Coronavirus

Steve McCabe Excerpts

Tuesday 7th July 2020 Commons Chamber

[Mr Speaker]

Chorley A&E may be able to help you with that, Secretary of State.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

What is the current level of funding for research projects into the long-term effects of covid-19 funded from the National Institute for Health Research, in which I think the Government claim to put £1 billion?

[Matt Hancock]

This is a really important point. The hon. Gentleman will have heard at the weekend that the NHS has opened a long-term covid impact service. That is on the health side. On the research side, we have so far put £8.4 million into a research call, but of course we will be happy to expand that if we get research projects that are worthwhile.

Covid-19 Update

Steve McCabe Excerpts

Tuesday 5th May 2020 Commons Chamber

[Matt Hancock]

There is strong evidence that the under-10s are less likely to have symptoms of coronavirus, but unfortunately the evidence on the under-10s’ transmission of coronavirus is mixed and there is not a conclusive scientific base on that yet.

[Steve McCabe (Birmingham, Selly Oak) (Lab) [V]]

Is the Secretary of State content that the advice and guidance given to pregnant women working on the front- line of health and social care, on both safety and income, are sufficiently clear and consistent?

[Matt Hancock]

Yes.

Oral Answers to Questions

Steve McCabe Excerpts

Tuesday 5th May 2020 Commons Chamber

[Robert Courts (Witney) (Con)]

What steps the Government is taking to support the early years sector. [R]

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

What recent assessment he has made of the adequacy of support available to childcare providers and nurseries during the covid-19 outbreak.

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

What assessment he has made of the effect of changes to the coronavirus job retention scheme on the ability of nurseries and childcare providers to retain staff.

--- Later in debate ---

[Vicky Ford]

My officials and I are in continual contact with early years sector organisations through regular meetings and working groups and feed their messages right into the heart of Government. We have put £3.6 billion into the sector through funding the entitlements this year and will continue to ensure that providers get the best possible support on the many different Government schemes while also staying within the rules. We also have a new announcement for parents. Parents who are normally eligible for the Government’s free childcare will continue to be eligible for those entitlements during this summer term, even if their income levels have changed because of the virus. This will be a massive support to families as well as to providers.

[Steve McCabe [V]]

Nurseries and childcare providers have struggled to stay open during this crisis. The Minister will know that the confusion over the Department for Education statements on free entitlement and the furlough scheme has caused many financial headaches. Last week, the First Secretary of State said at PMQs that if those providers were finding it too much to bear, the Government will look “afresh” at what can be done. Can the Minister tell me when the Secretary of State will look afresh at what needs to be done, and, given that the Minister is regularly in touch with nurseries, will she tell me the last time that she spoke to the nurseries and childcare providers in my constituency, because they do not seem to know about plans to rescue their provision?

[Vicky Ford [V]]

I spoke to early years organisations only last week, and speak to them on a weekly basis through my officials and in meetings that I join regularly. On the coronavirus job retention scheme, the initial guidelines were first published by the Government on 26 March. I am sure that Members understand that it would not be right for providers—or, indeed, any business —to receive two Government incomes for the same costs. We have worked closely with the sector to clarify this position, and will always make sure that early years providers get the best support possible. This will be an important discussion at the next spending review—

Supermarkets’ Role in Tackling Childhood Obesity

Steve McCabe Excerpts

Wednesday 18th March 2020 Westminster Hall

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I beg to move,

That this House has considered the role of supermarkets in tackling childhood obesity.

It is a pleasure to serve under your chairmanship, Mr Robertson. Even as we struggle with the threat of covid-19, I want to stress the importance of this debate, because childhood obesity is a subject whose importance cannot be overestimated. It is without doubt the time bomb that will increasingly affect the lives and wellbeing of our society in the years ahead. We need clear steps to address it. The report, “Healthy Families: The present and future role of the supermarket”, from the all-party parliamentary group on a fit and healthy childhood, sets out to contribute to the debate. It does not seek to cast supermarkets as the villains of the piece; rather, it recognises the influence that they have and how that influence can be used positively to help tackle health issues.

Supermarkets have always occupied a special place in our psyche. It was J. K. Galbraith who told us:

“A person buying ordinary products in a supermarket is in touch with his deepest emotions”,

and Jonathan Sacks who suggested:

“A Martian would think that the English worship at supermarkets, not in churches.”

Supermarkets are now widespread in many countries. This country’s development trailed behind that of the USA. Indeed, by 1947 our self-service sector consisted of a mere 10 shops, but by 1969 supermarkets numbered about 3,500 and were well and truly established as part of our shopping experience. Store layout, daily promotions and sensory cues are all part of a formidable arsenal designed to encourage customer purchases, often regardless of the nutritional value of the product.

Price promotion is a key element in the strategy. A Cancer Research UK report in 2019 argued that three in 10 food and drink purchases are determined by price. The households making the greatest use of price promotion bought more products high in fat, salt and sugar. The upper quartile of promotional purchasers are 43% more likely to be overweight than the lower quartile, irrespective of income and age demographics.

[Jim Shannon (Strangford) (DUP)]

I suspect that the hon. Gentleman shares my concern that supermarkets place chocolates just in front of the tills, so that there is almost a wish to buy them as people make their purchases. Does he feel that supermarkets should move them away from the tills, so that there is not that temptation for mothers and children as they come to pay for goods?

[Steve McCabe]

I certainly agree. There is quite a lot of research to show that children, almost irrespective of their age, are influenced by that, and that the placement of products influences purchases.

The Obesity Health Alliance’s 2018 report “Out of Place” focused on the prime locations in stores for selling particular goods—exactly the point that the hon. Member for Strangford (Jim Shannon) has just made. It found that 43% of all food and drink promotions situated in prominent places, such as entrances, checkouts, aisle ends and so on, were for sugary food and drink. Fruit and vegetables amounted to less than 1% of products promoted in high-profile locations.

