Oral Answers to Questions

James Cleverly Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Nigel Adams]

The hon. Lady makes a correct point, and we are very keen that patients receive this drug. I understand her ire, but perhaps it should be directed at Vertex, the manufacturer. The offer of £500 million over five years for the size of the eligible population is the largest-ever commitment of its kind in the 70-year history of the NHS, and it would guarantee immediate and expanded access to Orkambi and to other drugs.

[James Cleverly (Braintree) (Con)]

15. What steps he is taking to improve preventive care in the NHS.

[The Minister for Care (Caroline Dinenage)]

Our NHS offers a range of world-leading preventive care services, but we can go further and faster. The Secretary of State has named prevention as one of his top three priorities, signalling a renewed focus on public health, community and mental health services.

[James Cleverly]

I thank the Minister for her reply. She will know, because I have spoken about this to the Secretary of State’s team, about the pressures on my constituency, and particularly on the Church Lane GP surgery. Specifically on preventive services, wearable tech, health tech and medical tech provide an opportunity to keep people healthier for longer, and can provide early digital diagnosis that can relieve pressure on medical services. What more can be done to pursue this way of relieving pressure on the health service?

[Caroline Dinenage]

I completely agree that technology can really help in this way. I recently visited Hampshire County Council, which is using a range of gadgets including a really simple one involving a light bulb that comes on when someone gets out of bed in the night to go for a pee. That is ingenious, and it is helping to prevent avoidable falls.

Mental Health Units (Use of Force) Bill

James Cleverly Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Justin Madders]

I am not going to give way. Many other Members wish to speak and there are other items of business that we want to get to.

As Members have highlighted, there is an issue with unconscious bias. Young black men are statistically more likely to be seen as having psychosis or schizophrenia, and are at risk of being subject to inappropriate use of force, as are women.

[James Cleverly (Braintree) (Con)]

Will the hon. Gentleman give way?

--- Later in debate ---

[James Heappey (Wells) (Con)]

May I add my congratulations to the hon. Member for Croydon North (Mr Reed) on bringing forward this Bill? I warmly support it and applaud his willingness to work with people across the House to ensure that the Bill fully meets the concerns of Seni’s parents and family and others who have been in such circumstances—I will share another story with Members on behalf of one of my constituents shortly—and works properly for those who are involved in mental healthcare in our country and who, like our police, will occasionally have cause to restrain those who are mentally ill. Those people work in very challenging circumstances and it is important that the Bill fully reflects that and is workable and fair to them as much as it is fair and transparent for those who are on the receiving end of its provisions.

I wish to discuss three areas, the first of which is the story of my constituent, James Herbert, who died in police custody in 2010. He was mentally ill and had been restrained shortly before his death. Secondly, I wish to look at how this Bill might have helped in that situation and how, in so many ways, it will certainly help to ensure that those sorts of events do not happen again. Thirdly, I will consider what additional training we might offer not only to our police, but to those who work in mental health. We need to make sure that, yes of course, there are safer techniques for restraint, but that there is also a much greater understanding of how we de-escalate those circumstances so that restraint might not be necessary.

James Herbert was known to the Avon and Somerset police, particularly those serving locally in and around Wells, as being mentally ill. Over the course of the day on which he died, there were a number of occasions when the police had had cause to observe his behaviour. On the evening after a hot June day, he was detained by the police. In the process of that detention, he was restrained. He was then put into a police van and driven for 45 minutes to a custody suite where he was stripped naked and put into a police cell. He died later that night of a cardiac arrest. The Independent Police Complaints Commission has looked in full into his death in the seven years since, and its report “Six missed chances” is rightly very critical of what happened that night. It is important to note that the police officers involved—one of whom is still a constituent of mine; the other, very sadly, took his own life a year or two ago—have not been held personally responsible for what happened. The failings that were identified were systemic, institutionalised failings—that sort of misunderstanding of mental health and the way that the processes were handled.

The Bill brings forward a very important aspect of how we deal with those with mental ill health. Sometimes, restraint is unavoidably necessary, but how that is done can have a profound impact on people such as the constituent of the hon. Member for Croydon North and my constituent, James Herbert.

Undoubtedly, the Bill will help. Staff not deliberately restraining people in a way that constrains an airway is clearly a very important and necessary provision, so, too, is restricting the intervention of a restraining technique that causes pain. Similarly, people should always seek to use the least restrictive method of restraint possible. Those are necessary de-escalatory measures, which in themselves could help, not quite to calm the person but at least not aggravate them further, which happens so often. The more that I have spoken to police officers about James Herbert’s case, the more they tell me that their concern to get their job done and retain the person means that they find themselves naturally going up through their levels of force and the application of their physical power. As both sides seemed to rub off of one another, they both got more and more aggravated, and the use of force became all the greater. The police reflected afterwards that they might have approached the situation differently in the first place.

