Hospital Car Parking Charges
Mike Penning Excerpts(6 years, 3 months ago)
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Sir Mike Penning (Hemel Hempstead) (Con)
Thank you for calling me to speak, Madam Deputy Speaker. This takes me back a long way, to 2006, when you were a Health Minister and I shadowed you for some four years. The issue of car parking charges was around at that time, and successive Governments have talked about addressing it. This is a regressive tax. It is a tax on everybody, because everybody needs the NHS—that is why it is there. It is even more regressive for NHS staff, who are taxed even more just to go to work their difficult shift patterns. That is completely unacceptable.
I have raised this issue many times before. Members might remember that I used to be a firefighter. Firefighters do not pay to park in the yard at the fire station. Our excellent police do not pay to park their cars. The ambulance service is part of the NHS in my constituency, and its staff do not pay, either. They drive to work and they go to the pound to pick up their ambulance. So why should other emergency workers be charged in this way? It is fundamentally wrong.
This issue has gone back and forth across the Floor of the House, no matter which colour Government we have. Contracts have been signed, by previous Governments and by ours, that have locked us into hugely expensive agreements, particularly the private finance initiatives. We need to do something about that, and I will say more about it in a moment.
Bob Stewart
It seems to me that there should be staff car parks. There should be a set-up in which staff have separate parking arrangements so that they do not block public parking spaces. They should also have guaranteed slots, so that they are not late for their shifts.
Sir Mike Penning
That happens in some parts of the world. For example, that is what they do at the Luton and Dunstable University Hospital NHS Foundation Trust, which looks after part of my constituency. I went there the other day to visit someone who was in palliative care. I did not know how long I was going to be seeing them, or whether I would see them again. The fantastic news is that they are now at home, being looked after by the hospice movement, of which I have been a member for 40 years. That is what the hospice movement is very much for.
Interestingly, I parked and paid in what I thought was a public car park, but I was in the staff car park. So, when I went to try to get out, the barrier would not go up. I pressed the button to talk to someone, and they said, “You’ve parked illegally.” I said, “How have I parked illegally? I’ve got a ticket.” Fortunately, they had no idea who I was, because they probably would have just lifted the barrier to get the MP out of there as fast as possible, which is normally what happens when we visit our hospitals, isn’t it—everything is brilliant, rosy and shiny and everything is great. I said to the person, “No. If you’re going to fine me, fine me. I’ll see you in court, because I have paid in an NHS public car park that you have designated.” They eventually just said, “Oh, go away.” I have been waiting for the fine to come through—it probably will now—and I will see them in court, but the charging is morally wrong.
The situation is even more difficult for patients. The previous debate was about babies and parenting. Babies come out when they want to, usually, not when we want them to, and not based on how much time is left on a car parking ticket. That is what happens, and yet people are getting fined every day because they have outstayed their time in the car park. How can that be right?
A Member who could not be in the Chamber today because they had to attend another meeting, asked me to mention volunteer drivers. What would we do without them? They are fantastic, but they have to pay to park in some hospital car parks before they take patients home, which they do as volunteers because the patient ambulance service is struggling so much. In some parts of the country—I know that it is happening in my area—people are actually asking for patient transport because the car parking facilities are so bad. They are putting more of a burden on patient transport because they cannot find a parking space and they are petrified of being late for their appointment. If they are late for their appointment owing to patient transport, that is okay, but if they cannot find a parking space, they hear, “Oh, you’re a bad person.” We have heard that people are parking outside hospital car parks. Blue badge holders are being charged to park in a car park when they can park for free on the road, so that is what they do. We know that is happening, and it is really very wrong.
I know that the Minister is a good man, and an honourable man, but when he stands up to reply he will almost certainly say that parking is devolved to NHS trusts, and that it is for them to decide how they run their facilities. But for those of us who are Members of Parliament, NHS trusts are completely unaccountable. We can moan about this, but they will not listen in the slightest. They will be looking at whether they can get away with it and how much they can raise.
This is not just about money; it is about space. We have heard that if car parks do not charge, they will be full of people from the town centre. When the acute facility at the excellent Hemel Hempstead Hospital was closed, it was moved to the middle of Watford town centre, next to a football stadium. Apparently Watford play there, and a lot of my constituents will be very upset when they hear about me being derogatory about Watford, but they have a huge number of fans. I went to Watford General Hospital on a Saturday morning to visit a constituent, a good friend of mine, and I parked and paid. When I came out, there was a group of parking people around who clearly wanted to give me a ticket. I had paid in the football bit that is designated for use by Watford football club when they are playing at home. What has that got to do with going to see and look after someone at an NHS hospital, or go to that hospital?
Unfortunately, the parking attendants did recognise me, and they were very apologetic, but I do not think that is right. What would have happened if they had not known who I was? The ticket was coming. How on earth can we have a full acute hospital in the middle of a town as big as Watford, next to a football stadium, and then call that a modern NHS hospital? The parking facilities there for staff and patients are frankly almost non-existent, not least because tons of it has been carved off for the football club. I want Watford to be very successful, but what I want in our part of the world is a brand-new hospital, with proper parking facilities, on a greenfield site away from the town centre, so that we do not have any concerns about whether people will park there all day in order to go shopping. At the moment, though, I do not have that.
There is the acute hospital in Watford, which struggles—it has just come out of special measures and I wish it well—and Hemel Hempstead Hospital, which is basically a clinic these days. We have out-patients; we have a few intermediate wards. They charge the staff, and patients with out-patient appointments, to park there. The car park is empty. Hardly anybody parks there because there is nothing on the site any more, but the hospital still insists on charging. That pushes the patients outside, so there is restricted parking outside, which is also an issue. It is cheaper to park in the council car park in the town centre and walk 400 yards up the hill than to park in a car park that is empty because there are so few facilities at the hospital.
This problem has to be sorted out from central Government, and the central Government guidelines have to be enforceable. I was a Minister for many years: Departments can issue as many notices as they like, but nothing will happen if they do not come out with the stick. Could the money be raised in other ways? Could there be savings in the NHS? As we have heard, the amount of money being raised, compared with the overall pot, is peanuts. One of the more recent chief executives of my very small acute trust was on a package of over £300,000 a year. If we want to save money instantly, let us take a look at the salaries of the really top people in the NHS and let us look after the people at the bottom—we certainly should not charge them to park when they go to work.
Tracy Brabin (Batley and Spen) (Lab/Co-op)
It is a pleasure to follow my hon. Friend the Member for Slough (Mr Dhesi), and I congratulate the right hon. Member for Harlow (Robert Halfon) on his extremely powerful speech and on raising this important issue.
I want to start with an experience that our family recently went through. My daughter started to show signs of acute appendicitis. As any family could imagine, we quickly bundled our daughter, who was in agony, into the car and drove to the hospital—it was not a very calm journey. I am sure that many Members will have had a similar experience. We were panicking and scrambling around for change so that we could park the car, then taking turns to pop out every few hours to move the car or top up the ticket. That was obviously a one-off and bearable, but for many a trip to the hospital is sadly not a one-off experience, and they are forced to take several trips a week because of chronic illness. They are people going through the worst of times, and the cynical approach of charging them to park is unacceptable. It is not anyone’s choice to be ill, and they should not be exploited.
