Deaths in Mental Health Settings

Jane Ellison Excerpts

Friday 27th February 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate my hon. Friend the Member for Broxbourne (Mr Walker) on securing this debate on the investigation of deaths in mental health settings. He has shown considerable interest in this area of policy over many years, and has championed the thorough investigation of deaths of people in custody settings. I commend him for his valuable work. It is important that he gives a voice here in Parliament to people who feel, on occasion, voiceless. He has spoken out on the human rights of those detained in custody, and of their families. He alluded to a recent meeting with some of the affected families, who I am sure are appreciative of his efforts on their behalf.

In my hon. Friend’s thoughtful speech, he stressed the need for vigorous and transparent investigations of deaths in all custody settings. He has highlighted to all of us the distress endured by the families of people who have died, especially when it seems that the death may have been preventable, and how important it is that mental health providers ensure that the investigation does not cause further distress. He also rightly highlighted the need for investigations to be held in a timely manner, and for families to be informed and involved throughout. It is important that investigation findings are clear and indicate what can be done to prevent future deaths, so that families have the comfort of knowing that their loved ones did not die in vain and that lessons have been learned.

My hon. Friend highlighted the report by the charity INQUEST, which calls for better investigations of deaths in mental health settings and makes a number of recommendations for change. I will turn to each of those recommendations and make comments, but I first wish to make some more general points about the ways in which the Government are trying to respond to the issue of mental health crises, and about work involving the police. It is good to be joined on the Front Bench by the Minister for Policing, Criminal Justice and Victims, who is showing his interest in this important subject.

Although today’s debate focuses on investigating the deaths of people detained in mental health settings, it is also important that we focus our efforts on preventing people from being detained in hospital and, where we can, diverting people with mental health illness away from police custody and prison. That is why this Government have invested £33 million this year in developing early intervention services for psychosis, and in supporting people in a mental health crisis to access the right care in the right place.

Last year, we published the mental health crisis care concordat, which is an agreement between more than 20 national bodies on the care and support that people need in a mental health crisis, and we are now working with local areas to ensure that they have local action plans in place for providing that support. We are investing an extra £35 million to develop and expand liaison and diversion services to ensure that people of all ages with mental illness who come into contact with the criminal justice system have their needs identified as soon as possible and are referred to appropriate mental health services.

[Hazel Blears (Salford and Eccles) (Lab)]

I am grateful to the hon. Member for Broxbourne (Mr Walker) for raising this issue in the House. Clearly, it is a matter of significance to our communities. Is the Minister aware of the excellent work being done by Greater Manchester police and by the chief constable, Peter Fahy, around the whole issue of mental health? Sir Peter is very concerned that his officers do not have the necessary skills—this is exactly what the hon. Gentleman said in his contribution—to deal with many circumstances, so the pressure on the police forces is intense. I am delighted that the Policing Minister and the Health Minister are here today. A greater degree of integration at local level would be extremely helpful in ensuring that we get the right people in the right place with the right skills to support the people the hon. Gentleman mentioned.

[Jane Ellison]

As ever, the right hon. Lady makes an extremely good point. My right hon. Friend the Policing Minister has confirmed that he has been to Greater Manchester and seen the work in progress. I will touch on street triage, which is an aspect of the work going on in this area, but first let me say that the right hon. Lady is absolutely right. As a constituency Member, I have been out on a Friday night with my local police’s rapid response team. Very caring young police officers have stressed to me the importance of not only equipping them with skills, but ensuring that they are not asked to do things that are not part of their core duties, and that they get proper support to deal with people in a sensitive way. The right hon. Lady’s point was very well made.

Police forces are piloting a street triage initiative, in which mental health professionals travel with police officers on patrol, providing on-the-spot help to people with possible mental health needs who come into contact with the police. There have been positive results in the Leicestershire pilot area, where street triage has led to a reduction in detentions under section 136 of the Mental Health Act 1983. I know from a Backbench Business debate a few weeks ago that that is an impressive reduction in detentions, and the right hon. Lady mentioned progress in her area, too.

We are also investing a further £30 million next year to further develop liaison psychiatry services to support people with mental illness in accident and emergency and when being treated for physical illness in a general hospital setting. As well as focusing on preventing people from being detained in mental health settings, we must also look at preventing avoidable harm and deaths when people find themselves in hospital. My hon. Friend the Member for Broxbourne mentioned that.

INQUEST’s report highlights the issue of suicides in mental health settings. Earlier this year, the Government announced our ambition for the NHS to adopt a zero suicide strategy to reduce dramatically suicides in health settings and in the community. At the beginning of the year, we also laid before Parliament the revised Mental Health Act 1983 code of practice, which comes into effect from April and strengthens our commitment to safeguarding the rights of people detained under the Act. The revised code of practice gives greater prominence to the need for better and more rigorous risk assessments, and for care planning that is centred around the patient and involves their carers and relatives wherever possible. That picks up on the well-made point from my hon. Friend about the need to involve families and to ensure that patients are treated in safe environments.

