Public Health

Janet Daby Excerpts

Wednesday 6th January 2021 Commons Chamber

[Janet Daby (Lewisham East) (Lab) [V]]

I am grateful to be able to speak in today’s debate. I start by extending my deepest sympathy to my staff member, Ruzina, who today lost her mother to coronavirus. Words cannot describe the devastation that this virus has caused to so many.

There are so many concerns that I have about the impact of the Government’s handling of this pandemic, and there are too many pressing issues in Lewisham East to mention, but today, I would like to raise the crisis facing our ambulance services. I have been speaking with a constituent of mine, Mr Clive Tombs, who is a technician in the London ambulance service. Mr Tombs told me of the sheer stress levels that he and his colleagues are experiencing. As the secretary of his branch of the GMB union, Mr Tombs speaks not just for himself, but for thousands of members serving the capital.

Staff sickness in the ambulance service is at an all-time high. Mr Tombs estimates that around 6,000 staff across the service are off sick, the majority with covid-19. He has lost colleagues to the virus and other colleagues are hospitalised. Many others are understandably suffering from declining mental health after seeing the very worst of the impact of this virus and the impact which it is having on our people. Post-traumatic stress disorder is also becoming commonplace.

Phone operators are having to play God in choosing who among the hundreds of callers will get an ambulance. Mr Tombs also speaks of the relentless shifts that those in the ambulance profession are working. Those on the frontline are working 12, 13 and sometimes 14-hour-long shifts, and all too often, they do not get a rest or a break before starting their next demanding shift. We cannot expect our ambulance service to work all hours of the day and night, providing high-quality care, thinking quickly, making smart decisions and putting themselves in danger, without having enough time to rest. I would be grateful to hear from the Secretary of State for Health and Social Care on this issue.

Many of us have been distressed by images over the Christmas period of ambulances piling up outside hospitals, particularly in London. Every one of those ambulances has someone who is in urgent need of medical care and, for some of them, their lives depend on it. A&E departments are not able to keep up with the level of demand, so ambulances, with patients in them, have to wait for hours upon hours—up to 11 hours, Mr Tombs says. They wait on trolleys that provide them with little comfort and are meant only for short use. Staff sit with them in vehicles but struggle to provide safe ventilation in the cold weather. There is no access to a toilet or a washbasin in an ambulance. None of us would like to imagine our parents, partners, elderly neighbours or loved ones suffering on an ambulance trolley waiting to be admitted. What is more—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sorry, Janet, your time is up. I apologise.

Covid-19 Update

Janet Daby Excerpts

Monday 14th December 2020 Commons Chamber

[Matt Hancock]

We are always open to finding new ways to protect the economy as much as possible and bring the virus under control. I share my right hon. Friend’s desire to get it under control and to keep it under control until a vaccine can make us safe, but unfortunately this is no longer just a problem among school-age children in Waltham Forest and north-east London, which it has been until the last week’s data. The case rate among the over-60s in Waltham Forest is now over 250 and we are seeing that rising over the last week. We are also seeing rising admissions to hospital.

I have a huge amount of sympathy for everybody affected by these decisions in Waltham Forest, but it is absolutely essential to get this under control now to protect the NHS from being overwhelmed in the future. We must break the inexorable link from cases now to hospitalisations in the future—and, sadly, deaths—by using the vaccine and by testing. Until we can have the vaccine fully rolled out and people inoculated by having their second dose, and until enough vulnerable people have had that second dose and have therefore become inoculated, unfortunately measures like this are necessary.

[Janet Daby (Lewisham East) (Lab)]

The Health Secretary is fully aware that hundreds of thousands of jobs have been lost during the pandemic, which continues to hit our economy. That means a vast number of families and individuals are diving into hardship. Having no heating and no hot water is what many residents across our country will face this Christmas, as they visit food banks. What discussions has he had with the Secretary of State for Work and Pensions with regard to reducing the rising level of poverty?

