Medical Records (Confidentiality)

Julian Lewis Excerpts

Tuesday 11th February 2014 Westminster Hall

[Mr George Mudie (Leeds East) (Lab)]

It is a pleasure to hold this debate under your distinguished chairmanship, Mr Hollobone.

The debate deals with one of the most accepted and appreciated relationships, which is that between patients and their doctor, with the knowledge that whatever information is recorded by the GP is confidential and kept securely in the medical records held by the practice. Next month, that will change. Under controversial legislation passed in 2012, family doctors will be required to pass to a new national database created by NHS England all the medical records of the patients in that practice.

The personal GP record may be added to by any other social care organisation that deals with the patient and with hospital records that exist for an individual. This is being done, according to NHS England, to improve the delivery of health care to benefit researchers inside and outside the national health service. I have no reason to suggest that this move will not lead to improvements in health care, and, no doubt, the Minister will deal with that matter more fully.

I have sought the debate for two main reasons. My first concern is shared by many people, including some present in the Chamber: the security dangers of bringing all such personal data together in one huge national database. The second reason is my dismay and even anger at the deliberate manner in which the public have been deprived of consultation and information on what could be, and I think will be, a significant threat to their right of privacy in respect of their medical records.

On the first threat, to security, we are assured by NHS England that the information

“will be stored…in a secure environment with the highest standards of information governance and technical expertise to protect the data.”

If patients are reassured by that statement, the US Government must have lower standards. For example, Angela Merkel, the German Chancellor, learned about the USA hacking her personal phone from sources inside the US. A young lad from Glasgow was extradited to the USA in the past 19 months to face charges, because from his Govan bedroom he had breached military systems in the US. This weekend, closer to home, Barclays bank admitted that delicate, sensitive and important financial details of 35,000 of its customers had been stolen.

[Dr Julian Lewis (New Forest East) (Con)]

Does the hon. Gentleman believe, as I do, that the single most important point, which I hope that he will elaborate for us, is whether the identities of the people whose data are being stored are also being stored? If they are being stored, I am entirely with him; if they are not and only data without identity are being stored, there might be more to be said for the scheme. I am interested to know what he has to say.

[Mr Mudie]

That is an important intervention, and I will deal with that, because it gets to the nub of the matter. Health care improved, fine, but there must be a balance with the right of individuals to have their privacy. I will deal with that.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure, Mr Hollobone, to serve under your chairmanship. I congratulate the hon. Member for Leeds East (Mr Mudie) on securing this debate and all hon. Members on their contributions.

I pay particular tribute to my hon. Friend the Member for Mid Norfolk (George Freeman) for his excellent speech, in which he highlighted the importance of sharing data to improve patient care. He talked about empowering patients to take greater control over their health care. That is important and the key to it is ensuring that patients have the right data to do so. He also talked about improving research, ensuring that we can properly combat disease and linking data properly to understand exactly how to find cures for rare diseases. Importantly, he referred to the fact that we need properly to understand how good health services are, and to recognise where there is good practice. That is particularly important following the Francis inquiry and report, which outlined the importance of delivering high-quality care and transparent and properly used data to deliver that. He made those points very well.

[Dr Julian Lewis]

My hon. Friend the Member for Mid Norfolk (George Freeman) also referred to a major project involving people at the Maudsley hospital who had suffered serious mental illness. I want to hear from the Minister that there is no way under the sun that people who have suffered mental illness, for example, would find their data getting into the wrong hands. Without that guarantee, the project seems to be very dangerous.

[Dr Poulter]

In the time available, it is difficult to speak about detailed points. I apologise to my hon. Friend for that and I will write to him addressing some of the points that he raises. However, I can assure him that robust safeguards are already in place to protect patients with mental illness, and those safeguards will remain robust, if not more so under the systems that we will put in place.

It is important to recognise that the big challenge facing the health and care system is the fact that in the past we have had too much silo working, which has been to the detriment of patient care. The health system has often operated in a fragmented and siloed way. The operation of the health and care systems is not integrated and joined up. Key to driving improvements in patient care is ensuring that we join up the information that informs what good care looks like. Integration involves ensuring that a process exists to join up health and care information to improve care for patients.

We want to look after people with diabetes, dementia and long-term illnesses and to give them dignity of care in their own homes. It is important to do that and to have the right information and evidence to do so. We are well into that journey. The £3.8 billion integration fund will help with the provision of services, and the health and social care information centre will help us to get the right evidence base to drive properly joined-up, integrated care.

Mrs M. Barnes (NHS Treatment)

Julian Lewis Excerpts

Thursday 6th February 2014 Commons Chamber

[Kevin Barron (Rother Valley) (Lab)]

I thank Mr Speaker for allowing me to raise this subject in today’s Adjournment debate. I understand that he makes the decision on a Thursday afternoon.

