Mental Health Units (Use of Force) Bill

Steve Reed Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Mr Steve Reed (Croydon North) (Lab/Co-op)]

I beg to move, That the Bill be now read a Second time.

Seni Lewis was a young graduate embarking on his life, aged 23, and living with his parents in Thornton Heath, when he suffered his first ever mental health episode. His parents recognised what was happening and took him to their local hospital. Seni ended up in the Bethlem Royal mental health hospital in Croydon. His parents stayed with him all day, but had to leave at 8 o’clock in the evening. Seni became very agitated when he realised they had gone, and he tried to leave, too. According to the coroner, the staff lacked the training to deal with him, and although there are no allegations that he attacked anyone, they called the police. Eleven police officers took Seni into a seclusion room and, using pain compliance techniques—the kind used against violent criminals—they took it in turns to hold him face down on the floor for 30 minutes in total. His hands were cuffed behind his back, and his legs were in restraints. They held him like that until he could no longer breathe, and he suffered a heart attack. He went into a coma, and four days later Seni was dead.

The coroner criticised Seni’s treatment as “disproportionate and unreasonable”. No patient entering a hospital for care should suffer and die in the way that Seni did. But the family’s agony did not end there. It took seven years of struggle by Seni’s grieving parents until an inquest was finally opened only this year. The coroner found severe failings by the police and the mental health services, and she gave the stark warning that

“there is a risk that future deaths will occur unless action is taken.”

That action is this Bill. What happened to Seni Lewis is not an isolated incident. According to the Independent Advisory Panel on Deaths in Custody, 46 mental health patients died following restraint between 2000 and 2014.

[Nick Thomas-Symonds (Torfaen) (Lab)]

I am grateful to my hon. Friend for bringing forward this very important Bill. Many families in my constituency have contacted me, including some affected by autism, and they are very concerned about the kind of face-down restraint that he has described so movingly in talking about this case. Does he agree that it is very important to have boundaries on the use of this restraint, and that families have some certainty about what can and cannot happen in such facilities?

[Mr Reed]

I completely agree, and I am delighted that the National Autism Society fully supports the Bill and its provisions.

I was talking about the number of patients who have died following the use of restraint, and the many more who have been seriously injured. Government guidelines say that face-down restraint is so dangerous it should not be used at all, but it was used over 9,000 times in the last year alone, including 2,500 times against children as young as seven. People who have been restrained talk about the experience with horror. They say that it is frightening, painful and humiliating, and they feel stripped of their dignity. In the words of one woman:

“It made me feel like a criminal, like I had done something wrong, not that I was ill and needed to get better.”

Statistics from the campaign group Agenda show that women are more likely to be restrained face down on the floor than men. Up to half of all women in mental health hospitals have been physically or sexually abused by men. Subjecting these women to face-down restraint by groups of men adds to the trauma that in many cases led to their mental illness in the first place.

It is difficult to understand clearly from the existing data what exactly is going on. There is no standardised way of recording why, when or how restraint is used. However, from their own data, there appear to be wide discrepancies between mental health providers. Some restrain as few as 5% of patients, while others restrain over 50%. There is no good reason for that variation.

[Wera Hobhouse (Bath) (LD)]

Does the hon. Gentleman agree that it is now time for each provider to publish, correctly and robustly, the data available, and should not the Minister make a commitment to the publication of the data?

[Mr Reed]

I agree, and I very much hope that the Minister will make such a commitment today.

There are fears about unconscious bias in the mental health services. The Angiolini review, a very important review published earlier this week, notes how a disproportionate number of people from black, Asian and minority ethnic communities have died after the use of force in custody more generally. Black people are four times more likely to be sectioned than white people. If we look at the faces of the people who have died after severe restraint in a mental health hospital, we see many more young black faces than in the population as a whole. We need to understand the extent to which assumptions based on stereotypes are causing that, but to do so we need standardised data recording.

What the Bill proposes is simple, but it will make a big difference. It will standardise the way in which the data on every instance of the use of force are recorded, so that we can better understand where force is being used unnecessarily, and the extent of any bias and disproportionality in the system. It will improve arrangements between the police and mental health services, and require the police to wear body cameras when carrying out restraint, unless there are good operational reasons not to do so.

[David Hanson (Delyn) (Lab)]

I support my hon. Friend’s Bill, particularly clause 13 on police body cameras. Is he aware that that provision applies to England only? Police body cameras are a slight anomaly in that they cannot be used by units in Wales because that matter is devolved to the Welsh Assembly. Once the Bill has been given a Second Reading, will he look at that and discuss it with the Welsh Assembly?

[Mr Reed]

My right hon. Friend is absolutely right. The idea of engaging with the Welsh Assembly as the Bill proceeds through this Parliament is an excellent one, and I hope to have his support in doing so.

[Dr David Drew (Stroud) (Lab/Co-op)]

I congratulate my hon. Friend on the Bill. I declare a non-pecuniary interest in that my son is a community psychiatric nurse, although not a practising one. Does my hon. Friend agree that we need to look at the wider process of how people are taken into care? The sectioning process under the Mental Health Act 1983 does not allow any accountability to the victim. Does he agree that while the Bill is important, it needs to be seen in the wider context of how we deal with someone—at their most vulnerable—when they have been sectioned?

[Mr Reed]

I very much agree with my hon. Friend. The Government are commissioning a much wider review of mental health services. I hope it will encompass the points he raises, but that would be for the Minister to clarify.

The Bill will make sure that every mental health provider has a policy in place governing the use of force, including a clear deliverable plan for reducing its use, and ensuring that staff are properly trained in equalities and the de-escalation techniques needed to avoid the use of force. It will speed up justice and allow learning to take place by making sure that any non-natural death in a mental health unit automatically triggers an independent investigation, and making sure that recommendations from investigations and inquests are taken into account when improving mental health services in ways that currently do not happen.

The Bill is a significant step forward for our mental health services, moving them from the containment of patients to the care of patients. It will make sure that people with mental ill health are treated with compassion, not cruelty. There is overwhelming support for the Bill across the mental health sector. I am grateful for the practical support I have received from INQUEST, in particular its director Deborah Coles, and from Raju Bhatt, the widely respected solicitor who has represented so many bereaved families following deaths in custody. I am grateful to YoungMinds UK, Mind, Rethink Mental Illness, Agenda, the Labour Campaign for Mental Health, my hardworking staff and the Croydon North Ethnic Communities Forum. Also, 38 Degrees hosted an online petition that has been signed by over 60,000 people to demand this change.

[Mr Jim Cunningham (Coventry South) (Lab)]

More broadly, having watched documentaries on this issue, does my hon. Friend agree that there is an argument for providing the police with better training, so that they understand the difficulties facing people with mental health issues?

[Mr Reed]

I absolutely agree with my hon. Friend. Unfortunately, that is outside the scope of the Bill, but I very much hope it will be in the scope of the wider review the Government are commissioning.

[Philip Davies (Shipley) (Con)]

I am grateful to the hon. Gentleman for the time he gave me to discuss the Bill a few weeks ago. He talks about mental health professionals supporting the Bill. I have spoken to my local care trust in Bradford, which, while it supports much of what is in the Bill, has concerns about some aspects. I therefore wonder how receptive the hon. Gentleman would be to amendments, either in Committee or on Report, that try to address those concerns, or is he determined that the Bill must end up in its current form?

--- Later in debate ---

[Mr Reed]

I thank the hon. Gentleman for his very helpful intervention. The only way to go forward with the Bill is through consensus. I have made it absolutely clear to both Ministers sitting on the Government Front Bench that I want to work with them constructively in Committee, as they have worked with me so far, so that we can secure an outcome that is supported by both sides of the House and right across the profession.

This week, the chief executives of 29 mental health organisations published a letter urging Parliament to back the Bill. It is supported by the Royal College of Nursing, the Royal College of Psychiatrists, the Care Quality Commission, NHS England and trade unions representing staff who do such an incredible job working in the mental health services. I must add my thanks to the Minister, the Under-Secretary of State for Health, the hon. Member for Thurrock (Jackie Doyle-Price), for working with me so constructively; as well as my right hon. Friend the Member for Islington North (Jeremy Corbyn), who supported the campaign long before he became the Leader of the Opposition.

[Ruth George (High Peak) (Lab)]

I congratulate my hon. Friend on bringing forward the Bill. Seni Lewis was a young man who grew up in my constituency of High Peak. His cousin was telling me yesterday what a lovely young man he was, that he was never in trouble with the law, and what a loss to society he is. Does my hon. Friend agree that his family should not have had to fight for six years to get an inquest? Will he pay tribute to them for all they have done to make sure that this never happens to another family?

[Mr Reed]

I absolutely agree. There is an old line that justice delayed is justice denied. No family who have lost their child in these circumstances should then have to fight the state to find out what went wrong, or to secure a modicum of justice for what happened.

Before I continue, I want to put on record my thanks also to the Prime Minister, who has met the Lewis family on more than one occasion and who I know supports the objectives of the Bill.

I have come to know Seni Lewis’s parents, Aji and Conrad, very well over the past few years. They are two of the most dignified and inspirational people I have ever met, but they have suffered pain and anguish that no parent should ever have to face. When I asked Aji and Conrad what they hoped for after all they have been through, they told me that they do not want Seni’s death to be in vain. They do not want any other family to suffer as they have suffered. I say to this House now, and to his parents, that Seni Lewis did not die in vain. We can honour his memory by making sure that no one else suffers the way he did, and by making our mental health services equal and safe for everyone. I dedicate this Bill to Seni Lewis. This is Seni’s Law. I commend it to the House.

[Several hon. Members rose—]

--- Later in debate ---

[James Heappey]

I accept that there are situations that require immediate intervention. As a former soldier who was used to working on immediate notice to move at times, I suggest that the solution is that there must always be somebody in a custody suite or a mental health ward who is wearing the right kit and is on immediate notice to move. It should be a requirement, and it should be a simple drill for those managing the facilities. That is not to say that everybody needs to be sat around at all times, wearing their stab vest and their camera. But one person in a custody suite should be required to be wearing the appropriate kit at all times. Perhaps that is something to include in the Bill. The cameras are a great addition to what police officers wear. In fact, they are a de-escalatory measure in themselves. Away from cases of people suffering with mental health issues, I have been told by the local police commander for my part of Somerset that the simple act of turning them on has such an effect. People on the high street who have had a few too many drinks see themselves on the screen and know that their behaviour is being recorded; things immediately start to calm down and responsibility returns.

[Mr Reed]

I am grateful to the hon. Gentleman for raising this important point and I agree with the point made by the hon. Member for South East Cornwall (Mrs Murray). The hon. Gentleman will be interested to know that there is a weight of published academic evidence showing that the mere presence of police wearing body cameras reduces the likelihood of force being used in these circumstances by nearly 50%. That alone is reason enough to require police to wear body cameras.

[James Heappey]

The hon. Gentleman is absolutely right. It is great on days like today when the House is in such violent agreement. The cameras really are a great addition for our police forces. They give transparency for those who want to complain about perceived unfair treatment. But they also give a protection as important as the stab vest, by reassuring police officers that they will have a video record of what they did.

--- Later in debate ---

[James Cleverly]

I only really have detailed experience of medical and policing practices from my time on the Metropolitan Policy Authority in London and now, as the representative of Braintree, from the Essex Police and my local mental health trust, so I cannot talk about the universality of the situation. However, without a shadow of a doubt, the message that I am picking up is that there is huge variation across and within constabularies and trusts.

The group of clauses relating to accountability is one of the most significant parts of the Bill, and my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) touched on this. I am one of those gruff and grumpy old Tories—[Interruption.] At this point, Members are supposed to join in a chorus of “You’re not that old.”—[Hon. Members: “You’re not that old!”] I thank hon. Members, although no one cried, “You’re not that grumpy.” Clause 7 is incredibly important. I am a gruff and grumpy old Tory, and my instinct is to take away as much red tape and administrative burden as possible but, as my hon. Friend the Member for Faversham and Mid Kent highlighted, this modest additional administrative burden is welcomed by the profession.

There is an old saying in management consultancy, “If you want to change something, measure it”—[Interruption.] I can see my hon. Friend the Member for Faversham and Mid Kent nodding. It is important to register the use of force whenever it is applied, because that will do two things. It will prompt a small pause for reflection if someone knows that they will have to justify the use of force, and it is inevitably a good thing if they recognise in that moment of pause that the use of force is not appropriate. Perhaps more importantly, if the decision is made that force is the appropriate action, clause 7 will mean that there is a record of all the times that force has been used, including the times when that force does not lead to injury or, in the most tragic cases, death. That will enable us to get an accurate understanding of how many times the use of force unfortunately leads to injury or fatality, which is important because it will remind us of the difficulty faced by many professionals.

[Mr Reed]

I am grateful for the hon. Gentleman’s generous comments earlier. I should make it clear that it is not my intention that the Bill should impose any additional administrative burden. Institutions already collect data on the use of force, but they do not collect it in the same way, so it cannot be compared. The Bill will simply standardise what currently happens to allow greater scrutiny, rather than imposing a new burden.

[James Cleverly]

That is a fair and balanced intervention. In my next sentence—honestly, this is true—I was going to list some things that, if they are not already collected, really should be collected. It is not a bad thing if the Bill creates a standardisation so that we can see the differentials between forces and trusts.

One of the most difficult and contentious points—this goes to the heart of my opening remarks about the impact the Bill could have on British society—is that, without a shadow of a doubt, we know that examples of huge community friction, of civil disorder and of further injury and loss of life have been caused when families, friends of families and wider communities feel that the use of force has led to an unnecessary death. I will be as cautious as I can with my words because of the sensitivities, but it is particularly acute in Britain’s black communities.

