Southern Health NHS Foundation Trust

Baroness Berger Excerpts

Wednesday 8th June 2016 Westminster Hall

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

It is a great pleasure to serve under your chairmanship this afternoon, Mr Hanson. I congratulate the hon. Member for Fareham (Suella Fernandes) on securing this important debate, and on her heartfelt contribution. She made some excellent points, which I am sure the Minister will be keen to address. It is impossible not to be moved by the catalogue of tragedy that has unfolded at Southern Health foundation trust. This afternoon we have heard the distressing and tragic cases of the most vulnerable people in the country—people with learning disabilities or mental health conditions.

The trust has an enormous responsibility. In my role as shadow Cabinet Minister for mental health I see many trusts across the country, and I am struck by the trust’s size, and the fact that it is responsible for more than 40,000 patients. That is significant in the context of this afternoon’s debate.

We have remembered the lives that have been cut short. We have heard about Connor Sparrowhawk, “Laughing Boy”, who was tragically left to drown in a bath—the same bath in which another patient died in 2006; Angela Smith, who took her own life; David Hinks, who we heard about from the hon. Member for Havant (Mr Mak); and David West, who died in the care of Southern Health. Like too many families, David’s father Richard was repeatedly dismissed when he persistently raised his concerns, and he was treated very badly after the death of his son.

I believe that we are here today only because of the resilience shown by these families, their friends and campaigners. I make special mention of Sara Ryan, Connor Sparrowhawk’s mum, who sadly cannot be with us today but who I am sure will be looking closely at Hansard after this debate. Despite the horrendous way they have been treated after the death of their loved ones, and the barriers—not least financial—that they have faced in their quest for justice, they have never given up in their campaign to reveal the truth.

Only this morning I was at a trade union conference, where I heard from Margaret Aspinall, chair of the Hillsborough Family Support Group. She talked of the struggle that she and the other families of the 96 went through to access justice. I am reminded of the parallels, because she has very publicly challenged why publicly funded organisations can spend significant sums of money on legal fees for inquests, but the families are, in Margaret’s words, left to “beg and borrow”. I have previously asked the Government how much the NHS is spending on legal representations at inquests, to try to shed light on this particularly significant matter. The Minister was not able to give me a reply, but in the context of this debate I urge him to try again. It is particularly relevant and pertinent that we should know how much is being spent while families throughout the country, and particularly in the cases we are speaking about this afternoon, are having to spend enormous sums of money just to access justice on behalf of their loved ones who have passed away.

It should not be left to families alone to have to fight for the answers. Too many people have been denied decent care and systematically let down by the very organisation that was charged with their wellbeing. We have heard about hundreds of unexpected deaths that occurred at Southern Health between April 2011 and March 2015, most of which were not considered to require an investigation. We know that, over the past five years, 10 patients who had been detained for the safety of themselves or others jumped off the roof of a hospital run by the trust. Access to a roof was still permitted to people at risk of suicide.

We have also heard about the reports on Southern Health that have demanded changes and improvements to patient safety—improvements and changes that, by and large, the trust has failed to implement over far too many years. I believe it is a story of chronic management failure. Most astonishingly of all, it is a story of a chief executive who remains in post despite this litany of failures on her watch over a number of years. I cannot imagine a chief executive in any comparable organisation who would still be in post with such a record. I take a different view from the hon. Member for Fareham and the Minister: I do not say this lightly, but I do not believe that Katrina Percy should still be in post. Does the Minister have confidence in the chief executive of Southern Health foundation trust?

Like other Members, I welcome the appointment of Mr Tim Smart as the new chair of the trust, following the previous chair’s resignation. We know that he has recently launched a new appraisal of the capabilities of those involved in the governance of Southern Health, and that is not before time. I understand that he has met some of the victims’ families, and I hope that marks the start of an ongoing and meaningful dialogue, not a one-off encounter. Mr Smart has an incredibly difficult job to do to rebuild faith in the trust and to ensure that governance arrangements are robust and sustainable. Most importantly, he must move swiftly, after months of sclerosis, to ensure that patients are not at risk and that no more preventable deaths can ever be allowed to occur.

When the Secretary of State responded to the urgent question on Southern Health from the Labour shadow Secretary of State last December, he rightly said that, more than anything, people want to know that the NHS learns from such tragedies. But the most recent CQC report shows that Southern Health has not learned from these tragedies. The Secretary of State also said:

“Nor should we pretend that this is a result of the wrong culture at just one NHS trust. There is an urgent need to improve the investigation of, and learning from, the estimated 200 avoidable deaths we have every week across the system.” —[Official Report, 10 December 2015; Vol. 603, c. 1141.]

We know that the case of Southern Health is not unique. In my role as shadow Cabinet Minister for mental health, I receive many pieces of correspondence from people right across the country. I was contacted only recently by Richard Evans, father of Hannah, who took her own life while in the care of the NHS.

Hannah had a very long-standing history of complex mental illness. The conclusion of the inquest was that Hannah had died by hanging. The jury’s narrative verdict listed nine serious failings that contributed to her death, describing her treatment as “limited... inadequate...and insufficient.” The coroner further submitted a regulation 28 report in which he included the full jury narrative, stating that it

“revealed a serious breakdown of care in relation to Hannah”,

an individual with

“exceptionally complex needs who represented a very high risk of suicide.”

One of the most serious failings was that Hannah was able to get hold of an electrical cable, which she later used to take her own life.

Hannah’s tragic case shows that failures of care are not the preserve only of Southern Health; they take place in other parts of the NHS and in other parts of the country. We have also heard of at least three deaths this year of young people in the care of Priory Group hospitals. I am in regular communication with Inquest, a charity that works with those bereaved by a death in custody or detention, which sends me details of case after tragic case from across the country.