New figures show that the money raked in from NHS car parks in England run by private firms has increased to £500,000 every day. The £175 million that was made from hospital car parking charges in 2016-17 is equivalent to only 0.001% of the total health spend, but still, ruthless private car parking firms pocket most of it. It cannot be fair that worried family members who visit their loved ones can end up with eye-watering fines if they arrive late back to their cars. As my hon. Friend the Member for Heywood and Middleton (Liz McInnes) said, it cannot be fair that NHS staff who have parking charges deducted from their wages are fined for parking in the wrong bay when they cannot find a space in the correct bay.
Some may recommend that regular hospital visitors use public transport, but in my constituency, Batley and Spen, the bus that used to connect Birstall with our local hospital has been cancelled, as have local bus services in many smaller communities. That has forced more people to use a car and thereby incur parking costs. My local hospital, Dewsbury and District Hospital, charges after 20 minutes, so people get 20 minutes for free. There is a reduction for blue badge holders, but they still have to pay. There is a stress-inducing pay-on-exit system, and it is quite complicated to get car parking concessions approved by hospital staff on the day. It is not an ideal situation.
Sir Mike Penning
Does the hon. Lady agree that in the 21st century, means-testing at the point of delivery, which is what we are talking about here, is morally unacceptable in an NHS of which we should be and are proud?
Julie Cooper
I thank the right hon. Gentleman for that comment.
I am grateful to Members on both sides of the House because it seems that there is much agreement on the matter. It is heartening to hear Members mentioning—and fully understanding—its impact on patients, visitors, carers and NHS staff. My hon. Friend the Member for Great Grimsby (Melanie Onn) mentioned the effect on the greater transportation system.
The hon. Members for Telford (Lucy Allan) and for Cleethorpes (Martin Vickers), and my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) made powerful speeches, as did my hon. Friend the Member for Colne Valley (Thelma Walker), who accused the system of profiteering. My hon. Friend the Member for Heywood and Middleton (Liz McInnes) made an important point on behalf of staff. The right hon. Member for Hemel Hempstead (Sir Mike Penning) referred to the burden of having to pay to go to work. My hon. Friends the Members for Batley and Spen (Tracy Brabin) and for Enfield, Southgate (Bambos Charalambous) mentioned personal family issues when people are taken away from a sick family member’s bed to replenish parking meters.
No one likes to pay to park, but to pay to park at a hospital really does add insult to injury. We are not talking about a luxury experience, a shopping trip or a fun night out; we are talking about paying to visit a hospital. People are not queuing up to go to the hospital café, as the hon. Member for Telford pointed out. No one goes to hospital because they want to. People go because they are sick. They go for treatment, for surgery, for chemotherapy and for kidney dialysis, and they go to visit loved ones. In short, hospitals are not destinations of choice: people go because they must. I am quite shocked that it is free to park at Trafford shopping centre yet I must pay to park at my local hospital.
During the past three years, I have spent hours and hours visiting my mother in hospital. I have often gone backwards and forwards two or three times a day, juggling hospital visiting around work and other commitments. I have to say that it has all been very distressing. As I leave the hospital each night worried, wondering what tomorrow will bring, the last thing I want to do is to stand outside in the cold queuing to pay for my parking. This burden is, of course, in addition to the actual cost.
Some hospital car parks demand payment in advance, as we have heard. This brings its own set of problems, because patients and visitors have to judge how long each hospital visit will last, and then often have to leave the ward or treatment room to feed the ever-hungry parking machine. Of course, running to and fro between the car park and the hospital is impossible for someone hooked up to a dialysis machine. Many dialysis patients suffer with multiple conditions and are unable to work, so paying to park three times a week for dialysis sessions that each last four to five hours is a real financial burden for them and their carers.
Paula in my constituency relies on the weekly £62.70 carer’s allowance she has received since she was forced to give up work to provide round-the-clock care for her husband, who suffered a severe stroke. He has been in hospital for the past month. She has visited every day, often staying for two to three hours to support and comfort him. This costs her more than £20 a week. By the time she has paid for her petrol, half her carer’s allowance is gone.
We have a national health service that was set up to be free at the point of delivery. It was established in 1948 to make healthcare a right for all, but that is not what is happening. Even though hospital car parking is free in Scotland and Wales, here in England, hospital users are forced to pay often extortionate rates, with charges varying from £1.50 an hour to £4 an hour. We are charging the chronically ill, the terminally ill, and their carers and visitors. More than half of all people over 76 have conditions that require regular hospital appointments, and hospital car parking charges are an extra burden for them and their families. The Alzheimer’s Society reports that patients with dementia stay five to seven times longer in hospital than other patients aged over 65. Hospitals can be frightening places for people with that condition. They rely on family and carers visiting them to give support. Parking charges are an extra burden that these families could well do without.
The Patients Association has commented:
“For patients, parking charges amount to an extra charge for being ill…Hospital appointments are often delayed or last longer than expected, so even if you pay for parking you could end up being fined if your ticket runs out. Visiting a hospital can be stressful enough without the added concern of whether you need to top up the parking.”
Macmillan Cancer Support says:
“The core principle of the NHS is to provide free healthcare for all at the point of access. But sadly some cancer patients in England are paying extortionate hospital car parking charges in order to access treatment for a life-threatening illness.”
Bliss, the charity for babies born prematurely or sick, says in its “It’s not a game: the very real costs of having a premature or sick baby” report that these charges can contribute to the financial burden that many families face when their babies need neonatal care.
In the midst of all this misery, the average hospital trust is making £1 million of profit from car parking charges, and several hospitals the length and breadth of the country report profits of over £3 million. Last year, NHS hospitals made a record £174 million from charging patients, visitors and staff. In addition, 40 trusts report additional income from parking fines.
Some people point out that public transport is an option that avoids parking charges. Public transport provision has been reduced in response to funding cuts, but even where it exists, there are many for whom it is not an option. Some patients are too unwell or too frail to travel on a bus. Others, including cancer patients attending for chemotherapy, have reduced immunity and must avoid contact with the general public.
Sir Mike Penning
The hon. Lady is making a compelling case, as have most Members. Public transport has its place for out-patients and so on, where it is available, but imagine someone going into labour and saying, “Can I wait for the No. 2 bus, please?” This is farcical. We need car parks to be there for people when they need them, rather than being a cash cow.
Julie Cooper
I entirely agree and thank the right hon. Gentleman for his intervention.
Patients and carers are often balancing work and other commitments, and have tight time schedules that preclude public transport. I have spoken to the parents of a terminally ill child who left their child’s bedside only to tend to the needs of their other children. They do not have time to wait for a bus.
No discussion of hospital car parking charges would be complete without a consideration of their impact on NHS staff, which Members have spoken about eloquently. These staff pay to go to work and are still not even guaranteed a space. That can lead to them being late for the beginning of their shift. Some hospital staff whose shift overruns because they are tending to patients’ needs face fines for overstaying their parking time. That is clearly no way to treat our health professionals. It is no wonder we face a crisis in recruitment and retention.
