Mental Health (Approval Functions) Bill

Jeremy Hunt Excerpts

Tuesday 30th October 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

Detaining people under the Mental Health Act raises fundamental questions of individual liberty and public safety, requiring the most careful consideration. I am sure that there is general agreement across the House that the circumstances in which we find ourselves today are far from ideal. Members on all sides will want to use the time we have to satisfy themselves that the measures that the Government are asking the House to approve today are justified.

Emergency legislation tends to be forward looking in its scope, so the retrospective nature of the Bill before us is unusual and potentially troubling for Members. As I said yesterday, we will need to be sure that this is the only real course of action available and that it is not setting a precedent whereby emergency legislation can be used as a convenient means of correcting administrative failings, which could in itself breed a culture of complacency in public administration.

In asking those legitimate questions, however, we must have at the forefront of our minds the simple fact that the uncertainty which has arisen in the past week affects thousands of highly vulnerable people and their families, as well as having serious implications for patients and public safety. If we leave that uncertainty hanging, it will have the potential to cause real harm to the individuals concerned, and to damage public trust in our systems of individual and public protection.

The Secretary of State was right to act quickly, and to come to the House yesterday to make his exceptional and urgent request for legislation. I am surprised that he did not make the case for that legislation to the House in person today, but the Opposition have nevertheless concluded that, on balance, the public interest is best served by our supporting the Government in the swift action that they propose, and we will ensure as far as possible that that pragmatic approach is reflected in the other place.

In reaching our judgment, I think we can take some comfort from the fact that the main mental health organisations, as well as the Royal College of Psychiatrists, are, for now, supporting the Government’s course. However, concerns and questions have already been raised today—not least by my right hon. Friend the Member for Oxford East (Mr Smith)—which have not been fully answered. I must say to the Government that it is vital for the fullest possible answers to be given to the House today before any approval is given to this exceptional retrospective measure. I shall be seeking answers not just to the questions that I am about to ask, but to questions that the Secretary of State did not answer yesterday. There are matters of detail here, but matters of principle also arise, and I want to cover both in my speech.

[The Secretary of State for Health (Mr Jeremy Hunt)]

May I clarify something? I had intended to make the Second Reading speech earlier, but I will be winding up the debate, and during that speech I shall seek to address any points raised by the right hon. Gentleman—and, indeed, any outstanding points raised by other Members.

[Andy Burnham]

I thank the Secretary of State for his intervention. We understand that these are urgent matters, and I am sure that he is receiving briefings from the Department, but I think that there is a sense among Opposition Members that that is not good enough, and that he should have been here to answer the questions that were asked. We appreciate that he will be winding up the debate, but I hope he will take careful note of all the questions that are asked, and will give every Member present the fullest possible answer.

First things first: let us begin with the detail. I think it would help the House to know more about the extent of the checks that have been carried out on the 4,000 to 5,000 cases involved. The very fact that the number remains vague suggests that there has not yet been a thorough case-by-case review. Does the Minister—or, indeed, the Secretary of State—agree that it is essential to conduct such a review, and to put a precise number on the extent of the problem? I asked yesterday whether the Department could tell us how many of the people concerned were in high-security hospitals. I think that that is an important aspect of the issue, and I should be grateful if the information could be given to us at some point this afternoon. Without detailed case-by-case checks, how can we be sure that this procedural defect was the only technical irregularity in the process that was operating in the four SHAs concerned? We need to be reassured that there are no further problems that will need to be corrected at a later date.

That brings me to another question that was not answered yesterday. Families of the people involved will have heard yesterday’s news, and will no doubt have been unsettled by it. Does the Secretary of State agree that it is important for the Government to make arrangements, urgently, for direct communication to take place with the families who have been directly affected so that the issue can be explained to them more fully, and in isolation from some media coverage that may not give them the reassurance and support that they seek? Have such arrangements been made, and has any facility been provided enabling questions to be answered so that people can be given that reassurance and support?

That, in turn, brings me to another important point. If the Government were to leave a vacuum in terms of advice and communication, it could of course be filled by less scrupulous elements of the legal profession seeking to initiate compensation claims. We have already read warnings today that efforts may be made to encourage patients to sue for £500 or £600 a day, the amount that a prisoner would receive in compensation for unlawful detention. I am sure the Secretary of State agrees that any such activities would be highly unsettling, and would amount to the potential exploitation of vulnerable people. I hope he will join me in sending the clearest of messages to the legal profession that that would not be at all welcome. On the other hand, we would not want to see any curtailment of individuals’ legitimate right to challenge the decisions made affecting their liberty as a result of the Bill.

[Andy Burnham]

That is a good point. So many cases are involved that challenges may have already been in progress before this technical problem arose. There may have been complaints about the nature of the decision-making process, the number of professionals involved, or any matter relating to the process by which the decision was made.

I hope that it will reassure the hon. Gentleman to learn that I have been given access to Government lawyers—the Secretary of State promised that yesterday, and I am grateful to him for arranging it—and I have been assured that the Bill will not wipe away an individual’s right to issue a legal challenge on a different point of process. That is a fundamentally important point, and I am glad that the hon. Gentleman has given me an opportunity to put it on the record. We would certainly not support the Bill if it were intended to wipe away an individual’s rights retrospectively, and I am sure that the hon. Gentleman would not either. We are grateful for that reassurance from the Government.

Along with the urgent steps that are being taken to correct the legal position, we need a review of how this came about in the first place. If it had happened in a single SHA, the explanation might have been easier to ascertain and understand, but the fact that it happened in four SHAs points to a more widespread issue of concern. It raises the question whether the problem arose from historical practice among clinicians and NHS bodies in the four regions concerned, or whether a piece of Department of Health guidance that was circulated in the past may have been responsible. I hope that the Minister or the Secretary of State will be able to enlighten the House further.

We want the Harris review—which I support—to cover all the technical issues surrounding mental health, so that the House and the public can be absolutely certain that no other technical failures or breaches of regulation have been identified. Let me make two appeals to the Secretary of State. First, I ask him to consider widening the remit of the review, and ensuring that in future it can take the broadest possible view of arrangements for sections under the Mental Health Act 1983. Secondly, I ask for the review to be conducted as swiftly as possible, so that it can inform the current reorganisation of the NHS.

It seems to me that the crux of the issue is the interrelationship between the 1983 Act and the potential for reorganisations of the NHS to disturb important existing arrangements and procedures for the carrying out of these essential public functions. That is the crux of the matter. I accept that a problem may have arisen as a result of the introduction of SHAs and PCTs in 2003, and we will have to wait and see whether that was the case. Regardless of the answer to that, however, the Government still have to face a relevant and current issue: they have to be absolutely sure that the changes they are proposing—and which the Opposition continue to believe are unnecessary and highly disruptive to an NHS that is functioning well for the vast majority of people—will not run the risk of causing further confusion.

We have not had anywhere near enough clarity from the Secretary of State—or his predecessor, the right hon. Member for South Cambridgeshire (Mr Lansley), who has just left the Chamber—on how some of the essential functions of NHS bodies to do with safeguarding and public protection are to be handled in the new NHS structure. Many months have passed since the publication of the Government’s first White Paper, yet there are still doubts in the minds of clinicians and others practitioners on the ground. That is an indictment, and shows the confusion the reorganisation has created. We are seeing the emergence of myriad new bodies in the NHS whose functions are not yet fully understood or specified by the Government. This crowded landscape has the potential to cause for further uncertainty. I therefore today ask for more clarity on this matter.

As things currently stand, what will the NHS arrangements be for sectioning people under the mental health provisions to be introduced from April 2013? I do not yet know with confidence what those arrangements are, and if I do not know there is a good chance that the wider public and many people working in the NHS have no idea. The Government need to answer these questions.

There is a further specific question the Department needs to answer, and it goes to the heart of the issues under discussion. I am sure I heard the Secretary of State say yesterday that the secondary approval function that SHAs are meant to carry out will come back to the Department of Health following the Government’s current reorganisation of the NHS.

[Mr Jeremy Hunt]

indicated assent.

[Andy Burnham]

The Secretary of State is nodding from a sedentary position, so I assume that is correct. Surely, therefore, a concern arises that the SHA part of the process is no more than a rubber-stamping exercise. The Department will be entirely remote from the local situation on the ground relating to the individuals involved and the clinicians and institutions making the judgments. If this process is taken up to the national level, will that not give rise to more concerns that mistakes might be made in the future, because of the distance between the process of approval and the individual cases on the ground? Has the Secretary of State had discussions with mental health organisations about whether they believe those arrangements are acceptable? I must say that I have serious concerns about them.

--- Later in debate ---

[The Secretary of State for Health (Mr Jeremy Hunt)]

I start by apologising to any Members who had hoped to intervene on me at the start of the debate, but I hope that I will now be able to give a fuller answer not just to any interventions, but to speeches made by right hon. and hon. Members. I thank the Opposition and the whole House for the very responsible attitude that they have taken towards this extremely sensitive and difficult issue. I intend to respond fully to all the points made by right hon. and hon. Members about the need to act so fast and retrospectively. Those are important issues that deserve the fullest attention.

