Mental Health

Baroness Morgan of Cotes Excerpts

Thursday 14th June 2012 Commons Chamber

[Nicky Morgan (Loughborough) (Con)]

I beg to move,

That this House has considered the matter of mental health.

I am particularly grateful to all members, old and new, of the Backbench Business Committee for allocating time for this debate in the Chamber. The effort to secure the debate has been done jointly with my hon. Friend the Member for Broxbourne (Mr Walker), the chairman of the all-party group on mental health, which he has led so well, and with my hon. Friends the Members for Worthing West (Sir Peter Bottomley), for New Forest East (Dr Lewis) and for Halesowen and Rowley Regis (James Morris)—I hope I have pronounced that one correctly—and the hon. Members for Dagenham and Rainham (Jon Cruddas) and for Foyle (Mark Durkan).

We were quite clear when we put in our bid that we wanted a full debate on the Floor of the House. Why? It is at least four years, and probably slightly longer, since the general topic of mental health was debated in the Chamber. That is a long time, given that 25% of the population—one in four people—will experience a mental health problem at some point in their lives. Just imagine if this were a physical health condition and it had not been talked about by Members in the House of Commons other than in very specific ways such as Adjournment debates for a very long time.

Mental health comes at an economic and social cost to the UK economy of £105 billion a year, yet mental health has been a Cinderella service—poorly funded compared with other conditions and not spoken about nearly enough either inside or outside this House. It is the largest single cause of disability, with 23% of the disease burden of the NHS, yet the NHS spends only l1% of its budget on mental health problems.

[Mr Kevan Jones (North Durham) (Lab)]

Does the hon. Lady agree that it is not only a matter of the effects on individual mental health because mental health issues can lead to physical disabilities, leading to extra costs to the NHS on top?

[Nicky Morgan]

I entirely agree with the hon. Gentleman. The Centre for Mental Health has shown that for a person who has a physical and a mental health condition, the costs of treatment are increased by 45%. Those are additional costs around mental health problems, which are often untreated initially and then have to be treated at a later stage, so the hon. Gentleman is absolutely right.

According to the Centre for Mental Health, only a quarter of people with mental health conditions—children as well as adults—receive any treatment. I have no reason to doubt that statistic, and I find it shocking that three quarters of people with mental health conditions are not being treated. We should ask ourselves why that is.

Recent figures have shown that depression alone is costing the economy £10 billion a year. As we all know, we do not have a lot of money to spend, so we should be working as hard as we can on preventive measures. One in every eight pounds spent on dealing with long-term conditions is linked to poor mental health, which equates to between £8 billion and £13 billion of NHS spending each year.

I welcome the Health and Social Care Act 2012. I hope that today’s debate will be conducted on pretty non-partisan terms, but I realise that that may strike Opposition Members as a controversial comment. I welcome the opportunities that the Act offers for the commissioning of mental health services. I spoke in the Third Reading debate, and I especially welcomed the Government’s acceptance of an amendment tabled in the other place to ensure parity between physical and mental health. Although those are only words in a Bill, they are very important words, and they send a very clear signal not only to sufferers from mental health conditions and their families, but to those working in the NHS. I hope that, in his annual mandate to the national commissioning board, the Secretary of State will insist that the board prioritise mental health.

How are we to achieve parity between physical and mental health conditions? The question is about money, certainly, but it is also about awareness. Confessing to having a mental health condition carries far too much stigma. That is part of the reason for our wish to hold a debate on the Floor of the House. If we do not start to talk about mental health in this place, and encourage others to talk about it, how can we expect to de-stigmatise mental health conditions and enable people to confront their problems?

I find it interesting that, when I was preparing for the debate, a few people who had initially said to me “Yes, go ahead, mention my name” came back after thinking about it for a couple of days and said “Actually, I would rather you didn’t, because I have not told my employer,” or “I have not told all my friends and my family.” It is clear that mental health conditions still carry a considerable stigma. Admitting to having been sectioned is traumatic, especially when the information appears on Criminal Records Bureau checks connected with job applications.

I welcome the work of Time to Change, which has been funded partly by the Department of Health as well as by Comic Relief. I also welcome the Sunday Express campaign on mental health. However, the de-stigmatisation of mental health conditions is down to all of us, and it is especially important for those of us who are employers not to discriminate against people who may be working for us and who tell us that they have a mental health condition. I hope that today’s debate will constitute another firm step on the path to ensuring that mental health conditions are de-stigmatised, because I think that without that de-stigmatisation, successful treatment will be very hard for a person to achieve.

We asked for today’s debate to be kept deliberately general, so that Members in all parts of the House could raise many different issues on behalf of their constituents and, perhaps, themselves or their families as well as looking at the mental health policy landscape. Mental ill health is no respecter of age or background. It can strike anyone, often very unexpectedly. That includes people in senior positions such as Members of Parliament, company directors and school governors. I am sure that my hon. Friend the Member for Croydon Central (Gavin Barwell) will refer to the private Member’s Bill that he will be presenting, which would end discrimination against people in such positions who have mental health conditions.

I expect that during today’s debate we shall hear about new mums with post-natal depression. For them, a time of life that should be one of the happiest is often one of the most difficult. I welcome the recent Government announcement that health visitors will be properly trained to recognise signs of post-natal depression, which I think was long overdue. I expect that we shall also hear about veterans from our armed forces who suffer from mental health conditions, and about older people who suffer from dementia. Particular issues affect our black and ethnic minority communities, as well as those who find themselves in the criminal justice system. I am sure that we shall hear from the Minister abut the Government’s widely welcomed framework document “No health without mental health”, which was published last year. We now await the detailed implementation plan on which the Department of Health is working alongside leading mental health charities.

I want to talk, very briefly—I have noted Mr Speaker’s strictures about time limits—about three specific matters: listening to patients, integrated care, and the wider mental health well-being landscape. We made it clear during the passage of the Health and Social Care Act that one of the developments that we wanted to see, as a Government, was “No decision about me without me.” That means patients having a voice in their care. It seems to me from my discussions with those in the mental health system who have been sufferers that once the initial crisis has been dealt with, they tend to want choice and involvement in their treatment. They are facing a lifetime condition. They will have to self-medicate, look after themselves and identify the point at which they may be deteriorating or potentially reaching crisis point for years and years to come. They want a voice. They want to be heard by the health care professionals, and I think that it is up to us as a Government to help them to achieve that.

[John Pugh (Southport) (LD)]

The hon. Lady has just said that people who suffer from mental health problems have a lifelong condition. I think that many people have an occasional mental health problem.

[Nicky Morgan]

I am not sure that I entirely agree with the hon. Gentleman. I agree with him that people often enter the system at a time of crisis and experience a single episode, but others who experience episodes will get better. For years they may have no problems at all. The hon. Gentleman shakes his head, but I can tell him on the basis of the experience of constituents and family members that it is possible to go in and out of the system. One of the hardest things for people to accept when they are diagnosed with a mental health condition is that they will be on drugs for years and years. That is often difficult for people to admit, particularly when they are striking up a new relationship or working for a new employer. I think that that is why people want to have a voice in the way in which they are treated.

According to Mind, people are three times as likely to be satisfied with their treatment if they are presented with a choice of treatments, and failure to stay on medication is the main cause of relapses, when people often have to re-enter the system at a time of crisis. There is a need to work with and trust health professionals. According to a recent study by the university of Kent,

“Low levels of trust between mental health patients and professionals can lead to poor communication which generates negative outcomes for patients, including a further undermining of trust”,

and

“trust can play a significant role in facilitating service users’ initial and ongoing engagement with services, the openness of their communication, and the level of co-operation with, and outcomes from, treatment or medication.”

In 2009, a mental heath in-patient survey by the Care Quality Commission revealed that in some mental health trusts as few as 40% of people diagnosed with schizophrenia felt that they were involved as much as they wanted to be in decisions about their care and treatment. I am no health professional—I hope that some Members who are health professionals will speak later this afternoon—but what people have said to me suggests that medication is not always the answer, at least in the long term. Research by Platform 51 has found that a quarter of women have been on anti-depressants for 10 years or more, that half of women on anti-depressants were not offered alternatives at the time of prescription, and that a quarter of women on antidepressants have waited a year or more for a review of their medication

I welcome the Government’s investment of £400 million in treatments under the improving access to psychological therapies programme. I should add, to be fair, that that builds on announcements made by the last Government. I also commend the report by the Centre for Social Justice on talking therapies, which calls for a broadening of therapies. Every patient is different, and patients will respond differently to different medications and therapies. Mental health patients must have real choice, and I think that Any Qualified Provider and Payment by Results must be extended to them in the way in which they are being extended to patients with physical health conditions. We must also ensure that patients’ voices are heard within the management structures of both clinical commissioning groups and health and wellbeing boards, whose job it is to hold services to account for the care that they are giving.

