BAME Blood, Stem Cell and Organ Donation
Jackie Doyle-Price Excerpts(5 years, 10 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
It is a pleasure to serve under your chairmanship, Sir Henry. I thank the hon. Member for Bedford (Mohammad Yasin) for securing this important debate on an issue that has been exercising me for the past year. Since I became Minister with responsibility for this area, the disparity in access for people from black and minority ethnic communities to blood, organs and stem cells has been of great concern to me. I have been working with NHSBT on this theme for the past year, and I hope I can give the hon. Gentleman some comfort. We are making some progress, but I want to assure all hon. Members that I am under no illusions about how big this challenge is, for a host of reasons that I will come on to.
I thank the hon. Member for Wolverhampton South West (Eleanor Smith) for being here. I read her report with interest and agreed with every word. The principles she articulated are key to increasing donation. If I were to highlight one particular issue, it would be the culture of normalising donation in those communities. The hon. Member for Hampstead and Kilburn (Tulip Siddiq) has just given a beautiful example of how local leadership can do that, and that is something we can all take away.
Whenever we debate a subject like organ and blood donation, everyone brings their own personal story, because we have all been touched by people who have needed a transplant. That is what brings the issue alive for us; it is about saving lives.
My overall objective is to increase the rate of donation across the board. Although it is true that a person is more likely to die waiting for a transplant if they are from a black and minority ethnic community, the fact is that we are losing too many people who are waiting for a transplant. We need a concerted effort to improve the rate of donation from all parts of our society. There is much we can do to achieve that. Hon. Members will be aware of the private Member’s Bill from the hon. Member for Coventry North West (Mr Robinson), which seeks to change the opt-out system. It will be a big help, but it will not solve the problem by itself. There is a lot more we need to do to educate the public about the importance of donation and to dispel the fears and myths about it.
Colleen Fletcher
The Minister mentioned the private Member’s Bill of my hon. Friend the Member for Coventry North West (Mr Robinson). I hope she is aware that stem cell transplantation is very much done when the person is alive, which is what makes it so easy. People do not have to die to donate. I just want to make sure people listening to this debate know that.
Jackie Doyle-Price
That is a point well made. It is the same for blood, of course—donors do not have to die to give blood. People who give blood do so regularly because they get into the habit and it has become normal. Perhaps we need to do a lot more about stem cell transplants.
I am particularly moved to be having this debate today because only this weekend I lost a very good friend of mine to lymphoma at the age of 47. That brings home how cancer and illness can kill people at a very young age. It will be in honour of my dear friend David Furze that I will do something to reboot stem cell donation.
On the barriers to more donation, some have serious concerns about faith and religious beliefs. Tackling those concerns is a big challenge for us in Government, because of the element of trust. The hon. Member for Bedford mentioned that quite often people do not trust medical professionals, but they trust Government even less. We must find innovative ways of getting that message out. We need the right messengers. Dare I say, the people in this Chamber are among the right messengers? Most of us have respect in our communities and are able to show leadership in our communities. We can go out, speak, raise awareness and encourage donation. I have given NHSBT the challenge to do exactly that.
Eleanor Smith
Other organisations are also trying to do that, such as the African Caribbean Leukaemia Trust, but they get very limited resources. One of my recommendations is about sharing resources with groups that are already organised and going out to the community, because with limited resources they can do very little.
Jackie Doyle-Price
The NHSBT strategy has that in mind. Recently, we had a faith summit where we worked with the individuals who are able to go out and give those messages. The approach must be organic. I have also tasked NHSBT to work with me to develop an MP’s toolkit to help us to go out in our constituencies and develop the right networks and links. The hon. Lady is right to say that people from these communities will listen to their elders and other representatives, and that is why we need to work through those people. We are doing that with a number of organisations.
Turning to stem cell donation, all hon. Members articulated beautifully the real disparity of access to appropriate treatment. It is only by building and diversifying the UK stem cell register that we will be able to provide the best match for patients. Hon. Members have raised the issue of an international register; the Department funds Anthony Nolan’s efforts in this area. Members of the World Marrow Donor Association already promote global collaboration. We will continue to support that as best we can, working with Anthony Nolan and NHSBT.
NHSBT continues to grow both its cord blood banks and bone marrow donor registers, with the explicit intent of increasing the number of black and Asian donors. Overall, we have paid more than £20 million to NHSBT and Anthony Nolan specifically for stem cell donation since 2015. So far, we have made some progress in increasing donations from black, Asian and minority ethnic backgrounds, but not nearly enough to address the disparity. We will all continue to make our efforts count in that area.
I pay tribute to the initiative of the Bandhan Bedford Group that the hon. Member for Bedford mentioned. If there is a good local champion that captures local imagination, real progress can be made. We all need to encourage those sorts of activities.
Turning to blood, there is a real need for black donors and donors from the Asian community to increase supplies, not least because they are more likely to suffer from diseases that will require blood transfusions, specifically sickle cell anaemia. We are undertaking initiatives to increase the number of black and Asian blood donors. We are holding “know your type” events in high population areas, where people can learn their blood type with a finger prick test. That will help NHSBT to manage its blood stocks and develop a database of exactly the type of blood that there is a shortage of.
We are supporting others, such as the music of black origin awards, to reach audiences. Those who watch “Britain’s Got Talent”—I watch it—will have seen the B Positive choir, who did so much to raise awareness and were absolutely fantastic.
Mr Dhesi
In terms of outreach work, whether with the MOBO awards or otherwise, can the Minister outline the steps that have been taken to reach out via the media? I am not just referring to the national media but the culturally specific and ethnic media, which have a greater outreach in those ethnic minority communities.
Jackie Doyle-Price
The hon. Gentleman makes a good point. I could not give him a definitive answer at this moment in time. I would expect NHSBT to be using those outlets to spread the message. If it is not, I will make sure it does, but I will ask that question and I will write to him with a fuller answer.
Turning to organs, we have discussed that there are around 6,000 people waiting for an organ transplant, of whom 34% are from a black or Asian background. That illustrates the disparity, given that only 6% of deceased donors were from those backgrounds. There is a real challenge to ensure that we are able to save all the lives we can through transplant. We have a big campaign designed to improve the rates of organ donation.
We estimate that if the private Member’s Bill from the hon. Member for Coventry North West successfully passes through Parliament, it will save an additional 200 lives a year. That is not to be sniffed at. As a Health Minister, I would be failing in my duty if I did not do everything I possibly could to secure the passage of that Bill, and I will do that. But that does not alter the fact that we still need more black and Asian people to agree to go on the register. We are working on a number of tools to address people’s real concerns, whether they are about faith, belief or heritage. We need to be able to produce materials that attack misconceptions but do so in an extremely sensitive way to those who will react to them.
Again, I encourage all Members to get involved in helping us to develop those tools and in spreading those messages as best they can. We have a library of resources that are specifically tailored to particular communities, but I am always open to any suggestions for what more we can do, because ultimately this is a very serious injustice that we need to tackle. I have a very large black African Christian community in my constituency, so I am used to engaging with them, having these debates and encouraging them to sign up to the register. We can all do that.
I am very grateful to the hon. Member for Bedford and to all hon. Members who have shown support for this debate. I am under no illusion about the challenge here, but I am very heartened to see that so many Members recognise that this is a problem and are taking positive steps to do something about it. Those are the ingredients for success, but I will not be complacent—this is a tough one for us to tackle. I thank all donors, whether of blood, stem cells or organs, for everything that they have done to save people’s lives.
Question put and agreed to.
Oral Answers to Questions
Jackie Doyle-Price Excerpts(5 years, 10 months ago)
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Liam Byrne (Birmingham, Hodge Hill) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
We take a comprehensive approach to reducing health inequalities, underpinned by legal duties. This includes addressing the wider causes of ill health, promoting healthier lifestyles, and tackling differences in health access and outcomes. A formula is used to allocate funding to clinical commissioning groups, and health inequalities form part of this.
Liam Byrne
Birmingham has some of the worst health outcomes in the country. It is not a surprise, as A&E waits of over four hours are up by more than 127% in recent years, and waits of more than 18 weeks for treatment are up by 65%. Yet, according to freedom of information request responses I have received, our trusts in Birmingham have to make savings of £155 million this year. What are the Government going to do to save the health system in Birmingham, which is currently in a state of collapse?
Jackie Doyle-Price
It is disappointing to hear the right hon. Gentleman making such negative points about his local NHS when 86% of GPs in his area are rated good or outstanding. Everything about yesterday’s announcement will tell Members that we are not complacent about the health challenges facing us, and we will make the necessary resources available. It ill behoves Opposition Members to keep continually talking down our NHS.
Andrew Bridgen (North West Leicestershire) (Con)
Does the Minister agree that the best way in which to reduce health inequalities across the country is to continue to build a strong economy that offers good jobs and prospects to all the people of our country?
Jackie Doyle-Price
I could not have put that better myself—[Laughter.] Opposition Members can laugh, but the Government firmly believe that work is good for people’s health. We are committed to getting 1 million more people with disabilities into work so that we actually treat them as assets, and we are encouraging them to be more independent and to take control of their own lives. The only way to achieve that is by having a strong economy.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
When the coalition Government came into office in 2010, life expectancy began to stall for the first time in over a century. This, coupled with eight years of funding cuts, means that there are grossly disproportionate health inequalities across the country. For example, according to Northern Health Science Alliance, people in the north are 20% more likely to die early than people in the south. Is not it a failure of the Government’s funding deal for the NHS that it comes with no public health money to tackle these astonishing regional health inequalities?
Jackie Doyle-Price
No, it is not. Labour Members like to draw attention to north-south divides and so on, but the issues about health inequalities are much more complex than how money is spent and where. Within my constituency, for example, there are differences of 10 years in life expectancy depending on the particular locality. We need a much more multi-layered approach to tackling inequality, and that is what this Government will have.
Layla Moran (Oxford West and Abingdon) (LD)
Stella Creasy (Walthamstow) (Lab/Co-op)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
NHS England has a legal duty to commission services to meet local need, which includes people who are homeless, and we are very clear that a patient should not be turned away from a GP if they cannot produce any supporting documentation. If they state that they reside within the boundaries for the practice, the GP is expected to accept the registration. The same applies for dentistry, and training is in place to remind people of their obligations.
Stella Creasy
Mags Drummond is a Walthamstow woman on a mission, to try to help our many rough sleepers get decent quality healthcare, but she, like me, has hit a brick wall with our local dentists and doctors. It is little wonder that one study shows that 15% of homeless people have pulled out their own teeth because they cannot get access to services. Will the Minister meet Mags and me to look at what we can do to change that and make sure that her promises are not toothless?
Jackie Doyle-Price
Very good—I commend the hon. Lady for her wit, and I agree with her. Notwithstanding our expectations of GPs and dentists in this regard, it is quite clear that homeless people do not always have access to the treatment they should have. The hon. Lady will be aware of the work that we are doing to support rough sleepers, and I would be delighted to meet her and Mags Drummond to see what insight they can provide on how we can improve services in this area.
Several hon. Members rose—
Nic Dakin (Scunthorpe) (Lab)
There are homeless people in the Scunthorpe area who present with mental health problems. What are the Government doing to ensure that proper mental health support is there for people who present as homeless?
Jackie Doyle-Price
The hon. Gentleman is quite right. Mental health is both a symptom and a cause of homelessness, and we will tackle that as part of our work on rough sleepers.
Mr Speaker
Does anyone else want to come in on this? Apparently not. I do not wish to proceed to the next question because of the unpredictability of the time that it will take. Colleagues will want to prepare themselves for the one-minute silence that we are about to observe. I think I can say with some confidence that everyone who is in the House today will wish to observe that one-minute silence. Perhaps they will think it appropriate to stand. That one-minute silence is going to start very soon. The next question is grouped, so it would be highly inconvenient to take it. Any moment now we shall observe the silence. [Interruption.] There is much merit in repetition in certain circumstances.
Order. We shall now observe silence for one minute to remember those who died or were affected by the attack outside Finsbury Park mosque, I remind colleagues, a year ago today.
