Oral Answers to Questions

Paula Sherriff Excerpts

Tuesday 19th February 2019 Commons Chamber

[Jackie Doyle-Price]

As we outlined in the 10-year plan, we fully recognise that there needs to be much more investment in community and crisis care, including direct access via the 111 service. By April, we will be able to put more flesh on the detail of how we will roll that out. I assure the hon. Lady that I am in no way complacent about the challenges we face in ensuring that our mental health services are what people should expect of them.

[Paula Sherriff (Dewsbury) (Lab)]

Last week, The Guardian revealed that hospital admissions for eating disorders have surged in the last year. Meanwhile, the number of children and young people with urgent cases of eating disorders who are treated within a week has fallen, and the number of those waiting between one and four weeks has risen. If prevention is better than cure, why do so many children and adolescents with eating disorders end up in A&E?

[Jackie Doyle-Price]

The hon. Lady is right in the sense that we have waiting targets for eating disorders, whereby the most acute cases should be seen within a week. We have seen very good progress—indeed, in most areas those targets are met. I will look into the cases that she has highlighted because we need to give attention to where the targets start to be missed. However, I assure her that we recognise that tackling eating disorders among our youngest people through early intervention must be done because prevention is always better than cure.

Mental Capacity (Amendment) Bill [Lords]

Paula Sherriff Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

Amendments 28 to 37 all refer to the requirements of assessors under the Bill. These amendments will ensure that the person who completes the assessments and determinations required for a liberty protection safeguards authorisation has the appropriate experience and knowledge to complete those assessments and determinations. They give the Government the power to determine who can complete medical and capacity assessments and who can determine whether the authorisation conditions are being met. These amendments ensure that the decisions about whether the authorisation conditions are met are made by those with the necessary skills, and will be based on assessments carried out by suitably qualified individuals.

[Paula Sherriff (Dewsbury) (Lab)]

What assurances can the Minister give that the regulations will be genuinely co-created with practitioners and cared-for people? If they are not, how can we be sure that the amendments are not a way of clandestinely watering down the protections of the Bill?

[Caroline Dinenage]

The Bill is very clear about the skills and qualifications necessary for those carrying out the assessments, but the code of practice that goes alongside the Bill will be carried out in partnership. We already have a working group made up of third sector organisations that are working to ensure that the statutory document that goes alongside the Bill is as robust as we can make it.

Appropriate ME Treatment

Paula Sherriff Excerpts

Thursday 24th January 2019 Commons Chamber

[Carol Monaghan]

I thank the hon. Gentleman.

This condition is largely unknown, because those affected are often hidden away. I commend the ME community for lobbying so successfully to ensure so many Members are here this afternoon. Ultimately, what that community wants is better treatment and care for people with ME.

[Paula Sherriff (Dewsbury) (Lab)]

Will the hon. Lady give way, on that point?

[Carol Monaghan]

Again, very briefly.

[Paula Sherriff]

I congratulate the hon. Lady on her sterling work on this issue. It is my privilege to represent Lucy, a lovely teenage girl in my constituency who has ME. Her parents have requested me to ask the House to ensure that biomedical research shapes all aspects of support—in which case it must be funded—and to reiterate that ME is a physiological condition, although it is often treated as a psychological condition. Lucy was asked if she needed to get around. She was told to just get up and walk, but she needs a wheelchair. Much more awareness is needed generally.

[Carol Monaghan]

Yes, ME receives far less research funding than other similarly prevalent conditions. That, I fear, reflects the attitude of some in the medical community who consider it to be behavioural rather than a pathological condition.

--- Later in debate ---

[Nicky Morgan (Loughborough) (Con)]

It was a pleasure to apply for this debate with the hon. Members for Glasgow North West (Carol Monaghan) and for Ceredigion (Ben Lake) and others. [Interruption.] How could I possibly forget the hon. Member for Ealing North (Stephen Pound)?

Like other Members, I will speak about my own constituents’ experiences. As we have already heard, so many Members are here on a Thursday afternoon to talk on behalf of their constituents. We held out for a debate on the Floor of the House, and we are debating not a “take note” motion but a substantive motion. This House debates many contentious issues, passions can run high and there can be many points of order, but hopefully we will see the House of Commons at its finest this afternoon as we do our job of bringing to the attention both of Ministers and of the wider public an issue of real importance that devastates the lives of our constituents and their families.

We have already heard about the issues of funding for biomedical research, and it is clear that, given the prevalence of the condition, there must now be an increase in funding not only to help advance our understanding of its underlying biology but to develop new diagnostic tests and better, more targeted treatments. The problems and dangers of graded exercise therapy and CBT have already been powerfully set out. My constituents have also called for NICE to take their concerns into account and to remove those treatments from its guidelines. We have heard the call for NICE to issue an immediate public statement on the harm that may be caused by the current guidelines for the period they remain active.

It is right that we want GPs and health professionals to know more.

[Paula Sherriff]

My constituent has to travel 40-odd miles to Manchester for treatment. With a condition such as ME, that is particularly distressing. Does the right hon. Lady agree that we need many more specialists throughout the country?

Mental Capacity (Amendment) Bill [ Lords ] (Third sitting)

Paula Sherriff Excerpts

Thursday 17th January 2019 Public Bill Committees

[Steve McCabe]

I am prepared to concede that the Minister has offered some reassurance—as a doubting Thomas, I would like an awful lot more. To be terribly honest, I am not that convinced. “Appear” is not a technical legal term; it is a description of the professional who would review a cared-for person’s situation for determination. Clause 18 sets out that the

“assessment must be carried out by a person who appears to the relevant person to have appropriate experience and knowledge.”

There is nothing too technical or legal about that. I say as gently as possible that if I were the Minister, I might go back to my officials and have another conversation about that in order to establish exactly why that wording has been chosen.

