Mental Health Units (Use of Force) Bill

Christopher Chope Excerpts

Report stage: House of Commons
Friday 15th June 2018 Commons Chamber

[Sir Christopher Chope (Christchurch) (Con)]

I am grateful to the hon. Gentleman for his indication of support for these amendments. When the Government have explained to him why they cannot deal with them, have they explained how the objections he has raised do not occur where the treatment is provided in part by the NHS but not in toto?

[Mr Reed]

As the Minister is present, it is probably best to allow her to speak for herself, rather than for me to attempt to interpret this on her behalf.

I wish to turn next to the amendments tabled by the right hon. Member for North Norfolk, many of which I support in principle, having raised a number of them myself at previous stages. I am broadly satisfied that many, if not most, of the points will be dealt with through guidance issued by the Department after the legislation, but I look forward to the Minister’s further comments and explanations on those points.

Important additions have been made to what falls under the definition of “use of force” as this Bill has developed. One is the use of “chemical restraint”, which amendments 88 to 91, standing in the name of the hon. Member for Christchurch, would remove from the Bill. I am afraid that I cannot support those amendments, because the potential effect is that the Bill could limit the use of physical restraint, only to lead instead to an increase in the use of medication—for example, rapid tranquilisation. It is important therefore that the Bill covers all forms of restraint, both physical and chemical.

[Sir Christopher Chope]

I tabled these amendments on the basis of a sad, current constituency case involving the parents of a very ill young man of 25. He is in and out of a mental health unit, and normally he is in there because he has failed to take his medication. It is designed to reduce the need for force, because he would be violent without it. Surely, the giving of such medication to a person in the circumstances I have described should not be regarded as “force” under the Bill.

[Mr Reed]

I hear what the hon. Gentleman is saying, but the point remains: if we take measures to deal with only physical restraint but not chemical restraint, we may simply push the services to use chemical restraint, such as rapid tranquilisation, more frequently and we would not wish to see that as an unintended consequence of amending the Bill further.

On the nature of the use of force, the hon. Member for Shipley has tabled amendments 44 to 78, which would replace the word “force” with the term “ restraint” throughout the Bill. I do not wish to pre-empt his reasons for doing that, and I suspect he will explain himself well later this morning, but let me say that we used the term “restraint” rather than “force” during an earlier draft of the Bill, so I agree with the general intention behind these amendments. I was persuaded, however, that the current wording ensures greater consistency with other legislation and therefore that the Bill does not run the risk of adding confusion into how the professionals interpret the language used.

The right hon. Member for North Norfolk has tabled a number of amendments dealing with the information provided to patients. Amendment 38 would include in the information given to patients details of their right to independent advocacy, which would help the patient to make the right decisions about their care and involve, where appropriate, carers and families. I certainly agree on the need to give more power to service users, so I would gently encourage the Minister to set out how those objectives might be achieved.

The Bill, as amended in Committee, says that information does not need to be provided where it would “cause the patient distress”. I understand that the hon. Member for Christchurch also has concerns about that, which is why both he and the right hon. Gentleman have tabled amendments to remove that potential loophole. I agree on this, and following discussions with the Minister, I am happy to accept Government amendments 1 to 3, which remove this “distress” loophole.

On staff training, the hon. Member for Shipley has tabled amendments 11 and 12, which seek to strengthen the Bill by adding usefully to the list of training topics. I know that he has discussed the Bill with his local care trust, and I welcome that spirit of engagement and representation. Amendment 11 would require training to be given on “roles, responsibilities and procedure” if the police are called to a mental health unit, as happened in the case of Seni Lewis and in many others. That strikes me as a sensible addition to the Bill, ensuring a more joined-up approach between police officers and staff in mental health units. Amendment 12 would also strengthen the Bill. It would add

“awareness of acute behavioural disturbance”

to the list of training topics. That is clearly a valuable thing for staff to be aware of in terms of how restraint may affect someone displaying behavioural disturbance. I support amendments 11 and 12, but before accepting them, it is important to hear whether the Government intend to deal with them through guidance.

There are, however, amendments that I am not happy to accept. Amendment 9 would remove the need for training on diversity, but that is a crucial part of the improved training and it goes to the heart of the Bill’s purpose in ensuring equal treatment for everybody by identifying those areas where treatment is not being delivered equally to everybody, whether because of ethnicity, type of disability or gender. If we do not capture that data, we cannot see the problem, and if we do not recognise the problem, we cannot put in place the measures to deal with it. Therefore, I cannot support that amendment.

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[Philip Davies]

I am grateful to the Minister for that. I appreciate that we are in a strange situation in which the Government do not have time to decide whether to agree with the amendments, but they certainly have time to write speeches on why they will disagree with them because they are not in a position to accept them. We have got ourselves into a completely farcical situation. The Minister is going to read out the speech that has been prepared to say why she cannot accept the amendments, but we all know that the reason why she cannot accept the amendments is that she does not have the Department organised to get things decided within eight days. As I said, that gives the impression that the Government have been taken hostage by the civil service. The Department of Health and Social Care is probably one of the worst offenders for being taken hostage by its civil servants. I am being charitable in saying that, because I presume that that is why so many socialist, nanny-state proposals come from the Department. I cannot believe that the Ministers actually believe in all that rubbish, so it must be the civil servants who are running the Department if those things are coming forward.

With this Bill, it seems that the civil servants, who never want to accept any amendments tabled by anybody other than themselves, are doing their best to try to stop any improvements to the Bill. It is a shame that we have got ourselves into a farcical situation. The Minister is absolutely right: there is nothing to prevent Members from tabling amendments—we know that because we have tabled them, and we are grateful to you for selecting them, Mr Speaker—but we have got ourselves into a rather farcical situation in which we have done an awful lot of work, and my staff have done an awful lot of work, I might add, to try genuinely to improve the Bill, and then we come across this ridiculous bureaucratic situation, about which I have only just found out with this Bill but which no doubt applies to every Bill. It is important that everyone knows that if Members table amendments at this stage of a Bill, they are wasting their time. It is a completely pointless exercise.

[Sir Christopher Chope]

I do not think that we are wasting our time when we table amendments. Contrary to what my hon. Friend says, I still have faith in the Minister, as I think she believes she is in charge. I believe she comes to this debate with an open mind, and, if, having heard the merits of a particular amendment, she decides that she will allow it, then she will say so from the Dispatch Box.

Let me mention another issue. We often find that because of the constraints on private Members’ business, people say, “We’ll amend it in the Lords.” If the Bill is amended in the Lords, its progress is jeopardised because it then has to come back here again for us to consider the Lords amendments. So in fact the Government should be more assiduous and quick in dealing with amendments to private Members’ Bills than amendments to their own legislation.

[Philip Davies]

My hon. Friend is absolutely right, but he is being slightly naive in thinking that we will get some rapid decision making. As, I think, Mr Speaker, you were alluding to in your response to my point of order, the only time that the Government appear to be able to act with speed is when they think they are going to lose a vote. At that point, they seem to be able to react with miraculous speed. We do not seem to need any write-arounds at that point, or eight days of write-arounds; they appear to be able to cobble something together within seconds, particularly if my right hon. and learned Friend the Member for Beaconsfield (Mr Grieve) clicks his fingers. They then appear to swoop into action in no time whatsoever. It seems to me that if hon. Members actually want to improve the Bill, they should be busily telling their Whip that if we put these amendments to a vote, they will vote for them—I hope, Mr Speaker, that you will allow some of them to be put to a vote, particularly where the hon. Member for Croydon North says that he actually agrees with them. Perhaps then we might have some rapid decision making after all. We will see, but it has been yet another depressing morning in the history of Parliament for me. I have been here 13 years, but have found out only today how these things work. I started off cynical and I have become even more cynical as time has gone on.

I shall go through the farce of speaking to my amendments, even though we cannot actually make any headway on them. As the hon. Member for Croydon North alluded to, amendments 44 to 78 apply throughout the Bill and change the wording from “use of force” to “use of restraint”. I was encouraged to hear him say that he had originally believed that the term should be the “use of restraint”, but had been persuaded to change it to “use of force” by, I think, the Government.

The comments I make here largely come after consultation with my local Bradford District Care NHS Foundation Trust. The amendments that I have tabled would ensure that the terminology used in the Bill was correct and in line with that commonly used by mental health trusts. The term “use of force” is predominantly used by police forces in reference to the use of physical force while carrying out their duties. It is important to note that, although the police do play a part in the restraining of patients, it appears that the Bill’s primary focus is on the restraint methods used by staff in a mental health unit. Although we must not forget that the police are on occasion called to assist in the physical restraint of patients, it would be more appropriate to adopt the correct mental health terminology for actions used predominantly by mental health staff in a mental health setting. Not only that, but the use of the word “force” in this regard is somewhat misleading and suggests that the restraint being used on patients is being conducted with a degree of aggression, violence or excessive force, which is simply not the case.

I am told that restraining a patient, particularly in a mental health unit, often involves little to no use of actual force in the sense that most of us would understand it. The term “restraint” has been adopted as common terminology within mental health trusts and covers varying degrees of interaction with a patient. It can be applied, for example, to a person simply holding out a hand to stop someone advancing towards them, or to methods of calming such as simply talking to a patient. They are examples of the use of restraint.

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[Philip Davies]

I understand the points that my hon. Friend makes, and I will come on to some of them later on, as they probably sit better with other amendments that have been tabled. I certainly accept his point, and as always, he makes it well.

I am also concerned that using the word “force” might worry people who are thinking about seeking treatment for mental health conditions. If they see that, it might scare them into wondering what may happen to them in some mental health settings. My view is that the word “force” in this case is not appropriate, not sensible and not actually what is generally used. Of course an element of force is used at times to carry out some methods of restraint, but common sense would suggest that the terminology used in the Bill should be what the sector uses.

[Sir Christopher Chope]

When one looks at the drafting of clause 1 (6), references to the use of force are to

“the use of physical, mechanical or chemical restraint”.

Force is being limited there to restraint, except that there is also,

“the isolation of a patient.”

Is it not the case that the drafting is really confusing? It suggests that the only difference between force and restraint is the addition of the isolation of a patient in the definition of use of force.

[Philip Davies]

My hon. Friend is absolutely right. He has made the point that I was literally just about to make. The use of force is defined as being physical restraint, mechanical restraint and chemical restraint. I reiterate my earlier point that, quite clearly, the most appropriate term to use is “use of restraint”. That is what the definition of the use of force is in the Bill. It sounds more sinister than it actually is, and that is clearly more appropriate terminology. I have tabled more than 60 amendments, but that point deals with more than 30 of them—about 35—in one fell swoop. I hope that other Members will accept that “use of restraint” is the more appropriate terminology.

Let me move on now to my other amendments. Amendment 9 to clause 5, which is about training on the appropriate use of force, would remove paragraph (c), which is about

“showing respect for diversity generally”.

The hon. Member for Croydon North mentioned that earlier. Restoring the faith of the public in their services is a key element and purpose of this Bill, and why not? We should all have the confidence and reassurance of knowing that when we go to any public service, we will be treated properly. However, when it suggests that illnesses are not diagnosed in proportion to the demographics of our society, I question whether people will draw the wrong conclusion from that. We could question whether anything in our daily lives mirrors social demographics. Of course it does not; it would be absurd to think that it does. What we need to keep in mind is that any illness, and specifically mental illness, is not selective in whom it touches and the outcomes that it can cause. It does not discriminate by people’s ethnicity, sexual orientation, religious belief or gender or in any other way. Mental illness is a very complicated and personal experience, which—as is well documented—can have a harrowing and life-changing effect on those who are directly affected by it, and on the people and families around them.

It has been argued that different ethnic groups have different rates and experiences of mental health problems, with people from black, Asian and minority ethnic groups in the UK more likely to be diagnosed with mental health problems and more likely to experience a poor treatment outcome. It is documented that for every 1,000 people of the black/black British population, approximately 41 are in contact with secondary mental health services. What is not mentioned so much is that for every 1,000 people of the white British population, approximately 37 are in contact with the same level of service. In actual numbers, 1.3 million of the total 1.5 million patients in contact with this service are of a white ethnicity, so the use of the ratio format instead of the actual figures over-exaggerates a point that is already not entirely convincing. For example, for every 1,000 people of the Asian/Asian British population, approximately 26 are also receiving secondary mental health care. In actual numbers, this is approximately 69,000 patients—higher than the total of mixed ethnicity and other ethnic groups combined, and 16,000 patients more than the black/black British category.

I do not want to make it sound like a competition for numbers; it clearly is not. These numbers represent people. But the Bill currently makes it appear as though this is an issue that only affects one ethnicity, when that is quite clearly far from the case. The suggestion that there should be a conscious overview of regulating the diagnosis and treatment of a patient not according to their symptoms, but according to their ethnic background, may result in turning it into a competition. By putting in place such measures, the good intentions of stopping ethnic discrimination—the existence of which is already questionable—would instead create discrimination against those who are not of a BAME background or, more specifically, not of black/black British ethnicity. This would therefore generate another problem altogether. In the simplest of terms, asking to provide further intensive training on unconscious bias and diversity, on top of what has already been established at the core of the service that is currently being provided, not only creates an unnecessary segregation among patients but is patronising towards staff to an unwarranted level.

I draw a parallel with the stop-and-search issues in London. It seems to me that a very well-meaning intention to stop a disproportionate number of black people being stopped and searched has led—directly or indirectly—to an increase in the amount of knife crime in London and in the number of people who are dying as a result of knife crime in London. I might add that it is largely young black men who have been the victims of that well-meaning policy.

I fear that mental health staff, rather than being asked to treat people exactly the same irrespective of their backgrounds, may well—directly, indirectly or because they feel some pressure—start to treat people differently as a result. That will have serious consequences. I fear that it is some people from black and minority ethnic backgrounds will who suffer most and not get the treatment they should as a result.

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[Philip Davies]

The hon. Gentleman’s motives are entirely honourable and decent, and I support them 100%. My fear is about what will happen in practice, because of the evidence of what happened with stop and search in London, to be perfectly honest. Exactly the same thing happened in that case, so it is not as if we have no evidence on which to base this fear. If the hon. Gentleman speaks to police officers, they will tell him that they were petrified of stopping people from a particular ethnic background because they feared they would be castigated for being racist. That is absolutely what happened. All I am saying is that my fear is that that may well happen as a result of this legislation, although I accept that it is not the hon. Gentleman’s intention.

[Sir Christopher Chope]

My hon. Friend is making an excellent point. Is it not also the case that substance and drug abuse has developed enormously, particularly in urban areas, as a result of this misguided policy on stop and search? It is then drug and substance abuse that so often leads to mental health issues.

[Philip Davies]

My hon. Friend is absolutely right to draw that comparison. It goes to show that well-meaning initiatives can often have the exact opposite result to what was intended.

In addition, diversity training programmes do not show any particular progress in the area that they are trying to improve. In fact, they have often proved to have the opposite effect. In a 2016 edition of the Harvard Business Review, an article entitled “Why Diversity Programs Fail” states:

“It shouldn’t be surprising that most diversity programs aren’t increasing diversity. Despite a few new bells and whistles, courtesy of big data, companies are basically doubling down on the same approaches they’ve used since the 1960s—which often make things worse, not better.”

The article says that companies have been heavily reliant on diversity training to reduce workplace bias, and bias during the recruitment process and employee promotions. It also says that studies have shown that this consistent and forceful approach to tackling diversity can

“activate bias rather than stamp it out.”