There is huge disproportionality between the black community in Britain and the rest of the communities in Britain—and it cannot possibly just be chance—in the rate of death and injury in custody of people suffering mental health episodes. That has to be addressed. No single Bill can solve the situation, as it has been long in the making and will take a very long time to resolve, but this Bill could be a big step in the right direction.

If, as I suspect it will, the Bill reduces the incidence of serious injury or fatality among people suffering mental health episodes, that will in itself have a knock-on effect in reducing some of the community friction and disorder that we have seen in the past. Unfortunately, I suspect there will be further cases where a black man is detained and dies after contact with the police, but if it can be evidenced that in all instances force is applied modestly, minimally and only when absolutely necessary, that might help to defuse some of the tensions that have in the past led to further difficulties.

In conclusion, I thank the hon. Member for Croydon North, and the other hon. Members who have supported this Bill, for introducing to this place a Bill that makes it easy for those of us who want to see genuine improvement both in mental health and community cohesion to support it. I commend it to the House.

Mental Health Units (Use of Force) Bill (First sitting)

Steve Reed Excerpts

Committee Debate: 1st sitting: House of Commons
Wednesday 28th March 2018 Public Bill Committees

[The Chair]

On the basis of the motion just agreed, and given that the required notice period in Public Bill Committees is three working days, amendments should be tabled by 3 pm on Fridays for consideration on Wednesdays. I encourage Members to submit amendments earlier, if they can. I advise Members that, as a general rule, I do not intend to call starred amendments, which have not been tabled with adequate notice.

[Mr Steve Reed (Croydon North) (Lab/Co-op)]

I beg to move,

That the Bill be considered in the following order, namely, Clauses 1 to 6, Clauses 9 to 11, Clauses 7 and 8, Clauses 12 to 20, new Clauses, new Schedules, remaining proceedings on the Bill.

It is a pleasure to serve under your chairmanship, Ms Buck. We have finally got the Bill to Committee, and I am delighted that we are all here. The Committee has been delayed for four weeks in a row, because of the Government’s failure to lay a money resolution, which would allow us to consider the Bill in its entirety and all the amendments. Even this morning we will not be able to consider several amendments because a money resolution has still not been laid, despite the fact that the Bill enjoys the support of the Government and received the unanimous support of the House on Second Reading. When I asked the Government why the money resolution had not been laid, they said it was not possible because of the heavy schedule of business going through the Chamber, but both yesterday and last Tuesday the Adjournment was early because of insufficient business going through the House.

I want to register my disappointment that the money resolution has not been laid at this stage, and I urge Government and other Members to use their influence with the Whips to encourage the Government to do so as soon as possible. The Bill contains an important reform that will dramatically improve safety for many highly vulnerable people using mental health services, and I see no reason for it to continue to be delayed in such a fashion.

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

It is a pleasure to serve under your chairmanship this morning, Ms Buck. I thank the hon. Gentleman for the points he has made. He is absolutely right to say that the Government support the measure. We support it very much because of the co-operative discussions that we have had, to get it to a place where everyone can agree. I fully endorse his point that the Bill is an important social reform; it is an important ingredient in our broader agenda to improve the treatment of people with mental health problems and illness.

The hon. Gentleman made his point about the need for a money resolution robustly. I will relay his representations to the House business managers, so that we can proceed without delay, as we all want such an important reforming measure to be on the statute book as soon as possible.

Question put and agreed to.

Clause 1

Key definitions

[Mr Reed]

I beg to move amendment 2, in clause 1, page 1, line 5, leave out subsection (3) and insert—

‘(3) “Mental health unit” means—

(a) a health service hospital, or part of a health service hospital, in England, the purpose of which is to provide treatment to in-patients for mental disorder, or

(b) an independent hospital, or part of an independent hospital, in England—

(i) the purpose of which is to provide treatment to in-patients for mental disorder, and

(ii) where at least some of that treatment is provided, or is intended to be provided, for the purposes of the NHS.’

This amendment replaces the definition of “mental health unit” with a new definition which clarifies that a unit may form part of a hospital. The amendment also removes care homes and registered establishments from the definition, and includes mental health units in an independent hospital within the definition only where the unit provides NHS treatment.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 3, in clause 1, page 1, line 8, leave out subsection (4) and insert—

‘( ) In subsection (3) the reference to treatment provided for the purposes of the NHS is to be read as a service provided for those purposes in accordance with the National Health Service Act 2006.’

This amendment ensures that “treatment for the purposes of the NHS” is read in accordance with the National Health Service Act 2006. It also makes a change which is consequential on the removal of care homes from the definition of “mental health unit” (see Amendment 2).

Amendment 4, in clause 1, page 1, line 12, leave out subsection (5) and insert—

‘( ) “Patient” means a person who is in a mental health unit for the purpose of treatment for mental disorder or assessment.’

This amendment provides a new definition of “patient”. This definition makes clear that a patient includes a person who is in a mental health unit in order to be treated for mental disorder or to be assessed in the unit.

Amendment 6, in clause 1, page 2, line 1, leave out subsections (7) and (8) and insert—

‘(7) References to “use of force” are to—

(a) the use of physical, mechanical or chemical restraint on a patient, or

(b) the isolation of a patient.

(7A) In subsection (7)—

“physical restraint” means the use of physical contact which is intended to prevent, restrict or subdue movement of any part of the patient’s body;

“mechanical restraint” means the use of a device which—

(a) is intended to prevent, restrict or subdue movement of any part of the patient’s body, and

(b) is for the primary purpose of behavioural control;

“chemical restraint” means the use of medication which is intended to prevent, restrict or subdue movement of any part of the patient’s body;

“isolation” means any seclusion or segregation that is imposed on a patient.’

This amendment provides a revised definition of “use of force” which uses simpler language. It also removes threats from the definition and includes the isolation of a patient in the definition.

New clause 7—Interpretation—

‘In this Act—

“health service hospital” has the same meaning as in section 275(1) of the National Health Service Act 2006;

“independent hospital” has the same meaning as in section 145(1) of the Mental Health Act 1983;

“the NHS” has the same meaning as in section 64(4) of the Health and Social Care Act 2012;

“responsible person” has the meaning given by section 2(1);

“relevant health organisation” means—

(a) an NHS trust;

(b) an NHS foundation trust;

(c) any person who provides health care services for the purposes of the NHS within the meaning of Part 3 of the Health and Social Care Act 2012;

“staff” means any person who works for a relevant health organisation that operates a mental health unit (whether as an employee or a contractor) who—

(a) may be authorised to use force on a patient in the unit,

(b) may authorise the use of force on a particular patient in the unit, or

(c) has the function of providing general authority for the use of force in the unit.’

This new clause compiles various definitions for terms that are used throughout the Bill.

[Mr Reed]

I thank the Minister for her earlier comments. It has been a great pleasure to work with her and her team in such a constructive manner. I said in the Chamber that we would pursue the Bill in a constructive, co-operative and cross-party manner, and that is what all Members have tried to do so far. I suspect that we will not detain the Committee for too long this morning, such is the level of consensus on the amendments, so perhaps I should get on with it without any further ado.

Clause 1 sets out some of the important terms used throughout the Bill. The amendments are minor and aim to ensure that those terms are clearly defined. Amendment 2 strengthens the definition of “mental health unit” to make clear that any such unit may form part of a hospital. Amendment 3 ensures that “treatment provided” is read in accordance with the National Health Service Act 2006. Amendment 4 defines what the Bill means by “patient”, which is someone in a mental health unit who is there to be treated or assessed for mental ill health. Amendment 6 clarifies the definition of “use of force”, using more straightforward language, and it includes “isolation” as part of that definition. New clause 7 compiles and explains various other definitions used throughout the Bill.

[Jackie Doyle-Price]

I confirm that the Government entirely support these amendments, which make the language in the Bill consistent with the 2015 code of practice under the Mental Health Act 1983, and with broader guidance. That makes for a much tidier way of achieving the objectives of the Bill.

Amendment 2 agreed to.

Amendments made: 3, in clause 1, page 1, line 8, leave out subsection (4) and insert—

‘( ) In subsection (3) the reference to treatment provided for the purposes of the NHS is to be read as a service provided for those purposes in accordance with the National Health Service Act 2006.’

This amendment ensures that “treatment for the purposes of the NHS” is read in accordance with the National Health Service Act 2006. It also makes a change which is consequential on the removal of care homes from the definition of “mental health unit” (see Amendment 2).

Amendment 4, in clause 1, page 1, line 12, leave out subsection (5) and insert—

‘( ) “Patient” means a person who is in a mental health unit for the purpose of treatment for mental disorder or assessment.’—(Mr Reed.)

This amendment provides a new definition of “patient”. This definition makes clear that a patient includes a person who is in a mental health unit in order to be treated for mental disorder or to be assessed in the unit.

[Mr Reed]

I beg to move amendment 5, in clause 1, page 1, line 15, leave out subsection (6)

This amendment is consequential on Amendment 7.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 7, in clause 2, page 2, line 26, leave out subsections (1) to (3) and insert—

‘( ) A relevant health organisation that operates a mental health unit must appoint a responsible person for that unit for the purposes of this Act.

( ) The responsible person must be—

(a) employed by the relevant health organisation, and

(b) of an appropriate level of seniority.

( ) Where a relevant health organisation operates more than one mental health unit that organisation must appoint a single responsible person in relation to all of the mental health units operated by that organisation.’

This amendment replaces the requirement for mental health units to have a “registered manager” with a requirement to appoint a “responsible person”. That person must be employed by a relevant health organisation and be of an appropriate level of seniority. If an organisation operates multiple units, only one responsible person needs to be appointed in relation to those units.

Amendment 11, in clause 3, page 2, line 38, leave out “registered manager” and insert “responsible person”

This amendment is consequential on Amendment 7.

Amendment 60, in clause 7, page 4, line 38, leave out “registered manager” and insert “responsible person”

This amendment is consequential on Amendment 7.

[Mr Reed]

The clause establishes a named accountable individual in a mental health unit who will be responsible for a reduction in the use of force. It seeks to create established, clearer lines of accountability for the existence of appropriate policy, and for when things go wrong, so that it will be possible to find somebody who can explain exactly what circumstances might have led to any problems or failings with the use of force.

Amendment 7 replaces the phrase “registered manager” with “responsible person”. The change in language avoids confusion with existing Care Quality Commission regulations that use the phrase “registered manager”, but the intention remains the same. By introducing the legal concept of a responsible person for mental health units, the Bill increases accountability and leadership. Ultimately, the responsible person will be accountable for the requirement that the Bill places on mental health units, so it is important properly to define them as a senior officer in the organisation. They will set the organisation-wide direction for a reduction in the use of force. The responsible person will be at board level, with more detail about who is appropriate set out in guidance by the Secretary of State under clause 6. Amendments 5, 11 and 60 are consequential on changes of the phrase “registered manager” to “responsible person”.

[Jackie Doyle-Price]

The Government support the amendments. Perhaps one of the most important aspects of the Bill is that it enshrines accountability for ensuring that any institution fulfils its responsibilities. The buck needs to stop somewhere, and it is important that happens with someone at board level. The amendments are important for improving leadership, governance and accountability for the use of force. The amendments were drafted in line with the existing positive and proactive care guidance. It is also worth emphasising that this will not incur any additional burden on healthcare organisations; it will simply strengthen and enshrine accountability. On that basis, the Government are happy to approve the amendments.

Amendment 5 agreed to.

Amendment made: 6, in clause 1, page 2, line 1, leave out subsections (7) and (8) and insert—

‘(7) References to “use of force” are to—

(a) the use of physical, mechanical or chemical restraint on a patient, or

(b) the isolation of a patient.

(7A) In subsection (7)—

“physical restraint” means the use of physical contact which is intended to prevent, restrict or subdue movement of any part of the patient’s body;

“mechanical restraint” means the use of a device which—

(a) is intended to prevent, restrict or subdue movement of any part of the patient’s body, and

(b) is for the primary purpose of behavioural control;

“chemical restraint” means the use of medication which is intended to prevent, restrict or subdue movement of any part of the patient’s body;

“isolation” means any seclusion or segregation that is imposed on a patient.’—(Mr Reed.)

This amendment provides a revised definition of “use of force” which uses simpler language. It also removes threats from the definition and includes the isolation of a patient in the definition.

Clause 1, as amended, ordered to stand part of the Bill.

Clause 2

Mental health units to have a registered manager

Amendment made: 7, in clause 2, page 2, line 26, leave out subsections (1) to (3) and insert—

“( ) A relevant health organisation that operates a mental health unit must appoint a responsible person for that unit for the purposes of this Act.

( ) The responsible person must be—

(a) employed by the relevant health organisation, and

(b) of an appropriate level of seniority.

( ) Where a relevant health organisation operates more than one mental health unit that organisation must appoint a single responsible person in relation to all of the mental health units operated by that organisation.”.—(Mr Reed.)

This amendment replaces the requirement for mental health units to have a “registered manager” with a requirement to appoint a “responsible person”. That person must be employed by a relevant health organisation and be of an appropriate level of seniority. If an organisation operates multiple units, only one responsible person needs to be appointed in relation to those units.

Clause 2, as amended, ordered to stand part of the Bill.

Clause 3

Policy on use of force

[Mr Reed]

I beg to move amendment 8, in clause 3, page 2, line 36, leave out subsection (1) and insert—

‘(1) The responsible person for each mental health unit must publish a policy regarding the use of force by staff who work in that unit.’.

This amendment replaces Clause 3(1) and provides a clearer duty for the responsible person to publish a policy regarding the use of force in mental health units.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 9, in clause 3, page 2, line 37, at end insert—

‘( ) Where a responsible person is appointed in relation to all of the mental health units operated by a relevant health organisation, the responsible person must publish a single policy under subsection (1) in relation to those units.’.