I wish to discuss the treatment of a constituent of mine, Mrs Monica Barnes, who lives in the village of South Anston. I have been dealing with her over many years now, regarding different aspects of her health care, but my reason for wanting to speak today has to do with what has been recorded on her patient records at the Kiveton Park medical centre and the effect it may have had on her clinical treatment.

Mrs Barnes wrote to me on 5 July 2002. She said:

“Whenever I have attempted to obtain treatment some reference to litigation past or present has shown itself in my medical records and/or in letters of referral from the GP. This clearly shows there to be discrimination in my case. This time reference is made in the Patients Summary to the court case. See copy sent to me in very small print, enclosed.”

I have indeed got the patient’s summary. It is dated 18 January 2001. On the bottom, it says “await judges ruling”. My constituent contacted the Information Commissioner, and a letter was sent to the practice manager on 5 September 2002. It contained the patient’s summary and the court case entry. It said:

“In order for me to assess the practice’s compliance with the First Principle, I would be grateful if you could confirm whether individuals are made aware that personal data about them may be disclosed to other health professionals in the course of their care and treatment and the extent of such disclosures. In particular, could you please confirm whether such data as were disclosed in Mrs Barnes’ case are disclosed to other health professionals as a matter of routine, which of the conditions in the Schedules the practice is relying upon in order to make any such disclosure and whether individuals are made aware of the disclosure. Given that Mrs Barnes did not expect this, I would also welcome confirmation of these issues with regard to her case. If there is no legitimate basis for holding and disclosing the data in question when Mrs Barnes did not expect such processing, it is likely to be in contravention of the requirements of the First Principle.”

Mrs Barnes received a reply from the Information Commissioner on 6 March 2003. I have to say that the Information Commissioner had to write to the practice on 16 December to remind it of the letter it had been sent on 5 September 2002 about what was held on Mrs Barnes’s record.

Mrs Barnes received a reply from the Information Commissioner. It said:

“I understand that having considered its relevance to your patient summary records, the practice has removed the entry which states “court case”. (I have requested that the practice ensures that this does not appear elsewhere in your medical records).”

That was dated 6 March 2003. Presumably, my constituent would have been quite happy with such a positive reply. The letter went on to say:

“Consequently, on the balance of probabilities it does seem that the data in question is not relevant and is excessive for medical purposes. It is also our view that on the balance of probability it does seem that it was not necessary for the practice to disclose the details without your consent, when you did not expect this.”

That is a pretty firm statement that the Information Commissioner felt that it was wrong for the records to have been kept in such a way.

In the autumn of 2010, Mrs Barnes decided to join another practice in central Rotherham that had been built in the walk-in centre that had been opened. Her medical records were requested by the South Riding Health Services Support Agency, an organisation that I had never heard of in my 20-odd years as an MP, and they were sent on 3 November before being sent on to the new practice in Rotherham town centre. When Mrs Barnes visited her new doctor in November 2010, the practice had her medical records but on her next attendance her new GP said that he did not have them. Mrs Barnes told me that she was prompted to investigate their whereabouts.

In 2011, Mrs Barnes asked me to write to the chief executive of NHS Rotherham, who wrote back to me on 11 March saying that he had had the case investigated by his complaints officer who confirmed that the notes were sent on 3 November. The chief executive went on to say:

“However, I am informed that shortly after forwarding the medical records…the…practice received a letter from the Information Commissioners office advising them that the amendments were to be made to Mrs Barnes’…records. In order to comply with the Commissioners advice, the notes had to be retrieved from Mrs Barnes’ current GP via the SRHSSA. Whilst it is acknowledged that the Kiveton Park practice had Mrs Barnes’s medical records for several weeks, it is important to note that implementing the Commissioner’s advice was onerous.”

The chief executive wrote to me on the basis that the submission from the Information Commissioner had come in around November 2010, when my constituent was moving to another GP’s practice.

I then received a letter from NHS Rotherham on 1 June 2011, which accepted that the Information Commissioner’s advice was given in 2003 and not more recently, as mentioned in the chief executive’s letter. That was the reason for the retrieval of the records from her new GP, as it was felt “prudent” that the medical records should be reviewed for absolute accuracy. The two doctors concerned verified that the removal of information as advised by the Information Commissioner had been carried out.

Mrs Barnes referred her case to the ombudsman. She wrote to me in October 2011 setting out a number of instances in which she believed discrimination might have taken place and said in that letter:

“When I assessed my medical records at the Sheffield Northern Hospital in June 2011, I discovered that reference to court case etc, was still to be found in my patient summary.”

It seems clear to me that the advice of the Information Commissioner given in 2003 was not adhered to. The instruction was to remove that reference from her medical records in the practice and anywhere else it might appear.

