In-patient Abuse: Autistic People and People with Learning Disabilities
Debate between Jim Shannon and Baroness Keeley(1 year, 7 months ago)
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Barbara Keeley
I thank the right hon. and learned Gentleman for his intervention. That is very much the sentiment I will be expressing in this debate tonight, but I would go further and say we cannot just accept continual targets. I will remind Members that the original target was to reduce to zero the number of people in inappropriate in-patient units, and I shall say that that is the target we should get back to.
As I said, I would like to begin with the experiences of two young autistic women who were detained in in-patient units commissioned by the NHS. Their stories were told recently in a powerful Channel 4 “Dispatches” programme, on which they and their families spoke with immense bravery about the abuses they faced. I encourage all Members to watch it.
Amy is a 22-year-old autistic woman who was, until recently, detained at the Breightmet Centre for Autism in Bolton, run by ASC Healthcare. The unit is supposed to provide care tailored to the needs of autistic people that would not be available on a general psychiatric ward. While she was detained at the Breightmet Centre, Amy said that her eating disorder actually worsened and that “it’s all about punishment”, not treatment. Amy reported that not a day went by when staff members did not use restraint and that the threat of violence was used to make patients conform. She said:
“They’ve chucked me about…they will nip you, they have pulled my hair out, they will push your wrists down. When I tell them it hurts they do it more”.
After staff at Breightmet were told that Amy had spoken out in the Channel 4 documentary, they took her phone away from her. When she got it back, she sent photos of dark bruises covering her arms.
Amy was moved to a different hospital and the Care Quality Commission has taken further enforcement action against the Breightmet Centre, stating that
“if there is not rapid, widespread improvement”
it
“will start the process of preventing the provider from operating the service.”
The CQC reports there are still 12 patients at the Breightmet Centre, and I am deeply concerned that they may be having similar experiences to the abuse suffered by Amy. It should not have taken a TV programme for the CQC to take action, because the Breightmet Centre has been placed in and out of special measures since 2019. Amy had to return there even after the CQC rated it as inadequate in 2022—it was rated not safe, effective, caring or well-led.
Danielle is another young autistic woman who told her story to the Channel 4 “Dispatches” programme. Like many autistic people admitted to in-patient units, Danielle has spent not weeks or months but years detained. In one unit she was 320 miles away from her family. Her mother Andrea reported that Danielle had lost half her life—13 years—spent in hospital in-patient units. While she was held at the Littlebrook Hospital in Dartford, Danielle was placed in solitary confinement for 551 days—more than 18 months. She was locked in a room with just a mattress on the floor and drugged heavily. According to the UN’s special rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, confinement lasting for more than 15 days and lacking meaningful engagement constitutes torture. Danielle endured that for 551 days, a punishment not even inflicted on violent criminals. Yet Kent and Medway NHS and Social Care Partnership Trust paid to impose that treatment on a young woman whose only offence was to be autistic in a society that does not understand or support that diagnosis.
Solitary confinement in those units is so commonplace that data on the practice is collected and published by NHS England and broken down by the kind of restraint used, from chemical injection to prone physical restraint and seclusion. From those datasets we can see that more autistic people and people with learning disabilities are held in solitary confinement now than three years ago. That is a failure of care, and people such as Danielle are paying the price.
Danielle’s story gets even worse. Her mother Andrea told the “Dispatches” programme that during her stay at Littlebrook Hospital, Danielle was taken by staff members to areas away from cameras. She was then molested and raped. That is no isolated incident. Further investigation by the “Dispatches” team found that 18 reports of sexual assault and 24 reports of rape at Littlebrook Hospital were made to the police between 2020 and 2023. No charges have been brought in any of those cases to date, including Danielle’s case. The programme later showed Danielle on a ward in a general hospital being surgically fed through a tube, because she is now refusing to eat. Danielle’s mother said:
“After 13 years of trauma and neglect, she can’t see an end to it, so she’s been starving herself. She just wants this to stop.”
As the Minister hears these stories and listens to the words of those parents speaking out, I wonder whether she really believes that the right support is being given to autistic people. I hope that she can pledge action to help Danielle. I understand that Danielle needs housing so that she can move back to the community with support. Will the Minister look at her case, to avoid Danielle being shifted from facility to facility? Her life seems to be at risk. I have discussed the case with the family’s MP, the hon. Member for Maidstone and The Weald (Mrs Grant).
Jim Shannon (Strangford) (DUP)
I commend the hon. Member for Worsley and Eccles South (Barbara Keeley) on bringing this subject forward. She has outlined two tragic and poignant cases, and I commend her on the respectful way that she has done so. In Northern Ireland, the Muckamore inquiry recently brought to light the abuse of people in care. I had a mother in my office whose heart broke when it happened to her child. Some 2,045 people are detained in in-patient settings, and a lot of families only want the best for their loved ones. Does the hon. Lady agree this problem does not just pertain to the individual but affects the entire family circle? That is the wider aspect that we need to look at.
Barbara Keeley
I very much agree. What the hon. Gentleman says is true; I have seen many reports from Muckamore and I know that there are similar issues. It is desperate for the parents and the families because they rightly sought help for their children, but they ended up being abused and their lives are ebbing away—particularly those with eating disorders, who are not getting the support that they need.
The truth is that the abuses experienced by these two young women have been mirrored in similar scandals across the country. There was a toxic culture of abuse at the Edenfield Centre, revealed by BBC “Panorama” last September. There were the preventable deaths of three adults with learning disabilities held at Cawston Park hospital, who were subjected to torture and neglect, including the appallingly named “crucifix restraint”. At Cygnet Yew Trees hospital, staff members were arrested after reports that they kicked, slapped and dragged around the autistic women and women with learning disabilities being held there. Before that was the BBC “Panorama” exposé of the scandal at Whorlton Hall, which I cannot discuss in any detail due to ongoing legal cases.
All those reports were preceded by the scandal at Winterbourne View, revealed by BBC “Panorama” in 2011. Members will remember the scale of the outcry when that programme was broadcast. There was a feeling then that something might change. I remind the Minister that the coalition Government actually committed to closing all inappropriate in-patient beds for autistic people and people with learning disabilities by 2014.
