Covid-19: BAME Communities
Tanmanjeet Singh Dhesi Excerpts(4 years, 6 months ago)
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Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
I thank my hon. Friend the Member for Brent Central (Dawn Butler) for securing this important debate. Without doubt, the nation needs a full independent public inquiry into the Government’s handling of the covid crisis, but one area in particular that demands scrutiny is the Government’s handling of the effects of covid-19 on the black, Asian and minority ethnic communities. Why have Ministers ignored the evidence, dragged their feet and almost certainly contributed to a situation where people from BAME communities have been disproportionately ravaged by this terrible disease?
For me, this is personal. I have lost loved ones to covid, such as Jagir Kaur, my lovely grandmother, our family matriarch, from whom I learnt so much, but whose coffin I was not even able to carry on my shoulder. Satnam Singh Dhesi, my fun-loving, Slough taxi-driver uncle was taken away from us way too early, and then I had to endure the indignity of watching his funeral online via Zoom. Hemraj Jaymal, my brother-in-law’s father, somehow contracted covid in a Slough care home, and, inexcusably, none of us was there to hold his hand when he breathed his last. May they all rest in peace and may we be forgiven for not being there. Families cannot attend bedsides and because the usual rituals and rights of funerals are disrupted, it makes loss even harder and grief even harsher, and there are tens of thousands of people suffering bereavement.
Back in April, we saw BAME people being disproportionately affected by covid-19 as data came in from emergency admissions to hospital from more than three months ago. On 22 May, King’s College London research showed that patients from BAME groups admitted to hospital with covid-19 are, on average, a decade younger than white patients. In May, the Office for National Statistics reported that black people were more than four times more likely to die from covid-19 than their white counterparts; that Bangladeshi and Pakistani people were more than one and a half times more likely to die from covid-19; and that the situation was similar for people with an Indian heritage. That was published more than a month ago.
Of course, Ministers have had a wealth of evidence from BAME organisations presented to Public Health England, which Ministers initially tried to delay, then cover-up and have released under pressure only this week. The evidence tells us what we already knew: ethnic inequalities in health and wellbeing in the UK existed before COVID-19, and the pandemic has made these disparities more apparent and undoubtedly exacerbated them. Why is this? One major reason is racism, and this racism, unfortunately, is also within our lovely NHS.
Figures released last week by the NHS Confederation show that the number of ethnic minority chairs and non-executive directors of NHS trusts in England has almost halved from 15% in 2010 to a mere 8% in 2018. Quoted in the Eastern Eye newspaper, Dr Ramesh Mehta, the president of the British Association of Physicians of Indian Origin, said that this was down to “rampant discrimination” and a “club culture” within NHS professions.
Representation matters, and the dismally low number of executive directors of NHS trusts is inexcusable. If BAME doctors and nurses are good enough to die on the frontline, surely they are good enough to lead. While I am proud to be a part of the most diverse party and the most diverse Parliament ever, the lack of leadership positions in most key industries is shocking, including the all-important finance sector, where the majority of FTSE companies still have all-white boards. Rather than just tweeting about Black Lives Matter, those companies need to take a long hard look at themselves to judge whether they are indeed a part of the change that they proclaim to be.
Diversity is crucial because it brings in people with fresh perspectives and different priorities, thereby enhancing and improving the overall performance for all of us, so perhaps the Minister can comment on how she intends to tackle the racial discrimination within the NHS. It took until 16 June for Public Health England to publish its seven-point plan, but surely this should have been done from the very start. We do not just want to carry on collating data.
Of course I pay tribute to the frontline NHS staff across my Slough constituency, including at Wexham Park Hospital, who undoubtedly face incredible challenges and risks, but the British Medical Association reports that 90% of doctors and 60% of NHS staff who have died are from BAME backgrounds. Those absolutely staggering statistics should make us realise that something is very wrong.
We are lacking time, so in conclusion I want to ask the Minister to reflect on the plans to commemorate all those who have lost their lives, with a focal point of remembrance, and assure us that we will learn the lessons. More than anything, I hope she can allay my concerns. Black lives matter, and we demand deeds, not words.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
I speak today not just for my constituents, but to represent my right hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), which may surprise most people, because in her 33 years in this place, I think everyone would agree that she has never needed anyone to speak for her. She has been perfectly capable, able and talented at speaking up on inequality repeatedly in her 33 years, and she was the first ever black woman to be elected to this place. Sadly, the Government’s refusal to allow remote participation means that she is unable to attend today because she is shielding, but she wanted me to speak for our borough together, because of the concerns we both share about the number of deaths from covid-19 of black, Asian and minority ethnic people. I am proud to stand with her. She has spoken up for the marginalised for many years, and I am proud to have her as a neighbouring MP and a friend.
My right hon. Friend highlights that black deaths from covid-19 have been particularly traumatising for the black, Asian and minority ethnic communities, who are very likely to know someone who has died. We have heard that very firmly in the Chamber today. I also want to highlight the very important work of Councillor Carole Williams, a cabinet member on Hackney Council, who highlighted this inequality at an early stage. She was ahead of the curve of many people in this Chamber today, and of the Government. It is because we live and work in the community, and understand its needs and its trauma, that we really wanted to raise these points today.
Hackney is the 22nd most deprived local authority district in England and the third most densely populated. Our housing overcrowding is severe, as I have often mentioned in this House. When we break that down in terms of ethnicity, over 70% of people on our housing waiting lists are from ethnic minority backgrounds. These are inequalities that we are all weary of raising. As my hon. Friend the Member for Brent Central (Dawn Butler), who has done a great job in securing the debate today, highlighted, it is a pattern that we recognise and are weary of having to highlight again and again and again. I echo the points raised by my hon. Friend the Member for Slough (Mr Dhesi) and my right hon. Friend the Member for Tottenham (Mr Lammy) about the need for action now. We know a lot of these problems. We have raised them repeatedly. We need to see action.
Hackney has the third-highest death rate per 100,000 people, at 183, of all local authority areas. With 40% of our population from BAME backgrounds, it is not surprising that we have had 175 deaths from covid-19, but 70% of those deaths were of people born outside the UK and 60% of the deaths were of people employed in routine and manual occupations. As my right hon. Friend the Member for Hackney, North and Stoke Newington highlighted when we were discussing this matter today, we also know that it is not just a matter of underlying health conditions. Black people are disproportionately employed, as other colleagues have highlighted, in sectors exposed to covid: transport, social care and the NHS. They are more likely to be agency staff or in roles with zero-hour contracts, so feel less empowered to insist on proper PPE. This goes very much to workplace rights as well and the ability to call out something when it is wrong. If you call it out and lose your job, it is of course harder to do that.
Mr Dhesi
Does my hon. Friend not agree that with more than 200 recommendations from previous reviews already gathering dust, the reason why so many of us are pointing out, again and again, that we need action and not more reviews and investigations is that we have not even implemented a single recommendation from the previous reviews?
Meg Hillier
I agree with my hon. Friend. My right hon. Friend the Member for Hackney North and Stoke Newington is calling for a public inquiry into black deaths from covid. I support her in that, but, as my hon. Friend highlights, it must not be an excuse to kick this issue down the road. We need action now for the people at the frontline who are still affected by this. If we have the second peak that we all fear is coming, they need to be protected. If people are moved out of frontline jobs to be shielded and protected because of their greater risk of death, they must not see detriment to their career path. We need action now. We need workplace plans to support people. It is a tragic and visible reminder of the inequalities we see.