I got involved with the Parliamentary and Health Service Ombudsman on Mrs Barnes’ behalf and corresponded with the office in December 2012. The ombudsman had earlier refused to investigate the case until the medical practice had the opportunity potentially to offer Mrs Barnes some compensation. That did not materialise, for whatever reason. My understanding was that the insurers might have wanted to consider the case and decide whether to take any action. In a letter to me in December 2012, the ombudsman asked Mrs Barnes for further clarification in three areas. The first was whether she had considered taking a legal remedy and why she might not have chosen to do so. The second was the level of compensation she hoped to recover. The letter said:

“The Ombudsman does not operate a tariff system and we are very much guided by what people hope to achieve. The levels of financial redress we may be able to recommend are modest when compared to sums that could be recovered by legal action and it is helpful for us to know whether we would be likely to meet the financial outcomes a complainant has expressed. This helps to ensure that they can be quickly directed to the most appropriate route to consider their concerns and helps to avoid complainants being dissatisfied at the outcomes we may be able to offer.”

The third point related to how Mrs Barnes felt that she had suffered damage as a result of the practice’s failings.

Mrs Barnes came back to me on this matter and we discussed in some detail how she should respond. In March 2013, I wrote to the assessor at the health service ombudsman saying that Mrs Barnes and I continued to be unhappy with the handling of her case. I reminded them that a letter I had received from them on 28 March 2012 stated that

“the Ombudsman will not normally consider a complaint unless the NHS organisation concerned has had a reasonable opportunity to resolve the complaint”.

I then went on to say that in relation to their letter dated 11 December, Mrs Barnes did not wish to go down the legal route because of the potentially high costs involved.

In relation to the ombudsman’s comment about the compensation that Mrs Barnes would wish to recover, as I have already pointed out, I said that

“she cannot risk going down the legal route because of the cost. Consequently, she feels the only route she has open to her is to go through the Ombudsman”.

I then said that I would appreciate it if they could be more specific about what level of financial redress they may be able to recommend if they were to settle the case for her. They told me that they had no tariff, which I quite understand.

On the third point, I reiterated that Mrs Barnes had previously provided them with information on how she felt about the damage suffered as a result of the practice’s failings. It was not just the one incident; there were many other incidents in the letter that I received from Mrs Barnes at the time.

Further correspondence took place between Mrs Barnes and the ombudsman, and in a letter to them, no doubt in her frustration, she said:

“I refuse to involve clinical negligence solicitors due to my having taken legal action against a particular hospital in the past with no outcome.”

Hence, presumably, the reference on her patient record. She went on to say:

“The only people who seem to benefit from litigation are the solicitors themselves. I refuse to further fill their pockets and barristers’ pockets with taxpayers’ money.”

That quote was used in a letter sent to me dated 18 June from the ombudsman’s office. Also in that letter it was stated:

“Mr and Mrs Barnes complaint correspondence referred to a number of other interactions with NHS Care that did not involve the practice since around 1990 and were not part of our considerations”.

That is an important point, and I agree with it. This complaint was about the issue of what was on Mrs Barnes’s medical record and how it may have been used by others if they had seen what was on that.

After further correspondence, I received a letter from the director at the ombudsman’s office in August 2013 after a review had taken place of the action/inaction of the ombudsman’s decision not to progress the complaint. That letter stated that when I wrote to the ombudsman on 24 June 2013 I had said that Mrs Barnes was unhappy with the decision because she did not have the money to take the case to court. It was said that Mrs Barnes had previously told the ombudsman that she was not prepared to put money into the pockets of solicitors and barristers, but not, so far as I can see, that she could not afford to take legal action.

The letter continued:

“However, while a person’s ability to pay legal costs is relevant in cases such as this, it cannot be the sole factor. Mrs Barnes is seeking damages for personal injury that she says she has sustained at the hands of a number of clinicians over more than 20 years and her claim arises from an action for which the law provides a specific remedy. In the circumstances we agree with our original decision that the matter is properly for the courts and is not one we should investigate.”

[Dr Julian Lewis (New Forest East) (Con)]

This is a very complicated case and I just want to be sure that I understand exactly what the ombudsman is recommending. My understanding is that the ombudsman is recommending that a lady who has had a lot of trouble because she once previously went down the legal route should, instead of pursuing a complaint about that with the ombudsman, go down the legal route all over again. Have I got that right, or am I missing something?

[Kevin Barron]

The hon. Gentleman is absolutely right. What gets me about the last two letters more than anything else is the fact that they are completely contradictory. The first states:

“Mr and Mrs Barnes’ complaint correspondence referred to a number of other interactions with NHS care that did not involve the Practice since around 1990 and were not part of our considerations”.

The last letter basically states, “No, we aren’t going to pursue any action at all. We’re not going to look at it.” It then states—I am sorry to repeat this, but I think that it is important—that

“Mrs Barnes is seeking damages for personal injury that she says she has sustained at the hands of a number of clinicians for more than 20 years”.

They are completely contradictory.