The Minister must address these questions in his response. I asked him this in an urgent question last month, and I ask again: does he have full confidence in the governance arrangements at Southern Health? If so, what evidence does he have to support his view? If not, what is he going to do to change, reinforce and strengthen governance arrangements at Southern Health? Is he content with the pace of change at the trust and the degree to which the trust’s board has implemented the recommendations made to it over recent months? What steps has he taken to ensure that similar situations cannot arise in other NHS trusts? What steps will he take to ensure that when a family loses a loved one, they are not left to fight and pay for justice on their own?

On that last point, I hope the Minister can go into some detail, because if any good can come from this sorry and tragic tale, it is that new systems are put in place to ensure that no other families are put through the sorrow and grief that the families of the victims of Southern Health have been put through, and that when deaths occur, they receive full independent investigations. Appallingly, such investigations have happened only on a few occasions.

We all understand that the NHS is a vast, complex institution. It deals with 1 million patients every 36 hours and employs more than 1 million people. Of course human error and tragic mistakes cannot always be prevented, but the lesson of Southern Health is that sometimes things go beyond human error. They can escalate to catastrophic levels of systemic failure, preventable deaths and cover-ups; they can descend into a culture of denial and secrecy; and they can end up at the opposite end of the spectrum of decency and compassion that characterises so much of our national health service and the caring professionals who work for it. That is why we call for a full public inquiry into preventable deaths in the NHS, so that light can be shone, families can grieve, and justice can be done. The victims and their families deserve nothing less.

It should not be left to individual families to have to fight and fund their own efforts to achieve justice. The British public, as the owners and funders of our national health service, need to be reassured that every part of it is working to its highest standards, with the best quality of care, particularly for some of the most vulnerable people in our country.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 10th May 2016 Commons Chamber

[Mr Hunt]

Of course I am happy meet my hon. Friend and his constituents. A close friend of mine who wanted to take a place in this House ended up dying tragically early because he had type 1 diabetes and was not able to get the care that he needed, so I am very aware of those issues. What we are doing in England, which is different from Wales, is publishing transparent indicators of the quality of diabetes care CCG by CCG. Those data will be published before the summer recess and will enable us to look at the disparities in care. I am sure there is more we can do.

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

Research published yesterday by NHS Providers and the Healthcare Financial Management Association showed that half of mental health trusts had not had an increase in their budget in 2015-16 and just a quarter of providers are confident that they will receive a funding increase for this financial year, 2016-17. Will the Secretary of State finally admit that the supposed additional investment in mental health that he talks about so often has not materialised for the patients and services that need it most? What is he going to do about it?

[The Minister for Community and Social Care (Alistair Burt)]

I thank the hon. Lady for her question and for her support for me in the recent London marathon. With reference to her question, it is precisely for the reasons she gives that it is so important for us to make sure that CCGs do transfer the extra money that is available for mental health into mental health services. That is why there will be more transparency and a scorecard for CCGs. She is absolutely correct—it is essential that that money flows through and we are determined to ensure that. Yesterday’s report only shows how right our current actions are to make sure that that happens.

Southern Health NHS Foundation Trust

Baroness Berger Excerpts

Tuesday 3rd May 2016 Commons Chamber

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

Urgent Question: To ask the Secretary of State to make a statement on the safety of care and services provided by Southern Health NHS Foundation Trust.

[The Minister for Community and Social Care (Alistair Burt)]

I thank the hon. Member for Liverpool, Wavertree (Luciana Berger) for her question. At the outset of my response, I want to express my deep concern and apologies to the patients and family members who will again have felt let down by the contents of last week’s report from the Care Quality Commission. Our first duty to patients and their loved ones is to keep them safe. This applies to all of us with a role to play in the NHS, from the frontline to this House, and the Government are therefore clear that it is imperative to be open and transparent about what has gone wrong in order to minimise the risk of similar failings occurring throughout the NHS as a whole. We must ensure that the trust itself continues to be scrutinised and supported to make rapid improvements in care. If that means intervention from the regulators, they will not hesitate to take the necessary action, and we will not hesitate to back them.

Last week’s CQC report followed a focused inspection announced and requested by my right hon. Friend the Secretary of State in December 2015. The report from the CQC set out a number of concerns, including: a lack of robust governance arrangements to investigate incidents; a lack of effective arrangements to identify, record or respond to concerns about patient safety; and a need for immediate action to address safety issues in the trust environment. The report also found that the senior management and board agendas were not driven by the need to address these issues. None of those matters is acceptable.

NHS Improvement has taken action in recent months to address the issues at the trust. It has been working closely with the CQC and the trust, and on 24 March, NHS Improvement appointed an improvement director to the trust. On 14 April, following a CQC warning notice on 6 April, NHS Improvement placed an additional condition on the trust’s licence, asking it to make urgent patient safety improvements to address the issues found by the CQC. That condition gave NHS Improvement the power to make management changes at the trust if it did not make progress on fixing the concerns raised.

On 29 April, following the resignation of the trust chair Mike Petter, NHS Improvement announced its intention to appoint Tim Smart as the chair of the trust. As chair, Mr Smart will have responsibility for looking at the adequacy of the trust’s leadership. Given the centrality of issues of governance to the CQC’s report, I welcome the action taken by NHS Improvement. The direct appointment of a new chair by a regulator is a relatively rare step, and it reflects the seriousness of the issues at the trust. NHS Improvement will continue to monitor the situation closely in the coming weeks and months.

I understand that the CQC is considering the trust’s response to its warning notice, and the risks it highlighted, before deciding whether to take any further enforcement action, and none of its options is closed. The notice required significant improvements to be made by 27 April. Dr Paul Lelliott, the deputy chief inspector at the CQC, was directly responsible for the report, and I spoke to him this afternoon. He informs me that the delivery plan required by 27 April has been received and is in the process of being evaluated. NHS Improvement is working closely with the CQC and the trust, and the improvement director appointed by NHS Improvement is on site regularly, so there is constant independent oversight of the progress being made, as well as the formal monthly progress meetings between NHS Improvement and the trust.

