Care Quality Commission: Deaths in Mental Health Facilities

Debate between James Cartlidge and Edward Argar

Friday 16th October 2020 Commons Chamber

[The Minister for Health (Edward Argar)]

I congratulate my hon. Friend the Member for South Suffolk (James Cartlidge) on securing this important debate and his dedication in representing his constituents. He is an old friend of mine and I know how committed he is to his constituents’ interests. Having spoken to him about this particular case, I know how much it matters to him. I was very sorry to hear about the tragic circumstances of this case.

I wish to put on record, at her request, the fact that the Minister for Patient Safety, Mental Health and Suicide Prevention would dearly love to have been in the Chamber today, given how closely she has been involved with this case and situation. However, as a contact of a recent positive covid case, she is doing the right thing, as always, and staying away. I know that she is watching this debate as we speak and that she will continue to keep very much in touch with developments. I am sure she will speak to my hon. Friend the Member for South Suffolk very soon.

I thank my hon. Friend for raising the concerns about the tragic circumstances around the care of his constituent, Richard Wade, at the Linden Centre, and the CQC’s role in investigating the events. As my hon. Friend set out, in May 2015, Richard tragically took his own life while under the care of the Linden Centre, a mental health facility in the Essex Partnership University NHS Foundation Trust. I put on record my heartfelt sympathies for and condolences to Richard’s family. I understand the devastating impact this must have had on their lives. The passage of time will do nothing to dim that, so I wanted to put that on the record.

As a Minister in the Department of Health and Social Care, I am fully committed to ensuring that we provide the highest standards of quality and safe services to patients, and that when there are failures in the delivery of those standards, we are transparent about how we are learning lessons. My hon. Friend raised important issues about the failings of the CQC in responding to the concerns of Mr Wade’s family following his death, and I have noted the CQC’s review of its handling of these matters. The CQC states that it decided not to use criminal enforcement powers to prosecute the trust—it states that this decision was taken after liaison with the Health and Safety Executive and Essex police—and instead to use civil enforcement powers against the trust after Mr Wade’s death. The CQC further states that there was, in its view, insufficient evidence to proceed to criminal enforcement as, according to the CQC, the evidence indicated that breaches were committed by a series of individuals whose actions lay outside the CQC’s prosecution powers. However, my hon. Friend has clearly set out his views on that and on the CQC’s actions. The CQC has unreservedly apologised to Mr Wade’s family for its handling of this case.

As my hon. Friend set out, the CQC review findings identified areas for improvement and organisational learning. The CQC has committed to internal learning for staff and to support providers to recognise ligature risks and improve safety for people who use mental health services. The regulator is providing mandatory training across all inspection teams on decision making and has strengthened its enforcement training for new inspectors. Importantly, the CQC works closely with families and ensures that their involvement and feedback is considered as an integral part of what the regulator does.

On the wider health system and learnings, last year the CQC wrote to all NHS providers of mental health services regarding concerns about the quality and safety of care provided on mental health wards. While progress has been made, there is still significant variation across the country, with a lack of improvement in some mental health settings. In July this year, the CQC wrote to all NHS providers of mental health services, highlighting that it will be looking at this in inspections of wards. Where insufficient improvements have been made, the CQC will take enforcement action.

In 2018, we launched a zero-suicide ambition for mental health in-patients, which means that every mental health trust now has a zero-suicide ambition plan in place. Those trusts will be supported by a new mental health safety improvement programme, which we committed to in the NHS long-term plan.

As my hon. Friend will be aware, the Parliamentary and Health Service Ombudsman laid a report before Parliament in June 2019 on a series of significant failings in the care and treatment of another two vulnerable young men who died shortly after being admitted to the Linden Centre: Matthew Leahy and Mr R. My thoughts are with the families of all those patients who died at the former North Essex Partnership University NHS Foundation Trust, and we are committed to learning lessons from those tragic events.

As my hon. Friend said, the Minister for Patient Safety, Mental Health and Suicide Prevention gave evidence to the Public Administration and Constitutional Affairs Committee last year. The Committee looked into missed opportunities and the recommendations made by the PHSO, and my Department is considering its response to the Committee’s report, which it looks forward to publishing in due course.

As you alluded to, Mr Deputy Speaker, the Health and Safety Executive has investigated the trust, and as a result of that investigation, the Health and Safety Executive has brought a prosecution against the Essex Partnership University NHS Foundation Trust. As Members will understand—and in line with your advice, Mr Deputy Speaker, and that of the Clerks—I am unable to go into any further details on the HSE investigation. However, it has advised that the first hearing in that case will take place in Chelmsford in November. I will say no more on the case than that, in line with your guidance, Mr Deputy Speaker. It is never acceptable for patients to be exposed to avoidable risks. When things do go wrong, clinicians need to be open, honest and able to learn from their mistakes.