It seems to me that the parliamentary ombudsman, which is also taxpayer funded, has not only made contradictory statements, but handled Mrs Barnes’ case in a negative way. As we discussed when she and her husband visited my office, which they did on several occasions, this was not about what had or had not happened to her with the medical professional over the years; it was about what had been held on her personal records. In 2003 the Information Commissioner said that that was wrongly done and suggested it should be removed. We then found out that in 2010 the records were scooped back in again when they moved to another practice. I can only assume that the chief executive of NHS Rotherham did not know about the Information Commissioner’s decision at the time, because the second letter I received from the chief executive stated that it was more recent than he had been led to believe and that the records had been brought back from the new practice because they had just received information from the Information Commissioner that they had to change them.

I am deeply concerned about the situation. My constituent has effectively been railroaded into a situation she does not want to be in, and that she should not have to be in. Indeed, the British taxpayer has been railroaded into a situation that I do not think it should be in. My constituent said, not with my blessing—I give it my blessing now, though—that far too many people are forced into litigation in this country, at taxpayers’ expense, rather than following common sense by sitting down, looking at the problem and deciding what should be done sensibly, not feeding the law courts.

I have to tell the Minister that I am deeply disappointed that the Parliamentary and Health Service Ombudsman—I know that it is not directly a part of Government—can be run in that way and make those contradictory decisions. It seems to me that its decision is this: “We don’t have to do anything, so we’ll force her back to litigation if she does not want to go. That’s the end of the matter.” That cannot be correct, and I would like to know whether the Minister agrees.

--- Later in debate ---

[Dr Poulter]

The right hon. Gentleman is absolutely right. It is difficult, in terms of the care pathway, for any patient to draw these distinctions. However, the NHS complaints procedure relates to NHS care, and the ombudsman’s role is as a public sector ombudsman. That goes to the heart of some of the difficulties we are talking about.

If a complainant is dissatisfied with the outcome of their complaint locally, they have the right to take it to the health service ombudsman, whose office was set up under the Health Service Commissioners Act 1993. When complaints are escalated, it is important that they are investigated independently, free from the political process, to ensure that there is no question of bias. The health service ombudsman is completely independent of the Department of Health, the Government, and the NHS. It is therefore difficult for me to comment on the ombudsman’s decisions directly.

If a complainant is dissatisfied with the ombudsman’s decision, they may make use of her own complaints process. The recourse open to anyone after the ombudsman has made a final decision is to seek a judicial review. During the entire complaints process, we assume that patients would take legal advice whenever they think it necessary. That is in their best interests and, in some cases, it is often important that patients have advice from a completely independent source.

If, on the basis of the legal advice received, patients decide to commence legal action against the NHS, that is, of course, to be expected. The House will understand that I cannot comment on legal advice given to patients, including Mrs Barnes, as that is entirely a matter between the patient and her lawyer. Complaints about lawyers are not a matter for the Department of Health or the NHS, nor for this House to consider in this context. I am aware that Mrs Barnes has exhausted all the legal remedies open to her. Her case has been considered by a number of courts, including the Court of Appeal, and has on each occasion been rejected. It goes without saying that these matters will have been considered carefully by the various judges involved, and I should not and will not cast any doubt on their judgments.

[Dr Julian Lewis]

I was not familiar with this case until I heard it outlined in such detail, but as I understand it the pointed issue is not about the merits or otherwise of this lady’s original arguments with the health service. I think I am right in saying that the only pointed issue is that the Information Commissioner’s Office directed that certain data should be removed from the record. They were not and she complained to the ombudsman, who does not seem to want to say whether it was right that they were left on her record or whether they ought to have been removed.

[Dr Poulter]

My hon. Friend will be aware that patients have open access to their records and can request to see them, but it is not for a patient forcibly to remove relevant clinical information from them. I am not sure whether that was the case in these particular circumstances, but I hope to be able to reassure the right hon. Member for Rother Valley.

It is worth pointing out that, during the long line of litigation, in 2007 Mr Justice Simon said, following a hearing, that

“this is not a case of professional conspiracies by the medical or legal professions; it is a case where the balance of the evidence before the Court fell decisively and conclusively in favour of the defendant”,

meaning the NHS. There is a long history of legal rulings that make that point clearly. Indeed, I understand that the NHS Litigation Authority obtained cost orders in its favour for that case, although it was unable to recover its costs. I reassure the right hon. Gentleman, however, that I shall look into the issues he has raised about the ombudsman and the Information Commissioner and write to him about them.

Mid Staffordshire NHS Foundation Trust

Julian Lewis Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

Never has the hon. Lady spoken with so much support from this side of the House—I do not wish to destroy her credibility with her own party! She points to something that the public feel very strongly about and that is an issue in some parts of the nursing profession. We looked carefully at whether we should remove the requirement for graduate qualifications and decided that nurses are now asked to do a great deal more than they were 20, 30 or 40 years ago in, for example, giving people medication and the clinical procedures they are asked to be involved in. We need to make sure that there is the right culture in nursing. That is why I proposed—it was very controversial at the time, although I think it has been quite broadly accepted now—that before becoming a nurse people should spend some time, potentially up to a year, on the front line as a health care assistant to make sure that those going into nursing had the right values and recognised that giving this personal care is a fundamental part of what being a nurse should always be about.