Government action to date has been limited to a series of recommendations on hospital car parking. Currently the Government recommend that hospital car parking charges should not be applied to blue badge holders, carers, visitors of relatives who are gravely ill, and patients who have frequent out-patient appointments. In reality, those recommendations count for very little. In fact, the trend is to increase car parking charges and to reduce the number of those who are exempt. Many hospital trusts have even begun to charge blue badge holders.
It is not good enough for the Government to abdicate responsibility. This is a matter of principle. Scandalously, Conservative Members have previously argued in the Chamber that the NHS needs the income from parking charges. I have no doubt that the NHS needs this revenue, as it is common knowledge that the service has been starved of funding since 2010, but is it right that we fund our health service by taxing the sick?
Labour Members will have none of this. I am proud that the next Labour Government will ensure that our NHS is properly funded and will abolish car parking charges at all hospitals. To pay for that, we will increase the premium tax on all private health insurance policies. Crucially, no hospital will lose funding as a result of our policy.
In 2015, I asked the Government via a private Member’s Bill to exempt carers from hospital car parking charges. At the time, that relatively modest proposal was met with derision from Government Members. My attempt to remove this financial burden was dismissed as a worthy aim, but not worthy enough for the Government to support. Indeed, Conservative Members went to great lengths to talk the Bill out.
Times, I hope, have changed. Today I am asking, along with the right hon. Member for Harlow, that the Government remove all car parking charges at NHS hospitals. Today we ask the Government to do the decent thing by removing this tax on the sick and taking action to ensure that we truly have an NHS that is free at the point of access.
Stephen Barclay
With respect to my right hon. Friend, it is a statement of fact, as confirmed by my officials—I am very happy to correspond with him further about it—that 67% of NHS sites do not charge. If one wants to get into the definition of a hospital, it actually covers more than acute services. I do not want to get distracted by that point. The one I was seeking to make is to recognise that this issue is particularly concentrated on acute hospitals, and that is the issue before us.
The hon. Member for Great Grimsby recognised that there is considerable room for flexibility within trusts. One of the key issues in this debate is the distinction between charges covering the maintenance of car parks, and how a reduction in charges may lead to a reduction in the number of spaces and the quality of the facilities—we heard, for example, about the state of the car parks in north Manchester—and those involving profiteering, with charges going beyond of the cost of maintenance. The hon. Lady is concerned about that, and the interplay with the current guidance. The hon. Member for Colne Valley (Thelma Walker) also mentioned that when she highlighted the distinction between the charges at her hospital and those of the local authority, and raised the issue of transparency.
The right hon. Member for Kingston and Surbiton (Sir Edward Davey) expressed concerns about transparency in relation to blue badge holders. They are not means-tested, so an affluent blue badge holder could be spared a charge while a less affluent visitor to a hospital is charged. Transparency about how the guidance is applied is therefore a factor, as has been recognised.
Sir Mike Penning
May I push the Minister a little bit on blue badge holders? Quite rightly, blue badge holders are not means-tested. The key is their ability to access services. It does not matter how much they have in the bank. If they need to go to a hospital and they have a blue badge, surely spaces should be free and as close to the point of entry as possible.
Stephen Barclay
Absolutely. As my right hon. Friend will be aware, the guidance speaks to that. My hon. Friend the Member for Cleethorpes (Martin Vickers) mentioned the 64 pages of guidance. I am very happy to take away and look at why there are 64 pages of it. Blue badges are part of the conversation that my right hon. Friend the Member for Harlow began in 2014.
Stephen Barclay
Of course, but equally the hon. Lady must recognise that the fact that charges are still being applied under PFI agreements put in place by a previous Government in 2008 signals that there are often complexities, in terms of what can be done when different factors apply. As my hon. Friend the Member for Solihull highlighted, there are factors relating to displacement. That is why trusts have local discretion, but as the House has discussed today, we need to understand the transparency around that and how it is applied.
Stephen Barclay
I will, but then I will press on, because I want to give my right hon. Friend the Member for Harlow some time.
Sir Mike Penning
I am sure we have time, on this important issue. The Minister raised the issue of complexity. Clearly, as has been shown by Members across the House today, some cases would be easier to address than others. I fully accept, as I said in my speech, that some ludicrous PFIs were put in place, both before the present Administration came to power and since. Do the easy ones first; that is the answer. That is what Scotland did. Then come to the more difficult ones. Ruling out any change at all because there are some difficult issues is surely not the way forward.
Stephen Barclay
A point was raised about whether free parking could be addressed through tokens and barriers, but colleagues in the NHS raised concerns about how that would apply, in terms of any burden on staff. We heard examples of frequent users of a hospital being able to access concessionary schemes, but staff have raised concerns about the impact on them, and how they might be expected to assist in the administration of the scheme in regard to those visiting hospitals as a one-off.
The pertinent point about the impact on staff was raised by Members from across the Chamber. Many Members have been visited recently by representatives from the Royal College of Nursing, regarding the wider discussions between NHS employers and the RCN on pay. It was helpful to hear in the debate contributions about the RCN’s understanding of the benefits, pressures and issues.
Across the House, there is no question, as was reflected by my right hon. Friend the Member for Harlow, about the desirability of addressing iniquities and variance, and about the scope to ensure compliance with the guidance, but we need to be mindful of unintended consequences, and particularly about constraining the car parking available for those who need it. I am happy to continue my discussions with my right hon. Friend on this policy. I commend him and colleagues on a very constructive debate.
Hormone Pregnancy Tests
Mike Penning Excerpts(6 years, 5 months ago)
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Sir Mike Penning (Hemel Hempstead) (Con)
I beg to move,
That this House regrets that the terms of reference for the Commission on Human Medicines Expert Working Group on Hormone Pregnancy Tests asked the Commission to consider evidence on a possible association between exposure in pregnancy to hormone pregnancy tests and adverse outcomes in pregnancy, but the Commission’s Report concluded that there was no causal association between the use of hormone pregnancy tests and babies born with deformities between 1953 and 1975, even though it was not asked to find a causal link; believes that the inquiry was flawed because it did not consider systematic regulatory failures of the Committee on Safety in Medicines and did not give careful consideration to the evidence presented to it; and calls on the Government, after consultation with the families affected so they have confidence in the process, to establish a Statutory Inquiry under the Inquiries Act 2005 to review the evidence on a possible association with hormone pregnancy tests on pregnancies and to consider the regulatory failures of the Committee on Safety in Medicines.
I think we all, as constituency MPs, would have hoped that this debate was unnecessary. We all hoped that the “inquiry”—I use the word advisedly—that the Government constituted in good faith would give confidence to the families and loved ones of thousands—[Interruption.] Shall I pause while the hon. Member for Paisley and Renfrewshire South (Mhairi Black) stops laughing?
Mhairi Black (Paisley and Renfrewshire South) (SNP)
No, I was talking to my colleagues.