I turn to one of the key points that my hon. Friend raised. I am very much aware, as is my hon. Friend the Member for Mid Bedfordshire, of the petition from families of patients who have died while under the care of NHS services in the Essex area, calling for a public inquiry into the deaths. I completely understand that they have concerns that they want to have heard in public. They want answers, and they want to know what happened. My hon. Friend the Member for Mid Bedfordshire has given careful consideration to the failures in care at the former North Essex Partnership University NHS Foundation Trust. On her behalf, I am announcing today that she has set out her intention to commission an independent review into the serious questions raised by a series of tragic deaths of patients at the Linden Centre between 2008 and 2015.

[James Cartlidge]

That will be incredibly welcome for all the families connected. Can the Minister confirm that it will include the case of Richard Wade? Does he appreciate that many other Members—particularly those representing Essex constituencies, and many of whom are Ministers and therefore cannot contribute—will be incredibly pleased to hear this announcement? Frankly, none of us expected it, even though we have waited for it for so long.

[Edward Argar]

I am grateful to my hon. Friend. Although the formal terms of reference of the independent review have yet to be fully agreed, the conditions relating to Mr Wade’s death and the date certainly appear pertinent to this review and are likely to be considered as part of it. I will turn to the details in just a second.

This review will build on the recommendations made in the 2019 Parliamentary and Health Service Ombudsman’s “Missed Opportunities” report. I emphasise again, because I know that my hon. Friend has argued for this powerfully, that it will be independent. He rightly alluded to the fact that, although he is raising Mr Wade’s case today, there is a broader context, and there are other hon. and right hon. Members who have constituents who have been in a similar position and families who have approached them about this. I know that they will want to be involved as well.

[James Cartlidge]

The Minister will appreciate that this is very significant news for many constituents because of the trauma they have experienced. He is right that the key word he has used is “independent”. Will he confirm that that means, basically, that what those constituents have been asking for will be granted, because it is the best chance they will have to learn the truth of what happened?

[Edward Argar]

I am grateful to my hon. Friend for his intervention. I am just coming on to the process that will be set in train now. I emphasise that although, for the reasons I set out, it is me announcing this to the House, the work has been done by my hon. Friend the Member for Mid Bedfordshire. I want it to be recognised just how much work she has put into this issue.

We have decided to start the process now, so that the lessons learned can benefit care across the wider NHS as quickly as possible. We will work with the HSE to ensure that the review does not in any way prejudice the legal action that is under way.

Turning to the specific issues that my hon. Friend raised, the Minister for Patient Safety, Mental Health and Suicide Prevention will also be seeking as swiftly as possible a meeting with the families affected by these events, as well as with my hon. Friend and other hon. Members who are involved with this issue, to understand what they would wish to see from this process as the terms of reference and scope are agreed. The Minister is very keen to fully involve them in understanding the scope and terms of reference that need to be set and how we can seek through this process to bring them at least some degree of resolution. She will provide further details on that in due course.

[James Cartlidge]

The Minister is right to stress the work of our hon. Friend the Minister for Patient Safety, Mental Health and Suicide Prevention, who cares passionately about this. I did say this in my earlier remarks, but I must stress that I know that when she met my constituents—the parents of Richard Wade—it cut to her heart. She has shown huge compassion, which is what has driven this. It is thanks to that that my hon. Friend has announced the news he has today.

[Edward Argar]

My hon. Friend is absolutely right, and I will turn briefly to that in a second. I hope that this announcement today to commission an independent review into issues at the former North Essex partnership trust shows the strength of our commitment and my hon. Friend’s commitment in addressing the concerns he and his constituents have raised and in listening to and working with the families involved in these tragedies. We are committed to learning lessons at a national level to improve services across the whole mental health system, so that no other family experiences the same devastating loss as Richard’s family and the families of other patients who died at the former North Essex partnership trust.

In the few minutes remaining, let me say that my hon. Friend is absolutely right in what he says: my hon. Friend the Member for Mid Bedfordshire brings compassion, decency and determination to her dealings not just on this issue, but across the field of suicide prevention, mental health and patient safety. She is absolutely passionate about it. She has not only a background in medical services, but a genuine passion. It is her energy that is driving this forward and I have to say that it is a privilege to be a colleague of hers and to work alongside her in the role that I hold in the Department.

I conclude by saying once again that, of course, my thoughts and those of colleagues in this House will remain very much with Richard Wade’s family and all the families who have lost loved ones in these circumstances.

Question put and agreed to.

