Coronavirus Regulations: Assisted Deaths Abroad

Fiona Bruce Excerpts

Thursday 5th November 2020 Commons Chamber

[Matt Hancock]

The hon. Gentleman is quite right that this is not an issue in which there is any party politics, and there is rightly no Government position. On the specific question of assisted dying, I am glad to have been given the opportunity to clarify the impact of the coronavirus regulations on that law, but he also asked the wider question about palliative care. It is important that we support palliative care, and that we locate this question in a wider question about how people can have choice. After all, patient choice has been a growing feature within healthcare—in my view, rightly so—over the last generation. This is one area where that choice is constrained in law.

It is important that we invest in high-quality palliative care. We have put further funding into palliative care and hospices because of the pressures caused by the coronavirus pandemic. Making sure that we have high-quality palliative care services and a hospice service that we can all support fully is obviously very close to my heart.

The hon. Gentleman also asked about mental health support, and there has been increased investment in mental health support to ensure that people get the support they need in what are inevitably difficult times.

[Fiona Bruce (Congleton) (Con)]

At this time, when the whole country is making huge sacrifices to protect life, at a time of exceptionally high levels of physical and mental stress, and when many people may feel very vulnerable, does the Minister understand and accept the views of many, including in this House, that it would be completely inappropriate—indeed, insensitive—of this Parliament to go anywhere near considering making access to any form of suicide easier?

[Matt Hancock]

I respect my hon. Friend’s views, which are deeply and sincerely held, and I respect the fact that the House will debate all views. It is right that that debate is taken forward and led by Parliament, rather than by Government, as my hon. Friend just demonstrated.

Oral Answers to Questions

Fiona Bruce Excerpts

Tuesday 6th October 2020 Commons Chamber

[Miss Sarah Dines (Derbyshire Dales) (Con)]

What steps his Department is taking to support the adult care sector during the covid-19 outbreak.

[Fiona Bruce (Congleton) (Con)]

What steps his Department is taking to support the adult care sector during the covid-19 outbreak.

[Scott Mann (North Cornwall) (Con)]

What steps his Department is taking to support the adult care sector during the covid-19 outbreak.

--- Later in debate ---

[Mr Speaker]

Order. We have to get through this grouped set of questions, and it is going to take us well into topicals time; the Minister really does need to speed up on the answers.

[Fiona Bruce]

I thank the Minister for the social care winter plan announced two weeks ago. Can she tell me when this half a billion pound infection control fund will be released to councils covering constituencies such as mine in Congleton, in order to help protect residents and staff over the winter?

[Helen Whately]

The infection control fund is being distributed in two equal instalments, the first of which has already been paid to local authorities. My hon. Friend’s local authority, Cheshire East Council, will be receiving £4.7 million in total, so it should already have received £2.35 million to go towards the extra costs for care providers and others in infection prevention and control.

Independent Medicines and Medical Devices Safety Review

Fiona Bruce Excerpts

Thursday 9th July 2020 Commons Chamber

[Ms Dorries]

We will be considering all the recommendations and returning to the House with a full report as soon as possible.

[Fiona Bruce (Congleton) (Con)]

As vice-chair of the all-party group on valproate and other anti-epileptic drugs in pregnancy, I thank the Minister for her tone today. Does she agree that it is shocking that the Committee on Safety of Medicines as long ago as 1973—this is the predecessor of the MHRA—was clearly aware of the risks in pregnancy of the use of anticonvulsants? It said that they are liable to produce abnormalities. Over that period of time, 20,000 children could have been affected. There are families, such as those of Janet Williams and Emma Murphy, who have campaigned tirelessly—I pay tribute to them too on this issue—who now have to care for those children, potentially for their entire lives. Much more support is needed for those children from local authorities and health authorities. It has not been given until now as a result of the lack of recognition of the link between, and risks of, anticonvulsants in pregnancy and abnormalities. Will the Minister, when she meets us, focus on ensuring that that issue is taken forward so that more support can be provided?

[Ms Dorries]

I absolutely will. My hon. Friend highlights how long it takes for women’s voices to be heard—since 1973—and I will do as she asks.

Alcohol Harm

Fiona Bruce Excerpts

Tuesday 17th March 2020 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

I beg to move,

That this House has considered tackling alcohol harm.

It is a pleasure to serve under your chairmanship, Mr Paisley.

I thank the Backbench Business Committee for allocating time for this debate. The request for it was made some six months ago, in the hope of it being granted in the run-up to Christmas or when many join in Dry January, but pressure on parliamentary time meant that it has only just been granted. I appreciate that now we are in a very different time as regards health concerns. None the less, alcohol harm is an ongoing and long-term concern not just for those who drink to excess but for their families and wider society, and it will still be with us even after—as we hope—the coronavirus crisis is past.

I thank the Minister for Care for stepping in to respond to the debate at a time of great pressure for her and the Department of Health and Social Care. I pay tribute to the great leadership being provided by the Prime Minister, the Secretary of State for Health and Social Care, the other Health Ministers and all those involved in leading on the exceptional and unprecedented crisis in our nation—thank you.

I appreciate that the current unprecedented situation means that fewer colleagues are present for the debate. Many put down their names and intended to speak. I thank those who are in attendance. One colleague asked me to mention that she regrets being unable to be here: the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who is chair of the recently instituted all-party parliamentary group for the excellent 12 steps programme, which has made a difference in so many people’s lives.

There are, and have been for a long time—as long as I have been in Parliament, which is now some 10 years—several all-party groups concerned with alcohol harm: one under that name, one on foetal alcohol spectrum disorder, another on the children of alcoholics, and the drugs, alcohol and justice all-party group, and I am delighted to see its secretariat in attendance today. Alcohol harm, therefore, is not a minority concern here in Parliament, as some may think.

Before I go on to talk about the concerns that many of us have about the impact of alcohol harm, this debate is in no way intended to denigrate the fact that drinking responsibly and enjoying a drink is something that I and many others do. That is not what we are here to do today; we are here about drinking to excess, harming oneself and others.

I will come on to the speech that I had prepared, although that was before we found ourselves in these exceptional circumstances this morning, when the country faces the prospect of many self-isolating for long periods. Even so, while Ministers in the Department of Health focus on the crisis, over the coming weeks when giving health advice, they might still send out a few helpful messages to those stuck at home who may be tempted to drink more than is good for them.

Many tips, many of them straightforward, have been given over the years by organisations such as Drinkaware, whose work I commend, but perhaps not sufficiently widely promoted. This might be an opportunity to do that—for example, taking a non-alcoholic drink before an alcoholic one, having a glass of water by the side of the alcoholic drink, or trying alcohol-free drinks. Last year, here in Parliament, our all-party group hosted an alcohol-free drinks event attended by 60 colleagues. We had an enjoyable time—alcohol-free gin, champagne, lager—[Interruption.] I am very aware that the hon. Member for Strangford (Jim Shannon) attended that event and it was indeed enjoyable. We should try alcohol-free drinks and, as Drinkaware suggests, aim for two or three alcohol-free days a week to rest the liver.

To turn to the substance of the debate, 10 million people are drinking at levels that increase the risk of health harm.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Lady on this timely debate. Does she agree that, in these exceptional circumstances, one of our concerns over the coming weeks and months should be the massive reduction in social interaction? There will inevitably be a spike in the number of people drinking alcohol at home. Both Government and communities have to be aware of that to try and ensure people do so responsibly and not to significant excess, which may well happen in the coming weeks.

[Fiona Bruce]

The hon. Gentleman has expressed far more eloquently than I have exactly the issue that many will face. It is particularly interesting that the 55 to 64 age group is one of the most at risk, with its excess drinking described by charities working in the field as a “national health disaster”. There is an opportunity here to gently—I am aware there is a lot of other stress—help people understand the implications of drinking to those levels.

In the Green Paper published in July 2019, the Government said

“the harm caused by problem drinking is rising.

Over 10 million people are drinking at levels above the official guidelines and putting themselves at extra risk.”

Tragically, exactly the same thing was stated by Public Health England in the third line of its 2016 evidence-based review, “The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies”:

“there are currently over 10 million people drinking at levels which increase their risk of health harm”.

It goes on to talk about

“1 million hospital admissions relating to alcohol each year”.

Interestingly enough, half of those occur in the lowest three socioeconomic areas.

“More working years of life are lost in England as a result of alcohol-related deaths than from cancer of the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate, combined.”

Sadly, several years on, we still do not have what is very much needed: a distinct and discrete alcohol strategy—it could be better called an alcohol harm strategy—to address the issue. I recommend the Health Minister to look at the alcohol charter, if she has not seen it, which was produced by some of our all-party parliamentary groups following the 2016 report and makes some suggestions as to what that strategy could contain. They include tackling the increased availability of excessively cheap alcohol, empowering the public to make fully informed decisions about their drinking and providing adequate support for dependent and non-dependent drinkers.

If I had a main call today, it would be to ask that the Government produce an up-to-date alcohol strategy. The last one was produced in 2012 and it is out of date, not only because of statistics—I am afraid I will bore colleagues with some more shortly—but also with reference to our approach to minimum unit pricing, which I will refer to later.

