Shotley Bridge Community Hospital
Kevan Jones Excerpts(3 years, 6 months ago)
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Mr Kevan Jones (North Durham) (Lab)
I congratulate the hon. Gentleman on securing the debate. He is right about the community support in not only his constituency but North Durham, which the hospital also serves. If the moneys are in place, that is welcome news, but there seems to be confusion locally about where the site will be and whether there will be 16 beds. Does he have an update on those details?
Mr Holden
I thank the right hon. Gentleman for mentioning that. My understanding is that there are still three sites under discussion, but it will be around Consett. I am pushing the Minister on whether there will be 16 beds, because that is what was in the Secretary of State’s letter to me, and I want to ensure that that is the case.
Mr Kevan Jones
Those community beds are needed for respite and other things in the area, and the hon. Gentleman is right about the cancer treatment done at the trust, but the CCG wrote to me this week saying that there is not yet clarification about whether there will be 16 beds.
Mr Holden
We are both pushing the Minister on that exact point.
Crucially, I would like the Minister to confirm that Government funding from the hospital programme will cover the difference between moneys sourced so far from local trusts—the £17 million confirmed last year—and whatever will be needed for this facility. It is great to see capital investment delivering on the levelling-up agenda on which I was elected. It is not all about capital—it is also about investment in schools, so it was great to hear the investment announced last week in skills and training—but part of it is, because communities like mine feel that over decades, they have not been given a fair crack of the whip and have been left behind.
I would also like the Minister to confirm that this will not be done under any form of private finance initiative deal, which my constituents have mentioned. They are concerned that, over the last few years, and especially under the last Labour Government, hospitals have been left with essentially very large debts, which caused them problems in the longer term. That has afflicted hospitals and facilities across County Durham.
Finally, I want to highlight the great work done at Shotley Bridge and by all the great NHS staff across County Durham and Darlington, some of whom were seriously ill, and a couple of whom died from covid. There are a lot of local questions about covid at the moment. Could the Minister talk a bit about the work he is doing to ensure that none of the measures taken at either a local or national level—including those asked for by local authorities in our area—will be in place any longer than they need to be? We want to see our communities back up and running as quickly as possible and providing the healthcare services that people want across the board.
Edward Argar
I am grateful to my hon. Friend. Having secured that re-invitation, I look forward to that. I would like to put on record, as he did in his speech, my thanks to all who work in Shotley Bridge Hospital and more broadly in the County Durham and Darlington NHS Foundation Trust for the amazing work they have done for his constituents and more broadly during the pandemic, and indeed for the care that they all provide day in, day out, all year round, regardless of the public health context.
Shotley Bridge Hospital is, as my hon. Friend said, a key part of the local healthcare landscape in the services it provides, but he has effectively made the case that it has the potential to do even more. I know that the sustainability and transformation plan set out the long-term approach to the strategic delivery of health services in these areas, but the CCG and the trust itself have undertaken considerable work on this as well. As I say, the staff are doing an amazing job, but the current hospital faces challenges. In the last financial year—I am sure my hon. Friend will correct me if I get this wrong—it had total running costs of around £1.7 million and £570,000 annual maintenance costs simply to keep the buildings working. These annual costs are a challenge, but so too is the nature of the physical space, including its usage of the current site and the access to it.
The case for, and commitment to, the hospital is clear. As I understand it, there has already been a consultation on elements of this matter in spring 2019. I was therefore extremely pleased that my hon. Friend’s campaigning had paid off and that a new hospital for Shotley Bridge was included in the list relating to the £3.7 billion investment in 40 new hospitals to be built, which my right hon. Friend the Prime Minister announced late last week. This is a reflection of a Government delivering on their pledge to build 40 new hospitals, and it is a fantastic example of this Government delivering on their commitment to levelling up.
This new hospital for the people of North West Durham, and indeed more broadly, reflects the healthcare needs of the local population and the local context. As I understand it, the CCG and the trust are continuing to work out the details and consult further, and I encourage my hon. Friend to continue to work closely with them in that endeavour, as I believe he is doing. Let there be no doubt about what he has achieved with this announcement, less than a year after being elected and after a decade of this matter barely being raised in this House. I make an honourable exception to that, because I know that the right hon. Member for North Durham (Mr Jones) has continued to raise it, and that he has worked with my hon. Friend. However, I know that it is my hon. Friend’s passion, as the Member for North-West Durham, that has delivered this result.
Mr Kevan Jones
I congratulate the hon. Member for North West Durham (Mr Holden) on his efforts, but a lot of work has been done on this over many years, including by many councillors. I know that the hon. Gentleman mentioned councillors, but he excluded the Labour councillors and Durham County Council, who have been working with the CCG and others to deliver this. It is something that will benefit the entire area, and yes, I congratulate him, but the important thing is that a lot of this work was done before he even knew where Consett was.
Edward Argar
I suspect that my hon. Friend has long known where Consett is, and he has been campaigning hard since his election, but I shall take the right hon. Gentleman’s intervention in the spirit in which it is meant. I have alluded to his work on this, which is only right, but he is right to point out, in relation to my earlier references to the work that had been done previously during the consultation by the CCG and others, that I should also recognise the work done by councillors and other local campaigners and, indeed, by local people in that context.
The new hospital for the people of North West Durham —and the broader region, as the right hon. Gentleman rightly says—will be part of a model of care developed to reflect the healthcare needs of that local population. My hon. Friend the Member for North West Durham, in working to understand those healthcare needs and working with others, as is his way, has secured agreement for the delivery and funding of one of his key local election pledges when he stood for this House in 2019. To answer some of his questions specifically, we will fund this new hospital, and I have no intention of that being through a PFI.
My hon. Friend has been clear, and I agree with him, that this new hospital will not only contain, as he has set out, an enhanced range of services, but, crucially, those in-patient beds that he has been so very clear about. As the trust and others work through—
Covid-19 Update
Kevan Jones Excerpts(3 years, 6 months ago)
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Matt Hancock
My right hon. Friend makes a really important and heartfelt plea. I have been working with the travel sector and discussing the matter with them. While the testing capacity is, as it is now, on the current technology, we have to use it for the clinically prioritised groups, but of course we would all love to see when further expansion can mean that we can use testing more broadly in the sorts of ways that she describes.
Mr Kevan Jones (North Durham) (Lab)
Since the beginning of this crisis, the Government’s approach has been one of central control. We are fixated on the number of tests, but is the real issue not the number of tests, but what we do with the information we get from them? Before the new restrictions were applied to County Durham, NHS Test and Trace took testing capacity out of County Durham. Is it not now time to just admit that the national system has failed? What is needed is to give responsibility directly to directors of public health, with the resources to do not only the testing, but the more important thing, which is tracing, which they are more able to do than people in national call centres?
Matt Hancock
We put in money, including into the right hon. Gentleman’s constituency, to do exactly that—to make sure that there is local support. He says we should follow a localised approach. That is exactly what we did in the north-east: when the seven north-east councils came to national Government, they asked for a set of interventions to be put in place, and we did that. That is exactly the sort of approach that we ought to be taking, and we will continue to do so.
Coronavirus Act 2020 (Review of Temporary Provisions)
Kevan Jones Excerpts(3 years, 7 months ago)
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Nick Thomas-Symonds (Torfaen) (Lab)
I am grateful for the opportunity to speak in this debate, having taken the Bill through its Committee stages back in March.
We come to the House today to debate the renewal of the provisions of the Coronavirus Act, in the gravest of circumstances. Here in the United Kingdom, we have seen over 42,000 deaths, lives altered in ways unimaginable a year ago, and our economy facing one of the worst recessions on record. We accept the challenge that presents, which is why we have recognised that, in a pandemic, any Government need extraordinary powers available, and why, with a heavy heart, facing this highly unsatisfactory situation of an all-or-nothing motion, we will not block its passage.
We have supported the Government when it has been right to do so, and the British people, who have sacrificed so much in the national effort to address this virus, deserve nothing less. But today we say to the Government that things cannot go on as they are. The incredible efforts of the British people have not been matched with competence and grip by the UK Government. Announcements about measures have been made overnight, with no proper notice and no proper power of review, and Government Ministers have appeared on national media with absolutely no idea of what the rules are. The public are being let down on a grand scale.
The Government have had virtually all the resources and brilliance of our remarkable country on demand for over six months. They have been able to call on the UK’s remarkable frontline workers, who have shown incredible skill and bravery through this crisis. Yet we have ended up with one of the highest death rates in the world and on the threshold of one of the deepest recessions.
At the same time, the road ahead is anything but clear. Our testing system is inadequate, at the very moment we need it most, and this is having a devastating impact. Losing control of testing means losing control of the virus. It is that loss of control that makes further restrictions necessary. It is restrictions that are having a devastating effect on families and businesses up and down the country. This dire situation was not inevitable. It is the result of a chronic failure of Government. Today we must take stock of where we are and the urgent need for the Government to get a grip.
Mr Kevan Jones (North Durham) (Lab)
Does my hon. Friend agree that the Government are attempting to shift blame on to local councils? The councils quite rightly want restrictions, but what is happening is that they are asking for things but not being given them. There is also no consultation at all on how the restrictions should be implemented locally, which is leaving the councils with the confusion that we have had over the last few—
Nick Thomas-Symonds
My right hon. Friend is absolutely right. The UK Government need to get a grip and work with the other Governments and local councils around the United Kingdom on an equal basis.
Right at the start of the pandemic, the World Health Organisation said that we should “test, test, test”, and it was clear that that would be a vital element in regaining any form of normality. The Government had the country’s full resources on hand, and on 20 May the Prime Minister promised a “world-beating” test, track and isolate system by 1 June. I am not asking for a world-beating system; an effective one would do just fine. But shamefully, this has not been achieved all these months later. Is not this the problem with the Prime Minister? He always promises a better tomorrow, but he never delivers today.
Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) (Amendment) Regulations 2020
Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) (Amendment) (No. 2) Regulations 2020
Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place and on Public Transport) (England) (Amendment) Regulations 2020
Kevan Jones Excerpts(3 years, 7 months ago)
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Justin Madders (Ellesmere Port and Neston) (Lab)
It is a pleasure to serve under your chairmanship, Mr Efford.
I thank the Minister for her detailed introduction. As she rightly pointed out, today we are debating amendment No. 2 to the original regulations on face coverings, which we debated only a week ago, and the amendment to the regulations on the wearing of face coverings in a relevant place and on public transport.
The first amendment to the face covering regulations, which, as we heard, came into force on 8 August, required the wearing of face coverings in additional indoor premises to those listed previously. It added indoor places of worship, crematoria and burial grounds, chapels and museums, galleries, cinemas, public libraries, public spaces in hotels, such as lobby areas, and community centres to the list of relevant places.
On the face of it—if you will pardon the pun, Mr Efford—those are all indoor settings that are not fundamentally different in character from those covered by the initial set of regulations. I would be grateful if the Minister set out why, in those circumstances, an amendment was necessary. Was it that the scientific advice changed between July and August about the places where face coverings would be effective, or was it simply that those places were an oversight in the first set of regulations?
The regulations also list the premises exempted from the definition of “shop”, including premises offering certain medical services, gyms and photography studios, and add premises that were previously exempt from the definition of a shop as relevant places where face coverings must be worn, unless an exemption or reasonable excuse applies. Those include places such as nail, beauty and hair salons and barbers, tattooists, piercing parlours, massage parlours, storage and distribution centres, auction houses, spas, funeral directors, veterinary practices, premises providing professional services including legal and financial services, theatres, casinos, nightclubs, dance halls, conference and exhibition centres, bowling alleys, amusement arcades, indoor soft play areas, skating rinks or other indoor recreation activity premises. Again, I would be grateful if the Minister set out the rationale for the changes to the definitions in what would appear to be a very short period of time.
The amendment (No. 2) regulations, which came into force on 22 August, added further indoor premises where face coverings must be worn, including casinos, members’ clubs, social clubs and conference centres, and removed premises that were previously exempt, meaning that face coverings must also be worn in funfairs, theme parks or other premises for indoor sports, leisure or adventure activities. The regulations also added further examples of circumstances in which a person would be exempt from wearing a face covering in the relevant places, including for elite sportspersons, the coach of an elite sportsperson, referees, and professional dancers and choreographers when they are either acting in the course of their employment, training or undertaking competition, and for pupils at religious schools who are under the age of 19 and are undertaking educational training in a place of worship as part of the curriculum.
Finally, the Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place and on Public Transport) (England) (Amendment) Regulations 2020, which came into force on 28 August, amended the penalty amounts for fixed penalty notices issued under the legislation that governs the wearing of face coverings on public transport and in relevant places. As we have heard, this means that the penalty for a first offence remains at £100, reduced to £50 if paid within 14 days. For each additional breach of the face covering regulations on public transport and in relevant places, the fixed penalty notice amount now doubles, up to a maximum of £3,200—a system that is now known as laddering.
The regulations also provide that fixed penalty notices issued before this approach was implemented will not be included in the laddering. For people who received a fixed penalty notice before 28 August, the first fixed penalty notice issued after that date will be for £200. Each subsequent fixed penalty notice will double in cost, up to a maximum of £3,200. All subsequent fixed penalty notices issued after the £3,200 limit has been reached will be levied at £3,200, and any discounts for early payments will not apply to fixed penalty notices issued for £200 and above. I very much doubt that anyone has yet been issued with the maximum fixed penalty notice of £3,200, but I would be grateful if the Minister set out whether anyone has reached the top of the ladder—or escalator, as it might well be called.
I want to make it clear, as I did during the debate last week on the initial regulations, that the Opposition support these SIs. We all have our part to play in beating this virus. It is important that we all follow the advice to wear a mask, unless someone is exempt. As we know, that is important not just for keeping each of us safe, but to ensure that people can go about their livelihoods as much as possible.
As cases begin to rise again, people are concerned about what the winter holds for them and their families. With the sharp rise in coronavirus cases and the difficulties that people across the country are facing in getting a test, there is mounting concern that we do not have the virus sufficiently under control. There is no doubt that Professor Chris Whitty and Sir Patrick Vallance gave an extremely sobering message this morning about the challenge we face over the coming months.
The Opposition will support the SIs because they will help limit the transmission of the virus, but it is also important that this place plays its role in scrutinising the legislation, which is why we are having this debate. I want to raise a number of issues, starting with the timing of the regulations. Since 11 May, the Government have been advising the public to wear face coverings in enclosed spaces where they might find it difficult to maintain social distancing and might come into contact with people whom they would not normally meet, yet face coverings became mandatory on public transport in England only on 15 June, in shops and transport hubs on 24 July, and in the other relevant places covered by the regulations on 8 and 22 August.