The article points out that social studies have found that people too often rebel against rules in a bid to assert their autonomy, and argues that companies—in our case, public services—will see far better results when they drop control tactics to make people conform. Even eminent people at Harvard are not particularly convinced that such a measure would have the result that the hon. Member for Croydon North intends.

On top of that, there are so many variations of diversity these days that there is a vast array of specifics to cover. For example, to my knowledge there are at least 71 variations of gender. I have a list here, but I will not test the patience of the House by reading them all out. Hon. Members who thought that there were only two genders are, I am afraid, well behind the times; there were 71 at the last count. I am sure that my hon. Friend the Member for Walsall North (Eddie Hughes) knows about this, as an esteemed member of the Women and Equalities Committee. I am sure that he can reel them all off from the top of his head, but most people could not.

Then we get on to the variations of religion that could be discussed. There are estimated to be approximately 4,200 different religions around the world, going far beyond those commonly observed in the UK. They include beliefs such as mysticism, paganism—which has, I think, 47 variants within it—Raëlism, Judaism, the ghost dance movement, chaos magic, and the happy science movement. The one that I personally liked most of all—I had not heard of it before but I am thinking about becoming a convert to it—is the Prince Philip movement. Being a great fan of Prince Philip, that sounds to me like a marvellous organisation.

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[Philip Davies]

I cannot accept that at all, Madam Deputy Speaker—it is a delight to see you in the Chair. My amendment is clearly pertinent to the Bill given that I am trying to remove something that is in it. If it was not pertinent, no doubt Mr Speaker would not have selected it. I am afraid that I cannot accept my hon. Friend’s challenge to the authority of the Chair. I am sure, Madam Deputy Speaker, that were I to be out of order, you would be the first to leap to your feet and put me right.

Will all these different religions, genders and all the rest of it be covered in the diversity training that I am trying to remove from the Bill? We cannot ignore the fact that they exist and therefore have as much right, presumably, to be detailed in diversity training as anything else. Let us not forget diversity of ideological beliefs. Will that be covered too? This is a throwaway phrase—one of those things that everybody puts into everything. It is meaningless. There are lots of meaningless things in political discourse: social justice—nobody knows what it is but everyone is in favour of it; sustainable development—we are all in favour of it, but nobody has ever been able to tell me what it actually means; diversity training—let us shove it in as a little part of our Bill, but nobody really knows what it is trying to achieve. I am not entirely sure that there is any point to it, and if there is any point, it will be counterproductive. I cannot accept this aspect of the Bill, and that is why my amendment 9 tries to remove it.

Amendment 10 to clause 5 is about training on appropriate use of force. It would remove paragraph (k) on training on

“ethical issues associated with the use of force.”

I am trying to make sure that legal issues are the focus of the training, not ethical issues. How does one go about taking account of ethical issues in the use of force or restraint? As I said earlier, staff have a very difficult job as it is. When they are focusing on whether they should be using restraint with a particular patient, are we seriously saying that they have to start considering, at that moment, the ethical issues associated with it? Surely this House is about making sure that people act within the framework of the law, not about what I, the hon. Member for Croydon North or somebody else thinks are the relevant ethical issues. How do we decide what the ethical issues are that people should be considering? The ethical issue that I might think is particularly pertinent may be different from the one my hon. Friend the Member for Christchurch (Sir Christopher Chope) or the hon. Member for Croydon North thinks pertinent. What sort of a situation are we putting staff in when they have to be thinking about the ethical issues, as intended in this Bill? I would not be able to explain that to them. We should be removing these bits of flim-flam from the Bill and making sure that we are instead asking people to follow a legal framework.

[Sir Christopher Chope]

As always, my hon. Friend is making an excellent point. In his extensive research, has he been able to ascertain the source of the support for the flim-flam that he is describing with regard to the use of the word “ethical”? The Minister said earlier that the Bill has the support of all stakeholders—I do not think she used that word, but she might have chosen to do so. Where is the evidence that the stakeholders are behind the use of ethical issues being part of the training?

[Philip Davies]

I am afraid I cannot answer my hon. Friend’s question. I do not know. The Minister was absolutely right to highlight the fact that although stakeholders do welcome this Bill, it would be wrong to say that they welcome every provision within it. That is certainly the feedback that I have had from my local care trust. While it certainly agrees with the thrust of the Bill and many of its provisions, there are still some it is not comfortable with. I cannot tell my hon. Friend about the genesis of this or any widespread level of support for it, because I am not aware of it. Perhaps the hon. Member for Croydon North or the Minister can help out. All I can say is that that definition of “ethical” is

“relating to moral principles or the branch of knowledge dealing with these”.

I am not sure whether my hon. Friend is any more enlightened by that definition that members of staff may have to take into account. I have no idea what it all means, to be perfectly honest, and yet we are expecting members of staff who are dealing with patients in difficult situations to be weighing up all these things.

I think it can be established that everyone has their own individual take on morals, but surely we cannot start applying ethical and moral views in serious situations such as these. This will end up being the beginning of a long list of other factors that it will be demanded people be mindful of. My view is that healthcare should be provided in a legal and law-abiding way, and not with the addition of anybody’s personal, individual ethical take on what is moral and not moral.

[Philip Davies]

My hon. Friend may well be right; I do not know. I have not been able to find any evidence for that, but it may exist somewhere. Perhaps the promoter of the Bill or the Minister will be able to enlighten us. If my hon. Friend has any evidence, I would be very happy to change my mind, but as it is, I cannot see any purpose to the provision.

The general thrust of my argument is that while this Bill should indeed be making staff and institutions accountable, it should also be helping them in their daily job, but it is making their life far more difficult than need be. I do not see that it is helping to protect the rights of patients, which is at the heart of what it is supposed to do.

[Sir Christopher Chope]

My hon. Friend has referred to the definition of “ethics” and “ethical”. Paragraph (k), to which he is addressing his remarks, talks about the “principal” ethical issues—not all ethical issues but the “principal” ones. Does he have any insight into which ethical issues are “principal” and which are not?

[Philip Davies]

My hon. Friend makes a good point. I do not know the answer to that—who knows? It is a mystery to me, and therefore it will almost certainly be a mystery to any institutions trying to implement these measures. We have to bear in mind that this is not just meaningless. This will be the law of the land. Institutions and members of staff could well be taken to court over whether they have sufficiently taken into account these “principal” ethical issues. Surely it would be intolerable to put people in that legal uncertainty. I am not entirely sure that we, the people who are passing this piece of legislation, have any idea what it means ourselves, so how on earth are the people who are supposed to implement this meant to?

Surely laws have to be fit for purpose. I know that my hon. Friend the Member for Christchurch is an eminent lawyer by background, and no doubt his profession will be dancing in the aisles at the prospect of all this uncertainty, because they are the only people who will benefit. The patients will not benefit, the staff certainly will not benefit, and the institutions will not benefit, because they will probably find themselves facing expensive legal suits. Unless this is simply a benefit for the legal profession, I cannot see any point to it whatsoever.

I am confident of scoring a few more runs on amendment 11, because the hon. Member for Croydon North indicated that he supported it. As I indicated to Mr Speaker at the start, I may wish to press the amendment to a Division and test the will of the House on this matter. The amendment would insert new paragraph (l) in clause 5(2), which relates to training in the appropriate use of force, to include training for mental health staff about who is responsible, and the roles and procedure when the police are called to assist.

Some people may say—I would not necessarily dismiss this out of hand—that clause 5 is already too prescriptive. There is an argument for saying that we should take out this detailed list of things that people should be trained in and effectively leave it to institutions and local experts to sort out training for themselves, rather than putting every little element of what that training should consist of in statute. There is certainly an argument for saying that we should get rid of all these areas of training that are prescribed. Of course, the problem with prescribing everything is that what will happen is that everything prescribed will be covered, but nothing else will be. Something may well have been missed out from the list, but if it is not on the list, institutions will not bother with it. That is my problem. Given that we are prescribing so much, it is essential that we get those things right, otherwise important things will be missed in the training. It seems to me that we go one of two ways: either we do not prescribe any of it; or we prescribe everything, because otherwise things will be missed out.

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I hope that the Government make sure that the amendments are included, and I am grateful that the hon. Gentleman accepts that they should be. Our job in this House is to make sure that the Government put them in the Bill, given that, I suspect, if they had had the time to consider it, they would have agreed to do so. Let us force them to do it. I hope that the Minister, having listened to those cases, will decide that never mind the write-rounds, these things need to go in the Bill today.

[Sir Christopher Chope]

I certainly agree with my hon. Friend about the necessity of putting the two amendments in the Bill, and I think that everybody who has been listening to his speech will be of the same opinion. I wonder whether he would be able to tempt the Minister to intervene now and say that, having heard my hon. Friend’s compelling case, the Government will indeed accept amendments 11 and 12.

[Philip Davies]

I am grateful to my hon. Friend. If the Minister wishes to intervene, I will not stop her.

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[Philip Davies]

There you go, Madam Deputy Speaker. What can you say? The civil service script has been brandished. There is always a reason in the civil service why anything should not be done, but all I can say to the Minister is that, to be perfectly honest, the idea that it is not necessary could apply to every single individual thing that is already listed. If we wanted to go down that line, we could say that all these things are being done anyway individually by this person or that person. Either there has to be a comprehensive list of things that the Government feel are essential, which must be covered in the training, or they do not. How on earth, knowing what happened to Mr Lewis and in the other cases that I have mentioned, can anybody stand up and say, “Having listened to that, we do not think these things are absolutely necessary.”? It is literally beyond belief. We literally could not make it up. It is a shameful situation that we have got ourselves into, to be perfectly honest. I will let people decide which side they are on. I hope that we can test the will of the House on those amendments, so we can see what people make of them and whether they want to be in the civil service box of deciding that nothing needs to be done, having listened to those cases. We will let the House make its mind up, and that is that.

[Sir Christopher Chope]

Looking at the amendments on what should be in the training, has my hon. Friend had a chance to look at my amendment 98? It would introduce into clause 5(2)(a) the involvement of “patients” and “their families” in the planning, development and delivery of care and treatment. It seems that with the cases that he has cited, family involvement can be crucial, and this should also be part of the training.

[Philip Davies]

The answer to my hon. Friend’s question is yes—I have looked at his amendment and agree with it. If he would allow me, I had planned to go through my amendments first, before moving on to other people’s. I have his amendment in my sights and I will come to it later. I have read it and very much agree with him.

My next amendment—amendment 14—moves us on to clause 7(2), which states that reporting the use of force

“does not apply…where the use of force is negligible”.

My proposal would amend it to include restraint that does not include physical contact. The amendment would ensure that there is a not a series of pointless recording of every interaction with a patient that falls under the category of restraint. I am still using the word “restraint”, but I am appreciate that I am in danger, at the end of these amendments, of losing the battle, and that it will be called “force”. However, for the purposes of putting forward my amendments, I will still call it “restraint”, as I am seeking to do. Restraint is defined in the dictionary as the

“deprivation or restriction of liberty or freedom of action or movement”.

It must be reiterated, however, that it can be conducted in the most subtle of ways. The law entitles people to freedom of movement provided that they are not harming others or themselves while exercising that right. The policies of NHS services vary between trusts. Overall, the guidance for all medical staff follows the same basic principles, but specific details are more varied.

It would be fair to say that health trusts across the board consider physical restraint to be a last resort that should be used only following the exhaustion of all other methods. Staff are advised to call for the assistance of security when physical restraint is considered, as they will have been trained in restraint techniques. Bradford District Care Trust advises that the assistance of police be called upon only as a final resort when usual restraint methods have failed and there is a serious concern for the safety of the patient, staff or other patients on the ward. I have been told that as a general rule a patient would have to be exhibiting sustained high levels of physical aggression, often involving some kind of weapon, before the police were called.

Some services, such as the London Ambulance Service, apply a different approach and advise that police be called at the earliest sign of physical restraint being required. That is due to the service not providing its staff with training in physical restraint and therefore leaving them vulnerable without the back-up of police services. In all cases of restraint, staff are required to apply the principle of using the least restrictive and most proportionate option to control behaviour, for the least time possible. Again, the word “proportionate” is reiterated through the guidelines on restraint, which reminds us that it is consistently a consideration when restraint is conducted.

The types of restraint fall into three categories: low-level restraint—interventions that prevent a person from behaving in a way that threatens to cause harm to themselves, others or trust property and/or equipment; physical restraint—any manually applied method, be it physical, mechanical, material or equipment, that immobilises or reduces the ability of a person to move their arms, legs, body or head freely; and chemical restraint—a drug or medication used to manage a patient’s extremely violent or aggressive behaviour that can be administered, if necessary, against the patient’s wishes. Such drugs might, of course, also be used when the threat of harm is less immediate, with the patient’s consent, or if it is in the assessed best interests of a patient who lacks capacity.

Low-level or psychological restraint methods are the initial exercises conducted to try to prevent a situation from escalating quickly. Most often, this will be a variation of calming methods, which are less restrictive than methods in other categories, and which can ultimately allow the patient to have a timeout in isolation to calm down. Essentially, that can be as simple as telling someone not to do something or depriving them of equipment or possessions that may enable them to do what they otherwise would do—for example, removing glasses, hearing aids and mobility aids. It is less invasive and more frequently used with those who suffer with dementia.

Those less invasive approaches to patients allow them to retain a certain element of control over the outcome, but it is precisely those approaches that I fear will fall through the loophole of being constantly recorded, which will take the time of carers and care trusts away from the patients who actually need help. The key restraint methods the Bill is concerned with are those that require an element of physical contact, which should be reported appropriately. It is important that we remove the need to report minor interventions, which are not really at the heart of the Bill.

In the interests of time, I will group the next few amendments together. Amendment 15 to clause 7, on recording the use of force, would remove paragraph (k). Amendment 17 to the same clause would remove subsections (9) and (10), which require the recording of relevant characteristics of the patient—race, sexuality and so on. Amendments 21 to 30 are to clause 7 and amendment 31 is to clause 8, on statistics prepared by mental health institutions. Amendment 21 would insert new paragraph (q), which would add

“the relevant characteristics of the staff involved (if known)”

to the list of relevant characteristics in subsection (9). The other amendments would change the list to include the relevant characteristics of both patients and staff, make the list plural to cover both patients and staff and include the relevant characteristics of the staff involved.

Amendments 32 to 35 to clause 7 would remove paragraphs (c), (e), (f) and (h), which deal with a patient’s marriage status, race, religion and sexual orientation. Those amendments would remove such unnecessary labelling of patients. I am not one for putting people into categories, and I am not a fan of labels. All these things are irrelevant to the treatment of people with mental health problems, and we should not be getting bogged down listing everybody’s gender, race, sexual orientation, marital status and so on. It is all irrelevant to the treatment of people with mental health problems, and we should not be bogging down the staff with all this political correctness.

[Sir Christopher Chope]

Is it not extraordinary that the list to which my hon. Friend refers makes no reference to whether the patient has any family or relatives?

[Philip Davies]

Again my hon. Friend is absolutely right. One could argue that that is important and should be logged. I am sure we would all want to involve the family in discussions about the treatment of family members. That might well have helped in the case of Mr Lewis. Yes, it is extraordinary that the bit that could actually be relevant to the treatment of the patient is not included and all this other stuff, which is completely irrelevant to their treatment, is included. It seems like unnecessary political correctness.

In recording the use of force, the inclusion of race to help tackle racism, of sexuality to tackle homophobia, and of gender to avoid sexism, will do nothing to aid the patients. Surely, if we believe in equality, all those things are irrelevant. We should not be pointing out people’s differences. Those things cannot be changed and are not relevant, and we should not be passing legislation that tries to make them an important part of treating people with mental health conditions.