I expect that Members will refer to integrated care: the need for all services to work together. Poor mental health has an impact on every area of Government policy: health care, benefits, housing and debt, social exclusion, business and employment, criminal justice and education, to name but a few. One person with a mental health condition may need help from many different agencies, but too often care is not joined up, and each agency deals with its own bit and passes the person on. Sometimes there is no follow-up, and the person is lost in the system.

In a 2011 survey, 45% of people contacted by Mind said that they had been given eight or more assessments by different agencies in a single year. YoungMinds, which campaigns on behalf of children and young people with mental health conditions, has called for one worker to be allotted to each child needing support for a mental health condition, so that children can avoid multiple assessments and need not re-tell their story each time they see a new person in the system. However, there must be a clear care pathway, whatever the point at which access is gained to the mental health system.

The other thing patients are calling for is the ability to self-refer. We need to do all we can to prevent people from reaching crisis point, and often it is patients themselves who are best able to tell when they are about to reach that point. My West Leicestershire clinical commissioning group is developing an acute care pathway in partnership with Leicestershire Partnership NHS Trust. It plans to replace the many and varied access routes to secondary care and mental health services with a single access point, in order to provide speedy access at times of greatest need. That move has come out of both patient and GP feedback.

[Mr Robert Buckland (South Swindon) (Con)]

I congratulate my hon. Friend on securing this debate, and I am particularly interested in the proposed single access point for services. That could be useful not only for acute services, but for non-acute services and well-being provision. Does my hon. Friend agree that well-being provision is an important part of mental health provision?

[Nicky Morgan]

My hon. Friend is absolutely right, and I shall talk about well-being shortly. We often talk about these subjects in very negative ways. If we all talk about our mental well-being, and are regularly asked about it when we see our GPs, that will help a lot to de-stigmatise mental health issues.

I want to touch briefly on secondary care. One of the Sunday Express campaign demands is that all hospitals should be therapeutic environments where people with mental health problems feel safe and are treated with respect and have someone to talk to. In a debate in this House last November, I mentioned patients who abscond from secondary care units, and in particular the tragic case of my constituent Kirsty Brookes, who was able to escape from a unit in Leicester and subsequently hanged herself. I am sure the Minister will remember that debate, and our discussion of the definition of absconding.

The Care Quality Commission has published its first report on absconding levels, and I welcome that, but the picture in respect of absconding and escape numbers is still unclear. The numbers provided in this first CQC report need to be broken down further, therefore, but the report showed that in the year in question—2009-10, I think—there were 4,321 incidents of absence without leave from secondary care. Some of them were, of course, far more serious than others; some will have involved a person missing a bus on the way back to the unit, while others might have ended in tragic circumstances. I make this point not to beat up on secondary care providers and health providers generally, but we must know the scale of a problem before we can begin to tackle it.

The impact of the voluntary and community sector on mental health must not be forgotten either, and I hope Members will talk about that. The sector offers vital support, and it must be part of the commissioning landscape.

[Jeremy Corbyn (Islington North) (Lab)]

I congratulate the hon. Lady on securing this important debate. Many smaller voluntary sector organisations give a very good service and understand their communities. Under the commissioning process, however, they often lose out to very large enterprises—large charities and medical companies—that have no real understanding of the local community, particularly ethnic minority communities. Does the hon. Lady agree that the Minister needs to consider that issue further?

[Nicky Morgan]

I agree; that is an issue. The commissioning structures are being changed, with local GPs now deciding what care they want to buy and where they want to buy it from. I hope that change will allow them to explore the value of smaller organisations, which tend to know particularly well the people they are treating. Although such organisations might not have the clout of large organisations, they are often more successful in terms of patient care. I am sure the Minister has heard that point.

I want to thank one of my regular correspondents, Mike Crump of My Time, a community interest company based in the west midlands. He may well be in the Public Gallery for this debate. My Time provides evidence-based, culturally sensitive professional counselling and support services. He said to me that a great deal of many people’s recoveries

“is owed to therapies based on basic common sense not the miraculous powers of a tablet or the mysterious wonders of the medical profession.”

Let me turn briefly to policing. My chief constable in Leicestershire is also the Association of Chief Police Officers mental health lead. In Leicestershire in 2011-12 there were 444 detentions under section 136 of the Mental Health Act 1983, which gives powers to take a person to a place of safety. Leicestershire police deal with serious incidents involving mental health issues on a daily basis, and it has provided me with a snapshot of what happened on the jubilee weekend. From 8 pm one night to 7 am the next morning they dealt with 10 incidents in which mental health conditions or concerns were clearly prevalent. That night, police officers spent four hours with a man in hospital after he was detained under section 136. I therefore ask this question: are the police the right people to be dealing with such incidents?

I hope Members will talk about the criminal justice system, and the fact that nine out of every 10 prisoners have a mental health problem. The Government are investing more than £19 million this year in diversion services, but it is still taking too long to get prisoners out of prison and into secure hospitals.

Finally, I want to talk about the mental well-being landscape. All of us have mental health; it is just that some people’s is better than other people’s. We need to get to a situation where it is as normal to talk about our mental well-being as about our physical well-being.

Public health policy has a role to play. Local authority public health services are key in promoting good public health. I welcome the Leicestershire joint strategic needs assessment chapter on mental health, which was published recently. It makes it clear that mental health is important and says that it cannot be seen in isolation, as many factors contribute to mental ill-health, including the economic instability at present—which I am sure we will hear about this afternoon—and the welfare reform changes, such as asking people whether they are fit enough to go back to work. I think such questions need to be asked, but I thank my constituent Jo Gibbs, who recently brought me a letter outlining her concerns about these changes and the anxiety and pressure they are causing her and others.

[Julie Hilling (Bolton West) (Lab)]

I congratulate the hon. Lady on securing this debate, and on her speech. On welfare reform, does she share my concern that people with mental health issues are being kicked off disability support allowance? Increasing numbers of people in that situation are coming to see me. Recently a constituent came to me who is bipolar on the Asperger’s spectrum and who scored zero in the assessment for that allowance.

[Nicky Morgan]

I thank the hon. Lady for her intervention. I am sure we will all have similar constituency cases. A survey by Mind found that most people with mental health problems want to work but may not be well enough. For some people, employment—the right employment with the right employer and the right support—is the right way forward once they are better. For other people, however, employment is not the answer. The hon. Lady is right that assessors have not always understood the mental health needs of certain people. The Government have tried to address that through the two Harrington reviews. The system is never going to be perfect. That is where Members of Parliament come in; we will be making arguments on behalf of our constituents. I understand the hon. Lady’s point, however. We need to do more, and we need to promote awareness of these issues.

Other aspects of modern life do not help, such as loneliness and isolation. We live in an ever busier world, but people lead more isolated lives. We must not forget the question of families either. Sometimes they can be the cause of a person’s problems, but at other times they can be the solution. I commend the Centre for Social Justice for its work and its report, “Completing the Revolution”, about the importance of families and how significant family breakdown can be in respect of mental health problems.

This is an important debate, but it is only one step along the path of giving mental health the priority that Members clearly feel is needed given the number of them present today. I look forward to hearing their views. We need to talk about mental health far more openly, and we need to make it much easier for people to find out information about how they can get help before they need it. It is too late when people reach crisis point.

I look forward to the no health without mental health framework being implemented. Talking must never stop, but we must now also start implementing. I thank everybody who has contacted me in the run-up to this debate and shared their often very personal stories about their experiences in the mental health system. The House is all too often known for Members shouting at each other. I hope today shows that we are about more than that, and I hope we can all agree with the motion before us, as mental health is a huge priority for Britain and for our constituents, whether they are sufferers or carers. Working together, we can come up with integrated care that responds to the needs of patients and gives our mental well-being the prominence it merits.

--- Later in debate ---

[Mr Jones]

I totally agree and I shall give some examples of that in a minute.

We must try to get a system in which employers, even in these tight economic circumstances, understand the mental health issues and can make adaptations. Whether we support employers who take people with mental health issues on for a certain period or whether we do other things, we need to think it out a bit more than it is at the moment.

[Nicky Morgan]

One statistic that I did not use in my speech was that only 1% of the access to work funding, which employers can use to help to smooth someone’s path back into employment, is used for mental health facilities. It could be used for counselling or support workers, but only 1% is spent on such provision in the context of the prevalence of mental health issues in the general population.

[Mr Jones]

The hon. Lady makes an important point that should be considered. That is where we need to join up the two relevant Departments.

Mental Health North East has carried out a survey and I thank that organisation and Derwentside citizen’s advice bureau for the examples I am going to use. Like the hon. Member for Loughborough, I asked whether I could use names. One person said that I could, but late last night she rang me to say no. I am sure that people will understand why I use letters to refer to these individuals rather than their names.

