Surgical Mesh

Kevin Foster Excerpts

Thursday 19th April 2018 Commons Chamber

[Kevin Foster (Torbay) (Con)]

It is a pleasure to be called to speak in this debate, and I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing it. It has been quite something to listen to the many stories that have been repeated here this afternoon. My involvement in this issue was prompted not only by conversations with my former colleague in the Ministry of Housing, Communities and Local Government, my hon. Friend the Member for Eastleigh (Mims Davies), but by the case of my constituent, Mrs Beverley Jelfs, who had mesh inserted for a prolapse.

When she emailed me, she said:

“My life has changed so much since having this device inserted in me in 2011. I can no longer work due to pain, fatigue, not able to sit or stand for long. The mesh eroded through my vaginal wall, which 7 weeks later had to have part removal. I have no intimate relationship with my husband, due to the mesh damaging me…I have gone from a very busy and socially active life, to being a depressed lady.”

That sums up the impact that the issue has on her. Although her work was done at a local private hospital, I also asked my local Torbay Hospital—the main NHS hospital serving my constituency—for details of the approach it adopted.

Given the age demographics of Torbay, I had expected slightly more cases to be raised with me. Those that have been raised involve people who have been treated at a particular private hospital. Given that this is a wider issue, I do not think that it is constructive to bring the name of the hospital into the debate, but it is interesting to note that that is where these queries come from.

I was pleased to get a detailed response from Julian Barrington, the consultant in obstetrics and gynaecology at the hospital, giving me some of the figures for the work he has done. I am pleased to note that the failure rates reported back on some of his cases have been a lot lower than some of the averages, but in his letter he makes the point that none of the patients in Torbay has been treated with Ethicon meshes, over which most of the concerns and complications have arisen. His other comment is welcome: given some of the issues being raised, since October 2017 he has suspended all vaginal surgery using synthetic mesh until the results of the NICE recommendations are published and until professional medical bodies make a decision.

[Owen Smith]

The hon. Gentleman is making an incredibly interesting point. Does he agree that it is inexplicable that NICE continues to say that it cannot produce its new guidance until the spring of 2019, when we and the medical fraternity have been asking for it for the past two years?

[Kevin Foster]

I think that the comments make it clear that medical practitioners are waiting to hear what the guidance is and would like it as soon as possible. As politicians in this Chamber, we should not necessarily look to say what the NICE guidance should be and should not put pressure on NICE to come up with particular outcomes, but NICE should look to resolve this uncertainty.

I welcome the pre-emptive approach that my local hospital has taken, but that then leads to a debate about whether other practitioners are continuing and whether my hospital is taking the right approach—I believe it is, and I suspect that Opposition Members who have been involved with this issue believe that it is, too. It is clear that guidance needs to be produced as quickly as it sensibly can be to allow hospital clinicians dealing with patients day to day to know that they are making the right decisions. I welcome the fact that my hospital has made a pre-emptive decision, but agree with the hon. Member for Pontypridd (Owen Smith) that it makes sense for NICE to try to resolve the issue as quickly as possible and provide clarity.

It would be interesting to hear from the Minister whether it is becoming common practice in the NHS for individual hospitals and surgeons to adopt the approach taken by Torbay and South Devon NHS Foundation Trust. Is it more common or does it involve only a small number of hospitals? Is there an emerging body of medical opinion on this matter? Although I might welcome what Torbay Hospital has done, if individual hospitals effectively start forming their own policy that will raise questions in other locations.

Given the concerns raised with me, I welcomed the review announced in February 2018. I can remember being in the Chamber to listen to the Secretary of State’s statement on this and a range of issues affecting women’s health, as well as on whether some of the processes we have in place are as strong as they are in other areas. To reflect on the point made by the hon. Member for Glasgow North West (Carol Monaghan), given the issue, many of those affected are reticent about making a noise. I sought direct permission from my constituent to mention her name and condition in the Chamber, but one wonders whether there are a number of people who do not want to make a noise about this—through embarrassment, to put it bluntly—which makes it different from concerns about other treatments.

I would also be interested to hear from the Minister what liaison is taking place between the UK Government and the Governments of New Zealand and Australia, who have adopted an approach that is similar to my hospital’s. What impact is that having? I have not had complaints from people about not being able to have a procedure for a particular problem while this treatment is suspended, and that tells me that the hospital’s decision has not had a negative effect. I would be interested to know the experience of clinicians in other jurisdictions that are incredibly similar to ours, particularly those from New Zealand.

Reading the motion, I can understand the call for a public inquiry. My only reticence is that such inquiries can become lawyer-fests. I would much rather we were dealing with the situation now, and getting guidance to clinicians in place quickly. We could decide at a later date, perhaps, whether such an examination of what happened would be appropriate. For me, the priority is to get action towards a resolution and for those women and men who have been affected to find medical solutions that can deal with their existing, ongoing pain.