The Minister knows the Opposition’s view. She knows the view of quite a number of important organisations that are involved in this work day in, day out. It is probably better if I agree to withdraw the amendment now and take it on trust that the Minister will look further at our concerns. I therefore beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Paula Sherriff (Dewsbury) (Lab)]

I beg to move amendment 32, in schedule 1, page 13, line 46, at end insert—

“(aa) a determination made on an assessment in respect of the cared-for person as to whether the person’s capacity is likely to fluctuate, and”.

This amendment requires that an assessment of whether a person’s capacity is likely to fluctuate is included within the initial capacity and medical assessments, and therefore seeks to ensure that fluctuating capacity is reflected in the care plan of the cared-for person.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 31, in schedule 1, page 13, leave out lines 47 and 48 and insert—

“(b) a determination made on an assessment by a registered medical practitioner in respect of the cared-for person that the person has a mental disorder.”

This amendment would require the medical assessment to be carried out by a registered medical practitioner.

Amendment 33, in schedule 1, page 14, line 2, after “appropriate” insert “skills,”.

This amendment would require the person carrying out a medical or capacity assessment to have the appropriate skills to do so, as well as the appropriate experience and knowledge.

[Paula Sherriff]

It is a particular honour to speak for the very first time from the Front Bench in a Bill Committee under your chairmanship, Mr Austin. I will speak to the amendments and ask some questions of the Minister about the parts of schedule 1 to which they relate.

Amendment 32 relates to people who may have fluctuating capacity to consent and would require an assessment of whether a person’s capacity is likely to fluctuate to be included within the initial capacity and medical assessments. It therefore seeks to ensure that fluctuating capacity is reflected in the care plan of the cared-for person. It is our intention that the assessor must state whether the capacity of the person is likely to fluctuate and, if so, the likely duration of any period during which the person is likely to have capacity to consent to those arrangements.

This group of people were mentioned at length in the Law Commission’s draft Bill, but are conspicuous by their absence from the Government’s proposals. The Law Commission identified this point as a significant weakness in the DoLS system, as fluctuating capacity is dealt with entirely within the code of practice rather than in the legislation. I hope the Minister can explain why the Government’s Bill differs from the Law Commission’s proposals in this regard.

When the Law Commission launched its consultation, despite not specifically seeking views on fluctuating capacity, it was clear that it was a major concern for practitioners. One psychiatrist told it that

“the ‘black and white’ nature of the Mental Capacity Act’s approach to capacity fails to reflect the reality and complexity of fluctuating capacity.”

The Law Commission found that when it comes to fluctuating capacity, there is a disconnection between legislation and practice. That applies generally in relation to the Mental Capacity Act 2005, but raises specific issues when it comes to deprivation of liberty. There is little consistency in how different care settings treat fluctuating capacity. The Law Commission visited one care home where everyone with fluctuating capacity was deemed not to have capacity at any point, which meant that they received safeguards, but even on good days they were not able to make their own decisions. At another care home, everyone with fluctuating capacity was deemed to have capacity at all times. Although that gave them greater autonomy, it also meant that they did not have the safeguards that the Mental Capacity Act provides for.

The Bill does not change the status quo. It requires a binary decision to be made—either the person has capacity or they do not. The Law Commission found it unacceptable for the legislative framework to simply ignore fluctuating capacity, as it exposes health and social care professionals and those authorising a deprivation of liberty to significant legal risk. I hope the Minister will give the Committee her own assessment. Does she accept the Law Commission’s warnings on that risk? Will she explain why the Government have not adopted those proposals?

The amendment would introduce a degree of nuance and reduce that risk. Requiring fluctuating capacity to be considered and recorded lays the foundation for authorisations that vary based on changes in somebody’s capacity. Inclusion also has other benefits, which the Law Commission raised and which the amendment would reinstitute. Inclusion provides access to important legal rights, such as rights to representation and support by an advocate or another appropriate person. We will return to that point in the discussion on amendment 45, where we will set out what it means in more detail, but I hope that the principle will receive the Government’s consideration and support.

This group of amendments and the section of the Bill they seek to amend may seem technical, but they go to the heart of one of the most serious issues that we as parliamentarians ever consider: the circumstances under which the citizens we represent can be denied the liberty that it is our historic role to safeguard. I hope that the Minister will address our points and, if she accepts the principles behind it, accept the amendment.

--- Later in debate ---

[Alex Cunningham]

Indeed; that applies to this Bill as well. We are dealing with the most serious issue possible—the right of the authorities to deprive someone of their liberty—so we must get it right. We have seen failure time and again in the areas I mentioned. When people with inadequate knowledge carry out assessments of various things, they get it very badly wrong, and the client ends up winning their appeal. More than half of them, in some cases, win their appeals, but only after many weeks and even months, so they are often left without the support they need.

I wonder what happens in this sort of situation, when we are dealing with the deprivation of people’s liberty. We cannot allow those types of failure to be repeated in the system set up under the Bill, because the consequences are so far-reaching. It is taking somebody’s liberty away. It will not just be a decision to deprive people of their welfare benefits; it will actually take away their freedom.

I agree with my colleagues who have spoken in the debate that assessments should be undertaken by people who have the knowledge, skills and experience and hold the appropriate professional registration. If we do not put that into the Bill, the Bill will simply not be strong enough. It is far too important to be in the follow-up code of practice. We have heard a lot about the code of practice, but of course we have not seen anything that is in it. It is far more important than that. We must ensure that there is a sufficient level of scrutiny within the legislation.

I wonder what the Minister would tell Dr Haider Malik, a consultant psychiatrist who provided written evidence to the Committee. He said:

“In current Bill there is complete oversight of mental health assessor’s role. Though DoLS is considered complicated and bureaucratic piece of legislation but in my view Liberty Protection Safeguarding…would fail the stress test.”

The evidence we have received from a number of stakeholders is very clear. There is a clear demand out there, from people who know what they are talking about, for us to ensure that those carrying out the assessments are qualified to do so. Anything short of that is a betrayal not just of the individual, because it could lead to them wrongly losing their freedom, but of our duty to legislate to protect them.

[Paula Sherriff]

I will move on to amendment 31, which addresses who should be able to carry out medical assessments.