Black, Asian and minority ethnic households are nearly five times more likely to be overcrowded than white households. I have repeatedly raised in this place the tragedy of families who are living in double households, with one family in the living room and one in the bedroom. My right hon. Friend the Member for East Ham (Stephen Timms) highlighted how no recourse to public funds also feeds into that, and 43.9%—so nearly 44%—of London NHS staff are from black, Asian and minority ethnic backgrounds. A staggering 67% of adult social care staff in our capital are from black, Asian and minority ethnic backgrounds.
One interesting and important point is how we communicate public health messages. Sometimes one size does not fit all. If you live in an overcrowded household and are told to self-isolate, it is a different challenge than if you live in a home with spare bedrooms, studies, extra living rooms, large gardens and big kitchens. People need advice about how to manage the public health situation in their own domestic situation and their own workplace. The digital divide is a big concern in my constituency when it comes to getting that message across, with 11% of Hackney residents having no access to the internet.
This is near Shoreditch. Shoreditch is part of my constituency—part of the borough that my right hon. Friend the Member for Hackney North and Stoke Newington and I represent together—yet just over one in 10 residents have no access to the internet and 20% say they are not confident using the internet.
This has been a thoughtful, measured debate, and I do not doubt that every Member here, and many others who would have liked to have spoken, means every word they say about action now. The Under-Secretary of State for Health and Social Care, the hon. Member for Bury St Edmunds (Jo Churchill), is a reasonable and thoughtful woman and I look forward to her response, but I must repeat that the Prime Minister under whom she serves has repeatedly used racist language. Where is the word “piccaninnies” from? I am not going to give a history lesson, but look it up. It is not acceptable for a Prime Minister of this country to have only in recent times described people in those pejorative terms, using the phrase “piccaninnies” with “watermelon smiles” and talking about women in burqas with “letterbox” slits.
That does not set the tone or give me confidence that the Government will act. I believe that there are good people in the Government. There are good people in the Prime Minister’s party, but he needs to shape up. Just as Marcus Rashford educated him about the poverty and hunger of children on free school meals, my right hon. Friend the Member for Hackney North and Stoke Newington and I stand ready, with our constituents and with colleagues across the House, to educate the Prime Minister about how badly wrong he is getting the messaging on this. He needs to act now.
Draft Food and Feed (Chernobyl and Fukushima Restrictions) (Amendment) (EU Exit) Regulations 2019
Draft Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019
Tanmanjeet Singh Dhesi Excerpts(5 years, 9 months ago)
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Steve Brine
It is nice to see you in the Chair, Mr Wilson. These instruments, which concern food and feed law, are made under the powers in the European Union (Withdrawal) Act 2018 to make the necessary amendments to UK regulations. This is the third bundle of such regulations that we have debated in these fun sessions.
The Government’s priority is to ensure that the high standard of food and feed safety and consumer protection we enjoy in this country is maintained when the UK leaves the European Union. These statutory instruments correct deficiencies in regulations to ensure that the UK is prepared in the event that it leaves the EU without an agreement. They are limited to necessary technical amendments to ensure the legislation is operative on EU exit day; they make no policy changes.
Leaving the EU with a deal remains the Government’s policy. That is what the public want and expect us to do, and it is most certainly what I as a Minister expect us to do. We are working hard to get to a position where we do that. As the House made clear last night, it does not wish to leave without a withdrawal agreement at the end of March. Regardless, we have to make necessary preparations, and that is what this Committee sitting is about. The primary purpose of these instruments is to ensure that legislation that allows for the protection of the public from radioactive contamination of food resulting from past and any future nuclear accidents is operative on EU exit day. I do not think I have introduced many regulations that we so much hoped would not be needed.
The draft Food and Feed (Chernobyl and Fukushima Restrictions) (Amendment) (EU Exit) Regulations 2019 cover the importation of food from areas affected by historical nuclear accidents at Chernobyl in present-day Ukraine and at Fukushima in Japan. The instrument makes alterations to the legislation governing imports of food from the areas affected by the Chernobyl accident, which, believe it or not, was in 1986, when I was still at school—the shadow Minister was yet to get there. The Chernobyl accident resulted in widespread radioactive contamination, which affected food production in many countries. Thirty-three years after the accident, levels of contamination have fallen, and now only certain products, including wild game, wild mushrooms and berries——
Steve Brine
I just want to cover the berries, which are very important; those products and berries, such as blueberries and cranberries, show high levels of contamination. On berries, I give way.
Mr Dhesi
Sadly, my intervention does not relate to berries. Will the Minister confirm that standards and safeguards will not be watered down as a result of these statutory instruments? We enjoy very high standards and safeguards for permitted levels of radioactive contamination. Can he reassure us that that will continue to be the case post Brexit?
Steve Brine
I can absolutely assure the hon. Gentleman that that is the case. The draft regulations are an import from EU regulations. The European Union (Withdrawal) Act 2018, which I referred to, is a housekeeping piece of legislation, not a changing piece of legislation. If we wished to make changes either way—to strengthen or to weaken such regulations—they would come through the House and be examined by it. I am sure the hon. Gentleman and the good people of Slough would rightly take an interest and have something to say about them—as, indeed, would I.
Draft Food and Feed (Chernobyl and Fukushima Restrictions) (EU Exit) Regulations 2019
Draft Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019
Tanmanjeet Singh Dhesi Excerpts(5 years, 9 months ago)
General CommitteesRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Steve Brine
It is nice to see you in the Chair, Mr Wilson. These instruments, which concern food and feed law, are made under the powers in the European Union (Withdrawal) Act 2018 to make the necessary amendments to UK regulations. This is the third bundle of such regulations that we have debated in these fun sessions.
The Government’s priority is to ensure that the high standard of food and feed safety and consumer protection we enjoy in this country is maintained when the UK leaves the European Union. These statutory instruments correct deficiencies in regulations to ensure that the UK is prepared in the event that it leaves the EU without an agreement. They are limited to necessary technical amendments to ensure the legislation is operative on EU exit day; they make no policy changes.
Leaving the EU with a deal remains the Government’s policy. That is what the public want and expect us to do, and it is most certainly what I as a Minister expect us to do. We are working hard to get to a position where we do that. As the House made clear last night, it does not wish to leave without a withdrawal agreement at the end of March. Regardless, we have to make necessary preparations, and that is what this Committee sitting is about. The primary purpose of these instruments is to ensure that legislation that allows for the protection of the public from radioactive contamination of food resulting from past and any future nuclear accidents is operative on EU exit day. I do not think I have introduced many regulations that we so much hoped would not be needed.
The draft Food and Feed (Chernobyl and Fukushima Restrictions) (Amendment) (EU Exit) Regulations 2019 cover the importation of food from areas affected by historical nuclear accidents at Chernobyl in present-day Ukraine and at Fukushima in Japan. The instrument makes alterations to the legislation governing imports of food from the areas affected by the Chernobyl accident, which, believe it or not, was in 1986, when I was still at school—the shadow Minister was yet to get there. The Chernobyl accident resulted in widespread radioactive contamination, which affected food production in many countries. Thirty-three years after the accident, levels of contamination have fallen, and now only certain products, including wild game, wild mushrooms and berries——
Steve Brine
I just want to cover the berries, which are very important; those products and berries, such as blueberries and cranberries, show high levels of contamination. On berries, I give way.