It is important to record our appreciation at this stage for the invaluable help and advice that we received from partners outside the House, such as Mind, Rethink and the Royal College of Psychiatrists. Their primary concern is naturally those whom they represent so ably, but we are genuinely grateful for the mature and calm way in which they have responded. Everyone in the House has shared the same ultimate objective—to do what is best for the patients directly affected by a technical error.

Let me go through the points raised in the debate. I shall try to respond as fully as I can. With respect to the devolved Administrations, I have spoken to Health Ministers in Wales and Northern Ireland today, and I spoke to the Advocate-General for Scotland yesterday. They have been extremely supportive of the position that the Government and the whole House have taken, and they understand the need for speed. In Wales it is a sensitive matter because the Welsh Assembly is in recess, but I managed to speak to the Health Minister and go through the issues involved.

A number of Members asked about the extent to which we will be communicating with patients. We are working closely with the Royal College of Psychiatrists as to the best way to do this. That also extends to the families and carers of patients. Sir David Nicholson, the chief executive of the NHS, is writing to all strategic health authorities, stressing the need to communicate broadly across all mental health organisations, including patients and their families, and including, as has been mentioned, not just the patients who are directly affected, but potentially other patients who have been detained under the Mental Health Act, who may also have concerns. We have not been able to complete that communication exercise at this stage, because of the speed necessary to pass the Bill, but we will need to make sure that it proceeds as a matter of urgency.

[Andy Burnham]

We welcome the exercise being carried out by the NHS chief executive, but it is not the same as a personal communication to the individuals directly affected, so will the Secretary of State address the specific point of whether or not they will receive explanatory information from him or the Department?

[Mr Hunt]

Yes. What Sir David Nicholson is doing is ensuring that all SHAs have a proper communication process in place, but we want to follow clinical advice on the appropriateness of individual communications with individual patients. Where we are advised that is clinically sensible, we must ensure that it happens, but we want to listen to the advice carefully because of the vulnerability of some of the patients involved. The right hon. Gentleman makes an extremely important point. We must do this properly but, as I know he will agree, we must proceed with extreme care and caution.

I will start with some of the issues that the right hon. Gentleman raised, particularly the role of the review being conducted by Dr Geoff Harris. He is absolutely right that it needs to be done speedily because of the changes being introduced by the Health and Social Care Act 2012. I want to reassure him that Dr Harris’s review will not be simply a retrospective review; he will not just be asking, “Why did this happen?” He will also be stepping back and asking, “Where might this happen again and are our governance procedures sufficient to ensure that it does not?” In particular, he will look at the new structures that will be put in place over the next few months to give us good and independent advice on whether we have the safeguards in place to prevent this from happening again. That is an important point.

With regard to how many people are affected, the figure is up to 5,000. We think that the number includes all the patients at Rampton and 57 patients at Ashworth, but we are still verifying the exact numbers. I will keep the right hon. Gentleman informed as more information becomes available.

The right hon. Gentleman’s other point was about the new arrangements that are being put in place. He wondered, legitimately, whether, as the powers are returning to the Department of Health following the abolition of the SHAs—he was correct to pick that up from my comments yesterday—there is a danger that the process could be more remote for local areas. We will keep him informed of our plans in that regard, but we do not intend to have a single national panel doing this. We intend to have a structure that draws on local and regional expertise to help us to make the right decision on the suitability of doctors for the role. That is also something we hope Dr Harris will advise us on when he conducts his review.

I will move on to some of the comments made by the right hon. Member for Oxford East (Mr Smith). Independent oversight is also something we will ask Dr Harris to look at. He is independent and he is looking at it. We will also ask him to look at the general issue of independent oversight and whether it has been missing in the structures we have had to date and, therefore, whether it contributed to the concerns that we are now addressing.

The right hon. Gentleman and the hon. Member for Wolverhampton North East (Emma Reynolds) raised another issue: the wording we have been using, the fact that we believe there are good arguments for saying that the detentions that happened as a result of approvals made by the doctors in the four SHAs were and are legal and, therefore, why we feel the need for emergency retrospective legislation. It is a reasonable question. The answer is that we believe that there is legal precedent for why, in so sensitive a situation, a court, in deciding whether a detention was lawful or unlawful, would consider what the will of Parliament was when it passed the original law. Therefore, we believe that we have a good argument for why a court should rule that these detentions were and are lawful.

However, because of the technical irregularity in the process of approving some of the doctors who made the decisions in the four SHAs, that argument could be challenged. That is also an important part of the advice we have received. It is because it is so important to put the decisions beyond doubt, with respect to this narrow and technical issue, that the Bill is so incredibly important. However—this might help to address some of the concerns raised during the Opposition winding-up speech—this piece of retrospective legislation refers only to that narrow and technical issue. If people question the grounds for their sectioning under the Mental Health Act on clinical grounds and claim that the wrong clinical judgment had been reached, for example, or if they do not agree with what the panels have said, the Bill will not affect their right to challenge the decision and, if the court upholds the challenge, to get compensation if they have been detained. The Bill relates only to the very narrow issue of the technicality.

[Mr Andrew Smith]

I am grateful to the Secretary of State for giving way and for his response to one of my earlier points. As he is adopting a belt-and-braces approach to this—a sort of “We think it was lawful, but let’s make absolutely sure” approach—would it not also be wise to arrange, if not in the Bill then as an executive action, for the doctors in question to be re-approved by the correct process?

[Mr Hunt]

The right hon. Gentleman makes an extremely important point. I am pleased to reassure him that that has happened. That was one of the first things that happened, and it was completed yesterday, so all the doctors who are currently making these approvals in the four SHAs were approved using the correct process. We are confident that the problem will not arise in future, but we still have the issue of the decisions they took when the technical process had not been followed.

We have taken a number of actions to deliver parity of esteem for mental health services. I wholeheartedly agree with the concerns that have been raised about mental health issues having been for too long the poor relative in a number of areas. The right hon. Member for Leigh (Andy Burnham) will know that in July we published the implementation framework for our mental health strategy, “No health without mental health”. We have legislated, with his party’s support, for parity of esteem. The operating framework for the NHS expands access to psychological therapies, which is one of the key things we can do. The number of people accessing psychological therapies has increased to 528,000 people this year, which is more than double the figure for last year, and the amount of money going into it has increased from £364 million to £386 million. Those therapies have a very good success rate of about 45%, and we think that we can get it up to 50%. I want to reassure right hon. and hon. Members that we note the general view of the House that more emphasis needs to be put on mental health services.

[Andy Burnham]

But overall there has been a significant real-terms reduction in spending on mental health, as the figures given by the right hon. Gentleman’s colleague in the House of Lords a few weeks ago indicate, which suggests that the NHS is making disproportionately more redundancies in the field of mental health than in other areas and that it is reverting to that default position. Therefore, although I appreciate the Secretary of State’s words at the Dispatch Box today, the reality on the ground suggests that, as ever, mental health is bearing the brunt of some of the reductions and redundancies taking place and that the capacity of people to deal with these kinds of issues will perhaps be reduced. What will he say about safeguarding against that?

[Mr Hunt]

The right hon. Gentleman makes an important point. I believe that in actual terms the spending on mental health has increased slightly, but when we take inflation into account it might have gone down slightly in real terms. I do not think that it is a significant drop, but overall, as he knows, the NHS budget has been protected. I would be extremely disappointed if, as we go through a process of finding important efficiency savings in order to meet the increased demand on the NHS, the picture that he paints were to be the case, but I will be watching the situation very carefully. I will expect him to hold me to account for my commitment to ensuring that mental health services are properly addressed.

Crucially, it is not just about what we say but about what we deliver, particularly as regards the progress that we make towards improving access to mental health services, which were never included in the waiting times targets that were introduced by the previous Government. There are obviously financial implications in doing that, but we are working on it. Parity of esteem needs to include access to mental health services and not just the availability of those services.

[Mr Andrew Smith]

Does not parity of esteem also, crucially, need to apply to research funding—a point that was made earlier during the urgent question on Winterbourne?

[Mr Hunt]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. We are again going very wide of the Bill and the points that are supposed to be made in relation to it. The right hon. Gentleman’s question does touch on that, but I would be grateful if the Secretary of State, in responding, returns to the Bill by focusing on the items that we will be voting on today.

[Mr Hunt]

The answer to the right hon. Gentleman is yes. I will now return to the specific questions asked about the Bill.

The hon. Member for Southport (John Pugh) talked about the important issue of discrimination—that is, whether we are behaving differently because these patients have a mental illness. Removing discrimination does not mean treating everyone exactly the same. In fact, we will remove discrimination in the mental health field by better understanding the vulnerabilities and needs of people who have serious mental health problems, and that might mean treating them differently to account for that. The hon. Gentleman is absolutely right to say, as was the hon. Member for Hackney North and Stoke Newington (Ms Abbott), that important human rights issues need to be considered. I want to reassure him that, even in the four SHAs where the technical irregularity in the approval of doctors arose, the criteria were as rigorous as those used to make the clinical assessment that it was necessary to detain someone under the Mental Health Act. The same quality of expert advice was drawn on in order to make those decisions.

