Mental Health Act 1983

Debate between Steve Reed and Jackie Doyle-Price

Thursday 25th July 2019 Westminster Hall

[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.

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[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.

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

Debate between Steve Reed and Jackie Doyle-Price

Wednesday 25th April 2018 Public Bill Committees

[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.

--- Later in debate ---

[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.

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[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?

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[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.

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[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.

--- Later in debate ---

[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 ---

[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 (Second sitting)

Debate between Steve Reed and Jackie Doyle-Price

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

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

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

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

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

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

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

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

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

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

Debate between Steve Reed and Jackie Doyle-Price

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

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

I beg to move,

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

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

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

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

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

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

Question put and agreed to.

Clause 1

Key definitions

[Mr Reed]

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

‘(3) “Mental health unit” means—

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

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

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

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

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

--- Later in debate ---

[Jackie Doyle-Price]

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

Amendment 2 agreed to.

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

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

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

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

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

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

[Mr Reed]

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

This amendment is consequential on Amendment 7.

[Mr Reed]

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

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

[Jackie Doyle-Price]

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

Amendment 5 agreed to.

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

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

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

(b) the isolation of a patient.

(7A) In subsection (7)—

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

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

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

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

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

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

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

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

Clause 2

Mental health units to have a registered manager

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

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

( ) The responsible person must be—

(a) employed by the relevant health organisation, and

(b) of an appropriate level of seniority.

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

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

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

Clause 3

Policy on use of force

[Mr Reed]

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

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

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

--- Later in debate ---

[Mr Reed]

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

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

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

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

[Jackie Doyle-Price]

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

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

Amendment 8 agreed to.

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

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

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

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

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

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

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

This amendment is consequential on Amendment 7.

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

This amendment is consequential on Amendment 13.

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

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

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

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

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

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

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

“at the mental health unit”

and insert

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

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

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

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

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

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

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

Clause 4

Information about use of force

[Mr Reed]

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

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

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

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

(a) to each patient, and

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

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

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

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

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

--- Later in debate ---

[Jackie Doyle-Price]

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

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

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

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

Amendment 84 agreed to.

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

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

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

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

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

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

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

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

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

This amendment is a drafting change linked to Amendment 22.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Clause 5

Training in appropriate use of force

[Mr Reed]

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

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

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

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

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

(c) showing respect for diversity generally,

(d) avoiding unlawful discrimination, harassment and victimisation,

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

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

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

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

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

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

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

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

--- Later in debate ---

[Mr Reed]

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

[Jackie Doyle-Price]

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

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

--- Later in debate ---

[Mr Reed]

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

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

[Jackie Doyle-Price]

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

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

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

Amendment 28 agreed to.

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

“responsible persons and relevant health organisations”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Clause 9

Annual report by the Secretary of State

[Mr Reed]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Jackie Doyle-Price]

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

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

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

Amendment 70 agreed to.

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

Clause 10

Requiring information regarding the use of force

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

Oral Answers to Questions

Debate between Steve Reed and Jackie Doyle-Price

Tuesday 19th December 2017 Commons Chamber

[Mr Reed]

Many young people with mental ill health report that crisis care is not good enough. Of course, the pressures on them can get even worse over Christmas, so will the Government back the call by the charity YoungMinds to set up a crisis hotline for children and young people that would be available through the existing 111 service?

[Jackie Doyle-Price]

We are approaching Christmas, and the hon. Gentleman is quite right to highlight the fact that it can often be the moment of greatest crisis for people with mental health issues. I was with the Samaritans yesterday to commend it for all its work—it is obviously a good pathway to help—but, absolutely, we will speak with YoungMinds.

Oral Answers to Questions

Debate between Steve Reed and Jackie Doyle-Price

Tuesday 4th July 2017 Commons Chamber

[Jackie Doyle-Price]

I will be delighted to meet my hon. Friend, who is a committed and passionate campaigner in this area. I am keen to explore anything that improves care and choice for all patients at the end of their life.

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

22. Croydon’s NHS, including end-of-life care, has been funded below the London average every year since the Conservatives first came into government. That is leading to the closure of services in Croydon that are available elsewhere, and to longer waiting times for GPs or the A&E in Croydon. When will Croydon’s funding be brought up to the London average?

[Jackie Doyle-Price]

The amount of resource that is dedicated locally is a matter for clinical commissioning groups, and we continue to make sure that funding is fair. I suggest the hon. Gentleman takes that up with his CCG.