Health and Social Care

Debate between Nadine Dorries and Baroness Keeley

Thursday 3rd December 2020 Ministerial Corrections

[Ms Dorries]

Matthew Leahy died by hanging while he was in the care of the NHS.

Deaths in Mental Health Care

The following is an extract from the debate in Westminster Hall on deaths in mental health care on 30 November 2020.

[Barbara Keeley]

The point has been made that Melanie Leahy has campaigned on this for eight years and has done a wonderful job. I understand the reasons for trying to do this quickly, but it is too hasty for the Minister to move ahead and appoint a chair unless she is clear that the families, and particularly Melanie Leahy, are happy with that. The chair has to be seen to be independent. I am not sure that I am particularly happy with what the Minister is outlining.

[Ms Dorries]

We will go through the processes that we have been through within the Department of Health and Social Care. They are set in law and abided by during every inquiry; that has included all the past inquiries such as the Dixon inquiry, the Paterson inquiry and the Morecambe Bay inquiry. The same protocols and the same process will be adhered to.

[Official Report, 30 November 2020, Vol. 685, c. 20WH.]

Letter of correction from the Minister for Patient Safety, Mental Health and Suicide Prevention, the hon. Member for Mid Bedfordshire (Ms Dorries).

An error has been identified in my response to the hon. Member for Worsley and Eccles South (Barbara Keeley)

The correct response should have been:

Deaths in Mental Health Care

Debate between Nadine Dorries and Baroness Keeley

Monday 30th November 2020 Westminster Hall

[The Minister for Patient Safety, Mental Health and Suicide Prevention (Ms Nadine Dorries)]

It is a pleasure to serve under your chairmanship once again, Mr Stringer. I congratulate the hon. Member for Hartlepool (Mike Hill) on securing such an important debate on the e-petition calling for a full public inquiry into the tragic circumstances surrounding the death of Matthew Leahy, and the wider issue of deaths in mental health in-patient settings.

I thank all hon. Members present for making such valuable and powerful speeches on such an important issue. I am going to make quite an important announcement. Therefore, if anybody feels the need to intervene, could they wait until I have finished so that there is no ambiguity on the part of the relatives who may be listening, and so that they fully understand what I am saying and the reasons why I am saying it? In this case, that is quite important, particularly for Mrs Leahy and the relatives.

Matthew Leahy took his own life while he was in the care of the NHS.[Official Report, 3 December 2020, Vol. 685, c. 3MC.] His death was avoidable, as were the deaths of a number of other people in the same facility. While nothing that I or any of us can say today can ease the pain of their families and friends, I am determined that we learn the lessons of these tragic events.

[Barbara Keeley]

I should like to raise a question with the Minister. She said that Matthew took his own life. Melanie Leahy does not accept that, and I think it would be easier if we used the words “he was found hanging”. The inquest recorded an open verdict, so I do not think it is appropriate in this debate to say that he took his own life.

[Ms Dorries]

Until we have proceeded a bit further, there is a form of words that I have to use at the moment, and that is the form of words. There is absolutely no contention about how Matthew died or the appalling circumstances in which he was found, but I have to use a particular form of words at this point.

As I said, nothing can ease Melanie’s pain, or that of the relatives of others who were found in similar circumstances in the Linden Centre. Matthew died in November 2012 while he was in the Linden Centre, a mental health facility in the former North Essex Partnership University NHS Foundation Trust. I understand the devastating impact that that has had on Matthew’s family, especially Melanie, whom I have spoken to twice. My heartfelt condolences go out to them now, as was the case when I spoke to them and will continue to be so.

The petition we are debating today calls for a public inquiry into the death of Matthew Leahy on the grounds that past investigations have been inadequate. I first met Melanie last year and I was deeply moved by her story. I took that story away and have continued to work since I first spoke to her. I have since met her again and I have met some of the other families whose loved ones have died at the Linden Centre, and my thoughts are equally with them.

