Social Care
Jackie Doyle-Price Excerpts(6 years ago)
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The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
I should open with a thank you to those Members who have made some very thoughtful contributions to today’s debate. We recognise the challenge we face, and the hon. Member for Central Ayrshire (Dr Whitford) put it most strongly when she said that it is the result of something very positive: that we are all living longer. That requires some serious strategic thought about how we fund social care. It is in that spirit that we are rising to the challenge.
Both Opposition Front Benchers, the hon. Members for Worsley and Eccles South (Barbara Keeley) and for Denton and Reddish (Andrew Gwynne), expressed their dissatisfaction with the speed with which we are pursuing these reforms, but it is important that we get it right and that we take people with us. With that in mind, we have put together an advisory group to work with on the reforms. The whole sector is co-operating with us and actively contributing to the debate, because it more than anyone recognises the need to fix this and get the solutions right. I make no apologies for the fact that we are where we are now, but we are well down the track with the process. In the spirit of cross-party consensus that I have heard a lot about this afternoon, I will not get into some of the partisan points that have been made, but I want to set the context of where we are with the debate. When we introduce the Green Paper, I hope it will be received in the spirit of the comments that we have heard from most hon. Members today.
Debbie Abrahams
The Minister who opened the debate was unable to respond to my question, so I will repeat it to this Minister. What assessment have the Government made of the impact of social care cuts on the ability of disabled people to live independently, and will she apologise to those disabled people for what the UN has described as this Government’s “grave and systematic violations” against disabled people?
Jackie Doyle-Price
To be frank with the hon. Lady, one of our priorities is to make sure that disabled people can live independently for longer. That is very much a central part of our approach and we are making more money available for it. [Interruption.] She can sit and smile, but that informs our approach.
I should also like to associate myself with the comments made by a large number of colleagues in paying tribute to the hard-working, committed people who make up our social care workforce and to the informal carers who play such a vital part in our health and social care system. Central to the points made by the hon. Members for Stretford and Urmston (Kate Green) and for Keighley (John Grogan) is that we all collectively need to send a clear message that the work that those people do is valued. We are working with Skills for Care to put more value on this as a profession. People who work in the care sector do so because they are personally motivated and money actually matters less to them. We ought to give them a clear message that we really appreciate all the efforts that they make.
Many Members have raised the issue of funding cuts to council budgets. That subject obviously informed the comments from the hon. Member for Denton and Reddish just now. I will not run away from the fact that there have been challenges for councils in recent times— [Interruption.] Opposition Members mention cuts, but the bottom line is that we can only spend what we collect from taxpayers. That is the reality of the situation. I will be first in the queue to pay tribute to those councils that have stepped up to the challenge, coped well with the reductions and worked hard to become efficient. They have shown real innovation in rising to the challenge.
Andrew Gwynne
I fully appreciate the Minister’s point that we can only spend the money that we raise from taxes, but this is a question of priorities. Why did she vote for a £5 billion cut to the bank levy in the Budget? Is that not the wrong priority?
Jackie Doyle-Price
I think the hon. Gentleman will find that we actually have a very progressive tax paying system none the less.
I want to celebrate those areas that have continued to deliver their social care responsibilities in challenging circumstances. We have heard a lot about what has gone wrong, but let us just remember this statistic: 81% of people in care homes are in homes that have been rated good or outstanding. I think that is an achievement, and something to be celebrated. I also want to compliment those councils that have really stepped up to the plate to deliver an improved performance on delayed transfers of care. Stoke and Trafford in particular have cut their delayed discharges by more than half. This comes down to leadership and determination. Where councils show real leadership, that will deliver improvements and change—[Interruption.] I have just named those councils: Stoke and Trafford.
Kate Green
The Minister is right to say that we are making progress on delayed transfers of care, but the figures have been very high. It really comes down to the fact that we just do not have enough well-funded places to enable people to be discharged from hospital quickly and get into the care in the community that we all want them to have.
Jackie Doyle-Price
I do not disagree with that point. That is why we need to embark on a process of reform and really get it right. We are embarking on the process on that basis.
A number of Members, including the hon. Member for Blaydon (Liz Twist), mentioned sleep-ins, and I just want to restate what was said, because it seems to have been misunderstood. We fully recognise the pressure on the sector resulting from the ruling on sleep-ins and the fact that the historical liabilities could be a problem. We are working closely with providers, in liaison with the European Commission, to come up with a solution. Hon. Members will understand that the matter is too commercially sensitive for me to say any more than that—[Interruption.] We are working with providers and meeting them on a regular basis.
Liz Twist
I understand what the Minister has just said about sleep-ins and that she is working with providers. We all understand the pressure on those providers, but I asked earlier, are we looking at a way to reward the staff properly for the work they do during sleep-ins, or are we trying to avoid the question?
Jackie Doyle-Price
The ruling from HMRC is clear that those on sleep-in shifts are still entitled to the minimum wage, so we are working out a solution to those historical liabilities. We are clear that we expect all employers to abide by the national minimum wage legislation, and I hope that that gives the hon. Lady some clarity on that point.
We can expect the Green Paper to be brought forward, but I also want to address what Members have said about the variation in quality and availability of provision. As has been said, local councils are responsible for responding to that, and the CQC has rated 81% of care services as good, but it is important that we work with those that are performing less well to achieve significant improvements so that everyone is entitled to the best possible care.
I was pleased to hear the contribution of my right hon. Friend the Member for Ashford (Damian Green). His philosophical approach perhaps reflects the amount of time that he has spent thinking about this topic. I associate myself with the comment made by him and several Members across the House about the fact that no one has an unblemished record when it comes to debates about social care. If we are genuinely to come up with a long-term solution, we need a spirit of consensus to take people with us, and people on both sides of the House need to remember that.
In conclusion, we have had a full debate and it will not be the last time that we debate this subject. We are now quite a way down the track when it comes to working up real proposals to bring genuine reforms of the social care system to equip ourselves for a world where life expectancy ends not at 70, but at 100. That will require significant change. We are stepping up to the challenge and will bring forward proposals in due course.
Question put and agreed to.
Resolved,
That this House notes that Government cuts to council budgets have resulted in a social care funding crisis; further notes that Government failure to deal with this crisis has pushed the funding problem on to councils and council tax payers and has further increased the funding gap for social care; is concerned that there is an unacceptable variation in the quality and availability of social care across the country with worrying levels of unmet need for social care; and calls on the Government to meet the funding gap for social care this year and for the rest of this Parliament.
Barbara Keeley
On a point of order, Mr Speaker. The motion that has just been unanimously agreed calls on the Government
“to meet the funding gap for social care”—
widely said to be £1.3 billion—
“this year and for the rest of this Parliament.”
Given that Ministers have agreed to the motion, can you advise when we might expect an announcement from the Government on this important agreement on social care funding?
Mental Health Units (Use of Force) Bill (Third sitting)
Jackie Doyle-Price Excerpts(6 years ago)
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Mr Reed
It is a pleasure to serve under your chairmanship, Mr Gray. I hope a few more of my colleagues will turn up before we get too far through this morning’s business. It is a pleasure to see everybody here, and I hope that we will make a little more progress this morning than we did last week. I am sure we will, thanks to the money resolution that was laid yesterday evening—I thank the Minister for ensuring that that could go ahead.
Clause 7 creates a new duty to keep a record of any use of force on a patient in a mental health unit. Currently, it is not possible to find out how or when force is used, or to compare one hospital with another regarding the way, and extent to which, they use force. Requiring mental health units to collect and record data in the same way will ensure transparency in our mental health services, meaning that if force is used disproportionately against particular groups, such as black, Asian and minority ethnic patients or women, we will have a mechanism to expose it and, if necessary, to prevent it, and to ensure that the services operate equally for everybody.
Most of the amendments are minor changes to ensure that we are recording information consistently. They are based on information collected in a local incident report, and are in keeping with the data protection principles. They also ensure that the relevant characteristics of the patient, such as age, gender and ethnicity, are recorded in line with the Equality Act 2010, ensuring consistency across the Government system. Further detail about information to be recorded will be set out in guidance under clause 6.
Amendment 88, which the Government were keen to include and I was happy to table, means that the duty to record information will not apply in cases where the use of force is negligible. Statutory guidance will set out the meaning of “negligible”, so it is important that that definition, provided by the Secretary of State, is right and defines the term very tightly. In some cases, the minor use of force, such as guiding a patient by the elbow, should clearly not need to be recorded, as that would create an unnecessary burden on professionals working in mental health units. However, I know that the Minister is aware of the need to avoid that becoming a loophole.
The guidance will be subject to consultation, and I know that advocacy groups, which have been providing so much support to us all as the Bill has progressed, have concerns that they want to raise. The consultation will allow them to do so formally, and I welcome that, because the Bill has so far proceeded on the basis of consensus. Indeed, that is the only way that it will succeed.
The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
It is a pleasure to serve under your chairmanship this morning, Mr Gray. As the hon. Gentleman explained, the clause and amendments will impose a duty on a responsible person to keep a record of any use of force by staff who work in the unit. The aim behind all the measures is to bring greater transparency to the use of force. Through transparency, we can ensure accountability. What is not to like about that?
I am grateful to the hon. Gentleman and to the interest groups to which he referred for the dialogue we have had to get this right. The list of information required, as amended by this group of amendments, is welcomed by the Government. It provides clarity and consistency, with positive and proactive care guidance. We know that there are currently limitations, and we believe that this proposal will make a material improvement for all concerned—patients and institutions alike.
The hon. Gentleman referred to guidance. I am aware of some of the concerns that have been raised by some lobbyists. I would reiterate what he said: we have embarked on taking this Bill forward with him in the spirit of constructive dialogue, and we hope to bring everyone with us. When the Bill becomes an Act—touch wood—and it is then implemented through guidance, it is very much our intention to take the development of that guidance through in the same spirit. We will involve all interested parties in drafting that guidance.
Amendment 94 agreed to.
Amendments made: 88, in clause 7, page 4, line 15, at end insert—
“(1A) Subsection (1) does not apply in cases where the use of force is negligible.
(1B) Whether the use of force is ‘negligible’ for the purposes of subsection (1A) is to be determined in accordance with guidance published by the Secretary of State.
(1C) Section 6(1B) to (3B) apply to guidance published under this section as they apply to guidance published under section 6.”.
This amendment would mean that the duty to record information regarding the use of force would not apply in cases where the use of force is negligible.
Amendment 37, in clause 7, page 4, line 16, leave out subsection (2).
This amendment removes the requirement for the Secretary of State to prescribe in regulations the information that must be recorded under Clause 7.
Amendment 38, in clause 7, page 4, line 18, leave out lines 18 and 19 and insert—
“The record must include the following information—”.
This amendment is consequential on Amendment 37.
Amendment 39, in clause 7, page 4, line 19, at the end insert—
“( ) the reason for the use of force;”.
This amendment would require the responsible person to record the reason for a use of force.
Amendment 40, in clause 7, page 4, line 20, leave out “time” and insert “date”.
This amendment replaces the requirement to record the time of a use of force with a requirement to record the date of a use of force.
Amendment 41, in clause 7, page 4, line 21, leave out paragraph (b) and insert—
“(b) the type or types of force used on the patient;”.
This amendment clarifies that the responsible person should record the types of force used in cases where more than one type of force is used.
Amendment 89, in clause 7, page 4, line 21, at end insert—
“() whether the type or types of force used on the patient form part of the patient’s care plan;”.
The amendment inserts a requirement for responsible persons to record whether the force used on a patient formed part of the patient’s care plan.
Amendment 43, in clause 7, page 4, line 22, leave out “identity of the patient” and insert—
“name of the patient on whom force was used”.
This amendment makes a drafting change to refer to “name” rather than “identity” in Clause 7(3)(c).
Amendment 44, in clause 7, page 4, line 22, at end insert—
“( ) a description of how force was used;”.
This amendment inserts a requirement for responsible persons to record how force was used. For example, if physical restraint was used, the responsible person would need to record what particular technique was used on the patient.
Amendment 45, in clause 7, page 4, line 22, at end insert—
“(ca) the patient’s consistent identifier;”.
This amendment inserts a requirement for responsible persons to record the patient’s consistent identifier, which the patient’s “NHS number”.
Amendment 46, in clause 7, page 4, line 23, leave out “identity” and insert “name”.
This amendment makes a drafting change to refer to “name” rather than “identity” in Clause 7(3)(d).
Amendment 90, in clause 7, page 4, line 23, leave out “those who restrained” and insert—
“any member of staff who used force on”.
This amendment ensures consistency of language with the rest of Clause 7.
Amendment 48, in clause 7, page 4, line 24, leave out—
“anyone not employed by the registered manager”
and insert—
“any person who was not a member of staff in the mental health unit”.
This amendment makes a drafting change to clarify that the responsible person needs to record whether a person who was not a member of staff at the mental health unit was involved in a use force.
Amendment 49, in clause 7, page 4, line 26, leave out—
“disorders or main mental disorder”
and insert “disorder (if known)”.