[Matt Hancock]

We are trying to support the economy as much as possible throughout all these difficult decisions. The extraordinary levels of financial support are a part of that, including the furlough scheme, which has now been extended to the end of March. I, of course, talk to my right hon. Friend the Work and Pensions Secretary regularly to make sure we take the action that is necessary in a way that supports people as much as possible.

Deaths in Mental Health Care

Janet Daby Excerpts

Monday 30th November 2020 Westminster Hall

[Janet Daby (Lewisham East) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer. The circumstances of the debate are truly heartbreaking. I begin by extending my condolences to the family of the late Matthew Leahy and all families who have lost loved ones with mental illness at the hands of those who were supposed to protect them and care for them.

For many decades, mental health has not received enough attention or funding in comparison with physical illness. I draw attention to the mental health unit in Lewisham, which has already been viewed as not being fit for purpose—it was not built for people who have mental health problems—yet funding has never materialised for the changes needed to make it suitable for people with mental health problems. With the pressures of the pandemic, medical professionals are reporting more and more that people are suffering with mental illness due to economic hardship or loneliness, so it is clear there will be greater demand for mental health services over the next few years. It is imperative that we have well-functioning and well-funded mental health services to prevent needless deaths of the most vulnerable who are in need of those services. Medical professionals, the police and everybody around them also need support to be able to care for people with mental health illnesses. They need training, supervision and, most of all, not to be overworked. They also need to be able to debrief when they find things difficult.

I would like to raise the case of the late Kevin Clarke, from my constituency of Lewisham East, who sadly died following a mental health relapse. My condolences go out to his family, who are still bereft from the loss of Kevin, who, despite not posing an immediate threat to anyone, was handcuffed and placed in a leg restraint while telling the police that he could not breathe. In October, an inquest concluded that the officer’s restraint and supervision towards Kevin were excessive and sadly contributed to his death. However, the police were not the only professionals involved in his care. Other professionals were also in contact with him prior to this tragic incident.

A strategy of care needs to be in place for all mental health patients, one in which patients are listened to and family members are involved, so that loved ones can talk about preventative measures and their concerns, as well as contribute to the care plans that are needed. Mental health doctors, mental health nurses, social workers and care staff all need to work collaboratively with all professionals involved in keeping the most vulnerable people safe and secure, and to prevent these fatal, awful incidents of suicide or types of restraints leading to death. Change needs to happen.

[Graham Stringer (in the Chair)]

Hon. Members have either not turned up or taken less time than expected, so, unusually, I will increase the time limit for the last speakers to five minutes.

Covid-19 Update

Janet Daby Excerpts

Thursday 16th July 2020 Commons Chamber

[Matt Hancock]

Yes. My hon. Friend has raised this point with me, privately as well, about access to the data. It is incredibly important. We are constantly improving the data that is available because we are constantly getting better data. That is an important part of the work strand.

[Janet Daby (Lewisham East) (Lab) [V]]

We cannot praise enough carers, key workers and NHS staff during this pandemic, including, of course, in Leicester. My constituent Anthony Francis launched a petition for a national day of recognition for our NHS and key workers. He proposes 26 March, which was the first day of clap for our carers. The petition has reached over 100,000 signatures from across the country. Will the Secretary of State commit to this?

[Matt Hancock]

I will certainly look at it; it seems like a very interesting idea. I think that clap for our carers was an absolutely brilliant initiative. I love the fact that it was essentially a social initiative. It did not come from Government. We embraced it enthusiastically and all went out clapping, as did everybody, and a way to mark that permanently is something that I am absolutely open to.

Coronavirus

Janet Daby Excerpts

Wednesday 11th March 2020 Commons Chamber

[Matt Hancock]

I have heard some of the noises off. I merely encourage everybody to base their decisions and judgments on science, rather than politics.

[Janet Daby (Lewisham East) (Lab)]

I thank the Health Secretary for his continued updates to the House. The partner of a constituent of mine suffers from cystic fibrosis and other related illnesses and requires daily treatment that includes cleansing—alcohol wipes, gels and so on—but because of the panic buying in some shops they have been unable to purchase these items, which could result in serious health issues for them. Are there any other measures the Government can put in place, working with supermarkets, to manage this?