[James Cleverly]

I do not know the ethnicity of the constituent who died in custody, but does my hon. Friend agree that it can be intimidating for police and medical professionals when the person they are dealing with is physically big and robust? As well as the measures in the Bill, they need our support to ensure safety for them and for the people for whom they are caring.

[James Heappey]

My hon. Friend, as ever, makes an excellent point. These are highly challenging, confrontational situations. James Herbert was white, but he was a big guy. As his anger and emotions built, so did the efforts of the police officers who were trying to restrain him for his own safety. My hon. Friend is right to observe that there some people who require restraint are physically very intimidating. The police officers or mental health workers involved in the restraint often fear for their own physical safety, which may lead them to use overly aggressive techniques. They may really be focusing on self-preservation, instead of on de-escalation. A great confidence is required in the techniques that have been taught for restraint, and in understanding how to deal with those who have acute mental health challenges. That confidence is absolutely necessary so that people are able to apply the right skills in the right way to bring about the right outcome, instead of fearing the physical situation in which they find themselves.

I agree very much with some of the other provisions in the Bill. Seclusion should be an absolute last resort. It is an alienating and escalatory measure. Then there is the immediate, confident and sympathetic engagement of other people involved in the care of the mental health patient. When the police were detaining James Herbert, they phoned his mother to talk to her about something very different, rather than to ask her about James’s condition and what she might be able to share with them in order to manage him much more appropriately in the situation.

I agree passionately with the use of body cameras. I have seen the profound impact of James Herbert’s case not only on his own family and friends, but on the careers, lives and mental health of those involved in his detention and, sadly, his death. Body cameras would have made an enormous difference in this case.

--- Later in debate ---

[James Heappey]

My hon. Friend is right, but whenever attending a call-out to a mental health unit—just as in attending any other event in the community—the police officer would have deployed in their patrol car wearing their full kit. They would already have been wearing the camera and would have switched on it on as they were entering the situation, if they thought that were necessary. The much more likely scenario, as perhaps would have been the case with James Herbert, is of people being called into a situation when they are not out on the street, but are just nearby and lending a hand. The fixed cameras in the building may be obscured by those doing the detention, so I also see real merit in body-worn cameras being used in those situations.

This is not just about how to ensure that acute, immediate interventions are handled properly. It is also about the additional training that might be offered to police and mental health workers to make sure that these situations do not arise in the first place. Training is key. That goes without saying for mental health workers, who, by vocation, understand this stuff very well indeed, but the police are much less confident in dealing with people with mental health issues than they should be.

Training for the police so that they can spot those signs and intervene appropriately with concern and care would be helpful and would prevent a large number of the instances that we are debating. There are techniques for reassuring people, for de-escalating, and for managing the anxiety that often manifests itself in people with mental illness. Equipping police with those skills would be very welcome indeed.

[James Cleverly]

A number of years ago, when I served on the London Assembly, I visited Feltham young offenders institution. I cannot help but think that there are a number of young men in Feltham who had mental health problems but whose interactions with the police and authority during mental health episodes reached a stage at which they became violent and ultimately found themselves incarcerated, perhaps at least in part because of that lack of understanding and training on the part of the police. It is not a moral criticism but an observation that training could help the police officers and some of those young men, who were ultimately incarcerated in what was not necessarily the most appropriate institution.

[James Heappey]

I very much agree. It is interesting to reflect on conversations I have had with police and community support officers in my constituency. The nature of their job means that they understand or know more intimately the community they serve. Very often they have an insight into the mental health of people they routinely see around town who are on the edges of antisocial behaviour or even breaking the law. They can often deal with them very differently because they understand who they are dealing with. The PCSO job description is such that PCSOs naturally seek to de-escalate and deter, rather than enforce the law. My hon. Friend makes an interesting observation, and I certainly agree that it is possible to avoid these circumstances arising as often as they do.

--- Later in debate ---

[James Cleverly (Braintree) (Con)]

I am conscious that it can sometimes be a blight on a Member’s political career to have someone from the other side of the Chamber lavish praise upon them, so I apologise in advance to the hon. Member for Croydon North (Mr Reed) because the opening comments of my speech could hang like a political albatross around his neck for some time. I hope he recognises, however, that even if that is the case—I suspect it will not be—the work he has done in bringing forward this private Member’s Bill will more than offset any detriment.

I suspect that when the Bill makes its way through the House and is enacted, people will look back at this as a tipping point. That is exemplified by the first few names on the list of sponsors. It is of great credit to the hon. Gentleman, both as an individual and a parliamentarian, that he is able to get support from all the parties in England and from both sides of the House. The Bill is drafted in a way that makes gaining cross-party support as easy as possible and gives it the best chance of being enacted. At a time of ultra-partisan politics around the globe and when things are proposed specifically to create division and to play games, it is refreshing to see a Bill that is clearly designed to improve and, in many instances, save lives, so I thank him for that.