This amendment clarifies that the responsible person only needs to record a patient’s mental disorder if it is known. It also makes the language consistent with the Mental Health Act 1983.
Amendment 50, in clause 7, page 4, line 27, after “patient” insert “(if known)”.
This amendment clarifies that the responsible person only needs to record a patient’s relevant characteristic if they are known.
Amendment 51, in clause 7, page 4, line 28, leave out “had” and insert “has”.
This amendment is a drafting change so that Clause 7(3)(h) uses the present tense.
Amendment 52, in clause 7, page 4, line 28, leave out “autism” and insert “autistic spectrum disorders”.
This amendment ensures consistency with the Autism Act 2009 and the Code of Practice published under the Mental Health Act 1983.
Amendment 53, in clause 7, page 4, line 29, leave out paragraph (i)
This amendment leaves out the requirement to record whether any medication was administered during the use of force. This information should be recorded by virtue of Amendment 44.
Amendment 54, in clause 7, page 4, line 30, at end insert—
“( ) a description of the outcome of the use of force;”.
This amendment requires a responsible person to record a description of the outcome of a use of force.
Amendment 91, in clause 7, page 4, line 31, leave out paragraph (j) and insert—
“(j) whether the patient died or suffered any serious injury as a result of the use of force;”.
This amendment requires a responsible person to record whether a use of force resulted in a death or serious injury.
Amendment 56, in clause 7, page 4, line 35, leave out “all” and insert “any”.
This amendment makes a drafting change.
Amendment 57, in clause 7, page 4, line 35, leave out “restrain” and insert “use force on”.
This amendment ensures consistency of language with the rest of Clause 7.
Amendment 92, in clause 7, page 4, line 35, at end insert—
“() whether a notification regarding the use of force was sent to the person or persons (if any) to be notified under the patient’s care plan;”.
This amendment requires a responsible person to record whether a notification regarding a use of force on the patient was sent in accordance with the patient’s care plan.
Amendment 59, in clause 7, page 4, line 36, leave out paragraph (l).
This amendment removes the requirement for a responsible person to record whether consent was given by the patient before force was used on the patient.
Amendment 60, in clause 7, page 4, line 38, leave out “registered manager” and insert “responsible person”.
This amendment is consequential on Amendment 7.
Amendment 61, in clause 7, page 4, line 38, leave out “an entry in”.
This amendment ensures consistency of language with Clause 7(1).
Amendment 62, in clause 7, page 4, line 38, leave out “at least 10” and insert “3”.
This amendment reduces the number of years that records must be kept under Clause 7 from 10 years to 3 years.
Amendment 64, in clause 7, page 4, line 39, leave out from “made” to end of line 42.
This amendment removes the requirement for records to be kept at a mental health unit.
Amendment 65, in clause 7, page 4, line 42, at end insert—
“( ) In subsection (3)(ca) the ‘patient’s consistent identifier’ means the consistent identifier specified under section 251A of the Health and Social Care Act 2012.”.
This amendment is linked to Amendment 45 and defines “patient’s consistent identifier”.
Amendment 95, in clause 7, page 4, line 42, at end insert—
“( ) This section does not permit the responsible person to do anything which, but for this section, would be inconsistent with—
(a) any provision made by or under the Data Protection Act 1998, or
(b) a common law duty of care or confidence.”.
This amendment clarifies that the responsible person’s duty to keep a record of any use of force on a patient and to retain that information is subject to the Data Protection Act 1998 and the common law duties of care and confidence.
Amendment 66, in clause 7, page 5, line 3, leave out paragraph (c).
This amendment removes a paragraph from the definition of “relevant characteristics” that deals with gender reassignment.
Amendment 67, in clause 7, page 5, line 6, leave out from “pregnant” to the end of line 7.
This amendment removes from the definition of “relevant characteristics” whether a patient has maternal responsibility for the care of a child.
Amendment 68, in clause 7, page 5, line 12, leave out subsection (6) and insert—
“( ) Expressions used in subsection (5) and Chapter 2 of Part 1 of the Equality Act 2010 have the same meaning in that subsection as in that Chapter.”.—(Mr Reed.)
This amendment make a drafting change to ensure that the relevant characteristics in Clause 7 are interpreted by reference to the meaning of the protected characteristics in the Equality Act 2010.
Clause 7, as amended, ordered to stand part of the Bill.
Clause 8
Statistics prepared by mental health units
Mr Reed
I beg to move amendment 69, in clause 8, page 5, line 16, leave out subsections (1) to (5) and insert—
“(1) The Secretary of State must ensure that at the end of each year statistics are published regarding the use of force by staff who work in mental health units.
(1A) The statistics must provide an analysis of the use of force in mental health units by reference to the relevant information recorded by responsible persons under section 7.
(1B) In subsection (1A) ‘relevant information’ means the information falling within section 7(3)(a), (b), (g), (h) and (j).”.
This amendment replaces the provisions of Clause 8 with a duty imposed on the Secretary of State to ensure that statistics are produced regarding the use of force in mental health units.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
I thank my hon. Friend for his representations. I apologise for being a few minutes late—I was at another event.
Amendment (a) is about accountability: it would ensure we have annual updates on progress. Ultimately, that is the motivation behind the amendment. Having annual statistics on the use of force under clause 8 would ultimately lead to a minimisation of, and reduction in, the use of force. That is why we are all here today, so that update is absolutely critical.
In the Committee’s first sitting, clause 9 was amended to require the Secretary of State to publish a report relating to any reviews, and other reports about individual cases, particularly relating to deaths and serious injuries, but there is no requirement for the Secretary of State to publish a report relating to the annual stats on the use of force. Therefore, there is no opportunity for Parliament to scrutinise the progress towards the goal of reducing the use of force, which is the purpose of the Bill. That is the motivation behind the amendment.
Jackie Doyle-Price
This clause, which relates to the requirement for the Secretary of State to report on the use of force, goes to the heart of what we are trying to achieve with this Bill in terms of improving transparency. The amendments are the result of our discussions with the hon. Member for Croydon North and other interested parties, so they were reached in the spirit of consensus.
I am confident that the publication of statistics about the use of force in mental health units, building on the improved local data recording powers under clause 7, will significantly improve our national understanding of how force is used. The Government fully support the hon. Gentleman in his wish to see improved recording and reporting on the use of force. I am pleased that we agree that NHS Digital is the right organisation to collect and publish those important statistics.
I completely agree with the sentiments behind the amendment in the name of the hon. Member for Liverpool, Wavertree. It will often be appropriate for the Secretary of State to lay before Parliament a financial statement, an important report or a draft piece of guidance to facilitate parliamentary scrutiny. For example, the Mental Health Act 1983 requires the Secretary of State to lay a copy of any changes to permanent practice before Parliament. As the hon. Lady said earlier, in our discussions in a previous sitting we said we very much anticipate that the Secretary of State will lay an annual report on the use of force before Parliament. To make the report specifically about the statistics collected would introduce an aberration into how we treat NHS Digital statistics. We produce a wide range of health statistics each year, and to single out that subset would not be welcome. However, I expect that, in the course of making the annual report on the use of force, the publication of the statistics will provide a basis on which the Secretary of State will report.
I ask the hon. Lady not to press her amendment, on the basis that it is too prescriptive about the use of statistics. I hope she recognises that that is in no way an attempt to undermine transparency, which she and I want the Bill to secure. Once these figures are out in the public domain, there will be any number of ways in which all hon. Members can hold the Secretary of State to account, and experience tells me that the hon. Lady will always use them to hold us to account in relation to the use of these powers.
I hope that reassures the hon. Lady. For the reasons I set out, we are content to support the hon. Gentleman’s amendment and the clause, but we oppose amendment (a).
The Chair
Luciana Berger
I rise briefly to support my hon. Friend’s amendments, which are critical because, outside this place, organisations and families affected by the loss of a loved one in a mental health setting are looking to us to address this injustice. He said that there is an automatic independent investigation in some settings. If someone loses their life in prison, for example, the prisons and probation ombudsman carries out an independent investigation. It is absolutely critical that that happens if people are taking their lives or losing their lives in prison.
People in a mental health setting are at their most vulnerable, and I believe that one person taking their life is one person too many. Unfortunately, too many people in mental health settings in our country take their lives. We have a responsibility to them, their loved ones and their families to ensure that proper investigations take place so that real learning can occur. There are too many examples. We have heard about the suffering of the Lewis family—we are here today because of what they went through—who had to wait a long time to get justice and an understanding of what happened to their son.
There is also the experience of the family of Connor Sparrowhawk. Sara Ryan has been an incredible campaigner since her son’s death in 2013. Despite her indomitable campaigning, strength and courage, it took five years for that family to get justice and to understand what happened to their son, who died in a bath in a mental health setting. Those are just two families; there are many others who do not have that strength. I totally understand why they might not: in the wake of the loss of a loved one, they might not have the wherewithal to pursue the relevant organisations, particularly if the family cannot match the legal and financial might at the organisations’ disposal. We see time and time again that they can prolong proceedings, send lengthy letters and keep batting things away.
I anticipate that colleagues on both sides of the Committee will reflect on their experiences from their constituencies. Our constituents come to us because they face that wall and are unable to challenge the system. We have a responsibility if we are serious about adequately contending with this issue. I welcome the Government’s support in helping us to get to where we have got so far. I see this measure as part of a bigger picture. Without it, we will be failing people. We must be serious about equality of mental health and parity of esteem in this country. In my view, this is a social justice issue: disproportionately, it is black men in mental health settings who are affected in this way.
People should automatically get an independent investigation. They should not have to fight for one or go through an incredibly drawn-out legal process. Some people manage to get investigations at the moment, but it should be automatic. That is why my hon. Friend’s amendments are critical. Many organisations are concerned about this issue, including INQUEST, a charity that fights on behalf of many people in our country to ensure they get access to justice and an understanding of what happened. Often, it is about the unknown. People were not there at the time, and they really want to understand how their loved one came to take their life.
Without real movement on this issue, we will be doing an injustice to people up and down the country. I support my hon. Friend’s amendments, and I hope the Government give them due consideration to ensure we adequately deliver for people in our country.
Jackie Doyle-Price
This clause and group of amendments go to the heart of the approach taken by the hon. Member for Croydon North to this Bill. Justice delayed is justice denied, and the incredible length of time that some investigations have taken is totally unacceptable. I welcome the fact that this Bill will build on measures the Government have already taken to address those unacceptable delays. We should challenge head-on the fact that that makes the whole system discriminatory.
The hon. Member for Liverpool, Wavertree alluded to black men, and the Prime Minister is particularly concerned about that. The hon. Lady also mentioned Connor Sparrowhawk. I think people with learning disabilities are massively discriminated against in our system. By ensuring more transparency, we are trying to improve the rights of everyone in the system and strengthen social justice.
Mr Reed
If the investigations are being carried out by people in another part of the NHS who have sufficient understanding of the service they are investigating, is there not a risk, given the relatively small number of professionals working in the sector, that the investigation could be compromised by pre-existing relationships between the people being investigated and those charged with carrying out the investigation? Would that risk rendering the findings insufficiently robust?
Jackie Doyle-Price
Clearly, that is the risk that the hon. Gentleman is determined to settle here. We do take it very seriously, but I am satisfied that, through governance and external scrutiny by the CQC, we can ensure that that is not the case. It is important to have investigators who have that specialist knowledge to be able to undertake a full investigation.
I am confident that the governance of the serious incident framework will provide the right guidance to ensure that all individuals carrying out the investigations are suitably qualified and sufficiently independent. I hope that assures the hon. Gentleman. We will continue to address the matter with full external scrutiny so that we can genuinely ensure their independence.
Let me be completely clear: this is not just a process—not just a rubber-stamping exercise. We need proper independent investigation to ensure that there is accountability in the system and that, in future, families such as that of Seni Lewis, do not feel frustrated and lost and that the system is not responding to them—that is absolutely not the case. We must use this opportunity to ensure that that independent investigation is thorough and rigorous.
I turn now to the amendment on legal aid for investigations. Clearly, any family in this situation does need some independent support and advocacy. It is very difficult when there is no one person to whom a family can turn to get independent support at such a time. The Bill is not the place to resolve any issues around legal aid, but let me assure the hon. Gentleman about wider discussions that are taking place within Government.
The hon. Gentleman will be aware that the Ministry of Justice is committed to the ministerial board on deaths in custody, and I am one of the rotating co-chairs of that board. We are looking at an urgent review of the provision of legal aid for inquests, and the position is due to be published later this year as part of the Government’s response to Dame Elish Angiolini’s review of deaths and serious incidents in police custody. We will take up this matter as part of that. As the hon. Gentleman says, it is important that we consider deaths in mental health detention on the same basis as those in other methods of detention, such as prisons. That review will ensure consistency of support for families.