[Dr Julian Lewis (New Forest East) (Con)]

Will the package of reforms and the greater accountability put into effect as a result of the Mid Staffs tragedy have any bearing on other areas such as the all-too-prevalent cases of people being injured or even dying as a result of hospital-acquired infections?

[Mr Hunt]

Absolutely, because this is a package designed to deal with all avoidable harm, and hospital-acquired infections are an avoidable harm. It is designed not only to have much more transparency on the levels of harm in our hospitals, but to make sure that there is a culture of openness so that when people spot things that are going wrong, it is in their interests and in those of their hospital that they speak out. The changes are likely to result in—my hon. Friend will be the first to notice this—an increase in the amount of reported harm over the next few months. That will not be a bad thing, because it will mean that hospitals will be reporting harm that up until now they have not reported. We should welcome the fact that that will then mean that this harm will be addressed.

Mid Staffordshire NHS Foundation Trust

Julian Lewis Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

We will have a full statutory duty, in line with what Robert Francis says, when it comes to the boards of hospitals. We are carefully considering whether that should apply to individual hospital employees, but we want to wait until we have Don Berwick’s review of zero harm.

[Dr Julian Lewis (New Forest East) (Con)]

Does my right hon. Friend accept that the best system in the world will not succeed if individuals who behave inhumanely get away with it and people who observe them behaving inhumanely do not report it? I therefore re-emphasise what my hon. Friend the Member for Cardiff North (Jonathan Evans) has just said: if individuals see this inhumane behaviour, they must report it.

[Mr Hunt]

I agree with what my hon. Friend says.

Health Professionals: Regulation

Julian Lewis Excerpts

Monday 4th March 2013 Commons Chamber

[Dr Poulter]

I thank my hon. Friend for her intervention. We have made it clear, both in opposition and in government, and indeed in the health care mandate, that we do not find it acceptable that Britain, compared with some other European countries, is not doing well when it comes to survival rates for a number of diseases, including some types of cancer and some respiratory diseases. We all know that the NHS must achieve more in that regard. It is not necessarily an isolated issue that applies to one particular trust. That is why we made it a priority in the NHS mandate set by my right hon. Friend the Secretary of State for Health at the end of last year, but the priority should be clinical outcomes, and a key priority is improving mortality for a number of diseases, particularly those that are attributable to patients with long-term conditions.

I thought that it might be worth discussing in more detail a few of the points my hon. Friend the Member for North East Cambridgeshire raised. He talked in particular about the Francis report. For everybody who cares about the NHS and works in it, as I still do, the day the Francis report was published was a humbling one. There was failure at every level: a systemic failure, a failure of regulation, a failure of front-line professionalism, a failure of management and a failure of the trust board. There are systemic problems with the NHS that we need to focus on and address. That is what my right hon. Friend the Secretary of State will outline when we give our further response to the Francis report later this month.

My hon. Friend the Member for North East Cambridgeshire was also right to highlight that there has been too much covering up in the past and not enough transparency. If we are to put right some of the systemic failings highlighted in the Francis report, we need to be grown up enough to acknowledge that sometimes the NHS does not come up to standard and the care that we would expect to be delivered to patients is not always good enough. If we care about our NHS, and if we want an NHS we can continue to be proud of and that will continue to be the envy of the world, we must acknowledge when things go wrong and ensure that we face up to the problems in an open and transparent way. We must ensure, as many hospitals with a more transparent culture do, that good audit and proper incident reporting are in place for when things go wrong. We must ensure that, rather than having recriminations and closed doors, bad things are learned from, and that where things have gone wrong and patients have not been treated properly, hospitals and the whole the NHS make more active efforts to deal with problems and failures of care.

[Dr Julian Lewis (New Forest East) (Con)]

I thank the Minister for his courtesy in giving way. It might be helpful, Mr Speaker, if you would give us guidance on whether pre-notification is still required. What the Minister says is all well and good but why is it, after so many people died in such an unacceptable way, that nobody seems to have carried the can or taken responsibility?

[Mr Speaker]

Order. I thought, in the circumstances, that I would let the debate flow, but for clarification I ought to say that there is a requirement that a Member who wishes to make a speech in someone else’s Adjournment debate secures agreement in advance, but there is no such requirement—this point is widely misunderstood—in respect of an intervention. It is purely for the Minister to decide whether to take an intervention. No impropriety has been committed by the hon. Member for Bristol North West (Charlotte Leslie); her virtue is unassailed.

Social Care Funding

Julian Lewis Excerpts

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

The hon. Lady might show a little humility after her Government did nothing about this for 13 years. We are doing something about it, as quickly as we possibly can.