The question of why there was such a delay between the Government’s recommending their use and mandating their use featured heavily in the debate on the wearing of face covering regulations last Monday, more than seven weeks after they originally came into effect on 24 July. As the Minister will no doubt recall, I asked her at the time whether she could explain why there was such a delay between the Government’s advising people to wear masks on 11 May and the introduction of the wearing of face coverings regulations on 24 July—a period of some two and a half months. The Minister responded not in the debate but in subsequent correspondence, and I am grateful to her for her reply. I would have been even more grateful if I was satisfied with the answer I had; unfortunately, that has not proved to be the case.
In a letter to me, the Minister says:
“Our advice from the Deputy Chief Medical Officers is that evidence is limited but suggests that face coverings may have some benefit in reducing the likelihood of someone with the infection passing it on to others, particularly if asymptomatic disease is common, which is now established for the novel coronavirus.”
That is something that we all understand and accept—hence we are not opposing the regulations—but it does not really explain the reason for the delay in making it mandatory, although the Minister goes on to say in her written response to me:
“The Government reflected on how the public had responded to the guidance to wear face coverings in enclosed spaces.”
Again, it is not in dispute that the Government would have reflected on this, but we do not know what those reflections uncovered or why it was determined that regulations were required. The letter continues:
“As lockdown restrictions began to ease across the country, we felt it necessary to mandate the use of face covering in some indoor settings such as shops, supermarkets and indoor transport hubs. As shops reopened, we anticipated an increase in footfall and introduced these measures to provide some reassurance to people and help them benefit from some small additional protection that face coverings can offer when it is not always possible to socially distance. Nevertheless, social distancing and hand hygiene remain the most important way to control the virus.”
I think that that articulates rather better the Government’s thought processes, although it is to be noted that their position is that social distancing and hand hygiene remain the most important weapons against coronavirus; however, neither of those measures has become compulsory. It may be that it has been deemed, on balance, that they are too difficult to enforce in any meaningful way, but if the Minister could add anything on that point I would be grateful.
I have a couple of quibbles with the explanation. It talks about shops reopening, but of course supermarkets have remained open throughout, so I am not sure how that can be part of the reason for the delay. Although some shops were closed in the lockdown, most were reopening by early June and all non-essential retail was back open by 15 June. On that basis, the regulations should have come into force by that date—not five weeks later. Given that the Government’s own explanatory memorandum states that mandating the use of face coverings in a range of public indoor settings offers a reasonable protective measure to reduce the risk of infection on contamination by the virus, why was there a delay? Why not introduce the measures more uniformly across indoor settings in the case of shops when they reopened, instead of five weeks later? In the case of other settings, why do it in stages over the period of a month, causing confusion over when they were or were not required? As Members of this House and the other place have rightly said, the delays have not only fuelled confusion over where people should wear face coverings; they have caused people to lose trust in the Government’s message and, sadly, to stop following their advice.
That brings me to another issue, which is that conflicting advice and confusing statements from Government are not helpful in the fight against the coronavirus. If we want people to understand the rules and follow them, we need clear communication from the Government and the rules need to make sense.There is a struggle to understand, at times, why the rules still apply only to some people and not others. Will the Minister explain why, for example, the regulations do not apply to those who are actually working in shops, transport hubs and the other places where they apply? That was raised in the previous debate, but we did not get a satisfactory answer. Surely someone in a restaurant or pub serving members of the public is going to come into contact with large numbers of the public, so I wonder why it is not a requirement that they wear a face covering.
It is correct that many retail environments have put up screens to ensure that their checkout staff are protected, but many staff are of course engaged in other activities around the store, such as stacking shelves, often when members of the public are walking past. What is the difference between someone in that situation spending a significant amount of time in the aisles, and someone who is shopping there as a member of the public?
The last time the Committee met I also did not get a satisfactory answer about schools. It is notable that in the incredibly long list of indoor places where people gather and might find it difficult to socially distance, schools, colleges and universities barely get a mention. The National Education Union was right to say that the “slow” and “incoherent” way in which the decision was reached would not inspire confidence from parents or teachers. We are aware of the confusion caused by the Government’s 11th-hour U-turn about requiring secondary school pupils to wear face coverings in school corridors in local lockdown areas in England—an announcement made just days before schools returned. Of course that makes little sense to a pupil who lives in a local lockdown area but who is educated in an area that is not under lockdown, and who therefore is not subject to the same requirements.
Current guidance means that it is school leaders who have to make individual decisions about the use of face coverings in their school. Not surprisingly, the National Association of Head Teachers has said that that approach is “neither helpful nor fair”. I for one have received emails from concerned parents asking why the wearing of masks in schools is not compulsory. I understand their concerns when the country has about 75,000 teachers off, and 740 schools that are either wholly or partly closed because of the virus, and when teachers and pupils alike are unable to get tests.
As the general secretary of the National Association of Head Teachers said, it was
“in no way unpredictable or surprising that the demand for Covid-19 tests would spike when schools reopened more widely this term”.
We certainly have been calling on the Government to take more action over the summer to prepare for the autumn.
Obviously, with increasing numbers of local authorities now facing lockdown restrictions that affect more than 13 million people, more areas face local restrictions, meaning that more pupils will be required, by default, to wear face coverings in communal areas. But what about other areas? It is widely acknowledged that we are now seeing a rise in cases all across the country, with the R rate estimated at being between 1.1 and 1.4.
The Opposition support the use of face coverings becoming compulsory in communal areas in secondary schools as a step towards reducing infection rates. In her response to the debate, I would be grateful if the Minister could explain why that is not being made mandatory and why instead we continue to see this variation across the country.
Also, what about universities? It has been reported that some universities require face coverings to be worn in all shared indoor spaces, while others do not. Again, the responsibility should not be placed on individual institutions. Local authorities are also rightly concerned about spikes in infection as universities return. Universities have been calling for clear national guidance on the use of face masks on campus to help reduce the spread of the virus. As many students have returned to university, will the Government or the regulator publish guidance calling for all universities to take that step?
On enforcement, as the explanatory memorandum notes, although the majority of the public have complied with the regulations, there is a minority who have not done so. We support measures against the very few people who are frequently and repeatedly breaking the rules that, of course, are there to protect us all.
As we have already discussed, the new premises cited in the amended regulations include casinos, members’ clubs, social clubs and conference centres. Putting aside for a minute the question of why they were added to the list so late on, I want to explore the inclusion of members’ clubs and social clubs in a little more detail.
There is no doubt that such clubs have been extremely hard-hit, like many other parts of the economy. In particular, the restrictions on large gatherings have affected their ability to hold functions, which for so many of them represent the difference between their making a profit or a loss. However, something perplexes me somewhat—what is the fundamentally different element between what I would generically describe as a social club and a pub? What is the difference? I do not know how often the Minister frequents either of these types of establishment—
Mr Kevan Jones (North Durham) (Lab)
Could it not be argued that a social club has more control over who is inside the club? Unlike a pub or a bar, where anyone can walk in, in a registered social club people have to be members or signed in, so there is proof of who is there. Does my hon. Friend agree that social clubs have more control than a pub over who is actually in their space?
Justin Madders
My right hon. Friend is absolutely right. Of course, it was the case until fairly recently that there was no legal requirement on pubs to take test and trace details, so they were in a very different position from social clubs.
However, the main thing that perplexes me is that if we look at the layout, the function and the activity of pubs and social clubs, they seem to be extremely similar. Can the Minister explain from either a political or scientific perspective why they are being treated differently for the purposes of these regulations?
It has been said that these regulations play an important role in giving people the confidence to travel, to return to the workplace and to frequent the retail and the hospitality sector. However, for that confidence to be in place, we need the enforcement regime to be universal and rigorous, and at the moment that does not appear to be the case.
The latest figures that we have for public transport show that between the regulations being introduced, which was on 15 June, and 20 August, there were 115,423 interventions to remind passengers to wear face coverings, with at least 365 fixed penalty notices issued. However, we also know that by 20 August only eight fixed penalty notices had been issued under the relevant place regulations, but if the Minister can update us on that today I would be grateful.
Even allowing for the time difference between introducing the regulations for public transport and transport hubs, one has to wonder why there is such a disparity between those figures. They suggest that people are more compliant in transport hubs and retail spaces than they are on public transport, but frankly that is unlikely. Alternatively, is it more likely that the disparity can be explained by the lack of enforcement in transport hubs and shops? Can the Minister confirm if that is the case and can she also confirm what is being done to ensure compliance?
As several Members said in the previous debate, we need clarity on how these requirements will be enforced. What we are hearing across the country is that they are not being enforced as effectively as they could be. The legal requirement to wear a face covering when using public transport was introduced in June, and then in shops the following month, but it was clear that the police did not see it as their role to enforce that requirement
I wonder whether the high level of interventions taking place on public transport are mainly in London. The Minister will recall how we discussed during the last debate the fact that Transport for London staff were specifically mentioned in the regulations. As I know from my own constituency, however, little enforcement is happening on public transport. I have had multiple constituents complaining that when they go on buses and trains, some travellers seem to be able to travel without face coverings, and are not being challenged. Despite the regulations providing very broad powers to a wide range of people, it is still not clear who those people are, and whether bus or rail companies have the powers they need to enforce the regulations, despite their staff being an obvious choice.
We have the same unanswered questions about the retail sector, which faces similar problems with enforcement. Just as bus companies are reluctant to ask their bus drivers to enforce the rule, many of the major supermarkets are not asking their staff to police it, relying instead on encouraging shoppers to play their part through signs and public address announcements in store. Regarding enforcement numbers, it would be interesting to know how many of the fines or fixed penalty notices that have been issued so far related to transgressions in retail environments.
We know from a shopworkers’ survey carried out last month by the Union of Shop, Distributive and Allied Workers that 75% of shopworkers have been abused by customers who were asked to socially distance, and almost half had experienced abuse as a result of asking shoppers to wear face masks. In that circumstance, it is not surprising that shop staff are reluctant to carry out that role. Nobody should face abuse for asking people to comply with public health measures, and such reprehensible behaviour by members of the public should not go unpunished.
The Minister has quoted a figure of 96% compliance with the wearing of face coverings in shops. I wonder if she could explain the nature of that survey: was it simply asking people whether they had complied with the regulations, or was it based on observation? I should imagine that most people contacted by a polling company and asked whether they intend to comply with the law would answer that they did—who wouldn’t? Four percent, possibly, but from my own observations, I suspect that the compliance rates are rather lower. Next time Members visit their local shops, I urge them to have a look around and see for themselves whether there is an issue of compliance and enforcement.
In July, the Prime Minister increased the pressure on the police to uphold face mask laws, seemingly at odds with the Police Federation, which described the task as “impossible”. Does the Minister agree with that description? If not, would she at least accept that the low number of fixed penalty notices may indicate a problem with enforcement?
Listening to those who represent the people on the frontline is important. With the rule of six and the new legal requirement to self-isolate, the number of enforceable restrictions is increasing. I was concerned to read, in a response to a written ministerial question I received last week, that no physical checks are currently being carried out on people who are requested to isolate. Presumably, if fines are now to be issued to those who break quarantine, there must be some kind of enforcement to make that effective. There are very real pressures on the police, due to the reduction in their numbers over the past decade, and they simply cannot continue to be handed responsibilities if those responsibilities are not accompanied by sufficient resources to enable them to do their job. We need answers that have not been forthcoming to date. Will the Minister set out what resources have been handed to the police to ensure these measures are complied with?
Despite media reports that covid marshals are already operating in the streets, we still have not got to the bottom of who they are, what their role is, or how they will be resourced. We do know that council leaders have expressed concerns that they are not able to resource them, following a decade of cuts; of course, councils are already facing significant, multi-million-pound shortfalls in their finances this year. The Minister was unable to answer questions in Committee last week, and the concern is that despite the emphasis the Prime Minister has placed on them, the scope of covid marshals will turn out to be disproportionate to the reality of what is happening on the streets.
When the Minister responds, will she be able to confirm whether covid marshals will be required to enforce the wearing of face coverings in relevant places, on public transport, or both? If that is the case, how will they be funded, and how will this be communicated? It is important that people know not only that their actions can be subject to enforcement, but by whom.
For there to be public confidence in the rules, adherence to them and compliance with their enforcement, it is vital that everyone understands who has the power to enforce them. Uncertainty about that will only create friction, tension, and greater uncertainty.We need absolutely crystal clarity from the Government about who is able to enforce these rules and the circumstances in which they are able to do so.
Justin Madders
No doubt the Minister can answer the questions raised by my right hon. Friend the Member for North Durham and by my hon. Friend the Member for Warwick and Leamington (Matt Western) last week on whether the wide enforcement powers created by the original regulations, the amendments to which we are discussing, were intended to cover face coverings as well.
Mr Jones
It is not clear; we have not been given a list of people who can actually enforce these powers. The regulations are relevant to marshals if marshals are given the powers and included in the list. We do not know whether marshals are in the list of individuals to whom the Secretary of State could give powers.
Justin Madders
My right hon. Friend is absolutely right, and I hope that we finally get some clarity on that today.
I again raise the Opposition’s concerns about the way these regulations have been brought in, and the delayed scrutiny and debate of them. Many points and questions I and other Members have raised should not be being heard weeks after the regulations came into force. Although the amendments to the regulations on the wearing of face coverings were laid during the summer recess, as I raised earlier, had the initial regulations been debated in a timelier manner, perhaps that situation could have been avoided altogether. As the Minister will be aware, the Opposition have repeatedly called for regulations to be debated before they come into force. I have raised the issue of new regulations being introduced and not debated until weeks later on every occasion that we have discussed coronavirus regulations, yet it still happens every time we debate a new statutory instrument.
Despite the Government’s own acknowledgement that they are aware of Parliament’s concerns about allowing for the timely scrutiny of regulations, particularly in relation to the timing of debates, we are once again debating regulations weeks after the event. I note that we are perhaps debating these regulations rather more promptly than the previous face covering regulations, and that the Government have scheduled 17 sets of regulations for debate this week, which will hopefully bring us a little bit more up to date. Of course, I have made it clear on numerous occasions that we accept that the initial coronavirus regulations had to be introduced hurriedly in response to the initial threat from rising numbers of infections from what was, at the time, a new and unknown disease, but we are no longer in that situation.
Each of these regulations contains the phrase at the start:
“the Secretary of State is of the opinion that, by reason of urgency, it is necessary to make this instrument without a draft having been laid before, and approved by a resolution of, each House of Parliament.”
I accept that, earlier on, that would have been the case, but that cannot really be said of these regulations. What is the urgency for these two sets of regulations to correct oversights and omissions from earlier regulations and other regulations increasing the level of fines for transgressions? Is it really the Government’s position that correcting their own mistakes is a good enough reason to override parliamentary scrutiny? What is the reason for the urgency in the increase in fines? As I say, we have no problem with the laddering proposals in these regulations, but what required them to be introduced before there was any debate?
