Local Contact Tracing

Steve Reed Excerpts

Wednesday 14th October 2020 Commons Chamber

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

Our country faces an unprecedented health crisis as we battle covid-19. No Government could be expected to get everything right first time, but a competent Government would learn as they go along, recognise their mistakes and put them right. Tragically for our country, this Government’s incompetence continues to put lives and livelihoods at risk. I am grateful to the Members who have detailed that failure up and down the country—there were too many on the Opposition Benches to name them individually, but was it not notable how few Conservative MPs came to speak in defence of the Government’s record of failure?

A second spike in infections was never inevitable, and nor were the restrictions and lockdowns that are now necessary to consign it. They are the result of this Government’s failure to control the spread of the virus. There are two reasons why the Government keep getting it wrong: the first is their urge to over-centralise control, so that they fail to use the experience and expertise on the frontline; the second is their dogmatic urge to marketise everything, bypassing procurement rules to hand out multibillion-pound contracts to Conservative party cronies who lack the skills to do the job. That is how they got it wrong on PPE distribution, on testing, on shielding and on contact tracing. They keep repeating the same mistakes because they refuse to listen.

I have been listening to council leaders since the start of the pandemic. As far back as April, they told me that the Government were not listening to them about contact tracing, even though local government is where the country’s experts work. Public health directors and their teams have years of experience of mapping how infections spread, contacting those at risk and containing the spread. They know how their local community moves around, they know where the transmission hotspots are and they know how to communicate best with their local communities on how to keep safe. The expertise exists up and down the country, but the Government chose to ignore it.

Instead, the Government wasted months and millions of pounds on the shambolic development of an app on the Isle of Wight that never worked. They spent more than £11 billion on outsourced contracts and an army of management consultants, including Serco, whose contact-tracing system SAGE now tells us needs a major overhaul because of its

“relatively low levels of engagement”

and

“marginal impact”.

They spent £11 billion on that. And as we have heard this evening, some Boston Consulting Group managers are paid the equivalent of annual salaries of £1.5 million for their role in this Government failure. It is a disgrace.

The Government knew that they could not open up society or the economy safely without a functioning track and trace system. Without it, a second spike and a second lockdown became inevitable. The Prime Minister and his Cabinet chased the headlines rather than chasing down the virus, and we have ended up where we are today. The only thing this Government are world beaters in is incompetence. Nineteen of the 20 areas that have been in local lockdowns for more than two months have seen infection rates rise, not fall, because contact tracing is not working. We all have constituents who have tested positive telling us they are contacted only towards the end of their period of self-isolation, when it is too late to stop their contacts spreading the infection. That is why the R is rising.

Without a functioning track and trace system, the Government’s tiered system of restrictions is too weak to stop the virus spreading, but severe enough to cause economic harm. They have managed to find a way to lose on both fronts: damaging the economy, but without fully protecting the public. The answers are there if only the Government would listen. We have already heard how a locally led tracing system contacts over 97% of affected people in Cumbria, while the Government’s failing national system contacts barely two in five people in Slough.

The way to fix track and trace is to put the experts on the frontline in charge of public and private partnerships. We cannot let this Government’s blinkered over-centralising dogma stand in the way of public health. This is a great country and we can revive the economy after the pandemic, but we cannot revive the dead. This Government’s incompetence is lethal. We need them to get a grip, recognise that they have failed, and set free those who are best placed to fix contact tracing and stop the virus spreading in every community up and down the land.

Testing of NHS and Social Care Staff

Steve Reed Excerpts

Wednesday 24th June 2020 Commons Chamber

That this House expresses thanks to the heroic work of frontline NHS staff who have saved lives throughout the Covid-19 pandemic; pays tribute to the at least 312 NHS and Social Care staff who have died of coronavirus in the United Kingdom; recognises the impact that coronavirus will have upon the NHS to deliver routine care including mental health care without additional Government support; notes that NHS waiting lists are projected to reach 10 million by the end of 2020, that cancer referrals fell 60 per cent during the peak of the coronavirus lockdown and that four out of five children have reported their mental health has got worse during the pandemic; further notes that there is a backlog of NHS care that needs to be tackled and that it is vital to prepare NHS services to deliver safe care alongside care for coronavirus, including preparing for winter and ensuring necessary supplies of PPE and medicine; and recognises the unprecedented action the Government has taken in its tireless efforts against Coronavirus to protect the NHS and save lives.

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

On a point of order, Madam Deputy Speaker. Has the Speaker received notification from the Secretary of State for Communities that he wishes to give a statement on the documents he has recently released regarding the Westferry decision? There appear to be significant discrepancies between what the Secretary of State told the House and what is revealed in the documents, specifically: that he did not immediately notify officials following his dinner with the applicant, Richard Desmond; that rather than closing discussion down with the developer as the Secretary of State implied, he instead initiated contact with him the next day via text; and that the letters confirm that he rushed through the decision deliberately to help the developer avoid a £30 million to £50 million levy payable to Tower Hamlets Council.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the hon. Gentleman for that point of order. I have received no notification that the Secretary of State intends to make a statement, but those on the Treasury Bench will have heard his comments. It is obviously up to Ministers to come to the House if they wish to say anything to correct the record through a statement or any other means.

Mental Health Act 1983

Steve Reed Excerpts

Thursday 25th July 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) for a very moving opening speech. It was a very brave speech, because he was sharing difficult personal experiences, and that made it all the more compelling.

I want to focus on the use of restraint, which is one of the four key issues that the review covers. Last year, Parliament passed my private Member’s Bill, which became known as the Mental Health Units (Use of Force) Act 2018, but is better known as Seni’s law. I was very grateful to the Minister for her support on the Bill, which introduced a system for reducing the use of abusive and coercive restraint in mental health settings. It establishes in law, for the first time, some very important principles, including the need for trauma-informed care. Some of the principles in the Act, which was of necessity relatively narrowly drawn, could and should be applied more widely. That is the point I hope to impress on the Minister this afternoon.

Perhaps I can remind colleagues of the human story behind Seni’s law—the Minister knows it, but other colleagues might not. Seni Lewis was a young graduate aged just 21. His parents found him having a traumatic mental health episode at home one Sunday morning, something he had never experienced before. They took him to the local hospital, expecting to find the care that he needed and deserved. He ended up at the Bethlem Royal Hospital, where his parents stayed with him until late evening before leaving to go home. Seni became very alarmed when he found out that he was alone, and he tried to leave. The hospital staff decided to section him and therefore tried to stop him leaving.

There were never any allegations that Seni threatened or assaulted anyone, but the hospital called the police. It ended up with 11 police officers dragging Seni, with his hands cuffed behind his head and legs in braces, into a seclusion unit, where they took turns sitting on him as he was pinned down on the floor. Seni’s spinal column was broken and he went into cardiac arrest, then into a coma. He died shortly afterwards.

Looking at the pictures of people who have died in mental health detention, we see many young black faces like Seni’s. Widely held prejudices about young black men and psychosis, drugs and aggression lead them to be subject to more severe treatment than other patients. In extreme cases such as Seni’s, it leads to death. It is a form of institutional racism, and we need to call it out and confront it.

I first met Seni’s parents three years after his death, just after I had been elected to Parliament in a by-election. They came to see me three years after this terrible incident because there had still been no inquest into his death, no public explanation of how or why their beloved son had died, no learning to prevent similar deaths in the future, no closure and no justice for Seni’s deeply distraught family. It was only after a very long public campaign and the intervention of the then Minister for mental health, the right hon. Member for North Norfolk (Norman Lamb), and the then Home Secretary, the right hon. Member for Maidenhead (Mrs May), that an inquest was finally opened, seven years after Seni’s death. It found that Seni had been subject to severe and prolonged restraint that had caused his death. It castigated the police and the mental health services and warned that, without change, other people in the mental health system would die in the future, just as too many have died in the past.

Seni’s law began as a cross-party attempt to start the process of change by creating a new national system for recording the use of restraint in mental health settings. We will soon be able to see what is happening in different mental health trusts and hospitals, and compare like with like to identify and spread best practice in reducing the use of abusive and coercive restraint. However, the same system needs to be extended to all settings where people with mental ill health might be subject to restraint, and I invite the Minister to comment on any plans she has to do that.

[David Hanson in the Chair]

The review makes it clear that we need to do more. Deaths in mental health settings should be investigated in the same way as deaths in any other form of state detention are investigated. When someone dies in prison or in a police cell, there is an automatic external investigation by an independent national body, which publishes a final report and shares what it has found. However, when someone dies in a mental health setting, as Seni Lewis did, there is no such fully independent investigation. In Seni’s case, the health trust investigated itself, and lessons that needed to be learned were not learned. Owing to errors by the Independent Police Complaints Commission, the Metropolitan police were able to block an inquest for a full seven years after his death. It should not be possible for the organisation under investigation to control the scope, timeliness, quality and content of the report on their own potential failure, because of the risk of a cover-up.

I pay special tribute to the powerful campaigning work on this issue that has been carried out by the charity Inquest. I fully support its demand for non-means-tested legal aid to be available to families at inquests, so that there is a level playing field between the bereaved family and the well-funded organisations accused of potential wrongdoing. Such investigations must be conducted by fully independent bodies that command the confidence of the public and bereaved families. By failing to learn from preventable mental health deaths, we condemn other vulnerable people to the same tragic fate.