[Matt Hancock]

Yes, absolutely; this is really important. We have some supplies of these sorts of things, in the supply chains and, in some cases, within the shops themselves, and we are working with the shops to ensure availability of things that can be critical to people’s care. We are working on that with DEFRA, the NHS and within the Department, particularly in relation to pharmacies, to make sure we get the right kit to the people who need it.

Health Inequalities

Janet Daby Excerpts

Wednesday 4th March 2020 Commons Chamber

[Janet Daby (Lewisham East) (Lab)]

It is a pleasure to follow the hon. Member for Bury North (James Daly) and to hear his suggestions on how to reduce health inequalities.

Professor Marmot’s recent review on health inequalities since 2010 has highlighted how the Government’s decade of austerity has taken its toll on aspects of people’s lives. In particular, the report highlights: rising child poverty; the closure of children’s centres; declines in education funding; zero-hours contracts; increasing insecurity in work; the housing crisis; a rise in homelessness; an increase in the number of beggars on the street; people not having enough money to lead a healthy lifestyle; and more and more people turning to food banks. If those outcomes are not bad enough, things are even worse for our minority ethnic population, and that area is my focus in this speech.

Ethnicity has not been a consistent focus of health inequalities policy; very few policies have been targeted at minority groups. Two factors affecting the action—or the lack of it—on ethnic health inequalities are the availability of data on ethnicity and the legal obligations on racial equality. For example, data on ethnicity is not collected when a death is registered, so it is not possible to calculate life expectancy estimates. Having that data on ethnic groups in our health statistics would be an important aid to researchers, who would then be able to investigate differences in health. Education for our health professionals is also most important if we want to address health inequalities and to enable those professionals to feel that practical steps can be taken to help to reduce the inequalities. For example, sickle cell disorder affects some of my diverse community in Lewisham East, but not enough research has been done on it, and not enough time has been spent on evaluating the preventive measures and how to reduce people’s risk of having a sickle cell crisis. Clearly much more needs to be done to understand the disorder and how it disproportionately affects a section of our diverse population in the UK.

Many health professionals would agree that there is a desperate requirement to increase training on sickle cell disorder, as well as diversity training in the General Medical Council, the General Pharmaceutical Council and the Nursing & Midwifery Council, in order to address these needs. The Marmot review makes one thing clear: the effects of austerity are reducing quality of life and, in some cases, they are taking life.

NHS Funding Bill

Janet Daby Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Matt Hancock]

I need to make some progress.

Let me turn to what is happening on top of the funding in the Bill. The revenue budget does not cover the budgets for training and for infrastructure investment, so the increase in the training budget and the money for new infrastructure will be in addition to the £33.9 billion for the core day-to-day running costs. We made clear in the manifesto that we would have more nurses in the NHS—50,000 more—and I am delighted that the latest figures, released last week, show an increase of 7,832 over the last year,

[Janet Daby (Lewisham East) (Lab)]

rose—

[Matt Hancock]

If the hon. Lady wants to welcome that increase of over 7,000, she is more than welcome to do so.

[Janet Daby]

I thank the Secretary of State for giving way, and of course I welcome more nurses in our NHS. Why wouldn’t I? My mum was a nurse in the NHS. However, I want to ask the Secretary of State about the increase for the recruitment and retention of mental health nurses, and whether he will agree to ring-fence new mental health funding to ensure that it goes to the Department to which it is meant to go.

[Matt Hancock]

I can guarantee that the mental health funding will be ring-fenced; and I want us, from the House, to pay tribute to the hon. Lady’s mum.

We are going to have more nurses, and I am delighted that we already have a record number of registered nurses, a record number of midwives, a record number of nursing associates and a record number of nurses in training. If the current trends continue, 36,000 nurses will join the NHS each year from the domestic and overseas workforce, which means that we will have more than 140,000 new nurses by 2024. However, we need more nurses now, and we will have 50,000 more by the end of this Parliament. That is a critical manifesto commitment on which we intend to deliver.