Our relationship with alcohol is complex, and so are its harms. Alcohol is embedded in our culture. Whether we are celebrating, had a tough day or need to reward ourselves, alcohol very often seems to play a role. It has become normalised. It is increasingly difficult to find a birthday card that does not wish an un-beer-lievable or gin-tastic birthday to someone, or makes another reference to alcohol. Although our culture celebrates alcohol—enjoyment in the right proportions is not a bad thing—we are too silent about its harms. All too often, we stigmatise people who are dealing with the consequences of harmful alcohol consumption, or leave them to cope with those consequences alone.

Most of us know a person or family affected by harmful drinking. The statistics are, if I may say, sobering: across the UK, more than 80 people a day die from alcohol-related causes. That figure is far higher in areas of poverty where people struggle to cope. Alcohol is now the leading risk factor for death, ill-health and disability among 15 to 49-year-olds in England, and is associated with around 40% of violent crime. In my local authority of Cheshire East, there were 185 alcohol-related deaths and 8,460 alcohol-related hospital admissions in 2017. The number that sticks out the most, however, is the number of people who do not get help: 88% of dependent drinkers in Cheshire East are not in treatment and do not get the support that they need.

[John Howell (Henley) (Con)]

My hon. Friend said that the effects of drinking alcohol were obvious, but does she accept that for men trying to have a family, for example, the effects can lead to permanent difficulties such as infertility, which is not always obvious?

[Fiona Bruce]

My hon. Friend makes an excellent point. Having engaged on this subject for many years in this place, I thought that there was nothing that I did not know, but I did not know that, so I thank him for drawing people’s attention to it. Similarly, it is of great concern that many people are unaware of the impact of foetal alcohol syndrome, which arises from drinking during pregnancy—we cannot emphasise enough the importance of not doing so.

Public Health England estimates that only one in five dependent drinkers in England gets the right support. That is sad because treatment, when obtained, can be very effective and good value for money. For every £1 spent, there is a societal benefit of £3. It does not stop there, though. Alcohol not only impacts individuals, but wider society and public services, costing NHS England £3.5 billion every year. There is no better time than now to remind ourselves that we should encourage help and the prevention of harm where we can, so that our NHS staff, whom I thank in this time of crisis, can treat those in health difficulties.

Anyone who has been in an A&E on a Friday or Saturday night will not be surprised to hear that alcohol-related incidents account for 25% of A&E work in England. Sir Ian Gilmore, who chairs the Alcohol Health Alliance—I thank them and commend their work informing the public and supporting parliamentarians—said

“While A&E departments used to feel the impact on Saturday nights, it’s now every night of the week”,

and that

“The lack of a strategy is really harming the nation”.

English police spend more than half of their time dealing with alcohol-related casework.

Alcohol’s impact on families is stark: in England, about 200,000 children live with an alcohol-dependent parent. I will speak a little about that, but I will first commend the Government because when my hon. Friend the Member for Winchester (Steve Brine) was Health Minister, he was very conscious of the issue and granted more than £6 million to help the children of alcoholics, following a campaign run by colleagues in the House. He rightly said:

“Alcohol abuse can tear lives apart, not only for the people trapped in the grip of an addiction but for their children, who are often robbed of the support, comfort and structure they need from their parents.

I am committed to finding new ways to help families in the midst of these heart-breaking situations.”

I would be interested to hear from the Minister about progress on the pilot schemes in several local authorities, which I expect are now quite well developed, to help children of alcoholic parents or carers, following his initiative.

I have always found Health Ministers to be very concerned about the issue, but one of the systemic problems appears to be that the Home Office leads on alcohol strategy. That has to change. There is a lot of concern among Health Ministers and the Department of Health and Social Care about the issue, but we need them to lead on it.

Children of alcoholic parents or carers experience real difficulties. They are twice as likely to experience difficulties at school, three times more likely to consider suicide, four times more likely to develop alcohol problems of their own, and five times more likely to develop eating disorders. I am pleased by the progress that I have mentioned, but we still have a long way to go on tackling harms.

The Government are rightly excited about the positive impacts of alcohol care teams in hospitals, and I encourage them to go further and ensure that a team is embedded in every hospital when time can be given to that. However, we know from listening to dependent drinkers that help in hospital needs to be complemented by help in communities, if they are truly to be helped.

The loneliness agenda and social prescribing are important initiatives that need to include suitable provision for dependent drinkers. Having attended an Alcoholics Anonymous meeting as a guest, I was really impressed with the care and support that members of that AA group gave one another. It was clearly proving very effective, but we need to do more.

I thank Adrian Crossley, the head of addiction and crime at the Centre for Social Justice, who is doing a lot of work on alcohol treatment. He basically says that we have to assign funding to each local authority in accordance with locally recognised need. I know that this is an unpopular term, but we must ring-fence it so that it really can make a difference.

We must also develop the Government’s promised addiction strategy to ensure that there are wrap-around services to help to stabilise and then promote lasting recovery—particularly the family support that is needed for the 200,000 children in England who are living with an alcohol dependent parents. Those are important initiatives. There is no wrong door to accessing the most appropriate services, but we need to join them up—whether they are local family services, voluntary groups or mental health support.

If I may, Mr Paisley, I will take a little longer than normal to make my speech, because there are not too many colleagues present. I was disappointed in the Chancellor’s view on alcohol duty in the recent Budget. I thank him for providing £2.5 million towards the development of family hubs in local areas. Such hubs are one-stop-shops where people will be able to go—several are up and running in the country now—for joined-up services from local health providers, local authorities and voluntary groups.

People can go to such hubs with any issue that relates to their family life. One of those issues should, and hopefully will, be addiction. Sadly, many families do not come forward for help. They are ashamed of the stigma, are soaked in a culture that celebrates the products that often blight their lives, and carry a burden that is often unrecognised and unsupported. We need more accessible, practical support for families.

We need to remember, too, that the harms from alcohol do not fall evenly across the UK. The burden falls most heavily on poorer communities. The north of England, for example, has significantly higher rates of alcohol-related deaths than London or the south-east. I am delighted that this one nation Conservative Government are committed to reducing inequalities and levelling up across the country, but, as I have mentioned in this House before, we will not be able to do that simply by repairing physical infrastructure such as roads and bridges. We need to create stronger, healthier communities and families, and one of the ways we can do that is by tackling alcohol harm.

The figures I have mentioned demonstrate that alcohol presents a grave public health challenge. Without question, we need a paradigm shift. Tackling alcohol-related harm needs to become a fundamental policy priority. Regulation certainly plays a part in shifting behaviour on a personal level, as we have seen over the past few years with tobacco; I commend parliamentarians who took a lead on that. As we have seen there, the Government can create an environment that enables us to make informed choices and lead healthier, happier lives.

I will now focus on price. Why? Because the 2016 report from Public Health England concluded:

“Policies that reduce the affordability of alcohol are the most effective”

policies in health treatment. Yet, over the past few years since then, and even before then, quite the opposite has occurred. Alcohol duty rates have been cut or frozen in Budget after Budget and as a result, in real terms, beer duty is some 18% lower than in 2012, duty on spirits and cider is 10% lower and duty on wines 2% lower. We all know that the price of something has an impact on whether we will buy it, and alcohol is no exception; as I say, Public Health England said price was the number one factor in determining how much alcohol is bought.

Alcohol has become dramatically more affordable in the past 30 years. The affordability of beer in the off-trade has more than tripled in real terms since 1987 and off-trade wine and spirits are 163% more affordable. One of the most targeted approaches to addressing the price of the cheapest alcohol is minimum unit pricing. I urge the Minister to look at it again.

Minimum unit pricing, as the name suggests, sets a price below which alcohol cannot be sold. In Scotland, which introduced minimum unit pricing two years ago, it is currently 50p. That means that a pint of beer containing two units of alcohol—for the record, as many here will know, the chief medical officer’s suggestion for sensible and moderate drinking is 14 units a week—cannot be sold for less than a pound.

Minimum unit pricing would have hardly any effect on pubs and restaurants, where the vast majority of alcohol is sold at more than 50p per unit. Instead, it is highly targeted at the cheapest products that cause the most harm, such as white cider and super-strength cheap lager. If the Minister cares to look, I introduced the Alcohol (Minimum Pricing) (England) Bill in 2018, so there is one oven ready if the Government would like to take it up.

One reason the Government did not take it up was that they said they wanted more evidence that MUP would work. I remember the Chancellor saying that we would await the outcome in Scotland. As I say, two years since Scotland implemented MUP, the evidence is very encouraging. Consumption fell by 3.6% in Scotland in the year after MUP was implemented. During the same period, it rose by 3.2% in England and Wales. The important thing is that the fall in consumption appears to have occurred particularly among those consuming the most alcohol, who are most at risk, and it seems to have been in the high-strength, dangerous drinks of the sort that I mentioned that consumption has fallen.

Wales has decided to follow Scotland’s lead and is implementing MUP this month. Following the evidence, these are the statistics. Again, I apologise to colleagues for more statistics. In England, a 50p MUP is predicted to save 525 lives and prevent over 22,000 hospital admissions and 36,000 crimes annually when at full effect. The evidence is clear, we need to act without delay and implement MUP in England. It was interesting that the 2012 alcohol strategy referred to this very positively. I refer the Minister to the foreword by the then Prime Minister:

“We are not rejecting MUP, merely delaying it until we have conclusive evidence it will be effective”.

Will the Ministers look again at MUP and the evidence following Scotland?

The duty escalator which was in place between 2008 and 2012 increased alcohol duty by 2% every year. The result was that alcohol-related deaths fell while it was in place. They have started to rise again since it has been abolished. Last week, the Chancellor announced in this year’s Budget alcohol duty will be frozen across the board. In real terms, this means a cut. It will lower the price of alcohol. All decisions present trade-offs.