This amendment provides that if there is a single responsible person for all of the mental health units operated by a relevant health organisation, the person needs to provide a single policy for those units.

Amendment 10, in clause 3, page 2, line 37, at end insert—

‘( ) Before publishing a policy under subsection (1), the responsible person must consult any persons that the responsible person considers appropriate.’.

This amendment requires the responsible person to consult before publishing the policy under Clause 3.

Amendment 12, in clause 3, page 2, line 38, leave out second “the” and insert “any”.

This amendment is consequential on Amendment 13.

Amendment 13, in clause 3, page 2, line 40, leave out subsections (3) and (4) and insert—

‘( ) The responsible person may from time to time revise any policy published under this section and, if this is done, must publish the policy as revised.

( ) If the responsible person considers that any revisions would amount to a substantial change in the policy, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised policy.’.

This amendment requires a further consultation under Clause 3 if the responsible person intends to make substantial changes to the policy published under that clause. Amendment 12 is consequential on this amendment.

Amendment 14, in clause 3, page 3, line 2, leave out “minimise and”.

This amendment removes the requirement that the policy under Clause 3 must minimise the use of force. Instead it will require the policy to reduce the use of force.

Amendment 15, in clause 3, page 3, line 2, leave out

‘at the mental health unit’

and insert

‘in the mental health unit by staff who work in that unit’.

This amendment ensures consistency with Clause 3(1) as amended by Amendment 8.

Amendment 16, in clause 3, page 3, line 3, leave out subsection (6).

This amendment removes the requirement for the registered manager to take all reasonable steps to ensure compliance with the policy published under Clause 3.

Amendment 17, in clause 3, page 3, line 6, leave out subsection (7).

This amendment removes a consultation requirement that is superseded by the changes made by Amendment 10.

[Mr Reed]

This is a very important clause, because it establishes the requirement for mental health units to have in place a policy regarding the use of force in that unit. That requirement does not currently exist, so there is wide divergence and variation between procedures, practice and means for controlling and managing the use of force in different health units, which can be detrimental to the safety of patients.

A written policy will effectively govern the use of force within the units, and there is a real opportunity for NHS trusts to work with service users and their families to formalise and replicate the best of what many are already doing to reduce the use of force. The use of force varies enormously across NHS trusts. Some already have robust policies in place to minimise the use of force but others do not. The amendment will put an end to the regional disparity between trusts. Based on currently available figures, the variation can be as wide as between 5% and 50% of patients being subject to the use of force while attending mental health units for treatment.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I congratulate my hon. Friend on bringing forward the Bill, which is a fantastic achievement. The fact that he has used his private Member’s Bill slot for this Bill is to be highly commended. My local mental health trust, Mersey Care, adopts the “no force first” approach, which is very important. I just wanted to shine a spotlight on the fact that some trusts adopt that approach. I welcome the fact that the Bill seeks to eradicate the differences in approach across the country.

[Mr Reed]

I thank my hon. Friend for her intervention. Mersey Care is well known to me and to many others in the room as a fine example of the best practice that we wish to replicate everywhere across the country, so that patients, wherever they are, can enjoy the very best levels of service, to which they ought to be entitled.

I will go through the amendments in the grouping. Collectively, they are intended to add greater clarity and consistency to the policies. Amendment 9 provides that, for relevant organisations that operate a number of health units, the responsible person needs to publish only one policy to cover all staff in all those units. Amendments 10 and 13 ensure that the policy is consulted on when it is first published and when changes are made. It is important that the responsible person considers and consults the views of current and previous service users to ensure that their experiences form part of improving policy and guidance into the future.

Amendment 14 requires the policy to include reducing the use of force, which is a key purpose of the Bill, and a key commitment that the use of force should only ever be used as a genuine last resort, as indeed it is in Mersey Care and other mental health trusts. We should be clear that this is only a start—we would like the use of force to be minimised and not just reduced—but this puts into legislation the Government’s intention to reduce the use of force, and we will be holding them to that.

Amendment 16 places into statutory guidance a requirement on the responsible person to take all reasonable steps to ensure compliance with the policy, and makes a failure to have regard for the guidance a breach of the statutory duty.

[Jackie Doyle-Price]

The Government entirely support the need for every institution to which the Act will apply to make a policy on the use of force. Central to that is the concept of accountability; having a named person, as we have already discussed, plus a policy for an organisation to be held to account to, is clearly important to achieve that. The Government support these amendments and see them as important ingredients in reducing the use of force overall in mental health units. We will ensure that any guidance produced under this clause gives further detail about what policies should include. We expect that to look like what is already set out in positive and proactive care guidance. We expect it to say that responsible persons will have a duty to have regard to this guidance in the development of their organisation’s policy, which will help ensure that each policy meets the same basic criteria as well as allowing for local flexibility.

I associate myself with the comments of the hon. Members for Liverpool, Wavertree and for Croydon North on Mersey Care, which offers a good example. The culture of transparency in itself generates sensible use of force, and only when appropriate. It is a truism for everybody in this room that we want to see minimal use of force. There are occasions when, for the safety of both patient and staff, it sometimes needs to be used, but the way to be sure that it is only used appropriately is to have that culture of accountability. Many organisations could learn from Mersey Care in that regard. We support these amendments.

Amendment 8 agreed to.

Amendments made: 9, in clause 3, page 2, line 37, at end insert—

‘( ) Where a responsible person is appointed in relation to all of the mental health units operated by a relevant health organisation, the responsible person must publish a single policy under subsection (1) in relation to those units.’.

This amendment provides that if there is a single responsible person for all of the mental health units operated by a relevant health organisation, the person needs to provide a single policy for those units.

Amendment 10, in clause 3, page 2, line 37, at end insert—

‘( ) Before publishing a policy under subsection (1), the responsible person must consult any persons that the responsible person considers appropriate.’

This amendment requires the responsible person to consult before publishing the policy under Clause 3.

Amendment 11, in clause 3, page 2, line 38, leave out “registered manager” and insert “responsible person”.

This amendment is consequential on Amendment 7.

Amendment 12, in clause 3, page 2, line 38, leave out second “the” and insert “any”.

This amendment is consequential on Amendment 13.

Amendment 13, in clause 3, page 2, line 40, leave out subsections (3) and (4) and insert—

‘( ) The responsible person may from time to time revise any policy published under this section and, if this is done, must publish the policy as revised.

( ) If the responsible person considers that any revisions would amount to a substantial change in the policy, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised policy.’

This amendment requires a further consultation under Clause 3 if the responsible person intends to make substantial changes to the policy published under that clause. Amendment 12 is consequential on this amendment.

Amendment 14, in clause 3, page 3, line 2, leave out “minimise and”.

This amendment removes the requirement that the policy under Clause 3 must minimise the use of force. Instead it will require the policy to reduce the use of force.

Amendment 15, in clause 3, page 3, line 2, leave out

“at the mental health unit”

and insert

“in the mental health unit by staff who work in that unit”.

This amendment ensures consistency with Clause 3(1) as amended by Amendment 8.

Amendment 16, in clause 3, page 3, line 3, leave out subsection (6).

This amendment removes the requirement for the registered manager to take all reasonable steps to ensure compliance with the policy published under Clause 3.

Amendment 17, in clause 3, page 3, line 6, leave out subsection (7).—(Mr Reed.)

This amendment removes a consultation requirement that is superseded by the changes made by Amendment 10.

Clause 3, as amended, ordered to stand part of the Bill.

Clause 4

Information about use of force

[Mr Reed]

I beg to move amendment 84, in clause 4, page 3, line 12, leave out subsections (1) to (3) and insert—

‘(1) The responsible person for each mental health unit must publish information for patients about the rights of patients in relation to the use of force by staff who work in that unit.

(1A) Before publishing the information under subsection (1), the responsible person must consult any persons that the responsible person considers appropriate.

(1B) The responsible person must provide any information published under this section—

(a) to each patient, and

(b) to any other person who is in the unit and to whom the responsible person considers it appropriate to provide the information in connection with the patient.

(1C) The information must be provided to the patient—

(a) if the patient is in the mental health unit at the time when this section comes into force, as soon as reasonably practicable after that time;

(b) in any other case, as soon as reasonably practicable after the patient is admitted to the mental health unit.’

This amendment replaces Clause 4(1) to (2) with a duty to publish information about the rights of patients in relation to the use of force in a mental health unit. Before publishing the information, a consultation must be carried out. The published information must be given to patients in the mental health unit and to new patients admitted to the unit, and to any other person considered appropriate if in the unit.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 19, in clause 4, page 3, line 24, leave out from “provided” to “in” in line 27.

This amendment removes the requirement that the Secretary of State must prescribe the form that information under Clause 4 must be provided.

Amendment 20, in clause 4, page 3, line 27, leave out “with regard to” and insert “having regard to”.

This amendment is a drafting change to Clause 4(4)(b).

Amendment 21, in clause 4, page 3, leave out line 28.

This amendment removes a paragraph that deals with providing information under Clause 4 that has regard to the patient’s communication needs because that paragraph is unnecessary.

Amendment 22, in clause 4, page 3, line 29, leave out “capacity” and insert “ability”.

This amendment is a drafting change to avoid confusion with the terminology of the Mental Capacity Act 2005.

Amendment 23, in clause 4, page 3, line 30, leave out subsection (5).

This amendment is a drafting change linked to Amendment 22.

Amendment 24, in clause 4, page 3, line 31, at end insert—

‘( ) The responsible person must keep under review any information published under this section.

( ) The responsible person may from time to time revise any information published under this section and, if this is done, must publish the information as revised.

( ) If the responsible person considers that any revisions would amount to a substantial change in the information, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised information.’

This amendment requires the responsible person to keep information published under Clause 4 under review. If the responsible person intends to make substantial changes to the information published under that clause, then a consultation must be conducted.

Amendment 85, in clause 4, page 3, line 31, at end insert—

‘( ) The duty to provide information to a patient under subsection (1B) does not apply if—

(a) the patient refuses to accept the information, or

(b) the responsible person considers that the provision of the information to the patient would cause the patient distress.

( ) The duty to provide information to another person under subsection (1B) does not apply if—

(a) the patient requests that the information is not provided to the person, or

(b) the responsible person considers that the provision of the information to the person would cause the patient distress.’

This amendment provides exceptions to the duties to provide information under Clause 4. It provides that a patient can refuse to accept the information or request that it is not provided to another person, and the information does not need to be provided if it would cause distress to the patient.

--- Later in debate ---

[Mr Reed]

The amendment deals with the requirement to provide patients with information about their rights. Many patients entering a mental health unit will be in a state of considerable distress. Many of them will be unaware of their rights regarding the use of force. Currently it is not universal practice that those patients are informed about what those rights are so that they can ensure that those rights are not infringed.

It is important that any patient entering a mental health unit is aware of what may or may not be done to them regarding the use of force, so that if people in the unit seek to do things to them that go beyond their rights, they are able to call it out and stop it. This applies not just to the individual concerned, but to their carers, family members or close relatives who might be there with them, who are often unfamiliar with mental health units and have equally high levels of concern. It is important that they, too, are aware of what their loved one’s rights are.

--- Later in debate ---

[Jackie Doyle-Price]

I said at the beginning of today’s proceedings that I view the measures enshrined in the Bill as an important social reform. These amendments and this clause go to the heart of that, in the sense that it is all about empowering patients and enshrining their rights. That is very much the spirit in which we are embarking on the review of the Mental Health Act, so we completely support the clause and the amendments.

The amendments ensure that other appropriate people, such as patients’ carers and relatives, will normally receive information about use of force, which is key for patients who do not always understand the information that is given to them, as the hon. Gentleman suggested. It is also important to understand that sometimes too much information can cause patients further distress at a difficult time. In those circumstances, a good relationship with relatives and carers is extremely important. That can be as much about empowering the patients as furnishing the individual with such information.

On the specific concern that amendment 85 might cause a loophole, I must emphasise that the exception is not about letting any unit off, but about recognising when it might be appropriate so that information will not cause further unintended distress and ensuring that patients’ interests are protected. Different patients will require different approaches, and a one-size-fits-all approach does not count.

When the measure is set alongside the other provisions in the Bill, we are satisfied that we have the right balance between protecting the rights of patients and empowering them—and empowering their carers and relatives to look after them—while having appropriate safeguards to prevent further distress. I support the amendments.

Amendment 84 agreed to.

Amendments made: 19, in clause 4, page 3, line 24, leave out from “provided” to “in” in line 27.

This amendment removes the requirement that the Secretary of State must prescribe the form that information under Clause 4 must be provided.

Amendment 20, in clause 4, page 3, line 27, leave out “with regard to” and insert “having regard to”.

This amendment is a drafting change to Clause 4(4)(b).

Amendment 21, in clause 4, page 3, leave out line 28.

This amendment removes a paragraph that deals with providing information under Clause 4 that has regard to the patient’s communication needs because that paragraph is unnecessary.

Amendment 22, in clause 4, page 3, line 29, leave out “capacity” and insert “ability”.

This amendment is a drafting change to avoid confusion with the terminology of the Mental Capacity Act 2005.

Amendment 23, in clause 4, page 3, line 30, leave out subsection (5).

This amendment is a drafting change linked to Amendment 22.

Amendment 24, in clause 4, page 3, line 31, at end insert—

“( ) The responsible person must keep under review any information published under this section.

( ) The responsible person may from time to time revise any information published under this section and, if this is done, must publish the information as revised.

( ) If the responsible person considers that any revisions would amount to a substantial change in the information, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised information.”.

This amendment requires the responsible person to keep information published under Clause 4 under review. If the responsible person intends to make substantial changes to the information published under that clause, then a consultation must be conducted.