I welcome the debate. It is good to have had contributions at such a level. I am pleased to note the approach my local trust has taken, and I would be interested to see whether that trend is emerging across the NHS and, if it is, what impact it is having on statistics for those who are negatively affected. Does it have any impact at all on waiting times for a particular treatment? If it does not, the pre-emptive approach would seem to be right clinically, in dealing with the problems we have heard about today and in preventing more people from being affected.

I hope that today’s debate will also give hope to those who are suffering that their plight has not been ignored—it is not something that has been talked about quietly somewhere else because of any perceived embarrassment. I hope that lessons will be implemented that prevent others from having to go down the same path as my brave constituent, Mrs Jelfs. I know that her priority in speaking out and having her story relayed was to prevent at least one other person going through what she has been through over the past seven years.

Cancer Treatment

Kevin Foster Excerpts

Thursday 19th April 2018 Commons Chamber

[Kevin Foster (Torbay) (Con)]

It is a genuine pleasure to follow the quality of speech we have just heard from the hon. Member for Hove (Peter Kyle). He may not know it, but we are similar in both having lost our mothers to cancer.

My mother, Linda, was diagnosed with bowel cancer back in March 2011. By that point the cancer had spread to her liver and lungs. She had a couple more good years with us, but she had reached the point where, despite all the treatments, the cancer’s progress could not be stopped. She was very stoic in the face of it.

I was a councillor at the time, and my mother knew I had to take time away from my duties. I remember her saying from her hospital bed, “You do know you can tell people about it?” That was quite a decision for her, because she was usually quite a private person—she was always the person in our family who was not ill or unwell. She did not usually want to talk about her issues, but she was clear that I should talk and tell people about it: if people saw my position, I would get publicity and people would want to know why I was away. The idea that I was spending my weekend with my mum and my family is very different from the idea that I was helping my dad care for my mum when she had just come back from hospital.

All the way through, my mum was keen that her experience should be talked about, and she would be pleased that, even today, it is still being mentioned, because she wanted people who have a suspicion to go and get a test and to find out about it. It is better to find out than to worry and not do it.

My mum was 56 when her cancer was picked up in March 2011, and the irony is that my father had been 60 the year before and they had received the bowel cancer test kit for him in the September or October. He dutifully did what he needed to do with it in the bathroom and sent it back. Of course, it came back clear. Had my mother used the kit, it may well have been a very different scenario. The key thing that came out of it for me is that her tumour was located up, over and right the way back down in her bowel, so the more visible signs did not show. There would have been no blood in the toilet because the blood would have dissipated through her system. But a test would have picked it up, which is why it is so important to me that that message is heard, because people do sometimes think this might be embarrassing and find that when they read the instructions of what to do with the test it sounds a bit odd. There is nothing to worry about. People should not just use it because they are feeling ill; they should use it because it is there and it can tell them that there is something wrong.

The Minister spoke briefly to us before we came into the Chamber and I hope, given my family’s experience, that real consideration is being given to how the faecal immunochemical test can be expanded and, thus, help save more lives, particularly among the under-60s. The fact that this was started at 60—it was a good initiative, which has helped saved lives—almost sent a message of, “Well, when you’re 60 you might get this”, whereas plenty of people younger than that get it. Sadly, my mother passed away from bowel cancer at 59, before the age at which she would have got the test in the post in order to try to identify whether she had the illness.

My mother’s case highlighted one other thing, which we have seen in other cases: once a doctor has concerns, it is important that we can get the tests done quickly to identify exactly what is wrong. With my mother, it was unexplained anaemia and stomach pain that finally triggered the test to be done, but it can be all sorts of complaints. The hon. Member for Hove gave the example of something being wrong but we cannot quite pin down what. I know the ACE—accelerate, co-ordinate, evaluate—centres are being created, and I am interested to hear the Minister’s comments about how he thinks they can be expanded and developed. Where a GP has a concern with a patient—where something seems to be not quite right but they cannot put their finger on exactly what aspect of cancer it might be or whether it is cancer—we need the ability to get the tests done and a diagnosis made quickly, which then means treatment can start.

It is absolutely right to say that cancer is not the death sentence it once was and it is not taboo to talk about it, as it once was. The only thing my mum hated was when anyone called it “The big C”. She said, “Oh, for goodness’ sake, if you are calling it ‘The big C’ you might as well say what it is. What a load of nonsense!” That was her reaction; she wanted us to call it cancer, because that is what it is. She used to say, “Look, I’ve got bowel cancer. It is not bowel with the big C. It is bowel cancer.” That was very much her view. For some people, that description helps but for her it gave the idea of not being up front about what it is and this was about being able to get treatment. So I hope something good can come out of her experience.

Thankfully, more people are surviving cancer than used to be the case, but this sort of debate is so important. I say that, first, because it brings this up and it is about sharing personal experience. No one is immune from cancer. I know my family history and I know that in my mid-50s there are some tests I need to have. My mum was worried that I might have her genetic condition and so be more liable to get this, but I just said to her, “Well, if it is, the one thing we can guarantee is that I am going to be one of the monitored people in western Europe for that particular condition. Don’t be embarrassed about it, mum.” This was certainly an informative experience for me, and I do hope we can do more. I hope that the result of this debate is that more people can be helped and we can get the death rates down even further.