The first case is that of Mr A, a 50-year-old man who lives alone and received ESA. He suffers from depression, anxiety, agoraphobia and anger issues. Despite the support he is getting and the drugs that he is taking, he was called by Atos to a work-related interview. He got no points at all even though he finds it very strange to go outside the house, let alone to interact with people. He decided to appeal and attended the appeal. There is a huge backlog in the appeals system that is adding to people’s anxiety as they are having to wait a long time, and the pressure on citizen’s advice bureaux and local welfare rights organisations to support those appeals is creating a crisis in some of them. When I give some of these examples, Mr Speaker, you will see that they should never have gone to appeal in the first place.

This case was very interesting. Mr A turned up at the appeal, which, as my hon. Friend the Member for Islington North mentioned earlier, caused him huge stress as he thought he was going to lose. He turned up in the afternoon, and his appeal had been heard that morning without his being present and his award had been granted on the basis of the medical evidence. If the appeal hearing could do that, why could Atos not do so? The reason is that Atos is not taking medical evidence into account at all.

The second individual is from Stanley in my constituency and I have known this young lady since she was in her early 20s.

--- Later in debate ---

[Nicky Morgan]

I am sorry that in the short time available, I will not be able to mention all the fantastic speeches we have heard this afternoon. We can definitely say that we have considered the motion fully—and we should all be very proud of that achievement.

I shall make a few brief points to draw the issues of the debate together. First, we all agreed that the debate was somewhat overdue and that it was time that mental health was discussed more often in the Chamber. I hope that we have shown the House of Commons at its best. I certainly think we have; I think this is one of the best debates I have attended since I was elected just over two years ago. We were right to hold out for a debate in the main Chamber, which was an important issue.

Secondly, we have shown that Members of Parliament are not immune to mental health experiences. I would like to pay particular tribute to the speeches of the hon. Member for North Durham (Mr Jones) and of my hon. Friends the Members for Broxbourne (Mr Walker), for Totnes (Dr Wollaston) and for South Northamptonshire (Andrea Leadsom), who should win an award for bringing the name of Harry Potter into her speech.

We have shown this afternoon why it is so important for my hon. Friend the Member for Croydon Central (Gavin Barwell) to introduce his private Member’s Bill. I am sure that we all wish him well with it and look forward to working with him on a cross-party basis—another significant achievement from today’s debate. I thank both Front-Bench teams for their support for my hon. Friend’s private Member’s Bill.

I think it was the Minister who said that this issue is not about them and us; it is just about us. Mental health affects everybody within society, and it is up to all of us to challenge stigma. Mention was made of media leadership, particularly of the campaign run by the Sunday Express. Mention was also rightly made of the importance of using the right language when we talk about mental health. That is certainly something that I shall take away from this debate.

The point has been made that many different treatments work and that we should respect that. I entirely take the shadow Secretary of State’s point about moving the NHS into the 21st century. His point about the physicality and the separateness of our mental health trusts and buildings was a good one. I had not considered that point before; the right hon. Gentleman was absolutely right.

The hon. Member for Lewisham East (Heidi Alexander) talked about the many challenges faced by local mental health services and those working in them, and her speech perhaps best summed them up. We have also heard concerns about the work capability assessments.

My hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) argued that different parts of the Government needed to work more closely together in the sense that a number of different Ministers could have sat on the Front Bench to talk about this issue.

Finally, I want to thank all the speakers, the Backbench Business Committee for securing the debate, everyone who has watched it outside and, as my hon. Friend the Member for Bracknell (Dr Lee) mentioned, everyone working within the mental health system.

Question put and agreed to.

Resolved,

That this House has considered the matter of mental health.



business of the House (19 June)

Ordered,

That, at the sitting on Tuesday 19 June the Speaker shall put the Questions necessary to dispose of proceedings on the Motion in the name of Secretary Theresa May relating to immigration not later than four hours after their commencement; such Questions shall include the Questions on any Amendments selected by the Speaker which may then be moved; proceedings may continue, though opposed, after the moment of interruption; and Standing Order No. 41A (Deferred divisions) shall not apply.—(Michael Fabricant.)

Health and Social Care Bill

Baroness Morgan of Cotes Excerpts

Tuesday 20th March 2012 Commons Chamber

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I think the hon. Gentleman will find that he is referring to the wrong group of amendments. The group that we are discussing is headed “Secretary of State, NHS Commissioning Board and CCGs”. We will be discussing the amendment to which he referred later, and I presume that for that reason he will now resume his seat.

[Nicky Morgan (Loughborough) (Con)]

I will speak very briefly. Let me begin by pointing out to the hon. Member for Leicester West (Liz Kendall), who said that we did not have enough time to consider all the amendments, that if we had not spent an hour and a half discussing the risk register yet again, we would have had more time to discuss the amendments.

I congratulate the Government on accepting Lords amendment 1, which relates to parity of esteem between physical and mental health. As the Minister said, genuine parity cannot be laid down in legislation, and the mental health framework will be very important to the achievement of it. However, research findings published by the Centre for Mental Health, which I mentioned to the Minister during health questions recently, show the link between physical and mental health conditions. As I am sure we all know from our constituency casework, when someone presents with a physical health condition, it may be clear that there is an underlying mental health condition which has been either undiagnosed or untreated, and which is therefore hampering the person’s physical health recovery.

The Minister spoke of the “symbolic significance” of including a reference to mental health. He is right, but I think that on a day when we have seen Her Majesty the Queen address Parliament, we should recognise that there is sometimes a place for symbolism, particularly when it comes to something that is as cherished on the Government Benches as the NHS. I know that the Opposition claim ownership of the NHS, but in fact it is cherished by all of us, and by our constituents.

I also thank the Government for accepting Lords amendments 19, 32 and 33, which concern the duty of commissioners and commissioning groups to provide patient-focused care—the “No decision about me without me” duty. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) rightly spoke of the importance of mental health care in that regard. I have certainly found, when listening to patients in the mental health system, that they want their doctors, consultants and everyone else in the system to ensure that they are involved in their own care. I am glad that the clinical commissioning groups will be given guidance on that, but I do not expect the very best CCGs and GPs to need to follow it. They are likely to know that treatment is more likely to succeed if patients are involved in it.

Having spent 10 weeks on the Public Bill Committee, and having been present during all the debates on the Floor of the House, I am especially pleased to be able to welcome the amendments.

[John Pugh (Southport) (LD)]

Let me begin by paying tribute to my colleagues in the House of Lords, who have improved the Bill significantly.

I want to raise two issues relating to conflicts of interest. Subsection (1) of the new section proposed in the amendment tabled by Baroness Barker states:

“Each clinical commissioning group must maintain one or more registers of the interests of—

(a) the members of the group,

(b) the members of its governing body,

(c) the members of its committees or sub-committees or of committees or sub-committees of its governing body, and

(d) its employees.”

I looked in vain for a paragraph (e) specifying “parties with which it is contracted for commissioning support”. I think that that is a live issue. There will be commissioning support organisations—some of which will be private institutions, and some of which will be allied with organisations that provide the clinical services that are commissioned—and there may be occasions when those advising the commissioners make recommendations that benefit some parties with which they are contracted. That model, involving the influence of the executive, will be fairly familiar to those who have been members of local authorities. Councillors, like doctors, are often very busy. They rely heavily on expert advice provided by officers, and they generally follow it.

The issue was raised in the House of Lords—I believe that it was raised by Lady Barker—but, when I read the report of that debate, I could not help feeling that it had been glossed over. I should welcome any enlightenment from the Minister on how such a quandary can be dealt with. Clearly it must be dealt with, because otherwise it will create general anxiety about how commissioning will proceed.

The second issue is a bigger one. I think that it is of particular interest to us all, because it affects the general position of the commissioning consortia themselves. There is a view that PCTs are more or less in the same legal boat as GP or clinical commissioning consortia would be. I disagree with what the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said about that. The PCT, as a unit, is not built around general practices, which, as we have said several times in this place, are small businesses. It is possible to view a clinical commissioning consortium as an association of undertakings, which creates serious issues as to how it is able to use public money. If it used public money to benefit itself, that would obviously become a big issue immediately.

Health and Social Care Bill

Baroness Morgan of Cotes Excerpts

Tuesday 13th March 2012 Commons Chamber

[Nicky Morgan (Loughborough) (Con)]

I rise tonight to oppose the motion and the amendment. The motion is clear on the e-petition, on calling on the Government to drop the Health and Social Care Bill, and on declining to support the Bill in its current form. I see no mention of the risk register, yet when we debated it several weeks ago the shadow Secretary of State did not want to talk about it; he wanted to talk about the Bill. I shall come to the very confused position of the Opposition on this issue.

I will obviously not support the amendment—that will come as no great surprise to the hon. Member for St Ives (Andrew George)—but I agree with his reference to patients’ organisations. Such references have been missing from the speeches of Opposition Members. I would prefer a reference to patients and service users, because my first point is that the voice of patients has not been heard. Those are not my words, but those of somebody who gave evidence to the all-party parliamentary group on mental health last week. We have not heard the voices of patients in the debate so far—[Interruption.] Opposition Members are welcome to stand to correct me, but I have heard no mention from them of the words and views of patients.