I am concerned that the Government appear to be falling into a regrettable pattern of treating parliamentary scrutiny as an afterthought, relying on claims of urgency that are really not justified as Members on both sides of the House and in the other place have repeatedly expressed their desire for these debates to be held in a timelier way, to ensure full parliamentary scrutiny. Despite those multiple pleas and the Government’s assurances that they have listened to those concerns and are working hard to address the problem, it seems that every time we face new regulations, we still face a rubber-stamping exercise, weeks down the line.
These regulations are too important not to be debated and given full and timely parliamentary scrutiny before they become law. I make this plea as I have done on a number of occasions. The Government should be aware that we remain extremely concerned about the continuing contempt being shown for parliamentary scrutiny. They can and should make time to debate regulations before they become law.
We believe it is possible to arrange, through the usual channels, for these Committees to be set up at short notice, so that important regulations such as this are debated in a proper manner before they become law. I know that many on the Government Back Benches share that view, and I will of course clear my diary, if necessary, to ensure that the Opposition play our part in ensuring proper scrutiny of, and accountability for, such regulations. It seems likely there will be more regulations on their way. I hope we can debate those in the proper and orderly manner that it is this Parliament’s duty to do.
Mr Jones
I will not challenge you, Mr Efford, and I welcome you to the Chair today. We had a debate last week about enforcement and who could and could not enforce the regulations. The Minister promised to write to us last week with a long list of individuals, but we have still not got it.
Mr Jones
Well, I am sorry but I have not received it, and I do not think my hon. Friend the Member for Ellesmere Port and Neston has, either. The list would include people who could be designated by the Secretary of State. He could designate, for example, marshals, but I shall leave it there.
In terms of these regulations, my hon. Friend points out a growing trend with this Government: they seize emergency powers. We in Opposition support them because we saw back in March that clear action needed to be taken, but there has been no give and take in terms of trying to involve the Opposition or even Parliament in how the regulations are implemented.
My hon. Friend raises a very good point about the way in which the regulations have been introduced, because it raises a broader issue here. For these regulations to be effective, they have to have public buy-in. We are elected to this place to represent our constituents. We have seen over the past few weeks the utter confusion there is now about what people can and cannot do—added to that is the announcement of just half an hour ago. When the Secretary of State introduced the lockdown regulations for the north-east last week, he excluded any reference to childcare, so my inbox and that of everyone else in the north-east was inundated with people questioning whether they could take their grandchildren to school. I am glad to see that sense has been arrived at this afternoon and the clarification has been made, but that is one example, and these regulations will lead to more confusion, as I shall illustrate.
Again, these regulations have not been well thought through. First, we discussed last week how a relevant place is defined. The first regulation extends the number of places where a face mask is needed in what is deemed a relevant place. Before, it was shops, supermarkets, shopping centres, banks and post offices, but not included were restaurants that could provide table service to customers, bars, pubs or areas of a shop or shopping centre that provided for the consumption of food and drink, and seating areas in coffee shops, supermarkets, cafés and food courts. We discussed whether seating areas in transport hubs were covered, and I got clarification on that from the Minister this week.
The relevant places are then extended to include indoor places of worship, crematoria, burial ground chapels, museums, galleries, cinemas, public libraries, public spaces in hotels such as lobby areas of hotels, and community centres. I will come back to the issue of clubs in a minute. To me, this is not very clear. Many hotel lobbies, for example, have seating areas where people perhaps just want to sit and wait to be checked in, but many hotels have seating areas where someone can order a sandwich or a drink or another type of refreshment, so are those areas excluded? Occasionally, for example, I walk into the Radisson Blu hotel or the Royal County hotel in Durham and ask for a sandwich at the reception, and it is delivered to me as I sit in the reception area. Am I then exempt from wearing a face mask or not?
I will come on to community centres, and I am sure hon. Members will know of similar situations to mine. I have a number of very good community centres in my constituency that provide food, but not regularly. They have seating areas for luncheon clubs and various catered events. Under the definition in the regulations, the community centres should be excluded on the basis that they have seating areas and provide food. Do they actually have to provide food at that time? Are we saying that if they are providing food, people there do not have to wear face masks, or that if they are not providing food, people do have to wear face masks? Those are things that will be very confusing to local organisations. It would be interesting to know how that actually works.
Another issue is the definition of a place of worship. That is pretty simple in that a place of worship is a church, a synagogue, a mosque and so on, but increasing numbers of churches do not actually have fixed buildings. They meet in people’s houses as community churches. I have a number in my constituency, and I am sure that there are some in London as well. Are they covered under the rule of six? I imagine that there would be more than six people in those congregations. Are those houses covered as places of worship? For those individuals, that is what they are. We might not recognise them as traditional places of worship, but for their congregations, they are. Will those congregations have to wear face masks in the houses where they hold their services?
I take the point made by my hon. Friend the Member for Ellesmere Port and Neston about social clubs. Many of them were struggling before the pandemic as it was. Their membership tends to be elderly, so a lot of people will not be going to the clubs. They are no different from pubs, in my opinion—except that, importantly, the regulation around them is more strict because they know exactly who goes in, and there are disciplinary proceedings if things happen. Putting them at a disadvantage is wrong.
I now come to the question of wearing face coverings in nail bars, beauty and hair salons, barbers, tattoo and piercing parlours, massage parlours, storage and distribution centres, auction houses, spas, funeral directors, veterinary surgeons and so on. Based on these regulations, if the hon. Member for Aldershot goes into his barber or his hairdresser to have his locks coiffured, he will have to wear a face mask. I am aware that many women, as well as men—the hon. Gentleman included—have their hair washed when they go to their barber or salon. I am sure that the hon. Gentleman goes to a salon rather than a barber. Does the person have to wear the face mask while they are actually having their hair washed? That creates some very difficult problems, does it not?
I went my local barbers a few weeks ago, where I had a disposable gown put on me. To be fair to them, they were good at making sure that people socially distanced, and hygiene was very good. If we are asking people to wear a face mask when they go to a salon, including when they have their hair washed, that will be very difficult.
Mr Jones
The Minister says no, and I am sure that the hon. Member for Aldershot has a different view. Asking a person to wear a face mask when they have their hair washed will cause difficulty, because they will then be sitting in a salon with a damp or wet face mask on. What is the science as to how effective a face mask is if it is wet? I am not a scientist, and we do not have here my hon. Friend the Member for Blackley and Broughton (Graham Stringer), who last week actually went into the science of the way in which face masks work. Clearly, some of the more robust ones might stand up to that use. The one that I have with me may well do—I think it was washed yesterday by Mrs J—but I am sure, Mr Efford, that by the end of your salon appointment some of the more disposable ones would be floating around in the handbasin. Again, the issue is just the confusion that the measure causes.
The other issue is about fines. Clearly, No. 10’s strategy over the weekend was to sound tough on fines: “We are going to start fining people. If people don’t follow the rules, they are going to get fined.” [Interruption.] Does the Minister want to intervene?
Mr Jones
Was it wind?
The problem is that what No. 10 was saying might sound tough, but, as my hon. Friend the Member for Ellesmere Port and Neston said, how many people have actually been fined? The problem with these types of regulations is that they are confusing to people, so people are not going to be very clear about how they will be enforced. This does come down to enforcement—we had this discussion last week. I have no problem with a police officer or someone else—I think it was a community support officer under the regulations last week—giving out fixed penalty fines if they think that right. We asked for a definition last week of a TfL official, for example; they are not identified. We also asked another question, because in the regulations there is a long list of people and then there is a catch-all provision whereby it could be anyone whom the Secretary of State designates to give those fines. That is why my hon. Friend and I raised the issue about marshals. I do not want to go down that path and upset you in any way, Mr Efford, but if the Secretary of State actually gave local authority marshals the power to issue fines, I would find that very uncomfortable; I am quite happy if people have had training in dealing with these situations. We were offered a list last week, but I am still waiting for it.
This does matter, because we are now extending the regulations to other areas. I come now to my closing remarks, which are about the entire Government approach to this area. We are supposed to be seeing now a super-duper new communications centre at No. 10, but frankly, there is confusion outside the House and these provisions will add to it. The unintended consequences of some of the regulations that have been brought in lead to that confusion, and it is made worse by some Ministers who try to act tough in the way in which they put things over. It is important that we be able to communicate the position, and I do not think we can, with the way these provisions are structured. The Government have been remiss. We should have had more opportunities for debate. I am glad to now hear from Conservative Back Benchers the arguments for why we need more scrutiny of these things in Parliament, which would allow us, as representatives of the people, to have a say before they actually come forward.
Ms Dorries
There were an extensive number of questions from the hon. Member for Ellesmere Port and Neston, but if he does not mind, I will first answer the questions from the hon. Member for North Durham.
Ms Dorries
Absolutely. I do apologise: he is right honourable—he will be “Sir” soon.
On face masks for hair washing, salon owners have a responsibility to their staff and themselves and to their customers to keep everyone safe. I hope that my hon. Friend the Member for Aldershot will not mind my saying that I am not quite as follicly challenged, and I had my own hair washed at the hairdressers two weeks ago and I wore my own mask. I will admit that the ties that went behind my ears got slightly damp, but there were no masks floating in sinks or anything like the other extravagant descriptions that the right hon. Member for North Durham provided us with about a day in the hairdressers. There were no problems whatever. I have yet to see anybody not wearing a mask walk into a hairdresser’s salon without their being given a mask by the staff there. It would be extraordinary if somebody had an appointment at a hairdresser’s salon and just walked in without wearing a mask. So, the answer is, “No—that is not a problem at all”.
Mr Jones
I accept the point the Minister is making, but until now there was no indication that people actually needed to wear a face mask. She talks about her own experience, but how, for example, would a hairdresser cut the hair of the hon. Member for Aldershot, or shave it round the sides, if he had a face mask on? Does that not make it very difficult?
Ms Dorries
The tie on a face mask is close to the skin; it is not worn in the hair. It is worn like a hearing aid—around the skin.
Ms Dorries
I literally cannot go into the ins and outs of a hairdresser’s means and ways of cutting somebody’s hair, Mr Efford; all I will say is that we have had no complaints.
The right hon. Gentleman raised the issue of worship in homes—the answer is a very blunt no. Houses are not covered. He also mentioned hotels and hotel foyers. Again, if there is a bar or a café inside the hotel, or wherever one may be, then one is allowed not to wear a mask.
Ms Dorries
I will ask for an answer on that one. I would imagine that if it were in an environment where food was normally served in a hotel, it would not have to be open, although I will wait for a definite answer.
However, I would challenge the right hon. Gentleman—and I will answer a question asked by him and the hon. Member for Ellesmere Port and Neston during this debate about the figure of 96% of people wearing masks. That figure came from the Office for National Statistics. It was not a case of what the right hon. Gentleman suggested, but with the ONS—people were actually just answering a survey. All the people here have been going around shops and hairdressers, and it is hard to go anywhere in a public space and find anyone who is not wearing a mask. However, I have asked for an answer about whether a bar has to be open, and I will ensure that the right hon. Gentleman receives it.
As for community centres—[Interruption.] Sorry, I thought the right hon. Gentleman mentioned social clubs.
Mr Jones
No, I just mentioned community centres. Many community centres have facilities for providing food, but do not provide it on some days, for example. On the days when they do not serve food, will people have to wear face masks, or will people be exempt only when they are actually serving food?
Ms Dorries
Again, a community centre will be run by people who are responsible, and have responsibility for their staff and the people in the community centre. Any community centre would have a policy that people should wear masks. But again, I will get back to the right hon. Gentleman on that particular point.
Mr Jones
If a luncheon club is going on and the Minister is saying that people have to wear face masks, it gets down to the point about leaving it to the actual local people to decide. That is not the regulation. It needs clarifying, so they can say, “Fine. If we’re providing food, then people don’t need to. Clearly, if we don’t, or have some other event on and food is not included, then they may have to comply.”
Ms Dorries
As I said, Mr Efford, I will revert to the right hon. Gentleman with an answer to that particular point.
On the substantive points raised by the hon. Member for Ellesmere Port and Neston, he raised one overarching question a couple of times in his speech, namely why, if we made the guidance on 11 May, we did not introduce it officially until after that date. That is for two reasons. First, the science on wearing masks was evolving, and evidence was coming in from China, Lombardy and other places where masks were being worn, or not, and where studies were taking place on the efficacy of masks in prohibiting the spread of the virus.
Secondly, at the same time, we began to ease restrictions, and as we eased the restrictions we saw an increase in footfall. It was necessary to bring in the regulations because we were easing the restrictions, and the public were coming out on to the streets and into the areas where we were doing so. However, as I have said before, we have seen huge compliance from the public.
The right hon. Member for North Durham did not mention that I was incredibly generous in engaging with him last week on the points that he made about covid marshals. They are out—I was hoping for a nod from the Chair—
Ms Dorries
I will not take any more interventions, and we will now move on. Covid marshals will be subject to their own SI shortly, but this Committee is about three SIs on face coverings. I will keep to the point of face coverings, which is what I am here to address. I am not here to debate an SI on covid marshals.
I have set out why we felt it necessary to do as we did after the guidance. We were also receiving information that people were happy with wearing face coverings, and, from public compliance and people wanting to keep themselves safe, it was obviously the right thing to do at that time.
Ms Dorries
I revert to the substantive point: we were constantly easing regulations at the same time as we had issues to do with Leicester. We had areas in the country where rates were rising at the same time as we had national easement. It is very complex, but at the time it was felt that the public had complied and were wearing masks to go into shops and public places. However, we felt it was important, as footfall increased and we had spikes in other parts of the country, that we introduce guidance nationally for people to wear masks.
I will answer some of the shorter points that the hon. Gentleman raised. He asked me how many people had received FPNs: it is eight to date. I am not aware of what fines were charged, and whether they were on the ladder or went up to the full amount, but eight FPNs have issued so far. I was also asked why we are not legislating for handwashing.
Covid-19 Update
Kevan Jones Excerpts(3 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Matt Hancock
Yes, of course. We take action at as local a level as possible, but unfortunately we do have to take action in this case. I was in the north-east on Monday. I would echo her comments that people will do what is necessary to control this virus and to look out for their communities. I pay tribute to the work that she has done in representing people from Bishop Auckland and her whole constituency in what are difficult times.
Mr Kevan Jones (North Durham) (Lab)
Many of my constituents cannot get tests, including people who work for the NHS. Others have been sent as far afield as Aberdeen for tests. At the same time, there has been spare testing capacity in the region. Last week, NHS Test and Trace moved all its mobile testing units out of County Durham. The measures that the Secretary of State has outlined today will be enacted by the people of the north-east—I agree with my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell)—but unless we have an effective local test and trace system, this will not work. Is it not time to just admit that the national system has failed and that the effort now has to go into directors of public health being given the finance locally to put in place effective test and trace systems that local people can have confidence in?