Sir Mike Penning
Thousands of people went in good faith to see their GP because they thought they might be pregnant. That is probably the most important time in any woman’s life. Certainly, as the father of two gorgeous girls, the most important time in my life was when my wife told me that she was expecting our children. It was so important to these families that often they went to their GP, which is a natural thing to do, so we had an NHS patient going to an NHS surgery to see an NHS doctor for advice about whether they were pregnant.
Look at the dates for when these potential mothers-to-be went to see their GP: between 1953 and 1975. That is quite a span of time. My mother could have gone to her GP then, because I was born in 1957. In many ways, it could easily have been me who was a victim of this—God forbid—and my mother would have been a victim as well. That is one of the reasons why I am so passionate about getting to the bottom of the disaster that happened to these ladies who went to their GPs.
These women went to their NHS GP in an NHS surgery as an NHS patient, and very often that GP would open the drawer and give them a tablet—two sometimes—with no prescription or advice, and no concern about the consequences or side effects of the drug. The GPs handed the tablets over to the ladies, and many of them took them there in the surgery. The GP simply said, “If your period starts tomorrow, you’re not pregnant. If your period doesn’t start, you are.” In good faith, which we all have for our GPs, the ladies followed that advice, even though the Department of Health and the drug companies knew that there were issues with this drug.
I am going to use a tiny bit of privilege, because every time I look around for information to do with this subject, including in the House of Commons Library debate pack “Hormone pregnancy tests” and the “Report of the Commission on Human Medicines’ Expert Working Group on Hormone Pregnancy Tests”, I see the phrase “hormone pregnancy tests”. The drug was Primodos. It was made by a drug company and often given free to GPs, who then handed it out without a prescription to determine whether a lady was pregnant.
Other companies in the world knew that there were issues. I will not go into all the evidence that was given to the so-called review, but let me just touch on some of the things that Ministers asked for when the group was set up. The first point was that the Government should set up an expert working panel “inquiry”. No such inquiry took place. At the third meeting, as I understand it, the barrister to the inquiry advised that the word “inquiry” should be changed to “review”. Under whose authority? When a Minister sets up an inquiry, should there not be an inquiry? Perhaps those people did not want an inquiry, but who cares? They should have come back to the group—the victims—and, more importantly, to the Minister. They could have spelled out their advice and the Minister could have made a decision. Some might think that this is just semantics, but it is not. If people are trying to get to the truth, it is vital that they know what a group can do. Even when the report came out—not the original report, because that was removed and draft was changed, as others will mention—it did not say “review”, because it was not a review.
There should be full disclosure and a review of all the evidence. That “review” said that it did that, but it did not. The Royal College of General Practitioners, to give just one example, informed the Department and the drug company that it had concerns way back in the 1960s, but its evidence was never sought. If Members read the report, they will find that no evidence at all from the Royal College of GPs was given to this review, which should have been an inquiry.
Sir Mike Penning
I will give way, but I will only give way on a couple of occasions because I am conscious of the time and I want everybody to have the opportunity to speak.
Margaret Greenwood
I thank the right hon. Gentleman for giving way. Is he aware that The BMJ reported that most of the scientific evidence considered by the working group was from the 1960s, ’70s and early ’80s. One expert in the field, Dr Neil Vargesson of Aberdeen University, told The BMJ that there were not that many scientific studies available. Does he agree that the Government should fund new research with the aim of enabling a definitive conclusion to be reached?
Sir Mike Penning
Yes, I do, and I will come on to that point. It is vital that we have proper evidence, not some historical evidence that was used by the report. More modern evidence was rejected because it had not yet been peer reviewed. The whole point about having all the evidence is one reason why the motion under debate today, which I hope will be passed unanimously, actually says that there should be a judge-led inquiry so that all that evidence can be considered.
Sir Mike Penning
I will give way to my hon. Friend and then I will make some progress.
Mims Davies
I thank my right hon. Friend for giving way. I must acknowledge my constituent, Charlotte, and her family, who are here on behalf of her brother, Stephen, who has been greatly affected by this drug. One of the biggest issues is the way in which the drug was handed out with absolutely no discussion of the risks.
Jackie lost her baby, Louisa, 19 years later—in 1977. At that time, the product had been on the market for two years with Government warnings, but still GPs did not point that out to patients. There is a lot of evidence here, so why is it not in the report?
Sir Mike Penning
I completely agree with my hon. Friend. One thing that has surprised me is that although, on average, every single MP will have a victim of Primodos in their constituency, many of the victims think that what happened was their fault and that they are on their own. In the fantastic documentary on Sky, people came forward to say, “I have been affected by this, but I thought that I was on my own. I thought that I was the only one.”
Sir Mike Penning
Another point was that the inquiry should be conducted fairly and independently. Members should consider that for a few seconds and take a look at who was on the committee while I take an intervention from the right hon. Gentleman.
Mr Howarth
The right hon. Gentleman is making a very powerful case. Given that the inquiry/review has now been very much discredited—it has certainly been rejected by all of those who have suffered—does he agree, as I am sure he will, that the way forward is set out in his motion, which calls for a
“Statutory Inquiry under the Inquiries Act 2005 to review the evidence on a possible association with hormone pregnancy tests on pregnancies and to consider the regulatory failures of the Committee on Safety of Medicines.”?
Sir Mike Penning
I praise the Clerks who helped me to draft the motion. I was very angry when we started drafting it, after reading the report, but they helped me get it into some kind of parliamentary language.
An inquiry has to be independent and judge-led, and it has be able to subpoena people to give evidence before it on oath, so that we can get to the absolute truth. It also has to look at the regulatory system that was in place at the time. I am afraid that the Department of Health cannot hide behind this report. To me, that is vital.
Let us look again at the point about the inquiry being fair and independent. One of the ways we thought it could be independent and fair was to have an expert witness who was not part of the campaign, but whom everybody massively respected. For those of us who have been involved in the thalidomide campaign over the years, it was a really positive thing when we heard that Nick Dobrik’s name would be put forward.
Interestingly enough, although Nick was there as an expert witness, he was not asked to play a part in drawing up the conclusions in any shape or form. In fact, he was asked to leave the room. Nick was very surprised—actually, he was gobsmacked—when, in good faith, the Minister and then the Prime Minister said that Nick Dobrik had fully endorsed the conclusions of the report. I know now that the Minister and the Prime Minister know—I have met the Prime Minister, and Nick has done an interview with Sky today—that he categorically does not endorse the conclusions of the report. It was fundamentally wrong for anyone to advise the Prime Minister or the Minister that he did. He does not blame the Prime Minister; I do not think I blame the Prime Minister. As a former Minister—I know that there are former Ministers on the Opposition Benches—I know that we take advice from our officials and they tell us what the situation is. In good faith, the Minister at the urgent question, and the Prime Minister at Prime Minister’s questions, said that Nick endorsed the conclusions.
