Mental Health Units (Use of Force) Bill (Third sitting)

Luciana Berger Excerpts

Wednesday 25th April 2018 Public Bill Committees

[Mr Reed]

In which case, I will comment briefly. My hon. Friend raises a point that we discussed at an earlier stage. The Minister took the view that there was a better way to achieve these objectives, but I look forward to hearing my hon. Friend’s comments before we take a decision.

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

I thank my hon. Friend for his representations. I apologise for being a few minutes late—I was at another event.

Amendment (a) is about accountability: it would ensure we have annual updates on progress. Ultimately, that is the motivation behind the amendment. Having annual statistics on the use of force under clause 8 would ultimately lead to a minimisation of, and reduction in, the use of force. That is why we are all here today, so that update is absolutely critical.

In the Committee’s first sitting, clause 9 was amended to require the Secretary of State to publish a report relating to any reviews, and other reports about individual cases, particularly relating to deaths and serious injuries, but there is no requirement for the Secretary of State to publish a report relating to the annual stats on the use of force. Therefore, there is no opportunity for Parliament to scrutinise the progress towards the goal of reducing the use of force, which is the purpose of the Bill. That is the motivation behind the amendment.

[Jackie Doyle-Price]

This clause, which relates to the requirement for the Secretary of State to report on the use of force, goes to the heart of what we are trying to achieve with this Bill in terms of improving transparency. The amendments are the result of our discussions with the hon. Member for Croydon North and other interested parties, so they were reached in the spirit of consensus.

I am confident that the publication of statistics about the use of force in mental health units, building on the improved local data recording powers under clause 7, will significantly improve our national understanding of how force is used. The Government fully support the hon. Gentleman in his wish to see improved recording and reporting on the use of force. I am pleased that we agree that NHS Digital is the right organisation to collect and publish those important statistics.

I completely agree with the sentiments behind the amendment in the name of the hon. Member for Liverpool, Wavertree. It will often be appropriate for the Secretary of State to lay before Parliament a financial statement, an important report or a draft piece of guidance to facilitate parliamentary scrutiny. For example, the Mental Health Act 1983 requires the Secretary of State to lay a copy of any changes to permanent practice before Parliament. As the hon. Lady said earlier, in our discussions in a previous sitting we said we very much anticipate that the Secretary of State will lay an annual report on the use of force before Parliament. To make the report specifically about the statistics collected would introduce an aberration into how we treat NHS Digital statistics. We produce a wide range of health statistics each year, and to single out that subset would not be welcome. However, I expect that, in the course of making the annual report on the use of force, the publication of the statistics will provide a basis on which the Secretary of State will report.

I ask the hon. Lady not to press her amendment, on the basis that it is too prescriptive about the use of statistics. I hope she recognises that that is in no way an attempt to undermine transparency, which she and I want the Bill to secure. Once these figures are out in the public domain, there will be any number of ways in which all hon. Members can hold the Secretary of State to account, and experience tells me that the hon. Lady will always use them to hold us to account in relation to the use of these powers.

I hope that reassures the hon. Lady. For the reasons I set out, we are content to support the hon. Gentleman’s amendment and the clause, but we oppose amendment (a).

[The Chair]

Does the hon. Lady wish to press the amendment?

[Luciana Berger]

On the basis of what the Minister has said, I am content not to press the amendment.

Amendment 69 agreed to.

Clause 8, as amended, ordered to stand part of the Bill.

--- Later in debate ---

[Mr Reed]

Mr Gray, perhaps with your indulgence, this is an appropriate moment to acknowledge the presence of Seni Lewis’s parents, Aji and Conrad Lewis, who are extremely welcome here this morning.

The principles in the clause are fundamental to the Bill and to correcting injustices that have affected not just the Lewis family but far too many other families. After Seni Lewis’s death in such tragic and avoidable circumstances in 2010, his parents faced a seven-year battle to get an inquest opened, simply so that they could find out what had really happened to their child. The mental health services would also have had the opportunity to learn from those mistakes, to ensure that they were not repeated.

No grieving parent—indeed, no one—should ever have to face the ordeal of fighting for justice for so many years after the loss of a deeply loved relative. There is currently a glaring disparity between the way that deaths are investigated in mental health settings and in other forms of state detention. If a person dies in police custody, there is an automatic external investigation by an independent national body. If a person dies in a mental health setting, the trust or private provider investigates itself or appoints another trust or individual to do so. That means that reports end up being delayed or kept secret, or are not sufficiently robust. That is a denial of justice and a failure to learn the appropriate lessons as swiftly as necessary.

The system does not learn from mistakes, and it has lost public confidence, particularly among the BAME community. That means we end up with a series of isolated tragic incidents that keep happening time and again. We need a truly independent investigation system for non-natural deaths in mental health settings, just as we have in other forms of state custody.