As a result of what I have heard from both Melanie and other relatives, I can confirm today that there will be an independent inquiry into the events at the Linden Centre, covering the period from 2000 to the present day, as requested in Mrs Leahy’s petition. This will mean that all the tragic events are given the attention they deserve to ensure that lessons are learned. The scope will not go earlier than 2000 or later than 2020, in order to keep the inquiry focused and to have it report in a timely manner. I consider that 20 years is a more than adequate timeframe to enable us to understand what happened at the Linden Centre and to learn from it.

I am in the process of appointing an independent chair, and I am considering half a dozen leading candidates at present. They will need to be robustly independent and command the confidence of the families. I have chosen to go down the route of an independent inquiry rather than a public statutory inquiry so that we can move quickly. To inform its findings, the inquiry will be able to call witnesses and undertake a close examination of what actually happened to patients who died at the trust. I will also appoint a barrister—a QC—to assist the chair in their investigations, along with a full secretariat. The inquiry will be independent and will consult families on the specific terms of reference. As an independent inquiry, it can determine how it wishes to work with the families so that they are able to give their accounts.

I will not pull any punches. Hon. Members will be aware of the report of the inquiry into the life and death of baby Elizabeth Dixon, published last week, which set out the details behind what it described as a “20-year cover-up”. I can cite two more inquiries: the Morecambe Bay investigation and the Paterson inquiry, both of which were independent inquiries commissioned by my Department. They left no stone unturned and were frank in their criticisms.

I expect witnesses to come forward irrespective of the type of inquiry. While public inquiries can compel witnesses to appear and give evidence under oath, importantly, they do not have to give evidence that would incriminate them. However, it is incumbent on all holders of public office, and on health professionals, to demonstrate their fitness by voluntarily co-operating with independent inquiries that seek to protect future patients and offer closure to families.

[Barbara Keeley]

Will the Minister give way?

[Ms Dorries]

I will when I have finished this point.

The independent Paterson inquiry—this is an important point—referred to the General Medical Council two doctors who had refused to give evidence to the inquiry, and they are being investigated. It is not the case that if someone in a professional capacity refuses to give evidence to an independent inquiry, they are not held accountable. That is patently demonstrated by the case of the doctors who are being investigated by the GMC.

With the timeframes that we originally set, I had hoped that the inquiry might report within 18 months. As I have today extended its scope to cover a 20-year span from 2000 to 2020, it will take longer, but I hope that it will report its findings within two years. I hope to announce the chair and outline the terms of reference in a written ministerial statement—

[Barbara Keeley]

Will the Minister give way?

[Ms Dorries]

I will.

[Barbara Keeley]

I think it would be easier if the Minister just let me ask the question. It was clear from what my hon. Friend the Member for Hartlepool (Mike Hill) said that Melanie Leahy is not necessarily happy with an independent inquiry. We should be clear about that. There is the question of compelling witnesses to attend.

The Minister is talking about appointing the chair. It is important that, for complete independence, any inquiry has the support of families such as Matthew’s. Can she tell us whether she will consider having the position of chair approved by an independent body or, for instance, the Health and Social Care Committee? I do not think people will be comfortable with her appointing the chair. As other hon. Members have said, there has been too much of people appointing other people, and saying, “You review me and I review you.” That is an important point.

[Ms Dorries]

I would like to get the inquiry going. As in all other inquiries, I believe it is the case—I will come back to the hon. Lady with the reasons why—that ministerial responsibility has to be taken.

As I was about to say, I want to get the inquiry under way before Christmas. I would like to make a written ministerial statement to the House before the Christmas recess to set out the terms of reference of the inquiry and to name the chair, with the provision that the inquiry will commence in the second week of February.

[Barbara Keeley]

The point has been made that Melanie Leahy has campaigned on this for eight years and has done a wonderful job. I understand the reasons for trying to do this quickly, but it is too hasty for the Minister to move ahead and appoint a chair unless she is clear that the families, and particularly Melanie Leahy, are happy with that. The chair has to be seen to be independent. I am not sure that I am particularly happy with what the Minister is outlining.