[Karl Turner]

I am obliged to the hon. Lady for giving way. The mere fact that more than 170,000 people have signed the e-petition surely must speak volumes to her.

[Nicky Morgan]

If the hon. Gentleman wants to talk about maths or numbers—

[Karl Turner]

I am not talking about maths.

[Nicky Morgan]

We could talk about the number of people who have taken part in the Royal Colleges petitions.

[Karl Turner]

I am talking about the 170,000 people who signed the petition. What are you talking about?

[Nicky Morgan]

Well, 175,000 have signed the petition, but there are nigh on 60 million people in this country.

[Madam Deputy Speaker (Dawn Primarolo)]

Order. Mr Turner, do not shout over the Chamber. Either intervene or listen to the points that are being made. You do not have to agree with them; you just have to be quiet.

--- Later in debate ---

[Nicky Morgan]

Thank you, Madam Deputy Speaker. After many, many weeks on the Health and Social Care Bill Committee, there is no danger of the hon. Gentleman agreeing with any of the points that I make, but that will not stop me making them.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) talked about mental health. Those who spent time on the Public Bill Committee will know that I am particularly involved and interested in mental health, and I hope that we will have a debate on mental health in the Chamber soon, but what has struck me in discussions of the Bill is that mental health service users want to be involved in decisions about the commissioning of their services. They have that opportunity in the Bill through the health and wellbeing board, HealthWatch, the clinical commissioning groups, the involvement of the voluntary sector, and, as hon. Members have said, the integration of health and social care services. The Secretary of State talked about shared decision making. It is incredibly important that that is allowed to flourish under the Bill.

My next point—a damning and depressing one for a Member of Parliament to make—is the misinformation that has been perpetuated about the Bill. Tonight, we heard the shadow Secretary of State say that time is running out for the NHS. An hon. Member said that the shadow Secretary of State spoke in December of our having 72 hours to save the NHS, and another said that their constituents are worried about the services that will be on offer. All that is scaremongering, and it is unfair on those who do not have the time, capacity or inclination to read the Bill. We need to talk about the reality.

[Grahame M. Morris]

On the charges of scaremongering, is the hon. Lady aware that the George Eliot hospital in Nuneaton is engaged in conversations with two private sector providers—Serco and Circle—on taking over that provision? In my 30-odd years involved in the NHS, I have never known that to happen.

[Nicky Morgan]

I thank the hon. Gentleman for his point and the measured way in which he made it. That is welcome in the debate on the Bill. As a midlands MPs, I am aware of what is happening in Nuneaton, but it is not my constituency so I will refrain from saying too much. I will say only that the hospital management have asked in other providers because they are concerned and want to ensure the best possible care. Is that not what we want?

[Grahame M. Morris]

They are private providers.

[Nicky Morgan]

That could be the voluntary sector or the community sector. They are all private. If someone has a physio appointment, it could be with a private provider. At the end of the day, we want the best care for patients and constituents. That is what we all want.

[Dan Byles (North Warwickshire) (Con)]

The hon. Member for Easington (Grahame M. Morris) will be aware that the George Eliot hospital is on the edge of my constituency and serves my constituents. There are six people on the shortlist of people it is talking to—six people who have asked to be spoken to. It is wrong to imply that the George Eliot has gone out and spoken to only two private providers. The rest are all NHS providers.

[Nicky Morgan]

I am grateful to my hon. Friend for clarifying that.

The shadow Secretary of State talked about trying to be constructive. I am unclear whether he supports his own motion. Is he calling for the Bill to be dropped or for a conversation? This reflects the position of the Royal College of General Practitioners, which says that it now wants to work with the Government to implement the Bill, having previously opposed it. That is because the people in the NHS are beginning to recognise that implementation is critical if we really care about patient care and service users. There has been talk about how people in the House have stopped listening. I suggest that it is the Opposition who have stopped listening. I am fed up with receiving repeat e-mails. When I reply, making this point and trying to engage in a debate, all I get is another standard e-mail telling me about privatisation and how the NHS will not exist in its current form. That is not correct and not fair on the patients who rely on the NHS.

As my hon. Friend the Member for South West Bedfordshire said, implementation is already happening in many parts of the country, and that is to be welcomed. In Leicestershire, I have three excellent clinical commissioning groups and a health and wellbeing board being set up. I salute the public health professionals in Leicestershire who are working hard on implementation, the secondary care providers, the patient participation groups and everybody else who has taken part. The trouble is that implementation is being hampered by this ongoing political debate. I have a real feeling of groundhog day every time I come in and speak on this. We are going round and round in circles, and I repeat that the people who are missing out are patients and service users. Loughborough has taken the difficult decision to move our walk-in centre, but the GPs have taken that decision, and although I did not agree with it, they are clear that it will result in better urgent care services, and they are spending more money on them. I am willing to trust their judgment.

Members want to talk about the vote of the RCGP. It is interesting to note that out of 97,000 professionals, only 4,700 have taken part in the debate on the Bill. That should tell us something. We need to get on with the Bill now.

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The British public, as I think everyone here acknowledges, have a great care and concern for the national health service. That is not an idle superstition, as Conservative Members sometimes imply, but probably arises because we all interact with the health service when we are at our most vulnerable and at pivotal moments of our lives. Perhaps it happens when we are having our children or when a parent is dying or when we are ill and frightened. It is therefore unfortunate, to put it mildly, that no Government Members have been prepared seriously to engage with the depth of public concern about this Bill.

Let me quote a joint editorial, written by the editors of the British Medical Journal, the Health Service Journal and Nursing Times—publications that originally supported this Bill, to which fact I draw the Secretary of State’s attention. They describe the Bill as

“poorly conceived, badly communicated, and a dangerous distraction at a time when the NHS is required to make unprecedented savings.”

That is the consensus within the NHS. Ministers talk about the GPs involved in clinical commissioning groups. Of course GPs are moving forward and trying to engage with the changes—because they want what is best for their patients, not because most of them support the Bill in principle.

I have spoken about opinion within the NHS. As some Members know, my mother was a woman who gave her life to the NHS. She came to this country in the 1950s as a pupil nurse, and she ended her career working in a mental hospital just outside Huddersfield in West Yorkshire. She was part of that generation of men and women who built our NHS in the years after the second world war. In preparing for this debate and thinking about how to cut through the bluster, allegations, counter-allegations and politicking, I thought to myself, “Perhaps I should say what my mother would want me to say”. She was not a politician; she was not the head of a royal college; she was not a manager; she did not work for a glitzy Westminster think-tank: she was just an ordinary woman who was very proud indeed to say that she worked for the British NHS. My mother would have wanted me to say that the NHS is special and that from its earliest years it has been about change and adaptability. She would have wanted me to say, too, that politicians should handle it with thoughtfulness, not engage in party political games, but give the debate the care and thought that she always gave her patients.

I have to reinforce the point about the specialness of the NHS because part of the Secretary of State’s narrative, as this year has worn on, is that the NHS is somehow broken, and only his Bill can fix it. Well, we have heard that the Commonwealth Fund says that the NHS is one of the world’s leading health care systems for quality and value for money, and we know that it had the highest satisfaction ratings ever at 72%. Even the Secretary of State said on Second Reading that on a number of indicators,

“including mortality rates from accidents and self-harm, equity and access to health care—the NHS leads the world”.—[Official Report, 31 January 2011; Vol. 522, c. 606.]

This is far from a health care system that is broken.

My Labour Front-Bench colleagues and I need no reminding of how special the health service is and how we should respect the people who work in it at every level. We have spent the past year going up and down the country, shadowing workers in the NHS. We have met radiotherapists in Wirral, physiotherapists in Northumbria, ambulance crew in Cambridge, mental health nurses in Rochdale, cancer nurses in Birmingham, hospital porters in Leeds, paediatricians in Bristol and midwives in London. These were different people working at different places at different levels, but from every visit, we heard the same abiding message—“Our NHS is not for sale.”.

The second point that I am sure my mother would have wanted me to make is that from its earliest years the NHS has always been open to change and improvement, as I said. Workers are not opposed to change. Why would workers in the NHS be opposed to change? It is a service where people and science interact. Of course people are different first thing in the morning from how they are when they go to bed. Of course NHS workers are able to deal with change. No one needs to tell a nurse’s daughter that there have always been things in the NHS that could have been improved.

The Labour party is not opposed to change. It was our willingness to change and reform that drove down waiting times to unprecedentedly low levels. Some of the things we tried were so radical that some of us could not vote for them, but it is no discredit to my right hon. and hon. Friends that they were willing to try every lever they could to bring down waiting times and provide a service for the people who voted us here.

[Nicky Morgan]

Will the hon. Lady give way?

[Ms Abbott]

Time is against me, I am afraid.