[Dr Julian Lewis (New Forest East) (Con)]

I warmly welcome the rise in the assets threshold, but I am not clear about one aspect. People such as my father had to sell their home to pay the costs of residential care. It is being suggested that accommodation and food will not be covered by the proposals, but, given that the residential care aspect is so important, can my right hon. Friend give us reassurance?

[Mr Hunt]

These proposals cover the care costs, but we will be making an allowance for accommodation and food of £1,000 a month at 2017-18 prices. The reason for doing that is that a person would face those costs whether or not they were in a residential care home, and we think it would be wrong to create a system where that person was better off financially being in a residential care home than living at home.

Business of the House

Julian Lewis Excerpts

Thursday 6th September 2012 Commons Chamber

[Mr Lansley]

The hon. Gentleman raises an issue that is clearly of great importance to his constituents. I do not know the answer to his question, but I will gladly raise it with my Foreign and Commonwealth Office colleagues and ask them to respond to him.

[Dr Julian Lewis (New Forest East) (Con)]

May I say to my former chief at the Conservative research department what a pleasure it is to see one of the most decent people in political life now occupying one of the most distinguished positions in Parliament? In return for that, may we have a statement from a member of the new Defence ministerial team on the situation of Commonwealth soldiers who would normally be in a good position to apply for citizenship at the end of their service, but who are being prevented by the UK Border Agency, on very questionable grounds such as minor military disciplinary infractions? We owe those soldiers a debt of honour, and they should not be discriminated against in that way.

[Mr Lansley]

I am grateful to my hon. Friend, and I will raise that issue. I know that people feel strongly that service personnel who serve this country should be treated with the greatest respect and honoured as a consequence. My colleagues at the Ministry of Defence will want to reply to him on that matter.

People with Learning Disabilities (Abuse)

Julian Lewis Excerpts

Monday 3rd September 2012 Commons Chamber

[Paul Burstow]

I am sure that Lord Morris would have been following these matters very closely and with great interest, and I am grateful to the right hon. Gentleman for raising them.

The events at Winterbourne View that the right hon. Gentleman so clearly described were horrifying and depressing. They were horrifying because they so sharply defined everything that is rotten and can go wrong in closed institutions where people are out of sight. What took place at Winterbourne View was criminal. A culture of abuse was allowed to fester and grow undetected and unchecked. The serious case review by Margaret Flynn sets out in great detail the failings of Castlebeck Care Ltd, and it makes grim reading. The right hon. Gentleman reported many of its findings to the House. The events at Winterbourne View were depressing because, as the report by Mencap and the Challenging Behaviour Foundation, “Out of Sight”, reminds us, it is not the first time that closed institutions have let down people with learning disabilities. The right hon. Gentleman highlighted the personal stories that are contained in that important report, and those stories are very telling, with families feeling let down by the system and the sense that the best interests of the individual are not being served and that their views, wishes and feelings were not sought, and if they were sought were not understood.

In October this year, the court will hand down sentences to the 11 members of staff who have pleaded guilty to maltreatment of patients at Winterbourne View hospital. There are no excuses and no mitigating circumstances. What happened was degrading, dehumanising and despicable. I understand that the Crown Prosecution Service will ask the judge to take into account the fact that these are disability hate crimes when determining the sentence of the defendants.

[Dr Julian Lewis (New Forest East) (Con)]

Can the Minister inform the House whether the people who behaved in such a sadistic way had, prior to recruitment, shown any evidence of tendencies of this sort? We would usually expect people who go into the caring professions to be empathetic, sympathetic and caring. How come people who gloried in sadism found themselves in such positions?

[Paul Burstow]

That goes to the heart of a number of the points made in the serious case review about the nature of the recruitment processes that were used by Castlebeck and the way in which it then carried on inadequately to train, supervise and monitor the conduct of those staff. I will come back to some of the actions that the Government are taking in that regard to make it much more difficult for that to occur again in future.

Of course, what happened at Winterbourne View came to light only as the result of the actions of the whistleblower, Terry Bryan, and the Panorama programme broadcast by the BBC. I personally thanked Terry for his actions when I spoke to him some months ago about the interim report that we published in June, and I do so again tonight. Thanks to Terry, the Care Quality Commission has changed its systems and set up a dedicated whistleblowing team. An even greater emphasis is being placed on the importance attached to the role of whistleblowers. That is why the Government have introduced a free whistleblowing helpline, not only for NHS staff but, for the first time, for social care staff, so that they can get advice on how to report concerns that they have. There has also been a strengthening of the NHS constitution to make these matters clear to their employers as well.

