Release of Bodies from Hospital

Jim Shannon Excerpts

Wednesday 30th October 2013 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

As ever, Mr Hood, it is a pleasure to serve under your chairmanship. I particularly thank Mr Speaker for granting this important debate on a subject that, had it not been brought to my attention by a constituent, I would not have believed possible outside the scripts of comedy or perhaps, more appropriately on the day before Hallowe’en, a horror film. However, the occurrence is possibly far more widespread than is known about, and my constituent fears that it is the modem equivalent of body-snatching by unscrupulous undertakers who, keen to ensure that they are subsequently contracted by bereaved families to organise funerals, take unlawful control of a body.

This situation, which the funeral industry states is rare, and the hospital concerned states arose under unusual circumstances, is none the less one raised by my constituent amidst fears that it was in fact a deliberate attempt to exploit bereaved families in the immediate aftermath of a death, and that it was made possible by a legal grey area and poorly drafted Department of Health guidelines. As a result of my constituent’s case, and after acquainting myself with the guidelines on how bodies are dealt with, I decided to seek this debate to raise two issues. The matter is clearly of limited interest to colleagues, but I welcome the opportunity to make my points direct to the Minister, and I look forward to his response.

First, the existing legislation needs clarification. There is a definite need for guidelines for hospitals and hospice staff to be revised, so that they comply with the existing law, and prevent staff from being exposed to unwarranted prosecution based on the technicalities of existing legal grey areas. Secondly, and probably more importantly, I want to highlight a culture of complicity between undertakers and hospital staff, and potentially deliberate unscrupulous practices deployed by undertakers, who get away with them not in spite of Department of Health guidelines but, worryingly, because of them.

A further point worth raising is Bristol royal infirmary’s failure in its duty of care towards the deceased and her family. On Saturday 23 March this year, Gladys Pugh, the mother-in-law of my constituent, Mr Peter Williams, sadly died in Bristol royal infirmary. Her body was taken to the hospital’s mortuary to await the coroner’s permission for it to be released. The following Tuesday, Mr Williams and his wife began the painful task of contacting undertakers to ask for quotes and to discuss possible funeral arrangements. Three funeral directors were contacted. Mr and Mrs Williams planned to travel to Bristol to register the death and to visit the funeral directors they had contacted, but with the long Easter weekend so close, they could not make the journey until 2 April. The family contacted all the undertakers they had spoken to and informed them they would come back to them if they were interested in taking matters further after the Easter break.

On 2 or 3 of April, one of the undertakers, Thomas Davis, part of Bristol Funeral Directors group and a member of all the relevant trade organisations, including the National Association of Funeral Directors, contacted Mr Williams and asked what was happening about the arrangements. Mr Williams informed them clearly that they had decided to engage the services of another undertaker, thanked them for their interest, and left it at that.

It then transpired that without the permission of the Williams family and without any form of verbal or written contract, Thomas Davis had driven to the hospital’s mortuary on 27 March, the day it was contacted by Mr Williams, and removed Mrs Pugh’s body to one of its own facilities. The situation came to light 10 days after Mrs Pugh’s body had been taken from the mortuary when the company subsequently appointed by my constituent contacted the mortuary to arrange collection of Mrs Pugh’s body, only to be told that it had been taken away some 10 days previously.

There was an understandable feeling of horror, shock and disbelief that Mrs Pugh’s body had been kidnapped by an undertaker whose sole instruction was to offer a quote, which incidentally was never forthcoming, and to inquire about available dates for cremation. I use the word “kidnapped” after considerable thought. First, I cannot use the word “stolen” as a dead body is not technically the property of anyone except the deceased. That is one of the grey areas that legal experts agree needs clarification. Secondly, as kidnapping is the removal of a person without their consent, and as a dead person is still considered a person in law but is unable to give such consent—and, as “stolen” would not be legally correct—“kidnapped” is the only suitable word that I can use to describe what happened.

I argue that Thomas Davis acted unlawfully, because all that had been requested by the Williams family was for a quote to be provided for the services, and for provisional inquiries to be made with a local crematorium. There was no contract, no formal quote, and at no time were the family informed that the body had been collected. Furthermore, at no time was any of the paperwork required under Department of Health hospital guidelines for the release of Mrs Pugh’s body handed over by the family to Thomas Davis.

It is that point—the lack of consent given by the Williams family—that makes the removal of the body unlawful. That is where the first issue arises. Ignoring the motivation for a moment, how can an undertaker take possession of a body from a hospital lawfully? The answer—for it to be lawful, the person in control of the body must be enabled by law, by dint of their status in the life of the deceased or through being appointed the agent of such a person. In the case of Mr Williams’ mother-in-law, the undertakers had not been given the legal right to take control of the body by the family and were therefore not in legal possession of it.

What checks were made by the mortuary staff to ascertain the lawful right of the undertakers to take responsibility for the body? None, it would appear. It seems that the law is at the same time both very clear and utterly confusing on that point, and furthermore, contradicts the Government’s own guidelines. I hope that my hon. Friend the Minister will bear with me while I try to explain that.

Although NHS trusts have very strict guidelines on releasing bodies, largely based on the Department of Health’s publication, “Care and Respect in Death: Good Practice Guidance for NHS Mortuary Staff”, and usually stipulate that the person collecting the body must be in possession of the relevant paperwork, often including “the green form”—an interim death certificate releasing the body for disposal—those guidelines are, I am told, probably of no legal effect. In the case of Bristol royal infirmary, its own release note, which Mr Williams was told would be essential for the release of the body, is also possibly not worth the paper it is printed on.

That is because case law dating back to 1841 states that once a person has died, unless the medical staff or the coroner order an autopsy, the deceased person’s body becomes the responsibility of—but not the property of—in the following order: the executor of the will; the next of kin; or, in the absence of the above two, a person or persons intending to pay for and arrange the funeral. Failing that, the local authority must take control. There are, therefore, a limited group of people to whom lawful control of a body can be given, which can also include their appointed representatives. That is the bit of the law that is absolutely crystal clear.

