Abuse and Deaths in Secure Mental Health Units

Maria Caulfield Excerpts

Thursday 3rd November 2022 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on abuse and deaths in secure mental health units.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I am grateful to the hon. Lady for raising this important question. Everyone in any mental health facility is entitled to high-quality care and treatment and should be kept safe from harm. The findings from the investigation into the deaths of Christie, Nadia and Emily make for painful reading. The death of any young person is a tragedy, and all the more so when that young person should have been receiving care and support. My thoughts and, I am sure, the thoughts of the whole House are with their families and friends, and I want to apologise for the failings of the care that they received.

As I told the House on Tuesday, these incidents are completely unacceptable. The Secretary of State and I are working closely with NHS England and the Care Quality Commission, and they have updated us on the specific situation and the steps that the Tees, Esk and Wear Valleys NHS Foundation Trust is taking to improve the care at its services. Those include investing £5 million in reducing ligature risks across the estate; improving how it develops and implements care plans for young people; strengthening its policy on observation; and improving staff training and the culture that can exist within the trust.

I recognise that these worrying findings come in the context of broader concerns highlighted by other recent scandals. The Minister for Health and Secondary Care, my hon. Friend the Member for Colchester (Will Quince), was at the Dispatch Box last month responding to an urgent question on the unacceptable abuses at the Edenfield Centre. These challenges are, rightly, the subject of sharp focus in my Department, and we understand that every part of our system has a responsibility to keep patients safe. That is the driving motivation behind our new mental health safety improvement programme and the patient safety incident response framework.

I am not just the Minister for Mental Health; I am also responsible for patient safety, and I am not satisfied that the failings we have heard about today are necessarily isolated incidents at a handful of trusts. The Secretary of State and I are urgently meeting the national director of mental health to look at the system as a whole, the role of CQC inspections and the system for flagging concerns. I will also be meeting the new patient safety commissioner to seek her guidance, and based on that, we will make a decision on how we proceed in the coming days.

[Dr Allin-Khan]

It pains me that we are here again after failings in patient care and I send my heartfelt condolences to all the families affected. Emily Moore, Nadia Sharif, Christie Harnett: these are the names of three young women who tragically lost their lives after systemic failings to mitigate self-harm. This cannot go on. I thank my hon. Friend the Member for Middlesbrough (Andy McDonald) for his tireless work with the families involved.

Sadly, those are not the only cases. In the last five weeks, there have been reports on the Huntercombe Group, the Essex Partnership University NHS Trust and the Edenfield Centre. Why do undercover reporters seem to have a better grip on the crisis than the Government? Patients are dying. They are being bullied, dehumanised and abused, and their medical records are being falsified—a scandalous breach of patient safety.

The Government have failed to learn from past failings. I wrote to the previous Secretary of State, the right hon. Member for Suffolk Coastal (Dr Coffey), yet I never received a response. I have written to the new Secretary of State and he has not replied. Are the Secretary of State and the Government taking this seriously? It certainly does not seem so.

Will the Government be conducting a rapid review into mental health in-patient services? What are the Government doing to ensure that patients’ complaints about their care are taken seriously? These reports are becoming a weekly occurrence. I ask the Minister to put herself in the shoes of patients in these units and understand what their relatives are feeling. Will she apologise for the anguish that families are experiencing? This is a scandal and the Government should be ashamed.

[Maria Caulfield]

I will not stand at the Dispatch Box and deny any of the instances that we have seen, their consequences or the failings that have been identified. I apologised in my opening remarks for the care that failed the most vulnerable patients in our system. I commit to right hon. and hon. Members from the Dispatch Box that we are urgently looking not just at these cases but across all mental health in-patient services, and not just at adult mental health, but at offenders and other users of mental health facilities.

We have brought in a number of measures. We introduced new legislation, which was enacted in March, on the use of force and restraint. We are identifying best practice and trying to get that rolled out across the country. We are looking at putting in place a number of measures to improve safety and to support staff in units where staff shortages have been identified as a cause of the problems.

With regard to the hon. Lady writing to the Secretary of State, I signed off a letter to her early on Tuesday, which she should receive any day now. I apologise that she did not previously get responses in a timely manner.

NHS England has commissioned a system-wide investigation into the safety and quality of services across the board, particularly around children and adolescent mental health services. I am pushing for those investigations to be as swift as possible.

