Organ Donation (Deemed Consent) Bill

Jackie Doyle-Price Excerpts

Committee Debate: 1st sitting: House of Commons
Wednesday 12th September 2018 Public Bill Committees

[Dame Cheryl Gillan (Chesham and Amersham) (Con)]

Mr Wilson, it is a pleasure to serve under your chairmanship. I rise to support the amendments in the names of the hon. Member for Coventry North West and the Minister.

I rise only briefly to say that I am a convert. Originally, when I was Secretary of State for Wales, I was not convinced that an opt-out system would be beneficial. I have changed my mind; when the facts change, one should, as a politician, change one’s mind. One of the things that has changed my mind is personal contact with a family where an organ will be needed to save a young man’s life. There is nothing more powerful than having that presented to one as a politician. That means that all of us must have an open mind about so many things.

The way the trend has been going, particularly in Europe, is interesting. I think now more than 24 countries in Europe have some form of opt-out system. Although we have not yet really seen the benefits in Wales of the legislation that came in in December 2015, I frankly think that we need to improve the mathematical odds. We will do so only by creating a culture in which organ donation is spoken about, not in hushed tones or with accompanying difficulty, so that it becomes part of the common parlance.

The testimonies given by other Members in Committee show that the fact that a loved one may go, but parts of that loved one can contribute to saving or enhancing the lives of others, has to be a good thing. I support the amendments and hope the Bill gets a very fair wind so that it becomes law.

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

It is a pleasure to serve under your chairmanship, Mr Wilson, and with colleagues across the Committee. Without exception, everyone in the room has been a passionate advocate for organ donation. I am grateful for all the efforts made to promote this important procedure and movement.

With your indulgence, Mr Wilson, I would like to reflect on some of the comments made by members of the Committee before I address the amendments in detail. The Government fully support the Bill and are grateful to the hon. Member for Coventry North West for promoting it. The amendments are a tidying-up exercise and I put my name to them.

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[Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab)]

I thank the Minister for making that point. Under the current system, when people have a donation card, it is still the responsibility of the next of kin to make the decision to donate. In most instances, that decision is not made. Therefore, the value of that card is not upheld.

[Jackie Doyle-Price]

The hon. Gentleman makes a good point. One of the difficulties in making legislation such as this, where things are put very clearly on the statute book, is that we must have regard to what really happens at the bedside. It is one thing for something to be written in law, but how do relatives losing a loved one in the most atrocious circumstances deal with this? It comes back to a cultural change. The most important thing any of us can do if we want to increase organ donation is ensure that we all have those conversations with our families, so that they understand our wishes. Let us put ourselves in the position of being at the bedside of a loved one who is losing their life. We can put all the support in place—specialist nurses to talk them through the process and so on—but unless families really understand their loved one’s wishes and have had that conversation, naturally the next of kin will be reticent to give consent. One of the great virtues of the Bill and the surrounding campaigns is that we have encouraged people to have those conversations. It has been a real driver of cultural change in that sense.

The hon. Member for Strangford also shared his experience, for which I am grateful, and reiterated that no one would be compelled. Finally, my right hon. Friend the Member for Chesham and Amersham was, as always, wise in her observation that, when the facts change, people should change their minds. It is not a weakness if politicians do so from time to time. I am grateful to all Committee members for their support.

The amendments constitute a tidying-up exercise that essentially make it clear that we are talking about organ transplantation. Their effect would be to remove novel transplants—such as hand and uterine transplants—from the scope of the Bill. The medical advances that allow such transplants are amazing, but in order that the law keeps pace with those developments, we need to make those exemptions and state that we really are only talking about organs. Amendment 7 amends the long title of the Bill to better describe what the Bill will do.

Most points around the Bill have already been made, but I will touch on some of the procedural issues that will flow from it. We expect a rise in the number of organ transplants as a consequence of this legislation, because more organs will be available. We could estimate that, and it could be anything from one to 700, but even one extra life is enough for me. However, I am confident that it will be much more than that. We will also have to put in place the register and the mechanics around it and publicise the changes. Following the Bill’s passage to becoming an Act—touch wood—we are looking at an implementation period of a year before everything is completely nailed down, enshrined and operational.

There has been lots of talk about the role of families. Ultimately, families will clearly wish to have a role in the welfare of a person who lacks the capacity to make a decision after deciding to be a donor. We need a system that takes families with us on this. We are sensitive to people’s faiths and beliefs, and that will all be considered as part of the wraparound care that we will put in place. We will obviously undertake further discussions with the Welsh Government to see how far we can learn from their experiences. By the time the Bill’s passage is complete, we will essentially have the same legal structure across Wales, England and Scotland.

I have talked about novel transplants, and clearly we will have the power to alter the regulations if other kinds of transplantation become possible over time. This legal framework should therefore be future-proof and able to react to changes in medical practice.

The hon. Gentleman ably spoke to the amendments. I do not have much more to say, other than that this is an extremely valuable piece of legislation. As a Health Minister, I have been given a wonderful tool to help us to save lives. It has been an absolute pleasure to work with all Committee members and to achieve this change one way or another. I look forward to seeing the Bill on the statute book. Everybody here, who has fought so much for these measures, can be extremely proud.

[Mr Robinson]

So many generous words have been extended in my direction that I feel that some redressing of the balance is necessary. I was lucky, and I hope I chose my Bill well. Judging by the support we have had through all its stages, it seems as though there is a groundswell of approval, opinion and acclamation for it, but one thing must not be overlooked, and that is that the Bill would have been very difficult if not impossible but for the support of the Government, including the Prime Minister in person. Throughout this, she has stuck to what she said in Liverpool.

I must also say that there have been tight moments, awkward moments, but the presence of the Minister with responsibility for the Bill, who is with us today, has throughout been one of charm—a smoother who, with her grace, has been able to get us through those moments too. She said it had been a pleasure to work with the Health Committee and it has indeed, and it has been a great pleasure to work with the Minister.

We keep saying these things, but perhaps we should cut down on further compliments to each other until we get the Bill through the Lords. On that basis, we are all in this together and still working hard, because we are not there yet, and who knows what the Lords will throw at us—

Organ Donation (Deemed Consent) Bill (Money)

Jackie Doyle-Price Excerpts

Money resolution: House of Commons
Tuesday 11th September 2018 Commons Chamber

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

I beg to move,

That, for the purposes of any Act resulting from the Organ Donation (Deemed Consent) Bill, it is expedient to authorise the payment out of money provided by Parliament of any increase attributable to the Act in the sums payable under any other Act out of money so provided.

I am pleased to say that the Government fully support this Bill, which has been ably promoted by the hon. Member for Coventry North West (Mr Robinson), who I congratulate on his fantastic efforts to build cross-party support for this significant piece of legislation, as evidenced by the attendance this evening, well past home time.

Oral Answers to Questions

Jackie Doyle-Price Excerpts

Tuesday 24th July 2018 Commons Chamber

[Eleanor Smith (Wolverhampton South West) (Lab)]

6. What steps his Department is taking to increase the number of BAME blood, stem cell and organ donors throughout England.

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

We urgently need more black, Asian and minority ethnic donors to save lives through the gift of organ donation. That is a priority for the Government. Last week, I launched a national campaign to address myths and barriers and bring attention to the life-saving power of organ donation. It is crucial that these messages be properly tailored to enable everyone to participate.

[Eleanor Smith]

In 2017-18, only 1 33 people from the BAME community in this country donated an organ. While they are still living, BAME people make up a third of the people on transplant waiting lists and have to wait over a year longer than white patients. I know that the Government announced a new campaign, following NHS Blood and Transplant’s annual report on organ donation, within the BAME community, but it fails to address many of the recommendations in my report “Ending the Silent Crisis”, published in June. I sent a copy to the Minister, along with a request for a meeting, but I have yet to receive a response. Will she agree to meet me after the recess to discuss the recommendations in my review?

[Jackie Doyle-Price]

I am sorry the hon. Lady has not received a response, because I instructed my office to say I would agree to meet her. I commend her work in this area, because it is very important that we tackle this injustice. Central to that is reaching out to those communities and engaging with them in a way that inspires them. We have found in our work over the last year that there is a sense of distrust among some minority ethnic communities towards health providers. I will be bringing out some tools in the autumn and would encourage all Members to reach out to their minority ethnic communities to tackle the fact that, as she says, a third of people on transplant waiting lists are from black and Asian communities and that we need more donors.

[Mr Jim Cunningham (Coventry South) (Lab)]

7. What steps he is taking to improve access to NHS adult eating disorder services.

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

The Government are committed to improving eating disorder services for adults. The National Institute for Health and Care Excellence has updated its guidelines, and NHS England recently completed a national review of provision and is considering next steps. We will also be ensuring that people remain properly served as they transfer between children’s and adults’ services.