Mr Dhesi
Sadly, my intervention does not relate to berries. Will the Minister confirm that standards and safeguards will not be watered down as a result of these statutory instruments? We enjoy very high standards and safeguards for permitted levels of radioactive contamination. Can he reassure us that that will continue to be the case post Brexit?
Steve Brine
I can absolutely assure the hon. Gentleman that that is the case. The draft regulations are an import from EU regulations. The European Union (Withdrawal) Act 2018, which I referred to, is a housekeeping piece of legislation, not a changing piece of legislation. If we wished to make changes either way—to strengthen or to weaken such regulations—they would come through the House and be examined by it. I am sure the hon. Gentleman and the good people of Slough would rightly take an interest and have something to say about them—as, indeed, would I.
Mental Capacity (Amendment) Bill [Lords]
Tanmanjeet Singh Dhesi ExcerptsTuesday 12th February 2019
(5 years, 10 months ago)
Commons ChamberRead Full debate Mental Capacity (Amendment) Act 2019 View all Mental Capacity (Amendment) Act 2019 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 12 February 2019 - (12 Feb 2019)
Madam Deputy Speaker (Dame Eleanor Laing)
It will be obvious that three people have indicated they wish to take part. I am sure that they will all limit their remarks not to a very small amount, but if they could be limited to six or seven minutes then everyone will get a chance to put their view.
Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
It is a pleasure to follow the hon. Member for Torbay (Kevin Foster).
It is my firm belief that the Bill is deeply flawed. Even with the concessions Ministers have made, and the forensic scrutiny and dogged determination of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and her Opposition Front-Bench team, as well as those in the other place, the Bill will do very little to help the crisis in our mental health services. Even at this late stage, I would add my name to those of my many colleagues and a plethora of stakeholder organisations urging Ministers to delay the Bill to allow proper deliberation and discussion. Why do I say that?
First, we cannot debate the Bill without a clear sense of the issues at stake. We are talking about the state’s right to remove liberty from a citizen without trial or the judgment of their peers. That goes to the very heart of habeas corpus and our most fundamental human rights. It concerns the very liberties that this Parliament has stood for centuries to defend. When Parliament has played fast and loose with our right to be free from arbitrary imprisonment, the consequences have brought shame upon us, so we must always think very carefully before passing laws that remove a person’s liberty, no matter how compelling we consider the reasons.
Secondly, we must never forget the history of the treatment of people with mental illness in this country. We have a sorry and shameful history of incarcerating people with mental illness, autism, dementia and other conditions. Often the incarceration was unnecessary and cruel, and motivated by malice not medicine. Women in particular could be locked up for so-called “hysteria” when husbands wanted them out of the way. We must tread very carefully.
Thirdly, there is the question of scrutiny of the Bill. We must act only after the deepest of thought and most widespread discussion and consultation. Unfortunately, the Bill has not been subject to the widest consultation and the deepest discussion. The discussion and suggestions that we made in Committee seem to have been largely ignored by the Government. We might have expected Ministers to have learned the lessons from the Health and Social Care Act 2012, which was imposed without consultation and then had to be delayed after its flaws were exposed. It then cost us hundreds of millions of pounds for an unnecessary raft of reckless reforms.
The Bill has been rushed and the consultation with stakeholders has been incomplete. You do not have to take my word for it, Madam Deputy Speaker. Just consider the remarkable open letter issued on Friday 8 February by so many of the organisations closest to the issue: the Voluntary Organisations Disability Group, Disability Rights UK, Foundation for People with Learning Disabilities, Action on Elder Abuse, Dementia Friends, Sense, the National Autistic Society, Royal Society for Blind Children and Mencap, just to mention a few—a very few—of the more than 100 local and national organisations across England and Wales who wrote to the Care Minister and the Parliamentary Under-Secretary of State, Baroness Blackwood.
What did this huge coalition of caring organisations come together to say? They raised “serious concerns” and “significant objections”. They called the Department for Health and Social Care’s consultation “piecemeal”. They talked about “serious conflicts of interest”. They highlighted the facts that impact assessments have been late and limited in coverage, and that there is a lack of clarity about how the system will be regulated with independent oversight. They concluded:
“We believe that the reforms in their current guise pose a threat to the human rights of those requiring the greatest support in life.”
A threat to human rights is a serious charge. When so many organisations are making it, surely Minsters must listen and not just plough on regardless?
There is a saying in the disability rights movement: no decisions about us without us. When I served as a trustee of the Alzheimer’s & Dementia Support Services and as a Mencap Society committee member, that was a principle we held dear, yet those in their place on the Treasury Bench are not listening. To be clear with the House, we have a serious problem that needs fixing. We have vulnerable people waiting for months, families at the end of their tethers and mental health and care professionals feeling frustrated, and that is why the system is broken.
Jim McMahon (Oldham West and Royton) (Lab/Co-op)
I congratulate my hon. Friend on a fantastic, very heartfelt and experienced speech. Does he share my concern that the foundations on which this is being laid—primarily on local government—are very weak, with an £8 million funding gap? The Government have not faced up to that crisis yet.
Mr Dhesi
I thank my hon. Friend and I fully agree with him. The cuts to local government have been devastating and the Bill will merely exacerbate the situation.
Finally, we have come a long way in our understanding of mental illness, dementia and neurodiversity. I note with pride that a new group was founded this weekend—the Labour neurodiversity group—to build on the success of our party’s neurodiversity manifesto. We wish the group all the very best. We have made great strides in tackling stigma and prejudice, thanks to the efforts of people such as my right hon. Friend the Member for North Durham (Mr Jones) and my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), who deserve nothing but praise.
We are learning all the time and our laws must reflect our enlightened attitudes and the latest thinking, not the outdated views of previous eras. I am happy to associate myself with the Labour amendments being discussed this afternoon. If there is one I would highlight, it is the proposed amendment that guarantees a vulnerable person the right to an advocate. In too many cases, they have no one to speak up strongly on their behalf, to articulate their wishes and to champion their best interests. It is surely right that such a person should always be available.
As a member of the Bill Committee, I know that we made some progress in improving the Bill, but I remain unconvinced that it will be enough to rescue this piece of legislation and to provide a fair, workable system that ensures the best possible care for hundreds of thousands of people and guarantees their human rights. Many hon. Members have highlighted the 2017 Law Commission review.
Fiona Bruce
The hon. Gentleman keeps talking about human rights, but what answer does he have for the fact that up to 125,000 people are currently being unlawfully deprived of their liberty, in breach of article 5 of the European convention on human rights? That is the problem that the Bill seeks to rectify.
Mr Dhesi
I thank the hon. Lady for her intervention, but in terms of human rights, this issue is being raised not just by me, but by more than 100 pre-eminent organisations in the field. The only way to solve that is through funding—that is the only way in which we can lay this matter to rest. The hon. Lady highlighted the 2017 Law Commission review of the deprivation of liberty safeguards, which stated that the current regime is
“in crisis and needs to be overhauled.”