Diabetes UK reports that one in three children in primary schools in England currently suffer from excess weight, increasing their risk of type 2 diabetes. Excess weight or obesity accounts for up to 85% of someone’s overall risk of developing the condition. The Obesity Health Alliance makes a similar point: as well as causing type 2 diabetes, obesity can lead to cancer, heart and liver disease, and associated mental health problems.

[Jim Shannon]

I think it is wise to reflect on diabetics. I declare an interest, as I have been a type 2 diabetic for almost 15 years. There are 5 million diabetics in the United Kingdom, and the number is rising. It is one of the greatest health problems for future generations. Does the hon. Gentleman agree that there should be a campaign to address the issue across the whole United Kingdom of Great Britain and Northern Ireland?

[Steve McCabe]

I do, because we have to educate people who could avoid this condition about to how to do so, not least because, as the Obesity Health Alliance points out, the annual cost of overweight and obesity-related ill health to the NHS is £6.1 billion.

Like other organisations, Diabetes UK acknowledges that products high in sugar are more likely to be promoted through price promotions. It argues that we must have a rebalancing of price promotions to favour healthier products, which would make healthier options cheaper and encourage people to buy such products. Polling conducted by Diabetes UK shows that 82% of adults favour front-of-pack traffic light labelling to help them make a more informed choice. As Britain negotiates new trade arrangements following our EU exit, there is an obvious opportunity to ensure that the UK can introduce legislation to mandate such labelling.

Supermarkets are showing that they have the capacity to reach out to different segments of our society and to play an important social role. In 2014 Sainsbury’s introduced a disability-friendly trolley, designed in conjunction with parents of disabled children. In 2018 Morrisons introduced a quiet hours scheme, with dim lighting and music switched off to help parents with autistic children. There is widespread agreement that the biggest driver of food poverty is lack of money, and that low-income families are therefore nudged by economic factors towards a diet characterised by highly processed, calorie-dependent foods with less fibre and less vitamin and mineral content. The consequent long-term health risks of such a diet can include heart disease, type 2 diabetes and cardiovascular illnesses.

Supermarkets are the sole largest food source for families in England and could support disadvantaged households in making healthy choices. There are good examples in other countries. Denmark, Norway and Sweden use a keyhole label to facilitate healthy choices. Since 2000 there has been a requirement in Finland for a “healthy heart choice” symbol to be displayed on over 11,000 products. In Israel, co-operatives sponsor community physical activity, as does Sainsbury’s in this country—it has helped raise over £186 million for sports equipment through its Active Kids scheme. In the United States, we have seen experiments with stocking healthier products at checkouts. In New York, 170 supermarkets participated in a study that found that displaying low-calorie drinks at eye level increased sales. In Australia, a study found that healthy signs on shopping baskets influence purchases. In New Zealand, supermarkets have co-operated on a health star rating and on programmes to encourage healthy eating.

Supermarkets have a major role to play in the drive to improve the nation’s health, but their potential is as yet untapped. In order to support families to make healthier choices, supermarkets must address the current retail environment by ensuring that healthy foods are available and conveniently located in stores. Snacks are popular across all income groups but tend to comprise a higher proportion of all food consumed by those on lower incomes. Major retailers could improve the availability of higher-quality snacks to low-income families by developing their own brand lines and diverting surplus waste food towards the production of affordable, healthy snacks. They could agree to place high-fat, salt and sugar products alongside like items, rather than supporting out-of-context promotions. Healthy products should be in prime locations, such as the end of aisles, at eye level on shelves and at checkouts.

I acknowledge the good that is done. Tesco’s free fruit for kids and “helpful little swaps” are welcome, as is Sainsbury’s investment in reducing the cost of fruit and vegetables and its measures to end multi-buy promotions. However, we need supermarkets to agree that all customers should have access to clear, accurate nutritional and value-for-money information on all products. Fruit, vegetables and other healthy foods should be positioned in prominent places. Price discounts and multi-buy promotions should be discouraged, or offered on healthy foods.

I do not want the Government to bludgeon supermarkets; I want supermarkets to be partners in this exercise. I want the Government to provide more information, in the context of health and education campaigns, about the psychology of shopping and the importance of lists and meal planning, but I also want the Government to consider legislative measures on price and multi-buy promotions. We can make a real difference here. I want supermarkets to use their influence to play their full part in helping us tackle the problem of childhood obesity.

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing this important debate, and on his work with the all-party parliamentary group on a fit and healthy childhood. I remember responding to him in one my first outings as a then Under-Secretary of State and finding myself, with a slight degree of nervousness for my ministerial career, agreeing with virtually everything he said. However, I am still here, and it has not done me any harm. I fear that I may be in agreement with a number of his points again today, but hopefully at no risk to my ministerial career.

Before turning to the detail of the hon. Gentleman’s points, I thank our supermarkets, particularly at this important time. They are very much in the frontline of our battle with covid-19, and I know that they, and particularly all their staff, in whatever capacity, are doing all they can to keep shelves stocked, deliveries going out and the nation fed. It is a complex job at any time, so I thank them. In parallel, I encourage customers and shoppers to be responsible, to purchase only what they need and to think of others. Working together, I am confident that the supermarkets will ensure that their supply chains remain robust and that shelves will continue to be full.

In its 15th report, “Healthy Families: The present and future role of the supermarket”, alongside the previous reports to which the hon. Gentleman referred, the APPG has provided a valuable contribution to the ongoing debate on improving children’s health and reducing childhood obesity—I have a copy here, and I very much enjoyed it as my bedtime reading last night. He is right; with more than one in five children entering primary school overweight or obese, rising to more than one in three by the time they leave, it is right that we take bold action to improve the nation’s diet. There can be no doubting the key role, as he has said, that supermarkets and other retailers play in helping consumers make healthier choices. I know that many supermarkets and businesses get this. They know that their customers want a healthier offer and that it makes business sense.

Although I am not familiar with the group that produced the report, I saw a recent report by ShareAction that highlighted the importance of investors’ decisions in the sector and factors such as those highlighted by the hon. Gentleman. With environmental, social and governance considerations playing an ever more important role in investment decisions by big investors more broadly, it is right that supermarkets recognise that this agenda is good not only for their customers, but for their business.