In addition to the action we are taking on Southern Health, it is vital that we learn the wider lessons for the NHS as a whole. First, I hope the whole House can agree that it is right that we have robust, expert-led inspection from an independent CQC that provides an objective view about issues of safety and leadership, and that this is backed with action from NHS Improvement where that is required. Secondly, it is vital that we take the issue of avoidable mortality as seriously for people with learning disabilities and mental health problems as we do for other members of our society. To that end, the learning disability mortality review programme has been put in place by NHS England to ensure that the causes of this inequality are understood, and with the aim of eliminating them. In addition, the CQC will be leading a review of how all deaths are investigated, including those of people with learning disabilities or mental health needs. There can be no question but that the CQC report makes for disturbing reading, and that it demands action at local and national levels. We owe our most vulnerable people care that is safe and secure, and I am determined that we will do all we can to ensure patient safety.

[Luciana Berger]

I thank the Minister for very brief advance sight of his response. Patients and parents have a right to be angry at the failure of Southern Health NHS Foundation Trust, and we in this House have a duty to be angry on their behalf. To read the litany of failure, missed warnings, reports and recommendations ignored, and secrecy over the last four years would make any reasonable person angry, too. Friday’s CQC report shows that very little has been done since the House last discussed the matter in December.

The scandal at Southern Health has happened on this Government’s watch, and Ministers must take responsibility for what has happened to some of the most vulnerable people in our country. We should be angry that Connor Sparrowhawk was left to drown in a bath. We should be angry that Angela Smith took her own life. We should be angry that David West died in the care of this NHS trust—his father was repeatedly ignored when he raised his concerns. All of them were denied the care that they so desperately needed. Last week, the BBC reported that over the past five years, 12 patients who had been detained for their safety or that of others have jumped off the roof of a hospital run by this trust. Access to a roof was still permitted to people at risk of suicide. If all those tragic incidents were the only signs of systemic failure, we should be angry, but there is a much bigger story of neglect and malpractice, which aggregates into a major scandal.

When the Secretary of State responded to the urgent question on Southern Health in December, he rightly said:

“More than anything”

people will

“want to know that the NHS learns from”

such

“tragedies”.—[Official Report, 10 December 2015; Vol. 603, c. 1141.]

The CQC report published on Friday shows that that clearly has not happened. So I ask the Minister: first, what guarantees can the Minister give to the 45,000 patients currently in the care of Southern Health, and their families, that they are safe? Secondly, where is the accountability, the culpability and the responsibility? There seems to be very little. I heard what he said about the chair, but does he agree that the chief executive’s position is now untenable, and that she should be sacked? Thirdly, will he listen to the heartfelt pleas of the victims’ families, the campaigners, and all of us who are demanding a full public inquiry into Southern Health and broader issues, such as the abject failure adequately to investigate preventable deaths?

As the Secretary of State said in December, such issues are not confined to one trust. The Ofsted-style ratings that he previously mentioned will make a difference only if there is proper accountability and the ability to take action to make real improvements to patient care and patient safety. The families have behaved with such dignity and tenacity, and we owe them a debt of gratitude, but it should not be left to them alone to push for accountability.

I listened carefully to what the Minister told the House, but I remain unconvinced that enough has changed. Four months ago, we heard similar reassurances. Today, we are debating the Government’s failure to act. The time for yet more warm words and hollow reassurances is over. We need action, and we need it now.

[Alistair Burt]

I thank the hon. Lady for her response. We are not actually debating the Government’s failure to respond at all. The Secretary of State did exactly what he said he was going to do, and the CQC’s inquiry and work that followed can be seen in the report that was produced last week. The report contains a number of further concerns—there is no doubt about that—and people are right to be angry, but there is a process to find out what is going on and to do something about it and that process is in place. That is what NHS Improvement is doing and it is important that that is done.

There is an issue of urgency, which is really important. There are things that are discovered and things take time to get done. I am not content with that in any way, but the process is in place to do something about that. The CQC has been engaged and has ruled out no option for further action. Its options are quite extensive, including prosecution for things that it has found. The process started by the Secretary of State is not yet finished. That my right hon. Friend has demonstrated his commitment to patient safety from the moment he walked into that office cannot be denied by anyone, and this is a further part to that.

I asked the same question that the hon. Lady asked about safety directly to the CQC this afternoon, and I spoke to Dr Paul Lelliott who compiled the report. I asked whether people are safe at the foundation trust today. People are safe because, as we know, the CQC has powers to shut down places immediately if there is a risk to patients. It has not done so, but I am persuaded that if it had found such a risk it would have closed things down. There is therefore no risk to safety in the terms that the hon. Lady suggests.

On the chief executive’s position, the power to deal with management change is held by NHS Improvement. I also offer a brief word of caution. There is a track record of Ministers speaking out, at great cost, about the removal of people in positions over which they have no authority. That is understandable in situations of great concern when an angry response seems right, but it is not an appropriate response. The chair has gone, and processes are available should any more management changes be necessary, which is important. Colleagues in the House can say whatever they like, but a Minister cannot and must say that appropriate processes can be followed, because that is right and proper.

I do not yet know about an inquiry, and I want to wait and see what comes out of the further work being done in the trust. I do not rule out some form of further inquiry, but an inquiry is physically being carried out now by the actions taking place on the ground. What needs to follow is urgent action to respond to what the CQC has said, and a long drawn-out public inquiry is not necessarily the right answer. More work might be necessary, but I need to consider that in relation to further work being done at the trust.

On preventable deaths, as I made clear in my statement, I am sure that not enough attention has been given to those cases that require further investigation across the system, often dating back many years and preceding this Government. We have turned our attention to that issue, and we will make changes because such inequality must end.