I agree. There is a crisis and the current system cannot cope, but surely the answer is not to replace bad laws with yet more bad laws, and that is what we are in danger of doing.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
I will be brief. My hon. Friend the Member for Rhondda (Chris Bryant) has tabled an excellent amendment, which I support. We know that the system is broken. What we are doing is replacing it with an even worse system. Just to acknowledge how broken the system is, the Alzheimer’s Society’s national dementia helpline receives over 100 calls a month about the Mental Capacity Act, which is clearly confusing and complicated for people with dementia, as well as for their families and carers. However, as we have heard, so many different disability organisations and a whole range of charities, as well as the Law Commission, are saying that this Bill is not fit for purpose.
I particularly support the amendments tabled by my hon. Friend the Member for Rhondda. The Greater Manchester Neuro Alliance, which I have supported for several years now, has several concerns, particularly about a person who presents inconsistently and has a cognitive impairment, mental health problems or is simply vulnerable and does not accept or appreciate their illnesses and the limitations. One member of the alliance from Oldham told me:
“My son has been deemed as having capacity because he can answer questions yes or no but he can’t be left alone or allowed to go out unsupported, he doesn’t take his medication and doesn’t have the ability to plan or manage anything including lifesaving treatment every three weeks”.
Such examples are not addressed in the Bill.
I will move swiftly on, Madam Deputy Speaker. I share the concern that my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) has expressed so clearly about care home managers and the conflict of interest in the Bill. It is a minefield and needs to be addressed. She made that point clearly.
Amendment 48, tabled by my hon. Friend the Member for Stockton North (Alex Cunningham), would rightly prevent cared-for people from being charged for the assessments required by the system, potentially providing a financial incentive to do the mental capacity assessments. Without the amendment, we cannot be sure that people will not be charged more for their care solely because they require liberty protection safeguards to be granted. If the Minister does not accept the amendment, I would like to know why. On advocacy, we need to ensure that the “best interests” test is changed to place more weight on a person’s wishes.
There are several other issues with the Bill. It has not had a sufficient airing. It has not been consulted on greatly, but I will hand over to my hon. Friend the Member for Stockton North.
Mental Capacity (Amendment) Bill [ Lords ] (Sixth sitting)
Tanmanjeet Singh Dhesi Excerpts(5 years, 11 months ago)
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Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
We have referred to the code of practice, or the Minister has, on several occasions. We have consistently asked for it to be published. Surely the provisions would be nonsensical without it given we are being referred to it in relation to so many of the provisions we are arguing for. If a code of practice does not exist, where does that leave us in this whole scenario?
Barbara Keeley
Indeed. It is salutary to use the following quotation again:
“Whatever the weight given to the Code by section 42 of the Mental Capacity Act 2005, it does not create an obligation as a matter of law to apply to court in every case.”
We have wanted to know what is in the code of practice. We think knowing what is in it is important in deciding our position on what is in the Bill. The Government have declined to put too many aspects in the Bill and have instead favoured the code of practice. When legislation and codes of practice exist together, they are drawn up together and published together. That has not happened in this case and it is the wrong approach. We cannot leave crucial details about how a new system of protections would work, including what resources will be given to it, to a code of practice that has not been drawn up yet, but that is what the Government have done.
On the first day of this Committee the Minister said that she would supply Committee Members with a list of what should be contained in the code of practice, and I thank her for doing so last night. Unfortunately, that does not answer many of our concerns. For instance, we raised concerns about the length of authorisations. It is welcome that there will be guidance in the code of practice, but we still do not know what it will say. Similarly, the Minister’s letter says that the code of practice will contain
“guidance on the necessary separation and operation independence from any independent hospital an AMCP is conducting a review in”.
Again, I am glad that there will be guidance, but we still do not know what it will be. Nothing prohibits any of the relationships we are concerned about and have discussed at length: it simply says that some relationships may be prohibited. That is simply not good enough at this stage. As such, the Minister’s letter does not answer the concern of my hon. Friend the Member for Slough. We remain worried that there will not be proper oversight of this code of practice. Without seeing the full code, we cannot be certain that its contents are sufficient or appropriate.
Overall, the Government’s approach of constantly mentioning the code of practice as being the place where whatever is not in the Bill will be plays fast and loose with the rights and liberties of cared-for people. It further reinforces the mess that the Government have made of the Bill by rushing it through Parliament. Had they done the sensible thing and paused the process, they would have had time to draw up a draft code of practice so that we could consider it alongside the Bill, as is commonly the case. They have given reassurances that many of the concerns can be addressed in subsequent regulations and the code of practice, but that is simply unacceptable to those of us on the Opposition Benches. To that end, we have tabled the amendment to ensure that the Bill cannot be enacted until a code of practice has been published and approved by votes in both Houses, rather than just published.
An important principle that I want to discuss briefly is that legislation can begin in the House of Lords where it is deemed to be non-controversial. That was not the case with the Bill. It is not simply a reproduction of the Law Commission’s draft Bill, which was widely consulted on. As the recent media coverage in places such as The Guardian has shown, the Bill is not without controversy. The code of practice should not be passed through a negative resolution procedure in secondary legislation on the grounds that it is non-controversial. The Minister has indicated that the code of practice will have a real vote in both Houses. Let us see whether that will be a meaningful vote.
Alex Cunningham
I think the imperative is the other way around. It is important for us to have the understanding of what the Government are proposing and their attitude to the review, so that we can understand how the legislation will work and how the two Acts will work together.
I believe the Government would be reckless to plough ahead with implementing the provisions in the Bill while that piece of legislation relating to it is still being reviewed. The Challenging Behaviour Foundation has also added its weight to the concern of the interface of the Bill with the Mental Health Act review. Providing written evidence to the Committee, it said:
“The current confusion in the use of Deprivation of Liberty within the MCA and the MHA often means the needs of people with learning disabilities are not being met in a timely and appropriate fashion…The independent review of the MHA has considered this and made recommendations around when a person should be detained under which Act around objection…The Mental Health Act Review makes the recommendation that the Code of Practice for the MHA and for the MCA make clear in what circumstances professionals should consider whether or not someone has capacity to make decisions…We also think that both Codes should make clear who should carry out capacity assessments in these situations. This needs to be explored further and needs to be considered under this Bill to ensure both legislations work together.”
That is very clear evidence from the sector. Perhaps the Minister will share with us her perspective on the interface between the Bill and the Act. There is a theme running through the written evidence submissions that we have received. The conclusion they come to is that the Government are rushing this Bill through.
Mr Dhesi
I thank my hon. Friend for raising the concerns of organisations such as Mencap. Does he agree that the likes of Mencap not only enhance our understanding through national policy formation but, as I have learned from my experience as a member of the Gravesend and district Mencap society, they also work on the ground? People such as Linda and Chris Norris and other volunteers, through their work, help their national organisations in policy formation. As parliamentarians we would be very wrong to ignore their recommendations.
Alex Cunningham
I very much commend the work of organisations from the grassroots right through to the national level. The reason I sat down with people from my local authority before the start of this Bill Committee was so that I could understand what was happening at the grassroots. That grassroots work that feeds all the way through the system informs us and it is important that we take account of it.
My hon. Friend the Member for Slough will know that, with the amount of written evidence submitted to the Committee, we could have stood here and made three-hour speeches ensuring that we raised the issues that they wanted raised. Some of us are a little more kindly and will be relatively brief.