Mr Marcus Jones (Nuneaton) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
The mental health workforce plan published last summer underpins our expansion of mental health services, as set out in the “Five Year Forward View for Mental Health”. We aim to create 21,000 new posts in mental health by 2021.
Mr Jones
I thank the Minister for her response. Mental health is one of the many complex drivers of rough sleeping, and can add to the complexity of getting rough sleepers off the street and into accommodation. Will my hon. Friend say how the new mental health employees in the NHS can help us to get rough sleepers off the streets and into accommodation?
Jackie Doyle-Price
I hope the expansion of mental health services will stop people becoming rough sleepers in the first place by bringing forward support earlier in the process. In January, we announced a £1 billion investment in mental health, part of which will be focused on crisis care and helping people who are experiencing crisis to stay out of hospital. The workforce plan backs that commitment by planning 5,200 posts to support those in crisis. We will be working with the Ministry of Housing, Communities and Local Government on a forthcoming strategy to make sure we honour our commitments.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
It is not just the size of the mental health workforce that is critical, but the pressures faced within those workforces. We have just learned that there was the highest number of out-of-area placements in January since records were first kept. Mental health doctors and nurses often spend hours hunting for out-of-area beds, taking them away from other patients. When is the Government’s pledge to reduce and eventually ban out-of-area placements actually going to start to become a reality?
Jackie Doyle-Price
The hon. Lady is right to raise this issue. We are determined to end out-of-area placements, but clearly that will require behavioural change on the part of commissioners, as well as making sure that the investment takes place. I know she will continue to hold me to account on this issue, because it is clear that out-of-area placements can cause harm and we must tackle them.
Paula Sherriff (Dewsbury) (Lab)
According to data from 48 of 56 NHS mental health trusts, 3,652 patients suffered an injury in 2016-17 through being restrained—the highest number ever. There are concerns that increased use of insufficiently trained agency and bank staff since 2013 is contributing to this increase. Employing 21,000 new staff by 2021 just is not good enough. What is the Minister doing now to ensure that wards are safely staffed and patients are not injured?
Jackie Doyle-Price
I am grateful to the hon. Lady for her question. She will be aware that I have been working with her colleague the hon. Member for Croydon North (Mr Reed) on his Bill to limit the use of restraint, because we on the Government Benches also very firmly believe in that. An essential part of his measure will be to improve training for staff in mental health units. That will be a tool in making sure that restraint is minimised.
Sir Roger Gale (North Thanet) (Con)
Nic Dakin (Scunthorpe) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
I recently met the hon. Gentleman’s party colleague, the hon. Member for Birmingham, Selly Oak (Steve McCabe), to discuss this matter with the facility. We are very clear: we expect all clinical commissioning groups to honour the NICE guidelines. I am very cross that CCGs tend to view IVF services as low-hanging fruit with which to make cuts. That is totally unacceptable and I will be taking steps to remind them of that.
Robert Halfon (Harlow) (Con)
My hon. Friend has visited Princess Alexandra Hospital in Harlow and has acknowledged that it is not fit for purpose. Will he use the excellent £20 billion of extra NHS funding to ensure we get the Harlow hospital health campus we need?
Lisa Nandy (Wigan) (Lab)
Jackie Doyle-Price
I reject that accusation; we are far from burying it. The Prime Minister is looking at responding to the interim report. I will repeat what I said to the hon. Lady when she last asked this question. We are quite clear that the child migrant policy was wrong. We have apologised for that policy, and we have established a £7 million family restoration fund. The response from the Government to that report will be laid in due course.
Kirstene Hair (Angus) (Con)
Can the Minister provide an update on the work being undertaken by the policy research unit on obesity to consider the relationship between the many streams of marketing and obesity, and can he tell us whether the unit is looking specifically at childhood obesity?
Wera Hobhouse (Bath) (LD)
What comparison has the Minister made of the cost of preventing children and young people’s mental health issues by tackling adverse childhood experience in the first few years of life, rather than letting them develop into much costlier issues for school-age children?
Jackie Doyle-Price
The hon. Lady will be aware that there is much work going on in this area. We are clear that we need to tackle these issues in schools, which is in the Green Paper, but more support also needs to be given in the early years. We are looking at how we can do that.
Peter Heaton-Jones (North Devon) (Con)
Northern Devon Healthcare Trust recently announced that it is to share the chairman and chief executive of the Royal Devon and Exeter NHS Foundation Trust. Will the Minister meet me to ensure that the new arrangements will help to secure services in North Devon?
Mental Health Units (Use of Force) Bill
Jackie Doyle-Price ExcerptsFriday 15th June 2018
(5 years, 11 months ago)
Commons ChamberRead Full debate Mental Health Units (Use of Force) Act 2018 View all Mental Health Units (Use of Force) Act 2018 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 15 June 2018 - (15 Jun 2018)
Philip Davies
May I start by commending the hon. Member for Croydon North (Mr Reed), who is an excellent Member of this House? We clearly do not agree on a lot of things, but he really is an excellent MP. I commend him for two things. First, he has introduced legislation that is of particular interest to him, not least because of what happened to his constituent. He should be commended for doing that, and it goes to show the kind of local MP that he is. It is absolutely right that the tragic case of Olaseni Lewis has prompted him to introduce this legislation, the thrust of which I absolutely support, as he well knows.
Secondly, unlike many Members who promote private Members’ Bills, the hon. Gentleman has engaged in a rather constructive manner with everybody who has tabled amendments. I wish it were always like that—as we know, it often is not—but he has certainly engaged, and I absolutely commend him for that. The way in which he has conducted himself throughout the Bill’s passage through the House does him an enormous amount of credit, and I am grateful to him.
Having said that, there are parts of the Bill on which the hon. Gentleman and I disagree, as he alluded to in his speech. I absolutely support the thrust of what he is trying to achieve, and a great many parts of the Bill will make a considerable difference, but, as with most pieces of legislation, it would be naive to think that it could not be improved. As I said in the point of order that I made earlier, I fear that we are in danger of passing a piece of legislation that everybody in the House knows is not as good as it could and should be, largely because of the paralysis in Government decision making, which means that they do not seem to be able to assess and agree amendments with the speed with which the hon. Gentleman appears to have been able to do so. I suspect that is partly because the civil service appears to have taken the Government hostage in the running of public policy.
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
My hon. Friend is perhaps one of the most passionate Members about defending and championing the interests of Back Benchers, but I remind him of what the hon. Member for Croydon North (Mr Reed) has just said. The Government have worked with the hon. Gentleman to get his private Member’s Bill into a shape that they can support, while recognising that it is his Bill, and it has been taken forward in consultation with the sector. Rather than blame civil servants and processes, my hon. Friend could acknowledge that we want to take the whole sector with us on this Bill.
Philip Davies
I am sure we do, which is why I have consulted my local trust, Bradford District Care NHS Foundation Trust, about the Bill’s merits, and why I have tabled some amendments as a direct consequence of the discussions that I have had with the trust. I find the idea that only the Government are interested in moving forward with consensus rather offensive. I have been trying to move forward with consensus, too, as the hon. Member for Croydon North knows only too well. We have reached the stage at which the Government are saying, “I wish we’d known about some of these amendments earlier, because in that case we may well have been able to accept them.” What on earth is the point of having a deadline for the tabling of amendments three days beforehand if the Government cannot organise themselves to decide within that timescale whether those amendments should be agreed to? They should operate like most organisations and business do: if they have a timescale to meet, they should meet it, rather than pretend that the timescale is of only passing interest to them.
Jackie Doyle-Price
This is great fun. I come back to the point that this is a private Member’s Bill and the Government have agreed their position on it. We are not getting in the way of Back-Bench MPs tabling amendments, because although I will articulate the Government’s view on those proposals, it will be for the House of Commons to decide.
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.
Jackie Doyle-Price
I advise my hon. Friend that the guidance we will issue on the Bill will be subject to consultation. I fully anticipate that we can pick up the themes mentioned in his amendments as part of that consultation.
Philip Davies
I am grateful to the Minister. As I suggested, the Government have the authority to put these things in guidance, but not in the Bill. I do not understand that, but there you go, Madam Deputy Speaker—that is the vagaries of the establishment and the Executive for you.
The point that I want the hon. Member for Croydon North to note, given that this is his Bill, is that if we have 11 things in statute, putting two others in guidance does not really cut the mustard, because they will not be statute but guidance. Institutions will focus on what is in the law and what they can be taken to court for if they do not act properly. We cannot have a pick-and-mix effort, with some of these things in law and some in guidance because, by definition, the things that are in guidance are clearly not as important as those in law. My contention is that the matters specified in amendments 11 and 12, with which the hon. Gentleman said he agreed, are so important that they should be part of the list that goes into law. Guidance just is not good enough; it is not acceptable.
Amendment 11 would include in the Bill training for mental health staff on who is responsible, and on roles and procedures when the police are called to assist. The amendment would ensure that we have a structured approach regarding the involvement of the police when restraining a patient, and it goes to the heart of one of the purposes behind the Bill. This is one of the reasons why the hon. Member for Croydon North brought forward the Bill in the first place, in my opinion, so it would be extraordinary if the Bill did not include training on the thing that is central to it. The amendment stems from that inspiration.
The hon. Gentleman has detailed on several occasions in the Chamber the case of his constituent, Olaseni Lewis, and the treatment he received in the lead-up to his death. On reading through the inquest into Mr Lewis’s death, alongside the coroner’s report, a number of things stood out to me, but predominantly the fact—I believe it can be agreed—that the entire scenario that took place on the evening of his death was a mess. It was a shambles, and it should not have happened. There seemed to be a sudden shedding of responsibility from the medical staff to the police, which I believe caused the quality of medical care that Mr Lewis received to be compromised.
What I find most disturbing is that the police seem to be blamed for Mr Lewis’s death, yet his cause of death was identified by the coroner as medical negligence. I therefore ask what responsibility medical staff have in such events and what responsibility the police have. That is fundamental to this particular case behind the Bill. Common sense suggests that if a patient is in a medical unit and experiencing an episode of mental illness, the priority is for medical staff to control the situation, due to the cause of the situation being medical, and the police are purely there to assist in giving someone appropriate medical care and treatment.
An interesting case is that of the former premier league footballer, Dalian Atkinson, who died in the early hours of Monday 15 August 2016. Police were called to attend a report of concern for safety. Neighbours had reported that Mr Atkinson was banging on and kicking his father’s front door after
“flying into a booze-fuelled rage”.
They had also reported that Mr Atkinson was trying to enter his father’s property because he claimed that he was homeless. Mr Atkinson’s father, who was not the person who called the police, stated of his son:
“I don’t know if he was drunk or on drugs but he was very agitated and his mind was upset…He was threatening and very upset.”
At the time of the incident, Mr Atkinson was reported to have been suffering for some time from a series of illnesses that left him in a fragile state, with a weakened heart. Alongside pneumonia and liver problems, Mr Atkinson was also said to have undergone dialysis for kidney failure and to be battling depression. Mr Atkinson’s brother Kenroy stated that, on the night of his death, Mr Atkinson
“had a tube in his shoulder for the dialysis”,
which he had removed himself, leaving him “covered in blood”. He also said that his brother had attacked their father, who was 85, and held him by the throat, telling him that he was going to kill him. He told their father that he had already killed his sister and another of his brothers, which was not true.
What makes Mr Atkinson’s case different from Mr Lewis’s is that, instead of force from person-to-person contact, Mr Atkinson was subject to the use of a Taser gun. With a combination of multiple health issues and a weak heart, this caused him to suffer cardiac arrest, which subsequently caused his death. In the days following his death, Mr Atkinson’s nephew, Fabian Atkinson, said of his uncle:
“He had some health issues that he was trying to get through and that’s why his heart was weak. When a Taser is deployed, as soon as a Taser is deployed, they need to automatically call an ambulance. How do they know the health of the guy or the girl that they are affecting?”
That is exactly my point.
When the police are called to an incident, they are not aware—they cannot possibly be aware—of a person’s medical history. There is no briefing beforehand, because that is simply not possible when they are put into an urgent situation. Training is designed to help them attend incidents and de-escalate them quickly and efficiently. The question is: how is it possible for this to be done and for them also to be able to take on the additional task of medical assessment?