The right hon. Member for Oxford East asked why we are not limiting the legislation to the four SHAs where we have identified this technical irregularity. That is because we do not know at this stage whether the problem may have predated the establishment of SHAs—we should remember that these powers go back to the Mental Health Act 1983—and therefore, to make sure that we deal with the problem in its entirety, it is better to include the whole country in the legislation lest we find at a later date that the problem had existed in other parts of the country, perhaps prior to the foundation of SHAs.

On human rights, I have signed a piece of paper saying that I believe that the Bill is compliant with the European convention on human rights. I did that on the advice of Government lawyers and of the Attorney-General. The Attorney-General believes that, were a case to be brought now, people would be entitled only to nominal compensation because this is a technical, not a substantive, irregularity, and it is therefore not, on this occasion, a breach of people’s human rights to pass a law retrospectively.

The hon. Member for Arfon (Hywel Williams) asked why this has taken so long—why, for example, the Mental Health Commission did not identify the problem in its years of existence. That is a very important question. I cannot pretend that I have the answer now, but I want Dr Harris to look into that issue in enormous detail because I want to know whether there is a risk that other errors, similar or related, might exist in other parts of the system. The House needs to understand much better whether we should be concerned about that and whether the right governance procedures are in place.

The hon. Gentleman mentioned advocacy. As he will know, all patients have a right to an independent mental health advocate, but that process has not always worked as well as it should. I want to use the opportunity of the transfer of those responsibilities from primary care trusts to local authorities to make sure that we have proper procedures in place so that people really do get the advocacy support that they need.

Let me confirm to the hon. Gentleman—we received this piece of information as my hon. Friend the Minister was speaking—that someone approved in one SHA is able to practise in other SHAs. That is partly why the legislation needs to be UK-wide. We have had a lot of discussions about this with doctors’ representatives, particularly the Royal College of Psychiatrists. I do not believe that there are any implications for the second doctor or the social worker, but if I receive advice to the contrary I will write to him to let him know.

I think that I have covered most of the points raised by the hon. Member for Wolverhampton North East. She asked what is going to happen when the SHAs are abolished. We will be asking Dr Harris to address that when he carries out his independent review.

Finally, I turn to the hon. Member for Hackney North and Stoke Newington and her important comments about the seriousness with which we must treat any retrospective legislation. She referred to what Hayek said about that, with which I wholeheartedly agree. I did not think that we would be agreeing across the Dispatch Box about Hayek, but there it is. She made the important point that due process is about respecting technicalities, so we cannot brush it aside. That is why this legislation is necessary. A failure of due process—a failure to observe technicalities—puts us in an extremely difficult situation where ordinarily we would want to say that due process should be observed in all circumstances and that we should not pass retrospective legislation on that. In this particular case, however, it would have been against the clinical interests of 5,000 highly vulnerable people were we simply to consider that single legal perspective; the broader clinical perspective needs to be recognised.

The advice that I received from Professor Sir Bruce Keogh, the medical director of the NHS, was very important in persuading me that we needed to take the route of emergency retrospective legislation. He said that the alternative, which was to go through all 5,000 people and redo the entire sectioning process now that all the doctors have been properly validated, presented serious clinical risks to those individuals. It is a very difficult matter. As the hon. Lady and I are trading political thinkers, perhaps I could refer her to Isaiah Berlin and say that sometimes important moral principles are not totally consistent with each other. This is one of those occasions, and we have to weigh her very important points about the need to avoid retrospective legislation, even on technicalities, against the clinical interests of a highly vulnerable group of people.

[Dan Byles]

In a previous life, I sat on the board of a Mental Health Act scrutiny committee in a west midlands mental health trust. Does my right hon. Friend agree that this retrospective change does not in any way undermine the fact that every single one of the patients he has mentioned has been through a very robust system of checks and balances throughout the sectioning process in order to be sectioned, and then while they are sectioned, and has access to a very robust appeals mechanism that the Bill in no way undermines?

[Mr Hunt]

My hon. Friend is absolutely right. The key point is that those patients are free to challenge any element of the clinical decisions made as part of that very thorough process. This proposed law is about the technical irregularity only, and it is precisely because of the legal risks associated with that irregularity that we think it is necessary, in the interests of those 5,000 people, to enact this Bill.

[John Pugh]

I totally accept the point that the clinical need trumps the patient’s right to due process, but if the clinical need is questioned by the patient themselves it becomes more arguable, does it not?

[Mr Hunt]

If the patient wishes to challenge their clinical assessment, they are free to do so and the Bill will not affect that in any way. It is important that that point is understood. In fact, the Bill is very narrowly defined for that precise reason, and I think that is why the Attorney-General felt comfortable saying that it complied with the ECHR.

In conclusion, we have had a constructive debate on this very important and sensitive issue, but there are broader lessons to be learned about the importance, more generally, of mental health issues, and I and my colleagues in the ministerial team will take those very seriously as we progress. I am grateful to all hon. and right hon. Members present for their contributions to this debate.

Question put and agreed to.

Bill accordingly read a Second time; to stand committed to a Committee of the whole House (Order, this day).

Mental Health (Approval Functions) Bill

Jeremy Hunt Excerpts

Tuesday 30th October 2012 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

Perhaps I can assist in this matter. I do not believe that there is a drafting error, but the hon. Lady is absolutely right to scrutinise every word of the Bill carefully and ask questions.

Clause 1 does not mention “any doctor” because it is about the power for an SHA to delegate the authority in question, not about a doctor’s decision or clinical ability. It refers to the person who approves that power of delegation. I hope that that clarifies the matter.

[Ms Abbott]

We have listened to what the Secretary of State and the Minister have said. We remain concerned about the broad nature of the clause, but we rest our case.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clause 2 ordered to stand part of the Bill.

The Deputy Speaker resumed the Chair.

Bill reported, without amendment.

Third Reading

[Mr Jeremy Hunt]

I beg to move that the Bill be now read the Third time.

This has been a distinctly unusual process for the House, and one that is unprecedented for recent Members. Only after hard—if very rapid—consideration over the weekend did I decide that emergency legislation was the only safe course, and recommend that to the Prime Minister.

Retrospective legislation affecting an individual’s right to liberty is a major step, and it would be intolerable to have any doubt about such an important part of the law. Such a situation would be unacceptable for patients, their families, and doctors and nursing staff in NHS and independent hospitals. I have been insistent throughout that the clinical needs of patients should take priority within the law, and that legislation should be as tight as possible to ensure that patients’ legal rights are protected.

I thank Opposition Members for the way they have responded and for making it possible to legislate in such short order. I also thank hon. Members generally for their constructive challenge and scrutiny. Although there is need for urgency, it is essential that the Bill is properly tested, which hon. Members have done.

The House has acted wisely and swiftly in the interests of up to 5,000 highly vulnerable people. It has recognised the important human rights issues involved, and balanced that with clinical advice about the best interests of those people. I commend the Bill to the House.

Mental Health Act 1983

Jeremy Hunt Excerpts

Monday 29th October 2012 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With permission, Mr Speaker, I wish to make a statement about an issue relating to the Mental Health Act 1983.

It has become apparent that there are some irregularities around the way in which doctors have been approved for the purpose of assessing patients for detention under the Act. For assessments and decisions under certain sections of the Act, including detention decisions under sections 2 and 3, three professionals are required to be involved—two doctors and an approved mental health professional. The latter will usually be a social worker.

In 2002, when strategic health authorities came into being, the then Secretary of State properly and lawfully delegated his function of approving doctors under the Act to them. However, it came to light last week that in four of the 10 SHAs—North East, Yorkshire and Humber, West Midlands and East Midlands—between 2002 and the present day the authorisation of doctors’ approval appears to have been further delegated to NHS mental health trusts.

I was made aware of the issue and kept up to date with the actions being taken last week. Our latest best estimate is that approximately 2,000 doctors were not properly approved, and that they have participated in the detention of between 4,000 and 5,000 current patients within institutions in both the NHS and independent sectors. Rampton high-secure hospital is in one of the affected areas, and some patients at Ashworth high-secure hospital are also included.

There is no suggestion that the hospitalisation or detention of any patient has been clinically inappropriate; that the doctors so approved are anything other than properly qualified to make such recommendations; or that these doctors might have made incorrect diagnoses or decisions about the treatment that patients needed. All the proper clinical processes were gone through when these patients were detained. We believe that no one is in hospital who should not be and that no patients have suffered because of this. The doctors would have had no reason to think that they had not been properly approved. They acted in good faith and in the interest of their patients throughout this period.

In the light of our legal advice, we do not believe that any decisions made about patients’ care and detention require review because of this irregularity. Doctors should continue treating patients currently detained under the MHA in the usual way. We have received advice from the First Treasury Counsel that there are good arguments that the detentions involving these particular approval processes were and are lawful, but the counsel also argues the need for absolute legal clarity. The legal advice is that this should be resolved through emergency retrospective legislation.

As soon as the irregularity was identified, my Department worked swiftly to identify the best course of action and to put the necessary preparatory work in place. It first became aware of the problem last week. Officials immediately sought initial legal and clinical advice. We then swiftly analysed possible options, including the option of reassessing all potentially affected patients, working with the health leads in the regions affected and clinical experts from the Royal College of Psychiatrists.

