Human Medicines (Amendment) Regulations

Debate between Norman Lamb and Jackie Doyle-Price

Monday 18th March 2019 Commons Chamber

[Jackie Doyle-Price]

I come back to what I said to my hon. Friend earlier. The terms under which pharmacists will be able to exercise their discretion will be clearly set out in each protocol, and there will be full consultation by an expert panel, with ministerial approval in such an event.

[Norman Lamb]

Will the Minister clarify whether, if there are adverse effects as a result of some change that has been made in these circumstances, the prescriber, the dispenser or the Government would ultimately be liable?

[Jackie Doyle-Price]

The protocol will be very tightly drafted, which will really limit the ability of the pharmacist, who would only be able to prescribe outside the terms of the prescription within the narrow confines of the protocol. As I say, this has been done to secure continuity of supply when there is a potential challenge, but I would expect to take advice from a pharmacy panel, in conjunction with those most affected, to make sure that we put in place appropriate risk management on those occasions.

Mental Health First Aid in the Workplace

Debate between Norman Lamb and Jackie Doyle-Price

Thursday 17th January 2019 Commons Chamber

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

I should like to thank all the contributors to the debate. It has been marked by a lot of enthusiasm and passionate advocacy in support of improved mental health. In particular, I would like to pay tribute to the hon. Member for Liverpool, Wavertree (Luciana Berger), the right hon. Member for North Norfolk (Norman Lamb) and my hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) for securing the debate and for bringing their characteristic ambitious agendas into play, alongside their well-informed and passionate advocacy on behalf of them. It can often be challenging to respond to all three of those Members, but on this occasion I have really enjoyed listening to their contributions and I agreed with much of what they said.

We all share the same objective, which is to secure support as early as possible for people who are suffering mental ill health and, more specifically, to enable more people with mental ill health to stay in work. That is good for their health—as long as it is good work and they are well supported—but it is also good for the economy when more people are encouraged to work. That was clearly illustrated by the figures cited by the hon. Member for Liverpool, Wavertree for those receiving care from Mersey Care, which bring into stark relief the size of the challenge. They show that only 3% of those patients are in work, which is something we should all reflect on. It underlines the importance of ensuring that we get better at supporting people who are suffering mental health challenges and at encouraging them into work.

I am pleased to be joined on the Front Bench by the Minister for Disabled People, Health and Work, my hon. Friend the Member for Truro and Falmouth (Sarah Newton). She is also responsible for the Health and Safety Executive, which obviously has a big role to play in this agenda. She has been listening carefully to all Members’ contributions today. She and I are united in an objective to ensure that we keep more people with all kinds of disability in work, and that we get those who are currently excluded from the workforce into it. We have a wide package of measures that we are taking forward in that regard, some of which have been referred to today.

The Government are committed to building a country that works for everyone, and that must include ensuring that disabled people and people with mental health conditions can go as far as their talents can take them. Too many people with a mental health condition are unable to do that, and that is a burning injustice that must be tackled. As the right hon. Member for North Norfolk pointed out, people who are unemployed for more than 12 weeks are between four and 10 times more likely to suffer from depression and anxiety. That statistic illustrates why it is good for society, as well as for the individual, that we tackle this issue. The good news is that staying in or returning to work after a period of mental ill health really does aid mental health recovery. It really does make perfect sense.

[Norman Lamb]

The Minister will be aware of the objective in the five year forward view to double the number of people who get access to individual placement and support. Can she indicate how that programme is going? If she cannot do so now, will she write to me?

[Jackie Doyle-Price]

I can say that we are making progress, but I would prefer to write to the right hon. Gentleman with more details, if I may. I have seen some of that individual placement and support in operation, and it is hugely inspiring. In those mental health trusts that are giving one-to-one support, people are finding that the reward and discipline of going to work really does aid their recovery, even in some of the most challenging cases. I will write to the right hon. Gentleman with more information on that.