World Autism Awareness Week

Baroness Berger Excerpts

Thursday 28th April 2016 Commons Chamber

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

I congratulate the right hon. Member for Chesham and Amersham (Mrs Gillan), and the other sponsors of the debate, on enabling the House to discuss the important issue of autism. Let me echo a remark that was made by my hon. Friend the Member for Heywood and Middleton (Liz McInnes). We have heard many excellent speeches, but I am particularly grateful for the contributions of Members who have shared their experiences as parents of children with autism. That added greatly to our discussion.

I welcome one of the central calls in the motion, the call for an enhanced national awareness campaign. Raising the profile and public understanding of autism would break down some of the stigma, tackle the prejudices, and make it easier to explain autism to those who remain unaware of the realities of the condition. I pay tribute to the charities working in this field, including the National Autistic Society, Autistica, and Ambitious about Autism, which are fighting for people with autism and their families. They are campaigning for proper diagnosis, decent treatment, social acceptance and full, productive and dignified lives for people with autism. I also commend the many organisations, campaigns, towns and cities that are doing so much to raise awareness. There have been many contributors to the debate, but I have only eight minutes so I hope that hon. Members will forgive me if I do not mention them all.

The National Autistic Society has brought some important survey evidence to our attention. It has already been mentioned in the debate, but it is worth reiterating that although almost the entire population of this country has heard of autism, only 16% have any real understanding of the condition. That reveals a huge gulf between awareness and understanding, which is why a national campaign to develop better awareness of the realities of autism would be a welcome development. It should be led by, and involve fully, people with autism and their families, so that the campaign can be authentic and focus on the issues that really matter. Research by Ambitious about Autism has highlighted two specific audiences for such a campaign: teachers—40% of whom say that they lack the knowledge they need—and employers and jobcentres. While 99% of young people with autism say that they want to work, only 15% of adults with autism are in employment.

It is clear that people with autism and their families face terrible prejudice and stigma. The figures in the National Autistic Society survey show that too many people with autism and their families feel socially isolated or do not go out because they are worried about how the public will react to their autism. My hon. Friend the Member for Lancaster and Fleetwood (Cat Smith) shared the fact that people do not understand what a meltdown is. People are sometimes asked to leave a public space because of behaviour associated with their autism. This paints a picture of social isolation and daily humiliation. Autism is a condition in which people have difficulty interpreting the world around them, and that is compounded by the reactions and hostility of other people.

It is obvious that we are a long way from having public spaces that are safe for all people with autism. I welcome the fact that my own city, Liverpool, has started a bid to become one of the first autism-friendly cities, but we need to become an autism-friendly nation. [Interruption.] The Minister for Community and Social Care, mentions Manchester from a sedentary position, and I note the remarks made by my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) in that context. I hope that the Minister will address the issues of awareness, stigma and prejudice. I hope that he will also commit to supporting the Autism Access Award, to ensure that our public buildings and spaces are autism friendly. I am pleased that the House of Commons started work on this earlier in the year, and I hope that we can make progress to ensure that our workplace also becomes autism friendly.

Many hon. Members have mentioned the challenges relating to the Department of Health. Will the Minister tell us what efforts individual Departments and agencies beyond the Department of Health are making to support people with autism and which Departments and agencies have an up-to-date strategy for dealing with autism? What commitment will he make today to ensure that any that do not have such a strategy will adopt one?

The second substantive part of the motion relates to the length of time it takes to diagnose someone with autism. Many Members on both sides of the House have talked about this today. Autism requires an early diagnosis to enable individuals with autism and their families to be properly supported. As we have heard, however, adults are having to wait more than two years for a diagnosis, and for children, the figure now stands at 3.6 years. On my weekly visits across the country, I hear many of the stories that have been echoed in the Chamber today. In my own city, Liverpool, there are no fewer than 700 families waiting for an assessment. That is totally unacceptable; it is far too long. The long wait compounds the condition and makes a bad situation worse.

I have heard at first hand from the Liverpool Autistic Children’s Alliance, a parent support group that meets in my constituency, the difficulties experienced while waiting for a diagnosis, particularly in relation to education. The parents talk about not getting an education, health and care plan and therefore having no access to training to help them to support their children. They also speak of challenges in accessing appropriate education. We have heard that the NICE quality standard on autism makes it clear that people should wait no longer than three months, once referred, for their first diagnostic appointment. That standard is clearly not being met across the country, meaning that thousands of people are being let down. Given the importance of prompt, accurate diagnosis, I hope that the Minister will commit to asking NHS England to report on autism diagnosis waiting times for every clinical commissioning group in the country and then to hold them to account when the waits are too long. I hope that he will also ensure that NHS England’s new autism care pathway includes and reduces those diagnostic waiting times.

Research presented by Autistica and drawn up by the London School of Economics shows that the costs associated with autism are more than those of cancer, heart disease and stroke combined. They are at least £32 billion a year and include expenditure on hospital services, home healthcare, special educational facilities and respite care and lost earnings for both people with autism and their parents. Despite the costs, the outcomes for people with autism remain so poor. We heard during the debate about co-morbidities, extremely high rates of mental illness, poor physical health, social exclusion, lack of opportunities for employment and education, and, tragically, early deaths. Several contributions discussed the amount spent on awareness, but research also has the power to improve all those poor outcomes. Research spending on autism remains incredibly low at just £3 million a year, which is paltry given the scale of the challenge.

As shadow mental health Minister, I am aware that mental illness is also a huge challenge for people with autism, who are far more likely to have at least one mental health condition. The burden of anxiety and depression on people with autism is vast, about which we heard many personal accounts during today’s debate and which I hope the Minister will address in his remarks.