Jackie Doyle-Price
Yes. It is very much being taken forward by that ministerial board, of which I am co-chair alongside Ministers from the Home Office and the Ministry of Justice, to achieve exactly that consistency. I hope that reassures the hon. Gentleman on that point. I will also be happy to support him if he wishes to make representations to the Ministry of Justice, which owns that work, although I am very much part of it.
Luciana Berger
Forgive me if I missed it, but would the Minister share the timelines with us? When do we anticipate that process from the Ministry of Justice concluding?
Jackie Doyle-Price
I will write to hon. Members about that to set it out clearly. I could give a flippant answer, but it might not be accurate, and I do not wish to mislead the Committee. I would say that the ministerial board is actively meeting and consulting with external stakeholders at this very moment. It is not going to be a long-grass project, but we will give hon. Members more clarity in due course.
On that basis, I ask the hon. Gentleman to withdraw the amendment. The Government propose that clause 12 be replaced by new clause 6, which sets out the method of investigating cause of death. New clause 6 requires that, when a patient dies or suffers a serious injury in a mental health unit, the responsible person would have regard to certain guidance that relates to the investigation of deaths or serious injuries, including the NHS serious incident framework and any relevant guidance from the CQC, NHS Improvement and NHS England. The new clause moves the process more consistently into the body of the health service and the framework for investigation.
I know the hon. Gentleman’s objective is to prevent a recurrence of the experiences of the Lewis family, whose investigation got stuck for many years. We have drawn up the new clause on that basis. We want to avoid any confusion that introducing a completely new system might lead to. We want to avoid duplication, but establish independence, which we have already started to move forward on with the Healthcare Safety Investigation Branch.
The coroner already has a responsibility to investigate deaths of those detained under the Mental Health Act 1983 and any death that is unexpected or unnatural, which would include deaths that occurred during, or as a result of, the use of force. The NHS serious investigation framework sets out robust procedures for investigating and learning from an unexpected patient death, including an independent investigation when criteria are met.
To reassure the hon. Gentleman on timing, which I know is a big issue here, we would expect any investigation into a serious incident to be concluded within a year and certainly to commence within three to six months. There might sometimes be issues that elongate that investigation, but we will avoid any case just being stuck and left. Investigations will always be undertaken as soon as practicable.
I ask the hon. Gentleman to withdraw the amendment and not to press new clause 1. I ask the Committee to disagree to clause 12.
Mr Reed
I am grateful to the Minister for her comments and in particular for the new information and assurances that she has given. I am sure that will be widely welcomed. It is clear that we have the same objectives, but there are perhaps some small remaining disagreements over the best way to achieve those objectives.
I hope that the bottom line for both of us is that investigations of deaths need to be triggered automatically, they need to be fully independent, and families of the deceased need access to legal aid so that they are operating on a level playing field with the people who are being investigated for having caused the death. I understand that the Minister seeks to achieve that by a different route; it is important to give her the space she will need to be able to demonstrate to not just me but the many stakeholders and families outside this place that she has robust means of doing that.
While reserving the right to reintroduce amendments into the Bill at a later stage if necessary, at this stage, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Jackie Doyle-Price
I very much welcome the provisions in clause 13, as amended. When first mooted, the use of body-worn video by police officers met some resistance, but I have spoken to those who now use it, and they absolutely welcome it. The provision brings further transparency, which is in the interests of police officers and anyone they come into contact with, and I am convinced that it is a welcome part of the Bill.
Body-worn video has been shown to reduce the use of force, which lies at the heart of the Bill, and it is vital to take the opportunity to require police officers to use it, unless, as the hon. Gentleman said, there are good reasons not to. We would not want to interfere with the operational effectiveness of the police by insisting on cameras, but body-worn video would be good practice and should be encouraged as much as possible.
The amendment will ensure that recording is specific to the incident, and that the use of body-worn video is not disproportionate, so that the rights and interests of those at the unit—patients, staff and visitors—are protected. Recording will take place only when the officer is assisting staff in the care of a patient with mental health issues. I am pleased that some forces already have local agreements in place—again, it is in everybody’s interest that this happens—and we anticipate that all forces across England and Wales will continue in that direction.
We will seek to implement this measure with guidance that sets out principles with examples of special circumstances, and it is right to ensure that professional bodies are involved in this work. Although the list may not be as exhaustive as some would like—it is impossible to set out every instance—every attempt will be made to ensure that it is as comprehensive and thorough as possible.
Luciana Berger
I am listening closely to the Minister, who is making important points about how this measure will work in practice, which I welcome. Does she think, as I do, that this provision will also work as a counter to what we increasingly see on undercover programmes, which is what happens when cameras are not there? Sometimes footage is taken by people who bravely go undercover. I am thinking, most recently, of the “Dispatches” reporter who went undercover in the Priory. In some settings, we saw the use of force on a patient, and how traumatic that was for the patient and for inexperienced staff. We are discussing the police and ensuring that they have cameras when they go into such settings, but does the Minister think that, in time, we should discuss the use of cameras in all mental health settings to protect patients?
Jackie Doyle-Price
The hon. Lady makes some excellent points, and in the run-up to the Bill, we discussed some of those wider issues. It is incredibly sad that undercover reporting has, on occasion, shown such bad abuse. The fact that there is a camera will affect people’s behaviour in a positive way, although perhaps it is sad that we need to rely on that. We must, however, balance that with the need for privacy, and we can have further discussion on that. However, I see no reason why we would not have cameras in communal areas, for example. We will discuss the provisions in the Bill with organisations such as the College of Policing, and that will enable a discussion to take place with providers about where it is appropriate to have cameras. I am sure we will return to that issue.
Helen Hayes (Dulwich and West Norwood) (Lab)
I rise briefly to support my hon. Friend the Member for Liverpool, Wavertree and the potential exploration of the use of cameras in secure mental health settings. I have worked on behalf of a constituent with autism who was detained at St Andrew’s, which is a private mental health facility in Northampton, and I have got to know other families who had children in that facility who did not have an extensive capacity to communicate for themselves. Those families had grave concerns about the use of force and their children’s treatment more widely, which manifested itself in aspects of their behaviour—they became withdrawn and fearful, and there were some physical signs as well. The families were unable to say, however, that detention had taken place, and there is a case to be made for the kind of transparency that the use of cameras would bring, perhaps in rooms where detention and the use of force are more likely to take place—
Jackie Doyle-Price
The hon. Member for Dulwich and West Norwood makes excellent points for us to consider further. The Bill, which is specifically about detention and use of force in detention, is perhaps not quite the right space for that, but her points are well made. I am particularly concerned about people with learning disabilities, who are often treated as the Cinderella in the system. It is incumbent on all of us to ensure that we do our best to protect their rights, as well as those of other groups. On that basis, the Government are content to support the amendments tabled by the hon. Member for Croydon North.
Amendment 93 agreed to.
Amendments made: 75, in clause 13, page 7, line 26, leave out subsection (3).
Clause 13(3) is omitted because the protection provided by the Data Protection Act 1998 and guidance on use of body cameras is sufficient.
Amendment 96, in clause 13, page 7, line 31, at end insert—
“( ) In this section—
‘body camera’ means a device that operates so as to make a continuous audio and video recording while being worn;
‘police officer’ means—
(a) a member of a police force maintained under section 2 of the Police Act 1996,
(b) a member of the metropolitan police force,
(c) a member of the City of London police force,
(d) a special constable appointed under section 27 of the Police Act 1996, or
(e) a member or special constable of the British Transport Police Force.”—(Mr Reed.)
This amendment reproduces definitions from Clause 17, except for minor amendments to the definition of “body camera”, and omitting community support officers and adding special constables in the definition of “police officer”.
Clause 13, as amended, ordered to stand part of the Bill.
Clause 14
Retention and destruction of video recordings
Question proposed, That the clause stand part of the Bill.
Mr Reed
I am grateful for your further clarification, Mr Gray. I believe that the understanding was that those clauses should not stand part of the Bill, as the provisions in them have already been addressed elsewhere in the Bill or have become unnecessary because of provisions in other legislation. For those reasons, I am proposing that the clause not stand part of the Bill.
Jackie Doyle-Price
As the hon. Gentleman has just outlined, many of the provisions in clauses 14 to 17 are covered by other legislation, such as the Data Protection Act, and oversight by the Information Commissioner’s Office. There are obviously powers of enforcement accruing in that way. In the spirit of avoiding duplication, we are content that the clauses be removed from the Bill.
Mr Reed
You are very kind, Mr Gray. Clause 18 sets out how regulations under this Bill are to be made. Amendment 81 ensures that commencement regulations under clause 20 are not subject to any parliamentary procedure, which is the convention. Parliament will have approved the principle of the provisions of the Bill by enacting them. Any other regulations made under the Bill will be subject to the negative procedure. I hope that makes more sense to other hon. Members than it necessarily does to me, and that the Committee accepts the clause as amended.
Jackie Doyle-Price
This clause sets out that regulations under this Bill should be made by statutory instrument; the only amendment is to ensure that regulations under clause 20 are not subject to further parliamentary procedures. Those are to undertake the commencement and any transitional provisions required to implement the Bill.
Amendment 81 agreed to.
Clause 18, as amended, ordered to stand part of the Bill.
Clause 19 ordered to stand part of the Bill.
Clause 20
Commencement, extent and short title
Mr Reed
I beg to move amendment 83, in clause 20, page 9, line 35, leave out subsections (3) and (4) and insert—
“(3) The other provisions of this Act come into force on such day as the Secretary of State may appoint by regulations.
(4) Regulations under this section may appoint different days for different purposes or areas.”
This amendment gives the Secretary of State the power to commence the Bill by regulations.
Mr Reed
Clause 20 sets out when the Bill’s provisions are to be brought into force and amendment 83 allows the requirements of the Bill to be brought into force as and when it is feasible to do so and by regulations, rather than within six months as originally drafted.
New clause 4 gives the Secretary of State the power to make transitional provisions for the implementation of the Bill, which, where appropriate, will allow flexibility in its application as it comes into force. I know that the Minister is committed to the Bill; we have strengthened it by working consensually cross-party and with the many interested parties outside the House.
Jackie Doyle-Price
I reassure the Committee that I want to ensure that the requirements of the Bill are commenced as soon as they are ready. We are certainly not in the business of delay, but we recognise that some aspects of the Bill will be quicker to implement than others. We will be able to commence some things very quickly, but if we take clauses 7 and 8, for example, getting the right systems in place for local recording and publication of statistics may take a little longer than some other aspects of the Bill. Commencing by regulations allows the Government to bring the new requirements into force as and when that is feasible, having regard to those parts of the system that move at a different pace.
The transitional provision will allow the Secretary of State to make transitional provisions in connection with the coming-into-force provisions of the Bill. That is important particularly where the Bill’s requirements represent a substantial change in practice. For example, if training under clause 5 is carried out before the responsible person is appointed, the transitional provision could state that the training is deemed to have been provided by the responsible person. That will also allow us to give the NHS and other providers some time to prepare for their duties under the Bill. The Government accept the amendment to clause 20 and the new transitional provision.
Amendment 83 agreed to.
Clause 20, as amended, ordered to stand part of the Bill.
Mr Reed
On a point of order, Mr Gray. Thank you very much for guiding us through the sometimes confusing proceedings so skilfully this morning. I thank hon. Members for participating this morning and on the previous occasion on which we met. I thank hon. Members and the officials who have worked on the Bill for their hard work in getting us this far.
I thank Seni Lewis’s parents, Aji and Conrad Lewis, for joining us this morning. When I have spoken to them about what happened to their son and the need for this Bill, they have reiterated to me their very deep desire for Seni’s death not to have been in vain. I believe our work on this Bill creates a legacy for Seni Lewis, which is that no one else suffering or living with mental ill health need suffer in the way Seni Lewis did.
Jackie Doyle-Price
On a point of order, Mr Gray. I associate myself with the hon. Gentleman’s remarks. I thank you and the Clerks for guiding us safely and promptly through the procedure. It has been a very good use of our time and resources. I also thank my officials, who have worked very quickly to pull this Bill together in a way that delivers the hon. Gentleman’s objectives in a way that works. It can be challenging when these things come through in a private Member’s Bill.
I pay tribute to the hon. Gentleman, who has brought forward a very important reform to how we treat people detained under the Mental Health Act. From my perspective as Minister, we have reached the position whereby, if we are going to achieve parity of esteem, there needs to be a complete reconfiguration of the law as it applies to mental health, to strengthen people’s rights. This very important reform will achieve exactly that.
I also associate myself with the tribute the hon. Gentleman paid to Seni Lewis’s parents. They have taken an incredible tragedy and channelled it into doing something positive. They will achieve a real legacy that strengthens the rights of people who find themselves detained. I pay full tribute to them for doing so.
My final thanks go to all hon. Members who have turned up—quite often to do nothing, because we did not have a money resolution to progress the Bill, but I am very grateful to them for doing so.
Luciana Berger
On a point of order, Mr Gray. I put on the record my thanks to my hon. Friend the Member for Croydon North for promoting this important Bill.