Mental Health Units (Use of Force) Bill

Debate between Norman Lamb and Jackie Doyle-Price

Report stage: House of Commons
Friday 15th June 2018 Commons Chamber

[Jackie Doyle-Price]

I thank my hon. Friend for that intervention. I hope that we will continue to consider everything that we can do to support people, and I welcome those suggestions. Ultimately, such people are facing massive injustice at the hands of the state, and we should never stop looking at what we can do to support people in those circumstances. The simple truth is that those people have put their trust in the institutes of the state, so there is double pain when they are failed by them, and we must ensure that we do everything possible.

I hope that what I have said about legal aid and the investigation process satisfies the hon. Member for Croydon North, so I hope that he will not press his amendments to a Division so that we can get the Bill into the other place and deliver the objectives that he and I both want.

To clarify something that I was saying about the Government amendments, we unwittingly included a loophole that would allow institutions not to provide patients with information, and I might have suggested that that was a matter of discretion. However, it is actually in the Bill that they must provide information unless “the patient refuses” to accept it. I just wanted to make that clear in case there was any misunderstanding. The remaining Government amendments are largely technical, linking the Bill with the Data Protection Act 2018, for example, and providing clearer definitions regarding mental health units. Those are very much drafting changes, and I hope that the House will approve them.

Turning to the amendments tabled by my hon. Friends the Member for Christchurch and for Shipley and the right hon. Member for North Norfolk, I have already discussed the Government’s view on such matters, but I will refer first to the right hon. Gentleman’s amendments in relation to threats and coercion. The Government’s main concern is that putting the use of threats of force and coercion on the face of the Bill might cause confusion for staff working in mental health units when we are trying to encourage them to use de-escalation techniques. We have the same objective as the right hon. Gentleman, which is to minimise restraint, but we are concerned that the amendments might act as an impediment to what we are trying to achieve.

[Norman Lamb]

Will the Minister look at whether the guidance will be clear about the importance of staff not inappropriately threatening force or coercion, because that all goes down to the culture of the organisation?

[Jackie Doyle-Price]

The right hon. Gentleman is right about that, so let me go through the provisions we think are in place to protect patients from exactly that circumstance. The care quality regulations—the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014—clearly set out the types of behaviours that are prohibited and create an offence of failing to comply with the requirement to protect service users from those behaviours. We are satisfied that those provisions would be an appropriate tool with which to tackle this issue. Clearly, we will be relying on guidance to implement much of this Bill, and I can give him every assurance that these issues will be very much part of that guidance; this process will be consultative and I am sure he will want to remind me of the undertaking I have just given him as and when that comes through.

My hon. Friend the Member for Shipley has discussed his amendments 44 to 78, providing us with his understanding of the use of the terms “force” and “restraint”. The point he made was that he wanted the Bill to be consistent with language used elsewhere in mental health settings. It is important that we make sure the language we use is consistent. The term “force” is a more overarching description of what is happening to a patient, and the individual elements that the definition needs to cover are the types of restraint. In the context of this Bill, those are physical, mechanical and chemical restraint, along with isolation. We have chosen to use the term “force” because it works alongside the Mental Health Act 1983 code of practice, with which practitioners are familiar, and it reduces any risk of confusing the drafting due to the use of similar terms, where that can be avoided. This approach has very much been accepted in our consultation with the sector. I heard my hon. Friend say that he had received representations to suggest the opposite, so I would be pleased to take that up with him offline, in order to satisfy his local care trust that what we are doing is consistent with other law, because it is important that we take everyone with us.

My hon. Friend the Member for Christchurch has tabled amendments that would remove certain types of force from the Bill, particularly chemical restraint and isolation, which covers segregation and seclusion. I am grateful to him for testing our conscience via these amendments, because it is entirely legitimate for him to worry that practitioners might be impeded from administering medication to their patients, as, obviously, that would be harmful if those patients needed it. I can give him the assurance that when we talk about “chemical restraint”, we are not considering a patient’s normal medication. The type of medication used for chemical restraint would usually be different from that used as part of a patient’s normal medication to control or treat their mental health condition. As part of a chemical restraint, patients would not simply be given more of their medication. The types of medication used in chemical restraint are a particular kind of product, lasting for only a short period and not having the effect of over-medicating a patient. It is important that we record and receive national data on the use of those products so that we understand their use and shine a light on areas where they might not be used appropriately. I hope that gives him some comfort.

