Family Visits in Health and Social Care Settings: Covid-19

Esther McVey Excerpts

Wednesday 11th November 2020 Westminster Hall

[Esther McVey (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new call list system and to ensure that social distancing can be respected. Members should sanitise their microphones using the cleaning materials provided before they use them, and then place those materials in the bin. They should also respect the one-way system around the room. Members should speak only from the horseshoe, and they can speak only if they are on the call list—that applies even if debates are undersubscribed.

Members cannot join the debate if they are not on the list. Members are not expected to remain for the wind-up speeches. I remind hon. Members that there is less of an expectation that they stay for the next two speeches once they have spoken—that is to help manage attendance in the room. Members may wish to stay beyond their speech, but they should be aware that if there are lots of speakers, doing so might prevent Members in the seats in the Public Gallery from moving to the horseshoe.

[Joy Morrissey (Beaconsfield) (Con)]

I beg to move,

That this House has considered family visit access in health and social care settings during the covid-19 outbreak.

It is an honour to serve under your chairmanship, Ms McVey. My main focus in speaking today is to highlight the need for improved patient advocacy and adult safeguarding via visitation rights for family members of working-age disabled adults in full-time residential care, including those admitted to hospital. Such patients often cannot speak for themselves and need additional access to family members who are able to advocate and communicate on their behalf.

I applied for the debate because of an awful situation of a mother in my constituency—a mother, much like me or any hon. Member present, who has had to endure a situation that I hope no mother has to face in the future. She is a teacher, a local community advocate, a single mother and someone who has tirelessly fought for her child’s care needs. She was prevented from caring for her son, Jamie, and forced to abandon him to a care home that did not live up to its name. At 21 years old and with no visitors, he was left isolated, bewildered and depressed, often calling out in anguish, “I want my mum. I want my mum.”

Jamie was a warm and affectionate young man who loved touch, kinaesthetic learning and being with people. His mother was denied access to her child, and I cannot begin to imagine what it must have felt like, knowing that her son was denied the care of his family for months—denied a hug, denied the comfort of a warm hand holding his, and denied dignity in his suffering. As a mother, my constituent felt powerless but sure that, had she been able to see him, she would have identified his decline and been able to intervene.

Underfed, Jamie wasted away, getting thinner and thinner in his confusion and isolation. Separated from those he loved and trusted, with multiple bedsores and open wounds left untreated, he began to withdraw within himself and into a catatonic state of unresponsiveness—a young adult with complex disabilities and care needs, left to suffer in silence. By the time his mother was able to see him, it was too late. She reflected on the lack of status that she felt as a mother, which she felt was shared by many family members. It felt to her as though families are often seen as a nuisance or even a threat, and they are sidelined and ignored by some in adult care homes. This mother also felt strongly that some adult care homes do not embrace the care of the whole person.

Jamie entered full-time care at age 13. As a child in a care setting, it was wonderful. The care was holistic and helped support Jamie in every aspect of his daily life and learning. He thrived in that environment, but the change came when he moved into adult social care. Many adult care homes are excellent and highly skilled in supporting adults with complex disabilities, but others—it might be a very small minority—seem reluctant to work with families or to provide adequate levels of transparency and care. It is an ongoing problem, which existed well before the covid pandemic; that has only highlighted these issues.

Disallowing visits or video links that allow families to see and interact with patients takes away a level of scrutiny that makes those already vulnerable chronically so. Depriving vulnerable working-age disabled adults who have complex disabilities and needs, especially those who already struggle with communication, of the love and support of their families is inhumane and cruel. As a society, we lessen our dignity and humanity when we allow our loved ones to perish alone and to wither away and give up on life. Jamie had no voice, so I am here today to speak on his behalf, and on behalf of his mother and grandmother, to make sure that his story is remembered and that other deaths can be prevented this winter.

I welcome the Government’s support for care homes and adult social care during the pandemic and I thank the Minister for reaching out to me the moment that I applied for this debate. She has been incredibly helpful and I thank her for her active participation in finding a solution and justice in Jamie’s case. I thank the Government for their care home support package in March that announced £1.6 billion funding for local government and £1.3 billion to go to the NHS and social care. In April, a further £1.6 billion was announced for local government and for the adult social care action plan and, in September 2020, the Government published “Adult social care: our COVID-19 winter plan 2020 to 2021”, which was shaped and recommended by the adult social care taskforce. The plan set out key elements of national support available for the social care sector for winter 2020; I welcome everything that was outlined in it.