While I appreciate the desire to support our local industry of pubs and brewers, I want to reflect on the impact of this decision on health. Research from the University of Sheffield—I am sure the Minister’s staff will look at the report, because it is commendable—has shown that changes in alcohol duty since 2012 have led to nearly 2,000 additional deaths and 61,000 hospital admissions in England. There was an enormous human cost, but also a strain on public services by adding an estimated £317 million to NHS England’s bill. It is estimated the duty changes could have cost England’s businesses as much as £58 million in lost working days since 2012.

Increasing alcohol duty also raises urgently needed revenue. Considering the impact of the current cuts alongside all changes to duty policies since 2012, in this year, 2019-20, the Government are losing out on nearly £1.3 billion in forgone revenue. That is enough money to pay the salaries of more than 40,000 nurses. By 2024-25, the cumulative costs of these cuts will be £13 billion.

While the budget focused on supporting pubs, I do not believe that cutting duty will be that helpful for them. Ending the alcohol duty escalator after 2012 and the subsequent duty cuts and freezes have not made a measurable difference to the rate of pub closures. This reflects the experiences of those working in the pub trade. Nearly 90% of publicans in the north-east said that duty cuts have not had a positive effect on their business. Less than 5% felt that alcohol taxes were the main cause of pub closures, while a majority thought that cheap alcohol from supermarkets and off-licences was to blame.

Before I end, I want to address alcohol labelling. If we want to create an environment in which people are supported to make informed choices to live healthier, happier lives, we need to make sure they have all the information they need. At the moment, people do not get it. We have more information on a pint of milk than when buying alcohol. It is no surprise that only one in five people know that the chief medical officers commend us not to drink more than 14 units a week, but the public wants to know this information. Research from the Alcohol Health Alliance found that more than 70% of people support warnings that exceeding the drinking guidelines can harm one’s health. I put down an EDM on this last June. It is interesting that it garnered support from 20 colleagues. It stated that two and a half years after the chief medical officer’s guidelines of 14 units per week for low-risk drinking were published:

“a survey of 320 products found that two-thirds of alcohol labels still displayed the old guidelines; … that the pregnancy logo and number of units are not legally required to be shown on labels”.

We believe they should be and there is a lack of information generally on alcohol labels compared with other food and drink labels. Will the Government look again at labelling and make the information on alcohol products mandatory? The public want to know more. It is not just that alcohol increases health risks and that therefore information on alcohol content is wanted, but that they are actually interested in the calorific content. I was involved in a joint event with the all-party parliamentary group on obesity some years ago. It was remarkable. Evidence was given that when people drink with a meal and are perhaps not as thoughtful about what they are eating, the overall increase in calorific consumption can be 400 in that meal alone. It is time to look again at alcohol harm. Alcohol containers should, like any other food and drink container, have to display ingredients, nutrients and calories. They should display the CMO’s guidelines and warnings that exceeding this amount could damage one’s health. We can no longer ignore the harm caused to our society, communities, constituents, families and friends by alcohol.

--- Later in debate ---

[Fiona Bruce]

I thank the Minister for giving way and for stepping in to respond to the debate. She said that most people drink responsibly, but Drinkaware’s statistics, which are very worrying, show that 49% of men are classified as increasing or higher risk drinkers compared with 31% of women. That is a very high percentage.

[Helen Whately]

As I said, I fully appreciate and respect my hon. Friend for the huge amount of work that she does to urge us to recognise the harmful effects alcohol can have.

We know that alcohol misuse can have an impact on hospital care and demand. It contributes to a wide range of conditions including cardiovascular disease, cancer and liver disease, as well as accidents, violence and self-harm. Some 12% to 15% of A&E attendances are alcohol-related, and alcohol is a causal factor in the patient’s diagnosis for more than 1.1 million hospital admissions every year. We absolutely take my hon. Friend’s concerns seriously.

As part of our NHS long term plan, alcohol care teams are being introduced in hospitals with the highest number of alcohol-related admissions. It has been shown that those teams significantly reduce avoidable bed days and re-admissions. The seven-days per week service at Royal Bolton Hospital saved 2,000 bed days in its first year, and modelling suggests that alcohol care teams in every non-specialist acute hospital will save 254,000 bed days and 78,000 admissions per year by their third year of operation.

Thanks to the personal testimony and campaigning by hon. Members present and by others who were unable to attend, the Government have invested £6 million to improve outcomes for children with alcohol-dependent parents. That funding includes £4.5 million for nine local areas to test innovative ways of working and to join up systems to support children and families—promising results are emerging in those areas. We have also allocated £1.5 million to voluntary sector organisations to build resources and capacity at national level, including helpline and contact-centre support through the National Association for Children of Alcoholics. We are also investing £6 million through a capital fund to enable local authorities to improve services and facilities for people with alcohol problems.

We continue to educate the public, ensuring that people are aware of the health risks of alcohol through local and national programmes, such as Public Health England’s One You campaign. The alcohol risk assessment in the NHS health check is used to inform a discussion on reducing the individual’s risk. New guidance encourages referral for liver investigation, where risk is identified. In addition, there is a commissioning for quality and innovation—CQUIN—scheme to incentivise increased cirrhosis and fibrosis tests for alcohol-dependent patients.

My hon. Friend also mentioned labelling. We have worked with industry to communicate the UK chief medical officer’s low risk drinking guidelines on the labelling of alcohol products. The Portman Group and others in the industry have made a commitment that labels will reflect the guidelines and we are closely monitoring progress.

We have also made a commitment in the prevention Green Paper to work with industry to deliver a significant increase in the availability of alcohol-free and low-alcohol products by 2025. A roundtable is being organised to take this work forward. Encouragingly, sales of no or low-alcohol beer are up 30% since 2016 and “nolo” alcohol is set to be one of the driving trends of 2020, although I am sure trends are being reviewed in the light of the pandemic.

Public Health England supports local authorities in their work of needs assessment and commissioning alcohol and drug prevention and treatment services by providing advice, guidance and data. PHE is developing UK-wide clinical guidelines for alcohol treatment. That work will promote good practice and improve the quality of service provision, resulting in better outcomes for patients.

We know that alcohol-exposed pregnancies present a significant public health problem across the country. Foetal alcohol spectrum disorder can have a major impact on the early years development of children and their life chances. There is great work under way at local levels to tackle this. For example, the Greater Manchester health and social care partnership recently launched its #DRYMESTER campaign to raise awareness of drinking alcohol when pregnant. NICE are currently consulting on a draft quality standard on FASD. The voluntary sector also plays a vital role here. As part of the children of alcohol-dependent parents funding programme, over £500,000 is being made available to support work on FASD.

Finally, the good news from the budget is that £46 million in funding is being provided to improve support to individuals experiencing multiple complex needs. That includes tackling homelessness, reoffending and substance abuse, including alcohol misuse. In addition, as part of our rough sleepers programme, there is £262 million of new funding for substance misuse treatment services. When fully deployed, that is expected to help more than 11,000 rough sleepers a year. It will enable people to move off the streets and support them to maintain a tenancy for the long term. The funding complements £237 million announced by the Prime Minister for accommodation for rough sleepers, and a further £144 million for associated support services.

Several hon. Members raised minimum unit pricing, particularly the hon. Member for North Ayrshire and Arran (Patricia Gibson), who drew on her experience in Scotland. There are no plans to implement minimum unit pricing in England at present, but the Government continue to monitor the evidence as it emerges from Scotland and Wales.

Several hon. Members talked about the Government’s alcohol addiction strategy. As announced in November, we are undertaking a UK-wide cross-Government addiction strategy. Plans on the contents of the strategy are being developed and we will have more to say on this shortly.

--- Later in debate ---

[Fiona Bruce]

I thank the Minister for Care for stepping in to respond to this debate. I also want to thank my hon. Friend the Member for Henley (John Howell), the hon. Members for East Lothian (Kenny MacAskill), for Strangford (Jim Shannon), for Blaydon (Liz Twist), for North Ayrshire and Arran (Patricia Gibson) and for Ellesmere Port and Neston (Justin Madders) for their contributions.

It is very rare that we hear in this place such a united voice from Members of Parliament from all political parties, but we did so today, because we recognise that alcohol harm is a major threat to our country’s wellbeing. It is a blight, particularly on the lives of the most vulnerable—the youngest and those in many of our most deprived areas. Wider society, too, is paying an incalculable toll. What came across again and again in the debate was that, although all the initiatives that we have heard from the Minister are good and we are grateful for them, much more needs to be done. Alcohol harm must be elevated in the national prevention agenda. A distinct and separate alcohol harm strategy is essential.

Question put and agreed to.

Resolved,

That this House has considered tackling alcohol harm.

Health and Social Care

Fiona Bruce Excerpts

Thursday 16th January 2020 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I congratulate the hon. Member for Luton North (Sarah Owen) on her speech. It was a pleasure to listen to such a clearly articulated speech by a new Member, with humour thrown in. I am sure she will be a very caring and committed Member of Parliament for her constituency.

I am delighted that this one-nation Conservative Government want to level up opportunity across our country, particularly in areas like Burnley, where I grew up and where we now celebrate a new Conservative Member of Parliament. I welcome the words of Her Majesty in the Gracious Speech:

“A White Paper will be published to set out my Government’s ambitions for unleashing regional potential in England”.