I will conclude on an important point about the fact that too many people with autism in our country are dying too young. The figures are startling. If we look at the research that was in the press only a few months ago, we see that people on the autistic spectrum die on average 18 years earlier than the general population. For autistic people with a learning disability, that figure rises to 30 years. That cannot be acceptable in this country in 2016. People with learning disabilities are at greater risk of suicide, and the most disturbing statistic is that the risk of people with autism committing suicide is nine times higher than that for the typical population, which is a scandal. I raise it during this debate because, as we have heard in some contributions, it is a particularly specific and pertinent issue that needs addressing, particularly in the light of the fact that suicide prevention organisations are not providing autism-appropriate services. From representations from many autism organisations, I know that phone lines for those who might be having suicidal thoughts are not appropriate for someone with autism. I hope that the Minister will address suicide prevention strategies and ensure that they are appropriate for people with autism.

I welcome today’s debate and its many superb, thoughtful speeches. I hope that the families listening to our discussions will feel that we are addressing their many concerns. I look forward to the Minister’s reply.

Mental Health Taskforce Report

Baroness Berger Excerpts

Wednesday 13th April 2016 Westminster Hall

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

It is a real pleasure to serve under your chairmanship this afternoon, Mr Wilson. I congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) both on securing this vital debate on the final report of the independent taskforce on mental health and on his excellent contribution. I am pleased that we have the opportunity to examine this incredibly important piece of work and to hear a detailed response from the Government. I thank all Members who have spoken in the debate; the quality of the speeches we have heard is testimony of the strength of feeling on both sides of the House on the issue of mental health.

I echo previous contributions today in saying that the taskforce report is an extremely comprehensive piece of work. I pay tribute to all those who were involved in delivering it. The recommendations it makes are robust and wide-reaching and signal what the chair of the taskforce—Paul Farmer CBE from Mind—has rightly described as a

“landmark moment for mental health”.

I also thank vice-chair Jacqui Dyer for her commitment and passion.

If implemented in full, the changes could make a huge difference to a system that is under increasing and unsustainable pressure. The real challenge lying before us now is ensuring that the aspirations set out in the report are actually delivered. For too long the rhetoric on mental health has not matched the reality on the ground. Members today have reflected the concerns felt by the people whom we represent across the country—people who themselves suffer from mental health conditions, their families and the services and professionals that care for them—who are anxious to ensure that the opportunity we now have to transform mental health in our country is not wasted.

I will focus my remarks on implementation and three key areas where unanswered questions remain—funding, transparency and accountability. Turning first to the money, the taskforce identified a £1.2 billion funding gap in mental health services each year by 2020. The Government responded to the publication of the report with an announcement of an additional £1 billion of investment for mental health services up to 2020. That is, of course, very welcome but I understand that the £1 billion will be taken from the £8 billion set aside for the NHS up to 2020. If that is the case—perhaps the Minister can confirm that for us today—I struggle to see how it will meet what the taskforce says is required.

Given that mental health receives just under 10% of the total NHS budget, it is difficult to see how the funding announced could be considered as additional, particularly in the context of the £600 million cut that mental health trusts have experienced over the course of the last Parliament. I should have thought that the Minister would have allocated that proportion of the £8 billion to mental health anyway, so I am keen to hear his response on that point.

There are also real concerns about how this funding will be distributed and what systems will be in place to ensure that it reaches the front-line services for which it is intended and not siphoned off to plug the deficits of acute trusts. That point has already been made by the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Bexhill and Battle (Huw Merriman). The Minister is right to prescribe that CCGs must increase the amount of their budget that they allocate to mental health at a rate that is at least in line with the general growth in their budget. However, as that budget information is not published centrally, I have yet to see any evidence from the Government that they are able to guarantee that CCGs are fulfilling that commitment. In fact, I have had to make freedom of information requests, which have exposed the fact that more than one in three CCGs are not meeting that expectation.

Just before Christmas, the Health Secretary announced that from June there will be independently assured Ofsted-style ratings for mental health provision by CCG area that will expose the areas that are not making the commitment to mental health that they should. I asked then if he would clarify whether that commitment would include publishing a clear picture of mental health spending for every CCG. I am still awaiting a response to the follow-up letter I wrote seeking clarification on that very important point, and I would be pleased if the Minister were able to confirm that for us today. As he will know, the Opposition strongly believe that the annual survey of investment in mental health must be reinstated. It was stopped in 2011, and it is an absolutely crucial piece of information.

That is especially important given the concerns that have been raised not only by many hon. Members today, but by the Mental Health Network, which represents mental health trusts, who have said that providers of mental health services are yet to see the difference from the investment in child and adolescent mental health services that the Government announced last year. During this debate, many hon. Members have raised specific concerns about CAMHS and the imbalance in the amount that they are allocated from the overall mental health budget. It is less than 10%, and it is a significant challenge. I am interested to hear the Minister’s response both to those very serious concerns and to the proposal from many mental health leaders that the cash should be ring-fenced—I am very keen to hear what he thinks about that.

That brings me to the second key theme of the report—the startling lack of transparency and accountability in our mental health system, which was mentioned by my hon. Friend the Member for York Central (Rachael Maskell) and the hon. Member for Gillingham and Rainham (Rehman Chishti). The significant gaps in the information that the Government collect on mental health present a significant obstacle to their ability to deliver what they have promised on mental health. On Monday we saw further shocking evidence of that information gap during the BBC’s “Panorama” programme, which highlighted the discrepancy between the data that the Government hold on the number of children who have died in in-patient mental health trusts and units and the figures from the charity Inquest’s research. I raised that in the House yesterday.

[Norman Lamb]

I totally agree with the point that the hon. Lady is making. I always took the view that I was operating in a fog, without access to the proper data. The “Panorama” programme made reference to the fact that I gave a parliamentary answer saying there had been no deaths in children’s mental health services—an answer that was wrong, because I was given the wrong information. I have asked the Secretary of State for a full investigation into how that happened. We have to have absolutely accurate reporting of these things.