On behalf of Nick, who cannot defend himself in this Chamber, I would like whoever gave that advice to the Minister and the Prime Minister to formally apologise to Nick Dobrik. He is a fantastic campaigner not only for the Thalidomide Trust, but for all injustices, especially within the pharmaceutical area. The victims do not feel that the inquiry was fair and independent at all. They should have trust and confidence.
The most important thing is that the inquiry was asked to find a “possible” association—not “causal”, but “possible”. I and other members of the all-party group asked the experts from the panel why, after taking the word “inquiry” out, the remit was changed again, because “causal” is very difficult to prove. They said that they followed the science, but they were supposed to follow their remit and do what they were told. If they felt that they could not do that based on the evidence in front of them, fine. They could have gone back to the Minister and the victims and explained that. Instead, we had the farcical situation of the group looking for something when they knew full well—it is clearly in the documents—that they could not reach the conclusion that there was a causal link.
Interestingly enough, the group also could not come to the conclusion that there was not a causal link, because the evidence was not there for either conclusion. As I said during the exchanges on the urgent question, an injustice has taken place. Natural justice is the reason we are sent here. We defend our constituents when the system has come down against them and caused such horrific, horrible things to happen to them, so we need to address that injustice.
Sir Mike Penning
I will give way once more and then I will conclude to give other colleagues time to speak.
Chris Elmore
I am exceptionally grateful to the right hon. Gentleman. He says that everyone has constituents who have been affected. Two of my constituents have told me that they believe that they lost their children as a result of the drug. It is even more severe than losing a baby; one of them lost several children by taking the advice of their GP. This is a fundamental issue of trust—trusting the GP, trusting the NHS and trusting the inquiry. All those things have failed. Both my constituents told me over and over, “We no longer have any faith in the system.” They believe that the report is a whitewash, which is why I wholeheartedly agree that there should be a full and frank inquiry.
Sir Mike Penning
I thank the hon. Gentleman for his support for the victims.
As I said earlier, there is no constituency in this country that does not have someone who lost their baby due to stillbirth or dying shortly after birth, or whose life was transformed—for those who survived. However, many people were advised to have an abortion, and the figures on that are not available to us. Reports that the inquiry was not allowed to have are starting to come through.
I fully endorse the fact that we need some money so that we can ensure that we have modern reports, because the methodologies used back then would never be allowed today. We also need to see the missing reports. We need to find the stuff that has gone missing in Germany, where the drug company knew there were issues. We need to know why the drug company settled in America—it was using a slightly different name for the product, but it was the same company. What evidence was put before the legal system in America, where the company settled as fast as possible, and then gagged everybody and kept everything quiet?
We have a duty in this House to call things into question when they go wrong. These things started going wrong many years ago—before I was born. I have been a Minister, so I know that Ministers have to support their Department, but one role of a Minister is to question the advice that they get. I know that that is what the Prime Minister is going to do now, and I hope the House will support the victims so that they can have some confidence in the system and the NHS once again.
Several hon. Members rose—
Peter Heaton-Jones
I thank the hon. Lady for that clarification. Many of these studies have been into the historical evidence and the paperwork, which have been sifted through over and again—she is right to make that point—but there are still differences of opinion between what was said in the 1970s, in 2016 and in 2017, and that is the difficulty.
I have asked the House of Commons Library for quite a lot of background information, which I was going to try to get into, but in the six minutes allowed to me I cannot do too much. What I will say, however, is that, having read the latest report by the expert working group, it is clear that there is a concern, highlighted by my right hon. Friend the Member for Hemel Hempstead and others, about the contradiction between what it was asked to do and what it then actually found out. The question is whether there is a causal link or an association. We need to explore that: were the terms of reference of this expert working group followed in the way it carried out its investigation? On that, I absolutely agree: we need to look further into what exactly has been done here.
Further evidence from the expert working group is due to be published in the new year. That will be important.
Sir Mike Penning
It is not coming from the expert working group; it is coming from a professor. The expert working group rejected the evidence because it had not been peer-reviewed, but it will be in the next few days.
Peter Heaton-Jones
My point is that there is more information to come and I thank my right hon. Friend for that clarification on its source. It is really important that we keep looking for this information and that we gather everything we possibly can to help the people affected.
Many other right hon. and hon. Members wish to speak, so I shall not continue for too long. The Government and previous Administrations have consistently tried to look for answers and I know the Minister is sincere in seeking to do that. To support the Government and the people affected, I would like to work together to find a way forward to find the answers they seek. Let us get together and everyone be experts—the Department of Health, Members on both sides of the House and, crucially, the families—to try to get the answers.
I would like to end by referring back to my constituent Diane Surmon, because those affected must be at the centre of our work. In a further letter to me, she wrote:
“In my heart, I feel positive it was the drug Primodos which caused Helen’s injuries. After I took those tablets I was in and out of hospital. I carried a lot of fluid, which I have since been told is a sign of an abnormal foetus. I had had two normal pregnancies before Helen.”
She ends with these words, which I think are extraordinarily powerful:
“I feel very angry. I feel we were used as guinea pigs.”
For the sake of Diane Surmon and all the others whom we on both sides of the House represent, let us focus on the effect the drug has had on them and their families. Let us all work together. I know the Minister is sincere in wishing to do that. Let us all work together to find the answers they seek, while keeping them and their suffering at the centre of our work at all times.
Sir Mike Penning
I thank everybody for giving up their Thursday in their constituencies to be here. I have been praised extensively for securing the debate, but I would not have been able to do it without the all-party group—we had 57 signatures.
I have constituents whose lives were changed—blighted, completely wrecked—by Primodos, and we have heard of others on both sides of the House today. I heard the Minister say, “Nothing is ruled out. I am willing to listen.” I am really pleased, because he is going to have to listen an awful lot. If this report is still on his desk and being used as a way to go forward, I am afraid that that is an insult to the victims.
This document was described to me in a way that I cannot repeat in the House today, but a better way of describing it is that it was crap. It is fundamentally flawed and does not do what it said on the tin when the Minister asked for it to be done. The Department can talk and move on, and talk and move on, but there has to be an independent public inquiry. If that inquiry decides it needs further evidence, it needs the finance to get that, and it needs to suspend while we find further evidence—and there will be evidence coming forward in the next couple of days.
That is because the victims are the most important people in what we have been discussing today. If we forget that, we forget why we are here and why the NHS has the greatest reputation in the world. Schering is a great brand—we need its drugs—but its reputation has been damaged, and so has the national health—
Deafness and Hearing Loss
Mike Penning Excerpts(6 years, 5 months ago)
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Sir Mike Penning (Hemel Hempstead) (Con)
It is a pleasure to serve under your chairmanship, Mr McCabe, and a pleasure to speak in a debate secured by my good friend the hon. Member for Poplar and Limehouse (Jim Fitzpatrick). We have been on many campaigns together over the years, not least in our previous careers.
I need to declare an interest at the outset. I have been honorary patron of the Hertfordshire Hearing Advisory Service—a fantastic charity that works not only in Hertfordshire but across many counties—for more than 10 years.