People outside this place may not know how the private Member’s Bill process works. It starts with a ballot, in which Members put their names in a book. They might get drawn out of the hat and be at the top of the list—I have been taking part for the past eight years and my name certainly has not been pulled out of the hat—but they then have to make the difficult decision of what to use their private Member’s Bill slot for. It is difficult: I have seen the swathes of emails that Members receive, not only from constituents but from countless campaigning organisations across the country that want Members to champion their proposed legislation or campaign.
Not only has my hon. Friend chosen a critical issue—I am so glad that he did so—but he has done so in a way that ensures that the Bill will progress and that, after its passage concludes, we will actually see some action. We cannot say that for every private Member’s Bill. There are others for which we come together on a Friday and vote for or against it and they do not progress. My hon. Friend has chosen something that ensures that he will actually effect change in this country—the chances for which, particularly for Opposition MPs, are in short supply.
I put on the record my thanks to my hon. Friend for his courage and dedication and for the work he has done with countless organisations outside this place. He has introduced something so practical that has gained Government support, and collectively we have ensured that we can actually make a difference for what I believe will be thousands of people in our country.
Mental Health Units (Use of Force) Bill (Money)
Jackie Doyle-Price Excerpts(6 years ago)
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The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
I beg to move,
That, for the purposes of any Act resulting from the Mental Health Units (Use of Force) Bill it is expedient to authorise the payment out of money provided by Parliament of:
(1) any expenditure incurred under or by virtue of the Act by the Secretary of State, and
(2) any increase attributable to the Act in the sums payable under any other Act out of money so provided.
The Bill seeks to reduce the inappropriate use of force against people with mental disorders in mental health units. It also seeks to increase oversight and allow greater scrutiny of the system when it goes wrong.
Like many Members, including the hon. Member for Croydon North (Mr Reed) who brought forward the Bill, I was very moved by the events that led to the untimely death of Seni Lewis. I pay tribute to the Lewis family, who have campaigned tirelessly to ensure that such a tragedy does not happen to any other family. The Bill is testament to the commitment of the Lewis family and the hon. Gentleman to ensure that we properly hold the system to account.
National Bereavement Care Pathway
Jackie Doyle-Price Excerpts(6 years ago)
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The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
I congratulate my hon. Friend the Member for Colchester (Will Quince) on securing this debate on the important work of the national bereavement care pathway. It is only three years since he was elected to this House, but in that time, he has done more than simply putting this important issue on the political agenda. He has drawn considerable attention to it and really moved it forward, and I thank him most sincerely for that.
I also thank the hon. Member for North Ayrshire and Arran (Patricia Gibson), who has been a willing ally and partner in that work. We thank her for sharing her experiences, which I know must have been very painful. I am also grateful for the efforts of my hon. Friend the Member for Banbury (Victoria Prentis), who has applied her very considerable energy to this project. It is with pride that I stand alongside all these Members today to address this important subject which, as I have said, has really moved on in the past three years. I must also pay tribute to my hon. Friend the Member for Ludlow (Mr Dunne), from whom I have inherited this part of my portfolio. He left it in very good shape, which makes it very much easier for me to address the House on it this evening.
I was fortunate enough to attend the launch of wave 2 of the pathway here in Parliament just last week, when I met the charities, led by Sands, that are working hard to expand the pathway, and representatives from the wave 1 and wave 2 permanent sites. That uplifting event celebrated the difference that the pathway is making to parents across the country, and I was pleased to hear about the positive evaluation of the wave 1 pilot sites since the pathway was launched last October. I was particularly moved to hear the story and experiences of Cheryl Gadsby. She really brought to life the huge difference that the right care can bring to bereaved parents. Against that background—
Jackie Doyle-Price
I am glad you did that then, Mr Speaker, because I was just getting to a good bit.
Although my hon. Friend the Member for Colchester said that he did not want to put me on the spot about further funding, he actually did—very effectively—so before I go any further this evening, I am pleased to announce that the Department of Health and Social Care will provide additional funding for Sands to further develop and roll out the national bereavement care pathway in the coming financial year. It is a shame that the House is not busier, because it is not often that Ministers get the chance to say such things from the Dispatch Box.
The Department has been in conversation with Sands and can confirm £106,000 of funding to support the roll-out of the pathway in 2018-19. That is more than double the Department’s original funding of £50,000 to support the first year of the programme. While I am sure that all Members present understand that funding for future years cannot be committed at present, I hope that the announcement of this funding demonstrates the Government’s commitment to supporting the pathway as it moves towards national roll-out. The funding comes following recognition of the great strides forward that the pathway project is making in ensuring that all bereaved are offered the right high-quality care at a time of enormous tragedy.
I should pause here, as I did at the parliamentary event last week, to highlight the Government’s wider ambitions for maternity care because, as we have heard this evening, the number of deaths at childbirth are too high. The Secretary of State’s ambition is to reduce rates of stillbirths, neonatal and maternal deaths and brain injuries by 50% by 2025. Our even closer goal is to achieve a 20% reduction by 2020, which illustrates our desire to make rapid progress.
To that end, the Secretary of State launched a refreshed maternity strategy last year—not long after the moving debate on baby loss in the House last October. The strategy highlights further action that the Government and NHS England have taken to improve safety and reduce the number of stillbirths and other adverse maternity outcomes. The initiatives include funding for the new healthcare safety investigation branch to develop investigation standards and conduct independent investigations into all cases that meet the criteria of the “Each Baby Counts” programme run by the Royal College of Obstetricians and Gynaecologists. That will amount to around 1,000 cases annually and will improve the rigour and quality of investigations into term stillbirths, neonatal and maternal deaths and serious brain injuries, and of learning from the investigations. The investigations began this month and will be rolled out to all areas of England by this time next year. Other initiatives include more support for safety training for all maternity and neonatal staff and an ambition to reduce the national rate of pre-term births from 8% to 6%, building on the world-class expertise already available across the 35 pre- term birth clinics in England.
The Department of Health, together with the Health Departments in Scotland and Wales, has funded the development of a national standardised perinatal mortality review tool to support systematic, multidisciplinary reviews of the circumstances and care leading up to every stillbirth and neonatal death. The tool is now available and enables teams to provide clear and accurate information to parents about why their baby died. It will also help staff to understand where lessons can be learned and allow for future care to be improved.
I am happy to report that we are making progress towards achieving our 2020 ambitions. The stillbirth rate in England has fallen from 5.1 per 1,000 births in 2010 to 4.3 in 2016. The neonatal mortality rate was 2.7 deaths per 1,000 births in 2016, down from 2.9 in 2010, but we must continue to do all we can to ensure the best maternity care in this country and the most appropriate support if parents do suffer bereavement at birth.
We are committed to providing high-quality bereavement care, as I hope I have proved and demonstrated with my announcement this evening. Since 2010, the Government have invested £35 million in the NHS to improve birthing environments, including better bereavement rooms and quiet spaces, at nearly 40 hospitals. On 2 February 2018, the Secretary of State announced the Government’s intention to conduct a review of whether the law should be changed to allow parents to register a pregnancy loss that occurs at less than 24 weeks’ gestation, as many hon. Members have called for. The review will also look more broadly at what can be done to improve care and support for parents going through such losses.
It is crucial that parents who experience pregnancy loss, regardless of the gestation stage at which the loss occurs, receive the best possible care and support, and that we use all opportunities to learn for the future when things go wrong. The review will speak to parents, clinicians, midwives and other experts to develop recommendations to ensure that pregnancy losses before 24 weeks’ gestation are handled with the same sensitivity and care as losses at a later gestation.
The Department is also conducting a review of whether the law should be changed to enable or require coroners to investigate stillbirths. Currently, coroners have the power to investigate only if there is doubt as to whether a baby was stillborn or lived independently, regardless of whether doctors declared it a stillbirth. Some parents feel that a coroner’s investigation would help to provide answers when a baby is stillborn and that such learning could help to avoid similar tragedies in future. As part of that review, the Department is working with the Ministry of Justice to consult parents and experts about whether and, if so, how current legislation on coronial powers in relation to stillbirths should be amended to ensure that all avenues for investigating and learning from tragic events are considered.
Once again, I thank all Members of the House who have done so much to raise awareness of what can be done to support bereaved families through such tragedies. I am delighted to have been able to announce further funding for the national care bereavement pathway today, and I will closely follow its development as wave 2 of the pilot sites gets under way.
Question put and agreed to.
Sodium Valproate Regulation
Jackie Doyle-Price Excerpts(6 years ago)
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The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
My hon. Friend the Parliamentary Under-Secretary of State for Health (Lord O’Shaughnessy) has made the following statement:
The EU review into the safety of sodium valproate has now been completed and has recommended that a contraindication for valproate should be introduced in pregnancy and in girls and women of child bearing potential unless they are enrolled in a pregnancy prevention programme.
Valproate is a very effective treatment for epilepsy and bipolar disorder. For some women with epilepsy it may be the only effective treatment. Use of valproate (Epilim, Depakote and other generic brands) in pregnancy is associated with a 40% risk of persistent neurodevelopmental disorders and a 10% risk of physical birth defects. Clear information on the risks of valproate in pregnancy is failing to reach patients, and the warnings issued over the last four years have not had a significant enough impact on valproate prescribing in women of childbearing age. Despite repeated communications on this risk, it is estimated that 400 women in the UK took valproate during pregnancy in 2016.
Following the completion of the EU review, the UK healthcare system will now be making changes to ensure that girls and women of childbearing potential are only taking valproate if there is no other suitable treatment, and that the woman is enrolled in a pregnancy prevention programme. This programme will ensure that every girl or woman knows about the risks of valproate in pregnancy, that where appropriate she is on effective contraception, and that she has a review by her specialist prescriber at a minimum once a year, when a risk acknowledgement form will be discussed and signed by both prescriber and woman herself.
There are approximately 27,000 women of childbearing age receiving prescriptions for valproate in primary care. Within the coming months, GPs should identify all relevant women and girls on valproate in their practice, check that they are on effective contraception as appropriate, and refer them for specialist review unless they have already had a review in the last year.
Specialist prescribers should assess whether treatment with valproate is necessary for women of childbearing potential referred to them, namely that there is no suitable alternative treatment. If continued treatment is necessary, the woman must be enrolled in the pregnancy prevention programme, be on effective contraception, and understand the need to avoid pregnancy.
Pharmacists will ensure the medicine is dispensed in packs which will include the new pictogram and the warning statement. Pharmacy professionals will also make sure that the GP has discussed the risks in pregnancy with female patients and where this has not happened advise them to make an appointment with their GP to have this discussion at the earliest opportunity.
The Medicines and Healthcare products Regulatory Agency has been working in partnership with professional bodies and the healthcare system to bring together a package of measures to support healthcare professionals in implementing these important changes. Educational materials for healthcare professionals and patients are being sent to GPs and specialist prescribers. NICE has updated its guidelines which mention valproate to reflect the new regulatory measures. GP electronic system providers have provided a search and audit function to facilitate the identification of women of childbearing age on valproate and are updating the alerts for valproate.
The MHRA will be closely monitoring the effectiveness of the new measures for avoiding prescribing of valproate to women of childbearing age and in preventing pregnancies from being exposed to valproate. Relevant data will be published and there will be ongoing follow up to ensure progress is being made.
I would particularly like to thank the families involved the Valproate Stakeholder Network who have shared their experiences and expertise. Their dedication, support and altruism will help to keep future generations of children safe.
[HCWS640]
Surgical Mesh
Jackie Doyle-Price Excerpts(6 years ago)
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The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
I add my thanks and congratulations to the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this debate. She approached this issue with her characteristic passion and forthrightness and gave me a number of challenges—again. I am pleased that she acknowledged that, since we last debated this, there has been progress. It is in that spirit that we need to continue this dialogue not just to address the issues, but to make sure that we do the right thing by those women who have been harmed by the use of vaginal mesh.
Ultimately, the tragedy of this case is that women have put their trust in the medical establishment to look after them and to make them well, and they have come out with the most debilitating, life-changing injuries. In many cases, these were very young women. It is very clear from the clinical guidance on these products that they should not be used as a first intervention, and should be used only in very extreme cases. We are to be very concerned about the extent to which this has been adopted.
It is great that the evidence shows that the use of this product is less than it was. Clearly, as the hon. Member for Pontypridd (Owen Smith) pointed out, there was a spike in the use of the product, and that use was not always appropriate. That highlights the need for proper understanding of the risk of any medicine or product, and underlines the need for very mature and sensible conversations between medical professionals and their patients so that people understand the risks of treatments, as opposed to understanding just the benefits. Most of all, it illustrates the need for informed consent on the part of the patient. I have been horrified in this debate to hear how many women did not understand the treatment that they were getting. That is clearly unacceptable.