On the issue of a public inquiry, I am not necessarily saying that there will not be one, but it needs to be national, not on an individual trust basis. As we have seen in maternity services, when we repeat these inquiries, they often produce the same information and we need to learn systemically how to reduce such failings. My issue with public inquiries is that they are not timely and can take many years, and we clearly have cases that need to be urgently reviewed and to have some urgent action taken on them now. I will look at the hon. Lady’s request but, as I said, the Secretary of State and I are taking urgent advice, because we take this issue extremely seriously. One death from a failing of care is one death too many.

[Mr Speaker]

I call the Father of the House, Sir Peter.

[Sir Peter Bottomley (Worthing West) (Con)]

Lessons need to be learned and I am glad that the authorities and the Government will do that.

From the time that I served on the council of Mind, which was known as the National Association for Mental Health, I have tried to emphasise the importance of recruiting good people to work in the various categories of profession and assistance in secure units and in the whole mental health field.

I pay tribute to those who, day in, day out and at all hours of the day, cope with some of the most challenging situations and try to help some of the most desperate people. In each of our constituencies, we have tragic suicides; many more are prevented because of the work of these good workers. Let us try to support them and recruit more people to work with them.

[Maria Caulfield]

I thank the Father of the House for his very important point, because staff shortages often contribute to some of the failings we have seen. We are aiming to recruit 27,000 more mental health workers. As of June this year, there were over 133,000 full-time equivalent people working in the mental health workforce, which is an increase of more than 5.4% compared with June 2021. We are increasing the workforce, but it is a particularly difficult area to work in both in dealing with people with mental health problems and the environments in which they are working. This is not just about recruiting more staff; it is about training, developing and retaining them.

[Janet Daby (Lewisham East) (Lab)]

Mental health services often feel like the poor relative of the NHS, and financial investment is just not there in the same way. Mental health nurses and support staff work long shifts and are often experiencing burnout, while wards are repeatedly short of staff. There is a high turnover of psychiatrists and many are moving to work overseas. So it stands to reason that there are repeat failures within mental health services and mental health settings. What will the Government do to bring about urgent change and the long-term change that is so desperately needed?

[Maria Caulfield]

I want to reassure hon. and right hon. Members across the House that mental health is not seen as a poor relation by this Government. We are investing record levels of funding in mental health services—£2.3 billion annually—and we are recruiting record numbers of staff into the service as well. As I said to the shadow Minister, I fully accept the failings that have been laid bare, whether by media investigations or by internal investigations of the individual trusts. I am not shying away from those challenges, and I have set out the urgency with which I and the Secretary of State will be looking at this problem. I want to be satisfied that, across the country, safety is as good as it can be, and that where flags are being raised, they are acted on as quickly as possible, which does mean now, not in 18 months or two or three years. We are seeing young people die because of failings of care, and I understand the urgency of the situation.

[Paul Howell (Sedgefield) (Con)]

I would like to acknowledge what has been said already about the difficulty for staff working in this environment. It is a very challenging space, and my respect goes to anybody and everybody there. My respect also goes to people who work in suicide prevention, whether in Mind, the Samaritans or organisations like them, because this is a very difficult place.

I would like to come back to the specifics, and I will start by expressing my sincere thanks to the hon. Member for Middlesbrough (Andy McDonald) for his lead on the stuff going on up in our part of the world. It is a tremendous effort, and I applaud him and thank him for it. This week finally saw the publication of the independent investigation into the deaths of the three young ladies in the care of the Tees, Esk and Wear Valleys NHS Foundation Trust. Christie Harnett, one of those young ladies, was a constituent of mine, and her stepfather is among those calling for a public inquiry. I hear what the Minister is saying, but I really would encourage her to have this looked into very closely. I very strongly support the family on this.

Christie, along with Nadia and Emily, were badly let down. In Christie’s case, the report identified 21 care delivery problems and 20 service delivery problems. It was not an isolated mistake; this is systemic and massive, and it really needs to be looked at. May I ask the Minister to support this call for a public inquiry, please, and may I also ask her to confirm that a reply is imminent to the letters delivered by Mr Harnett to Downing Street on 10 October? He cycled from Newton Aycliffe down to here, a distance of 250 miles, to hand them in. This is emotional, but Christie’s family’s description of her in their statement in the report was:

“Family was everything to Christie and we all miss her so much, nothing will ever be the same again now our sunshine has gone.”