As hon. Members know, one of the three criteria for authorising the deprivation of liberty is that the cared-for person has a mental disorder. On the face of it, that is one of the most straightforward provisions in the Bill. However, the only provision for who should carry out the assessment is contained in paragraph 18(2), which states that the assessor must appear

“to the relevant person to have appropriate experience and knowledge.”

I am sure that I am not the only person present who is somewhat unclear about what constitutes the appropriate experience and knowledge.

Unlike other areas of the Bill, the assessment of a mental disorder is not wholly subjective; it is a medical assessment made under the Mental Health Act 1983. If someone wants to detain someone else for assessment under that Act, they need the recommendation of not one but two registered medical practitioners, yet under the Bill, it may be possible for a mental disorder to be diagnosed without the input of a medical practitioner.

Amendment 31 has been supported by the Royal College of Psychiatrists, which is concerned about the potential impact of assessments made by people who are not registered medical practitioners. One of its concerns is that the Bill says that the person commissioning the assessment has to decide whether the person carrying out the assessment has the relevant skills and experience, which could lead to a significant watering down of the levels of protection if we do not clearly state who can carry out such assessments. Furthermore, it has raised the possibility of misdiagnosis where a different disorder presents as a mental disorder, which would lead to the person being wrongly deprived of their liberty under the Bill.

The amendment also brings the Bill into line with the principles laid out by the European Court of Human Rights in relation to the diagnosis of a mental disorder. In Winterwerp v. the Netherlands in 1979, the European Court ruled that article 5 requires:

“Objective medical evidence of a true mental disorder of a kind or degree warranting compulsory confinement, which persists throughout the period of detention”.

Given that requirement for objective medical evidence, the Bill needs to guarantee that only a registered medical practitioner with appropriate training has the power to determine whether someone has a mental disorder. Anything else would risk creating legal issues, as people will challenge what constitutes objective medical evidence.

I hesitate to wake up Conservative Members by pushing a point about Europe, but the Minister will know that the Secretary of State has signed a statement on the front of the Bill to say that, in his view, its provisions are compatible with the convention rights. Can the Minister therefore confirm that the Government have considered that legal point and tell us with total confidence that the Bill meets the requirements for objective medical evidence without setting the requirement that a registered medical practitioner provide it? The requirement need not be excessively burdensome on the medical profession, as the Bill already makes provision for previous assessments to be used for certifying that somebody has a mental disorder.

The Royal College of Psychiatrists has helpfully supplied some examples of where there is a clear requirement for a registered medical professional to carry out the medical assessment, which I hope the Committee will find helpful in clarifying why we have tabled amendment 31. The first case relates to an 80-year-old woman, who has been settled in a care home for a year. Suddenly, without any obvious cause, she becomes agitated and distressed and tries to leave the care home. It would not be unreasonable for a lay person to conclude that she is no longer happy with the arrangements that are in place and needs an LPS to be granted.

In fact, the reason for the woman’s agitation is that she has developed a urinary infection, which has caused her to develop delirium. Once that is diagnosed and treated, she regains capacity and no longer needs an LPS. Delirium is not only easily missed, but life threatening. By having the involvement of a registered medical professional, it is much more likely that delirium will be correctly diagnosed.

In a second example, a wealthy man in a nursing home has met a younger woman via the internet. She has offered to move him out of the home and look after him in exchange for payment. The nursing home and social services feel that an LPS should be used to keep him in the nursing home, despite his wanting to leave. Following a detailed examination of his mental state, there is no evidence to suggest that he has a mental disorder. That example shows that it is important for an experienced medical professional to conduct a full and thorough assessment, rather than assuming that someone has a mental disorder purely because they engage in activity that others might see as reckless or unwise.

The third and final example relates to a woman living in a care home. She has been becoming more confused over time, and it is now thought that an LPS is needed. However, increased confusion is secondary to a recently commenced combination of medication. Once that is identified and her medication regime is changed, her confusion settles. After that, she is happy to remain in the home. In that case, it was important to have a medical professional with experience of analysing the impact of medication to assess the case. That meant that the changes in her mental state could be correctly ascribed to a mix of medicines that is not working, rather than a mental disorder.

All those examples illustrate cases in which the medical assessment needed to be carried out by a registered medical professional. Indeed, without the input of medical professionals at that point, it is possible that people would be not only wrongly deprived of their liberty, but subjected to totally inappropriate treatment regimes.

So far, the Government have said only that the code of practice will set out the requirements for the assessor under the new LPS scheme. I hope that the Minister will guarantee to the Committee that the code of practice will match the requirements of amendment 31 for an assessment by a registered medical practitioner. As my hon. Friend the Member for Worsley and Eccles South said, a code of practice does not carry the full weight of law. If this provision will be contained in the code of practice anyway, I see no reason to resist our amendment, which would give it that weight in the Bill. The Minister in the Lords suggested that the assessor will be a physician, but there has been no further clarification of that. I make it clear that the amendment is not merely probing; it is an amendment that needs absolute clarity.

The requirement for the assessment to be carried out by a medical practitioner is a vital safeguard. It helps to align our laws with the established position of the European Court. As such, that requirement must be included in the Bill, not shoehorned into a code of practice that we have not yet seen and that is to be published later.

Amendment 33 focuses on the skills of the people carrying out the medical and capacity assessments. The amendment goes slightly further than the Bill, which focuses only on experience and knowledge. In a number of places, that might make a difference, but it does so most clearly in relation to people with communication difficulties. The Royal College of Speech and Language Therapists stated:

“A person with a communication need may be at risk of being labelled as ‘lacking mental capacity’ if people mistake their communication problems for a lack of capacity.”

That could lead to people being deprived of their liberty under the Act when, in reality, they have the capacity to consent or not to consent to the arrangements.

One example of how that can look in practice involves speech and language therapists. In one case, a speech and language therapist used an inclusive communication approach to support a young man who had had a traumatic brain injury to understand a complex ophthalmic surgical procedure. He was then able to demonstrate that he could understand and consider the pros and cons of surgery, enabling him to make his own decision. Without that input, he would likely have been deemed to be lacking capacity and the best interests process would have been implemented.