In order to truly release the potential of all our communities—to promote healthy, caring and resilient communities—we need to strengthen families. Colleagues may not be surprised to hear me say that.

The Conservative manifesto said on page 14:

“A strong society needs strong families. We will improve the Troubled Families programme…to serve vulnerable families with the intensive…support they need to care for children—from the early years and throughout their lives.”

I believe we need to do much more than support troubled families, not that the news two weeks ago of a £165 million boost to extend the troubled families programme is unwelcome—it is welcome. We now need to build on the good work of the previous Conservative-led Government and broaden our commitment to help strengthen families. Indeed, why not rename the troubled families programme the wider “strengthening families programme” that it should be? Every family goes through challenges, and every family needs support at some time.

I also welcome the Prime Minister’s commitment at last week’s PMQs to champion and support family hubs, which every Member of Parliament could similarly promote and champion locally. Family hubs are a practical way to help strengthen families, with a place in every local community offering help to families as and when they need it. More of that shortly.

Building a stronger, healthier society surely starts with the family, the basic building block of society. When we fall on hard times or become seriously ill, our family is often the first port of call. Our family, at best, teach us our values, shape our identity and nurture our sense of responsibility to society.

Weakness in our family units—when they are dysfunctional, when they disintegrate or when our closest relationships do not work and we become distressed about them—has repercussions in so many ways. It can increase children’s mental ill health and insecurity, preventing them from attaining their best education and employment potential. It puts pressure on GP surgeries through increased rates of depression, addiction and other ailments. It puts a strain on housing provision when families split up, and it increases work absenteeism, exacerbates loneliness in old age and makes state provision for elderly care completely unsustainable. In other words, it makes not just our families but our wider communities less cohesive, less healthy, less productive and less resilient to the inevitable shocks that life throws at us all.

If we really mean what we say about levelling up those parts of our country that feel they have been neglected, we must realise that we will never achieve that simply by repairing neglected physical infrastructure, such as roads and bridges, good though that is. If we are really to make a local-lasting, generational difference in the lives of people who feel left behind, it must surely also mean helping them to strengthen local communities where relationships have fractured. That should mean, as a priority, strengthening families, so that they can not only flourish but contribute positively to those local communities going forward.

Family breakdown is serious, socially, culturally and economically, and this country has one of the highest rates of it among 30 OECD countries, yet successive Governments have shied away from accepting and addressing this. Let this Government be bold and different. Why? Because the young, the poorest and the most vulnerable pay the highest price when family life fractures, with children from fractured families being twice as likely to develop behavioural problems and being more likely to suffer depression, turn to drugs or alcohol, or perform worse at school and not achieve their job or life potential. There is an increased chance of their living in income poverty in the future and of their own relationships being less stable in adulthood.

It is not just children who suffer from family collapse. Divorce and separation have led to increasing estrangement between elderly parents and older children in later life, with growing loneliness among older people. More than a quarter of a million people over 75 in this country spent this Christmas day alone. This epidemic is causing widespread misery and impeding the life chances, health and wellbeing of millions of people. It is a national emergency that should warrant the same level of concern and attention as climate change. It should warrant the Government reshaping their Departments, for it affects almost all of them. It requires a Cobra-style committee to pull together across Government to champion families and not condemn another generation to the destructive effects of dysfunctional family relationships. At its worst, we see that in people’s involvement in county lines; reportedly, it involves as many as 10,000 young people, with many seeking the comfort of a gang to replace that of a family.

It is a tragedy that more than a million children in this country today have no meaningful contact with their father. The poorest and working-class families are bearing the brunt of family breakdown most. Such families are more prone to break up and they are less resilient when it happens. Greater financial security inevitably allows for insulation from some of the pressures that often drive poorer people apart or result from their splitting up.

What should be done? First, we need to champion the strengthening of families right across Government and as individual Members of Parliament. The public want us to do that. Recent polling by the Centre for Social Justice shows that 72% of adults believe that family breakdown is a serious problem in Britain and 81% think that strengthening families is important in order to address our current social problems. That should start with focusing on communities that feel they have been left behind and that feel dislocated, with a loss of belonging, where there has been a rise in poverty and street crime.

We should focus on places where people feel unequal and where there are high levels of children in care and a large proportion of isolated adults. Government must champion the family—that must be central to the way that every Department thinks, because family policy does not fit neatly into a single Department. There should be a Cabinet lead and an office for family policy, and every Department should develop a family strategy. The family impact assessment—also known as the “family test”—should be put on a statutory footing. We could do worse than to have one of the Members successful in last week’s ballot pick up the oven-ready Bill that I introduced on this issue in the last Parliament.

However, I am delighted that the Government are committed to championing family hubs, as those are one way in which we can all help to strengthen our local communities and family life within them. What are family hubs? I will not take much longer, Mr Deputy Speaker, but let me say that they are one-stop shops offering a range of support and specialist help to parents, couples and children, aged nought to 19 and beyond. That can include relationships counselling and mental health services, childcare, early-years healthcare and employment support. They provide help with a troubled teen or a carer, and much more. They are backed by the local authority but they work in conjunction with charities and local businesses. They bring together statutory and voluntary approaches and are currently developing in half a dozen towns across the country.

The hubs are proving that they can have significant outcomes, with children and young people feeling safer; families being helped to improve parenting and children’s behaviour; mothers and children having better emotional wellbeing; good lifestyle choices being made; and families being more resilient when shocks occur. We need more of these hubs. Let us avoid the trap of previous Governments, where families remained everyone’s concern but nobody’s responsibility. Let us take up our responsibility as a one-nation Government to fulfil our manifesto commitment to strengthen families and strengthen society.

Oral Answers to Questions

Fiona Bruce Excerpts

Tuesday 29th October 2019 Commons Chamber

[Matt Hancock]

I am very happy to meet my hon. Friend and colleagues from the MS Society. She is right to say that we need to ensure we get the evidence that the clinicians understandably want, and in fact we have committed public funds, through the National Institute for Health Research, to establish clinical trials to develop that evidence base.

[Fiona Bruce (Congleton) (Con)]

7. What steps he is taking to support end-of-life care.

[The Minister for Care (Caroline Dinenage)]

We are absolutely committed to supporting end-of-life care, not only through £4.5 billion-worth of investment in primary and community services but through providing an additional £25 million to palliative care and hospices in 2019-20. Today, I am in a position to announce how the geographical spending of that money will be allocated, and I will be putting the regional breakdown in the Libraries of both Houses this afternoon.

[Fiona Bruce]

What are the Government doing to better resource support for children’s palliative care, including addressing the shortage of specialist doctors and hospice nurses needed to care for children with life-limiting conditions?

[Caroline Dinenage]

We care passionately about the way in which children’s palliative care is delivered. That is why we have increased the children’s hospice grant from £12 million this year to £25 million in 2023-24. We have also seen a nearly 50% increase in doctors working in palliative care medicine since 2010, but the interim NHS people plan will set out actions to meet the challenges of workforce supply and demand.

National Marriage and Mental Health Awareness Weeks

Fiona Bruce Excerpts

Thursday 16th May 2019 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

I beg to move,

That this House has considered National Marriage and Mental Health Awareness Weeks.

It is a pleasure to serve under your chairmanship, Sir David. This year, National Marriage Week and Mental Health Awareness Week fall at the same time—this week. I am grateful to the Backbench Business Committee for allowing debate time to explore the connection between these two issues.

Increasingly, evidence is showing that mental health challenges are exacerbated when we experience relationship difficulties. There is a link between emotional health and wellbeing and mental health and wellbeing. As our most important and closest relationships are within our families, it is not surprising that when they are broken or dysfunctional, there is an increased likelihood of our mental health being affected. Evidence from a variety of sources, which I shall turn to shortly, increasingly demonstrates that.

However, the point of this debate is not just to draw the findings together, but to ask what the Government can do to address the matter through public policy decisions. We are suggesting not that the Government should tell people how to run their lives, but that a little bit of support—often it does not take much if it is provided early enough, whether that means early enough in life or early enough when relationship challenges occur—would help people to build stronger and more enduring relationships and, in turn, help to address the distressingly high level of mental health challenges in our country today, particularly among young people, reaping potentially lifelong benefits for them and benefits for wider society. That, of course, is a key thrust of “A Manifesto to Strengthen Families”, which was launched a year and a half ago here in the House of Commons and which has the support of more than 60 Conservative MPs as well as colleagues from other parties. Some are here today, and I thank them for attending.

At this point, I want to thank the Government, because they increasingly recognise the importance of addressing these issues. They are, for example, addressing poorly functioning relationships through the troubled families programme. The Department for Work and Pensions publication from a couple of years ago entitled “Improving Lives: Helping Workless Families” resulted in £39 million of funding for the reducing parental conflict programme, which focuses specifically on the couple relationship and on conflict that falls below the domestic violence and abuse threshold, but which means that parents need help to communicate and relate to each other. There is increasing recognition of the need to improve inter-parental relationships, as a primary influence on children’s long-term mental health and future life chances. I therefore welcome what is being done. Of course, it is geographically limited and, in terms of funding, will not reach all those who need the help and need it now.