The final thing that ordinary health service workers would wish me to say is that if anything has exemplified the unfortunate practice of politicians of saying one thing and doing another, it is the frequency and vehemence with which the Government decried top-down reorganisations when they were in opposition. In 2006, the right hon. Member for Witney (Mr Cameron), then Leader of the Opposition said:

“So I make this commitment to the NHS and all who work in it. No more pointless reorganisations.”

In 2007, the then shadow Health Secretary said:

“The NHS needs no more pointless organisational upheaval”.

In 2009, still as Leader of the Opposition, the right hon. Member for Witney said:

“But first I want to tell you what we’re not going to do. There will be no more of those pointless re-organisations”.

Then, the coalition agreement of 2010—I do not want to touch on private grief here for Liberal Democrat Members—said:

“We will stop the top-down reorganisations of the NHS that have got in the way of patient care.”

We are thus presented with a Bill that is based on a bizarre sort of life support—the arrogance of the coalition leadership.

Now we know that the doctors, the nurses, the midwives, the health visitors, the paramedics, the cleaners, the porters, and the scientific and technical workers will do their very best with this Bill if it becomes law. That is what Clare Gerada was saying this morning: if it becomes law, they will do their very best, but why should they have to see an already discredited Bill on the statute book? Why should they have to see more bureaucracy, which is what the Bill will mean, and why should they have to see billions of pounds wasted at a time when the health service is under unprecedented financial pressure? Government Members have sought to denigrate those who oppose the Bill by saying that their opposition is merely party-political. Of course it is not: we are proud to be part of a coalition of concern about the Bill.

My right hon. Friend the Member for South Shields (David Miliband), my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds), my right hon. Friend the Member for Manchester, Gorton (Sir Gerald Kaufman), my hon. Friends the Members for Stoke-on-Trent North (Joan Walley) and for Worsley and Eccles South (Barbara Keeley), my right hon. Friend the Member for Wentworth and Dearne (John Healey) and my hon. Friend the Member for Bethnal Green and Bow (Rushanara Ali) spelt out our concern about the Bill. It is extraordinary that we can proceed while the Government are still refusing to reveal the risk register. There is concern throughout the NHS about the fragmentation that will result from the Bill. Government Members say that we are scaremongering—[Hon. Members: “You are.”]—but private sector companies such as Humana and Capita are already advertising their willingness to take over GPs’ commissioning powers on their websites.

The NHS does not belong to the Secretary of State, and it does not belong to the Deputy Prime Minister. It belongs to the people of Britain who built it after the war. The NHS is not for sale, and I urge the House to support the motion.

Oral Answers to Questions

Baroness Morgan of Cotes Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Lansley]

The hon. Gentleman clearly has no idea of what is actually in the Bill or the modernisation process. It is only about simple things. It is about giving patients information and choice. It is about empowering doctors and nurses and health professionals, and it is about strengthening the ability of the NHS to improve care in the future. That is all that it is about, and it cuts the cost of bureaucracy in so doing. It will enable us and the NHS to do the things that his Government supported in the past—he might not have supported them, but his friends did—including commissioning by clinicians, patient choice and using the best qualified provider. Those are the things that his Government used to believe in, and they are the things that we are doing. There is no privatisation, no charging and no break-up of the NHS. There is only supporting the NHS.

[Nicky Morgan (Loughborough) (Con)]

Ministers will be aware of the Centre for Mental Health’s report last week, which showed that physical health outcomes are linked to mental health outcomes, and that both need to be treated at the same time. Can the Minister update the House on the Department’s progress on implementing its mental health strategy?

[Paul Burstow]

I can indeed. We will shortly be publishing a more detailed implementation plan showing the role that the NHS Commissioning Board, the clinical commissioning groups and others will play, alongside the voluntary sector, in delivering the strategy. More importantly, we are also doing work on long-term conditions that will begin, for the first time, to join up the way in which we commission physical and mental health services. We have to do that in order to deliver better outcomes for people.

Care of the Dying

Baroness Morgan of Cotes Excerpts

Tuesday 17th January 2012 Westminster Hall

[Mr Burrowes]

Indeed. We need to retain the present law, which continues to provide a strong deterrent to the exploitation of vulnerable people, while giving prosecutors discretion in hard cases. Parliament has agreed, through a detailed Select Committee inquiry and three votes in the past six years, to retain that protection. We have to recognise that it is easy, in the comfort of Parliament, to make fine-sounding points about terminal illness. I recognise that there are no easy answers for those who feel they are not valued and who may feel that they may be wasting resources or are a burden on their family or society. However, they are the very people who most need the protection of the law and the provision of good-quality palliative care. How do we best safeguard their dignity and autonomy?

When we talk about dignity in the context of a health debate, it can all too often be restricted to privacy and physical care, but palliative care recognises a wider, proper understanding of dignity. Good palliative care recognises the social, emotional, spiritual and psychological needs that put an embrace around a terminally ill patient, rather than the proposed arbitrary, so-called safeguards that put a straitjacket around patients and doctors. For example, the prognosis for a terminally ill patient is notoriously difficult to determine. The best safeguard is through specialist palliative care that helps a patient live with uncertainty. Take the case of a motor neurone disease sufferer who wants to end his life but, unknown to his GP, has developed fronto-temporal dementia and whose thinking has become distorted. Such a condition could only be noticeable if someone knew that patient very well before the illness. The best safeguard to help the patient live with those fluctuating moods and thoughts is specialist palliative care. The proper way to empower patients’ choice and protect the vulnerable is through driving up palliative care standards, not new legislation.

In 2010, the Economist Intelligence Unit ranked Britain, rightly, as top of the league of countries for the provision of end-of-life care. Much of the credit is no doubt due to the expansion of local charitable hospices that provide more than £700 million of care, the majority of which is donated by the communities that they serve. Additionally, more than 100,000 people donate their time to local hospices each year.

[Nicky Morgan (Loughborough) (Con)]

I congratulate my hon. Friend on securing the debate. The fact that there are so many hon. Members here at 9.30 on a Tuesday morning shows what an important subject this is. He talks about local hospices. The Rainbows children’s hospice, which is in my constituency, now looks after young adults with life-limiting conditions as well. In this debate, we will perhaps focus on older people, but we should not forget children with life-limiting conditions. One point that the hospice has made to me—I think that my hon. Friend is coming on to this—is the fact that we need to integrate both health care and social care. Rainbows children’s hospice would like to see more of that from the Minister.

[Mr Burrowes]

I am grateful for that point. Integration is needed, and we see that in the context of hospices and palliative care. We hope for that future in the reforms that are going through Parliament.

Although we should be proud, rightly, of individual examples in our constituencies, we should not rest on our laurels. We need to build on that solid foundation, because far more can be done. End-of-life care is not available to everyone who needs it. In fact, the palliative care funding review found that 92,000 people die in England every year without access to the services that they need. That figure equates to nearly 500,000 people during the term of this Parliament, and 700 people in each of our constituencies dying without the good palliative care services that they deserve.

Nationally, hospices receive about a third of their funding from the NHS, but that can vary substantially across the country. Indeed, in my constituency in Enfield, the NHS contributes less than 20% of what the hospice spends on care for Enfield patients. One of the biggest issues facing the terminally ill is where they will die. Currently, more than half the people who die in England do so in hospitals and just 20% die at home, although various studies have shown that two thirds of people would choose to die at home.

In Enfield, there are excellent palliative care services. I pay tribute to Nightingale Cancer Support Centre and North London hospice, which provides a community service providing care in people’s homes alongside an in-patient unit. In Enfield, the North London hospice community team are able to ensure that only 28% of people cared for by the hospice die in hospital.

According to the Minister, the Government should consider allocating national resources to continue to promote and extend palliative care. I look forward to hearing from the Minister about the progress in implementing the new per-patient funding system for hospice and palliative care providers, which will provide incentives to enhance services within community settings.

Patient Security (Mental Health System)

Baroness Morgan of Cotes Excerpts

Monday 7th November 2011 Commons Chamber

[Nicky Morgan (Loughborough) (Con)]

I am extremely pleased to have the opportunity to raise this important topic in the Chamber tonight. I should declare at the outset my position as a vice-chairman of the all-party parliamentary group on mental health.

The Government’s recent mental health strategy stated that mental ill health represented up to 23% of the total burden of ill health in the UK, and that it was the largest single cause of disability. At least one in four adults will, at some point in their life, experience a period of mental ill health. For some, it may be a relatively mild, one-off episode. For others, the first episode will herald the start of a long-term relationship with the mental health services in all their guises. Such episodes, whether short term or long term, have a profound effect not only on the person suffering with a mental health condition but on their families and friends, many of whom will never have come into contact with these conditions or this part of the NHS before.