In short, amendment 33 is about ensuring that we do not assume that people lack the capacity to make decisions purely because they might struggle to make themselves understood. Our amendment would ensure that whoever carries out the assessments has the appropriate skills to communicate with the cared-for person. What those skills include might of course vary from person to person. For example, if someone is non-verbal, it might well be that an assessor who can use Makaton is needed to ensure that their capacity can be considered adequately.

Will the Minister confirm that for a small number of people who have been deprived of their liberty, the main reason given was a hearing impairment? I do not think that any of us in Committee would be happy if it turned out that the person who ruled on capacity in those cases did not have the skills needed to communicate with someone who cannot hear.

The Minister in the House of Lords made assurances that the code of practice would set out the skills expected of assessors. Will the Minister for Care expand on that assurance and guarantee to the Committee that she will address communication specifically? None the less, at the risk of repeating myself, a code of practice simply does not carry the same weight as a provision of the Bill. It is absolutely unimaginable that somebody should be able to make a decision on a cared-for person’s capacity if they are unable to communicate with them properly. Amendment 33 would simply ensure that they could communicate with them.

--- Later in debate ---

[Caroline Dinenage]

Both, really. For example, the Bill lays out how every authorisation has a programme of reviews—if there is a change in the circumstances meaning that authorisation conditions are no longer met, the authorisation is no longer valid, and a review is triggered by reasonable request or significant changes in a person’s circumstances—so it is well within the scope of the Bill to address people with fluctuating capacity and to make sure that there is the necessary capacity.

The other issue that I have to take into consideration is that in a case regarding a patient known as CDM, fluctuating capacity has been considered by the Court of Protection, and that is currently being appealed. We are awaiting that decision, which will give useful guidance on how care workers should assess those with fluctuating capacity. That is something we will want to reflect on.

The hon. Member for Dewsbury spoke about the Law Commission and asked why we have differed a little bit from what it recommended. It is simple. The Law Commission had anticipated an entirely separate scheme for fluctuating capacity, adding a hugely complex dimension to this whole piece of work. Under its recommendations, people with fluctuating capacity would be dealt with in a separate authorisation process not directly linked to the main scheme. That is why there is a bit of confusion there.

There will be an awful lot of detail on this matter in the code of practice, which we consider the most appropriate form of guidance, given the level of detail it will require—this is a very serious matter. That will continue the practice under the current deprivation of liberty safeguards system, where the code of practice addresses fluctuating capacity. As I say, the Bill talks about regular assessment, including a limit of a year in the first instance—that is the maximum. The assessments can be set at very short-frequency time periods in order to deal with somebody who might have fluctuating capacity. Statutory guidance will include cases where a person with fluctuating capacity meets or does not meet the authorisation condition of lacking capacity to consent to arrangements, and will cover whether the authorisation continues in force or ceases to have effect.

Amendments 31 and 33 seek to ensure that medical assessments are completed by a registered medical practitioner. I completely agree that the person who conducts the medical assessment must of course be suitably competent, but the Bill already states that a person carrying out a medical capacity assessment must have “appropriate experience and knowledge”. We expect capacity assessments to be completed by a registered professional such as a nurse, social worker or occupational therapist, and medical assessments must be completed by physicians, such as family GPs and other doctors. However, we have to take into consideration that objective medical evidence does not require a registered doctor in all cases. Case law confirms that it can also include psychologists, for example, as was confirmed by the Law Commission.

In addition, to show the complexity of the issue, registered medical practitioners can include doctors who do not currently have a licence to practise. I know the hon. Member for Stockton South will be aware of that, given his knowledge and profession, but we need to consider carefully the law of unintended consequences when thinking about putting that in the Bill. We could be opening up a whole unwanted can of worms. We need to consider carefully whether we allow that particular group to give medical evidence.

It should also be noted that case law on article 5 of the European convention on human rights already requires that a deprivation of liberty must be based on objective medical expertise. The focus is therefore on competence at every stage rather than on qualifications. We are making it clear that all appropriate medical professionals should be included, which includes the speech and language therapists in the case that the hon. Member for Dewsbury spoke about.

I hope I have provided confirmation that medical and capacity assessments will be completed by somebody with the appropriate experience and knowledge to do the job, and that they will have the competence required to make a reliable assessment. I hope that I have provided Members with the reassurance they need to not press the amendments.

[Paula Sherriff]

I am grateful the Minister has agreed to have another look at the requests we have made today, but, in summary, medical and capacity assessments are a fundamental part of the proposed LPS system. They play a crucial role in preventing people from being wrongly deprived of their liberty. I have given examples today of where it is particularly important that the medical assessment is carried out by a registered medical practitioner. The European Court of Human Rights has held that deprivation of liberty on the grounds of unsound mind is permissible only on the basis of objective medical evidence. We need a guarantee in the Bill that medical assessments will be carried out by registered medical practitioners, otherwise we cannot ensure the Bill is fully compliant with European law.

I thank my hon. Friends for their contributions, including my hon. Friend the Member for Stockton South, particularly for his valuable medical experience on this issue, and my hon. Friends the Members for Stockton North and for Nottingham North.

The Law Commission wrote at length on the importance of considering fluctuating conditions. The amendment would ensure that an assessment has to be made of whether a person’s capacity will fluctuate. Without our amendment on fluctuating conditions, we might end up in a situation where anyone with fluctuating capacity is subject to different restrictions, depending on how a particular care setting treats them.

Finally, amendment 33 provides for capacity assessors to have the skills appropriate to carry out an assessment. That is especially important for people who have communication issues, as I outlined earlier. The Minister in the House of Lords said that skills will be covered in the code of practice, but we still have not seen the code. We need assurances in the Bill to ensure that people are not deprived of their liberty simply because an assessor could not understand them.

Question put, That the amendment be made.