However, what follows is much more confusing. Even where guidelines stipulate which forms must be presented before a body can be released—such as Bristol royal infirmary’s own release form—in fact, once someone who can lawfully take responsibility for a body demands to be allowed to do so, the hospital is apparently powerless to prevent the release of the body, irrespective of trust or Department guidelines, and irrespective of what paperwork the person or persons may or, in this case, may not have.

That is a very important, albeit technical, point, which I wish the Minister to take note of, because if a hospital employee, following the appropriate guidelines, refuses to release the body to someone who can lawfully take control of it, honestly believing that he or she is doing the right thing, that employee can technically open themselves up to prosecution for preventing a burial or cremation—even if that was never the intention and even if they were simply seeking to establish whether the person taking responsibility was legally entitled to do so.

[Jim Shannon (Strangford) (DUP)]

I spoke to the hon. Lady beforehand about this issue. She has outlined technical issues about how the body should have been released and where the process has fallen down. Is she also concerned at the impact that such a situation has on the families at a time of grief and sorrow? No matter what, that cannot be overlooked.

[Caroline Nokes]

I thank the hon. Gentleman for that intervention. He is, of course, exactly correct on that point. It is a time of great grief and distress to families, and they are often not in a position either to know what the legal technicalities are or to ensure that they are properly implemented. I will come on to his specific points very shortly.

According to some legal experts, this grey area has arisen from a number of test cases—including one in 1974—that have apparently established that a person claiming lawful control does not need to provide any paperwork at all to justify their claim over a body. Furthermore, and of great concern, not only are there no stipulations in law regarding what paperwork must be presented, or what conditions met, irrespective of guidelines, it is apparently illegal to demand that anyone seeking lawful control of a body do anything to justify their claim. In other words, unless my understanding is incorrect, not only are trust guidelines of no legal effect, but they can actually put the staff seeking to implement them at a technical risk of prosecution—something that I know will be of concern to my hon. Friend the Minister.

The first issue, therefore, that I would like my hon. Friend the Minister to consider is clearing up the discrepancy between the guidelines that NHS, hospice and care home staff are given and the technical exposure to prosecution that they face if they seek to abide by them. Furthermore, perhaps the law can also, at the same time, be clarified to state what rights the next of kin have over a body, which is something that it does not clearly do at the moment, because, as I said earlier, the body is not technically considered to be the property of anyone.

I turn to the second point that has been highlighted by my constituents. The right of lawful control does not pass to undertakers unless they have been properly contracted and bestowed with the right to take the body. Furthermore, departmental guidelines clearly state that that right must be demonstrated by the production of the relevant paperwork. What we have to ask, therefore, is how did this situation arise and how widespread is the practice?

In accordance with Department of Health guidelines, Bristol royal infirmary operates a system where a body will not be released without staff being presented with one of its own release notes—something that my constituent was very clearly told. However, in this case, no such release note was presented, because the undertaker was never given it. How, then, did the body come to be given to the undertaker? In answer to that, I again draw the attention of my hon. Friend the Minister to his Department’s guidelines, which, like the law, can at best be described as vague.

For example, while the guidelines state that a body must be released to “the correct recipient”, they do not say who that is. The guidelines also say that “standard operating procedures” should be known by all staff through training, and be robustly audited. They clearly state:

“Before a deceased person’s body is released, mortuary staff should check that all necessary documentation is complete”.

Even if that was a legal requirement, which it seems it may not be, in this case there were clearly no checks of the paperwork because none can have been presented. The guidelines go on to state:

“The body of a person who has died may be collected from the mortuary by the family, but is usually released to a representative, most often a funeral director. Mortuaries should therefore ensure that they have good lines of communication and working relationships with local funeral directors.”

Here, the advice is that hospitals need good working relationships with local undertakers. It seems that that advice has been taken far too literally in this case at least, and I fear elsewhere, with the establishment of a very cosy relationship between undertaker and hospital—a relationship where it is deemed that things can be taken on trust, and contrary to guidelines, no checks are required as to the legal right of the undertaker to take control of the body. That is not a good working relationship with clear lines of communication; it is an abuse of trust.

Certainly, what is clear in this case is that Bristol royal infirmary and the undertakers did not act in accordance with the Department’s guidelines and were, in fact, acting like some modern-day Burke and Hare operation. What is abundantly clear is that Bristol royal infirmary’s response to Mr Williams is inadequate. Although some changes to policy have been implemented, those are changes that my constituent calls “minimal”, and there is no guarantee that it will not happen again. As my constituent noted in a letter to the hospital’s chief executive, Mr Woolley:

“The Post Office would appear to take more care in the release of a parcel than the BRI did in the release of a body”.

To say that my constituent is unhappy with the response that he has received from the hospital would be an understatement. He is desperate to see the changes required to prevent other families experiencing the kidnapping of bodies belonging to their loved ones, but feels that the points he has raised with the hospital have simply been ignored, with the hospital blaming a member of staff for not following procedures.

Mr Williams asks two perfectly reasonable questions in his complaint to the hospital. Those questions are, as yet, unanswered. First, why did Thomas Davis arrive at the hospital without the paperwork that the hospital itself says is essential for a body to be released? Secondly, why was the body released without that paperwork? Mr Williams is worried that the answer to both those questions is this: because the undertaker assumed that he would not need the paperwork—an assumption based on past experience of acting in a similar manner. That begs the obvious question: how many other bodies have been taken in that way? It appears that the hospital will not accept responsibility for its failure in its duty of care towards the Williams family, seeming to want to blame individual hospital employees and the funeral industry.

That is another area of concern to Mr Williams, because all that has been received from the funeral industry is a response that is, to say the least, disappointing, stating only that “these mistakes sometimes happen” and offering nothing beyond that. My constituent has rightly complained to the health service ombudsman, and we await with interest the decision on that complaint, but there is no redress against the undertakers who took the body of my constituent’s mother-in-law, held it unlawfully and refused to take responsibility for doing so, knowing that they are virtually free of any legal consequences for their unlawful behaviour.

I hope that, in his response, the Minister will touch on both aspects of this sorry tale: the lack of legal clarity, rights and protection that both relatives and NHS staff have; and measures designed to prevent undertakers from seeing distressed and grieving families as representing a lucrative opportunity provided that they can first kidnap the body by relying on the cosy relationship that they might enjoy with the local hospital, which the Department’s own guidelines encourage.

