Crisis Houses

Yvonne Fovargue Excerpts

Wednesday 22nd May 2024 Westminster Hall

[Yvonne Fovargue (in the Chair)]

I will call Bambos Charalambous to move the motion and then call the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

I beg to move,

That this House has considered crisis houses.

Until October 2021, I had never heard of a crisis house and did not know what one was, but that all changed when one of my constituents got in touch to tell me about the tragic circumstances of her daughter’s death in a crisis house, following a referral there from the local clinical commissioning group.

What is a crisis house? Crisis houses are broadly defined as community-based residential settings that give clinical and social support to people during a crisis. The emphasis is on providing a safe alternative to hospital admission when an individual is undergoing a mental health crisis. Some crisis houses are staffed by volunteers, while others are staffed by medical professionals. The level of support can vary greatly, from accommodation and emotional support to acute mental health support. Despite the varying degrees of support that they provide, crisis houses are not regulated. I will explain why that is a problem by speaking about the tragic case of my constituent’s daughter, Jess. The details of Jess’s case, which I will draw on in my speech, were reported at her inquest and are publicly available online.

In 2020, 27-year-old Jess Durdy entered Link House, a crisis house in Bristol. Link House is run by a charity and was commissioned by the local care commissioning group to provide mental health support. It was not registered with the NHS or the Care Quality Commission. Jess was moved from regulated NHS care to a service that was unregulated, where her care co-ordinator was not a registered practitioner. Five days later, she took her own life.

Jess’s death was almost certainly preventable. She died because staff at Link House were entirely lacking in the training necessary to deal with patients suffering from severe mental ill health. They failed to take seriously or act on Jess’s repeated warnings that she was having intrusive suicidal thoughts; they used unsafe door locks that prevented them or paramedics from reaching her quickly; and they were unable to provide emergency services with the information necessary to arrive on time to save Jess’s life. For Jess’s family, there were and there remain many questions. Could Jess’s death have been prevented? Was the crisis house that Jess entered a safe alternative to hospital care? How could they raise their concerns about the care provided to their daughter?

Despite growing numbers of crisis houses dealing with some of the most vulnerable in society, the regulatory oversight of these organisations is a complex patchwork of different regulators and regimes, including the CQC, the Charity Commission, local authorities and so on. The CQC can only regulate providers of certain regulated activities, including in such areas as accommodation for nursing or personal care and family planning. In Jess’s case, the CQC had no oversight of the care and treatment provided by Link House. It could only examine the procedures of the commissioning Avon and Wiltshire Mental Health Partnership NHS Trust in ensuring patient safety. Without proper regulation and oversight, there is always the risk that other vulnerable people will take their lives. For that reason, the Government must introduce regulation for the sector to ensure basic standards of care before another tragedy occurs.

I pay tribute to Jess and her family. Jess’s mother Moira Durdy is my constituent, and I have been supporting her attempts to get justice for Jess to ensure that no other family has to experience the terrible loss of a loved one in similar circumstances. Jess was originally from north London. Her family describe her as a dearly loved, bright and caring child. They are hugely proud of the kind, loving, generous and loyal person she was and of her intelligent and inquiring mind. After spending time in Bangladesh working for Engineers Without Borders, Jess returned to her university town of Bristol to live and work in 2016. Jess had struggled with mental health since her teens, and had been diagnosed with anxiety, depressive disorder and bulimia. Despite this, her family say that she always had a smile and often hid her struggles.

Jess approached her GP for additional support in June 2020 and was under the care of Avon and Wiltshire Mental Health Partnership NHS Trust. She struggled with the medication provided, and by October 2020 her health had further declined. She was referred by the trust to Link House, which is run by the housing association Missing Link. Places at Link House were commissioned by the local clinical commissioning group. It provides care to patients with mental ill health who need more support than can be given in their homes. Despite this, its staff are support workers and not qualified medical professionals.

In the three days before she died, Jess disclosed to Link House staff that she felt suicidal and wanted to end her life. However, staff lacked the training necessary to understand how seriously to take Jess’s reports. They simply made phone calls to the recovery team and failed to follow up on those calls when there was no response. They did not make calls to the crisis team because, as Jess had not been admitted under the crisis team, they mistakenly assumed that it would not respond to calls. They failed to remove the ligature from Jess’s room that she ultimately used to take her life. There was a lack of clarity in the pathway for the escalation of risk and an assumption that the welfare checks that they were doing were sufficient.