Seni Lewis died in the most horrific circumstances, and his parents then had to fight for justice over seven years, just to find out what had gone wrong. Seni’s law stands as a testament to his life, but it is time to go further. The review of the Mental Health Act 1983 creates an opportunity to do so. We need to ensure that every bereaved family can get the justice they deserve. We need to ensure that, through a fully independent system, every lesson we need to learn is learned and acted on, so that we can keep every vulnerable person with mental ill health safe in future.

--- Later in debate ---

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

This is probably as well informed and good a debate as I have ever had to respond to. I hope I can do justice to all the good points that have been made, because we have covered all the key issues relating to how we better support people will mental ill health.

I associate myself with the comments about the personal speech of the hon. Member for Bermondsey and Old Southwark (Neil Coyle), which he made in such a dignified way that I was incredibly moved by his story. What struck me about the experiences that he detailed was that they were his normal, which brought it into stark relief that we are talking about the real day-to-day lives of human beings. It is incredible to hear what people have to cope with on a daily basis. He reminded us that the 1980s had the best pop music, and I was reminded of the “Karma Chameleon” lyric:

“Every day is like survival”.

When we are talking about people with severe mental ill health, every day is like survival, so I thank him for that.

The hon. Gentleman’s speech covered everything that we need to tackle and I do not disagree with anything he said. Obviously, some of the charges that he levelled at me are challenging and I do not want to duck them. Everybody is impatient that we are perhaps not doing as well as we would like in helping people with mental ill health. I share that impatience, but I will not promise that it can be sorted overnight. We are rolling out a significant increase in services and in the workforce to deliver them, which takes longer than anyone would wish.

I will try to address the points that have been made. It was a great pleasure to hear from the hon. Member for Croydon North (Mr Reed) and to support him in delivering Seni’s law. In connection with that law, he has reminded us that when deaths happen to people who are detained by the state, we absolutely owe it to their loved ones, and to the person who died, to be open with them. The truth is often anything but, because the associated institutions of the state collude to protect themselves. Other Ministers and I are determined that we are the servants of the people, and those institutions that are there to deliver services for the people should remember that and should engage in a spirit of openness.

I have met Seni’s parents and I could not admire them more for the dignity with which they have borne their experience and the good use that they have put it to. I genuinely feel guilty, however, that we have let them down. Hon. Members will be pleased to know that we have a ministerial board that investigates deaths in custody and what can be learned from them, but I emphasise that we—including colleagues in the Home Office and the Ministry of Justice who, along with me, sit on those boards—are becoming rather concerned that not enough progress has been made. I am glad to be in continued engagement with Inquest, which does a fantastic job advocating on behalf of bereaved families. We need to do more to learn from events when they go wrong.

[Mr Reed]

It is clear from the Minister’s comments that she cares passionately about the issues that we are talking about and for which she has responsibility. A consultation on the serious incident framework started in March 2018 with a promise that the findings would be published in spring 2019. From the temperature today, we know that we are way past spring and into summer, but we still do not have a date for when they will be published. Can the Minister share a date by which we might expect that to happen?

[Jackie Doyle-Price]

I cannot give the hon. Gentleman a straightforward answer to that question but I will write to him with a commitment. It is very boring, but Brexit has diverted officials in the Department. Obviously, no-deal preparations in the health service are a matter of public concern, so we need to make them, but we still need to get on with business as usual. It is an important issue.

The hon. Member for Worsley and Eccles South (Barbara Keeley) mentioned the case of Matthew Leahy. I will go away and reflect on that, but I will give the same message as I gave in response to Seni’s law. Generally, we need to get a proper grip on how we learn from deaths that happen when somebody is in the state’s care, because that is clearly unacceptable. We have coronial reports of all those occasions. People should not be waiting the length of time that they are waiting for inquests. When inquests happen, again, there is usually representation from the various institutions involved and the family can be left feeling very under-represented against a mass of organisations trying to avoid liability. We need to tackle that properly.

We have had those discussions at the ministerial board. My ministerial colleagues in other Departments and I want to get a grip on how we properly hoist in the learnings from coronial reports. I look forward to engaging with hon. Members on that, but I will write to the hon. Lady specifically on the issue of Matthew Leahy. It is worth noting that we are looking at the principles of sexual safety in wards, which is not just about getting rid of mixed-sex wards. People are very vulnerable in those situations and it is all about the care regime.

--- Later in debate ---

[Jackie Doyle-Price]

This comes back to housing. One challenge is getting access to a bed, and another is when the person comes to leave, because we need to discharge people into safe living environments. Are there enough supported housing solutions? No, not always, so the bed remains full. I am having conversations with colleagues in local government to see what more we can do to deliver more supported housing so we can get the pathway going. We could fix it by making more beds available, but that is not really the answer. I am concerned that the longer we leave people in in-patient care, the more harm we do. We have to get that movement through the system. Hopefully, if we do that, people will be less likely to grab the first bed because they can be confident that more will become available more frequently. That is where we need to get to. I appreciate that right now it feels desperate.

There is an issue with quality. The Care Quality Commission has a challenge in deciding whether more harm will be done by taking enforcement action on a place rather than working with it to improve. We see that writ large in TV programmes such as “Panorama”. There is a massive disparity in the quality of care. I challenge the CQC to be a lot more aggressive when we see poor standards of care.

The hon. Member for Bristol East mentioned private providers. People have heard of The Priory. They hear that celebrities go there and they think it is a centre of excellence. The truth is that the care there is less than optimal, but someone with a loved one who needs hospital treatment will not know that. We need the CQC to have a lot more teeth in terms of improving what comes out of its inspections. The system generally needs to support it in doing that.

[Mr Reed]

I am grateful to the Minister for giving me another opportunity to ask a question. While she is on housing, there is a growing issue of vulnerable young people and looked-after children being placed in unregulated, semi-supported homes or hostels. Some of them have severe mental ill health. When they are placed in such settings, they do not receive the support they require and become a danger to other people residing there. That happened in the awful case of Lance Scott Walker, a looked-after teenager in the care of Islington Council. He was placed in a hostel in Ealing, where he was stabbed to death by another young person with schizophrenia. It is clearly inappropriate for young people to be put in those kinds of setting. Is the Minister intervening with local authorities and the Department to try to prevent a repetition of that case?

[Jackie Doyle-Price]

I thank the hon. Gentleman for sharing that case. I was not aware of it. Some local authorities are not as good as they should be in discharging their responsibilities as corporate parents. It is clearly their duty to ensure that looked-after children are housed in an appropriate setting. That issue lies outside my purview, but I will take it up with colleagues in the Department for Education to ensure that we are properly enforcing our obligations towards looked-after children in relation to housing. That is clearly a concern to us.

Gosh—I have so much to get on to. The hon. Member for Bermondsey and Old Southwark talked in particular about Southwark and rightly challenged me by saying that seeing perhaps only 35% of children was not enough. I agree, but I have been really impressed by the efforts made by Southwark on mental health support for the school population. It illustrates the importance of good leadership and working collaboratively with other organisations. I was pleased to visit Charles Dickens Primary School—I do not know whether it is in his constituency.

Children and Mental Health Services

Steve Reed Excerpts

Tuesday 16th July 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Burton (Andrew Griffiths) on securing this important debate. I thank hon. Members on both sides of the House who have contributed some extremely moving testimony from their own lives and their experience as constituency MPs. I will refer to some of their contributions during my speech.

Fundamentally, children’s mental health services are in crisis because the funding is inadequate and prevention has been cut at a time when the pressures on children are higher than they have ever been. Difficulties in childhood, such as growing up in poverty or experiencing neglect, abuse or childhood bereavement, which my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) spoke about, can have a huge impact on a child’s mental health. There are also new pressures that affect all children, which many of us did not experience, such as the increase in exams and tests at school and the rise of social media, which has created new forms of bullying and has put new pressure on children in relation to their self-image and how they feel about their bodies.

I want to explore the issue of childhood trauma a little more, because it plays an important role in developing higher incidence of childhood mental ill health. There are three high-risk factors that indicate that a newborn baby’s life chances will be dramatically reduced: having a parent who is addicted to drugs or alcohol, having a parent with severe mental ill health, or witnessing a parent being subjected to domestic violence. Any one of those three factors creates a significant risk for the child, but shockingly 16,000 babies are born every year in this country to parents with all three of those risk factors.

Without intervention and support, those children have very little chance in life. They will become the young people committing knife crime. They will end up in the care system. They will fill our prisons, as my hon. Friend the Member for St Helens South and Whiston (Ms Rimmer) pointed out. They will end up living on the streets, develop mental ill health and die younger. My hon. Friend the Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) pointed out the alarming increase in the rate of suicides.

One in three mental health conditions relates directly to adverse childhood experiences. A study by Safelives shows that more than half of children who witness domestic violence develop behavioural problems and have difficulty forming relationships later in life. Their fragile young minds are deeply traumatised by seeing their mother beaten up by a violent and abusive partner in their home, which should be a safe space in which to grow up. Professionals do not always recognise that the problem underlying what they may term “difficult behaviour” may be mental ill health caused by traumatic experiences in earlier childhood. Professionals who work with children are not routinely trained in how trauma can affect behaviour, so the child does not get the help they really need. We need services to get dramatically better at identifying when challenging behaviour comes from trauma so we can treat the problem at source, rather than continuing to fail the child, who had precious little chance from the moment they were born.