Organ Donation (Deemed Consent) Bill

Kevin Foster Excerpts

2nd reading: House of Commons
Friday 23rd February 2018 Commons Chamber

[Kevin Foster (Torbay) (Con)]

I will keep my remarks brief, Madam Deputy Speaker. I too support the Bill and I am delighted that the hon. Member for Coventry North West (Mr Robinson)—my hon. Friend; I have known him for a number of years—has used this slot for this very noble cause.

I would like to mention the Bright Green Stars campaign in Torbay. Four years ago, the Bright Green Star Man hung up stars across various points in the bay to encourage more people to think about organ donation. When his daughter Lottie was three, she was one of the lucky ones to receive a transplant very quickly.

The safeguards in the Bill provide an option for those who strongly object to the idea of organ donation, and the ability for families to provide evidence that someone would have objected, on reasonable grounds, if they had known about the opt-out system. Let us be clear: I do not see my body as a piece of property that my relatives will inherit on my death. I see it as something very special, and if there is something we can do to help people to continue to live after our life on this earth has finished, I think that is totally noble. One way I can help is not just by registering to be an organ donor, but by supporting the Bill today. It will save lives in Torbay and across the country. I hope the Bill receives its Second Reading.

Medicines and Medical Devices Safety Review

Kevin Foster Excerpts

Wednesday 21st February 2018 Commons Chamber

[Mr Hunt]

That is the entire purpose of the review. Obviously, Baroness Cumberlege will want to involve patients in the process right from the start, and I will talk to her about that. I will also write to the hon. Lady to spell out in detail the way in which the Baroness intends to involve patients in the process.

[Kevin Foster (Torbay) (Con)]

I thank the Secretary of State for his statement, which will be of comfort to vaginal mesh implants victims in my constituency. It is right that the review will be wide-ranging, but will he confirm whether those who have been barred from receiving compensation owing to the statute of limitations under the Consumer Protections Act 1987 will be included?

[Mr Hunt]

Absolutely.

NHS Winter Crisis

Kevin Foster Excerpts

Monday 5th February 2018 Commons Chamber

[Stephen Barclay]

Again, the hon. Gentleman is ignoring the huge number of measures that have been put in place. As Sir Bruce Keogh himself recognised, there was much more planning this year at a much earlier stage. We have had better integration between NHS England and NHS Improvement. We have had a much more comprehensive planning cycle. We have had better access to primary care, reducing pressure on the front door. We have had stronger action on delayed discharges, addressing issues at the back door. We have had changes to the way ambulance services respond to calls, so there is better prioritisation. We have also had financial incentives focused on A&E performance, so there is a huge range of measures, in addition, as I said earlier, to 1 million more people being vaccinated against flu. Those are all part of the actions taken by this Government to prepare and plan for the pressure of the flu issue we have had to manage.

[Kevin Foster (Torbay) (Con)]

While my constituents will welcome the £1.1 million of extra winter funding, they do not want to believe that this issue is decided purely by knockabout in the House of Commons, which is what some others wish to focus on. Will the Minister reassure me that he will look for independent clinical advice on how to deal with pressures in the NHS and then base his response on that advice?

[Stephen Barclay]

My hon. Friend is right. There is a desire among Labour Members to avoid the reality of what is happening in Wales, where clinicians said that their best performance is often akin to the worst performance in England. However, we recognise that there needs to be much more integration in the system. That is why the Minister of State, my hon. Friend the Member for Gosport, is looking at how we have better integration in the NHS and the community in terms of domiciliary care, and at how we address some of the issues in the pipeline—the pathways—in hospitals to get a better flow, so that the discharging of patients is not delayed. Much progress has been made, but we recognise that more needs to be done.

NHS Winter Crisis

Kevin Foster Excerpts

Wednesday 10th January 2018 Commons Chamber

[Huw Merriman (Bexhill and Battle) (Con)]

It is a pleasure to follow the hon. Member for Crewe and Nantwich (Laura Smith) in this important debate on the NHS and the challenges that, unfortunately, it tends to face in winter. We should bear in mind that, for decades, winter has given the NHS challenges to meet, and as a result, clinicians have been asked not to take time off in January. Last Friday, I spent time with a GP practice, where staff confirmed that the flu epidemic is one of the worst they have seen for many years.