[Mr Cunningham]

Two thirds of adults wait more than four weeks and one third wait 11 weeks for treatment. What are the Government going to do about it, in the light of the review that the Minister has just mentioned?

[Jackie Doyle-Price]

As I have said, NICE has published its new clinical guideline on the recognition and treatment of eating disorders in people over the age of eight, including adults, and we will make clear to NHS organisations what we expect of them. We are ensuring that we meet the waiting times for eating disorder treatment, and we are delivering against those standards.

[Paula Sherriff (Dewsbury) (Lab)]

Data from NHS Digital show that the number of beds for people with serious mental health conditions, such as eating disorders, has fallen by nearly 30% since 2009. The Government say that they are committed to ensuring that everyone with an eating disorder has access to timely treatment, but according to the hon. Member for Central Suffolk and North Ipswich (Dr Poulter)—who I believe is also an NHS doctor—there is often a long wait for patients with eating disorders who need beds for urgent in-patient care. Does the Minister agree with him?

[Jackie Doyle-Price]

The hon. Lady’s starting point was “since 2009”. It is certainly true that there was a decline then, for a number of reasons, not least the fact that we are improving treatment in community settings rather than acute in-patient beds. Our Five Year Forward View began in 2014, and we have been delivering improvements in the number of beds and staff since that date.

[Rosie Duffield (Canterbury) (Lab)]

8. What recent assessment he has made of the effect on the health and social care sector of the UK leaving the EU.

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[Andrew Percy (Brigg and Goole) (Con)]

13. What assessment he has made of the extent to which the draft Human Fertilisation and Embryology Act 2008 (Remedial) Order 2018 meets his Department’s policy objectives on equality.

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

The revised remedial order laid last week addresses the potential inequalities that were identified by the Joint Committee on Human Rights, but it also goes further, ensuring that a sole applicant biologically related to the child will always be able to apply for a parental order regardless of their relationship status. That is a step forward for equality.

[Andrew Percy]

On behalf of the all-party parliamentary group on surrogacy, I thank the Minister for meeting us recently and for laying the order, which removes an inequality. Surrogacy helps to build families, be they heterosexual, same-sex or individuals, so what more can she do to promote it?

[Jackie Doyle-Price]

My hon. Friend is right. There has been considerable growth in surrogacy arrangements in recent years, but I am unsure whether the law has kept pace with the changing practice. We have been revising the guidance to ensure that everyone can approach the matter with greater certainty but, more specifically, I have commissioned the Law Commission to have a good look at the law in the area so that we can ensure good practice in this country without driving people overseas.

[Melanie Onn (Great Grimsby) (Lab)]

What action is the Minister taking to ensure that the National Institute for Health and Care Excellence guidelines on equal access to IVF are adhered to, so that people such as my constituent Rebekah Hambling, who sadly lost her IVF baby to group B strep, are not denied further rounds of IVF in North East Lincolnshire because they would still have been eligible in other CCG areas?

[Jackie Doyle-Price]

I agree with the hon. Lady. It is unacceptable that seven CCGs offer no IVF treatment at all, which is establishing a postcode lottery. We keep reminding NHS England and CCGs of the NICE guidelines and we expect them to follow them.

[Mr Speaker]

I call Bim Afolami. Not here. This is a rum state of affairs. I hope the fellow is all right. He was here earlier, but he has beetled out of the Chamber at a most inopportune moment. Well, there is nothing to be done, and the grouping breaks down, but I hope Bim’s okay. Reports would be welcome.

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[Mary Robinson (Cheadle) (Con)]

19. What steps his Department is taking to help protect children’s mental health from the harmful effects of social media.

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

Our chief medical officer is leading a systematic review of international research to improve our understanding of social media use and children’s mental health. We are also working with the Department for Digital, Culture, Media and Sport to consider what more can be done to reduce potential harm to children’s mental health from social media. This is being done through the Government’s upcoming internet harms White Paper, which is due later this year.

[Mary Robinson]

The longer people spend online, the more likely they are to experience cyber-bullying. Research by Childline, a service of the National Society for the Prevention of Cruelty to Children, shows that the number of young people seeking counselling as a result of online bullying has increased by 88% in just five years. What are the Government doing to improve research on this issue and to better understand the potential harms?

[Jackie Doyle-Price]

My hon. Friend is right to highlight this, but it is worth bearing in mind that there are also positive effects from engagement on social media. The relationship between social media use and its impact on mental health is not conclusive. That is why the chief medical officer is carrying out a review of all the evidence in this area, so that we can understand and shape future policy. That report will be due next year.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

The Government acknowledge that we are seeing an increase in the number of children suffering with their mental health. We have only to look at the figures on the number of children turning up at accident and emergency in a crisis to know that that is the case. This is a serious state of affairs. Why then are the Government releasing their response to the consultation on the Green Paper on young people’s mental health later this week, when we are in recess, and thus avoiding scrutiny in this House?

[Jackie Doyle-Price]

Respectfully, I say to the hon. Lady that this is a response to the consultation on the Green Paper, which has had considerable debate in this House. The suggestion that we have avoided scrutiny really does not pass.

[Mr Speaker]

I know the hon. Gentleman, who has returned to the Chamber in rude health, is in fact deeply grateful to me for my generosity in accommodating him, notwithstanding his rather eccentric disappearance, and the fact that he did not mention it was a mere oversight.

[Jackie Doyle-Price]

I can confirm that the Government will be publishing their online harm White Paper by the end of this year to address the very subject my hon. Friend mentions.

[Chris Elmore (Ogmore) (Lab)]

I have asked the previous Secretary of State whether he would agree to engage in my all-party group inquiry on social media and the impact on young people’s mental health. May I ask this Minister to go a step further and engage in our oral evidence sessions, which are starting when the House returns in September, about how we can find solutions to the problems that the impact of social media causes to young people’s mental health?

[Jackie Doyle-Price]

I would be more than happy to engage with the hon. Gentleman and the all-party group on this issue, because it is important we do as much as we can to learn and to get as much evidence as possible in this area.

[Anna Turley (Redcar) (Lab/Co-op)]

21. If he will ensure that funding for services commissioned by South Tees clinical commissioning group will not be reduced as a result of that group being placed in special measures.

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[Lilian Greenwood (Nottingham South) (Lab)]

T3. Last month, a constituent contacted me about the care of her adult son who needed to be admitted to hospital under the Mental Health Act 2007. She was told that no beds were available anywhere in the country. The following day, a bed was identified but when, after three hours’ wait, the ambulance had not arrived, the bed was filled by another patient. Three days later, he was finally admitted to hospital. The head of mental health at Nottingham City Council told me that this is not an infrequent occurrence. Secretary of State, how is this an acceptable standard of mental healthcare?

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

Clearly, the sequence of events that the hon. Lady has outlined is completely unacceptable. We have obviously set out clear expectations on NHS England to commission sufficient beds to enable local placements where possible and specialist care where a more acute service is required. It is up to NHS England to ensure that sufficient services are commissioned and I will readily take up that case with NHS England.

[Nicky Morgan (Loughborough) (Con)]

I welcome my right hon. Friend to his new position.

On Friday, a retired NHS consultant visited my surgery to talk about carpal tunnel syndrome. It appears that some of the operations are not going to happen now, and he said that they can happen at general practice level for about a third of the cost that they happen at hospital level. Is there an opportunity, yes, to save money but also to do things better by moving surgery out to community facilities? Can we explore such opportunities before these decisions are taken?

[Ellie Reeves (Lewisham West and Penge) (Lab)]

T4. Despite previous reassurances from Health Ministers, I continue to receive reports from constituents of waiting times for referrals to child and adolescent mental health services in excess of nine months and, with an extremely high threshold for support, many are turned away. The Government spend less than 1% of the NHS budget on children’s mental health. When will the Department stop failing our children and gives CAMHS the investment that it desperately needs?

[Jackie Doyle-Price]

The hon. Lady will be aware of the proposals that we have in the children and young people’s mental health Green Paper. We have very ambitious plans to roll out a whole new workforce to work in schools to support children at an earlier stage of mental ill health. Why we have these proposals is that we readily admit that an insufficient number of children are able to access services at present, and that is why we are making this investment.

[Martin Vickers (Cleethorpes) (Con)]

My constituent, Aaron Winstanley, from Barton-upon-Humber is currently in Germany receiving immunotherapy treatment for a rare form of cancer. The local community has reacted magnificently, raising around half of the £300,000 that this treatment costs. Could the Minister outline what is being done to introduce this treatment into England?