As the hon. Gentleman alluded to in various examples, many supermarkets have already taken the lead in the UK and feature the voluntary front-of-pack nutrition labelling on their pre-packaged foods, helping consumers make informed and healthier choices about the food they buy. The UK-wide voluntary front-of-pack traffic light labelling scheme introduced in the summer of 2013 is proving successful, but he makes a good point. It is important to ensure that UK labelling remains effective for UK consumers. We will always be willing to consider a range of measures to build on the success of the current traffic light system to ensure that it keeps up to date and continues to be successful. It is right that people are informed when choosing what they eat and what they buy.

As the hon. Gentleman mentioned, we have seen great work by supermarkets in a range of areas. I will add a few to the list. I hasten to add that if I miss any out, it is not because of any conscious decision; I have merely picked a few examples to illustrate the work that supermarkets do. For example, Aldi and Lidl—a point he touched on—were the first retailers to introduce healthier checkouts in 2015 when they removed all confectionery and sweets from checkouts and replaced them with healthier options, including dried fruit, nuts and water. I have seen that in Waitrose and other supermarket checkouts. It goes to the point made by the hon. Member for Strangford (Jim Shannon) about the importance of what is in the physical environment as we queue up at the checkout and the influence that can have at the last minute, with young children saying, “Mummy, Daddy, can I have that?” It is therefore important that supermarkets do their bit at least to gently steer people in the direction of healthier options.

Sainsbury’s has removed all multi-buy promotions on food and replaced them with lower regular prices on everyday items. Tesco has reformulated its entire soft drinks portfolio—the first supermarket to do so—to be below the level for the soft drinks industry levy, and has given away 100 million pieces of fruit to children in their free fruit for kids campaign. All supermarkets and many larger retailers have restricted the sale of energy drinks to children. In January, Aldi and Lidl announced that they will remove familiar figures from their own-label cereal boxes. All of that is important and positive and should be welcomed. However, as the report acknowledges, there are areas where supermarkets can go further, including doing more to promote and market a healthier food and drink offer more broadly.

As the hon. Gentleman pointed out, promotional marketing by price and store location can impact on the food purchases that we all make. Some can increase the amount of food and drink that people buy by around 20%, which can lead to overconsumption of less healthy products and can cost consumers more money in the long run. Obviously, parents want a healthier balance of offers and deals, but they are not helped by the fact that most deals and offers are currently for unhealthier products.

I am conscious that none of us wants to be hectored and lectured about what to eat. I feel strongly that people should have the right to choose freely for themselves and their families as they know best, but they need to do that on the basis of making an informed decision. People need information to make the choices about their and their children’s lives. It is not fair when all the promotions in store are mostly for unhealthy food, so the balance of the promotions needs to shift towards healthier options to make it easier to make healthier choices when shopping.

To respond to the point made by the hon. Member for Strangford (Jim Shannon), we hear the frustration of parents about what could be called pester power, particularly when queuing at checkouts. It can be hard to say no, so it is important that supermarkets do what they can to help parents in that situation. Again, rebalancing promotions in prominent locations such as tills and shop entrances towards healthier options can help reduce excess calorie consumption and contribute to reductions in childhood obesity in the long term. Many supermarkets are doing so, and I commend them for that, but there is more to do. I encourage supermarkets to continue down that path.

All of that is why in the second chapter of our childhood obesity plan we committed to consult on our intention to restrict promotions on products high in fat, sugar or salt by location and price in businesses that sell food and drink. The consultation closed last year and we will set out our response as soon as we can. I know that both hon. Members who spoke in the debate and the APPG will want to study the response carefully. They may well revert with their reflections on the adequacy of the Government response and whether it goes as far as they would wish. Indeed, I encourage that; it is part of what the House and debate are for.

We want a fairer deal for everyone wherever they live or shop, and whatever their background or financial situation. We want the healthy option to be an easier option for everyone so that we can help all our children grow up healthier. Indeed, as we look towards the future and the demands on our NHS and social care, we are always conscious of what changing demographic demands might do in the future and what children and young people may be letting themselves in for by virtue of their diet or lack of exercise, which in future may require longer-term care and have an impact not only on them but on the NHS and social care’s ability to meet those needs. It is right that, as well as ensuring that the social care and health system can meet those needs, we do everything we can to prevent long-term conditions coming about in the first place.

[Steve McCabe]

I have no desire to bludgeon supermarkets, and I understand the Government’s desire to work with them but, given the Minister’s point about long-term health conditions, I was struck that Public Health England’s report showed how some supermarket’s own food products—I will not name the supermarkets—showed increases in sugar content. An increase was found over the period of the report in sweet confectionary, chocolate spreads and morning goods. While the Government are trying to persuade supermarkets, should they also consider fiscal measures as an incentive to meet sugar reductions?

[Edward Argar]

The hon. Gentleman gently tries to tempt me into an area that is perhaps more properly the remit of my right hon. Friend the Chancellor of the Exchequer. I do take the point behind what he says: we need to use multiple means to encourage supermarkets—perhaps that is the best way to phrase it. Again, I encourage him and the all-party parliamentary group to wait for the consultation response and beyond that to engage fully. I am sure that he will. We may well find ourselves here in a few months’ time—or when the report is published—for another debate in the light of the Government’s response.

I think the hon. Gentleman will agree that we will need supermarkets to continue their good work, alongside the out-of-home sector, health professionals, schools, local authorities, families and individuals, who all play an important role. We must also be willing to encourage supermarkets, building on their good work to date, to be ambitious and go that step further. We all have a role to play in what we eat, keeping ourselves healthy and doing the right thing by our long-term health. It is important that supermarkets play their role, and it is important that all of us do as well.

Question put and agreed to.