Amendment 85, in clause 4, page 3, line 31, at end insert—

‘( ) The duty to provide information to a patient under subsection (1B) does not apply if—

(a) the patient refuses to accept the information, or

(b) the responsible person considers that the provision of the information to the patient would cause the patient distress.

( ) The duty to provide information to another person under subsection (1B) does not apply if—

(a) the patient requests that the information is not provided to the person, or

(b) the responsible person considers that the provision of the information to the person would cause the patient distress.’—(Mr Reed.)

This amendment provides exceptions to the duties to provide information under Clause 4. It provides that a patient can refuse to accept the information or request that it is not provided to another person, and the information does not need to be provided if it would cause distress to the patient.

Clause 4, as amended, ordered to stand part of the Bill.

Clause 5

Training in appropriate use of force

[Mr Reed]

I beg to move amendment 86, in clause 5, page 3, line 33, leave out subsection (1) and insert—

‘(1) The responsible person for each mental health unit must provide training for staff that relates to the use of force by staff who work in that unit.

(1A) The training provided under subsection (1) must include training on the following topics—

(a) how to involve patients in the planning, development and delivery of care and treatment in the mental health unit,

(b) showing respect for patients’ past and present wishes and feelings,

(c) showing respect for diversity generally,

(d) avoiding unlawful discrimination, harassment and victimisation,

(e) the use of techniques for avoiding or reducing the use of force,

(f) the risks associated with the use of force,

(g) the impact of trauma (whether historic or otherwise) on a patient’s mental and physical health,

(h) the impact of any use of force on a patient’s mental and physical health,

(i) the impact of any use of force on a patient’s development,

(j) how to ensure the safety of patients and the public, and

(k) the principal legal or ethical issues associated with the use of force.’.

This amendment replaces Clause 5(1) with a revised duty on the responsible person to ensure that training is provided for staff that covers a wide range of topics relating to the use of force in mental health units.

[The Chair]

With this it will be convenient to discuss amendment 87, in clause 5, page 3, line 39, leave out subsection (2) and insert—

‘(2) Subject to subsection (2A), training must be provided—

(a) in the case of a person who is a member of staff when this section comes into force, as soon as reasonably practicable after this section comes into force, or

(b) in the case of a person who becomes a member of staff after this section comes into force, as soon as reasonably practicable after they become a member of staff.

(2A) Subsection (2) does not apply if the responsible person considers that any training provided to the person before this section came into force or before the person became a member of staff—

(a) was given sufficiently recently, and

(b) meets the standards of the training provided under this section.

(2B) Refresher training must be provided at regular intervals whilst a person is a member of staff.

(2C) In subsection (2B) “refresher training” means training that updates or supplements the training provided under subsection (1).’.

The amendment sets out when training under Clause 5 should be given to staff. A definition of “staff” is given in NC7.

[Mr Reed]

These amendments are to the clause relating to improving training for staff working in mental health units before they are able to use force of any description against patients. It is clearly better for patient safety that any staff administering force should be properly trained, but it is worth noting that it is also important for staff safety that they are properly trained before they engage in administering force to patients.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I commend my hon. Friend for introducing the Bill. On the need for training, I want to flag my experience of young patients with autism being held in secure psychiatric units. In my experience, there is a lack of expertise and training across the board for staff treating young people with autism, so they fail to understand that much challenging behaviour arises from the intense levels of anxiety experienced by young people with autism. In such circumstances, the use of force further compounds that anxiety, and indeed traumatises those young people. I ask the Minister whether, when laying down guidance to accompany the Bill, specific regard will be given to the lack of training and understanding of autism within our mental health services?

[Mr Reed]

I am grateful to my hon. Friend for making that important point and I look forward to hearing the Minister’s comment. That point has been made to me by many service users and advocacy groups, including Rethink Mental Illness, YoungMinds and others.

Many of the approaches outlined in the Bill ought to be applied more widely for people who experience mental ill health in many other circumstances. I hope that the Government’s ongoing review into mental health will do that. I hope that some of the principles in the Bill will take us forward and allow that review, when it reports back, to make a bigger impact than it perhaps might have made otherwise.

Moving back to the principles of training in general, the Bill includes provisions on training to recognise the Equality Act 2010 and de-escalation techniques that reduce the need for force to be used in any circumstances. The amendment will also strengthen the requirement for trauma-informed care. It is important to include in the Bill that staff are trained in the impact of further traumatising patients, whose mental ill health may have already been exacerbated by forms of trauma.

I am informed by Agenda that more than 50% of female patients in mental health units have experienced physical or sexual abuse by men, which in most cases contributes significantly to their mental ill health. After those experiences, being forcibly restrained—generally by groups of men—can further traumatise those women and make their mental health conditions even worse, so it is very important that staff are fully aware and trained in the risks of re-traumatising patients who have already been traumatised.

It is also important that training takes full account of the risks of unlawful discrimination regarding race. Dame Elish Angiolini’s report last year into deaths and serious incidents in police custody found that:

“The stereotyping of young Black men as ‘dangerous, violent and volatile’ is a longstanding trope that is ingrained in the minds of many in our society.”

We only have to look at pictures of the faces of people who have died in state custody, including in mental health custody, to see how severe the risk of unconscious bias in the system is. A much higher proportion of those faces will be of young black men than the proportion present in the population as a whole. In order to ensure that staff will not be acting out of prejudice against people who enter a publicly funded health service for treatment on equal terms with everyone else, it is important that staff are trained to be fully aware of the risks of unconscious bias and racism in that service.

Putting anti-discrimination training into legislation is a move towards ending such unlawful discrimination, as is the overall aim of the Bill, and towards exposing the use of force to much closer scrutiny by standardising data recording across the whole country, so that it is possible to compare performance in mental health units on the same basis in different parts of the country. That is not currently possible, and it is a loophole that was pointed to by Dame Elish Angiolini in her report. I am pleased that the Bill will close the loophole.

Crucially, staff must also be trained in the use of techniques to avoid or reduce the use of force—essentially de-escalation. That makes the situation safer for everyone involved. It is critical that anything that might trigger behaviours in a patient that could lead to their being restrained should be avoided, if at all possible, so that the use of force can be minimised.

Amendment 86 sets out a revised duty on the responsible person to ensure that training is provided for staff in mental health units. Amendment 87 sets out when training should be provided to staff. It should be provided as soon as the provision comes into force, and there should be refresher training at regular intervals. That will build the institutional knowledge needed to ensure that force will only ever be used as a genuine last resort.

[Luciana Berger]

My hon. Friend, and many other Members, will probably have seen the “Dispatches” programme last month, in which a temporary member of staff went to work in a privately owned but NHS-funded mental health unit. That undercover report revealed scenes that were difficult to watch. Part of the challenge was that the individual was not given any appropriate training when she was asked to care for some very unwell people in secure parts of the accommodation. I want to reinforce what my hon. Friend has been saying: the issue is critical for existing and new staff, and often there are too many temporary staff working in such units.

[Mr Reed]

My hon. Friend makes an important point, clearly and eloquently. There are no circumstances in which an untrained member of staff, whether full-time or not, should be able to use force—effectively violence—on a patient. If they have not been properly trained, that should be an absolute no.

[Jackie Doyle-Price]

The clause relates to ensuring that all members of staff are appropriately trained on when it is appropriate to use force. It is worth emphasising that it will make any institution or organisation safer for patients, but also for staff. It is important to prioritise and enhance training in de-escalation techniques. That will make for a safer environment for everyone, with less harm to patients, and will probably help to some extent with their continuing care and recovery. I totally endorse the clause, and the amendments, which will make it more effective. Clearly these measures are important for a Government whose approach to leadership in health involves prioritising patient safety.

We see the provisions as an opportunity to build on the positive and proactive care guidance. The amended clause will now go much further to address the points made by the hon. Members for Croydon North and for Liverpool, Wavertree. Only people working in a professional capacity would be able to use force on patients; any volunteers would not be able to do so. In that sense, it is a much stronger measure, because we are giving a clear view that the use of force is not something that volunteers should be involved in.

--- Later in debate ---

Guidance about functions under this Act

[Mr Reed]

I beg to move amendment 28, in clause 6, page 4, line 2, leave out “Care Quality Commission” and insert “Secretary of State”.

This amendment places the duty to publish guidance under Clause 6 on the Secretary of State rather than the Care Quality Commission.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 29, in clause 6, page 4, line 3, leave out “registered managers” and insert

“responsible persons and relevant health organisations”.

This amendment is consequential on Amendment 7 as well as including relevant health organisations as subjects of the guidance published under Clause 6.

Amendment 30, in clause 6, page 4, line 3, at end insert—

‘(1A) In exercising functions under this Act, responsible persons and relevant health organisations must have regard to guidance published under this section.’

This amendment places a duty on responsible persons and relevant health organisations to have regard to the guidance published under Clause 6.

Amendment 31, in clause 6, page 4, line 3, at end insert—

‘(1B) The Secretary of State must keep under review any guidance published under this section.’

This amendment places a duty on the Secretary of State to review any guidance published under Clause 6.

Amendment 32, in clause 6, page 4, line 3, at end insert—

‘(1C) Before publishing guidance under this section, the Secretary of State must consult such persons as the Secretary of State considers appropriate.’

This amendment imposes a duty onto the Secretary of State to consult before publishing guidance under Clause 6.

Amendment 33, in clause 6, page 4, line 4, leave out subsection (2).

This amendment removes Clause 6(2) which is legally unnecessary.

Amendment 34, in clause 6, page 4, line 10, leave out subsection (3) and insert—

‘(3A) The Secretary of State may from time to time revise the guidance published under this section and, if this is done, must publish the guidance as revised.

(3B) If the Secretary of State considers that any revisions would amount to a substantial change in the guidance, the Secretary of State must consult such persons as the Secretary of State considers appropriate before publishing any revised guidance.’

This amendment places a duty onto the Secretary of State to consult before publishing revised guidance under Clause 6 where the revisions to the guidance are substantial.

New clause 3—Delegation of responsible person’s functions—

‘(1) The responsible person for each mental health unit may delegate any functions exercisable by the responsible person under this Act to a relevant person only in accordance with this section.

(2) The responsible person may only delegate a function to a relevant person if the relevant person is of an appropriate level of seniority.

(3) The delegation of a function does not affect the responsibility of the responsible person for the exercise of the responsible person’s functions under this Act.

(4) The delegation of a function does not prevent the responsible person from exercising the function.

(5) In this section “relevant person” means a person employed by the relevant health organisation that operates the mental health unit.’

This new clause gives a power to the responsible person to delegate functions under the Bill subject to the limitation that the person to whom functions are delegated is of an appropriate level of seniority. The obligations associated with the functions remain with the responsible person despite any delegation.

[Mr Reed]

Rather than including too much prescriptive guidance in the Bill, we have decided that it is best dealt with through statutory guidance, so that it can always be kept up to date with the latest best practice or other information and can be changed more quickly than legislation. Clause 6 sets out the requirements for guidance to be issued to set out compliance with the various requirements of the Bill. Amendment 28 places a duty on the Secretary of State to produce that guidance. That is a more appropriate level at which to produce the guidance than the CQC, although the CQC will have an important role to play in monitoring and regulating compliance with the Bill. The guidance will be statutory, so a failure to have regard to it will be a breach of a statutory duty. The amendments provide me with the assurance that operators of mental health units will be fully aware of their duties and the requirements under the Act.

New clause 3 gives the responsible person the power to delegate their functions under the Bill to another employee of appropriate seniority, but it does not mean that the responsible person will no longer be accountable for that function. It is important that in every unit there is always a named individual who is responsible for compliance with the provisions of the Bill and accountable, should there be any failure to comply with the provisions.

[Jackie Doyle-Price]

I agree that it is more appropriate for the Secretary of State to produce the guidance under the clause. The guidance will provide mental health units and the healthcare organisations that operate them with a detailed explanation of the requirements of the Bill. That will help to ensure that they understand the obligations they are under and, in turn, help them reduce the use of force so that it is only ever used as a last resort and carried out appropriately.

I want to clarify something I said earlier, in case I gave a slightly wrong impression when I referred to volunteers. We do not expect volunteers to use force and, accordingly, we do not expect them to be given training. There will not be an outright ban, but clearly the emphasis in the Bill means that only appropriately trained professional staff will be involved.

The duty to consult will ensure that there is input from a wide range of partners and stakeholders, so that the guidance is well received within the health service. On that basis, the Government are content to support the amendments. We are also content to support the new clause, which will allow a responsible person to delegate some of their functions to the right person within the organisation, but still retain overall accountability for compliance with the requirements of the Bill.

Amendment 28 agreed to.

Amendments made: 29, in clause 6, page 4, line 3, leave out “registered managers” and insert

“responsible persons and relevant health organisations”

This amendment is consequential on Amendment 7 as well as including relevant health organisations as subjects of the guidance published under Clause 6.

Amendment 30, in clause 6, page 4, line 3, at end insert—

‘(1A) In exercising functions under this Act, responsible persons and relevant health organisations must have regard to guidance published under this section.’

This amendment places a duty on responsible persons and relevant health organisations to have regard to the guidance published under Clause 6.

Amendment 31, in clause 6, page 4, line 3, at end insert—

‘(1B) The Secretary of State must keep under review any guidance published under this section.’

This amendment places a duty on the Secretary of State to review any guidance published under Clause 6.

Amendment 32, in clause 6, page 4, line 3, at end insert—

‘(1C) Before publishing guidance under this section, the Secretary of State must consult such persons as the Secretary of State considers appropriate.’

This amendment imposes a duty onto the Secretary of State to consult before publishing guidance under Clause 6.

Amendment 33, in clause 6, page 4, line 4, leave out subsection (2)

This amendment removes Clause 6(2) which is legally unnecessary.