[Liz Twist (Blaydon) (Lab)]

T6. Three times more people die by suicide each year than in road accidents. Today, Samaritans volunteers across the UK are taking part in its awareness campaign, “The Big Listen”. What action is the Secretary of State taking to ensure that local agencies are encouraged and resourced to carry out awareness-raising work to get out the message that suicide is preventable, not inevitable, in line with NICE’s draft guidelines?

[Jackie Doyle-Price]

I thank the hon. Lady for her dedicated work on this issue. She is right to pay tribute to the work of the Samaritans, and the Department is pleased to do everything that we can to support the Samaritans in this area. Our real tool for tackling suicide is to ensure that the local suicide prevention plans are up to spec to deliver a reduction in suicides. We will be taking steps properly to interrogate the quality of the plans so that we can deliver against the guidelines.

[Chris Green (Bolton West) (Con)]

I welcome the Secretary of State to his position, especially given his background in data and digital. What is he going to do to improve NHS data management to enable its use to develop the next generation of drugs and medical technologies to deliver better health outcomes?

Perinatal Mental Illness

Jackie Doyle-Price Excerpts

Thursday 19th July 2018 Westminster Hall

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

It is good to see you in the Chair, Mr Rosindell. The debate has been excellent. I have enjoyed listening to all the speeches, which, without exception, have been thoughtful, constructive, and, in the case of people who have been through motherhood, very honest and gritty about the reality of the situation that we face. I pay tribute to the hon. Member for Stockton South (Dr Williams) for making as articulate a speech as possible on the issue. It covered the whole breadth of subjects that we need to consider. It was a real pleasure to listen to him. I will say the same about my hon. Friend the Member for South West Bedfordshire (Andrew Selous). I am pleased to see two men leading the charge on this subject. It is an important message that this is not a woman’s problem; it is a problem for society and for families. Ultimately, if we do not tackle it, society picks up the tab. It is great that two male Members of the House are leading the charge.

Many themes have come up in the debate, and I will try to address them all. I will begin by tackling the issue of the first 1,001 days. A number of hon. Members present are members of the all-party parliamentary group for the prevention of adverse childhood experiences. We recognise that the period from conception to age two is vital for every child’s development, and that is why we are prioritising and focusing on ensuring that there is sufficient perinatal mental health support at that stage. On the wider issue of adverse childhood experiences, the hon. Member for Stockton South mentioned that having four of them makes someone more likely to end up in prison. This is about the best kind of early intervention—for me, that is a no-brainer. We can identify those young people or children who are most at risk of falling out of society. Therefore, we should look at how best we can intervene early to support them.

[Luciana Berger]

I am delighted to hear the points the Minister has made about the importance of the first 1,001 days and the nought-to-two agenda. On that basis, might we expect the Government to respond to their Green Paper consultation on young people’s mental health by putting in place measures to support and help under-fives?

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[Jackie Doyle-Price]

As I have often said, the real focus of the Green Paper is on schools and measures that we are taking with the Department for Education. However, the hon. Lady and others will be aware that we have committed to extra funding for the NHS and we are working with NHS England on what we can all expect with that extra funding. I am open to representations as we develop that 10-year plan as to what else we can do in this space. As we are in discussions with NHS England, I cannot make any commitments but this is exactly the time when we should rigorously be testing policy suggestions and interventions that we might be able to deliver.

[Dr Paul Williams]

It was reported in the Health Service Journal two days ago that the chief executive of the NHS, Simon Stevens, has outlined five priorities for the 10-year plan and that one is reducing health inequalities. Does the Minister think that a serious focus on reducing health inequalities—particularly those that are embedded from the beginning of life—should be a focus for the 10-year plan?

[Jackie Doyle-Price]

The hon. Gentleman earlier used the phrase “spend to save”, so the answer is yes, because obviously if we make interventions earlier and they help people to help themselves, there is a long-term saving to the NHS. That is the exact spirit in which we are entering the 10-year plan for the NHS. I look forward to hearing suggestions from the APPG—get in touch with us soon.

I thank everyone who has contributed to the debate and hope that we can go forward with the shared objective of doing the best we can for new mothers. By that I mean not only improving services, but giving support in general to women who are going through the experience of motherhood. As many Members have said, we are offered a fairy tale fantasy about how everything is perfect and wonderful, when actually there is a lot of associated vomit, pain and misery—joyful as the experience is overall. We need to tackle the taboo, because the fact that we think that everything is a perfect fairy tale means that the pressure on those women who are struggling makes them feel like failures. They are not: it is all entirely normal.

I am always struck by the fact that one in three women suffers from incontinence. People do not know about it, because everyone suffers in silence and just gets on with it. I often ask, “How would it be if one in three men suffered from incontinence?” We would hear about that a lot more. We need to be generally more open and give women the message: “Do you know what? It is normal to feel you are struggling, and feel miserable, because you have gone through a life-changing experience and a physical trauma. It is inevitable that it will affect your mental health.” Giving them the message that it is normal is half the battle, because they will realise that they are not a failure but just need to manage and work through the situation. We need the right services in place to help them.

[Andrew Selous]

Is the Minister aware of the Best Beginnings “Baby Buddy” app, which has videos of parents sharing their experiences to help reduce the isolation some parents feel? It encourages women to take the time to look after themselves and their relationships, if they are with a partner. Does she agree that that is practical? It is free and lottery funded. It is not making a profit, as far as I am aware. I think it is run by a charity. Things like that can be helpful to mothers who might otherwise be quite isolated.

[Jackie Doyle-Price]

That sounds like a good resource, not least because it means women can get access to help in a more anonymous, less threatening way. We need sufficient tools to be available for women—and families, for that matter.

We have heard constantly throughout the debate that women are not always asked about their mental health in GP health checks. For that matter, they are not always asked about their physical health either; it is all about the baby. One of the challenges we have in improving the way in which we deliver health comes from the fact that an NHS practitioner faced with a patient will focus on the immediate problem and not the patient’s holistic needs. There is a need to consider mother and baby together. A baby cannot be looked at in isolation. The role of the mother, and the relationship with the mother, is part of the child’s welfare. We need to spread better practice in that regard.

[Andrew Selous]

I agree very much about looking at the mother as well as the baby, but does the Minister agree that, where there is a relationship with a partner, dad must not be left out, and that working on the couple’s relationship is a key matter, given that mums probably look to their children’s parent more than anyone else for emotional and practical support?

[Jackie Doyle-Price]

I thank my hon. Friend for being my conscience—we absolutely must not forget dad or partner, or for that matter the wider family. Members have expressed concern about the declining number of health visitors, and the beauty of having a health visitor is exactly the fact that they develop a relationship with the family and can talk to dad as well. Quite often, dad feels excluded from the process.

[Wera Hobhouse]

Valuable and important as that exchange is, the point about the #HiddenHalf campaign is that often attention is diverted away, because the baby and the dad are there. #HiddenHalf is looking for quality time for the mother in particular. I want that space to be preserved, however much is done by the GP. It is important that a woman who has gone through the trauma that the Minister described is able to feel, “Someone is just looking after me.” It is important to recognise that.

[Jackie Doyle-Price]

I agree and do not think the two points are in conflict. We need both—we need the wider package of support.

The theme we have been considering—of women not always being asked about themselves, and its being all about the baby—is not confined to the issue of perinatal mental health. Women face that across the board with respect to their health. The hon. Member for Worsley and Eccles South (Barbara Keeley) spoke about a women’s health strategy and women’s mental health. I co-chair a women’s mental health taskforce with the chair of Agenda, and in the coming weeks we will present our report on a year-long piece of work. It will have information about tools to enable the health service in general better to support women’s mental health. I am also doing more to raise the whole issue of women’s mental health, because I feel strongly that women are often disempowered in health settings. We need to give them the tools to take control of their own care and to feel empowered to engage in good conversations with medical professionals, to benefit their health.

We have heard anecdotal accounts of women’s experiences, and what has come across is the arrogant behaviour of some medical professionals. They see a large number of patients and they are not always sensitive to how best to communicate with certain individuals. We need that practitioner-patient relationship to work a lot better, particularly in the case of women. I am open to representations from everybody about what tool we can use.

The hon. Member for West Ham (Lyn Brown) is no longer in her place, but I have been impressed by her work on hysteroscopies with women. We are developing tools on that. I reassure all Members that women’s health and the way in which the national health service can better serve women are high on my agenda. I am not going to stand here and say that the world is perfect, but we have made perinatal mental health a priority in the five year forward view. We are midway through that review, so I should give Members an account of how far we have got and what more needs to be done.