It might be assumed, from the medical setting, that there is the reassurance of a medical professional being present to monitor the person’s health. In the Royal College of Emergency Medicine’s best practice guidance, the advice is that when a patient is restrained in the emergency department, even if the police are providing that intervention, the ultimate responsibility for the patient’s safety and wellbeing rests with the doctors and nurses of the emergency department. I think that that is absolutely crucial.
I appreciate that those guidelines are for a patient who is taken to an accident and emergency department, while Mr Lewis was in a specialist mental health unit where there were medically trained staff who should have been well versed in such situations. From reading the reports, it seems to me—other people may have a different interpretation—that the staff felt it appropriate to pass responsibility for Mr Lewis’s medical wellbeing to police officers, who are not of course medical professionals. I believe that that was the most detrimental aspect of the last moments of Mr Lewis’s life. That is why this matter should be one of the key focuses of the Bill.
In its memorandum of understanding, “The Police Use of Restraint in Mental Health & Learning Disability Settings”, the College of Policing states:
“People who talked to us wanted mental health staff to be proactive and use their therapeutic skills to de-escalate situations and only call on the police when absolutely necessary…Each situation where the police are called for emergency assistance should be properly assessed on its merits…The police role is the prevention of crime and protection of persons and property from criminal acts.”
This provides a very clear distinction between the responsibilities of the services. In case it was not already apparent, the police are responsible for crime, and the medical staff are responsible for health.
I do not want the police to have to be given a full medical briefing before assisting with the restraint of a patient—in most cases, there simply will not be time—so there needs to be understanding about the co-operation of the medical services and the police, with the medical staff giving direction to the police. I ask that amendment 11 be made to ensure that staff are given clear training to alleviate the possibility of a similar chaotic scenario arising when the police are involved in restraining a patient, and so that they are fully aware that the police are there to assist, not to take over additional responsibilities that the medical staff would otherwise have.
It seems to me that amendment 11 goes to the heart of what the Bill is trying to achieve: to prevent anyone from suffering in the same way as Mr Lewis suffered on that particular occasion. I do not understand how the Bill can be fit for purpose unless it specifically puts that aspect of the training into statute. If it does not cover that, I do not think we are being diligent in making sure that what happened to Mr Lewis is prevented. The hon. Member for Croydon North is quite right to bring that terrible situation to the attention of the House and to try to prevent such a scenario, but the provision in my amendment is what would most help to achieve that, and it is not right that it is not in the Bill. I hope that hon. Members will overcome the bureaucratic nature of the Government and insist that the amendment goes into the Bill. I would like to see that, and the promoter has said that he would also like to see that. It is our job to make the Bill fit for purpose.
Amendment 12 to clause 5—“Training in appropriate use of force”—relates to the same area. It would insert another new paragraph—paragraph (m)—with regard to training on acute behavioural disturbance, which is another really important thing that has been missed out of the list of areas that must be covered in training. The amendment would ensure that there was staff awareness training on acute behaviour disturbance, which can be life threatening when paired with restraint techniques on a patient.
I will again refer to the case of Olaseni Lewis, whose cause of death was detailed by the coroner as hypoxic brain injury caused by restraint in association with acute behavioural disturbance, or ABD. It states in the circumstances of death that Mr Lewis became agitated and fearful, resisting efforts to leave him alone in the seclusion room. Officers restrained him but were unable to regain control. Eventually, Mr Lewis became unconscious and suffered cardiac arrest.
Hypoxic brain injury, or hypoxia, is caused by an interruption to the constant flow of oxygen that the brain requires. The brain uses 20% of the body’s oxygen intake to survive, and that is needed to make use of glucose, which is its main energy source. Interruption of the oxygen supply causes a disturbance in the brain function and will therefore cause immediate and irreversible damage. A person can take as little as 15 seconds to fall unconscious due to a lack of oxygen, and damage begins to take place after four minutes.
Hypoxia is not easily identified at the beginning of an examination since the primary cause is often unrelated to the brain. Common causes can be low blood pressure, heavy blood loss such as a haemorrhage, suffocation, choking, strangulation, asthma attack, drowning, exposure to high altitudes, smoke inhalation, carbon monoxide inhalation, poisoning, drug overdose, electric shock, and predominantly—as was the case with Mr Lewis—cardiac arrest and heart failure. It is the acute behavioural disturbance element, which was referred to by the coroner in Mr Lewis’s case, that I feel would be most beneficial to add to the training, and I want to explore it further.
According to guidelines written by the Faculty of Forensic & Legal Medicine, acute behavioural disturbance may occur secondary to substance misuse, such as intoxication and withdrawal; physical illness, such as following head injury or hypoglycaemia; and psychiatric conditions, including psychotic and personality disorders. Of all the forms of acute behavioural disturbance, excited delirium is the most extreme and potentially life threatening. Similar to abnormal brain function, it can cause a loss of consciousness, confusion, stupor and agitation, which is the contributing factor to causing the characteristic outburst of violence.
The agitation element of the symptoms can stem from several causes, as stated in module 4 of the College of Policing’s personal safety manual. The causes are acute brain inflammation such as meningitis; limited oxygen supply to the brain, such as through acute pneumonia or heart attack; metabolic problems, as diabetes can cause high or low blood sugar levels, both of which can cause severe changes in personality and behaviour—from sleeping to agitation—and can be lethal if untreated; and general illness, in that severe sepsis can cause confusion.
It then goes on to list the symptoms associated with more severe agitation, which are as follows:
“Psychiatric illness…
Acute intoxication with a broad range of drugs or withdrawal from them”
or an
“Acute brain injury (such as a ‘stroke’”
Aside from violent behaviour, other clinical symptoms may include impaired thinking, disorientation, hallucinations, acute onset of paranoia and panic, shouting, unexpected physical strength, sudden tranquillity after frenzied activity or vice versa, high mental and psychological arousal, aggression and hostility, and insensitivity to pain and incapacity.
Philip Davies
I am grateful to my hon. Friend. If the Minister wishes to intervene, I will not stop her.
Jackie Doyle-Price
I am happy to give some clarification on the Government’s position on this issue. When I discussed the amendments with my hon. Friend, I emphasised to him that we did not feel that his amendments were necessary. I advise him that a memorandum of understanding about police involvement is already in existence. The Mental Health Act 1983 has been amended to emphasise that people in mental health settings should be in clinical settings with clinical care. The Angiolini report states specifically that agreement should be in place between health partners and police, which emphasises that health takes the lead on the use of force, in line with the principles of the already existing national memorandum of understanding. I say again that I do not believe that my hon. Friend’s amendments are necessary.
Philip Davies
I made it clear that I support and encourage the use of such cameras, but there may be occasions when, for whatever reason, they cannot be used, and the wording says “must”.
Jackie Doyle-Price
I completely agree with my hon. Friend’s points. It was precisely to address such concerns that the phrase “if reasonably practicable” was placed on the face of the Bill. To clarify, we do not want the fact that a police officer is not wearing a camera to impede them from doing what is right in this context. My hon. Friend raises concerns about the potential for the criminalisation of police officers, but that is not our intention. The subsections to which he refers are consistent with those in the Police and Criminal Evidence Act 1984, and they are there just to remind the police of their obligations. He rightly draws attention to the fact that cameras protect police officers as well as patients. As a force for transparency, they are an effective tool. I reassure my hon. Friend that his concerns are addressed in the Bill.
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.
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—
Jackie Doyle-Price
My hon. Friend is again mischaracterising the Government’s position. Our position is that the amendments are not necessary. I have already outlined to the House that the specifics of the role and responsibility of police officers on these occasions are subject to a memorandum of understanding on which the College of Policing, which my hon. Friend has praised, has led. I ask him again not to press his amendments, because they are not necessary.
Philip Davies
Perhaps when the Minister responds to the debate she can tell us which amendments the Government would accept if they could get their write-around sorted out in time—[Interruption.] The Minister indicates “none” from a sedentary position, but that is absolutely not what the Government communicated to me yesterday. They said to me yesterday, “I wish we had seen these amendments earlier.” The Minister’s indication flies in the face of that.
Philip Davies
Yes, that point has been raised. Basically, we are going to cover everything that is not in the Bill but should be in guidance. It seems that the Minister has made it abundantly clear that she is hardening her position as every minute goes by. We have gone from a situation of her saying, “If only we’d had the amendments earlier, we would have done something about them,” to, “They’re not necessary,” and now to, “We don’t agree with any of them.” The latest indication is that the Government do not agree with any of them.
Jackie Doyle-Price
Again, I would have appreciated sight of the amendments earlier, not least because we could have had a sensible discussion about how to achieve the outcomes that my hon. Friend wants. I am very clear that we can achieve that through guidance, which we will bring forward in consultation—we have consulted throughout the passage of the Bill—with the sector. I am talking about statutory guidance, and all institutions will need to have regard to it. We are in this position following dialogue with the sector and we have carried out parliamentary scrutiny. The Bill is not the only opportunity to bring forward legislation in this sphere because consultation on Healthcare Safety Investigation Branch legislation and the review of the Mental Health Act 1983 are taking place as we speak. This will not be the only opportunity for my hon. Friend to bring forward legislative proposals.
Philip Davies
Well, the only problem with that is that we will end up in the same game in which I table an amendment and the Government say that there is not time to do a write-around about it. I do not even follow the Government’s position any more. We have gone from them saying, “We wish we’d had these amendments earlier,” which the Minister has just reiterated, to then saying that they are not necessary—[Interruption.] The Minister says, “No they are not,” and then she says that they will be covered in guidance. Well, if they are not necessary, why would she put them in guidance? We will have to start getting our story straight. Are these things necessary or not?
Jackie Doyle-Price
My hon. Friend has been a Member of Parliament for a lot longer than I have, so he will be aware that Bills set out the principles of legislation, and it is standard practice for the detail under a Bill to be enshrined in guidance.
Jackie Doyle-Price
First, I thank and congratulate the hon. Member for Croydon North (Mr Reed) on his tireless work getting this important Bill to Report, and I hope it makes further progress. It is an important reform that will significantly enhance the rights of patients in mental health settings and will be a force for justice. We have had numerous references to its inspiration, and I pay tribute to the dignified and determined way in which Olaseni Lewis’s family have pursued an important reform that will materially improve the treatment of patients.
The Government welcome the measures on monitoring and reducing the use of force in mental health settings. The Bill will provide clarity in several areas, including on recording and reporting, and is very much in the spirit that sunlight is the best disinfectant—that transparency is the most effective tool for ensuring good treatment and performance. It will facilitate better and more consistent data collection, which in turn will give us better evidence by which to measure the success of the Bill and these reforms in minimising the use of force in mental health units. I take up enthusiastically the challenge from the right hon. Member for North Norfolk (Norman Lamb). We who believe strongly in these issues owe it to the public to campaign for the adoption of best practice and the minimisation of restraint. I will say more about his amendments later.
The Government have tabled amendments to clause 4 to remove an unintended consequence of amendments made in Committee, where we unwittingly inserted a loophole that might have enabled providers not to inform patients of their rights. We have made amendments to close that loophole, while still enabling an element of discretion in the system where advising patients might cause them further distress. I notice that my hon. Friends the Members for Shipley (Philip Davies) and for Christchurch (Sir Christopher Chope) tabled similar amendments. I hope they will support at least the action I have taken in response to those concerns.
The Government agree that it is important that patients have access to advocacy services, which are very much a part of the right to information on rights and something that the hon. Member for Croydon North and his stakeholders have repeatedly raised with me, but we do not want to put this provision in the Bill. That said, to reassure them about how we are treating the issue of advocacy, which we recognise is important, I remind the House that the independent review of the Mental Health Act 1983, which was set up to look at how its provisions were being used and how practice could be improved, will examine this issue. The interim report was published in May and the final recommendations will appear in the autumn. Following that, we will develop guidance through consultation. The report and recommendations will give us another opportunity to discuss this and ensure we are happy with the standards of advocacy in place. I hope the hon. Gentleman will understand why I cannot accept his representation.