It is imperative that we do all we can to give the families of these young ladies what little satisfaction can be delivered by a proper and full inquiry into these atrocious failings.

[Maria Caulfield]

I thank my hon. Friend for his comprehensive question about the issues we face. He is absolutely right to say that systemic failings were identified, and as I have said, at this stage I have not said no to a public inquiry. We need urgently to address these issues, and ensure that, nationally, the same failings are not happening across the board. My concern about a public inquiry is the time that such inquiries take, and whether a rapid review would be more appropriate. I will make that decision in the coming days once advice has been taken. Nationally, some work is being done. For example, the Care Quality Commission is introducing a new approach into how it undertakes inspections. As with maternity services, one concern I have is that the CQC can do an inspection and rate a service as good, yet soon afterwards incidents are happening. I want to be satisfied that the CQC inspection process and the new approach it is taking will address issues and flag them as quickly as possible.

The National Mental Health Director wrote to every mental health and learning disability trust on 30 September, to ask them urgently to review their services in light of the findings we are seeing. The Secretary of State and I will meet her soon to follow up on that. NHS England is also reviewing everyone with a learning disability or autistic people in long-term segregation mental health in-patient units, because they are extremely vulnerable patients who may not have the ability to speak out when there are problems. I also want to look at whistleblowing, and support staff who want to flag problems but may not feel confident in doing so. We need to look at range of areas, but I very much take my hon. Friend’s points and I will look into the petition urgently today.

[Wera Hobhouse (Bath) (LD)]

Mental health services are overstretched not only in hospitals but in those services that provide support before patients become so ill that they need to go into hospital. What are the Government doing to support the very overstretched early intervention services?

[Maria Caulfield]

As I highlighted to the Father of the House, we are increasing the mental health workforce dramatically, with 27,000 extra mental health workers in the system. We have already increased those numbers this year, compared with last year. We are also providing self-referral mechanisms for patients. For psychological and talking therapies patients can now refer themselves without having to go and see a GP, and more than 1 million patients have taken up that offer. I fully agree with the hon. Lady that early intervention is a key factor, and we are supporting early intervention services so that patients can access them more easily and we have the staff to make that happen.

[Andy McDonald (Middlesbrough) (Lab)]

I thank colleagues across the House for their kind remarks. We must also pay tribute to the parents, who have so resolutely stuck at this campaign for two and a half years, and we now have these reports. I recognise what the Father of the House said: we admire the work that people do in this sector. It is so difficult. But in these particular instances, we had three young women whose needs were known. It was not as if they came by surprise —those families camped outside the hospital saying, “This hospital is killing my child”. Michael, Christie’s dad, cycled down to London. These issues were known by the families and by the parents. I welcome the Minister’s consideration of a public inquiry and a wider inquiry, but I ask that she meet me, the families and colleagues to discuss these matters. The purpose of this is to secure truth, justice and change. We need change in this environment hook line and sinker. A fundamental review is needed, and I trust the Minister will meet us to discuss these matters further.

[Maria Caulfield]

May I put on record my thanks to the hon. Gentleman for all he has done in raising these issues and supporting families? He is right. One area of concern with mental health care—we have also seen inquiries into maternity services—is that often patients and families have flagged issues and raised concerns to regulators and the individual trust, but they go unheard.

That is why I want to look at things such as making the whistleblowing process easier. The CQC recognises that and is changing its inspection process to ensure that families, staff, friends and patients have input into inspections. That is also why we introduced the patient safety commissioner, who took up her role in September, so that patients, staff and families have another avenue for raising concerns. If they feel that they are not being listened to at a local level, they have someone to go to who will raise concerns on their behalf.

It is absolutely devastating that the families recognised the problems and their voices were not heard. I would be very happy to meet him and the families to discuss that further.

[Alex Cunningham (Stockton North) (Lab)]

I join in the tributes to my hon. Friend the Member for Middlesbrough (Andy McDonald). As he and others have said, the report into the tragedy that saw three young women die in the north-east points to multiple failures by the Tees, Esk and Wear Valleys NHS Foundation Trust, which still struggles to deliver the services that our community needs.