Coronavirus

Steve McCabe Excerpts

Wednesday 11th March 2020 Commons Chamber

[Matt Hancock]

We are not proposing to delay the local government elections and the other elections—for instance, for police and crime commissioners—that are happening in early May. That is not part of the proposal, and local authorities should plan as normal for those elections. If people think they may need a postal vote—they may want to have a postal vote just in case—I would always advise them to get a postal vote. I am very happy for that message to go out loud and clear.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I also commend the Secretary of State’s measured approach. Are there any plans to offer specific guidance for dealing with rough sleepers and unaccompanied children—two quite vulnerable groups who, for different reasons, will pose a challenge to the authorities?

[Matt Hancock]

Yes. I entirely agree with the hon. Gentleman, and he is very wise to raise that point. That strand of work is being led by the Communities Secretary.

Medicines and Medical Devices Bill

Steve McCabe Excerpts

2nd reading & 2nd reading: House of Commons & Money resolution & Money resolution: House of Commons & Programme motion & Programme motion: House of Commons & Ways and Means resolution & Ways and Means resolution: House of Commons
Monday 2nd March 2020 Commons Chamber

[Matt Hancock]

We do not have a figure for medicines and medical devices specifically. As a nation, we have a goal that we should reach 2.4% of GDP spent on research. We are increasing the medical research budget; for instance, we are doubling the budget for research into dementia. As my right hon. Friend rightly points out, the public budget for research is only one part of it. There is huge private sector and charitable sector investment —for instance, from the Wellcome Trust. The Bill will allow research money—whether it comes from the public sector, private sector or third sector—to go further and get medicines and medical devices to NHS patients faster, as well as supporting our life sciences sector.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I recognise the Secretary of State’s support for innovative medical technology. I am interested in the registers to which he referred, covered in section 13 of the Bill, and in particular the need to ensure that we get the maximum benefit without their being too onerous. Will he give an assurance that there will be some kind of consolidation where there are multiple registers in the same field and that we will only collect information that is specific to the subject stated for the registers?

Learning Disabilities Mortality Review

Steve McCabe Excerpts

Wednesday 15th May 2019 Commons Chamber

[Caroline Dinenage]

My hon. Friend is absolutely right that nobody with a learning disability, autism or any other condition should expect to receive worse care. Everybody should expect the same level of quality care, no matter who they are or where in the country they live. That is what we are working towards, and learning from deaths is a key element of helping to deliver that aim.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I am pleased to hear the Minister condemn “do not resuscitate” instructions based on a person having a learning disability, but surely this situation is not a matter of mild neglect requiring a reminder letter; this is a grave abuse of power perpetrated on some of the most vulnerable people in our society. Does it not require disciplinary action?

[Caroline Dinenage]

The hon. Gentleman has partly tapped into my frustration with the fact that I am here today commenting on leaks of a report that has not yet been published, rather than on the full report, which, when it comes out, will provide clear recommendations as to how we can move forward on this matter. As I have said, we are already writing to reinforce the message that should be self-evident—that learning disabilities should never be a reason for a “do not resuscitate”. When the report is finally published, it will include a very well-considered recommendation as to how we tackle this issue in a way that will ensure that this situation will never happen in future.

Eurotunnel: Payment

Steve McCabe Excerpts

Monday 4th March 2019 Commons Chamber

[Matt Hancock]

I can go even further than that: it will not be paid over unless it is being spent on security, resilience and other measures, so we will get some of the improvements that my hon. Friend seeks.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

With all due respect to the Secretary of State for Health and Social Care, surely the House and the taxpayer are entitled to hear today what the main mistake made by the Secretary of State for Transport was that has resulted in this unnecessary pay-out of £33 million. Where does this latest shambles rate in the Secretary of State for Transport’s top 10 catalogue of ministerial mishaps?

[Matt Hancock]

Frankly, I do not think we should really pay much heed to such a statement, rather than a question, unless the hon. Gentleman is going to vote for the deal as well.

Mental Capacity (Amendment) Bill [Lords]

Steve McCabe Excerpts

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

[Chris Bryant]

Yes, I do have that anxiety. I want to be a bit critical of the Government on that, because this is a two-year Session of Parliament and there is no reason why this could not have been done in a proper way. I am slightly conscious that there is not a great deal of time left today, however, so I am keen to bring my remarks to a close.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Before my hon. Friend concludes, since the code is going to be so central to the operation of the Bill, and since none of us will have seen it before the Bill concludes its proceedings, does he think that it is vital for the Minister to say today that there will be proper and extensive consultation on the code before it is implemented?

[Chris Bryant]

Yes. The Government have effectively already said that, but to be really nasty, we should have had the code before today, in all honesty, even if it was only in draft form, so that we would be able to see what we are really talking about, and I would then not have been talking about these amendments.

I want to bring my remarks to a close as soon as I can. We need to build in an incentive to make sure that there is proper neurorehabilitation provision for people with acquired brain injuries. All too often, patients and carers in this field feel as though they are being processed. That is not because health clinicians are nastily minded, but because people sometimes end up having to deal with so many different departments that they feel as though they are being pushed from pillar to post. That is why it is really important that the Government strike the right note when it comes to the next stage of introducing the code.

Amendment 1 simply says that

“the Secretary of State must lay before Parliament a report on”

the “likely effects” of the Bill on ABI before it comes into effect. Amendment 2 requires the “relevant person”, who could be somebody managing a care home, to consider

“the effects of any treatment undergone by the cared-for person, including prescription brain injury rehabilitation therapy”

in addition to the length of time since the assessment was originally made. Amendment 3 would mean that an authorisation that was not renewed would lapse after 12 months, after a time specified in the original authorisation, or, as I would like it to be,

“at the end of a period of prescription brain injury rehabilitation therapy”.

I think that is key to making sure that there is an incentive to ensure that therapy is provided. Amendment 4 refers to the renewal of an authorisation and requires the responsible body to take into account

“any treatment to be undergone by the cared-for person, including prescription brain injury rehabilitation therapy”.

I do not think that any of those amendments would do the Bill any harm—no harm at all—and I am feeling a bit more grumpy with the Minister than I was yesterday when I met her, so who knows? We might end up voting on them.

--- Later in debate ---

[Barbara Keeley]

I very much agree with that. We have heard about a code of practice and regulations, but we cannot see any of these things. With this Bill, we should have had the promised detail on the code of practice. We should not be passing the Bill without it.