To go back to 2010, the situation was really quite poor. Only 15% of localities had fully fledged specialist services in the community, and 40% of communities provided absolutely no service at all. People talked about a postcode lottery; clearly, we could not allow that to continue. We need to work towards universal provision. We are implementing the recommendations of the five year forward view for mental health taskforce, which reported in 2016. From 2015 to 2021, we are investing £365 million into perinatal mental health services. NHS England is leading a transformation programme to ensure that, by 2021, at least 30,000 more women each year are able to access specialist mental healthcare during the perinatal period. In May, NHS England confirmed that, by April next year, new and expectant mums will be able to access specialist perinatal mental health community services in every part of the country. We are making progress. The key to that is community provision.

[Barbara Keeley]

I asked the Minister a specific question: we are halfway towards the deadline for the 30,000 target—does she know how that target is going? Has there been an improvement of 15,000?

[Jackie Doyle-Price]

I will write to the hon. Lady with some detail on the figures, but the point is that the access is there. Obviously, it will take time to become embedded. We have a good direction of travel to deliver against that commitment and we will continue with that. Community-based provision is key, but we also need to ensure that there are sufficient specialist perinatal mental health beds in mother and baby units for particularly severe cases. NHS England has taken a more strategic approach to commissioning, so that there is a level of access that does not involve wide-scale moving out of area.

As ever with transformation programmes, change takes time, but we are on track to meet our commitments. We are investing £63.5 million this financial year to support the development of those specialist perinatal mental health community services across England. Our pace of change is to enable 2,000 more women to access specialist care. Last year that was exceeded, so we should maintain the pace that we planned in the five-year forward view.

I have visited one of the new in-patient mother and baby units in Chelmsford, where there are four new beds. That centre is expanding its capacity. As well as opening new centres, we are expanding the capacity of existing ones to give more support. In Devon, the trust opened a four-bed mother and baby unit in a reused space in April this year while the new unit is being built, so we still have that provision even though there is not the physical space. By the end of this financial year, we will have expanded the capacity of those beds by 49% since 2015 and there should be more than 150 beds available for mothers and babies in those units.

We are also expanding psychological therapy services, which successfully treat many women who experience common mental health conditions such as depression and anxiety disorders during the perinatal period. We have set an ambition for at least 25% of people with common mental health conditions to access services each year by 2020-21, including extending provision to ensure swifter access for new and expectant mothers. However, as we have heard today, getting perinatal mental healthcare right is not just about expanding specialist services in isolation. Many professionals in different parts of the health and care system are well placed to support women in the perinatal period. NHS England is working with partners to ensure that care for women is integrated and joined up effectively. More than £1 million was provided in 2017 to enable the training of primary care, maternity and mental health staff, to increase perinatal mental health awareness and skills.

NHS England has also invested in multidisciplinary perinatal mental health clinical networks, which will include GPs across the country to support that strategic planning, working across services to ensure that those wider services are in place. The role of GPs is central in identifying when someone is suffering from perinatal mental illness, and to ensure that those women are directed towards treatment. The role includes monitoring early-onset conditions, including pre-conception counselling, referring women to specialist mental health services, including access to psychological therapies, and specialist perinatal community teams where necessary.

I am aware of the NCT’s #HiddenHalf campaign; I am grateful for its campaigning on this important issue. The National Institute for Health and Care Excellence recommends post-natal checks for mothers and new-born babies. NHS England expects commissioners and providers of maternity care to pay due regard to the NICE guidelines. My hon. Friend the Member for South West Bedfordshire raised this issue and said that, since this was part of what we should expect from GPs, it seemed anomalous that so many mothers and babies were not getting such checks. We make clear to GPs what we expect of them, as part of their contract, but ultimately we rely on clinical commissioning groups to ensure that GPs deliver against the obligations that we expect of them. This is not the only case where this happens—many GPs are not delivering learning disability health checks either. We need to be clear with NHS England that we expect that obligation to be delivered.

[Dr Paul Williams]

The hon. Member for South West Bedfordshire referred to a maternity additional service that only four general practices have opted out of. Is the Minister aware of what period of time that additional service covers?

[Jackie Doyle-Price]

I will come back to the hon. Gentleman, but this area requires further exploration because we need to be clear about how we deliver on those things.

[Dr Williams]

I will gladly tell the Minister: the period of time covers pregnancy but ends 14 days after birth. Whereas it may be very appropriate for a GP to provide care during that time, the additional service that the hon. Member for South West Bedfordshire referred to ends 14 days after birth. We are talking about a different issue: the opportunity to do a check six weeks after birth. There is no commissioning of that check at the moment. It is helpful that the Minister says that she expects commissioners to commission that check, but is that a commitment from the Government to ensure that commissioners are funded to be able to commission that six-week check?

[Jackie Doyle-Price]

I was coming to that—I was just dealing with the point made by my hon. Friend the Member for South West Bedfordshire.

Moving on from the NICE guidelines, we clearly expect GPs to do their part in identifying and supporting women. We are aware of the campaign, but any changes to GP contracting arrangements to specifically include the six-week check-up would need to be negotiated with the GP committee of the British Medical Association. Those negotiations are taking place and will be completed by September. I cannot give any firmer commitment than that, other than to say that we obviously want to see GPs make their contribution.

[Barbara Keeley]

I just want to reiterate what I said earlier: the Opposition support that campaign and would look at implementing it in government. I outlined that the NCT put a cost of £20 million on it. Clearly, the Minister could have that figure checked out, but it is balanced against the £1.2 billion extra cost to the NHS and social care of perinatal mental health problems in every one-year birth cohort. There really is a point here about investing to save further down the road.

[Jackie Doyle-Price]

I thank the hon. Lady for that. As she says, if we are talking about £20 million in a broader settlement, that clearly should be under consideration given the outcomes that could be achieved on the basis of the evidence we have seen. I am not negotiating the contract, but we will have the outcome of those negotiations in the not-too-distant future. Members on both sides of the Chamber expressed very clearly the view that they want GPs to be able to do more to support new mothers. That message has been well noted, and I thank Members for making it. They said they wished to give me as much as assistance as they could in my battles on these things, and they certainly made a very strong case.

I want to come back to health visitors. I am a firm believer that health visitors are uniquely placed to identify mothers who are at risk of suffering, or are suffering, perinatal mental health problems and to ensure they get the early support they need. In fact, I visited the Institute of Health Visiting only a couple of weeks ago and heard a moving story from a new mum who had gone through a mental health crisis. It is striking that she had experienced all the feelings we have talked about—she felt there was something wrong with her, she could not bond with her baby, and she got more and more depressed and withdrawn about it. The other interesting thing about that case was that it was dad who felt utterly powerless to do anything. Only their relationship with their health visitor enabled them both to reach out for help.

I am under no illusions about the importance of health visitors. I was privileged to meet so many fantastic advocates for them as part of the NHS’s 70th birthday. They are our eyes and ears in so many ways, and they are our intelligence network in tackling adverse childhood events. I am full of praise for the important job they do in supporting new parents and families through a child’s early years. I am really pleased about the success of the Institute of Health Visiting perinatal and infant mental health champions training programme. Those 570 champions play a crucial role in spreading good practice and early identification of mental health problems.

Some hon. Members raised concerns about the decline in the number of health visitors. There was a substantial increase in the run-up to 2015, and there has been a fall since. I am bothered about that, so I will look at how we can encourage local authorities to alter that situation, recognising that in some areas local leaders have realised that health visitors can do so much more to deliver better outcomes for their communities. Blackpool, for example, has substantially increased the number of visits. I am really looking forward to seeing the outcome of that work, so that we can encourage that good practice in other local authorities.

I reiterate my thanks to all Members for their thoughtful comments and questions, but I especially thank the hon. Member for Stockton South and my hon. Friend the Member for South West Bedfordshire for securing the debate. I am very proud of our direction of travel in delivering and transforming perinatal mental health services so that we ensure that more expectant and new mothers are able to access high-quality mental health support, but we should never be complacent about that. I look forward to continuing the transformation programme.

Human Fertilisation and Embryology Act 2008: Remedial Order

Jackie Doyle-Price Excerpts

Thursday 19th July 2018 Written Statements

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

We are today laying a revised non-urgent remedial order, which will enable a sole applicant to apply for a parental order, which transfers legal parenthood after a surrogacy arrangement.

The Joint Committee on Human Rights (JCHR) published its report about the initial draft remedial order on 2 March 2018. The Government have carefully considered the issues raised in the report and have accepted the recommendations made by JCHR. We have taken additional action so that the revised order ensures that a biological parent in a surrogacy arrangement is not blocked by their relationship status from obtaining legal parenthood.