I pay tribute at this point to the extraordinary work carried out by the campaigning charity INQUEST, which has exposed many failings, such as that that affected the Lewis family, shone a light on them and helped bring us to the position we are in today, making these recommendations in the Bill.

Amendment 1 would require that any person appointed to investigate deaths is completely independent of the NHS or of any private mental health service provider. It is an opportunity to ensure that there is fully independent scrutiny before any inquest begins. Crucially, that means that no family will have to fight for years for justice, in the way that the Lewis family had to.

I now turn to the serious incident framework, which is now in place but was not at the time of Seni’s death. I agree that it is an improvement, but I still have concerns about certain aspects of the guidance and the investigations themselves. We have already discussed the need for the full independence of investigations, but we must also consider the independence of those who commission a level 3 investigation under the new framework.

My concern is that under the framework as it is drawn up, it is still possible for the NHS to avoid such an investigation because it regards it, perhaps wrongly, as an unnecessary burden. As a result, lessons will not be learned, the system will not be held to account and more patients will suffer injury or even death.

I respectfully invite the Minister, therefore, to comment on who takes the decision to commission a level 3 investigation under the new framework and whether it is possible for the NHS to avoid commissioning the right level of investigation so that the appropriate lessons are not learned and the system not held to account. Moreover, does the framework guarantee that a level 3 investigation will take place following the death of a patient from the use of force?

That is key, because it is the loophole through which the Lewis family fell following the death of their son. That failing led to them being denied justice and to the trauma of not only losing their child in such horrific circumstances but having to fight the state for seven years just to secure justice and to find out what had gone wrong to leave an otherwise healthy 23-year-old losing his life.

I hope that the Minister will be able to give a full assurance that families will not have to experience the same long delays under the new framework. For example, how soon following a death should it start, and how long should it take to be completed?

Finally, I am concerned about the quality of the investigations under the framework. The charity INQUEST and others have been absolutely clear for many years that too many investigations are inadequate because they are not fully independent of the organisation that is being investigated. We simply cannot allow that to continue. If the Minister will not support my amendments, I would very much appreciate hearing from her how she intends to address those very important concerns, which I know from conversations and previous debates she shares with me.

I now move on to new clause 1. Another barrier to justice for families is the lack of funding for legal advice and representation. Dame Elish Angiolini’s report concluded last year that

“families face an intrusive and complex and mechanism for securing funding”,

because there

“is no legal aid for inquests other than in exceptional circumstances”.

The Angiolini report recommended that legal aid should be awarded to families in the case of deaths in police custody. The Government have accepted that there is a need to look at that in the Lord Chancellor’s ongoing review of the provision of legal aid. To me and many others, it makes little sense not to extend that to situations in a mental health unit. Restraint in police custody is not different from restraint in a mental health unit, which is the whole point of the Bill.

We need—and I believe that this is also the Government’s intention—consistency in the way in which people with mental ill health are treated across the whole system. We cannot have differences between one form of state custody and another. We have already seen that lead to too many deaths, disproportionately of young black men. Here is an opportunity to correct that unfairness, to make the system more equal for everyone, regardless of their background.

New clause 1 will ensure that legal aid is available to family members in relation to an investigation of an unnatural death in a mental health unit, as described in clause 11. It is very important that we level the playing field. There is a serious imbalance when the state has access to high-quality legal advice but a family in highly traumatised circumstances does not. That is an injustice which my proposal will correct, although I look forward to hearing from the Minister whether there is an alternative means of achieving the same objectives, which I believe that she shares.

[Luciana Berger]

I rise briefly to support my hon. Friend’s amendments, which are critical because, outside this place, organisations and families affected by the loss of a loved one in a mental health setting are looking to us to address this injustice. He said that there is an automatic independent investigation in some settings. If someone loses their life in prison, for example, the prisons and probation ombudsman carries out an independent investigation. It is absolutely critical that that happens if people are taking their lives or losing their lives in prison.

People in a mental health setting are at their most vulnerable, and I believe that one person taking their life is one person too many. Unfortunately, too many people in mental health settings in our country take their lives. We have a responsibility to them, their loved ones and their families to ensure that proper investigations take place so that real learning can occur. There are too many examples. We have heard about the suffering of the Lewis family—we are here today because of what they went through—who had to wait a long time to get justice and an understanding of what happened to their son.

There is also the experience of the family of Connor Sparrowhawk. Sara Ryan has been an incredible campaigner since her son’s death in 2013. Despite her indomitable campaigning, strength and courage, it took five years for that family to get justice and to understand what happened to their son, who died in a bath in a mental health setting. Those are just two families; there are many others who do not have that strength. I totally understand why they might not: in the wake of the loss of a loved one, they might not have the wherewithal to pursue the relevant organisations, particularly if the family cannot match the legal and financial might at the organisations’ disposal. We see time and time again that they can prolong proceedings, send lengthy letters and keep batting things away.