Amendment 34, in clause 6, page 4, line 10, leave out subsection (3) and insert—

‘(3A) The Secretary of State may from time to time revise the guidance published under this section and, if this is done, must publish the guidance as revised.

(3B) If the Secretary of State considers that any revisions would amount to a substantial change in the guidance, the Secretary of State must consult such persons as the Secretary of State considers appropriate before publishing any revised guidance.’

This amendment places a duty onto the Secretary of State to consult before publishing revised guidance under Clause 6 where the revisions to the guidance are substantial.—(Mr Reed.)

Clause 6, as amended, ordered to stand part of the Bill.

Clause 9

Annual report by the Secretary of State

[Mr Reed]

I beg to move amendment 70, in clause 9, page 5, line 39, leave out subsections (1) to (4) and insert—

‘(1) As soon as reasonably practicable after the end of each calendar year, the Secretary of State—

(a) must conduct a review of any reports made under paragraph 7 of Schedule 5 to the Coroners and Justice Act 2009 that were published during that year relating to the death of a patient as a result of the use of force in a mental health unit by staff who work in that unit, and

(b) may conduct a review of any other findings made during that year relating to the death of a patient as a result of the use of force in a mental health unit by staff who work in that unit.

(1A) Having conducted a review under subsection (1), the Secretary of State must publish a report that includes the Secretary of State’s conclusions arising from that review.

(1B) The Secretary of State may delegate the conduct of a review under subsection (1) and the publication of a report under subsection (1A).

(1C) For the purposes of subsection (1)(b) “other findings” include, in relation to the death of a patient as a result of the use of force in a mental health unit, any finding or determination that is made—

(a) by the Care Quality Commission as the result of any review or investigation conducted by the Commission, or

(b) by a relevant health organisation as the result of any investigation into a serious incident.’

This amendment replaces the provisions of Clause 9 with a duty imposed on the Secretary of State to review reports each year made by coroners under the Coroners and Justice Act 2008 (often referred to as “regulation 28 reports”). The Secretary of State can also review other findings. After the review, a report must be published that includes the Secretary of State’s conclusions arising from the review.

This clause is very important. When there has been a fatality in a mental health unit, a coroner investigates the circumstances and the causes of that death and produces a report. I sat in for part of the coroner’s hearing following the death of Olaseni Lewis in Croydon. The coroner’s findings in that case were very damning of failures that had occurred leading up to that young man’s death, which were certainly avoidable, had lessons from previous coroners’ inquiries been properly learned and applied.

The purpose of the amendment and the clause is to ensure that all findings from coroners’ reports over a year are collated by the Secretary of State and published in an annual report, with the Secretary of State’s conclusions on how the state is learning from any incidents that occurred during that year.

That is an important step towards transparency and a culture in which lessons are learned quickly and effectively. A striking element of the findings in coroners’ reports over the years is how frequently the same recommendations are made again and again. If there was learning in the system and those lessons were being applied, that repetition would be far less likely to occur.

The proposal is to ensure that when those findings are made, they do not vanish into the ether; they must to properly understood and incorporated into the future development of best practice, to keep mental health patients safe. Amendment 70 would make the necessary provisions for the Secretary of State to carry out the publication of the reports.

[Jackie Doyle-Price]

Transparency is such an important ingredient in ensuring that we strengthen the rights of patients in mental health settings, and ensuring the accountability of organisations that are discharging their responsibilities at the behest of the state. That is why transparency is at the heart of the measures in the Bill.

Having read more than my fair share of coroners’ reports since taking this job, I fully endorse the provisions in the clause and the amendment. It is important that the broader system learns lessons when things go wrong. If we learn lessons when things go wrong, the chances that they will not happen again are much stronger. It is very important that the healthcare system is able to learn lessons from any death of a patient in a mental health unit that results from the use of force.

Drawing together the lessons learnt from a variety of sources into one report will allow greater transparency and shine a light on the issues that need to be tackled by organisations, and it will ensure that the learning from these tragic events is not lost. For that reason, the Government support the amendment.

Amendment 70 agreed to.

Clause 9, as amended, ordered to stand part of the Bill.

Clause 10

Requiring information regarding the use of force

Question proposed, That the clause stand part of the Bill.

--- Later in debate ---

[Mr Reed]

This will be brief. I am asking the Committee to vote against clause 10, because the provisions that were originally included in it have now been placed in clause 7, where they have also been strengthened, so the clause is no longer required.

Question put and negatived.

Clause 10 accordingly disagreed to.

Clause 11

Duty to notify Secretary of State of deaths

Question proposed, That the clause stand part of the Bill.

[Mr Reed]

Similarly, I am asking the Committee to vote against clause 11, because it duplicates existing duties in regulations 16 and 17 of the Care Quality Commission (Registration) Regulations 2009, so it is no longer required.

Question put and negatived.

Clause 11 accordingly disagreed to.

[The Chair]

We have made very good progress this morning, but we can go no further with the line-by-line consideration until the House has passed a money resolution for the Bill. I invite Steve Reed to move the Adjournment motion.

Ordered, That further consideration be now adjourned. —(Mr Reed.)

Mental Health Units (Use of Force) Bill (Second sitting)

Steve Reed Excerpts

Committee Debate: 2nd sitting: House of Commons
Wednesday 18th April 2018 Public Bill Committees

[The Chair]

Before we begin, can everybody have their electronic devices switched to silent, please?

As the Committee cannot consider the remaining clauses of the Bill until the House has agreed to a money resolution, I call Steve Reed, as the Member in charge of the Bill, to move that further consideration of the Bill be adjourned.

[Mr Steve Reed (Croydon North) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship this morning, Ms Buck, however briefly. I thank Members for coming—I wish we were going to spend more time together, but it seems we are not.

I will just make a few points before I formally move the Adjournment. This is the fifth successive week the Committee has been unable to complete its work, and that is excluding the two weeks of recess. The reason is that the Government have not yet laid a money resolution, so we are not allowed to consider the remaining clauses. I have raised this directly with the Opposition Whips, who have raised it with the Government Whips. I have raised it in a direct question to the Leader of the House in business questions, and I pursued it in a letter to the Leader of the House, from whom I had a very charming reply that does not shed any further light on why the delays may be happening.

After five weeks, I am starting to feel that this is a little disrespectful to members of the Committee and to the Bill’s many supporters outside this House. I do not doubt for a moment the support of the Minister, or indeed the Government, who have consistently reiterated their support for the reform we are trying to get through, but it would be nice if the Government were able to let the Bill Committee get on with its work. With great respect, I would ask the Minister whether she has had any conversations with the Government Whips or Government business managers, what they may have said and when we might expect to have the money resolution.

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

I share the hon. Gentleman’s impatience with the current state of affairs, not least because I really do believe that this is a very important reform, and the sooner we get it on the statute book, the better. However, as he alluded to, such matters are for the Government business managers. I am pleased that he has kept the pressure up at his end and raised this with the Leader of the House, and I know that those discussions are continuing.

I would remind the Committee that we have just had two weeks of recess and a very intense few days in terms of other business, which has perhaps dominated the business managers’ thinking this week. However, I hear the hon. Gentleman’s message completely, and I completely understand where he is coming from. Following this meeting, I will resume my conversations with the Government business managers so that we can make very fast progress.

Ordered, That further consideration be now adjourned.— (Mr Reed.)

Mental Health Units (Use of Force) Bill

Steve Reed Excerpts

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

[Mr Steve Reed (Croydon North) (Lab/Co-op)]

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss the following:

New clause 2—Independent investigation of deaths: legal aid—

‘(1) Schedule 1 to the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (civil legal services) is amended as follows.

(2) After paragraph 41 (inquests) insert—

“41A  Investigation of deaths resulting from use of force in mental health units

(1) Civil legal services provided to an individual in relation to an investigation under section (independent investigations of deaths) of the Mental Health Units (Use of Force) Act 2018 (independent investigation of deaths) into the death of a member of the individual’s family.

(2) For the purposes of this paragraph an individual is a member of another individual’s family if—

(a) they are relatives (whether of the full blood or half blood or by marriage or civil partnership),

(b) they are cohabitants (as defined in Part 4 of the Family Law Act 1996), or

(c) one has parental responsibility for the other.”

Amendment 86, in clause 1, page 1, line 13, leave out sub-paragraph (ii).

Amendment 87, page 1, line 15, leave out subsection (4).

Amendment 44, page 2, line 3, leave out “force” and insert “restraint”.

Amendment 40, page 2, line 4, after “use” insert “or threat ”.

This amendment, together with Amendments 41 to 43, would extend the definition of the use of force for the provisions in the Bill to cover threats of the use of force and coercion.

Amendment 88, page 2, line 4, leave out “mechanical or chemical” and insert “or mechanical”.

Amendment 89, page 2, line 5, leave out paragraph (b).

Amendment 41, page 2, line 5, after “isolation” insert “or threat of isolation”.

See explanatory statement for Amendment 40.

Amendment 42, page 2, line 5, at end insert “or

(c) the coercion of a patient.”

See explanatory statement for Amendment 40.

Amendment 90, page 2, leave out lines 14 and 15.

Amendment 91, page 2, leave out lines 16 and 17.

Amendment 43, page 2, line 17, at end insert—

““Coercion” means the use or threat of force, with the intention of causing fear, alarm or distress to control a patient’s behaviour or elicit compliance with the application of a use of force.”

See explanatory statement for Amendment 40.

Amendment 92, in clause 2, page 2, line 20, leave out “a relevant” and insert “any”.

Amendment 93, page 2, line 23, leave out “relevant”.

Amendment 94, page 2, line 25, leave out “relevant”.

Amendment 45, page 2, line 30, clause 3, leave out “force” and insert “restraint”.

Amendment 95, page 2, line 32, leave out “relevant”.

Amendment 37, page 3, line 2, at end insert—

‘(6A) A policy published under this section must set out that the use of force will only be used without the sole intention of inflicting pain, suffering or humiliation, or subjecting patients to tortuous, inhumane or degrading treatment, or without inflicting punishment or intimidation.”

This amendment would prevent the use of force with the sole intention of causing suffering or harm to a patient, in line with the Mental Health Act code of practice and the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.

Amendment 36, page 3, line 3, leave out from “out” to end of line 4 and insert—

“(a) a description of each of the methods of restraint that may be used in the mental health unit;

(b) what steps will be taken to reduce and minimise the use of force in the mental health unit by staff who work in the unit;

(c) a description of the techniques to be used for avoiding or reducing the use of force in the mental health unit by staff who work in the unit; and

(d) a commitment to reducing the overall use of force in the mental health unit.”

This amendment would require mental health units to commit to reducing the overall use of force, and increase transparency about how they intend to achieve this and what types of force they permit.

Amendment 46, page 3, line 4, leave out “force” and insert “restraint”.

Amendment 47, in clause 4, page 3, line 7, leave out “force” and insert “restraint”.

Amendment 38, page 3, line 8, at end insert—

‘(1A) Information under subsection (1) must include a patient’s right to advocacy and how to access an advocate.”

This amendment would ensure that people’s legal rights to advocacy, under existing provisions, are communicated to them in relation to the use of force.

Government amendment 1, page 3, line 16, at end insert—

“unless the patient (where paragraph (a) applies) or the other person (where paragraph (b) applies) refuses the information.”

This allows for cases where a person refuses the information provided, and supersedes subsections (9)(a) and (10)(a).

Government amendment 2, page 3, line 22, leave out subsection (5) and insert—

‘(5) The responsible person must take whatever steps are reasonably practicable to ensure that the patient is aware of the information and understands it.”

This expands the duty to provide information accessibly so that it requires the responsible person to take whatever steps are reasonably practicable to ensure the patient understands.

Government amendment 3, page 3, line 33, leave out subsections (9) and (10).

Subsections (9)(a) and (10)(a) are superseded by Amendment 1. Subsections (9)(b) and (10)(b) are unnecessary as the information will not be of a nature that would cause distress.

Amendment 96, page 3, line 36, leave out “the responsible person considers that”.

Amendment 97, page 3, line 42, leave out “the responsible person considers that”.

Amendment 48, in clause 5, page 4, line 3, leave out “force” and insert “restraint”.

Amendment 79, page 4, line 3, at end insert—

‘(1A) The Secretary of State must publish quality standards for training provided under subsection (1).

(1B) The Secretary of State may delegate the publication of quality standards for training under subsection (2).”

This amendment would require training on the use of force to comply with quality standards.

Amendment 98, page 4, line 6, after “patients” insert “and their families”.

Amendment 9, page 4, line 9, leave out paragraph (c).

Amendment 49, page 4, line 11, leave out “force” and insert “restraint”.

Amendment 50, page 4, line 12, leave out “force” and insert “restraint”.

Amendment 80, page 4, line 13, at beginning insert “trauma-informed care, including”

This amendment, together with Amendment 81, would ensure that training requirements for staff include training on trauma-informed care.

Amendment 81, page 4, line 14, at end insert

“and the impact of the use of force on a patient who may have experienced violence and abuse.”

See explanatory statement for Amendment 80.

Amendment 51, page 4, line 15, leave out “force” and insert “restraint”.

Amendment 52, page 4, line 16, leave out “force” and insert “restraint”.

Amendment 99, page 4, line 18, leave out “the principal”.

Amendment 10, page 4, line 18, leave out “or ethical”.

Amendment 53, page 4, line 18, leave out “force” and insert “restraint”.

Amendment 11, page 4, line 18, at end insert—

“(l) the roles, responsibilities and procedure in the event of police involvement,”

Amendment 12, page 4, line 18, at end insert—

“(m) awareness of acute behavioural disturbance.”