[Luciana Berger]

I thank the right hon. Gentleman for his intervention. I believe it is absolutely imperative that we are able to see how deaths in psychiatric care are not only treated and recorded, but investigated and learned from. We have heard from the Minister that there will be progress on that front.

The situation is particularly concerning given the ongoing case of Southern Health NHS Foundation Trust, which was found to have failed to investigate more than 1,000 unexpected deaths of mental health and learning disability patients since 2011. Only last week, more than two years since the very tragic death of Connor Sparrowhawk, Southern Health trust was found by the Care Quality Commission not to have addressed serious concerns that were raised about the safety of its patients and was issued with a warning notice. I would be grateful if the Minister shared with us what the Government are doing specifically to improve the mental health data that are being collected, published and made accessible to the public. When will we have a further update on avoidable deaths in the area of mental health and learning disability? Data are absolutely critical, not only to enable the Government to understand the realities of what is happening on the ground, but to allow us to check that the Government are delivering on what they have promised.

That brings me to the final point I wish to cover today—accountability for the implementation of the taskforce’s recommendations. The taskforce asked NHS England, the Department of Health and the Cabinet Office to announce what governance methods they intend to introduce for the delivery of the recommendations. That really is needed as a matter of urgency. We need greater transparency than before in the way that the recommendations are implemented. I note that one recommendation of the taskforce report is that the Government accept the recommendations from the previous taskforce on CAMHS—another issue raised by many Members during today’s debate—which reflects the fact that the delivery of these recommendations has been too slow. I should be grateful if the Minister would confirm what plans there are to publish and publicise updates on implementation of the taskforce’s recommendations.

The Centre for Mental Health has produced a fantastic report for NHS England, exploring what helps and what hinders the implementation of policies and strategies relating to mental health. I do not know whether the Minister has had a chance to read the report but, among other things, it calls for a robust implementation infrastructure to support local agencies in delivering the report’s recommendations. I should be grateful if the Minister would share with us today what plans there are to support local authorities, CCGs and mental health trusts to deliver on that strategy.

Many recommendations in the taskforce report also require Government Departments—such as the Ministry of Justice, the Department for Work and Pensions and the Department for Education—to deliver their own areas of work that relate to mental health. I was very pleased to see those recommendations, and as I have said and will continue to say, we will not address the challenges of our nation’s mental health just from the Department of Health. Prevention and early intervention are absolutely crucial, which was a point made by my hon. Friend the Member for Coventry North East (Colleen Fletcher).

Take the work of the Ministry of Justice, for example. The report calls for the completion of the roll-out of liaison and diversion services, as well as the increased uptake of mental health treatment requirements and improvements to prison mental health care. At a time when, as a country, we are seeing one person take their life every four days in our prisons, it is absolutely crucial that we address this very serious issue.

Another point made by the taskforce was about housing and the local housing allowance, which the Government seriously need to address. During today’s debate other Members have talked about the importance of employment and what more needs to be done to support employers to help people with mental health conditions into the workforce, and to support people who might be experiencing those issues. It was disappointing that the Government accepted only formally the taskforce’s recommendations relating to the Department of Health and its arm’s length bodies. I hope the Minister will confirm today whether other Departments will accept and implement the other recommendations.

In conclusion, for the many thousands of people who could benefit from these changes and the others set out in the taskforce’s final report, Ministers must keep their promise and deliver the vital reforms that are long overdue and desperately needed. We have heard a lot of rhetoric and warm words on mental health. Now is the time for real action and to translate parity of esteem into reality. I look forward to the Minister’s reply.

Points of Order

Baroness Berger Excerpts

Tuesday 12th April 2016 Commons Chamber

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

On a point of order, Mr Speaker. I have made the Minister for Community and Social Care aware of my intention to make this point of order. In an answer to my written parliamentary question asking for the number of deaths that have occurred in child and adolescent mental health units since 2010, the Minister said that only one such death had been recorded by the Care Quality Commission. However, freedom of information requests conducted by Inquest have found that at least nine young people have tragically died in England while receiving in-patient psychiatric care since 2010. In response to this research, the Minister stated in an interview on last night’s BBC “Panorama” programme that he did not know how many children and adolescents have died in psychiatric units in recent years. This discrepancy between the Government’s account of the number of child deaths and the data collected from FOI requests raises serious questions about how the deaths in psychiatric care of some of our most vulnerable people are treated, recorded, investigated and learned from.

Can you advise me, Mr Speaker, whether you have received any indication from Ministers that they intend to clarify for the parliamentary record what the accurate figure is for the number of children who have tragically died in all NHS-funded psychiatric in-patient settings since 2010?

[Mr Speaker]

Extremely important questions are raised by this matter and by the broadcast, although not for me. We cannot have Question Time on the basis of points of order, but as the Minister of State is in the Chamber and apparently willing to say some words, we are happy—exceptionally—to hear him.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Alistair Burt]

There are two things that can help the hon. Lady. The first is the commitment to build £30 million a year into budgets over the next five years to support those with eating disorders, about which I spoke at a conference last week. The second is the earlier detection of eating disorders. We reckon that, by 2020, 95% of urgent eating disorder cases will be seen within a week, with routine cases seen within four weeks. There is recognition of the real danger now posed by eating disorders.

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

Earlier this month, school and college leaders reported a large rise in the number of students suffering from anxiety. Two thirds said that they struggle to get mental health services for their pupils, and of those who had referred a student to child and adolescent mental health services—CAMHS—most rated them as “poor” or “very poor”. Despite the Minister’s warm words, things are getting worse, not better. Will he confirm that every single penny promised to children’s mental health will reach those services and that none of this money will be used to plug the gap in hospital budgets?