At one time, reports and investigations into the scandals gave rise to the hope of change, but despite the relentless efforts of journalists, charities and activists, the criticisms reported in the CQC’s inquiry into Winterbourne View all that time ago are as true today as they were 12 years ago: there is a
“systemic failure to protect people or to investigate allegations of abuse”.
Each of the scandals I have outlined across the decade, from the events at Winterbourne View to those at the Edenfield Centre, shows striking similarities. I encourage Members and the Minister to read the safeguarding adults review on Whorlton Hall and to decide whether anything has changed since the inquiry into Winterbourne View, despite all the promises of action.
More recently, we seem to have entered a phase of total apathy. Each scandal that hits national TV or the press results in a more muted and defensive response from the Government. As calls to address repeated failed targets grow more desperate, less and less appears to be happening to rectify the situation.
In February, NHS England quietly published a report analysing 1,770 individual reviews of the care of autistic people and people with learning disabilities, including children, who were detained in in-patient services. The report was commissioned following the tragic deaths of Joanna, Jon and Ben at Cawston Park. It found evidence of high levels of restrictive practice, that people’s medication was not always reviewed in a timely way and that more than half the people were being detained a long way from home. Most concerningly, the report found that 41% of people did not need to be in hospital at all. NHS England stated that many people could not be discharged because there was no adequate care provision in the community and because staff did not always have the training necessary to support people’s transfer from hospital. These findings are a deplorable indictment of the Government’s failure to act.
We are now 13 years on from the inquiry into Winterbourne View and not a single Government target to reduce the use of in-patient beds has been met, as referred to by the right hon. and learned Member for South Swindon (Sir Robert Buckland) in his earlier intervention. After the coalition Government’s ambition to close all in-patient beds by 2014, a succession of watered-down targets have been announced over the years, none of which has been met. As the right hon. and learned Member said, the goal is now to close 50% of in-patient beds by March next year, but it looks impossible for the Government to meet even that much-delayed target. The latest data indicates that bed numbers will reduce not by half but by around only a quarter in 2023, compared with the 2015 benchmark.
Over the last three years, even the meagre progress made earlier has stagnated. The number of autistic people and people with learning disabilities in mental health hospitals has actually increased since the publication of the Government’s Building the Right Support action plan last July, which was meant to drive cross-Government action.
There is also a problem with the data itself, whereby data for past months is retrospectively amended, sometimes by quite large margins. That makes it difficult to understand with any accuracy how many people are being detained. Getting the data right really matters. When the risk of abuse is as high as the evidence suggests, it is a dereliction of duty to have so much variation in data collection. How are the Government supposed to measure progress when the targets keep shifting?
A similar story can be told when it comes to financial investment in the Building the Right Support agenda. The Government’s own review from last summer stated that
“the limited ability to analyse financial data…to provide a national perspective is a significant barrier to the effective oversight and management of the BtRS programme overall.”
An answer to my written parliamentary question confirmed that the Department of Health and Social Care did not hold data on how much money had been spent on developing community services for autistic people and people with learning disabilities, either since 2015 or since the Winterbourne View scandal in 2011. The data that was provided instead of the data I asked for showed that investment in community services had actually fallen between 2021-22 and 2022-23, from £62 million to £51 million, and that funding for discharging long-stay patients has remained frozen, despite the fact we now have rocketing inflation, meaning soaring costs to providers. That financial picture is clearly unacceptable.
In her response, the Minister may want to point to the draft Mental Health Bill. While the draft Bill includes some provisions to address the detention of autistic people and people with learning disabilities, concerns have been raised by charities that the Bill must be significantly strengthened if it is to achieve its aims. There are also concerns that the Bill will take years to come into force and will not end the scandal on its own, without urgent investment in both social care and mental health services.
In the meantime, last year’s Building the Right Support action plan is woefully inadequate. Not only was it published a full 11 years after Winterbourne View, but it is vacuous, it is unambitious and it has been derided by organisations working in the sector. I believe that to call it an action plan is absurd. Instead of a fully funded strategy for caring for people at home rather than in hospital, the Government have established the Building the Right Support delivery board, which is responsible for monitoring the commitments in the Building the Right Support action plan. After so many years of allowing mistreatment to continue, it seems pathetic that the best system of accountability the Government can come up with is a delivery board that I have discovered has met for only six hours in the 22 months since it was established.
We know from more than a decade of reports and evidence that investment in social care, in community support and in the workforce is critical to reducing the number of autistic people and people with learning disabilities who are detained in inappropriate in-patient settings. However, the Government have just announced that they are halving the already pitiful £500 million budget for the social care workforce for the next three years. I believe that that will have a severe impact on a workforce who are already overstretched and are operating with a vacancy rate of 11%. I ask the Minister what assessment her Department has made of the repercussions that the cut to the social care workforce budget will have on the quality of care.
I could go on listing the repeated failures of successive Conservative Governments to do anything about the matter. The fact is that well over 2,000 autistic people and people with learning disabilities are still being held in inappropriate in-patient units. Approximately one in 12 are being held in units rated inadequate by the CQC. Some 40% have been there for more than 10 years. Fewer than ever have a planned date of discharge. Many people are being detained far from home. The risk of abuse is shockingly high, as we saw in the cases highlighted by Channel 4’s “Dispatches” programme, yet at every turn Government Ministers have lacked any humility. Nor have they made any apology for their abject failure to get a grip on this national scandal.
I hope the response this evening will be different. Will the Government now finally stop choosing to ignore the issue? Will the Minister instead offer assurances that her Department will take urgent action to end the inappropriate detention of autistic people and of people with learning disabilities, which is destroying the lives of so many people detained and their families?
Deaths in Mental Health Care
Debate between Jim Shannon and Baroness Keeley(3 years, 12 months ago)
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Barbara Keeley (Worsley and Eccles South) (Lab)
It is a pleasure to speak in this debate with you in the Chair, Mr Stringer. I thank the Petitions Committee for granting this important debate and my hon. Friend the Member for Hartlepool (Mike Hill) for opening it, and I congratulate Melanie Leahy on the strength of her campaigning to get us to this debate.