From grave robbery to daylight robbery, the funeral industry has questions to answer, as, having spoken to campaigners in preparation for this debate, I can tell the Minister that, despite the comments of the industry, this practice is said to be far more widespread than is believed or acknowledged. Sadly, I am told that people rarely complain, because they simply want to grieve and move on, and the funeral industry is rarely held to account.

I suspect that neither the Department nor the funeral industry keeps figures on how often this practice happens. It would be interesting to know whether the Department has some figures. However, my constituent fears that his experience is merely the tip of the iceberg—a view shared by campaigners in this area. I hope that now that this issue has been highlighted, the Department will seriously consider bringing clarity to what the legislation says and will offer protection to NHS, hospice and care home employees and to grieving families, protecting them from undertakers who should be there to offer a service at the time of greatest need and ensuring that bereavement and grief are not exploited.

Hepatitis C (Haemophiliacs)

Jim Shannon Excerpts

Tuesday 29th October 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Member for Wythenshawe and Sale East (Paul Goggins) on bringing this important matter to the House’s consideration. I will speak specifically on behalf of my constituents, as I think will everyone who speaks today, from a heartfelt understanding of the problems that those constituents have faced for a number of years. My hon. Friend the Member for Upper Bann (David Simpson) illustrated the time scale. If ever there were a powerful case for the Minister to answer, this is one. Many of the speeches made today will be impassioned. I welcome the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison) to her position, and I look forward to working together on many issues in future.

The background to the case is clear. I have spoken to constituents of mine who are victims. Some of my constituents live daily with these illnesses through no fault of their own but rather as a result of the Government’s inaction at a time when action was important. My constituents have sent me a briefing, and I have relied on them for information as well as for the personal details that they have given me, although I do not intend to mention any names out of respect for confidentiality and personal issues.

The Archer inquiry investigated the fact that between the 1970s and late 1980s, 4,670 people with haemophilia were infected with hepatitis C through treatment by the NHS that they loved and respected, which ultimately, unfortunately, let them down. Of those, 1,243 people with haemophilia were also exposed to HIV, as the right hon. Gentleman said. Almost half of those infected with hepatitis C and almost three quarters of those co-infected with HIV have since died and many have tragically left families behind. When looking at the impact on the individuals, we can never forget about the effect on their families; many individuals have experienced poverty and discrimination as a result of their infections. People, either through mistrust or lack of knowledge, sometimes unfairly discriminate against those with infections. The provisions recommended by the Archer inquiry would offer appropriate support and compensation to those affected and would ensure that steps were taken to improve blood safety.

The previous Government argued that the reason why financial support was not made available at comparable levels to those in the Republic of Ireland, for example, was that the disaster affected the two countries differently. I am unsure how that was worked out. Perhaps the disaster was measured in numbers, but the disaster is the same to each individual and each family. No-fault Government payment schemes were established to provide support to those affected. The Archer inquiry, which was non-statutory and funded from private donations, reported in February 2009 on the Government’s response. Among its recommendations was a call for reform of support for those affected in line with the scheme used in the Republic of Ireland. If we had had in Northern Ireland and the rest of the United Kingdom a scheme similar to that of the Republic of Ireland, our constituents would have been much more satisfied. What does the Minister think about the Republic of Ireland’s scheme? Is it possible that we can try to match it?

Despite the Government’s announcing on 10 January 2011 an increase in payments to some of those infected with hepatitis C, what has been put in place is not adequate to support people through their illnesses. The Government’s scheme now has two stages, as outlined by the right hon. Member for Wythenshawe and Sale East. A first stage payment of £20,000 is available to eligible people. Following that, successful recipients of the first stage payment whose hepatitis C infection has led to advanced liver disease can receive a second stage payment of £50,000. Those who have received the second stage payment are also entitled to additional annual payments of £14,000, paid monthly or quarterly. The money may look good and it sounds like a lot of support, but, as always, there is more than meets the eye to the press release. As the saying goes, the devil is in the detail, and that is clearly the case here. The Hepatitis C Trust supplied an interesting briefing and is calling for a rethink of the strategy and policy. The trust, with which I certainly agree, asks that the first and second stage categories be removed. As a constituent of mine said, the payment can never compensate for what has happened, but it can offer support and help people to adjust to and live a life affected by it.

People infected with hepatitis C can experience severe symptoms, including extreme fatigue, depression, aching limbs, headaches and abdominal pains, which may mean that they are unable to work for long periods of time. The right hon. Member for Wythenshawe and Sale East referred to Atos in his speech—I think it was also mentioned in an intervention. The situation of people who are unable to work for long periods of time needs to be understood. Symptoms can lead to difficulties in holding down a job and receiving an income. Sufferers rely on help from family and sometimes from other carers, and the fact that the annual sum starts only when a person’s hepatitis C has caused cirrhosis does not take any of that into account. Understanding the problem is the crux of the issue. The briefing I received from the Hepatitis C Trust put it succinctly:

“Some patients without cirrhosis are far more symptomatic than some who have reached that stage. Indeed, some patients die whilst still in stage 1. Therefore there should be no distinction between stage 1 and stage 2 payments for people who have been infected with hepatitis C through contaminated blood. They should be entitled to the full and on-going support immediately.”

The second point raised in the briefing is that there has been no Government apology to date. The right hon. Member for Wythenshawe and Sale East referred to the Pat Finucane case and the apology that the Prime Minister made, so I urge the Minister to consider an apology for those infected, who have suffered many years of illness as a result. Having listened to some of the apologies, which should never have been uttered, that have rolled off Government Ministers’ tongues to pacify and placate people for political gain, I find it difficult to believe that there has been no Government apology. I have sometimes heard Members of this House and the Prime Minister apologising on my behalf when no apology was needed and yet here, when there clearly was a fault and when innocent people lost their lives following treatment by the NHS, mouths seem to be suddenly closed. I cannot understand that mindset. A mistake was made that has cost lives and has cost other people the price of living with horrific diseases, and if that does not deserve a heartfelt apology then I am at a loss to think what does.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does my hon. Friend agree that what sufferers and their families need are empathy, an apology, to which he has alluded, and a commitment to ongoing support for the remainder of their days? If they saw that coming from the heart of Government, we would have accomplished a significant amount of what the right hon. Member for Wythenshawe and Sale East (Paul Goggins) and his predecessor have sought to achieve.