When I was briefed on the situation, I asked for detailed information on the time it would take and the clinical risks involved in reassessing all potentially affected patients. On Friday, I asked for an emergency Bill to be drafted over the weekend, as a matter of contingency. I also briefed the Prime Minister personally the next day. Following further discussions and analysis over the weekend, the decision to introduce emergency legislation was taken yesterday, and we have since worked to prepare the necessary materials.

At all times, my priority has been to resolve the situation in a way that follows clinical advice about the most sensitive way to deal with a highly vulnerable group of individuals. We have also worked to remedy the problem as it relates to current and future detentions. As of today, all the doctors involved have been properly approved. The accountable officers for the four SHAs in question have written to Sir David Nicholson, chief executive of the NHS, to confirm they have made the necessary changes to their governance arrangements. Furthermore, the accountable officers in the remaining six SHAs have written to Sir David to confirm that they have, in the light of this issue, reviewed their own arrangements and that they are in full compliance with the Act.

Although we believe there are good arguments that past detentions under the Mental Health Act were and are lawful, it is important that doctors, other mental health professionals and, most importantly, patients and their families have absolute confidence in the decisions made. That is why, in relation to past detentions, we have decided that the irregularity should be corrected by retrospective legislation. Although we are aware of the problem in only the four areas going back to 2002, the proposed legislation will apply in principle to the approval of all doctors under the Mental Health Act since its introduction in 1983. The proposed legislation will retrospectively validate the approval of clinicians by those organisations to which responsibility was delegated, up to the point when all the relevant doctors were fully re-approved and their status put beyond doubt. The legislation will not deprive people of their normal rights to seek redress if they have been detained for any reason other than the narrow issue of the delegation of authority by the strategic health authorities, nor will it affect any future detentions or legitimise any similar failures in future. We are proposing to introduce the draft legislation to this House and, through best endeavours, looking for it to complete its passage through all the appropriate stages in this House and the other place as soon as is practicable.

While addressing the technical issue, it is also important that we get to the bottom of how this happened and that we learn any lessons to help inform the operation of the new system architecture from April 2013. As such, I have asked Dr Geoffrey Harris, chair of NHS South and former chair of Buckinghamshire mental health trust, to undertake an independent review to look at how the responsibility was delegated by the four SHAs and, more broadly, the governance and assurance processes that all SHAs use for delegating any responsibilities. I will also ask him to look at this issue in the context of the new NHS structures that come into force from next April and to see whether any lessons need to be learned. It is imperative that the review is swift, and I have asked Dr Harris to report to me by the end of the year with recommendations to ensure that every part of the system employs the highest standards of assurance and oversight in the delegation of any functions.

I stress to the House that I have reviewed with lawyers, clinicians and NHS managers possible alternatives to introducing this retrospective legislation. I have been advised that all alternatives would be highly disruptive to many of the most vulnerable patients and would deprive many other patients of the care they need while any action is undertaken. However, all the advice I have received has been unequivocal in stressing the need for absolute clarity of the legal status of any hospitalisation or detention of patients, in the interests of those patients, their families, those caring for them and the wider public. That is why, in such exceptional circumstances, this retrospective legislation is being proposed. Both a Bill and the accompanying explanatory notes will be published this afternoon. I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement and for notice of it. Detaining people under the Mental Health Act raises the most serious issues of fundamental rights and of patient and public safety. Any reported failure will therefore always be a matter of the highest concern. I know this House will want to get to the bottom of the unacceptable breaches of procedure that we have just heard about. However, I am sure I speak for both sides in saying that the House will have been reassured by the Secretary of State today on three crucial points: first, that no patient has been wrongly detained, received care that was not clinically appropriate or will see their legal rights restricted by the legislation; secondly, that no doctor was unqualified to make decisions; and, thirdly, that urgent action is being taken to correct the situation and bring the clarity that is so essential.

Let me now turn to the serious questions that need to be answered. Will the Secretary of State say more about the events that brought this issue to light last week? Was it discovered in one SHA first, and by what process did the Department establish that it extended to three more? When exactly was the Department made aware, when was the Secretary of State informed and what action has been taken to establish the full extent of the problem? Have extensive checks been undertaken in all 10 SHA areas, and is he absolutely confident that no more patients and families are affected than the 4,000 to 5,000 he has mentioned?

I want to press the Secretary of State for more information on the people affected. Will he say whether he has any plans for direct communication with the patients and families affected? Are the patients living not only in the four regions mentioned but in all parts of the country? How many are in high-secure hospitals, and how many could pose a risk to the public?

We understand and support the Secretary of State’s wish to remove any doubt about the legal status of the patients concerned, but that must be set against the undesirability of asking the House to legislate tomorrow on an issue that it has found out about only today. Over the next 24 hours, will he ensure that Members have access to the fullest possible information, including a summary of the legal advice he has received?

There will be concerns about precedent. This is the first time that the House has been presented with emergency legislation in this area that will affect people’s rights. The public will want to know that it is being used in exceptional circumstances as a last resort, and not as a convenient means of correcting administrative failures. Will the Secretary of State therefore explain precisely what alternatives to legislation were considered, and why it was decided that they were not acceptable in these circumstances?

Let me turn to the investigation. We support the review under Dr Harris that will try to get to the facts and ensure that lessons are properly learned. We do not want to prejudge it, but is the Secretary of State in a position to confirm today whether the review is already proceeding on the basis that this is a failure of policy implementation rather than a defect in the original legislation? That is important, as practitioners working in this field will not want any unnecessary question marks hanging over the Mental Health Act 1983.

We also need clarity about the future. This area is currently the responsibility of SHAs, which are due to be abolished next April. So, as well as establishing the historical facts, will the Secretary of State ask his review to consider whether the new arrangements for sections, following the Government’s reorganisation of the NHS, are sufficiently well understood? Will he also ask the review to advise on how any danger of further confusion arising from the process of transition can be prevented?

I commend the Secretary of State for the pragmatic approach he is taking to this difficult issue. His request of the House is exceptional, but failure to act could cause unnecessary distress and uncertainty to many thousands of vulnerable patients and their families, and present risks to public safety. We will press him for answers in the areas that I have outlined, but we believe that his action is justified. He will have our support in removing any uncertainty.

[Mr Hunt]

First, I thank the right hon. Gentleman for the co-operation that he has shown to me and my Department over the weekend. There are occasionally moments when issues of public safety and patient well-being transcend the normal political divides, and I greatly appreciate his co-operation on this matter.

Let me deal with the important questions that the right hon. Gentleman has asked. The issue arose when a challenge was made to the authorisation of one doctor in Yorkshire and Humberside and, in dealing with that challenge, the irregularity in the way in which all authorisations had happened became apparent. Following further investigation, we discovered that this had happened in four other SHAs. We found out about this early last week, and I was informed towards the end of last week. Immediate action was taken to ensure proper validation last week of all the doctors who are currently taking section 12 decisions under the Mental Health Act, and that was completed as of today.

We have done exhaustive checks on the other SHAs, which is part of the reason why we asked all the SHA bosses to write to Sir David Nicholson—which they have all done today—to confirm that their processes in this area are in order. We do not believe that this issue affects any patients other than the ones we have talked about, to date. However, because people move and are moved to different hospitals and places of detention, it might be happening in other parts of the country beyond the four SHAs in which the irregularities in authorisation happened.

The right hon. Gentleman will understand that it is not the practice for Governments to publish legal advice because we want to continue to be able to receive frank legal advice in the future. However, I am happy to answer any questions about the legal advice and, as he knows, I am happy for him to talk to my Department’s legal advisers to satisfy himself on the precise legal situation.

Let me move on to the really important point about the alternatives that we considered, as it is highly exceptional to bring in emergency legislation. The right hon. Gentleman will know that authorities are allowed to detain someone under the Mental Health Act for 72 hours while the correct processes are followed to section them. Although, as I mentioned, we believe we have good arguments to show why these detentions were lawful, we did not know what a court might have decided if the detentions were challenged. We could have faced literally having to redo the entire process for 4,000 to 5,000 patients within 72 hours. Given the high level of vulnerability of many of them, we could not find a means of doing that in an orderly way that protected their well-being. I received clear medical advice from the NHS medical director, Professor Sir Bruce Keogh that that would not be an appropriate course of action. We looked at the position carefully and because we were trying to explore other alternatives we did not come to the decision to introduce emergency legislation until this weekend.

I can confirm that we do not believe that this has highlighted a defect in the legislation. We are not seeking in the emergency draft Bill to change the Mental Health Act. This is purely retrospective legislation dealing with some specific procedures under that Act; it will have no impact as this goes forward.

The right hon. Gentleman is absolutely right that we must be sure to minimise the confusion as we move towards the new structures. Under them, the problem would have been resolved, with the power reverting from strategic health authorities to the Department of Health. I do not want to be complacent: if this problem happened in one area, we want to be sure that it cannot happen in others.