It is also encouraging that the Government have committed some £90 million to addressing mental health problems in young people—probably, my right hon. Friend the Minister for School Standards tells me, with a particular view to providing mental health nurses in schools. However, the impact of that investment, as I have said to the Minister, will never be as it could be if those professionals worked not only with the children involved, but with their families. So often, the relationship issues within the home mean that families are the source of the mental health challenges that children bring into school. Unless the whole family are worked with, helping the child in school and then sending them back to the source of the challenges will never resolve the problem.

I want to divert for a few moments and commend a charity called Visyon, which it has been my privilege to be patron of for many years. A mental health charity based in my constituency of Congleton, it supports children and young people from the age of four when they have mental health challenges and it provides help right across Cheshire East and into north Staffordshire.

I am grateful to the chief executive for providing me with some pointers for today’s debate, which I shall summarise. The document states:

“The Government’s Green Paper, Transforming Children and Young People’s Mental Health Provision, recognises the important role that the voluntary and charities sector will play in the formation and delivery of support to schools and colleges. With an ever increasing demand for specialist NHS mental health services for children and young people, it will be vital that schools are able to identify the most appropriate interventions or services to prevent the escalation into costly specialist provision, where possible.”

I shall refer to one area of intervention where the charity works as a priority, which is with parents, but first I shall give a few statistics from Visyon. It says that three in four mental illnesses start in childhood, 75% of young people with a mental health problem are not receiving treatment, and the average wait for effective treatment is 10 years. It also says that UK funding for mental illness research equates to just £8 per person, compared with £178 for cancer and £110 for dementia.

The document that I have from the charity states:

“Visyon’s approach is to look at mental health holistically and provide interventions that involve and impact on all aspects of the…young person’s life…When a young person is struggling with their mental health it has a huge impact on the whole family. Parents are often desperate to support their children but…end up feeling lost, isolated and under skilled…At Visyon we approach our mission to improve a child’s mental health in a holistic way…parents can be a child’s biggest resource.”

Visyon runs a “Parent Empower Hour” programme and states that in a recent evaluation of it,

“parents were asked how family dynamics had changed since taking part in the group. Comments included ‘Our house is so much calmer. I feel less angry and overwhelmed’ and ‘I have found even ground now. I feel more in control and I know this is what my daughter needs’.

There is a conscious focus in Parent Empower Hour to encourage parents to look after their own wellbeing. This serves two purposes—it is important to model to children the importance of self-care and it recognises the emotional toil of caring for children who are struggling with their mental health. One parent commented ‘I have learned to look after myself more and not feel guilty about it. This makes it easier to cope when difficult situations arise.’”

It is encouraging that the Government recently launched their new relationships and sex education in schools curriculum, which requires an emphasis on building healthy relationships. The regulations recently passed by both Houses require that pupils learn about the nature of marriage and civil partnerships and their importance for family life and the bringing up of children; safety and forming and maintaining relationships; the characteristics of healthy relationships; and how relationships can affect physical and mental health and wellbeing.

I am delighted that my right hon. Friend the Secretary of State for Education has made the points for me in his foreword to the documentation that launched this. In his foreword to the guidance, he says:

“In primary schools, we want the subjects to put in place the key building blocks of healthy, respectful relationships, focusing on family and friendships, in all contexts, including online. This will sit alongside the essential understanding of how to be healthy. At secondary, teaching will build on the knowledge acquired at primary and develop further pupils’ understanding of health …Teaching about mental wellbeing is central to these subjects, especially as a priority for parents is their children’s happiness.”

I welcome all that the Government are doing, because that work is crucial, but much more needs to be done. We need to recognise that, just as fractured family relationships can affect the emotional wellbeing and, in turn, the mental health of us all, the impact on the mental health of children growing up and experiencing poor or broken family relationships from an early age can be lifelong.

How can Government help people in the earliest stages of life? I will review a number of recent studies on this issue, not all of which come from organisations that have what might be called a vested interest in the subject. Relate—the relationship people—cites the Early Intervention Foundation’s statement that the inter-parental relationship is a “primary influence” on children’s life chances. In particular, frequent and intense unresolved inter-parental conflict is highlighted as a key factor affecting children’s long-term health and wellbeing.

A 2017 Office for National Statistics survey, no less, showed that children aged between two and 16 who are living in families that struggle to function well are more likely to have mental health challenges than are children from healthy, functioning families.

Interestingly, just today The Times has published details of the latest 2019 ONS survey, under the headline:

“The key to happiness? Eat, drink—and be married”.

The article says that according to research published by the ONS just yesterday on relationships, married people gave the highest score when asked to rate their life satisfaction out of 10, as compared with those who are not married. Researchers looking at data from 2017-18 found that marital status has overtaken economic activity—for example, whether someone is in work—as the most important factor contributing to happiness after good health. That is good news in National Marriage Week, and from an unlikely source.

I will turn to other sources. The National Childbirth Trust says that new mothers may experience multiple mental health problems during pregnancy or after giving birth, including post-natal depression, as we know, as well as anxiety, eating disorders, obsessive compulsive disorder and post-traumatic stress disorder, with suicide the leading cause of direct maternal death after the first year following pregnancy. However, the NCT says that there is no requirement in the six-week maternal check, which mainly focuses on the baby, to include a check on the emotional health or wellbeing of the mother. NCT research shows that nearly half of new mothers’ mental health problems are not picked up by a health professional.

Also, as the National Society for the Prevention of Cruelty to Children says in “All Babies Count: The Dad project”, the role of fathers in supporting mothers can have a significant influence on improving the mental health outcomes of mothers after they give birth. Such early support is critical because parental mental health is a key factor in understanding the mental health of children.

Research by the Marriage Foundation found that family breakdown also has a major impact on teenagers’ mental health. Although its statistics showed that one in five 14-year-olds with a mental health problem live in an intact married family, just under double that number—two in five of teenagers with mental health problems—were the children of parents who live apart and had never married.

The Marriage Foundation also recently conducted an evaluation of factors affecting teen mental health, using data from the millennium cohort study of young people who are now aged about 14 or a little older, who were born around the millennium. The Marriage Foundation report suggests that family breakdown is the biggest factor behind the UK’s child mental health crisis. Its analysis of almost 11,000 families found that having parents who split up was the strongest influence on girls’ mental health in their teenage years, with strong links to emotional problems. It was also the joint strongest factor, alongside relationship happiness, in teenage boys’ mental health, with strong links to behavioural problems.

ChildLine’s latest annual review cites family relationships as the second leading reason why children contacted the service to talk. The Samaritans says that divorce increases the risk of suicide, because the individual becomes disconnected from their domestic relationships and social norms, and that those who divorce may experience a deep sense of “emotional hurt”.

The Mental Health Foundation kindly provided me with a briefing for this debate, entitled, “Relationships in the 21st century: the forgotten foundation of mental health and wellbeing”. The Mental Health Foundation says that people who are more socially connected to family, friends or community have fewer mental health problems than people who are less well connected. It also states that, as I have said, conflict within the family environment impacts negatively on the mental health of children within the family, and the negative effects can be felt across the whole of life’s course.

The Mental Health Foundation’s briefing says:

“The family relationship environment in pregnancy, infancy and childhood is of fundamental importance to future mental health. This is only now starting to be fully appreciated as the neuroscience of brain development is becoming known and being seen to support understanding gained through observational studies of human beings and their mental health.”

In this respect, I commend the Leader of the House, because she has set up a working party of Ministers to look at helping families with children in their very earliest years—the first 1,001 days of life. This subject needs to be focused on more closely by Government, so I am very pleased that my right hon. Friend has done that and I look forward to reading her report, which will come out soon, about what Government can do to support those early days, although of course there is a lot more that needs to be done in later childhood, and indeed in adulthood.

The Relationships Alliance concludes that relationships are a vital public health concern, stating:

“Evidence shows that the quality of our couple and family relationships is linked directly to specific areas of public health concern. Such areas include cardiovascular disease, child poverty, alcohol/substance misuse, depression and mental health, obesity/child obesity, children’s mental health/cognitive development, and infant attachment.”

Of course, the first attachment that we make with others is with our parents; that relationship is one of the most important in all our lives. Positive and secure attachment is important for positive emotional and social development, with children being able to adjust better to adversity and change; to use a favoured word now, they are more “resilient”. By contrast, insecure and disordered attachment relationships in early childhood are associated with depression, anxiety, self-harm, suicidal tendencies and post-traumatic stress disorder, among other mental health problems.

Living with parents who divorce before their child is 18 has now been assessed as an adverse childhood experience, or ACE, for that child. Having one or more ACE increases the risk of a child experiencing depression, poor academic achievement, time in prison or sexual violence, among other negative outcomes. As the Mental Health Foundation says, toxic relationships and negative experiences can have a serious impact on a young person’s mental health.

We should bear it in mind that our children are growing up in a country that has one of the highest levels of family breakdown in the world; indeed, the UK now has the highest divorce rate in Europe, such that nearly half of all our teenagers do not live with both their parents. This is a massive issue, as we also know from those who work in schools, colleges and universities, where supporting young people with mental health challenges is now a major concern.

Why am I referring to all this during National Marriage Week? Because it is not just the quality of the parents’ relationship that matters; it is also being increasingly recognised that the stability of the parents’ relationship matters, if that relationship endures through a child’s childhood. That is important not only for the children, but for the adults within that relationship. As the Centre for Social Justice says:

“Family environment is crucial to children’s outcomes. It is the instability and disruption caused by family breakdown, coupled with poor parenting, that is so damaging to their outcomes.”