Surrogacy has an increasingly important role to play in our society, helping to create much-wanted new families for a range of people. The UK Government recognise the value of this in the 21st century where family structures, attitudes and lifestyles are much more diverse.

The revised remedial order reflects an equal approach for a sole applicant or a couple in obtaining legal parenthood after a surrogacy arrangement. The order will allow a six-month period where an existing sole applicant can retrospectively apply for a parental order for a child born through surrogacy.

It will be for the Joint Committee on Human Rights to further scrutinise the revised order, take views from parliamentarians and stakeholders and advise the Government and Parliament on the appropriateness of the order. The Committee will have 60 days to undertake these considerations and then make recommendations to Parliament, before debates in both Houses.

[HCWS893]

Independent Medicines and Medical Devices Safety Review Update

Jackie Doyle-Price Excerpts

Tuesday 10th July 2018 Written Statements

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

In February, the Government announced the establishment of the Independent Medicines and Medical Devices Safety Review. Baroness Cumberlege is in the process of conducting the review into what happened in each of the cases of primodos, sodium valproate and surgical mesh, including whether the processes pursued to date have been sufficient and satisfactory, and to make recommendations on what should happen in future.

Baroness Cumberlege has reported to the Department of Health and Social Care an early finding of her review relating to surgical mesh. Following a number of engagement meetings with patients, she has concluded that there should be a pause without delay in the use of surgical mesh for stress urinary incontinence (SUI).

In letters to the Secretary of State, Parliamentary Under-Secretary of State for Mental Health and Inequalities, Parliamentary Under-Secretary of State for Health (Lords) and chief medical officer, Baroness Cumberlege has set out a number of conditions that should be met ahead of the resumption of mesh procedures used to treat SUI:

Surgeons should only undertake operations for SUI if they are appropriately trained, and only if they undertake operations regularly;

Surgeons report every procedure to a national database;

A register of operations is maintained to ensure every procedure is notified and the woman identified who has undergone the surgery;

Reporting of complications via MHRA is linked to the register;

Identification and accreditation of specialist centres for SUI mesh procedures, for removal procedures and other aspects of care for those adversely affected by surgical mesh; and

NICE guidelines on the use of mesh for SUI are published.

Ministers in the Department of Health and Social Care have taken advice from the chief medical officer and the senior clinicians in our health system on Baroness Cumberlege’s recommendation.

Having reviewed Baroness Cumberlege’s recommendation and having considered the NHS’s progress in implementing the relevant NICE guidelines across the system, the chief medical officer and senior clinicians have concluded that we should institute a pause in the use of vaginally inserted mesh to treat prolapse and the use of tape or slings to treat stress urinary incontinence. They have concluded that this should be done through implementation of a high vigilance programme of restricted practice. They have advised that this approach will allow the NHS to put in place a consistent, high-quality service that adequately meets the conditions set out by Baroness Cumberlege. Both the chief medical officer and Baroness Cumberlege agree that we should not introduce a blanket ban of the relevant procedures, and that there will need to be some exceptions within the pause, within a high vigilance programme of restricted practice. The Department has accepted Baroness Cumberlege’s recommendation, and the advice from the chief medical officer and senior clinicians.

NHS England is now working with other agencies in the system to implement the pause quickly and safely. A clinical advisory group is being established to ensure that appropriate measures are put in place to give effect to the high vigilance programme. NHSE will be writing to providers imminently.

NHS England and NHS Improvement will ensure that provider medical directors and nurse directors are equipped with timely advice and guidance to ensure that clinicians can support patients to make clear decisions about their treatment.

The Department will work with Baroness Cumberlege and senior clinicians in the NHS to act with pace on this decision. The Department is very grateful to Baroness Cumberlege and her review team for listening to the voice of patients and for intervening on their behalf; and to the chief medical officer and senior clinicians for their further advice and commitment to putting in place safe and effective changes for patients.

[HCWS841]

Mental Health Units (Use of Force) Bill

Jackie Doyle-Price Excerpts

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

[Sir Christopher Chope (Christchurch) (Con)]

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

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

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

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

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

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

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

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

[Sir Christopher Chope]

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

--- Later in debate ---

[Philip Davies (Shipley) (Con)]

I start by commending the hon. Member for Croydon North (Mr Reed) for his dedication to the Bill and, more importantly, for his dedication to his constituent Seni Lewis and his family, who have been through unimaginable tragedy.

The hon. Gentleman’s campaign to highlight the issues that the Lewis family have faced and to create a positive change in mental health practices is admirable and a true reflection of the care and compassion he applies to his role in his local community. As he knows, and as we have discussed on a number of occasions, I support the core principles of what he is aiming to do. The Bill is something of a curate’s egg, because some bits are very good, some bits are bad and, most frustratingly—this happens with virtually every Bill that comes before the House—some bits could have been much better, as he and I both agree.

As my hon. Friend the Member for Christchurch (Sir Christopher Chope) mentioned, the Minister said on Report that she could not agree to certain things being included in the Bill but that she wants them to be included in statutory guidance. I will outline my under-standing of the things that will go into statutory guidance, which the Minister will hopefully either confirm or correct. Hopefully, as I have always intended, the Bill will then be able to complete its passage in no time at all.

Clause 5, on training in appropriate use of force, is a positive step forward in the care of patients. It is an important change, as it centres on the very core of health services—the patient. Key elements of the training programme are listed in subsection (2). The use of techniques for avoiding or reducing the use of force, and the risk associated with the use of force are two fundamental points that are vital when restraint methods are part of a medical care plan.

It must not be forgotten that the most forceful restraint methods are advised to be used as a last resort. Medical staff should be fully versed in a wealth of techniques to avoid such restraints, where possible, but it must not be assumed that restraint should be banned altogether. Unfortunately, there are times when forceful restraint is necessary, but it is essential that such techniques are used with a full knowledge of the associated risks.

It is regrettable that my amendment 12, on introducing training on acute behavioural disturbance, was not accepted on Report, as it would have enhanced the Bill. I thank the hon. Member for Croydon North for supporting that amendment. I have been advised by the Minister that such training will be added to statutory guidance instead, and I thank her for sending me a letter on Wednesday to follow up on many of these points.

My concern, and I would like some clarification, is how the statutory guidance will be worded. In her letter to me, the Minister quoted the 2015 National Institute for Health and Care Excellence guidelines, which state that training on ABD

“should be included in staff training”.

The whole point of my amendment is that it would have ensured training on ABD must be included in staff training. My concern is that guidance is just that, guidance, rather than something that is mandatory. This is an opportunity to ensure the thorough education of staff on something we have established to be central to the Bill.

I therefore hope the Minister is able to confirm, whether today or in future, that training on acute behavioural disturbance must, rather than just should, be included in staff training. It must be mandatory.

[Jackie Doyle-Price]

I appreciate my hon. Friend’s frustration. One of the difficulties with clause 5, inevitably, is that a list of criteria could go on forever. He is right to highlight the issues of acute behavioural disturbance, which we consider already to be enshrined in guidance. I completely take his point, and I give him an assurance that we will use statutory guidance to make it very clear that staff need to be fully trained on acute behavioural disturbance, not least because, unless staff understand it, they cannot be proportionate when the use of force is, indeed, appropriate.

--- Later in debate ---

[Philip Davies]

Absolutely. The hon. Gentleman is not alone in that, and nor is the autism community—I want the Bill to become law, too. If he had not intervened on me, we could have completed this a bit sooner. I assure him that this Third Reading will complete very soon. I certainly do not intend to go on for long today and I do not think anyone else does. We want to complete this as quickly as possible and see the Bill on the statute book. I want to see that just as much as he does.

Clause 6 deals with recording the use of force and I am very supportive of having this in the Bill. It is right to record the carrying out of such practices on patients. The police have a system in place when using restraint as part of their role, so it is only right that medical staff should follow suit. I am advised by my local care trust that it does have some measures in place to record restraint of a patient, but this Bill will of course make it a legal requirement to do so, which is important and absolutely right. Again, I was disappointed that my amendment proposing that these records be added to the patient’s medical records was not accepted. As I have stated, restraint is considered to be a form of medical care and therefore should be documented in the patient’s medical notes. That would help people to know what reaction the patient had had when restraint had happened in the past. I hope the Minister will make sure that the statutory guidance can be used and updated to make sure that these things are added to people’s medical records at the same time. I hope she will be able to confirm that in the fullness of time, too.