[Ms Dorries]

We will go through the processes that we have been through within the Department of Health and Social Care. They are set in law and abided by during every inquiry; that has included all the past inquiries such as the Dixon inquiry, the Paterson inquiry and the Morecambe Bay inquiry. The same protocols and the same process will be adhered to.[Official Report, 3 December 2020, Vol. 685, c. 4MC.]

--- Later in debate ---

[Ms Dorries]

As a Minister, it is not my role to issue sanctions, but if the chair discovered anything even remotely untoward during the inquiry, it would be referred to the police. The inquiry does not cover up criminal activity—that is the case for any inquiry, not just this one. There would be accountability.

[Barbara Keeley]

I want to touch on inquests. Given the new evidence in Matthew’s case and many others, does the Minister think it would be appropriate to revisit inquests that returned open or narrative verdicts? That can be important to the families.

[Ms Dorries]

I cannot comment because, as the hon. Member knows, inquests and coroners are under the jurisdiction of the Ministry of Justice. Coroners are almost in the vein of judges, so that is a legal question for the MOJ to answer; it is not within the jurisdiction of the Department of Health and Social Care. Our job is to launch an inquiry, ensure that it has a robust, independent chair, that it is fully funded and staffed, that it establishes terms of reference in consultation with as many families as possible as soon as possible, and that it commences as soon as possible.

As hon. Members will be aware, the Health and Safety Executive has investigated how the trust managed environmental risks from fixed potential ligature points in in-patient wards between 25 October 2004 and 31 March 2015. As a result of the investigation, the Health and Safety Executive has brought a prosecution against the Essex Partnership University NHS Foundation Trust, which was formed following the merger of the North Essex Partnership University NHS Foundation Trust with the South Essex Partnership University NHS Foundation Trust. I am sure hon. Members will understand that I cannot go into the details of those proceedings as they are before the courts.

I could say quite a bit about the petition and the cases, but I will conclude to let the hon. Member for Hartlepool have the final say. I thank Melanie Leahy for her years of campaigning. I hope she will understand that a robustly independent inquiry that is unafraid to turn over stones and work with the families, calling those it sees fit to give evidence, is a way to discover what has happened at the Linden Centre over the past 20 years, including what culture developed, what practices were in place and what happened to those young boys who died there. As my hon. Friend the Member for South Suffolk (James Cartlidge) said, what is important is that we get to the truth. It does not matter what the framework or structure is; what matters is the truth, knowing how those young boys died, what happened and what we can learn from those dreadful mistakes.

Independent Medicines and Medical Devices Safety Review

Debate between Nadine Dorries and Baroness Keeley

Thursday 9th July 2020 Commons Chamber

[Ms Dorries]

I thank my hon. Friend for her comment. She is absolutely right. The report is entitled “First Do No Harm”, and we here have to do some good in response to it. Work is being undertaken—the all-party group for valproate and other anti-epileptic drugs in pregnancy works incredibly hard. It is about getting information out there. For some women with epilepsy, sodium valproate is the only drug that works, and the pregnancy prevention programme works alongside this. As I have said, I cannot comment on Primodos, but work is ongoing. We have seen a decline in the number of pregnant epileptic women taking sodium valproate. That decline needs to be driven down even further, in tandem with the pregnancy prevention programme, but my hon Friend is absolutely right. I hope that nobody ever has to come to the Dispatch Box again to discuss a report such as the Cumberlege report and have to apologise for what happened, with the glaring inconsistences in treatment that has been provided to those women who have not received the information they should have received when taking those drugs.

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

After decades of having their concerns dismissed and struggling to be heard, the victims of these scandals deserve both the apologies we have heard and ex gratia payments for the avoidable damage they suffered. Will the Minister confirm that it will be a priority to establish the independent redress agency recommended to help those affected by these scandals and a priority that the agency will be able to move quickly to provide the redress that the victims deserve? They have waited long enough.

[Ms Dorries]

Every recommendation in the report is a priority and everything will be given equal consideration. I hope that either I or the Secretary of State will be able to come back to the House as soon as possible after the report has been evaluated in full and make our own recommendations at that time.