If we will insist on going down this route, however, I am confused about why the Bill requires only the recording of the patient’s characteristics, and not those of the person giving out the treatment. If there is institutional racism, or whatever it is that people try to hang a hat on, surely the characteristics of the person using the force must be relevant. Surely a complete picture can never be grasped only by recording the characteristics of the patient. If we are trying, as I think the hon. Member for Croydon North is, to uncover unconscious bias, institutional racism, or whatever he wants to call it—people have their different terminology to hang their hat on—surely it cannot be done without amendment 21. He indicated in his opening remarks that he had sympathy with it, and I am grateful to him for that. I hope he agrees that it is not just useful but essential if we are going down this route.

The Bill also asks that the police wear body-worn cameras so as to literally give a full picture of their involvement in these cases. Why are we only reporting one side of the story when the police are not there? If the relevant characteristics of the staff are included in the report, the recorded statistics might give a better representation of the matter. I feel that the provision I suggest in the amendment was not originally added because it might highlight a very different narrative from that which some would like to present. One particular concern I have is that these reports will be used to try and back up the questionable argument of institutional racism in the health service, despite studies showing a lack of early diagnosis of mental health illness and psychosis because of a lack of trust in mental health services among people from BAME communities.

It is consistently documented that BAME patients, particularly those with African and African-Caribbean backgrounds, are more likely to be diagnosed with a form of psychosis, and to enter the mental healthcare system via a more confrontational approach than would be the case through a routine appointment with a GP. That is the basis for the institutional racism argument. However, it should be considered that the suggestion of institutional racism in the mental healthcare system is what is preventing people from seeking early medical help in the first place. It is not helping the situation; it is making the situation worse. People are being told, “Don’t enter these services, because there is institutional racism”, and that is not helping anyone.

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It is worth bearing in mind that a key argument in favour of the Bill is that there is currently no consideration of whether a patient has experienced a history of abuse or violence, and whether there are therefore some forms of restraint to which he or she should not be exposed. The one thing that is missing in the middle of all the reporting, statistic taking and analysis is the patient’s care plan. The purpose of restraint techniques is to prevent patients from causing harm to themselves and others around them when they are experiencing what could arguably be a very dark and turbulent period of their lives. Those methods are being branded tactics to control and humiliate patients, when in fact they are part of a broader care plan to protect the patient. That often seems to be forgotten. To put it in simple terms, they can form part of the patient’s overall treatment. I find it astounding that unless the Government change their mind, these instances will not be documented in individual medical notes as they should be.

[Sir Christopher Chope]

I think we have all encountered constituency cases in which people suffering from mental illnesses are shifted from one location to another—from one clinical commissioning group area to another, or from one part of the country to another. In one of my constituency cases, someone is being told that they must go up to Manchester to be treated for a mental condition. If people are being dealt with in different locations, it is all the more important for there to be one set of medical notes that records everything that has happened.

[Philip Davies]

That is a very good point. I had not mentioned that people might be moved from one institution to another, but that, of course, makes the amendment even more important. I am not in favour of excessive bureaucracy, but that strikes me as being an essential part of what the Bill is intended to achieve. The purpose of my amendment 16 is to deliver the Bill’s original aim. In fact, that is the theme of all my amendments. They are certainly not intended to weaken the Bill; if anything, they are intended to encourage the hon. Member for Croydon North to go further. The amendment is not just something nice to tag on to the Bill. I think that it goes to the heart of what the Bill should be about. Restraint techniques should be documented in medical notes to provide other medical practitioners who are treating the same patient with an overview of how that individual patient responds to the use of that form of restraint. I cannot see why that should not be part of the Bill.

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[Philip Davies]

As I said at the start, I genuinely appreciate the constructive way in which the hon. Gentleman has approached the Bill, and he has just given another indication of that. The question is—this is the dilemma that we always seem to have on a Friday—whether we should rush through legislation that we know is not as it should be, and try to patch up little defects with a bit of sticking plaster here and a bit of sticking plaster there, or whether we should make an effort to ensure that the Bill is in a fit state in the first place.

The hon. Gentleman is arguing—it is a perfectly respectable position to hold—that it is all right to gloss over the fact that lots of really important things are missing and to provide a big sticking plaster called guidance, telling people, “Here is some guidance. We forgot to put this in the Bill, by the way. It should have gone in, but we did not sort it out in time. Parliament couldn’t be bothered to do its job properly, so here is a list of all the things that you should and should not be doing.” That is a perfectly reasonable case to make, but I take the view that when we pass legislation in the House, we should be a bit more mindful of the people who will have to implement it, and make sure that it is fit for purpose the first time round.

It seems to me that it is possible for everyone to be satisfied. The last thing that we want is for the Bill not to go on to the statute book. It is broadly a good piece of legislation—although, as I have explained, I have reservations about it—but I think that we have an opportunity to make it better. We have three options. The first, which is the ideal option, is for the House to put the Bill into proper shape and accept some of my amendments, which I think are clearly necessary. The hon. Gentleman himself accepts that some of them should have been in the Bill originally. Secondly, we can opt for the sticking plaster route: we can cock it all up ourselves, then put a sticking plaster called “guidance” over it and hope that someone will be responsible for sorting it all out. Thirdly, we can give the Bill another slot at a future date so that the Government have time to consider and do their write-rounds, and the hon. Gentleman can do a bit more consultation. Hopefully we can deal with the Bill later in the year, along with some of these amendments—either agreed or not agreed—on the basis of the write-rounds and the consultation. That seems to me to be the most sensible way of going about it.

I think that what is important is for a sensible piece of legislation to go on to the statute book. There are plenty of days left in the current Session on which we could deal with the Bill. Putting everything that should be in the Bill in guidance at the end does not really do it for me. It might do it for the hon. Gentleman, it might do it for the Minister, and it might get us over a little hurdle, but I do not really think that it is the best way to pass legislation in the House.

[Sir Christopher Chope]

My hon. Friend sets out the three options very clearly, and if we went for the last of them that would give the Government an opportunity to produce the draft guidance so we can see what will be in it. What has concerned me so far is that the Minister has said that quite a lot of the things my hon. Friend and I think should be in the Bill are not necessary, and the Minister is not even saying they should be in the guidance. If we get the draft guidance, we will be able to see where we stand.

[Philip Davies]

My hon. Friend is right. The Minister is doing her best; she does not decide the Government’s bureaucratic nonsense of decision-making strategies and all the rest of it. This is not her fault; she is left in a difficult situation, and I am the first to appreciate that. But as my hon. Friend says, at present we are not even getting a guarantee that these things will be in the guidance; we are being told they might be dealt with in the guidance, and even that there is an expectation that they might be. But I have been here long enough; I have been shafted before on private Members’ Bills where I have been promised that an amendment will be tabled in the Lords to deal with something and then it never arrives. So a bird in the hand is certainly worth more than two in the bush, particularly when it comes to Government promises on amendments and guidance in my experience. That is not a party political point; both sides have been guilty of that in the past. I am therefore looking for a bit more than a waft here and a waft there suggesting this might be covered in guidance; I am looking for something a bit more concrete than that. Indeed, I do not think it does the Bill justice if it goes through Parliament when it is not in a fit in a state; we all want to see it in a fit state.

My amendments 18 to 20 to clause 12 relate to police body cameras. I propose to change subsections (1) and (2) to say that police “should…try to”, rather than “must”, take a video recording. I also want to remove subsections (4) and (5) which make police “liable to criminal…proceedings” if they fail to take a video.

As the College of Policing has stated, it is an indisputable fact in today’s society that law enforcement officers carrying out their duties, and the tactics they use, are under greater scrutiny than ever before. That is a good thing, and I am a massive fan of police body-worn cameras; they are fantastic for the interests of justice, and they safeguard the interests of police officers, who often face vexatious complaints. The footage can be produced to show that what they did was absolutely right, which is almost always the case. That is fantastic for the courts, too, because they can see at first hand what actually happened, rather than have to deal with conflicting accounts and have to choose to believe one witness over another and so forth. I am therefore a big fan of body-worn video cameras, and they are often the modern method of detailing interactions with the public by the police. Their aim is to improve the accountability and transparency of police conduct when police officers encounter the public. This is a move that the Home Office highlighted at the time of their launch as being the technology of the future, and as a means to help save police time and improve working practices.

General procedure for using the devices is that they are to be used only for recording encounters with the public and are not to be constantly recording for the duration of a shift. The policy of West Yorkshire Police, which covers my area, on body-worn camera video advises that it is to be used where a degree of investigation or exercising police powers is required unless there is a good reason not to. The rationale for not using body-worn video cameras may need to be explained at a later stage, and justified to a supervisor and/or during court proceedings. The recording must be proportionate, and the effect it may have on individuals and their privacy must be taken into account. It is advised that the cameras be switched on the moment the incident becomes apparent, and in some cases this may be en route for the incident. However, it is stated that officers must announce that they are using the recording equipment in clear wording: for example by saying, “I am wearing and using body-worn video. I just need to tell you that; you are being videoed and audio recorded.” The recordings taken are stored on the camera until they are returned to their docking station at the police station. From there, clips are downloaded and sent to the central system for viewing. These clips cannot be altered, changed or deleted by the officer in any way, which keeps them completely authentic for evidence purposes.

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[Philip Davies]

I am grateful to the Minister for that, and I am sure that police officers will be grateful, too. However, I just feel that there are occasions when it may be practicable to wear a camera, but for whatever reason—the pressure, time or the heat of the situation—they forget, and I wonder what will happen in such cases. There could be a situation in which it is practicable for them to wear a camera but, owing to the noises they make and the flashing lights or whatever, they think, “You know what? In this circumstance, I’m unsure I’m going to do that, because it might make this patient worse.” I worry that there are insufficient loopholes, so to speak, for police officers who are trying to do the right thing in difficult situations and that we are in effect trying to make things more difficult for them. I fear that, as a result of this Bill, criminal proceedings will be brought against a police officer that never should have been brought. It is all right to say, “We don’t think that that will happen,” but these things do happen. I want the law to be worded to make that as unlikely as possible. That is my only concern, and we will see whether my fears are realised.

[Sir Christopher Chope]

Is there any evidence to suggest that the police will not want to protect themselves by taking body-worn cameras to such incidents? Why do we need this measure in the Bill at all?

[Philip Davies]

My hon. Friend makes a good point. The evidence is that police officers are the biggest supporters of body-worn cameras. They are crying out for them and want to use them more often, and they want the cameras to have a longer battery life. I agree that it is entirely unnecessary, so do we need to go down the road of criminalising police officers because they forgot to wear a camera? It might have been entirely practicable, but they may have simply forgotten. Should that really be a criminal offence? I am dubious. We ought to be giving our police officers more support, not trying to make their lives harder.

I have been discussing my amendments, but other right hon. and hon. Members have tabled several amendments, and I want to start on those by discussing new clauses 1 and 2, tabled by the hon. Member for Croydon North. I understand what he is seeking to do, and it was perfectly reasonable for him to say that if there is death at the hands of the police, the Independent Police Complaints Commission—although I think it has a new title these days—will get involved and all the rest of it, so why should other deaths not be subject to a similar procedure? That is a perfectly respectable point, and I have every sympathy with that view.

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[Philip Davies]

We have been around that issue, so I do not intend to revisit it again. The fundamental amendments 11 and 12, which I have addressed at some length, go to the heart of what happened to Mr Lewis on that terrible occasion. They would ensure that training was given to staff to ensure that those things could not happen again. It is therefore essential that those amendments are made to the Bill and that these things are not just dealt with as part of guidance, which may or may not then be covered off by individual trusts. We have a duty to make sure that the things that happened to Mr Lewis are absolutely covered in the training given to staff.

[Sir Christopher Chope]

My hon. Friend is absolutely right not to fall foul of the scaremongering, because we are fortunate to be in a much longer Session than usual, and the Government are still to announce the extra Fridays that will be available to discuss private Members’ Bills. If a Bill such as this is supported by everybody in the Chamber—by the Government and the Opposition—but there is need for further improvement, why not improve the Bill, rather than putting it on the statute book in an imperfect state, given that we know jolly well how difficult it would be to amend it later through a further private Member’s Bill? Let us make this a good Bill.

[Philip Davies]

The Bill will definitely conclude its Report stage at some point, but if it does not pass today, it will not be my fault. For goodness’ sake, we still have two and a half hours to go. The Government still have plenty of opportunity to say that they will accept amendments 11 and 12, and if they do so, the Bill will go through today. If they need more time to do a write-around before those amendments can be agreed, that is literally in not my hands, but the Government’s. If they want the Bill to get through today—

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[Philip Davies]

But we do not know what will be in this guidance. I am making the case that it is absolutely essential that amendments 11 and 12 are made to the Bill. The hon. Member for Croydon North said quite clearly that he agreed with them and that he also thought they should be made to the Bill. I appreciate that he is trying to find a compromise but, strictly speaking, he would be happy for the provisions to be in the Bill. I think they should be in the Bill; he thinks they should be in the Bill. The Minister has not even made a commitment that these specific amendments would be reflected in the guidance. I am literally being offered nothing, apart from her saying, “Oh, we know this Bill is not good enough. We will try to sort out a bit of guidance here and there. It’s not perfect, but just let it through because it has a worthy sentiment behind it.” We must start treating legislation with a bit more respect in this place. The Minister says that the Bill has gone through parliamentary scrutiny, but this is parliamentary scrutiny. This is the Bill’s Report stage for goodness’ sake.

[Sir Christopher Chope]

The Government’s line seems to be that this legislation is an urgent measure. If it is so urgent, may I ask the Minister—through you, Madam Deputy Speaker—what state the guidance has reached?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The hon. Gentleman is making an intervention on the hon. Member for Shipley (Philip Davies), not the Minister.

[Sir Christopher Chope]

I invite my hon. Friend the Member for Shipley (Philip Davies) to ask the Minister whether she agrees that, because of the urgency of this legislation, the guidance is ready in draft form in her office and can be laid before the House tomorrow or in the next couple of weeks. I suspect that the Government have not even begun to draft the guidance, but we need the guidance before this legislation would ever be able to take effect.

[Philip Davies]

Absolutely. It appears, to me at any rate—I do not know about anyone else—that the Government are just making things up as they go along, desperately trying to get this Bill through in any form whatever. Whether it is good, perfect or indifferent is neither here nor there. They just want to get it through, presumably so that they can say at next questions, “We got the Mental Health Units (Use of Force) Bill through Parliament.” Well, perhaps they just want to pass any old legislation, include a few decent clauses and hope that it will do the job, but I am afraid that is not what this House should be about. It is about saying that we have identified areas where the Bill should be strengthened, and we therefore have a duty to find a way to do that. If the Government will not agree to do it today, I am afraid that we will have to try to ensure that they do it in the future.

I am determined that the Bill will go through in a proper form that will help to stop what happened to Mr Lewis ever happening again. We have to get back to the central reason for the hon. Member for Croydon North introducing this Bill in the first place. The points on which I am focusing are not just useful add-ons here and there; they are at the very heart of the purpose behind the hon. Gentleman’s Bill. I do not really see why he should be so complacent about letting it through without these things being included.

Anyway, hon. Members have tabled amendments that deserve to be scrutinised. The right hon. Member for North Norfolk has tabled quite a few. With amendment 40, he wants to include the threat of force as part of the use of force, so that the threat of restraint would be considered the same as the use of force. I am afraid that I cannot agree with that. We do not want to deter people from warning of the threat of force, when warning of the threat of force may actually stop them having to use it in the first place. I do not really see how the threat of force can be treated in exactly the same way as the use of force. Often, threat of force seems to be a legitimate restraint technique. If staff are not threatening to use force before they actually use it, the use of force might become more likely. I do not agree with that amendment.