Government amendment 4, page 4, line 30, leave out “meets the standards of” and insert

“is of an equivalent standard to”

This is a small drafting change that clarifies that training does not need to be provided under Clause 5 if training that was recently provided was of an equivalent standard to the training provided under that Clause.

Amendment 13, page 4, line 31, leave out subsections (5) and (6).

Amendment 100, page 5, line 8, clause 6, at end insert—

‘(7) Guidance under this Act shall be published no later than six months after this Act is passed.”

Government motion to transfer clause 6.

Amendment 101, in clause 7, page 5, line 11, after “any” insert “significant”.

Amendment 54, page 5, line 12, leave out “force” and insert “restraint”.

Amendment 39, page 5, line 13, leave out subsections (2) and (3).

This amendment would improve transparency and accountability about the use of force by ensuring consistency in the recording of all uses of force, not just those that are above a threshold to be set in statutory guidance.

Amendment 102, page 5, line 13, leave out subsection (2).

Amendment 55, page 5, line 13, leave out “force” and insert “restraint”.

Amendment 14, page 5, line 13, at end insert

“or does not involve physical contact”.

Amendment 103, page 5, line 14, leave out subsection (3).

Amendment 56, page 5, line 14, leave out “force” and insert “restraint”.

Amendment 104, page 5, line 17, leave out subsection (4).

Amendment 57, page 5, line 20, leave out “force” and insert “restraint”.

Amendment 58, page 5, line 21, leave out “force” and insert “restraint”.

Amendment 59, page 5, line 22, leave out “force” and insert “restraint”.

Amendment 60, page 5, line 23, leave out “force” and insert “restraint”.

Amendment 61, page 5, line 25, leave out “force” and insert “restraint”.

Amendment 62, page 5, line 26, leave out “force” and insert “restraint”.

Amendment 63, page 5, line 28, leave out “force” and insert “restraint”.

Amendment 64, page 5, line 31, leave out “force” and insert “restraint”.

Amendment 15, page 5, line 33, leave out paragraph (k).

Amendment 65, page 5, line 36, leave out “force” and insert “restraint”.

Amendment 66, page 5, line 38, leave out “force” and insert “restraint”.

Amendment 67, page 5, line 39, leave out “force” and insert “restraint”.

Amendment 68, page 5, line 40, leave out “force” and insert “restraint”.

Amendment 21, page 5, line 41, at end insert—

“(q) the relevant characteristics of the staff involved (if known)”

Amendment 16, page 5, line 43, at end insert—

‘(6A) Records must also be kept in the patient’s medical notes.”

Government amendment 5, page 6, line 5, leave out

“made by or under the Data Protection Act 1998”

and insert

“of the data protection legislation”

Amendments 5 and 6 are consequential on the Data Protection Act 2018.

Government amendment 6, page 6, line 6, at end insert—

‘( ) In subsection (8) “the data protection legislation” has the same meaning as in the Data Protection Act 2018 (see section 3 of that Act).”

Amendments 5 and 6 are consequential on the Data Protection Act 2018.

Amendment 17, page 6, line 7, leave out subsections (9) and (10).

Amendment 22, page 6, line 7, leave out from “(5)(k)” to “mean” and insert

“(5)(k) and (q) the ‘relevant characteristics’ in relation to a patient and member of staff”

Amendment 23, page 6, line 8, leave out “the patient’s” and insert “their”.

Amendment 24, page 6, line 9, leave out “the patient has” and insert “they have”.

Amendment 32, page 6, line 11, leave out paragraph (c).

Amendment 25, page 6, line 11, leave out “the patient’s” and insert “their”.

Amendment 26, page 6, line 12, leave out “the patient is” and insert “they are”.

Amendment 33, page 6, line 13, leave out paragraph (e).

Amendment 27, page 6, line 13, leave out “the patient’s” and insert “their”.

Amendment 34, page 6, line 14, leave out paragraph (f).

Amendment 28, page 6, line 14, leave out “the patient’s” and insert “their”.

Amendment 29, page 6, line 15, leave out “the patient’s” and insert “their”.

Amendment 35, page 6, line 16, leave out paragraph (h).

Amendment 30, page 6, line 16, leave out “the patient’s” and insert “their”.

Amendment 69, in clause 8, page 6, line 21, leave out “force” and insert “restraint”.

Amendment 70, page 6, line 22, leave out “force” and insert “restraint”.

Amendment 31, page 6, line 26, leave out “and (n)” and insert “(n) and (q)”.

Amendment 71, in clause 9, page 6, line 33, leave out “force” and insert “restraint”.

Amendment 72, page 6, line 35, leave out “force” and insert “restraint”.

Amendment 82, page 6, line 39, at end insert—

‘(2A) The report published under subsection (2) must make reference to the annual statistics published under section 8.”

This amendment, together with Amendments 83 to 85, would improve accountability and transparency in the progress towards reducing the overall use of force.

Amendment 83, page 6, line 39, at end insert—

‘(2B) The Secretary of State must make a statement to Parliament, as soon as practicable following the publication of report under subsection (2).”

See explanatory statement for Amendment 82.

Amendment 84, page 6, line 41, leave out “and”.

See explanatory statement for Amendment 82.

Amendment 85, page 6, line 41, at end insert

“and the statement under subsection (2B).”

See explanatory statement for Amendment 82.

Amendment 73, page 7, line 2, leave out “force” and insert “restraint”.

Amendment 18, in clause 12, page 7, line 38, leave out “must take” and insert “should consider taking”.

Amendment 19, page 8, line 2, leave out “must wear it and” and insert

“should wear it and try to”

Amendment 20, page 8, line 6, leave out subsections (4) and (5).

Government amendment 7, in clause 13, page 8, line 32, leave out

“has the meaning given by section 2”

and insert

“means a person appointed under section 2(1)”

This improves the drafting of the definition of “responsible person”.

Amendment 74, page 8, line 42, leave out “force” and insert “restraint”.

Amendment 75, page 8, line 43, leave out “force” and insert “restraint”.

Amendment 76, page 8, line 46, leave out “force” and insert “restraint”.

Government motion to transfer clause 15.

Amendment 77, in clause 17, page 9, line 24, leave out “Force” and insert “Restraint”.

Amendment 78, in title, line 2, leave out “force” and insert “restraint”.

Government amendment 8, line 2, leave out “and similar institutions”.

This removes from the long title a reference to “similar institutions” as these are not covered by the Bill.

[Mr Reed]

rose—

[Philip Davies (Shipley) (Con)]

On a point of order, Mr Speaker. I am sorry to interrupt the hon. Member for Croydon North (Mr Reed), but I want to raise a matter of some importance. Also, I am sorry that I have not given you advance notice of this.

Mr Speaker, you are well regarded for your reputation of championing the rights of Back Benchers, but it has become apparent over the past few days that the rights of Back Benchers in this House are being massively curtailed. The deadline for tabling amendments for Fridays is Tuesday evening, which gives people the opportunity to consider the amendments that have been tabled. The timescale is the same for every Bill’s Report stage.

It has become apparent over the past day or so that the Government have a policy of saying that they will not agree to any amendments tabled unless they have at least eight days in which to consider them and to do a write-round of all Departments. That means that no Back Bencher has an opportunity to have any amendments that they table on Report accepted—the Government will automatically not accept those amendments because they have not had time to consider them. This means that the rights of Back Benchers are being massively curtailed, and also that laws will be passed that are not fit for purpose, because amendments that would otherwise have been accepted by the Government will not have been accepted. Will you look into this matter, Mr Speaker?

It seems to me that if Back Benchers are to have the opportunity to get their amendments accepted, we will need a new regime under which they will have to be tabled at least eight days before a Bill is considered; otherwise, we will have no chance. That would mean that the business of the House would have to be brought forward. Can you also confirm that, for anyone who has taken the time to table amendments to improve this Bill, the only way to have their amendments properly considered would be to ensure that we did not get to the end of our debate on these amendments today, meaning that proceedings would have to be rescheduled for a subsequent day, as that would give the Government time to consider whether to accept the amendments? Is that the only course of action open to a Back Bencher who has spent lots of time trying to improve the legislation?

[Mr Speaker]

I am grateful to the hon. Gentleman for his point of order, which is a source of some concern to me. Off the top of my head, it seems important to distinguish between two not altogether unrelated but, in important senses, separate matters. One is the question of the selection of amendments; the other is the question of the House’s treatment of them and the opportunity for treatment of them.

So far as selection is concerned, that is, as the hon. Gentleman knows, a matter for the Chair, and I will go about my duty in this matter the way that I have always done. I hope that I do this dispassionately but with a regard for Back Benchers. He and other colleagues will have discovered over the years that the views of the Government are not a matter of any particular interest or concern to me. If I think something should be selected, it will be selected.

Secondly, the hon. Gentleman will probably not be entirely surprised to know that I was not aware of any new intended arrangements being drawn up for the administrative convenience—I use that term non-pejoratively—of the Executive branch. That is not something of which a Whip has notified me. The Government might well think it most convenient to have rather longer, for the reasons that the hon. Gentleman has adduced, but it is not something of which I have been made aware. I think it would be useful to have knowledge of such a matter, but I do not think that anything can be done today. However, it would be a pity if Back Benchers were hampered in any way.

I would just add that in my limited experience—like the hon. Gentleman, I have never served in government, which I say as matter of some considerable pride—Governments are perfectly capable of operating quickly when it is convenient for them to do so, and of operating at a more leisurely pace when it is convenient for them to do so. If the hon. Gentleman is asking whether I have managed to discern the mindset of the Treasury Bench, I can say only two things. First, I have been here only 21 years, which is quite a short time in which to try to discern the mindset of those on the Treasury Bench. Secondly, if the hon. Gentleman were to think that I did understand fully the mindset of those on the Treasury Bench, he would be attributing to me an intellectual weight that I do not claim for myself.

If there are no further points of order for now, perhaps we can proceed with the oration of Mr Steve Reed.

[Mr Reed]

Thank you, Mr Speaker. I have sympathy for what the hon. Member for Shipley (Philip Davies) said, but I hope that during today’s debate we will find ways of achieving the objectives of his constructive amendments.

The Bill is known as Seni’s law after Seni Lewis, a young man from Thornton Heath in my constituency who died in 2010 after a period of severe and prolonged face-down restraint. Seni is one of too many people who have suffered unnecessary and avoidable deaths in our mental health services, and that comes alongside any number of unnecessary and avoidable injuries. Following the inquest into Seni’s death, the coroner’s verdict was clear that, without change, what happened to Seni will happen again, and it has already happened to others. That change is this Bill, and I am grateful for support from Members on both sides of the House, the Minister and every single professional and patient advocacy group working in the sector.

New clause 1 is probing. It arises from the fact that Seni Lewis’s parents, having suffered the trauma of the loss of their child in completely avoidable circumstances in 2010, had to fight the state for seven years simply to obtain an inquest to find out how their previously healthy 21-year-old son ended up dead on the floor in hospital. The coroner pointed to severe failings by the mental health trust, the police and the Crown Prosecution Service that led to delays in that inquest opening. The root cause of the problem was the insufficiently independent investigation conducted by the mental health trust into its own failings. The answer is to ensure that any death in such circumstances automatically triggers a fully independent investigation into the circumstances and causes of that death, with legal aid provided to the families of the deceased persons so that there is a level playing field for all parties taking part in the inquest.

Currently there is a huge disparity between how investigations are conducted for deaths in mental health units and those in other forms of state detention. When somebody dies in police custody, an external investigation by an independent national body happens automatically, but the same does not happen in a mental health setting. If a patient dies, the trust or private provider investigates itself or appoints another trust or individual to do so. That lack of accountability means that reports can be delayed or kept quiet, and can lack the necessary independence and rigour.

[Jeremy Quin (Horsham) (Con)]

I congratulate the hon. Gentleman on the progress of the Bill, which I hasten to say that I support, but I have a concern about new clause 1. I appreciate that he has tried to address it in subsection (7), which aims to avoid conflict with the coroners, and he may have dealt with my concern, but I was worried about the interaction between the new independent report, the coroner’s work and the work of the police, if that is relevant. The hon. Gentleman referred to the external reports produced in other custodial circumstances, so is he able to reassure the House that, were this proposal to go ahead, there would be no conflict between the different authorities: the coroner, the police and the author of the independent report that goes to the Secretary of State?

[Mr Reed]

The hon. Gentleman raises an important point, and I look forward to the comments of the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price). It is important that there is consistency across all forms of state detention so that those who suffer traumatic circumstances, or even death, are treated in the same way.

If lessons are not learned from such incidents, the chance to prevent further deaths is missed, and we end up with a series of what look like isolated tragic incidents, such as Seni’s death, that are actually part of a wider institutional problem that has not been recognised and therefore not dealt with. It is unacceptable that institutions responsible for the care of patients suffering from mental ill health are subject to less scrutiny than institutions that detain criminal suspects and prisoners. It is no wonder that the casework of the campaigning charity Inquest, which works with bereaved families, shows that so many people who rely on such services no longer have confidence in them.

Another barrier to justice for families is funding for legal representation. Dame Elish Angiolini’s excellent report concluded last year that

“families face an intrusive and complex mechanism for securing funding”,

because there

“is no legal aid for inquests other than in exceptional circumstances”.

The Angiolini report recommended that legal aid should be awarded to families in the case of deaths in police custody. The Government have accepted that there is a need to look at that in the Lord Chancellor’s review and, in the spirit of consensus that has characterised the development of the Bill, I would welcome an update from the Minister on what work is being done on that. It makes little sense not to extend legal aid to situations in a mental health unit, because we need consistency across all forms of state custody. The families of patients should certainly not be disadvantaged compared with other bereaved families, and new clause 2 would ensure that legal aid is available to family members in relation to an investigation of an unnatural death in a mental health unit.