Oral Answers to Questions

Paula Sherriff Excerpts

Tuesday 15th January 2019 Commons Chamber

[Jackie Doyle-Price]

The hon. Gentleman has quizzed me about this a number of times, and I know that he cares very deeply about it. One of the specific issues he has raised with me is the awareness of GPs and their involvement in diagnosing these problems. Obviously we are taking that forward as part of the GP contract. I can also advise him that there is a significant expansion in perinatal services. We are confident of achieving the national trajectory of 2,000 more women accessing specialist care this year, and more than 7,000 additional women accessed such care as of March 2018.

[Paula Sherriff (Dewsbury) (Lab)]

Recent analysis of NHS digital mental health workforce statistics reveals that NHS England is not on course to meet its targets of 21,000 additional mental health staff by 2021. This means that it is unlikely to meet the goals set in the five year forward view and the recent long-term plan. Mental health services are in real danger of further decline, so may we have an absolute guarantee from the Secretary of State that these targets will be met, and if they are not, will he resign?

[Jackie Doyle-Price]

I have to advise the hon. Lady that we are on course to meet the targets in the five year forward view, but she is right to raise concerns about the workforce. Frankly, that keeps me awake at night. We are investing in a significant expansion of mental health services and that requires appropriate staff to deliver them. I can assure her, however, that we are in productive discussions with clinical leads in NHS England. We need to be much more imaginative about how we deliver services, and we are seeing substantial gains and improvements in performance through the increased use of peer support workers, who provide the therapeutic care from which many can benefit. However, the hon. Lady is right to hold me to account.

Mental Capacity (Amendment) Bill [Lords]

Paula Sherriff Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Paula Sherriff (Dewsbury) (Lab)]

I thank all right hon. and hon. Members who have participated in this important debate. There have been many worthwhile and thoughtful contributions from all parts of the House, including from my right hon. Friend the Member for North Durham (Mr Jones), the right hon. Member for North Norfolk (Norman Lamb), the hon. Member for Berwick-upon-Tweed (Anne-Marie Trevelyan), my hon. Friend the Member for Stockton North (Alex Cunningham), the hon. Member for Stafford (Jeremy Lefroy), my hon. Friends the Members for Swansea West (Geraint Davies) and for Stoke-on-Trent Central (Gareth Snell), the hon. Member for Lewes (Maria Caulfield), and my hon. Friends the Members for Oxford East (Anneliese Dodds) and for Birmingham, Selly Oak (Steve McCabe).

The Bill was supposed to be a welcome proposal to simplify a complicated system, but what is before us is equally problematic and will not fix the fundamental challenges that it was supposed to fix. That point was eloquently articulated by my hon. Friend the Member for Stockton North. Put simply, the Bill has been rushed from start to finish. It has not received the meticulous and careful planning that befits legislation about the human rights of the most vulnerable people in our society.

The Government have shifted the goalposts. First, they agreed with the recommendations of the Law Commission’s draft Bill, but the Bill before us has only five clauses, compared with the Law Commission’s 15 clauses. The Law Commission consulted widely with stakeholders over a two-year period, but the Government did not consult those stakeholders even once before developing their much-changed Bill. Do they think they know better than the Law Commission, which spent years developing its draft legislation? I know from my own discussions with those stakeholders the serious concerns about how the Bill has proceeded. Surely the Government should have started consulting them at an early stage rather than proceeding at what Mencap, the National Autistic Society and many others have called “a breakneck speed”.

There are other examples of the Government acting hastily. There has still been no code of practice, and no definition of “deprivation of liberty”, on which much of this whole debate hinges. As we have heard, the Bill’s equality impact assessment was published only yesterday—that is not good enough—and despite what the Government say, it was not simply an update of a previous impact assessment in the House of Lords. That impact assessment, which is now completely out of date, discussed only the savings that the new system would make for the taxpayer. This process has been bungled to the point that Baroness Barker called the Bill the worst piece of legislation ever to have come before the House of Lords. It was clearly designed with one thing in mind: to save money on dealing with the backlog of DoLS applications.

We accept that the backlog that has arisen since the Cheshire West judgment, which widened the scope for what constitutes a deprivation of liberty, needs dealing with. That could be done through properly resourcing local authorities to deal with the problem, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) pointed out earlier. We know that the Government initially intended to solve the problem by foisting this responsibility on care home managers. Leaving aside the massive pressure that this would add to already overstretched care home managers and the worryingly high vacancy rate of care home managers, this would have created a dangerous conflict of interest. Thankfully that was amended in the House of Lords, but an equally dangerous conflict of interest remains in the role that has been given to independent hospitals. It simply cannot be right that this House legislates to give independent hospitals, so many of which are detaining people for years on end under the Mental Health Act, a similar ability under the Mental Capacity Act. It is totally unacceptable to enable them to determine whether appointing an independent mental capacity advocate is in someone’s best interest. It could create the very conditions that my hon. Friend described so harrowingly earlier. We could see even more Bethanys, and that would be a truly horrifying prospect for this House.

It is only down to the tenacity of the noble Lords, including my colleagues on the Labour Benches in the other place, that vital concessions to address some serious problems with this Bill. However, this Bill still falls far short of what is required. This debate has discussed the concept of an individual’s best interest, which should be at the heart of this Bill. If that were the case, the Government would have implemented the Law Commission’s recommendations in full. There are still several areas where the Government have diverged fatally from the Law Commission’s recommendations.

This Bill did not adopt the Law Commission’s recommendation that independent mental capacity advocacy should be available on an opt-out basis and not dependent on a best interest test. There are still worrying shortcomings in the arrangements for approved mental capacity professionals, and there has been no consideration of the interface between the Mental Capacity Act and the Mental Health Act, which has recently been the subject of review by Sir Simon Wessely. Sir Simon made important recommendations about the overlap between those Acts. The hon. Member for Central Suffolk and North Ipswich (Dr Poulter) suggested a pause to consider that interface, and I concur with him on that.