On clause 6(5), the information listed to be included in the report is largely constructive. Where I feel it falls short is in insisting on adding what are referred to as “relevant characteristics”. As the hon. Member for Croydon North knows too well, I do not agree that that is necessary. I am of the opinion that including these “relevant characteristics” detailing race, sexuality, religion, marital status and so on is purely a politically correct gesture in order to be seen to be doing something to combat discrimination, when instead it causes the illusion of discrimination. There is a notion that this creates a more transparent mental health service, but that is not the case. For instance, the detailing of these “relevant characteristics” will extend only to the patient and not the staff. My amendment to say that staff members should be included in this was also supported by the hon. Gentleman, for which I am grateful. I hope that the Minister takes on board those points and will ensure that the statutory guidance she produces in conjunction with the Bill will set out that staff members’ “relevant characteristics” will be included alongside those of the patient.

[Jackie Doyle-Price]

I confirm to my hon. Friend that we will reflect on that when we come to discuss this matter with consultees. I want also to come back to the point he made earlier about families. On the face of it, we should be enshrining the rights of families in the Bill, recognising, as the hon. Member for Huddersfield (Mr Sheerman) said in regard to autism, that we often rely on families to protect individuals whose mental capacity is not enough to consent to treatment. However, we are also aware that patients suffering mental ill health can often not be best served by family members, so enshrining this in the Bill and in law could have unintended consequences. On the role of families, we strongly feel that statutory guidance gives us a better tool with which to manage both guaranteeing their rights and protecting individuals who might be vulnerable to their family under the law.

[Philip Davies]

Again, I am very grateful to the Minister for that and for her positive approach to ensuring that the points being raised here and that we raised on Report will be considered for the statutory guidance. We will therefore look forward to seeing it when it is published.

Finally, I wish to refer to clause 12, which deals with video recording and specifically details the police use of body-worn cameras when assisting in restraint at a mental health unit. Largely, police body cameras are used in this instance, unless there are special circumstances. I am a big fan of body-worn cameras, which are a beneficial tool for both officers, protecting them when complaints are made about them, and the public, in making sure that the true facts of a situation are seen by everybody. However, the Bill states that the police

“must take a body camera”

and

“must wear it and keep it operating at all times”.

It goes on to state that a “failure” to “comply” makes

“the officer liable to criminal…proceedings.”

As the Minister and the hon. Member for Croydon North know, I feel that that creates a severe disproportion of consequences between the actions of the police and the actions of the medical staff.

[Philip Davies]

I am grateful to my hon. Friend for that intervention. I cannot recall whether he was here on Report, but we went through this in some detail then and so I do not wish to test the patience of the House by going through it all again this morning. If he looks back at the transcript of the debate, he might not be so confident in what he said. I think there is some doubt about this provision and it offers some doubt for police officers, who have also looked at the Bill. Notwithstanding that intervention by my hon. Friend, may I ask that the Minister takes this issue into careful consideration when creating the statutory guidance, if that provides an opportunity to look at this? I ask her to make sure that there are no unintended consequences. My hon. Friend the Member for Croydon South (Chris Philp) sums up exactly what is intended by the Government and the promoter of the Bill, but I hope that when the Minister brings forward her statutory guidance she will clarify the situation, because police officers are concerned about it.

[Jackie Doyle-Price]

Perhaps I can give my hon. Friend reassurance by saying that the College of Policing will be fully involved in the development of the statutory guidance.

[Philip Davies]

Again, I am extremely grateful for that and am pleased to hear it.

To conclude, I reiterate my support for the Member for Croydon North with his private Member’s Bill. As I have said on a number of occasions, I support the core principles of the Bill, although I feel that there have been some missed opportunities to achieve fully the objectives he set out. I hope that his constituents, the Lewis family, feel that the Bill is something they can proudly remember the life of Seni Lewis through, knowing that his death was not in vain. It was a terrible tragedy for the family, but it was not in vain, in the sense that they have worked very hard and constructively, and they have a fantastic Member of Parliament who has taken on board their campaign, on the back of which they have played their part in making sure that the terrible thing that happened to Seni Lewis does not happen to other families. On that basis, we should all be pleased that the Bill is passing its Third Reading today.

--- Later in debate ---

[Chris Philp (Croydon South) (Con)]

Let me start by congratulating my constituency neighbour, the hon. Member for Croydon North (Mr Reed), on piloting this piece of legislation through the occasionally shark-infested waters of the private Member’s Bill process. He has done a very good job in getting the Bill to this stage. It is a particular pleasure to support it because, of course, it was the terrible suffering of a Croydon resident, one of his constituents, that inspired and motivated him to bring forward this very important piece of legislation in the first place.

This Bill, which I hope shortly will become an Act, does a very important thing in emphasising that physical force in a mental health context should be used as an absolute last resort and only after very careful thought and with great restraint, which, clearly, was not the case in the tragic death of Seni Lewis. I have been encouraged by the declining use of police custody suites as places of safety under the Mental Health Act; it has roughly halved over the past five or six years, which is a very welcome trend. I would like to see that reduced to zero.

The hon. Member for Liverpool, Wavertree (Luciana Berger) also made a very important point when she said that the use of any sort of physical force in a mental health environment is a symptom of failure. No mental health case should ever be allowed to progress to the point where physical intervention is required, although it may sometimes be unavoidable. Therefore, an emphasis on prevention, early intervention and treatment long before any physical intervention is extremely important. I am pleased that the Government are spending more money in this area. The more we can do to make sure that patients are treated well before things escalate, the better the system will be.

The Bill as amended for our consideration today is a very good Bill. I strongly support it and look forward to voting for it shortly. However, I have a couple of comments and questions that I hope the hon. Member for Croydon North and the Minister might be able to comment on and answer. My first question relates to clause 3, which is about the requirement to publish a policy on the use of force. It requires “the responsible person” to publish a policy, but as far as I can see there is no prescription as to the contours or limits imposed on that policy. For example, one might have expected to see a requirement in the Bill that any such policy limits the use of force to reasonable force. That may be done in regulations, or perhaps there was another reason it was not considered appropriate to put it in the Bill, but one might have expected some explicit statement limiting force to reasonable force. I would be interested to hear from the hon. Gentleman and the Minister why that does not appear in the Bill.

My second point relates to clause 5 on training, about which I have two questions. The first concerns subsection (2)(c) on

“showing respect for diversity in general”.

I wonder whether the hon. Gentleman could amplify a little what that means in practice. I would have expected a requirement that everyone should be treated equally, regardless of their background. Perhaps that is what he means, but I am not sure whether “showing respect for diversity” quite conveys that meaning. I would be interested to hear his and the Minister’s comments on that.

My other question relates to subsection (5) on refresher training, which it specifies should take place “at regular intervals”. I wonder whether regulations would specify what is meant by “regular intervals”. Annually would be a sensible degree of regularity, but if someone was not being true to the spirit of the Bill, they might interpret “regular” as once every 10 years, which clearly would not be frequent enough. I would be interested to hear the hon. Gentleman’s and the Minister’s views on what is suitable regularity and how that will be enforced. My view is that such training should be annually or at least once every two years.

[Jackie Doyle-Price]

I appreciate the spirit in which my hon. Friend is making these points. We do not want to be too prescriptive by putting in particular timings on how often the training should be, because obviously that depends very much on the context of the facility and how much wider training there is. At the same time, however, we want to be very explicit that it is regular training so that there is no excuse for staff not being properly informed about best practice in this area.

[Chris Philp]

I thank the Minister for her helpful intervention. Of course, I entirely sympathise with the point that Parliament should not impose unduly onerous requirements on already very busy and possibly, in some cases, overstretched mental health units, but I am concerned to make sure that we have not left a little loophole that might, perhaps inadvertently, end up being exploited so that training is not being given the degree of regularity that perhaps the House intends.

My final point of detail is on clause 6(10), which specifies the “relevant characteristics” of a patient. My hon. Friend the Member for Shipley (Philip Davies) questioned whether we need to record these “relevant characteristics”, which are listed in quite some detail. If we are going to do so, and any inference is to be drawn from those characteristics in future, it is important to measure them against the same characteristics for the whole population treated in any particular mental health unit. If we are going to say, for example, that X% of people who have been subject to this procedure have a particular gender, sexual orientation, religion or ethnicity, then before drawing any inference from that, it is important to compare that statistic with the proportion of people in the unit with the same characteristic. One needs to use those statistics with of careful thought to make sure that inappropriate or inaccurate inferences do not end up being drawn.

I am, like my hon. Friend the Member for Shipley, a great supporter of the use of police body-worn cameras, which are a great innovation. They have been responsible for a huge reduction in the number of complaints against police officers, because the officer is aware that the camera is being worn and recording—that, I am sure, has some moderating influence—and the person the officer is dealing with is aware of the same thing. I am sure that that has also reduced the number of vexatious complaints against the police. It is a very welcome move.