As we have heard, Matthew’s case is a tragic one, with a catalogue of failures that culminated in his death. I know that nobody here can fail to be moved by what Matthew and his family went through—the hon. Member for South Suffolk (James Cartlidge), who has just spoken, certainly was. Melanie has been fighting for answers and justice for her son for eight years now; I pay tribute to the work she has done, but I also say it should not have been necessary.
Matthew was in the Linden Centre for only a few days. In that time, he reported a sexual assault to the police, but they took no follow-up action on his report. Staff claimed that he lacked mental capacity, despite no assessment being carried out. He was heavily medicated with anti-psychotics and tranquillisers, despite him telling staff that he would attempt to kill himself if he was given injections. As we have heard, only a week after being admitted, he was found hanging in his room and he died.
That catalogue of failures would be shocking in itself, but it ended with a young man dying. In cases such as Matthew’s, we have a duty to learn the lessons and ensure that others in mental health care do not end up dying preventable deaths.
Jim Shannon (Strangford) (DUP)
I sympathise greatly with the hon. Lady and the story that she is telling and that other hon. Members have told. Does she agree that when it comes to helping people who have mental and psychiatric issues, who need help more than anyone, it is important that facilities are modern? They need in-patient care and they need the staff to be trained and able to respond. If those things were improved, does she think that would be a step in the right direction to try to help people and prevent such tragedies from happening?
Barbara Keeley
There is much that needs to change, but the hon. Member is right that that is one aspect of it. The mental health estate is known for being run down and out of date.
The learning of lessons has not happened in the Linden Centre or in mental health services in Essex. The charity INQUEST has worked on more than 28 cases involving deaths in mental health settings in Essex since 2013, yet despite the many investigations, reports and inquests that have highlighted failures, preventable deaths have continued. At the Linden Centre, INQUEST is aware of six in-patients found hanging between 2004 and 2019. Despite repeated inspections and visits by the Care Quality Commission, people have continued to die in those services.
The ombudsman’s report found clear signs of a cover-up at the Linden Centre. As Melanie told me:
“Matthew had no key worker. Records of observation levels and when he had been observed were changed. His care plan was falsified after he died. His claims of rape were ignored. Lots of documents were missing and a whole catalogue of policy failings were uncovered.”
That speaks of a culture that is less interested in learning from failings than in avoiding the blame for Matthew’s death.
The only way to restore trust in our mental health services is to publicly demonstrate that all those issues, including the one that the hon. Member for Strangford (Jim Shannon) mentioned, are considered and addressed. Melanie Leahy has suggested that the only way to do that is through a full public inquiry. At the inquest into Matthew’s death, the coroner asked the NHS trust to consider commissioning an independent inquiry.
The ombudsman, in his recommendation, said that the review due to be held by NHS Improvement,
“should consider whether the broader evidence it sees suggests that a public inquiry is necessary.”
In an interview on ITV, the ombudsman went further on the failings, including about Matthew’s care plan being altered after he died and his claim of rape not being investigated. He described them as
“a catalogue of failings which are entirely unacceptable.”
He also said that he would fully support a public inquiry if one was recommended, and that he would like to have investigated further if he had had the powers.
Both public officials who have investigated Matthew’s death, the coroner and the ombudsman, have said that they would support a public inquiry. I ask the Minister, on behalf of Melanie Leahy, to set up a public inquiry. Only a public inquiry will have the transparency and broad participation needed to rebuild trust in the services. The Minister will know that that is the only way that witnesses can be compelled to give evidence without seeking to apportion blame, and evidence must be given on oath.
As Melanie has said,
“Since Matthew’s death I have been on a mission to get to the truth of what happened to Matthew and to get justice for him. On my journey I have not only found that many other families are in the same position as me, but also individuals who have the survived the quotes ‘care’ that they received.”
In this most tragic case, inadequate and neglectful care led to the death of a young man like Matthew. His mother has had to take on a fight over many years to get to the truth. I thank all the families and parents such as Melanie Leahy who have put so much of themselves into their campaign. I return to what she said to me:
“To say the current situation is not good enough is a massive understatement. We know what has to change and we have known for decades. What will make the Government take real action? How many times do we need to hear the same information and recommendations? How many more Matthews have to die?”
European Union (Finance) Bill
Debate between Jim Shannon and Baroness Keeley(9 years, 5 months ago)
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Barbara Keeley
I hesitate to say that I think we agree on this point, but I think we do. [Interruption.] All right, then: we enthusiastically agree on this point. It is very clear indeed that, particularly with youth unemployment, we have a serious problem. It is a problem throughout the EU. We must spend more on that and we must find a way of doing so. Although the Minister spoke at great length, he did not tell us at any point what the difference would be between the ongoing review in the EU and the existing commitments. We want to send a very strong message. Until the Bill is passed, it is our last chance for a considerable period to make these points strongly to the EU, and we believe that we should do so.
Jim Shannon (Strangford) (DUP)
One issue that concerns me in the area that I represent is the fishing industry. There is to be a review of the common fisheries policy. One thing that could come off the back of that is our young people getting jobs in the boats, because up until now they have not been encouraged to do so. We need not just a better common fisheries policy, but encouragement and incentives for our young people to take the jobs in the local fishing boats, and thereby create employment and prosperity for them as well. Does the hon. Lady agree?
Barbara Keeley
Indeed. We have focused a great deal on agricultural spending and the CAP, but I do not think any of us would say that there has been a fair deal for people in the fishing industry. Fisheries policy, in many places, has been a disaster and has caused great problems for our fishing industry. It is a shame and a pity if, as I think is the case, young people no longer believe that they can have a career in fisheries.