Therefore, one of the factors that promotes wellbeing is stability in family relationships, and all the evidence shows— we cannot avoid it—that marriage, as opposed to cohabitation, is much more likely to endure and to promote stability. Just one married couple in 11 splits up before a child’s fifth birthday, compared with one unmarried couple in three.

The CSJ produced a substantial new report just last month, entitled “Why Family Matters—A comprehensive analysis of the consequences of family breakdown”. Before I give Members the statistics, and people reject the comments made in that report as the mere opinions of those who have an interest in promoting such arguments, I will clarify the methodology that has been used. These statistics have been calculated using a sophisticated methodology known as logistic regression. I know; I had never heard of it before, either. That means that the influence of other demographic attributes such as gender, age, socioeconomic grade and ethnicity, as well as experience of social issues, are controlled for. The result is that the statistics arrived at are a true reflection, in this case, of the impact that family breakdown has on the life of a young person.

Here are some of the statistics that the report has produced: those who experience family breakdown when aged 18 or younger are over twice as likely to experience homelessness; twice as likely to be in trouble with the police or spend time in prison; almost twice as likely to experience educational under-achievement, not being with the other parent of their children, alcoholism, teenage pregnancy or mental health issues; and more likely to experience debt and living on benefits. Surely those statistics alone should persuade us that Government should be doing much more to address family breakdown. The cost of not doing so is too great, not just in financial terms—although that cost is huge, far more than the £51 billion often quoted for tackling these issues, which are the consequences of family breakdown—but, tragically, in terms of the lost life potential of the millions involved.

The CSJ states that one adult in 10 who experiences mental health issues says that family breakdown was a contributing factor. Put simply, the CSJ says:

“Marriage leads to the better mental health of children. Children of married parents are more likely to achieve at school, less likely to use drink and drugs and less likely to get involved in offending behaviour.”

Marriage reduces the risk of violence and abuse, and the CSJ states that marriage is more enduring and stable than just living together:

“Marriage is directly linked to better mental and physical health amongst adults, the same benefits are not found amongst co-habiting couples. It is specifically a marriage effect.”

This is very much a social justice issue. Better-off people get this; they get married in far greater numbers than poorer people. Poorer people do not marry as much, and therefore are the ones who sadly experience the consequences of breakdown that I have described. That is not social justice, and it is a key reason that we need to address this issue.

Those tragic, heartrending consequences for millions of young people surely cry out for Government to prioritise supporting all of us to build healthy, close personal relationships, just as no one now blinks when Government recommend that we should eat healthier so that our physical wellbeing is maintained and improved. The steps that we can learn for improving our close personal relationships are not that complicated—I will mention a few shortly—but the benefits we can all glean are unquantifiable. If we can strengthen our emotional wellbeing, we can help to protect our mental health. Not just children in school who are learning through relationships and sex education, but all of us who are learning about relationships capability, would benefit.

The term “relationships capability” has been given to me, and very well promoted, by the organisation Soulmates Academy. About two weeks ago, its founders came to speak at a meeting of the all-party parliamentary group for strengthening couple relationships and reducing inter-parental conflict. That organisation says that we have ignored investing in relationships at our peril. It provides courses and helpful advice on relationships capability to individuals and groups, as well as corporate organisations, which increasingly understand the beneficial effect of relationships capacity on productivity. As Soul- mates Academy says, building a stronger relationship need not be complicated; its relationship tips can be summarised as follows:

“BE CURIOUS, not critical…BE CAREFUL, not crushing... ASK, don’t assume…CONNECT, before you correct”.

I recommend its website for more information.

The Mental Health Foundation also provides tips for building and maintaining stronger relationships, which again can be summarised. It says that there are five things we can do: make more time to connect with our family; try to be present with them, not always on our phone; actively listen in a non-judgmental way; concentrate on the needs others are expressing; and express our own feelings honestly. It says:

“As a society and as individuals, we must urgently prioritise investing in building and maintaining good relationships and tackling the barriers to forming them. Failing to do so is equivalent to turning a blind eye to the impact of smoking and obesity on our health and wellbeing.”

People are with us. In a recent YouGov poll carried out for Relate, the relationships charity, no fewer than 99% of people agreed that strong and healthy couple relationships are important to a person’s physical and mental wellbeing—I am sure that any colleague in the House would love a poll that was 99% in their favour. That is why Government need to invest much more in helping all of us to develop our relationship capability. Supporting organisations such as Soulmates Academy to do so would be a good start during National Marriage Week. As that organisation says:

“If we agree that our committed, long-term personal relationships & marriages are actually what anchor us in life and allow us to go on to achieve our potential, what are we doing to invest in them and build skills to develop them?”

We need a national strategic approach to strengthening families. We have a dedicated Minister for loneliness; why not one for relationships? A coherent strategy across Departments, led by a dedicated Minister at Cabinet level, would be very helpful in ensuring that relationships and families were supported at all stages and ages in life, not just when they run into trouble.

Such a Cabinet Minister could promote all the other policies in the manifesto to strengthen families, including the development of family hubs in local communities where that kind of relationship help could be made available. I am pleased to say that those hubs are springing up in different areas across the country, and the launch of the family hubs network to connect the growing number of hubs in local authorities will happen in Parliament’s Jubilee Room on 5 June. I hope the Minister, all colleagues and all those who have come to listen to today’s debate will attend.

--- Later in debate ---

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

Thank you, Sir David. I am sure you do not want to listen to me until 4.30 pm; in fact, I know very well that you do not. It is a pleasure to be here with you this afternoon.

I have really enjoyed listening to this debate. There have been some compelling arguments on a subject that we do not really discuss very often, yet it is the foundation of our society. This debate is a welcome opportunity to do that. Certainly, listening to all hon. Members’ remarks, I was given considerable food for thought, so I shall do my best to address the points that were made. I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on securing the debate and on having the imagination to bring together National Marriage and Mental Health Awareness Weeks.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) talked about who might have responded to the debate were it not for the reference to mental health, which is an interesting question. Various Departments have an interest, including the Department for Work and Pensions, the Department for Education where the issue affects children, my Department where it impacts on mental health, the Ministry of Justice where it might lead to offending behaviour and the Ministry of Housing, Communities and Local Government in so far as it might lead to addiction.

This all comes back to the state delivery of services and how it tends to rely on a uniform process, yet we are dealing with human beings. If they require support, a one-size-fits-all, tick-box approach will not necessarily be effective in all cases. To be honest, when we see people whose adverse childhood experiences have led them to harm either themselves or others, I view that as a state failure. Perhaps we ought to look at the drivers of child poverty and see whether we can ensure a more effective Government response. When I sit on various cross-departmental working parties looking at domestic violence, mental health or knife crime, I often think they could all be brought together to look more holistically at the children who need early intervention. We need to get much better at that.

Obviously, how we raise our children and family relationships are crucial to how they turn out. We know that for some people, particularly those living in poverty or with an addiction or those who suffer stress, life can be hard. It ought to be available to us to give people extra help. My hon. Friend the Member for Congleton referred to the troubled families programme in her opening remarks. The ethos behind the programme was to support the families that needed extra help. We need to learn from that programme to see what works best so that we can do things better. That is very much in our thinking.

My hon. Friend also talked about some of the initiatives that we are already taking with respect to mental health and highlighted the new mental health teams that we are creating. She suggested that the teams need to work not only in schools but in families. Sir David, you heard me speak about the Charles Dickens primary school in Southwark in another meeting. I visited it as we were developing our thinking on the new support teams, and it had taken a very imaginative approach to embedding mental wellbeing throughout the school and the curriculum. Instead of having teaching assistants in the classroom assisting, the teaching assistants were doing one-to-one interventions with children. As well as one-to-one tuition, some of them were involved in reaching out and building relationships with the parents. Our school network is exactly where we ought to be able to identify the people who need a little more help.

[Fiona Bruce]

I am delighted to hear that. I do not know whether the Minister has heard of a similar approach taken by Middlewich High School in my constituency, but what is excellent about that is that the school is now reporting improved GCSE results because it works not only with the pupil, but with the whole family.

[Jackie Doyle-Price]

As my hon. Friend says, it is not rocket science. If someone is physically, mentally and socially fit, they will have a feeling of wellbeing overall. If any of those pillars falls down, it drags down the rest. If people have a happy environment at home, they will be happier in school and more disciplined and focused. If they live in a dysfunctional environment, they will want to escape, and that will not be good for their GCSEs or anything to do with their long-term development.

[Fiona Bruce]

Will the Minister allow me to intervene again? I do not want to interrupt too many times.

[Jackie Doyle-Price]

We have plenty of time.

[Fiona Bruce]

Yes, so we have heard from Sir David. Corporates are also realising how important this is to the bottom line: productivity. If people arrive at work having left a happier home, they will be more productive, which is an interesting factor to consider if we multiply it across the nation. It is fascinating that we have one of the highest levels of family breakdown in the world, but also low productivity compared with many of our competitor countries. The Minister touches on that when she talks about the flourishing of a human being in terms of relationships and productivity, which are not disconnected.

[Jackie Doyle-Price]

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

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

--- Later in debate ---

[Fiona Bruce]

I am sure, Sir David, that colleagues were relieved and impressed by your astute wisdom in announcing after I had spoken that the debate could continue for longer. I thank all hon. Members who spoke, and I particularly thank the hon. Member for Strangford (Jim Shannon) and my hon. Friend the Member for South West Bedfordshire (Andrew Selous) for their thoughtful contributions. I was very pleased to hear the Minister respond in such a constructive way. Her tone, as well as her words, said a lot when she recognised both the impact of family relationships on mental health and the fact that more needs to be done.