Finally, I welcome the Government’s announcement on visiting guidelines from 5 November. Allowing visitation is so important for patient care, advocacy, safeguarding and mental wellbeing, particularly for disabled vulnerable patients who may not be able to advocate for their own care needs. Allowing family members to visit could save many lives during the winter months and prevent other vulnerable disabled patients from being neglected, abused and left to suffer and die in silence, while restoring a level of compassion, empathy and humanity to patient care both in hospital and in the care home setting.

Now that we are in the second lockdown I ask the Minister and others to consider what lessons we have learned from the excess deaths in care homes and from the adult safeguarding issues raised during the first lockdown. I understand that the main goal of the Department of Health and Social Care is to protect the NHS, particularly during the winter months, but we also need to save the lives of the vulnerable disabled by allowing each patient to have a family member with them as their advocate and carer. That would be aided by the improvement in mass testing in the coming months and the availability of personal protective equipment. This cohort needs a special exemption. A carer would allow for lives to be saved and, with mass testing and the arrival of a vaccine, that could help safeguard many other lives in the future.

If the NHS reaches capacity, as it often does in the peak winter months of January and February, another alternative would be for a family member or carer of the vulnerable patient to care for them directly in a home, a hospital or care home setting. A family member or loved one can also help with caring for the vulnerable person at home, further reducing the burden of care to the NHS. Many of these family members are able-bodied adults who are at a lower risk of developing serious health problems from covid-19 transmission. We also have to allow people to care for those they love.

I welcome the Government’s announcement in the winter care plan that local authorities should work with social care services to reopen safely, especially day services and respite services. Reopening such day centres would allow families to manage a disabled loved one’s care more effectively, while perhaps reducing the need for full-time residential care and lightening the burden on full-time carers who do not have access to vital daycare facilities. The Relatives and Residents Association, which is an advocacy group, reported that helpline callers had been concerned about the standard of care falling as already stretched services face staff shortages and burn-out. Stopping visits from family and friends restricts the ability for oversight and advocacy.

One of the callers to the association’s helpline said that his wife

“starved herself to death. Her death was due to the pandemic but she did not die from the virus itself. It wasn’t coronavirus—it was death due to a refusal to eat. She was isolated and alone.”

Perhaps the Minister could provide clarity as to whether families are now permitted to remove their loved ones from residential care home settings, and what the protocol for that would be, moving forward.

Jamie’s care home was in a neighbouring county, but his mother and grandmother lived in my constituency. Buckinghamshire County Council and the NHS are excellent and I worked extremely closely with them during the pandemic and the first lockdown to protect care homes and elderly residents, and to reduce the rate of transmission and death in care homes. I was proud of the work that we all did to protect the elderly in South Bucks.

However, the issue of working-age adults with complex disabilities in residential care facilities completely passed me by in the first lockdown, because many of my residents had additional needs and were at home. They were reliant on day centres and respite care. That was the issue I was seeing, not the issue of the long-term residential care crisis.

I did not learn about Jamie’s treatment during lockdown until the week before his death, when it was too late for me to help. That is why I am raising the matter now. This patient cohort cannot speak or advocate for their own care. They require extensive care and support from care home and hospital staff, and could run the greatest risk of being sidelined during a spike in hospital admissions, when staff resources are spread more thinly and they have to prioritise patient care.

Because these patients require the most care it is important that they have a family member who can be with them as their patient advocate and carer, to help ensure that they make it through these winter months. I welcome the Government’s announcement of a vaccine and I know that, with the highlighting of safeguarding, we can get through these winter months, and that Jamie’s memory will not be forgotten.

[Esther McVey (in the Chair)]

It might be helpful to colleagues to know that I intend to call the Front Benchers by 3.30 pm at the very latest. I would like to ensure that all colleagues get to speak today.

Contaminated Blood

Esther McVey Excerpts

Tuesday 11th July 2017 Commons Chamber

[Ms Esther McVey (Tatton) (Con)]

Trust is the key word—trust and faith, if people have that, in the inquiry. Every story is different. My constituent Barry Flynn is a twin. His twin is not here, but on his behalf he wants to be able to trust the inquiry. He wants the victims to be heard and to decide the remit, and he wants their evidence to be taken. Does my hon. Friend agree that that is the way to get trust?