From the perspective of patients, it is wrong that those who have waited months for surgery—perhaps routine, but for a condition that has an impact on their lifestyle—have been told that it has been cancelled. We need to change, but I believe we need to change the entire structure. It is all very well and good for the Opposition to write cheques that they know would bounce. What we have to do is reform the NHS within the resources available. We also have to consider the impact of the ageing population and the challenge—which we embrace, of course—of looking after them. In the last decade, 17% of this country’s population was over 65; in the present decade, the proportion rises to 20%; and in the next decade, it will be 30%. That might be why the number of hospital admissions has risen by 40% over the past 10 years. I am delighted therefore that the Department of Health is now responsible for social care, and particularly reform to it; that is long overdue. We need a cross-party approach. I am aware that every governing party tends to say that, but I would ask Opposition Members to please rally round. There are some great ideas that we can all get around.

I want to focus on the pressures facing GP surgeries and the pressures that puts on our hospitals. Too many patients are going to A&E because their GP surgery is not there for them. I spent some time with a GP who had just returned from visiting a patient he had made comfortable at home. He pointed me to another area my hospital trust covers where that patient would have been put into hospital for some weeks, which would not have been good for the patient or all those other patients waiting for their care. We have seen huge demand from the elderly. I am still greatly concerned that the social care system is set up on a local authority basis. Many local authorities to which people retire do not have the same business rates as other areas—they have a lot of elderly folk but not the business to fund them—and certainly not as much council tax. In looking at reforms, I would like the Government to consider putting social care on the same footing as the central NHS.

[Kevin Foster (Torbay) (Con)]

Will my hon. Friend give way?

[Huw Merriman]

I will not, I am afraid, because of time. I am sorry.

I would like to see more powers given to CCGs, or perhaps a tier above, to enable them to intervene where GP surgeries are not functioning as they should be. At the moment, there is no sharing of data, so CCGs cannot see where surgeries might be about to fall over. We expect CCGs to intervene and take over when things go wrong, but that is often too late, so I would like to know if more taskforces could be put in place. It is clear that the GP model that we have continued with since 1947 is not the GP model that younger GPs want to buy into: they do not necessarily want to buy into the practice model, are concerned about litigation and do not necessarily want to stay in the same place for all those years. We need great reform, therefore, and I add my support to the voices on both sides of the House saying that perhaps a royal commission is the way to take this forward.

Social Care

Kevin Foster Excerpts

Thursday 7th December 2017 Commons Chamber

[Jackie Doyle-Price]

I think we made it clear in the recent general election that we will be revisiting this issue. The hon. Lady wants certainty about how we fund the care system in future, and on what obligations individuals and their families will or will not have. It is therefore important to have that full public debate, and work together to bring forward proposals that will put our long-term care system on a sustainable footing. In the absence of that we will not achieve any resolution, and that is contributing to misery for people who do not currently have a limit on their overall care costs. That is what we are trying to address through this process. [Interruption.] I hear noise from Labour Members about needing cross-party consensus, then I look at the behaviour of those on the Front Bench—lacking.

[Kevin Foster (Torbay) (Con)]

I welcome the Minister’s pledge to consult more widely about a long-term solution, given the pressures on Torbay due to this issue. One problem is people’s complete lack of understanding about how the current system works with unlimited liability. If we just put in a blunt cap, that will mean little to someone who has worked for their whole life and bought a house in Torbay, yet quite a lot to someone who has a multi-million pound pile in the south-east. We must look carefully at how we do this on a long-term basis.

[Jackie Doyle-Price]

My hon. Friend encapsulates the problem in a nutshell. Many people do not understand that care must be paid for by the individual; nobody understands that they have to pay for it for as long as they have to pay for it. That is why we cannot simply implement the previous proposals because people do not understand them. If we are to expect people who are living longer to fund that care, we must take them with us. That is why we need a fully informed public debate, which is what the Green Paper is designed to achieve. I implore all hon. Members to engage with that and to help to inform the public about exactly what our care system is now, and how it can be improved for their long-term security and that of the country.

Maternity Safety Strategy

Kevin Foster Excerpts

Tuesday 28th November 2017 Commons Chamber

[Mr Hunt]

I am happy to do that. I think I have met most of those parents. The hon. Gentleman has been incredibly supportive to them locally—they have told me that. When Carl Hendrickson came to see me, he brought his 11-year-old son, and I offered for the son to wait outside, but he said no—he wanted his son to be with him. I think it was because he wanted his son to know that he had been to the top to try to understand why his child and his wife died because of mistakes in that maternity unit. The hospital has done an incredible turnaround job—we are all really proud of what it has done—and we are confident that it would not happen again, but that is not to say that there is not a huge amount more we all need to do.

[Kevin Foster (Torbay) (Con)]

I welcome the Secretary of State’s remarks and the overall tenor of the comments made so far. Does he agree that the most important thing for families who experience tragedy in childbirth is to receive the straight answers they deserve and to know that lessons will be learned where necessary?

[Mr Hunt]

I do agree. I have visited my hon. Friend’s trust in Torbay and have been very impressed with the learning I saw from the Sam Morrish case, which was a very sad story of where that did not happen initially. However, as I say, I think the trust has learned all those lessons extremely impressively.