Terry Bryan blew the whistle on the worst excesses of a wider systemic failure. As I acknowledged in the Department of Health’s interim report in June, the problems revealed at Winterbourne View are more systemic. There has been a tendency when reporting on Winterbourne View to heap much, if not all, of the blame on the CQC. Indeed, the CQC seems to stand as the barrier to everyone else who should be in the dock being criticised, scrutinised and challenged for what went wrong. Although the CQC, rightly and properly, acknowledged its failings and apologised at the time, the issue of staffing and the freeze that this Government introduced on coming into office in May 2010 was specifically lifted for the CQC in October 2010, and there were no restrictions on staff recruitment. If there were failings of recruitment, the CQC would need to answer for them—indeed, it has—before the Health Committee.

Every part of the system—NHS and social care commissioners, providers, regulators and health and care professionals—has a part to play and, indeed, has questions to ask itself about what has passed.

Oral Answers to Questions

Julian Lewis Excerpts

Tuesday 17th July 2012 Commons Chamber

[Paul Burstow]

Yes, we are liaising with the devolved Administrations. Yes, we had a productive meeting with the trust and the council, which confirmed that they will shortly submit to us the second-year evaluation of the pilot programme. I undertook to look at that carefully and enter into further discussions with a view to reaching a conclusion and making further announcements this autumn.

[Dr Julian Lewis (New Forest East) (Con)]

Ministers may recall the concern of patients and carers in the New Forest area about the decision to close a third of acute adult mental health beds in Hampshire. Are Ministers aware of a similar trend in other parts of the country, and if they are, as they should be, what do they think about it?

[Mr Burns]

My hon. Friend has raised that issue in different forms on many occasions, and feels strongly about it. The decision to reconfigure services in his constituency was made locally, and the Hampshire overview and scrutiny committee decided not to write to my right hon. Friend the Secretary of State asking him to refer it to the Independent Reconfiguration Panel, because it presumably believes that it is the right way forward to continue to provide first-class quality care for patients.

Mental Health

Julian Lewis Excerpts

Thursday 14th June 2012 Commons Chamber

[Paul Burstow]

That is an important and challenging point, and I will want to go away and think about what we do. For patient safety, we still need to learn lessons when things go wrong in our system, acknowledge when things have not been done properly and put them right. In that sense, confidential inquiries are an important part of the learning mechanism. One point of frustration that I hear in debates in the House and see in correspondence from hon. Members is the sense that lessons are not learned. As part of our reforms, with the NHS Commissioning Board taking on responsibility for patient safety, we need to ensure that that is not the case in future.

We are investing £16 million in “Time to Change”, and we were delighted when Comic Relief decided to put in an additional £4 million, one of the biggest grants that it has ever made.

I wish to make another point that touches on the contributions of my hon. Friend the Member for Broxbourne and the hon. Member for North Durham. One in five people still think that anyone who has a history of mental health problems should not be allowed to hold public office. How many former Presidents, Prime Ministers or Ministers would have been excluded if that view had been applied? [Hon. Members: “Churchill.”] Precisely. Such a law is as outdated as asylums and as outdated as many of the attitudes that sit behind it. It has to be consigned to the history books just like asylums have been, and under the coalition Government’s watch, it will be. I congratulate the hon. Member for Croydon Central (Gavin Barwell) on securing a slot for a private Member’s Bill on the subject.

Looking ahead, although we have made progress there are still big challenges to tackle. Reference has been made to the implementation framework that will be published to support the roll-out of the “No health without mental health” strategy. That framework has been produced in conjunction with five national mental health organisations—Rethink Mental Illness, the NHS Confederation, the Centre for Mental Health, Turning Point and Mind—and many others have been involved.

We have previously had a very good debate about “Listening to Experience”, Mind’s excellent report on acute and crisis care, and Mind’s policy team have been directly involved in ensuring that the framework delivers on those issues. It will provide a route map for every organisation with contributions to make to improve the nation’s mental health. It will spell out how progress will be made, measured and reported.

What does success look like? To me, it means more people having access to evidence-based psychological therapists; services intervening earlier, particularly for children and young people; services focusing on recovery and people’s needs and aspirations above all; and service users and carers being at the heart of all aspects of planning and service delivery.

Today, economists tell us that mental ill health in this country costs £105 billion a year, and that is just in England. If we succeed and put in place the right combination of public health, anti-stigma policies, accessible psychological therapies and excellent community and acute services, we can dramatically reduce that figure. Put another way, if we can deliver the right evidence-based treatment to children and young people so that their conditions do not persist into adulthood, we can prevent as many as two in five of all adult mental health disorders. As a society, we have made huge progress in how we recognise people’s mental illness, but despite that we have not fully accepted that mental health is equal to physical health and that parity of esteem is needed between the problems of the body and the problems of the mind. That is the challenge—

[Dr Julian Lewis (New Forest East) (Con)]

Will the Minister give way?

[Paul Burstow]

I will.

[Dr Lewis]

I have waited many years to intervene on a Minister in his final sentence, and I have achieved that today.

Does the Minister accept, having made a convincing case for people being able to live with their illnesses by being at home, that part of the reassurance that they need to do that is to know that in periods of acute crisis, there will be a bed available for them should it be needed? That should be not only for detained patients but for voluntary patients.