[Sir Christopher Chope]

And, of course, every threat of the use of force would have to be recorded, would it not? The threat of force was actually included in the original drafting of the Bill and was taken out in Committee, so I do not understand why the right hon. Member for North Norfolk (Norman Lamb) wants to include it again.

[Philip Davies]

I agree. The same applies to amendment 41 —also in the name of the right hon. Member for North Norfolk—which would include the “threat of isolation” alongside isolation itself, and to his amendment 42, with which he wants to include the “coercion of a patient”. I am not entirely sure why such an amendment is needed, to be perfectly honest. He includes a definition of coercion in amendment 43, as

“the use or threat of force, with the intention of causing fear, alarm or distress to control a patient’s behaviour or elicit compliance with the application of a use of force.”

I am not really sure what that adds to the Bill, to be perfectly honest. I do not think that anything it does add to the Bill is something that I could support anyway. I think that he is taking these definitions a bit too far given the Bill’s purpose.

The right hon. Gentleman’s amendment 37 would insert into clause 3:

“A policy published under this section must set out that the use of force will only be used without the sole intention of inflicting pain, suffering or humiliation, or subjecting patients to tortuous, inhumane or degrading treatment, or without inflicting punishment or intimidation.”

With regard to using force with

“the sole intention of inflicting pain, suffering or humiliation”,

I look to people who are more legally qualified than me, but surely that must already be illegal. I cannot believe that that can already be lawful in this country. Therefore, this amendment is not necessary either.

Amendment 36 refers to a

“description of each of the methods of restraint that may be used…what steps will taken to reduce and minimise the use of force”

and

“a description of the techniques to be used”.

Paragraph (d) is the worst bit. It refers to

“a commitment to reducing the overall use of force in the mental health unit.”

Would that potentially mean that restraint and force is not being used when it should be used because somebody had a commitment to reduce its overall use? Surely, we should be seeking to make sure that restraint and force are used appropriately—at the right times, in the right situations, with the right patients. As long as that is being done, the number of cases is neither here nor there. It is the appropriateness that matters, not the numbers. This amendment would mean that restraint would not be used when it should be used. The lack of trust in staff in this is something that I cannot possibly support.

Amendment 38 says that

“subsection (1) must include a patient’s right to advocacy and how to access an advocate.”

Again, this may deter staff from using restraint even when it is necessary, thinking that they are going to get into a compensation culture with vexatious legal claims being made against them. We should not be passing laws that encourage that.

Amendment 79 says:

“The Secretary of State must publish quality standards for training”

and

“The Secretary of State may delegate the publication of quality standards for training”.

There is already a requirement to have standards for training; the right hon. Gentleman seems just to want to add the word “quality”. I am not sure that there is any indication that the standards for training would not be of quality anyway. It goes without saying that we want quality standards of training; we do not need to put that into the Bill.

Amendment 80 refers to “trauma-informed care”. I do not have a particular problem with that. Again, it is an issue of how prescriptive we should be in relation to the training. I have already spoken at length about that. The right hon. Gentleman makes some fair points.

The right hon. Gentleman’s other amendments include amendments 83, 84 and 85. Amendment 83 says:

“The Secretary of State must make a statement to Parliament, as soon as practicable following the publication of report under subsection (2).”

It is difficult to disagree with that, to be honest. I do not see why that should not happen. I would be perfectly happy about it.

My hon. Friend the Member for Christchurch has also tabled some amendments. His amendment 88 would

“leave out ‘mechanical or chemical’ and insert ‘or mechanical’.”

I think that he wants to get rid of the chemical type of restraint from the Bill. A chemical restraint can be described as a medical restraint to restrict the freedom of movement of a patient. Such chemical restraints can sometimes also be used to sedate a patient if necessary. I think that his amendment is understandable. My only concern is whether it might lead to perverse outcomes whereby chemical means of force are used more often than they should be to get round the Bill. I am a bit nervous that that may happen. I would therefore deter him from pressing ahead with it, although I certainly understand where he is coming from.

Amendment 90 to clause 1 seems to be a consequential amendment, so we do not need to deal with that. Amendment 89 would leave out paragraph (b) from clause 1(6), to remove the isolation of a patient from the list of things referred to by “use of force”. I am much more sympathetic to this amendment, because my hon. Friend makes a good point. I am sure he will express his own opinion when the time comes on why he feels so strongly about that, but my view on first reading is that it is perfectly sensible. Amendment 91 is consequential to that.

Amendment 98 is one to which my hon. Friend referred in an earlier intervention. It would insert the words “and their families” after “patients”, to allow patients and their families to plan, develop and deliver their care and treatment in a mental health unit. This is an excellent amendment. It is essential that families are involved in the treatment of their family members. In many cases, if the family could have been more involved from the start and been able to help and warn what the situation was, such problems and terrible situations would not have happened. It is a very sensible amendment, and I hope that he will pursue it with vigour, because it is really important that we involve family members in treatment.

Amendment 100, which would ensure that guidance is published no later than six months after the Act is passed, is particularly pertinent to the discussions we have been having. My only quibble is that six months may be too long, but I certainly agree with the thrust of it, which is that there should be a time limit.

[Sir Christopher Chope]

It all depends on when the draft guidance is produced. My amendment is referring to the guidance that emerges after any consultation. As I said earlier, I think that the consultation should take place very early, but six months is a maximum.

[Philip Davies]

My hon. Friend is on to something with that, and I certainly agree. It is quite extraordinary that we do not have the draft guidance already, but I will not go over that again.

Amendment 101 is sensible. It would insert the word “significant” after “any”, to require a record to be kept of any significant use of force on a patient by a member of staff. That is sensible because we do not want to include other things that should not be included. The point I make is that the word “significant” is rather subjective. One person’s “significant” may not be another person’s “significant”, and it might be a bit difficult for trusts and staff to understand what counts as “significant”. My only concern is whether that adds confusion.

[Sir Christopher Chope]

At the moment, clause 7(2) states that subsection (1) does not apply to cases where the use of force is “negligible”. That is refined in subsection (3). I am effectively saying in my amendment that “significant” is non-negligible.

[Philip Davies]

I hope that my hon. Friend will expand on that later. He makes a good point, and I am broadly sympathetic to it.

I have now gone through the amendments on the amendment paper. Different Members have tabled quite a few amendments, and therefore it takes a bit of time. I would like to think that, like the hon. Member for Croydon North, people have been convinced of the necessity of amendments 11 and 12, which go to the heart of what the Bill is supposed to be about.

[Sir Christopher Chope]

Some people looking at today’s proceedings may say that my hon. Friend has been speaking for a long time, but we need to remember that when Bills are considered, the amendments are often grouped so that we do not consider all amendments in one discussion. Today, we are considering all the amendments to the Bill in one group, which I think explains why he has spoken for a bit longer than he might sometimes do.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. May I just say that we do not need to be reminded of how long the hon. Member for Shipley (Philip Davies) has spoken? All that does is use up precious time, and I know you would not want to do that, Sir Christopher.

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[Jackie Doyle-Price]

This is an important reform that will considerably alter the balance of the scales of justice in favour of patients and bereaved families. I want it to make rapid progress, and the specific case of how long it took for Seni’s family to get a resolution in relation to his death is the inspiration for this Bill.

[Sir Christopher Chope]

Will my hon. Friend expand a little more on the timescale within which an independent forensic pathologist must reach a conclusion following a death? The husband of a constituent of mine died more than nine months ago, and the coroner ordered a pathology report but that still has not been carried out, causing enormous distress to everybody involved.

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[Jackie Doyle-Price]

The right hon. Gentleman is right about that, so let me go through the provisions we think are in place to protect patients from exactly that circumstance. The care quality regulations—the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014—clearly set out the types of behaviours that are prohibited and create an offence of failing to comply with the requirement to protect service users from those behaviours. We are satisfied that those provisions would be an appropriate tool with which to tackle this issue. Clearly, we will be relying on guidance to implement much of this Bill, and I can give him every assurance that these issues will be very much part of that guidance; this process will be consultative and I am sure he will want to remind me of the undertaking I have just given him as and when that comes through.

My hon. Friend the Member for Shipley has discussed his amendments 44 to 78, providing us with his understanding of the use of the terms “force” and “restraint”. The point he made was that he wanted the Bill to be consistent with language used elsewhere in mental health settings. It is important that we make sure the language we use is consistent. The term “force” is a more overarching description of what is happening to a patient, and the individual elements that the definition needs to cover are the types of restraint. In the context of this Bill, those are physical, mechanical and chemical restraint, along with isolation. We have chosen to use the term “force” because it works alongside the Mental Health Act 1983 code of practice, with which practitioners are familiar, and it reduces any risk of confusing the drafting due to the use of similar terms, where that can be avoided. This approach has very much been accepted in our consultation with the sector. I heard my hon. Friend say that he had received representations to suggest the opposite, so I would be pleased to take that up with him offline, in order to satisfy his local care trust that what we are doing is consistent with other law, because it is important that we take everyone with us.

My hon. Friend the Member for Christchurch has tabled amendments that would remove certain types of force from the Bill, particularly chemical restraint and isolation, which covers segregation and seclusion. I am grateful to him for testing our conscience via these amendments, because it is entirely legitimate for him to worry that practitioners might be impeded from administering medication to their patients, as, obviously, that would be harmful if those patients needed it. I can give him the assurance that when we talk about “chemical restraint”, we are not considering a patient’s normal medication. The type of medication used for chemical restraint would usually be different from that used as part of a patient’s normal medication to control or treat their mental health condition. As part of a chemical restraint, patients would not simply be given more of their medication. The types of medication used in chemical restraint are a particular kind of product, lasting for only a short period and not having the effect of over-medicating a patient. It is important that we record and receive national data on the use of those products so that we understand their use and shine a light on areas where they might not be used appropriately. I hope that gives him some comfort.

[Sir Christopher Chope]

Will the Minister make a statement on which products would be covered by the Bill and which would not? From talking to my constituent, I had the impression that the products used in his case would be covered.

[Jackie Doyle-Price]

I will commit to writing to my hon. Friend with details of the products licensed by the National Institute for Health and Care Excellence for the purpose of restraint, if that would be helpful.

--- Later in debate ---

My hon. Friend the Member for Christchurch has tabled amendments that would make the legislation cover independent hospitals that treat wholly private patients. I understand the intent behind that, but he will be aware that we have been taking the Bill forward very much in the spirit of consensus, and to avoid a big consultation with the sector, we have framed the legislation around services that the NHS commissions. To give my hon. Friend some assurance, the NHS will clearly place patients only where there are the best possible services. We think that that will guarantee that the legislation will apply in all cases. That is very much consistent with how we would apply the law.

[Sir Christopher Chope]

Would the Bill cover situations in which the NHS is paying for private services in mental health units?

[Jackie Doyle-Price]

It would; indeed, to be more explicit, any service with which the NHS commissions mental health services would be expected to have procedures that comply with the Bill. That will cover non-NHS patients in those institutions as well.

My hon. Friend the Member for Shipley asked some testing questions about training. I really want to say that from my perspective the detail of what will be covered in training will be taken forward through statutory guidance that will be subject to consultation. He has made it clear that he believes that the training of police forces and training on acute episodes need to be factored into that. That is something that we will take forward as part of that consultation. In all honesty, I do not believe that his amendments will be necessary; in any case, we will take that forward as part of the consultation.

On police roles and responsibilities, my hon. Friend will know now that, as I have mentioned, we have a memorandum of understanding that governs how the police and health services interact in these circumstances. That is owned and taken forward by the College of Policing, and I am sure that he will agree that they are the right people to own that. If a provision affects the police in that way, I cannot make any decision without further consultation with colleagues across the Government.

I hope that I can assure my hon. Friend that I fully take on board his points; indeed, the hon. Member for Croydon North supports the inclusion of those issues in training. We will take forward that proposal as part of the consultation process that will develop the guidance. I hope that that is enough to persuade my hon. Friend to withdraw his amendments.

On enforcement, there have been representations such that the guidance should be published within six months of the Bill being passed. Again, I do not want to prejudge Parliament’s decision. We will take forward the consultation as and when the Bill is passed. These are significant issues and a 12-month process would be more appropriate in the context. It is better to get it right than to be guided by speed, however impatient we are to achieve the desired outcomes.

[Sir Christopher Chope]

My hon. Friend is being very generous. Will she tell us the current state of the guidance? Can it be published for consultation immediately this Bill attains Royal Assent?

[Jackie Doyle-Price]

We will undertake it speedily and it will be made public, but, as my hon. Friend will appreciate, the whole purpose of consultation is that it consults and we want to ensure that we are taking everybody with us. Personally, I will want to do it in an extremely timely fashion.

There are many amendments to go through, but I hope that I have articulated the Government’s overall support for this measure and what we are trying to achieve in terms of supporting the hon. Gentleman’s Bill. Central to all this is the need to underline transparency and to strengthen accountability so that patients are protected. Clearly, we desire to minimise the use of force. The best way that we can achieve that is by shining a light on those incidents. We will continue to take this forward in the spirit of openness, and the Secretary of State will be producing reports on how this is being implemented.

Let me turn now to my final point. I have already addressed this in response to the remarks of my hon. Friend the Member for Shipley. On police body cameras, I can give him this assurance: the proposal does not create a criminal offence for not wearing a body camera. We have been very deliberate in our language to say that it is practicable to make sure that we do not get in the way of the police doing what is right in these situations. The references he makes to the law are consistent with the Police and Criminal Evidence Act 1984, but this would not raise any issue of a police officer being faced with criminal prosecution for not wearing a camera. I hope that that gives him some satisfaction.

--- Later in debate ---

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

If it goes wrong, it is obviously going to come back on me. In the end the right hon. Gentleman must make the decision, but overall I would say yes; my view is that the actions he mentioned would lead to more time for a better debate.

If there are no further points of order, I call Sir Christopher Chope to speak—briefly, I presume, because I know that he wants to get on with the amendments.

[Sir Christopher Chope]

There is only a bare hour left, Mr Deputy Speaker.

[Mr Deputy Speaker]

Twenty-five minutes will do you, then. Come on, Sir Christopher!

[Sir Christopher Chope]

It is a pleasure to follow the Opposition spokesman. He was right to pay tribute to the work of the hon. Member for Croydon North (Mr Reed), because this is a really good example of how somebody who is successful in the private Members’ ballot can bring forward a Bill that is to the benefit of their constituents and arises from a constituency case. The right hon. Member for North Norfolk (Norman Lamb) put the issue in context by saying that in the last year for which figures are available, more than 3,500 patients and more than 2,500 staff were injured in mental health units. It is therefore an issue of quite considerable significance.

I intervened on the Minister when she was dealing with new clause 1, and I want to say a little more about timescales for the independent investigation of deaths. As I said, I have a constituency case in which the coroner ordered an investigation that went out to an independent forensic person, who then became ill and has not been able to complete her work. It has not been possible, for all sorts of reasons that I cannot really fathom, to get anybody else to take over the responsibility for that work, with the result that my constituents—and, indeed, other families in Dorset—are waiting for results of post-mortems in respect of loved ones’ deaths many, many months ago. That is intolerable.