On the morning of Jess’s death, when staff found that she was not responding to the morning check-up, they were unable to enter her room, because the doors at Link House were locked from the inside. The door closure inside the room was a readily available ligature point, and an inward opening door is contrary to the usual standard in mental health facilities. Staff did not know how to communicate the seriousness of the issue to paramedics, such that the emergency call was made a category 3 welfare check call. The result was that Link House staff stood helpless outside Jess’s door for 30 minutes before paramedics arrived. The paramedics were eventually able to break down the door, by which time Jess could not be saved. Had the call been made to the fire brigade, which has specialist equipment for breaking down doors, the outcome might well have been different.

The lack of clinical oversight and regulation at Link House meant that it was not a safe place for Jess to be housed. Jess was continually and graphically describing how she would ligature, and it is clear that the welfare checks and her environment were not suitable for her. Patients like Jess are extremely vulnerable and require specialised care and support, which was lacking in this case.

This is a tragedy that unfolded at one crisis house, but this is not just about one crisis house. In response to my written parliamentary question in June 2023, the Minister informed me that there were “around 70 crisis houses” around the country, with the number continuing to rise. However, I was concerned that figures for the number of crisis houses that were NHS-commissioned but not managed by NHS staff were not available. In September 2023, the Minister confirmed to me that the Government are committed to expanding mental health crisis services as alternatives to emergency hospital admission, and that they are investing over £140 million to expand the provision of emergency care options such as crisis houses.

The existing regulation in this space is complex. If providers offer regulated activities, they must register with the CQC as a provider of health or care services. That requires certain basic standards of training and care, but in many cases what crisis houses offer is outside the scope of those regulated activities, so there is no requirement to meet those standards despite crisis houses dealing with a patient population with complex needs. In the case of Link House, for example, the housing association Missing Link is regulated only by the Charity Commission, which is not an appropriate oversight body for ensuring proper standards of healthcare.

With all NHS services struggling after more than a decade of under-investment, crisis houses may be commissioned as a low-cost option and staffed by support workers without sufficient training for the task that they are asked to undertake, creating a potentially dangerous environment for patients. Consistent and appropriate standards are needed as a matter of urgency to ensure that as more vulnerable patients enter crisis houses, they get the care that they need to be safe and to recover.

I ask the Minister again: when will the Government bring forward legislation to harmonise regulation across the sector, bringing all crisis houses under the same regulatory oversight? If the aim is to use an increasing number of crisis houses to provide a safe alternative to hospital in which to recover from mental health crises, where is the oversight to ensure that those environments are safe? Regulation is essential to ensure both appropriate and consistent standards of care and training for staff at all crisis houses and to create an effective and transparent mechanism for residents or their families to raise concerns, and complaints where standards of care fall short.

There is a long list of regulated activities, including treatment of those being treated for substance misuse or detained under the Mental Health Act 1983, that, if provided, require organisations to register with the CQC. It is regrettable that the Government are declining to expand the list, which would require crisis houses supporting those going through a mental health crisis also to register with the CQC, rather than relying on local integrated care boards and local authorities to provide oversight.

The Minister wrote to me that there were no plans to change the national definition of a crisis house, but added:

“We do however expect crisis house services to be designed in a way that aligns with national requirements, guidance and local structures, to ensure that appropriate safeguarding processes are in place, including enabling the escalation of risks.”

But where is the mechanism to ensure that crisis houses meet those expectations? Where does a bereaved family turn when standards fall tragically short? I hope that, following today’s debate, the Minister will consider all the points that I have raised and will give a commitment to regulating crisis houses to help to prevent any future tragedies.