This Bill is simply not fit for purpose. We cannot and must not rush legislation that deals with fundamental human rights. The Government must pause and take stock of the concerns that are being raised by so many voices urging them to revise these disastrous proposals. Some excellent suggestions have been made in this debate this afternoon. It is time to stop and think again.

NHS: Staffing Levels

Paula Sherriff Excerpts

Tuesday 11th December 2018 Westminster Hall

[Tracy Brabin (Batley and Spen) (Lab/Co-op)]

I beg to move,

That this House has considered staffing levels in the NHS.

It is an honour to serve under your chairmanship, Mr Hollobone. It is a pleasure to lead this debate and I thank hon. Members for being present. I know that many are eager to contribute, and the fact that they have taken the time to be here, during one of Parliament’s more eventful weeks, emphasises the strength of feeling in the House about staffing levels in the NHS. I also thank the many organisations that have contacted me, offered support and shared their research.

It is clear that the issue of staffing in the NHS is a great and growing concern to many. Indeed, the case of my local NHS trust inspired me to apply for this debate. Most of my constituents rely on the Mid Yorkshire Hospitals NHS Trust for a range of acute hospital-based and community services. The trust serves not just the people of Batley and Spen, but more than half a million people across Wakefield and North Kirklees.

[Paula Sherriff (Dewsbury) (Lab)]

I thank my hon. Friend and neighbour for securing this important debate. My constituents also use the Mid Yorkshire Hospitals NHS Trust. There are still several hundred nursing vacancies there, and that is having a significant impact on the delivery of patient care. Does she agree that the chaos of the current Brexit situation is not helping to recruit nurses, potentially from the European Union?

[Tracy Brabin]

I shall go on to discuss that in more detail, but my hon. Friend and neighbour is absolutely right. We have both been in meetings with the trust where that has proved to be of great concern to it.

--- Later in debate ---

[Tracy Brabin]

My sister is also a nurse. When someone has a nurse in the family, they understand how hard they work. My hon. Friend must be psychic, because I am about to go on to that point.

When it comes to the recruitment and retention of NHS staff, it could not be further from the truth that austerity is over. The Royal College of Nursing did not mince its words when it said:

“The UK is experiencing a nursing workforce crisis”,

particularly in England. With one in three nurses due to retire within a decade, we are looking at a perfect storm of increasing vacancies across health and care.

[Paula Sherriff]

Does my hon. Friend share my concern that, as a direct result of staffing shortages at Dewsbury and District Hospital, the midwife-led birthing unit has had to be closed several times? September was a particularly bad month for closures. That has a traumatic effect on mums-to-be, who expect to give birth there but turn up and get sent elsewhere.

[Tracy Brabin]

Capacity, particularly in midwifery, is a massive issue, and midwife recruitment is also a problem. A mum who is about to have a baby wants to make sure that they are guaranteed a bed and a midwife who will be with them throughout the process, so of course that is a concern. There are almost 41,000 vacant nursing posts in the NHS and it is estimated that that number will grow to almost 48,000 by 2023—just five short years away.

--- Later in debate ---

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate the hon. Member for Batley and Spen (Tracy Brabin) on securing this debate and on highlighting the biggest challenge facing the NHS: the creeping workforce crisis that has been evolving for some time now. We are now seeing that crisis beginning, in real terms, to affect patient care.

The hon. Lady was right to highlight the fact that a lack of staff in some parts of the country means that operations are being cancelled and beds are being closed. She was also right to point out the challenges that Brexit poses to the recruitment and retention of frontline NHS staff; in the past decade, we have been increasingly reliant on European Union staff coming to work in the UK—before that, it was staff from outside the EU who provided most of the overseas workforce in the NHS. I am sure that all of us would like to put on the record our support for the excellent work that NHS staff from the UK and from all over the world do in caring for patients.

I will also do what I should have done at the beginning of my speech and draw attention to my declaration in the Register of Members’ Financial Interests, as I am a practising NHS hospital doctor working in mental health services.

[Paula Sherriff]

Will the hon. Gentleman give way on that point?

[Dr Poulter]

I will not, because of the time limit and because I want to let other people speak; I am sure that we can talk about this issue in detail after the debate.

Very briefly, Mr Hollobone, the Government have made a number of promises about NHS staffing and yet, unfortunately, those promises are failing to come to fruition. In 2015, there was a promise of 5,000 more GPs. Recently, I submitted a written parliamentary question about how much progress had been made in realising that target but I did not get an adequate answer. I would be grateful if the Minister updated us in his concluding remarks by saying how close we are to realising that target of 5,000 additional full-time GPs.

I would also like to highlight some of the challenges in community and mental health services. Very often in this Chamber, we talk about hospitals, and very often the NHS is seen through the prism of that acute sector, but the key challenge to keeping people out of hospital is doing more in the community, building up community mental and physical health services—and they are the very services that are seeing reductions in frontline staff.

I want to touch briefly on mental health. We know that the number of full-time-equivalent mental health nurses fell by 6,000 between 2010 and March 2018, including a reduction of more than 1,800 in learning disability nurses alone. The number of child and adolescent mental health service and learning disability consultant psychiatrists has also slightly declined over the past decade, and many parts of the country, particularly outside London, are struggling to fill higher registrar training posts in those services.

Perhaps more concerning is that the number of junior doctors in specialist psychiatry training—core and higher psychiatric trainees who will become the consultant psychiatrists of tomorrow—has also fallen, by 490 full-time equivalent doctors, from 3,187 in 2009 to 2,697 in March 2018. [Interruption.] The civil servants are rapidly checking my figures; they are from answers to parliamentary questions, so they are absolutely correct.

That is a woeful record of decline in the psychiatric and mental health workforce, and it must be corrected. If the Government are serious about their rhetoric on mental health, about improving the quality of provision for people with poor mental health, they need to recognise that the workforce has already declined. Even if there is the promised increase in numbers, it will be from a lower baseline than that of about a decade ago.