We need the right number of nurses and we need them to have the right skills, with nursing increasingly becoming a highly skilled as well as a caring role. From September this year, we will give every student nurse a training grant worth at least £5,000 to support them in their studies and ensure recruitment and retention. We are also expanding the routes into nursing with more nursing associates and nursing apprenticeships, making it easier to climb the ladder to become a fully registered nurse, and prioritising the care of our nursing staff to encourage more of them to stay in the NHS.

Of course, that training grant will also apply to midwives, paramedics, dieticians and all allied health professionals. Too often, the media use “doctors and nurses” as shorthand, and sometimes, if I am honest, we do that in this House, too. We should instead recognise the essential contribution of our allied health professionals, without whom our NHS family is incomplete and on whom our increasing move to multidisciplinary teams depends. This £2 billion training package is in addition to the funding contained in this Bill.

Finally, as well as revenue and training, the NHS also needs more money for infrastructure. On that point, I will give way to the hon. Member for Rhondda (Chris Bryant).

--- Later in debate ---

[Jonathan Ashworth]

My hon. Friend speaks movingly about the situation in her local trust. Of course, St George’s is one of the trusts that has a high maintenance backlog of around £99 million. The reason why hospitals such as St George’s have maintenance backlogs, which mean that they cannot get the flow through the hospital that is needed so that my hon. Friend’s constituents are treated on time, is because capital budgets have been raided repeatedly. The underfunding of the NHS has been such that NHS chiefs have had to shift money from capital budgets into the day-to-day running of the NHS. That is what Tory austerity has done to our NHS. That is what Tory austerity means for my hon. Friend’s constituents.

[Janet Daby]

Does my hon. Friend agree that we have a crisis in respect of mental health nurses, who are not being recruited and supported in the way in which they should be? Not only is that putting strain on the mental health nurses who are there, but it will affect patient care as well.

[Jonathan Ashworth]

My hon. Friend is absolutely right. Of course, we are short of 44,000 nurses across the whole national health service. One of the most damaging policy decisions that George Osborne made—probably another of the Secretary of State’s ideas—was to cut nurse training places in 2011 and get rid of the training bursary. The Government say that they will bring back a grant, but they are not going to go the whole hog, are they? They are not going to get rid of tuition fees. They still expect people to train to be nurses and build up huge debts, because the nature of the training that they have to go through means that they will not be able to take a job on the side. I do not believe that is the way we should recruit nurses for the future; we should bring back the whole bursary for nurses, midwives and allied health professionals.

Mental Health Act 1983

Janet Daby Excerpts

Thursday 25th July 2019 Westminster Hall

[Neil Coyle]

That is very much what I will be coming on to and what I hope we will hear more from the Minister on; it was the subject of an independent review.

I was talking about the prevalence of mental health conditions in Southwark and people I have seen at constituency surgeries. These statistics for Southwark are from the South London and Maudsley NHS Foundation Trust, which is my local mental health trust. Close to 4,000 people have what it defines as a serious mental illness; that does not include things such as dementia. Almost 48,000 people are currently experiencing a common mental health condition. Across the borough, 22,000 people have both a mental health condition and a long-term physical condition. And almost 4,000 children in Southwark have a mental health condition.

[Janet Daby (Lewisham East) (Lab)]

I thank my hon. Friend for making a speech that is very powerful and very personal. The number of mental health nurses in England has fallen by 6,000 in the past 10 years. Does he agree that we need the correct number of staff, and staff with the correct expertise, to meet the needs of the service in supporting people with mental health issues?

[Neil Coyle]

I absolutely agree and will come on to some of those figures.

I referred to the children in Southwark who have mental health conditions. The NHS’s overall target for ensuring that children and adolescents can access mental health treatment is just 35%. That is remarkably low, and I hope the Minister will have something to say about it today. In the meantime, while that is the national standard, Southwark’s Labour council has set an ambition to ensure that 100% of children and adolescents can have access to mental health care. As part of that commitment, the council has made £2 million available for local schools to support the emotional wellbeing and mental health of pupils. It is also developing a mental health hub service for young people. That is in partnership with—jointly funded by—the local clinical commissioning group.