I disagree with hardly anything that has been said in this really positive debate. I think that people watching and others will realise that the House can work together not only for people who are hard of hearing, but for people who are hard of hearing and have other issues. We have not discussed the fact that people who are hard of hearing or deaf often have other ailments, which can be as difficult for them as being hard of hearing.
I can assure hon. Members from experience that Ministers usually do not like former Ministers to stand up and talk about things that they might know something about. For a short time, I was the disability Minister and responsible for Access to Work. Let me be positive about Access to Work and break some of the taboos about it. As we have heard, it is one of the great schemes for people across this great nation who had been left behind, ignored and told that they could not work. Employers told people that they could not employ them because it was not safe to do so. That was complete and utter rubbish. I do not have to take the hon. Gentleman’s word for it, because there is evidence in the Department for Work and Pensions that people with disabilities work harder, are more likely to turn up for work and are more dedicated and more committed than any other employees. That is a fact. We know that.
I went around the country as part of the disability confident scheme trying to encourage employers to take on people with all types of disabilities. That was pretty easy with bigger companies. There are some fantastic large companies out there—particularly Royal Mail. It gets biffed around a little at times in the House, but its commitment to people who either arrive with disabilities or acquire disabilities during their employment is fantastic. However, it is really hard with small and medium-sized enterprises. There is a myth that there is a risk: people say, “Health and safety prevents me.” I was the Minister with responsibility for health and safety, too, and I was happy to go around and dispel that myth. We have to work really hard with SMEs.
Access to Work was fantastic in helping thousands of people to get into work and have the confidence to stay. The cap was brought in just before I became the Minister responsible, and one of the first things I said was, “Where is the Department’s evidence that we need to do this and that the cap will work?” Let me put this on the record: there is evidence in the DWP, the Department knows exactly what it is, and it is continually reviewed. Ministers are taught always to say at the Dispatch Box, “The Government continue to keep under review” this, that or whatever. I assure hon. Members that the Department keeps that evidence under review.
It is a shame that my hon. Friend the Minister, who was my Parliamentary Private Secretary, is responsible for responding to this debate, but the DWP, which will see the record of this debate, knows whether the cap will work, is keeping it under review and needs to be open and honest about how it is working. If it is not working, it needs to be adjusted. As a former Minister, I will not have all that great work and all those people’s aspirations and commitment to work lost because of a cap that does not actually save a huge amount of money in real terms.
Jim Fitzpatrick
The right hon. Gentleman makes the same points that we have all made. Access to Work is a great scheme. It works. As I understand it, the logic for the cap is that there is only so much money in the pot—that is always the case for Governments—and therefore its purpose is to try to spread what is available as widely as possible. But for people with fantastic talent who could be advocates and champions for the deaf community by becoming chief executives and leaders of their professions and so on, the glass ceiling has been reinforced, because they can now get only £43,000. This is not a criticism—well, it is in some respects—but we need to ensure that the evidence is looked at regularly.
Sir Mike Penning
Governments need to be kicked and beaten up when they get things wrong and praised when they get things right. I was proud that a Conservative Government brought in Access to Work, which is massively important. There will always be examples of abuse in the system and so on, but that does not give the Government carte blanche to say, “No, the only way this can work is with a cap,” particularly if the evidence does not show that a cap will work. The Minister will have looked twice when he came into the Chamber and realised what this debate would mostly be about, which is not his responsibility but the DWP’s. I am more than happy to go across to my old Department and sit with my old officials and explain to them exactly where the evidence is in their cupboards.
Let me touch briefly on two other areas, and then on one thing that has not been touched on at all. I do not understand why, in the 21st century, a recognised language is not recognised in the House or across the country. I really do not understand why, all these years after I made a point of order in the main Chamber in 2005 to complain that a hearing loop was not available for my constituents when they were in the House—even when it was installed, it did not work properly—this is the first time a debate has been signed for our constituents. People will always go on about how that must cost more money. The cost is minimal compared with the benefit to our constituents of being part of the democratic process.
Stephen Lloyd
I thank the right hon. Gentleman for kicking off about the induction loop years ago, because I could not function as an MP in the Chamber without it.
Sir Mike Penning
The things I do for everybody in this House. It was genuinely embarrassing. I remember it vividly. I said to the Speaker, Michael Martin, “My constituents have come to see this world heritage site and their Parliament at work. I took them on a tour, and frankly they got hardly any benefit apart from visuals, because they couldn’t understand or hear a word I was saying.” I seem to remember that there was the comment, from a sedentary position, “Well, they didn’t miss very much,” but I was trying to get across a point. This is the mother of Parliaments, and as we have heard from colleagues, we are way behind the loop again. I am sorry to use that terrible pun, but we are really behind. I hope that we will have a lurch forward. I have noticed all the Clerks coming in, and have heard that the Speaker will be reported to, and all that, and that is great, but it is absolutely useless unless someone actually does something. Then we can move on. I know this is a trial, but signing should be transmitted live.
Secondly, there should be a GCSE. I find it fascinating: we can see all the different courses that our young people do in schools and colleges, yet they are excluded in this way. If people do not want any more GCSEs, we could drop one of the ones that would not get used anywhere near as much as this. It would make people aware. In my constituency, people who are not deaf or hard of hearing have said to me that they want to be able to communicate like this; they want to do these courses as well. They want to have a GCSE, so that they can chat away with their mates in that sort of way. That is a simple thing, and I cannot see huge cost implications, so it should be moved on, as we have heard this afternoon.
Finally, I will touch on people whose hearing has been impaired by industrial injuries. That has not been mentioned at all in the debate, but not because people think it should not be. It is just one of those issues. People cannot see this type of industrial injury. It is not like the industrial injuries that my hon. Friend the Member for Poplar and Limehouse and I saw in our former jobs as firemen. There is something very wrong about how we measure industrial injuries, and hearing impairment industrial injuries in particular. So many people who have a hearing impairment do not admit it to themselves, their wives and their loved ones, even though their wives and loved ones are probably aware that there is an issue. They certainly do not talk about it to their employer or previous employers.
I can talk about this, because my eardrum is perforated. I did not know about that until I started to miss conversations that I thought I should be picking up. You just do not think there is something wrong. However, when I was a Minister at the Ministry of Defence, I had to have a medical before I was allowed to go into operational fields, and it was obvious that I had a perforated eardrum. It was almost certainly from live firing when I was in the armed forces—the specialists told me that—although it was not picked up then. That is not so important to me, but where industrial injuries are common, it is massively important that there be a level playing field on decibel levels. Completely different levels are used for hearing damage in the armed forces and what I call civvy street, and that cannot be right.
We must encourage people to come forward, not so much so that they can get compensation, but because, as we heard earlier, if we can pick this up earlier, it saves the state and everyone a lot of money, and also makes life much better for that person, who can start to accept the disability that they have and continue to live a happy life.