I anticipate that colleagues on both sides of the Committee will reflect on their experiences from their constituencies. Our constituents come to us because they face that wall and are unable to challenge the system. We have a responsibility if we are serious about adequately contending with this issue. I welcome the Government’s support in helping us to get to where we have got so far. I see this measure as part of a bigger picture. Without it, we will be failing people. We must be serious about equality of mental health and parity of esteem in this country. In my view, this is a social justice issue: disproportionately, it is black men in mental health settings who are affected in this way.

People should automatically get an independent investigation. They should not have to fight for one or go through an incredibly drawn-out legal process. Some people manage to get investigations at the moment, but it should be automatic. That is why my hon. Friend’s amendments are critical. Many organisations are concerned about this issue, including INQUEST, a charity that fights on behalf of many people in our country to ensure they get access to justice and an understanding of what happened. Often, it is about the unknown. People were not there at the time, and they really want to understand how their loved one came to take their life.

Without real movement on this issue, we will be doing an injustice to people up and down the country. I support my hon. Friend’s amendments, and I hope the Government give them due consideration to ensure we adequately deliver for people in our country.

[Jackie Doyle-Price]

This clause and group of amendments go to the heart of the approach taken by the hon. Member for Croydon North to this Bill. Justice delayed is justice denied, and the incredible length of time that some investigations have taken is totally unacceptable. I welcome the fact that this Bill will build on measures the Government have already taken to address those unacceptable delays. We should challenge head-on the fact that that makes the whole system discriminatory.

The hon. Member for Liverpool, Wavertree alluded to black men, and the Prime Minister is particularly concerned about that. The hon. Lady also mentioned Connor Sparrowhawk. I think people with learning disabilities are massively discriminated against in our system. By ensuring more transparency, we are trying to improve the rights of everyone in the system and strengthen social justice.

--- Later in debate ---

[Jackie Doyle-Price]

Yes. It is very much being taken forward by that ministerial board, of which I am co-chair alongside Ministers from the Home Office and the Ministry of Justice, to achieve exactly that consistency. I hope that reassures the hon. Gentleman on that point. I will also be happy to support him if he wishes to make representations to the Ministry of Justice, which owns that work, although I am very much part of it.

[Luciana Berger]

Forgive me if I missed it, but would the Minister share the timelines with us? When do we anticipate that process from the Ministry of Justice concluding?

[Jackie Doyle-Price]

I will write to hon. Members about that to set it out clearly. I could give a flippant answer, but it might not be accurate, and I do not wish to mislead the Committee. I would say that the ministerial board is actively meeting and consulting with external stakeholders at this very moment. It is not going to be a long-grass project, but we will give hon. Members more clarity in due course.

On that basis, I ask the hon. Gentleman to withdraw the amendment. The Government propose that clause 12 be replaced by new clause 6, which sets out the method of investigating cause of death. New clause 6 requires that, when a patient dies or suffers a serious injury in a mental health unit, the responsible person would have regard to certain guidance that relates to the investigation of deaths or serious injuries, including the NHS serious incident framework and any relevant guidance from the CQC, NHS Improvement and NHS England. The new clause moves the process more consistently into the body of the health service and the framework for investigation.

I know the hon. Gentleman’s objective is to prevent a recurrence of the experiences of the Lewis family, whose investigation got stuck for many years. We have drawn up the new clause on that basis. We want to avoid any confusion that introducing a completely new system might lead to. We want to avoid duplication, but establish independence, which we have already started to move forward on with the Healthcare Safety Investigation Branch.

The coroner already has a responsibility to investigate deaths of those detained under the Mental Health Act 1983 and any death that is unexpected or unnatural, which would include deaths that occurred during, or as a result of, the use of force. The NHS serious investigation framework sets out robust procedures for investigating and learning from an unexpected patient death, including an independent investigation when criteria are met.

To reassure the hon. Gentleman on timing, which I know is a big issue here, we would expect any investigation into a serious incident to be concluded within a year and certainly to commence within three to six months. There might sometimes be issues that elongate that investigation, but we will avoid any case just being stuck and left. Investigations will always be undertaken as soon as practicable.

I ask the hon. Gentleman to withdraw the amendment and not to press new clause 1. I ask the Committee to disagree to clause 12.

--- Later in debate ---

[Jackie Doyle-Price]

I very much welcome the provisions in clause 13, as amended. When first mooted, the use of body-worn video by police officers met some resistance, but I have spoken to those who now use it, and they absolutely welcome it. The provision brings further transparency, which is in the interests of police officers and anyone they come into contact with, and I am convinced that it is a welcome part of the Bill.