[Dr Johnson]

Absolutely; the victims and their families have the right and deserve to know what happened. They deserve answers to their questions. They need to know when people knew that these blood products could be causing harm and, if those people did know, why the products were still given.

The House should be under no illusions—I am sure it will not be, after listening to many eloquent Members describe their constituents’ cases—about the suffering people have been through, losing their family members. There is a stigma that still exists today around many of these medical conditions, particularly HIV. Other people, such as victims’ wives and children, have been put at risk, and many others still suffer today from poor health.

I very much welcome the announcement of the public inquiry, which I hope will get to the bottom of all the issues. I hope that the victims receive the compensation they deserve.

Care (Older People)

Esther McVey Excerpts

Tuesday 6th September 2011 Westminster Hall

[Gareth Johnson]

The two issues are separate. When Southern Cross went bankrupt, for example, it blamed in part the increase in health and safety legislation, some of which was sensible and some completely unnecessary. Ensuring that people who reside at care homes have some rights over the land that they are living on is a separate matter. I do not see that as placing increased burdens on those running the care homes; it simply gives the individual residents the same rights that we would have if we leased a flat. Those living in residential care homes, who are perhaps among the most vulnerable in society, should surely have that extra protection. The challenge for the Government is to find a solution that is both affordable and fair—affordable, so that the Government can cope with the ageing population and the increasing demand on care homes, and fair, so that the elderly are not forced to sell their homes and lose out because of their earlier, sensible financial decisions.

[Esther McVey (Wirral West) (Con)]

I am delighted to take part in the debate, which echoes the conversation I had earlier in the week with the residents of Hoylebank in West Kirby about the diverse and huge issues involved. Those residents believe that they are part of an invisible generation. They would like to be visible and, like my hon. Friend the Member for Chatham and Aylesford, they are calling for a Minister for the elderly to go through everything thoroughly.

[Gareth Johnson]

I am sure that the residents in Hoylebank have similar difficulties to many residents all around the country: they are often screaming loudly and not being heard by anyone. It is incumbent on Government to listen to the messages we hear from care homes and to see where we can make improvements to their rights to ensure that their homes are protected as well as possible. We need to find a more sensible balance than is currently in place. Care homes provide a vital link in the health chain. The hon. Member for Birmingham, Erdington (Jack Dromey), who is not now in the Chamber, made the important point that if we reduce the availability of care home provision, the amount of so-called bed blocking in hospitals will inevitably increase, with all the extra difficulties and costs arising.

We all want to facilitate elderly people remaining in their homes as much as possible, but the ideal should be about choice and not about forcing people who want to go into a care home to stay at home, or forcing people who want to remain in their own homes to go into care. Their individual choice should be paramount, and their opinion should count for a great deal. I therefore look forward to the spring, when the Government intend to announce their intentions regarding the Dilnot report and what happens thereafter. I look forward to finding a balance that works for the whole of the older generation.

Patient Confidentiality (Mentally Ill)

Esther McVey Excerpts

Thursday 9th December 2010 Commons Chamber

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

I am delighted to have secured this debate. This is the second time I have addressed the House today and I hope that the consensus that was lacking in the earlier debate will be restored for this one, because hon. Members in all parties have the welfare of the mentally ill very much at heart. We are all constituency Members and we all have to deal with sad cases. Sometimes, we can do something to help people and sometimes it is too late to do anything to help those whom we have lost, but we can still try to achieve something in their memory to help other sufferers in future.

By way of background, I want to make it clear that I have no expertise or practical qualifications in mental health and that my doctorate is not a medical degree. I do, however, have a certain amount of experience stemming from when I first set foot in the House, in 1997, and came second in the private Member’s Bill ballot. The individual who came first in the ballot promoted a Bill to ban hunting and the Chamber was packed on that Friday. I am sorry to say that when we came to debate my private Member’s Bill, which was on improving conditions for people who suffer catastrophic breakdowns and need in-patient treatment, the House was back to its normal sparse attendance. Nevertheless, despite that somewhat cockeyed sense of priorities, the issue of mental health is an enduring one that requires great sensitivity.