I was not present for the lengthy debate that my hon. Friend mentioned about whether a failure to wear a body-worn camera might be considered unlawful in the light of clause 12. Personally, I draw comfort from subsection (4), which appears to say expressly that there is not criminal liability. However, I will certainly follow his advice and refer to the report of the previous proceedings on that point. In general, the use of body-worn cameras when the police are dealing with mental health cases is extremely welcome and will, I am sure, assist with the problems that have existed in this regard.

I reiterate my very warm congratulations to my constituency neighbour, the hon. Member for Croydon North, for his tireless work in this area. I am sure that not just the London Borough of Croydon but the whole House and the whole country are grateful for his work.

Health and Social Care (National Data Guardian) Bill

Jackie Doyle-Price Excerpts

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

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

I thank all hon. Members who have contributed to the debate today. I particularly want to thank my hon. Friend the Member for Wellingborough (Mr Bone). I cannot believe that this is the first private Member’s Bill that he has taken through to Third Reading, as he has had so many. I am delighted to have collaborated with him on achieving this. It is quite an achievement. He was typically generous about me in his comments, which was completely undeserved. He was quite right when he said that thanks need to go to my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who was the inspiration behind the Bill.

I want briefly to set out why the Government view the Bill as an important measure and why we are keen to see it progress and to put the National Data Guardian on to a statutory footing. The Government are committed to ensuring that the health and adult social care system in England realises the full benefits of sharing health and care data in a safe, secure and legal way. We have talked a lot today about the benefits of such data sharing. However, if data and information are to be used effectively to support better health and care outcomes, it is essential that the public have trust and confidence that safeguards are in place to protect the data from inappropriate use. That is the ethos behind the establishment of the National Data Guardian. The guardian will be an independent, authoritative voice for individuals on how their data should be used. At the heart of this is the relationship between health providers and individuals, and we need to maintain an appropriate balance between safeguarding and privacy as well as underlining the serious principle of informed consent by patients.

I should like to clarify the scope of the legislation. The National Data Guardian’s remit covers all health and adult social care data, which is defined in the Bill as essentially the same as “patient information” under section 251 of the National Health Service Act 2006. That basically enables the National Data Guardian to influence anything that impacts on the processing of health and adult social care data held by all the organisations listed in the Bill. This will enable the promotion of good challenge and the building of assurance across the health care system, as well as enabling the system to access the data it needs in order to run safely, effectively and efficiently.

I cannot emphasise enough the fact that the voice of the patient and the service user is really the paramount principle under which the National Data Guardian will operate, notwithstanding the fact that she will be working through the use of guidance to providers. It is basically taking the position of what is in the best interests of the patient. In so doing, we hope that the guidance she issues will establish confidence on the part of the public that their data is being used effectively.

Much has already been said today about the role of Dame Fiona Caldicott, who is the first National Data Guardian. She has been described as phenomenal, energetic and influential, but I wish to take this opportunity to recognise the enormous contribution she has made. I am sure she will take full advantage of the statutory powers that will follow once the Bill reaches the statute book.

I am delighted to have the support of the Opposition on the Bill, because the use of data sharing is essential to secure the best possible health treatment for all patients. The hon. Member for Ellesmere Port and Neston (Justin Madders) expressed the desire that the National Data Guardian should have real teeth. I emphasise again that she will act in the interests of patients, and that will mean challenging providers. As we all know, some providers are instinctively cautious and defensive about data sharing, and the real challenge is that patients are sure, thanks to the National Data Guardian’s advocacy, that it is the right thing to do. Nor should there be any escape for health professionals and providers.

The National Data Guardian will, as the hon. Gentleman said, use her powers by issuing guidance, and the clear expectation is that everyone will abide by that guidance. We see the aim as one of changing organisational behaviour rather than having rules. The fact that the National Data Guardian will produce an annual report on how she is discharging her obligations, and how the health sector is reacting, will be a powerful tool. We often find that transparency can be much more effective than rules, regulations and laws. Once behaviour that is not delivering the outcomes that we intend through legislation is highlighted, the public embarrassment will be more effective than many of the tools that we have at our disposal. It is heartening to see the interest in the Bill in the Chamber, and we have heard some individual examples of poor practice. I am sure we will have plenty if anyone does not abide by Dame Fiona’s advice.

We expect the National Data Guardian to use her annual report to implement further guidance. We fully expect that the duty for adult health and social care organisations and providers to have regard to that guidance will also be taken into account by the Care Quality Commission and the Information Commissioner’s Office, so it is not just the Government and the National Data Guardian that can hold them to account. We expect a serious change in behaviour in the future.

The National Data Guardian will look at her own operating approaches to see what more can be done to ensure that the role has teeth. That is also part of the reason for putting the role on a statutory footing. The fact that her advice will have legal clout will give it more teeth. She will have day-to-day communication mechanisms at her disposal to highlight areas of good and poor practice, and the statutory duty to consult people she considers appropriate before publishing guidance. That will fuel an important debate about behaviour in this area.

Other issues that have arisen in the debate today and in Committee include concerns as to why children’s social care data is not covered by the Bill. I would like to explain the reasoning behind that and why it is not a weakness in the Bill. Data relating to children’s social care has its own safeguards and protections, which operate under a different legal framework from adult health and social care. Those safeguards and protections are governed by their own statutory guidance, and we would not want to include anything that conflicts with established guidelines.

The context and imperative for using and sharing data to safeguard children is also different, and the most important consideration is whether sharing information is likely to safeguard and protect a child. That is an important point, because with children safeguarding trumps privacy and personal ownership.

Rather than extending the National Data Guardian’s role to cover children’s social care data, action should remain targeted elsewhere on improving timely and proportionate information sharing to keep children safe. Officials in the Department for Education and the Department of Health and Social Care have reached a sensible interpretation of the Bill, which would not preclude the National Data Guardian from engaging constructively with the Department for Education on adult social care data and its interaction with children’s social care data. There has been an exchange of letters between the Departments to formalise that agreement. On safeguarding children, the powers in the Children and Social Work Act 2017 are the mechanism for the Departments to act and to share information.

We worked across Government to amend the Data Protection Act 2018 to introduce safeguarding as a condition by which information can be shared without consent to keep children safe. We will continue to work with local authorities to consider and monitor the impact of the National Data Guardian in this space, where it is appropriate to work outside the remit of the statutory powers set out in the Act in a way that is consistent with the law and regulations as they currently apply to sharing data on children. We will keep a watching brief on that but, at this stage, we should not do anything to disrupt established obligations. We can establish good practice in this area through sensible discussion between the National Data Guardian, the DFE and the Department of Health and Social Care, which is entirely consistent with how we co-ordinate the respective obligations of children’s social care and adult social care services.

I have very little time, but I will touch on one or two other issues before concluding. There was a brief discussion earlier on the territorial extent of the Bill, and I can confirm that the Bill applies only to England. The Bill technically applies to England and Wales because of how we approach legislation in this place, but it extends only to England.

I can also confirm that public health data is included in the remit of the Bill, so that data will also be shared. I also confirm that the Bill covers local authorities where they are actioning services with regard to adult social care and, of course, public health.

I conclude by confirming again the Government’s commitment to this Bill and our desire to see it succeed. I am confident that the Bill will achieve the aims my hon. Friend the Member for Wellingborough and all hon. Members have set out. After today’s important stage, I hope the Bill will make swift progress and will receive Royal Assent as soon as possible.

Child Migration Programmes (Child Abuse)

Jackie Doyle-Price Excerpts

Tuesday 3rd July 2018 Westminster Hall

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

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

I thank the hon. Member for Wigan (Lisa Nandy) for securing the debate. It is difficult for me to disagree with anything she said. It is four months since the report came out and, dare I say it, we are all a bit distracted by the soap opera that is Brexit, which means that on some of these issues the eye has been taken off the ball. One reason I am grateful to her, therefore, is that this debate helps me to focus some of my colleagues’ minds. She alluded to the fact that this issue affects not just my Department and that we need agreement across Government. I thank her for the opportunity to say where the Department of Health and Social Care is on the issue.

I am pleased to hear that some of the child migrants are watching the debate with interest. I would like to convey to them that we are taking this seriously and will respond to the issues raised in the report. I thank the hon. Lady for showing such interest and passion in speaking on their behalf, because they deserve our support.

I do not think anyone in the Chamber disagrees that the child migration policy was so misguided and harmful and caused such suffering and distress. For us as Members of Parliament in the 21st century, it beggars belief to think that any British Government could think that was a reasonable policy. It clearly caused great suffering and distress to children, who should be protected by institutions of the state. It is crucial that we learn from the mistakes of the past in order to protect and safeguard future generations of children from abuse.