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the prompt action taken by my right hon. Friend and the support he has secured from Opposition Front Benchers for putting this sensitive matter on a secure legal footing. Is not the key point the fact that no patient has been sectioned and no doctor has been authorised who would not have been sectioned or authorised under the legislation? Is not the purpose of the emergency Bill, as always with retrospective legislation, simply to put the position as Parliament intended it to be in the first place?

[Mr Hunt]

My understanding is exactly the same as that of my right hon. Friend. The key point is that this was a technical irregularity, but we do not believe that any patient has been sectioned, detained or hospitalised who would not have been if the correct procedures had not been followed. It is none the less very serious that this technical breach happened; that is why, as well as correcting the technical breach and providing absolute clarity, we are conducting this review to make sure that we do everything we can to avoid anything similar happening again—even under completely different structures than the SHAs.

[Derek Twigg (Halton) (Lab)]

I do not necessarily disagree with anything the Secretary of State said, but I noted that he used the term “we believe”, which means that it is not simply factual at this point that no one has been detained who should not have been. It would be worth the Secretary of State addressing the reverse position: does he believe that no one who should have been detained has been released and then gone on to commit a serious offence?

[Mr Hunt]

As a result of the technical irregularities that we have identified and put right, I do not believe that what the hon. Gentleman describes has happened. Let me explain that when I say “we believe”, it reflects the advice we have had that there are good arguments on why the detentions were and are lawful, but that is not to say that those arguments cannot be challenged or that a court would necessarily agree with us. That is why it is necessary to take this unusual step of introducing emergency legislation.

[Mr Charles Walker (Broxbourne) (Con)]

Removing the liberty of ill people is serious business, and deserves to be taken seriously. That has not been the case for the past decade, or perhaps even longer. I hope that, as we go forward, we can ensure that people who are ill get the representation and advocacy they deserve and that they—and, most importantly, their rights—are taken seriously.

[Mr Hunt]

My hon. Friend is absolutely right. As a result of the new structures in the NHS, responsibility for ensuring that all patients who are threatened with detention receive the advocacy to which they are entitled under the Mental Health Act will be transferred from primary care trusts to local authorities. We will use this opportunity to review the arrangements, talk to local authorities, and do all that we can to ensure that those functions are discharged in the way my hon. Friend seeks.

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

Two mental health trusts that do a fantastic job in my constituency, Humber NHS Foundation Trust and Rotherham, Doncaster and South Humber NHS Foundation Trust, have been involved in this. Can the Secretary of State tell us how many patients have been affected by what has happened in trusts, so that if families approach us we can offer them the information that they require?

[Mr Hunt]

I shall try to give my hon. Friend that information later.

[John Howell (Henley) (Con)]

Does the Secretary of State agree that speed is of the essence in the provision of clarity, and will he accept our congratulations on having moved with such commendable speed?

[Mr Hunt]

I am grateful to my hon. Friend for saying that, but I think that we should extend our gratitude to the Opposition on this occasion. It is possible to move with speed only when there is cross-party co-operation, and I think that everyone has recognised the seriousness of the situation.

[John Pugh (Southport) (LD)]

Given the huge, overwhelming concentration on the subject of detention during the passage of the National Health Service Act 2006, which revised the Mental Health Act 1983, why was this departure from the law not brought to Members’ attention, or, indeed, to light? Someone in the Department of Health must be answerable, surely.

[Mr Hunt]

The truth is that no one in the Department of Health knew that this irregularity was happening. I do not think that anyone in the system knew that it was happening, until the issue arose in Yorkshire and Humberside when a particular decision was challenged. However, the hon. Gentleman is right: there is an important question mark over why it was possible for the irregularity to continue for so long without being noticed. I think that we need to listen to what Dr Harris says about why he believes that it was possible for it to continue for so long, and to act on his advice.

[Guy Opperman (Hexham) (Con)]

I declare an interest, as someone who represented a number of individuals under section 12 of the Mental Health Act—and also as someone who is owed money by the state for the work that he did on behalf of such individuals three and a half years ago, but I leave that to one side.

I welcome the drafting of retrospective legislation to resolve this problem, but has advice been obtained on whether the section 12 patients will retain any right to challenge their original detention procedures by way of judicial review?

[Mr Hunt]

My hon. Friend makes a very important point. All the patients’ rights to challenge their detention are preserved, with the exception of their rights relating to the technical irregularity over the authorisation of doctors under section 12. If they are challenging any other clinical or legal due-process decision, they are free to continue to do so: that will be completely unaffected by the retrospective legislation.

[Iain Stewart (Milton Keynes South) (Con)]

Can my right hon. Friend explain the position of trusts such as Milton Keynes PCT, which was part of South Central strategic health authority but is now part of East Midlands SHA? I understand that that is one of the SHAs that were affected. Will my right hon. Friend look into whether any issues have arisen from that transfer?

[Mr Hunt]

I can reassure my hon. Friend that if any issues have arisen from the technical irregularity involving the authorisation of doctors under section 12, they will be dealt by the retrospective legislation.

[Mr Robert Buckland (South Swindon) (Con)]

I welcome my right hon. Friend’s approach, which is responsible and right. May I urge him to ensure that the review being undertaken by Dr Harris will include the effect of the changes in NHS structures on all relevant provisions of the Mental Health Act—for example, the provision of information about bed availability to courts under section 39?

--- Later in debate ---

[Mr Hunt]

I shall certainly pass my hon. Friend’s question on to Dr Harris. It is not clear that the irregularity is a result of reorganisations, but I want to give Dr Harris a completely free hand. We shall then listen to what he says very carefully.

[Rehman Chishti (Gillingham and Rainham) (Con)]

rose—

[Rehman Chishti]

I am so sorry, Mr. Speaker.

I am very grateful to the Secretary of State for his statement. Despite the irregularity, sections 2 and 3 of the Mental Health Act give patients an automatic right to a tribunal hearing, and the tribunal will have been able to consider their applications for release.

[Mr Hunt]

That is correct. Nothing in the legislation will affect any rights that patients have, except with respect to the technical irregularity involving the authorisation of doctors under section 12.

South London Healthcare NHS Trust

Jeremy Hunt Excerpts

Monday 29th October 2012 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I wish to inform the House that the trust special administrator appointed to South London Healthcare NHS Trust in July by my predecessor is publishing a draft report today making recommendations to me in relation to securing a sustainable future for services provided by that organisation.

Details about the appointment of the administrator, Matthew Kershaw, were given in a written ministerial statement issued on 12 July 2012, Official Report, columns 47- 48WS.

In accordance with chapter 5A of the National Health Service Act 2006, as introduced by the Health Act 2009, the trust special administrator has provided me with a copy of the draft report, which has today also been laid before Parliament. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. The report will also be available at: www.tsa.nhs.uk.

I will consider the detail of the draft report but do not anticipate commenting on its recommendations at this stage. It is for the trust special administrator to now consult locally on his draft recommendations. That consultation will run from 2 November to 13 December. Significantly, it will give the public, patients, NHS staff and NHS commissioners, as well as all other key stakeholders, the opportunity to have their say about the future of services currently provided by South London Healthcare NHS Trust and the wider south-east London health economy.

Following consultation, the trust special administrator must make final recommendations to me as to the action I should take in relation to the trust in a final report by 7 January 2013. I expect those recommendations to consider the views of all persons and organisations taking part in the consultation. It will be for me, as Secretary of State, to make a final decision about whether or not to accept the administrator’s recommendations by 1 February 2013, after having also considered the responses to the administrator’s consultation. I will publish my final decision and the reasons for it, and lay a notice of such, in Parliament.

A key objective of the Government is to ensure that all NHS organisations deliver high-quality services to patients that are clinically and financially sustainable for the long term. The provisions in chapter 5A of the National Health Service Act 2006, referred to as the regime for unsustainable NHS providers, give the Government a mechanism to address fundamental, systemic issues that have rendered an NHS trust such as South London Healthcare NHS Trust unsustainable.

Past efforts did not succeed in putting South London Healthcare NHS Trust on a sustainable path. Using the regime is about protecting services for patients in the context of an organisation that is no longer sustainable and to ensure that a prolonged, challenging situation can be resolved speedily to give certainty to NHS staff. Despite some recent improvements in clinical performance, there are significant concerns about sustaining them because of the trust’s very considerable financial challenges. As the House has previously been informed, in 2011-12, South London Healthcare NHS Trust incurred the largest financial deficit of any of the 248 NHS provider organisations in England, at over £65 million. The trust is losing well over £1 million of taxpayers’ money a week, which means that vital resources are being diverted from other parts of the NHS. I am clear that patients and NHS staff of the trust must be given the benefit of services, in future, that can be delivered on a sustainable footing.

In making my final decision, next year, on the future of South London Healthcare NHS Trust and the services it provides, my objective will be to ensure that services are delivered more efficiently and to a high standard for the people of south-east London. Patients and taxpayers deserve this.



I fully understand that use of the regime may be unsettling for NHS staff and local residents. However, no decisions have been made at this stage and everyone affected should rest assured that the Government are seeking to bring about further improvements in quality of care as well as dealing with the financial challenges of South London Healthcare NHS Trust through a stable and sustainable solution that will benefit everyone.