As I have said, I think that my personal experience has given me an additional strength in working with local people and families who are affected by these issues, but being open about my family experience does not mean that I have not seen discrimination or stigma at first hand. I was about 10 or 11 when I said to a friend at school that Mum had schizophrenia and he asked whether that meant I had two mums. That was a surprising reply, but obviously there was a lot of confusion then about what schizophrenia actually was. Some of it is still out there.

Sadly, one thing that remains is the perception that people with schizophrenia are somehow more dangerous. Actually, mum’s experience and that of many people with schizophrenia is that they are more likely to be targeted, because their erratic behaviour when they are unwell can draw the attention of others, who might target them for robbery and other offences.

--- Later in debate ---

[Neil Coyle]

Certainly, there is insufficient support for a whole range of people. We have sadly seen a roll-back of support, independence of choice and control in a number of areas, including social care support, health services and direct benefits for some disabled people, particularly in the past nine years.

The extensive powers, which I described, were used to detain 50,000 people last year—a 47% increase in the past decade. The only other people detained in this country are those in criminal custody. Those citizens have safeguards to protect them from going to jail, but we do not have the same safe standards of support and safeguards for mental health care. Those who commit a criminal offence have a police investigation, the CPS evidence threshold, a trial, the right of appeal and advocacy throughout, but for the 50,000 detained under the Mental Health Act few such safeguards exist, despite the deprivation of liberty, choice and control.

We can turn this situation around. The independent review of the Mental Health Act, chaired by Professor Sir Simon Wessely, recommended that four principles be written into a revised Act. First, it recommended that choice and autonomy, even for someone detained under the Act, must be respected, enabled and enhanced wherever possible. Secondly, it recommended that the compulsory powers contained within the Act should be exercised in the least restrictive way possible. Thirdly, it recommended that services and treatments should be of therapeutic benefit and delivered with a view to minimising the need for Mental Health Act powers to be used. Fourthly, it recommended that the individual must be respected, and that care and treatment must be provided in a manner that treats them accordingly.

I seek the Minister’s views on those principles being incorporated in forthcoming plans. If those four principles had existed when my mum was detained—she has been sectioned more times in my lifetime than I can remember—I would have had more reassurance that her needs, rights and wishes would have been the starting point for the care and treatment she received. Sadly, that was not the case.

This is the first debate to be held on the Mental Health Act since that review was published, which is astonishing, given the level of use of the powers in the Act and the level of support for reform. The review made 154 recommendations. The Government accepted two immediately and agreed to publish a White Paper by the end of this year to bring forward full legislation. I welcome that; there is no one who does not want to see that. However, given the paralysis caused by Brexit, and the new Prime Minister and Cabinet, can the Minister confirm that that timetable has not slipped?

[Janet Daby]

Does my hon. Friend agree that a new mental health Act must prioritise children and young people? The statistics relating to young people are cause for concern.

[Neil Coyle]

It certainly should, but we should not have to wait for new legislation—some measures can be taken before that. Given that the White Paper is due by the end of the year, legislation many not come soon enough to help some of those young people who are experiencing problems now.

I hope the Minister will indicate that the Government’s rhetoric on parity of care will be matched by action on preventing the need for detention. Sadly, all the evidence points in the other direction. Parity of care—the requirement to treat mental and physical health equally—was enshrined in law in 2012 and became part of the NHS constitution in 2015. Although mental health accounts for 28% of the overall disease burden, as the NHS terms it, it received just 13% of NHS funding, according to the Centre for Mental Health. In cash terms, the King’s Fund has shown that between 2012 and 2017, funding for acute and specialist hospitals grew by almost 17%, while that for mental health trusts grew by just over 5.5%.

The Royal College of Psychiatrists has found that, taking into account inflation, the real-terms income of mental health trusts across the UK has fallen since 2011. It says that 62% of mental health trusts in England reported a lower income at the end of 2016-17 than in 2011-12. Sadly, only one trust experienced a rise in funding in all five financial years. The Royal College of Psychiatrists has also reported that mental health trusts received £105 million less in 2016-17 than in 2011-12, at today’s prices. There is no parity of funding, even though the Government are legally committed to it.