[Alistair Burt]

Following long and frank conversations between me, the NHS and the Treasury, I can give the hon. Lady that assurance—every penny of the £1.4 billion pledged in the 2015 Budget for CAMHS and for eating disorders will be spent on children’s mental health by the end of this Parliament. It is not fair continually to say that nothing is going on. The first tranche of money—£173 million—is being spent: £75 million to the clinical commissioning groups; £30 million to tackle eating disorders; £28 million for the expansion of children’s IAPT—improving access to psychological therapies—services; £15 million for perinatal services; and £25 million to address other issues involving training. That is money already committed and it is being spent now. The problems that she mentions are a high priority and are being dealt with.

[Luciana Berger]

I listened carefully to the Minister, but by his own admission—in response to parliamentary questions—he is going to underspend this year by £77 million on his pledge to spend £250 million on CAMHS, and by £11 million on his £15 million pledge regarding perinatal mental health. He talks about the importance of intervening earlier. Does he agree with Labour that every child should receive personal, social, health and economic education so that young people are equipped with the resilience better to support their mental health?

[Alistair Burt]

We cannot have it both ways, it would seem. I have given a pledge, which the hon. Lady asked for in her first question, that the £1.4 billion committed to CAMHS will be spent by the end of this Parliament—and it will be. It is known that the first tranche has not been fully committed, but this is the first year and some money has to roll over. However, I have made absolutely sure that that money will be spent, including on perinatal services, which will reach a much better place than when we came into office, and that is very important. The work will be done. PSHE is not a matter for this Department, but I fully agree that it is important that children have such information. The pressure caused through social media, sexting and the like means that children these days need to have a very up-to-date, modern understanding of issues associated with personal health and social education, which I fully support.

Mental Health Taskforce

Baroness Berger Excerpts

Tuesday 23rd February 2016 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health to make a statement on the Government’s response to the final report of the independent Mental Health Taskforce.

[The Minister for Community and Social Care (Alistair Burt)]

Achieving parity of esteem for mental and physical health remains a priority for this Government. I appreciate the hon. Lady’s raising of the urgent question this afternoon. We welcomed the independent Mental Health Taskforce launched by NHS England last year, with its remit to explore the variation in the availability of mental health services across England, to look at the outcomes for people who are using services, and to identify key priorities for improvement.

The taskforce, chaired by Paul Farmer, chief executive of Mind—I thank him, the vice-chair, Jacqui Dyer, and the whole team for the remarkable work they did—also considered ways of promoting positive mental health and wellbeing, ways of improving the physical health of people with mental health problems, and whether we are spending money and time on the right things.

The publication of the taskforce’s report earlier this month marked the first time a national strategy has been designed in partnership with all the health-related arm’s length bodies in order to deliver change across the system. This also demonstrated the remarkable way in which society, the NHS and this House now regard mental health and how it should be seen and approached.

This Government have made great strides in the way we think about and treat mental health in this country. We have given the NHS more money than ever before and are introducing access and waiting-time targets for the first time. We have made it clear that local NHS services must follow our lead by increasing the amount they spend on mental health and making sure that beds are always available. Despite those improvements, however—and I referred earlier to the way in which we view these matters—the taskforce pulled no punches. It produced a frank assessment of the state of current mental health care throughout the NHS, pointing out that one in four people would experience a mental health problem during their lifetime, and that the cost of mental ill health to the economy, the NHS and society was £105 billion a year.

We can all agree that the human and financial cost of inadequate care is unacceptable. The Department of Health therefore welcomes the report’s publication, and will work with NHS England and other partners to establish a plan for implementing its recommendations. To make those recommendations a reality, we will spend an extra £1 billion by 2020-21 to improve access to mental health services, so that people can receive the right care in the right place when they need it most. That will mean increasing the number of people completing talking therapies by nearly three quarters, from 468,000 to 800,000; more than doubling the number of pregnant women or new mothers receiving mental health support, from 12,000 to 42,000 a year; training about 1,700 new therapists; and helping 29,000 more people to find or stay in work through individual placement support and talking therapies.

I assure all Members that they will have ample opportunities to ask questions and debate issues as we work together to implement the taskforce’s recommendations.

[Luciana Berger]

The final report of the Mental Health Taskforce, commissioned by NHS England, provides a frank assessment of the state of mental health care, and describes a system that is “ruining” some people’s lives. It contains a number of recommendations which, if implemented in full, could make a significant difference to services that have had to contend with funding cuts and staff shortages at a time of rising demand, leaving too many vulnerable people without the right care and support.

It is extremely disappointing that the Opposition have had to compel the Minister to come to the Chamber today to ensure that Parliament can give the report and the Government’s response to it the attention and scrutiny that they deserve. It is all the more regrettable because the Prime Minister himself chose to announce their response to the media during last week’s recess—a courtesy which, had it not been for the urgent question, would still not have been afforded to the House. The Government’s apparent announcements included the announcement of a supposed “additional” £1 billion of investment by 2020, but a number of vital questions remain unanswered.

Will the Minister explain why the report was delayed and published during the recess? Did Ministers or No. 10 have a say in the timing, and, if so, does the Minister accept that such a level of interference on the part of Ministers raises questions about the independence of the report? Can the Minister confirm that no additional money will be allocated from the Treasury to fund what the Government have announced, and that it will be funded from the £8 billion that has already been set aside for the NHS to receive by 2020? Given that mental health is given just under 10% of the total NHS budget, surely mental health services would have expected to receive much of that additional money as part of the NHS settlement anyway. Can the Minister explain how the money can be expected to deliver the “transformation” in our mental health services that the taskforce says is urgently required?

Can the Minister also confirm that he is accepting all the recommendations relating to the NHS? Does he intend to respond to the other recommendations, and when can we expect that response? As the report makes clear, we do not solve the challenges of our nation’s mental health by means of the Department of Health.

On behalf of the many thousands of people who have been let down by the Government, who are desperate to see a change in the way in which we approach mental health, and who are owed a full explanation from the Government of their response to this damning report, I look forward to the Minister’s reply.