Dementia Funding

Jeremy Hunt Excerpts

Thursday 25th October 2012 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am announcing a £50 million capital funding in 2013-14 for the NHS and local authorities to work with providers to create care environments to help people with dementia live well with the condition.

Dementia is one of the biggest challenges we face as a society as our population ages and we are determined to transform the quality of dementia care for patients and their families. In March, the Prime Minister launched his challenge on dementia, which sets out the Government’s ambition to increase diagnosis rates, raise awareness and understanding and to double funding for research by 2015.

Research by the King’s Fund demonstrates that good design can help with the management of dementia. People with dementia are less likely to get confused or become distressed within an environment designed with their needs in mind. Examples include an intelligent use of colour to mark out different areas to aid memory, clearer signage and the opportunity to take part in activities such as gardening.

Local authorities working in partnership with social care providers and the NHS will have the opportunity to bid for a share of £50 million capital funding to invest in 2013-14 in improved care environments to help people with dementia and their carers manage their condition better. The funding is aimed at expanding the range of health and care services offering dedicated dementia friendly environments—and to stimulate further use of supportive environments to help the growing number of people with dementia get the best possible care.

Projects that are successful in securing funds will form part of a national pilot to disseminate best practice and evidence across the NHS and social care system of the best examples of “dementia friendly environments”. The findings and evidence will be used to develop future guidance in this area, assisting organisations that provide services to people with dementia as well as commissioners of services and local health and wellbeing boards to become one of the best in Europe.

The criteria for applying for funding and the deadline for receipt of applications will be announced shortly. The successful projects will begin from April 2013 and will be subject to national evaluation.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Peter Bone (Wellingborough) (Con)]

1. What his latest estimate is of the likely cost of the NHS in 2012-13.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The latest estimates of NHS spending are those published in the 2012 Budget. The planned NHS spending for 2012-13 is £108.8 billion.

[Mr Bone]

The Conservative-led coalition Government are increasing spending on the NHS, unlike what Labour would do. In my constituency, we will get an urgent care centre in a few months as a result of Tory health reforms. People in Corby already have an urgent care centre as a result of Tory reforms. Does the Secretary of State agree that, while Labour talks about the NHS, Conservatives deliver on the NHS?

[Mr Hunt]

I absolutely agree with my hon. Friend. Indeed, last week we announced that waiting times are at near-record lows. The number of hospital-acquired infections continues to go down and mixed-sex wards have been virtually eliminated. I am very pleased that my hon. Friend has an urgent care centre, and am sure that Mrs Bone will appreciate it even more than he does.

[Grahame M. Morris (Easington) (Lab)]

Does the Secretary of State recognise that the Office for National Statistics survey shows that the mortality rate in north-east England is 12% higher than that in the rest of the UK? Does he recognise the need to invest in more advanced radiotherapy equipment, bearing in mind that 70 of the 212 systems will need to be replaced by 2015?

[Mr Hunt]

I would not necessarily expect the hon. Gentleman to follow announcements that are made at the Conservative party conference, but we did make the big announcement that access to radiotherapy will be transformed, making it available to everyone for whom it is clinically necessary and cost-effective. Improving mortality rates is extremely important. As I have set out, one of my key priorities is to transform the NHS so that we have the best mortality rates in Europe. I hope that that is welcome news for his constituents.

[Charlie Elphicke (Dover) (Con)]

Does my right hon. Friend agree that there will be less budget pressure on the NHS if we do better with long-term conditions, get better at integrated care and use data better to predict ill health? To that end, will he come and see the work of the Kent Health Commission on those issues?

[Mr Hunt]

I would be delighted to see the innovative things that are happening at the Kent Health Commission. Looking at how we deal with people with long-term conditions—that is 30% of the population, and the proportion is growing with the ageing population—will be a vital priority for the NHS over the coming years.

[Andy Burnham (Leigh) (Lab)]

May I welcome the Secretary of State and his new team to their positions? As the only other person to have made the jump from Culture to Health, I am sure that he will find me a constant source of useful advice.

The Secretary of State has not said much since his appointment, but he did set out his mission in The Spectator:

“I would like to be the person who safeguards Andrew Lansley’s legacy”.

Let us talk about that legacy. Just last week, the Secretary of State slipped out figures on the latest costs of NHS reorganisation. Would he care to update the House on the current estimates?

[Mr Hunt]

Let me tell the right hon. Gentleman that Andrew Lansley’s legacy is—

[Mr Speaker]

Order. The Secretary of State has been in the House for seven and a half years. I think he knows that we refer to Members by constituency, not by Christian name. It is not difficult.

[Mr Hunt]

First, may I say how delighted I am that the right hon. Gentleman and I once again have the same brief? I look forward to having a constructive relationship with him, not with total optimism, but I will try my best.

The right hon. Gentleman talked about my predecessor’s reforms and legacy. One of the finest things about my predecessor’s legacy is that he safeguarded the NHS budget—indeed, he increased it during this Parliament by £12 billion—when the right hon. Gentleman said that it would be irresponsible to increase it.

[Andy Burnham]

Look at the figures: the previous Secretary of State gave the budget a real-terms cut for two years running. Let me give the exact figures, which the Secretary of State did not give the House. The costs of the reorganisation are up by 33% or £400 million, making the total £1.6 billion and rising. And what is that money being spent on? A full £1 billion is being spent on redundancy packages for managers: 1,300 have got six-figure pay-offs and there are 173 pay-offs of more than £200,000. Scandalously, that news comes as we learn today that the number of nurse redundancies has risen to more than 6,100. Six-figure pay-outs for managers, P45s for nurses and the NHS in chaos—is that the legacy that the Secretary of State is so proud of?

[Mr Hunt]

Let us look at some of the facts. The number of clinical staff in the NHS has gone up since the coalition came to power. The right hon. Gentleman talked about the cost of the reforms, which is about £1.6 billion. Thanks to those reforms, we will save £1.5 billion every single year from 2014 and the total savings in this Parliament will be £5.5 billion. Let me remind him that he left the NHS with £73 billion of private finance initiative debt, which costs the NHS £1.6 billion every single year. That money cannot be spent on patient care. He should be ashamed of that.

[Mr Philip Hollobone (Kettering) (Con)]

Will the Secretary of State confirm that NHS spending will increase in real terms during the lifetime of this Government, and that there are no plans from anyone to close the accident and emergency department and the maternity unit at Kettering general hospital? Will he condemn those who say that the Government want to close the hospital, when nobody is going to do that at all?

[Mr Hunt]

My hon. Friend is absolutely right: that is a mendacious scare story that is being put out on the ground. Real-terms spending on the NHS has increased across the country, which has not been possible across all Government Departments. Because of that, we are able to invest more in patient care, cancer drugs, doctors and facilities across the country, and indeed in Kettering.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

2. How many patients waited longer than half an hour in an ambulance to be transferred to accident and emergency in each year since 2009-10.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The Department’s records date back to 2010-11. The number of ambulance handovers delayed by longer than half an hour was 63,892 between 1 November 2010 and 24 February 2011 and 77,543 between 1 November 2011 and l March 2012.

[Tom Blenkinsop]

On 27 September, patients and paramedics were left waiting outside James Cook university hospital in Middlesbrough for two and a half hours before being handed over. Dr Clifford of the college of emergency medicine described such delays as being due to an unacceptable mismatch in demand and supply. Does the Secretary of State agree with Dr Clifford, and what steps will he take to ensure that those problems do not recur for my constituents?

[Mr Hunt]

I am extremely concerned about what happened on 27 September. I can confirm to the hon. Gentleman that all the red 1 calls on that day were met within the target time of eight minutes, but the delays were completely unacceptable. I know that the trust is taking measures to ensure that the problems are not repeated, particularly looking forward to the winter time when there is likely to be extra pressure on ambulance services. I will follow the matter very closely, and I expect the trust to come up with measures to ensure that his constituents are properly safeguarded.

[Andrew Bridgen (North West Leicestershire) (Con)]

In the summer, I spent an interesting and thought-provoking day observing the work of a crew of the East Midlands ambulance service. Can my right hon. Friend confirm that ambulance trusts across the country, including the East Midlands ambulance service, are performing well in meeting their response time targets?

[Mr Hunt]

I can absolutely confirm that. In fact, I was extremely pleased to see last week that all the standards are being met for both eight-minute category A calls— red 1 and red 2 calls—and 19-minute calls. That is as it should be, but it is no grounds for complacency. Although that is a country-wide picture, there are parts of the country where those standards are not being met in the way that we would like. We will continue to monitor the situation closely.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I will be charitable to the Secretary of State, but he brushed over the figures in his answer to my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop). I have got the actual figures through a freedom of information request. They show that under this Government, 100,000 additional patients are being left waiting in ambulances outside accident and emergency departments for more than half an hour when they need urgent treatment—a totally unacceptable situation. What more evidence does the Secretary of State need of the chaos engulfing the national health service under his Government? It shows that the focus has slipped off patient care and that our accident and emergency units are struggling to cope.