In that spirit, I want to continue this dialogue. As the hon. Member for Central Ayrshire (Dr Whitford) pointed out, women are often sent away and told that, “It’s women’s problems.” Women are often patted on the head by members of the medical establishment. None of us women in this place is a shrinking violet, but we have also fallen victim to that behaviour, which is just not acceptable. We need to do more to change the culture of our health service and the way in which medical professionals interact with women. If we do not, the outcome is exactly the experience to which those ladies who are sitting in the Public Gallery can attest. I am very grateful to them for sharing their experiences. Sharing our very intimate and distressing personal details is not the most comfortable thing in the world, but the work they have all done in sharing their experiences has raised awareness and put the issue on the agenda. It has also made us more vigilant about protecting our own health when we are faced with problems. I thank them all.
Although there may be some specific points on which we differ, it is clear that we all share a determination to address the issues that have been raised. Clearly, a number of women have experienced extreme suffering, and it is important that the NHS does its best to make life better for those women and gives them the treatment that they need. I say to Members that if there is any evidence that women are not getting the treatment that they should be getting following a complex mesh procedure, please raise that with me and bring it to my attention and I will take action accordingly.
Gordon Marsden
I am very grateful to the Minister for giving way. She is acknowledging the depth of disquiet, suffering and pain, but she will also be aware from my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy), and indeed from my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), who spoke from the Front Bench, that there have been persistent calls for NICE to speed up the process. I ask the Minister a very specific question: what conversations has she had with her officials and NICE as to why they cannot bring this forward? Is it a question of a lack of appropriate aggregate evidence; is it a question of their own internal priorities; or is it a question of resources?
Jackie Doyle-Price
It is actually an issue of rigorous process. We need to make sure that NICE guidance has clinical integrity. The guidance to which the hon. Gentleman refers comes at the end of a longer process of other guidance that is going through the system. None the less, that intelligence is shared throughout—it is an entirely consultative process. The issues that we need to settle are all part of the public debate. Essentially, the publication of the NICE guidance comes at the end of that. The important thing is that everyone knows the issues and that we are very clear about the context in which this is an appropriate treatment. The guidance is very clear: this treatment should not be offered as a routine first intervention.
Owen Smith
I am not sure that that answer is correct, in as much as we know that there is no new clinical evidence to be produced in this area; there are no outstanding trials. Therefore, there is no reasonable reason why NICE cannot bring forward that guidance, and it certainly does not make sense for it to wait another year.
Finally, was the Minister surprised when the chief medical officer, who was sitting next to the Secretary of State, said on Facebook Live that she thought that the rate of complication in respect of mesh was between 15% and 20%—a stark difference from all previous estimates by Ministers or officials?
Jackie Doyle-Price
Let me emphasise that it is the robustness of the process that is at issue here. The guidance will be published for consultation later this year, and completed next year. There is a robust process for doing so.
The hon. Gentleman is right that the CMO suggested that there was a 15% to 20% complication rate, but I understand that she has written to him explaining that she misquoted the statistics and that the situation is more complex. That is one reason why the retrospective audit is so important. We now have a body of evidence that we can properly analyse, and as has been mentioned, my noble Friend Lord O’Shaughnessy has tasked the CMO with properly analysing the audit published this week so that we might more quickly draw conclusions.
Owen Smith
That is very interesting. I do not believe I have received a letter from the chief medical officer explaining that she got the statistics wrong. May I press the Minister to make sure that when the CMO looks at the register she offers a proper narrative analysis of what the numbers mean? We still have contested analyses of whether they show a bigger problem than we thought or whether it is the same. I think it shows a much bigger problem, but we need to understand the numbers.
Jackie Doyle-Price
I can absolutely give the hon. Gentleman that assurance. It is crucial that we address the matter transparently—that is very much the spirit in which I want to take this forward.
Dr Julian Lewis
Before those interventions, the Minister said that if people are still not getting adequate treatment, it should be brought to her attention. As I mentioned, I have been contacted by constituents saying they felt trapped because the people who did the procedures were refusing to refer them elsewhere for a second opinion and for possible help from the very small number of people who specialise in the rectification and reversal of these procedures. What advice can she give my constituents about how to break out of this restriction on being referred to people in whom they can have more confidence?
Jackie Doyle-Price
I listened carefully to my right hon. Friend’s representations on behalf of his constituents, and they filled me with alarm, because we have given a clear indication on this point and have established 18 specialist centres to deal with the consequences of mesh. There is, therefore, no excuse for patients who require further intervention not being properly referred. Perhaps he and I could take this up offline to make sure his constituents get the support they deserve.
I want to put this in the context of our broader emphasis on patient safety. We have learned, through difficult experience, that there is never one measure or magic bullet to suddenly transform services for patients; it is about sensible dialogue between patients, clinicians and sometimes politicians—sometimes we can have a role in catalysing the debate. We all need to pull together to tackle all aspects of the issue. In some respects it is about the actual product—the vaginal mesh—but it is also about clinical practice and behaviour, as we have talked about. The most important thing, however, is the need to listen to patients, who, in this context, are of course women. We have to make sure that we listen to women when concerns are raised so that we can properly tackle those concerns as they arise. As I have said before, I am concerned about informed consent for patients, but the issues go much further, and generally we could do much to improve the performance of the NHS by placing a greater emphasis on that.
We need to consider the whole issue of clinical advice. We know that this product should not be routinely offered as a first intervention, yet clearly it is. I am horrified to hear of women in their 20s and 30s being treated with this product, when clearly it is not intended for them. It is obviously easy for me to make a superficial judgment on that without knowing about the particular cases, but on the face of it, it seems quite wrong.
The issue has been raised of what is an acceptable level of risk. I do not like to think about that in terms of percentages, because the acceptable level of risk will differ from patient to patient. If we are talking about some new mums, the level of risk clearly would not be outweighed by the benefits, but if we are looking at women suffering from horrendous conditions of incontinence, that is a very different debate. Again, we need to think about the broader issues. It all comes down to making sure that the guidance is properly applied and that clinicians who are recommending the use of mesh are properly making that assessment in discussion with their patients.
There has been a demand for a public inquiry. We have introduced the Cumberlege review, which is designed to make sure that we properly assess the interests of patients going forward. I know that many patients have felt that their views have been ignored. Baroness Cumberlege is very keen to hear directly from individual patients about their experience, and will be going round the country to do exactly that.
I could say much more, but I must conclude so that we can move on to the next debate. I will write to hon. Members, who I thank for contributing to the debate, to address some of their other points. We are determined to do our best for women who have been badly treated in having this procedure.
Emma Hardy
I thank everyone who has contributed to this debate, and I welcome the continued dialogue between the all-party group and the Department of Health. It was interesting to hear for the first time that the Department recognises that it is not just the process but the product about which there are serious concerns. I also welcome what appears to be an admission that NICE is introducing draft guidelines this year—is that correct?
Emma Hardy
That is excellent. That is one of the things we called for. One thing that has come out more and more is that there needs to be informed consent. People need to know a lot more about the risks. All the risks need to be written down in front of someone in block capitals so that they know exactly what they are letting themselves in for.
I press again, as I did at the beginning of my speech, for all new mothers to be offered pelvic floor physiotherapy, as happens in France. As the Minister has just said, it is unacceptable that a new mother with a small, relatively minor inconvenience should be offered something that could result in permanent, life-changing disability. I urge the Minister to look into that as well.
I very much welcome the fact that we will have the draft NICE guidelines next year. As we have spent a lot of this debate talking about our mums and what they say to us, I will quote my mum. She always said, “Where there’s a will there’s a way”. If there is a way of bringing forward those NICE guidelines, let us make it happen, because if there is a determination across the House to make it happen, I am sure that the Department can find a way to do it and end this misery for so many women.
I end by thanking again all the fantastic women up there in the Gallery right now watching this debate. We are only talking about this now because of your bravery in coming forward and speaking out, and I thank each and every single one of you. We cannot undo the suffering you have experienced, but by speaking out and being so incredibly brave, you will stop women in the future going through what you have gone through. I and every Member who has spoken today thank you.
Austerity: Life Expectancy
Jackie Doyle-Price Excerpts(6 years ago)
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The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
It is a pleasure to see you in the Chair, Mr Paisley. I thank all hon. Members who have contributed. Clearly, we all want the best possible outcomes for all our constituents, and it is in that spirit that we approach this debate. I congratulate the hon. Member for Sheffield, Heeley (Louise Haigh) on securing the debate. I know her constituency well. Actually, looking at hon. Members opposite, I know the constituency of the hon. Member for Lewisham, Deptford (Vicky Foxcroft) well, also. That really brings into stark relief some of the issues we are talking about, because at the heart of the issue of life expectancy is the issue of inequality. I can speak from personal experience in my own constituency. The hon. Member for Washington and Sunderland West (Mrs Hodgson) talked about the differences between north and south, and rich and poor. Within my constituency there is a 10-year difference in life expectancy in the two-mile trip from the north of my constituency to the south, where it is poorest.
We are all acutely aware that inequalities lead to lower life expectancy. It would be a poor Minister for Health—indeed, a poor Member of Parliament or anyone involved in public life—who did not think that was important. It is important that we address it and we are determined to do so. I will run through some things, which tell a better story than the stark figures we have heard today. I will also address some of the points made about those figures, because I think it would be premature to draw too many conclusions at this stage about the causes of those and whether this is a long-term trend.
My hon. Friend the Member for South West Bedfordshire (Andrew Selous) also made some wise points. Ultimately, we can only spend what we collect from taxpayers. We are having an active debate on the extent of the funding we need to make available for health and social care. In this 70th anniversary year of the founding of the NHS, it is appropriate to focus on that. We will continue, notwithstanding the fiscal challenges that we face, to prioritise spending on health.
It is important to emphasise that this dip in life expectancy is not unique to the UK. We have seen it elsewhere in Europe. We need to be circumspect about drawing too much by way of conclusion.
The hon. Member for Washington and Sunderland West mentioned the Prime Minister’s speech. I want to supply the context of the Government’s approach against the background of that speech. The Prime Minister made it a priority to fight injustice and inequality. Ultimately, we know that by focusing actions on the people, communities and localities with the greatest needs, we will achieve the best health outcomes. As the hon. Lady said, we will also reduce long-term demand on the NHS and social care services, so it is smart to focus our strategy on tackling inequality.
We need to be honest about facing up to what the sources of inequality are. Sometimes, those will make us uncomfortable. One of the most disadvantaged groups in our society is those with learning disabilities. They will live 20 years less than the rest of us. For me, that is a very uncomfortable truth to live with. Successive Governments have tried to direct resources to help that group of people, but it is still not working. That leads to the realisation that this is as much about behaviour and leadership as it is about money.
David Hanson
Putting that aside for one moment, could the Minister explain to Members of the House why infant mortality rose for the first time in 30 years in 2016 and 2017? If it is not linked to the issues that my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) mentioned, what is it linked to?
Jackie Doyle-Price
The right hon. Gentleman knows that we have made tackling that a priority. It is too early to draw any conclusions. It is the case that poverty is a big source of inequality, but we need to do more work before drawing conclusions. Having developed the evidence, we will act. There is a reason that we have developed a national maternity safety strategy. There is a reason we are focusing resource on the perinatal phase, because we recognise it is critical. We will also continue to spend money on the healthy living supplements to give children a better start in life and to tackle some of those inequalities.
Dr Whitford
The Minister accepts in her speech that poverty is a big driver of these changes and talks about doing more, but we expect that over the next few years another quarter of a million children will be driven into child poverty. It is not a matter of doing more. In fact, the policies at the moment are making the situation worse.
Jackie Doyle-Price
I do not accept that. The real issue for us as a Government is being able to make those interventions that address the sources of inequality. It is about giving practical steps, which I will come to in more detail.
The hon. Member for Sheffield, Heeley referred to the article in The BMJ by Hiam and Dorling about the spike in mortality and winter deaths. She was absolutely right to highlight that. We must pay attention to emerging studies. However, using the total number of deaths can be misleading and needs to be put in the broader context. It does not take account of the ageing population and the fluctuations in population numbers. We use the age-standardised mortality rate as the accepted measure, which looks broadly stable. Clearly this is not something we should be complacent about, and we should continue to keep a very close eye on trends in those numbers.
I mentioned people with learning disabilities living for 20 years less than the rest of us. It is good that that figure has come down since 2000. Their life expectancy has risen by seven years since the millennium. We must encourage that direction of travel by supporting them to live full, healthy and independent lives. That goes to show that having better health is not just an issue for the NHS and health services, but is about having more support to get people into work and to help them to live in the community. We need to use every interface with the state to achieve that.
If we take a lifestyle approach to securing the best possible health outcomes and tackling inequalities, an individual’s start in life is the beginning of that. We are focusing on pregnancy through early years and into old age to ensure that every child gets the best start and journey through the rest of their life. Public Health England is leading programmes to ensure that women are fit during pregnancy. It is leading programmes to ensure that children are ready to learn at two and ready for school at five. We want to continue to support smoke-free pregnancy, which leads to better health for children. Central to that is local commissioning driving best-quality service and interventions as appropriate.