[Jim Shannon]

I thank my hon. Friend for that contribution, which refers to something that we would all want to see. I am reminded of what my mother told me as a child: “Compassion is your pain in my heart.” She was referring to an understanding of the problems facing other people, which, in a way, is why we are here. We are here not just because we want to be MPs, but because we are privileged to be elected by our constituents. We see their problems and we must illustrate and expand those problems in this great House, of which we are privileged to be a part.

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

I congratulate the right hon. Member for Wythenshawe and Sale East (Paul Goggins) on securing a debate on this important issue.

What are the thoughts of the hon. Member for Strangford (Jim Shannon) on the role of specialist hepatitis C nurses in providing support to sufferers who are haemophiliacs and more generally? The NICE guidelines suggest a minimum of one specialist hepatitis C nurse for every 40 patients in the community and one such nurse for every 20 patients in a hospital setting. Does the hon. Gentleman think that the Government’s plans to transfer resources through the clinical commissioning group allocations will help or hinder the improvement of support for hepatitis C sufferers?

[Jim Shannon]

I thank the hon. Gentleman for helpfully highlighting the role of specialist nurses. I hope that the Minister will be able to give us an indication of the importance of the role of nurses and therefore the importance of retaining them and ensuring that the numbers are correct.

Just a few minutes spent reading the stories of victims and their families on the taintedblood.info website brings a lump to the throat. In this House, where we have the privilege to represent our constituents, we cannot continue to leave the families behind. I wholeheartedly support the removal of the two-tier system, which would entitle people to an annual sum to help them to cope with the side effects of this terrible disease and would take a little pressure off the families who are faced with watching their loved one fade away before their eyes. It is well past time that we do the right thing by those affected, and that will not be done by separating and segregating those infected by the same disease. I urge the Minister to take on board what is said today by the right hon. Member for Wythenshawe and Sale East and others and to do the obvious and right thing by providing the apology and response that we need.

Several hon. Members rose—

[Jim Dobbin (in the Chair)]

Order. I intend to call the shadow Minister at 20 minutes to 11 and five or six hon. Members want to speak, so I ask them to watch the length of their speeches before I have to impose limits.

In-patient Mental Health Services (Children and Adolescents)

Jim Shannon Excerpts

Wednesday 23rd October 2013 Commons Chamber

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

Last week, Dr Martin Baggaley, medical director of the South London and Maudsley NHS Foundation Trust, said that mental health services in England are unsafe and in crisis. At the same time, BBC News and Community Care magazine printed the results of a freedom of information request to mental health trusts around the country, which revealed that 1,500 mental health beds had closed since 2011. The Royal College of Psychiatrists is among the many expert organisations that have expressed concerns about poor in-patient mental health provision, particularly for children and adolescents. In response, the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb) who I am pleased to see is present, said that he was determined to end the institutional bias against mental health. This debate presents an opportunity for him to do something in pursuit of that noble objective.

There is increasing demand for mental health services, and all the research shows that early intervention is essential to prevent mental health problems developing in later life. One in 10 children aged between five and 16 suffer from a diagnosable mental health disorder, half of which, with the exclusion of dementia, start before the age of 14. Yet, although the Government claim to be increasing expenditure on health, child and adolescent mental health services in England have been grappling with unprecedented cuts to their funding over the past two years.

Many MPs will know that from their experience in their constituencies, where social care and education funding, which is such an important part of CAMHS budgets, is having to be reduced dramatically. The charity YoungMinds found that since 2010 two thirds of local authorities in England have reduced their CAMHS budget. The contrast with physical health budgets is a stark manifestation of the institutional bias against mental health.

The West End unit in my constituency was the only in-patient mental health facility for Hull and the East Riding. It closed in March while a consultation on CAMHS—which, incidentally, gave no opportunity for respondents to voice an opinion on whether the unit should remain open—was still under way. So much for “No decision about me, without me”.

Can the Minister confirm that the guidance to section 244 of the National Health Service Act 2006 concerning consultation states:

“No final decisions—even decisions in principle—must be taken until the public has been consulted and the results of the consultation have been considered by the NHS body”?

When I raised that appalling breach of the Government’s own guidance on consultations, I was told that West End was closed by the unaccountable monolith otherwise known as NHS England. It changed the specification for tier 4 services and the West End in-patient unit that provided high-quality services in Hull and the East Riding for 20 years closed as a result.

I felt sure that Hull could not have been the only area affected, so I submitted a parliamentary question asking how many in-patient mental health units had ceased to operate.

[Jim Shannon (Strangford) (DUP)]

In my constituency 33% of young people have depression. That rises to 50% among those who are unemployed. Does the right hon. Gentleman’s area have the same concerns as I have in my area? We have taken steps in Northern Ireland to address the issues, and perhaps the Government need to do the same here.

[Alan Johnson]

This debate is about services in England, but I confirm that part of the problem is the fact that there is a rising need for adolescent and child mental health services and a decreasing capacity to deal with that need.

I asked the Minister in a parliamentary question which other areas had been affected and which units had ceased to operate. I was told by the Minister that no units had ceased to operate as a result of this change and nor were any closures expected when the change was introduced on 1 October. As I said, the unit in Hull closed in March. The change had already happened. Will the Minister take this opportunity to correct that answer?

Not only did West End close in March, but we are beginning to hear of closures across the country, including in Devon and Somerset, where my right hon. Friend the Member for Exeter (Mr Bradshaw) has been pursuing this issue vigorously with the chief executive of NHS England, who confirmed in a letter to him that other units had closed as a result of the change to tier 4 specification well before the spurious 1 October date.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Jane Ellison]

I am glad my hon. Friend has raised the issue of working with schools and education, and I have already had initial discussions with my opposite number at the Department for Education. We think we have an exciting agenda to take forward, and I hear what my hon. Friend says.