Hormone Pregnancy Tests

Kevin Foster Excerpts

Thursday 16th November 2017 Commons Chamber

[Steve Brine]

I can only give the House the facts. Dr Vargesson’s research was there, and he presented it orally, and orally only, to the group. The expert group felt that it wanted more than that, and he has not been able to provide it. At some point, if he does, I am sure that the group will be more than happy to look at it.

[Kevin Foster (Torbay) (Con)]

One of the key points here is transparency. What work does the Minister think he can do to increase people’s confidence and to share more information to dispel the image that things are being kept secret?

[Steve Brine]

As I have said, I think that I have been very honest about the way in which the families have been handled, about the notice that they have been given and about Members being able to attend report launches. There is no great secrecy here, but I can see how events like that merely feed that notion.

Mental Health Units (Use of Force) Bill

Kevin Foster Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Oliver Dowden]

My hon. Friend is absolutely right. This is about not just understanding the experience of the person who is suffering from mental health, but the knock-on effect on the entire family. One thing that my constituents frequently raise is the impact on other siblings when one child in the family has mental health issues and ensuring that the others do not feel neglected or disadvantaged when one sibling necessarily gets more attention.

Not only do we need to change cultural attitudes towards mental health, we need to look at the legislative framework. Most of us would agree that 1983 was the last time we had a serious, large-scale piece of legislation and, in 1983, the old model that I was discussing earlier was the prevalent model. There is a pressing need for a larger piece of legislation that can build upon on the measures in this Bill and ensure that we take a more comprehensive look at things.

[Kevin Foster (Torbay) (Con)]

I am enjoying listening to my hon. Friend’s speech. Does he agree that the use of police cells is a big area for review? While we have seen a welcome decline in the use of police cells as places of safety, it is unacceptable that someone can end up in a cell not because they are suspected of a crime, but because they have been unwell.

[Oliver Dowden]

My hon. Friend makes an important point and that is something that we are waking up to. As Home Secretary, my right hon. Friend the Prime Minister made great strides to seek to change the approach taken by the police so that people are not automatically put in a cell. If somebody is already suffering from a mental health condition, the worst possible thing for them is a night in the cells, the conditions of which we have all seen as constituency MPs.

[Kevin Foster]

Will my hon. Friend briefly give way again?

[Oliver Dowden]

I will, but I am conscious of the time.

--- Later in debate ---

[Kevin Foster]

My hon. Friend is being extremely generous. The situation is ironic, because we have strict time limits for detention without a magistrate’s warrant due to the mental health impact on criminal suspects, yet we do not have the same for mental health. That could be looked at in future legislation.

[Oliver Dowden]

Again, my hon. Friend makes an important and interesting intervention, which comes back to the wider question of how we achieve parity. Parity is about not just funding or treatment by GPs, but all these other forms of, for want of a better phrase, micro-discrimination.

--- Later in debate ---

[Mrs Trevelyan]

My hon. Friend is absolutely right. Interestingly, even in the social media world we all live in, a storm of anonymity allows a level of poor behaviour. If the body-worn camera empowers people to remember that anything from good manners and good behaviour to constructive dialogue rather than more violent interventions is the way forward, this must be a tool we should be encouraging across the board. One hopes that behaviour can improve once people remember how these things can be done more constructively and with less violent interventions.

[Kevin Foster]

Does my hon. Friend also agree that one bonus of footage from body-worn cameras is that people have to go through a less lengthy investigation? Such investigations take the police officer off duty and put them on gardening leave. Having the certainty these cameras provide means that for both sides a quick resolution can be reached, and the organisation can then move on.

[Mrs Trevelyan]

My hon. Friend is exactly right. These common-sense measures could have a dramatic impact on the way our mental health units work, and for the well-being of both staff and those who are there receiving treatment.

Another important aspect of the Bill is the proposal that justice for a potential victim would now become possible. Our country and our values are based on the rule of law, but for justice to be done we need a new and open approach which would allow our public services to learn from past mistakes and ensure that no family or individual has to suffer the tragedy of loss or injustice that has too often been experienced by patients and their families. I have a constituency case in which a young girl had been put in restraint, not within a mental health unit, but within a special school environment, and, as a result of the fits from which she suffered, she hit her head and lost her sight. That is truly tragic, and the family has fought and fought to find a way to get redress and a better educational framework for this child to learn, having developed this entirely avoidable blindness. There is a great challenge in ensuring that we have a system that is open and transparent, and that families can be heard and do not have to fight for years.

--- Later in debate ---

[James Heappey]

From discussions with local police constables and with the police commander, it seems that police officers have an instinct for when they are going into certain types of situation. One would imagine that if an officer were on the custody desk and heard that something required their intervention, they would obviously flick on their camera as a matter of drill while they were going down to the cell or wherever something was happening. That is assuming what we were just discussing—that it should be standard practice that somebody in those circumstances is always fully kitted out.

[Kevin Foster]

The requirement in the Bill is for officers to wear body-worn cameras when attending a mental health unit. My understanding is that that means that the unit has an issue and has called the police to attend. In many instances, custody suites have cameras, even though they may not be body-worn. The real solution is that response officers—those who are deployed ready to attend 999 calls—should have body-worn cameras. That would help not just in these instances, but in many other circumstances.

