on the urgent care centre by the difficulty in securing access to that part of the GP provision in the area. My understanding is that there is a federation of GPs, beyond the immediate catchment of the UCC but within the CCG area, that has much better access. Work should be done as part of the consultation to see how the performance across the entire CCG area can be improved to relieve some of the pressure on the urgent care centre.
A consequence of that pressure is that the original contract, designed to undertake 120 patient episodes a day, has been dealing with more like 170 patients a day attending the urgent care centre. Of those patients, the vast majority—88%—could be dealt with either in that facility or in the GP practice itself. As I understand it, 12% definitely require treatment at the urgent care centre, and some of those are then referred to either Kettering General Hospital or, in a small number of cases, to Northampton’s A&E facility.
There is a need for an urgent care setting, but there is as much of a need to ensure that those who could be treated in the primary care environment can be. Part of the consultation will look at the appropriateness of a primary care home arrangement. That is an establishment that brings together primary care providers, social care providers and other providers, such as pharmacies, within an area, to provide a more integrated primary care service. That in itself might have benefits for improving access to treatment for the population served by the UCC at present.
My hon. Friend will be well aware of the history of the contracting challenge between the CCG and Lakeside Plus. I will not exhaust his patience by going into that in any detail, but will simply say that it is the intent of the CCG to re-establish a contractual relationship. The CCG wishes to have this moving forward on a four-month rolling basis while the consultation takes place, and then any subsequent arrangements will need to go out to tender. The intent is that this contract will continue until the successor arrangements are in place, so that there is continuity of care for his constituents—something that the Department absolutely supports.
I conclude by saying that it is really important that we use this public consultation to get the model of care right for the people in the area served by the UCC. That needs to take into account the evidence base for the clinical model, the right to patient choice for the people who will be using it, to meet the local need—my hon. Friend spoke eloquently about the particular local needs in the Corby area, and those are recognised—and also value for money. The approach has to be coherent and comprehensive, to come up with the right solution for the future.
I heard what my hon. Friend’s neighbour, my hon. Friend the Member for Wellingborough (Mr Bone), said about looking for a similar hub in Wellingborough. I will look with interest to see how his private Member’s Bill progresses, to endeavour to bring that about. I also note his comments regarding the structure of the CCGs in the area. That is really a matter for the STP—the sustainability and transformation partnership—to make progress on and decide the structure of both commissioning and provision of service in the area. It is not really for me to comment on that off the cuff here today, but I note what he says and am aware that this is one of the smallest CCGs in the country. I am also aware that there is a very substantial programme of collaboration already underway with the neighbouring CCG at Nene, so I think that the CCGs themselves see the benefits of closer integration of their working.
On that basis, I say to my hon. Friend the Member for Corby that I will endeavour to keep him informed as matters come to my attention, and I am quite sure he will continue to keep me and the Department informed as well.
Question put and agreed to.
Of course I want to work—as will the current Care Minister, the Under-Secretary of State for Health, my hon. Friend the Member for Thurrock (Jackie Doyle-Price)—with the respected former Care Minister, and with any other Members who have any sensible suggestions. Taxation is of course a matter for the Chancellor at financial events, and there will obviously be a Budget later in the year.
On the areas where there are care challenges, we have picked up 12 local areas for review, as the Secretary of State said earlier this week. We have published the details that are suitable for the review, which we have developed from the dashboard criteria. We will give those involved every possible support, as we do with the inspection regime for hospitals, for instance. Such inspections are to get hospitals out of special measures and get them to a better place, and we will do the same for those areas. I will be very happy to meet the right hon. Gentleman. In fact, if he had not asked me, I would have offered to meet him.
No, I cannot go into the detail of why that is, as I suspect my right hon. Friend realises. There will be a one-NHS STP process in his area, and it will have to come up with proposals that meet the five criteria for any reconfiguration. As he will know, there were previously four criteria that had to be met, but there are now five; Simon Stevens, the chief executive of the NHS, has added a fifth on patient safety. My right hon. Friend mentioned St Leonard’s hospital, and any reconfiguration or change of service in relation to it will have to be considered in that context.