Body-worn video has been shown to reduce the use of force, which lies at the heart of the Bill, and it is vital to take the opportunity to require police officers to use it, unless, as the hon. Gentleman said, there are good reasons not to. We would not want to interfere with the operational effectiveness of the police by insisting on cameras, but body-worn video would be good practice and should be encouraged as much as possible.

The amendment will ensure that recording is specific to the incident, and that the use of body-worn video is not disproportionate, so that the rights and interests of those at the unit—patients, staff and visitors—are protected. Recording will take place only when the officer is assisting staff in the care of a patient with mental health issues. I am pleased that some forces already have local agreements in place—again, it is in everybody’s interest that this happens—and we anticipate that all forces across England and Wales will continue in that direction.

We will seek to implement this measure with guidance that sets out principles with examples of special circumstances, and it is right to ensure that professional bodies are involved in this work. Although the list may not be as exhaustive as some would like—it is impossible to set out every instance—every attempt will be made to ensure that it is as comprehensive and thorough as possible.

[Luciana Berger]

I am listening closely to the Minister, who is making important points about how this measure will work in practice, which I welcome. Does she think, as I do, that this provision will also work as a counter to what we increasingly see on undercover programmes, which is what happens when cameras are not there? Sometimes footage is taken by people who bravely go undercover. I am thinking, most recently, of the “Dispatches” reporter who went undercover in the Priory. In some settings, we saw the use of force on a patient, and how traumatic that was for the patient and for inexperienced staff. We are discussing the police and ensuring that they have cameras when they go into such settings, but does the Minister think that, in time, we should discuss the use of cameras in all mental health settings to protect patients?

[Jackie Doyle-Price]

The hon. Lady makes some excellent points, and in the run-up to the Bill, we discussed some of those wider issues. It is incredibly sad that undercover reporting has, on occasion, shown such bad abuse. The fact that there is a camera will affect people’s behaviour in a positive way, although perhaps it is sad that we need to rely on that. We must, however, balance that with the need for privacy, and we can have further discussion on that. However, I see no reason why we would not have cameras in communal areas, for example. We will discuss the provisions in the Bill with organisations such as the College of Policing, and that will enable a discussion to take place with providers about where it is appropriate to have cameras. I am sure we will return to that issue.

--- Later in debate ---

[Jackie Doyle-Price]

On a point of order, Mr Gray. I associate myself with the hon. Gentleman’s remarks. I thank you and the Clerks for guiding us safely and promptly through the procedure. It has been a very good use of our time and resources. I also thank my officials, who have worked very quickly to pull this Bill together in a way that delivers the hon. Gentleman’s objectives in a way that works. It can be challenging when these things come through in a private Member’s Bill.

I pay tribute to the hon. Gentleman, who has brought forward a very important reform to how we treat people detained under the Mental Health Act. From my perspective as Minister, we have reached the position whereby, if we are going to achieve parity of esteem, there needs to be a complete reconfiguration of the law as it applies to mental health, to strengthen people’s rights. This very important reform will achieve exactly that.

I also associate myself with the tribute the hon. Gentleman paid to Seni Lewis’s parents. They have taken an incredible tragedy and channelled it into doing something positive. They will achieve a real legacy that strengthens the rights of people who find themselves detained. I pay full tribute to them for doing so.

My final thanks go to all hon. Members who have turned up—quite often to do nothing, because we did not have a money resolution to progress the Bill, but I am very grateful to them for doing so.

[Luciana Berger]

On a point of order, Mr Gray. I put on the record my thanks to my hon. Friend the Member for Croydon North for promoting this important Bill.

People outside this place may not know how the private Member’s Bill process works. It starts with a ballot, in which Members put their names in a book. They might get drawn out of the hat and be at the top of the list—I have been taking part for the past eight years and my name certainly has not been pulled out of the hat—but they then have to make the difficult decision of what to use their private Member’s Bill slot for. It is difficult: I have seen the swathes of emails that Members receive, not only from constituents but from countless campaigning organisations across the country that want Members to champion their proposed legislation or campaign.

Not only has my hon. Friend chosen a critical issue—I am so glad that he did so—but he has done so in a way that ensures that the Bill will progress and that, after its passage concludes, we will actually see some action. We cannot say that for every private Member’s Bill. There are others for which we come together on a Friday and vote for or against it and they do not progress. My hon. Friend has chosen something that ensures that he will actually effect change in this country—the chances for which, particularly for Opposition MPs, are in short supply.

I put on the record my thanks to my hon. Friend for his courage and dedication and for the work he has done with countless organisations outside this place. He has introduced something so practical that has gained Government support, and collectively we have ensured that we can actually make a difference for what I believe will be thousands of people in our country.

[The Chair]

Those were all entirely bogus points of order, but they are none the less very welcome. They were entirely appropriate. I will pass colleagues’ thanks to my co-Chair, Ms Buck.

Question put and agreed to.

Bill, as amended, accordingly to be reported.