--- Later in debate ---

[Jackie Doyle-Price]

We will undertake it speedily and it will be made public, but, as my hon. Friend will appreciate, the whole purpose of consultation is that it consults and we want to ensure that we are taking everybody with us. Personally, I will want to do it in an extremely timely fashion.

There are many amendments to go through, but I hope that I have articulated the Government’s overall support for this measure and what we are trying to achieve in terms of supporting the hon. Gentleman’s Bill. Central to all this is the need to underline transparency and to strengthen accountability so that patients are protected. Clearly, we desire to minimise the use of force. The best way that we can achieve that is by shining a light on those incidents. We will continue to take this forward in the spirit of openness, and the Secretary of State will be producing reports on how this is being implemented.

Let me turn now to my final point. I have already addressed this in response to the remarks of my hon. Friend the Member for Shipley. On police body cameras, I can give him this assurance: the proposal does not create a criminal offence for not wearing a body camera. We have been very deliberate in our language to say that it is practicable to make sure that we do not get in the way of the police doing what is right in these situations. The references he makes to the law are consistent with the Police and Criminal Evidence Act 1984, but this would not raise any issue of a police officer being faced with criminal prosecution for not wearing a camera. I hope that that gives him some satisfaction.

[Norman Lamb]

This is my very final point. Even if this is not in the Bill, does the Minister agree that it would be a good thing if the Secretary of State reported to Parliament annually on the basis of the data that was produced by NHS Digital?

[Jackie Doyle-Price]

That issue did come up in Committee. Although I appreciate the spirit with which the right hon. Gentleman makes that inquiry, we would not want to make a particular arrangement for one set of NHS data over another. Clearly, we need to explore this issue to make sure that there is some annual return on how this Bill operates when it becomes an Act.

I could say so much more, Mr Deputy Speaker, but I will not. Everybody in this House is very clear that they want this Bill to make progress. I appreciate that I cannot keep all Members happy all the time, but I do hope that I have been able to assure my hon. Friends the Members for Shipley and for Christchurch on how we will take forward their representations and that I can persuade them not to push their amendments to a vote.

Psychosis: Early Intervention

Debate between Norman Lamb and Jackie Doyle-Price

Thursday 15th March 2018 Westminster Hall

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

It is fitting that you are in the Chair for this debate, Mrs Moon, given your interest in these matters. I am grateful to the right hon. Member for North Norfolk (Norman Lamb) for securing this debate. It is always with some mixed feelings that I face him across the Chamber, not least for the reasons that the hon. Member for Liverpool, Wavertree (Luciana Berger) pointed out. However, this has been an extremely well-informed debate on both sides. I have not disagreed with very much of what has been said. It is great to respond to such a passionate debate, among people who genuinely care about the issue.

The right hon. Gentleman is absolutely right that improving access and waiting times for early intervention in psychosis must be a top priority. I will set out some of the things that we are doing, which I hope will reassure him of the direction of travel. He is rightly holding us to account on where we are. I quite agree that it is not good enough, and assure all Members who have participated in today’s debate that I am not complacent in any way about any of this.

First, I want to set the context. The hon. Member for Liverpool, Wavertree often challenges me that we have not achieved parity of esteem. I do not pretend that we yet have, but we have embarked on a genuinely transformational programme to raise the treatment of mental health issues to parity with physical health. However, that is essentially a cultural change, which will take time.

I want to set out that we do have a plan, to reassure the hon. Member for Stockton South (Dr Williams). We have now got to the stage in that plan where we have to be a lot more outcome focused, and really get to the grit of what is happening on the ground. As the right hon. Member for North Norfolk set out, there is widespread regional variation. We have to ensure that we are not only increasing access, but doing so in a consistent way. There are lots of challenges in doing that. People have raised the issue of the workforce. Obviously, we cannot magic up a workforce overnight, but there are plans to address that issue.