The Minister will agree that the trust must learn from the tragedy, but it needs much more support to drive up standards and avoid more deaths. The trust, like many others, struggles to recruit the professional staff that it needs, because they are simply not available. I also question whether it has the capacity to drive the rapid improvement that we need. What plans does she have to intervene at the trust? What will she do to ensure that it and others can recruit the people they desperately need?

[Maria Caulfield]

As I said in my opening remarks, the trust is taking a number of steps urgently to improve its services, from investing £5 million on reducing ligature risks right through to looking at how it develops and implements care plans. However, the response must be wider than the individual trust. We must ensure that when inspections take place, they pick up the red flags that will alert someone to the problems happening in a unit. The CQC is also changing its inspection processes. It is vital that patients, staff and families can raise concerns if they have them and that they are properly inspected. We need to address this issue at a national level. The trust is not an isolated example—there have been a number of incidences—and both I and the Secretary of State want to be satisfied about exactly where the problems are occurring and that we have a national response, not just individual trusts having to deal with problems themselves.

[Liz Twist (Blaydon) (Lab)]

With young people’s mental health, we often talk about access to preventive services. That is hugely important, but here we have a tragedy of three young people who were in a mental health facility and sadly lost their lives. One can only send out our thoughts to their families and friends. As we review the mental health strategy and the suicide prevention strategy, what steps will the Minister take to ensure that the lessons learned are incorporated?

[Maria Caulfield]

I take the hon. Lady’s points. Indeed, legislation on the use of restraint has recently come in, which would have influenced some of the actions that perhaps happened previously. We also have the draft Mental Health Bill undergoing pre-legislative scrutiny in the other place, which may provide an opportunity to reconsider some of these issues. This place can inform that legislation going forward. I will obviously update the House on its progress.

[Rachel Hopkins (Luton South) (Lab)]

I refer the House to my entry in the Register of Members’ Financial Interests. Too many families are concerned about their loved ones as they wait ever longer for treatment, particularly in children’s mental health services. The Minister said that she wants to look at the system as a whole, so what conversations is she having with the Secretary of State for Levelling Up regarding local government, and local government finances in particular, ahead of the fiscal statement in a couple of weeks? Overstretched and underfunded children’s services in local councils up and down our country are often on the frontline of the crisis in children’s mental health.

[Maria Caulfield]

The Secretary of State will be having discussions around the autumn statement with colleagues not just in local government but across Departments. The failings that we have seen are of in-patient facilities—these young women had accessed treatment—so the issues are interlinked, but my main concern is about the safety of in-patient facilities. That is where my focus will be over the coming days.

[Rachael Maskell (York Central) (Lab/Co-op)]

The challenges are not confined to the Tees, Esk and Wear valleys, because the trust also extends to York. The extent of the trust and the size of the organisation perhaps explain some of the challenges. The reality is that the challenges are systemic and widespread. The trust has had 10 years of failed CQC reports, which should have easily raised a flag with the Department way before these tragedies occurred. As well as the steps that the Minister has proposed today, there should be a judge-led public inquiry into what is happening across mental health facilities. Nothing less will do.

[Maria Caulfield]

I thank the hon. Lady for making those points. As she knows, one of the facilities was closed in 2019 because of failing inspections and it has since reopened under another organisation, so action is taken where failings are found. My concern is that failings are often missed. That is why the director of mental health at NHS England wrote to every single trust on 13 September asking them urgently to review their services. As I said, I am taking advice and will report to the House in the coming days about what action we will be taking.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister very much for her answers. It feels like new cases of abuse of our vulnerable are coming to light weekly and it shakes our society to its very core. Every one of us is annoyed at what has happened. Humanity is judged by how we treat our most vulnerable and it appears that failures just continue to happen over and over again. How can the thousands of facilities that are doing right by their patients have trust in a system that sees them judged by the gross actions of others? Can the Minister confirm the additional support to ensure every facility has adequate staff and that controls are in place?

[Maria Caulfield]

The hon. Member is right and that is why I want to review at a national level. We are seeing a number of cases coming forward of unacceptable care in in-patient facilities. As more cases come forward, that gives confidence for others to speak out about the care that they or their loved ones received. That is why I want to take a national approach. Whether looking at staffing levels, practice, the ability to whistleblow when there are concerns, or the inspection process itself, we need to make sure that wherever someone is receiving mental health provision they are safe while they are receiving that care.