Eating Disorders Awareness Week

Debate between Nadine Dorries and Baroness Keeley

Thursday 5th March 2020 Westminster Hall

[Ms Dorries]

Absolutely, and the Green Paper, which I am sure the hon. Gentleman will be aware of, references the mental health of young people in schools. However, it is also about the trailblazer schemes, peer support workers and other people who go into schools who specialise in how to identify this and pick it up. Teachers have a huge job, and I think if we were to say that they needed to pick up when someone is suffering from an eating disorder, they would probably throw their hands up, because it requires specialised training. It is a skill, and it takes careful handling when identifying someone who is suffering from an eating disorder. So yes, of course we work across Departments, but it is those specialised and trained mental health workers in schools who will pick this up.

[Barbara Keeley]

We have a few moments left, so I refer the Minister back to the point I raised about relapse. We are largely talking about adults, and there is a mismatch between the average duration of an adult eating disorder—a large number of patients have severe and enduring illnesses—and the shortness of the therapies that they get. Professor Janet Treasure told me that a solution could be to increase the knowledge and skills of patients with those long, enduring conditions and their carers, so that they can self-manage the illness in parallel with clinical care. She is working on a pilot of that. I do not know if the Minister has heard about that, but I wanted to raise it as something that we ought to give attention to.

[Ms Dorries]

That is incredibly interesting. I had not heard about it, but I am sure that my officials will take note of it. We have an open door for anything that we can identify that helps us in targeting and providing services. We are looking for solutions to the problem. As I said, the money is there. Claire Murdoch, who I mention in almost every debate, and Professor Tim Kendall are rolling out mental health services across the country via NHS England. They have probably heard of it and are probably looking at it, but I am sure that we will take note and check if that is the case.

Although eating disorders are commonly first experienced by people when they are young, they can continue into adulthood. Following a report on how NHS eating disorder services were failing patients, NHS England convened a working group with Health Education England, the Department of Health and Social Care and other partners, which goes to the point that my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) made. We are working in collaboration to address the report’s recommendations and to take them into account when planning for improvements to adult eating disorder services. Work is in progress on that.

We are continuing the investment in mental health services through the NHS long-term plan, as I think most people know. The £2.3 billion is with NHS England, which has a long-term plan to deliver on mental health and is moving at incredible pace. Even today, although it is not relevant to the debate, it announced the opening of gambling clinics across the UK. Community services are being rolled out across the UK so that people in mental health crises do not end up in casualty. It is an incredibly impressive roll-out of mental health services across the UK, including for eating disorders.[Official Report, 5 March 2020, Vol. 673, c. 12MC.]

That long-term plan will give an additional 345,000 children access to mental health support; 380,000 adults access to psychological therapies; and 370,000 adults access to better support for severe mental illness by 2023-24. It commits to the delivery of eating disorder waiting time standards, which I have already spoken about, and I hope that we will reach those before the end of next year. The plan has also committed to the design and roll-out of a new integrated model of adult community mental health care.

To increase further the number of people seeking treatment for their eating disorder, the Government recognise that raising awareness and reducing stigma are incredibly important. Here I should come on to a few of the points made by the right hon. Member for Knowsley. I shall go through them backwards, because that will be more positive in terms of affirmative answers. He mentioned social media providers, their role in body image and the impact that they have on young women. My right hon. Friend the Secretary of State for Health and Social Care has already—this happened recently—held a roundtable with social media providers. It was an incredibly positive meeting, but that is something that needs to continue, because when it comes to social media interactors, providers and platforms need to be aware of the impact that their forums have on young women, so we are continuing that dialogue with them and, I hope, are continuing to push that point.

The right hon. Gentleman made a point about the entertainment industry and its relationship and responsibilities with regard to body image. I announced two weeks ago that I am holding a roundtable with the entertainment industry. That was as a result of the death of Caroline Flack, who took her own life. For me, that was a watershed moment. It is time for the entertainment industry to be aware that it does not have a duty of care only to the people who they take on a contract to work with them. This is not just about sudden fame and reputation loss. The industry has a wider responsibility in relation to images that it projects and how it projects them, because young women and, indeed, many people absolutely are influenced by what they see—their perceived role models—through the lens of television or the cinema. The entertainment industry definitely has a responsibility, so in response to the right hon. Gentleman’s question, I can say that I have already put that in train.