Matt Hancock
The test and trace system works in a combination of the national and the local. If we took away the national, we would not have the record testing capacity, but if we took away the local, we would not have the local knowledge and the boots on the ground to solve problems and to find people who need to self-isolate. It is the combination of the two that works. I urge the right hon. Gentleman to work with his local council and with the national teams to do everything we can to get the virus under control in his area.
Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) Regulations 2020
Kevan Jones Excerpts(3 years, 7 months ago)
General CommitteesRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Justin Madders (Ellesmere Port and Neston) (Lab)
It is a pleasure to see you in the Chair, Mr Twigg. I thank the Minister for her detailed introduction. As she said, the instrument requires members of the public to wear a face covering when in the relevant place. It came into effect on 24 July.
I will be clear from the outset that we support the instrument. As the Minister said, it is an exceptional measure, but we are in exceptional times and we all have to play our part in beating the virus. Unless someone has an exemption, it is important that, where advised to wear a mask, we all should. That is important for not just keeping each other safe, but opening up the economy and saving people’s livelihoods.
As the Minister outlined, the regulations define a relevant place as a shop, including shops, supermarkets and enclosed shopping centres. It does not include areas of shops and shopping centres that are provided for the consumption of food and drink, such as seating areas provided in coffee shops, supermarket cafés and food court areas in shopping centres. It covers transport hubs, including any enclosed stations, terminals, ports or other similar premises from or to which a public transport service operates.
Mr Kevan Jones (North Durham) (Lab)
The regulations do include transport hubs, and they are clear about TfL having the powers to issue fines in London, but they are sketchy on other transport hubs, many of which, civil servants may wish to know, exist outside London.
Justin Madders
As we have commented from time to time, it seems that to this place, there is not much life outside London. Of course there are a number of transport operators operating up and down the country that the regulations do not cover. For example, my public transport operator on the railways, Merseyrail, has said that it does not currently have the powers for its staff to be able to enforce the regulations. That will certainly need to be ironed out in future regulations.
The regulations that require a person to wear a face covering unless they have a reasonable excuse also set out the categories of people to whom the requirement does not apply. They include children under the age of 11, shop employees in the course of their employment, and a non-exhaustive list of what may constitute a reasonable excuse.
I have some questions about some of the specific provisions in regulation 3 in relation to the requirement to wear a face covering, particularly regulation 3(2)(b) where the requirement does not apply to someone working in the course of their employment. The Minister set out that the regulations are not intended to cover workplaces, because employers are expected to deal with that. I appreciate that employers have a legal responsibility to create covid-secure environments, but there will be occasions when the workplace or the nature of the work mean that that is not possible. Will the Minister explain the Government’s position in respect of those situations, especially given that they are encouraging people to return to work where possible?
Regulation 3(2)(c) says that the requirement does not apply to
“any other person providing services in the relevant place under arrangements made with the person responsible for a relevant place”.
That is catchy; it trips off the tongue. The list of relevant places is in part 1 of schedule 1, but will the Minister explain who
“any other person providing services”
is intended to cover?
Part 2 of schedule 1 contains a list of premises where there is an exemption to the requirement for face coverings. Some, such as dentists, are obvious, but others, such as cinemas, theatres and libraries, require a little further explanation as to why they are exempt.
Will the Minister say a little more on that point?
These regulations were laid before Parliament on 23 July —the day after the House adjourned for the summer—despite the fact that they were announced on 14 July and, as my hon. Friend the Member for Blackley and Broughton pointed out, were discussed extensively for many weeks previously. As the Minister is acutely aware, the Opposition have repeatedly called for regulations to be debated before they come into force. I have raised the issue of new regulations being introduced and not debated until weeks later on every occasion that we have discussed coronavirus regulations. It is seven weeks later in this instance.
It was acknowledged when we were debating a previous set of regulations that the Government are aware of Parliament’s concerns about allowing the timely scrutiny of regulations, particularly in relation to the timing of the debates. The Government indicated that they would endeavour to hold the debate as soon as possible after the regulations were laid before Parliament. I have made it clear on numerous occasions that we accept that the initial coronavirus regulations had to be introduced hurriedly in response to the initial threat from the rising number of infections from what was, at the time, a new, unknown disease.
Justin Madders
It is fair to say that there is a difference between dealing with someone in a clinical setting and dealing with them on a day-to-day basis, but there is no doubt that, at a very early stage, there was evidence to suggest that the virus would be transmitting through the air. I think the reason it took so long to get where we ended up is to do with the question of how effective face coverings would be outside of a clinical setting. Nevertheless, the Government’s position was very clear from early May, yet it has taken until now for us to debate these regulations.
The regret motion also rightly raises concerns about the confusion that was caused regarding where people were required to wear face coverings, due to detailed legal requirements not having being made available in advance. I am sure the Minister will acknowledge that there was confusion at the time, given that Cabinet Ministers themselves appeared to be confused by the mixed messages. We all remember the debate on the Pret paradox that the Chancellor of the Duchy of Lancaster was involved in. Within three days, the Prime Minister said he favoured face coverings, the Chancellor of the Duchy of Lancaster said he did not and the Justice Secretary said he was not sure, but he was perhaps in favour. That kind of conflicting advice and those confusing statements from Government are not helpful in our fight against the virus. We need clear communication from the Government. That is vital in combatting the spread of covid-19.
We needed it then, and we need it now. Going forward, clear and consistent messages about the wearing of face coverings are absolutely required. Clarity was also missing in the situation concerning schools reopening, with another 11th-hour U-turn from the Government on secondary school pupils being required to wear face coverings in school corridors in local lockdown areas in England—an announcement that was made just days before schools returned. Even then, new guidance that allows headteachers in any secondary school the flexibility to introduce masks in their schools was half-baked, leaving the National Education Union describing the way the decision had been reached as “slow” and “incoherent” and saying that it would not inspire confidence from parents or teachers. The National Association of Headteachers said:
“It is neither helpful nor fair to ask school leaders to make individual decisions about face coverings in their school.”
It has been reported that some universities require face coverings to be worn in all shared indoor spaces, including study settings, while others do not. Again, that responsibility should not be placed on individual institutions. Universities have been calling for clear national guidance on the use of face masks on campus to help reduce the spread of the virus. As many students have already returned to university, can the Minister say whether there will be any last-minute guidance for universities?
The regulations permit a relevant person, namely a police constable, a police community support officer or a TfL officer in
“any transport hub from or to which a TfL public transport service is provided”
to deny a person entry to the relevant place, or to direct members of the public to wear a face covering or to leave the relevant place if they are not wearing a face covering.
Mr Jones
It is actually worse than that. I have no problem with a community support officer or a police officer issuing someone with a fixed-penalty fine, because they have the training and expertise to do that. It does not sit comfortably with me that these regulations extend those powers to a large number of people who would not normally have the authority to give out such fines.
Justin Madders
The issue is that the police are not in a position to enforce this. That has been clear from what we have heard already.
Mr Jones
No, it is worse than that. I am comfortable with a police officer being able to issue the fine, but these regulations do not define what a TfL officer is. It could be anyone TfL decides. There is a catch-all later in the regulations that says they are
“a person designated by the Secretary of State.”
Surely, extending the ability to be able to issue a fine in that way is pretty draconian.
Justin Madders
It is an important point that we are giving, to use my right hon. Friend’s term, draconian powers to people, but that is deemed necessary to fight the spread of the virus. The issue that we on the Front Bench have is whether the resources and the appropriate training are following those powers. At the moment, it seems there is a huge gap.
Turning back to the powers, and the ability to issue fines and require people to move on, we need clarity on how those requirements will be enforced, as my right hon. Friend said in his intervention. When the legal requirement to wear a face covering when using public transport was introduced in June, and then in shops the following month, it clearly appeared that the police did not see it as their role to enforce that. I know from my own constituency that there is little enforcement happening on public transport. I have had multiple constituents complaining that when they go on buses and trains, some travellers seem able to travel without face coverings and are not being challenged. Bus companies say they will not put their drivers at risk. I mentioned Merseyrail earlier, which operates in my constituency on the railways, and it says that it has not been given the powers to intervene.
We have this strange situation where, as my right hon. Friend the Member for North Durham says, there seem to be very broad powers being given to a wide range of people, yet other people, who we would think are pretty obviously the right people to have them, have not been given them.
Mr Jones
As I said earlier, these are very London-centric regulations, because they refer to TfL but do not refer to other types of transport operators. However, the catch-all is in regulation 7(11)(d), which talks about the people who can give fines. It says that the authorised person will be
“a person designated by the Secretary of State for the purposes of this regulation.”
There is no list in the explanatory memorandum of the people who could be authorised. Is there any guidance on that? There is nothing at all in the explanatory memorandum to say who is being given those powers. It could potentially be anybody.
Justin Madders
My right hon. Friend makes a very fair point. I do not know whether that power relates to the announcement last week about covid marshals; we are still waiting for further information on them. I hope that the Minister will be able to clarify who that particular measure relates to and whether that power has been exercised at all so far, because, clearly, one of the things that we do not want to see, in terms of public confidence in and adherence to the rules, is people about whom we have had no warning or indication that they have the power to enforce these rules coming along and starting to do so. That will create friction, tension and uncertainty. We absolutely need crystal clear clarity from Government about who is able to enforce these rules and the circumstances in which they are able to do so.
I was referring to the problems on public transport, in particular, but the same problems arise in the retail sector. Many of the major supermarkets—Sainsbury’s, Asda, Morrisons and the Co-op—have all said they will not ask their staff to police the rule, but will instead urge shoppers to play their part, through signs and public address announcements in store. Of course, it is absolutely right that most people do play their part, and that many people have legitimate reasons for not wearing a face covering, but it remains the case that there is an element out there who will not wear a face covering on a point of principle. I am not sure what that principle is, but it is causing difficulty.
A survey of shop workers carried out last month by the Union of Shop, Distributive and Allied Workers found that 75% of shop workers had been abused by customers who were asked to socially distance, and almost half had experienced abuse as a result of asking shoppers to wear face masks. That is totally unacceptable; nobody should face abuse for asking people to comply with public health measures.
At the moment, however, I am concerned that such reprehensible behaviour by members of the public is going unpunished. In July, the Prime Minister increased the pressure on the police to uphold face mask laws. It was a task that was described as “impossible” by the national chair of the Police Federation, who said that forces did not have the staff or the resources to ensure compliance. We all know the pressures on the police and the reduction in their numbers that has happened over the last decade, so it is not enough for them to be handed additional responsibilities if those responsibilities are not accompanied by sufficient resources for them to be able to do their job. When the Minister responds, will she therefore set out what resources have been handed to the police to ensure that these measures are complied with?
Of course, as we have already referred to, the Prime Minister has announced that there will be covid marshals to enforce the new rule of six. Local council leaders, who it is assumed will take over responsibility for such marshals, have already said that they are not in a position to resource them, having already faced a significant multi-million pound shortfall in their finances this year. When the Minister responds, will she confirm whether covid marshals will be required to enforce the wearing of face coverings, as is possibly implied by the regulations, and if so, how will they be funded?
I understand absolutely the Government’s desire to try to get the economy moving again and to encourage people to go back to work and to shop, but those efforts will go unrewarded if people do not feel confident enough to go out because they feel, and indeed see, that the rules on face coverings are not being properly enforced.
In her opening speech, the Minister talked about the importance of confidence for people returning to the workplace and for retail. It is really important that that confidence is supported by a rigorous and universal enforcement regime. In that regard, I would be grateful if the Minister could set out how many fixed penalty notices have been issued so far under these regulations, and whether she has any details of the geographical areas or physical settings where penalties have been issued in greater numbers.
Finally, I will say a few words on the converse situation—people who are exempted from wearing coverings and why. I am sure that many Members will have been contacted by concerned constituents who, when they have been shopping, felt uncomfortable at the numbers of people not wearing a mask, or who have actually been confronted with abuse as a result of not doing so. We see stories in the press about people unable to comply with wearing a face covering for health reasons being challenged and abused and then being afraid to go out. Many charities, including Mind, Dementia UK, the National Autistic Society, Mencap, Asthma UK and Sense, have called on the Government to mount a public awareness campaign about hidden disabilities and the mask exemption rules, which allow for those who find it difficult because of physical or mental illness or disability, those who assist someone who relies on lip reading to communicate and those for whom wearing a mask could cause severe distress to be exempted from wearing a face covering in shops or on public transport. The Minister said in her opening remarks that there had been a public awareness campaign, and indicated that it might be “ramped up”, to use her terminology, so I will be grateful if she could advise on when we are likely to see that, given that these rules are likely to be in place for some time to come.
I will also be grateful if the Minister could say a little about the “severe distress” exemption. I do not want to spell out some of the reasons why people may need to rely on such an exemption, but as it is a subjective and broad exemption, it is open to misuse. Is the Minister aware of individuals who, when challenged, have sought to rely on such an exemption inappropriately, and the response of the enforcement body?
On the point of being able to communicate, as we heard from the right hon. Member for Elmet and Rothwell, I am sure that many of us have been contacted by constituents concerned about the impact of the use of face coverings on deaf people and those with hearing loss who rely on lip reading and facial expressions to communicate. Back in June, the Government confirmed that they had been in discussion with audiologists in the NHS about the use of face coverings and what can be done to reduce the impact on those who rely on lip reading, so can the Minister update us on what steps the Government are taking to ensure all their face covering policies are inclusive for people who may have hearing loss?
In conclusion, we will not seek to divide the Committee on these regulations, but, as I hope I have shown in raising a number of issues, I believe that our democratic process deserves better than for such an important law to be debated so long after it has come into force. I hope the Government finally act on those concerns and hand back control to this Parliament.
Mr Jones
It is a pleasure to serve under your chairmanship, Mr Twigg. I agree with my hon. Friend the Member for Blackley and Broughton on the lack of scrutiny of much of this legislation, and even a cursory glance at the regulations shows that we are extending quite draconian powers to people who, in my opinion, should not have them.
My hon. Friend just referred to mixed messages. Well, we are putting mixed messages in legislation here, and I have to say, if it had been properly debated, some of those things would have been questioned. He mentioned marshals, for example, which I will come to in a minute.
I want to pick up on the issue of sign language, which was mentioned by the right hon. Member for Elmet and Rothwell. It is referred to in the legislation under reasonable excuses, but it is portrayed in a very strange way. Regulation 4(b) states that a person—“P”—has a reasonable excuse if:
“P is accompanying, or providing assistance to, another person (“B”) and B relies on lip reading to communicate with P”.
Are we saying that anybody who lipreads needs someone else and they must go around in twos? Clearly, if someone lipreads, they often do it when they are on their own. Is the legislation saying that the only time that they would be exempt is when they had someone with them? Is that what the Minister is saying? That, frankly, is bonkers.