[Jim Shannon (Strangford) (DUP)]

In 2011-12, childhood obesity rose by 37% across the United Kingdom. Will the Minister take into account the child marketing strategy of the fast-food industry when considering how best to address the issue?

[Jane Ellison]

I am interested in looking at what the hon. Gentleman says, and I will be happy to talk to him about that.

Psychological Therapies

Jim Shannon Excerpts

Wednesday 16th October 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to come here and support the hon. Member for Halesowen and Rowley Regis (James Morris), who has brought this matter to Westminster Hall for consideration. As my hon. Friend the Member for East Londonderry (Mr Campbell) said here yesterday, whenever we come to Westminster Hall, we congratulate the Member whose debate it is on bringing an important matter to the attention of the House. This is an important matter.

The hon. Gentleman clearly outlined the issues and their importance. My interest and that of my hon. Friends is in how such issues affect our young people. That will be the thrust of my speech. I also want to give a Northern Ireland perspective, which I believe is mirrored across the whole United Kingdom.

[Dr McCrea]

Does my hon. Friend agree that, for many years, mental ill health has been a taboo subject? Many of those suffering from mental health difficulties were pushed away or hidden from society. The value of such a debate is that it ensures openness in society, to deal with the important issue of mental ill health.

[Jim Shannon]

I thank my hon. Friend for raising that matter. That is exactly the problem; if I wanted to sum it up in one phrase, that is the phrase I would use. There was a taboo around mental ill health in the past, but hopefully we can discuss it now. I hate the word “mental”, because it almost puts the thought in one’s mind of someone to be kept at bay. We must be able to find another word in the English language that is more sympathetic. I am not sure what it would be, but we should give the matter consideration.

Psychological therapies are defined as an interpersonal process designed to bring about modification of feelings, cognitions, attitudes and behaviour—all issues the hon. Member for Halesowen and Rowley Regis mentioned—that have proved troublesome to the person seeking help from a trained professional. That is what we want to achieve.

The psychological therapies in the NHS 2013 event marked the halfway point of the coalition Government’s mental health strategy. Psychological therapies generally fall into three categories: behavioural therapies, which focus on cognitions and behaviours; psychoanalytical and psychodynamic therapies, which focus on the unconscious relationship patterns that evolved from childhood, which are important; and humanistic therapies, which focus on self-development in the here and now. We need to focus on those three categories.

I presume that most Members catch up on the news on BBC or Sky before they come here. A story today covered the role of carers and what they do for elderly people, but it also mentioned their role for those with mental health issues and focused in particular on the time that carers have to deliver care to people in those two categories. It underlined where we are in the debate about those who suffer from psychological imbalance and emotional issues.

The improving access to psychological therapies programme was built on evidence, produced in 2004 by the then National Institute for Health and Clinical Excellence, on treating people with depression and anxiety disorders. It was created to offer patients a realistic and routine first-line treatment, combined, where appropriate, with medication, which traditionally had been the only treatment available.

Things have changed. The Minister, whom I respect greatly, will outline the issues when he responds. The IAPT programme was dedicated to spending more than £700 million on psychological therapies between 2008 and 2014. It was first targeted at people of working age, but in 2010 was opened to adults of all ages. There has been success—it would be wrong to say that there has not.

In the first three years, 900,000 people were treated for depression and anxiety; 450,000 patients are in recovery, with another 200,000 moving towards recovery; 25,000 fewer people with mental health problems are on benefits; and the average waiting time has reduced from 18 months to a few weeks. In terms of what has been done so far, that is good news, but it is fair to say that there is a lot more to do. There has been a significant increase in the number of people with such issues, and all statistics indicate that that number will continue to grow.

People require psychological therapy for many reasons. Members have spoken about the things that lead to the position we are in today and why society and Government must respond. Reasons for therapy can be to do with home life and bereavement. On many occasions in my constituency office, we deal with bereavement and how it affects not only the partner, but the young people in the house. The hon. Member for Halesowen and Rowley Regis referred to that in his introduction. I regularly see it in my office—the frailty of life, the suddenness of death and how that affects people.

Unemployment, when young people who cannot get the jobs they need or the discipline that a job brings, and trouble in the workplace are other reasons for therapy. Another reason is childhood trauma, as we can see from the sexual abuse cases of the past few years. Many people were not aware of such trauma, but it existed. Social deprivation is another one, and all those issues contribute to where we are.

[David Simpson]

My hon. Friend mentioned young people again. Surely our schools, whether primary or secondary, need to focus on our teachers being trained to identify when a child has difficulties—the hon. Member for Halesowen and Rowley Regis (James Morris) mentioned early intervention—so that treatment can be introduced at an early stage, which could solve the problem for a lifetime.

[Jim Shannon]

As my hon. Friend and colleague mentioned, education is one of the areas in which Government can play a role, as can, I would say, Departments responsible for health, social services and welfare. They all need to come together.

Among many other factors, one comes to mind to do with young carers who look after their mum, dad, brothers or sisters. In my constituency, there are about 230 young carers, which is a massive number. They are making a contribution to society, but they are also the main carers for their adults or siblings. Again, that is a real issue.

In Northern Ireland, unemployment, too, causes problems because, among the regions of the United Kingdom, it has the highest percentage of working-age population not in paid employment—the figure is 30% higher than the UK average, which is 19% of individuals receiving a form of out-of-work benefit. The highest rates are recorded in Londonderry with 29%, Strabane with 29% and Belfast with 26%. Some 9% of the working-age population receive disability living allowance, including the 3% who receive DLA for mental health reasons. That proportion has risen by 25% since 1998, and is more than the UK average, while 70% of those registered with a disability are not in paid work.

Incidentally, am I the only elected representative to have had an increase in referrals for those who have served in the forces suffering from post-traumatic stress disorder? I know the answer: no, I am not. In all my years as an elected representative, I cannot recall having so many referrals of soldiers, male and female, for emotional, mental-health trauma suffered as a result of their service.

The Prince’s Trust, which many of us have knowledge of and great faith in, has found that one in four young people at work are down or depressed “always” or “often”—for people of that age to be downhearted or depressed is incredible. Unfortunately, that leads to an increase in the suicide rate among young people. In parts of our Province, suicide is at frightening levels. A few years ago in my constituency, there was a spate of suicides by young people, which was saddening for the people of our area, because we knew most of them—young people who did not feel that there was much for them in the future. We must address that issue.