NHS Patient Data
Debate between Jim Shannon and Baroness Keeley(10 years, 8 months ago)
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Barbara Keeley
Very much so. I must tell the Minister that we have not had time to absorb all of what has happened at the HSCIC, but we are disturbed by much of what we have learned. It seems as if there has been a proliferation of organisations and committees and that, as the use of that data and commercial data has burgeoned, the NHS has lost control of what is going on. That is of real concern.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Lady on bringing this matter to debate and on her perseverance at every stage. Does she agree that although the commitment given regarding a patient’s right to their data will be respected, perhaps patients in the NHS see this issue from their own points of view? They do not see the IT implications of what is taking place; because of that, there need to be more assurances for the patient on what happens.
Barbara Keeley
I very much agree. Last night I tweeted that I was to have this debate today and I was astonished with the response I got—an awful lot of people are very concerned about the issue. I will come on to opt-out in a moment, but let me conclude the point I was making about the director of public assurance’s post being made redundant. There will be considerable interest from Parliament on the basis for and the terms of that redundancy. I hope there will be no suggestion of a compromise agreement or gagging clauses. There are serious questions to ask about some of the activities.
While Dr Davies is still in post, there are a number of questions to ask about his role and those of his colleagues in the NHS Information Centre that later became the HSCIC. Dr Davies has been the chair of the four-person data access advisory group. Having two senior HSCIC employees on the advisory group on sensitive data releases, including its chair, brought criticism about a lack of independence. As chair of the group, Dr Davies also had the right to approve data releases unilaterally from the HSCIC, outside the committee. He was therefore in a powerful position. Indeed, it was reported in The Guardian last year that Dr Davies used that power to release to the Cabinet Office the confidential medical records of teenagers taking part in the national citizens service.
Perhaps more recently, Dr Davies’s views were becoming out of line on some aspects of the Government’s stance on care data. The Guardian reported in January that Dr Davies said that there was a “small risk” that certain patients could be “re-identified”, because insurers, pharmaceutical companies and other companies had their own medical data that could be matched against the pseudonymised records. He said:
“You may be able to identify people if you had a lot of data. It depends on how people will use the data once they have it. But I think it is a small, theoretical risk”.
The risks in this area have been rightly getting much attention and the Health Committee heard more about them this afternoon. Examples can be taken from the websites of both Harvey Walsh, a company that boasted of having more than a billion linked patient-level records and an ability to track patients over time, and OmegaSolver, the company with the patient analyser tool that it claimed can track patients throughout their hospital care.
In the case of OmegaSolver, its website held example screens showing use of its Patient Analyser tool, which it said could track actual patients within every hospital in England, providing up-to-date information for every disease area.
Care Bill [Lords]
Debate between Jim Shannon and Baroness Keeley(10 years, 8 months ago)
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Jim Shannon (Strangford) (DUP)
I was under the illusion that there would be five speakers ahead of me, but I am none the less pleased to make some comments on amendments (a) and (b) to Government new clause 34, and on new clause 25. I thank the hon. Member for Totnes (Dr Wollaston) for setting the scene, and the hon. Member for Worsley and Eccles South (Barbara Keeley) for her contribution.
My inbox, like many others, has been full with messages from various charities on different aspects of the Bill. Having sat on the Care Public Bill Committee, I can well understand many of their concerns. I received a briefing from Cancer Research UK, as many other Members did. It was informative and clear, and raised points that I do not believe have been addressed in the Bill and require greater clarity through amendment.
Along with Cancer Research UK, I warmly welcome the clauses that will introduce the Health Research Authority as a non-departmental government body. I have the highest respect for the Minister, but last night clarity on this was sought by the shadow Secretary of State, the right hon. Member for Leigh (Andy Burnham), the hon. Members for Easington (Grahame M. Morris) and for Worsley and Eccles South (Barbara Keeley) and me. With respect, I do not think that Hansard gives the clarification that right hon. and hon. Members, Cancer Research UK and Macmillan are seeking. I am hopeful that the Minister will today be able to give us that assurance and clarity.
Clarification of the amendment of section 261 of the Health and Social Care Act 2012 is needed to ensure that access to data for research is not restricted on the basis of the amendment. Cancer Research UK states:
“While we appreciate the context of this amendment and understand that the motive behind it is to avoid inappropriate disclosures of data, we are concerned that the wording of this is unclear. We would like reassurance that access to data for researchers is included under ‘provision of health care and adult social care’ and that access to research data will not be restricted on the basis of this amendment.”
I hope the Minister will be able to provide assurance on that.
Cancer Research UK is one of the largest funders of clinical research in the United Kingdom of Great Britain and Northern Ireland. It is currently running more than 240 clinical trials, which in 2012 recruited some 37,000 patients. Clinical research is important to find drugs that work and treatment that saves lives. Today in Westminster Hall, we were made aware that with better access to new cancer drugs, 5,000 more people would be alive today and that many more lives could be saved. It is essential that we develop an understanding of both new and existing treatments, and that they are offered through the NHS. We therefore want to see a regulation and governance system in the NHS that promotes and supports research, while also protecting patients.
There has been significant controversy surrounding the proposed care data upload of GP records to the Health and Social Care Information Centre and there have been at least two debates in Westminster Hall on these issues where Members have expressed their concerns strongly. Concerns have been expressed that the public have been insufficiently informed about this upload and that data may be released inappropriately, for example to insurance or marketing companies. I know the Minister replied last night to my intervention, but the doubt lingers even today within Cancer Research UK, Macmillan Care and other charities that had expressed initial concerns. I have concerns regarding the nature of the release, but it was never my intention to restrict data going to the likes of Macmillan or Cancer Research UK to aid in their fight against the scourge of cancer.
Barbara Keeley
I read a blog article this morning written from the point of view of people with disabilities who had real concerns about the mention of insurance providers. It is often very difficult for people with serious conditions to get insurance, even travel insurance, and the notion that their medical data are being linked to insurance information, or might be sold in future to companies that are insurance providers—even if those are health and social care providers—is a real worry for them. They are really fearful about this and I think we would see a mass opt-out by people who have that fear.
Jim Shannon
That is the issue, summed up in a couple of sentences. The Minister may look to his civil servants for some direction; he may have it already. If so, that is good news.