Conversion Practices

Yvonne Fovargue Excerpts

Wednesday 6th December 2023 Westminster Hall

[Several hon. Members rose—]

[Yvonne Fovargue (in the Chair)]

Order. I remind Members that they should bob if they wish to be called in this debate. I will be imposing an informal time limit of five minutes on speeches, and interventions should be short.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

It is a real pleasure to serve under your chairship, Ms Fovargue, and to speak in this debate. I may have a slightly different opinion from many here due to where I come from. I hope that right hon. and hon. Members will show the respect that I have shown in listening to them and listen to me as I put forward my point of view. I say that, but some of the speeches this morning were incredibly balanced. As I have said, I may have a different opinion, but I’ll tell you what: Members have put their point of view over very admirably and in a very balanced way, and that is appreciated.

I am very grateful that we are having this debate today on an important subject that will affect many in our constituencies: I have certainly had occasion to use my position as a representative to try and help people, although not on a regular basis. I will be very conscious not to give away any confidential information on issues or conversations I have had. I am not even going to talk much about individuals, because I would not want to have any impact on them, but parents have come to me with great concern over what is happening with their children.

I am going to give a parent’s point of view, as both a parent and a representative. I very much recognise the need for nuance and a careful, measured analysis of the impacts of any policy proposals. It is vital to preface any discussion of conversion therapy by clearly condemning abuse and coercion of any kind, be it physical, mental or emotional. There can be no tolerance for any form of abuse in this country or any other. I express my deepest concern, sorrow and sympathy for all who have suffered from any form of harassment, abuse or discrimination. I say that very clearly as an introduction.

The issue at hand is wide-ranging and affects a number of areas. When we discuss possible legislation, we must reflect this broad awareness of the situation. Banning conversion therapy involves several parties, including children and youth, parents, schools, religious and belief communities, and others. I would like to address potential issues for several of those parties that may be caused by a ban on conversion therapy.

First, children and youth may be affected in significant ways by a conversion therapy ban as currently described. Such a ban could lead to limitations on the ability of children and youth to maintain informal or formal religious groups, such as prayer groups, which are used to promote spirituality and repentance in the Christian context. That is where I am coming from. People make their choices, but I am trying, as I do in all areas of my life, to be balanced in what I say and respect other people and points of view. With that in mind, I hope that people will also respect my point of view.

As a Christian myself, I recognise the importance of prayer as a tool to promote wellbeing. I believe that prayer can move mountains: the mountains in our lives, the mountains in the world, and the obstacles we come up against. For many Christians, it is an important devotional practice that may be limited by a conversion therapy ban. I am giving a parental point of view, and hopefully a very balanced Christian point of view as well—I am trying to do that very humbly, respectfully and sincerely to everyone.

Another consequence of a potential conversion therapy ban is that parents could be significantly affected in their daily responsibilities for the welfare of their children. According to some of the proposed conversion therapy bans, parents could be legally threatened if they choose not to allow their children to take puberty blockers. My hon. Friend the Member for North Antrim (Ian Paisley) has referred to it twice, and I cannot ignore it. We cannot ignore this issue. It is a transformative medical practice, into which parents of children and youth surely ought to have an input. That is what the hon. Gentleman said, what my hon. Friend the Member for East Londonderry (Mr Campbell) has said, and that is what I believe as well.

I fear that a conversion therapy ban could leave well-meaning, responsible parents vulnerable to unfair legal measures and social retaliation. The hon. Member for Vauxhall (Florence Eshalomi) encompassed many of my thoughts. I know the hon. Lady very well, and we have had conversations, so I understand the issue.

Ms Fovargue, I recognise that the time you indicated is up. There are some things I need to put down. Do we have time?

[Yvonne Fovargue (in the Chair)]

Yes

[Jim Shannon]

Thank you very much; I appreciate that.

It is vital for the wellbeing of any family that parents have the ability to raise their children within their own culture, religion or belief standards. If they are unable to do so, we will see negative impacts on families of all types, which will affect the wellbeing of communities and schools. We ought to embrace diversity, understanding and tolerance of others. Conversion therapy was addressed in the 2021 Queen’s Speech. The background briefing notes for the Speech noted the Government’s intention:

“We will ensure the action we take to stop this practice is proportionate and effective, and does not have unintended consequences.”

There are unintended consequences to a conversion therapy ban—potentially some of those that have been described. I ask that we all diligently examine the effects of such a ban on every party that might be affected.