I turn now to the hon. Gentleman’s amendments on the independent investigation of deaths and legal aid. I am grateful for the opportunity to address these points, which go to the heart of what he is trying to achieve in the Bill. The appalling, dehumanising experience suffered by Seni’s family during the investigation, which went on for an unacceptably long time, is really the test by which we should measure the effectiveness of the Bill.
Let me now explain why we would resist the amendment, describe the steps that we have taken to improve investigations of deaths in custody, and, hopefully, give the House some reassurance that the experience we are discussing today will not be repeated under the current regime. That is at the heart of the Bill: we want to ensure that what was experienced by Seni’s family is never repeated.
Clause 10 in its current form requires that when a patient dies or suffers a serious injury in a mental health unit, the responsible person must have regard to the relevant guidance relating to investigations of deaths or serious injuries, published by a list of organisations that are responsible for regulation: for example, NHS Improvement and the Care Quality Commission. That means that in the current NHS Improvement guidance, the NHS serious incident framework, which was last revised in 2015, will be put on a statutory footing. The framework outlines the process for conducting investigations of deaths and other serious incidents in the NHS for the purpose of learning to prevent recurrence. It requires the treating clinician to report an unexpected death when natural causes are not suspected. All deaths of detained patients must be reported to the coroner, the CQC and the provider’s commissioner as serious incidents. That will ensure that all deaths in custody are automatically reported.
If the death occurred in a mental health in-patient or hospital setting, NHS providers are responsible for ensuring that there is an appropriate investigation into the death of a patient detained under the Mental Health Act, or where the Mental Capacity Act 2005 applies. The death of a voluntary in-patient will also be investigated by the coroner, and under the NHS serious incident framework, if it was violent or unnatural. These are not inquiries into how a person died, as that is a matter for coroners, and they are not conducted to hold any individual or organisation to account. Other processes exist for that purpose, including criminal or civil proceedings, disciplinary procedures, employment law, and systems of service and professional regulation. That is an important point, because overlapping interests will need to be managed. I hope that I can give the hon. Gentleman some comfort, and reassure him that we are tackling the real problem that the Bill is intended to tackle.
Independent investigations within the framework are commissioned and undertaken independently of those directly responsible. I know that throughout our discussions on the Bill, the issue of independence was extremely important to everyone with an interest. It will be normal for the provider to conduct its own internal investigation, but that investigation will be reviewed by the relevant commissioner, and it will be for the relevant commissioner to commission an independent investigation. Commissioners must satisfy themselves that the investigation is clearly independent, and that there is no potential for conflicts of interests and no previous relationships. It will be their responsibility to establish that.
We expect commissioners to ensure that the family is properly informed throughout an investigation, and that all agencies involved in an investigation are held to account for their roles. We expect them to take the lead in commissioning an inquiry, and to take a number of steps including listing all the agencies that have had a stake in the care of those involved with the incident, and ensuring that they are aware of the process and their responsibilities in relation to the inquiry. It is up to them to identify all legal issues that may be relevant to the independent investigation or court proceedings and obtain appropriate legal advice. It is for them to co-ordinate meetings and discussions between the investigation team, the trust representatives, the police representatives and other agencies with an interest that have agreed to participate, so that all are agreed as to what their responsibilities are. They are responsible for early discussion with the local coroner. Crucially, they are responsible for informing the patients, carers and families about how the process will work and how they can be involved.
It is extremely important that as part of the investigation process the families’ needs and wishes are properly respected and they feel some ownership and accountability and can hold the process to account if dissatisfied with how things are progressing—that is extremely important. It will be for the commissioner as well to ensure they have access to the investigation team if they so wish. I also expect the commissioner to agree the timescale for the investigation together with timings and setting a date for the report. As much as I would like to be able to say that we will never have such a situation ever again, we can never say never, and if there were to be any delay the reasons must be clearly explained to the patients and families involved as part of keeping them fully informed and making sure they are fully supported.
The serious incident framework sets out clear guidance on who should be involved in the independent investigation team and that the healthcare commissioner is to identify a lead investigator who appoints the investigation team. The framework says the following, and I will quote directly again to underline the real independence of these investigations:
“In order to ensure independence and avoid any conflict of interest, no member of the independent investigation team can be in the employment of the provider or commissioner organisations under investigation, nor should they have had any clinical involvement with the individual(s) to whom the investigation relates.
Investigators must declare any connectivity that might, or might appear to, compromise the integrity of the investigation.”
I hope that is explicit and gives the hon. Member for Croydon North some comfort about what we are doing to establish that independence.
I should also mention that we have just completed a consultation on the serious incident framework, and independence of investigations was a key theme, so we will be continuing to review this to make sure we can guarantee that independence. We will be bringing forward our response to the consultation by the end of the year, so we have another opportunity to ensure that we are satisfied that what we have is fit for purpose.
Another complication in the case of Seni Lewis was the interaction with the police investigation. That is where there is still the possibility of delay, and again we need to do everything we can to ensure that families are supported in that context.
Michelle Donelan (Chippenham) (Con)
Does my hon. Friend agree that this Bill is vital and it is a testament to the work of Seni Lewis’s family? Is she as concerned as I am about jeopardising this Bill, because it is so important, not least to my constituents, that we tackle this important area?
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.
Jackie Doyle-Price
I am grateful to my hon. Friend for making that point. As he says, the longer the answers take, the more distressing and dehumanising it is for the bereaved. I will come to the timescales later in my remarks, but one of the real achievements of the Bill is that it places clear expectations on the authorities in regard to investigations.
As I was saying, a police investigation could be carried out at the same time, depending on the type of incident involved. That was the case when Seni died. NHS guidance now clearly states that, whenever feasible, serious incident investigations must continue in parallel with police investigations. That is an important point, because what happened in Seni’s case was that the police investigation basically put a brake on the NHS investigation. We are clear that these investigations should take place in parallel. That is possible because the terms of reference for the investigations are quite different, and where this eventuality arises, it should be considered in close consultation with the police so that they can be clear about the purpose of the healthcare-led investigation and how it will be managed.
If, following discussions or a formal request by the police, coroner or judge, an application is made to suspend the NHS investigation, it could be put on hold. However, the family must be very much involved in that decision, and the commissioner must ensure that they can agree a date for completion once the investigation can recommence. It is very much down to the commissioner to establish that timeframe. Whether an investigation is put on hold or not, it is absolutely central to our proposals that families should be kept engaged and informed of when the investigation will start up again, and when it will be completed. We also have national guidance on learning from deaths, which was published in March 2017. That now sets out clear expectations of NHS organisations for engaging with carers and families in these circumstances. Dialogue is absolutely central and underpins everything we are doing in this space.
I want to provide some details about what happens if a death follows police contact, when that contact may have caused or contributed to the death, as this is particularly relevant to the events that followed Seni’s death. In such circumstances, the police are under a duty to refer the matter as soon as possible to the Independent Office for Police Conduct. Following an investigation, a report is sent to the police force. The report provides the IOPC’s opinion about what should happen to those involved in the incident. For example, it might recommend further training, a misconduct meeting or a gross misconduct hearing. The police force will then provide its own view about what should happen. If the IOPC disagrees with the force, it has the power to recommend that it should take appropriate action, such as holding a misconduct meeting or hearing. Ultimately, the IOPC can direct the force to do that.
Under the scheduled reforms, this process will be further streamlined so that the IOPC will make the decision on whether there is a case to answer for misconduct or gross misconduct, and decide what form the disciplinary proceeding should take. The IOPC will provide a copy of the investigation report to the relevant police force, and to the complainants and the family of the person involved, as well as to the coroner and the Crown Prosecution Service, which will consider whether any further action should be undertaken.
I want to return to concerns about the quality of investigations, and to briefly explain the role of the Healthcare Safety Investigation Branch. The Lord Chancellor is looking at how we support people going through an investigation, and the hon. Member for Croydon North has also raised the issue of legal aid. It is important that we ensure that families have appropriate support as they navigate this process. This is not just about the process of walking through the contacts with the NHS investigating bodies, which can be quite formal; they could end up in a situation involving legal action or criminal proceedings, at which point they would need that support.
Much reference has been made this morning to the Dame Elish Angiolini review, in which she was clear that all deaths in custody should be treated on an equivalent basis, and I can confirm to the House that the Lord Chancellor’s review into legal aid for deaths in custody will consider deaths in mental health settings on the same basis as deaths in prisons and other forms of custody. I can also advise the House that the ministerial board on deaths in custody constantly reviews what we are doing and how we are implementing the recommendations of the Angiolini review, so the review of legal aid for inquests will consider how it can be applied to deaths in mental health settings, too.
Kevin Foster
The Minister is making some interesting points about the legal aid review. Will she confirm what groups she is considering talking to? I am thinking of third-sector groups, community groups and, potentially, law centres.
Jackie Doyle-Price
I thank my hon. Friend for that intervention. I hope that we will continue to consider everything that we can do to support people, and I welcome those suggestions. Ultimately, such people are facing massive injustice at the hands of the state, and we should never stop looking at what we can do to support people in those circumstances. The simple truth is that those people have put their trust in the institutes of the state, so there is double pain when they are failed by them, and we must ensure that we do everything possible.
I hope that what I have said about legal aid and the investigation process satisfies the hon. Member for Croydon North, so I hope that he will not press his amendments to a Division so that we can get the Bill into the other place and deliver the objectives that he and I both want.
To clarify something that I was saying about the Government amendments, we unwittingly included a loophole that would allow institutions not to provide patients with information, and I might have suggested that that was a matter of discretion. However, it is actually in the Bill that they must provide information unless “the patient refuses” to accept it. I just wanted to make that clear in case there was any misunderstanding. The remaining Government amendments are largely technical, linking the Bill with the Data Protection Act 2018, for example, and providing clearer definitions regarding mental health units. Those are very much drafting changes, and I hope that the House will approve them.
Turning to the amendments tabled by my hon. Friends the Member for Christchurch and for Shipley and the right hon. Member for North Norfolk, I have already discussed the Government’s view on such matters, but I will refer first to the right hon. Gentleman’s amendments in relation to threats and coercion. The Government’s main concern is that putting the use of threats of force and coercion on the face of the Bill might cause confusion for staff working in mental health units when we are trying to encourage them to use de-escalation techniques. We have the same objective as the right hon. Gentleman, which is to minimise restraint, but we are concerned that the amendments might act as an impediment to what we are trying to achieve.
Norman Lamb
Will the Minister look at whether the guidance will be clear about the importance of staff not inappropriately threatening force or coercion, because that all goes down to the culture of the organisation?
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.
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.
Norman Lamb
This is my very final point. Even if this is not in the Bill, does the Minister agree that it would be a good thing if the Secretary of State reported to Parliament annually on the basis of the data that was produced by NHS Digital?
Jackie Doyle-Price
That issue did come up in Committee. Although I appreciate the spirit with which the right hon. Gentleman makes that inquiry, we would not want to make a particular arrangement for one set of NHS data over another. Clearly, we need to explore this issue to make sure that there is some annual return on how this Bill operates when it becomes an Act.
I could say so much more, Mr Deputy Speaker, but I will not. Everybody in this House is very clear that they want this Bill to make progress. I appreciate that I cannot keep all Members happy all the time, but I do hope that I have been able to assure my hon. Friends the Members for Shipley and for Christchurch on how we will take forward their representations and that I can persuade them not to push their amendments to a vote.
Justin Madders (Ellesmere Port and Neston) (Lab)
May I start by congratulating my hon. Friend the Member for Croydon North (Mr Reed) on progressing this extremely important Bill to this stage? I had the pleasure of speaking to it on Second Reading back in November. I am sure that the past seven months have felt pretty long to him, particularly as there were delays outside his control with the money resolution, and I am sure that that feeling was present again at times this morning. I hope that his diligence and persistence will pay off. We all know how much it will mean to see this Bill finally enshrined in statute. Nothing can demonstrate better the positive impact that a constituency MP can have in such circumstances, where there are clearly shortcomings in the current law, which we hope to put right.
I congratulate all hon. Members who have contributed so positively to the progress of the Bill, and the Minister on her constructive approach. I also echo the tributes paid to the Lewis family for the dignified and helpful way in which they have assisted in shaping this legislation. It has been evident from contributions that hon. Members have made during the passage of the Bill just how united we all are in our determination to do something to ensure that the tragic case of Seni is not repeated.