The 40% rise in detention over the past decade has come at the same time as a loss of overnight beds—between 2010 and 2017, the figure went down from more than 25,000 to less than 20,000—and a 15% decrease in the number of mental health nursing posts. Demand is rising as a result of detentions, but the number of staff has diminished and there is also less space available. The Care Quality Commission, which regulates mental health services, has reported that previously preventable admissions are now not being prevented because of cuts to less restrictive alternatives, such as community mental health services. There has also been an increase in the number of people with at-risk factors when it comes to detention, such as social exclusion and untreated drug or alcohol misuse.

Clearly, it is not in someone’s best interest to be detained if that is avoidable. A breakdown of mental health and behaviour can be deeply damaging for individuals, and their families and loved ones, but detention is extremely costly, especially compared with drug and alcohol treatment services or other interventions and support in the community. The average cost of each detention is estimated to be just over £18,000. The 50,000 detentions over the past year cost an estimated £900 million. That money could have gone so much further in earlier interventions to prevent detention.

Of course, there are also costs to how people are identified or present themselves in crises that result in detention. Sometimes they are homeless. I know the Minister has done a lot of work on that. We have met on several occasions and I know that she views homelessness as a public health issue—an issue that overlaps with the topic of this debate. Homelessness as a result of mental ill health increases physical health issues, which result in costs to the NHS.

Sometimes people in crisis are identified by the police. The last time my mum was sectioned—I think it was in 2016—she had had a car accident in which she hit a bollard. No one was injured, but she was prosecuted for the accident. My family and I—including my sister Alex, who I know is watching—had sought help for mum. We knew that she was becoming unwell and that she was not taking her medication, and we tried in advance to alert people to her need for support and to get her back on track, but that did not happen. She had agreed to plead guilty when the case went to court—she was guilty; she hit the bollard and no one else was responsible—but when she was asked how she would plead, she said that she could not be guilty because she had been wearing blue that day. Of course, that made no sense to anyone and resulted in the ordering of a psychiatric assessment, which was a pathway back into mental health care.

That was not necessary. Police and court involvement cause unnecessary cost to the taxpayer. If earlier interventions had occurred at the request of family members, that could have been avoided. I ask those hon. Members who have not been out with their local police and emergency responders to please do so. The last time I did it in Southwark, the police responded to a surprising number of 999 calls that involved someone with a mental health condition. That is not just anecdotal evidence; it is backed up by national statistics.

Troublingly, police statistics show an increased use of section 136 of the Act. That power is used by the police exclusively to remove

“mentally disordered persons without a warrant.”

Between 2015-16 and 2017-18, the use of that power in Southwark doubled, from 60 detentions to 121. That number fell slightly last year, but the shocking overall rise shows the price of underfunded mental health services, with the police often picking up the pieces in situations that should be handled by healthcare specialists and community interventions. Of course there will be some who are unknown to services, but most are not, and there are some who present with issues relating to suicide. Tackling the majority of cases upstream should be the target. I hope the Minister will state how that will be done through a White Paper or new legislation.

I welcome the previous Prime Minister’s commitment to end the use of police cells to detain people who are experiencing mental ill health. I hope that that commitment will continue under the new Government, because a police cell is no place for someone who is experiencing a mental health crisis. Although there has been a 95% fall in the use of cells and custody facilities since 2011, in the latest figures from 2016-17 they still accounted for almost 4% of detentions. I hope that the Minister will set out when the Government expect the number of people going through the system to be zero.

The point that I am trying to ram home is that overreliance on sectioning and detention can be bad for the individual and their families, but also for the taxpayer. We can do better than that. It is not just a matter of the loss of liberty; the Care Quality Commission has also sounded the alarm over risks for people when they are detained, including compulsory treatment and sexual assault. It reports that almost one fifth of patient records—double the proportion in the previous year’s study—

“showed no evidence of consideration of the least restrictive options for care.”