In relation to a review of the long-term effectiveness of CBT, I defer to the expertise and knowledge of our friend from the Scottish National party, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who made the point that short-term CBT may not be as effective, in terms of how it is delivered, for such long-term conditions. It may be part of the treatment, but as we know, when it comes to eating disorders, treatment is very prolonged in some cases. I am sure that CBT has a definite role, but it should not be seen in isolation. Management of eating disorders takes the input of physicians and psychologists—people who are expert in managing these conditions and working in this field. Therefore I would say yes, but not in isolation.

[Ms Dorries]

I am sure that Claire Murdoch and Tim Kendall at NHS England are all over that and very aware of that. A streamlining approach to treatment is about getting people seen within the first week. If people are first seen within the first week when they present with their first crisis, that is the time when greater intervention can happen and when that treatment plan can be designed and put in place and there can be that entire care pathway through. I will not say that I think that that would shorten the illness, because I do not know. The hon. Lady probably knows more than I do, but I would think that an effective treatment plan with CBT and everything that is involved in that would provide a better outcome than piecemeal interventions along the way.

The right hon. Gentleman’s first point was careful consideration of Beat and so on. I am a huge admirer of Beat. It provides an incredible service. Its helpline deals with 30,000 people a year, I think, if I am not mistaken—it is a few weeks since I saw Beat. The support service that it provides, particularly to young women who are looking for someone to talk to and advice and help, is second to none. We are absolute supporters of Beat.

Let me just go on to the point made by my hon. Friend the Member for Broxbourne (Sir Charles Walker) about diabulimia. It is also of course the point that the right hon. Member for Knowsley raised repeatedly. We are absolutely committed to ensuring that people with diabulimia receive the treatment that they need. That is why NHS England announced in February 2019 the piloting of services. The services are being piloted on the south coast and in London, and NHS England will evaluate and monitor the pilots and take the learning from them. I will raise what the results show, if the results are through yet from the pilots, and what learning there has been and how it will apply across the UK.[Official Report, 19 March 2020, Vol. 673, c. 13MC.] I am sure that the officials will take a note, and when I have had that meeting, I will report back to the right hon. Gentleman and let him know exactly what the findings are and where we are going on that. The group that we are talking about is very small, but it is at the extreme end and requires very serious consideration.

I think that those are all the points that were raised and that I need to answer.

[Barbara Keeley]

Could I remind the Minister of another two? I think that a number of us raised the issue of training, and I asked whether she would be a champion of improving training.

[Ms Dorries]

Sorry, yes, I will reply to that.

[Barbara Keeley]

There is also the question about when waiting time targets will be introduced for adult eating disorder services.

[Ms Dorries]

Absolutely. On training for GPs, I take the hon. Lady’s point exactly. The NICE guidelines are incredibly clear, in terms of the Hope Virgo campaign and taking BMI, weight and other things into consideration. The NICE guidelines are clear, and it is up to the clinical commissioning groups to ensure that GPs and others do not take weight as a consideration. Tim Kendall is all over this and is working on it. We want GPs and others to abide by what are already very strict NICE guidelines. We have the guidelines; we just need the medical profession to implement them, but I had an idea when the hon. Lady asked her question. We are talking about training for GPs with the General Medical Council and we will continue to hold conversations about that, and I am sure that NHS England is doing exactly the same thing, but there are quicker ways to get information through to GPs.

When I was a nurse and I was training, it was the Nursing Times that informed us, on a weekly basis, of what was new in treatments and operative procedures. For GPs, it is Pulse and other magazines that they receive. I think that there might be a quicker way into GPs’ surgeries to alert them to the fact that the NICE guidelines are not being applied by GPs or by clinical commissioning groups. I think that there may be more inventive ways around that. Yes, training GPs absolutely is important; it is important to include this issue in the GP training programme, but in terms of getting a message through to GPs now, I think that we need to look at a more innovative way of doing that.