I will briefly address some of the amendments tabled by the Government, the hon. Members for Shipley and for Christchurch (Sir Christopher Chope), and the right hon. Member for North Norfolk (Norman Lamb). I welcome their efforts to strengthen the Bill, which has progressed through the Commons with a real sense of consensus, both from the Minister, and from every professional body and patient advocacy active in the sector. It is important that such work continues during the Bill’s remaining stages and beyond.

On the scope of the Bill and which mental health units it applies to, the hon. Member for Christchurch tabled amendments 86, 87 and 92 to 95, which would extend the Bill’s scope to cover all independent providers of mental health care. The principle behind the amendments seems sound, because every patient, whether NHS or private, should be protected by the same rights. However, I know that the Minister has some concerns about the practicalities of extending the Bill’s scope in that way, not least about how wholly private providers would report data through NHS Digital and the limits of statutory guidance in that respect, so I look forward to her comments.

[Norman Lamb (North Norfolk) (LD)]

Does the hon. Gentleman share my view that whether the measure gets into the Bill or not, we need to reach a point at which data is provided from private providers and from the NHS in exactly the same way so that we can compare how people are treated on both sides of the divide?

[Mr Reed]

I absolutely agree. The Bill sets up a process and attempts to change the culture of the services, and I hope that the Bill’s successful passage will not be the end of that process. The right hon. Gentleman’s point needs to be taken into account.

[Sir Christopher Chope (Christchurch) (Con)]

I am grateful to the hon. Gentleman for his indication of support for these amendments. When the Government have explained to him why they cannot deal with them, have they explained how the objections he has raised do not occur where the treatment is provided in part by the NHS but not in toto?

[Mr Reed]

As the Minister is present, it is probably best to allow her to speak for herself, rather than for me to attempt to interpret this on her behalf.

I wish to turn next to the amendments tabled by the right hon. Member for North Norfolk, many of which I support in principle, having raised a number of them myself at previous stages. I am broadly satisfied that many, if not most, of the points will be dealt with through guidance issued by the Department after the legislation, but I look forward to the Minister’s further comments and explanations on those points.

Important additions have been made to what falls under the definition of “use of force” as this Bill has developed. One is the use of “chemical restraint”, which amendments 88 to 91, standing in the name of the hon. Member for Christchurch, would remove from the Bill. I am afraid that I cannot support those amendments, because the potential effect is that the Bill could limit the use of physical restraint, only to lead instead to an increase in the use of medication—for example, rapid tranquilisation. It is important therefore that the Bill covers all forms of restraint, both physical and chemical.

[Sir Christopher Chope]

I tabled these amendments on the basis of a sad, current constituency case involving the parents of a very ill young man of 25. He is in and out of a mental health unit, and normally he is in there because he has failed to take his medication. It is designed to reduce the need for force, because he would be violent without it. Surely, the giving of such medication to a person in the circumstances I have described should not be regarded as “force” under the Bill.

[Mr Reed]

I hear what the hon. Gentleman is saying, but the point remains: if we take measures to deal with only physical restraint but not chemical restraint, we may simply push the services to use chemical restraint, such as rapid tranquilisation, more frequently and we would not wish to see that as an unintended consequence of amending the Bill further.

On the nature of the use of force, the hon. Member for Shipley has tabled amendments 44 to 78, which would replace the word “force” with the term “ restraint” throughout the Bill. I do not wish to pre-empt his reasons for doing that, and I suspect he will explain himself well later this morning, but let me say that we used the term “restraint” rather than “force” during an earlier draft of the Bill, so I agree with the general intention behind these amendments. I was persuaded, however, that the current wording ensures greater consistency with other legislation and therefore that the Bill does not run the risk of adding confusion into how the professionals interpret the language used.

The right hon. Member for North Norfolk has tabled a number of amendments dealing with the information provided to patients. Amendment 38 would include in the information given to patients details of their right to independent advocacy, which would help the patient to make the right decisions about their care and involve, where appropriate, carers and families. I certainly agree on the need to give more power to service users, so I would gently encourage the Minister to set out how those objectives might be achieved.

The Bill, as amended in Committee, says that information does not need to be provided where it would “cause the patient distress”. I understand that the hon. Member for Christchurch also has concerns about that, which is why both he and the right hon. Gentleman have tabled amendments to remove that potential loophole. I agree on this, and following discussions with the Minister, I am happy to accept Government amendments 1 to 3, which remove this “distress” loophole.

On staff training, the hon. Member for Shipley has tabled amendments 11 and 12, which seek to strengthen the Bill by adding usefully to the list of training topics. I know that he has discussed the Bill with his local care trust, and I welcome that spirit of engagement and representation. Amendment 11 would require training to be given on “roles, responsibilities and procedure” if the police are called to a mental health unit, as happened in the case of Seni Lewis and in many others. That strikes me as a sensible addition to the Bill, ensuring a more joined-up approach between police officers and staff in mental health units. Amendment 12 would also strengthen the Bill. It would add

“awareness of acute behavioural disturbance”

to the list of training topics. That is clearly a valuable thing for staff to be aware of in terms of how restraint may affect someone displaying behavioural disturbance. I support amendments 11 and 12, but before accepting them, it is important to hear whether the Government intend to deal with them through guidance.

There are, however, amendments that I am not happy to accept. Amendment 9 would remove the need for training on diversity, but that is a crucial part of the improved training and it goes to the heart of the Bill’s purpose in ensuring equal treatment for everybody by identifying those areas where treatment is not being delivered equally to everybody, whether because of ethnicity, type of disability or gender. If we do not capture that data, we cannot see the problem, and if we do not recognise the problem, we cannot put in place the measures to deal with it. Therefore, I cannot support that amendment.

[Jeremy Quin]

I wonder whether the hon. Gentleman has any thoughts on amendment 113, which I do not think will be debated. It was tabled by my hon. Friend the Member for Witney (Robert Courts) and it seeks to define what “regular intervals” are and whether there should be annual training. At the moment, the training is to be given at “regular intervals”, so does the hon. Gentleman have any thoughts on how regular those intervals should be and whether there should be an annual stipulation?

[Mr Reed]

I agree with the sentiment, but I do not think that the Bill should be too prescriptive. It is for the Government, working with professionals in the field, to determine the appropriate period within which refresher training should take place. However, it should definitely take place, because training done several years previously can easily be forgotten or the circumstances can change. There is always a need to keep professional practice absolutely up to date.

Research shows that there are real fears about unconscious bias in our mental health services. The Angiolini review, published by the Government last year, shows how a disproportionate number of people from black, Asian and minority ethnic communities have died after the use of force in custody. Black people are four times more likely to be sectioned than white people. Training must reflect those challenges and consideration must be given to the effects of that kind of unconscious bias.

There are also concerns, as shown in amendment 13, proposed by the hon. Member for Shipley, about the frequency with which staff receive training—indeed that point has just been made in this debate. The principle of refresher training is important and the Bill deliberately does not specify how often it is provided, as that needs to be up to the Government, in consultation with professionals. I welcome and accept Government amendment 4, which ensures that training need not be undertaken by a member of staff if they have recently been trained to an equivalent standard.

Turning to the recording of data, the Bill sets out what should be recorded by mental health units when using force, and this is how trusts will be held accountable for the types and frequency of restraint used, as well as which patients they use it on. A number of amendments have been tabled on this issue, and I will deal with a few of them. I appreciate that there is concern about the provision in clause 7(2), which provides that the use of “negligible” force does not have to be recorded; amendments 102, 103 and 39 seek to remove the subsection. I shared similar concerns at an earlier stage of the Bill because I, too, feared that this might be a loophole. The reason this provision is in the Bill is that we want to avoid unnecessary burdens on staff, who might feel otherwise that they have to record every physical contact, such as guiding a patient through a door by the elbow. Such recording would be unnecessary and it is important that the Bill does not set up such circumstances.

I welcome the Minister’s assurance that the definition of “negligible” will be very tightly defined in the guidance, and I hope that gives the proposers of those amendments reassurance on the point that was behind them. The Minister has shown real commitment to building consensus on this Bill as it is has developed and I am sure she will do the same on the guidance. I hope that that encourages those Members not to press those amendments to a vote.

On what data should be recorded and why, I note that the hon. Member for Shipley proposes that the characteristics of staff who carry out restrain should also be recorded. That makes sense to me in principle, and the point has been made to me by people who work in the sector. There are real concerns about pre-existing prejudice against people with mental ill health, which might lead to inappropriate behaviour by some staff if it is not identified and corrected. However, up to this stage in the Bill’s development, there has been no engagement with the sector on this point, and the opinions and experience of those who work in the sector must be taken into account before we legislate. I look forward to hearing the Minister’s views on that, but my preference is for the issue to be considered through consultation, after legislation, and to be dealt with through guidance, if necessary.

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[Philip Davies]

My hon. Friend is absolutely right. He has made the point that I was literally just about to make. The use of force is defined as being physical restraint, mechanical restraint and chemical restraint. I reiterate my earlier point that, quite clearly, the most appropriate term to use is “use of restraint”. That is what the definition of the use of force is in the Bill. It sounds more sinister than it actually is, and that is clearly more appropriate terminology. I have tabled more than 60 amendments, but that point deals with more than 30 of them—about 35—in one fell swoop. I hope that other Members will accept that “use of restraint” is the more appropriate terminology.

Let me move on now to my other amendments. Amendment 9 to clause 5, which is about training on the appropriate use of force, would remove paragraph (c), which is about

“showing respect for diversity generally”.

The hon. Member for Croydon North mentioned that earlier. Restoring the faith of the public in their services is a key element and purpose of this Bill, and why not? We should all have the confidence and reassurance of knowing that when we go to any public service, we will be treated properly. However, when it suggests that illnesses are not diagnosed in proportion to the demographics of our society, I question whether people will draw the wrong conclusion from that. We could question whether anything in our daily lives mirrors social demographics. Of course it does not; it would be absurd to think that it does. What we need to keep in mind is that any illness, and specifically mental illness, is not selective in whom it touches and the outcomes that it can cause. It does not discriminate by people’s ethnicity, sexual orientation, religious belief or gender or in any other way. Mental illness is a very complicated and personal experience, which—as is well documented—can have a harrowing and life-changing effect on those who are directly affected by it, and on the people and families around them.

It has been argued that different ethnic groups have different rates and experiences of mental health problems, with people from black, Asian and minority ethnic groups in the UK more likely to be diagnosed with mental health problems and more likely to experience a poor treatment outcome. It is documented that for every 1,000 people of the black/black British population, approximately 41 are in contact with secondary mental health services. What is not mentioned so much is that for every 1,000 people of the white British population, approximately 37 are in contact with the same level of service. In actual numbers, 1.3 million of the total 1.5 million patients in contact with this service are of a white ethnicity, so the use of the ratio format instead of the actual figures over-exaggerates a point that is already not entirely convincing. For example, for every 1,000 people of the Asian/Asian British population, approximately 26 are also receiving secondary mental health care. In actual numbers, this is approximately 69,000 patients—higher than the total of mixed ethnicity and other ethnic groups combined, and 16,000 patients more than the black/black British category.

I do not want to make it sound like a competition for numbers; it clearly is not. These numbers represent people. But the Bill currently makes it appear as though this is an issue that only affects one ethnicity, when that is quite clearly far from the case. The suggestion that there should be a conscious overview of regulating the diagnosis and treatment of a patient not according to their symptoms, but according to their ethnic background, may result in turning it into a competition. By putting in place such measures, the good intentions of stopping ethnic discrimination—the existence of which is already questionable—would instead create discrimination against those who are not of a BAME background or, more specifically, not of black/black British ethnicity. This would therefore generate another problem altogether. In the simplest of terms, asking to provide further intensive training on unconscious bias and diversity, on top of what has already been established at the core of the service that is currently being provided, not only creates an unnecessary segregation among patients but is patronising towards staff to an unwarranted level.

I draw a parallel with the stop-and-search issues in London. It seems to me that a very well-meaning intention to stop a disproportionate number of black people being stopped and searched has led—directly or indirectly—to an increase in the amount of knife crime in London and in the number of people who are dying as a result of knife crime in London. I might add that it is largely young black men who have been the victims of that well-meaning policy.

I fear that mental health staff, rather than being asked to treat people exactly the same irrespective of their backgrounds, may well—directly, indirectly or because they feel some pressure—start to treat people differently as a result. That will have serious consequences. I fear that it is some people from black and minority ethnic backgrounds will who suffer most and not get the treatment they should as a result.

[Mr Reed]

Surely the point about an unconscious bias is that it is unconscious. If we do not collect the data and evidence to show what is happening to a particular group, it will continue to happen because no one has interrogated the data to understand what the problem is. For instance, women are more likely to be restrained than men in mental health services. More women are restrained than men, even though there are more men present in mental health services. If we do not understand why that is happening, we cannot do anything to correct it.

[Philip Davies]

I understand the hon. Gentleman’s point and I am not totally unsympathetic towards it. My fear is what will happen as a result of such a measure and the impact on staff, who have a very difficult job. Their job is difficult enough as it is and they do a great job. When we are passing legislation like this, it is important to say—at least in passing—how much we appreciate what staff do in many of these places. They are doing their best, often under difficult circumstances and with limited resources. I do not want these people, who are working their socks off, to think that we are trying to kick them in the teeth and tell them that they are not doing a good job. On the whole, they are doing a very good job.

My point is that their job is difficult enough as it is and I fear that it will be made even harder when, in effect, they are subconsciously given the message, “Oh, you’ll want to be careful what you do with different minority groups, because you may be accused of being racist if you’re using restraint on too many people from a particular background.” That is exactly what happened to the police with stop and search, when they were told, “Even though you should be stopping and searching people, don’t bother doing it with somebody from a particular ethnic background, because you might be accused of being racist if, when it’s all totted up, you’ve stopped more black people than white people.” We should not put people in that kind of situation.