Mental ill health affects not only the most vulnerable young people, of course. As we have heard, one in eight children experiences mental ill health, yet the recent NHS mental health prevalence survey found that only one in four young people with a mental disorder is seen by a mental health specialist. My right hon. Friend the Member for North Durham (Mr Jones) is right to call for better access to care. As my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury) said, on average it can take three visits to a GP before a child is referred for specialist assessment. They then have to wait an average of six months for treatment to start. Of course, there are far worse waiting periods. My hon. Friend the Member for Ashfield (Gloria De Piero) spoke about a 72-week wait, and my hon. Friend the Member for Barrow and Furness (John Woodcock) spoke about a young man, Drew, waiting 15 months for a CAMHS assessment. In that time, the child’s mental health condition gets worse. It is a very long time for the child, with very serious implications for the rest of their lives.

Many more severe mental health problems could be avoided if we invested more in early help and prevention. We know it works, but the cross-party Local Government Association points out that children’s services face a £3 billion funding shortfall, to which my hon. Friend the Member for Warrington South (Faisal Rashid) referred. That means that the lack of early intervention work is now reaching an absolute crisis point. This country is failing some of the most vulnerable children in our society and then blaming them for our failure to provide the help that they needed. Thousands of young people did not have a chance from the moment they were born.

I have the highest regard for the Minister from our previous interactions on related issues. I know that she is deeply committed to these issues, so I hope she will act on what she has heard today. I have some questions of my own to ask before she responds. Will she ring-fence NHS mental health budgets and require that they be spent on mental health services, rather than being reallocated elsewhere, as we are currently seeing? Will she invest in prevention and early help, rather than waiting for mental health problems that develop early in a child’s life to turn into crises as they grow up? Will she ensure that children’s services professionals are trained to recognise trauma and provide appropriate care that meets the child’s needs, rather than blaming them for behaviours that have arisen because of the trauma that they have experienced? Will she make sure babies born to parents with the highest risk factors get the support they need from the moment they are born, rather than allowing their lives to be written off and wasted? I hope very much that we will hear positive responses from the Minister, because no country that loves its children can keep treating them like this.

Whorlton Hall

Steve Reed Excerpts

Thursday 23rd May 2019 Commons Chamber

[Caroline Dinenage]

I am grateful to my hon. Friend for raising that, because it is the whistleblowers who have brought these concerns to everyone’s attention. It is deeply regrettable that whistleblowers brought this to people’s attention before, and it was investigated, but this abuse was not rooted out and stopped. We need more protection for whistleblowers. We have accepted some of the CQC’s recommendations on encouraging whistleblowers to come forward, and we are always looking at more ways to offer protection and encourage them to do so. It is always wrong when deeply disturbing practices have to be brought to light by those who shine a light on them.

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

Children with autism and learning disabilities are still being pinned face-down on the floor, tied to beds or locked up in seclusion rooms. The Government promised five years ago to publish guidance to prevent that kind of abuse, but they still have not done it. After Whorlton Hall, we desperately need a date. When will the Government publish that guidance?

[Caroline Dinenage]

The Secretary of State commissioned a report on exactly that—segregation and restrictive practice. It was published on Tuesday, and we have accepted all the recommendations. We are working very hard on this. There will be guidance, but it is more important than that. As shown in the TV programme last night, there was training and guidance on the restrictive practices to be implemented, but it was ignored, and restraint was recorded incorrectly. This is a much bigger issue than the one the hon. Gentleman highlights.

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.

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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

“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.

--- Later in debate ---

[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.

--- Later in debate ---

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.

--- Later in debate ---

[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 (Third sitting)

Steve Reed Excerpts

Wednesday 25th April 2018 Public Bill Committees

[The Chair]

I welcome the Committee back to consideration of the Bill, and bring apologies from Ms Buck, who is unable to be here today. You will have to make do with the second division—namely, me. Last night, the House agreed a money resolution on the Bill, which is very good news. That enables us to resume the line-by-line consideration that was curtailed.

Clause 7

Recording of use of force

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

I beg to move amendment 94, in clause 7, page 4, line 15, leave out subsection (1) and insert—

“(1) The responsible person for each mental health unit must keep a record of any use of force by staff who work in that unit in accordance with this section.”

This amendment replaces Clause 7(1) and inserts a revised duty on responsible persons to record the use of force in mental health units in accordance with that clause.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 88, in clause 7, page 4, line 15, at end insert—

“(1A) Subsection (1) does not apply in cases where the use of force is negligible.

(1B) Whether the use of force is ‘negligible’ for the purposes of subsection (1A) is to be determined in accordance with guidance published by the Secretary of State.

(1C) Section 6(1B) to (3B) apply to guidance published under this section as they apply to guidance published under section 6.”

This amendment would mean that the duty to record information regarding the use of force would not apply in cases where the use of force is negligible.

Amendment 37, in clause 7, page 4, line 16, leave out subsection (2).

This amendment removes the requirement for the Secretary of State to prescribe in regulations the information that must be recorded under Clause 7.

Amendment 38, in clause 7, page 4, line 18, leave out lines 18 and 19 and insert

“The record must include the following information—”.

This amendment is consequential on Amendment 37.

Amendment 39, in clause 7, page 4, line 19, at the end insert—

“( ) the reason for the use of force;”.

This amendment would require the responsible person to record the reason for a use of force.

Amendment 40, in clause 7, page 4, line 20, leave out “time” and insert “date”.

This amendment replaces the requirement to record the time of a use of force with a requirement to record the date of a use of force.

Amendment 41, in clause 7, page 4, line 21, leave out paragraph (b) and insert—

“(b) the type or types of force used on the patient;”.

This amendment clarifies that the responsible person should record the types of force used in cases where more than one type of force is used.

Amendment 89, in clause 7, page 4, line 21, at end insert—

“() whether the type or types of force used on the patient form part of the patient’s care plan;”.

The amendment inserts a requirement for responsible persons to record whether the force used on a patient formed part of the patient’s care plan.

Amendment 43, in clause 7, page 4, line 22, leave out “identity of the patient” and insert

“name of the patient on whom force was used”.

This amendment makes a drafting change to refer to “name” rather than “identity” in Clause 7(3)(c).

Amendment 44, in clause 7, page 4, line 22, at end insert—

“( ) a description of how force was used;”.

This amendment inserts a requirement for responsible persons to record how force was used. For example, if physical restraint was used, the responsible person would need to record what particular technique was used on the patient.

Amendment 45, in clause 7, page 4, line 22, at end insert—

“(ca) the patient’s consistent identifier;”.

This amendment inserts a requirement for responsible persons to record the patient’s consistent identifier, which the patient’s “NHS number”.

Amendment 46, in clause 7, page 4, line 23, leave out “identity” and insert “name”.

This amendment makes a drafting change to refer to “name” rather than “identity” in Clause 7(3)(d).

Amendment 90, in clause 7, page 4, line 23, leave out “those who restrained” and insert

“any member of staff who used force on”.

This amendment ensures consistency of language with the rest of Clause 7.

Amendment 48, in clause 7, page 4, line 24, leave out

“anyone not employed by the registered manager”

and insert

“any person who was not a member of staff in the mental health unit”.

This amendment makes a drafting change to clarify that the responsible person needs to record whether a person who was not a member of staff at the mental health unit was involved in a use force.

Amendment 49, in clause 7, page 4, line 26, leave out

“disorders or main mental disorder”

and insert “disorder (if known)”.

This amendment clarifies that the responsible person only needs to record a patient’s mental disorder if it is known. It also makes the language consistent with the Mental Health Act 1983.

Amendment 50, in clause 7, page 4, line 27, after “patient” insert “(if known)”.

This amendment clarifies that the responsible person only needs to record a patient’s relevant characteristic if they are known.

Amendment 51, in clause 7, page 4, line 28, leave out “had” and insert “has”.

This amendment is a drafting change so that Clause 7(3)(h) uses the present tense.

Amendment 52, in clause 7, page 4, line 28, leave out “autism” and insert “autistic spectrum disorders”.

This amendment ensures consistency with the Autism Act 2009 and the Code of Practice published under the Mental Health Act 1983.

Amendment 53, in clause 7, page 4, line 29, leave out paragraph (i).

This amendment leaves out the requirement to record whether any medication was administered during the use of force. This information should be recorded by virtue of Amendment 44.

Amendment 54, in clause 7, page 4, line 30, at end insert—

“( ) a description of the outcome of the use of force;”.

This amendment requires a responsible person to record a description of the outcome of a use of force.

Amendment 91, in clause 7, page 4, line 31, leave out paragraph (j) and insert—

“(j) whether the patient died or suffered any serious injury as a result of the use of force;”.

This amendment requires a responsible person to record whether a use of force resulted in a death or serious injury.

Amendment 56, in clause 7, page 4, line 35, leave out “all” and insert “any”.

This amendment makes a drafting change.

Amendment 57, in clause 7, page 4, line 35, leave out “restrain” and insert “use force on”.

This amendment ensures consistency of language with the rest of Clause 7.

Amendment 92, in clause 7, page 4, line 35, at end insert—

“() whether a notification regarding the use of force was sent to the person or persons (if any) to be notified under the patient’s care plan;”.

This amendment requires a responsible person to record whether a notification regarding a use of force on the patient was sent in accordance with the patient’s care plan.

Amendment 59, in clause 7, page 4, line 36, leave out paragraph (l).

This amendment removes the requirement for a responsible person to record whether consent was given by the patient before force was used on the patient.

Amendment 61, in clause 7, page 4, line 38, leave out “an entry in”.