In conclusion, abuse of any kind is unacceptable, as is discrimination and intolerance. I ask that each of us—individually—closely examine our policies to ensure that those behaviours are properly condemned in all settings. We need to be building cultures of love, warmth and growth. I am grateful for my colleagues’ important contributions to that effort, which I may or may not agree with. Let us continue to seek solutions that will foster those environments, while respecting the rights and duties of parents every time—of parents from diverse backgrounds. A conversion therapy ban as typically described does not, to me and to others, seem to do so. But I believe that we can, and will, come to solutions that will be in the best interest of all affected parties.

Horserace Betting Levy Board and Horse Welfare

Yvonne Fovargue Excerpts

Wednesday 6th December 2023 Westminster Hall

[Yvonne Fovargue (in the Chair)]

I will call George Eustice to move the motion and then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as per the convention of the 30-minute debate.

[George Eustice (Camborne and Redruth) (Con)]

I beg to move,

That this House has considered the Horserace Betting Levy Board and horse welfare.

I am delighted to have the opportunity to discuss this matter. The British horseracing industry is important and successful, and the UK is a global leader in thoroughbred breeding. However, it is also a sector that faces some challenges: some financial and others relating to the growing pressure on the social licence that is necessary for horseracing to continue. Behind episodes such as the invasion of the course by animal rights activists at the grand national last year, there is a broader but far less vociferous public concern about equine welfare linked to horseracing and, in particular, the fate of horses that retire from horseracing. It is my view that activities that depend on the maintenance of that social licence for their continuation cannot take those matters for granted or dismiss such things as the views of animal rights activists. They have to work constantly to improve their approach to animal welfare.

Thankfully for the industry, there are many fabulous charities. In my own constituency, we have Racehorse Relief, which I visited earlier this year. The charity focuses on rehoming retired racehorses through a combination of retraining them so they can be used for riding and pairing them with the right rider who can take care of them properly and, crucially, is able to handle them. The charity maintains an interest in the horses in its care throughout their lives, even when they might be placed with new owners who will ride and take care of them. Yet like any charity—any Member who visits charities will face this—funding is an issue. As we have seen rising costs, particularly for things such as forage, hay and so on, funding has become a challenge for the charity and many others like it across the country.

Last summer, I went on something of a wild goose chase to try to identify the right place to get funding for great charities such as Racehorse Relief. First, I thought I had come up with a brilliant idea: what we really needed to do at a point of policy was to have a levy on the betting companies that make the money from horseracing and then use that money to support charities such as Racehorse Relief, which deal with some of the externalities linked to horseracing and in particular the welfare of retired horses. I was over the moon to discover that I was not the first person to come up with such an idea. Indeed, this House passed the Betting Levy Act 1961, establishing the Horserace Betting Levy Board, which collects a significant budget each year from bookmakers.

At that point, I had spoken to and investigated the Horserace Betting Levy Board and I was told that it tends not to give direct grants to individual charities and makes money available through other organisations that then deal directly with charities. I thought that was fair enough and I understood that. It was suggested to me that I ought to talk to the charity Retraining of Racehorses. That sounded like a perfectly obvious thing to do, because the name is on the tin. As an organisation that retrains and rehomes racehorses, it seemed to be the right place to go.

When I went to Retraining of Racehorses, it too had no money. I understand that a couple of years ago, the horseracing industry carried out a review of what it called aftercare—that is, the charities such as Racehorse Relief that care for horses when they have retired. It was concluded at that point that RoR should be the lead charity in that space. It is fair to say that the board of RoR and the chief executive at the time sensed a hospital pass coming their way with such a recommendation. They feared they would end up with the responsibility and that everybody would be signposted to them to support such charities, but they had no funding to deliver on that.

At this point, it was suggested to me that what I really needed to do was to talk to the Racing Foundation, which was established following the sale—the privatisation —of the Tote. I thought that this was something, that George Osbourne was a clever chap who had it all in hand and was thinking about these things, and that it is the Racing Foundation that makes grants available for equine welfare. I looked on their website and, rather ominously, under the equine welfare sector, it refers to other organisations that might be able to help; there are a multitude of additional signposts to other organisations. On the specific issue of welfare, the Racing Foundation website simply states that there are no more grants available for equine welfare, since it has decided to make all of its support available through another organisation called the Horse Welfare Board.