Francis Report
Debate between Jim Shannon and Baroness Keeley(10 years, 8 months ago)
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Barbara Keeley (Worsley and Eccles South) (Lab)
I want to talk about the Francis report, which detailed failures that were a betrayal of NHS values—we have heard repeatedly about those failures in this debate—but before I do so I will speak briefly about NHS change day, which shows so much that is good about the values of the NHS.
This week saw the second NHS change day. It is a front line-led movement, the largest of its kind, with the shared purpose of improving health and care. Its mission is to inspire and mobilise people everywhere—NHS staff, patients and the public—to do something better together to improve care for people. Hon. Members have until 31 March to make pledges for NHS changes, and it may be that Ministers and shadow Ministers will want to adopt some of them. Some inspirational pledges have been made that are making a real difference to care. An example I like is the “Hello, my name is...” campaign by Dr Kate Granger.
In December 2012, Dr Kate Granger was herself an in-patient, and she noticed how infrequently health care professionals introduced themselves. She wrote:
“As a healthcare professional you know so much about your patient. You know their name, their personal details, their health conditions, and much more. What do we as patients know about our healthcare professionals? The answer is often absolutely nothing, sometimes it seems not even their names. The balance of power is very one-sided in favour of the healthcare professional.”
It might seem astonishing that a campaign to encourage health care staff to introduce themselves to patients is needed, but it is an important part of the change in culture that people are trying to bring about.
Some 390,000 pledges have been made for the second NHS change day. It will run to the end of March, so that figure might reach half a million. This is a very good movement inside the NHS to improve care, in addition to the important matters we are discussing today. It is valuable that NHS staff, patients and carers are making pledges to do just that.
It is clear that staffing is one of the most important issues in the Francis report. The report talks about
“a lack of staff, both in terms of absolute numbers and appropriate skills”.
A survey of nurses published by Nursing Times one year on from the Francis report found that more than half those surveyed believed that their wards remained dangerously understaffed. Indeed, 39% of those who responded warned that staffing levels had worsened in the past 12 months. Various numbers have been bandied about during the debate, but that is a key factor. Only 22%—a fifth—of the nurses surveyed reported an improvement. I think it notable that more than half said that their own wards were dangerously understaffed, because that is the same percentage as a year ago. If understaffing was identified as an issue in the Francis report, it is still an issue now.
I believe that one pledge that politicians can make to improve care in the NHS is a pledge to support the Safe Staffing Alliance. The fundamental standard is a ratio of no more than eight patients to one nurse; other key aspects of safe staffing are use of a management tool to work out the safe staffing levels and the publication of staffing levels so that they can be seen by patients and their families. Let me repeat what I have said to Ministers a number of times over the last year, now that they recognise that Salford Royal is an excellent hospital. Salford Royal works out minimum staffing levels with a management tool, and publishes actual versus planned staffing levels on whiteboards on the wards every day. Again and again, we hear about failures in hospitals that, like the failure at Mid Staffordshire, are related to understaffing and the awful position in which it puts nursing staff. In another debate on this subject, the Secretary of State said:
“Salford Royal is one of the best hospitals in the country and we should always learn from what it does”.—[Official Report, 19 November 2013; Vol. 570, c. 1107.]
I hope that he will now start to take his own advice.
People in Salford were thrilled when Salford Royal’s chief executive, David Dalton, was knighted earlier this year. I believe that that was well deserved, because Salford Royal and David Dalton have done a huge amount to improve patient safety and reduce mortality. In its report “After Francis”, the Health Committee said that it had
“been impressed by the approach of Salford Royal NHS Foundation Trust to the development of a staffing management tool. This appears to the Committee to be good practice, and the Committee recommends the adoption of this or similar systems across the NHS.”
Other Members have also mentioned that.
The Health Committee also said—we keep returning to staffing levels—that
“Ensuring adequate levels of both clinically- and non-clinically-qualified staff in all circumstances is therefore a fundamental requirement of high quality care, whatever the financial circumstances.”
As I have said, that is a key point. It is clear to me what should be done to ensure safe staffing levels—we have that excellent example—but it is also clear to me that the Government’s proposal for monthly publication of staffing levels is not adequate. Robert Francis is a convert to the position of the Safe Staffing Alliance and has said that minimum safe staffing levels should be drawn up by the National Institute for Health and Clinical Excellence and policed by the Care Quality Commission. He did not say that in his report, but he has subsequently said it to the CQC.
As we heard earlier in the debate, the Francis report was published as the Government’s NHS reforms took effect. It is clear that the structural changes involved in their unnecessary top-down reorganisation have caused upheaval and created new problems. Many Members have talked about restructuring decisions today. Those decisions are proving impossible to implement in many parts of the country, because there is no one really in charge. The chair of the British Medical Association, Dr Mark Porter, made that point earlier this year. Reorganisation costs are another problem, because they have taken money away from patient care. Change of that kind has not improved care in the NHS and has worked against the recommendations of the Francis report. As we heard earlier, the findings of surveys identify the problems that have been caused: seven out of 10 NHS staff members think that the Government’s reorganisation has had a negative impact on patient care, while only 3% think that it has improved patient care. That is a vote against what the Government have done.
Nothing makes the impact of the reforms clearer than the deteriorating performance of A and E departments and the crisis in recruitment to them. It is interesting to note the Public Accounts Committee report this week, which is in a very similar vein to that of the Health Committee. We know that more patients are waiting in A and E departments for longer than four hours: last year the figure was 1 million, whereas in 2009-10 it was only 345,000. The numbers speak for themselves. We know, too, that emergency admissions have increased by 51% in the past decade, with a 26% rise in admissions of over-85s in four years. That is serious: the biggest cause of pressure on local A and E services is the rising number of frail and older people with multiple long-term conditions.
Some Members have questioned the relevance of this to the Francis report, saying we should not be discussing all these issues, but I disagree. If we are concerned about safety and mortality rates, what happens on admission to A and E is a key factor. The consequences if things start going wrong was well understood by Salford Royal hospital: more people were dying unnecessarily at the weekends because of a lack of consultant cover, so the hospital changed that. Work on safety does not ignore what is going on in A and E or how much consultant cover there is; instead, it takes that into account and does something about it.