Ipswich Hospital: Orthopaedic Services

Debate between James Cartlidge and Edward Argar

Tuesday 7th July 2020 Commons Chamber

[The Minister for Health (Edward Argar)]

I thank my hon. Friend the Member for Ipswich (Tom Hunt) for securing a debate on the important topic of orthopaedic services at Ipswich Hospital. His commitment to his constituency is commendable and well known. He raised this issue with me when we met very recently, and in his recent letter. I pay tribute to the persistence that he has shown in ensuring that his constituents’ voices are heard on this topic, as on all others.

If I recall correctly, when my hon. Friend last spoke in the House on this matter and I responded, he secured my commitment to visit, which I had the pleasure of doing, with him, in February, and it was a visit that I greatly enjoyed. He is undoubtedly a strong voice for his constituents. Of course, when circumstances allow it, I will be very happy to visit Ipswich once again. I also had the opportunity, that same day, to visit Colchester with my hon. Friend the Member for Colchester (Will Quince), who is a similarly strong voice for the interests of his constituents, his local hospital and the needs of his county, and I pay tribute to him.

[James Cartlidge]

Many of my constituents use both Ipswich Hospital and Colchester Hospital, and I pay tribute to their staff for the incredible effort they have put in throughout the pandemic to look after my constituents, and those of my hon. Friend the Member for Ipswich, to ensure that we get through this keeping our NHS intact. We should be proud of that.

[Edward Argar]

I am grateful to my hon. Friend, whom I have known for many years. As ever, he puts his finger on exactly the right point. I join with him in paying tribute to all the staff at Ipswich Hospital, Colchester Hospital and across our NHS for the amazing work they do day in, day out, particularly at this time.

My hon. Friend the Member for Ipswich set out his case very clearly. I would say that his hospital has no greater friend than him. I reassure him that there is no question of Ipswich Hospital continuing to be anything other than the first-class hospital it is today. He highlighted in outline a little of the background on this issue. In 2015, Suffolk and North East Essex sustainability and transformation partnership concluded that change in the organisation of services was needed, particularly in orthopaedic planned surgery. Since then, East Suffolk and North Essex NHS Foundation Trust has been developing a proposal for an orthopaedic elective surgery centre. As he touched on, the proposal outlines that the centre would see a roughly £35 million investment in orthopaedic surgery services for the population, offering at least 48 new beds and up to six state-of-the-art ultra-clean operating theatres, providing additional capacity for emergency patients across the area. The NHS in Suffolk and Essex ran a consultation, between 11 February and 1 April 2020, on the specifics of the proposal to create an elective orthopaedic care centre in Colchester, but, as I have set out, those plans have been in genesis for many years and have been extensively and widely consulted on.

I note the points raised by my hon. Friend in his speech and, indeed, those raised in his letter to the chief officer of Ipswich and East Suffolk clinical commissioning group recently. I encourage the clinical commissioning group to take that letter seriously and to respond fully to my hon. Friend, as part of the local accountability which is so important to all our public services. Let me be clear—I will emphasise this again later—that this is a process and a proposal that is rightly driven by the NHS at a local level in his and my hon. Friends’ constituencies. He is right to commend the performance of Ipswich hospital over recent years. I appreciate that he wants to ensure that for his constituents, and, indeed, for all those who use the hospital, the reconfiguration does not in any way diminish the achievement of his hospital and its staff, or have any impact on its other services.

My hon. Friend will appreciate that in winter the number of emergency admissions is much higher than it is during the summer. One aspect of this consultation is that it seeks to address planning for that by enabling more beds across the hospitals to be used to meet that demand. I would not seek, and nor should I seek, to prejudge the decision that will be reached next week by the CCG on this matter—it is rightly its decision—but I will set out its rationale in putting the proposals forward. It states that, in practice, if the orthopaedic centre were built at Colchester, it would release 24 in-patient beds at Ipswich, where they are indeed needed. The new orthopaedic centre would be adjacent to the main Colchester Hospital, but away from the emergency department.

I greatly appreciate the insight my hon. Friend has shared from his constituents in Ipswich, who are thankful for the brilliant surgeries they have been able to access in the NHS. Indeed, that was something he highlighted again when I went to wonderful Ipswich with him. When the CCG considers this matter, I would of course expect it very carefully and respectfully to reflect on the points that he and his constituents have made. The proposals reflect the importance of the surgeries. I hope he and his constituents will welcome the fact that the proposals will not remove access to orthopaedic services at Ipswich Hospital. Of nearly 46,000 in-patient day cases and out-patient appointments completed for orthopaedic patients at Ipswich last year, only about 3% would move to the new centre at Colchester under what the trust is proposing. In its proposal, the trust sets out that day surgery, including shoulder and elbow joint replacements, would remain at Ipswich Hospital, as would services for emergency patients, such as joint replacement after a hip fracture.