[Alistair Burt]

I thank the hon. Lady for her questions, which give me an opportunity to say still more about what we are doing in relation to mental health and how far it has come since 2010. For instance, she could have pointed out that 1,400 more people a day have access to mental health treatment than had access to it in that year, simply as a matter of comparison between what was done then and what is done now. However, it is absolutely right to make the essential point that there is more to be done—a view that we share—and that is what the report did.

The timing of the report was not up to the Government. It is an independent report, commissioned by the NHS from an independent taskforce, and the timing and the content were decided by the taskforce. I had the occasional meeting with Paul Farmer about it. I made sure to speak to him to say, “This is absolutely your report. Forget the guff in the papers about who wants what in the report and all that; this is yours and it’s got to be yours”—and it is absolutely clear that it was. The decision to publish it was theirs. The Prime Minister was able to respond, which was great, and that emphasises again the importance given to this issue now, as compared with times past.

On the finance, the important thing to note is that the Prime Minister announced in January how the £600 million in the spending review, which is included in the NHS bottom line until 2021, would be spent. That included the new money for perinatal mental health, crisis care, psychiatric liaison in A&E and the crisis care community work. What was said by the Prime Minister in relation to the taskforce report represents new money that will be available for the NHS and mental health by 2021. That will be £1 billion extra by 2021, with the additional number of people to be treated that I outlined.

I spoke to the taskforce after the issuing of the report. I do not particularly want just to produce a response to the taskforce report; I said that I would prefer a series of rolling responses, as it were, so that when we have responded to a recommendation and when we are moving on and delivering on it, I would say so. That will come in a variety of different forms, but will be related to what the taskforce has done. That may well involve announcements to Parliament, whether by written ministerial statements or other means. I did not want one big bang of a response, as it were, because the Prime Minister has already said that we will accept the recommendations, as they go with the grain of what the Government were going to do anyway. I wanted to give an indication that the report will not just sit on a shelf gathering dust. By making constant reference to it when we do something—saying, “This is a response to what the taskforce said we should be doing towards 2021”—it can get the stamp of support and recognition, which is important.

On the hon. Lady’s claim that thousands have been let down, again I would gently remind her that this Government were the first Government to set waiting times for physical and mental health—a chance missed by the hon. Lady’s Government when they were in office and set physical health waiting time limits. It is this Government who have actually made the commitment of £10 billion extra to the NHS, a commitment never made by her or her party. It is very easy for people to talk about new things in mental health when they do not have a budget or an economic team producing anything of any credibility, but this Government have got the responsibilities and are doing the work.

We are absolutely agreed that the state of mental health services cries out for more to be done; we have said that, and that is what we are doing. The direction of travel and the physical delivery is happening on a day-by-day basis. We will do more; we will continue to work together to do more, and I welcome the hon. Lady and her team’s very regular pressure on me and my right hon. Friend the Secretary of State to continue to do more. We will meet that challenge—and we are meeting it in a way that no Government have ever met it before.

--- Later in debate ---

[Alistair Burt]

I am happy to do so, and I welcome my hon. Friend’s question. As I indicated earlier, something that has perplexed me since I have been in this role is the variation in practice in different places. It has never been easier to transfer information by electronic means and make people aware of best practice, but it is still difficult to move things around. We need to make sure that there is a website—a clearing house—for ideas in such areas.

[Luciana Berger]

It already exists in the Positive Practice collaborative.

[Alistair Burt]

Absolutely. We need to make sure that we have proper ways to access all the different ideas. A lot of work has gone into this, and we need to make sure that it is easy to access different ideas. There is a lot going on, and a lot can be done in relation to spreading best practice.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 9th February 2016 Commons Chamber

[Ben Gummer]

The fact the right hon. Gentleman missed out was that that was a different survey, so the figures are not comparable. However, I agree that choice is important. We are still not doing enough, and we should do more. I would like to take this opportunity to congratulate the team at his local hospital, which has just been rated good by the CQC—the first hospital in the south-west to receive that rating.

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

Patients needing mental health services do not get to choose where they receive their care, as highlighted in the Commission on Acute Adult Psychiatric Care report, which was published today. The report says

“the whole system has suffered from a steady attrition in funding…in recent years.”

It highlights

“poor quality of care, inadequate staffing and low morale.”

It describes the situation as “potentially dangerous”. Does the Minister now accept that the Government have let vulnerable people down? Will he implement the commission’s recommendations in full to put this serious situation right?

[Ben Gummer]

We have just received the report. It is a good report; we have taken note of it; and NHS England is already working on its recommendations. I remind the hon. Lady that this Government have put mental health on equal parity of esteem within the NHS constitution for the first time. [Interruption.] Opposition Front Benchers say that is meaningless, but why did they not do it when they were in office? We have done it for the first time and we are acting on it, not just in the constitution but in funding for the NHS, which is going up in real terms in the course of this spending review.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 5th January 2016 Commons Chamber

[Alistair Burt]

Indeed; the ability to see how these pilot projects respond to the different demographics in different areas enables one area to learn from another. Torbay has come up frequently in this context, and I am pleased to be able to praise it again. While I am on my feet, I should also like to point out that many of those involved in adult social care were greatly affected by the recent flooding in the north of England and that they were looking after vulnerable people and working beyond the front line. That work was very important, and I am grateful to Ray James of the Association of Directors of Adult Social Services and to all those working in local authorities in the affected areas who contributed so well to looking after vulnerable people during that period.

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

The report on the appalling failures at Southern Health NHS Foundation Trust highlighted the fact that more than 1,000 unexpected deaths of mental health and learning disability patients, many of which took place outside hospital, had not been investigated. Given that the Health Secretary did not allow the House an opportunity to scrutinise those findings before Christmas, will he or the Minister respond today to the widely held concern that the experience of that NHS trust is not an isolated one? Does the Minister agree that a national public investigation is now needed?