The Linden Centre in Chelmsford serves my constituency, and I regularly have meetings with its management and with the Essex Partnership University NHS Foundation Trust. It is clear that the management of that mental health centre are passionate about protecting service users and improving the mental health of the people under their responsibility. I also have a close working relationship with Essex Police, whose officers are also passionate about protecting people. Before I go on, I want to echo the words of my right hon. Friend the Member for Wells (James Heappey)—[Interruption.] He is not yet a right hon. Member.

[Philip Davies]

It is only a matter of time.

[James Cleverly]

It is inevitable. I echo the thanks that my hon. Friend the Member for Wells put on the record to the medical professionals, police and others who work so hard to try to protect people who have either acute or chronic mental health episodes. I would not want any of the conversation about deaths and restraint in mental health units and by police officers and others to be in any way seen as an implicit criticism of them. They do incredibly important work, often in the most difficult and challenging of circumstances.

[Bob Stewart]

My hon. Friend has close links with the police and with medical professionals. Do they use the same approach to restraining people? I would have thought that the police might be harder than nurses; do they use the same techniques and just apply different sections of the techniques?

[James Cleverly]

I only really have detailed experience of medical and policing practices from my time on the Metropolitan Policy Authority in London and now, as the representative of Braintree, from the Essex Police and my local mental health trust, so I cannot talk about the universality of the situation. However, without a shadow of a doubt, the message that I am picking up is that there is huge variation across and within constabularies and trusts.

The group of clauses relating to accountability is one of the most significant parts of the Bill, and my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) touched on this. I am one of those gruff and grumpy old Tories—[Interruption.] At this point, Members are supposed to join in a chorus of “You’re not that old.”—[Hon. Members: “You’re not that old!”] I thank hon. Members, although no one cried, “You’re not that grumpy.” Clause 7 is incredibly important. I am a gruff and grumpy old Tory, and my instinct is to take away as much red tape and administrative burden as possible but, as my hon. Friend the Member for Faversham and Mid Kent highlighted, this modest additional administrative burden is welcomed by the profession.

There is an old saying in management consultancy, “If you want to change something, measure it”—[Interruption.] I can see my hon. Friend the Member for Faversham and Mid Kent nodding. It is important to register the use of force whenever it is applied, because that will do two things. It will prompt a small pause for reflection if someone knows that they will have to justify the use of force, and it is inevitably a good thing if they recognise in that moment of pause that the use of force is not appropriate. Perhaps more importantly, if the decision is made that force is the appropriate action, clause 7 will mean that there is a record of all the times that force has been used, including the times when that force does not lead to injury or, in the most tragic cases, death. That will enable us to get an accurate understanding of how many times the use of force unfortunately leads to injury or fatality, which is important because it will remind us of the difficulty faced by many professionals.

[Mr Reed]

I am grateful for the hon. Gentleman’s generous comments earlier. I should make it clear that it is not my intention that the Bill should impose any additional administrative burden. Institutions already collect data on the use of force, but they do not collect it in the same way, so it cannot be compared. The Bill will simply standardise what currently happens to allow greater scrutiny, rather than imposing a new burden.

[James Cleverly]

That is a fair and balanced intervention. In my next sentence—honestly, this is true—I was going to list some things that, if they are not already collected, really should be collected. It is not a bad thing if the Bill creates a standardisation so that we can see the differentials between forces and trusts.

One of the most difficult and contentious points—this goes to the heart of my opening remarks about the impact the Bill could have on British society—is that, without a shadow of a doubt, we know that examples of huge community friction, of civil disorder and of further injury and loss of life have been caused when families, friends of families and wider communities feel that the use of force has led to an unnecessary death. I will be as cautious as I can with my words because of the sensitivities, but it is particularly acute in Britain’s black communities.

There is huge disproportionality between the black community in Britain and the rest of the communities in Britain—and it cannot possibly just be chance—in the rate of death and injury in custody of people suffering mental health episodes. That has to be addressed. No single Bill can solve the situation, as it has been long in the making and will take a very long time to resolve, but this Bill could be a big step in the right direction.

If, as I suspect it will, the Bill reduces the incidence of serious injury or fatality among people suffering mental health episodes, that will in itself have a knock-on effect in reducing some of the community friction and disorder that we have seen in the past. Unfortunately, I suspect there will be further cases where a black man is detained and dies after contact with the police, but if it can be evidenced that in all instances force is applied modestly, minimally and only when absolutely necessary, that might help to defuse some of the tensions that have in the past led to further difficulties.