As I just mentioned, my hon. Friend described the life-changing impact such surgeries have had on constituents who have been treated at his hospital. This proposal, as the trust sets out, seeks to achieve shorter waiting times for surgery and shorter stays in hospital, so that patients can seek the comfort of home more quickly, and to minimise the risk of cancellation of surgery, as the proposed centre will be built safely away from the emergency department and the knock-on impacts that a busy emergency department can have. It also seeks to achieve improved clinical outcomes in terms of reliability from the standardisation of care and provide training, education and research opportunities for clinicians. The trust maintains that it is on that clinical basis that it is putting forward the proposals, which, it states, seek to support the excellent performance of hospitals in the area by organising services in a sensible way so that necessary elective operations can take place while the system supports patients admitted in an emergency.

My hon. Friend also mentioned the merger of Ipswich and Colchester in June 2018. At the time, NHS England outlined several service improvements that the merger would bring about. As well as improvements in various services from paediatrics to emergency ambulatory care, the enlarged organisation would also have an expanded catchment area, leading to improved opportunities for training, providing a more attractive option for clinicians, resolving a number of historical recruitment and retention issues at both trusts and improving finances. It is important, however, as my hon. Friend alluded to, that the trust is held to account for those promises and that it ensures, by the merger, that both hospitals continue to improve.

I briefly touched on the consultation earlier in my remarks, and my hon. Friend raised several points about the process. He is absolutely right to say that important decisions are made with the best interests of patients from across the area in mind, and that the views of local clinicians should not be diminished. There has been much lengthy consultation. As well as the formal process, my hon. Friend highlights the petition, which has been signed by many of his constituents and, I suspect, more widely. It is absolutely right that everyone has their say, and I commend him for what he is doing to ensure that they have their say. Again, such views should be considered with respect and care when decisions are reached.

My hon. Friend also rightly raised the issue of patients and transport, and that they must be supported to travel should the plans go ahead. He has raised the need for a comprehensive plan, both locally and with Ministers, to ensure that all patients can be supported to access the right care. Access to the current patient transport scheme will, the trust states, be available for those unable to make the journey themselves. Under the proposals, pre-surgery and post-surgery appointments would still take place at the patient’s normal point of care at Ipswich or Colchester. Indeed, I pay tribute to my hon. Friend for fighting his constituents’ corner, should the decision not turn out the way he wishes, and for playing an important part in highlighting that issue as well. The only change for patients would be the actual site travelled to for the planned surgical procedure, which would involve a lengthy stay of three days in hospital. I have also been reassured that local partners completely recognise that, alongside these provisions, additional support will be needed for some patients and, should the proposal be approved, further work is already under way to address that.

Being conscious of the time, I reassure my hon. Friend that the Department of Health and Social Care recognises how important these decisions are and recognises that the right accountability, consultations and people must be included in the process of discussing proposals to change services. This is, of course, not a decision for me or, indeed, for the Secretary of State. The next step, as my hon. Friend said, is the final decision, which will be made locally by the CCG on 14 July, but the proposal is not to downgrade or diminish Ipswich, but to promote an alternative way of delivering clinical services. I have no doubt that the CCG will have heard my hon. Friend’s case today, as will his constituents, in whose interests he has spoken so eloquently. I again encourage the CCG to ensure that it carefully considers his words and the representations in making its decision.

I conclude by thanking my hon. Friend and congratulate him on securing this debate. I also thank those other Members who have intervened. My hon. Friend has set out his case powerfully and his constituents are lucky to have him as their Member of Parliament.

Question put and agreed to.

Social Distancing: 2 Metre Rule

Debate between James Cartlidge and Edward Argar

Monday 15th June 2020 Commons Chamber

[Edward Argar]

The hon. Gentleman makes a typically sensible point. It is important that the review is able to be conducted with proper scientific and economic rigour to ensure that we have the evidence base we need. I am not going to prejudge what the decision will be or what the review will say, but he is also right to highlight the importance of businesses having as much time as possible to prepare for whatever decision may be made.

[James Cartlidge (South Suffolk) (Con)]

On the health arguments, should we not remember that our hospitals have lost capacity in order to operate at 2 metres, and will the Minister assure me that the review will look at how many more beds we could get into hospitals to deal with the elective surgery backlog once they are safe in terms of covid?

[Edward Argar]

My hon. Friend makes an important point about getting our NHS back up and running again not just for emergencies, but for elective procedures and other procedures, which is what we have been doing. The infection control context within a hospital is slightly different—indeed, considerably different—from that in businesses and other contexts, but he is right to highlight the impact that the necessary restrictions are having in a range of contexts on the ability to treat people or to serve people and businesses.