I am concerned that the number of frail older people attending A and E will continue to increase and that that situation will worsen as a result of continued cuts to social care budgets. We had a warning about that from Sandie Keene, director of the Association of Directors of Adult Social Services. She said
“it is absolutely clear that all the ingenuity and skill that we have brought to cushioning vulnerable people as far as possible from the effects of the economic circumstances cannot be stretched any further, and that some of the people we have responsibilities for may be affected by serious reductions in service—with more in the pipeline over the next two years.”
Unfortunately, excellent though our local hospital is, we are facing a situation where 1,000 people will lose their care packages this year, and I am very concerned about that.
Jim Shannon
The Francis report makes some recommendations on mental health, which is in the social care category. One of those suggestions was the training of family members to look after those with mental health conditions better at home, so as to improve their quality of life and help rehabilitate them. I do not see much of that in the report. Would the hon. Lady like there to be more emphasis on family members who are under pressure and are helping others with mental health conditions at home?
Barbara Keeley
Indeed, and our most recent inquiries in the Health Committee are about mental health issues. There is a series of issues that need to be looked at. It is rare in a health debate for me not to mention carers. We need to be realistic about the fact that we are now putting a huge amount of pressure on those carers. Removing social care packages will affect our local hospital, but it will also affect those family members, because in the end who is the person who cares? It is the family member to whom the role falls.
To conclude the point about staffing issues in A and E, we found in our earlier inquiry that fewer than one in five emergency departments were able to provide consultant cover for 16 hours a day during the working week, and the figure is lower at weekends. The whole issue of mortality rates is very much linked to that, and we cannot ignore it. We must keep focusing on the problem with recruitment and the lack of consultant cover.
My right hon. Friend the shadow Health Secretary referred to the warnings by the president of the College of Emergency Medicine. During the time when the college was warning about these issues, Ministers were tied up in knots by the challenges of reorganisation. That is key. Ministers have insisted that they are acting now, but it is clear that those warnings from the CEM in 2010 did not get enough attention until recently. The staffing situation can hardly improve when so few higher trainee posts in emergency medicine are being filled. In the latest recruitment round, 156 out of 193 higher trainee emergency medicine posts went unfilled.
My final point is about the difficulties caused by the cost of the NHS reorganisation reforms. In the past few months the spotlight has fallen on unnecessary spending and waste. We all should be concerned about that. We know that emergency departments are spending £120 million a year on locums, and this could be getting worse. The Health Committee has also recently focused on redundancy costs, which have absorbed £1.4 billion of NHS funding since 2010, with £435 million attributed just to restructuring costs. The scandal of the scale of redundancy payments to NHS staff was made worse when we found out that such a revolving door was in operation. The Health Committee was told that of 19,100 people made redundant by the NHS, 3,200 were subsequently rehired by the NHS, including 2,500 rehired within a year and more than 400 rehired within 28 days. There were reports of payments of £605,000 made to an NHS executive whose husband also received a £345,000 pay-off, with both reported to have been subsequently rehired elsewhere in the NHS. That is a scandal. I know that the Minister said it would not happen again, but that is £1 million that could have been spent on patient care.
General Matters
Debate between Jim Shannon and Baroness Keeley(12 years, 2 months ago)
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Barbara Keeley (Worsley and Eccles South) (Lab)
May I, too, welcome the Deputy Leader of the House to his post and to the debate? I once replied to 400 speeches—40, not 400—in a pre-recess Adjournment debate, so I understand the task that faces him.
Last week, I said at Culture, Media and Sport questions:
“The all-party group on women’s sport and fitness wants to see our fantastic women athletes in the media, inspiring girls and women of all ages to take part in sport. However, outside the Olympics, women’s sport gets 5% of the media coverage and less than 1% of the commercial sponsorship.”—[Official Report, 13 September 2012; Vol. 550, c. 413.]
I asked the Minister whether he agreed that the situation must change. I was surprised at how effective my question was, because on Saturday the Secretary of State for Culture, Media and Sport wrote to all national broadcasters telling them to reassess their coverage of women’s sport. I agree with that action, because the lack of media coverage for women’s sport is a vital issue.
Across our leading newspapers there are no female sports editors. Only 2% of the articles and 1% of the images in the sports pages of the national newspapers are devoted to female athletes and women’s sport. Earlier this year, the Women’s Sport and Fitness Foundation reviewed the sports pages across all national daily newspapers to assess the level of coverage given to women’s sport. I am indebted to the Women’s Sport and Fitness Foundation for the authoritative reports and statistics that it produces on women’s sport. Over the three days of the review, those newspapers published more than 1,500 articles on sport, yet only 2% were on women’s sport. TV sports schedules were also reviewed. On one Friday, of the 72 hours of sport broadcast on three Sky channels, only three were devoted to women’s sport. I am sad to say that the online coverage of women’s sport reviewed was little better—although I should mention the Sportsister website, which is dedicated to women’s sport. However, apart from that exception, on the 10 sports news internet sites that were reviewed on one day in April, only 1% of the links were to articles on female sports, and there was not a single image of a female athlete on the front page of the top 10 websites.
That is the normal situation outside the Olympics, but if that level of coverage had applied during the Olympics, we would have missed a great deal. Team GB women athletes won 22 of our 65 medals, 10 of them gold. If our women athletes had received only 1% or 2% of the news coverage during that time, we would possibly have seen some of Jessica Ennis’s gold in the heptathlon, but what would we have missed? We would have missed Nicola Adams winning the historic first gold in the boxing; Victoria Pendleton’s individual gold; the team gold for Dani King, Laura Trott and Joanna Rowsell, and Laura Trott’s gold in the omnium; the rowing golds—won when we had got hardly any gold medals—of Heather Stanning and Helen Glover, Katherine Grainger and Anna Watkins, and Katherine Copeland and Sophie Hosking; Charlotte Dujardin’s magnificent gold in the dressage and her gold in the mixed team dressage; and Jade Jones’s gold in the taekwondo.