First, I wish to talk about amendment 50, which addresses the role proposed in the Bill for care home managers. A number of Members have raised that issue, and we fundamentally disagree with that role, in the same way that we disagreed with the role in the liberty protection safeguards system being given to independent hospitals, which the Government are now amending. There is no logic in the Government removing one conflict of interest from the Bill and not the other.

When this Bill was introduced in the House of Lords, it placed almost all power and responsibility for the LPS in the hands of care home managers. It would have allowed them to be judge and jury, deciding when to deprive people of their liberty. I accept that the Bill has been marginally improved from the original position. The Government were forced to make concessions in the House of Lords, but what they have done so far is the bare minimum. The Bill still hands far too much power to care home managers. Stakeholders across the sector, including care home managers themselves, are very concerned about this. Care England, the representative body for care homes, has said:

“As providers we are very concerned about the inherent conflict of interest associated with placing Liberty Protection Safeguards assessment responsibilities on care home managers “

I also want to quote something that was written in evidence to the Public Bill Committee. A submission made by the Albert House nursing home stated:

“Managers in Care Homes are already stretched and heaping further responsibility on them could lead to more people giving up and looking for easier work.”

It seems clear that even care home managers do not want this responsibility to be given to them. I cannot understand why the Government are insisting on doing so, unless of course the reason is just cost saving.

Under the Government’s proposals in the Bill, local councils will be able to delegate the assessment and consultation process to the care home manager whenever they see fit. That risks creating a postcode lottery, where some local councils with adequate resources carry out LPS assessments themselves, while others will have to reduce their role to simply rubber-stamping the applications they get from care home managers. That cannot be right.

We have to be clear in this Chamber that one issue facing the current system is that some local councils are not able to properly resource their DoLS teams following years of cuts to their funding. This Bill would allow cash-strapped local councils to outsource the process entirely, with serious consequences for cared-for people. If care home managers organise the authorisation process, they decide who carries out medical assessments, and who determines whether the arrangements are necessary and proportionate. I have heard colleagues expressing concern that the statement provided by the care home manager forms the basis of authorisation. We know that many local councils do not currently have the resources to fund their DoLS teams properly now. Conservative Members have talked about the backlog and concerns about that, but in recent weeks we have seen a further £1.3 billion taken out of grant funding to local councils. The Minister has given us no reassurance that the Government will provide any new funding for the proposed system.

[Steve McCabe]

While my hon. Friend is on the subject of care home managers, may I ask whether she agrees that if they are responsible for the consultation, which is supposed to be one of the safeguards protecting a person’s liberty, the person cannot possibly be at the heart or centre of the Bill? Such a provision drives a coach and horse through the notion that their liberty is being protected.

[Barbara Keeley]

I absolutely agree with that. Local councils face a serious resource issue, and we see a pressing of this role away to care home managers. I have got some examples with me, but I do not know whether I will have time to go through them. However, we can see that there will be a strong temptation in local councils simply to presume that the care home manager is right. We have to recognise that over-stretched professionals in local councils will sometimes simply accept the word of care staff without fully investigating the case.

In the Public Bill Committee, I talked about the recent case of Y v. Barking and Dagenham. This was the case of a young man who was placed in an inappropriate care home. Initially his parents were satisfied with his placement, but over time the quality of his care deteriorated. We hear a lot and have great concerns about restraint. That young man was restrained in that care home 199 times in two years and suffered significant harm. Y eventually got out of that placement, following a court-appointed guardian visiting and raising concerns, but it took the intervention of somebody outside the care home—that is the key thing.

--- Later in debate ---

[Fiona Bruce (Congleton) (Con)]

I rise to support the Bill and, in particular, to speak in favour of Government amendments 24 and 33.

Before I do so, let me respond to some of the points that have already been made. First, with regard to the timescale in which the Bill is being taken forward, there has been plenty of opportunity for colleagues to look at its details. I draw Members’ attention to the fact that there have been not just one but two detailed reports on this issue by the Joint Committee on Human Rights, one in June 2018—our seventh report of this Session—and then, in October 2018, our 12th report, in which we considered the draft Bill in some considerable detail. At that point, we welcomed the recommendations of the Law Commission. Of course, the Law Commission had itself been some three years in preparing its recommendations, so the Bill can hardly be described as rushed.

[Steve McCabe]

Does the hon. Lady recognise that the Law Commission objects to the fact that its recommendations were not taken up by the Government when they constructed the Bill?

[Fiona Bruce]

I was about to say that the Joint Committee welcomed the Law Commission’s recommendations because they clearly highlighted the need for changes to be made.

As we pointed out in our seventh report, as far back as last June, the Cheshire West case that the Minister mentioned had resulted in a 10-fold increase in the number of DoLS applications. That is why there has been such a backlog. That case placed extreme pressure on local authority resources. Some 70% of the almost 220,000 applications for DoLS authorisations in the year up to our report were not authorised within the statutory timeframe. Consequently, many incapacitated people continued to be deprived of their liberty unlawfully. Those responsible for their care, or for obtaining authorisations, were having to work out how best to break the law. That is completely unacceptable, and it is why this Bill needs to brought forward in a timely way.

There also needs to be, as the Committee recommended in our 12th report, a definition in the Bill. I hear colleagues’ reservations about that definition, but, as we said—I am glad that the Government took up our recommendation—that it is important to give cared-for people and their families, and professionals, greater certainty about the parameters of any scheme so that we can ensure that scrutiny and necessary resources are directed where needed. We said:

“It is undeniable that any definition in statute may be refined by future case law”.

That remains that case. None the less, not to have endeavoured to provide a definition would, we believe, have been wrong.

Having made those preliminary comments, I will speak in more detail about amendment 24 and expand on the remarks made about the importance of family engagement and keeping the family informed. Information for the family and those who care deeply about the welfare of the person is the cared-for person’s greatest safeguard against exploitation and bad care. It is paramount that families have a role to play in their relatives’ care planning, wherever that is desired by the cared-for person, not least by giving them the option to stay fully informed and to object to proposed plans if they are not satisfied.