It is shocking to hear that, according to the Independent Advisory Panel on Deaths in Custody, 46 mental health patients died following restraint between 2000 and 2014. Victims of restraint in these circumstances have said that face-down restraint by groups of men adds to the trauma that in many cases led to their mental illness in the first place. As well as bias towards women, there is evidence to suggest that members of the BAME community are disproportionately more likely to experience restraint, so we strongly support the Bill, which we hope will reduce the use of force and address the unconscious bias currently reported in the system, by increasing transparency, evidence, accountability and justice.
In terms of transparency, data is not currently collected consistently, so it can be hard to collate accurate data on how often restraint is used and on how restraint is used disproportionately against certain demographics. We hope that the Bill will create a level of uniformity that is currently missing. Recording how and why restraint is used, who it is used on and what steps were taken to avoid its use will inject much needed transparency and consistently into the system. We will then be in a much stronger position to tackle the issues of unconscious bias or overuse of restraint to which hon. Members have referred throughout the passage of the Bill.
We need to ensure that if tragedies of this nature occur again, they are independently investigated and that justice is not only done, but seen to be done. As my hon. Friend the Member for Croydon North has set out, new clause 1 would make it compulsory for an independent investigation to be carried out whenever a death occurs in a mental health unit. He set out the thinking behind the new clause very well. The Minister set out why it is not something that she can take on board, but she did give a clear view of some of the safeguards that will be needed regarding independence, particularly when it comes to potential conflicts of interest or, as she said, appearances of conflicts of interest. She was clear and strong about the need for the ownership and involvement of the families in any investigation. That is of paramount importance. I look forward to hearing whether my hon. Friend considers that a satisfactory response.
In conclusion, the Bill is a step towards a model of care, rather than one of containment. Of course, it does not have everything that we would want, but it is an important step in the right direction that will support patients, their families and emergency service workers. I commend my hon. Friend the Member for Croydon North on his hard work in reaching this stage and look forward to Seni’s Bill becoming Seni’s law.
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.
Jackie Doyle-Price
I cannot pay tribute enough to the hon. Member for Croydon North (Mr Reed) for his incredible leadership in getting us to this point. He has made it extremely easy for me to work with him and to engage with the sector. I cannot overstate the signal that this reform will send both in terms of how we treat mental health and how we treat patients and enhance their rights; it will be extremely significant indeed. When, as I hope, the Bill gets on to the statute book, he can really be proud of a very significant achievement. I am very pleased that he was able to use his place in the ballot to bring forward such a progressive and important measure.
I could not disagree with a word the hon. Gentleman said as he introduced the Bill’s Third Reading. He was absolutely right. For too long, restrictive interventions have been accepted as the norm in health and in mental healthcare settings, as the right hon. Member for North Norfolk (Norman Lamb) said.
It has been great to have the right hon. Gentleman’s input into today’s proceedings. He is the one who blazed the trail that I am trying to follow, which is quite a tough act it has to be said, but we are all extremely grateful for the real efforts that he made while he was a Minister, and I hope to build on the change that he started to embed.
We must expect that restrictive interventions and the use of force must never be used for the purpose of punishment, or to degrade or to humiliate patients. Mental health settings are places where people should feel safe, and it is clear that the existing guidance is not having the impact that the Government expected, and that we must do more. This Bill will be a very important tool to achieve that.
I come back to why we are here today: the death of Seni Lewis. The measure of the Bill’s success will be in the strength of the independence of the investigations and in the support that bereaved families get should, unfortunately, any other family find themselves in this situation. That is the yardstick against which the Bill should be measured. We should be very sensitive to ensure that we all continue to do our best so that, when people are let down by organisations of the state, we in this House are at the front of the queue to see that they get justice—and justice promptly, because justice delayed is justice denied.
Health and Social Care (National Data Guardian) Bill
Jackie Doyle-Price ExcerptsWednesday 6th June 2018
(5 years, 11 months ago)
Public Bill CommitteesRead Full debate Health and Social Care (National Data Guardian) Act 2018 View all Health and Social Care (National Data Guardian) Act 2018 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 6 June 2018 - (6 Jun 2018)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
It is a pleasure to serve under your chairmanship, Dame Cheryl, and an absolute pleasure to respond to the Bill of my hon. Friend the Member for Wellingborough. I congratulate him on bringing this important reform forward and thank him for working so constructively with the Government to put the National Data Guardian on a statutory footing.
This is an important reform. As the shadow Minister mentioned, the public are rightly concerned about information and data that is held on them and the extent to which that is shared. The new National Data Guardian will do much to reassure people that the environment in which data is held and managed is one that respects their privacy, while at the same time ensuring that appropriate safeguarding can be achieved. Given the culture that exists within our health services, the comfort with which organisations can respond to the advice given by the National Data Guardian will make for a much more effective system to support the public.
I confirm the Government’s support for and commitment to the Bill. We very much wish it to succeed. We see real benefits to all individuals in ensuring that we share health and care data in a safe, secure and legal way. The Bill will go a long way to increasing public trust in the appropriate and effective use of health and care data. The National Data Guardian has already established herself as an independent and authoritative voice for the patient and service user in how their data is used in the health and adult social care system.
Let me address some of the points that have been raised. Clearly, my hon. Friends will be concerned about the potential costs, as we would be as Conservatives. The estimates we have established as a result of the impact assessment provide for some extra expenditure, and that is for additional staffing so that the published guidance has a legal status—that will be a natural outcome of putting the Data Guardian on a legal footing. There will be some additional costs, and we have been generous in our estimates for them.
The shadow Minister asked a number of questions about other agencies that might be covered by the Bill, and as my hon. Friend the Member for Wellingborough said, the Bill as drafted covers public health. Provisions in the Bill will extend to local authority functions with respect to adult social care, but not to children because they are covered by a different legal framework.
The hon. Member for Rhondda raised some good points to which we could ask the National Data Guardian to have regard. He is right to say that we as Members of Parliament often take up health and social care issues on behalf of our constituents, and nothing is intended to get in the way of that. Indeed, it could be helpful to us if the National Data Guardian gave instructions to those bodies about their obligation to be open and transparent. I am sure that the hon. Gentleman, and other hon. Members, have often found that the spirit of openness that we expect when we challenge something is not always respected. In that culture of openness, and with respect for privacy and safety, we support the Bill.
Mr Bone
I am grateful for the support from the Minister and the shadow Minister, and I wish to pick up on a couple of points. The appointment will be down to the Secretary of State, but I absolutely expect it to go to the Health and Social Care Committee—I think that is understood. A point was raised about advice and having written reports on what is being done, but the argument against that is that we want to see action. There is some confusion—the Data Guardian is not a regulator, and therefore that is not its role. All organisations are covered by a regulator and will take into account what the National Data Guardian says. That is why I do not think that such a provision would work.
Justin Madders
I wish to raise a point on the exclusion of children’s data. I appreciate that hon. Members have referred to it already, but we are slightly concerned that although children’s data may be covered elsewhere, the guardian does not have any ability to write to bodies in that respect. It is perfectly reasonable for that to be included; indeed, I think it was included in the original Bill as drafted. We see it as a safety net, rather than an added complication.
Jackie Doyle-Price
I confirm that the Government support the clause. On the point about children, it is our interpretation that the provisions do not prevent the National Data Guardian from engaging constructively with the Department for Education on adult social care data and its interaction with or effect on children’s data. Clearly, this is something we will monitor, but, bearing in mind that the whole ethos behind the creation of the National Data Guardian is to spread good practice and make representations rather than regulations, the concern that the hon. Gentleman has expressed is important, but we do not think it will get in the way of sensible engagement.
Chris Bryant
Will the Minister clarify what she understands from clause 2(5)? It states:
“‘The health service’ means the health service continued under section 1(1) of the National Health Service Act 2006.”
That obviously includes ambulance services, but does it include those provided by St John Ambulance?
Jackie Doyle-Price
If I may, I will come back to the hon. Gentleman on that point. I would say that it would not, but I will confirm in due course.
Mr Bone
The shadow Minister makes a fair point, which goes to the heart of a problem that I have found in the past—that children are looked after by the Department for Education and not the health service. When I dealt with modern-day slavery, I came across exactly the same problem. What the shadow Minister said should be heard loud and clear by the Department for Education.
Question put and agreed to.
Clause 2 accordingly ordered to stand part of the Bill.
Jackie Doyle-Price
The consequential amendments introduced are typical for setting up such a body. The Government are content with the clause, as drafted.
Question put and agreed to.
Clause 3 accordingly ordered to stand part of the Bill.
Schedule 2 agreed to.
Clause 4
Extent
Question proposed, That the clause stand part of the Bill.
Mr Bone
The clause sets out the Bill’s territorial extent. The Bill extends to England and Wales only. The Committee will note that clause 1 provides for the Data Guardian to publish guidance and give advice, information and assistance, but that applies only to the processing of health and social care data in England. However, in regard to application, the provisions extend to England and Wales but apply only to England. The provisions do not extend or apply to Scotland or Northern Ireland. I hope that is perfectly clear.
Chris Bryant
Well no, it is not really. In fact, it is a little bit worse than that. We return to clause 2(5), which says:
“‘The health service’ means the health service continued under section 1(1) of the National Health Service Act 2006”,
but that Act states:
“The Secretary of State must continue the promotion in England of a comprehensive health service”
and so on. I therefore do not understand why the Bill extends to England and Wales. Will the provision will have any relevance whatever in Wales? If not, I do not know why it says that it does.
Jackie Doyle-Price
In regard to application, the provisions extend to England and Wales but apply only to England. I have to confess that my knowledge of devolution arrangements is perhaps not as good as it should be, but our view is that the Bill applies only to England. Although the provisions could extend to England and Wales, it would be within the competence of the National Assembly for Wales to appoint a guardian and make such arrangements. That said, the National Data Guardian is an advisory role—it is not a reserved power under devolution arrangements—and as is common in the operation of the health systems in all four nations, I would expect that the advice and guidance given by the National Data Guardian would be heard and, when appropriate, acted on by the health services in the other nations.
Justin Madders
My understanding when preparing for the Committee was that it would apply to England only. I think that is what the Minister has confirmed. Certainly in my part of the world there is quite a lot of movement of patients both ways between England and Wales, because we are quite close to the Welsh border. Can the Minister explain what will happen to patient records in that situation?
Jackie Doyle-Price
Clearly the Bill extends to England, but the purpose of the National Data Guardian is to give advice on the appropriate sharing of data and best practice. I should expect practitioners to have regard to the advice regardless of where they come from, because, notwithstanding the legal framework in which they operate, all health professionals want to behave in a responsible way. We expect the guidance of the National Data Guardian to be good practice. She has been giving advice without statutory powers to do so, and that advice has been respected; I think that that will continue. It is largely through an accident of the current structuring of the health service that the provisions are as they are. The principles under which the Data Guardian will give advice extend way beyond the geography of England.
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.
Mr Bone
I am grateful for the contributions by my hon. Friend the Member for Christchurch and the hon. Member for Rhondda. I absolutely agree with their general comments. I looked carefully when drafting the Bill at the issue they raised. I could have included a provision that the Bill would come into effect, say, six months after it became law, but I did not because we already have a Data Guardian, so there will not be any gap, and I know how much the Government support the Bill. That is the reason we did not put in a date, but under other circumstances I absolutely would have insisted on one.
Question put and agreed to.
Clause 5 accordingly ordered to stand part of the Bill.
Clause 6
Short title
Question proposed, That the clause stand part of the Bill.
Jackie Doyle-Price
The Government are content with the clause.
Question put and agreed to.
Clause 6 accordingly ordered to stand part of the Bill.
The Chair
Before I close proceedings, may I thank all Members for taking part in the scrutiny of the Bill, and the Hansard reporters and officials from both the House and the Department who have supported us?
Jackie Doyle-Price
Further to that point of order, Dame Cheryl. I echo the thanks of my hon. Friend and again thank him for his real industry on what will be an important reform. I also thank colleagues who showed up today for their probing questions, which are always important as we scrutinise legislation.
The Chair
I do not think those are points of order for the Chair, but it is good that they have been put on the record.