If women’s sport in the Olympics had received only 5% of media coverage or three of the 72 hours of broadcast coverage, we would definitely not have seen Gemma Gibbons’s silver in the judo or her emotional response, which for many ranks as one of the high points of the Olympics; Christine Ohuruogu’s magnificent defence of her earlier performance, with a silver in the 400 metres; Rebecca Adlington’s bronzes in the 400 and 800 metres swimming; the women’s team bronze in hockey; Samantha Murray’s silver in the modern pentathlon; the bronze for Beth Tweddle—a wonderful gymnast at the end of her career—on the uneven bars; or even Lizzie Armitstead’s race for silver in the pouring rain, our very first medal for Team GB.
It would have been ridiculous if we had not seen those moments in the women’s events, yet that is what happens all the time outside the Olympics, with very few exceptions. There is netball coverage on Sky and some coverage of women’s football on the BBC, albeit not enough—although I should mention that BBC2 is showing the England women’s game against Croatia tomorrow, an important qualifier for Euro 2013. There was even some live coverage of the England women’s cricket team in the T20 recently, but there should be so much more coverage of women’s sport.
Let us take women’s rugby as an example. The Rugby Football Union feels that there are great opportunities for growth in women’s rugby. The numbers of those playing are up 91% since 2004, with more than 13,000 women and girls currently registered as playing rugby each week across 533 clubs. England hosted the 2010 women’s rugby world cup, which was deemed to be the most successful world cup to date. The legacy of that event was a much greater increase in the number of women taking up rugby than in ordinary years. However, although the RFU feels that there are great opportunities for growth in the women’s game, I feel that they will be hard to achieve at the current levels of media coverage, which I outlined earlier.
Jim Shannon (Strangford) (DUP)
Does the hon. Lady agree that this is not only about encouraging women’s sport through the media of television, radio and so on? Is it not also about ensuring that there should be free entry to games wherever possible? For example, the Northern Ireland women’s football team are playing tomorrow night, and entry is free in order to encourage everyone to go. That is another way of encouraging media coverage and ensuring that games are promoted.
Barbara Keeley
That is right, but that has not happened in women’s football. I have to say, however, that I would be much more comfortable if people were prepared to pay to watch women’s rugby and football, because I think that those games are as good as the men’s.
That leads me to the subject of the success of the England women’s rugby team. They are an extremely successful team internationally. In the 2011-12 season, our team beat the current champions, New Zealand, in a three-match test series, as well as winning their seventh six nations tournament in a row, which was also their sixth grand slam. The England women’s sevens team won the European championships, the European grand prix series and two out of three International Rugby Board challenge series events. Despite all that success, however, only two of the games were broadcast live throughout the whole season. England will host the rugby world cup in 2015, and we must ensure that plans are in place to reach the widest possible audience, in order to inspire women and girls to watch and play rugby.
What needs to be done? As the Secretary of State said in her letter to broadcasters, the Olympics and Paralympics have shone a spotlight on women’s sport, and we need to ensure that that continues after the games. She also highlighted the fact that the substantial television audiences for the summer Olympics illustrated the public appetite for mainstream coverage of women’s sport. Indeed, 16.3 million people watched Jessica Ennis win her heptathlon gold, and 11.3 million watched Rebecca Adlington win her bronze medal in the 800 metres freestyle swimming event. As we got further into the tournament, we also saw capacity audiences watching the England women’s football team, and it was a pity that the team did not make more progress.
I support the Secretary of State’s initiative and her proposal to meet those broadcasters, but there is a need to go much further. The Women’s Sport and Fitness Foundation has identified three priority areas. First and foremost, there should be more media coverage of women’s sport. We need that increased media profile because it will be crucial to drive public interest and to fill the grounds for games. It will also be vital to drive the commercial sponsorship of women’s sport. Let us remember that women in sport are unfairly treated in that regard. They have only 1% of the total commercial sponsorship of sport. When we think of our great women cyclists, we must remember that there is no Team Sky for women. Lizzie Armitstead cycles in a team based in the Netherlands, which I understand is losing its sponsor at the end of 2012 She has had fabulous medals success, but will have no sponsorship by the end of the year.
As a second priority, our female athletes need to be showcased as role models. Having positive, active role models is crucial if girls and young women are to be inspired to lead physically active, healthy lifestyles. Surveys conducted since the Olympics have shown that 81% of adults agree that the female athletes at London 2012 were better role models than other female celebrities. It is not about dieting to be slim; it could be about exercising to be slim.
Thirdly, we must concentrate on increased leadership. Only 22% of leadership positions in sport are held by women. That figure needs to increase to ensure that sport is governed and run in ways that appeal to the widest possible market. I would like the Secretary of State to tell me whether she regards those three areas as priorities, and what action her Department plans to take on them in the coming months.
Finally, the all-party parliamentary group on women’s sport and fitness has asked the Culture, Media and Sport Select Committee to consider undertaking an inquiry into the media profile of women’s sport. Through the medium of this debate, I would like to urge the Chair and members of the Select Committee to consider that proposal, because this is absolutely the key time to make a difference to women’s sport.
Caring Responsibilities
Debate between Jim Shannon and Baroness Keeley(13 years, 5 months ago)
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Jim Shannon (Strangford) (DUP)
I do not think of my constituency as different from anyone else’s, so I am sure that the hon. Lady will agree that young carers clearly play an important role. Those who are 16 years old and under do not qualify for any financial assistance, but their role is critical for the family, parents and those they look after. Does she feel that the coalition Government should address the importance of young carers?
Barbara Keeley
I very much agree. I have a point to make later about that topic, because the staff who work on the young carers project in my constituency have said that they are very concerned about carers losing their education maintenance allowance. That is the one support that the state gave young carers and it is going, which is a worry.
To return to the testimony from Parkinson’s UK, the final points were about more carers contacting the staff member to ask for help finding respite because they are struggling to cope; financially, they cannot now afford a break, a treat or a holiday. I am glad that the hon. Member for Banbury raised that point. The staff member said:
“I know of one carer who has had to take on a part time cleaning job in the early evening because money is so tight. She puts her husband to bed before she leaves”—
for work—
“at 4pm so that he is safer and so she won’t worry that he will fall while she is out.”