Families can play an important role in monitoring care if they are given sufficient information. The care itself is important. The quality of care will vary between and within care homes, but monitoring the care plan is essential to ensure that the cared-for person’s dignity is maintained. The cared-for person’s quality of life depends on how they are treated day in, day out and whether they receive care in a way that enhances their personal dignity or whether, sadly, they are treated less well.

Families are well equipped to monitor care, but only if they are kept informed. That is why I support amendment 24, which improves access to information for the cared-for person and their appropriate carers and supporters, which may well include their family. The requirement for information to be

“accessible to, and appropriate to the needs of, cared-for persons and appropriate persons”,

means that the cared-for person is placed at the heart of the liberty protection safeguards authorisation process. Not only that, but now that relatives can be informed about their loved one’s care plan, they will notice if the plan states something that is not happening and question why.

I am pleased to see that the amendment requires the publication of information on the cared-for person’s rights and the circumstances in which it might be appropriate to request a review or make an application to the court. People must know what their rights are and the legal procedures. This will not be costly. It will certainly be far less costly than the court cases that are likely to come if the requirement to provide information about all aspects of the process and the plan are not on the face of the Bill. It will save costs in the long term and ensure that the approved mental capacity professionals act always as they should.

The code of practice will play an important role. It would be helpful to see examples of family members working with the responsible bodies and the care teams to ensure that care plans are being delivered appropriately and are in the best interests of cared-for individuals. I am sure we all want to see that.

I turn to amendment 33. In the JCHR’s 12th report, we indicated that there has been concern as to

“whether care home managers have the necessary skills and knowledge to arrange or undertake the assessments and whether they are sufficiently independent to do so”

and whether care home managers are

“trained and resourced to take on these additional responsibilities.”

It is heartening to hear that the Government have listened and are clearly stating that care home managers and staff should not, and under these proposals will not, complete assessments. It is equally heartening that the Government, having listened to concerns expressed in Committee, are saying that all those doing such assessments must have the necessary skills, knowledge and qualifications—for example, as physicians, nurses or social workers—and that that will be specified in regulations. I want Ministers to put in place appropriate arrangements to assess whether implementation of this element of the Bill is working well—for example, to ensure that specifications of required qualifications and the experience of assessors are kept updated and that the revised system is working well and without difficulty in practice.

Ministers might consider taking up the recommendation in the JCHR’s 12th report that particular vigilance should be exercised by local authorities where care homes are rated by the CQC through an inspection as inadequate or requiring improvement, to ensure that those who are making referrals are properly competent to do so.

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

Steve McCabe Excerpts

Tuesday 22nd January 2019 Public Bill Committees

[Dr Paul Williams (Stockton South) (Lab)]

It is a pleasure to serve under your chairmanship again, Mr Austin.

Like other hon. Members, I would like to share some cases to do with the issue of appropriate advocacy. Briefly, I will describe a simple intervention by an advocate who challenged assumptions made by care home staff and improved the quality of life of a person living with dementia. A relevant person’s paid representative was appointed for a woman who, it was reported, had been financially abused by her child following her diagnosis of dementia. She had been placed in a care home by the local authority because of safeguarding concerns.

Visits from the RPPR identified that the woman appeared to be happier now that she was not subject to the conduct and behaviour of her child. However, she had none of her own clothes, photographs or personal artefacts with her. When she was asked about that, she said that that made her feel sad. The RPPR made representations and said that if she had those possessions, she might be happier. Contact was made with her child. The intervention resulted in her child bringing items of clothing and photographs to the care home and also having some supervised contact with her mother. The woman told the representative that she was happy for that to continue.

The care home staff had initially provided information that the woman was content and did not need anything further, but the difference in her demeanour when she was wearing her own clothing and surrounded by personal artefacts was remarkable. She even wrote a note to her advocate, thanking her for supporting her and helping to get her child back in her life. Later on, her child wished to take her out of the care home, but the RPPR listened to the woman, who said she wanted to stay where she was, and supported her to make the decision to remain where she felt safe and comfortable.

That case illustrates why appropriate advocacy must be available to all who need it. The new legislation must ensure the right of the person to object to and challenge arrangements if they wish and to have the support and representation to do so. Support from an IMCA should not depend on a person’s best interests, as defined by other people. It should be a right that everyone is able to access an advocate, and people can then choose to opt out. That would improve the Bill by offering clarity to the cared-for person and the responsible body. I am happy to support the amendment.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I, too, want to support amendment 46. I would like to draw on a case study that has been provided by the organisation POhWER, which concerns an arranged marriage. I wish to draw the Committee’s attention to it because this occurs in the Birmingham area with remarkable frequency.

The case concerns a young woman who, for the purposes of the debate, I will call Layla. The authorities were contacted by her sister and advised that she was about to be taken to the airport and flown overseas for an arranged marriage. Her sister was extremely concerned that Layla did not understand what was happening and did not have the capacity to consent to sexual relations—many similar cases have been reported in the press. Having been alerted, the authorities decided on this occasion to step in, and Layla was given an emergency placement with a deprivation of liberty order while the matter was properly investigated. Following that, POhWER arranged for an advocate to be made available.

As the shadow Minister said, this is about the level of contact, because details are sometimes revealed during subsequent visits or after some time. During the advocate’s initial visit things seemed fairly straightforward, and the young woman did not express anxiety about being detained at the care home. She did not say she was unhappy, and there was no reason to suppose there was any great problem. During subsequent visits, however, it became clear that she was very bored and isolated, largely because most of the other residents were elderly, and although she was safe, she was in quite an inappropriate place.

The other day I spoke to a friend in Birmingham who works at a care home, and she told me a remarkably similar story. Because of the pressure on places and funding, it is not always possible for people—particularly if placed as a result of an emergency situation—to be given an ideal placement. It is therefore common for people to find themselves in a place that is safe, but that most of us might regard as not that appropriate in terms of its potential to allow them to improve or develop.