[Mr Reed]

But nobody, in this Bill or elsewhere, is advocating proportionality in the way in which restraint is used. We are merely trying to ensure that the factors that may underpin unconscious bias are understood and articulated.

[Philip Davies]

The hon. Gentleman’s motives are entirely honourable and decent, and I support them 100%. My fear is about what will happen in practice, because of the evidence of what happened with stop and search in London, to be perfectly honest. Exactly the same thing happened in that case, so it is not as if we have no evidence on which to base this fear. If the hon. Gentleman speaks to police officers, they will tell him that they were petrified of stopping people from a particular ethnic background because they feared they would be castigated for being racist. That is absolutely what happened. All I am saying is that my fear is that that may well happen as a result of this legislation, although I accept that it is not the hon. Gentleman’s intention.

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[Philip Davies]

That is a very good point. I had not mentioned that people might be moved from one institution to another, but that, of course, makes the amendment even more important. I am not in favour of excessive bureaucracy, but that strikes me as being an essential part of what the Bill is intended to achieve. The purpose of my amendment 16 is to deliver the Bill’s original aim. In fact, that is the theme of all my amendments. They are certainly not intended to weaken the Bill; if anything, they are intended to encourage the hon. Member for Croydon North to go further. The amendment is not just something nice to tag on to the Bill. I think that it goes to the heart of what the Bill should be about. Restraint techniques should be documented in medical notes to provide other medical practitioners who are treating the same patient with an overview of how that individual patient responds to the use of that form of restraint. I cannot see why that should not be part of the Bill.

[Mr Reed]

I am sorry to intervene on the hon. Gentleman—I know that he is trying to be as brief and succinct as he can possibly be. [Laughter.] I take his point about medical records. I—like him, I suspect—believe strongly in patient empowerment, and I think that there is a case for the inclusion of records of restraint in patients’ medical notes. However, I am loth to support changes in the Bill when we have not consulted either patient groups or medical professionals. Given that it is possible to make this change through guidance after the Bill is enacted, if the Minister will give an assurance to that effect, I shall be content to deal with the issue in that way, because that would meet the objective for which the hon. Gentleman is arguing.

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“would be investigated as a Serious Incident…in line with NHS England’s “Serious Incident Framework”. Once an SI has been identified we have 12 weeks in which to complete our root cause investigation and report. The family of the deceased would be invited to be involved in that process from the outset…the only thing that might prevent us from proceeding with an SI investigation would be if the police told us not to for fear of prejudicing their own investigation. In other words, the initial NHS-led investigation would be very quick. I cannot speak for the police’s internal investigation. If an independent, external review is also required that can take a very long time (which might be an unintended negative effect of insisting that all inpatient deaths are automatically subject to external review).”

[Mr Reed]

I look forward to hearing the Minister address that point because I believe that she has proposals on how we take this forward. May I just take this opportunity to welcome to the Chamber Seni Lewis’s parents, Aji and Conrad Lewis? Following the tragic death of their son in 2010, they had to fight for seven years, because of a botched internal investigation, to secure an inquest to find out what had happened to their son and why he had died, and to secure the modicum of justice that surely they, as bereaved parents, deserved right from the start.

[Philip Davies]

I am very grateful for that intervention, and I also very much welcome them and salute them for everything they have done in Mr Lewis’s honour. I would just say two things to them. First, they have a fantastic Member of Parliament who has done a great job representing their interests in the House—they should be very proud of their Member of Parliament. Secondly, we are all agreed that it is essential that this House passes laws—through this Bill, we hope—that will ensure that what happened to Mr Lewis will never happen to anybody else ever again. That unites everybody in this debate, whatever our individual views on any particular amendment.

[Philip Davies]

I hear what the right hon. Gentleman says, but clearly he has not heard what I have said. The Bill would not be lost, as he well knows. He has been here long enough to know exactly how procedure works in the House. As the Bill has already started its Report stage, it would very easily slot to the top of the queue on a future date, when it could go through. I hope that it would go through in a better state, once the Government have had time to look at the amendments that they need to consider in order to make the changes to the Bill that the hon. Member for Croydon North has agreed should be made. All I am trying to do is to deliver what the hon. Gentleman wants in the Bill.

[Mr Reed]

Although I agree with the hon. Gentleman that I would like to see changes, I am perfectly happy to accept the Minister’s assurances about dealing with them through guidance.

[Philip Davies]

We have been around that issue, so I do not intend to revisit it again. The fundamental amendments 11 and 12, which I have addressed at some length, go to the heart of what happened to Mr Lewis on that terrible occasion. They would ensure that training was given to staff to ensure that those things could not happen again. It is therefore essential that those amendments are made to the Bill and that these things are not just dealt with as part of guidance, which may or may not then be covered off by individual trusts. We have a duty to make sure that the things that happened to Mr Lewis are absolutely covered in the training given to staff.

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[Philip Davies]

On that basis, my hon. Friend is basically saying, “Let’s get a Bill with a nice title, with any old nice-sounding provisions in it, and bang it on to the statute book without any scrutiny whatsoever.” The whole point of Report is to try to improve Bills. I am still confident that people will decide that what I am saying is sensible, because the amendments are sensible improvements to the Bill. It is not my fault that the Government cannot carry out their decision making in time. To address the point raised by the hon. Member for Croydon Central (Sarah Jones), the whole point of requiring amendments to be tabled by Tuesday evening prior to their being debated on Friday is to give people time to consider them.

[Mr Reed]

If the hon. Gentleman were generous enough to draw his remarks to a close within a reasonably short period of time, the Minister would be able to put on record how the Government intend to deal with some of the issues that he quite rightly and legitimately raises. My belief is that there are other ways of dealing with them that would allow the Bill to proceed today.

[Philip Davies]

Yes, that point has been raised. Basically, we are going to cover everything that is not in the Bill but should be in guidance. It seems that the Minister has made it abundantly clear that she is hardening her position as every minute goes by. We have gone from a situation of her saying, “If only we’d had the amendments earlier, we would have done something about them,” to, “They’re not necessary,” and now to, “We don’t agree with any of them.” The latest indication is that the Government do not agree with any of them.

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I have already said that clause 7 does not make sufficient reference to family and relatives, and other amendments to the Bill are of less significance than those tabled by my hon. Friend the Member for Shipley. I hope that when responding to the debate, the hon. Member for Croydon North will reinforce the view that amendments 11 and 12 go to the heart of this matter. The issues that were dealt with in extenso by my hon. Friend were highly informative and persuasive. It may be that there is just a technical problem as far as the Government are concerned, but that they buy into the idea. Indeed, I am sure there is every possibility that they might buy into it a bit more if, when he responds to the debate, the hon. Member for Croydon North makes clear that he strongly supports amendments 11 and 12, as do I.

[Mr Reed]

I am grateful to right hon. and hon. Members across the Chamber for the constructive way in which they have engaged with this debate, and for the kind comments thrown my way. It is important to say, however, that this Bill is the work of many people who have contributed to its development and to getting it to its current stage. I hope that this debate is a further contribution to strengthening the Bill and the shape that we have it in now. That includes the many campaign groups and advocacy groups outside the Chamber that have been working with me and with the Government, as well as the Government’s officials, who have been extremely helpful all the way through.

The driving force behind this Bill is something that the coroner said when we held the inquest into the death of Seni Lewis. Seni died in 2010 but we only got the coroner’s verdict in June 2017, while the general election was under way. She said that if things did not change to address the failings that led to Seni’s death, there would be more deaths of that kind. Seni was one of many people who died unnecessarily because of failings in the system and many, many others have been injured because of those failings. Report after report coming out of inquiry after inquiry, and inquest after inquest, pointed to what the problems were, but they were not being picked up by the system, nor lessons learned to keep people safe in future. The coroner said clearly that change must come. That change is this Bill, and I am grateful to everybody who has brought us to this point today.

I have a couple of specific thank yous. I pay particular tribute to the Minister, who has been robust and clear in her support for the Bill right from the start. She has been absolutely clear about the commitments that she could make as a Minister and has delivered on those, so I am immensely grateful to her. In my opinion, we are very lucky to have her as the Minister.

Above all, I pay tribute to the family—to Seni’s parents, Aji and Conrad Lewis, who are with us today, because the real reason we are here is the profound depth of love that they have for their son, who was lost in such tragic circumstances. That love has driven them to campaign for justice, not just for their son, but for everybody using mental health services. Their profound wish is that Seni did not die in vain, so this Bill is dedicated to them and to Seni. It his legacy and his testament, and because of this Bill no one else will need to suffer in the way that Seni did.

On the basis of the Minister’s assurances at the Dispatch Box, I am happy to withdraw my new clause 1 and not to press new clause 2, and I look forward to the further progress of the Bill. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

Clause 4

Information about use of force

Amendments made: 1, page 3, line 16, at end insert—

“unless the patient (where paragraph (a) applies) or the other person (where paragraph (b) applies) refuses the information.”

This allows for cases where a person refuses the information provided, and supersedes subsections (9)(a) and (10)(a).

Amendment 2, page 3, line 22, leave out subsection (5) and insert—

“(5) The responsible person must take whatever steps are reasonably practicable to ensure that the patient is aware of the information and understands it.”

This expands the duty to provide information accessibly so that it requires the responsible person to take whatever steps are reasonably practicable to ensure the patient understands.

Amendment 3, page 3, line 33, leave out subsections (9) and (10).—(Jackie Doyle-Price.)

Subsections (9)(a) and (10)(a) are superseded by Amendment 1. Subsections (9)(b) and (10)(b) are unnecessary as the information will not be of a nature that would cause distress.

Clause 5

Training in appropriate use of force

Amendment proposed: 11, page 4, line 18, at end insert—

“(l) the roles, responsibilities and procedure in the event of police involvement,”.—(Philip Davies.)

Question put, That the amendment be made.

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[Mr Reed]

I beg to move, That the Bill be now read the Third time.

Given that we have only nine minutes, I shall be extremely brief. I am grateful to Members from all parties for their support for the Bill’s intentions and ambitions. Having spoken to many advocacy and professional groups outside the House, I know that the Bill in its current state will, if passed, give the United Kingdom some of the best legislation in the world to protect mental health patients from abusive or excessive restraint. That is exactly as it should be.

The Bill will make a difference in four broad areas. First, on accountability, by requiring the appointment of a named senior manager in each mental health unit to be accountable for the existence and implementation of a policy governing the use of restraint and its reduction, the Bill will ensure clear and direct accountability for how restraint is used.

By standardising the reporting of incidents of restraint throughout the country so that they are recorded in exactly the same way against the same demographics, we will be able to see for the first time where the best practice really is, so that it can be spread. That will also allow us to scrutinise the data so that if particular groups—for example, women, BME people, young men and people with disabilities—are subject to more frequent or more severe forms of restraint than other groups, that can be corrected.

According to academic research, the requirement on the police, when operationally practicable, to wear body cameras in and of itself reduces the likelihood of restraint being used by the police by 50%. That alone makes it worth doing, but it also protects the police against vexatious complaints and provides evidence when things do go wrong so that lessons can be properly learned to prevent any repetition.

I am grateful for the Minister’s comments on Report about the investigation of deaths. It is important that those investigations happen immediately following a death or serious incident, and it is critical that they are sufficiently independent to allow people to learn what has gone wrong to prevent any repetition and deliver justice to the family of any victim. It is important, too, that there is consistency among all forms of state custody and that mental health custody is not treated disadvantageously compared with police or prison custody, so I welcome the Minister’s commitment to achieve that through the deaths in custody panel that she co-chairs.

I said that I would be brief, and I will to stick to my word. The Bill is an important step away from the containment of people who are mentally ill towards treating them with the care and compassion that their circumstances deserve. It will give this country mental health services that are fair and equal for everybody.

Mental Health Units (Use of Force) Bill

Steve Reed Excerpts

3rd reading: House of Commons
Friday 6th July 2018 Commons Chamber

[Mr Steve Reed (Croydon North) (Lab/Co-op)]

I would like to make a few concluding remarks. I have already spoken on the Bill, so I am grateful for this opportunity but do not intend to speak at length.

Perhaps I could start by acknowledging the presence in the Chamber of Seni’s parents, Aji and Conrad Lewis—we are delighted and proud to have them here—and also Marcia Rigg, who lost her brother Sean in very similar circumstances. Although the Bill is called Seni’s law, in honour of Seni, it has affected many people beyond Seni who have lost their lives or been injured simply because they were unwell, and the purpose of the Bill is to make sure that that cannot happen again.

This week we have marked the 70th anniversary of the national health service—one of the greatest things this House has ever created. What better way to celebrate that occasion than by giving the NHS a birthday present to make it even better, creating some of the best protections anywhere in the world for people with mental ill health? That is a wonderful way to celebrate the 70th anniversary of an institution that everybody in this country is so very proud of.

My thanks go to the many people who have had a hand in the Bill, from the Minister to Members on both sides of the House, but most of all to the families who have led the campaign to get this law on the statute book. I cannot put it better than Seni’s father, Conrad, did three weeks ago, when we concluded the Report stage of the Bill. We were standing outside in the Members’ Lobby and somebody came up to Conrad and asked him, “How do you feel about today?” He said, “I bear a burden that I will have to carry for the rest of my life. It is a burden I wouldn’t wish on my worst enemy, and I don’t want any other parent to have to carry that burden.” This is our chance to make mental health services safe and equal for everyone. I am confident that the House will seize that chance, and in doing so, we will create a lasting and proud legacy for Seni Lewis.

Question put and agreed to.

Bill accordingly read the Third time and passed.