I therefore tabled some questions to the Ministry of Justice. In fact, they were among the last questions answered there by my hon. Friend the Member for Bracknell (Dr Lee). He said that there was a provision in the Coroners (Investigations) Regulations 2013 that reports must be made as soon as practicable after the examination, but there is no absolute time limit. He also said that he would raise the question of timeliness with the Department of Health and Social Care and write to me. I hope that that question of timeliness will be on the Minister’s desk soon and that she will then also be able to write to me to explain what could be done to ensure that there is a finite period for these very sensitive post-mortems, and the investigations that flow from them, to be carried out. It would be very useful if we can achieve some progress on that.

The hon. Member for Croydon North says at paragraph (5) of his new clause:

“A person appointed under this section must provide a report within three months of that appointment.”

That is a clear time limit. If the Minister thinks that that is reasonable, then there is no reason why it should not be applied more widely. That could certainly address the problem that I have identified.

I now turn to my amendments. I am grateful to my hon. Friend the Minister for responding, in anticipation, to some of them. Amendment 86 is designed to extend the operation of the Bill to all mental health units in England and Wales, not just to those that in national health service hospitals or those where treatment is provided, or is intended to be provided, for the purposes of the NHS. I still do not understand this: my hon. Friend seems to be saying that she would like to extend these provisions to the independent sector—to all mental health units—but is inhibited in being able to do so because of the constraints of the need to consult on the legislation. Is that correct?

[Jackie Doyle-Price]

My hon. Friend, as a good small state Conservative, will appreciate my desire not to put burden on business. When we bring forward regulations that will introduce additional burdens, we go through a consultation process to take business with us. I am satisfied that the Bill will affect all patients, because the NHS commissions services from independent mental health care providers, and any institution where the NHS is commissioning services will be captured under the Bill. It will benefit private patients in private settings where those institutions provide services to the NHS.

[Sir Christopher Chope]

Will it apply to private patients in private institutions as well?

[Jackie Doyle-Price]

Where that institution provides services to the NHS, it will, because we will only commission services in places that are compliant with the Bill.

[Sir Christopher Chope]

Okay. That is very helpful. As my hon. Friend says, I am keen to avoid unnecessary burdens and regulation, so it is good to have clarification on that and to know that imposing fresh regulations purely on the private sector would trigger several regulations having to be repealed. Perhaps her Department’s list of regulations to repeal is running a bit short. I am grateful for her response.

Amendment 87 is consequential to amendment 86. I am grateful to the Minister for dealing with my amendment 88, which relates to chemical restraint, and for her offer to write to me with a list of the chemicals that satisfy the definition of “chemical restraint”. The Bill defines chemical restraint as

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

However, that does not provide as much clarity as I would wish. My concern is that medication should not be given because it will result in less violence from a patient—for example, if a patient normally takes their medication but becomes more violent if they do not. That seems to be a regular pattern, and I would not want there to be any perverse incentive or disincentive to give people their medication.

Amendment 89 deals with isolation, which the Bill defines as

“any seclusion or segregation that is imposed on a patient”.

I still cannot get my head around why the isolation of a patient is deemed a use of force. Quite often, isolation can prevent a patient from causing physical harm to other patients or indeed staff. Can the Minister expand on that?

[Jackie Doyle-Price]

My hon. Friend is right, it can, but that should be a clinical judgment. We are trying to tackle the use of seclusion as a method of control where it can do harm, because there are clearly cases where it can, but that will be very much a clinical judgment.

[Sir Christopher Chope]

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

I tabled amendments 92 to 95 because I was concerned about the term “relevant” health organisations and felt that we should be referring to all health organisations, but the Minister dealt with that point in response to an earlier amendment, so I will not press it. As my hon. Friend said, some of the issues relating to the unintended consequences of the amendments made in Committee have also been addressed.

I turn now to clause 5, and particularly my amendment 98. Clause 5 has turned out to be the weakest part of the Bill. My hon. Friend the Member for Shipley (Philip Davies) made a stunning and really illuminating speech in support of his amendments 11 and 12, which I most heartily endorse. I do not see how anybody who listened to him could do anything other than reach the same conclusion, which I am glad to say is the conclusion reached by the promoter of the Bill. A lot of my hon. Friends were sitting in the Chamber and listening to my hon. Friend the Member for Shipley, and I think they were also in strong agreement with the sentiments he expressed.

The Minister’s response has very much been to say that such amendments are not needed. I do not know whether she will respond in the same way to my amendment 98, but that amendment makes it clear that the training provided under subsection (1) must include how to involve not just patients but their families in the planning, development and delivery of care and treatment in mental health units. The involvement and engagement of families is of absolutely fundamental importance. If the Government have chosen to set out a whole list of what they consider to be very important ingredients in any training course, I cannot understand why they have omitted any reference to the involvement of families in the planning, development and delivery of care and treatment.

In one of the constituency cases I mentioned earlier, the parents have had an incredibly distressing time not just because of their personal circumstances, but because of their son’s circumstances. They have experienced great frustration in trying to get proper contact with the people in the mental health unit where their son is a patient. It seems to me that families, who often care for 20 years or more for mentally ill children, are in a really strong position to know and understand their children’s needs. It is also very important that they should be informed about what is happening. For example, in this case, the young person concerned is sometimes suddenly discharged from the mental health unit at the weekend, and he then goes and makes a nuisance of himself and the police have to bring him back to his parents’ house many miles away. On one recent occasion, he proceeded to trash the whole place. We cannot allow such situations to arise, and it seems to me that there is a really important role for involving and engaging with the families. I hope that my hon. Friend will confirm that the Government really take seriously the involvement of the families.

[Jackie Doyle-Price]

The Government most certainly do. I mentioned earlier that we are currently undertaking a review of the Mental Health Acts. The involvement of families is a key part of what is coming out of that, and there will be recommendations on that when the report is completed in the autumn. There are also issues regarding mental capacity, so the review of the deprivation of liberty law raises issues about the role of families, and we need to provide greater clarity. However, this is very much part of what we need to get right. My hon. Friend is absolutely right to say that families not only have an interest in, but can do much to support their loved ones. There are also occasions when that can cause harm and families ought not to be involved, but, again, that is part of the clinical judgment. I come back to the fact that all of this will be addressed in the guidance, which we will take forward in consultation with the sector.

[Sir Christopher Chope]

I am grateful to the Minister, and to you for your indulgence, Mr Deputy Speaker. It shows your flexibility that you allowed one long response, rather than having more interventions flowing on from that. [Interruption.] Well, it was very welcome for its content, and I am grateful to the Minister for putting that on the record.

My final point concerns clause 5(2)(k) and what we mean by

“principal legal or ethical issues”.

It seems to me that “principal” is redundant. Why do we need to talk about “principal” legal issues unless we specify more clearly what we mean by that? Do we mean that some laws or legal issues are more important than others? What does it mean? We have not yet had an answer on that—I do not know whether the Minister has one readily to hand.

--- Later in debate ---

[Sir Christopher Chope]

I, too, pay tribute to the hon. Member for Croydon North (Mr Reed) for bringing forward this Bill. He has done a masterly job. I was also impressed by much of what the Minister said in response to concerns that have been expressed. None the less, there are still some unanswered questions, particularly around the implementation of the Bill.

The Minister has said that she will bring forward guidance as a substitute for some of the provisions that we think should have been included in the Bill. She said that we did not need other aspects that we thought should be included in the Bill because they were already in law. I hope that we will be able to keep up the pressure on the Minister to come forward with more precise answers regarding when she will publish the draft guidance.

On Report, I asked the Minister what state the draft guidance was in at the moment and if it was in a form in which it could be produced. I did not get an answer to that question. I also did not get an answer to the question of whether draft guidance would be published before the Bill goes to the other place. There is a lot to be said for the Government publishing the draft guidance tomorrow, say, or next week. One merit of doing that would be that if the Bill’s Third Reading debate does not conclude today, we would have the chance to look at that draft guidance before commenting on it during the remainder of the debate.

As the hon. Member for Croydon North said, the Bill is important because it introduces means by which we can measure lots of things that are happening in our mental health units about which we are not aware at the moment. As we know, what we cannot measure, we cannot control.

I remain concerned that some of the information that will be produced as a result of the Bill could lead to unintended consequences, as my hon. Friend the Member for Shipley (Philip Davies) also mentioned. We heard a reference to the fact that women in mental health units suffer more force against them than men, but that might be because only the most serious cases of women in mental units are brought before the—

Health and Social Care (National Data Guardian) Bill

Christopher Chope Excerpts

Committee Debate: 1st sitting: House of Commons
Wednesday 6th June 2018 Public Bill Committees

[Mr Peter Bone (Wellingborough) (Con)]

It is a great pleasure to serve under your chairmanship, Dame Cheryl. I welcome the Minister and shadow Minister to the Committee.

The purpose of the Bill is to put on to a statutory footing the office of the National Data Guardian for Health and Social Care, and to promote the provision of advice and guidance about the processing of health and adult social care data in England. It would be remiss of me not to mention the work of my hon. Friend the Member for Bury St Edmunds (Jo Churchill): she has worked hard for a long time to establish the position of the National Data Guardian for Health and Social Care, and her perseverance and tenacity have ensured that we are on track to deliver it.

I thank the Minister and shadow Minister for their help and support with the Bill—and special thanks, of course, go to Dame Fiona Caldicott, who has pioneered the work on ensuring that the NHS handles data properly. She has been very helpful to me in the preparation of the Bill.

Clause 1 creates the Office of the National Data Guardian for Health and Social Care, referred to in the Bill as the “Data Guardian”. It makes general provisions about the Data Guardian’s functions and the way in which they are to be carried out. Subsection (2) empowers the Data Guardian to publish guidance about the processing of health and adult social care data in England. I should like to make it clear that it also covers public health data.

Subsection (3) imposes a duty on certain organisations and individuals to have regard to the National Data Guardian’s published guidance. Comment has been made as to why the Secretary of State is not included in the list. However, the Department of Health and Social Care is already included in the definition of those who have to have regard to the National Data Guardian’s advice, so it would be superfluous to include the Secretary of State.

Subsections (4), (5) and (6) cover requirements in relation to the Data Guardian’s published guidance. Those subsections are intended to keep the guidance relevant over time and, if necessary, updated to reflect new evidence. It has been suggested that subsection (5) should add an obligation that organisations and individuals that process health and social care data should provide the Data Guardian with appropriate information. I argue that that would create a duplication of the remit of regulators that already exist in those sectors. The Data Guardian’s role is as an advocate for the patient and the public, to build and maintain public trust. The role is as much about supporting individuals and organisations to get it right first time as it is about commenting, advising and providing guidance. It is not the intention of this Bill to create another regulator, but that the National Data Guardian should work with the Information Commissioner’s Office and the Care Quality Commission.

It has also been suggested that subsection (6) should add a duty that all data controllers and their data processors must publish their response to all advice issued. That would be extremely burdensome on those organisations and individuals, and it would be toothless without sanctions. Accountability should be assessed through actions, not written responses; the existing regulators would be able to assess the adherence to guidance and would cite the National Data Guardian during any investigation.

Clause 1(7) allows the Data Guardian to give informal advice, assistance and information to anyone, as long as it is about or relates to the processing of health and adult social care data in England. Clause 1(8) gives the Data Guardian flexibility in how far any particular piece of advice, assistance, information or guidance may be extended. The effect is to clarify that the Data Guardian can publish guidance and give advice on specific topics or themes, and can target it to certain organisations, individuals or sectors as appropriate. Clause 1(9) provides that the duty to have regard to the Data Guardian’s published guidance applies only in so far as the guidance is relevant to the functions or services of the body or person.

Clause 1(10) introduces schedule 1 to the Bill. As clause 1 and schedule 1 are being debated together, I will make some brief comments on schedule 1. The schedule makes further provision for the establishment, maintenance and operation of the Office of the Data Guardian. It sets out the Data Guardian’s terms of appointment and covers a broad range of matters related to the Office of the Data Guardian. It includes its constitution, its financial and reporting framework, and how members of staff and advisers are reported and remunerated. I draw the Committee’s attention to paragraph 15 of schedule 1, which provides that the Secretary of State must pay to the Data Guardian the amount that he considers appropriate for the purpose of enabling the Data Guardian to carry out his or her functions.

The Committee will be aware that there was some debate about the cost during the money resolution debate. I thank hon. Members who are here today and those who took part in the debate. I want to make clear that, although the estimated cost is £725,000 per year, that is only an additional £225,000 per year and relates to putting the Data Guardian on a statutory footing. As the Committee will know, there is already a Data Guardian, which costs £500,000; we are just putting this on a statutory footing and saying it is the right thing to do.

[Sir Christopher Chope (Christchurch) (Con)]

I congratulate my hon. Friend on having got his Bill so far. On the costs, the Data Guardian will basically be indemnified for the costs incurred, yet I see that the Data Guardian will have enormous flexibility to publish and give as much guidance or advice as they wish. Surely the Data Guardian could, by giving a lot more advice and guidance over which there is no control, result in significantly increased costs for the public sector?

[Mr Bone]

I am grateful for my hon. Friend’s intervention and the fact that he is on the Committee; I know that all Committees welcome his membership.

The reason why we have a Data Guardian is to provide safeguarding and to make sure that the data is handled properly. Those costs can only be estimated; as my hon. Friend says, they could be more or less, depending on the requirements. That is exactly why we need a guardian. I would like the costs to be minimal, because that means that we are handling the guardian properly. But if there needs to be more, because there is a requirement to do more, there will be more cost.

[Sir Christopher Chope]

Does my hon. Friend know of any case where a regulator given powers by Parliament has chosen to reduce the amount of powers that are used? Surely, the natural thing is for regulators to increase their activity, using the powers to the maximum and thereby increasing the costs.

[Mr Bone]

I agree, but what we are not doing today is creating a regulator; I would not be likely to propose a Bill to create a regulator. The Data Guardian already exists and it is not a regulator—I specifically said that in my opening remarks. Although it is probably true that regulators do that, that is not what I expect to happen with the National Data Guardian.

--- Later in debate ---

[Mr Bone]

The clause provides for all the Bill’s provisions to be brought into force by regulations made by the Secretary of State. It is a standard clause to be found in many Acts of Parliament.

[Sir Christopher Chope]

It may well be a standard clause, but such clauses are often abused by the Government. For example, Parliament passed a measure to outlaw exit payments for public sector workers in the Enterprise Act 2016. We are still waiting for the regulations under that primary legislation to be introduced. The Government now say that they will have to consult on them. Effectively, what Parliament thought was happening—the limiting of public sector exit payments—has not happened.

The Bill is supported across the House, as the measure I have mentioned was. I should be grateful for some indication from the Minister of when the Government will implement it. It could be delayed by the Government by means of the regulation-making powers in the clause; or by the Government’s not appointing the Data Guardian. There are other ways in which it could be delayed, and if we take the past as a guide to the future we should be suspicious of the Government when they are not prepared to include in the Bill a commitment for it to commence on a given date.

[Chris Bryant]

Christchurch and Rhondda speak as one, in a uniting of the Christophers, something that will not, I think, happen very often. It is a serious point; I understand that such clauses are a frequently used means of tidying up the process of a Bill coming into force. However, it adds cost, because the Government must go through an additional process; and frankly there is no reason why we should not just put in a date and tell the Government to get their act together—because everyone supports the measure.

I hope—I am sure—that the Minister will now say, “We intend to do it as soon as practicable after the Bill has been through both Houses,” and all the rest of it; but it would be better for the date to be in the Bill, because then she would not have to do anything later, and, to use a valleys word, it would be tidy. Let us be tidy.