I think that we would agree that we would rail at care agencies that put a person to bed at 6 or 8 o’clock, yet this carer has to put her husband to bed at 4 o’clock because that is the only way that she can do the cleaning job that she has to do.
I also had some input from a branch of Age Concern in Greater Manchester about how cuts to grants are affecting its dementia support service, which is important because it is another line of support. Cuts to grants of 40% over the next three years are affecting its capacity to deliver individual and group support. That goes against objectives 5 and 7 of the national dementia strategy. The staff member told me:
“Carer support groups have had to close. These are groups where carers can get a break, have a chat to other carers and get advice and information from staff. These groups help to maintain morale and prevent carers from becoming socially isolated.”
Even though there are personal budgets, which will come in in Greater Manchester, carers of people with dementia often find it hard to mix in other social groups because of the “different” behaviour of the person with dementia. Carers have described the groups as a “lifeline” and something “to look forward to”. The fact that they are being cut back is important.
The proactive support to carers of phoning them every few weeks is another aspect of Age Concern’s work that is being cut. The staff member said:
“We now have to wait for them to contact us for time-limited intervention. We know that many older people are proud and longsuffering and will often suffer in silence rather than ask for help.”
Before the cuts, branches of Age Concern in Greater Manchester ran special events for carers such as a carers day each year, parties and trips. The reduction in funding means that it can no longer offer the extras that it knows give people a better quality of life. I am very concerned to hear that carers in my area in Greater Manchester are starting to suffer.
I want to return to the two sides to the debate—values and choices. We are fortunate in Salford because, due to the way in which the cuts and the organisational turmoil in the NHS are being managed, we are not suffering as much as other areas. There are choices. Labour-run Salford city council is now one of only 15% of local councils still providing support to people with moderate care needs, as well as to those with substantial or critical needs. We are fortunate to have an excellent carers’ centre run by the Princess Royal Trust for Carers. Salford has tried to ensure that carers continue to be supported through these difficult times. As I mentioned earlier, however much the council and our local NHS bodies support carers and try to maintain what they are providing, the national changes and cuts affect our carers.
The young carers project will be affected when the young carers lose their education maintenance allowance. The centre manager told me of two other concerns: the changes to benefits and disabled people being called in to take work capability assessments. The extra worry of having to take them and of having benefits curtailed are starting to affect carers.
The centre manager also said that a major concern for her organisation was that although the carers’ centre was very well established, the service has to go out to tender through the joint commissioning process next year. She said:
“We are aware of a number of carers’ services which have gone out to tender in other areas, and bids have come in from organizations and agencies which have no experience, knowledge or expertise in carers and carer issues, including organizations from abroad.”
What reassurance can the Minister give to staff of the carers’ centre that an established, trusted and effective organisation such as theirs will not be undercut in the tendering process by organisations with no local knowledge and no experience or expertise with carers or in carers’ issues? Our carers in Salford would lose out if they lost the valuable support that they get from their carers’ centre.
The Government’s economic policies are damaging support to carers. Government cuts to local council budgets have gone too far, too fast. Councils pleaded not to have their budget cuts front-loaded. We have lost £1 billion from adult care services at a time of rising need, and we have lost billions in grants to the voluntary sector, but the worst thing is that we are only a few months into the first year of cuts, and we can already see the impact on carers. Carers are fearful about the cuts and distressed that they cannot manage financially. People with serious conditions such as Parkinson’s are being turned down for attendance allowance and made to feel like beggars if they appeal. Young carers are losing their education maintenance allowance. Carers are now unable to afford a break or holiday. It is shameful that a carer should have to take a part-time cleaning job and put her husband to bed at 4 pm.
That is not a record of which the coalition Government can be proud, and it is so early in this Parliament. I hope that carers week gives Ministers time to rethink the impact of the cuts that they are making.
Public Sector Funding
Debate between Jim Shannon and Baroness Keeley(13 years, 8 months ago)
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Barbara Keeley
Indeed. That is right, if there is an urge, as the Minister has said, to discuss partnerships between Government, business and civil society. I talked earlier about employee volunteering from business in the voluntary sector. That has to be arranged, however, because there is a big, wide cultural gap between the private sector and the voluntary sector. We cannot just leave a new business volunteer to flounder in an organisation. I used to arrange business volunteering as part of a job that I did in the past. I know that someone needs to be the link in-between, so I very much agree with my hon. Friend.
The Minister described one strand of action for the Government as
“encouraging more social action in our communities”.—[Official Report, 28 February 2011; Vol. 524, c. 132.]
How on earth is that going to happen if we cut away the infrastructure of organisations such as TimeBank?
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Lady on securing the debate. She has very clearly outlined the case for volunteers in our society. Every one of us in the Chamber this morning will be aware of the work of volunteers. It seems as if Ministers are diverting money to sports, heritage and arts, and away from voluntary and charity groups and those who do good work in the community. Does she share my concern that there are more worthy cases in relation to the voluntary and charity work that is done in the community?
Barbara Keeley
Indeed. I said in my opening paragraph that in the current economic context issues such as debt advice and other ways in which people volunteer in communities and societies are crucial. Volunteering in sports organisations is important, and sport and culture are important too, but in the current context the social function of volunteering roles are vital, so I agree with the hon. Gentleman.
I shall return to the question of how the Government will encourage more social action if they close off financial support to those small—and they are small—but vital charities that support and encourage people to volunteer. I just want to touch briefly on support for carers, which is one strand of the work that TimeBank is seeking to do, and which is under threat. Support for carers is vital and will become even more so, given the cuts and uncertainty that are now affecting us as a result of proposals in the Health and Social Care Bill. Schemes such as the one developed by TimeBank are essential, and working with Carers UK to put new carers in contact with experienced carers could be a lifeline. Such a scheme helps the new carer to care more effectively, which is important in our communities.