I know a lot of people who lipread and they do not need someone accompanying them all the time to go about their business. To put that in the regulations just shows sloppiness—reading some of the things in the instrument, this is like shooting fish in a barrel. I find it disturbing, to be honest, that that is being written into the legislation as “reasonable”. A reasonable excuse should be that someone relies on lip reading, for example.
I will come to some of the other things that I think are draconian. I do not consider myself a libertarian, but I question when the state starts interfering in people’s lives to such an extent where I do not think it needs to and whereby, in doing so, it causes the opposite effect from what the Government are trying to achieve, which is to stop the transmission of the virus.
That brings me to my transport theme, which I will start with the definition of transport hubs in regulation 2(4):
“In these Regulations, ‘transport hub’ means any premises used as a station, terminal, port or other similar premises from or to which a public transport service operates”.
That is pretty straightforward—I think we would all agree with that—but then it goes on to an interesting point. It says that that does not include
“(a) an area which is not open to the public;
(b) an area where seating or tables are made available for the consumption of food and drink”,
so, does that mean that a transport hub with tables where people can have cups of coffee from the kiosk is not a transport hub? By this definition, it does. I can think of quite a few transport hubs that have cafés and kiosks selling teas and coffees, and seating areas where people sit to eat and drink, but if I am reading the legislation correctly, those are not classified as transport hubs.
Then we come on to the draconian measures of actually dishing fines out. Again, as I said earlier, the measure is London-centric. I would like the Minister to clarify the role of police officers, which here is quite strange. The regulations refer to “a constable”,
“a police community support officer”,
and
“in relation to any transport hub from or to which a TfL public transport service is provided, a TfL officer”.
Finally, they specify
“a person designated by the Secretary of State for the purposes of this regulation.”
Those are the four categories.
First, as to the category of constable, not all police officers are constables. There are sergeants and inspectors. Does that definition cover all those? Is it only someone of the rank of constable who can issue a fine? Community support officers are defined in legislation. I served on the Bill Committee many years ago, when the Conservative party opposed them.
What is the definition of a Transport for London officer? Who are they? Is it left to TfL to decide who they are, or is it only certain people who already have enforcement powers? Finally, there is the
“person designated by the Secretary of State for the purposes of this regulation.”
There is no list of those individuals in the explanatory notes, which brings us back to the point made by my hon. Friend the Member for Blackley and Broughton about marshals. Will they be given such powers?
As an example, let me take Durham city bus station, which is run by the county council. I think that it is open to the public but on private land. There are operatives there who clean the area and operate the bus station. They clearly do not have the same powers as TfL. Nor do I imagine do the people at many other bus stations. It concerns me not only that definition is lacking on TfL, but that there is a long list of other people who could have quite draconian powers to hand out fines.
Even if the Minister cannot provide it tonight, I would like a list of the individuals who are covered. That would make a difference: as my hon. Friend said, we have no problem with police officers enforcing laws—or community support officers, for that matter—because they have the training and expertise to issue fixed penalty fines and other things, but it sits uncomfortably with me that some person designated by TfL could suddenly have those powers, or, for that matter, anyone else the Secretary of State deems fit to give them to. Again, this is going against what the Government are trying to do.
I agree with my hon. Friend about the science around face masks. In the past months and weeks, the Government have said they are following the science, but are clearly not; they send contradictory messages—and so do the regulations, all over the place. These measures will give individuals powers that I do not think we should give them, and it would have been better if the Government had gone down the route of saying, “What is common sense?”
Clearly, there is currently a spike in cases, but people are not wearing masks in pubs and restaurants, are they, in large numbers? That is why we have had the nonsense this weekend about the rule of six. The important point is that if we are going to bring in measures, they must be proportional—but they must also be explained to people. I do not think that the Government have done that. They have made things worse, with contradictory bits of advice. Frankly, if the public knew the Government were going to give powers to untrained individuals to issue fixed penalty fines, then, no. The sensible approach to face masks is surely advice and support, rather than going down this route.
Ms Dorries
On the point about covid marshals and data protection, we will get back to my right hon. Friend. A number of points have been made in a holistic and wide-ranging way by different people, and I will try to answer the specifics as much as I can. If I do not cover them all, hon. Members can shout at me; we will certainly ensure that they receive answers by tomorrow.
I will first address some of the wider points about lip reading, because there is some kind of misinterpretation of this. Somebody who has a disability, including deafness, does not have to wear a mask, nor does the person assisting someone. If a deaf person goes up to somebody in a shop and asks for help, the shop worker can remove their mask to provide assistance if they are told, “I can only lip read.” The assistant helping somebody with a disability or helping somebody to find their way—whatever need they have—can remove their mask. I wanted to make that clear.
Reference has been made to the fact that people are not wearing masks in pubs and restaurants, but they are socially distancing. There are hand sanitisers when people enter. As pubs and restaurants are keeping their staff safe, they are being very careful about how their clientele use their premises. I want to reiterate a point that I made in my opening speech: 96% of people wear masks.
On the question of why this took so long and the scientific evidence—a question that has been raised in a number of ways—we as politicians did not decide that it was now time for people to start wearing masks. That information comes to the Government and to politicians via a number of filters. It comes from SAGE. It then goes to the chief medical officer, the deputy chief medical officers—Jenny Harries and Jonathan Van-Tam—and, I think, Professor Stringer, our chief scientific officer. We then take the advice from the Behavioural Insights Team; we take the advice that we are given by the scientists.
The Welsh Government have been mentioned. They have their own chief medical officer and their own advisers. They take their advice; they are devolved. We do not tell them when people in Wales should start wearing masks, and they do not tell us. We have our own established scientific body of advice. We do not say to SAGE, “We don’t like your advice today. We’ll go and take it from somewhere else.” We are consistently advised by SAGE and by NERVTAG. When they tell us that the evidence now is such that people should start wearing masks because there will be some benefits, we will take it. In fact, people were wearing masks before we brought in the legislation. The public had already made their mind up, whether they had the scientific evidence or not, that they would start wearing masks, and indeed they were.
That is where we add. As politicians, we do not say, “Do you know what? It is time for everyone to start wearing masks.” We do not have the authority, the scientific background or the evidence—
Ms Dorries
No, because every policy dealing with covid has to be based on evidence and scientific facts. We have always followed the science and we are still doing that today.
Ms Dorries
On the hon. Member’s point about who advises the Welsh Government, I have no idea. I would imagine it is their chief medical officer. On whether the scientists take the decision about whether people wear masks, no, they do not. That is not their responsibility. Their responsibility is to evaluate and assimilate evidence and provide us with that evidence.
Mr Jones
I am sorry if the Minister wants to be flippant, but it is my job to look at the legislation and scrutinise it. She said that 96% have no problems with it. I never believe in putting forward legislation if there is no need.
I am sorry, but the Minister is wrong in what she just said. It is down to politicians to make the ultimate decision. I have been a Minister, and there are occasions when advice can be ignored—that is a political decision. It is no good hiding behind the scientists, which is what the Government have done all the way through the crisis.
Ms Dorries
This is the decision. That is what we are here debating—the decision to introduce the wearing of face coverings in public places. We have taken the decision; that is what we are doing right now.
I was asked why we were so slow to react to the wearing of face masks. It is because, to come here and introduce legislation, we needed evidence that wearing face masks works. As I think the hon. Member for Blackley and Broughton said, this is a new virus—globally, not just for the UK—and all over the world countries have taken their own decisions on the basis of whatever evidence they could gather over a short period and in a short timeframe. We have now got to the point where we believe the evidence is such that wearing a mask will provide protection even if the wearer is asymptomatic, not showing symptoms of coronavirus and not coughing. Therefore, we are introducing the regulations.
Ms Dorries
We know each other too well.
I want to ensure that what I give the hon. Gentleman is an absolutely accurate statement; therefore, I will give it to him in the morning in writing.
I will stick to the substance of the issues that were raised. On the comments about transport police, the British Transport police outside London have the authority and they use their four Es: engagement, encouragement—
Ms Dorries
Again, I will clarify that. They might not be in these regulations, but this is about not just Transport for London, but British Transport police across the UK.
On the point about people eating in cafeterias in transport hubs, of course people cannot eat through a mask. When people are purchasing food, or are sitting at a table eating and drinking, they obviously do not have to wear a mask.
Mr Jones
I am sorry, but that is not what the regulations say. It is in the definition of what a transport hub is. I will read it again:
“In these Regulations, “transport hub” means any…premises used as a station, terminal, port or other similar premises from or to which a public transport service operates, but does not include…an area which is not open to the public;…an area where seating or tables are made available for the consumption of food and drink”.
Surely a transport hub that has tables for food and drink is not classed as a transport hub under the definition in the regulations.
Ms Dorries
No, I cannot; I apologise. I will obtain the list of those who have the authority and ensure that the hon. Member for Warwick and Leamington has that tomorrow. The hon. Member for Ellesmere Port and Neston, I am sure, was trying his hand when he asked his question. He did so knowing very well that that is not something that I can commit to.
Ms Dorries
In this new world of coronavirus and covid-19, we as a Government have to have the right to respond, both urgently and in the case of an emergency, when we need to keep the public safe and to save lives. We have to retain the ability to do that.
The hon. Member for Ellesmere Port and Neston raised one other point that I would like to address. He talked about universities and further education and face coverings. Actually, this has been really interesting, because many universities are very enthusiastic about developing their own policies. They are keen to get their students back in. They are keen to get up and running in a way that is as “back to normal” as it can be in the context of social distancing, and the wearing of a face mask is something that many universities have themselves required. They have done their own messaging to students. I have seen some of this. “Don’t kill your nan” was quite extreme; that was at one university in my own home city. Universities have very much taken on board the fact that they want to keep their campuses safe, and they are launching their own campaigns.
Covid-19 Update
Kevan Jones Excerpts(4 years, 1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Matt Hancock
I will get back to my hon. Friend on that very, very important point. I am grateful that he raised it with me privately earlier, and I am sorry that I have not been able to get a reply in time.
Mr Kevan Jones (North Durham) (Lab)
I thank the Secretary of State for his statement. Will he join me in commending Pact House, a charity in my constituency in Stanley, which is delivering meals and food to the elderly with some 90 volunteers? It contacted me this morning because it is concerned that the building it operates from may need some type of certificate to keep operating, following the announcement yesterday.
Can he clarify the position? Will it just be allowed to open, or will it have to apply for some sort of letter to say that it can operate?
Matt Hancock
As long as it is operating within the guidelines that the Prime Minister outlined in his address to the nation last night, which are set out in detail on the gov.uk website, it is doing the right thing and does not need any further certification.
Coronavirus Bill
Kevan Jones ExcerptsMonday 23rd March 2020
(4 years, 1 month ago)
Commons ChamberRead Full debate Coronavirus Act 2020 View all Coronavirus Act 2020 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Committee of the whole House Amendments as at 23 March 2020 - (23 Mar 2020)
Matt Hancock
My hon. Friend makes an important point. We are absolutely clear that we are prepared to take the action that is necessary.
The fourth part of the Bill contains measures for managing the deceased in circumstances where many of those involved in the registration and management of death will themselves be self-isolating. We want to ensure that those taken from us by the virus are treated with the utmost dignity, while protecting public health and respecting the wishes of bereaved families. Among other measures, the Bill will expand the list of people who can register a death to include funeral directors. It will mean that coroners only have to be notified where there is not a medical professional available to sign a death certificate. It will allow death certificates to be emailed instead of physically presented. It will remove the need for a second confirmatory medical certificate in order for a cremation to take place, and it gives local authorities the power to take control of elements of the process if needed. Those powers would only be used if absolutely necessary and on clinical advice, but we plan for the worst, even while we work for the best.
Mr Kevan Jones (North Durham) (Lab)
The Secretary of State will know that a new medical examiner system has been introduced in many areas, including Durham. Their role is to look into deaths in hospitals, so they will be inundated if there is a large number of deaths. Is there any provision in the Bill that loosens up their role? Otherwise, they will be overwhelmed by the number of examinations that they will have to do.
Matt Hancock
I very much hope that they will not be. The medical examiners regime is very successful, and as the right hon. Gentleman says, we are expanding it across the country. We do not deem that necessary, not least because we think that we can expand it if necessary. We do not think that there is a need for statutory change in an area that is improving.
Women’s Mental Health
Kevan Jones Excerpts(4 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Kevan Jones (North Durham) (Lab)
My hon. Friend is making a very good point. Does she agree that we need not just to look at GPs and that one visit, but to try to ensure that we embed in health visitors and other professionals who come into contact with new mothers the importance of looking for early signs of mental illness?
Ellie Reeves
That is absolutely right. Health visitors have a huge role to play, and we know from our constituency work that they are under a huge amount of strain and often the same issues apply. Health visits are often rushed, not through any fault of the health visitor, but because of the pressures and constraints they are under. The situation for both GPs and health visitors needs to be considered.
The NCT is currently running a campaign that I fully support. It seeks full funding for the six-week maternal post-natal check, so that GPs have time to give every new mother a full appointment. It also seeks to improve guidance for GPs on best practice around maternal health, with dedicated appointments for the six-week maternal check, and to encourage the disclosure of maternal mental health problems. Finally, it wishes the NHS to support GP education in maternal mental health. The consequences of not tackling maternal mental health are far reaching, with around 20 new or expectant mothers taking their own lives ever year. Maternal mental health problems are considered an adverse childhood experience, and urgent action really is needed.
I will end by championing some of the great support that is available to new and expectant mothers in my constituency, and which plays a fundamental role in maternal health and wellbeing. Bromley, Lewisham & Greenwich Mind offers a Mindful Mums course and a volunteer-led maternal befriending service. Our children’s centres offer drop-ins, mindfulness and breastfeeding support. Mytime Active offers a comprehensive pre and post-natal fitness programme in Bromley leisure centres, which I know has been instrumental in me not developing pre-natal depression this time around. Bromley Libraries offers free Baby Bounce and Rhyme and other activity sessions, and there are local NCT groups and baby cafes, to name but a few. I thank the dedicated staff and volunteers, without whom such services would simply not exist.
However, those organisations cannot do it alone, and their budgets are already stretched. Since 2010, 12 children’s centres in Bromley have shut. Bromley library staff have been on strike since June due to cuts to the service, and Mind is operating with waiting lists, such is the demand for its maternal services. Without proper investment in maternal health, and without breaking down the stigma surrounding pre and post-natal depression, women will continue to suffer alone. I hope that the Government are listening, and that this debate will be the start of much needed change.
Tim Loughton
Nice try. West Sussex was the least funded shire county in the whole of England. Do not try and tell me that supposedly affluent areas such as West Sussex have not faced financial challenges. I do not know about the hon. Gentleman’s constituency, but the gap between the per capita funding that children get in my constituency and many of the London and other municipal boroughs is substantial. It is a question of how that funding is used and prioritised.