[Jackie Doyle-Price]

Tempted as I am to engage in debate on the abuse or otherwise of statutory instruments, I prefer not to go down that road. Suffice it to say, we should put provisions into action only once they are tidy, to use the term suggested by the hon. Member for Rhondda. We should be governed by the integrity of the rules we pass rather than by speed, but I can confirm that it is the Government’s desire to implement the Bill, which we fully support, as soon as practicable. Clearly, we already have a National Data Guardian; the Bill would just put it on a statutory footing. It is in all our interests that we do that as soon as possible, so the Government are content with the clause.

[Sir Christopher Chope]

Will the Minister assure us that she will take personal charge of ensuring that the Bill is brought forward quickly? To go back to the example I quoted earlier, I had a meeting with the Chief Secretary to the Treasury and pointed out to her that one of the reasons there was a delay in implementing regulations was that civil servants did not have their heart in it and did not give it sufficient priority. The only way of ensuring that the civil servants in the Minister’s Department deliver on the wishes of the Committee and the House is for her to take charge and deliver. Will she ensure that the Bill is commenced before the end of this calendar year?

[Jackie Doyle-Price]

I completely agree with everything my hon. Friend says. It is Ministers’ responsibility to ensure that the decisions made by Parliament are actioned as promptly and effectively as possible. I know him well enough to be sure that he will hold me to account on exactly that basis if he does not feel the Bill comes forward quickly enough. I would like to see it commenced by the end of the year, and I will work with my officials to ensure that that is the case. If we cannot achieve that, I will give him an explanation.

Health and Social Care (National Data Guardian) Bill (Money)

Christopher Chope Excerpts

Money resolution: House of Commons
Monday 21st May 2018 Commons Chamber

[Mr Bone]

I am grateful for my hon. Friend’s intervention, but I would like to deal with that later in my remarks.

There is the following deferred Divisions motion on the Order Paper in the name of the Prime Minister:

“That, at this day’s sitting, Standing Order No. 41A (Deferred divisions) shall not apply to the Motion in the name of Mel Stride relating to the Health and Social Care (National Data Guardian) Bill.”

That is interesting because under Standing Order No. 49 automatically there has to be a debate of up to 45 minutes on a money resolution, so I am not sure why that motion is on the Order Paper. The new version of Standing Orders published on 1 May is in the Vote Office today, and consideration of such a resolution automatically can go through the moment of interruption.

[Sir Christopher Chope (Christchurch) (Con)]

We have just allowed a money resolution to go through on the nod in relation to the Tenant Fees Bill and I think the sums involved are much higher than £700,000, yet under Standing Orders we were not allowed any separate debate on that. Can my hon. Friend explain why his Bill for £700,000 has 45 minutes but a much more expensive Bill has nothing?

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I do not think we need to consider that.

--- Later in debate ---

[Mr Bone]

That is exactly what I am saying, because it would come on as a second Bill and therefore, as it is quite a complex Bill, would not get through. I think that some people who may have been involved in rearranging when money resolutions come through—this new idea of having a choice in relation to money resolutions—were aware of that fact, but I am not sure that everyone in this House was. I considered standing up and recommending that Members should not support this money resolution. However, if I did that, I would be playing into the Government’s hands, because that would stop a private Member’s Bill.

[Sir Christopher Chope]

My hon. Friend seems to be saying—in his typically generous way—that, for the greater good, he would be prepared to make a short-term sacrifice in respect of his own Bill. From the debate that took place earlier today, we know that one way of avoiding the problem that he encounters by having to have a money resolution debated and voted on in the House tonight would be to have a Bill without a money resolution. When he drafted his Bill, did he consider whether it would be possible to draft it in such a way that it would not require any more public money?

[Mr Bone]

Absolutely. There was much discussion with the Clerks of the House on that point. As my hon. Friend knows, that money has already been expended on the system that we have. My Bill is actually not going to cost the public purse any more money than at present. I argued strongly that my Bill should not have a money resolution, but the Clerks persuaded me that it was the proper thing to do. I think they felt that, on balance, it was safer to do it like this.

I did not think I would be speaking about a money resolution for my Bill. I did not think that anyone would spend any time on this matter. What normally happens—[Interruption.] No, I think we need to scrutinise this properly—

--- Later in debate ---

[Sir Christopher Chope (Christchurch) (Con)]

I thank you, Mr Deputy Speaker, for allowing us to debate this motion up to the maximum of 45 minutes. I was disappointed when it was introduced, however, because there was not much detail. We have heard about the approximate sum of £700,000 a year, but paragraph 47 of the Bill’s explanatory notes states:

“The Bill may result in some implementation costs for the bodies and individuals required to have regard to the Data Guardian’s published guidance, in that they will need to review and assess the relevance of the guidance.”

When the Minister comes to respond to this short debate, I hope that she will explain how many of those bodies and individuals are actually funded out of the public purse, and therefore to what extent additional costs will be incurred for the Exchequer in addition to the approximate £700,000 per annum.

I do not know whether the Opposition will call a Division, which they can do following the decision that deferred Divisions shall not apply to this motion this evening, but if they are really keen to move forward with the Bill that they were complaining about this afternoon, which has not yet received a money resolution, they should be using every available procedural device available to them to promote that cause. One is sometimes left with the feeling that there is a bit of gesturing here and that people do not have their heart in it, so I want to see the Opposition’s heart reflected in votes in this House, rather than in just mere words. Having said that, some important points have been made, and I hope that the Minister will respond to them.

Question put and agreed to.

Oral Answers to Questions

Christopher Chope Excerpts

Tuesday 6th February 2018 Commons Chamber

[Stephen Barclay]

The Department wrote to all NHS and foundation trusts in September 2017 to remind them that tax avoidance schemes should not be entered into in any circumstances, but the hon. Lady makes a slightly strange point. She seems to be arguing that NHS hospitals are, in essence, paying too much tax to the Treasury, rather than having that money within the NHS. These subsidiaries are 100% owned by trusts themselves.

[Sir Christopher Chope (Christchurch) (Con)]

The Government have already legislated for but not implemented a proposal to introduce a £95,000 limit on exit payments for public servants in the NHS. Would it not be sensible, in the meantime, to charge NHS trusts VAT on any exit payments in excess of £95,000 to deter this waste of public resources?

[Stephen Barclay]

I admire how the VAT element of the original question was brought into a discussion of exit payments. As my hon. Friend will be well aware, I visited the issue of exit payments frequently as a member of the Public Accounts Committee, and I am happy to discuss it further with him.

Corby Urgent Care Centre

Christopher Chope Excerpts

Wednesday 13th September 2017 Westminster Hall

[The Minister of State, Department of Health (Mr Philip Dunne)]

Thank you, Mr Chope, for chairing the debate in your inimitable style. I was intrigued to learn that my hon. Friend the Member for Corby (Tom Pursglove) had not used the precincts of Westminster Hall to raise an issue before; I was somewhat surprised, because he is such an assiduous campaigner for his constituency and such a frequent contributor in the main Chamber. The reason may simply be that he does not manage to find time to get into Westminster Hall, so often does he raise his constituents’ interests on the Floor of the House. It is good to see him so well supported again today by his constituency neighbours from Wellingborough and Kettering.

We have discussed this matter privately and, to a limited degree, on the Floor of the House. My hon. Friend the Member for Corby referred to the Adjournment debate to which he contributed before Parliament rose for the summer recess. We have also discussed during the summer, as events unfolded in a more unpredictable way, what could be done to secure the future of the facility for which he has advocated so well today.

I feel reasonably up to speed with events in Corby; for the benefit of other Members present, I will rehearse a small number of them. I will not go into too much detail, not least because at the heart of the issue has been a contractual dispute, which has limited the ability of participants to describe the nature of it. That has, in itself, given rise to some problems in communicating to the local population what the problem has been. We remain bound by the confidentiality arrangements around the legal procedure, but suffice it to say that, as my hon. Friend correctly observes, we are close to a point where action has to be taken to maintain the facility from the end of this month.

From my conversations with the CCG leadership in preparation for this debate, I can assure my hon. Friend that on that side of the negotiating table they are determined to ensure that continuity of service is provided through the rolling four-month contract. They alerted him to that contract at the end of last month and are engaging with the provider, Lakeside Plus, to try to reach agreement. There is no doubt that without an agreement, some of the services would have to be provided in an alternative and less satisfactory way for the local population. That is inevitable, if it is put together in a short timeframe.

It is in everybody’s interest to make this work, but it will be a precursor to a longer-term solution, which is clearly required for the local population. I am pleased that my hon. Friend recognises that such a solution needs to be widely consulted on. Indeed, he is pressing for a more fulsome consultation than is perhaps typical. Given the circumstances surrounding this case, I will be urging the CCG regarding that full consultation. I have been alerted that it is due to start in November, and think that he has been given the same information.

I was not aware of a pre-consultation, and am not quite sure what it means. Hopefully, it means providing an opportunity to ensure that the full consultation is as detailed as necessary. I am quite sure that my hon. Friend will encourage all those who have been in touch with him to participate in that consultation when it gets under way. I was pleased to learn from him about the cross-party nature of the support and full engagement that he has been working, alongside the action group, to generate. I am sure that all those taking an interest will participate in the consultation.

To touch on the substance of the issue, I should say that the GP practice co-located with the urgent care centre has the largest patient list of any GP practice in the midlands, certainly, and possibly across NHS England’s footprint, so it has some unusual characteristics. One of the pressures on that practice, which my hon. Friend alluded to, is access to that GP surgery. Pressure is put on the urgent care centre by the difficulty in securing access to that part of the GP provision in the area. My understanding is that there is a federation of GPs, beyond the immediate catchment of the UCC but within the CCG area, that has much better access. Work should be done as part of the consultation to see how the performance across the entire CCG area can be improved to relieve some of the pressure on the urgent care centre.

A consequence of that pressure is that the original contract, designed to undertake 120 patient episodes a day, has been dealing with more like 170 patients a day attending the urgent care centre. Of those patients, the vast majority—88%—could be dealt with either in that facility or in the GP practice itself. As I understand it, 12% definitely require treatment at the urgent care centre, and some of those are then referred to either Kettering General Hospital or, in a small number of cases, to Northampton’s A&E facility.

There is a need for an urgent care setting, but there is as much of a need to ensure that those who could be treated in the primary care environment can be. Part of the consultation will look at the appropriateness of a primary care home arrangement. That is an establishment that brings together primary care providers, social care providers and other providers, such as pharmacies, within an area, to provide a more integrated primary care service. That in itself might have benefits for improving access to treatment for the population served by the UCC at present.

My hon. Friend will be well aware of the history of the contracting challenge between the CCG and Lakeside Plus. I will not exhaust his patience by going into that in any detail, but will simply say that it is the intent of the CCG to re-establish a contractual relationship. The CCG wishes to have this moving forward on a four-month rolling basis while the consultation takes place, and then any subsequent arrangements will need to go out to tender. The intent is that this contract will continue until the successor arrangements are in place, so that there is continuity of care for his constituents—something that the Department absolutely supports.

I conclude by saying that it is really important that we use this public consultation to get the model of care right for the people in the area served by the UCC. That needs to take into account the evidence base for the clinical model, the right to patient choice for the people who will be using it, to meet the local need—my hon. Friend spoke eloquently about the particular local needs in the Corby area, and those are recognised—and also value for money. The approach has to be coherent and comprehensive, to come up with the right solution for the future.

I heard what my hon. Friend’s neighbour, my hon. Friend the Member for Wellingborough (Mr Bone), said about looking for a similar hub in Wellingborough. I will look with interest to see how his private Member’s Bill progresses, to endeavour to bring that about. I also note his comments regarding the structure of the CCGs in the area. That is really a matter for the STP—the sustainability and transformation partnership—to make progress on and decide the structure of both commissioning and provision of service in the area. It is not really for me to comment on that off the cuff here today, but I note what he says and am aware that this is one of the smallest CCGs in the country. I am also aware that there is a very substantial programme of collaboration already underway with the neighbouring CCG at Nene, so I think that the CCGs themselves see the benefits of closer integration of their working.

On that basis, I say to my hon. Friend the Member for Corby that I will endeavour to keep him informed as matters come to my attention, and I am quite sure he will continue to keep me and the Department informed as well.

Question put and agreed to.

[Mr Christopher Chope (in the Chair)]

Order. As we have got a minute and a half spare, we can go straight on to the next debate because the Minister is here. I now call the next speaker, Mr Linden.

Adult Social Care Funding

Christopher Chope Excerpts

Thursday 6th July 2017 Commons Chamber

[Steve Brine]

Of course I want to work—as will the current Care Minister, the Under-Secretary of State for Health, my hon. Friend the Member for Thurrock (Jackie Doyle-Price)—with the respected former Care Minister, and with any other Members who have any sensible suggestions. Taxation is of course a matter for the Chancellor at financial events, and there will obviously be a Budget later in the year.

On the areas where there are care challenges, we have picked up 12 local areas for review, as the Secretary of State said earlier this week. We have published the details that are suitable for the review, which we have developed from the dashboard criteria. We will give those involved every possible support, as we do with the inspection regime for hospitals, for instance. Such inspections are to get hospitals out of special measures and get them to a better place, and we will do the same for those areas. I will be very happy to meet the right hon. Gentleman. In fact, if he had not asked me, I would have offered to meet him.

[Mr Christopher Chope (Christchurch) (Con)]

If the Government’s plan is to reduce the pressures on adult social care, will my hon. Friend explain why the Dorset clinical commissioning group is proposing to close down the St Leonard’s community hospital, which provides really good services at the moment and is approved of by the community?

[Steve Brine]

No, I cannot go into the detail of why that is, as I suspect my right hon. Friend realises. There will be a one-NHS STP process in his area, and it will have to come up with proposals that meet the five criteria for any reconfiguration. As he will know, there were previously four criteria that had to be met, but there are now five; Simon Stevens, the chief executive of the NHS, has added a fifth on patient safety. My right hon. Friend mentioned St Leonard’s hospital, and any reconfiguration or change of service in relation to it will have to be considered in that context.

Cities and Local Government Devolution Bill [Lords]

Christopher Chope Excerpts

Monday 7th December 2015 Commons Chamber

[Mr Christopher Chope (Christchurch) (Con)]

I am concerned about amendment 56 and the Government’s acceptance of it, albeit subject to the proposal in amendment (a).

The reasons for my concern go back some time. Twenty years ago, before I was privileged to be a Member of Parliament, I served on the Local Government Commission, which looked at structures of local government in England, including at whether councils should switch from a two-tier structure to a unitary one. The method we adopted in those days was to invite local people and councils to submit evidence, and to hold public inquiries and hearings on the evidence. It was very much a bottom-up process. That was decided by consensus in the commission. In due course, it made recommendations to the Government, which were adopted by Parliament if changes were involved.

In Dorset, which I have the privilege of representing in Parliament, there was a lively debate about whether Poole and Bournemouth should become unitary authorities, with Dorset County Council remaining a county council and a two-tier system operating in the rest of the county. In the end, it was agreed that Poole would become a separate unitary authority, as would Bournemouth, but the remainder of the county council area would be two-tier, with Dorset County Council dealing with the main services such as education and social services, and the borough or district councils dealing with the services closest to the people.