[Mr Hunt]

The hon. Gentleman speaks as though the problem of ambulance waits never happened for 13 years under Labour, but he knows that we actually had some appalling problems, with ambulances circling hospitals because hospitals did not want to breach their four-hour A and E wait targets. We are tackling the problem, and as I mentioned, if he looks at the figures published last week he will see that we are meeting the standards for ambulance waits that his party’s Government put in place. However, we are not complacent, and we are monitoring the figures closely. Particularly with the winter coming up, we want to ensure that the ambulance service performs exactly as the British public would want.

[Mr James Gray (North Wiltshire) (Con)]

Many ambulance trusts are indeed doing extremely well, as the Secretary of State indicated. Does he agree that that is at least partly due to localism in the ambulance service, which may be undermined if, for example, the Great Western ambulance service becomes an amalgamated regional service? Now it has been announced that the call centre in Devizes will be closed in favour of one in Bristol. Does he agree that there is at least a risk that the local service for people in Wiltshire will be reduced if such regionalisation is allowed?

[Mr Hunt]

I agree with my hon. Friend that the purpose of the changes that the coalition Government have brought to the NHS is to tap into local innovation, ideas and ambitions to transform services, and it is important that no changes undermine that. He should take comfort from the fact that my predecessor introduced clear tests for any major reconfigurations, including that they should be strongly supported by local doctors, that the public should be involved in any consultation, that the changes should improve patient choice and that there should be clear evidence of benefits to patients. I hope that that gives him and his constituents some reassurance.

[Mrs Mary Glindon (North Tyneside) (Lab)]

3. What his policy is on upholding national pay arrangements in the NHS.

--- Later in debate ---

[Christopher Pincher (Tamworth) (Con)]

5. What steps the Government are taking to help people cope with conditions such as diabetes and asthma.

[The Secretary of State for Health (Mr Jeremy Hunt)]

We are working on an outcomes strategy for long-term conditions such as diabetes and asthma structured around six shared goals, early diagnosis, integrated care, promoting independence, and steps to support those with long-term conditions to live as well as possible.

[Christopher Pincher]

Given that type 1 diabetes in under-fives is growing at 5% each year, what can my right hon. Friend do with the innovative Secretary of State for Education to ensure that nursery and primary school staff have the right skills and knowledge to ensure that they can help young children to cope with type 1?

[Mr Hunt]

The answer is that we are doing quite a lot—a good booklet, “Managing Medicines in Schools and Early Years Settings”, goes around schools, and there are other resources for schools—but we need to do more. We will be announcing a diabetes action plan, a long-term conditions outcomes strategy and a cardiovascular disease outcomes strategy, which will go further to address the issues that my hon. Friend raises.

[Keith Vaz (Leicester East) (Lab)]

I declare my interest as someone who has type 2 diabetes and welcome what the Secretary of State says. However, according to the latest report, another 700,000 people will contract the disease by 2020, and 80% of amputations are avoidable. Could he ensure that this very important subject is on the agenda of local clinical commissioning groups?

[Mr Hunt]

I certainly can. The number of diabetes sufferers overall will go up from about 3.7 million, which is already 5% of the population, to 4.4 million. We need to do a lot better in how we look after people with long-term conditions if the NHS is to be sustainable. We can also do a lot to transfer the individual care of people who have diabetes through things such as technology, which I will look into carefully.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my right hon. Friend agree that the effective delivery of care to people with long-term conditions relies on breaking down the silos within the health service, and between the health service, social care and social housing? Will he encourage the new health and wellbeing boards to follow through that agenda with a serious purpose?

[Mr Hunt]

My right hon. Friend is absolutely right. By 2018, nearly 3 million people will have not one but three long-term conditions. All too often, the system treats them on a disease or condition basis, and not as a human being who needs an integrated care plan. That is the route to lower costs, but it is also the route to transformed care.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Public Accounts Committee has heard that, of 20 trusts that needed to improve their diabetes care, only three took the accepted help. How will the Secretary of State ensure that care through health providers meets the grand targets he has set for himself?

[Mr Hunt]

The hon. Lady is absolutely right to point out that the consistency of provision is not good, but we will be publishing a diabetes action plan that will try to ensure more consistent provision throughout the NHS. We also need to raise our sights as to what is possible, because as I have mentioned, a third of the population have long-term conditions, and we can do much better at helping people to live with those conditions in a way that promotes their independence.

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[Mary Macleod (Brentford and Isleworth) (Con)]

9. What steps the Government are taking to improve care for people with dementia.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Tackling dementia—particularly the shockingly low diagnosis rates—is a key priority for me and the Prime Minister.

[Mary Macleod]

I welcome the Government’s steps to support carers and the work they have done, especially on the £400 million to give carers’ breaks from their important responsibilities. Will my right hon. Friend explain what is being done to increase awareness and understanding of carers’ health care needs?

[Mr Hunt]

My hon. Friend is right to highlight this point. In the draft Care and Support Bill, local authorities will be required to meet the eligible needs of carers. That is a particular concern with dementia, because, all too often, someone looking after a partner with dementia gets to a tipping point where there is no alternative to residential care, but, if we can give them better support, they will have a better chance of remaining at home, which, in the vast majority of cases, is where they want to be.

[Kate Green (Stretford and Urmston) (Lab)]

Many elderly people with dementia remain trapped in hospital, because there is not adequate provision in the community for them to be looked after at home. How does the Secretary of State intend funds to be extracted from hospitals to be spent in the community, particularly at a time when local authority funding cuts mean that many of the voluntary agencies providing that support are actually losing posts in my borough?

[Mr Hunt]

The hon. Lady is right to highlight this growing issue. One million people will have dementia by 2020, so we have to take it very seriously. It is not an either/or situation, though, because about 25% of patients in hospitals have dementia, and hospitals would like them placed in the community or at home, where they can be better looked after. This is one of those examples where, under the new reforms, we need much greater integration of services to ensure that those people are treated in the way they need to be.

[Mark Durkan (Foyle) (SDLP)]

10. What recent progress he has made on improving early diagnosis of pancreatic cancer.

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[Mr Mark Spencer (Sherwood) (Con)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

It is my privilege to serve as Health Secretary responsible for the national health service. I have identified four priority areas where I hope over the next two years to make the most progress. They are improving mortality rates for the major killer diseases so that we are among the best in Europe, which we are not at the moment; improving the way we look after people with long-term conditions such as diabetes and asthma; improving the way we deal with dementia, both as a national health service and as a society; and, perhaps most important of all, transforming the attitude to care throughout the NHS and social care systems so that the quality of care is seen to be as important as the quality of treatment.

[Mr Spencer]

What assistance can the Secretary of State give to the newly appointed chairman of the Sherwood Forest Hospitals Trust as he begins to wrestle with the private finance initiative signed under the previous Government and attempts to find repayments in excess of £40 million a year?

[Mr Hunt]

The first thing I would say to my hon. Friend about Sherwood Forest is that I know everyone in the House will join me in saying that our hearts go out to the families of the women who were misdiagnosed for breast cancer. We expect the local NHS to come up with a serious package of measures to make sure that that kind of thing cannot happen again.

My hon. Friend is right to talk about PFI. We inherited an appalling scandal. In order to tackle the PFI debts of just seven institutions, we are having to put aside £1.5 billion over the next 25 years, but we are working with all institutions to deal with this appalling debt overhang.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

We know that the Secretary of State’s views on abortion do not have a religious basis, so does he care to share with the House the scientific evidence to support his view that abortion time limits should come all the way down to 12 weeks?

[Mr Hunt]

Four years ago I voted with my conscience, as I am sure she voted with hers, but I did so as a Back-Bench Member of Parliament and we have made it clear that it is not the policy of the Government to change the abortion law. My job as Health Secretary is to implement the elected will of the House, which voted in 2008 not to reduce the abortion time limits.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

T2. What steps is the Department taking to tackle the growing incidence of drug-resistant cases of TB, which increased by more than a quarter in the past year?

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[Mr John Redwood (Wokingham) (Con)]

T3. What is the administration overhead cost to the NHS and the Department this year and how does it compare with 2009-10?

[Mr Jeremy Hunt]

I will get back to my right hon. Friend with the exact details, but the impact of the reforms that the Government have introduced will cut administration costs by a third across the whole NHS, leading to net savings of £4 billion during this Parliament.

[Jack Dromey (Birmingham, Erdington) (Lab)]

T7. Last Wednesday, the Prime Minister told the House that Kettering hospital was safe. The following day—Thursday—evidence in a document leaked to the Corby Telegraph said that 515 of the 658 beds in the hospital could be lost. Will the Secretary of State ask the Prime Minister to come before the House to put right the statement he made to the House, but will the people of Corby not conclude that whatever the Prime Minister says, the national health service will never be safe in Tory hands?

[Mr Hunt]

What a disgraceful comment. We do not need the Prime Minister to come before the House because I can tell the hon. Gentleman that Kettering hospital is safe, and that it is totally irresponsible scaremongering by the Labour party in the run-up to a by-election to suggest anything else.

[Rehman Chishti (Gillingham and Rainham) (Con)]

T4. Will the Secretary of State join me in welcoming the progress that has been made to reduce mixed-sex wards and improve patient privacy at Medway Maritime hospital in my constituency?