In the most serious cases, a patient might spend a period of time in an acute care setting, either voluntarily or while being detained under the Mental Health Act for their own welfare and the welfare of those around them. At such times, the patient and their families and loved ones will expect the patient to be kept safe and secure while they are given the appropriate therapy and treatment to enable them to resume their place in our communities. That expectation, and the fact that it is sometimes not fulfilled, are the focus of this short debate tonight.

In June 2010, shortly after I was elected as the Member of Parliament for Loughborough, I was approached by a constituent, Glyn Brookes, who told me about the tragic death of his daughter, Kirsty. I appreciate that the Minister is unlikely to be able to respond to this particular case, although I have sent his office a copy of the coroner’s report into Kirsty’s death. However, it is because of this case that I have ended up leading this debate tonight.

Kirsty was a patient at the Bradgate unit at University Hospitals of Leicester. She was able to escape from the unit using the frame of an external door to help her. Her escape was not dealt with as it should have been, and she was able to commit suicide before either the hospital authorities or the police found her. This has clearly been devastating for the Brookes family, and I would like to pay tribute to them, and particularly to Mr Brookes who contacted me to tell me their story. I would also like to pay tribute to the excellent coroner whose report helped, I think, to answer the Brookes family’s questions about the tragedy. I should say that I have spoken to the former and current chairmen of Leicestershire Partnership NHS Trust, which administers the unit, and I understand that work is ongoing to learn and act on the lessons of this case.

As a result of the case being raised with me, I began to wonder how many other patients absconded each year from units run by our mental health trusts. I submitted Freedom of Information Act requests to all 58 of the mental health trusts in England, 57 of which have replied. The figures make grim reading. Before I go into them, however, I should say that this exercise has shown me that there is a real variety in the quality of record keeping at the trusts. There also seems to be a real difference in the way in which the term “abscond” is used by the trusts as a basis for recording the relevant information. I hope that the Minister and the Department will be able to help with this matter.

The Mental Health Act 1983 defines “abscond” as when a patient who is liable to be detained under the Act

(a) absents himself from the hospital without leave granted under section 17 above; or

(b) fails to return to the hospital on any occasion on which, or at the expiration of any period for which, leave of absence was granted to him…; or

(c) absents himself without permission from any place where he is required to reside in accordance with conditions imposed on the grant of leave of absence”.

In responding to my request for information, some trusts used this definition, while others made the distinction between a patient who was “absent without leave”, “absent without explanation”, “missing” or escaped. In addition, some trusts use the terms “AWOL” and “abscond” interchangeably without definition or explanation. Other trusts used only “abscond”, but did not define what they meant by the term. Finally, some trusts provided the number of “incidents” of absconding, rather than the number of patients. Others did not make that distinction. For simplicity, however, the figures that I will now mention refer to the total number given for the five-year period that I asked about, and therefore do not differentiate the different types of absconding incident.

My research showed that in the past five years about 40,500 incidents of absconding occurred, ranging from a total of three reported incidents for Barnet, Enfield and Haringey Mental Health Partnership Trust to 3,891 for Lancashire Care NHS Foundation Trust. There is significant variation across the country, so clearly some trusts are doing things very differently from others. In the case of Leicestershire Partnership NHS Trust, the total figure for the past five years is 386. I must stress caution in comparing those numbers. We could, in many cases, be comparing different things—although the overall effect of patients absconding is the same—simply because the trusts use their own definitions, despite the fact that the Department of Health has published its definitions of absconding and escaping.

[Dr Julian Lewis (New Forest East) (Con)]

I do not know where on my hon. Friend's list the Hampshire Partnership NHS Trust figures, but did she find any correlation between the quality of the infrastructure of the units and the numbers of people absconding? Did she find, for example, that a brand-new unit, such as Woodhaven in my constituency, tended to have a lower rate of such problems? This is of particular interest to me, as that eight-year-old hospital is threatened with closure, and I have a debate on it later this week.

[Nicky Morgan]

I am grateful to my hon. Friend. I have seen the subject of his Adjournment debate later this week. Unfortunately, I did not have the opportunity to go into that level of detail, but I shall come to the quality of care and to demonstrate that it has a huge impact on the absconding rate for patients. As I shall come on to mention, this is an issue on which the Department of Health and the trusts could work together. Interested Members or other interested parties should see the link between absconding and the quality of care given. There is no doubt that there are innovative ways of ensuring that patients do not feel the need to abscond, and that if they are outside the environment, of ensuring that they will come back because they know that they will receive therapeutic treatment.

As I was saying, despite all the caveats, the numbers are simply too high for organisations that owe their patients a duty of care. The fifth agreed objective in the Government’s mental health strategy launched earlier this year stated:

“Fewer people will suffer avoidable harm—people receiving care and support should have confidence that the services they use are of the highest quality and at least as safe as any other public service.”

This is, of course, an objective that anyone who has an interest in any health service, but particularly mental health services, would want to see met. The fact is that guidance is already in place for mental health trusts and for those working within them to follow, although it would be fair to say that a lot of that guidance deals with how to react to an incident of absconding rather than offering concrete guidance on prevention. In the case of my constituent, the coroner expressly found that

“it would appear that the hospital had a system and policies in place to protect and supervise Kirsty from harm but at all material times those caring for her did not follow those policies.”

That is just not acceptable.

The Minister will remember the long sessions earlier this year discussing the Health and Social Care Bill in Committee Room 10 upstairs—how could we forget them? One of the recurring themes was not just that we all want to see high-quality services but how we ensure our health and social care services are of high quality and that everyone is focused on the primary objectives of the health system. Do we do so through inspections? Do we hope that everyone working within the health system works to their own high standards, as many thousands of employees surely do? Do we ensure that guidance is not only available but followed? And do we ensure that when things go wrong, as in the case of my constituent, thorough investigations follow and lessons are learned? Surely it must be a combination of all those things.

As I mentioned, hospital wards are meant to be places of therapy, but too often, especially in the case of mental health wards, they are anything but. In a recent report, the Centre for Social Justice said:

“Hospitals tend to be untherapeutic and dangerous places”.

In helping me to prepare for this debate, Mind sent me a note saying:

“The quality of care quite clearly has an impact on a patient’s decision to abscond. Unfortunately, as Mind’s forthcoming acute and crisis care campaign will show, people in inpatient settings often experience substandard quality, with no meaningful activities, little or no interaction with staff or each other, and at worst, lack of safety, abuse and coercive treatment.”

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Does my hon. Friend agree that one problem—she has done well in bringing this debate before us this evening—is the fact that people often become labelled when they are in a mental health care setting, whereas what we need to do if we are to deal with the issue properly is to break down and challenge those labels, so that the patient is not seen just as a mental health patient but as a person? All the therapies and preventive measures she is talking about relate to that issue. If we can get that right, we will be able to look at people and treat them in the way that they deserve—with respect, which will help to prevent the episodes of absconding or escape that my hon. Friend mentions.

[Nicky Morgan]

I entirely agree with my hon. Friend, who is a qualified NHS practitioner and knows far more about these matters than I do. Everything that he has said confirms the fact that we must not forget that people are at the heart of all cases of this kind—not just patients, but their families. The sooner patients receive good therapeutic treatments and can resume their place in society, the better. My hon. Friend made another important point: for too long a stigma has been attached to mental ill-health conditions, and people do not talk about them. I hope that tonight’s debate will mark the beginning of more open discussion of such conditions, in the House and beyond.

Kirsty's father told me that he believed that there was nothing to do at the unit where she was being treated. He said that there were no constructive therapies.

Rethink Mental Illness and the Royal College of Psychiatrists drew my attention to a 2010 report that had been prepared as part of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. According to the report, between 1997 and 2006 absconders accounted for 25% of all in-patient suicides and 38% of suicides that occurred off the wards. Absconding patients were also significantly more likely to have been under high levels of observation, but clinicians reported more problems in the observation of those who had absconded owing to ward design or other patients in the ward. The report made three recommendations for improvement: that staff need to pay better attention, not just to patients but to ward exits; that observation methods should improve, as there was little evidence regarding the protective effect of close observation, and high levels of observation may be ineffective for people who are intent on leaving the ward; and that there should be an increased focus on engagement and support by staff when patients are admitted.

However, as Mind pointed out to me, there is evidence that when wards take a more innovative approach to in-patient care, there are fewer incidences of both aggression and absconding. There is already an incentive for our mental health trusts to do better in terms of the treatment and care that they offer to in-patients.

Let me end by drawing all those thoughts together. First, we need more research in order to understand the scale of the problem. The information that I have obtained is, I hope, a good start, but I think that the Department could insist that trusts use one set of definitions so that numbers can be properly compared, and that trusts with low incidences of absconding could share their experiences with those whose absconding rate is very much higher. The Department could also insist on publication of the information that I had to obtain under the Freedom of Information Act.