I thank the Minister for not sticking to her notes, but instead responding so thoughtfully to so many of the comments that were made. As we have heard—it is a matter of social justice—there is a real need to put strengthening relationships at the heart of Government policy, nationally and locally, to provide joined-up support for families. As the Minister said, the troubled families initiative has started to do that.

As the Minister also said, we need to better support the many excellent voluntary organisations engaged in this area. Crucially, today we have also recognised the importance of marriage in helping to address the country’s major mental health problem. As Members have said, that is not in any way to criticise or condemn those whose home circumstances are different—far from it. We are saying that building relationship capability is for all of us, because we all aspire to have beneficial and flourishing relationships in our lives. We know their benefits.

I was particularly interested to hear the Minister say that because these issues straddle so many Government Departments, and because of the processes and the way that Departments work in silos, addressing them is quite a challenge. That is exactly why the proposal of a Cabinet Minister for the family, to draw together the work on such issues across Departments and support people more effectively, is so important. I close by saying that after the authoritative and compassionate speech that he gave today—it represented the tip of the iceberg of many years’ work on this issue—I cannot think of any hon. Member who would better fill that role than my hon. Friend the Member for South West Bedfordshire; I hope the Minister will forgive me for saying so.

Question put and agreed to.

Resolved,

That this House has considered National Marriage and Mental Health Awareness Weeks.

Oral Answers to Questions

Fiona Bruce Excerpts

Tuesday 26th March 2019 Commons Chamber

[Caroline Dinenage]

The Government take this very seriously. The NHS long-term plan sets out priorities for the NHS, and deaths from respiratory disease is a key indicator and an absolute priority. However, it is only right that people who can afford to pay for their prescriptions, like me—I am an asthma sufferer and I can afford to do it—do so. Local areas have to decide those priorities. At the moment, 90% of prescriptions are free.

[Fiona Bruce (Congleton) (Con)]

Can Ministers outline the latest steps to support the children of alcohol-dependent parents? In the forthcoming alcohol strategies, will greater support be promoted for the families of alcoholics, who are often best placed to help to reduce alcohol harm in their loved ones?

[Matt Hancock]

Absolutely. My hon. Friend is right to stress the role of families in supporting the children of alcoholics. We made progress on that and were able to announce funding just last week. I pay tribute to my hon. Friend the Member for Winchester (Steve Brine) for all his work—I enjoyed doing it with him—to do everything we can to support the children of alcoholics.

Community Hospitals

Fiona Bruce Excerpts

Tuesday 12th March 2019 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I was pleased to note that on announcing his long-term plan for the NHS, the Secretary of State for Health and Social Care said he is a strong supporter of community hospitals, so I am today asking if Health Ministers will kindly look into how some of the additional resources announced with the long-term plan can be earmarked for the community care provided by community hospitals, such as the much loved Congleton War Memorial Hospital in my constituency.

Congleton Hospital needs sufficient resources to ensure that it can continue to provide the all-round services it has already provided for several generations of my constituents for generations to come. The hospital is much valued locally, providing a range of services, such as the minor injuries unit, which saves residents travelling some distance to hospitals further afield with A&E facilities. Minor injuries such as burns, cuts, splinters and sprains can be treated quickly and efficiently at Congleton. As one person, who sustained a hand injury, told me:

“I popped down to Congleton Hospital, the wound was treated straight away and I was back at work within the hour.”

That person would have lost at least half a day’s work travelling for treatment elsewhere.

In recent winters, the minor injuries unit has, on occasion, been closed temporarily by East Cheshire NHS Trust, with staff redeployed to Macclesfield’s A&E. Then, in September 2018, the trust stated that it expected closures to be in place throughout weekends and bank holidays, plus ad hoc weekdays, throughout this winter. As a result, the minor injuries unit is currently scheduled to open only between 9 am and 5 pm from Monday to Friday, but with additional ad hoc closures within these hours. It was not open, for example, when I visited last Friday afternoon.

It is therefore not surprising that some people in need of urgent treatment decide not to risk calling at a unit that may be closed unpredictably, with user numbers no doubt affected accordingly. It is also understandable that these closures are causing grave concern among local people. On their behalf, I am calling on Ministers to ensure, please, that resources are put in place so that valuable community hospital facilities such as Congleton Hospital’s minor injuries unit are not only stabilised but strengthened.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this issue to the Chamber. I spoke to her beforehand to ask what her thoughts were on this issue and how I might helpfully intervene. I spoke to the Minister, too. In the past few weeks, the national and provincial press have highlighted a number of incidents in hospitals. They report NHS staff referring to “war zone” conditions in A&Es. The community hospitals the hon. Lady refers to are vital for the treatment of patients, but it is also good for the mental health of NHS staff to have hospitals where they can do their job—their duty—without facing any injury or threat to their life.

--- Later in debate ---

[Fiona Bruce]

The hon. Gentleman is right, as he so often is. Where they are properly resourced, minor injuries units can help relieve A&E facilities and enable them to treat more serious injuries more efficiently.

More broadly, the wide range of local healthcare services at Congleton Hospital includes a 28-bed in-patient intermediate care ward called the Aston unit, which is particularly appreciated by local families visiting patients. As the hospital’s website states, that unit helps those who no longer need the more acute wards of Macclesfield District General Hospital, relieves services there and allows people to

“recover in a homely and relaxed environment”

in Congleton. The website adds that the hospital

“has a very ‘family’ feel about it.”

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

The hon. Lady is making a wonderful point about the value of community hospitals. In north Staffordshire, Bradwell Hospital, Haywood Hospital and Leek Hospital all provide excellent care, but my clinical commissioning group is consulting on closing those hospitals and reducing bed spaces. Does she agree that closing community hospitals is detrimental to the overall impact of our health economy? Exactly as she says, such hospitals free up more expensive acute beds in the big hospitals and allow people who are medically fit for discharge but are not ready to go home to get the care they need.

[Fiona Bruce]

I am sure the Minister will have heard what the hon. Gentleman has said. Indeed, that is why I entitled the debate “Community Hospitals” rather than simply “Congleton Community Hospital”.

As I have said, the hospital at Congleton has a family feel. I can testify to that following my most recent visit, just last week. I met kindly nursing staff who were clearly dedicated and committed to serving the community in and around Congleton, and who were proud to tell me that they had, through sound management, recently achieved an increase in the number of in-patients treated. About 350 are currently cared for each year in the Aston unit.

In addition to the minor injuries unit and in-patient care facilities, the hospital provides out-patient clinics, with approximately 9,000 out-patient attendances each year in a wide range of specialties. For instance, there are about 1,600 appointments a year for adult audiology treatment and about 1,000 for general surgery, and a similar number of gynaecology treatments. There are also about 2,000 trauma and orthopaedic appointments. Other services include blood tests, occupational therapy, a physiotherapy gym, district nursing, dementia services, and a highly popular GP out-of-hours service.

[James Heappey (Wells) (Con)]

In my constituency, Burnham On Sea War Memorial Hospital, West Mendip Community Hospital and Shepton Mallet Community Hospital do so much of the great work that my hon. Friend is describing. Does she agree that in areas where the main hospitals are somewhat distant—in my case, Bristol, Yeovil, Taunton or Bath—community hospitals are vital in filling that gap, and it is essential for them to remain a core part of our future NHS?

[Fiona Bruce]

My hon. Friend has made one of my points for me. None of the major hospitals in east Cheshire lie within my constituency, although it is reasonably large, so my constituents must travel some distance to use their services.

I have mentioned the four-hour GP appointments on Saturdays and Sundays. They are always full, and are meeting a very clear local need. The convenience of such services cannot be overstated. During my visit, an elderly gentleman, clearly frail, arrived asking for directions to the X-ray department. I watched as he was directed to it immediately. He was seen, and he departed. All that happened within what seemed to me to be about three minutes flat.

The value of such local services for a population like mine, which contains a higher than average number of older residents, cannot be overstated. They are particularly appreciated by those who are less mobile owing to age or infirmity, or for whom a lack of convenient public transport facilities would make travel to the larger hospitals outside my constituency very difficult, if not impossible. Moreover, 9,000 fewer out-patient appointments across east Cheshire must reduce congestion.

The trust informs me that the Congleton Hospital site also has space for use by other NHS organisations, including providers of mental health and health visiting services. As local health partners and providers increasingly work together in support of their local communities’ health and wellbeing, Congleton Hospital, located as it is almost in the centre of the town, is ideally placed to become an even more strategic community health hub for additional services.

[Karin Smyth (Bristol South) (Lab)]

The hon. Lady is making a powerful speech on behalf of community hospitals. South Bristol Community Hospital was opened only in 2012, after 60 years of campaigning by local people. As three providers run different services in it and as it is a LIFT building, no one is really responsible for making it work. Does the hon. Lady agree that the health service must bear in mind that such hospitals are developed and fundamentally loved by their communities, and that those communities should have the ultimate say in what goes into them?

[Fiona Bruce]

The hon. Lady is absolutely right. Indeed, members of the community in Congleton are speaking out about the importance to them of their community hospital. I shall say more about that shortly.