We are obviously very concerned about childhood obesity. If we do not tackle it, it will set people up for poor life expectancy in the longer term. It is worrying to see the number of children entering school at the age of five who are already obese. We need to leave no stone unturned to achieve early intervention. Broader public education about the impact of sugar is helping, but there is much more we can do to encourage people to adopt healthier lifestyles.
Louise Haigh
Could the Minister confirm what the net change in investment in early intervention has been since the Conservatives came to power?
Jackie Doyle-Price
I cannot give the hon. Lady that information now, but I will write to her.
Alcohol is a source of poor health outcomes, so we are also doing much to tackle that. I am in dialogue with Members on both sides of the House about supporting the children of alcoholic parents, recognising that they are a particular need group. I thank those hon. Members who have been associated with that.
Dr Whitford
With Scotland having been the first place to ban smoking in public places, and now moving forward with minimum unit pricing for alcohol, will this Government consider following that lead for England to tackle alcohol?
Jackie Doyle-Price
I am grateful for that point, which consideration is being given to in the Department. There are any number of tools that we could use to tackle alcohol. Probably the most important thing is to give the message that unsafe drinking is bad for the health. It is always interesting to learn from Scotland’s experience, and we will keep an eye on that.
Tobacco is a major cause of poor health. It is worth noting how much progress we have made over decades to reduce the prevalence of smoking. That should lead to better health outcomes, but that has yet to be seen.
Mike Hill (Hartlepool) (Lab)
Rates of premature deaths in Hartlepool and the north-east are among the highest in the country. Other issues such as poor-quality housing, food poverty, fuel poverty and unemployment are also factors. Does the Minister agree that those factors also need to be taken into consideration?
Jackie Doyle-Price
I agree. That is exactly the point made by the hon. Member for Central Ayrshire (Dr Whitford). Housing is probably the single most important ingredient in good health. We often talk in this place about there being a housing crisis and about the need to fix the broken housing market and get more supply. Amen. The fact that we have failed to manage the supply of housing effectively for decades is bringing bigger health challenges. We really need to crack that if we are to tackle some of these issues.
I could go on, but we are running short of time. We are seeing very good rates of improvement in health for things such as cancer, and much better outcomes for people. The direction of travel means that there are good things to report. I am grateful to all hon. Members who have approached this debate with real thought about the very serious issue of the decline in life expectancy. I am sure that we will revisit the issue, but my lasting message is that we see the method of tackling this being tackling inequalities. That is what I pledge to do.
Question put and agreed to.
Resolved,
That this House has considered austerity and changes in life expectancy.
Mental Health Units (Use of Force) Bill (Second sitting)
Jackie Doyle-Price ExcerptsWednesday 18th April 2018
(6 years ago)
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Mr Steve Reed (Croydon North) (Lab/Co-op)
It is a pleasure to serve under your chairmanship this morning, Ms Buck, however briefly. I thank Members for coming—I wish we were going to spend more time together, but it seems we are not.
I will just make a few points before I formally move the Adjournment. This is the fifth successive week the Committee has been unable to complete its work, and that is excluding the two weeks of recess. The reason is that the Government have not yet laid a money resolution, so we are not allowed to consider the remaining clauses. I have raised this directly with the Opposition Whips, who have raised it with the Government Whips. I have raised it in a direct question to the Leader of the House in business questions, and I pursued it in a letter to the Leader of the House, from whom I had a very charming reply that does not shed any further light on why the delays may be happening.
After five weeks, I am starting to feel that this is a little disrespectful to members of the Committee and to the Bill’s many supporters outside this House. I do not doubt for a moment the support of the Minister, or indeed the Government, who have consistently reiterated their support for the reform we are trying to get through, but it would be nice if the Government were able to let the Bill Committee get on with its work. With great respect, I would ask the Minister whether she has had any conversations with the Government Whips or Government business managers, what they may have said and when we might expect to have the money resolution.
The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
I share the hon. Gentleman’s impatience with the current state of affairs, not least because I really do believe that this is a very important reform, and the sooner we get it on the statute book, the better. However, as he alluded to, such matters are for the Government business managers. I am pleased that he has kept the pressure up at his end and raised this with the Leader of the House, and I know that those discussions are continuing.
I would remind the Committee that we have just had two weeks of recess and a very intense few days in terms of other business, which has perhaps dominated the business managers’ thinking this week. However, I hear the hon. Gentleman’s message completely, and I completely understand where he is coming from. Following this meeting, I will resume my conversations with the Government business managers so that we can make very fast progress.
Ordered, That further consideration be now adjourned.— (Mr Reed.)
Cyber-bullying: Young People’s Mental Health
Jackie Doyle-Price Excerpts(6 years ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
I thank my hon. Friend the Member for Cheltenham (Alex Chalk) for securing this timely debate on the important issue of the effects of cyber-bullying on young people’s mental health. He articulated extremely well the challenges that we need to tackle, and I agreed with much of what he had to say about them.
I pay tribute to my hon. Friend for the report that was published recently. As he said, 1,000 young people participated in the inquiry and produced a useful body of evidence from which to draw conclusions. I also thank the Children’s Society and YoungMinds for their role in the inquiry. I met representatives of YoungMinds today, and I have regular dialogues with them on the broader issues relating to the mental health of children and young people. They are very important partners for us in this context.
As my hon. Friend recognised, a number of Departments have an interest in this matter. I have often said that silo culture is the enemy of good policy making, and I am pleased to say that the Department of Health and Social Care, the Department for Education and the Department for Digital, Culture, Media and Sport are all approaching the issue from their own unique perspectives, and attacking it from different angles. We are all committed to tackling the scourge of cyber-bullying, although, as my hon. Friend pointed out, it is an emerging issue that requires careful consideration of the evidence and joint working to enable us to start stemming the flow. He was right to say that we need to draw conclusions in a timely way to ensure that we have the appropriate tactics for prevention.
It is important to recognise that the term “cyber-bullying” is often misleading. We are talking about two separate elements. Bullying is a kind of behaviour that can take many forms, and social and other cyber-media are tools for that bullying. As my hon. Friend and my right hon. Friend the Member for New Forest East (Dr Lewis) have said, this has become a particularly acute problem to tackle as those tools can be anonymous. That dehumanises both the bully and the victim, and if we do not get it under control more effectively it will become the epidemic my hon. Friend has warned of.
Turning to what the Government are doing, the Department of Health and Social Care is focusing on improving services for children and young people’s mental health. We know that children and young people’s mental health services need to improve, and we have a programme of work under way, supported by more than £1.4 billion of additional funding, to achieve just that. As my hon. Friend the Member for Cheltenham will know, the Department of Health and Social Care and the Department for Education recently published a joint Green Paper on children and young people’s mental health, which was supported by a further £300 million.
Through that Green Paper, we acknowledged the potential impact of social media and the internet on children and young people’s mental health, but, most significantly, we identified that effective mental health care for young people does not have to take place in a clinical setting. That reinforces the importance of getting the right support in schools, which underlines my hon. Friend’s priority of preventive measures. That is why we are placing much more support in and around schools, where young people spend so much of their time.
We are also taking action to use the digital world to our advantage, using positive digital interventions for mental health. For example, NHS Digital is producing an apps library that brings together a number of digital tools to help improve health, including mental health and wellbeing, for all ages. Over time, many more tools will be added to the library to support more health needs and drive up quality.
Turning to the online world, where I think my hon. Friend is more interested in holding other agencies to account, the Department for Digital, Culture, Media and Sport last year published our internet safety strategy Green Paper. A response to the consultation process will be published imminently, and I am sure my hon. Friend will be first in the queue to read its conclusions. It will include a number of preventive initiatives to tackle cyber-bullying so that all users of all ages feel confident in being online. For example, during the consultation we proposed a voluntary social media code of practice. The intention is for the code to provide guidance to platforms about how they should tackle abusive behaviour and content and support all users, because adults can be bullied just as much as children on social media platforms.
I personally think the providers can do a great deal more. My hon. Friend referred specifically to Facebook. While Mark Zuckerberg’s comments to which he referred are welcome, I think a lot more can be done. Given that reporting to social media companies is low among those who recognise that they have been cyber-bullied, and that children have little confidence in social media companies to resolve cyber-bullying, the internet safety strategy Green Paper also involved consultation on annual online safety transparency reporting by companies. That reporting is intended to both develop better understanding of the extent of bullying behaviours and encourage those who are being bullied to make referrals to those companies. Social media companies must do more to raise awareness and improve the clarity of their reporting mechanisms in relation to cyber-bullying, and we hope that improving transparency reporting will help improve the likelihood of young people reporting these issues in the future.
As I have said, however, this is not an online-only issue, and the Department for Education is taking action to prevent bullying in general as well as cyber-bullying. All schools are legally required to have a behaviour policy with measures to prevent all forms of bullying. The Government have already put in place a number of powers and a range of support to enable schools to prevent and tackle cyber-bullying. For example, headteachers have the power to regulate pupils’ conduct when they are not on school premises. Where bullying outside school is reported to teachers, it must be investigated and acted on. We have also ensured that schools have the power to ban, limit the use of, or search mobile phones in school, and the Government Equalities Office funded the UK Safer Internet Centre to develop cyber-bullying guidance for schools and an online safety toolkit to help schools deliver sessions about cyber-bullying, peer pressure and sexting. I can advise the House that the Department for Education is also providing £1.75 million of funding over two years to support schools in tackling bullying, with cyber-bullying being an integral element of that.
Returning to the role of social media companies, we really believe that they have a central role to play. That is why we set up a joint working group with the Department for Digital, Culture, Media and Sport to discuss how to make progress in specific areas, particularly that of age verification. My hon. Friend said that many young people are spending a great deal of time online—more than was good for their health—and we want to explore time limits. On the question of age verification, I am clear that the social media companies could do a lot more to protect young people. The reality is that if they can collaborate on developing apps that allow people to harvest data, they can use the intelligence on their platforms to identify young people and communicate with them. We recognise that some companies have existing work in place, and we congratulate them on that, but a lot more can be done. There are significant challenges to overcome, and there remains a need for further action to be taken. We are actively encouraging companies to work with us and to make tangible progress in this area.
We have heard what the Government are doing to tackle these problems as they arise, but we also need to recognise that, without further research, our efforts will not reach the level that we need and that young people deserve. We have heard the statistics already this evening. Social media and the internet are an ever-growing part of children’s and young people’s lives. As my hon. Friend has said, some individuals are spending an inordinate amount of time online. More than half of 12-year-olds have a social media profile, and those are the people who really need our protection. However, although evidence has shown links between increases in social media use and poorer mental health, it is not clear whether that increased use causes poorer mental health, or whether poorer mental health drives an increase in use of social media. We need to develop more evidence on that.
We should also recognise that there are positive impacts of social media use that can really improve the lives of children and young people suffering with mental health issues. It can build a community that they can access to increase their self-esteem and get social support. In practice, that could mean children collaborating on projects through better online communities—for example, a homework WhatsApp group for people in the same class or a Twitter hashtag for those studying for school or university exams. So let us keep a balance here: there are some positives. Young people also take advantage of being able to access supportive online networks of people with similar health conditions, which could be more difficult in the offline world.
I should also like to welcome the Science and Technology Committee’s recently launched inquiry into the effects of social media on young people’s health. I am sure that my hon. Friend will be watching that with interest too. I look forward to contributing to the inquiry and to hearing its outcomes, which will add to our evidence in this area. I can also advise the House that, in order to better understand the relationship between social media and the mental health of children and young people, the chief medical officer is leading a systematic review to examine all relevant international research in the area. For the review, existing literature will be searched extensively, which will enable Professor Davies to build a map of research activity, identify the areas for in-depth review and subsequently allow her to examine the areas in detail. This will allow her to assess the relative strengths and weaknesses of the evidence base, as well as considering the positive and negative impacts of social media.
In conclusion, across Government, we are as clear as my hon. Friend is about the need to take action to tackle and prevent the increase in cyber-bullying, as well as the need to improve the support available to those suffering as a result of it. We are incorporating such action within related work streams across the Department of Health and Social Care, the Department for Education and the Department for Digital, Culture, Media and Sport. It is clear that a cultural shift is needed to ensure that future generations do not accept cyber-bullying as the norm, and that they know when and how to access support and help. We need to make it clear what online behaviour is acceptable and what is not. We have made it clear as a Government that we are prepared to work with social media and technology companies in this area, and, like my hon. Friend, we expect them to take significant further steps. However, the buck stops with them. The ball is in their court and they need to do much more. We will continue to maintain the dialogue on that basis. I thank my hon. Friend again for raising this important issue. I have no doubt that we will come back to the subject again.
Dr Julian Lewis (New Forest East) (Con)
On a point of order, Mr Speaker. With the blessing of the Government Whip here present, may I ask whether any steps have been taken to reinstate the curtain-and-commode system that used to envelop the Chair, so that on occasions like today, when you have sat there continuously from when the House first met until the House adjourns this evening, you might be able to do so in a little more comfort?