Nothing that has happened in the 20 years since leads me to believe that people in Christchurch, East Dorset or Dorset are anything other than content with the current arrangements. When there was all this talk about the possibility of change being forced through by the Government, I was assured by my right hon. Friend the Secretary of State that nothing would happen to change things in Dorset unless it had the wholehearted consent of the councils concerned. On that basis, a half-baked proposal introduced by Poole, with support from Bournemouth, to try to set up a new unitary authority incorporating Christchurch and East Dorset, could not work. Dorset County Council understandably said that it would mean that part of its area, which enables it to provide good services and make economies of scale, would be taken away and no longer be included in Dorset county. The line, which the Secretary of State articulated to me very persuasively, was that there was no need to worry, because nothing would be imposed from the centre. It was something that would only come from the bottom up.

That is where we were until today and the inclusion of amendment 56 on the amendment paper. I assumed that the amendment did not have Government support, and I had not applied my mind to the question of opposing it. I assumed, on the basis of what I had been told, that it would be opposed by the Government. Much to my amazement, I found that a manuscript amendment had been tabled, suggesting that the Government were going to accept amendment 56, albeit on the basis that it would only be in operation until 31 March 2019, which coincides with the end of the current period for district councils. The terms of office for all the district councils that were elected last May expire at the end of March 2019.

That is the effect of the Government amendment, and they have not provided any detail about the criteria that they will use to exercise their significant power to intervene against the wishes of one or more local councils in, to take my county example, Dorset.

[Sir Edward Leigh]

I hope that the Minister is listening, because it is open to him to intervene on my hon. Friend, to make it clear that in areas such as Lincolnshire and Dorset we should only proceed towards a unitary authority by consent.

[Mr Chope]

Of course, it would be open to the Minister to do so. I understand—I have been told privately, not on the Floor of the House—that the Government are neutral on this. They do not have an agenda to try and create unitary authorities.

[James Wharton]

May I take the opportunity, as presented by my hon. Friend the Member for Gainsborough (Sir Edward Leigh), to confirm that it is indeed the Government’s intention to build that consensus? We are not going to impose change on areas that do not want it. However, we have been persuaded, that, as proposed in amendment (a), areas should not at the same time be prevented from being part of devolution deals. We are seeking to build consensus, not impose change on areas, but we should have the flexibility to ensure that we can deliver the deals that local people want.

[Mr Chope]

I am grateful for that, so far as it goes, but will the Minister explain how he will deal with the situation in, for example, Dorset? The county council wishes to retain control over the area that it currently governs. If one or more district councils in that county council area wish to enter into a unitary arrangement with, for example, Poole and Bournemouth, who will prevail? Is it going to be the will of the county council or is it going to be the will of, for example, Christchurch Borough Council? In my constituency, a number of councillors serve on the borough council and on the county council. To which group will the Government pay heed, or will they say, “Because there is no agreement, there can’t be any progress”, which I understood was the Government’s policy?

[James Wharton]

Of course we want to find consensus. Tempted as I am to go down the route of discussing individual proposals in too much detail, there is no intention to set out here or at any other time some sort of rule that would allow districts always to determine what happens, or counties always to determine what happens. We want to talk with local areas, take representations from those local authorities and local people, from local enterprise partnerships and, of course, from hon. Members representing those areas to build a consensus as to how best we should go forward with this process. The Secretary of State will apply a statutory test, which I will talk about later, but I hope I can at least give my hon. Friend that reassurance.

[Mr Chope]

I am grateful to my hon. Friend, so far as it goes, but basically he is saying that the Government will now decide. A few months ago the process was to be bottom-up, driven by the local councils: if they wanted change, they would be able to introduce change. Now we are told that nobody will be able to dictate, neither a borough council nor the county council, but ultimately the Government will decide. This is a significant change of Government policy, announced in the form of a manuscript amendment to amendment 56.

[Sir Edward Leigh]

This is an interesting triangular discussion and it is terribly important. What I think my hon. Friend is looking for, and what I am looking for—again, the Minister can intervene on my hon. Friend—is an assurance that if either Dorset County Council or one of the district councils does not want change, that would effectively be a veto, and the same would apply to Lincolnshire and other rural areas. In other words, change would proceed only by consensus. The Minister says he wants to proceed by consensus, as I understand it, and that is extremely important. Again, he can intervene on my hon. Friend.

[Mr Chope]

I am grateful to my hon. Friend for his intervention and for his suggestion that we might be able to find a modus operandi between the two of us, who are very concerned about this, and the Minister, who I know is doing his best to give us assurances which will enable us to support amendment 56, as amended by the Government, rather than dividing the House on it. I am happy to give way once more to the Minister if he is able to give the sort of undertaking that my hon. Friend the Member for Gainsborough was suggesting he might like to give.

[James Wharton]

I thank my hon. Friend for giving way. I will talk more about this issue when I speak to the new clause and amendment later. It is important to be clear that this is not about allowing areas to veto. We want to allow flexibility to build that consensus. The Government’s intention is to work with local areas to deliver economically sensible areas of devolution, with structures that sit beneath them that allow those things to be delivered and that potential to be realised. So it is not about giving one area or another a veto or taking a particular mandated approach; it is about having the flexibility to deliver what different areas need. That is what the amendment allows, which is why we are looking at it so closely and are keen to see it discussed further and delivered as part of the Bill.

[Mr Chope]

I am grateful to my hon. Friend for that intervention, but I am afraid that what he said goes against the position that we have already established, which was explained to me by the Secretary of State—namely, that the Government were not pushing any of this agenda, but that this agenda could be promoted by individual councils if they wished and if they had the agreement of their neighbouring councils. Now we are told that it no longer depends on their having the agreement of their neighbouring councils, but that the Government will intervene if they think the consent of a neighbouring council is, for example, being unreasonably withheld. That has not been spelled out yet in the legislation, but it is implicit in what the Minister says—a completely different proposition from what we had before.

This is a sensational change in the Bill, because up until now we had been told that the Government were neutral and that they were enabling councils to do what they want. If this measure goes through as the Government obviously want it to do, one of the consequences is that between now and 2019, in counties such as Dorset, instead of getting on and running local services for local people, the councillors and their officers will be preoccupied with arguing the toss about new structures—structures which, as I have already said, were established 20 years ago and have not been criticised at all. Small councils such as Christchurch Borough Council—the ancient borough—are threatened with losing their independence. Likewise, East Dorset District Council is threatened with losing its independence, ultimately at the whim of the Government.

This is all done, supposedly, in the name of devolution, but a district council is a highly devolved body because it is close to the local people. It decides those all-important planning applications in accordance with the wishes of the local people. I see my hon. Friend the Member for Bournemouth West (Conor Burns) in his place. He will know that one of the reasons that Bournemouth has great tower blocks on its clifftop is that for many years it has had a different planning policy from that of Christchurch, which has an equally delightful clifftop but has not wrecked it by allowing enormous tower blocks on it. That is why Highcliffe is still an attractive place in which to take a holiday, like Friars cliff and other places in Christchurch, which are gems on the south coast.

--- Later in debate ---

[Mr Chope]

It is interesting that the opposition leader on Poole unitary authority said he thought it was important that this issue should be dealt with by the people of Poole and that there should be a local referendum. That was pooh-poohed by the leaders of Poole and Bournemouth. My hon. Friend refers to leaders, but we must ensure that the leaders accurately reflect the wishes of local people. At present they have no plans properly to consult the people of Christchurch, East Dorset, Bournemouth or Poole. They are just rushing into some discussions. If those discussions are given the extra momentum that the Minister wants to give them by accepting amendment 56, they will create enormous anxiety among the people in my area.

Christchurch and East Dorset have recently had a local plan inquiry. They now have a new local plan, under which they are able to preserve most of the green belt in their area. My constituents are very jealous of the green belt. Why is it that Poole and Bournemouth want to get their hands on the land in East Dorset and in Christchurch? It is so that they can impose their planning policies on the green belt and expand outwards into our area. That is the perception of my constituents and that is why they are so concerned about it. Up until today, I have been able to say, “Don’t worry. That is never going to make any progress,” because I know for a fact that Dorset county council regards as anathema the idea that it should have two boroughs within its two-tier system taken away from it, because that would make Dorset county council less viable. I had assumed up until now that that would give Dorset county council a veto and therefore that none of these half-baked ideas would make any progress.

[Mr Skinner]

The situation is very difficult, and it is pretty clear that the Government are making decisions on the hoof. It is almost a fag packet job. I live in and represent an area that is involved in two of these structures. One of them is dominated by Sheffield and the four adjoining council areas of Barnsley, Rotherham and so on. That is now attracting the attention of at least three, maybe four, councils in north Derbyshire—Bolsover, Chesterfield, North East Derbyshire and possibly Derbyshire Dales. On top of that, there is the D2N2 power structure which covers Nottinghamshire and Derbyshire. It is time that the Minister got to his feet and explained precisely what will happen if Sheffield demands the powers that currently reside with Derbyshire County Council around transport and takes them away from the county. We have got two power structures both vying for the same thing. Although Dorset is complicated, this is even worse.

[Mr Chope]

I instinctively think that the hon. Gentleman is right. I say that not only because I have on my wall at home a picture of his constituency that was presented to me by his council when I was a junior local government Minister—a picture that I chose—but because I think that his experience means that he understands the complexity of these issues and their potential impact on ordinary people.

The Government can sometimes give the impression that they get rather intolerant of those us who want to raise issues such as this.

[Graham Stuart]

I have tried to follow this closely but I may not have understood amendment 56, which I am trying to square with the assurances from the Minister. If his assurances are right, why would the Government support amendment 56, which will allow the imposition of this if only one affected local authority says so?

[Mr Chope]

My hon. Friend makes a good point, and perhaps the Minister will reply to it. If we are talking about genuine consensus—in other words, agreement between local authorities—then we do not need amendment 56, which is designed to enable the Government to intervene when some local authorities do not do as the Government think they should be doing. That is essentially what this is about. We might as well face up to the reality that this is a very centralising part of the Bill because it brings power back to the Government to enable them to change the structures of local government boundaries in areas such as Dorset.

[Sir Greg Knight (East Yorkshire) (Con)]

Further to the point made by my hon. Friend the Member for Beverley and Holderness (Graham Stuart), if amendment 56 is accepted, could it not, despite the promises from the Minister, be used as a lever against a recalcitrant council to say, “You’d better fall into line or amendment 56 will be brought into play”?

[Mr Chope]

My right hon. Friend knows all about levers, having been a deputy Chief Whip. That is exactly how I envisage this power being used. I am sure that that is why there was an attempt to smuggle it through at the last minute. Now we are, I hope, exposing it for what it is, which is a power grabbed by the Government to try to ensure that they can have the final word and beat their stick against a council that is not doing as they wish it to do.

[Bob Stewart (Beckenham) (Con)]

I am making the assumption that my hon. Friend would support the amendment proposed by my hon. Friend the Member for North East Somerset (Mr Rees-Mogg) to have a referendum.

[Mr Chope]

Absolutely. I am very supportive of that amendment, but I have not yet had a chance to talk about it because I am so concerned about amendment 56 and amendment (a). I am not going to restate the case about the referendum, but I think it is a necessary safeguard.

If we look at the history books we see the unintended consequences that can flow from local government reorganisation. It was only because Wandsworth council started a campaign to abolish the Inner London Education Authority that education was given back to the inner-London boroughs, which were then able to gain economic growth as a result of having good-quality education within their boundaries. The same thing happened with the Greater London Council. The Greater London Council was interfering in the lives of the boroughs in inner London and outer London, so those in charge of the boroughs at the time persuaded the Conservative Government to abolish it. As a result, parks such as Battersea park are run by the local authority—Wandsworth council—rather than by a remote authority for Greater London.

If we are not going to put proposals like this to the electorate, we must have the necessary safeguards. None of this stuff was in our manifesto. There was no suggestion that a Conservative Government were going to restructure local authorities so as to try to squeeze out small councils that are closest to the people. If we are not going to test this in a general election and amendment 56 is going to be on the statute book until the end of March 2019, it is all the more important that we should be able to have the safeguard of a referendum—the very safeguard that the Poole People party and the Liberal Democrats have sought, in vain, from the leaders of Poole, Bournemouth, East Dorset and Christchurch Borough Councils.

We are on the threshold of a big spat at local government level between different councils at different tiers and different councillors with different personalities and political parties. This threatens completely to preoccupy local government for the next three or four years. We will look back and say that this all started with the Government wanting to interfere in areas where they should not be interfering at all. They should be trusting local councillors and local people to decide what is best for them. They should not be taking away from Dorset County Council or East Dorset District Council, for example, the power to veto any proposals to change the boundaries in which they operate.

I very much hope that the House will not accept amendment 56 as proposed to be amended by the Government but will push them back to their previous position, which was that this is genuinely for local councils and local people to decide, and the Government are not going to interfere.

[Graham Stuart]

I will try to keep my comments brief, because contrasts are always a pleasant thing. It is a pleasure to follow my hon. Friend the Member for Christchurch (Mr Chope), who spoke powerfully about this issue.

--- Later in debate ---

[Graham Stuart]

It leaves me in a position of having profound doubts about amendment 56. I really appreciated the Minister’s interventions setting out what the Government want to do. The police reorganisation under the previous Labour Government was top down and people did not like it. It is not that we are neutral—my hon. Friend the Member for Christchurch was wrong to say that the Government have always said they would be neutral. The Government have a position and a vision, but I think it is much smarter to offer reassurances and tell people that, whatever we think, we are not going to push it on them, because we have seen that that does not work. People have to consent to it. There will be difficult council leaders who we will think are being a pain because of their own individual interests, but we should bind our hands and restrain ourselves from just pushing them aside. We need to listen and say to everybody, “Unless you can bang heads together yourselves and get a consensus, we’re not going to come piling in, because we’ve seen where that ends up.”

It might be a Labour Government’s instinct to think that they know better than the people, but it should be a Conservative Government’s instinct to recognise that they do not know better and that even if, in their opinion, the people are wrong—and history might show that they were wrong—it is the people who get to decide, and if they feel strongly about something that should be respected.

[Mr Chope]

Will my hon. Friend give way?

[Graham Stuart]

My hon. Friend has had a fair crack and I am going to sit down.

--- Later in debate ---

[James Wharton]

I hear what my hon. Friend says, but it remains the case that a council or group of councils can now, regardless of the Bill, ask the Secretary of State to implement a proposal for structural change through the traditional processes of the Local Government and Public Involvement in Health Act 2007, even where not all councils agree or where there are competing proposals for different councils. He has those powers, but only as part of a convoluted and lengthy process. This is not about forcing unwanted change on areas just because we have the power to do so; it is about enabling the flexibility to deliver the right devolution deals for areas and in a timely and flexible way. I know that hon. Members have raised concerns, but there are none the less statutory tests that have to be satisfied in doing that. This place would need to approve any change, but the fast-track process, with its significant safeguards, is a welcome one.

The new process would still require the Secretary of State to lay before Parliament a report on the fast-track process, including on matters he has taken into account when deciding to use it, and I reiterate that it could not be used without Parliament’s approval. Having carefully considered and weighed the arguments; having listened to the comments of my hon. Friend the Member for Carlisle and others; and having considered the need to ensure flexibility if we are to make devolution last, we have decided to support the amendment. We have tabled a manuscript amendment so that it is for a trial period and not something that would necessarily last in perpetuity; none the less we welcome the flexibility in the amendment.

[Mr Chope]

Will my hon. Friend confirm that the Secretary of State would not, under any circumstances, force change on a local authority against its will, and is really only interested in encouraging local authorities to talk to each other? He said, at the beginning of his remarks, that the starting point remains that change will not be forced on any one but suggested that ultimately the Government wished to have the power to force it.