Mr Jones
The hon. Gentleman is making the fundamental mistake that Members on the Government Benches often do—the idea that every area in the country is the same. I am sure that there are many more looked-after children in inner cities such as Liverpool, Manchester and others—and even in Durham—than there are in his area. That comes with a cost, and the areas cannot be treated the same.
Tim Loughton
That shows a fundamental misunderstanding. I declare an interest because this was my issue. Where children are placed is not necessarily a reflection of how many children are in the care system in that authority. Children in care placed in other authorities, such as Kent, where accommodation is cheaper than in London, are paid for by the placing authorities, and they can cause challenges to the host authorities. That is a wholly different issue. The original point that the hon. Member for Manchester, Withington (Jeff Smith) made was that children’s centres are part of the solution. We need children’s centres with well-trained people offering well-targeted support services to those who need them, but saying that this is purely a numerical issue, because now we have 3,200 children’s centres as opposed to 3,500, is missing the point. It is about the quality of the care offered to those who most need it.
I will wrap up now—as I see you want me to, Madam Deputy Speaker—by touching on a couple of other points affecting older girls. They include the impact of bullying, social media and bullying online, peer pressure relating to body image, the reports by groups such as the Girl Guides and the surveys showing the number of young teenage girls who do not like their appearance and would, if they could, pay for plastic surgery, which is hugely alarming. We have to give young women in particular the confidence to be able to say, “I am who I am. This is who I am, and if you don’t like it—tough.” That is something that we have a major role in getting across in society, and frankly social media need to be part of those positive messages. We still have problems with the internet and social media companies hosting sites that masquerade as sites giving advice to people with eating disorders, but which are in fact malignly encouraging anorexia and things like that.
Mr Kevan Jones (North Durham) (Lab)
I congratulate the hon. Member for Bath (Wera Hobhouse) on introducing the debate and welcome the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries), to her new position.
I welcome this debate because it is another opportunity to talk about mental health. As was said earlier, at one time it would not have been spoken about, but our debates, which have in large part been cross-party and consensual, have changed people’s attitudes. That is the real difference that we have made. The hon. Members for Southend West (Sir David Amess) and for East Worthing and Shoreham (Tim Loughton) were right that this is the House at its best—disagreeing politely, but ensuring that issues that frankly are not very popular are debated consensually. I welcome that. These debates have made a real difference in changing people’s attitudes to mental health. I pay tribute to the charities that have recently been involved in various campaigns, because eradicating stigma is a big issue that we still need to work on in our discussions about mental health.
The hon. Member for Bath pointed out in her introduction to the debate that one in five women can at some stage experience a common mental health issue, whether depression or anxiety. Often, they are the ones at greatest risk, especially young women. Although all the evidence suggests that men are more likely to take their own lives, there is an increasing danger among young women of taking their own lives. The statistics have not really budged since 2012, and I think the same is true for the suicide rate among women generally, which at the moment I think is 5.4 per 100,000 of the population. Those rates have remained static for the past 10 years. Some great work has been done on suicide prevention, which led to a slight drop—although I notice that the figures recently went up again—but we need to put more effort into looking in detail at the underlying reason why the suicide rate among women remains static.
The other issue is that women are more likely to suffer from mental illness because of trauma, such as domestic violence and sexual abuse, and issues around body image, which the hon. Member for East Worthing and Shoreham spoke about and which I will come on to.
I welcome the work of the women’s mental health taskforce, which reported in 2018. Let me put on record my thanks to the hon. Member for Thurrock (Jackie Doyle-Price) for the work she did. She was a great champion not only for women’s mental health but for the entire mental health agenda. Not only was she always available to speak to Members, but I know from speaking to charities and others working in the field that her door was always opened. She listened; she made sure she got change; and she can be proud of the work she did.
The taskforce’s report touched on something that is quite self-evident, but which we sometimes forget—namely, the clear link between poverty and socioeconomic conditions and women’s mental health. It found that 29% of women in poverty experience poor mental health. Another issue touched on, which was raised by the hon. Member for Southend West, was prisons. The report highlighted the depressing statistics for women self-harming in prison, which are obviously linked to other issues such as poverty, which has already been mentioned, and substance abuse.
I agree totally with the report’s conclusion that we need to link those issues up and take an holistic approach, but I would go one step further. I have spoken about this before, but we also need to hard-wire mental health and wellbeing into all public policy, whether nationally or locally. We need a system whereby any policy being developed should be tested against a matrix of mental health indicators before implementation, and I would include spending decisions in that. The hon. Member for East Worthing and Shoreham talked about spending cuts, and although we might disagree about their effects on Sure Start centres for instance, making what the Treasury might see as easy cuts leads not only to problems locally but to more expense for the taxpayer in the long term. We should certainly look at that when we are spending money, because while the call is often for more money—which we do need in mental health—we also need to ensure that it is spent correctly and joined up. We could achieve a lot more if we took a joined-up approach.
Let me give two examples of where not having that prerequisite for testing is leading to problems and costing the taxpayer and society more. One is the Department for Work and Pensions and its employment and support allowance assessment. I am clear that people should be encouraged to work, and we all—let us be honest—know that the right type of work is good for people’s mental health. However, we should not have a system that is very blunt in terms of assessment and that takes little account of those living in our communities with long-term mental health problems.
A constituent in her late 50s came to see me a few months ago, having lived with long-term mental health issues in the community. She went for her ESA assessment and got no points. She was then virtually suicidal. I intervened, although, frankly, it should not have taken me to intervene. She then had a mandatory reconsideration, and her payment was reinstated. If we look at that woman’s history, it is clear that she is not going to work, but the process did not take that into account. If that person had then been sectioned, had gone into hospital or had—let us be blunt—taken her life, that would have been a huge cost to society.
Wera Hobhouse
I have been an MP for a relatively short time, and I find increasingly that trying to access services or get universal credit throws perfectly healthy people into mental health problems, because it creates anxieties and delays. I am not surprised that a lot of people are being thrown into mental health problems, because our public services are increasingly not responding in a humane way to people’s needs.
Mr Jones
I agree, and I will come on to the other example I have in a minute. Those problems then result in a cost to the taxpayer. If we had road-tested the ESA policy in terms of mental wellbeing and assessment when we were developing it, that would have helped the situation.
The other example, which the hon. Lady has just referred to, is universal credit, which is creating huge problems for many of my constituents. They are going up to six weeks without any money. That is having a huge effect on women’s mental health, because the main carers in most of these households are women, who have to juggle budgets. Again, we should have thought beforehand about the cost to society and the taxpayer of the added mental health problems generated through this policy.
On women in prison, it saddens me a little that the Government have now taken up the “lock them up and throw the key away” agenda in the criminal system. We need to reduce the number of people who are actually in prison, and especially women. If we look at the evidence and at the reason why women are in prison, we see that it is linked to domestic violence, mental health problems and substance abuse.
In County Durham, I pay tribute to Durham police and the crime commissioner Ron Hogg, who introduced Checkpoint in 2011. He did that because he was sick and tired of putting women shoplifters through the criminal justice system when what they really needed was help. If we look at the statistics and at the changes that the programme has made, we see that it is cutting reoffending rates. It is addressing the real issue, which, in most cases, is domestic abuse and mental health issues.
In addition, we need clear pathways. The report says we need joined-up local services. That is not just about the acute sector and GPs; it is about the voluntary sector as well, and we need to ensure that it is part of that joined-up local system. Certainly, in my experience, it is delivering local services and good value for money very effectively for local communities. In my constituency, I have a fantastic project called Just for Women, which deals with women who have faced domestic violence and mental health problems and who have been in probation. The project staff do one simple thing: they allow time, and they talk to people. They use crafts and other things to get women’s confidence back. If we sit and talk to the women in that project, we find that most of them have been through every programme possible—they have gone through systems and systems. We need to ensure that we put in place a system that works.
Finally, I want to touch on body image. I welcome this year’s report by the Mental Health Foundation, which focused on the link between body image and the nation’s mental health. In the report, one in five UK adults said they felt ashamed of their body image and 43% of women had low self-esteem when it came to their body image. That does lead to psychological effects.
I agreed with the hon. Member for East Worthing and Shoreham when he talked about the internet companies. They have a huge responsibility in ensuring that the messages they put out do not perpetuate the myth of the perfect body image. That is leading not only to psychological problems but to people having unnecessary cosmetic surgery and interventions, which are harmful to them.
I have challenged Facebook, for example, to ask why it continues to carry adverts for Botox, which is a prescription drug. Just try to take one down; my constituent Dawn Knight, who has been campaigning on this, tried to take one down, but it cannot be done. These companies should take a proactive approach to blocking these adverts, because they are not only perpetuating the image of the perfect body, but are, in some cases, I think, actually breaking the law. If social media companies such as Facebook will not change, there needs to be legislation.
In conclusion, I welcome the debate, because we are talking again about mental health. Is this about money? Yes, it is. We do need investment in mental health services. However, we also need to ensure that we have that joined-up approach to not only services but methods and processes. That can reduce people’s mental illness and ensure not only that we have a society that is content with itself but that, when people do get into crisis, there is a service and support there for them.
Jackie Doyle-Price (Thurrock) (Con)
It is, as usual, a pleasure to follow the right hon. Member for North Durham (Mr Jones), who is always a fixture in these mental health debates, as, indeed, is the hon. Member for Bath (Wera Hobhouse), and I congratulate her on securing this debate.
I thank the hon. Member for Lewisham West and Penge (Ellie Reeves) for her very honest contribution. It is about time we were honest about the fact that childbirth is hard and that what happens after we have given birth is hard. We could be forgiven for buying into the myth that it is all hearts and flowers, but the reality is very different indeed for many women and their families. It is absolutely fantastic that she made that very honest contribution today. Those of us in this place need to be frank about our own experiences to make the system better.
It is a glib thing to say that it is a man’s world, but, frankly, it is. On so many levels, the health service, in terms of both physical and mental health, does not work well for women. I was therefore pleased to have chaired the women’s mental health taskforce with Katharine Sacks-Jones from Agenda, and I thank her today for her contribution. It is important that we look at women’s mental health, as distinct from that of men. In the same way, we ought to look at mental health through the prism of other things that end up being discriminatory. For example, there is the whole gamut of neurodiverse conditions, autism and attention deficit hyperactivity disorder. There are more mental health issues in people who have those conditions, and, frankly, we are not doing enough for them. That also plays out in further discrimination against women, because they are often diagnosed much later with autism and ADHD, and they are then not equipped with the tools to manage their conditions.
It was absolutely fantastic to get buy-in from people with real experience on the women’s mental health taskforce. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) talked about perinatal, and that was of course a big part of it. It is interesting that we are debating this issue today, just a day after that amazing debate on the Domestic Abuse Bill, because abuse is often a common factor underlying the prevalence of mental ill health in women.
We set up the women’s mental health taskforce because we were seeing an increased prevalence of mental ill health among women between the ages of 16 and 24. There is no doubt in my mind that an underlying cause is abuse, particularly the rise of sexual abuse and violence.
The women’s mental health taskforce concluded that we needed more by way of community services to support women, and one important part of that was improving the support for victims of sexual violence. I completely agree with the right hon. Member for North Durham about the contribution that voluntary services can make in this space. When I was the Minister, one of the messages I always gave to commissioners was not to medicalise everything. Voluntary services, particularly in mental ill health, can give so much additional support to people. That wraparound support can be as important to someone’s recovery or ability to manage their condition as any medical intervention. In welcoming my hon. Friend the Minister to her post, I ask her to continue giving that message to commissioners, not least because, as well as delivering the services well, voluntary services often provide much better value for money. So let us continue to do that.
I was pleased that earlier this year the NHS published its strategy to deal with sexual violence and to provide sexual violence support services. Within it was a commitment to a lifelong package of care for survivors of sexual abuse. The voluntary sector—the hon. Member for Bath mentioned rape crisis centres—has a huge role to play in making sure we continue to support victims of sexual abuse.
Women are often a secondary consideration in the way we deal with many problems, and by definition that becomes discriminatory. We have had a lot of debates in recent months about gangs and the problem of young men carrying knives and stabbing each other and the fact that there are far too many deaths, but another aspect of that gang culture that is not talked about enough is the grooming of girls. It is almost like Rotherham never happened. We must make sure that when we look at gang culture, we do not just talk about young men stabbing each other or the drug trade that goes with it; we must also tackle the grooming of young women, otherwise the incidence of mental ill health among women aged 16 to 24 will only continue to rise.
One thing not yet mentioned in this debate is the review of the Mental Health Act 1983. We must make sure that when we look after women with severe mental ill health we are not doing harm. We need to deal with some of the practices that still exist in our treatment of people with mental ill health. We used to think of people with mental ill health as an inconvenience to be managed. Thankfully, we are becoming much more enlightened, but there is still poor practice that needs to be weeded out. I repeat that abuse is often the underlying trigger that exacerbates a woman’s mental ill health, and when we treat women, we should not compound that harm by handing over the control of someone who has been sectioned to their abusive partner. Under the Act, however, when someone is sanctioned, the next of kin is effectively given control over them, which only compounds the harm. I have heard some incredibly distressing testimony from people who have been through exactly that. As that work continues, we must empower patients, including women who are victims of domestic abuse.
We have heard reference to eating disorders. We have actually made considerable progress in improving eating disorder services, but we need to do much more for adults. The health service needs to empower women, not just tell them to run along. Many Members will be aware of the campaign by Hope Virgo, the Dump the Scales campaign, but the really telling thing about Hope’s testimony is this: she has been through anorexia, she understands her condition, and she can see when she needs help, but when she goes to her GP, she is weighed and told she does not have a problem. That shows a fundamental misunderstanding about how eating disorders play out and how they should be managed. Members have discussed the need to make sure GPs behave better. One reason GPs do not behave as well as they should when dealing with mental health is that they are not adequately trained. I encourage the Minister to have that conversation with the royal colleges to make sure mental health training is a mandatory part of doctors’ training. The earlier we identify someone who needs help, the more effective that support can be.
I want to finish by picking up on an issue raised by several colleagues, including my hon. Friend the Member for Southend West (Sir David Amess): that of people in prison. We all know that prison should be a place where people go when they have done bad things, but anyone who visits a prison wanders around thinking, “A lot of these people shouldn’t be here at all.” They are people who have fallen out of society and been failed by the state. That is particularly the case for women. The more we can do to get that early intervention the better. We should not be allowing people to fall out of the care of society and then dealing with them only when they become a nuisance. That applies to people who have been through the care system and been victims of abuse.
Mr Kevan Jones
Does the hon. Lady agree that one of the problems that pertains particularly to women prisoners is that of short sentences, which do not give enough time for rehabilitation and over time disengage people from services outside and, in a lot of cases, from families and other support networks?