The only way to deliver the expansion in services that patients deserve—for example, specialist eating disorder services in Cumbria or East Anglia—is by having a much more serious approach to the recruitment and retention of mental health staff and by paying premiums to attract both doctors to work in CAMHS and people to work in parts of the country where there is a shortage of mental health staff. I look forward to the Minister’s response.

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

I congratulate my hon. Friend the Member for Batley and Spen (Tracy Brabin) on calling this vital debate.

I remember the challenging years of the mid-1990s, when I was working as a physio in the NHS. During that crisis time, I never knew when I would get home. Today’s scenario reminds me of the dying years of a Tory Government—the parallels are so strong.

In York, I read the Care Quality Commission reports in detail, and although the care given by our NHS staff is excellent, the real challenge that I pull out of the results of CQC reports is the staffing crisis. My local hospital currently has 59 doctor vacancies, and there are 580 nursing vacancies in bands 4 to 7, 312 of which are in bands 5 to 7. The trust has done everything it can to recruit. It went to Spain and recruited 40 Spanish nurses, 37 of whom left after a very short period. The reality is that NHS staffing is in crisis and that affects patient care.

Last year, the trust had to spend £8.5 million on agency staff. That pushed a trust that is already struggling because the funding formula does not work for York into further deficit, which has an impact on its control and on the resources it can get for the winter crisis—York had some of the highest levels of influenza last year. The Minister, therefore, must ensure that the money works, as well as addressing staffing.

I want briefly to look at primary care because, as we have heard, we need early intervention across all ages to keep people out of hospital. Rightly, the Government looked to increase the number of health visitors, and by 2015 the figure was up to 10,309, but since then we have seen a 23.8% fall, down to 7,852, meaning that young people are not getting the input they need. School nursing figures have also fallen by 25% since 2010. So we have a real crisis in our primary care workforce, and also in mental health, as the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said. Certainly we feel that in York, whether in the community or the hospital environment.

[Paula Sherriff]

Will my hon. Friend give way?

[Rachael Maskell]

I am going to continue.

The trust is doing everything it can to recruit, but it is impossible to recruit because the national pool of mental health staff is far too small. Therefore, it is vital that we consider the solution, which comes down, as has been said, to workforce planning. We need a partnership approach to planning the workforce. We need to understand the changing demographics and the increasing mental health challenges in order to put the right planning in place, but trusts will not be able to recruit unless the staffing framework is right. The removal of the bursary scheme has been seriously detrimental, particularly to the recruitment of mature students into nursing. People are giving up a job, but their staying in the profession for longer will pay dividends. Students have to pay to travel to placements, and I remember what that was like, so it is really important that they have bursaries.

Secondly on workforce planning, we need to look at how we educate healthcare professionals across the board. I remember discussions at a national level with the trade unions on that very issue, about needing to find a different way. In some countries they bring a real foundation into NHS training so that everyone works together in the first 18 months or two years of their training and has a breadth of understanding of medicine before going off to specialise. We, instead, train in traditional old silos of jobs that have clearly blended over the years, and we must look once again at how we structure that.

Thirdly, we need to look at the “Agenda for Change” package. There is no doubt that it is hard to recruit because people are poorly paid in the NHS and can be better paid elsewhere. Given the stress levels and the antisocial hours that people work, we need to look once again at the remuneration of our NHS workforce. Finally, the knowledge and skills framework has consistently been underutilised by the Government and NHS employers, and it is vital that we go back to that framework of professional development in the NHS.

Budget Resolutions

Paula Sherriff Excerpts

Tuesday 30th October 2018 Commons Chamber

[George Freeman (Mid Norfolk) (Con)]

Last year, after the disappointment of the general election manifesto process, I left the Government in order to make the case that we needed to make this a moment of much bolder national renewal, that we needed to move on from the first phase of reducing the deficit through a programme of austerity and that we needed to set a trajectory of higher growth, more public sector enterprise and innovation, and wage increases and tax cuts focused on the poorest—those on the lowest incomes—in our society. Let me start by saying that I strongly welcome the Chancellor’s Budget for all those reasons. He managed to square an almost impossible circle in a clever Budget that has done something important for some of the most vulnerable in our society.

As a constituency MP, I wish to mention in particular the measures to support the high street. In Mid Norfolk, as in many other rural constituencies, we have seen our high streets hit hard by a big transfer to online retail without the digital giants paying tax in return, and I welcome the measures that the Government have taken to support our high streets. In particular, in health and care day of the Budget debate, I want to highlight the £10 billion put aside for social care; the extraordinary announcement, which I strongly welcome, of the launch of the first mental health emergency service; the £10,000 for every primary school and £50,000 for every secondary school; the £400 million a year for our schools; and the £2 billion to make sure that universal credit is properly funded. These, I suggest, are compassionate steps taken by a Government still paying off the legacy of the appalling inheritance from the Labour party, but doing so in a way that tries to put the needs of the most vulnerable in society first.

All of that is made possible because of the extraordinary economic success over which we have managed to preside. It pains Opposition Members, which is why they are all looking away, that the rate of real income growth has been rising. In the next five years, the OBR forecasts that there will be a bigger real-terms rise in real incomes for the lowest paid than for anybody else, and 3 million new jobs. This is a success story, and nothing tells us how important it is more than the howls of derision from the Opposition, so upset are they that more and more people in this country are not in need of Labour party support. People are coming to us because they know that ours is the party that supports growth.

I want to acknowledge that after eight very painful years, there is a weariness afoot among both those on the frontline of public services, who have tightened their belts, and the lowest-paid people in work. Those two groups have tightened their belts far more than those in plum jobs in government, in Whitehall, or even in local government. We need, as a House, to say to them that they have earned it and to send a very sincere thank you. The British people have tightened their belts far harder than the Government have in the past eight years.

Talking of public sector workers and the need for public sector leadership, I want to thank the Chancellor for announcing the new public sector leadership academy—an academy to support those on the frontline of public services, who have one of the hardest jobs in our society. [Interruption.] The hon. Member for Dewsbury (Paula Sherriff) might say that is rubbish, but that is because she has never had to run anything. The people on the frontline of our public services are actually running very complex public services. They, alongside the lowest-paid people in work, are the people to we need to support in the next five years in tightening the belt and delivering the innovation and efficiency that the public want to see.