[James Heappey]

My hon. Friend is right, but whenever attending a call-out to a mental health unit—just as in attending any other event in the community—the police officer would have deployed in their patrol car wearing their full kit. They would already have been wearing the camera and would have switched on it on as they were entering the situation, if they thought that were necessary. The much more likely scenario, as perhaps would have been the case with James Herbert, is of people being called into a situation when they are not out on the street, but are just nearby and lending a hand. The fixed cameras in the building may be obscured by those doing the detention, so I also see real merit in body-worn cameras being used in those situations.

This is not just about how to ensure that acute, immediate interventions are handled properly. It is also about the additional training that might be offered to police and mental health workers to make sure that these situations do not arise in the first place. Training is key. That goes without saying for mental health workers, who, by vocation, understand this stuff very well indeed, but the police are much less confident in dealing with people with mental health issues than they should be.

Training for the police so that they can spot those signs and intervene appropriately with concern and care would be helpful and would prevent a large number of the instances that we are debating. There are techniques for reassuring people, for de-escalating, and for managing the anxiety that often manifests itself in people with mental illness. Equipping police with those skills would be very welcome indeed.

--- Later in debate ---

[Will Quince (Colchester) (Con)]

I add my congratulations to the hon. Member for Croydon North (Mr Reed), who is not in his place, on introducing the Bill and on the emotive and heartbreaking story that he shared with the House.

The Bill is an important part of a wider issue. We need to improve our approach to mental health. Without question, mental ill health carries a stigma and a taboo, and Members from both sides have played a huge role in tackling that. One of my passions is campaigning on baby loss, which has a similar stigma and taboo attached to it. We do not talk enough about it, and that has led many people to stay silent. If we are to tackle the stigma and taboo, we have to raise these issues as much as possible and ensure that people feel able to talk about them openly. There is no greater place to do so than on the Floor of the House of Commons Chamber.

The Mental Health Act has remained unchanged since it was first published in 1983, and many consider it to be no longer fit for purpose. As a comparison, when the legislation was introduced, the Diagnostic and Statistical Manual of Mental Disorders, which is known as the DSM, existed in its third edition. Since then, it has undergone multiple revisions, and it is now in its fifth edition. The research into mental health conditions and our understanding of them have developed, particularly over the last three and a half decades, but our legislation has not changed. That is not good enough.

The Bill is one important step among many towards ensuring that people with mental health conditions are treated appropriately. I want to make it clear that there will be circumstances in which restraint is required in mental health units. That is, sadly, inevitable. Staff in such units have an incredibly challenging job. We would all agree, however, that restraint should be the last resort, not the first. I pay tribute to Mind, which launched its campaign in 2011 to reduce the use of restraint in healthcare settings. It has made fantastic progress so far.

In 2014, the coalition Government published guidance in this area following investigations into abuses at Winterbourne View hospital and a report published by Mind, which found that restrictive interventions were not being used as a last resort. The guidance made it clear that staff must use such actions only if they represent the least restrictive option for meeting the immediate need. The guidance also made it clear that staff must not deliberately restrict people in such a way as to impact on their airway, breathing or circulation. That includes face-down restraint on any surface, not just on the floor.

I continue in the spirit of the coalition Government by paying tribute, as my friend the hon. Member for Bath (Wera Hobhouse) has done—she is currently looking at her phone on the other side of the Chamber, and I cannot attract her attention—to the right hon. Member for North Norfolk (Norman Lamb) for the work that he did as a Minister. I know that this is an issue that he cares deeply about. I know that the right hon. Gentleman is not in the Chamber at the moment, but I certainly want to put that on the record—the hon. Lady still has not realised that I am complimenting her colleague—because he did a huge amount of work in this area.

Later in 2015, the Mental Health Act 1983 code of practice was revised, and NICE updated its guidance on violence and aggression, both of which put the emphasis on prevention and advised against the use of prone restraints. What all this recognised is that the solution is not to blame the staff, but to give them the skills and confidence to deal with some incredibly challenging situations.

In September, I visited the Lakes mental health unit in Colchester to see at first hand what a mental health unit is like. I initially had a brief meeting with senior managers, including Sally Morris, the chief executive of the Essex Partnership University NHS Foundation Trust—the names of NHS trusts always seem to be a bit of a mouthful—which manages the Lakes unit in my constituency. I was then given a tour of Ardleigh ward and Gosfield ward, and we discussed many issues. Restraint was not one of the issues we discussed, but following the debate on this extremely important Bill—the hon. Member for Croydon North, who introduced it, is now in his place—I will definitely be asking questions about the use of restraint in that unit.