It also stated:

“We have seen limited or no improvement in the key concerns we have raised in previous years.”

That is the regulator saying, “Not only have we identified the problem this year, but we told you about it in previous years, and still no improvement has been made.” Its evidence shows that 1,120 sexual safety reports were made in a three-month period in 2017, of which 457 were about sexual assault or harassment of patients or staff. Some of our most vulnerable citizens are at risk of sexual assault while they are detained under the state’s powers. That is an absolutely appalling record in any civilised society.

These problems all undermine mental health treatment and use of the Act and make it no surprise that research commissioned by the Mental Health Alliance shows that individual experiences of being detained under the Act are far from positive. It surveyed more than 8,000 people, and the majority of respondents who had been detained did not believe that the Mental Health Act sufficiently protected them from inhuman or degrading treatment. Some 61% of respondents who had been detained disagreed with the statement, “People are currently treated with dignity when detained”, as did 41% of mental health professionals. The unity behind the case for reform and true parity of care could not be clearer. I hope that the Minister will cover those issues and confirm more of what the Government aim to put in their Bill when it appears, including human rights provisions.

At the Disability Rights Commission in 2004-05, I helped to bring organisations of and for disabled people together behind the principles that were then put in the Mental Health Act 2005:

“A person must be assumed to have capacity unless it is established that he lacks capacity.

A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.

A person is not to be treated as unable to make a decision merely because he makes an unwise decision is made.”

Our right to make bad decisions is enshrined in legislation. I apologise to any smokers present, but they make a bad choice every time they light a cigarette, and arguably the Conservative party has chosen badly in selecting the right hon. Member for Uxbridge and South Ruislip (Boris Johnson). The fourth and fifth principles are:

“An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.

Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.”

We have precedent in legislation, and we need to support that approach again in reforming the Mental Health Act, with a resolute belief in patient-centred care, with as much choice, control and dignity as is humanly possible.

People’s experiences of being detained vary wildly. It cannot be right that some people are treated worse simply because the place where they become unwell does not have access to the right level of support. We need more standardised access to care, and more standardised care when it has to be provided. I recognise that detention cannot always be avoided, and that it has welcome results when people come out better than when they went in, but even when it is necessary, it must be done better—and there are ways to do that.

Advance decisions were one of the review’s two recommendations that the Government accepted. It is crucial that patients be involved in planning their care as much as possible. The Care Quality Commission’s research shows that under the current legislation, a staggering one in five patients detained have no input whatever in their care plans. It examined the plans in place for those patients and found that most of them were of poor quality, lacked planning and had no evidence of patients’ consent to treatment when they were admitted to hospital. Introducing advance choice documents so that people can set out their wishes about future care and treatment, and giving them more legal weight than they have under the current system, would help to solve that problem and improve care for thousands of people.

I will give a quick practical example for anyone who needs it. Medication for schizophrenia has improved dramatically. Some of the medication that mum used to take would cause regular, sustained vomiting, which caused teeth loss and worse. Different treatments are available. If she were sectioned and put back on that medication, knowing the side effects, it would obviously make the treatment worse for her. I hope that the Minister will give a strong indication about the Government’s plans for advance decisions and the ability to make choices that can improve the treatments available.

When a person is detained under the Act, they have a “nearest relative” who has certain rights to be involved in their care. Many family members and patients value the fact that relatives are given a statutory role, but that relative is chosen from an outdated hierarchal list that is based on age, rather than on the views of the individuals involved or on whether they have a good relationship. The Government accepted that recommendation from the review. I hope that the Minister will have more to say about that today—[Interruption]—and less about stopping Brexit, which is the chant outside that may have been caught on the microphones.

Those who are detained under the Act have effectively no legal say over their treatment and no automatic right to advocacy in the event of their detention. The fact that such rights are not enshrined in the legislation illustrate that reform is badly needed. Establishing a right to an advocate for all mental health in-patients, whether voluntary or detained, without having to ask for one, would also radically improve care, as would the statutory inclusion of a patient’s advance wishes in their treatment plan. I hope that the Minister will give an indication on that matter today as well.