This amendment ensures consistency of language with Clause 7(1).

Amendment 62, in clause 7, page 4, line 38, leave out “at least 10” and insert “3”.

This amendment reduces the number of years that records must be kept under Clause 7 from 10 years to 3 years.

Amendment 64, in clause 7, page 4, line 39, leave out from “made” to end of line 42.

This amendment removes the requirement for records to be kept at a mental health unit.

Amendment 65, in clause 7, page 4, line 42, at end insert—

“( ) In subsection (3)(ca) the ‘patient’s consistent identifier’ means the consistent identifier specified under section 251A of the Health and Social Care Act 2012.”

This amendment is linked to Amendment 45 and defines “patient’s consistent identifier”.

Amendment 95, in clause 7, page 4, line 42, at end insert—

“( ) This section does not permit the responsible person to do anything which, but for this section, would be inconsistent with—

(a) any provision made by or under the Data Protection Act 1998, or

(b) a common law duty of care or confidence.”

This amendment clarifies that the responsible person’s duty to keep a record of any use of force on a patient and to retain that information is subject to the Data Protection Act 1998 and the common law duties of care and confidence.

Amendment 66, in clause 7, page 5, line 3, leave out paragraph (c).

This amendment removes a paragraph from the definition of “relevant characteristics” that deals with gender reassignment.

Amendment 67, in clause 7, page 5, line 6, leave out from “pregnant” to the end of line 7.

This amendment removes from the definition of “relevant characteristics” whether a patient has maternal responsibility for the care of a child.

Amendment 68, in clause 7, page 5, line 12, leave out subsection (6) and insert—

“( ) Expressions used in subsection (5) and Chapter 2 of Part 1 of the Equality Act 2010 have the same meaning in that subsection as in that Chapter.”

This amendment make a drafting change to ensure that the relevant characteristics in Clause 7 are interpreted by reference to the meaning of the protected characteristics in the Equality Act 2010.

Clause stand part.

[Mr Reed]

It is a pleasure to serve under your chairmanship, Mr Gray. I hope a few more of my colleagues will turn up before we get too far through this morning’s business. It is a pleasure to see everybody here, and I hope that we will make a little more progress this morning than we did last week. I am sure we will, thanks to the money resolution that was laid yesterday evening—I thank the Minister for ensuring that that could go ahead.

Clause 7 creates a new duty to keep a record of any use of force on a patient in a mental health unit. Currently, it is not possible to find out how or when force is used, or to compare one hospital with another regarding the way, and extent to which, they use force. Requiring mental health units to collect and record data in the same way will ensure transparency in our mental health services, meaning that if force is used disproportionately against particular groups, such as black, Asian and minority ethnic patients or women, we will have a mechanism to expose it and, if necessary, to prevent it, and to ensure that the services operate equally for everybody.

Most of the amendments are minor changes to ensure that we are recording information consistently. They are based on information collected in a local incident report, and are in keeping with the data protection principles. They also ensure that the relevant characteristics of the patient, such as age, gender and ethnicity, are recorded in line with the Equality Act 2010, ensuring consistency across the Government system. Further detail about information to be recorded will be set out in guidance under clause 6.

Amendment 88, which the Government were keen to include and I was happy to table, means that the duty to record information will not apply in cases where the use of force is negligible. Statutory guidance will set out the meaning of “negligible”, so it is important that that definition, provided by the Secretary of State, is right and defines the term very tightly. In some cases, the minor use of force, such as guiding a patient by the elbow, should clearly not need to be recorded, as that would create an unnecessary burden on professionals working in mental health units. However, I know that the Minister is aware of the need to avoid that becoming a loophole.

The guidance will be subject to consultation, and I know that advocacy groups, which have been providing so much support to us all as the Bill has progressed, have concerns that they want to raise. The consultation will allow them to do so formally, and I welcome that, because the Bill has so far proceeded on the basis of consensus. Indeed, that is the only way that it will succeed.

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

It is a pleasure to serve under your chairmanship this morning, Mr Gray. As the hon. Gentleman explained, the clause and amendments will impose a duty on a responsible person to keep a record of any use of force by staff who work in the unit. The aim behind all the measures is to bring greater transparency to the use of force. Through transparency, we can ensure accountability. What is not to like about that?

I am grateful to the hon. Gentleman and to the interest groups to which he referred for the dialogue we have had to get this right. The list of information required, as amended by this group of amendments, is welcomed by the Government. It provides clarity and consistency, with positive and proactive care guidance. We know that there are currently limitations, and we believe that this proposal will make a material improvement for all concerned—patients and institutions alike.

The hon. Gentleman referred to guidance. I am aware of some of the concerns that have been raised by some lobbyists. I would reiterate what he said: we have embarked on taking this Bill forward with him in the spirit of constructive dialogue, and we hope to bring everyone with us. When the Bill becomes an Act—touch wood—and it is then implemented through guidance, it is very much our intention to take the development of that guidance through in the same spirit. We will involve all interested parties in drafting that guidance.

Amendment 94 agreed to.

Amendments made: 88, in clause 7, page 4, line 15, at end insert—

“(1A) Subsection (1) does not apply in cases where the use of force is negligible.

(1B) Whether the use of force is ‘negligible’ for the purposes of subsection (1A) is to be determined in accordance with guidance published by the Secretary of State.

(1C) Section 6(1B) to (3B) apply to guidance published under this section as they apply to guidance published under section 6.”.

This amendment would mean that the duty to record information regarding the use of force would not apply in cases where the use of force is negligible.

Amendment 37, in clause 7, page 4, line 16, leave out subsection (2).

This amendment removes the requirement for the Secretary of State to prescribe in regulations the information that must be recorded under Clause 7.

Amendment 38, in clause 7, page 4, line 18, leave out lines 18 and 19 and insert—

“The record must include the following information—”.

This amendment is consequential on Amendment 37.

Amendment 39, in clause 7, page 4, line 19, at the end insert—

“( ) the reason for the use of force;”.

This amendment would require the responsible person to record the reason for a use of force.

Amendment 40, in clause 7, page 4, line 20, leave out “time” and insert “date”.

This amendment replaces the requirement to record the time of a use of force with a requirement to record the date of a use of force.

Amendment 41, in clause 7, page 4, line 21, leave out paragraph (b) and insert—

“(b) the type or types of force used on the patient;”.

This amendment clarifies that the responsible person should record the types of force used in cases where more than one type of force is used.

Amendment 89, in clause 7, page 4, line 21, at end insert—

“() whether the type or types of force used on the patient form part of the patient’s care plan;”.

The amendment inserts a requirement for responsible persons to record whether the force used on a patient formed part of the patient’s care plan.

Amendment 43, in clause 7, page 4, line 22, leave out “identity of the patient” and insert—

“name of the patient on whom force was used”.

This amendment makes a drafting change to refer to “name” rather than “identity” in Clause 7(3)(c).

Amendment 44, in clause 7, page 4, line 22, at end insert—

“( ) a description of how force was used;”.

This amendment inserts a requirement for responsible persons to record how force was used. For example, if physical restraint was used, the responsible person would need to record what particular technique was used on the patient.

Amendment 45, in clause 7, page 4, line 22, at end insert—

“(ca) the patient’s consistent identifier;”.

This amendment inserts a requirement for responsible persons to record the patient’s consistent identifier, which the patient’s “NHS number”.

Amendment 46, in clause 7, page 4, line 23, leave out “identity” and insert “name”.

This amendment makes a drafting change to refer to “name” rather than “identity” in Clause 7(3)(d).

Amendment 90, in clause 7, page 4, line 23, leave out “those who restrained” and insert—

“any member of staff who used force on”.

This amendment ensures consistency of language with the rest of Clause 7.

Amendment 48, in clause 7, page 4, line 24, leave out—

“anyone not employed by the registered manager”

and insert—

“any person who was not a member of staff in the mental health unit”.

This amendment makes a drafting change to clarify that the responsible person needs to record whether a person who was not a member of staff at the mental health unit was involved in a use force.

Amendment 49, in clause 7, page 4, line 26, leave out—

“disorders or main mental disorder”

and insert “disorder (if known)”.

This amendment clarifies that the responsible person only needs to record a patient’s mental disorder if it is known. It also makes the language consistent with the Mental Health Act 1983.

Amendment 50, in clause 7, page 4, line 27, after “patient” insert “(if known)”.

This amendment clarifies that the responsible person only needs to record a patient’s relevant characteristic if they are known.

Amendment 51, in clause 7, page 4, line 28, leave out “had” and insert “has”.

This amendment is a drafting change so that Clause 7(3)(h) uses the present tense.

Amendment 52, in clause 7, page 4, line 28, leave out “autism” and insert “autistic spectrum disorders”.

This amendment ensures consistency with the Autism Act 2009 and the Code of Practice published under the Mental Health Act 1983.

Amendment 53, in clause 7, page 4, line 29, leave out paragraph (i)

This amendment leaves out the requirement to record whether any medication was administered during the use of force. This information should be recorded by virtue of Amendment 44.

Amendment 54, in clause 7, page 4, line 30, at end insert—

“( ) a description of the outcome of the use of force;”.

This amendment requires a responsible person to record a description of the outcome of a use of force.

Amendment 91, in clause 7, page 4, line 31, leave out paragraph (j) and insert—

“(j) whether the patient died or suffered any serious injury as a result of the use of force;”.

This amendment requires a responsible person to record whether a use of force resulted in a death or serious injury.