The right hon. Gentleman mentioned the Secretary of State’s weekly meetings where we interrogate health officials. I assure him that we are reviewing each individual mental health trust to scrutinise their performance, and the Care Quality Commission advises us on a weekly basis about that performance. I assure him that it is improving—it has massively improved, in fact—but there is still more to be done.

When we bring in standards and targets, the risk is always that we build in perverse incentives, and that institutions can game the system. Until the data we collect is embedded properly, there will be some risk of that, but we have to be on it. I acknowledge the right hon. Gentleman’s pivotal role in introducing those standards, and all his work in Government to drive this agenda. Having inherited his mantle, I look forward to him continuing to challenge me to deliver what he set in train.

Given that time is short, I want to home in on what we are doing to implement the waiting time for early intervention. The latest data that we have shows that we are exceeding the target of 50% for access to early intervention in psychosis services, with more than 70% of patients starting treatment within two weeks in the most recent quarter. I know that the right hon. Gentleman has rightly raised concerns about his freedom of information request on mental health trusts. Only 29% of 49 trusts that returned the request could expressly confirm that they were able to deliver the full NICE-concordant packages of care to their patients. To reassure him, the moment at which he made his request was at the start of the programme.

[Norman Lamb]

It was this year.

[Jackie Doyle-Price]

It was measuring the kick-start of the programme. I would hope that if the right hon. Gentleman repeated that in a year’s time, he would get a very different picture. I assure him that we are making progress, but I invite him to continue his scrutiny, because sunlight is the best disinfectant, as I often say.

The hon. Member for Stockton South asked whether we had a plan. We do. The issue is that our plan is often based on inputs and structures. It is only when we get the kind of analysis that the right hon. Member for North Norfolk applies that we can see whether an input is really delivering the outcome that we want. Using our tools of leadership, we are now ensuring that we are holding everyone’s feet to the fire to deliver those standards, and that we are actually implementing the plan that we have in place.

To give some detail on what that plan is, we are investing an initial recurrent £40 million per annum for EIP in clinical commissioning group baselines. That will rise to £70 million recurrently by 2021. I have heard the message loud and clear from all hon. Members that they want to be reassured that that money is reaching the frontline. We will go away and think about how we can best illuminate that. We are funding clinical networks in all regions to provide clinical leadership for implementation, and to support local efforts across the country. Those networks provide a great deal of support on sharing best practice, training and innovation. Quite often, sharing best practice can be the best way of driving improvement.

We are investing in a national team to co-ordinate regional teams and to support the monitoring of delivery through the regions. We are developing the data set to illustrate how much progress we are making and how the interventions are being delivered to people. That will allow commissioners and providers to prioritise how they develop and improve their services in line with the National Institute for Health and Care Excellence guidance. What is especially welcome is that there is now a recognition of the link between mental and physical health in NHS England’s work, although we have to continue to build on that.

The hon. Member for Liverpool, Wavertree rightly raised the issue of support for new mums. I am glad to hear that she has visited mother and baby units, as I have. Seeing the reality of that treatment shows how important that service is. We continue to prioritise investment in tackling post-partum psychosis. We are investing £365 million into those services, and are currently looking at issuing contracts for four new mother and baby units. She asked me some specific questions about the number of beds. I will write to her on that, because although it might seem like a simple question, it is slightly more complex. As she has rightly highlighted, it is a very vulnerable time for new mothers. We must ensure that we have services available across the country, as we still have some geographical discrepancies in the level of provision. I highlight the fact that we are putting more support for new mums in the community, based around the whole ethos of early intervention. I think that is extremely important.

I could say an awful lot more, but I promise hon. Members that all those who spoke in today’s debate have given me many things to think about, and I will reflect on them. I look forward to debating all these measures regularly. It remains the Government’s priority to deliver a step change in how we provide services for poor mental health. That is a cultural change, and it will take time. That is why we have it as a five-year forward view. We will make the investment in additional staffing resources to deliver that step change, but I have no doubt that all hon. Members in this room will continue to hold my feet to the fire to make sure that we deliver.