Bill to be reported, without amendment.
Health and Social Care (National Data Guardian) Bill (Money)
Jackie Doyle-Price ExcerptsMonday 21st May 2018
(5 years, 11 months ago)
Commons ChamberRead Full debate Health and Social Care (National Data Guardian) Act 2018 View all Health and Social Care (National Data Guardian) Act 2018 Debates Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
I beg to move,
That, for the purposes of any Act resulting from the Health and Social Care (National Data Guardian) Bill, it is expedient to authorise the payment out of money provided by Parliament of any expenditure incurred under the Act by the Secretary of State.
I pay tribute to my hon. Friend the Member for Wellingborough (Mr Bone) for bringing forward this important Bill. I once again confirm the Government’s support for and commitment to it and our desire to see it succeed.
Human Medicines Regulations 2012 Advisory Bodies: Annual Report 2017
Jackie Doyle-Price Excerpts(5 years, 11 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
My hon. Friend the Parliamentary Under-Secretary of State for Health (Lord O'Shaughnessy) has made the following statement:
I have received the annual reports of the Human Medicines Regulations Advisory Bodies for 2017, which has been laid before Parliament today in accordance with the requirements of Part 2 Section 12 (4) of the Human Medicines Regulations 2012.
I am glad to acknowledge the valuable work done by the distinguished members of the Human Medicines Regulations Advisory Bodies and thank them for the time and effort dedicated in the public interest to this important work. I attach a copy of the report.
Attachments:
Annual Report 2017 (Human Medicines Regulations 2012 Advisory Bodies Annual Report 2017.pdf)
Attachments can be viewed online at http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2018-05-21/HCWS703/
[HCWS703]
ADHD Diagnosis and Treatment
Jackie Doyle-Price Excerpts(5 years, 12 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
I congratulate the hon. Member for Leigh (Jo Platt) not just on the passionate and articulate way in which she has introduced this important subject, but also on setting up the all-party parliamentary group. I am delighted to accept her invitation to come to a meeting and to hear some of the stories. I would also, through her, extend my congratulations to Michelle Beckett for her work in raising awareness.
The hon. Lady has highlighted that this group of people face quite intense, if unconscious, discrimination, because the way that our education system is set up does not really address their needs. That is something we should all wish to tackle. There are similarities with the way that autism and conditions such as dyslexia were treated in the past. If the abilities to learn are not there, people can fall out of the system. The truth is that they have a very different skill set and we should all be endeavouring to draw that out and, at the very least, not make them feel marginalised or discriminated against. As we have heard from other hon. Members, it is that sort of discrimination that leads them to fall out of the mainstream and perhaps fall into the criminal justice system, which is something that could easily be avoided if we were all more sensitive to it.
The hon. Lady mentioned data. I will take that away and look at it. It is fair to say that it is only very recently that the NHS has started to collect data regarding autism, for exactly the reasons highlighted today—the postcode lottery in terms of how different areas treat the condition. Quite often, it depends on having somebody in the area who gives a damn to give some leadership on the issue. Clearly, that is not good enough, as it will fail far too many people. I will go away and look at that. We have just introduced a new dataset for autism and I do not see any reason why we cannot extrapolate that methodology to look at ADHD. There is no doubt that we will continue our dialogue on these issues.
Dr Poulter
The Minister is absolutely right to highlight the issue of data, or the lack of it. In the interests of parity of esteem, is it also worth looking at introducing access targets in mental health for access to child and adolescent mental health services, which do a lot of the assessment of people with ADHD? Would that help drive better data collection in the NHS? Measuring against a target forces local healthcare providers to collect the data that is necessary to drive improvements.
Jackie Doyle-Price
I am just about to come on to issues about waiting times. The methodology that my hon. Friend suggests is absolutely right. Although it is Mental Health Awareness Week and we are looking at the issue through that prism, this is not just about mental health; it is about a learning disorder, and goes beyond that. Compartmentalising people who fall out of the mainstream as those with mental health issues is equally discriminatory, but we do have to ensure that we have the right care pathways for them to meet their needs.
Dr Poulter
I did not intend to come across as discriminatory in the point that I made; it is CAMHS professionals—mental health professionals—who tend to do the assessments for ADHD in children. What is the Minister going to do about the recruitment crisis in CAMHS? Without those CAMHS professionals, we shall not be able to provide the diagnosis and delivery of care.
Jackie Doyle-Price
My hon. Friend will be aware that we have addressed those issues in the Green Paper. We are investing in a whole new workforce in support of CAMHS, which will have a direct relationship with schools, where it will be possible for a lot of the wraparound help to take place.
I would like to make some progress on the specifics of ADHD and move on from CAMHS. The hon. Member for Leigh highlighted the massive variation in services across the country. I fully acknowledge that there are long delays for some to see a specialist and secure a diagnosis. That will clearly have a negative impact on those living with ADHD and their families, who can also find the experience confusing.
We are determined to see improvements in the patient journey. There are NICE guidelines. The earlier the diagnosis the better, and the better the chance of getting the right support and better outcomes for the individual. The NICE guidelines were published in 2016 and set out the process for managing ADHD for people aged three years and above. The guidelines aim to improve the diagnosis of ADHD, as well as the quality of care and support for people with an ADHD diagnosis.
An updated guideline was published in March this year, which particularly addresses under-diagnosis and misdiagnosis of ADHD in girls. People think it is just about behaviour, but in girls it does not play out in exactly that way; there is a lot to be done in education on exactly what this condition is. As the hon. Lady said, people think it is about bad parenting or bad behaviour when it is much more complex. The guidelines advise practitioners to be alert in such circumstances to the possibility of ADHD. We will be failing girls if we do not raise awareness of how that might be playing out.
The guidelines also recommend that people with ADHD would benefit from improved organisation of care and better integration of child health services, CAMHS and adult mental health services. Although NICE clinical guidelines are not mandatory, we expect health and care professionals and commissioners to take them into account fully as they design and put in place services to meet the needs of their local populations. NICE has published a range of tools to help local areas put the guidance into practice, but that is clearly not happening everywhere. I always find that sunlight is the best disinfectant, so the more we can do to ensure transparency, the better. That is why data is so important, as the hon. Member for Leigh said.
The NICE guidelines do not at this time recommend a waiting time for seeing a specialist for diagnosis, but they do recommend that parents of children whose behaviour is suggestive of ADHD should be offered a referral to group-based ADHD-focused support without waiting for a formal diagnosis. That will clearly be helpful, but we should also look at the waiting times.
An issue that I am particularly concerned about—I look forward to engaging with the APPG on this—is support for schools, which the hon. Lady mentioned. Getting the right support package for children with ADHD can be challenging for some institutions. I am concerned that anecdotal evidence suggests that people are being excluded disproportionately, so we really need to tackle that discrimination. Perhaps I can ask the APPG what we can do together to give schools extra support and better advice about how to support children with this condition, rather than simply marginalise them.
The Children and Families Act 2014 and the special needs code of practice set out ways in which care services should join up, and we need to hold them to account. We expect CCGs and local authorities to work together to support children with special educational needs or disabilities, including ADHD. That includes co-ordinating assessments of individual needs and, for those with the greatest needs, providing an individual education, health and care plan. I am interested in hearing evidence from the APPG about how many children are not receiving such plans.
I am not going to stand here and pretend that everything is perfect, because I know perfectly well that it is not, but we have the opportunity to highlight good practice, help local authorities and CCGs to learn from it, and highlight when people are being failed.
Martin Docherty-Hughes
On best practice, I asked the hon. Member for Leigh (Jo Platt) about the Department for Work and Pensions’ workplace assessments. Will the Minister speak to her colleagues in the DWP about how effective they are for adults with ADHD in the workplace?
Jackie Doyle-Price
I will be happy to look into that in response to the hon. Gentleman’s question. The Government are trying to encourage as many people into work as possible, and we want to get an additional 1 million people with disabilities into work. Employers should treat people sensitively, and people with ADHD can be valuable members of the workforce. I will be happy to have a conversation with my colleagues in the DWP to encourage that. Those people have a skill set that can be extremely productive for enlightened employers who are prepared to make concessions and work with them effectively.
I acknowledge that data is an issue. Without robust and comparable data about waiting times, we do not have the tools with which to challenge local areas, but hon. Members can raise anecdotal evidence in advance of our being able to put together a suitable dataset. I have asked my officials to explore with NHS Digital what data can be made accessible via the mental health dataset. We also need to work alongside the Department for Education, because people with ADHD start manifesting issues in school.
A number of hon. Members said that it is important for employers to improve outcomes for people with ADHD. Unless we get people with ADHD into meaningful employment, there is a risk that they will fall into the criminal justice system, quite unnecessarily. Work is not just about earning a living; it contributes to people’s psychological wellbeing and gives them a sense of belonging, purpose, confidence and self-esteem. As I have said many, many times before, work is good for people’s health, so we need to ensure that nobody is excluded.
People with ADHD can be well skilled, highly qualified and employable individuals, with exceptional and unique talents, who can bring real benefits to businesses. I am more than happy to bang the drum to encourage more employers to be sensitive to people with ADHD, as they should for people with autism, who also have big skill sets that they can offer to employers.
I do not have much time left. I thank hon. Members for their contributions. This group of people has been poorly served for a very long time. I therefore welcome the establishment of the all-party group and I look forward to having ongoing dialogue with all its members. I hope that, before long, we can achieve some material differences and improved outcomes for all those people.
Question put and agreed to.
Oral Answers to Questions
Jackie Doyle-Price Excerpts(6 years ago)
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Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
The Department is working with the NHS and across the Government to increase the support available for people with mental illness and on related issues. This includes investing £39 million to double the number of employment advisers in IAPT—increasing access to psychological therapy—as well as reviewing the practice of GPs charging for evidence of patients in debt crisis and the introduction of a duty under the Homelessness Reduction Act 2017 for the NHS to refer people at risk of homelessness to the local authority.
Dr Cameron
A quarter of people experiencing mental health problems are also in problem debt, and eight out of 10 mental health practitioners surveyed have said that they have less time to deliver clinical care because they are being asked to assist with the task of writing up debt management plans. Does the Minister agree that to ensure the best chance of recovery, commissioning groups require to integrate advice alongside mental health care, particularly for those in problem debt?
Jackie Doyle-Price
The hon. Lady makes a sensible point. Of course it is true that people’s personal circumstances are a symptom and a cause of mental ill health. We are doing more to enable those delivering mental health services to signpost people with problem debt to appropriate services. Clearly, that becomes easier where those services are co-located with citizens advice bureaux. In addition, the Breathing Space programme aims to provide a break for people with debt. I recognise, however, that this is a serious problem and that debt problems will cause mental illness.
Andrew Bridgen (North West Leicestershire) (Con)
Will the Minister explain to the House how the Thriving at Work programme will play a role in improving public mental health as well as benefiting our working lives?
Jackie Doyle-Price
I thank my hon. Friend for his question. It is very much this Government’s view that work is good for people’s health, and the more we can encourage people to live independently and feel in control of their lives, the better their health outcomes will be. We absolutely stand by the Thriving at Work programme.
Sir Vince Cable (Twickenham) (LD)
Is the Minister aware of the growing incidence of mental illness associated with gambling addiction and of the rapid rise in suicides as a consequence? Will she try to ensure that there is adequate psychiatric capacity within the NHS, and will she liaise with her colleagues in the Department for Digital, Culture Media and Sport on preventive action?
Jackie Doyle-Price
The right hon. Gentleman rightly identifies problem gambling as another important contributory factor to mental ill health. When it gets out of hand, it can lead to considerable stress. We will of course work with the Department for Digital, Culture Media and Sport to ensure that we have the right regulatory processes in place, as well as ensuring that we are giving support to those who need it.
Fiona Bruce (Congleton) (Con)
Does the Minister agree that, when children and young people have mental health challenges, it is important wherever possible to engage with their families to help them to overcome them?
Jackie Doyle-Price
What my hon. Friend says is self-evidently true. We are putting in more help in schools through the Green Paper, but we also need to ensure that we are engaged with families much earlier than that. We have the health visitor programme, and those visits help to build relationships with parents. We have also taken action on specific issues, including the initiative relating to the children of alcoholics. We will continue to focus support where it is needed.