Mental Health Units (Use of Force) Bill (First sitting)
Jackie Doyle-Price ExcerptsWednesday 28th March 2018
(6 years, 1 month ago)
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Mr Steve Reed (Croydon North) (Lab/Co-op)
I beg to move,
That the Bill be considered in the following order, namely, Clauses 1 to 6, Clauses 9 to 11, Clauses 7 and 8, Clauses 12 to 20, new Clauses, new Schedules, remaining proceedings on the Bill.
It is a pleasure to serve under your chairmanship, Ms Buck. We have finally got the Bill to Committee, and I am delighted that we are all here. The Committee has been delayed for four weeks in a row, because of the Government’s failure to lay a money resolution, which would allow us to consider the Bill in its entirety and all the amendments. Even this morning we will not be able to consider several amendments because a money resolution has still not been laid, despite the fact that the Bill enjoys the support of the Government and received the unanimous support of the House on Second Reading. When I asked the Government why the money resolution had not been laid, they said it was not possible because of the heavy schedule of business going through the Chamber, but both yesterday and last Tuesday the Adjournment was early because of insufficient business going through the House.
I want to register my disappointment that the money resolution has not been laid at this stage, and I urge Government and other Members to use their influence with the Whips to encourage the Government to do so as soon as possible. The Bill contains an important reform that will dramatically improve safety for many highly vulnerable people using mental health services, and I see no reason for it to continue to be delayed in such a fashion.
The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
It is a pleasure to serve under your chairmanship this morning, Ms Buck. I thank the hon. Gentleman for the points he has made. He is absolutely right to say that the Government support the measure. We support it very much because of the co-operative discussions that we have had, to get it to a place where everyone can agree. I fully endorse his point that the Bill is an important social reform; it is an important ingredient in our broader agenda to improve the treatment of people with mental health problems and illness.
The hon. Gentleman made his point about the need for a money resolution robustly. I will relay his representations to the House business managers, so that we can proceed without delay, as we all want such an important reforming measure to be on the statute book as soon as possible.
Question put and agreed to.
Clause 1
Key definitions
Mr Reed
I beg to move amendment 2, in clause 1, page 1, line 5, leave out subsection (3) and insert—
‘(3) “Mental health unit” means—
(a) a health service hospital, or part of a health service hospital, in England, the purpose of which is to provide treatment to in-patients for mental disorder, or
(b) an independent hospital, or part of an independent hospital, in England—
(i) the purpose of which is to provide treatment to in-patients for mental disorder, and
(ii) where at least some of that treatment is provided, or is intended to be provided, for the purposes of the NHS.’
This amendment replaces the definition of “mental health unit” with a new definition which clarifies that a unit may form part of a hospital. The amendment also removes care homes and registered establishments from the definition, and includes mental health units in an independent hospital within the definition only where the unit provides NHS treatment.
Jackie Doyle-Price
I confirm that the Government entirely support these amendments, which make the language in the Bill consistent with the 2015 code of practice under the Mental Health Act 1983, and with broader guidance. That makes for a much tidier way of achieving the objectives of the Bill.
Amendment 2 agreed to.
Amendments made: 3, in clause 1, page 1, line 8, leave out subsection (4) and insert—
‘( ) In subsection (3) the reference to treatment provided for the purposes of the NHS is to be read as a service provided for those purposes in accordance with the National Health Service Act 2006.’
This amendment ensures that “treatment for the purposes of the NHS” is read in accordance with the National Health Service Act 2006. It also makes a change which is consequential on the removal of care homes from the definition of “mental health unit” (see Amendment 2).
Amendment 4, in clause 1, page 1, line 12, leave out subsection (5) and insert—
‘( ) “Patient” means a person who is in a mental health unit for the purpose of treatment for mental disorder or assessment.’—(Mr Reed.)
This amendment provides a new definition of “patient”. This definition makes clear that a patient includes a person who is in a mental health unit in order to be treated for mental disorder or to be assessed in the unit.
Mr Reed
The clause establishes a named accountable individual in a mental health unit who will be responsible for a reduction in the use of force. It seeks to create established, clearer lines of accountability for the existence of appropriate policy, and for when things go wrong, so that it will be possible to find somebody who can explain exactly what circumstances might have led to any problems or failings with the use of force.
Amendment 7 replaces the phrase “registered manager” with “responsible person”. The change in language avoids confusion with existing Care Quality Commission regulations that use the phrase “registered manager”, but the intention remains the same. By introducing the legal concept of a responsible person for mental health units, the Bill increases accountability and leadership. Ultimately, the responsible person will be accountable for the requirement that the Bill places on mental health units, so it is important properly to define them as a senior officer in the organisation. They will set the organisation-wide direction for a reduction in the use of force. The responsible person will be at board level, with more detail about who is appropriate set out in guidance by the Secretary of State under clause 6. Amendments 5, 11 and 60 are consequential on changes of the phrase “registered manager” to “responsible person”.
Jackie Doyle-Price
The Government support the amendments. Perhaps one of the most important aspects of the Bill is that it enshrines accountability for ensuring that any institution fulfils its responsibilities. The buck needs to stop somewhere, and it is important that happens with someone at board level. The amendments are important for improving leadership, governance and accountability for the use of force. The amendments were drafted in line with the existing positive and proactive care guidance. It is also worth emphasising that this will not incur any additional burden on healthcare organisations; it will simply strengthen and enshrine accountability. On that basis, the Government are happy to approve the amendments.
Amendment 5 agreed to.
Amendment made: 6, in clause 1, page 2, line 1, leave out subsections (7) and (8) and insert—
‘(7) References to “use of force” are to—
(a) the use of physical, mechanical or chemical restraint on a patient, or
(b) the isolation of a patient.
(7A) In subsection (7)—
“physical restraint” means the use of physical contact which is intended to prevent, restrict or subdue movement of any part of the patient’s body;
“mechanical restraint” means the use of a device which—
(a) is intended to prevent, restrict or subdue movement of any part of the patient’s body, and
(b) is for the primary purpose of behavioural control;
“chemical restraint” means the use of medication which is intended to prevent, restrict or subdue movement of any part of the patient’s body;
“isolation” means any seclusion or segregation that is imposed on a patient.’—(Mr Reed.)
This amendment provides a revised definition of “use of force” which uses simpler language. It also removes threats from the definition and includes the isolation of a patient in the definition.
Clause 1, as amended, ordered to stand part of the Bill.
Clause 2
Mental health units to have a registered manager
Amendment made: 7, in clause 2, page 2, line 26, leave out subsections (1) to (3) and insert—
“( ) A relevant health organisation that operates a mental health unit must appoint a responsible person for that unit for the purposes of this Act.
( ) The responsible person must be—
(a) employed by the relevant health organisation, and
(b) of an appropriate level of seniority.
( ) Where a relevant health organisation operates more than one mental health unit that organisation must appoint a single responsible person in relation to all of the mental health units operated by that organisation.”.—(Mr Reed.)
This amendment replaces the requirement for mental health units to have a “registered manager” with a requirement to appoint a “responsible person”. That person must be employed by a relevant health organisation and be of an appropriate level of seniority. If an organisation operates multiple units, only one responsible person needs to be appointed in relation to those units.
Clause 2, as amended, ordered to stand part of the Bill.
Clause 3
Policy on use of force
Mr Reed
I beg to move amendment 8, in clause 3, page 2, line 36, leave out subsection (1) and insert—
‘(1) The responsible person for each mental health unit must publish a policy regarding the use of force by staff who work in that unit.’.
This amendment replaces Clause 3(1) and provides a clearer duty for the responsible person to publish a policy regarding the use of force in mental health units.
Mr Reed
I thank my hon. Friend for her intervention. Mersey Care is well known to me and to many others in the room as a fine example of the best practice that we wish to replicate everywhere across the country, so that patients, wherever they are, can enjoy the very best levels of service, to which they ought to be entitled.
I will go through the amendments in the grouping. Collectively, they are intended to add greater clarity and consistency to the policies. Amendment 9 provides that, for relevant organisations that operate a number of health units, the responsible person needs to publish only one policy to cover all staff in all those units. Amendments 10 and 13 ensure that the policy is consulted on when it is first published and when changes are made. It is important that the responsible person considers and consults the views of current and previous service users to ensure that their experiences form part of improving policy and guidance into the future.
Amendment 14 requires the policy to include reducing the use of force, which is a key purpose of the Bill, and a key commitment that the use of force should only ever be used as a genuine last resort, as indeed it is in Mersey Care and other mental health trusts. We should be clear that this is only a start—we would like the use of force to be minimised and not just reduced—but this puts into legislation the Government’s intention to reduce the use of force, and we will be holding them to that.
Amendment 16 places into statutory guidance a requirement on the responsible person to take all reasonable steps to ensure compliance with the policy, and makes a failure to have regard for the guidance a breach of the statutory duty.
Jackie Doyle-Price
The Government entirely support the need for every institution to which the Act will apply to make a policy on the use of force. Central to that is the concept of accountability; having a named person, as we have already discussed, plus a policy for an organisation to be held to account to, is clearly important to achieve that. The Government support these amendments and see them as important ingredients in reducing the use of force overall in mental health units. We will ensure that any guidance produced under this clause gives further detail about what policies should include. We expect that to look like what is already set out in positive and proactive care guidance. We expect it to say that responsible persons will have a duty to have regard to this guidance in the development of their organisation’s policy, which will help ensure that each policy meets the same basic criteria as well as allowing for local flexibility.
I associate myself with the comments of the hon. Members for Liverpool, Wavertree and for Croydon North on Mersey Care, which offers a good example. The culture of transparency in itself generates sensible use of force, and only when appropriate. It is a truism for everybody in this room that we want to see minimal use of force. There are occasions when, for the safety of both patient and staff, it sometimes needs to be used, but the way to be sure that it is only used appropriately is to have that culture of accountability. Many organisations could learn from Mersey Care in that regard. We support these amendments.
Amendment 8 agreed to.
Amendments made: 9, in clause 3, page 2, line 37, at end insert—
‘( ) Where a responsible person is appointed in relation to all of the mental health units operated by a relevant health organisation, the responsible person must publish a single policy under subsection (1) in relation to those units.’.
This amendment provides that if there is a single responsible person for all of the mental health units operated by a relevant health organisation, the person needs to provide a single policy for those units.
Amendment 10, in clause 3, page 2, line 37, at end insert—
‘( ) Before publishing a policy under subsection (1), the responsible person must consult any persons that the responsible person considers appropriate.’
This amendment requires the responsible person to consult before publishing the policy under Clause 3.
Amendment 11, in clause 3, page 2, line 38, leave out “registered manager” and insert “responsible person”.
This amendment is consequential on Amendment 7.
Amendment 12, in clause 3, page 2, line 38, leave out second “the” and insert “any”.
This amendment is consequential on Amendment 13.
Amendment 13, in clause 3, page 2, line 40, leave out subsections (3) and (4) and insert—
‘( ) The responsible person may from time to time revise any policy published under this section and, if this is done, must publish the policy as revised.
( ) If the responsible person considers that any revisions would amount to a substantial change in the policy, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised policy.’
This amendment requires a further consultation under Clause 3 if the responsible person intends to make substantial changes to the policy published under that clause. Amendment 12 is consequential on this amendment.
Amendment 14, in clause 3, page 3, line 2, leave out “minimise and”.
This amendment removes the requirement that the policy under Clause 3 must minimise the use of force. Instead it will require the policy to reduce the use of force.
Amendment 15, in clause 3, page 3, line 2, leave out
“at the mental health unit”
and insert
“in the mental health unit by staff who work in that unit”.
This amendment ensures consistency with Clause 3(1) as amended by Amendment 8.
Amendment 16, in clause 3, page 3, line 3, leave out subsection (6).
This amendment removes the requirement for the registered manager to take all reasonable steps to ensure compliance with the policy published under Clause 3.
Amendment 17, in clause 3, page 3, line 6, leave out subsection (7).—(Mr Reed.)
This amendment removes a consultation requirement that is superseded by the changes made by Amendment 10.
Clause 3, as amended, ordered to stand part of the Bill.
Clause 4
Information about use of force
Mr Reed
I beg to move amendment 84, in clause 4, page 3, line 12, leave out subsections (1) to (3) and insert—
‘(1) The responsible person for each mental health unit must publish information for patients about the rights of patients in relation to the use of force by staff who work in that unit.
(1A) Before publishing the information under subsection (1), the responsible person must consult any persons that the responsible person considers appropriate.
(1B) The responsible person must provide any information published under this section—
(a) to each patient, and
(b) to any other person who is in the unit and to whom the responsible person considers it appropriate to provide the information in connection with the patient.
(1C) The information must be provided to the patient—
(a) if the patient is in the mental health unit at the time when this section comes into force, as soon as reasonably practicable after that time;
(b) in any other case, as soon as reasonably practicable after the patient is admitted to the mental health unit.’