The figure for young people who are down or depressed always or often, but are unemployed, is 50%. That is a massive figure. Clearly, a large section of people are at risk and, in my opinion, early intervention can and will make a difference. However, to establish it, there must be funding. My hon. Friend the Member for Upper Bann (David Simpson) referred to those in education diagnosing cases early, and that is one thing we can do. Our own Health Minister in the Northern Ireland Assembly, Edwin Poots, has taken steps to address the issue, but a UK-wide strategy would be useful and must be considered. I am keen to hear what the Minister will say.

Improving access to psychological therapies in all areas such as health and employment for individuals, families and carers in Northern Ireland could relieve anxiety, depression and distress. The long-term benefits would be more than worth any initial cost. The funding has to be in order, but it has to be there to discharge effectively what has to be done.

In addition, improving mental and social well-being can help to prevent antisocial behaviour and family breakdown for children and young people—again, in my constituency, we regularly witness the effect on people of family breakdowns. It also might make a positive input into the rehabilitation of offenders and assist in the maintenance of independence, reducing reliance on residential and hospital care. The benefits are numerous and clear.

Due to the years of suffering through the troubles, many people in Northern Ireland have poor physical, emotional, behavioural and/or mental health conditions. Dr Nichola Rooney, chair of the division of clinical psychology in Northern Ireland, said that there is

“historical underinvestment in psychological therapy services for people suffering from mental health difficulties in Northern Ireland”.

I am sure that is replicated UK-wide.

Clearly, we must continue to invest and see the rewards of such therapy, not simply as a method of cutting the costs of help in the future, but because it changes the quality of people’s lives and—a knock-on effect— the lives of the people around them. Everyone benefits.

Accident and Emergency Departments

Jim Shannon Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

My hon. Friend has campaigned regularly on this subject and there is a lot of merit in what he says. We do need more young people to know the basics of first aid, and that can be extremely important—even life-saving. But we also need to ensure that the NHS is there when we need it, 24/7, and that is why we need to make some important changes to the way in which A and E departments operate, in both the short term and the long term.

[Jim Shannon (Strangford) (DUP)]

Twenty-four thousand elderly people died last winter due to cold-related illnesses, and many of them had been referred to A and E departments. What specific assurances will the Minister make to vulnerable elderly people, who really dread the onset of winter?

[Mr Hunt]

That is what today’s announcement is all about. We are trying to reassure them that we are leaving no stone unturned, and where there are things that we can do in the short term, we are doing those things because we want every older person to feel confident that their NHS will be there for them—that their local A and E department will be able to cope with the additional pressures that develop every winter. But I would also say to them that where there are alternatives to A and E departments, people should consider those as well. That is why some of the measures that we are investing in are good alternatives to A and E, which can often give more appropriate treatment.

Spinal Cord Injuries

Jim Shannon Excerpts

Wednesday 4th September 2013 Westminster Hall

[Ian Lucas]

I was just talking about the extraordinary work of the Midlands Centre for Spinal Injuries, which I witnessed some years ago and which continues. In connection with the immediate response to serious accidents where people have spinal cord injuries, a miraculous transformation can be carried out, provided that the right level of care is offered by specialists in the immediate aftermath of the accident.

The continuing effects of spinal cord injuries are important, and I want to concentrate on those today. Spinal cord injury results in a combination of the loss of motor, sensory and continence function, making it unique among long-term conditions. It is also a non-improving condition. Once rehabilitation is completed and health care needs have been identified, they are unlikely to decrease. Indeed, they are likely to increase over time, with complications brought on by ageing and as the condition continues. It is essential, therefore, that needs are well managed by a dedicated and trained team who understand spinal cord injuries. That will ensure that health complications and significant cost implications for the national health service are avoided or minimised.

How care is administered is a major concern to many people living with spinal cord injuries. It is not just the individual who is affected by the spinal cord injury; often, the family and the immediate community around that individual must cope with profound pressures. There is an increasing worry that health care provision is becoming a postcode lottery, with clinical commissioning groups interpreting the national framework differently to meet their budgets, rather than the specific needs of spinal cord injury patients.

The landmark legal case of Pamela Coughlan in 1999 set a precedent for how patients with a certain level of injury should expect to be treated. Ms Coughlan, a C5/C6 complete tetraplegic with no significant additional health needs, took her primary care trust to court when they attempted to transfer care provision responsibility from NHS continuing health care, within which health care is free, to the local authority, where charges may have applied.

[Jim Shannon (Strangford) (DUP)]

The hon. Member for Wrexham and I spoke beforehand about this issue and I wanted the information to be recorded. Perhaps the Minister will take it on board as well.

We have a specialised 15-bed unit that looks after the whole of Northern Ireland and its population of 1.7 million people. That unit has everything: trauma, orthopaedics, neurosurgery, neurology and an intensive care unit. There are dedicated teams for physio, nursing, occupational therapy, social work, psychology, dietetics, art therapy and complementary therapies. All that happens under one roof for all the people in Northern Ireland. The hon. Member for Wrexham said to me, “That is the sort of thing we need in my area.” I wanted to put that case on the record. Perhaps the Minister could look to Northern Ireland as an example of something that has been done and done well.

[Ian Lucas]

I thank the hon. Gentleman.

Going back to Ms Coughlan and the issue of continuing care, the ruling found that patients with a certain level of spinal cord injury have health care needs of a “wholly different category” than can be legitimately provided for by a local authority. These are profoundly and almost singularly serious conditions. Even spinal cord injured people with greater health needs than Ms Coughlan are finding themselves assessed as ineligible or seeing their care packages severely restricted, without any evidence of reduced need.

As local health budgets for continuing health care are being squeezed and, in many cases, reduced, many of these people are experiencing reduced care packages and unfair, and potentially unlawful, decisions on eligibility for continuing health care. There are many examples of continuing health care packages being denied or dramatically reduced after reassessments, without evidence of clinical improvement.

One individual who has been affected is John Burns. He addressed the all-party parliamentary group on spinal cord injury last year, and it is occasions like that that show the importance of all-party parliamentary groups. They allow individuals such as John to speak to Members of Parliament and explain the difficulties.