I support what the Bill is seeking to achieve on training, especially as set out in clause 5(1). In many ways, it strikes me as remarkable that frontline staff would not already be given such programmes, but this is a good way of ensuring that staff, particularly new staff, are aware of best practice and guidance on the use of force. I suggest, however, that the Committee looks at whether the provision should be wider than just induction, so that existing members of staff are also given this training. In any workplace environment, it is incredibly important for people to be given refreshers to ensure that training remains fresh and at the front of their mind.

Another area I want to touch on is the mandating of body cameras for any police officer who attends a mental health unit. A number of colleagues have already raised this issue, but I want to focus on one particular area. It is important to mention from the outset that the use of body-worn cameras is ultimately a decision for local police and crime commissioners. Police forces are at different stages in this process: some are just investing now; and others are looking at new equipment, because they have used body-worn cameras for some time and are now in the second phase of procurement.

I suggest—I mentioned this in an intervention on my hon. Friend the Member for Wells (James Heappey)—that clause 13(2)(a) is perhaps a little too eager in expecting officers to turn on their cameras. It states:

“The police officer must ensure that his or her body camera is recording…from as soon as reasonably practicable after the officer receives the request to attend the mental health unit”.

That might be looked at in Committee, because the focus should perhaps be on ensuring that there is a recording of their attending the mental health unit, rather than from the point at which they get such a request.

[Kevin Foster]

My hon. Friend is making some very interesting points. Does he agree that the presumption is that an officer who is on duty and using a body-worn camera should have it switched on? Only when an officer has a specific reason to turn it off—for example, when dealing with a vulnerable witness who is uncomfortable talking while the camera is on—should it be switched off.

[Will Quince]

My hon. Friend raises a very good point. I come back to what I said earlier about body-worn cameras, which is that police forces are at different stages in the evolution of these pieces of kit. Their cameras have different battery lives and different download capabilities—some recordings take several hours to download, but more modern functionality means that that can be done quite quickly—so it depends where police forces are with their procurement and how long they have had the equipment. I totally agree with him, however, that the presumption is that this piece of equipment should be on, and that is and should certainly be standard practice for newer cameras.

--- Later in debate ---

[Mike Wood (Dudley South) (Con)]

Like other hon. Members, I wish to start by congratulating the hon. Member for Croydon North (Mr Reed) on introducing such an important Bill. I know from my own experience two years ago of being drawn high up in the private Members’ Bill ballot that it can feel a bit of a mixed blessing. There are a few days in the lead-up to publishing the Bill when they are probably among the most popular Members of Parliament; telephone lines and email inboxes are rarely idle. Of course once the simple step of presenting the Bill is done, the really hard work begins, not only in producing the Bill and the explanatory notes, but in starting to build the consensus that allows the Bill to have a reasonable chance of progressing into legislation. The hon. Gentleman has done that exceptionally well to this point, and I know he will be proceeding as he has begun.

I also wish to thank my constituents who have contacted me, some with their own experiences and others with their own views of the current use of force in mental health units. I also thank West Midlands police and the range of organisations with an interest in mental health policy which have briefed us all, shedding new light on both the scale and nature of the problems in the system.

In recent years, mental health has come to the fore in public policy, and much of that is due to the outstanding work done by a number of right hon. and hon. Members who have a real passion for improving the way mental health is treated and ensuring that parity of esteem is not just a catchphrase but rather that it reflects the way mental health is treated, not only in the NHS, but across public policy and society more widely. In particular, I am thinking of the excellent work done by my hon. Friend the Member for Halesowen and Rowley Regis (James Morris), when he chaired the all-party group on mental health; by the Secretary of State for Health; and by my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and, of course, the right hon. Member for North Norfolk (Norman Lamb), when they were Ministers responsible for mental health.

We have seen the changes in the guidelines and the way sections 135 and 136 of the Mental Health Act 1983 are handled, and the new provisions that will be brought in through the Policing and Crime Act 2017, which gained Royal Assent earlier this year. The political consensus that there is a need to do more is being matched with real progress in both policy and legislation. All of us have welcomed the prominent place mental health reform has had, not just in the Conservative manifesto ahead of the general election, but in its being reflected in the Queen’s Speech and in the Prime Minister’s announcement that the Government would begin a comprehensive review of the Mental Health Act. Public servants who work in the police, the NHS and the justice system are often on the frontline of dealing with people with mental ill health, particularly those affected by acute episodes of mental ill health. My hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) was, though, right to question why we always talk about mental health in terms of mental illness, because it is also important to talk about mental wellness and consider how we support, develop and improve people’s positive mental health.

A lot of the changes in the public policy framework in recent years have been driven by innovation in public services. I think in particular of the excellent work done by Inspector Michael Brown, who blogs as Mental Health Cop. He previously worked for West Midlands police, and I think he now works for the chief constable of Dyfed-Powys police. It is largely because of his work that the need to address sections 135 and 136 came to the fore of the public policy agenda. In recent decades, section 136 has set the framework within which people suffering from mental ill health are treated in the police and criminal justice system. Although it is part of legislation that is nearly 35 years old, it is barely different from equivalent measures in the Mental Health Act 1959. That was 60 years ago, when there were still asylums in Britain and the whole approach to mental health was completely different. Thankfully, we no longer have asylums and we make huge efforts to treat people in the appropriate settings and in the community. We need to ensure that we adapt not only public policy but a legislative framework that was designed for a completely different society with a completely different outlook on and approach to mental healthcare. The Bill has an important part to play in changing the legislative framework.