Secondly, trusts should not only follow existing guidance, but work out how they do their best to prevent patients, when they are at their most vulnerable, from absconding and causing harm to themselves. My office did not have to look very far to find seven newspaper reports about patients who had absconded this year. Six of those cases tragically ended with the patients taking their own lives, and in one case the patient killed someone else. I believe that only by encouraging trusts to take those steps will the Department stand a chance of fulfilling the fifth objective in its laudable mental health strategy.

Finally, I should like us all to remember that at the heart of this are usually very ill people and their families. Mr Brookes said to me in July this year, “We trusted the system. We paid our taxes, and we expected the best care for those who are at their most vulnerable.”

We talk a lot in the House of Commons about physical health outcomes, but the time has come for mental health to get a proper look in. As someone speaking at one of the all-party meetings on mental health said, “We all have mental health; it is just that some people’s is better than that of others.”

We are talking about people, so there are no absolutes, and there will always be those who are determined to take their own lives, but I hope that tonight, by focusing on one part of the mental health system—the security of patients being treated in hospital settings—the House can begin to make clear its desire to see real parity between physical and mental health conditions in the context of funding and treatment. I believe that if we do not do that, we will be storing up huge trouble for the country, and there will be more tragic deaths of patients like Kirsty which could perhaps be prevented.

Oral Answers to Questions

Baroness Morgan of Cotes Excerpts

Tuesday 18th October 2011 Commons Chamber

[Mr Lansley]

It is an independent review and I can assure the hon. Lady that that is indeed the case. It will be based on the evidence. I am sure that she will have heard the response to a debate earlier in the year by the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), who said that while the review has put forward options for consideration, it should not be constrained to consider only those options.

[Nicky Morgan (Loughborough) (Con)]

Will my right hon. Friend confirm that the criteria for the review remain the same; that the rather strange remarks—about more people having voted for one option but more organisations having voted for another—have not affected them; and that those criteria will be used to judge the decision?

[Mr Lansley]

Happily, I can entirely confirm that.

Health and Social Care (Re-committed) Bill

Baroness Morgan of Cotes Excerpts

Wednesday 7th September 2011 Commons Chamber

[Owen Smith]

I am grateful to the Minister for that further intervention, just as I assume that he is grateful for the intervention of the civil servants in the Box, who must have passed him a note. Clearly, he was not aware of that earlier. When he said that CCGs must meet in public, he was under the impression that that was the case.

[Nicky Morgan (Loughborough) (Con)]

Will the hon. Gentleman give way?

[Owen Smith]

No. I shall move on now. We have debated the topic long enough.

[Owen Smith]

Indeed. The key difference is that it is for the clinical commissioning groups, in establishing their constitution, to determine what the rationale will be for allowing the public in or not. That is not set down in statute or in direction from the Minister or the Secretary of State. It is for individual CCGs to determine when they should let the public in. I give way to my colleague on the Bill Committee.

[Nicky Morgan]

I am grateful to the hon. Gentleman. I remember discussing with him whether he was a lawyer, and he was proud to say that by background he was not a lawyer. As he knows, there will be occasions when a clinical commissioning group is considering a matter which is sub judice. It could be an employment law matter; it could be a confidential matter relating to a patient—for example, a mental health patient for whom there has been very sensitive care. There will be times when it is appropriate and in the public interest and that of relatives—[Interruption.] I am making the point to the hon. Gentleman, not to those on the Opposition Back Benches. There will be occasions when it is appropriate for the CCG not to meet in public, as I am sure he will concede as a matter of common sense.

[Owen Smith]

I will not dispute that there may be occasions when it will be appropriate for the CCG to meet in private, but that is not what the Minister said. My point was to do with the tone and the misrepresentation that has been systematically applied by those on the Government Benches. That is the difference.

--- Later in debate ---

[Owen Smith]

It will. I have no doubt that the very many lawyers in the other place will have a field day in addressing these issues—just as, we fear, lawyers the length and breadth of this land will have a field day, not only during the passage of the Bill but for many years to come. That is because so many things will be contested, not only relating to the issues we are debating but, far more importantly, in relation to competition, which we debated yesterday, where it is undoubtedly the case that decisions that have hitherto been made to provide services from within the family of the NHS will be challenged by carpetbaggers—profit seekers—from outwith the NHS. Under the future provisions, those issues will need to be tested in the courts. The Government have conceded that on several occasions, and I am sure that they would do so today if they were asked.

Finally on the issue of the Secretary of State, and once again to hammer home the point that this is not just Labour scaremongering and that lawyers will be involved at every step of the way, I draw Members’ attention to the independent legal opinion that was provided by Stephen Cragg QC. Paragraph 1 of the executive summary states:

“It is clear that the drafters of the Health and Social Care Bill intend that the functions of the Secretary of State in relation to the NHS in England are to be greatly curtailed.”

It goes on:

“Effectively, the duty to provide a national health service would be lost if the Bill becomes law. It would be replaced by a duty on an unknown number of commissioning consortia with only a duty to make or arrange provision for that section of the population for which it is responsible.”

It states that the Bill is

“fragmenting a service that currently has the advantage of national oversight and control, and which is politically accountable via the ballot box to the electorate.”

That was the view of an independent QC on reading the Bill. It is a view that I and the Opposition share. I suggest that Ministers read it very carefully and do not dismiss it, as they have done today, as an inaccurate reading of the Bill.

[Nicky Morgan]

Is that the independent legal advice given to the campaign organisation, 38 Degrees? If it is and if the hon. Gentleman has any influence over that group, can he persuade it to release and make public the instructions given to counsel, because any instructing solicitor who instructs counsel to give advice usually gives very clear guidelines on, or an indication of, what they want the advice to say?

[Owen Smith]

I am ever so grateful to the hon. Lady for that intervention, because it is profoundly rich for anybody on the Government Benches to suggest that we should prevail upon an independent organisation to publish the instructions that it offered to an independent QC, when the Government will not even publish the independent advice that they have commissioned. They have refused to do so repeatedly. They will tell us that they do not agree with this independent opinion, but they absolutely will not publish their own. I suggest that she makes representations to those on her Front Bench, and I will do the same to 38 Degrees if I have a chance.

The independent legal advice goes on to say:

“Encouraged by the structure and clear intention of the Bill to give consortia autonomy from the Secretary of State,”—

which is, of course, in clause 4 of the new Bill—

“there is a real risk of an increase in the ‘postcode lottery’ nature of the delivery of some services, depending on the decisions made by consortia.”

That increase in the postcode lottery takes me on to the second set of proposals that I wish to touch on, which we believe would stop the Government effectively legislating to hardwire the postcode lottery into our NHS. We accept that it is already too variable across the country and that there needs to be greater equity and standardisation, with excellence provided to everybody across the country. That will become all the more difficult with the new provisions.

New clauses 10 and 11, which were tabled by the Labour Opposition, are designed to combat some of the possible malign consequences of the changes that hand to clinical commissioning groups the ability to determine the needs of the local health population and to set their priorities without interference or support from the Government, or indeed from regional strategic health authorities.

--- Later in debate ---

[Nicky Morgan]

In yesterday’s debate the right hon. Member for Holborn and St Pancras (Frank Dobson) said of the NHS that he believed that in most parts of the country and most of the time it does a good job for people, but I want to see it doing an excellent job for people in all parts of the country all the time, and that is what this Bill will achieve. Having served on the Bill Committee, it is a great sadness to me that that message, and the fact that patients will be at the heart of the NHS, has been lost in the months of scaremongering—a word used by the last speaker—and wrangling by those who have campaigned against it and have obscured all such messages. That has been totally unfair to the patients who rely on the NHS.

I briefly want to make two points. First, Members who served on the Committee will know of my passion for getting the right treatment for mental health patients, and at a meeting of the all-party group on mental health yesterday the Bill was described by GPs as a great opportunity: an opportunity for the integration of primary and secondary care—something they have not had before, and that will now be achieved.

Secondly, as my hon. Friend the Member for Totnes (Dr Wollaston) said, the Bill puts clinicians at the heart of commissioning. When the Bill was recommitted, my researcher said to me, “This Bill is a gift that keeps on giving.” Now it is time for this present to be handed over to the other place, but it needs to reach the statute book and we need to implement it on the ground. I have heard nothing from the Opposition in the past eight months to convince me that this Bill should not receive its Third Reading and get on to the statute book, and I urge all hon. Members to support it.

[Mr Deputy Speaker (Mr Nigel Evans)]

I am grateful for that short speech. I ask for another short speech from Kevin Barron.

Health and Social Care (Re-committed) Bill

Baroness Morgan of Cotes Excerpts

Tuesday 6th September 2011 Commons Chamber

[Grahame M. Morris]

I am privileged to have the opportunity to speak in this debate on an issue close to my heart. A number of Opposition Members—and perhaps Members across the whole of the House—have taken advantage of the opportunity to spend a day with the NHS to see at first hand some of the issues and problems and to discuss with staff and patients their concerns. Many Members have received e-mails and letters from constituents and from various interest groups, and the issues we are considering this evening are very important.