Jackie Doyle-Price
The right hon. Gentleman puts it very well. In those instances, we are just doing harm. We should be able to identify when somebody needs help. Just taking them away and putting them in prison without any programme of support only puts them on a conveyor belt to more offending. We need to make sure we are picking people up. There are some fantastic tales of how people do that. I once met a lady who had been convicted of drink driving after she reported herself. She had gone through a period of grief. What good would it have done to make her serve a prison sentence? It would have compounded her grief; she would have been away from her family; and she would have lost her job and probably her home—if she was renting—which would only have put her on a conveyor belt to disaster. We must be much more enlightened and make sure that our prisons are for people who are going to harm society, not people who are harming themselves.
I could say so much more, Madam Deputy Speaker, but time is limited, so I will finish there.
Ms Dorries
My hon. Friend is absolutely right: it is about breaking down the stigma in mental health. When somebody breaks their leg, they wear a plaster cast and we can see that they have broken their leg. We cannot always see when someone is suffering from a mental health issue, so it needs to be destigmatised. It also needs to be given the same consideration as physical illness, and I think it is.
Obviously, my speech has now been dumped, because so many points were raised in the debate and I feel that I have to answer them. I shall start with the hon. Member for Bath, who raised so many points when introducing the debate. I want to answer some of her questions. One of her first points was about rape crisis centres; this year, we will spend £35 million and fund 47 sexual assault referral centres, to ensure that when sexual violence occurs, there is the best possible response for victims. The centres are available to all victims—male and female, adults, children, and current and non-current victims of rape and abuse.
I want to mention the approach the Government have taken to mental health. I took up this post just as we announced £2.3 billion of expenditure on mental health. Let me put that into perspective: my hon. Friend the Member for Cheltenham (Alex Chalk) informed me that that is more than half the entire yearly prisons budget; that demonstrates how much money we are investing in mental health. The money is going into many areas, but in almost all areas it will have an impact on women and young girls— and this debate is all about women’s mental health. It is important that women are at the centre of all mental health policy. They should be not just be siloed off into their own particular areas; they should be at the centre of everything.
Mr Kevan Jones
I understand what the Minister says about the increase in budgets, but does she not also realise that cuts in other areas are actually adding to the problems? Therefore, it does not matter how much money we pour into mental health services. Public health funding, for example, which is devolved to local authorities such as Durham, has had a 40% cut, which means that existing services, such as those for substance abuse, have had to be cut. Putting money in one way and taking it out in another does not solve the problem.
Ms Dorries
The NHS budget is not bottomless, but the mental health budget is growing faster than the overall health budget, and the budget for children and young people is growing even faster than that. One Member—I think it was the hon. Member for Lewisham West and Penge (Ellie Reeves)—said that more people are presenting with mental health issues now than ever before. In fact, GPs agree with that, and say that a lot more people are presenting with those issues at their surgeries. That is due to many, many reasons. One Member raised the issues of the postings on Facebook and Instagram, of body image and of dieting. There are many reasons why people are suffering from mental health issues, and it is not just to do with service cuts, which are being addressed.
I need to race on with my speech because I have just three minutes left. On the maternal six-week check, we hope to ensure that that happens in all our GP contracts going forward.[Official Report, 7 October 2019, Vol. 664, c. 11MC.] The hon. Member for Bath mentioned the Istanbul convention. The Government signed the Istanbul convention in 2012 to reaffirm our strong commitment to tackling violence against women and girls. She also talked about eating disorders—I know that she has brought forward other debates on this issue. She also mentioned body mass index. We want all GPs to adhere to the NICE guidelines, which means that they must take a holistic approach to young women who are presenting with potential eating disorders. I am talking about taking a look at dental records, considering whether those women are still living a full life and still working, whether they are seen to be eating or whether they are absenting themselves after a meal. We need to look at everything in the round. Nobody should be referred for having an eating disorder based on their BMI alone. That is in the guidelines. We are raising awareness of that, and introducing more training for GPs, so that they are aware of this, too. The hon. Lady may be aware that I wrote an article on this subject recently, emphasising that point.
Perinatal mental health, as we discussed, is also important. According to one study published in 2014, a shocking 10% to 20% of women develop a mental health illness during pregnancy, or within the first year of having a baby. From April 2019, new and expectant mums have been able to access specialist perinatal mental health community services in every part of the country.
The NHS long-term plan, which I referred to earlier, commits to ensuring that an additional 24,000 women will have access to specialist perinatal mental healthcare, with more support for fathers and partners. I am pleased to see that NHS England has expanded the capacity of in-patient mother and baby units, which are in-patient services that support women with serious mental health issues, keeping them together with their babies, which is so important.
My hon. Friend the Member for Southend West (Sir David Amess) talked about female offenders. I know that women in prison often have a disproportionately high level of mental health problems, and there are also worrying levels of self-harm. We have recently published standards for healthcare for women in prison and are looking at improving care for pregnant women in prison.
The hon. Member for Lewisham West and Penge talked about health visitors. Earlier this year the Prime Minister announced our commitment to modernise the healthy child programme to reflect the latest evidence on how health visitors and other professionals can support perinatal mental health.
My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) talked about the closure of children’s centres. We are investing £84 million over the next five years to support up to 20 local authorities that are seeing high demand for children’s social care. This will help to support the most vulnerable families, and I am sure that that is welcomed by everyone. It is up to local councils to decide how to organise and pay for services in their areas, as they are best placed to understand local needs.
The right hon. Member for North Durham (Mr Jones) talked about social media and about his constituent trying to get Facebook to take down an advert. I actually congratulated Facebook and Instagram recently on removing all the diet advertisements for miracle cures and diet teas that simply do not work. That is a step in the right direction. I also thank all the women in my constituency who have emailed me on that the issue and others.
Ms Dorries
I do not have any time; I have only 30 seconds left.
The hon. Member for North Ayrshire and Arran (Patricia Gibson) spoke about poverty. Many of us in this place understand the impact of poverty and have experienced poverty ourselves, and we know that it can cause anxiety not only for women, but for young girls. We absolutely understand those issues.
Let me say to the shadow Minister that our £2 million programme Standing Together Against Domestic Violence looks at how the whole health system can better respond to domestic abuse. Like her, I was delighted that the Domestic Abuse Bill passed its Second Reading yesterday. On carers and increased access, the carers action plan published in 2018 sets out a range of ways that we will improve support for carers. We published a progress review in July this year to ensure that we focus on delivering the plan.
The shadow Minister also spoke about the use of restraint, which is abhorrent. The Government fully supported the Mental Health Units (Use of Force) Bill—a private Member’s Bill that became an Act of Parliament on 1 November 2018. The Act imposes requirements regarding the use of force, the publication of data, and how and when physical, mechanical and chemical force is used, as well as requirements for improved staff training. We want to end restraint. We know that it continues to be a routine occurrence on many wards, affecting women and girls disproportionately. That has to end.[Official Report, 7 October 2019, Vol. 664, c. 12MC.]
I will conclude by stating again that we are putting £2.3 billion into mental health, and that will benefit women and young girls. Never before have any Government ever considered mental health in such a way—with regard to policy, and finance to drive that policy and back it up. I thank the hon. Member for Bath for raising this very important issue. We are making progress, and I am determined that we will make more. I recognise that there is more to do and we will certainly be working on that.
Mental Health Act 1983
Kevan Jones Excerpts(4 years, 9 months ago)
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Neil Coyle
I absolutely agree and will come on to some of those figures.
I referred to the children in Southwark who have mental health conditions. The NHS’s overall target for ensuring that children and adolescents can access mental health treatment is just 35%. That is remarkably low, and I hope the Minister will have something to say about it today. In the meantime, while that is the national standard, Southwark’s Labour council has set an ambition to ensure that 100% of children and adolescents can have access to mental health care. As part of that commitment, the council has made £2 million available for local schools to support the emotional wellbeing and mental health of pupils. It is also developing a mental health hub service for young people. That is in partnership with—jointly funded by—the local clinical commissioning group.
As I have said, I think that my personal experience has given me an additional strength in working with local people and families who are affected by these issues, but being open about my family experience does not mean that I have not seen discrimination or stigma at first hand. I was about 10 or 11 when I said to a friend at school that Mum had schizophrenia and he asked whether that meant I had two mums. That was a surprising reply, but obviously there was a lot of confusion then about what schizophrenia actually was. Some of it is still out there.
Sadly, one thing that remains is the perception that people with schizophrenia are somehow more dangerous. Actually, mum’s experience and that of many people with schizophrenia is that they are more likely to be targeted, because their erratic behaviour when they are unwell can draw the attention of others, who might target them for robbery and other offences.
Mr Kevan Jones (North Durham) (Lab)
I thank my hon. Friend for the way in which he is opening the debate and particularly for his comments on schizophrenia. If they have the right support, there is no reason why anyone with schizophrenia should not live a normal life, including being able to work.
Neil Coyle
I completely agree. Sadly, the figure for people with schizophrenia in work remains at about 5%. It is just 5%, because the support simply is not there and the medication and treatment are not there on a routine basis to ensure that they are able to work.
Figures suggest that one in four of us will experience mental ill health at some point in life, often because of bereavement or a relationship breakdown. I pay tribute to all the organisations involved in the Time To Change campaign, which has done brilliant work to challenge the stigma and discrimination that affect people with mental health conditions in employment and elsewhere.
The change in language and awareness of conditions is one reason to seek reform now. For example, the Mental Health Act 1983 is defined as:
“An Act to consolidate the law relating to mentally disordered persons.”
The language around mental health has changed much since the current law was enacted. We also need to consider its far reaching powers.
The independent review of the Mental Health Act, published seven months ago concluded:
“The Mental Health Act gives the state what are amongst the most significant powers that it has; the power to take away someone’s liberty without the commission of a criminal offence and the power to treat that person even in the face of their refusal. Because of that, we think that is important that the purpose of the powers is clear, as should be the basis on which they should be used.”
It is hard to disagree with that conclusion, especially given the number of people who are affected by those extensive powers.
Mr Kevan Jones (North Durham) (Lab)
It is a pleasure to serve under your chairmanship, Ms Buck. I put on record my thanks to my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) not only for securing the debate but for the way in which he introduced it. I agree with the hon. Member for Plymouth, Moor View (Johnny Mercer) that someone speaking so powerfully brings to life what might be dry words on paper in an Act. To hear the experience that my hon. Friend and his family have been through highlights why it is important that we get things right.
My hon. Friend described how the Mental Health Act 1983 gives the state draconian powers to detain individuals and take away their liberty, not because they have done anything wrong but because they are mentally ill. As he said, 50,000 of our fellow citizens go through that process every year. There is something wrong if we are using the Act 50,000 times a year. I am sorry, but I just do not accept that in 2019 that is the only way we can deal with someone in mental health crisis who, rather than being a danger to anybody else, is possibly more of a danger to themselves.
Like others, I accept and welcome Professor Simon Wessely’s report. As my hon. Friend said, some of us remember the 1983 general election. It was a long time ago, but there are some similarities, as he said, with the current political world. Importantly, things have changed, including our attitudes on a whole range of things. The key issue that comes out of Sir Simon Wessely’s report is the need to put the individual at the centre of everything. The hon. Member for Plymouth, Moor View gave a very good example of how, when we get it wrong and do not put the individual at the centre, things are bad for that individual. Clearly, his constituent was treated inhumanely. We must put people at the centre. That is difficult, as people who are in mental health crisis can have great difficulty in making decisions, but that does not mean that they have lost capacity in all circumstances. That is one of the things that Sir Simon raised in the report.
The use of the Act should be a last resort, not the first course of action in dealing with people who are in mental health crisis. As the report says, we also need to involve the individual in decision making. That can be difficult; I accept that people can refuse treatment. However, if it is properly explained and people are involved in the decision, there are better outcomes for them individually and in-patient time will be reduced.
I have spoken before about advocacy. Owing to the draconian powers that the Act bestows on the state, it is important that the individual has access to independent advocacy. I welcome the recommendation for people to have to opt out of having an advocate. That puts the onus on the state to have independent advocates trained and available, and to ensure that people know how to access them.
My hon. Friend the Member for Bermondsey and Old Southwark also raised the issue of family members, which can be very difficult. The report’s suggestion to move towards having a nominated person is the way forward. In the past, assumptions have been made that an individual wants certain relatives involved; on a number of occasions they do not want that, and it may not be in their best interests. The right hon. Member for New Forest East (Dr Lewis) made the point that we need to try to involve family members where we can, because they are an important part of supporting the individual and ensuring that they get the help they require.
I am concerned about a lot of issues related to the Act, including the need for a timetable for implementing the recommendations. A White Paper has been promised. I do not criticise the Minister because, as I have said before, since she has been in post she has been a strong advocate for mental health issues. However, this matter has to be a priority. I know we can get blindsided by big issues regarding Brexit, but the implementation of these changes is important and should be a top priority.
The report states that we need to investigate why the Mental Health Act is used more against members of black, Asian and minority ethnic communities than others. I accept that there may be a stigma attached to mental health issues in certain BAME communities and that it might give rise to particular questions, but that topic needs an inquiry all of its own. Unless we get answers to why the Act is being used more in those communities, we will not be able to make the necessary changes.
Why is the Act being used more? Perhaps there is a simple answer. Ever since we closed the asylums in the early 1980s, we have put neither the investment nor the policy in place to support people with long-term enduring mental health conditions in the community. That is about money to pay for the support that individuals need, but it is also—my hon. Friend the Member for Bristol East (Kerry McCarthy) raised this point—about pathways, how people get into the system, and the disconnect between the various agencies with which people come into contact.
The all-party parliamentary group on social work has just conducted an inquiry on that subject. I am not going to steal the thunder of my hon. Friend the Member for Stockton North (Alex Cunningham), who chaired the inquiry. It was very informative, and I was privileged to be involved in it. The disconnection and lack of integration between local councils and the health service is clearly an issue, and it is not necessarily just down to money; it is also to attitudes. The system needs to be put back together. It is no good telling somebody who is in a mental health crisis, “I’m sorry, but you are not my responsibility; that is a local authority issue,” if they present to the NHS or vice versa. That needs to be put right.
In County Durham we have a very good integrated system of local government and NHS care, which works very well. If we are to put that wraparound care around individuals such as the mother of my hon. Friend the Member for Bermondsey and Old Southwark, it must be integrated; it must be joined up. It cannot be fragmented.
Is the problem all about the availability of beds? I would say no, it is not. The right hon. Member for New Forest East is right that we have cut beds back too quickly, thinking that we do not need them and that we can manage people in the community when we cannot. The argument that follows is, “The answer to this is more beds.” Well, I am sorry, I do not think it is, personally. What I want is a good community-based model to support people in the community. That is going to take money. It needs a clear, worked-through policy. It has to include local authorities and it has to include housing. One of the biggest issues that people leaving in-patient beds face is the question of where they will live, and it is not surprising that many of them end up on the streets in our communities. We need a joined-up approach.