On behalf of my constituents, I am pressing Ministers to consider resourcing Congleton Hospital as a community hub going forward. It has a very special place in local people’s hearts, as I have said, not least because of the manner in which it was funded many decades ago by local people’s contributions from wage packet deductions. It was founded in 1924 by public subscription as a memorial to those locally who gave their lives in the first world war, hence its full name: Congleton War Memorial Hospital. I spoke at greater length about this here in this place in 2014, when I raised concerns about the future sustainability of the hospital, so this is by no means a new issue. Indeed, in 1962 when there was a suggestion that the hospital be closed, it resulted in a mass meeting in the town hall with an overflow of some 2,000 residents, presided over by the then mayor leading to a petition of 24,000 signatures. Plans were quickly dropped. More recently, the £20 billion additional funding announced by the Prime Minister for investment in the NHS surely offers an opportunity for the future of the hospital to be secured, or even augmented as a community hub for the long term.

I have been in continuing dialogue for some months now with—and have met, together with local councillors—John Wilbraham, chief executive of the local NHS trust responsible for the management of the hospital, the East Cheshire NHS Trust. I am grateful to Mr Wilbraham for that open dialogue. We spoke again recently when he confirmed that, in his words, the sustainability of the site is on the agenda for the transformation programme to be discussed by the trust shortly. So also on the agenda is the future of the minor injuries unit, which is, as I have mentioned, causing particular concern to residents, as the trust is aware from recent public demonstrations which involved people from right across the community and political divides, including me and Congleton town mayor Suzie Akers Smith, who was in full mayoral regalia and chain.

I am grateful that Mr. Wilbraham has agreed to meet a cross-party group in the town shortly to discuss the hospital’s future further and look forward to that meeting. In the meantime, for the record I note that in his most recent letter to me of late December 2018 he confirmed, and I welcome this, that

“the Trust has no plans to change the service provision at the Congleton Hospital site and this remains the case. I continue to discuss with health and social care partners about the service offer from the hospital site and I understand the desire of you and the local population to maintain the facility. We await the publication of the NHS 10-Year Plan in early 2019 which provides the basis for the local health partners, including the town’s GPs, to set out its plans for the next 5-10 years. I am certain this will provide the opportunity to be clear on future service provision across the local health economy including Congleton.”

I am optimistic that both Mr. Wilbraham, as its chief executive, and the trust itself have listening ears. We need only witness the furore that arose in Congleton three years ago when there was a suggestion that car-parking charges be introduced at the hospital. The trust clearly registered the indignation of local residents, not least through a petition I presented here in Parliament at that time. That they could be asked to pay to park at their own hospital—a hospital they and their forebears had paid for by both wage packet deduction and subsequent fundraising and donations over the decades—aroused considerable consternation. The trust subsequently discounted the suggestion of car park charges outright; it listened to local people’s concerns.

I was pleased to note the chief executive’s reconfirmation of this in his most recent letter to me, with the words:

“I note the suggestion of car parking charges being introduced to supplement the income for the hospital site but this is not something the Board will be considering.”

Now that the 10-year plan has been published, and in the light of the Secretary of State’s indication of his support for community hospitals, I am today asking the Minister what more can be done to ensure that vital services provided by community hospitals in the heart of our local communities, like Congleton, are not swallowed up by larger hospitals at a distance. What the Congleton community seeks is reassurance that the future of Congleton hospital is put on a firm, clear and sustainable footing going forward, so that the periodic recurring concerns over the years about its future can be fully and finally put to rest.

Mental Capacity (Amendment) Bill [Lords]

Fiona Bruce Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

There is still much to do to improve this deeply flawed Bill. I hope that the Minister and other hon. Members will take this opportunity today to improve the Bill by passing our amendments so that we can improve the safeguards for vulnerable people.

[Fiona Bruce (Congleton) (Con)]

I rise to support the Bill and, in particular, to speak in favour of Government amendments 24 and 33.

Before I do so, let me respond to some of the points that have already been made. First, with regard to the timescale in which the Bill is being taken forward, there has been plenty of opportunity for colleagues to look at its details. I draw Members’ attention to the fact that there have been not just one but two detailed reports on this issue by the Joint Committee on Human Rights, one in June 2018—our seventh report of this Session—and then, in October 2018, our 12th report, in which we considered the draft Bill in some considerable detail. At that point, we welcomed the recommendations of the Law Commission. Of course, the Law Commission had itself been some three years in preparing its recommendations, so the Bill can hardly be described as rushed.

[Steve McCabe]

Does the hon. Lady recognise that the Law Commission objects to the fact that its recommendations were not taken up by the Government when they constructed the Bill?

[Fiona Bruce]

I was about to say that the Joint Committee welcomed the Law Commission’s recommendations because they clearly highlighted the need for changes to be made.

As we pointed out in our seventh report, as far back as last June, the Cheshire West case that the Minister mentioned had resulted in a 10-fold increase in the number of DoLS applications. That is why there has been such a backlog. That case placed extreme pressure on local authority resources. Some 70% of the almost 220,000 applications for DoLS authorisations in the year up to our report were not authorised within the statutory timeframe. Consequently, many incapacitated people continued to be deprived of their liberty unlawfully. Those responsible for their care, or for obtaining authorisations, were having to work out how best to break the law. That is completely unacceptable, and it is why this Bill needs to brought forward in a timely way.

There also needs to be, as the Committee recommended in our 12th report, a definition in the Bill. I hear colleagues’ reservations about that definition, but, as we said—I am glad that the Government took up our recommendation—that it is important to give cared-for people and their families, and professionals, greater certainty about the parameters of any scheme so that we can ensure that scrutiny and necessary resources are directed where needed. We said:

“It is undeniable that any definition in statute may be refined by future case law”.

That remains that case. None the less, not to have endeavoured to provide a definition would, we believe, have been wrong.

Having made those preliminary comments, I will speak in more detail about amendment 24 and expand on the remarks made about the importance of family engagement and keeping the family informed. Information for the family and those who care deeply about the welfare of the person is the cared-for person’s greatest safeguard against exploitation and bad care. It is paramount that families have a role to play in their relatives’ care planning, wherever that is desired by the cared-for person, not least by giving them the option to stay fully informed and to object to proposed plans if they are not satisfied.

Families can play an important role in monitoring care if they are given sufficient information. The care itself is important. The quality of care will vary between and within care homes, but monitoring the care plan is essential to ensure that the cared-for person’s dignity is maintained. The cared-for person’s quality of life depends on how they are treated day in, day out and whether they receive care in a way that enhances their personal dignity or whether, sadly, they are treated less well.

Families are well equipped to monitor care, but only if they are kept informed. That is why I support amendment 24, which improves access to information for the cared-for person and their appropriate carers and supporters, which may well include their family. The requirement for information to be

“accessible to, and appropriate to the needs of, cared-for persons and appropriate persons”,

means that the cared-for person is placed at the heart of the liberty protection safeguards authorisation process. Not only that, but now that relatives can be informed about their loved one’s care plan, they will notice if the plan states something that is not happening and question why.

I am pleased to see that the amendment requires the publication of information on the cared-for person’s rights and the circumstances in which it might be appropriate to request a review or make an application to the court. People must know what their rights are and the legal procedures. This will not be costly. It will certainly be far less costly than the court cases that are likely to come if the requirement to provide information about all aspects of the process and the plan are not on the face of the Bill. It will save costs in the long term and ensure that the approved mental capacity professionals act always as they should.

The code of practice will play an important role. It would be helpful to see examples of family members working with the responsible bodies and the care teams to ensure that care plans are being delivered appropriately and are in the best interests of cared-for individuals. I am sure we all want to see that.

I turn to amendment 33. In the JCHR’s 12th report, we indicated that there has been concern as to

“whether care home managers have the necessary skills and knowledge to arrange or undertake the assessments and whether they are sufficiently independent to do so”

and whether care home managers are

“trained and resourced to take on these additional responsibilities.”

It is heartening to hear that the Government have listened and are clearly stating that care home managers and staff should not, and under these proposals will not, complete assessments. It is equally heartening that the Government, having listened to concerns expressed in Committee, are saying that all those doing such assessments must have the necessary skills, knowledge and qualifications—for example, as physicians, nurses or social workers—and that that will be specified in regulations. I want Ministers to put in place appropriate arrangements to assess whether implementation of this element of the Bill is working well—for example, to ensure that specifications of required qualifications and the experience of assessors are kept updated and that the revised system is working well and without difficulty in practice.

Ministers might consider taking up the recommendation in the JCHR’s 12th report that particular vigilance should be exercised by local authorities where care homes are rated by the CQC through an inspection as inadequate or requiring improvement, to ensure that those who are making referrals are properly competent to do so.

--- Later in debate ---

[Fiona Bruce]

The hon. Gentleman keeps talking about human rights, but what answer does he have for the fact that up to 125,000 people are currently being unlawfully deprived of their liberty, in breach of article 5 of the European convention on human rights? That is the problem that the Bill seeks to rectify.

[Mr Dhesi]

I thank the hon. Lady for her intervention, but in terms of human rights, this issue is being raised not just by me, but by more than 100 pre-eminent organisations in the field. The only way to solve that is through funding—that is the only way in which we can lay this matter to rest. The hon. Lady highlighted the 2017 Law Commission review of the deprivation of liberty safeguards, which stated that the current regime is

“in crisis and needs to be overhauled.”

I agree. There is a crisis and the current system cannot cope, but surely the answer is not to replace bad laws with yet more bad laws, and that is what we are in danger of doing.