Amendment 56, in clause 7, page 4, line 35, leave out “all” and insert “any”.

This amendment makes a drafting change.

Amendment 57, in clause 7, page 4, line 35, leave out “restrain” and insert “use force on”.

This amendment ensures consistency of language with the rest of Clause 7.

Amendment 92, in clause 7, page 4, line 35, at end insert—

“() whether a notification regarding the use of force was sent to the person or persons (if any) to be notified under the patient’s care plan;”.

This amendment requires a responsible person to record whether a notification regarding a use of force on the patient was sent in accordance with the patient’s care plan.

Amendment 59, in clause 7, page 4, line 36, leave out paragraph (l).

This amendment removes the requirement for a responsible person to record whether consent was given by the patient before force was used on the patient.

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

This amendment is consequential on Amendment 7.

Amendment 61, in clause 7, page 4, line 38, leave out “an entry in”.

This amendment ensures consistency of language with Clause 7(1).

Amendment 62, in clause 7, page 4, line 38, leave out “at least 10” and insert “3”.

This amendment reduces the number of years that records must be kept under Clause 7 from 10 years to 3 years.

Amendment 64, in clause 7, page 4, line 39, leave out from “made” to end of line 42.

This amendment removes the requirement for records to be kept at a mental health unit.

Amendment 65, in clause 7, page 4, line 42, at end insert—

“( ) In subsection (3)(ca) the ‘patient’s consistent identifier’ means the consistent identifier specified under section 251A of the Health and Social Care Act 2012.”.

This amendment is linked to Amendment 45 and defines “patient’s consistent identifier”.

Amendment 95, in clause 7, page 4, line 42, at end insert—

“( ) This section does not permit the responsible person to do anything which, but for this section, would be inconsistent with—

(a) any provision made by or under the Data Protection Act 1998, or

(b) a common law duty of care or confidence.”.

This amendment clarifies that the responsible person’s duty to keep a record of any use of force on a patient and to retain that information is subject to the Data Protection Act 1998 and the common law duties of care and confidence.

Amendment 66, in clause 7, page 5, line 3, leave out paragraph (c).

This amendment removes a paragraph from the definition of “relevant characteristics” that deals with gender reassignment.

Amendment 67, in clause 7, page 5, line 6, leave out from “pregnant” to the end of line 7.

This amendment removes from the definition of “relevant characteristics” whether a patient has maternal responsibility for the care of a child.

Amendment 68, in clause 7, page 5, line 12, leave out subsection (6) and insert—

“( ) Expressions used in subsection (5) and Chapter 2 of Part 1 of the Equality Act 2010 have the same meaning in that subsection as in that Chapter.”.—(Mr Reed.)

This amendment make a drafting change to ensure that the relevant characteristics in Clause 7 are interpreted by reference to the meaning of the protected characteristics in the Equality Act 2010.

Clause 7, as amended, ordered to stand part of the Bill.

Clause 8

Statistics prepared by mental health units

[Mr Reed]

I beg to move amendment 69, in clause 8, page 5, line 16, leave out subsections (1) to (5) and insert—

“(1) The Secretary of State must ensure that at the end of each year statistics are published regarding the use of force by staff who work in mental health units.

(1A) The statistics must provide an analysis of the use of force in mental health units by reference to the relevant information recorded by responsible persons under section 7.

(1B) In subsection (1A) ‘relevant information’ means the information falling within section 7(3)(a), (b), (g), (h) and (j).”.

This amendment replaces the provisions of Clause 8 with a duty imposed on the Secretary of State to ensure that statistics are produced regarding the use of force in mental health units.

[The Chair]

With this it will be convenient to discuss the following:

Amendment (a), at end insert—

“(1C) The Secretary of State must make an annual statement to Parliament, as soon as practicable following the publication of the statistics under subsection (1).”

Clause stand part.

[Mr Reed]

Clause 8 places a duty on the Secretary of State to ensure that statistics on the use of force against mental health patients are published annually. That will allow us to identify trends in the way, and against whom, force is being used, and whether its use is reducing as intended, or whether some groups, such as BAME patients or women patients, are experiencing disproportionate use of force, as appears to be the evidence from the existing inadequate statistics.

The Secretary of State will be ultimately responsible for ensuring that NHS Digital publishes the statistics. Amendment 69 revises the list of information covered by the statistics to ensure that it covers the place, date and duration of the use of force; the types of force used on the patient; the relevant characteristics of the patient, such as age, ethnicity, gender or other demographic or similar characteristics; whether the patient has a learning disability or autistic spectrum disorder; and whether the patient died or suffered a serious injury as a result of the use of force.

My hon. Friend the Member for Liverpool, Wavertree—I am pleased to see that she has joined us—has tabled an amendment in this group, and I would be happy to give way to her so she can explain the reasons for that.

[The Chair]

Order. It is not a question of giving way. The hon. Member for Liverpool, Wavertree will be called afterwards.

[Mr Reed]

In which case, I will comment briefly. My hon. Friend raises a point that we discussed at an earlier stage. The Minister took the view that there was a better way to achieve these objectives, but I look forward to hearing my hon. Friend’s comments before we take a decision.

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

I thank my hon. Friend for his representations. I apologise for being a few minutes late—I was at another event.

Amendment (a) is about accountability: it would ensure we have annual updates on progress. Ultimately, that is the motivation behind the amendment. Having annual statistics on the use of force under clause 8 would ultimately lead to a minimisation of, and reduction in, the use of force. That is why we are all here today, so that update is absolutely critical.

In the Committee’s first sitting, clause 9 was amended to require the Secretary of State to publish a report relating to any reviews, and other reports about individual cases, particularly relating to deaths and serious injuries, but there is no requirement for the Secretary of State to publish a report relating to the annual stats on the use of force. Therefore, there is no opportunity for Parliament to scrutinise the progress towards the goal of reducing the use of force, which is the purpose of the Bill. That is the motivation behind the amendment.

--- Later in debate ---

Independent investigation of deaths

[Mr Reed]

I beg to move amendment 1, in clause 12, page 6, line 34, end insert—

“(1A) A person appointed under this section must be independent of the NHS and of private providers of mental health services.”

This amendment would ensure that the person appointed to investigate deaths is independent of the NHS and of private providers of mental health services.

[The Chair]

With this it will be convenient to discuss the following:

Clause stand part.

New clause 1—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 12 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.’”

This new clause would ensure that legal aid was available to family members in relation to an investigation under Clause 12, which would be launched in the event of a death as described in Clause 11.

New clause 6—Investigation of deaths or serious injuries.—

“When a patient dies or suffers a serious injury in a mental health unit, the responsible person for the mental health unit must have regard to any guidance relating to the investigation of deaths or serious injuries that is published by—

(a) the Care Quality Commission (see Part 1 of the Health and Social Care Act 2008);

(b) Monitor (see section 61 of the Health and Social Care Act 2012);

(c) the National Health Service Commissioning Board (see section 1H of the National Health Service Act 2006);

(d) the National Health Service Trust Development Authority (which is a Special Health Authority established under section 28 of the National Health Service Act 2006);

(e) a person prescribed by regulations made by the Secretary of State.”

This new clause imposes a duty for responsible persons to have regard to guidance that relates to the investigation of deaths or serious injuries when those occur in a mental health unit.

[Mr Reed]

Mr Gray, perhaps with your indulgence, this is an appropriate moment to acknowledge the presence of Seni Lewis’s parents, Aji and Conrad Lewis, who are extremely welcome here this morning.

The principles in the clause are fundamental to the Bill and to correcting injustices that have affected not just the Lewis family but far too many other families. After Seni Lewis’s death in such tragic and avoidable circumstances in 2010, his parents faced a seven-year battle to get an inquest opened, simply so that they could find out what had really happened to their child. The mental health services would also have had the opportunity to learn from those mistakes, to ensure that they were not repeated.

No grieving parent—indeed, no one—should ever have to face the ordeal of fighting for justice for so many years after the loss of a deeply loved relative. There is currently a glaring disparity between the way that deaths are investigated in mental health settings and in other forms of state detention. If a person dies in police custody, there is an automatic external investigation by an independent national body. If a person dies in a mental health setting, the trust or private provider investigates itself or appoints another trust or individual to do so. That means that reports end up being delayed or kept secret, or are not sufficiently robust. That is a denial of justice and a failure to learn the appropriate lessons as swiftly as necessary.

The system does not learn from mistakes, and it has lost public confidence, particularly among the BAME community. That means we end up with a series of isolated tragic incidents that keep happening time and again. We need a truly independent investigation system for non-natural deaths in mental health settings, just as we have in other forms of state custody.

I pay tribute at this point to the extraordinary work carried out by the campaigning charity INQUEST, which has exposed many failings, such as that that affected the Lewis family, shone a light on them and helped bring us to the position we are in today, making these recommendations in the Bill.

Amendment 1 would require that any person appointed to investigate deaths is completely independent of the NHS or of any private mental health service provider. It is an opportunity to ensure that there is fully independent scrutiny before any inquest begins. Crucially, that means that no family will have to fight for years for justice, in the way that the Lewis family had to.

I now turn to the serious incident framework, which is now in place but was not at the time of Seni’s death. I agree that it is an improvement, but I still have concerns about certain aspects of the guidance and the investigations themselves. We have already discussed the need for the full independence of investigations, but we must also consider the independence of those who commission a level 3 investigation under the new framework.