Several hon. Members rose—
Keith Vaz (Leicester East) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
People with long-term health conditions such as diabetes are at a higher risk of mental health disorders, and we are determined to improve co-ordination between services. That is why the national diabetes audit has started collecting information from GP practices on people who have both diabetes and severe mental ill health.
Keith Vaz
I should like to declare my interest. As the Minister knows, three out of five people with diabetes suffer from emotional and psychological problems, including depression and anxiety. A survey recently showed that 76% of diabetics were offered no emotional or mental health support. Will she look at the excellent work that is being done by the NHS in Grampian in Scotland, to see whether its programme could be rolled out for the rest of the country?
Jackie Doyle-Price
I would be delighted to look at the progress being made in Grampian, and we are always keen to learn from the experiences of other nations. The right hon. Gentleman makes an excellent point: people with long-term physical conditions are more likely to suffer from mental ill health. As for NHS spending, at least £1 in every eight that is spent on long-term conditions is linked to poor mental health and wellbeing spend. We have also produced a pathway for people with long-term physical health conditions to deliver more effective IAPT—increasing access to psychological therapy—services for them. However, we can always continue to learn about this subject.
Andrew Selous (South West Bedfordshire) (Con)
Obese adults are seven times more likely to have type 2 diabetes and the associated mental health problems that go with it. Is my hon. Friend that 140,000 obese children would qualify for adult tier 4 bariatric surgery, but there is little available? Should the NHS be fortunate enough to get some well-deserved extra money for its 70th anniversary, may I put in a bid for that area to be considered?
Jackie Doyle-Price
My hon. Friend is right that once children become obese they are going to become obese adults, with all the health problems that come with that. I do not want to steal the thunder of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), but rest assured that we will examine what more we can do to tackle obesity in children.
Jim Shannon (Strangford) (DUP)
I declare an interest as a type 2 diabetic. Bearing in mind that three out of five people with diabetes have mental health issues, will the Minister outline what support services GPs should be able to offer at the first diagnosis of diabetes? Early diagnosis is key.
Jackie Doyle-Price
I could not agree more. We need GPs to understand that they must consider a patient’s needs as a whole, not just the condition that is presented at the time, and that message has been sitting behind the guidance that we have been issuing to GPs on how they manage patients with long-term health conditions.
Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)
Jenny Chapman (Darlington) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
We are committed to improving mental health support for expectant and new mothers, and GPs are crucial to that. We recognise that specialist services are also required, and I am proud to announce today that NHS England will be spending £23 million on rolling out the second wave of community perinatal services to underserved parts of the country and is on course to achieve full geographic coverage by 2020-21.
Jenny Chapman (Darlington) (Lab)
Given that 95% of mums surveyed by the NCT said that they had experienced mental health problems, that only 22% said they were even asked about this by their GP and that only 24% of the country has any specialist provision, what more does the Minister think she ought to be doing?
Jackie Doyle-Price
The second wave roll-out will cover the entire geographical spread of the country. This is a transformational programme, so, by definition, it will take time to roll out, but I agree with the hon. Lady that GPs do have a role to play in this. The National Institute for Health and Care Excellence recommends postnatal checks for mothers, and NHS England expects commissioners to undertake that those guidelines are being met. As for any further support by GPs, she will be aware that there is a renegotiation of the GP contract and it will be covered there.
Several hon. Members rose—
Wera Hobhouse (Bath) (LD)
Given that children of mothers with perinatal health problems are at much higher risk of developing mental health problems themselves, why does the Government’s Green Paper on mental health not address prevention in respect of perinatal health?
Jackie Doyle-Price
As I have said before, the proposals in the Green Paper on children and young people’s mental health were very much focused on what we were going to be delivering through schools. Alongside that, we have a very ambitious programme on perinatal mental health, where we are spending an extra £365 million on delivering both acute care and more support in the community. Today, I have just announced the second wave of that funding.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
Back in 2010, we had 19 mother and baby units across this country, but cuts to those beds resulted in our then having 15 mother and baby units. Back in November 2016, the Government said we were going to see more beds opened. I listened closely to the statement the Minister has just made, but we are still waiting for beds that were announced back in November 2016. What are her Government going to do to ensure that mothers and babies will be kept together and can access the beds they desperately need?
Jackie Doyle-Price
I do not accept what the hon. Lady is saying. We are investing in new mother and baby units and making sure we have sufficiently good provision geographically so that mothers and babies can access them. We are also investing in more support in the community. I am pleased that the programme we are delivering, which is £365 million of additional support, will deliver early intervention for young mothers and babies.
Anne Marie Morris (Newton Abbot) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
The diverse health and social care needs of local communities are considered in this Government’s policy and implementation. We are actively supporting local areas, including through Public Health England’s joint work with the Local Government Association, providing evidence-based recommendations to tackle the different needs of rural communities.
Anne Marie Morris
Would the Minister find it helpful to ask the national centre for rural health and care, shortly to be launched, to identify the specific challenges facing the providers of health and care in rural areas?
Jackie Doyle-Price
The centre has already engaged with stakeholders to identify the issues and responses to the challenge of providing health and care in rural settings. The centre will focus on four areas—data; research; technology; and workforce and learning—and will work with partners to identify, scale up and promote the adoption of its activities across the public and private health sector to reduce health inequalities and improve the quality of life for all rural people.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
If the ministerial team want to learn about the comparison of health outcomes in urban and rural communities, they should come to Huddersfield, as we have both there. But what we want in Huddersfield is a great hospital, great GPs and a supportive community pharmacy network. When are we going to get them?
Jackie Doyle-Price
I will address the point the hon. Gentleman makes about urban and rural health, as my constituency has the same situation. Obviously, there are specific challenges with regard to sparsity of population, which have to be tackled through the funding formula. The new national centre for rural health and care will address that.
Matt Warman (Boston and Skegness) (Con)
For people in my rural constituency, the value of services at Boston’s paediatric unit could not be higher. Does the Minister agree with me—and with what the Prime Minister said last Wednesday—that we should leave no stone unturned when it comes to making sure that we can recruit the paediatricians we need and sustain the services at Pilgrim Hospital?
Jackie Doyle-Price
I am happy to associate myself with the comments of my hon. Friend and those of the Prime Minister. We should leave no stone unturned in making sure that we recruit enough paediatricians to support the service. I reiterate that every effort will be made to ensure that that happens.
Carol Monaghan (Glasgow North West) (SNP)
Jackie Doyle-Price
The hon. Lady will understand that the impact on the workforce is of as much interest to us south of the border as it is to her. We continue to engage in representations with colleagues to address such matters.
Mr Philip Hollobone (Kettering) (Con)
Northamptonshire has both rural and urban communities, but our biggest pressures are a rapid population increase because of house building and a big increase in the number of people who are, thank goodness, living to more than 80 years of age. Will the Minister ensure that those two issues are addressed in any future funding formula?
Jackie Doyle-Price
My hon. Friend is quite right that when we allocate funds we have to make sure that we keep pace with population growth among both the early years and the older years, which is where the demand comes from.
Several hon. Members rose—
Jackie Doyle-Price
I can add no more to what I have already said in answer to my hon. Friend the Member for Boston and Skegness (Matt Warman). We will do everything we can to make sure that we can recruit sufficient paediatricians for that hospital.
Julie Cooper (Burnley) (Lab)
What plans does the Minister have to increase the role of community pharmacies in meeting the health needs of rural and urban communities? In 2016, the Government promised to develop an extended role for community pharmacies. In particular, they committed in the House that the national roll-out of a minor ailments scheme would be implemented by April 2018. Given that it is now May 2018 and that has not happened, and that there has been an overall reduction in services commissioned via community pharmacies in both rural and urban communities, will the Minister tell the House when exactly the Government intend to honour their commitment?
Jackie Doyle-Price
The provision of community pharmacies is an important part of integrated primary care. We will continue to make sure that we direct sufficient resource to address the particular challenges caused by rural sparsity. I remind the hon. Lady of what we have already done: we spent £175 million from the Prime Minister’s challenge fund to transform GP access, and that is increasing access in areas such as North Yorkshire, Devon and Cornwall. We will continue to look into the particular challenges that rural communities face and make resources available.
Imran Hussain (Bradford East) (Lab)
Anna Turley (Redcar) (Lab/Co-op)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
The Government are looking at existing pre and post-conception health advice, including the use of folic acid supplements, which are recommended to help reduce the risks of neural tube defects in unborn children. We are carefully considering the recommendations in the Scientific Advisory Committee on Nutrition report on folic acid, and the Government will set out their position in due course.
Anna Turley
I thank the Minister for that answer, but the UK female diet leaves blood folate levels below World Health Organisation targets, and it was recommended back in 1991 that folic acid should be put into supplements and that flour should be fortified. There are 80 countries around the world where that is happening, and it is reducing cases of spina bifida and other serious illnesses by up to 50%. Will the Minister work with the Department for Environment, Food and Rural Affairs to look once again at the opportunities for fortifying flour with folic acid?
Jackie Doyle-Price
I can confirm that we will continue to look at that. The hon. Lady is right that a large number of countries fortify flour with folic acid, but the UK and other EU countries do not. We have advice that if the intake of folic acid exceeds given levels, that can also bring health problems, but we will continue to look at it.
Ian Murray (Edinburgh South) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
I am very grateful to my hon. Friend for raising this matter, and I very much welcome the contribution made by the charity to support teenagers in his constituency with psychological therapies and to help to address their mental health conditions. I join him in extending my congratulations to the mayor for choosing this very important cause and for endeavouring to raise so much money for it.
Faisal Rashid (Warrington South) (Lab)
Helen Whately (Faversham and Mid Kent) (Con)
I welcome the Green Paper on mental health in schools, which was published earlier this year, but it does prompt a question about the mental health of students in further and higher education. Does my right hon. Friend have any plans to look into that issue? If he does not, may I urge him to do so?
Jackie Doyle-Price
I thank my hon. Friend for her question and her continued industry on these matters. As she mentioned, the Green Paper outlined plans to set up a new national strategic partnership focused on improving the mental health of 16 to 25-year-olds. That partnership is likely to support and build on sector-led initiatives in higher education, such as Universities UK’s #stepchange project, whose launch I attended in September. The strategy calls on higher education leaders to adopt mental health as a strategic priority, to take a whole-university approach to mental health and to embed it across policies, courses and practices. [Interruption.]
Mr Speaker
Order. The hon. Member for Wigan (Lisa Nandy) need not worry; her Zebedee-like qualities will always make her visible. I am saving her for later. We will hear from her shortly.
Paul Masterton (East Renfrewshire) (Con)
My constituent Susan is desperately waiting for the Government to bring forward the remedial order for single parent surrogates. The Joint Committee on Human Rights published its response to the original draft in March. Is there any update on when we will get the next version?
Jackie Doyle-Price
I can reassure my hon. Friend that the Government are giving careful consideration to the implications of the JCHR’s recommendations and what changes may be necessary to address them. It is our current intention that a revised order be laid for JCHR scrutiny before the summer recess.
Several hon. Members rose—
Lisa Nandy (Wigan) (Lab)
This week marks two and a half months since the independent inquiry into child sexual abuse recommended that compensation be paid urgently to children sent abroad by their Government and subjected to the most appalling child abuse. In that time, the Secretary of State’s Department, despite repeated requests for action, has made not a single statement. Many former child migrants have died and others are dying. How many more will have to wait, and die waiting, for justice before this Government get their act together and pay them the compensation that is owed?
Jackie Doyle-Price
We have been quite frank about the fact that the child migration policy should never have happened and this Government have apologised repeatedly for it. I can assure the hon. Lady that I am currently working with officials to come up with a formal response to the committee of inquiry.
Leo Docherty (Aldershot) (Con)
Will the Minister update me on the FIT—faecal immunochemical test—for bowel cancer? It has long been promised and we know it saves lives. When will it materialise?