In my area, West Midlands police have made substantial progress in how they deal with people suffering from mental illness. In July, the office of the West Midlands police and crime commissioner and the West Midlands combined authority provided an update on and summary of some of their innovations, particularly the model of mental health triage that has been operating for the past few years. A successful model for mental health triage is being rolled out across the force, throughout the Black country, Birmingham and Solihull. The model relies on an ambulance vehicle, a mental health nurse and a paramedic being available between 10 o’clock in the morning and 2 o’clock the following morning, so that when there is a call-out and it is thought there might be mental health issues to consider, there can be an appropriate health response and health assessment, alongside and as part of the police response. Shortly before I was elected to Parliament, I had the privilege of joining a triage team on a call-out in Birmingham. I saw how it worked and the difference it made compared with the old model of police officers being deployed and, more often than not, somebody suffering from a serious episode of mental ill health ending up in a police cell or another custodial setting.

Let me give an example of how the system has worked. When the police and ambulance services received a report of a 19-year-old female self-harming in the street and threatening to kill herself, a check on the mental health systems was able to establish quickly that she had an extensive history with mental health services. The paramedic had wanted to take the female to an acute hospital immediately, but the deployment of the street triage team meant not only that her wounds could be dressed by the paramedic in the car at the scene, but that the mental health nurse could carry out a face-to-face assessment and make an urgent referral to the home treatment team. As a result, she got crisis access to services overnight and then home treatment the next day, which was a much more appropriate response for somebody going through a crisis. Ultimately, she was safeguarded with a friend for the evening, who took her home and stayed with her through the night, and the whole incident lasted 45 minutes, compared with the many hours it would have taken had she gone to A&E and then other more conventional settings.

The triage teams in the west midlands have treated about 9,000 people in the last year, and as a result—despite the worrying figures we have heard from around the country—the use of section 136 powers in the west midlands has been reduced by about a third over the last five years, from typically 1,200 to 1,300 a year to 852 last year. Remarkably, in the first half of the year, nobody at all in the west midlands was detained in police custody under section 136 of the Mental Health Act—the first time this has ever happened in the west midlands. Instead, more than 8,000 people have received alternative outcomes, including referrals to a GP or other partners, to ensure they get mental health care rather than have their case treated as a purely criminal justice matter.

Although significant progress has been made, and continues to be made, the Bill will help to make further progress, especially through the way it addresses the use of force and restraint against people suffering from mental ill health. Currently, the code of practice clearly states that restrictive practices should only be used where there is a real possibility of harm, either to the patient or to someone else, and should not be used either to punish or inflict pain or suffering, and should be used with minimum interference to autonomy, privacy and dignity. In the case of children and young people, it should not be used at all. Staff should always ensure that restraint is used only after taking into account an individual’s age, size, physical vulnerability and emotional and psychological maturity.

Although the guidelines exist, further openness around the use of force and restraint is not only welcome and progressive but absolutely necessary for the individuals involved and if our public service workers are to have confidence that their actions are reasonable and defensible. That is why clause 5, which requires that registered managers have a training programme for frontline staff, is particularly important. “Frontline staff” would include all registered managers who might reasonably expect to use force or authorise its use on patients. The proposal to guarantee that staff use the latest and safest procedures should be an opportunity to build on previous learning, not only on mental health care and proportionate use, but on wider issues of equality and necessity.

Clause 6 deals with the requirement on all mental health providers systematically to record information on their use of force. As has been said, if we can measure it, we can track progress and drive changes in behaviour. Including records on the gender, age and ethnicity of patients will help to improve our understanding and, more importantly, the understanding of public services about the use of restraint, particularly on the basis of gender and race.

Let me turn now to body-worn video. Clause 13 provides that on-duty police officers who are called to a mental health unit for any reason must wear body cameras that start recording from as soon as is reasonably practicable. The west midlands, which is within my own force area, is now rolling out body cameras to all its response officers. The kind of body cameras it is using can be automatically triggered by a siren or a blue light, or if airbags are deployed and firearms are drawn. We should consider how these body cameras can be automatically deployed and, without having to think about human error, can automatically stay on until they are manually turned off.

[Kevin Foster]

Does it make sense that, if a police officer is on duty in a response role, the presumption should be that the camera is on? We see that in other walks of life—for example, it is the case with ticket inspectors, so it should not be that difficult to apply this practice to on-duty, on-call police officers.

[Mike Wood]

My hon. Friend makes an excellent point, and he is absolutely right. We have seen body cameras used in other scenarios. They help to protect the police as well as those to whom they are responding.