My concern is that under the framework as it is drawn up, it is still possible for the NHS to avoid such an investigation because it regards it, perhaps wrongly, as an unnecessary burden. As a result, lessons will not be learned, the system will not be held to account and more patients will suffer injury or even death.

I respectfully invite the Minister, therefore, to comment on who takes the decision to commission a level 3 investigation under the new framework and whether it is possible for the NHS to avoid commissioning the right level of investigation so that the appropriate lessons are not learned and the system not held to account. Moreover, does the framework guarantee that a level 3 investigation will take place following the death of a patient from the use of force?

That is key, because it is the loophole through which the Lewis family fell following the death of their son. That failing led to them being denied justice and to the trauma of not only losing their child in such horrific circumstances but having to fight the state for seven years just to secure justice and to find out what had gone wrong to leave an otherwise healthy 23-year-old losing his life.

I hope that the Minister will be able to give a full assurance that families will not have to experience the same long delays under the new framework. For example, how soon following a death should it start, and how long should it take to be completed?

Finally, I am concerned about the quality of the investigations under the framework. The charity INQUEST and others have been absolutely clear for many years that too many investigations are inadequate because they are not fully independent of the organisation that is being investigated. We simply cannot allow that to continue. If the Minister will not support my amendments, I would very much appreciate hearing from her how she intends to address those very important concerns, which I know from conversations and previous debates she shares with me.

I now move on to new clause 1. Another barrier to justice for families is the lack of funding for legal advice and representation. Dame Elish Angiolini’s report concluded last year that

“families face an intrusive and complex and 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 ongoing review of the provision of legal aid. To me and many others, it makes little sense not to extend that to situations in a mental health unit. Restraint in police custody is not different from restraint in a mental health unit, which is the whole point of the Bill.

We need—and I believe that this is also the Government’s intention—consistency in the way in which people with mental ill health are treated across the whole system. We cannot have differences between one form of state custody and another. We have already seen that lead to too many deaths, disproportionately of young black men. Here is an opportunity to correct that unfairness, to make the system more equal for everyone, regardless of their background.

New clause 1 will ensure that legal aid is available to family members in relation to an investigation of an unnatural death in a mental health unit, as described in clause 11. It is very important that we level the playing field. There is a serious imbalance when the state has access to high-quality legal advice but a family in highly traumatised circumstances does not. That is an injustice which my proposal will correct, although I look forward to hearing from the Minister whether there is an alternative means of achieving the same objectives, which I believe that she shares.

[Luciana Berger]

I rise briefly to support my hon. Friend’s amendments, which are critical because, outside this place, organisations and families affected by the loss of a loved one in a mental health setting are looking to us to address this injustice. He said that there is an automatic independent investigation in some settings. If someone loses their life in prison, for example, the prisons and probation ombudsman carries out an independent investigation. It is absolutely critical that that happens if people are taking their lives or losing their lives in prison.

People in a mental health setting are at their most vulnerable, and I believe that one person taking their life is one person too many. Unfortunately, too many people in mental health settings in our country take their lives. We have a responsibility to them, their loved ones and their families to ensure that proper investigations take place so that real learning can occur. There are too many examples. We have heard about the suffering of the Lewis family—we are here today because of what they went through—who had to wait a long time to get justice and an understanding of what happened to their son.

There is also the experience of the family of Connor Sparrowhawk. Sara Ryan has been an incredible campaigner since her son’s death in 2013. Despite her indomitable campaigning, strength and courage, it took five years for that family to get justice and to understand what happened to their son, who died in a bath in a mental health setting. Those are just two families; there are many others who do not have that strength. I totally understand why they might not: in the wake of the loss of a loved one, they might not have the wherewithal to pursue the relevant organisations, particularly if the family cannot match the legal and financial might at the organisations’ disposal. We see time and time again that they can prolong proceedings, send lengthy letters and keep batting things away.

I anticipate that colleagues on both sides of the Committee will reflect on their experiences from their constituencies. Our constituents come to us because they face that wall and are unable to challenge the system. We have a responsibility if we are serious about adequately contending with this issue. I welcome the Government’s support in helping us to get to where we have got so far. I see this measure as part of a bigger picture. Without it, we will be failing people. We must be serious about equality of mental health and parity of esteem in this country. In my view, this is a social justice issue: disproportionately, it is black men in mental health settings who are affected in this way.

People should automatically get an independent investigation. They should not have to fight for one or go through an incredibly drawn-out legal process. Some people manage to get investigations at the moment, but it should be automatic. That is why my hon. Friend’s amendments are critical. Many organisations are concerned about this issue, including INQUEST, a charity that fights on behalf of many people in our country to ensure they get access to justice and an understanding of what happened. Often, it is about the unknown. People were not there at the time, and they really want to understand how their loved one came to take their life.

Without real movement on this issue, we will be doing an injustice to people up and down the country. I support my hon. Friend’s amendments, and I hope the Government give them due consideration to ensure we adequately deliver for people in our country.

--- Later in debate ---

Currently under the serious incident framework, an independent investigation must be commissioned and conducted independently of the parts of the system that are under investigation, including any directly involved commissioners. Given the complex nature of these incidents, it is important that the team carrying out the investigation has the right skills and experience. It is probable that those skills and experience will be held by people who have worked, or are still working, in the NHS. So, to tackle the point about the independence of the NHS, these people will have the expertise; the key point is that the governance ensures that they are entirely independent.

[Mr Reed]

If the investigations are being carried out by people in another part of the NHS who have sufficient understanding of the service they are investigating, is there not a risk, given the relatively small number of professionals working in the sector, that the investigation could be compromised by pre-existing relationships between the people being investigated and those charged with carrying out the investigation? Would that risk rendering the findings insufficiently robust?

[Jackie Doyle-Price]

Clearly, that is the risk that the hon. Gentleman is determined to settle here. We do take it very seriously, but I am satisfied that, through governance and external scrutiny by the CQC, we can ensure that that is not the case. It is important to have investigators who have that specialist knowledge to be able to undertake a full investigation.

I am confident that the governance of the serious incident framework will provide the right guidance to ensure that all individuals carrying out the investigations are suitably qualified and sufficiently independent. I hope that assures the hon. Gentleman. We will continue to address the matter with full external scrutiny so that we can genuinely ensure their independence.

Let me be completely clear: this is not just a process—not just a rubber-stamping exercise. We need proper independent investigation to ensure that there is accountability in the system and that, in future, families such as that of Seni Lewis, do not feel frustrated and lost and that the system is not responding to them—that is absolutely not the case. We must use this opportunity to ensure that that independent investigation is thorough and rigorous.

I turn now to the amendment on legal aid for investigations. Clearly, any family in this situation does need some independent support and advocacy. It is very difficult when there is no one person to whom a family can turn to get independent support at such a time. The Bill is not the place to resolve any issues around legal aid, but let me assure the hon. Gentleman about wider discussions that are taking place within Government.

The hon. Gentleman will be aware that the Ministry of Justice is committed to the ministerial board on deaths in custody, and I am one of the rotating co-chairs of that board. We are looking at an urgent review of the provision of legal aid for inquests, and the position is due to be published later this year as part of the Government’s response to Dame Elish Angiolini’s review of deaths and serious incidents in police custody. We will take up this matter as part of that. As the hon. Gentleman says, it is important that we consider deaths in mental health detention on the same basis as those in other methods of detention, such as prisons. That review will ensure consistency of support for families.

[Mr Reed]

Is the Minister saying that the Lord Chancellor’s review will be expanded to encompass deaths in mental health custody in the same way that it is covering deaths in other forms of state custody?

[Jackie Doyle-Price]

Yes. It is very much being taken forward by that ministerial board, of which I am co-chair alongside Ministers from the Home Office and the Ministry of Justice, to achieve exactly that consistency. I hope that reassures the hon. Gentleman on that point. I will also be happy to support him if he wishes to make representations to the Ministry of Justice, which owns that work, although I am very much part of it.

[Jackie Doyle-Price]

I will write to hon. Members about that to set it out clearly. I could give a flippant answer, but it might not be accurate, and I do not wish to mislead the Committee. I would say that the ministerial board is actively meeting and consulting with external stakeholders at this very moment. It is not going to be a long-grass project, but we will give hon. Members more clarity in due course.

On that basis, I ask the hon. Gentleman to withdraw the amendment. The Government propose that clause 12 be replaced by new clause 6, which sets out the method of investigating cause of death. New clause 6 requires that, when a patient dies or suffers a serious injury in a mental health unit, the responsible person would have regard to certain guidance that relates to the investigation of deaths or serious injuries, including the NHS serious incident framework and any relevant guidance from the CQC, NHS Improvement and NHS England. The new clause moves the process more consistently into the body of the health service and the framework for investigation.

I know the hon. Gentleman’s objective is to prevent a recurrence of the experiences of the Lewis family, whose investigation got stuck for many years. We have drawn up the new clause on that basis. We want to avoid any confusion that introducing a completely new system might lead to. We want to avoid duplication, but establish independence, which we have already started to move forward on with the Healthcare Safety Investigation Branch.

The coroner already has a responsibility to investigate deaths of those detained under the Mental Health Act 1983 and any death that is unexpected or unnatural, which would include deaths that occurred during, or as a result of, the use of force. The NHS serious investigation framework sets out robust procedures for investigating and learning from an unexpected patient death, including an independent investigation when criteria are met.