We should never be complacent. We have seen with the likes of Savile how organisations can collude to protect themselves from the worst kinds of allegations, and that continues to this day. Only last week we heard about Gosport, where there was massive collusion on real harm, which causes such distress. All citizens require our support as Members of Parliament to make sure that never happens again.

The hon. Lady told the most harrowing stories, perpetrated by organisations that purport to be Christian, and we heard many examples of cover-ups of abusive behaviour towards children, which I sincerely hope will be further highlighted by the child abuse inquiry. The hon. Member for Washington and Sunderland West (Mrs Hodgson), who spoke from the Opposition Front Bench, used the term “dehumanising,” which conveys exactly what we are talking about. That is what was done to those children.

We are four months on from the publication of the report, which asked that we take action within a year, so there are eight months to take action. I would like us to give a formal response much sooner—I intend to do so before the summer recess, as everyone has asked. Perhaps in some respects it will be useful to reflect on the points made in this debate for that formal response. All the questions that hon. Members have asked deserve to be answered as part of that, so I thank them for making those points.

[Lisa Nandy]

I would be grateful if the Minister addressed the two additional requests I made, which former child migrants have also made: for a full apology for the extent of the abuse we now know about; and for the further funding required for the family restoration fund.

[Jackie Doyle-Price]

We will indeed consider that. As the hon. Lady will be aware—she alluded to this—we are supportive of the family restoration fund and continue to work with the Child Migrants Trust to ensure that we are supporting that work as effectively as possible. Ultimately, we cannot apologise enough for what we have put these people through. We will pick that up as part of the response.

I talked about how institutions collaborated to cover up harm generally. That is why the independent inquiry into child sexual abuse is so crucial, and why we need to look at historical abuse as well as more recent events; otherwise, we will end up turning a blind eye to the same behaviours. As the whole House knows, this is very much an interest of the Prime Minister. She established the inquiry and she wants to shine a light on all such practices so that we can genuinely protect people from sexual abuse in future. Only by getting to the truth and exposing what went wrong in the past can we genuinely learn those lessons. We have now given a voice to victims and survivors. We have given them a chance to tell their stories, which will enable them to start moving on and to draw a line under the suffering that institutions of the state allowed to happen.

As we have heard, the number of children who were migrated is significant: 130,000 in total and 9,000 since the war. As the hon. Lady says, 2,000 of them are still alive today. The intention was well-meaning, but we know that, despite the good intentions, many children suffered terrible emotional, physical and sexual abuse. As she says, although it happened far from our shores, the fault does not lie entirely with overseas Governments. Having established the policy, we owed a duty of care to those people.

As has been mentioned, some children were sent from this country without their parents’ knowledge or consent and without any necessary approval. The obliteration of individual rights in such circumstances is truly abhorrent, and it shocks me that Great Britain, the mother of the free, could behave in this way to any one of its subjects. It is utterly shocking. We know that some parents were even told that their children had died, when in fact their names had just been changed when they were sent abroad. That is totally unthinkable.

It is right that the child migration programme was captured by that inquiry and very important that we looked at it as a matter of urgency, given the age of some of the survivors. All hon. Members will know that the Department of Health collaborated fully with the inquiry, as it did with all other investigations. We responded to all requests for information and gave full access to our files and records, as well as giving comprehensive evidence to the inquiry hearings.

The hon. Lady will also be aware that the inquiry heard harrowing testimonies from former child migrants. She has referred to some of those stories today. Essentially, everyone turned a blind eye to allow the conditions for that abuse to flourish. It is quite right that the inquiry concluded that systematic hardship and abuse did indeed occur as part of the programmes, and that insufficient protection and safeguards meant that they were allowed to continue for far too long.

The physical and emotional damage in childhood has had a lifelong negative impact on many former child migrants. I know that those watching today will agree that some still struggle to overcome their experiences, which continue to blight their lives and those of their families—not to mention the health consequences. I hear the hon. Lady’s message that since the report was published we have lost a further 10 survivors. That underlines the case for our responding to the report as soon as possible, and I give her my undertaking that I will do my level best to get that out as soon as possible.

One thing that we are grappling with within Government is whether there are issues of precedence in how we address the recommendations of the report. In particular, given the breadth of what the inquiry will be looking at, we have to be careful how we pitch it. That discussion is taking place at the highest level among Ministers. The spirit in which we established the inquiry will be ruined if we do not take those discussions seriously. I convey that message to all hon. Members. In her speech, the hon. Lady referred to a letter from solicitors pending legal action. I have seen that correspondence and it is receiving attention, so I can give her that assurance too.

I appreciate that I am not giving the answer that hon. Members would like, because they are all rightly impatient for the response. I hope that they will accept that we are carefully considering the report’s recommendations and are committed to responding as soon as we can, given the advanced age and declining health of the people we are talking about. Frankly, that is the only way to avoid neglecting them further. We should not shy away from our responsibilities now and there should be no dispute about the Departments that are responsible. The Department of Health and Social Care and its predecessor Departments have led the Government on these issues since they were first identified by Margaret Humphreys in the 1980s. I add my voice to those who have paid tribute to her today. She provided the challenge that made us all face up to what went on in our name in the past.

To conclude, the work of the child sex abuse inquiry brings to our attention the need for change in our approach to child sexual abuse. We should never turn a blind eye. We should always listen. We must also acknowledge that, since the moment when Gordon Brown first apologised for the treatment of child migrants, successive Governments have ensured that we have done our best to support and do right by them. The cross-party formal national apology to child migrants in 2010 was testament to how committed we all are across the House to righting some of the wrongs of the child migration programmes in a way that is meaningful to child migrants themselves. It is what they told us they wanted.

As the hon. Lady said, we have funded the Family Restoration Fund, which has funded around 1,200 trips to reunite families and rebuild family ties. It is important that we continue to support that work and to work with the Child Migrants Trust to deliver it.

Finally, I will say some last words to the former child migrants who, despite enduring such a damaging start to their lives, have managed with great courage to overcome their past and to positively shape their future. We owe it to them to learn the lessons of the past, and the inquiry’s work is designed to do that. I do not think that anyone can pay sufficient tribute to their stoicism and courage in moving on and shaping their lives—but they are quite right to remind us how we failed them.

I wish again to thank the hon. Lady for securing the debate, and I thank all hon. Members who have contributed to it. We will note the points that have been made as we develop our response to the child migration report, which I hope to share with everyone in the not-too-distant future.

GP Update

Jackie Doyle-Price Excerpts

Monday 2nd July 2018 Written Statements

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

NHS Digital recently identified a supplier defect in the processing of historical patient objections to the sharing of their confidential health data. An error occurred when 150,000 type 2 objections^[1] set between March 2015 and June 2018 in GP practices running TPP’s system were not sent to NHS Digital. As a result, these objections were not upheld by NHS Digital in its data disseminations between April 2016, when the NHS Digital process for enabling them to be upheld was introduced, and 26 June 2018. This means that data for these patients has been used in clinical audit and research that helps drive improvements in outcomes for patients.

Since being informed of the error by TPP, NHS Digital acted swiftly and it has now been rectified. NHS Digital made the Department of Health and Social Care aware of the error on 28 June. NHS Digital manages the contract for GP systems of choice on behalf of the Department of Health and Social Care.

TPP has apologised unreservedly for its role in this matter and has committed to work with NHS Digital so that errors of this nature do not occur again. This will ensure that patients' wishes on how their data is used are always respected and acted upon.

NHS Digital will write to all TPP GP practices today to make sure that they are aware of the issue and can provide reassurance to any affected patients. NHS Digital will also write to every affected patient. Patients need to take no action and their objections are now being upheld.

There is not, and has never been, any risk to patient care as a result of this error. NHS Digital has made the Information Commissioner’s Office and the National Data Guardian for Health and Care aware.

As part of our commitment to the secure and safe handling of health data, on 25 May 2018 the Government introduced the new national data opt-out. The national data opt-out replaces type 2 objections. This has simplified the process of registering an objection to data sharing for uses beyond an individual’s care. The new arrangements give patients direct control over setting their own preferences for the secondary use of their data and do not require the use of GP systems, and therefore will prevent a repeat of this kind of GP systems failure in the future.

The Government have the highest regard for data standards and are committed to ensuring patients can express a preference over how health data is shared for purposes beyond their own care.

^[1] Where individuals did not want NHS Digital to share confidential patient information that they had collected from across the health and care service for purposes other than the individuals care, they could register this preference, known as a type 2 opt-out.

[HCWS813]