[James Wharton]

I remind my hon. Friend of my earlier comments: those powers already exist. The Government’s intention is to find consensus, to build on the local desire for devolution and to deliver lasting devolution to areas that will benefit from it. Those powers are already there. This is about ensuring we can deliver, in a timely way, the devolution that local areas want, but I can absolutely reconfirm the Government’s commitment to seeking and building on consensus. That is how devolution will stand the test of time.

Amendments 16, 30 and 55 ensure that criminal liabilities of a public authority can be transferred to either a local government or combined authority on the same basis as other liabilities when public authority functions are conferred. Amendments 17 and 31 amend clauses 7 and 16 respectively and allow references in a transfer order or regulations to be made to a formal document, such as guidance, which can be amended from time to time.

Amendment 36 is a technical amendment substituting the original word “jointly” with the new word “concurrently”. The change is necessary to ensure that certain transport functions being carried out by strategic transport bodies and local authorities can be undertaken concurrently rather than jointly. Amendment 3 would change how mayors for combined authorities should be elected. We have debated this matter at length. We believe that, where we are electing an individual to exercise significant executive power, the voting system for which we have made provision is the right one, and that therefore the amendment should be rejected. Finally, amendments 10, 37 to 43, 45 and 44 are necessary to bring the Bill into line with the arrangement in London. They provide clarity and consistency in respect of mayoral deputies with police and crime commissioner functions.

I hope that hon. Members will accept the Government amendments and reject Opposition amendments and that the House will continue broadly to support the delivery of devolution, on which there is so much consensus and support.

--- Later in debate ---

[Greg Clark]

I thank all hon. Members from both sides of the House who have contributed to the development of the Bill, particularly those who participated in the extensive scrutiny on the Floor of the House both in Committee and on Report. The House will observe that we have followed the principle of listening to the views of Members, both in Committee and on Report. We made several improvements to the Bill after having heard serious representations from those across the House. I want to put on the record my thanks to my officials and to the Clerks, who have guided us adroitly through every clause.

I also want to thank councillors of every party and business leaders from across the country who have helped to give this Bill the momentum it deserves by embracing the localism agenda that began in the last Parliament. Important though the Bill is, it is worth noting that it is not the only means by which devolution is being advanced. For example, the Chancellor’s announcement that 100% of business rates would be retained by local government, rather than sent to the Treasury, is a significant step forward for the greater independence of local government.

I want the Bill to commence several things. I want it to allow the often latent potential for economic growth across all parts of the country to be better unleashed. The Bill and the process that we have introduced have brought businesses right across the country into close collaboration with their local authority leaders. The degree of enthusiasm for this has been gratifying.

The Bill allows reform where civic leaders and councillors desire it. It is a Bill that proceeds from the bottom up, rather than the top down. That makes it a novel Bill in the history of legislation concerning local government that this House has considered. It is a Bill that does something that previous Governments have baulked at, which is to transfer deliberately powers that Ministers and Governments have held and exercised in Westminster and Whitehall to authorities across the land. The insight of the Bill is that those objectives can be achieved together if local people are given their voice and allowed to set their arrangements in their own way.

The breakthrough is the recognition that not all places need to be the same. One of the glories of this House is that we know that each of our constituencies is very different from the others. No two places are the same. A world in which policy is identical in every part of the country is a world in which policy is not well set for particular parts of the country. Each place has a different history, different strengths and different capacities.

In the past, proceeding at the speed of the slowest has hampered efforts to devolve. Therefore, the approach that we have taken has been to invite every part of the country to make its proposals to the Government from the bottom up and to encourage those with the most ambitious proposals to advance them, while encouraging other places to find their feet and take the powers that they want for themselves and their people.

[Mr Chope]

Will my right hon. Friend give the House an assurance that amendment 56 will not be used by the Government to force change on any local authority?

[Greg Clark]

I will indeed. My hon. Friend raises an important point. The whole process by which we have operated and negotiated with places has recognised that the best ideas come from local places themselves. Previous local government Bills have attempted, with unhappy consequences, to impose a Government view of how local government should be organised on reluctant local authorities. This Bill does not do that and the amendment that he mentions will not be used for that purpose either. Rather, it will bring local communities and local authorities into a discussion about what is best for their area.

--- Later in debate ---

[Mr Chope]

I thank my right hon. Friend the Secretary of State for the thoughtful way in which he responded to the concerns that were expressed about amendment 56. I think that what he said will be very helpful in ensuring that the Bill is not just about devolution but evolution, and that changes happen gradually and work with the grain of what the people want locally, rather than being imposed top-down and from the centre.

What concerns people about local government—apart from the level of local taxes—is their wish to have some control over the way in which their own communities develop, and to control planning in particular rather than its being controlled by much more remote communities. For a short time I was a member of the Inner London Education Authority, which purported to make decisions on education matters throughout the inner-London boroughs. Most of its members had never ventured outside their own local authority areas, let alone visited all the other parts of London that were covered by ILEA. The danger with very large authorities is that they can lose touch with the sensitive issues that cause the greatest concern to our constituents and to local residents. I hope that as we evolve different administrative and representational models for local government we will bear in mind the need to retain the very powerful local involvement in planning. I speak on behalf of the people of Christchurch, an ancient borough with a priory church that goes back over 900 years where people enjoy the opportunity to elect their own local mayor. One of the downsides of some of the proposals is that they could result in people losing the power to be able to elect their own local mayor for their council—the person who could speak on behalf of the town. Councillor Spreadbury, who, sadly, died about a year ago, had the privilege of being the mayor of Christchurch in five successive decades, having welcomed Her Majesty in 1966 and then had four successive terms. He was typical of a local person brought up in the area and truly representing what the community felt.

Why not retain the distinctions between the different parts of our country? Why try and merge and homogenise the New Forest with Christchurch or Christchurch with East Dorset? A lot of change could be achieved by allowing back office services to be worked out together and by having single chief executives instead of multiple chief executives, but we must not lose sight of the fact that ultimately local government is for most people the body to which they look to take decisions in the best interests of the local citizens.

Question put and agreed to.

Bill accordingly read the Third time and passed, with amendments.

Junior Doctors Contract

Christopher Chope Excerpts

Friday 20th November 2015 Commons Chamber

[Alistair Burt]

Let me see what Sir Bruce Keogh said. [Interruption.] I did not write the letter, so I will have to look through it. He said:

“I would reiterate to both sides that I believe the best way to ensure patient safety is for the planned action not to take place. I would strongly urge you, even at this late stage, to come back to the negotiating table.”

As far as conciliation is concerned, I have made it entirely clear that the Secretary of State has not ruled it out. I cannot see ACAS mentioned in the particular letter that I am looking at. Sir Bruce Keogh said that there must be direct negotiations between those who know most about the matter. The Secretary of State has said that if that does not work, he is open to conciliation.

The Secretary of State has reviewed the contract, published the terms and dealt with the BMA, which said first that it was a pay issue, then that it was a safety issue and then that it was an issue about imposition. At each stage, it has moved the goalposts, whereas the Secretary of State has been open about what he wishes to see. It is now up to the negotiations. We all want negotiations to happen because nobody wants to see the withdrawal of junior doctors’ work and, I suspect, neither do they.

[Mr Christopher Chope (Christchurch) (Con)]

Is not the root problem that the NHS is a monopoly employer of junior doctors? If the veterinary profession can provide 24/7 care for sick animals, why cannot junior doctors provide the same for sick people?

[Alistair Burt]

As the House is well aware, the Commonwealth Fund said recently that the NHS was the best in the world. NHS staff, by implication, are the best in the world. They do an extraordinary job and junior hospital doctors do a fantastic job. Patient satisfaction is extremely high. We want that to continue. There is no reason to believe that NHS Employers, which is also calling for negotiations to continue and for the strike action not to take place, is not in full view of what staffing it needs to create an even safer health service. Its judgment is that the contract set out by the Secretary of State to be negotiated on provides the best basis for the employment of doctors in the health service.

Male Suicide and International Men’s Day

Christopher Chope Excerpts

Thursday 19th November 2015 Westminster Hall

[Philip Davies]

I am grateful to my right hon. Friend for coming to the debate and making that point. I would have preferred the debate to be in the main Chamber, especially given that the International Women’s Day debate is held there, but I am grateful that we have the opportunity to raise these issues, which we have never done before, so it would be churlish of me to be too critical.

I want today to be the day when we in this House start to deal with some of the forgotten men’s issues and realise why the political correctness that underpins issues relating to the differing treatment of the sexes can be damaging to men. It might sound odd for someone leading the debate on International Men’s Day to say this, but in many respects, I would rather we did not have to be here having this debate, because when we think about it, in so many ways, considering men and women separately as if they live their lives in complete isolation from one another is ridiculous. Neither group is isolated. Both sexes have mothers and fathers, sisters and brothers, uncles and aunts, grandmothers and grandfathers, sons and daughters, husbands and wives, boyfriends and girlfriends. Every woman has related male parties and therefore a vested interest in men’s issues.

The problem is that virtually everything we do and debate in the House seems to start from the premise that everything is biased against women and that something must be done about it. There is never an appreciation that men’s issues can be just as important and that men can be just as badly treated as women in certain areas.

The hon. Member for Belfast East (Gavin Robinson) supported my request for a debate, and I know he is sorry that he unfortunately cannot be here today. Had he been here, he no doubt would have shared the fact that last year, Belfast City Council hosted its first event to mark International Men’s Day. I understand that the event was held in Belfast castle and opened by the First Minister and the Lord Mayor of Belfast at the time, Nichola Mallon, following a proposal by Alderman Ruth Patterson. It seems our Ulster friends appreciate that there are some specifically male issues that should be addressed, with both sexes involved.

I want to be very clear: I do not believe there is actually an issue between men and women. Often, problems are stirred up by those who might be described as militant feminists and the politically correct males who sometimes pander to them. Members do not just need to take my word for it. Before the Equal Opportunities Commission was merged into the Equality and Human Rights Commission, it conducted research that found women had very clear views on these matters. Its findings included the following conclusion:

“There was little support for the idea that women, as a group, are unequal in society today.”

Presumably, that went down like a lead balloon in an organisation dedicated to fighting for women’s interests and rights, so it was pretty much swept under the carpet.

One of the most depressing things to happen recently was the introduction of the Select Committee on Women and Equalities. After everything else, in 2015 we have a separate Committee to deal with women’s issues, on top of the Women’s Minister, Women’s Question Time and the many strategies in this country that only deal with women.

For the record, I could not care less if every MP in this House were female or if every member of my staff were female, as long as they were there on merit. To assume that men cannot adequately represent women is a nonsense, just as it is to say that only women can represent other women. As a man, I can say quite clearly that Margaret Thatcher represented my views very nicely indeed, but I am not sure she would be a pin-up for many of the politically correct, left-leaning women who are obsessed with having more women in Parliament today.

It seems to me that we have an “equality, but only when it suits” agenda in Parliament that often applies just to women. The drive for women to have so-called equality on all things that suit the politically correct agenda but not on the things that do not is a great concern. For example, we hear plenty about increasing the number of women on company boards and increasing female representation in Parliament, but there is a deafening silence when it comes to increasing the number of men who have custody of their children or who have careers as midwives. In fact, there generally seems to be a deafening silence on all the benefits women have compared with men.

[Mr Christopher Chope (Christchurch) (Con)]

Would my hon. Friend add to that list the deafening silence about the shortage of male teachers in primary schools, who are important male role models?

[Philip Davies]

My hon. Friend is absolutely right; we hear very little about that. If there were a shortage of female primary school teachers, I suspect we would hear a great deal more about it.

The fight for equality on all things that suit women has ended up in a situation where we are quick to point out that women need special protections and treatment in certain areas but need greater equality in others. Let me give the example of prison uniforms. Men in prison have to wear a prison uniform; women in prison do not. How, I have asked on many occasions, can that possibly be fair? Where is the equality in that? I will come on to the treatment of men and women in our justice system later, but that is clearly an issue. What is the explanation? I am told that it is because women are different. As I have said, it is a question of equality, but only when it suits.

Off-patent Drugs Bill

Christopher Chope Excerpts

Friday 6th November 2015 Commons Chamber

[Marcus Fysh]

My hon. Friend makes a good point. The General Medical Council says that, traditionally, doctors have been reluctant to do that, partly because they may be wary of prescribing drugs for new uses owing to the increased level of personal liability that they may encounter.

Providing a way to overcome this reluctance, where efficacy has been demonstrated through licensing, deals with the argument made by the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), in the debate on the previous Bill that the current law best meets the individual clinical needs of patients. The flexibility clinicians currently have to prescribe medicines, which my hon. Friend described, is fine, and it is each doctor’s solemn prerogative, but it should not be used as a structural excuse not to pursue new treatments where they have been shown to be effective for non-clinical reasons. In practice, that can encourage a lack of consistency and assurance for the patient because of the lack of NICE approval in the form of a technology appraisal. NICE is, in fact, in a very good position to conduct studies that test efficacy on particular subsets of patients, with their consent.

A partnership in my constituency between Yeovil District Hospital NHS Foundation Trust, Somerset clinical commissioning group, South Somerset GP federation and Somerset County Council was selected this March by a rigorous NHS England process to be one of 29 partnerships spearheading new ways of working—a vanguard project in finding new models of care. This partnership, called Symphony, is looking in particular at the integration of health and social care, bringing together GPs, hospitals, community hospitals, mental health and social services, and is focused on joint commissioning based on outcomes for patients. The intention is for the lessons learned in implementing this new model to be taken on board in replicating the integration process across Somerset and beyond. We need to learn the lessons and move forward together—fast.

I believe that this vanguard, which is led by very committed and talented people in each partner organisation—I congratulate and encourage them today—could act as a leader not only in developing this new care model, but in working with NICE in its role under the Bill to conduct technology appraisals for new uses of off-patent drugs.

This has particular application to one of the most difficult issues of our time—the fact that our population is ageing rapidly. There are areas of Somerset, as elsewhere in the country, where a majority of people are of retirement age—and that is likely to increase dramatically over coming years. The management of conditions that are becoming more prevalent as our population ages must be taken forward with every tool available to us.

A report written by the governors at Yeovil district hospital in October last year shows that there has been an increase in the number of local patients with suspected cancer. Indeed, Somerset has one of the highest proportions of cancer prevalence in England. This may come as no surprise, as it is a very attractive place to live and work, and it has attracted many people moving from other parts of Britain, with many choosing to retire in the area.

I strongly support the new cancer drug fund that this Government have implemented, which has given more cutting edge treatment options to those with cancer, but we can go further by increasing access to new treatments through off-patent drugs, which can be much cheaper.

[Mr Christopher Chope (Christchurch) (Con)]

My hon. Friend, like me, strongly supports the Bill. Time is of the essence, so I think the best thing we can do as supporters of the Bill is to reserve what we wish to say until Committee, so that the Government can respond to this very important measure. [Laughter.]

[Marcus Fysh]

I thank my hon. Friend, who makes a good point—I am almost finished!

Given the seriousness of our healthcare challenges, I believe the Government should seek licences for off-patent drugs in new indications, thus increasing equality of access to proven treatments at an affordable price for more individuals and their families across our nation. I commend the Bill to the House.

--- Later in debate ---

[Alistair Burt]

When I get a chance to make a little progress, I can explain to my hon. Friend why that is the case.

[Mr Chope]

rose—

[Alistair Burt]

I will take one last intervention.

[Mr Chope]

I am grateful to my right hon. Friend, and I feel his pain. He says that he is concerned that he will not have sufficient time today to explain the Government’s position. In that case, why does he not allow this Bill to go into Committee, where he would have oodles and oodles of time in which to explain fully the Government’s position?