In conclusion, I thank the hon. Member for Croydon North, and the other hon. Members who have supported this Bill, for introducing to this place a Bill that makes it easy for those of us who want to see genuine improvement both in mental health and community cohesion to support it. I commend it to the House.

NHS Shared Business Services

James Cleverly Excerpts

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

I am sure that, regrettably, because of what happened extra work was created for GPs. However, because of GPs’ commitment to their patients, it appears that in the vast majority of cases patient harm was avoided. When results do not come through that a GP is expecting, the GP chases them to make sure that the right thing is done for patients—but of course, as the hon. Lady rightly says, at the cost of extra work.

[James Cleverly (Braintree) (Con)]

Does my right hon. Friend agree that had the then Labour Government not made such a catastrophe of implementing the NHS computer system, such records would have been digitised many years ago and problems with storage of paper records would not have impacted on the patients who are currently suffering?

[Mr Hunt]

My hon. Friend speaks wisely. Many members of the public will be faintly amused to hear Labour Members say how important it is that we move to electronic health records. The NHS IT project was an absolute catastrophe, costing billions of pounds. The intention was right but the delivery was wrong, and that is what we are trying to sort out.

A&E Services

James Cleverly Excerpts

Wednesday 24th June 2015 Commons Chamber

[James Cleverly (Braintree) (Con)]

Before I move on to the comments I intend to make, may I pay tribute to an excellent maiden speech by the hon. Member for Salford and Eccles (Rebecca Long Bailey)? Her pride in her home town is obvious. It shone through in a very punchy and effective maiden speech, and I thank her for giving it.

My mother spent most of her professional life as a midwife in Lewisham hospital, the hospital of my birth. I used to go to her office and do my homework there after I left school, so I was literally born and brought up in Lewisham hospital. Both my sons were born in Lewisham hospital—a hospital I love and am proud of. I do not doubt for a second the passion of Opposition Members for the NHS. I remind them, however, that they do not have a monopoly on passion and respect for the national health service.

We are talking today about waiting times in A&E. There are many complicated and compounding pressures that drive those waiting times. This debate could and should have been an opportunity to discuss them and look for solutions and mitigations. I was taken by the calm and professional speech of the hon. Member for Central Ayrshire (Dr Whitford). While she was speaking, it was impossible to be in the Chamber and not to be heavily influenced by the remarks she made. We would all be in a significantly better place if, during the rest of this speech and the rest of our time in this Parliament, NHS debates could be conducted in the manner in which the hon. Lady delivered her speech.

[Several hon. Members]

rose—

[James Cleverly]

I will not take interventions, because I am conscious of how many others wish to speak.

A&E waiting times are driven by three factors: the number of people coming in; the time it takes to treat them; and the ability to discharge or transfer patients. I do not have time to discuss the process that happens while patients are in an A&E department, so I will let others with more direct operational experience do that. It is ridiculous for any of us to pretend that the changes to the GP contract of 2004 did not have a significant and detrimental effect on waiting times for A&E. The fact that 90% of GPs chose to opt out of out-of-hours provision must have had an effect on the number of people going to A&E departments.

[Yasmin Qureshi (Bolton South East) (Lab)]

rose—

[James Cleverly]

I am not taking interventions.

The fact that the ability to discharge patients back into the community is dependent on the ability to care for them while they are in the community means that adult social care must be considered an essential and integral part of the A&E mix. If general wards are not able to discharge into the community, they are not able to make bed spaces available and, in turn, A&E departments are not able to transfer to other wards within the hospital.

I therefore pay tribute to the excellent work done on the Manchester model, putting together NHS provision and adult social care, so that the obvious inter-relationship between the two could be looked at holistically. I am happy that some Opposition Members—perhaps only some of them—welcomed the introduction of the Manchester model. Again, if we could work in a cross-party, collegiate way to learn the lessons from that integrated service model in Manchester and roll it out nationally, I think we would be in a much better place for looking at and subsequently dealing with the problem of A&E waiting times.

It has been alleged—I am sure Opposition Members will all leap to their feet to deny it—that Labour Members were keen during the last general election to weaponise the NHS. [Interruption.] Those were not my words. This is too important an issue to turn into a party political football. I will make this commitment—[Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order.

[James Cleverly]

I am obliged, Madam Deputy Speaker.

Let me make this commitment: if I perceive that my own Front Benchers are trying to turn the issue into a political football, I will be as critical of them as I am of Opposition Members.

Money is a very important part of the NHS mix, and I welcome the fact that my party has committed itself to funding the NHS to the levels recommended by experts in the field, but money alone is not enough. More money has been given to GPs’ surgeries, but the St Lawrence medical practice in my constituency is still struggling, which is forcing a number of people to use local A&E services.

This is an important issue; let us discuss it with decorum. I commend the Government’s actions.