Mental Health Services (Norfolk and Suffolk)
Jackie Doyle-Price Excerpts(6 years ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
I congratulate my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) on securing this important debate. I also acknowledge his own contribution to the NHS, not just as one of my predecessors but, as he has explained, as a doctor. He was entirely right to raise in the House the challenges facing his mental health trust. I am not in any way sanguine about those challenges, but we are determined to see the trust perform better for my hon. Friend’s constituents and for people throughout Norfolk and Suffolk.
My hon. Friend raised a number of issues, which I shall do my best to address. He mentioned the trust’s bid for £5.2 million of capital with which to raise its facilities to an appropriate standard, as advised by the CQC. We received a number of good bids, some of them from trusts that were more financially distressed than my hon. Friend’s and others that required more improvements. We could not meet all the bids that we wanted to, but may I, through my hon. Friend, encourage the trust to bid again, as we will look at it sympathetically? I hope that gives due encouragement for it to do so.
My hon. Friend is right that there are very challenging recruitment issues for that trust, and, as he has said, the vacancy rates for doctors are 19% and 16% for qualified nurses. That is particularly high. Central to dealing with that is the issue of leadership. We have a new chief executive in place, a new director of human resources, and a new director of nursing, and we are looking to them to lead the effort to recruit the necessary staff. The trust is also taking additional actions to deal with this. Hotspot areas have been identified and focused action plans are being implemented. As my hon. Friend said, this will include premium payments to encourage recruitment and help attract doctors and nurses to those locations. The trust is also running a series of recruitment campaigns and careers fairs, and is reviewing its skills mix and the appropriate balance of service. Rather than just leaving vacancies open, it is looking at using more occupational therapists and assistant psychologists, and at developing advanced practitioners. We are relying on good local leadership to deal with some of these challenges, but we pay close attention to what is happening there, and we will assist in any way we can to facilitate that improvement.
My hon. Friend mentioned out-of-area placements. At one time they were particularly high, but I am pleased to report that the trust has done a great deal to bring the number of out-of-area placements down. I am told that, as of today, there are eight intensive care out-of-area placements. That represents a massive downward trend from the high point of February this year, but the situation must be closely monitored, and I look forward to there being more co-operation and collaboration between the clinical commissioning groups, through the sustainability and transformation partnerships process, to make sure that there is the appropriate bed mix in the right places for that service to continue to be delivered.
An interesting point was made about integrating with other services, particularly housing, the police and addiction services. I believe that silo policy making tends to end in failure, and my hon. Friend is right that we must be much more joined-up and perhaps have interventions earlier in the process. There are particular points for intervention, such as when people start to hit the criminal justice system due to their addictions. Times of housing crisis also tend to be times when people are particularly vulnerable, and we are looking closely at that. I am not going to pretend anything is perfect; all the issues my hon. Friend raised tonight are entirely valid, and we are looking at them closely.
Turning to local action to put things right, since the CQC report, NHS Improvement has supported the trust to address the major safety concerns and is chairing monthly meetings with stakeholders to monitor progress on improvement. I am also mindful, however, that the CQC might well re-inspect against the areas identified in the warnings notice imminently, which is only right. That will give us more intelligence about what needs to be fixed.
Central to our approach is that all patients must be kept safe and receive the highest quality care. My hon. Friend mentioned the number of bed closures; that was driven entirely by issues of patient safety. Those beds were on wards that were particularly undermanned, but the intention is that those facilities will be reopened once a safe level of staffing can be guaranteed.
I am pleased that the new chief executive officer has been appointed and that he started work yesterday. He has quite a big to-do list, it has to be said. Leadership is so often the crucial ingredient in resolving endemic issues such as safety and recruitment, and we will have a completely refreshed leadership team, including a new chief operating officer, a new director of nursing and a new HR director. We will be looking to that team to build the foundations to tackle the problems that my hon. Friend has identified. It is also important that we, along with NHS England and the Care Quality Commission, continue to support the trust as it leads itself out of these difficult circumstances. Further support is being given by an improvement director from the East London NHS Foundation Trust, which is rated as outstanding by the CQC and will act as a buddy trust. That support will focus on quality improvement.
There is not much more I can say in the limited time I have left, but I can tell my hon. Friend that this is obviously not going to be tackled overnight, and my door is always open if he wants to raise these issues again. However, we now have new leadership in place with a focus on tackling recruitment, and I believe that we can make progress. I re-emphasise that I encourage the trust to bring forward another bid for that capital.
Question put and agreed to.
Lung Cancer
Jackie Doyle-Price Excerpts(6 years ago)
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The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
It is a real privilege to respond to my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) because he genuinely is a friend and has been a great friend to me. The public see this bear pit where we rip each other apart on a regular basis, but I am sure you will agree, Mr Deputy Speaker, that this is also a very special place.
The House takes a judgment of people and views us all as honourable Members, and my right hon. Friend is known for being one of the most decent men in this place. The genuine outpouring of concern and love when he was forced to make his announcement was tangible. I am not surprised that he was surprised to hear where some of the good messages came from, but he should take that as well deserved. He has talked today about a very personal and traumatic experience, and he did so with real purpose and dignity. In doing so, he has shown the best parts of being a Member of this House, and I warmly congratulate him. It has made it very difficult for me to answer, but there we are.
I congratulate my right hon. Friend on securing this debate. He suggested he was lucky to get an early diagnosis and the outcome that he has. There is an element of luck in it, but I will come back to that. The most important point he made was the fact that he followed up with his doctors and did not let it go. The most important thing in getting a good outcome from cancer is being vigilant and taking that early action.
In my right hon. Friend’s speech, he has humanised his story. We all recognise the behaviours that he outlined. It must have been a very painful decision for him to make—at the top of his game, having entered the Cabinet as Secretary of State and done really good stuff, he was suddenly faced with physical health issues but knew it was the right thing to do and took comfort from his family. The rightness of that is here for all to see.
Luck forms part of it, but we also need to properly engage with health professionals. Some people are dogged, others do not want to face up to it, but we all need to have a much more open conversation. The days when cancer was a death sentence are gone. Cancer survival rates in this country have never been higher. As my right hon. Friend pointed out, that is down to early diagnosis and good treatment. The latest survival figures show an estimated 7,000 more people surviving cancer after successful NHS treatment than three years ago, and that is testament to the hard work of our dedicated NHS staff, but we must do better. Our aim is to save an additional 30,000 lives by 2020. Some 130,000 people die from cancer every year, so there is much to do, which is why the Government have accepted all 96 recommendations in the cancer strategy and backed up this commitment with £600 million of additional funding up to 2021.
Mr Edward Vaizey (Wantage) (Con)
I congratulate my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) on a superb speech. It sounds a provocative thing to say perhaps, but it is becoming increasingly apparent that we have cured cancer, in the sense that if diagnosed early enough survival rates shoot up. This might also sound provocative, but it pays for itself. If we can screen people and catch it early, treatment is cheaper than when it is caught later, so although screening would entail a big upfront cost, it would not only save many lives but pay for itself.
Jackie Doyle-Price
It has always been a mystery to me why we spend £200 a year on an MOT for our car but do not do the same for our own health. But I will come to the issue of screening in a moment.
I first want to tackle some of the specific points about lung cancer that my right hon. Friend the Member for Old Bexley and Sidcup raised. As he said, it is one of the most common and serious types of cancer, with 44,500 people diagnosed every year in the UK. Early diagnosis is key but, as he said, in the early stages there are not necessarily signs or symptoms, which is why diagnosis can often come too late. We need to raise public awareness and people need to be vigilant.
The issue of smoking is a very important one. It says here in my brief that smoking is the leading cause of avoidable cancers, particularly lung cancer—that is true, but because it is true it has led to a stigma around the disease, and because of its close association to smoking, many people, even if only subconsciously, view it as a self-inflicted disease. As we can see, that was not the case for my right hon. Friend, but it is very unfair to reach such prejudiced judgments about what is a very unpleasant disease.
As was the case with my right hon. Friend, 15% of lung cancer patients are non-smokers, yet an international survey by the Global Lung Cancer Coalition revealed that a quarter of people in the UK had less sympathy for people with that illness than for those with other forms of cancer. It is clear that lung cancer is not just a smoker’s disease, yet some people believe that that stigma is one of the reasons that lung cancer does not receive the level of research funding that other cancers enjoy. When it comes to cancer research, we know that as well as Government funding there is lots of voluntary funding, and for as long as that prejudice exists, lung cancer will not attract as much investment.
It is important, however, that we continue to spend money on research because, as my right hon. Friend has pointed out, lung cancer survival rates are poor and, although overall cancer survival rates are at an all-time high, some cancers have a five-year survival rate of less than 20%. That is why the Government are supporting the less survivable cancers taskforce, which the Under-Secretary of State for Health, my hon. Friend the Member for Winchester (Steve Brine), launched last year and which will look specifically at lung cancer, but also liver cancer—which I suspect suffers from the same stigma—brain, pancreatic and stomach cancer. It will focus on encouraging more research into less survivable cancers. My right hon. Friend also referred to the Roy Castle Lung Cancer Foundation, which does fantastic work to raise awareness of the disease, and I thank it for its work.
By way of an aside, if people are diagnosed with lung cancer, that tends to be all people see. I had a relative who died of emphysema, but he was a smoker. His death certificate pointed out that the cause of death was emphysema due to smoking. It ignored the fact that he had spent most of his working life in mills, where he would have inhaled various things. That is something that the hon. Member for Coventry South (Mr Cunningham) touched on, and it is close to my heart because of my own experience, as well as that of my right hon. Friend.
On screening, the United Kingdom national screening committee advises Ministers and the NHS in all four nations about screening policy. At the moment, systematic population screening for lung cancer is not recommended, owing to a lack of evidence that it will save lives. There is a considerable amount of research worldwide on CT screening for high-risk groups, such as smokers and ex-smokers. In the Manchester pilots, NHS England offered free health checks and on-the-spot scans to smokers and ex-smokers in Manchester, as my right hon. Friend has explained, as a result of which 46 cases of cancer were discovered. There is evidence that we can achieve things by intervening, and that is something that we should look at. NHS England is encouraged by the results. As my right hon. Friend the Member for Wantage (Mr Vaizey) has said, by reaching diagnosis early, we take cost out of the NHS. What is not to like about that? We will look at it further.
I am running out of time, but the Floor belongs to my right hon. Friend the Member for Old Bexley and Sidcup, who is now trying to intervene on me.
James Brokenshire
I think my hon. Friend has a few minutes left, because we started just after 5 o’clock. I commit to working with her and her ministerial colleagues to advance screening. I know that there is a lot of discussion about how to do so in the expert working groups. The pilots were not so much about screening as they were about carrying out scans, so the set-up is slightly different. None the less, it is important that they inform our working together. As I have made clear, CT scanning has the clear benefit of ensuring that we can pick up cancers sooner and enabling patients to get the treatment that they need to live full and long lives.
Jackie Doyle-Price
My right hon. Friend has made a generous offer. I will address the point that he has made in two ways. The Under-Secretary of State, my hon. Friend the Member for Winchester, is responsible for cancer screening programmes. Our current advice is that national uniform screening would not be productive, but we know about that route. I come back to my right hon. Friend’s experience because he had the wherewithal and courage to face up to a health issue that he had identified and take things forward. I think that the best way of getting improved outcomes is to empower patients to look after and manage their own care, and to have mature conversations with medical professionals so that full investigations can be made. Such conversations would lead to earlier screening. I would be delighted to work with my right hon. Friend to achieve that. We educate the public by sharing real life examples, and that is how we give them the tools to look after themselves. I look forward to working with him on that.
In the time I have left, I re-emphasise that we are making good progress and remain on track to deliver each of the 96 recommendations in the cancer strategy. That will help us to transform cancer services in England, to the benefit of all cancer patients including those with lung cancer. I cannot thank my right hon. Friend enough for securing this debate. I wish him continued success with his own health and send my best wishes to his family, who have gone with him through a very painful and traumatic journey. I thank him again for all the work that he is doing to raise awareness of the disease.
Mr Deputy Speaker (Sir Lindsay Hoyle)
Before I put the question, I want to echo what Mr Speaker said. Welcome back, and know that this House is at its best when we need to support each other. I have been through that, and I cannot speak highly enough of the way that people get together. Welcome back, and may your health continue to be of the best.
Question put and agreed to.