On this occasion, the advocate made representations to social services about the young woman’s ability to access a college place. Again, that request was initially ignored—throughout the Bill, we have spoken about the pressure on various authorities and the danger that if someone subject to a detention order is regarded as being in a safe place, attention will switch to the next emergency or crisis. By pursuing advocacy, we will ensure that we do not stop at that point and that we continue thinking about what is best for the person involved and what will improve their chances.

The advocate continued to make representations, and eventually the conditions of the DoL order were changed to require the young woman to be able to access a college place. As a consequence, she made phenomenally rapid progress and learned to read and write. She became better able to comment on what had happened with her family and to understand the nature of the arrangements under the DoL order. The end point of this was that, at a subsequent assessment and review, she was judged to have sufficient capacity to live independently by herself with minimal support, and she went on to gain paid employment.

--- Later in debate ---

[Alex Cunningham]

I understand the hon. Gentleman’s point. Unfortunately, we have to cover everybody with an amendment such as this, otherwise we end up with exclusions left, right and centre. We cannot afford to have exclusions. If an advocate is in place, there is no additional problem associated with that. At least the person has some chance of representation.

[Steve McCabe]

I think the Minister covered the point made by the hon. Member for Halesowen and Rowley Regis when she cited the small number of situations she thought could be distressing or problematic—I presume that is what the hon. Gentleman was thinking about. That is exactly the sort of thing that the code of practice is supposed to cover. Is that not exactly what we would expect? On the one hand, the Bill clearly legislates in broad terms for what is and is not acceptable, and on the other hand, the code of practice gives the back-up information for professionals, so that they can recognise the sort of situation to which the hon. Gentleman refers.

[Alex Cunningham]

That is most certainly the case. I go back to my Second Reading speech. This is about the individual. This is about one of the most serious things we can do as a nation to somebody—take away their liberty. We should do anything and everything we can do to ensure that they have every single piece of support before that decision is taken, effectively, to lock them up. I agree with my hon. Friend.

I was quoting Age UK, which believes that everybody should have access to an advocate and that a person who chooses not be represented can then opt out. The quote continues:

“This will greatly improve the Bill and give clarity to the cared for person and the responsible body.”

Mencap believes, as I do, that independent advocacy is vital to help vulnerable people to understand and exercise their rights under the law. We have had several examples of that this morning.

Rethink Mental Illness is also on board with the amendment. I appeal to the Minister to provide an opt-out approach, which would greatly improve this Bill, as others have said, and give clarity to service users and providers.

I mentioned care home managers, but the risk of independent hospitals being responsible for assessments is another concern about the Bill, and as we said the other day, we hope the Minister will ramp up the assurances in this area. I have another real-life example for her. A man was held in hospital for almost a year—with no advocate for 10 months. He was angry because he wanted to go back to his two-bedroom home, but the local authority wanted him to move into accommodation with 24-hour support and to not return home. The reason given was that the brother had moved into the spare room at the cared-for person’s home and there had to be a spare room for any overnight carer, should the man return home.

What did the advocate find out by talking to the cared-for person? They found that, when he had been living at home, he had been sleeping in a chair in the lounge while his brother had his room and his carer had the spare bed. Then he had fallen and not been found for two days, as a succession of carers had failed to attend. The cared-for person’s statements were not taken into account by the social worker involved. If they had been, the process might have been very different. The man needed an advocate from day one.

The case eventually went to court, and the judge accepted evidence from the advocate and ordered the cared-for person to be returned home—[Interruption.] Bless you!

--- Later in debate ---

[Barbara Keeley]

The Minister knows that that is not an accurate interpretation of what I am saying. We spent a fair amount of time talking about independent hospitals, which are still a massive worry and concern. There is still great concern about the potential role of care home managers, because of the conflict of interest in the case of both independent hospitals and care home managers. There are too many actors in this process who could get in the way and be the people deciding whether a best interest test is met.

Were the best interest assessors the people who are used to this and have been doing this job in local authorities, I would be more comfortable. The Government are trying to give power over the process to care home managers and independent hospitals as responsible bodies, and we disagree with that profoundly, because of the cases that I have brought to the Minister’s attention. I think she and the Government are wrong to put faith in bodies where there is a conflict of interest. That is why I feel so strongly about this.

[Steve McCabe]

I was going to put a similar point to my hon. Friend. The danger in the Minister’s assertion is that she puts all her faith in the official position, in the position of the responsible authorities. As we have already discussed in the Committee, because of the pressures on those people, they may have other interests and other demands on their attention. If we want to represent properly the best interest of the person and make sure that they are at the centre of the process, we need a balancing mechanism, to ensure that all the issues that the authorities will take into account will be balanced against the best wishes of the person. That is why there is an argument for independent advocacy being set aside from the interest of the responsible organisations.

[Barbara Keeley]

That is very much the case. To summarise the debate, on the Labour Benches we have given some very powerful examples of the value of advocacy. I have been very impressed by the selection of cases and I thank my hon. Friends for their speeches.

Advocacy is one of the most important safeguards in a mental capacity Bill. It is—perhaps we do not like to use the word these days—a final backstop against improper deprivation of liberty. Our amendment makes it clear that the provision of advocacy must be the default position and I do not resile from that being the right thing to do. There are a few limited exceptions, but the provision of an advocate should go ahead, so that cared-for people are able fully to enact their rights. Without that support they will not be able fully to enact their rights.

We have heard powerful examples about getting people out of inappropriate settings and preventing someone’s home being sold when they did not want it to be sold, so that they could return to it. We should not underestimate—Labour Members do not underestimate—how vital advocates are. I know it is a wide-ranging amendment, but it seeks to improve the Bill in a number of ways, primarily guaranteeing an advocate for anybody who wants one.

Question put, That the amendment be made.