[Paul Burstow]

One thing I did not say—I was trying to cut down my remarks—was that there is an essential need to give more people the ability to control their health care through crisis plans. Crisis plans are an opportunity for people to make a statement in advance on how they wish to be treated in the event of a mental health episode that requires an intervention from mental health services. We know that when the plans are in place, they make a huge difference to the need for admission, and that they can reduce the length of stay. We need to ensure that there is a sufficiency of beds so that people can get appropriate treatment, but we also need to ensure that there is much more focus on good, community-based intervention at an early stage. Getting that balance right is always difficult for health commissioners to achieve—I know my hon. Friend is struggling with that in his patch at the moment.

Those are the challenges the NHS faces. They are challenges not just for our health commissioners and providers but, as this debate has clearly demonstrated, for our whole society. We can transform mental health in this country only if we transform our attitudes. This debate plays an important part in that.

--- Later in debate ---

[Dr Julian Lewis (New Forest East) (Con)]

Unlike the doctors who have spoken from the Conservative Benches, my hon. Friends the Members for Bracknell (Dr Lee) and for Totnes (Dr Wollaston), who spoke with such expertise, I have absolutely no medical qualifications whatsoever, but that has not stopped me giving my opinions on this subject in the past, and I am afraid that it is not going to stop me today.

I see from the index on my website that this will be the ninth speech that I have made on the Floor of the House or in Westminster Hall on mental health. Many of those speeches were supported by my hon. Friend the Member for Broxbourne (Mr Walker), and I do not think we will ever hear a finer speech than the one that he made today. In passing, I pay due credit to the hon. Member for North Durham (Mr Jones), whose interest in these matters I have known about for a long time, although not his personal history.

The speeches that I have made in the past have tended to concentrate on three themes: the importance of separate therapeutic environments for people who have to be admitted when they are acutely mentally ill—it is obviously unwise to have psychotic patients cheek by jowl with people suffering from suicidal depression, for example; the importance of single-sex wards, particularly in mental health units, although that applies to the NHS hospital network as a whole; and the importance of making adequate bed numbers available for people who require periodic admission to a mental health unit.

We heard from the Minister about the new emphasis on recovery-based programmes, and I am all in favour of that. There is everything to be said for that, but even its most ardent advocates do not deny that there will always be a need for in-patient beds for some people some of the time. I am concerned that the cuts imposed on in-patient beds may mean that if we are not very careful indeed there will be enough beds available in future only for people who are sectioned. Those people who wish to receive the support and the underpinning—the fall-back position—of an in-patient bed when they are experiencing an acute episode may be unable to secure one.

It has rightly been said that a debate at national level brings out the best in people in the House of Commons. However, the debate at local level does anything but bring out the best, given some of the schemes, plans and measures that have been introduced. In that connection, I pay tribute to the hon. Member for Lewisham East (Heidi Alexander) who, in a measured and thoughtful way, made a speech that has become all too familiar to me. She talked about the way in which Granville Park in her constituency has been scheduled for closure on the basis of a consultation that she regarded as somewhat suspect.

I refer the hon. Lady to the Adjournment debate on the Floor of the House introduced by my hon. Friend the Member for Burton (Andrew Griffiths), who discussed similar techniques that were used in his constituency, and to my own experience with the Southern Health Foundation Trust, which used a similar method to make 35% cuts in in-patient beds for acutely ill adults, even though bed occupancy figures were consistently over 90%. The pattern seems to be something like this: they hold a consultation; they make assertions based on, at best, subjective surveys of what they say people want; they then rely on pseudo-independent “expert” research, which usually turns out not to be independent at all; and finally they bulldoze their pre-existing plans through.

Therefore, to take the message that Mr Speaker always used to give when teaching the art of rhetoric, which is that a speech should have at most two main points, the main point in my speech is the need for the objective monitoring of statistics so that when we are reconfiguring services we at least know whether there really are spare beds before we close services down.

I would like to be fairly positive in this debate, brief as my contribution necessarily is, so I would like to say that the health overview and scrutiny committee of Hampshire county council, despite the harsh words I have had to use about it in the past, appears to be taking on board some of my concerns by seeking to ensure, as it has stated in its minutes,

“that further bed reductions are being safely managed”

and that it is

“made aware by the commissioner and provider should future acute inpatient bed demand regularly exceed bed availability in the service.”

I think that it is terribly important that in the process of reconfiguring we do not simply say that we are recreating a new system in the community while decimating the system that allows people the safety net of an acute bed during those episodes when they are really ill. As I said in my brief intervention on the Minister, if people are to have the confidence to get on with their lives and know that they can have useful and fulfilling careers even while living with and managing a mental illness, it is absolutely vital that they also know that, on the rare occasions when they really need the ultimate support of a few nights or even a week or two in an acute unit, a bed will always be available for them.