To reassure the hon. Gentleman on timing, which I know is a big issue here, we would expect any investigation into a serious incident to be concluded within a year and certainly to commence within three to six months. There might sometimes be issues that elongate that investigation, but we will avoid any case just being stuck and left. Investigations will always be undertaken as soon as practicable.

I ask the hon. Gentleman to withdraw the amendment and not to press new clause 1. I ask the Committee to disagree to clause 12.

[Mr Reed]

I am grateful to the Minister for her comments and in particular for the new information and assurances that she has given. I am sure that will be widely welcomed. It is clear that we have the same objectives, but there are perhaps some small remaining disagreements over the best way to achieve those objectives.

I hope that the bottom line for both of us is that investigations of deaths need to be triggered automatically, they need to be fully independent, and families of the deceased need access to legal aid so that they are operating on a level playing field with the people who are being investigated for having caused the death. I understand that the Minister seeks to achieve that by a different route; it is important to give her the space she will need to be able to demonstrate to not just me but the many stakeholders and families outside this place that she has robust means of doing that.

While reserving the right to reintroduce amendments into the Bill at a later stage if necessary, at this stage, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[The Chair]

The question is that clause 12 stand part of the Bill.

[The Chair]

That is not quite correct. Perhaps I can clarify. The situation is that the Government have proposed new clause 6, which will be voted on later, to replace clause 12. I think I am right in saying that the Member promoting the Bill agrees with that. Therefore, if we wish clause 12 to be removed from the Bill, and replaced by new clause 6 eventually, the correct answer will be no, rather than aye.

Clause 12 disagreed to.

Clause 13

Police body cameras

[Mr Reed]

I beg to move amendment 93, in clause 13, page 7, line 20, leave out subsections (1) and (2) and insert—

“(1) If a police officer is going to a mental health unit on duty that involves assisting staff who work in that unit, the officer must take a body camera if reasonably practicable.

(1A) While in a mental health unit on duty that involves assisting staff who work in that unit, a police officer who has a body camera there must wear it and keep it operating at all times when reasonably practicable.

(1B) Subsection (1A) does not apply if there are special circumstances at the time that justify not wearing the camera or keeping it operating.

(1C) A failure by a police officer to comply with the requirements of subsection (1) or (1A) does not of itself make the officer liable to criminal or civil proceedings.

(1D) But if those requirements appear to the court or tribunal to be relevant to any question arising in criminal or civil proceedings, they must be taken into account in determining that question.”

This amendment brings the effect of failing to wear or use a body camera into line with contraventions of the PACE codes, and takes into account whether it is reasonably practicable and whether particular circumstances justify not wearing or using a camera.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 75, in clause 13, page 7, line 26, leave out subsection (3).

Clause 13(3) is omitted because the protection provided by the Data Protection Act 1998 and guidance on use of body cameras is sufficient.

Amendment 96, in clause 13, page 7, line 31, at end insert—

“( ) In this section—

‘body camera’ means a device that operates so as to make a continuous audio and video recording while being worn;

‘police officer’ means—

(a) a member of a police force maintained under section 2 of the Police Act 1996,

(b) a member of the metropolitan police force,

(c) a member of the City of London police force,

(d) a special constable appointed under section 27 of the Police Act 1996, or

(e) a member or special constable of the British Transport Police Force.”

This amendment reproduces definitions from Clause 17, except for minor amendments to the definition of “body camera”, and omitting community support officers and adding special constables in the definition of “police officer”.

Clause stand part.

[Mr Reed]

I have only been here for five and a half years, Mr Gray, and I am afraid it takes an awful lot longer than that to get to understand the strange machinations of the House of Commons.

Clause 13 introduces a requirement for police officers who attend a mental health unit to wear an operational body camera. The roll-out of body cameras across the police, which I understand will be extended to all forces by autumn 2019, although the Minister will correct me if I am wrong, introduces an independent witness to police actions. Research I have seen shows that the use of cameras in these circumstances makes it up to 50% less likely that the police will use force at all. The number of complaints filed against police officers also reduces dramatically. We see from those statistics that transparency is good for patients, the public and the police. Practitioners also advise me that the presence of body-worn cameras on police officers can help to de-escalate a situation, by reassuring the patient that there will be a record of what is going on. The patient should, therefore, feel a greater level of security and protection than would otherwise be the case. We welcome that.

There was agreement on Second Reading about the need to get the provision right; we want maximum transparency without inadvertently preventing officers from attending an emergency if they are not equipped with a working body camera. Therefore, this clause, as amended, would ensure that officers are not in breach of the law if they are unable to access a working camera in an emergency. That means that police officers will use body-worn video cameras in a mental health unit unless there is a strong operational reason not to do so.

Amendment 93 brings the effect of failing to wear or use a body camera into line with the contraventions in the police and criminal evidence codes. Amendments 75 and 96 set out definitions and guidance to be used in the clause. Police community support officers are not within the definition because they are not trained in the use of force and so would not be called to assist in the management of a patient. However, as special constables have all the powers of a constable, they are included within the definition.

--- Later in debate ---

[Jackie Doyle-Price]

The hon. Member for Dulwich and West Norwood makes excellent points for us to consider further. The Bill, which is specifically about detention and use of force in detention, is perhaps not quite the right space for that, but her points are well made. I am particularly concerned about people with learning disabilities, who are often treated as the Cinderella in the system. It is incumbent on all of us to ensure that we do our best to protect their rights, as well as those of other groups. On that basis, the Government are content to support the amendments tabled by the hon. Member for Croydon North.

Amendment 93 agreed to.

Amendments made: 75, in clause 13, page 7, line 26, leave out subsection (3).

Clause 13(3) is omitted because the protection provided by the Data Protection Act 1998 and guidance on use of body cameras is sufficient.

Amendment 96, in clause 13, page 7, line 31, at end insert—

“( ) In this section—

‘body camera’ means a device that operates so as to make a continuous audio and video recording while being worn;

‘police officer’ means—

(a) a member of a police force maintained under section 2 of the Police Act 1996,

(b) a member of the metropolitan police force,

(c) a member of the City of London police force,

(d) a special constable appointed under section 27 of the Police Act 1996, or

(e) a member or special constable of the British Transport Police Force.”—(Mr Reed.)

This amendment reproduces definitions from Clause 17, except for minor amendments to the definition of “body camera”, and omitting community support officers and adding special constables in the definition of “police officer”.

Clause 13, as amended, ordered to stand part of the Bill.

Clause 14

Retention and destruction of video recordings

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

[Mr Reed]

May I take clauses 14 to 17 together, Mr Gray?

[The Chair]

Yes, you may take them together but we will decide on them separately.

[Mr Reed]

Thank you for your clarification, Mr Gray. Amendment 17 to clause 14—

[The Chair]

Order. That amendment has not been selected. The position is that no amendments have been selected for clauses 14 to 17, so the only debates possible are whether those clauses stand part of the Bill. If either side wishes a clause not to stand part, we can debate it and divide on it, but the view may be taken that we have debated the issues sufficiently elsewhere, so we can move on to clause 18, amendments to which have been selected. However, the Government or the Member in charge of the Bill are perfectly entitled, if they wish, to have a debate on clauses 14 to 17, but that will be on whether they stand part of the Bill.

[Mr Reed]

I am grateful for your further clarification, Mr Gray. I believe that the understanding was that those clauses should not stand part of the Bill, as the provisions in them have already been addressed elsewhere in the Bill or have become unnecessary because of provisions in other legislation. For those reasons, I am proposing that the clause not stand part of the Bill.

[Jackie Doyle-Price]

As the hon. Gentleman has just outlined, many of the provisions in clauses 14 to 17 are covered by other legislation, such as the Data Protection Act, and oversight by the Information Commissioner’s Office. There are obviously powers of enforcement accruing in that way. In the spirit of avoiding duplication, we are content that the clauses be removed from the Bill.

--- Later in debate ---

[The Chair]

For the sake of clarity, when I say that the question is that the clause should stand part of the Bill, the answer if you wish them to be removed from the Bill is no.

Question put and negatived.

Clause 14 accordingly disagreed to.

Clauses 15 to 17 disagreed to.

Clause 18

Regulations

[Mr Reed]

I beg to move amendment 81, in clause 18, page 9, line 25, at end insert

“(other than regulations made under section 20(3))”.

This amendment provides that commencement regulations under Clause 20 are not subject to any parliamentary procedure.

[The Chair]

With this it will be convenient to discuss clause stand part.

[Mr Reed]

I hope to sow a little less confusion in this particular clause.

[The Chair]

No confusion at all—very straightforward.

[Mr Reed]

You are very kind, Mr Gray. Clause 18 sets out how regulations under this Bill are to be made. Amendment 81 ensures that commencement regulations under clause 20 are not subject to any parliamentary procedure, which is the convention. Parliament will have approved the principle of the provisions of the Bill by enacting them. Any other regulations made under the Bill will be subject to the negative procedure. I hope that makes more sense to other hon. Members than it necessarily does to me, and that the Committee accepts the clause as amended.

[Jackie Doyle-Price]

This clause sets out that regulations under this Bill should be made by statutory instrument; the only amendment is to ensure that regulations under clause 20 are not subject to further parliamentary procedures. Those are to undertake the commencement and any transitional provisions required to implement the Bill.

Amendment 81 agreed to.

Clause 18, as amended, ordered to stand part of the Bill.

Clause 19 ordered to stand part of the Bill.