As I said earlier this week in another debate on mental health, we must have a joined-up local system that includes not just the agencies I have mentioned, but the community and voluntary sector. If we are going to support people in the community, in my experience it is often best done by voluntary and community sector organisations. As my hon. Friend the Member for Bermondsey and Old Southwark said at the beginning of the debate, many of those organisations are under pressure because grants are being cut. We need a joined-up approach.
While I am on my hobby horse about the voluntary and community sector, can such organisations bid for contracts from clinical commissioning groups and local authorities? In many cases they cannot, because they are not big enough. The contracts are drawn up in such a way that they are not available to those organisations. In terms of value for money and local input, that would be very important.
We must also support and develop staff in the sector. During the inquiry, we met some amazing, inspiring young people who were entering social work and majoring in support for people with mental health issues. In Durham a few weeks ago, I had the privilege of meeting some of the young people who were taking part in the Think Ahead programme—I think it was started by one of the Minister’s predecessors—which aims to get social workers trained in mental health work. Most of those I met said it was a very rewarding field to get into, when it was properly supported.
What about other Government policies? We need joined-up policy at the local level to support individuals, but we also need to make sure that mental health is hardwired into Government policy. I have said that on a number of occasions, and I will do so again. For example, if someone in the community has a long-term mental health condition, fails her personal independence payment assessment and is sectioned—I handled a similar situation a few weeks ago—what does that cost the taxpayer? It is no good for the individual and it is no good for the taxpayer. Under mandatory reconsideration, the PIP was reinstated. We have to make sure that consideration of mental health issues is built into policy and that the policies of other Government Departments are not creating problems for individuals.
Finally, as we know, many individuals in prison have mental health problems. The current system for transferring individuals from prison to mental health facilities is not working. That is another issue that I have raised previously. Those on indeterminate or fixed sentences who come up for assessment by the Parole Board face a double jeopardy situation. They have to have a mental health assessment by both a mental health tribunal and a Parole Board. That cannot be right. It leads to, on average, an extra 18 months in prison, where proper treatment and proper planning is difficult. It does not help them or the system, and it costs more to keep them in prison. We need a system where one single assessment would be enough to make sure that those people get the support they require.
This is about money and it is about reforming the existing system, but we must also ensure that both national and local policies enable a joined-up, wraparound service. With the right investment and the right political will, we can get there. We are not going to go back to putting people in institutions or asylums; people should be able to live a happy, contented and safe life in the community, with the wraparound care that they deserve. That is what we should be providing, as a decent society.
Alex Cunningham (Stockton North) (Lab)
It is a pleasure to serve under your chairmanship, Mr Hanson, and to follow not just the contribution from my hon. Friend the Member for Croydon North (Mr Reed), but the other speeches. Great expertise and understanding has been brought to the debate. I congratulate my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) on securing the debate, and I thank him for sharing a very powerful and personal testimony as well as offering solutions to the crisis in mental health. So often we can blather away in places such as here in Westminster Hall; we can talk about the problems, issues and suffering, but sometimes we do not offer solutions. It is our job to come up with solutions, and my hon. Friend the Member for Bermondsey and Old Southwark and others have offered some.
As some colleagues might know, I have the privilege of chairing the all-party parliamentary group on social work. As my right hon. Friend the Member for North Durham (Mr Jones) said, we recently undertook an inquiry on the role that social workers play in upholding the principles outlined in the independent review of the Mental Health Act 1983, and on how that role can be recognised and enhanced in new legislation.
I believe that social workers are regularly, if not always, undervalued, yet their work is incredibly valuable in supporting and helping the most vulnerable people in our society—be it children at risk, older people in need of a bit more support, or families who experience breakdown and need the independent support that a social worker can provide. Of course, social workers also support people with mental health needs, although many people do not realise the tremendous role that they play in that. They ensure that mental health problems are not a barrier to anybody achieving the things they want, and that people get the appropriate treatment and care that they need.
Back in 2018, I met with two approved mental health professionals in my role as the chair of the APPG on social work. They are known as AMHPs—perhaps it is something to do with their electrifying personalities. They explained that there was a need to promote the role of social workers in mental health services, and I now understand why that is necessary. The legislation and policy often skim over the work of social workers, perhaps because it is so varied and hard to pin down.
In December, the independent review of the Mental Health Act 1983 published its report and recommendations. In preparation for a Government response, the APPG decided to have our own inquiry and add to that great piece of work. Some 9,000 social workers work in a defined mental health role, accounting for about 4% or 5% of the core mental health workforce, and 95% of AMHPs are social workers. I know it will take more than legislation to embed the kind of changes we would like to see, and work will have to be done by CCGs, local authorities, the NHS and social work leadership—to name but a few—if we are to succeed and get the change that is needed. I am hopeful that the APPG’s report and recommendations will act as a staging post on the way to cultural and legislative change.
Mr Kevan Jones
Was my hon. Friend impressed, as I was, when we met various people giving evidence to the inquiry? The best practice was where local authorities and the NHS were co-located and working closely together, rather than when it was being divided.
Alex Cunningham
Yes, that was most certainly the case. I shall remark on that a little later in my speech. I was really concerned to find that the number of joint working arrangements was diminishing rather than increasing across the country, but I will address that a little later.
I was surprised to hear in the evidence sessions that health and social care integration, which the Government are officially pursuing, is going backwards. My right hon. Friend spoke about that in detail. A key message from the APPG is that the Government need to urgently examine how they can better support the integration programme, arrest the decline and ensure that people work together. Social workers in health and in local authorities need to work much more closely together.
Integration in mental health services is about bringing the social mode into healthcare settings, where social approaches sometimes struggle to gain acceptance and respect when compared with the medical model. We do not suggest replacing one with the other but, as integration implies, a full marriage of the two models so that the needs of the individual are met in one place. Better still, a properly integrated social model would make sure that treatment and care planning were guided by the person in their own context, rather than fitting them into a pre-existing diagnostic box. Such an approach means greater consideration of the social determinants of mental ill health—factors such as socio-economic background, education, housing and family dynamics. We have heard examples of that throughout the debate.
The APPG report made several recommendations. The new mental health legislation should open with a definition of the social model and the importance of addressing the social determinants of mental illness alongside biological and psychological determinants; it should explicitly name social workers as the key professionals doing the work; Ministers should ensure that the team preparing new mental health legislation also produces guidance on how it is intended to interact with other legislation such as the Mental Capacity Act 2005 and the Equality Act 2010; the CQC should be mandated to provide an annual report to Parliament on the progress of health and social care integration; and social work leadership—this is particularly important—on trust and CCG boards is necessary. I think it is more than necessary; it is essential. They are professional people with a major and specific role and they should be at the table where the decisions are made.
The report also recommended that new mental health legislation must have greater regard to both health and local authority resources. My right hon. Friend the Member for North Durham talked about the lack of resources within the system. CCGs should be held transparently accountable for their duties under section 140 of the current Mental Health Act, or any new legislation, making sure that there are enough beds in the right places. The people detained under section 3 of the Mental Health Act should be reviewed by a social worker, and families and carers of all people detained away from home because of a lack of local provision should be provided with financial support. That point was raised by my hon. Friend the Member for Bristol East (Kerry McCarthy), who talked about the effect that it can have on families when a family member in crisis is 150 miles or more away. A national dataset on the number of Mental Health Act assessments should be established as part of the DHSC mental health services dataset. Those recommendations are not unreasonable. I hope that the Department for Health and Social Care will take note and address the gaps where professionals say that they are.
I recently had the opportunity to serve on the Bill Committee for the Mental Capacity (Amendment) Bill, and key issues that I and other colleagues raised still need to be looked at. During the passage of that Bill, I was quite surprised to find out that the Bill had not been subjected to any pre-legislative scrutiny, despite its central role of redeveloping the laws of this country for depriving people of their liberty. I said that I thought the Government needed to pause and think again about the implications of the plans that Ministers were putting before us, listen to the countless charities, other organisations and professionals who work with the legislation every day, and come back with a Bill fit for purpose. It should not have been about a basic political argument between the Government and the Opposition. It is about a debate between the law makers and the people, some of whom at a particular time in their life can be subject to some of the most restrictive legislation that we have. Sadly, at that time the Minister did not listen, and the legislation we are left with will need to be reviewed before too long. I feel the same about moving forward with reviewing our legislation in general around mental health, and perhaps putting new legislation to this House, but whatever it is, it needs to reflect wide views.
The legislation that we create or amend affects the most vulnerable in our society, as I have said before, but it should be considered with extra care and attention. I do not think that we did that in the recent Bill Committee, so we must include those who know what they are talking about, such as the professionals, the experts and the social workers—those who have worked on the frontline of mental health care and know where the gaps are and how we can ensure that we do better for those who receive care under mental health provision. We must and can do better. I hope that as we move forward, Ministers will listen and get it right.
Barbara Keeley (Worsley and Eccles South) (Lab)
It is a pleasure to serve under your chairmanship, Mr Hanson, as it was to serve under Ms Buck earlier. I join others in congratulating my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) on securing this debate and echo their comments about the moving way in which he opened the debate. He started with his own family experience and then made a very powerful speech. I am sorry that you missed it, Mr Hanson. We heard contributions from the right hon. Member for New Forest East (Dr Lewis) and the hon. Member for Plymouth, Moor View (Johnny Mercer), as well as my right hon. Friend the Member for North Durham (Mr Jones) and my hon. Friends the Members for Bristol East (Kerry McCarthy) and for Stockton North (Alex Cunningham). I am sure we all want to thank Sir Simon Wessely and his team for their work in reviewing the Mental Health Act.
The wide range of perspectives in the debate is welcome. It shows how wide-ranging the work is and how it touches on so many different aspects. One thing on which we can all agree is that the current Mental Health Act is not working. It is too often overly restrictive and fails to give people the support they need, as we have heard. Before I discuss the contents of the review, I want to mention why it is so important that we get this right, because being detained under the Mental Health Act, although it is sometimes life-saving, can be immensely damaging if it goes wrong, and we have heard already about how it can go wrong. I, too, am going to talk about a case: the case of Matthew Leahy.
On 7 November 2012, Matthew was admitted to a mental health hospital under the Mental Health Act. On 15 November, he hanged himself in his room at the hospital. The Parliamentary and Health Service Ombudsman has identified failures in Matthew’s care that may have led to his death, but they have taken seven years to come to light. My hon. Friend the Member for Croydon North (Mr Reed) talked about delays. They are exasperating, concerning and impossible for families who have to live with the loss of a loved one. Some of the failures in Matthew’s case were truly shocking. He complained that he had been raped in the mental health hospital. The ombudsman found that had Matthew not phoned the police himself, it is not clear that staff on the unit would have done so. Anyway, the police failed to take action.
My hon. Friend the Member for Bermondsey and Old Southwark referred to the level of sexual assaults on patients—an appalling record, as reported by the CQC. It should be of deep concern to us that that is happening. Staff also failed to act when Matthew reported, and he had physical injuries that could have been caused by rape, which should have been a major cause of concern. It is also deeply concerning that his care plan was falsified and other paperwork was lost. Although he had a care plan for his first 72 hours in the unit, staff produced a fuller care plan only after he died. That that should have happened when he was apparently under the protection of the state is unacceptable. We must ensure that we know what went wrong in his and other cases of death so that we can act to prevent it from recurring.
There have also been issues with the subsequent investigation. The initial report by the NHS partnership contained inaccuracies about how Matthew’s care had been planned. Across the board, the partnership failed to learn the lessons of Matthew’s death, which compounds the tragedy of that young man taking his own life while he was in the care of the state. As my hon. Friend the Member for Croydon North has said, there should be independent investigations of deaths that occur in mental health hospitals. I know that the Minister has been asked before to set up an inquiry into Matthew Leahy’s death. I ask her to commit to doing so now, so that we can learn the lessons from that tragic event and prevent such a thing from happening again.
Sir Simon’s recommendations will not solve every problem with our in-patient mental health services, but the Opposition believe that they would improve them, and would remove many of the major issues with the Mental Health Act. Although we have a little time, we cannot focus on all 154 of the recommendations. I just want to discuss the principles that he felt should be central to the operation of the Act. My hon. Friend the Member for Bermondsey and Old Southwark outlined those four principles in his opening speech.
The first principle is choice and autonomy. Of course, it should go without saying that, wherever possible, we give people control over what is happening to them. I am glad that the Government have committed to introducing advance choice documents. Those will be central to ensuring that people can exercise choice over what happens to them. We have heard in many of today’s speeches why that is important. I ask the Minister to confirm today, if she can, when those plans will be brought forward. There will be instances when people cannot exercise the choice themselves, so Sir Simon’s proposals for the new nominated person role and increased use of advocates will ensure that in those circumstances people are still able to influence their care.
During the passage of the Mental Capacity Act 2019 there was a great deal of discussion, involving my hon. Friend the Member for Stockton North, about advocacy. We must ensure that local authorities are fully funded to provide those vital services. It would be a travesty if someone were denied a voice because of budget constraints at their local council. Can the Minister tell us whether the Government will provide additional funding for advocacy to ensure that that does not happen?
The second principle is that of least restriction. It seems self-evident that we should try to ensure that people retain as much of their freedom as possible, but we have heard of the number of ways in which that does not happen. It might mean supporting people to enter mental health hospitals voluntarily rather than their being detained, or ending the use of seclusion and segregation and the terrible cases of restraint that we heard about.
The third principle is therapeutic benefit. Again, it should be self-evident that everything done under the Mental Health Act should be clearly aimed at helping the person in question to recover. If it is not, what is the justification for detaining them? My hon. Friend the Member for Bristol East talked about people with autism and learning difficulties in mental health hospitals, and we have to question how often their detention for periods of five years, or five and a half years, helps them at all, and whether any of what happens to them could be talked about as treatment.
Finally, Sir Simon emphasised the importance of treating the person as an individual. In particular, that section of the review focused on the current experiences of young people and people from BAME communities in mental health facilities. We have heard about that in speeches today. My hon. Friend the Member for Bristol East talked about the lack of support for families of children with out-of-area placements. Sir Simon recommends that, while those still exist—my party pledges to do away with them—financial assistance should be available when a young person is admitted to a placement away from their family. We are committed to ending inappropriate out-of-area placements, but my hon. Friend the Member for Bristol East talked about a case where, if a facility was the only one that would be able to provide the care, a parent would choose it. However, that support and financial assistance must be available. It is not right to cut off a young person’s support network when they need it most.
My right hon. Friend the Member for North Durham also talked about why the powers under the Act are being used more with people from BAME communities, and we must focus relentlessly on the facts.
Mr Kevan Jones
Does my hon. Friend agree that we cannot leave the matter where it is? We need an inquiry into it. Sir Simon calls for more research, but unless we have an inquiry we will not be able to get the policy changes to identify what is, clearly, going wrong.