[Ms Karen Buck in the Chair]
Jim Fitzpatrick
When I had the hearing test that identified my audiological loss, as the right hon. Gentleman will know, the printout showed whether it was down to age or genetics, or whether it was industrial. Mine was at least partly industrial. I was told by my clinicians, “Your hearing loss is above the threshold for applying for industrial injury compensation.” I never did, because I had a great job here, so I did not have to, and it was not a matter of money. I have always felt a bit difficult about saying, “Well, I should have gone down as a statistic.” I am sure that, as the right hon. Gentleman says, there are a lot of us out there who have not registered and do not appear in the statistics. The base statistics are only of the people who absolutely needed to make sure that they registered.
Sir Mike Penning
Thank you very much—not Mr McCabe, but Ms Buck; I did a quick double-take. My hon. Friend has hit the nail on the head. It is not just about the money. Getting people in, whether at pensionable age or when they leave an employer or the armed forces, is vital. When I left the armed forces, my hearing was not tested. It was supposed to have been tested, but it was not, and if anyone can find a record of it being tested then, I can take them on about that. I am not raising the issue of whether people are entitled to compensation—that is someone else’s decision—but they are not entitled to compensation unless we get them tested. If we can get them tested, the specialists will know, as my hon. Friend said, the cause of the deafness. There are myriad reasons, but industrial damage is pretty well defined.
I am thrilled that there are so many people here on a Thursday afternoon—the other Chamber probably has half, if not less than half, the amount of people we have here. Perhaps my hon. Friend and I might go back to the Backbench Business Committee to get a proper debate on the Floor of the House on some of the specifics we have discussed. If necessary, that should be on Access to Work, because that is a life-changer and has been for many people. We must not lose that life-changing ability.
Hormone Pregnancy Tests
Mike Penning Excerpts(6 years, 6 months ago)
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Steve Brine
The hon. Gentleman referred to a “whitewash”. As I have said, this was a comprehensive, independent, scientific review of all available evidence by experts on a broad range of specialisms who, with respect, are far more qualified to consider the subject than either him or me. It was a rigorous, important and impartial review conducted over the best part of two years, and the experts were given access to all the available documents.
As for the families and issues relating to disclosure, yes, Mrs Lyon was on the panel. However, it is standard procedure for expert working groups to sign such an agreement, as all members of the panel did, in order to keep the process free from external influence and to prevent it from being constantly discussed in the media. The companies did meet the group and gave evidence to it. Having discussed the matter briefly with members of the Medicines and Healthcare Products Regulatory Agency this morning, I have to say that I think the families could have been treated a great deal better when they met the group. I thought that the layout of the room was intimidating. Not everyone is like a Minister or a Member of Parliament who can sit in front of a Select Committee and know how to handle it. I think that the process could have been handled better, and I made that very clear.
As for Ministers and meetings, my noble Friend Lord O'Shaughnessy, who ultimately has responsibility for the MHRA and whom I “shadow” in the House of Commons, has met the all-party group and the families group. He will meet them again on 6 December, now that the report has been published. The APPG is also meeting the chair of the expert working group.
The hon. Gentleman mentioned other research. He might have been referring to Dr Vargesson, an Aberdeen-based researcher who is, I believe, working on the components of Primodos in fish. He was invited to give evidence to the group, and he did so, but he did not want to leave his work and the evidence, which he said would shortly be published, with the expert working group. As far I am aware, that work has still not been published, but I know that the MHRA will be keen to look at any new work that is published.
Sir Mike Penning (Hemel Hempstead) (Con)
I know the Minister very well. He is a passionate and caring Minister, but I am afraid that I disagree with many of the things he said this morning. The families do—I think, rightly—feel that the report is a whitewash. Material has been removed from the draft, and the group looked into matters that were not within its remit. The question of a causal link was not in its remit. The question was whether there was link with a drug that was often given to our constituents with no prescription: a drawer would be opened, and it would be handed out to them so that they could find out whether they were pregnant. An open inquiry was needed, but I am afraid that the families, and many Members who are present today, will not feel that that was what happened. Will the Minister please meet the families again, with members of the all-party group, and try to understand why they are so upset? Will the Minister please also watch last night’s report on Sky News, which exposes much of what has being going on over many Parliaments? No matter who was in government, Governments have ignored these people, and we cannot continue to do so.
Steve Brine
My right hon. Friend and I do know each other very well, but I am afraid we will have to agree to differ on this; I do not agree that this is a whitewash. At the request of the Association for Children Damaged by Hormone Pregnancy Tests, an expert, Nick Dobrik, who the House and outside world will know well as a respected and well-known thalidomide campaigner, attended all meetings of the expert working group and was invited to give a statement to the Commission on Human Medicines. Mr Dobrik is many things, but the notion that he is some sort of Government yes-man who would have allowed a whitewash to go on does not stand up to much scrutiny, if any at all.
Deaths in Mental Health Settings
Mike Penning Excerpts(9 years, 2 months ago)
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Mr Charles Walker (Broxbourne) (Con)
I rise to congratulate Deborah Coles and INQUEST on publishing an extremely important document entitled “Deaths in Mental Health Detention: an Investigation framework fit for purpose?”. INQUEST’s report focuses on the deaths of those detained under the Mental Health Act 1983. There are two sad truths. First, too many people are dying in mental health detention—on average more than 300 people a year in each year between 2003 and 2013. Secondly, there is no mechanism for independent investigation of those deaths.
Mental health patients have an absolute right to life, and that right must not be forgotten, abused or cast aside. That absolute right to life extends to the state having a positive duty to safeguard those patients from taking their own life. When there is a death in custody, the police have the Independent Police Complaints Commission to investigate it. The Prison Service has the prisons and probation ombudsman to investigate, but the NHS has nothing that could be classed as independent.
The Coroners and Justice Act 2009 clearly states that deaths in mental health detention that are “violent or unnatural” or cases in which
“the cause of death is unknown”
should be scrutinised at inquests before a coroner sitting with a jury. However, in almost all cases in the NHS, the relevant trust or care provider is the investigating agency, so we have the NHS investigating itself when someone dies while in its care. There are many problems with that.
One of the main problems is that coroners are reliant on the reports provided by the NHS body that is investigating itself when someone dies in its care. Also, families are too often excluded from the investigation processes conducted by NHS trusts, and the length of time that an inquest can take is enormously variable. Some can be done very quickly, resulting in families feeling railroaded; others can take years. One anomaly that needs to be addressed is that any inquest that takes a year and a half or more is deemed to have taken a year and a half. So an inquest can wait to be heard for five years, yet for the purpose of statistics it has been waiting for only a year and a half—that is unacceptable.
As I have said in this place on numerous occasions, there is inequality in representation: the agents of the state are represented by QCs funded by the taxpayer, whereas the families are pretty much left to their own financial devices. I shall return to that issue later. There is also a desperately poor collation of statistics on the type, number, frequency and features of these deaths—there is no transparency. INQUEST observes in its report that its
“experience is that the practice of NHS Trusts in investigating these deaths, and the issues raised by them, is consistently falling short of the existing guidance”.
INQUEST reports that over the past five years it has been unable to identify a single independent investigation at the evidence-gathering stage following a self-inflicted death.