It is clear that what actually happened here is that, following the RoR’s decision not to become the lead in this space, the industry decided that what it really needed was another organisation—another board—to make sense of all of its boards and to try to join up all the inactivity of the rest of the organisations. I phoned the chairman of the Horse Welfare Board and said, “All signs point to you. Everyone says that they give the budget to you now and that you are in charge of delivering animal welfare and providing support for the aftercare sector”. He chuckled down the phone and said, “We have no money”. The reason for that is that the other organisations do not give any meaningful budget to the Horse Welfare Board; it operates on something of a shoestring. It does some very good work, and I pay tribute, in particular, to my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), who I know was instrumental in the setting up of that board—and also sits on it—but it has very limited resources.

In my experience in government, there is a phenomenon that I used to describe as circular signposting, where every organisation points an individual to a different organisation until they eventually end up back where they started. There are lots of organisations that could—and perhaps should—do something that find it too easy to do nothing and suggest that somebody else should do something. When a Minister comes across that phenomenon, there is a very important question they must ask: who has the money? In this case, it is very clear that the Horserace Betting Levy Board has the money. It collects almost £100 million a year from bookmakers.

The HBLB was established under the Horserace Betting Levy Act 1961, which was amended by several other Acts. The HBLB is currently principally governed by the provisions of the Betting, Gaming and Lotteries Act 1963. That Act sets out three quite broad criteria for the HBLB to pursue, which are improving breeding, investment in veterinary science, and another incredibly broad provision, which is simply to improve horseracing. That can be interpreted in a very broad way.

World Sepsis Day

Yvonne Fovargue Excerpts

Wednesday 13th September 2023 Westminster Hall

[Christina Rees]

I thank my hon. Friend for her very important intervention, and what she says is why World Sepsis Day is so important. Sepsis deaths are a global phenomenon and we need to do our bit in the UK to fight sepsis, as well as working globally.

Sepsis is a critical healthcare challenge in the UK and across the world, but it is one that we can tackle with determination, awareness and innovation. Early detection, rapid intervention, research and support for survivors are the cornerstones of our battle against this silent killer. I urge everyone to take sepsis seriously, to educate themselves and others about its signs and symptoms, and to support the ongoing efforts of the healthcare professionals and organisations working tirelessly to save lives and improve outcomes. Together, we can make a significant impact and reduce the devastating toll that sepsis has on our society.

On World Sepsis Day, we remember those who have lost their lives and those whose lives have been affected by sepsis. We stand by their families and friends, and we try to support them in any way we can. Their stories must be told. I ask the Minister to meet me, Dr Ron Daniels and Sarah Hamilton-Fairley from the UK Sepsis Trust, to discuss the help she can give to set up a national sepsis register.

When will the updated NG51 guideline be published? Can the Minister update us on the recent announcement by the Health Secretary in the main Chamber that he is exploring the introduction of Martha’s rule? He referred to Ryan’s rule, which has been successfully established in Queensland, in Australia, and which has prevented several potential tragedies. Ryan’s rule provides patients and their families with the opportunity to request a clinical assessment from a doctor or nurse when the patient’s health is deteriorating or not showing expected improvements. When will Martha’s rule be implemented?

The Swiss Government have recently announced 10 million Swiss francs of state investment—around £9 million—over a five year period for implementing sepsis improvement across five workstreams. The best possible way to mark World Sepsis Day would be for the Minister and the Government to commit to a similar investment in sepsis improvement work in the UK and, in so doing, prevent the UK from falling rapidly behind the international curve, when it should be leading.

[Yvonne Fovargue (in the Chair)]

The debate must conclude by 4.55 pm.

Insolvency Law and Director Disqualifications

Yvonne Fovargue Excerpts

Wednesday 14th June 2023 Westminster Hall

[Rebecca Long Bailey]

I thank the hon. Member for his comments and I agree completely. There are huge issues surrounding the area of pre-pack administrations and the issue of phoenix companies, whereby directors are allowed to reappear in another form with the same kind of company structure with complete impunity. This certainly needs to be addressed by the Government.