This is not a matter to be pushed through with little consideration because the consequences of getting it wrong are significant. I ask the Minister to think carefully, not just about the comments made by hon. Members but about the evidence that has come from the sector. We raise that evidence out of concern that the Government might be making the wrong move. We need to tread carefully and understand the implications.
Amendment 53 seems sensible and proportionate. How can we possibly pass legislation that would have an undue impact on local authorities and other responsible bodies without giving them the resources to carry out the functions required? I have spoken in previous sittings about care home managers and the impact provisions in the Bill would have on them. Not only do I believe that they do not have the adequate skills to carry out assessments. I am also concerned that they have a severe conflict of interest if they are expected to be involved in the assessment of those who reside in their care.
Alex Norris
Liberty, Mind, the Alzheimer’s Society, the National Autistic Society, POhWER, Parkinson’s UK, the British Institute of Human Rights, Sense, Compassion in Dying, YoungMinds, Learning Disability England and Headway all say that this is “rushed, incomplete and unworkable”, and that in general they feel the whole exercise is entirely unfit. It is well within the prerogative of the Government of the day to say that they are right and that all those organisations are wrong, but it is, dare I say it, quite a brave thing to do. For the benefit of the Committee, and of everybody else who has taken an interest in these proceedings, it might be worth explaining why the Government feel that they are right and the Bill is fit for purpose, and that the new clause, which very much puts the cherry on top of the Bill, is worth standing part of it.
Mr Dhesi
Does my hon. Friend agree that that is an indictment of the whole process, and of the rushed manner in which the Bill has been introduced? To have one organisation from among those 13 eminent organisations come forward in The Times today and use words such as “rushed”, “incomplete”, “unworkable”, “unfit” and “dysfunctional” would be bad enough; to have all 13 do so makes the entire process look like complete folly.
Alex Norris
I completely agree. To me it is a big, blinking red light that says that perhaps we need to pause and think again. Nothing typifies that more than new clause 1. It is helpful to have a definition in the Bill, and there is broad support for that. I also have some sympathy for its being exclusionary, rather than put in a positive manner, because we know, irrespective of what ends up in the Bill, that it will end up in court.
This is a hotly contested area of case law. It feels a bit like what it must be like to be an American legislator—we are almost waiting for what we do to be tested in court to see if it is okay. I have no doubt, with things as they are currently comprised, that we will be back. I do not know whether it will be a couple of months down the line or a couple of years, but if we carry on we will certainly be back.
The approach laid out by my hon. Friend the Member for Worsley and Eccles South is sensible and proportionate, and it might give us an opportunity to resolve the issue, by sending the new clause, which has appeared between stages, to the sector and asking, “How do you feel about this?” in order to get some engagement. That would give us more time for the lawyers to do their thing too. That seems quite sensible.
It would also give us a chance to take a breath on the whole Bill, and a little more time to see whether we can resolve some of the issues that we have discussed over the last two weeks. Many of the things we as an Opposition have put forward have had merit; perhaps our approach has not always been perfect, but to find better ways to try to address those things would be good for us all.
I will move on to my second concern. If new clause 1 becomes part of the Bill and the Bill becomes an Act, the smoke will come out of this place and send a clear signal: “We know that DoLS doesn’t work and hasn’t worked for a long time. Here is what is going to come next. Here is what we mean by ‘deprivation of liberty’ and here is what you can expect.” I maintain my anxiety that we will have only solved half of the problem, or one of two problems, because it is entirely possible for a big problem—in this case DoLS, the backlog and people’s experiences of that process—to be multifactorial.
No one has contested the fact that the DoLS system did not work and ought to be replaced, but there is a big, yawning and currently unanswered question of resources. I was concerned to hear the Minister say that they are the result of political decisions. I have been in that chair, as the local adult services lead on my council for three years, wrestling with DoLS. Is it a political decision? Yes, maybe it is, in the sense that we are basically trying to juggle whether to deal with assessing new people on their social care needs, assessing whether the needs of people currently in the social care system have gone up or down or, indeed, areas such as DoLS, all of which carry enormous risk to an individual, a local authority and a community as a whole.
In the sense that it is a political choice, it is like saying, “Your house is on fire; are you going to put out the lounge or the kitchen first?” You would just grab the bucket of water and chuck it at it, frankly. There is no political decision in that, or certainly not one of due prioritisation. Ultimately, if we are going to include this new clause in the Bill to set up the new system and legislation to set the new way, we must have absolute clarity that the finances are going to be met. Otherwise, the system will fail and we will, certainly with new clause 1, have elevated people’s expectations. At the moment people expect to be disappointed, because they know the system does not work. Now we are going to tell them that we have a new system that works, and then it will not. I suspect that is why all those eminent organisations have said that it is where it is.
On this point and on others, I feel that we on the Opposition Benches have made strong arguments about ways of improving the Bill, but it is not just us. It is not just partisan knockabout; it is not political. It is not a case where the Government say one thing so therefore the Opposition oppose. We should look at the organisations that are also saying, with flashing lights, “Please stop and have a think about this.” Otherwise, as I say, we will be back.
Mental Capacity (Amendment) Bill [ Lords ] (Fifth sitting)
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Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
It is a pleasure to serve under your chairmanship, Mr Austin.
I rise to support my hon. Friend the Member for Worsley and Eccles South and to state that advocates are extremely important. They should be provided by default, with cared-for persons having the right to decline such representation if they wish. To illustrate my point, I will refer to a case study from POhWER, an organisation that provides advocacy support. Its advocate supported a cared-for person to go to court and stopped the local authority’s attempts to sell his home. Thankfully, the client then returned home.
The disconcerting scenario is as follows. The POhWER advocate, or the relevant person’s paid representative, visited a client in a care home where he was able to state that he did not want to be there, and wanted to go back to his own home. A discussion took place about requesting a review, accessing the court or liaising with a social worker. There were no conditions attached to the DoLS, but there was a lot of evidence and many statements confirming that the client did not want to be in the care home.
The cared-for person asked his advocate to have a chat with the social worker initially. The advocate contacted them to discover that although the client had not been in the placement for a long period, the local authority had placed his home on the market with the intention of funding his placement with the proceeds. That is an absolutely ridiculous scenario. It could happen to anyone here: unbeknown to us, the local authority could, without advocacy support, place our house on the market to fund a care placement with the proceeds of its sale. The client had no knowledge of this and there was no evidence at all that he had been consulted. He was very upset and wished to access court.
The court process determined that the cared-for person had substantial personal funds and a home that could easily be adapted for any mobility issues, with numerous bedrooms for live-in staff, whom he could afford to pay for himself. Thankfully, the judge ruled that he was to return home, in line with his wishes, given that he would have chosen that for himself if he had had full capacity to do so. Before the client moved back home, the new social worker who was appointed involved him in selecting the carers, who would live with him on rotation, and he had trial visits including some overnights. The return home was successful and the DoLS ended.
I hope that that example illustrates to the Minister and to Committee members that, without advocate intervention, the cared-for person’s home would have been sold without his knowledge, and his wishes and feelings would have been completely discarded and ignored. That is why it is very important that advocacy should be there by default.
Dr Paul Williams (Stockton South) (Lab)
It is a pleasure to serve under your chairmanship again, Mr Austin.