Oral Answers to Questions

Debate between Norman Lamb and Jackie Doyle-Price

Tuesday 10th October 2017 Commons Chamber

[Jackie Doyle-Price]

On World Mental Health Day, I can confirm that we are spending £574 million more on mental health this year. It remains our principle that decisions should be made locally by CCGs, but we have very clear expectations of them, and they will be held to account via inspections.

[Norman Lamb (North Norfolk) (LD)]

The ‘Five Year Forward View’ suggested that the Government accepted the case for comprehensive maximum waiting time standards in mental health to match those in physical health. Given that children throughout the country are routinely waiting for months to start their treatment, may I ask what progress the Government are making with the introduction of a maximum waiting time standard for children’s mental health?

[Jackie Doyle-Price]

The right hon. Gentleman has raised an excellent point. Our Green Paper on children and young people’s mental health will address exactly those issues. We have made clear that we will tackle mental health through early intervention, and early intervention for children and young people is central to that.

Autism Diagnosis

Debate between Norman Lamb and Jackie Doyle-Price

Wednesday 13th September 2017 Westminster Hall

[Jackie Doyle-Price]

There is a good argument for being very open about this generally. The self-assessment framework obviously requires local authorities to mark their own homework, and even then we are not seeing the increase in performance that we would like to see. One of my main messages is that we can all learn from good practice elsewhere, and bad practice can also be a learning experience. The more sunlight we can bring to what is happening, the better. I am happy to write to my right hon. Friend on that.

That brings me to the results of the most recent self-assessment exercise, which show that only 22% of local authorities are meeting the recommendation of a maximum three months between referral and first appointment for an assessment. That is obviously not good enough. On the plus side, a further 23% said that they anticipated meeting recommended waiting times by March this year and that they would be able to sustain that, but that is still only half. Although the direction of travel is positive, there is a lot more work to do.

[Norman Lamb]

The Minister may be coming on to this, but will the Government consider introducing a national maximum waiting time standard for diagnosis, rather than for first appointment, so that every child knows that they will get that within a specified time?

[Jackie Doyle-Price]

I fully appreciate the right hon. Gentleman’s point. I am slightly uncomfortable about this, because often it can take a considerable amount of time for a proper assessment between first appointment and diagnosis, but perhaps we need to look at other measures. Generally, the more data we have in this area, the better we can measure performance. Clearly we need to ensure that we have sufficient specialists who are able to undertake these assessments and diagnoses. Sometimes that can be a challenge, so we need to ensure that local commissioners have access to those specialists.

Oral Answers to Questions

Debate between Norman Lamb and Jackie Doyle-Price

Tuesday 4th July 2017 Commons Chamber

[Jackie Doyle-Price]

I can give my hon. Friend that assurance. Indeed, the Care Quality Commission is undertaking a thematic review to see what works. He is right to identify early intervention as key but, as the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) highlighted, there is a need to consider the transition as well.

[Norman Lamb (North Norfolk) (LD)]

rose—

[Norman Lamb]

Thank you for the encouragement, Mr Speaker.

I have been alerted to an online posting yesterday on the social network Nextdoor by the father of a teenager who suffered awful trauma witnessing the horror at Grenfell Tower. He was after therapy for his daughter. Clearly there is an absolute need to ensure that everyone who may be in need knows how to get such therapy. What are the Government doing to ensure that everyone does know? Also, what are they doing to ensure that there is sufficient funding locally so that mental health services can provide for what will clearly be ongoing needs?

[Jackie Doyle-Price]

I thank the right hon. Gentleman for his question. I would be grateful to receive more details so that we can make sure that such support is going where it is needed. I advise him that, certainly in the case of the too-frequent disasters that we have had recently, we have been relying on more intervention on the ground. In our work on mental health first aid we are prioritising exactly those areas.