As my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) said during his contribution, the NHS holds a very special place in people’s affections. In many respects it is viewed not unlike a religion, in so far as it is loved and cherished. Members who have had the opportunity to travel to other countries and see different health systems will no doubt be well aware of the high esteem in which our own health service is held throughout the world. It is a real exemplar—a model of a publicly funded, publicly provided health service. As an aside, I point out as a member of the Select Committee on Health that we have a very frugal Chairman, and the furthest we have travelled is to Hackney. My knowledge is therefore based on reading and on evidence submitted to the Committee.

Let us consider the problem we face with the Bill and the amendments and new clauses. I listened carefully to the Secretary of State’s statement, and the real concern among patients, the public and the Opposition is, what are the motivations behind these reforms? I worked in the health service for a dozen years or more and have taken the trouble to look into the various options in some detail. Ministers have said that there are precedents for Bills of this complexity, but I would be staggered to find that there are. It is incredibly complicated and has been subject to numerous amendments. As members of the Bill Committee who are in the Chamber this evening know, many of the arguments originally made by Government Front Benchers were turned on their heads in Committee, and some of those that were rubbished by the Opposition were taken up and rehashed as part of the Future Forum.

[Nicky Morgan (Loughborough) (Con)]

I am listening very carefully to the hon. Gentleman, as I did in Committee. Indeed, those of us who served on both Committees—the original and the re-committal—deserve a badge of honour. He talks about the Bill being complex. Does he not think that the process has been made more complex by the use of misinformation and emotive language, and by campaigners obscuring the Bill and needlessly causing patients to worry about their ability to access the health service once the Bill has been passed? The point is that free access at the point of need is not changing, and that is what most patients care most about. Does he not agree?

[Grahame M. Morris]

I am afraid I do not agree with the hon. Lady, as she might expect. The Secretary of State said that it was a question of communication, but I suspect that part of the problem with the Bill is that, far from there being additional clarity, the more that Members of Parliament, the medical profession, health care workers, members of the public and informed commentators have examined the proposals in detail, the greater the number of concerns that have arisen.

If the Secretary of State had been open and honest about the direction of travel and the motivation for these health reforms, perhaps we could have avoided some of the confusions that have arisen. There is no electoral mandate for a huge structural review and reorganisation. I suspect that there is something seriously wrong with the whole privatising agenda and philosophy, which the Secretary of State denies.

--- Later in debate ---

[Grahame M. Morris]

Absolutely. At this late stage in the process, however, these are huge and significant changes.

[Nicky Morgan]

Just to help the hon. Gentleman, a number of the amendments relate to the continuity of services, which his party and those on his Front Bench asked to have considered by this House on Report rather than being left to the Lords. I am sure that the Ministers can help, but if that subject was not included, I suspect that the number of amendments would be significantly smaller. It is right that they should be considered in this House at this time—does he not agree?

[Grahame M. Morris]

That is a fair and reasonable point and I concede that.

--- Later in debate ---

[Emily Thornberry]

Exactly; I am very grateful to my hon. Friend.

The Secretary of State, like the Minister of State, the right hon. Member for Chelmsford (Mr Burns), is fond of quoting the Future Forum. I have a quote from Professor Steve Field that I hope will be of assistance to the House when it comes to discussion of the cap. He said in evidence to the Committee:

“if you opened the cap, it made you more likely to be under attack from EU law, competition and Monitor”.––[Official Report, Health and Social Care (Re-committed) Public Bill Committee, 28 June 2011; c. 14, Q24.]

That is one of the arguments that he used. If the Future Forum is concerned about this being another reason why we should not lift the cap, I hope that the Minister will at least listen to its arguments.

As we heard in Committee, a number of criticisms have been made on both sides of the House about the details of the cap and how it is implemented. Indeed, it is common ground that there ought to be some changes to it. We have no problem about changing and modifying the cap and making it more appropriate, but we do not understand why, just because the cap needs changing, it is simply being lifted completely.

A parallel can be drawn with the carbon emissions cap. If I were working in the Potteries in Staffordshire, I am sure that I would believe that the carbon emissions cap was unfair and went against my personal business. One would need to look at the cap and change it as appropriate in order to make it work properly; one would not get rid of it completely just because there are criticisms of it, unless one had another agenda.

The question is why on earth the Government are considering allowing as many private patients as wish to do so to go into our national health service at a time of crisis, pushing out national health service patients. [Interruption.] If the Minister believes that that is wrong, I will be interested to hear an intervention from him in which I hope he will be able to give us a complete assurance that that will not happen. The fact of the matter is that there are not the necessary safeguards. As we understand it, there will be absolutely no limit. We have no idea how foundation trusts are going to respond to the lifting of the cap. We do not know and neither, with great respect, does the Minister. Why is he allowing this great risk to be taken with our national health service? The clause needs to be looked at very carefully in this place, and I know that it will be looked at very carefully in another place.

[Nicky Morgan]

I am not sure whether the hon. Lady has seen a note from the Foundation Trust Network that was, I believe, circulated to all Members of the House and sets out six positive reasons why the private patient income cap has worked: it has allowed hospitals to build new units, to buy leading-edge technology, to extend mental health support, to offer fertility treatment, and to provide maternity services. There is also the fact that rental income is caught by the cap. There are some positive benefits in allowing private patients access to be treated by hospitals. In particular, at a time of financial crisis, bringing new technology into the NHS must be a good thing.

[Emily Thornberry]

I am grateful to the hon. Lady. I think that if we were to stop and walk away from party politics, we would be quite close on this matter. We do not have a problem with there being a cap; the problem is how it is implemented. I think that, deep down, she agrees with us. The difficulty is that her party wants to get rid of the cap completely, and that will have a completely different effect on the national health service. We are happy to sit down and talk to the agencies that will be affected and to make improvements in the working of the cap, but getting rid of it completely is behaving recklessly with our national health service.

[Nicky Morgan]

The misinformation and emotive language that has been used throughout the whole debate has been using patients at the heart of this. Everything we have heard so far on both sides of the House, perhaps prompted by the hon. Lady’s remarks, has been about how bringing in private patients is bad for the NHS. In fact there are some good aspects. I am pleased to hear that there can be some agreement between both sides of the House.

[Emily Thornberry]

That is why I have been relying on the Government’s impact assessment as perhaps the strongest part of my argument. I have also relied on what Professor Field has had to say. I would now like to turn to Baroness Williams, who wrote an article published on 4 September that I commend to the House, in which she says:

“One thing that remains…is the decision to lift the cap on private beds in foundation hospitals. Not only could that mean that many of our finest hospitals would gradually become private, it also means that inevitably foundation hospitals would be subject to European and British competition law.”

Many organisations and people agree with us on this, and that is why the House should pause and think about what we will be doing to the national health service if we accept this clause. I also pray in aid the Royal College of Nursing’s briefing, which Members who are closely following this debate will have read, in which it says that it is against the removal of the cap and does not believe that it will not have an effect on NHS patients’ access to health care. The BMA has said the same thing.

In essence, the argument is about whether we should have a cap or not. If the House votes tonight to lift the cap, our constituents will ask how it can be that their representative has voted for a clause that allows private patients to fill up the national health service hospital paid for by those constituents’ taxes so that they will be pushed out of it.

Reform of Social Care

Baroness Morgan of Cotes Excerpts

Monday 4th July 2011 Commons Chamber

[Mr Lansley]

The hon. Lady makes a number of important points. As the Minister of State, my hon. Friend the Member for Sutton and Cheam, made clear recently, one purpose of legislation in due course will be to put the safeguarding on a statutory basis, which is important. Working with the CQC, we must ensure that in domiciliary care as well as in residential care homes, mechanisms are in place that enable us to assess the quality of care and get feedback from residents. The social care outcomes framework must be developed in a way that captures an understanding of the experience of care users, their families and supporters.

[Nicky Morgan (Loughborough) (Con)]

I thank the Secretary of State for his statement and I welcome the Dilnot review. As other Members have said, however, hundreds of thousands of families across the country are already worrying about how they will pay for care bills for their relatives, including the Strachan family in my constituency, who said publicly this morning that they have only two months’ money left to pay care home bills and are not sure what they will do after that. When my right hon. Friend launches the consultation, may I urge him not to forget the needs of those already in the care system who are worrying about paying bills, as well as being rightly concerned about those facing future care bills?

[Mr Lansley]

My hon. Friend’s point relates to the degree of uncertainty and insecurity that the current system tends to engender. It is important that we deal with that, and that people understand the circumstances in which the state pays and will continue to pay. We should not give people who have no assets the sense that they will be required to pay when they have no means of doing so. The state will be there to support them. There will be a safety net, and the commission makes recommendations about how further to develop it in future. Beyond that, we must arrive at a place where people are able to understand better the nature of the care costs that they might meet, and where there are good, affordable, secure mechanisms through which they can prepare for those costs, so that they do not have the gross insecurity that exists at the moment.