Other mechanisms exist to sound the alarm on poor corporate governance. That is usually when the role of auditors should be key, but in recent years the unhealthy structure of the industry has been widely criticised, as well as the market dominance and conflicts of interest of the big accountancy firms. In this dysfunctional culture, firms must win and retain engagements from companies in order to generate revenue, but simultaneously they must objectively scrutinise the company reports of the very people they are trying to win business from. Indeed, the symptoms of this flawed culture are clear. The Financial Reporting Council has stated that 29% of the audits delivered by the seven biggest accounting firms fail to meet UK standards. It is abundantly clear that the UK corporate governance regime is in urgent need of reform

What actions have the Government taken so far? In his response to the debate, the Minster will no doubt refer to the Government’s White Paper on reforms to the UK corporate governance code, which the FRC is consulting upon as we speak. However, it is important to note that although the code is underpinned by listing rules that require premium-listed companies to “comply or explain” if they have not complied with a code provision, there is no strict legal requirement to comply with the code at all. It is merely a guidebook, and the lack of legal enforceability is clear. The Financial Times reported only last month that the FRC has reported falling levels of compliance since 2020, suggesting that boards are willing to risk avoiding the “comply or explain” requirements, particularly as the ultimate threat is simply to register dissatisfaction in a non-binding shareholder vote, or one that historically the company has a vanishingly small chance of losing.

Secondly, what is glaringly absent from the Government’s White Paper proposals so far is a statutory and enforceable Sarbanes-Oxley equivalent, which would make directors legally responsible for financial reporting governance. Instead, the White Paper opts for the fluffier “encouragement” of boards to include in their annual reports declarations about whether internal risk management and internal controls are effective or not. Similarly, the provisions that recommend that certain minimum clawback conditions or “trigger points” are included in directors’ remuneration arrangements are welcome in principle, but the reality is that these employment contracts are not publicly available so as to enable enforcement, and annual financial reports rarely provide comprehensive information.

Sadly, even the chief executive of the Institute of Chartered Accountants in England and Wales believes that the Government’s White Paper proposals on reform of the audit industry do not go far enough, stating:

“Taking these measures as a package with the draft audit reform Bill outlined, the government's approach has a half-hearted and lopsided feel to it… Lessons from Carillion and other recent company failures have been ignored, with little emphasis now on tightening internal controls and modernising corporate governance.”

A further five years on from Carillion, we are no closer to the creation of the Government’s long-promised audit, reporting and governance authority, or the passing of the Government’s promised audit reform Bill. When we can expect legislation on audit reform and the creation of ARGA?

Given these glaring deficiencies in the law, I will be grateful if the Minister considers some simple legislative changes that would provide much-needed clarity and protect workers, creditors, and the long-term health of companies. First, will he widen the scope of directors’ duties in section 172 of the Companies Act 2006, so that a duty is not owed solely to shareholders, as at present, but is owed to workers and other stakeholders as well? That must sit alongside a clear duty to prioritise the long-term welfare of a company, rather than simply the short-term maximisation of shareholder dividends.

Secondly, with regard to the duties of directors prior to insolvency, will the Government legislate to set clear definitions and parameters for when insolvency is deemed to be a “probable” event? That would provide much-needed clarity on when a duty to consult on redundancies is triggered, and when payments to workers and creditors need to be prioritised over shareholder dividend extraction.

Thirdly, will the Minister comment on why the Government proposals made in recent years to introduce workers on boards have been shelved? Will he commit to examine and develop policy in the light of the experience of other European jurisdictions, where direct representations of employees on both unitary and two-tier boards has actually helped to improve corporate performance and success, for the benefit of all stakeholders? Last, will he introduce clear Sarbanes-Oxley-equivalent legislation that would finally make directors legally responsible for financial reporting governance? If not, can he explain clearly the Government’s reasons for avoiding that in favour of more diluted and legally unenforceable guidance?

It is clear that the current UK corporate governance regime has become dysfunctional, ambiguous and unenforceable. Despite numerous scandals, it still has no room for the protection of employees and other stakeholders. I hope the Minister can reassure me today that things will change. Thank you for the opportunity to hold this debate, Ms Fovargue.

[Yvonne Fovargue (in the Chair)]

I call John McDonnell.