This amendment replaces Clause 4(1) to (2) with a duty to publish information about the rights of patients in relation to the use of force in a mental health unit. Before publishing the information, a consultation must be carried out. The published information must be given to patients in the mental health unit and to new patients admitted to the unit, and to any other person considered appropriate if in the unit.
Jackie Doyle-Price
I said at the beginning of today’s proceedings that I view the measures enshrined in the Bill as an important social reform. These amendments and this clause go to the heart of that, in the sense that it is all about empowering patients and enshrining their rights. That is very much the spirit in which we are embarking on the review of the Mental Health Act, so we completely support the clause and the amendments.
The amendments ensure that other appropriate people, such as patients’ carers and relatives, will normally receive information about use of force, which is key for patients who do not always understand the information that is given to them, as the hon. Gentleman suggested. It is also important to understand that sometimes too much information can cause patients further distress at a difficult time. In those circumstances, a good relationship with relatives and carers is extremely important. That can be as much about empowering the patients as furnishing the individual with such information.
On the specific concern that amendment 85 might cause a loophole, I must emphasise that the exception is not about letting any unit off, but about recognising when it might be appropriate so that information will not cause further unintended distress and ensuring that patients’ interests are protected. Different patients will require different approaches, and a one-size-fits-all approach does not count.
When the measure is set alongside the other provisions in the Bill, we are satisfied that we have the right balance between protecting the rights of patients and empowering them—and empowering their carers and relatives to look after them—while having appropriate safeguards to prevent further distress. I support the amendments.
Amendment 84 agreed to.
Amendments made: 19, in clause 4, page 3, line 24, leave out from “provided” to “in” in line 27.
This amendment removes the requirement that the Secretary of State must prescribe the form that information under Clause 4 must be provided.
Amendment 20, in clause 4, page 3, line 27, leave out “with regard to” and insert “having regard to”.
This amendment is a drafting change to Clause 4(4)(b).
Amendment 21, in clause 4, page 3, leave out line 28.
This amendment removes a paragraph that deals with providing information under Clause 4 that has regard to the patient’s communication needs because that paragraph is unnecessary.
Amendment 22, in clause 4, page 3, line 29, leave out “capacity” and insert “ability”.
This amendment is a drafting change to avoid confusion with the terminology of the Mental Capacity Act 2005.
Amendment 23, in clause 4, page 3, line 30, leave out subsection (5).
This amendment is a drafting change linked to Amendment 22.
Amendment 24, in clause 4, page 3, line 31, at end insert—
“( ) The responsible person must keep under review any information published under this section.
( ) The responsible person may from time to time revise any information published under this section and, if this is done, must publish the information as revised.
( ) If the responsible person considers that any revisions would amount to a substantial change in the information, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised information.”.
This amendment requires the responsible person to keep information published under Clause 4 under review. If the responsible person intends to make substantial changes to the information published under that clause, then a consultation must be conducted.
Amendment 85, in clause 4, page 3, line 31, at end insert—
‘( ) The duty to provide information to a patient under subsection (1B) does not apply if—
(a) the patient refuses to accept the information, or
(b) the responsible person considers that the provision of the information to the patient would cause the patient distress.
( ) The duty to provide information to another person under subsection (1B) does not apply if—
(a) the patient requests that the information is not provided to the person, or
(b) the responsible person considers that the provision of the information to the person would cause the patient distress.’—(Mr Reed.)
This amendment provides exceptions to the duties to provide information under Clause 4. It provides that a patient can refuse to accept the information or request that it is not provided to another person, and the information does not need to be provided if it would cause distress to the patient.
Clause 4, as amended, ordered to stand part of the Bill.
Clause 5
Training in appropriate use of force
Mr Reed
I beg to move amendment 86, in clause 5, page 3, line 33, leave out subsection (1) and insert—
‘(1) The responsible person for each mental health unit must provide training for staff that relates to the use of force by staff who work in that unit.
(1A) The training provided under subsection (1) must include training on the following topics—
(a) how to involve patients in the planning, development and delivery of care and treatment in the mental health unit,
(b) showing respect for patients’ past and present wishes and feelings,
(c) showing respect for diversity generally,
(d) avoiding unlawful discrimination, harassment and victimisation,
(e) the use of techniques for avoiding or reducing the use of force,
(f) the risks associated with the use of force,
(g) the impact of trauma (whether historic or otherwise) on a patient’s mental and physical health,
(h) the impact of any use of force on a patient’s mental and physical health,
(i) the impact of any use of force on a patient’s development,
(j) how to ensure the safety of patients and the public, and
(k) the principal legal or ethical issues associated with the use of force.’.
This amendment replaces Clause 5(1) with a revised duty on the responsible person to ensure that training is provided for staff that covers a wide range of topics relating to the use of force in mental health units.
Mr Reed
My hon. Friend makes an important point, clearly and eloquently. There are no circumstances in which an untrained member of staff, whether full-time or not, should be able to use force—effectively violence—on a patient. If they have not been properly trained, that should be an absolute no.
Jackie Doyle-Price
The clause relates to ensuring that all members of staff are appropriately trained on when it is appropriate to use force. It is worth emphasising that it will make any institution or organisation safer for patients, but also for staff. It is important to prioritise and enhance training in de-escalation techniques. That will make for a safer environment for everyone, with less harm to patients, and will probably help to some extent with their continuing care and recovery. I totally endorse the clause, and the amendments, which will make it more effective. Clearly these measures are important for a Government whose approach to leadership in health involves prioritising patient safety.
We see the provisions as an opportunity to build on the positive and proactive care guidance. The amended clause will now go much further to address the points made by the hon. Members for Croydon North and for Liverpool, Wavertree. Only people working in a professional capacity would be able to use force on patients; any volunteers would not be able to do so. In that sense, it is a much stronger measure, because we are giving a clear view that the use of force is not something that volunteers should be involved in.
Mr Reed
Rather than including too much prescriptive guidance in the Bill, we have decided that it is best dealt with through statutory guidance, so that it can always be kept up to date with the latest best practice or other information and can be changed more quickly than legislation. Clause 6 sets out the requirements for guidance to be issued to set out compliance with the various requirements of the Bill. Amendment 28 places a duty on the Secretary of State to produce that guidance. That is a more appropriate level at which to produce the guidance than the CQC, although the CQC will have an important role to play in monitoring and regulating compliance with the Bill. The guidance will be statutory, so a failure to have regard to it will be a breach of a statutory duty. The amendments provide me with the assurance that operators of mental health units will be fully aware of their duties and the requirements under the Act.
New clause 3 gives the responsible person the power to delegate their functions under the Bill to another employee of appropriate seniority, but it does not mean that the responsible person will no longer be accountable for that function. It is important that in every unit there is always a named individual who is responsible for compliance with the provisions of the Bill and accountable, should there be any failure to comply with the provisions.
Jackie Doyle-Price
I agree that it is more appropriate for the Secretary of State to produce the guidance under the clause. The guidance will provide mental health units and the healthcare organisations that operate them with a detailed explanation of the requirements of the Bill. That will help to ensure that they understand the obligations they are under and, in turn, help them reduce the use of force so that it is only ever used as a last resort and carried out appropriately.
I want to clarify something I said earlier, in case I gave a slightly wrong impression when I referred to volunteers. We do not expect volunteers to use force and, accordingly, we do not expect them to be given training. There will not be an outright ban, but clearly the emphasis in the Bill means that only appropriately trained professional staff will be involved.
The duty to consult will ensure that there is input from a wide range of partners and stakeholders, so that the guidance is well received within the health service. On that basis, the Government are content to support the amendments. We are also content to support the new clause, which will allow a responsible person to delegate some of their functions to the right person within the organisation, but still retain overall accountability for compliance with the requirements of the Bill.
Amendment 28 agreed to.
Amendments made: 29, in clause 6, page 4, line 3, leave out “registered managers” and insert
“responsible persons and relevant health organisations”
This amendment is consequential on Amendment 7 as well as including relevant health organisations as subjects of the guidance published under Clause 6.
Amendment 30, in clause 6, page 4, line 3, at end insert—
‘(1A) In exercising functions under this Act, responsible persons and relevant health organisations must have regard to guidance published under this section.’
This amendment places a duty on responsible persons and relevant health organisations to have regard to the guidance published under Clause 6.
Amendment 31, in clause 6, page 4, line 3, at end insert—
‘(1B) The Secretary of State must keep under review any guidance published under this section.’
This amendment places a duty on the Secretary of State to review any guidance published under Clause 6.
Amendment 32, in clause 6, page 4, line 3, at end insert—
‘(1C) Before publishing guidance under this section, the Secretary of State must consult such persons as the Secretary of State considers appropriate.’
This amendment imposes a duty onto the Secretary of State to consult before publishing guidance under Clause 6.
Amendment 33, in clause 6, page 4, line 4, leave out subsection (2)
This amendment removes Clause 6(2) which is legally unnecessary.
Amendment 34, in clause 6, page 4, line 10, leave out subsection (3) and insert—
‘(3A) The Secretary of State may from time to time revise the guidance published under this section and, if this is done, must publish the guidance as revised.
(3B) If the Secretary of State considers that any revisions would amount to a substantial change in the guidance, the Secretary of State must consult such persons as the Secretary of State considers appropriate before publishing any revised guidance.’
This amendment places a duty onto the Secretary of State to consult before publishing revised guidance under Clause 6 where the revisions to the guidance are substantial.—(Mr Reed.)
Clause 6, as amended, ordered to stand part of the Bill.
Clause 9
Annual report by the Secretary of State
Mr Reed
I beg to move amendment 70, in clause 9, page 5, line 39, leave out subsections (1) to (4) and insert—
‘(1) As soon as reasonably practicable after the end of each calendar year, the Secretary of State—
(a) must conduct a review of any reports made under paragraph 7 of Schedule 5 to the Coroners and Justice Act 2009 that were published during that year relating to the death of a patient as a result of the use of force in a mental health unit by staff who work in that unit, and
(b) may conduct a review of any other findings made during that year relating to the death of a patient as a result of the use of force in a mental health unit by staff who work in that unit.
(1A) Having conducted a review under subsection (1), the Secretary of State must publish a report that includes the Secretary of State’s conclusions arising from that review.
(1B) The Secretary of State may delegate the conduct of a review under subsection (1) and the publication of a report under subsection (1A).
(1C) For the purposes of subsection (1)(b) “other findings” include, in relation to the death of a patient as a result of the use of force in a mental health unit, any finding or determination that is made—
(a) by the Care Quality Commission as the result of any review or investigation conducted by the Commission, or
(b) by a relevant health organisation as the result of any investigation into a serious incident.’
This amendment replaces the provisions of Clause 9 with a duty imposed on the Secretary of State to review reports each year made by coroners under the Coroners and Justice Act 2008 (often referred to as “regulation 28 reports”). The Secretary of State can also review other findings. After the review, a report must be published that includes the Secretary of State’s conclusions arising from the review.
This clause is very important. When there has been a fatality in a mental health unit, a coroner investigates the circumstances and the causes of that death and produces a report. I sat in for part of the coroner’s hearing following the death of Olaseni Lewis in Croydon. The coroner’s findings in that case were very damning of failures that had occurred leading up to that young man’s death, which were certainly avoidable, had lessons from previous coroners’ inquiries been properly learned and applied.
The purpose of the amendment and the clause is to ensure that all findings from coroners’ reports over a year are collated by the Secretary of State and published in an annual report, with the Secretary of State’s conclusions on how the state is learning from any incidents that occurred during that year.
That is an important step towards transparency and a culture in which lessons are learned quickly and effectively. A striking element of the findings in coroners’ reports over the years is how frequently the same recommendations are made again and again. If there was learning in the system and those lessons were being applied, that repetition would be far less likely to occur.
The proposal is to ensure that when those findings are made, they do not vanish into the ether; they must to properly understood and incorporated into the future development of best practice, to keep mental health patients safe. Amendment 70 would make the necessary provisions for the Secretary of State to carry out the publication of the reports.
Jackie Doyle-Price
Transparency is such an important ingredient in ensuring that we strengthen the rights of patients in mental health settings, and ensuring the accountability of organisations that are discharging their responsibilities at the behest of the state. That is why transparency is at the heart of the measures in the Bill.
Having read more than my fair share of coroners’ reports since taking this job, I fully endorse the provisions in the clause and the amendment. It is important that the broader system learns lessons when things go wrong. If we learn lessons when things go wrong, the chances that they will not happen again are much stronger. It is very important that the healthcare system is able to learn lessons from any death of a patient in a mental health unit that results from the use of force.
Drawing together the lessons learnt from a variety of sources into one report will allow greater transparency and shine a light on the issues that need to be tackled by organisations, and it will ensure that the learning from these tragic events is not lost. For that reason, the Government support the amendment.
Amendment 70 agreed to.
Clause 9, as amended, ordered to stand part of the Bill.
Clause 10
Requiring information regarding the use of force
Question proposed, That the clause stand part of the Bill.