Mental Health Act: CQC Report

Luciana Berger Excerpts

Tuesday 27th February 2018 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

(Urgent Question): Thank you very much for granting this urgent question, Mr Speaker. This morning, the Care Quality Commission published—

[Mr Speaker]

Order. I am immensely grateful to the hon. Lady, but she needs to say, “To ask the Minister for a statement, etc.” She will get her full go—her full bite at the cherry—when the Minister has delivered the initial statement. That is the way it works.

[Luciana Berger]

To ask the Secretary of State for Health and Social Care to make a statement on the Care Quality Commission’s report, “Monitoring the Mental Health Act in 2016/17”.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

The Government welcome the CQC’s latest annual report, which it produces as part of its statutory duty to monitor how mental health providers exercise powers and discharge their duties when people are detained under the Mental Health Act 1983. We are committed to ensuring that the Act works better for patients and their families, and this is why we have commissioned an independent review led by Professor Sir Simon Wessely, which will make recommendations in autumn. We are also investing more in mental health than ever before, spending an estimated record £11.6bn this year.

We have seen that the number of detentions under the Act has been rising year on year: it rose by 2% last year and by 9% the year before that. We also know that black people are disproportionately affected. These were both driving reasons for the Prime Minister’s decision to call for a review of how the entire Act is operating. The Government have already acted when they saw that the Act was not working properly. Last year, we legislated to make it illegal to use police cells as places of safety for children under the Act, and to ensure that police officers consult health support staff before using their detention powers.

Sir Simon, his vice-chairs and the independent review’s team are consulting actively and widely with service users and professionals, and today are taking part in a major stakeholder event in Newcastle. Indeed, I welcome the fact that the CQC takes care in its report to state: “We have confidence that the independent review’s solutions-focused approach to identifying priorities, based on the feedback and experiences of people across the country, will offer a review of the MHA that has the confidence of patients and professionals.” The CQC is, of course, directly involved in that review.

The CQC’s report found examples of good practice, but we recognise that more needs to be done to ensure that people’s voices are heard and their rights respected. Where possible, we expect all patients to be involved in their care planning and that providers should consider how best to do this in the light of the CQC’s recommendations. In the spring, the review will provide an interim report identifying priorities for its work. It will then develop a final report containing detailed recommendations on its priorities. This final report should be delivered by autumn 2018.

There are problems with the Act, and we will address them, but we should remember that today no one gets sent to an asylum only to disappear within its walls. There are regular reviews, clear rights of appeal and checks to ensure that people are lawfully detained only to get the treatment they need. Our society is changing how it thinks about mental illness, however, and we want to ensure that people have as much liberty and autonomy as possible.

[Luciana Berger]

This scathing report finds that too many patients subject to the Mental Health Act continue to experience care that does not fully protect their rights or ensure their wellbeing. Some Members might have seen the harrowing episode of “Dispatches” last week, which showed scenes of a patient experiencing violent restraint at the Priory Group’s Dene Hospital. Today’s CQC report indicates that these experiences are not isolated. It shows no improvement in key areas of concern raised by the commission in previous years. It is totally unacceptable. In fact, some of the indicators are getting worse. Why is there still no evidence of patient involvement in 32% of care plans—up from 29% last year; of patients’ views being recorded in 31% of care plans—up from 26% last year; and of consideration of the least-restrictive care options in 17% of cases—up from 10% last year? This last, in particular, is a matter of serious concern. We know that the period following discharge from in-patient care is when most suicides happen. Why, then, in 24% of care plans was there no evidence that plans were made for discharging patients back home?

The report exposes the pressure on high secure hospital placements for women. One patient was in long-term segregation for over a year while waiting to access a bed. The Minister, to whom I listened closely, referred to the review by Sir Simon Wessely, but his review and report cannot provide answers to this patient or many hundreds more across the country today. Despite repeated Government promises of parity of esteem, we have seen yet another year of inaction. Does she accept that, in 2018 here in England, what is outlined in today’s CQC report is completely unacceptable, and will she tell us exactly what she is going to do this week to ensure that no patient in our country in a mental health unit is deprived unnecessarily of their human rights?

[Jackie Doyle-Price]

It is worth reminding the House why we introduced the CQC—to provide for transparent inquiry into the performance of our health services and so ensure they remain the best in the world. It is for precisely this reason—to make sure we do better—that we invite the CQC to do so so honestly and take any criticism arising from the transparent scrutiny that characterises this and all its reports. We recognise that we can always do better. The duty of candour in the NHS under this Government means that we will step up to the plate and respond to these challenges.

The hon. Lady describes the report as “scathing”. In fact, it highlights a positive direction of travel on access to advocates and promoting good physical health, and an improved direction of travel on care after discharge, so I do not accept the tenor with which she characterised the report. I would go further and quote the deputy chief executive of the CQC, who also highlighted the parallel review by Sir Simon Wessely. He says: “We have confidence that the independent review’s solutions-focused approach to identifying priorities, based on the feedback and experiences of people across the country, will offer a review of the MHA that has the confidence of patients and professionals.” The report also highlights that Sir Simon Wessely is already undertaking and identifying actions that can be taken outside new legislation, and the CQC is very much part of delivering that.

Far from being complacent, we recognise that we have a long way to go, which is one reason the Prime Minister has put mental health firmly at the top of our health agenda. The report identifies a positive direction of travel, but we will continue to turbo-charge it and deliver sustained improvements in mental health services.