Like other hon. Members, I would like to share some cases to do with the issue of appropriate advocacy. Briefly, I will describe a simple intervention by an advocate who challenged assumptions made by care home staff and improved the quality of life of a person living with dementia. A relevant person’s paid representative was appointed for a woman who, it was reported, had been financially abused by her child following her diagnosis of dementia. She had been placed in a care home by the local authority because of safeguarding concerns.
Visits from the RPPR identified that the woman appeared to be happier now that she was not subject to the conduct and behaviour of her child. However, she had none of her own clothes, photographs or personal artefacts with her. When she was asked about that, she said that that made her feel sad. The RPPR made representations and said that if she had those possessions, she might be happier. Contact was made with her child. The intervention resulted in her child bringing items of clothing and photographs to the care home and also having some supervised contact with her mother. The woman told the representative that she was happy for that to continue.
The care home staff had initially provided information that the woman was content and did not need anything further, but the difference in her demeanour when she was wearing her own clothing and surrounded by personal artefacts was remarkable. She even wrote a note to her advocate, thanking her for supporting her and helping to get her child back in her life. Later on, her child wished to take her out of the care home, but the RPPR listened to the woman, who said she wanted to stay where she was, and supported her to make the decision to remain where she felt safe and comfortable.
That case illustrates why appropriate advocacy must be available to all who need it. The new legislation must ensure the right of the person to object to and challenge arrangements if they wish and to have the support and representation to do so. Support from an IMCA should not depend on a person’s best interests, as defined by other people. It should be a right that everyone is able to access an advocate, and people can then choose to opt out. That would improve the Bill by offering clarity to the cared-for person and the responsible body. I am happy to support the amendment.
Alex Cunningham
The Committee is going to get this example whether it wants it or not. The case went to court, and the judge accepted the evidence and ordered that the cared-for person be returned home and that the sibling be evicted so that the live-in or an overnight carer could be accommodated. The gentleman in question returned home successfully and was later assessed as having regained capacity.
That is the power of an advocate, and it proves the necessity of an advocate in all cases, so I hope that the Minister takes these comments on board and ensures that she helps to enhance the quality of life for vulnerable people by including this amendment in the Bill. It would probably also ensure that she plays an important role in getting people who can be supported in the community the right result for their lives, rather than their being effectively locked up in a place where they do not want to be.
Mental Capacity (Amendment) Bill [ Lords ] (Third sitting)
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Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
As well as being against the 1989 Act, does my hon. Friend agree with me that it is common sense for parents to be at the heart of any DoLS? It is not good to be sidelining them on what is, in effect, the issue of the health and wellbeing of their children.
Alex Cunningham
That is very much the case. I always try to place myself into such a situation. I am at the grandfather stage of life now, and I think about how that would affect the children of my children, or other parts of my family who have children. I would most certainly want them to be at the centre of it—I would probably try to interfere a bit myself as well.
The Children Act, however, provides protection—it is a real safeguard—and yet the Bill is not at all clear about how it will sit with that existing legislation. Surely, as my hon. Friend the Member for Worsley and Eccles South suggested, parents must be consulted and have that ability to make decisions about their child, even if they are 16 or 17. We must ensure that such safeguards are enhanced, not watered down or in conflict with each other.
The Royal College of Psychiatrists has highlighted to me that encompassing 16 and 17-year-olds in the Bill can be positive where they lack capacity to make their own decisions, but that must be authorised by an appropriate safeguarding system. The RCP shares my belief that a parent or legal guardian with capacity to make the decision should be able to authorise the required deprivation of liberty.
Many social workers and other professionals in the field have made submissions. There is a strong consensus that additional safeguards should be available where objection is made by a person with parental responsibility. The Mencap submission, too, welcomes the inclusion of 16 and 17-year-olds in the Bill, but it also expressed concern that we might be reducing protections and eroding parental rights. Mencap has asked the Government to conduct further public consultation on the measures for 16 and 17-year-olds to understand the implications fully.
Does the Minister believe that the Government have consulted properly on the issue of 16 and 17-year-olds? Clearly, the organisations with an interest in such matters do not think so. Will she commit to undertake a rapid consultation exercise ahead of Report, in the hope that we in Committee can be reassured about parental rights and the very necessary protections for young people?
Mencap highlighted the particular uncertainty about how the new system works alongside existing legislation. I have already talked about that, but a complex web of legislation and guidance relates to those young people who might fall under the LPS system, including looked-after children. My hon. Friend, however, has already spoken about that. It is essential for the Minister to provide clarity in such areas, preferably now but certainly before Report.
In closing, I will make a general point about involving parents in all manner of processes in the health and social care world. For them to be excluded from the process, denied the right to report or told simply that the authorities know best must be an exception. It is not always the case that the authorities know best. At times, I have a tremendous caseload of parents coming to talk to me about issues affecting their children and how they feel excluded.
I put it to the Minister, if a child affected in a particular case was one whom she knew personally, one whose parents she has had contact with, would she be content for them not to have every possible access to information or not to be consulted at every stage? I remind her that a child is being deprived of liberty—this is an opportunity to lock a child up, basically. We need to understand and empathise with parents in their desire to be consulted in the decision-making process, and I believe that the amendment would go a long way to ensuring that that actually happened.
Dr Williams
The hon. Gentleman is right: it is a significant intervention that may well require not only a person with significant skills, knowledge and experience, but a series of different assessments over time to make the judgment.
Mr Dhesi
As the hon. Member for Halesowen and Rowley Regis just pointed out, a medical practitioner who can diagnose whether somebody has fluctuating capacity may be unavailable, in which case we should definitely not disregard the Law Commission’s advice. Otherwise, we open ourselves to legal challenge and other things. In the long run that would be to the detriment of not only the cared-for person but the system itself in terms of extra costs and distress.
Alex Norris
It is a pleasure to follow my hon. Friends the Members for Dewsbury and for Stockton South, who made compelling arguments that I hope to add to a little.
On fluctuation, by definition we are talking about some of the most challenged individuals in society. As a result, their medication needs could be significant, and the nature of their challenges can change over time. It is not only conceivable but probable that those individuals’ needs may vary. Therefore, the protections we need to give them may have to be slightly flexible.
Behind the Cheshire West case and the television documentaries that make us all throw our hands up in the air and think, “Goodness me, how awful”, is the idea that none of us thinks that someone whose liberty needs to be taken away for their own protection should ever be put away and forgotten about. None of us wants that at all. That is in keeping with the theme of wiring into the Bill the understanding that we are talking about human beings, and that things change and their conditions change, as they do with us all. Therefore, we may need to change the way they are looked after and supported.
I reflect on the point the hon. Member for Halesowen and Rowley Regis put so well; on Tuesday I was wringing my hands about my past anxieties about the lack of assessing capacity. I then put my name to an amendment that asks for greater specialism among those assessors as people who could pick up something that, as the hon. Gentleman said, was not trivial. I understand his view but do not completely share it. We want to include in the Bill the possibility that an individual’s needs may fluctuate—not how those needs will fluctuate. It would not necessarily mean that all the assessors have to have the ability to make that judgment. If the assessment says, “There is a reasonable chance that this individual’s needs may fluctuate,” that puts a “So what?” test on the responsible body, which may say, “Okay. We may therefore need to call in someone who has that specialism at an appropriate moment.” That could be covered in the code of practice. I do not think that test puts an unreasonable or unnecessary burden on the assessing capacity, which is finite.