John, who is married with three teenage sons, is a C2 tetraplegic following a water sports accident while on holiday with his family in 2007. Due to the extent of his injuries, John was initially put on a ventilator and awarded NHS continuing health care. After a period in a spinal cord injuries centre, John was discharged into a care home and was successfully weaned from his ventilator. Although he remained paralysed from his neck down, his continuing health care funding was consequently withdrawn, and he was told to expect to remain in a nursing home for the rest of his life. Without the appropriate funding, John was unable to receive the care and support he needed to be with his family and return home. He described that period as being like a “prisoner,” as he was denied time with his wife and sons in his own home. That is the type of individual that we, as a community, should be aiding, rather than denying them health care.

In a meeting with the Spinal Injuries Association, the then Minister of State with responsibility for care services, the right hon. Member for Sutton and Cheam (Paul Burstow), expressed concern about John’s case. Thanks to the involvement of the Spinal Injuries Association, an independent nurse was assigned to assess John’s case and immediately argued in his favour that funding should be reinstated. Yet John had to go through that process to restore the care that had been taken away from him. One can imagine the worry and distress experienced by John and his family during that period.

Despite the precedent of the Coughlan judgment, a large number of spinal cord injured individuals with health care needs demonstrably equivalent to or even greater than those of Pamela Coughlan are still denied NHS continuing health care. The culture of ineligibility continues. What action is the Minister taking to ensure that, where appropriate, spinal cord injured people have access to NHS continuing health care and that the legal ruling is adhered to? Is there a process for monitoring the level of care that individuals with severe spinal cord injuries are receiving from their immediate provider? How will the Department monitor the level of provision that is being given?

The Government must ensure that locally produced policies do not impose inappropriate and potentially unlawful care packages on a spinal cord injured person. Will the Government ensure that clinical commissioning groups adhere to the Coughlan judgment when deciding NHS continuing health care eligibility for spinal cord injured patients? Does the Minister believe that there should be a presumption of eligibility for tetraplegics when determining continuing health care? In addition to their injuries, such individuals and families should not have imposed on them the burden of worrying whether the care they received in the past will continue.

There is also concern that multidisciplinary teams assessing spinal cord injured patients for continuing health care frequently exclude health professionals with expertise in spinal cord injury when reaching their decisions. Along with the judgments that set legal precedents for NHS continuing health care, such as the Coughlan judgment, assessors and decision-making panels must carefully consider evidence from spinal cord injury clinicians and health care professionals from the NHS spinal cord injury centres. It is important that those individuals, who are so skilled in providing care, have input into the process of deciding what care the NHS is to supply in future. Will the Government take action to ensure that health professionals with expertise in spinal cord injury are included in multidisciplinary teams throughout the process?

There have been instances in which local commissioners have introduced policies that randomly restrict the amount of money available for “care at home” packages to the cost of non-complex care in a nursing home, disregarding the special care needs of spinal cord injured people and their right to family life. In an increasing number of clinical commissioning groups, local implementation policies place restrictions on the size of “care at home” packages, often based on arbitrary caps set against the equivalent cost of a placement in an establishment such as a nursing home. That has happened, for example, in the Sheffield clinical commissioning group cluster and in north-west London despite Department of Health practice guidance outlining the rights of people to choose where to live and to take risks, and despite the court’s indication that an individual’s human rights need to be balanced against cost.

The excellent spinal research charity Aspire commissioned Loughborough university to independently consider the impact on people with spinal cord injury of being discharged to nursing homes. The research found that living in a nursing home has a damaging psychological and physical impact on people with spinal cord injury. Spinal cord injury patients should not be expected to live in institutions rather than with their families. Generally, such people view care homes as a last resort.

The individual must be at the centre of the assessment process. Improving the implementation of NHS continuing health care will benefit its members, the clinical commissioning groups and the wider spinal cord injury community. Such issues affect people across the UK. They cause families and individuals profound worry, and they must be addressed urgently. The legal ruling must be adhered to, and the culture of ineligibility must end.

Tobacco Products (Plain Packaging)

Jim Shannon Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for Harrow East (Bob Blackman) for bringing this important matter to Westminster Hall for consideration.

I put a question to the Minister in June in which I referenced the fact that, when a patient is ill and visits their GP, they do as the doctor orders. One hundred thousand people will die of lung cancer this year and doctors support the campaign for plain packaging, so the question I put to the Government today is, when will they do as the doctor orders and bring in plain packaging for tobacco?

Numerous individuals, as well as groups such as Action Cancer and Cancer Research UK have contacted me. Schoolteachers have asked me to support the introduction of plain packaging in the hope that some of the cool factor will be lost and children will not take up the habit. Government research shows some 567 children start smoking every day. Half of those go on to become regular smokers, who will die as a result of their habit, despite anti-smoking advertising campaigns, attempts to educate children at school about the dangers and the fact that it is now illegal to sell cigarettes to anyone under 18 in Northern Ireland.

After much research, Cancer Research backs standardised plain packs due to the evidence that such packaging will help to save lives as part of a comprehensive tobacco strategy. No one here is claiming that it is the answer and will stop people smoking, but it can be and must be part of a campaign to save lives. Eight in 10 smokers start smoking by the age of 19 and 207,000 11 to 15-year-olds become smokers each year.

[Ian Mearns]

I hope that the hon. Gentleman agrees that marketing and advertising aimed at reaching young people on their birthday when they can buy and smoke legally for the first time will also have an effect on those who are only 13 or 14. From a marketing perspective, they are in the same age bracket.

[Jim Shannon]

I thank the hon. Gentleman for his intervention. It is clear that cigarette companies target young people and we need to address that. Cancer Research points to substantial evidence that shows advertising and promotion drawing young people into smoking and that packaging is an important part of tobacco promotion.

Standard packs would build on the success of the advertising ban. Eighty five per cent. of people back Government action to reduce the number of young people who start smoking and 63% of people support standard packs, with only 16% opposed. One hundred and ninety health organisations support standard packs, including the royal medical colleges and health charities, as well as the World Health Organisation.