--- Later in debate ---

[Alex Cunningham]

I find it incomprehensible that any emergency authorisation would need to last longer than 14 days. An emergency is just that: it is a serious, unexpected and often dangerous situation requiring immediate attention. That is my online dictionary definition. Once that emergency has been dealt with and the dangerous situation averted, the normal approach should then be adopted. Why on earth would the authorities need to detain a person for many weeks on end without carrying out that full assessment under the law? I suspect the Minister agrees that emergency authorisations would not need to be in place for very long, so everything would be fine and there would be no risk to the person involved. Sadly, nothing in this Bill nails that down. I hope she will have no problem providing us with a guarantee, or supporting this amendment—the real guarantee—to limit that duration of emergency authorisation to 14 days.

We must always take every opportunity to make sure that every precaution is there to ensure that those under emergency authorisations have safeguards and protections. We have been talking about it for days on end. Those authorisations are to be in place so that a person cannot face an indefinite order against them. Not just those of us on the Opposition Benches think that. No fewer than 200 people from my constituency have either commented on this Bill or have signed a petition through 38 Degrees calling for the kind of safeguards in the Bill for which we have been arguing. They are worried about the further erosion of an individual’s rights by the clause if it is not amended.

At every point in this Bill I have posed myself this same question: what does it mean to younger people—the 16 and 17-year-olds—who are captured by it? As I read it, a young person could be detained under these emergency powers. We have talked about insufficient safeguards for young people and parents under the Bill. Who knows how long it could be before they are fully assessed, even when the views of their parents or others were taken into consideration?

According to the Law Society, the Bill

“gives wide-ranging powers for depriving a person’s liberty through emergency authorisations for unlimited periods of time where a ‘vital act’ is deemed necessary. We believe this is unlawful.”

What action will the Minister take to ensure that such actions are not unlawful, as suggested by the Law Society? Although she said that the risks being taken in the care of vulnerable people are simply not there, she needs to convince us or support the amendment. The Law Society goes on to support the amendment in its evidence submission, saying that a

“time limit of 14 days is essential to prevent abuse in accordance with case law”.

Members have spoken at length and given full examples of how the Bill and proposed amendments could play out or have played out in the real world. It is also vital that we take note and address the issues that may arise outside this place in regards to any legislation introduced by us. Imagine the danger we could be unwillingly putting vulnerable people in if we do not pass the 14-day authorisation limit. A person under such an authorisation could be left for months and denied their freedom with no one having carried out a full assessment, perhaps because it is in the best interests of the person that has assessed them or not assessed them—a care home manager or an independent hospital director. Whatever it is, we have a duty of care over those deprived of their liberty under the measures. The Bill falls short of ensuring that we properly protect and safeguard them.

We have debated authorisation renewals. This measure falls into a similar category in that we should provide adequate checks to ensure that people are not needlessly deprived of their liberty for any unnecessary time. I am not convinced we are there yet. Within those 14 days there is an expectation that an adequate, comprehensive assessment will be carried out to determine whether the cared-for person meets the authorisation conditions. If it is more than 14 days, who is going to tell us when it will happen?

[Steve McCabe]

I do not know whether I am being a bit paranoid about this, but is there a danger that this could become the easy get-out clause? It will be a bit complicated to get all the parties together and carry out a proper assessment, but it will not be as difficult to get someone to say, “Ah—there’s an emergency.” That way, they have dealt with the paperwork in one fell swoop and they have the person where they want them. If there are no safeguards, it will become the clause that will bypass the rest of the legislation, because this is where people will go when they do not want to put in the work or they feel too hard pressed to do it.

[Alex Cunningham]

I share my hon. Friend’s paranoia. I do not understand why we would put any barriers at all in the way of people’s having a proper assessment within a reasonable time. Detaining someone for 14 days is effectively locking them up for 14 days. It means depriving them of their liberty and there may be no real necessity. An assessment, as quickly as possible, is essential.

Of course, if we allow those authorisations to go on for longer than 14 days or any other reasonable timeframe, we are putting people at risk of abuse, as the Law Society has said. I say to the Minister that we must put vulnerable people first. We must always put the individual first. We must have the safeguards in place, because to do anything else is to risk their liberty, and that is a risk I am not prepared to take. I hope she accepts the amendment.

[Caroline Dinenage]

Clause 2 allows caregivers, in limited situations, to deprive someone of their liberty for a short period of time prior to an authorisation being in place or in an emergency. That can be done only to provide the person with life-sustaining treatment or to prevent a serious deterioration in their condition. The clause enables a care home to place restrictions on the person for their own protection ahead of an authorisation being approved. That interim legal cover will be decision-specific and it will be targeted to life-sustaining treatment and care or to a vital act. Once those acts are completed, the conditions no longer apply and legal cover for depriving someone of their liberty ends.

In that way, the clause replicates clause 4B of the Mental Health Act 2005, already in DoLS. The emergency authorisation system applies in exactly the same way when a court application being made relates to a deprivation of liberty. There is no evidence at this time that it would lead to any lengthy deprivation of liberty, and the provision of the Bill builds on an existing and well-understood provision. The previous system also included an urgent authorisation. That has gone because it was used too often and its time limit was ineffectual.

Under the Bill, the legal cover is provided simply for as long as the life-sustaining care is needed and no longer. It is therefore a limited power and a better safeguard. An emergency is defined as a situation where there is an urgent need to act and it is not “reasonably practicable” to make an application under the liberty protection safeguards to the Court of Protection or under part 2 of the Mental Health Act. It was carefully considered by the Law Commission, which looked at the inclusion of a time limit and decided against it. We agree with its conclusion that a time limit could encourage care providers to aim for the time allowed rather than to adhere to best practice for that case and that person, which is certainly what we have seen in some urgent cases.

Given the seriousness of depriving someone of their liberty, it should be limited to the shortest possible timescale and should reflect the huge range of causes that it can be required to cover. The amendment would create a blunt, one-size-fits-all approach, rather than allowing us to reflect the different approaches called for.

[Steve McCabe]

The Minister cites the Law Commission, but is it not the case that the Law Society recommended this very type of safeguard?

[Caroline Dinenage]

I do not know about the Law Society. The Law Commission was tasked with reviewing the measure—it took three years to do so. The commission took evidence from across the sector and we have used its recommendations as the basis for this provision.