[Paula Sherriff (Dewsbury) (Lab)]

I note that the hon. Gentleman said that I have never had to run anything. I wonder whether he would like to change his mind given that I ran a crime management centre in a police station and two incredibly busy departments in a busy hospital. Perhaps he would like to correct the record.

[George Freeman]

I will happily correct that bit of the record, as long as the hon. Lady welcomes the public sector leadership academy, because, given her experience, she will know how important it is.

If we are really to tackle the structural legacy of the 13 years of a Labour Government that led to the biggest economic crisis in this country’s peacetime history—[Interruption.] That is a reality that Labour Members now shout down because it is inconvenient. The crisis that a new generation of voters needs to be consistently reminded of was the legacy of 13 years of a Labour Government. If we are to tackle that, we will have to do two important things: yes, we must continue to drive the modernisation of public service, but we must also increase the rate of growth and revenue generation in the economy by the Government. Even more powerfully, over the next five years we need somehow to make those two ambitions work together. I would like to share some thoughts on how we might do that.

The truth is that our growth rate has dropped since the EU referendum, from 3% to 1.5%. Therefore the first thing that we need to do is to get a good Brexit deal for business confidence. I hope that the Opposition will take the opportunity of the forthcoming Brexit votes to put the needs of business, prosperity and the economy ahead of ideology or party politics. We also need to create an environment in which we can unlock business investment in this country. There is £600 billion tied up on businesses’ balance sheets, and we need to trigger the confidence needed to unlock that money in the post-Brexit dividend. We will not get it unless the Brexit deal gives business the certainty that it needs in the years ahead.

We also need to go much faster on infrastructure. I am delighted that, at this point, the Chief Secretary to the Treasury has entered the Chamber, because for eight years she and I have been holding meetings to try to accelerate funding for the Ely rail junction. I want the Treasury now to recognise that, across the country, there are infrastructure schemes that could be funded by private finance. I am talking not about PFI, but about giving local authorities and mayors powers to set up infrastructure bonds to create more innovative ways of driving investment into our public services. If we regenerated rail links and rail lines, gave planning permission for stations and developed innovative schemes for capturing the value increase around those lines, we could harness that growth to fund new models of infrastructure.

I particularly welcome the Government’s continued emphasis, through the industrial strategy, on fields such as life sciences, robotics and artificial intelligence so that we can create in this country the research platform needed to support the creation of the jobs and businesses of tomorrow. But if we are to be more than just a research economy—if we are to be a genuine innovation nation that pulls innovation through into practice—we need an economy that uses innovation in the private and public sectors. The great trick is to harness the power of innovation in our public services, and nowhere more than in the NHS. If we are really to lead the world in digital health and digital medicine, and the extraordinary revolution that that offers, we will not do it with an NHS running on paper and cardboard. We need to make the NHS a genuine catalyst for UK leadership in digital health. It is the same in genomics. When I set up the UK genomics programme, the idea was not only that we would launch the world’s first genomic medicines service in the NHS, which we have, but crucially that, in so doing, we would make this country a leader in genomic research and life science investment.

This, in the end, is the key to getting out of the debt that we inherited from the Labour party—the high-debt, low-growth model that yesterday’s Budget acknowledged. We have to somehow unlock innovation in our public services and drive much higher rates of growth in the private sector. With Brexit coming to its resolution here in this House in the next few weeks, we have to make it a catalyst for the renaissance of innovation and enterprise, and the moment at which we set out a vision for public services in the 21st century.

Oral Answers to Questions

Paula Sherriff Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Matt Hancock]

The hon. Lady is right to draw attention to the need to ensure that funding for mental health services has parity with that for physical health services. Getting there is the work of a generation. We did not even measure access to mental health services until this Government brought that in, and we are working towards parity.

[Paula Sherriff (Dewsbury) (Lab)]

The Secretary of State boasted to the global ministerial mental health summit about the Government’s plans to recruit 21,000 more staff to the mental health workforce by 2021, but he did not tell the summit that by the end of May this year, nearly 25,000 mental health staff—one in eight of the workforce—had left the NHS and that fewer than 1,000 extra staff had been recruited by March, equating to just 0.5% of his target. Does he really think that he is in a position to lecture the rest of the world?

[Matt Hancock]

I welcome the hon. Lady’s commitment to this area. Clearly it is very important to have the workforce in place. As she said, we are making progress, but we still have more to do. As far as the international approach is concerned, the response to the summit was that many countries came together, because collectively we all face the same sorts of challenges. I am in absolutely no doubt that the leadership shown by some countries, including the UK, is warmly welcomed.

Oral Answers to Questions

Paula Sherriff Excerpts

Tuesday 24th July 2018 Commons Chamber

[Jackie Doyle-Price]

As I have said, NICE has published its new clinical guideline on the recognition and treatment of eating disorders in people over the age of eight, including adults, and we will make clear to NHS organisations what we expect of them. We are ensuring that we meet the waiting times for eating disorder treatment, and we are delivering against those standards.

[Paula Sherriff (Dewsbury) (Lab)]

Data from NHS Digital show that the number of beds for people with serious mental health conditions, such as eating disorders, has fallen by nearly 30% since 2009. The Government say that they are committed to ensuring that everyone with an eating disorder has access to timely treatment, but according to the hon. Member for Central Suffolk and North Ipswich (Dr Poulter)—who I believe is also an NHS doctor—there is often a long wait for patients with eating disorders who need beds for urgent in-patient care. Does the Minister agree with him?

[Jackie Doyle-Price]

The hon. Lady’s starting point was “since 2009”. It is certainly true that there was a decline then, for a number of reasons, not least the fact that we are improving treatment in community settings rather than acute in-patient beds. Our Five Year Forward View began in 2014, and we have been delivering improvements in the number of beds and staff since that date.