I was not aware that we waited for countries, such as Australia, to implement initiatives before we would do so in the UK. It was my impression that we sought to lead the field in safety. Even if we are waiting on smoke signals, or hopefully a lack of smoke signals—forgive the pun—from Australia, research from Cancer Research that is making its way back from Australia shows early indications not only that the policy is making cigarettes appear less appealing, but that there is no evidence of problems for retailers.

I spoke to my colleague, Northern Ireland Health Minister, Edwin Poots, about the issue and he said that he fully supports the concept of plain packaging. He further told me that it was essential that there is a UK-wide scheme to tackle smoking.

[Roger Williams]

Will the hon. Gentleman give way on that point?

[Jim Shannon]

I cannot. I urge the Government not to put off the measure by waiting to get the all clear from Australia, when too many people are not getting the all clear from lung cancer and other diseases. Take the steps necessary. They might prevent some of the 567 children who may start smoking today, every day and every week, from doing so.

Brain Tumours in Children

Jim Shannon Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Will the hon. Gentleman give way?

[Mr Raab]

I will just make a small amount of progress before giving way, because I do not want to give a disjointed account.

David’s case is tragic and moving, but it is not a one-off; that is why we are here in Westminster Hall today. The cases I have mentioned are not isolated incidents. Each year, 500 children are diagnosed with a brain tumour and brain tumours take three young lives every fortnight. Brain tumours kill more children in this country than leukaemia does; only traffic accidents take more young people’s lives than brain tumours. Brain tumours pose as great a danger to our children as meningitis, and yet most parents and doctors have at least a rough idea of how to identify the symptoms of meningitis. Of course, it is not just those children who lose the battle with a brain tumour who suffer. Of the children who survive a brain tumour, 60% of them are left with life-altering disabilities, including blindness and brain damage.

[Jim Shannon]

I congratulate the hon. Gentleman on bringing this matter to the House for consideration; it is a very important issue. He will be well aware that it is better for a child to be diagnosed with a brain tumour in the United States of America, for instance, than in the United Kingdom; to be precise, it is three times better. One reason why the United States does better in its diagnosis of children with brain tumours is that education and health work together there. Does he feel that perhaps what the Minister could do here is to have better co-ordination between staff in schools and the health system, to achieve better early diagnosis?

[Mr Raab]

I thank the hon. Gentleman for his intervention, and he is absolutely bang on. I will come on to discuss the three specific measures that are key as part of that co-ordination.

Many of these tragedies could be averted. Whether it is preventing avoidable deaths or limiting the permanent damage inflicted by brain tumours, early diagnosis is the key, as has already been said; I suspect that there will be consensus on that.

Managing Risk in the NHS

Jim Shannon Excerpts

Wednesday 17th July 2013 Commons Chamber

[Ann Clwyd (Cynon Valley) (Lab)]

As on six previous occasions, I shall read from testimony showing a lack of care and compassion from the 2,500 people who sent letters and e-mails to me.

The family of an 89-year-old patient wrote:

“During our daily visits, we had to locate a cup from the kitchen on the ward in order to give her some fluid. She never had a drink of any sort within reach. This resulted in severe dehydration, which was apparent by her sunken eyes, dry, scaly skin, fatigue and her unquenchable thirst when we provided her with drinks. The staff informed us that she was not eating but we found she would eat any food we brought in for her. Whilst in bed the staff neglected to move her on a regular basis and this resulted in circulatory problems and ultimately necrosis of both feet. She also developed many infections…the wound on one heel was so advanced that the bone was visible.”

A man whose son suffered further brain damage due to lack of care said:

“He was left lying in his own urine, faeces, etc. He was left without fluids for over 12 hours then he had a huge seizure. The doctor would turn up at 5 o’clock stating ‘What’s the plan for today?’ when the day was clearly over…I witnessed nurses allowing drugs and feed to go to the floor…the floor was in such a state my feet were sticking to it. You can’t blame the cleaners for MRSA!”

A woman writes about her father’s death in hospital:

“I used the term ‘conveyer belt to death’ at the time we lost our beloved dad. On that chaotic Friday afternoon, when all the Consultants and senior staff are dashing off for an early week end finish, a poor young doctor was pushed into our path by one of these Consultants from the palliative team and uttered the immortal words that will stay with me—“Is Tuesday OK?”…I only twigged later that night that that was the date to cancel any care and pull the plug.”

A woman writes of her father’s experience in hospital:

“I’ve tried to find out what he’s eating and how much but no one seems to know and the nursing staff just tell me they have too many plates to clear to remember who was eating what. My Dad is wasting away in front of my eyes and they just keep telling me they’re too busy to help. My Dad is 76 and he has always been fit and well but I’m fearful now that he will never come home from hospital alive.”

Another woman wrote:

“Having continually pushed for the best care available during his time there, it seemed that complaining wouldn’t make any difference, other than making me relive every humiliation, discomfort, stupidity and indifference…My father spent a month in hospital, and he said it was worse than his experiences in the Second World War…We watched one man fading away, naked apart from a soiled nappy, in full view of visiting families.”

The wife of a whistleblower wrote:

“My husband was a senior nurse who recorded what he considered to be gross ill treatment of patients to his senior Consultant…he was subjected to prolonged bullying campaigns and subjected to pseudo disciplinary procedures. He was supported by the RCN who managed to keep him in his job…To cut a long story short, after six years of abuse, stress and fear my husband suffered a major stroke while working at the hospital. He was later subjected to a vicious attack”

by the management

“at his back to work interview. He retired from the NHS on medical grounds. He was 46 years old. He lost the job he loved. The NHS lost a highly skilled super intelligent practical nurse who loved his patients and worked hard for them. His colleague who supported him lasted a bit longer but was also forced into retirement after her health was destroyed by bullying because she also witnessed and reported the abuse of patients”.

[Jim Shannon (Strangford) (DUP)]

The right hon. Lady is telling us some very compassionate and emotional stories. Does she feel that the voice of families, which she has illustrated very well, needs to be heard more by management and staff, and does she feel that the process should be improved to enable that to happen?

[Ann Clwyd]

Many people are afraid to complain. Some complain many years later, and some never do so at all. It must be made easier for people to complain.