Since those days, I have from time to time raised issues that affect my constituency. Most recently, I have been concerned about the closure of the psychiatric intensive care unit at Woodhaven hospital, which was constructed on the site of a former mental institution. I was delighted when that great facility was opened in my constituency a few years ago, and I worry about its future now that it has lost the intensive care unit. I recently set up a small group of people from different parts of the spectrum of mental health concern in the New Forest area. I asked members of that group, which is called “Support our Mental Health Services”, to drop me a note about why they had joined it. One lady, Mary Stephenson, is particularly concerned about the loss of the PICU at Woodhaven, even though we are left with an acute ward. She wrote:

“On any acute psychiatric ward, there should be an opportunity to remove very disturbed, noisy and possibly violent patients, to have private peace and ‘cooling-off’ facilities.”

That is also for the benefit of other people on the acute ward who do not require intensive psychiatric care. Unfortunately, that facility has now been lost.

We are also concerned about the future of Crowlin House, which is a sort of halfway house. People have joined our group because they are concerned that if that residential facility were to close, those currently housed there might find themselves put into care homes for the elderly or for those with dementia. That would not be suitable for people who are, in a sense, halfway between being in-patients and being in the community.

Other people have joined us from Solent Mind, which supplies various important services. It has drawn to my attention the fact that the community mental health team is coming under pressure, as it faces losing 20% of its budget because of the introduction of improving access to psychological therapies—IAPT. In itself, IAPT is a good idea, but it is fairly low level and not a specialist service. It was supposed to be in addition to the services available to my constituents. As I have said before in this House, the danger can be seen in what happened to the specialist student service in Southampton—I cite that example in view of today’s earlier debate. That service is no more because its functions were supposedly moved in the direction of IAPT, but in fact IAPT was not able to take them up. In addition, one of the beneficiaries of a scheme called supported permitted work, David Hayward, has written to me expressing his worry that that is under threat, and I understand that there are concerns about the position of the vocational advice service—my constituent, Lorraine Miller, has written to me about that.

I have painted a general picture about the state of mental health services, which is mixed. We have lost some good services, but we retain quite a lot of valuable assets, although we are worried that they might go. That is why we are setting up a campaign group to try to ensure their future.

My specific concern tonight is the problem that arises when somebody is mentally ill and the people treating that person feel unable to share information about that person’s treatment with their carers or their next of kin. For once, I can say that some excellent work has been done on the theory, but I am a little worried about the practice.

I have with me a briefing paper prepared under the imprint of the Department of Health, King’s college London, the Institute of Psychiatry at the Maudsley, Rethink and the NHS service delivery and organisation research and development programme. The paper goes right to the heart of the issue. It is entitled “Sharing mental health information with carers: pointers to good practice for service providers”, and it seeks to tread a delicate line between preserving patient confidentiality and letting people who care about these patients have vital information about them when they are not in their right mind.

[Esther McVey (Wirral West) (Con)]

I congratulate my hon. Friend on securing this debate and beating me to it. I wish to raise the issues faced by a constituent who looked after her husband 24/7 until he passed away in 2006. He suffered from hallucinations, paranoia and depression. He also had falls, lost consciousness and regularly became violent towards her, all of which put a lot of pressure on their relationship and left her upset. Her health deteriorated and she felt that she could not look after him properly. It was not until he passed away that she learned that he had dementia. I have a question for the Minister: should the safety of the carer be put ahead of the patient’s right to confidentiality? Should we consider the severity of the patient’s mental health problem in determining whether they are fit to keep their condition a secret?

[Dr Lewis]

I am so grateful to my hon. Friend for staying after this somewhat trying and long day to make that important contribution, because it shows that I am not talking about some quirky, one-off situation. It is a very real dilemma, which requires great thoughtfulness and sensitivity.

I do not have time to go into the contents of that briefing paper in great detail, but I shall select just a couple of quotations that show how good it is. It says:

“Carers play an important role in many service users’ lives. Their knowledge and expertise represent an enormous resource for statutory and voluntary mental health services. These are reasons why it is so important to include them through sharing information. Providing carers with information to support them in their role can improve outcomes for both service users and carers…Carers fear being denied access to important information to help them in their role. They are also concerned that their own confidences may be broken.”

I came to the topic through the case of Mr and Mrs Edgell—my constituents David and Kay—whose lovely daughter Larissa, aged 34, hanged herself in 2006. They have obviously done everything that they can to come to terms with that, but I have a detailed file, which I have shared, because I knew they would want me to, with the Department and the Minister. I shall not go into the detail, because I do not have the time to do so, but it shows that from the earliest stages, back in about 2000, they warned of their fears that Larissa, or Lara as she was known, was seriously at risk.