I will cut down the bit of my speech about resources, because they have already been mentioned and I know that other hon. Members want to speak. However, cuts have had serious implications, including for the distances that people, including children, have to travel for treatment: they are often taken hundreds of miles away from their friends, family and community. That cannot be acceptable. Wider cuts to council budgets and the public health agenda have also had an impact, and my constituency has experienced the knock-on effects. We lost an organisation called CoolTan Arts, which used to provide creative and employment support for many disadvantaged people with mental health conditions.

My very real fear is that the bad old days have crept back. For too long, Ministers have ignored the problems. There have been cuts to services, and we are seeing more ill-trained or morale-sapped staff; an overuse of agency crews; rising use of detention, which locks the problem away out of sight; and compulsion rather than empowerment. That must change. The new Prime Minister must listen to what is said in this debate; I hope he will. The White Paper that has been promised must be delivered and must reflect the spirit and ambition of the independent review.

New legislation must also be passed to update the Act. It is not just about getting a better piece of legislation; more importantly, it is about better treatment for the thousands of people with mental health conditions and their families up and down the country. There is cross-party support for this work: 49 colleagues have signed early-day motion 1242, which

“calls on the Government to reform the Mental Health Act…during this Parliament”.

There is appetite in the Commons for that reform, so I hope it will be delivered.

We have a window of opportunity to improve thousands of people’s lives. I hope that the Minister and the new Cabinet and Government will take it.

NHS Long-Term Plan: Implementation

Janet Daby Excerpts

Monday 1st July 2019 Commons Chamber

[Matt Hancock]

Yes, I am looking forward to that legislation being introduced. The work that my hon. Friend’s Select Committee—the Joint Committee on the Draft Health Service Safety Investigations Bill—did in the prelegislative scrutiny was incredibly important. The HSIB Bill promises to improve patient safety, which is an important part of the agenda, and I look forward to its being brought forward to the House.

[Janet Daby (Lewisham East) (Lab)]

I have recently become the vice-chair of the all-party parliamentary group on sickle cell and thalassaemia. Sickle cell is very much a hidden disability which is lifelong. Some people take up to five medications a day, which is very costly. If they have a relapse, they can be hospitalised, but it is more cost-effective and preventive to have free prescriptions than to end up in hospital. Will the Secretary of State review the matter and do what is both best for those patients and in the public interest?

[Matt Hancock]

I will certainly look at the matter. When I was on a night shift with a London ambulance crew, we attended a patient who suffered from sickle cell, and it was horrific to see the degree of pain that they were in. I have therefore seen at first hand exactly how horrific the condition can be and I will look into the hon. Lady’s suggestion.

Cystic Fibrosis Drugs: Orkambi

Janet Daby Excerpts

Monday 10th June 2019 Westminster Hall

[Janet Daby (Lewisham East) (Lab)]

I thank the hon. Gentleman for giving us such a comprehensive overview of cystic fibrosis. A constituent of mine, Joanne, has contacted me regarding her daughter Lauren, who suffers from cystic fibrosis. Access to treatments such as Orkambi, which has already been mentioned, would be absolutely crucial to managing hers and so many other people’s conditions in our country. Hon. Members might know that 16 May marks a year since the Prime Minister called for a speedy resolution to this issue. Does the hon. Gentleman agree that we need to hear the actions that the Government can take, and are taking, to open up access to these lifesaving treatments for people such as Lauren in my constituency?

[Paul Scully]

One of the reasons why NICE was set up in the first place was to take politics out of drug development. We need to ensure that we have the balance right between the Government intervening and the clinicians—the people who can make their assessments without political interference—making their decision. None the less, we clearly must have a view.

One of the things that some people have suggested—I think it was intimated in an earlier intervention—is Crown use of patents, to allow the use of generic drugs and effectively remove patents from pharmaceutical companies. Obviously, that is in extremis. There is an inherent problem with the potential lack of investment in future research, should we start taking away patents from private companies.