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

T8. Will the Secretary of State take a close personal interest in the proposed changes to the NHS in Trafford? Given the uncertainty about alternative accident and emergency provision, and indeed the delays in commissioning community services, will he ensure that any final decisions are deferred so that they can be considered as part of the wider review planned for NHS services across Greater Manchester?

[Mr Jeremy Hunt]

I should like to reassure the right hon. Gentleman that I take a close personal interest in all reconfigurations because they tend to end up on my desk. In this case, I encourage him to take part in the consultation for Trafford general, which will go on until the end of the month, but I remind him that the Government have put in place four important tests for any major reconfiguration. We must be satisfied that those tests are passed before we approve any reconfiguration, and those include the support of local doctors.

[Nick de Bois (Enfield North) (Con)]

T6. As breast cancer action month comes to an end, recent research by Breast Cancer Campaign has shown that 76% of women would like more information about breast cancer signs and symptoms. What steps are the Government taking to encourage early diagnosis of breast cancer?

[John Healey (Wentworth and Dearne) (Lab)]

Since his promotion, the Secretary of State has said little and, I assume, read a lot. Did his starter pack include details of the Prime Minister’s promise:

“This year, and the year after, and the year after that, the money going into the NHS will actually increase in real terms.”?

Did it include Treasury figures that show there has been a real terms cut each year since the election? What is he saying to NHS staff and patients who see the cuts and see the Prime Minister’s big NHS promise being broken?

[Mr Jeremy Hunt]

May I just remind the right hon. Gentleman that there has been a real terms increase in NHS spending? That contrasts rather starkly with what was said by the Health Secretary under the previous Government. He said it would be irresponsible to increase health spending in this Parliament. We ignored that advice and NHS patients are benefiting.

[John Stevenson (Carlisle) (Con)]

T9. The food labelling consultation closed in August. Could the Minister indicate when the Government response is likely to be issued and confirm that the Government will not bring in unnecessary burdens on the food industry over and above those set out in European regulation?

[Mr Andy Slaughter (Hammersmith) (Lab)]

The excellent children’s heart surgery unit at the Royal Brompton hospital will be pleased that a full review has been announced. Why does it have to report within four months, including the Christmas period, and why were previous referrals by both Brompton and Leeds refused? Will the review be full and impartial or not?

[Mr Jeremy Hunt]

It will be a totally impartial and very thorough review. This is an extremely important decision, and that is why I asked the Independent Reconfiguration Panel to take the time that it needs to do the review properly; that is the least that the hon. Gentleman’s constituents would want.

[Andrew George (St Ives) (LD)]

In order to get the Health and Social Care Act 2012 through this House, the Government gave explicit assurances that private companies could not cherry-pick the easiest procedures and patients, yet a recent letter from David Flory, the deputy chief executive of the NHS, back-pedals on the Government’s position, and shows that the Government are dependent purely on guidance. What can the Government do to put a bit of backbone back into that important policy?

[Mr Hunt]

May I reassure my hon. Friend that we are absolutely committed to the “no cherry-picking” provisions of the Act? We think that we have found the right way to achieve that in the NHS, and I will write to him to explain exactly how we will do that.

[Valerie Vaz (Walsall South) (Lab)]

Given the apparent increase in spending in the NHS and the £4 billion surplus, will the Secretary of State look at lifting the pay restraint for lower-paid workers, to increase morale and boost productivity?

[Mr Hunt]

The £12 billion increase in spending on the NHS under this Government, which the right hon. Member for Leigh (Andy Burnham) thought was irresponsible, means that we will be able to do a lot more for patients, but there is also rising demand. If we do not have that pay restraint, we will not be able to meet the needs of an ageing population.

[Justin Tomlinson (North Swindon) (Con)]

What specific consideration is being given to matching the annual growth funding uplift to actual changes in population? That is essential to my constituency, which has high population growth.

[Nick Smith (Blaenau Gwent) (Lab)]

The Public Accounts Committee says that 11 of the 144 foundation trusts across England are now in serious financial difficulty. What contingency funding is in place for those trusts, to protect patients?

[Mr Jeremy Hunt]

We have a clearly set out programme for all those trusts, to make sure that they get back to the proper financial controls and proper governance structures that they need. We do not want to get into the business of bailing them out; we want them to stand on their own two feet. That is the vision of the Health and Social Care (Community Health and Standards) Act 2003, passed by the hon. Gentleman’s party when it was in government.

[David Tredinnick (Bosworth) (Con)]

Will my right hon. Friend extend the scope of personal budgets? They help not only patients, giving them wider choice, but carers, allowing them to leave their post.

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[Mel Stride (Central Devon) (Con)]

My right hon. Friend will know that in this country, over 1,000 people a year die as a consequence of asthma. We have one of the highest prevalences of asthma in the world. Will he outline to the House what action we will take to get those mortality rates down?

[Mr Jeremy Hunt]

We are doing a lot of work on the outcomes strategy that will directly impact on asthma sufferers. As part of that work—we are as concerned as my hon. Friend is about this—we are looking at every single asthma death in a 12-month period, starting from this February, to try to understand better the causes of mortality, because we need to make very rapid progress.

Medical Revalidation

Jeremy Hunt Excerpts

Friday 19th October 2012 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today, I am announcing that from 3 December 2012, revalidation of doctors in the UK will commence.

This announcement follows the October 2010 commitment by the General Medical Council (GMC) and Department of Health to deliver a streamlined system of revalidation that provides assurance to the public and adds value for both patients and doctors. The tests of readiness for revalidation, as set out in that commitment, have now been met and I have received sufficient evidence from the UK revalidation programme board that all four UK countries are suitably prepared to proceed with implementation.

Revalidation is a way of regulating licensed doctors. It is a five-yearly process which gives doctors a clear framework to reflect on and improve their quality of care as well as ensuring that a doctor’s practice is systematically evaluated on an ongoing basis.

Through revalidation, doctors are required to demonstrate, via their annual appraisal, that they are working in a way that meets the values and principles set out in Good Medical Practice (GMC), the GMC guidance which sets out the principles and values on which good practice is founded, in order to renew their licence to practice. The evidence that doctors will bring to support revalidation will include participation in a process of annual appraisal, feedback from patients and colleagues, evidence of continuing professional development, reviews of complaints and information about clinical outcomes, where appropriate.

The new system will apply to all doctors in all settings in the UK.



For the small proportion of doctors about whom there are concerns, the strengthening of local clinical governance, together with a system of annual appraisal, provides the means for identifying problems earlier and putting in place appropriate arrangements to respond to any such concerns.

Medical revalidation will help doctors keep up to the standard expected of them by ensuring they stay up to date with the latest techniques, technologies and research. This will be key in making improvements in early diagnosis, such as with dementia and cancer—which is particularly important in bringing down mortality rates—and in helping people with long-term conditions manage them better.

Revalidation will also require a doctor to tackle any concerns with important skills such as bedside manner and maintaining trust with patients—particularly important when caring for the increasing number of older patients that the NHS treats.

As well as improving patient safety and quality of care, revalidation will improve public confidence that the doctors who are providing care and treatment to patients in the UK are up to date and fit to practise.

I would like to thank the GMC, the NHS revalidation support team, the independent healthcare advisory services, the British Medical Association, the Academy of Medical Royal Colleges, NHS employers, colleagues in the devolved Administrations, the NHS Confederation and UK patient organisations for the considerable amount of work they have undertaken in preparation for the commencement of revalidation. In summary, revalidation represents a world leading initiative that will increase the quality and safety of healthcare across all sectors.

NHS Modernisation

Jeremy Hunt Excerpts

Thursday 18th October 2012 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

The Government’s estimates of the costs and benefits of implementing those policies in the Health and Social Care Act 2012 that required legislation were contained in the “Coordinating Document for the Impact Assessments and Equality Analysis” published in September 2011. These estimates reflected the changes that the Government made to their proposals following the listening exercise and the report of the NHS Future Forum.

Officials have been tracking closely the actual costs and benefits of the changes. The publication of the Department’s annual report and accounts for 2011-12 provides an opportunity to give an update on these figures. I can now report to the House that the current estimate of costs is in the range £1.5 billion to £1.6 billion. Although higher than the most likely estimate made in the impact assessment (£1.2 billion to £1.3 billion), the costs remain within the wider possible range published in the co-ordinating document (£1.0 billion to £1.5 billion), after taking account of some costs (estimated at £127 million in total) that were excluded from the impact assessment either because they were out of scope (for example, because they related to measures not requiring legislation) or because they were redacted (for example, because they were commercially sensitive).

Within this forecast I now expect redundancy costs to be around £630 million, which is £360 million lower than the highest estimate in the impact assessment and some £180 million lower than the most likely estimate.

In the impact assessment, long-term annual savings arising from the changes were estimated at £1.5 billion per year from 2014-15 onwards. Gross savings over the transition period (2010-11 to 2014-15) were estimated at £4.5 billion.

Annual savings are still expected to be £1.5 billion from 2014-15 but the cumulative savings over the transition period are now forecast to be £1 billion higher, at £5.5 billion.

For comparability with the impact assessment, all the figures above are stated using 2010-11 prices.