Subsequently, in about 2004, Lara made a serious suicide attempt, but between then and 2006, when sadly—tragically—she succeeded, her parents were unable to know what was going on between her, the people who advised her in the NHS and, indeed, the people whom she saw privately, the private therapists.

I made it clear to Mr and Mrs Edgell that I felt that little could be done to improve on the excellent briefing document that I have only briefly quoted. It is an admirable piece of work and—unlike so much jargon produced in-house and, dare I say it, within the NHS—admirably clear. It is a first-class piece of work, and I would not alter a dot or comma in it.

When Mr and Mrs Edgell first came to see me in 2007, I wrote to the then Under-Secretary at the Department of Health—the hon. Member whose constituency I should have looked up. Is somebody going to tell me Ivan Lewis’s constituency? I am not the only who is stumped. That is the first time I have known Mr Speaker’s encyclopaedic memory to let him down. Sorry about that, Mr Speaker.

Anyway, I wrote to the hon. Gentleman and said that my main reason for doing so was to focus on two main issues relating to what had happened—[Interruption.] A voice off tells me that he is the hon. Member for Bury South (Mr Lewis). I am glad that we have sorted that out.

I said that I was writing on two main issues:

“The first is the frequent invocation by doctors who were seeing Larissa of the concept of ‘patient confidentiality’ when her desperate parents were trying to look after her interests at a time when she was too unwell to be the best judge of them herself.”

I went on to say that, after Larissa took her own life, Mr and Mrs Edgell investigated that matter and discovered that the Department of Health had an extremely good policy, set out in the paper that I have described, which it issued in January 2006. The paper seemed to show, as I said in my letter,

“a clear understanding of the importance of sharing vital information with those nearest to the mentally ill person”,

but, I pointed out,

“the best policy in the world is worthless if the doctors concerned fail to apply it either out of ignorance or obstinacy.”

Mr and Mrs Edgell discovered only when it was too late how many times—it said how many in the notes of their daughter’s various visits to medical professionals—she had had suicidal thoughts.

The response from the hon. Member for Bury South was rather disappointing. I see that I did write the name of his constituency on the reply, so I apologise for having embarrassed Mr Speaker for no good purpose.

In the reply, the then Minister states:

“As you state in your letter, the Department of Health had issued excellent guidance regarding confidentiality and people with mental illnesses. However, as you may be aware, the Government’s task is to set the national agenda, to put in place national standards and provide overall health service funding. The responsibility for deciding how the national agenda is delivered locally and determining how best to allocate these resources to meet the needs to their local populations rests with local health communities.”

I did not think that that was an adequate response. What is the point of producing excellent guidelines on highly sensitive, critically important, life and death matters, in that way and then relying on individual trusts to bestir themselves to the extent that they decide to apply or not to apply them? For once, it was the Conservative Opposition Member who was asking for a bit more central direction because, in this case, central direction was necessary.

The second main concern of Mr and Mrs Edgell was the lack of regulation of the private therapists whom Larissa had been seeing. Larissa was 34 when she died, and was well and truly an adult. However, it is a matter of concern that, even after her death, the people treating her outside the NHS have refused to give up any notes or information about what they were doing during the period she was desperately in need of help. Again, the reply basically said that Mr and Mrs Edgell might wish to contact the British Association for Counselling and Psychotherapy, which is a voluntary professional organisation that currently helps the psychotherapy and counselling profession to self-regulate. Frankly, that is no proper method of ensuring compliance when private therapists have been taking part in the treatment of someone who has ended their life under these circumstances.

My time is pretty much exhausted, so I will confine myself to saying that I hope I have done justice to my constituents and to the memory of their daughter. They have not failed to understand the delicacy of the issues involved and they hope that their daughter’s death will mean that, in the future, people recognise that the next of kin and/or the carer must be taken into confidence when people talk about doing away with themselves, even if those people are adults.

Adults do not have quite the same rights when they are not operating within their normal mental framework. We talk about people being “out of their mind,” which is perhaps an old way of saying something unpleasant about someone, but there is a literal truth in that phrase. I do not come from a Christian background, but I feel a particular sense of sadness when I hear people singing the famous hymn, “Dear Lord and Father of Mankind.” The third line states:

“Re-clothe us in our rightful mind”.

When people are not in their rightful mind, they need professional help. The professionals need to talk to each other and the mentally ill need the help of the people who have their interests most closely at heart. Those people are the next of kin and the carers. I would be most grateful if the Minister could give some reassurance for the future.