I support the point that my hon. Friend the Member for Dewsbury made. Most of this discussion has been framed around the idea that some people are deprived of their liberty because they are deemed not to have the capacity to look after themselves, but because their needs fluctuate, that may not have needed to happen. As my hon. Friend said, there is another cohort of people who are assessed not to have fallen into a deprivation situation, but that might not be safe for them either. It is important that we bring that into the discussion. This is not just about people who are deprived of their liberty when that may not need to be the case; it is also about people who, the vast majority of the time, are not in those circumstances, but in a conceivable situation relating to their personal health challenges, may need to be deprived of their liberty. That is a really important point.
Amendments 31 and 33 get to the nub of what we have been talking about for the past two and a half sittings. What are we trying to do with assessment? If the Bill tilts towards moving assessment away from local authority-hosted social work into care settings, with the people who are around the individual the most and have great familiarity with them, the Opposition have expressed some discomfort about that. Nobody is arguing for perfunctory or tick-box assessments—hon. Members on both sides of the Committee have been clear about that. With amendment 33, we want to put on the face of the Bill a requirement that the people who carry out assessments have the right qualifications—I hope that will apply to pre-authorisation assessments, too—so we have the confidence to say to people, after this Bill has wended its way through Parliament, that we have not created a system that has moved away from skilled assessment, which is expensive, finite and a challenge in this country, towards unskilled assessment because it is easier or cheaper. Nobody wants that; I certainly do not. By putting that on the face of the Bill, we can give comfort to the people who observe our proceedings and those who will engage with us during the Bill’s progress that we are not seeking to do that.
Mr Dhesi
My hon. Friend is making a very powerful case. As a former trustee of Alzheimer’s & Dementia Support Services, which dealt with people with very serious vulnerabilities, I can attest to the fact that amendments 31 and 33 are entirely sensible and should be incorporated in the Bill. Not having a registered medical practitioner undertaking these assessments, especially when we are dealing with very vulnerable individuals, would be detrimental to the entire process.
Alex Norris
I appreciate that intervention. One of my favourite things about being in this place—certainly in Bill Committees, out of the white heat of the Chamber—is that we learn a lot that we did not know about people’s knowledge and expertise, whether it is personal experience, professional experience or experience from their spare time. It helps us all. That contribution adds to the debate, and I greatly appreciate it.
These amendments will help to give confidence that what we are all trying to achieve here will be achieved in the Bill. I would expect it to be enhanced by the code of practice, but in law and in statute, in the Bill, we in this place will have made a clear commitment about what sort of legislation we want. In that spirit, I commend the amendments to the Committee.
Mental Capacity (Amendment) Bill [ Lords ] (Fourth sitting)
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Barbara Keeley
Much of our conversation on the Bill has so far focused on the role of approved mental capacity professionals, when they should be appointed and who they should be. We have given this topic so much time because AMCPs are a fundamental safeguard built into the proposed LPS system. This independent review process will prevent the deprivation of liberty from being applied for and approved within one system.
We tabled several amendments designed to strengthen the provisions of this safeguard and prevent anybody from being wrongly deprived of their liberty. I am sorry that the Government have not accepted our amendments, which would have provided for more people to have access to an approved mental capacity review. These reviews would have ensured that it is not only people who actively object to arrangements or are in independent hospitals who have access to the safeguard that an AMCP review would provide.
None the less, we are determined to continue to improve the Bill, so that those people who do not have access to an AMCP review are treated properly. Amendments 42 and 43 provide for AMCPs to meet the cared-for person in all cases that they review. We just had a little exchange about this, and the Minister seemed to say that there would always be meetings. I hope she meant that.
Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
On requiring the AMCP to meet the cared-for person before making their determination, the wording—
“appropriate and practicable to do so”—
is just not correct. Does my hon. Friend agree that we have a duty of care to each and every individual? Surely each and every life is as important as the next. We must do our level best in all circumstances, not only when it is appropriate and practicable to do so.
Caroline Dinenage
Let me make a bit of progress and I will hopefully answer the hon. Gentleman in the process, but if I do not, he can intervene again.
The exceptions where it would not be practicable and appropriate would depend on the circumstances of the case. Things such as workload, cost and distance would not count under the qualification of not appropriate or practicable. It might be not appropriate or practicable, for example, where the person is in a coma and the family has requested that the AMCP does not interview the person, because it would cause distress. Another example is where someone at the very end of their life needs to be deprived of their liberty in their last few days, and they do not want to see an AMCP. In many cases, we feel it would not be appropriate to override the person’s best interests and force them to meet with an approved mental capacity professional.
Mr Dhesi
The Minister makes some very good points that I have sympathy with, but why cannot we simply include what she says in the code of practice? Setting it in stone in the Bill gives completely the wrong signal to medical care professionals: it makes it the norm rather than the exception.
Mental Capacity (Amendment) Bill [ Lords ] (First sitting)
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Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
Does my hon. Friend agree that, with regard to 16 and 17-year-olds, we need to ensure there is provision for parents or guardians to object to care arrangements? If that has an impact on their child’s deprivation of liberty, that is not an acceptable situation.
Barbara Keeley
I agree with my hon. Friend, and we will talk specifically about that later.
The Court of Protection exercises powers under the Mental Capacity Act 2005, under section 25 of the Children Act 1989 or its inherent jurisdiction, or under the Mental Health Act 1983, should that young person require in-patient treatment. The limited protection safeguards created by this Bill introduce a new administrative process as an alternative means of authorising a young person’s deprivation of liberty, and that is why we have to be careful.
In one sense, having this alternative means of authorising a deprivation of liberty of a young person is desirable, in that it may address some problems associated with the cost of making an application to the courts under the pieces of legislation I just referenced. The liberty protection safeguards might also act as an appropriate and proportionate bulwark in cases where care arrangements are not contentious, due to the type of care that is provided, the level of restrictions imposed and the consensus on the suitability of arrangements. For instance, if the placement meets with the young person’s approval and has been made with the agreement of the young person’s parent—a point that my hon. Friend the Member for Slough raised—in relatively straightforward cases, the extension of liberty protection safeguards might act as a convenient and straightforward mechanism.
Steve McCabe
It is a pleasure to serve under your chairmanship, Mr Austin. I want to make a brief contribution, particularly on amendment 37.
If I may say so, the Minister was rather dismissive in her contribution. It has become evident in the past hour that the real challenge for the Bill will be to provide an affordable and worthwhile set of arrangements that guarantees that people who genuinely need care and protection get it, but that protects individuals’ liberties at the same time. We do not want to end up putting the wider establishment’s interests first and the individual’s second.
The Minister said that she was anxious not to put too much in the Bill, because that might expose it to challenges about what had been left out. Conversely, the Government cannot put too little in the Bill and ask us to rely on a non-existent code of practice. As legislators scrutinising legislation that will have a massive impact on the liberty and human rights of some of the most vulnerable people in our society, we need to ensure that the Bill is fit for purpose; I notice that Sense, an organisation with a lot of experience of many people who will fall within the Bill’s remit, takes the view that it is not. We need to be certain that we have the balance right, rather than tipping it in favour of the authorities or institutions—the people with power, effectively—against the interests of vulnerable people.