Clause 20

Commencement, extent and short title

[Mr Reed]

I beg to move amendment 83, in clause 20, page 9, line 35, leave out subsections (3) and (4) and insert—

“(3) The other provisions of this Act come into force on such day as the Secretary of State may appoint by regulations.

(4) Regulations under this section may appoint different days for different purposes or areas.”

This amendment gives the Secretary of State the power to commence the Bill by regulations.

[The Chair]

With this it will be convenient to discuss the following:

Clause stand part.

New clause 4—Transitional provision—

“The Secretary of State may by regulations make transitional, transitory or saving provision in connection with the coming into force of any provision of this Act.”

This new clause gives a power to the Secretary of State to make transitional provision in relation to the implementation of the Bill.

[Mr Reed]

Clause 20 sets out when the Bill’s provisions are to be brought into force and amendment 83 allows the requirements of the Bill to be brought into force as and when it is feasible to do so and by regulations, rather than within six months as originally drafted.

New clause 4 gives the Secretary of State the power to make transitional provisions for the implementation of the Bill, which, where appropriate, will allow flexibility in its application as it comes into force. I know that the Minister is committed to the Bill; we have strengthened it by working consensually cross-party and with the many interested parties outside the House.

[Jackie Doyle-Price]

I reassure the Committee that I want to ensure that the requirements of the Bill are commenced as soon as they are ready. We are certainly not in the business of delay, but we recognise that some aspects of the Bill will be quicker to implement than others. We will be able to commence some things very quickly, but if we take clauses 7 and 8, for example, getting the right systems in place for local recording and publication of statistics may take a little longer than some other aspects of the Bill. Commencing by regulations allows the Government to bring the new requirements into force as and when that is feasible, having regard to those parts of the system that move at a different pace.

The transitional provision will allow the Secretary of State to make transitional provisions in connection with the coming-into-force provisions of the Bill. That is important particularly where the Bill’s requirements represent a substantial change in practice. For example, if training under clause 5 is carried out before the responsible person is appointed, the transitional provision could state that the training is deemed to have been provided by the responsible person. That will also allow us to give the NHS and other providers some time to prepare for their duties under the Bill. The Government accept the amendment to clause 20 and the new transitional provision.

Amendment 83 agreed to.

Clause 20, as amended, ordered to stand part of the Bill.

--- Later in debate ---

Question proposed, That the Chair do report the Bill, as amended, to the House.

[Mr Reed]

On a point of order, Mr Gray. Thank you very much for guiding us through the sometimes confusing proceedings so skilfully this morning. I thank hon. Members for participating this morning and on the previous occasion on which we met. I thank hon. Members and the officials who have worked on the Bill for their hard work in getting us this far.

I thank Seni Lewis’s parents, Aji and Conrad Lewis, for joining us this morning. When I have spoken to them about what happened to their son and the need for this Bill, they have reiterated to me their very deep desire for Seni’s death not to have been in vain. I believe our work on this Bill creates a legacy for Seni Lewis, which is that no one else suffering or living with mental ill health need suffer in the way Seni Lewis did.

[Jackie Doyle-Price]

On a point of order, Mr Gray. I associate myself with the hon. Gentleman’s remarks. I thank you and the Clerks for guiding us safely and promptly through the procedure. It has been a very good use of our time and resources. I also thank my officials, who have worked very quickly to pull this Bill together in a way that delivers the hon. Gentleman’s objectives in a way that works. It can be challenging when these things come through in a private Member’s Bill.

I pay tribute to the hon. Gentleman, who has brought forward a very important reform to how we treat people detained under the Mental Health Act. From my perspective as Minister, we have reached the position whereby, if we are going to achieve parity of esteem, there needs to be a complete reconfiguration of the law as it applies to mental health, to strengthen people’s rights. This very important reform will achieve exactly that.

I also associate myself with the tribute the hon. Gentleman paid to Seni Lewis’s parents. They have taken an incredible tragedy and channelled it into doing something positive. They will achieve a real legacy that strengthens the rights of people who find themselves detained. I pay full tribute to them for doing so.

My final thanks go to all hon. Members who have turned up—quite often to do nothing, because we did not have a money resolution to progress the Bill, but I am very grateful to them for doing so.

Mental Health Units (Use of Force) Bill (Money)

Steve Reed Excerpts

Tuesday 24th April 2018 Commons Chamber

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

I congratulate the Government and the Minister on bringing forward the money resolution this evening. We have been anticipating it for a few weeks, so it is a great pleasure and slight relief to have it before the Chamber.

The resolution will allow the Committee to complete its work in the morning and take forward this important social reform, which we hope will make a big difference to the lives of some of the most vulnerable people in our country—people who are living with mental ill health and should not face extreme forms, or indeed other forms, of restraint, which can cause serious injury or even death, as we saw in the case of Seni Lewis. I thank the Minister for her commitment to seeing this through.

Question put and agreed to.

Cancer Treatment

Steve Reed Excerpts

Thursday 19th April 2018 Commons Chamber

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

I congratulate my hon. Friend and neighbour the Member for Croydon Central (Sarah Jones) on securing this important debate, and on making what I thought was a remarkable speech. I remember her telling me, days after her election, about the loss of her father. It was such a keenly felt loss, but I know how proud he must have felt to see his daughter enter this place—I think he hung on to see that happen. Had he heard her speech—and perhaps he did—I think that it would justify every ounce of his pride in her.

I will start by paying tribute to Tessa Jowell, if I may. She was one of the Members of Parliament representing the London borough of Lambeth when I was first leader of the opposition and then leader of the council. She was a fantastic, supportive local MP. Despite her serious, significant roles in Government, she was always available to talk to me about my role and the community that we both cherished and loved and for which we wanted to do our best. She became my mentor, and she became my friend.

Tessa was always thinking about how we could do more to help people, particularly the most vulnerable. We worked together to open schools and Sure Start centres. I particularly remember that in the mid-noughties, when there was that terrible spike in violent youth crime and knife crime—similar to what we are seeing now—in Tessa’s beloved Brixton, where she had started her career as a social worker, she took me to see a community-led project called Exit on the Moorlands estate, one of the most deprived inner-city estates in the country, where there was a horrifically high level of youth engagement in violence. Young people knew by name others who had been killed, including friends.

Tessa took me to see that project, which had been set up by the community. It was supported by youth workers and the police, but with the community in charge, and it was making a dramatic difference to the life chances of those young people by getting them out of danger—getting them out of gangs and steering them back on to a safer path that was giving them back the future that should have been theirs as a birthright. Tessa took me to see that project not just because she wanted the council’s support for it, but because she was teaching me an important lesson: it was not my job as a politician to find the answers for people; it was my job as a politician to help people find the answers for themselves, because they would be better answers. I have brought that lesson with me into Parliament; like many of us, I would not be here if it were not for Tessa, and Tessa taught me that people-based politics.

That same compassion, empathy and drive to support and help people is what has led Tessa to turn this great personal challenge in her own life today into a way to bring about change to help others. For that reason, as well as many others, I am very proud to stand here today and support Tessa’s campaign.

As we have been hearing, brain tumour research is underfunded and undervalued compared with other types of cancer research, despite the fact that it kills more people under the age of 40 than any other type of cancer and is the biggest killer of children of any kind of cancer. So we need to match the progress made in survival rates for other forms of cancer, such as leukaemia and breast cancer, by focusing much more on brain tumour cancer and what we can do as a country and a society to help people who find themselves living with that form of cancer.

[Joan Ryan (Enfield North) (Lab)]

May I join my hon. Friend in paying tribute to the courage and bravery of our friend, Baroness Tessa Jowell, and particularly her significant decision to make her medical data available? Does my hon. Friend agree that, given the low level of participation in clinical trials, if we are to achieve much better results for patients, the Government and all of us must do much more to encourage participation in these trials in all of our local areas and in our national politics?

[Mr Reed]

I thank my right hon. Friend for that well-timed intervention. We absolutely need to boost participation in clinical trials. Only 6.4% of adults with this particular form of cancer take part in those trials, whereas over 61% of people with leukaemia participate, so there is a clear need for a major increase in the numbers participating in these trials if we are to get the data we need to learn. I join my right hon. Friend, too, in congratulating Baroness Jowell on her historic decision to become the first patient to consent to share her data fully and openly, in order to speed up the discovery of new cures and ways to help other people; she is an example to so many people in so many ways, but here again we need to learn from Tessa’s example, because that is how we will help to find a cure for this terrible form of cancer.

I say to Ministers, who will be responsible for regulation as well as funding, that it is important that regulation is not drawn so tightly that it does not allow for innovation and for new treatments to be developed. We must be open to doing things in different ways and to learning from failure as well as success; we cannot regulate against failure, but we can always learn from it so that we can improve.

We must increase the funding going into the kind of research that will find a cure for this form of cancer and put it on a par with other, perhaps more high-profile, forms of cancer that have attracted levels of funding that are making a bigger difference. In that respect, I put my name on record in welcoming and congratulating the Government on the increase in funding of £45 million —I believe that is the figure—announced since the very moving debate, which many of us attended in the House of Lords, led by Tessa Jowell.

Tessa has been a fighter all her life and now she is in the fight of her life, but how typical it is that she has turned it into a fight to allow others to live well, live better and live longer. Every one of us in this Chamber, and many others beyond, are proud to stand with Tessa today. I would like to say this to her, if I may: Tessa, you have all our love and all our respect. Please keep going and keep being the inspiration to all of us that you have always been.

[Hon. Members]

Hear, hear!