Let me turn to the recommendations in INQUEST’s report. The first concerned the system for investigating deaths and the matter of independence. Coroners’ inquests provide independent investigation, and we must consider the evidence carefully to inform how we improve the quality and independence of investigations in mental health settings. It is right that we focus on improving the way deaths in such settings are investigated. Clear guidance should be given to the NHS to improve the integrity and quality of investigations.

NHS England is reviewing the NHS serious incident framework, which describes how serious incidents, including deaths, should be reported, investigated and learned from to prevent them happening again. I understand that NHS England is finalising the guidance and have been advised that it is being reviewed by the chief nursing officer. This is an opportunity to re-emphasise the responsibilities of providers and commissioners by holding providers to account for how they respond to serious incidents, and holding commissioners to account for overseeing the response to ensure that it is objective, proportionate and timely.

Secondly, the report recommends the proper and meaningful involvement of families in the investigation of deaths, so that it is on a par with the way in which deaths in other custody settings are investigated. NHS England’s guidance on managing investigations in the NHS will set out the commissioner’s responsibility for ensuring that all those affected by an incident are involved, and that the investigation is conducted in an open and honest manner. The commissioner will also have the opportunity to inform the terms of reference of the investigation, and can consider and will be consulted on the investigation’s findings. The efforts to engage those affected by the incident should also be recorded in the response to the investigation. It is therefore essential that people should be able to not just liaise with the family, but demonstrate how they have done so, and record how they did it.

Thirdly, the report recommends the better collation and publication of statistics on deaths in mental health settings, including further details on the circumstances and characteristics of the death. I was struck by what my hon. Friend said about some of the uncertainties in this regard, and about the need for people to be transparent about something so important. I am aware that the Care Quality Commission is piloting ways to improve how it collects and analyses data, in partnership with NHS England. That can help to improve the way the CQC monitors the Mental Health Act.

I understand that the Care Quality Commission is looking at how it might link data from hospital episode statistics and from the mental health and learning disabilities data set to enable better cross-referencing of the information it receives through notifications of deaths, which should help it to improve the availability of data at a national level so that it supports policy responses to deaths in detention. That important work is ongoing.

Fourthly, the report recommended that coroners’ inquests be more robust. I have shared the report with the Ministry of Justice, and I am sure that the Chief Coroner will read it with interest. The fact that my right hon. Friend the Policing Minister is here on the Front Bench demonstrates that—

[Mike Penning]

And Justice Minister.

[Jane Ellison]

Yes, he is wearing both hats today. He has confirmed that he will take this matter forward in the Ministry of Justice, and I am grateful to him for that. The fact that, in the last Adjournment debate of the parliamentary week, the two Departments most closely involved in responding adequately to these matters are represented by Ministers shows how important they are.

My hon. Friend the Member for Broxbourne might wish to raise his concerns about the robustness of inquests directly with the Office of the Chief Coroner. However, let me tell the House about another way in which the better use of data is helping in this situation. I understand that the Care Quality Commission is undertaking analysis of the information available from coroners’ investigations and inquests, along with other information it already receives on expected and unexpected deaths, which should help it to target requests from coroners better.

The Care Quality Commission is also working with the Coroners Society of England and Wales and the Office of the Chief Coroner to establish a memorandum of understanding, with the aim of achieving better working relationships and sharing of information. I am sure that my hon. Friend, having had the chance to highlight the importance of this issue today, will want regularly to ask questions, presumably in the next Parliament, about how this work is progressing and what the timetable is. Indeed, the Minister for Policing, Criminal Justice and Victims has heard his request for vigour and energy behind that work.

In conclusion, it is absolutely right that we should seriously consider how to improve the investigation of deaths in mental health settings.

[Mr Charles Walker]

The reason independent investigation is so important is that people can be detained against their will under the Mental Health Act 1983. There needs to be some oversight of their welfare, and they need to be safeguarded, but it is difficult if that is provided only by the NHS, the organisation that is responsible for detaining them. That is why independent oversight and safeguarding is needed.

[Jane Ellison]

I absolutely understand that point, which my hon. Friend has made with some power. I certainly undertake to speak with my colleague the Minister of State, the right hon. Member for North Norfolk (Norman Lamb), who leads on mental health matters in the Department, and ensure that he is aware of my hon. Friend’s strength of feeling about the issue. I will refer him to the Hansard report of this debate. I am sure that my hon. Friend will continue to press the case. I hope that the issues I have touched on in my response give him some sense that work is in train to look at this. The seriousness of the issue is very much acknowledged in both the Department of Health and the Ministry of Justice.

It is important that we set out clear requirements for rigorous, transparent and timely investigations of serious incidents, including deaths, and for all those affected, including the families, to be involved throughout those investigations. We must continue to seek to improve the overall process of learning from deaths to prevent further avoidable tragedies. The Department of Health, NHS England and the CQC continue to look at ways of improving the system, along with colleagues in other Departments, particularly in relation to transparency and ensuring that lessons are learned. I congratulate my hon. Friend once again on bringing these important matters to the attention of the House.

Question put and agreed to.