On money being diverted and ring-fenced, I think that the hon. Lady knows that the money from the £2.3 billion that goes to the CCGs is ring-fenced for mental health services only. They are not allowed to siphon it off and use it for anything else. We have our own queries as to whether some are doing that, and I know that NHS England, because I raised this with it the last time I met it, is doing an evaluation of clinical commissioning groups and having a look and checking that that money, which is ring-fenced, is spent only on—

Oral Answers to Questions

Debate between Nadine Dorries and Baroness Keeley

Tuesday 28th January 2020 Commons Chamber

[Ms Dorries]

The best way to improve life expectancy is to prevent health problems from arising in the first place. Prevention is one of the top five priorities for the health service, and we are taking action to help people live longer and healthier lives. The Government have a proven track record of reducing the harms caused by obesity, tobacco and other substances. That is where we need to focus our efforts to ensure that life expectancy rises in all areas throughout the country.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The most shocking trend in life expectancy is that people with learning disabilities die so early—on average 25 years younger than the general population. We must see action to learn the lessons from each of those early deaths. The contract for the University of Bristol’s running of the learning disability mortality review ends in May, and there is now a growing backlog of cases, so will the Minister tell the House what the future of this important review is, and what staff resources are needed to continue the vital work of reviewing and reporting on early deaths?

[Ms Dorries]

We will introduce mandatory training for all health and social care practitioners. I hope that that will address the particular problem that the hon. Lady has brought up. It comes back to the substantial life expectancy issue, which is that regardless of the group, prevention is key.

NHS Patient Data

Debate between Nadine Dorries and Baroness Keeley

Tuesday 25th March 2014 Westminster Hall

[Nadine Dorries (in the Chair)]

Order. Barbara Keeley.

[Barbara Keeley]

I, too, hope that the Minister will address that.

I want to give an example of data use approved by the Data Access Advisory Group of the Health and Social Care Information Centre, because I think that it is instructive. Minutes from the group’s July meeting show that the advisory group approved the use of hospital episode statistics data for HSpot Ltd and its FindMeHealth application. HSpot Ltd had requested HES data, including consultant codes, with the intention of publishing those data online to enable patients to compare procedures by hospital and clinician. Online information about FindMeHealth says that it is

“a new independent UK comparison site offering choice…to the growing number of people who are choosing to self-pay for private healthcare.

FindMeHealth compares prices across the top self-pay procedures and gives users access to the very latest data from NHS and private sources”.

What we have here is a kind of “Go Compare” website for private health care.

Much was said about uses of patient data in the debate on the Care Bill. The Minister said that information from the HSCIC

“may be disseminated for the purposes of ‘the provision of health care or adult social care’ or ‘the promotion of health’.”—[Official Report, 10 March 2014; Vol. 577, c. 136.]

Does the Minister think that the definition that he gave us extends to the HSCIC granting the release of patient data so that commercial companies can run comparison websites on the top self-pay procedures?

We need much greater transparency, and I thank hon. Members present for the questions that they have put on this matter. We need greater transparency from the Health and Social Care Information Centre, but we also need it about the other data sources and the other places where data are held. The chair of the information centre, Kingsley Manning, said in his speech last week that one of its key measures of success might have been that it was

“safely below the radar of public attention”,

but that organisation is no longer below the radar of public attention. Indeed, the organisation has become the story because of the errors that it has made, which mean that hon. Members and the public have discovered just how their confidential medical data are being used by insurers, by commercial companies and even on systems in the United States.

If people look at social media, as I did last night, they will see that there are many comments about just how much distrust people now feel towards the HSCIC. The organisation, as I said at the start, has claimed an “innocent lack of transparency”, but others accuse it of evasiveness and half-truths. As I have detailed, giving misleading answers to the Health Committee on established facts about who works for the organisation does not help.

All that has to change. Hon. Members, including me in this speech, have talked about ways in which the situation should and must change, and I hope that the Minister understands the vital need for that.