I know that the Minister’s intention is to streamline the process, but if she succeeds in streamlining it by flouting the legitimate liberties of some of our most vulnerable people, it seems to me that she is exposing the system to some risk. Disability Rights UK fears that one of the Bill’s dangers is that it
“takes the rights of disabled people backwards.”
Mr Dhesi
My hon. Friend is making very powerful points. Does he agree that there needs to be greater democratic accountability and responsibility? If a clinical commissioning group or local health board decides that a cared-for individual should be looked after in an independent hospital, it should be the responsible body. It is important that we have that accountability and responsibility in the whole process.
Steve McCabe
Yes, I agree.
I happily accept that every member of this Committee is committed to trying to do the right thing by very vulnerable people—there is no doubt about that. However, it is easy to rush such a Bill, particularly at a time when the Government are a bit distracted by other matters. The argument may seem simple on the surface: “Oh, we have a bit of a backlog, but let’s not concentrate on how it developed—maybe it was resource-driven. Let’s focus on the fact that we have a backlog and find a way of streamlining things to get that down.” When taking that approach, it is easy to gradually step away from the essential safeguards.
Sometimes these things take time. I do not want there to be unnecessary repeat authorisations. The Minister mentioned that to me recently and I accept that it is just pointless bureaucracy, but it is possible to try too hard to limit it. One of the reasons why protections and safeguards are built in is to stop us from trampling over people. It was a long time ago now, but I should confess that in my dim and distant past I was once a social worker, and I know what happens when people are under pressure. The case load of an average social worker these days is unbelievable compared to 30 or 40 years ago, and they are under enormous pressure to get things done with insufficient resources.
Mental Capacity (Amendment) Bill [ Lords ] (Second sitting)
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Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
To ignore the conflict of interest would be an absolute dereliction of our duty as parliamentarians. Does my hon. Friend agree that pre-authorisation reviews should be carried out only by individuals who are not in any way connected with that independent hospital, the day-to-day care provision for that individual or the treatment of that cared-for person?
Barbara Keeley
I agree with my hon. Friend, who makes a good point.
In essence, the case outlines the situation that the Government propose in the Bill. The care home provided reassurances to the local authority that the situation was appropriate and necessary, which lengthened the time that the young man spent in that inappropriate setting. The local authority accepted those reassurances, including when the case was reviewed. The end result was that somebody—this young man—was held inappropriately for two years.
To protect against that, we want all cases to be initially authorised by an independent body, which would organise the assessments and consultations itself. Because it would do that, the care home would not be able to provide initial assurances that may turn out to be incorrect. That would provide another layer of protection against people being wrongly deprived of their liberty.
We have been told that paragraph 20(1)(a) of schedule 1, which would allow care home managers to carry out the consultation with the cared-for person and others, is of concern. I have heard of cases where care homes decide to cut off contact between a cared-for person and their family, often on highly dubious grounds. As the hon. Member for Halesowen and Rowley Regis said this morning, in some cases that may be because the family are not helping the situation. However, in other cases—I am afraid to say that this applies to most of the examples that I have encountered—it is purely because the family object to something that is being done.
Fear of something like that happening can make it hard for someone to stand up to the people providing the care, whether they are the cared-for person or somebody close to them. The risk of having contact cut off, or the risk of reprisals when there is nobody there to object, can make people compliant even when they do not want to be.
I ask hon. Members to picture this situation: neither the cared-for person nor their family are confident enough to stand up to the care provider and object to the support that is being developed, and then that very same care provider asks them if they have any objection to a deprivation of liberty being granted. How many cases can Members imagine in which nobody says anything, not because they do not want to but because they are scared of the consequences?
One such case would be too many, but I suspect that there will be many more. I will raise two cases now in which such a situation could have been an issue. In one case, a resident—Mr A—had removed his hearing aid and his daughter had had to shout to make herself understood. She was then accused of bullying him and of other misdemeanours, and she was banned from the care home. She had been a regular visitor and had helped with many personal caring tasks. She was subsequently informed that the matter had been referred to safeguarding and that a DoLS referral had been made. The investigation made it clear that the restrictions had been imposed because she had asked a number of questions about the deterioration in the home’s standards of care, which the care home manager was finding difficult to answer.
In another case a daughter, Ms B, was concerned about her father, Mr B. Against all attempts to prevent it from happening, Mr B had been placed in a care home. Ms B felt that that was against both his wishes and his best interests, which is the important point that was just made. However, both the care home manager and her stepmother were content with the placement. Mr B’s behaviour quickly became increasingly aggressive and he made repeated attempts to leave the home, including by climbing out of a window. His daughter’s visits were then blamed for his behaviour. As a result, the care home manager prevented him from meeting friends outside the home and Ms B was asked not to visit the home.
In both those cases, relatives with a valid interest in a cared-for person’s welfare were restricted—on spurious grounds—from having contact with them. In both cases, the main “fault” of the relative was to express concerns about the care that was being delivered. If expressing negative views about a person’s care can get a relative banned from seeing them, of course people will be reticent about making their feelings known when they are consulted by the care home manager.
Mr Dhesi
My hon. Friend is making a very powerful point. Hopefully the Minister will acknowledge that if family members are excluded from the care process, alarm bells should ring throughout the entire process, because so often for vulnerable individuals their family members are the only people who visit them. That is why we need to ensure that family members have a connection with them in the future.
Barbara Keeley
By moving this responsibility in the Bill to local authorities, which currently have this responsibility, we can ensure that people are more confident about expressing their feelings. The consultation process should act as a crucial safeguard to prevent people from being deprived of their liberty against their wishes. Without our amendments, I am afraid that all too often the Bill will not achieve its purpose.
I turn now to the burden of work that the Bill will place on care home managers, because that is an important aspect. I hope that I have made it clear that I do not think that it can ever be appropriate for a care home manager to have a role in this process, but more than that there is no evidence that care home managers want this role or could carry it out. There is currently a vacancy rate of 11% for registered care home managers—11% of care homes do not even have a manager. That is higher than for any other role in the care sector. Care home managers are overworked in many cases, having to manage care homes that are operating on increasingly narrow margins. They are not experts in mental capacity nor trained to carry out assessments. In short, the role that they may be given is not one that they are prepared for or want.
Given that they are overstretched, we can expect them to make mistakes on occasion—that is understandable. When people are placed in high-pressure environments and expected to do more than they reasonably can or want to do, something has to give. We should not be in a situation where that something is the proper process for the authorisation of the deprivation of somebody’s liberty. It would not be acceptable if the result of the Government’s underfunding of social care was that people had their liberty taken away based on a tick-box exercise by a care home manager who lacks the time and skills to do any more.
I understand that the Government estimate that it will cost just £20 to train a care home manager to carry out this role. I think it was said at a recent meeting of the all-party parliamentary group on social work that it takes years to train a social worker to get to the point of carrying out assessments. Twenty pounds represents perhaps half a day of training. The idea that after a few hours a care home manager will be able to go out and manage liberty protection safeguards is not plausible. These complex issues should be carried out by people who have experience and expertise.
As we heard earlier, local authorities already have teams dedicated to deprivation of liberty safeguards, so it seems a wasted opportunity not to use that resource. Ultimately, it would not even save money.