INQUEST goes on to cite the following deficiencies in the process: a lack of family liaison with trusts following a death; families not being provided with any information about the investigation process or informed of their right to be involved in that process; no information being provided to families as to where they can find independent advice and support; families having little, if any, opportunity to raise concerns or questions; families not being provided with the terms of reference of an investigation; trusts refusing to provide families with the final versions of reports; and trusts failing to pass on a copy of the final report to the coroner. This situation is absolutely devastating for families and its impact on their morale cannot be overstated. It is wrong and something needs to be done. Sadly, the list I have read out is incomplete, but time prevents me from adding further points.
More generally, the superficial nature of investigations and the speed at which some cases move to the inquest hearing stage leave many families without any meaningful chance of establishing the circumstances of their relative’s death and, crucially, whether the death was preventable. As I said a few moments ago, there is another option for trusts keen to avoid their responsibility or owning up to their responsibility. One option is to push the investigation through extremely quickly, railroading people, but the other option is to drag its feet. As I said, an investigation that took five or six years to complete would still be deemed to have taken a year and a half when the coroner’s court reported. That is unacceptable.
Why is robust investigation so important? It is because our coroners generally rely on other agencies to gather relevant evidence before an inquest hearing, and have limited resources and powers to direct any initial investigations. So a coroner’s court will only be as good as the evidence provided to it. Therefore, it is currently the case that the rigour and thoroughness of inquests into deaths in mental health detention are ultimately dependent on the internal hospital investigation—the NHS investigating itself. The shortcomings in the current process mean that highly relevant evidence is often not identified, gathered and preserved, or, even worse, that the evidence-gathering process is influenced by those who have both control of the material and an interest in the outcome. INQUEST states:
“This incomplete or tainted evidence then flows through the inquest system and is effectively ‘fruit of the poisonous tree’”.
So if we are to continue with the current discredited system—I hope we are not—at the very least NHS trusts and health care providers need clear guidance, not just on the form of their investigations, but on who is responsible for undertaking them. Ultimately, what we need is the independent investigation of deaths, along the lines of the investigations undertaken by the Independent Police Complaints Commission and the prisons and probation ombudsman. We need an independent investigation that involves the families of the deceased, which, at its conclusion, produces a rigorous investigation report that is published and made widely available. That and only that will allow for robust inquests that get to the truth.
At these inquests there must be equality of representation. As I said earlier, it is simply not acceptable for the agents of the state to be represented by QCs funded by the taxpayer, while the families of the deceased are means-tested to see what they can afford. Quite simply, if someone is in the care of the state, the state has a duty of care.
If we are to have the proper investigation of deaths in mental health settings, we need greater investigatory independence matched to a coherent data set on the number of deaths in mental health settings. These data should record age, gender, ethnicity, the location of the death and the type of death—for example, whether it was self-inflicted, restraint-related or from natural causes. As death rates by individual units or clinical commissioning groups are not published, the statistics currently available in the public domain do not enable identification and analysis of where deaths in mental health settings take place. Again, this lack of transparency must be addressed.
The lack of publicly available data is particularly concerning in relation to ethnicity, where there are significant concerns about the continued over-representation of black people in mental health settings and the coercive use of force that features in some of their deaths. I would like to take this opportunity to briefly congratulate and thank Matilda MacAttram of Black Mental Health UK on her fantastic campaigning in this important area. I see that the Policing Minister is on the Front Bench; I am sure that he will pass on his congratulations to Matilda as well.
The Minister for Policing, Criminal Justice and Victims (Mike Penning)
indicated assent.
Mr Walker
Perhaps most worryingly, it is difficult, if not impossible, to identify from the current statistics the number of children who have died in mental health settings. This is simply not good enough. Children are detained in mental health settings and sadly, on occasions, some of those children are dying while being detained. We really need to minimise that occurrence as a matter of utter urgency.
The Minister replying to this debate will know that deaths in custody—or, more accurately, deaths while in the care of the state—is the topic of much debate at the moment, with the Equality and Human Rights Commission publishing its paper and concerns earlier this week. That paper was launched in the House of Commons. There is growing concern, and it is clear that there is a demand from many quarters, across the United Kingdom—people with a stake in this issue—for decisive action to be taken. Although for the past 10 years the overall trend has been downwards, deaths in mental health settings still account for 60% of all deaths in state custody.
More than half the deaths in mental health settings are ascribed to natural causes, but this in itself is a cause of concern, because the descriptor “natural causes” may mask deaths where contributing factors include the side effects of high-dose, multiple medication on the individual’s physical health. There is too much uncertainty hidden under the heading of “natural causes”, and it will stay that way until in-house investigators are replaced by independent investigators and independent oversight; because in an ideal world, where there is a violent death —a death that involves suicide, the use of force or restraint—the default position should be for an independent investigation. In cases where natural causes are suspected, an independent body could review the initial findings of the NHS trust before accepting them or asking for more information, with a view to mounting a formal investigation.
Seeing that the Policing Minister is here, I cannot let this occasion pass without saying that there is still widespread concern that on too many occasions police officers are being called to mental health wards—NHS environments—to restrain patients. Police officers are not trained to do that. I know this is causing the Minister concern; I know it is causing police officers concern. It should cause us all concern.
In conclusion, there is much work to be done to ensure that where a tragedy does occur in a detained mental health setting, there is a robust, independent system of investigation that gets to the truth, provides both closure and reassurance to grieving families and, through initiating changes in existing processes and procedures, prevents future deaths. I met some of the families last week who attended the launch of the INQUEST paper. It was a very sobering experience. These are good people who are seeking answers as to why husbands, wives—people they love—have lost their lives while in the care of the state. We need to be better at providing those answers.
Jane Ellison
As ever, the right hon. Lady makes an extremely good point. My right hon. Friend the Policing Minister has confirmed that he has been to Greater Manchester and seen the work in progress. I will touch on street triage, which is an aspect of the work going on in this area, but first let me say that the right hon. Lady is absolutely right. As a constituency Member, I have been out on a Friday night with my local police’s rapid response team. Very caring young police officers have stressed to me the importance of not only equipping them with skills, but ensuring that they are not asked to do things that are not part of their core duties, and that they get proper support to deal with people in a sensitive way. The right hon. Lady’s point was very well made.
Police forces are piloting a street triage initiative, in which mental health professionals travel with police officers on patrol, providing on-the-spot help to people with possible mental health needs who come into contact with the police. There have been positive results in the Leicestershire pilot area, where street triage has led to a reduction in detentions under section 136 of the Mental Health Act 1983. I know from a Backbench Business debate a few weeks ago that that is an impressive reduction in detentions, and the right hon. Lady mentioned progress in her area, too.
We are also investing a further £30 million next year to further develop liaison psychiatry services to support people with mental illness in accident and emergency and when being treated for physical illness in a general hospital setting. As well as focusing on preventing people from being detained in mental health settings, we must also look at preventing avoidable harm and deaths when people find themselves in hospital. My hon. Friend the Member for Broxbourne mentioned that.
INQUEST’s report highlights the issue of suicides in mental health settings. Earlier this year, the Government announced our ambition for the NHS to adopt a zero suicide strategy to reduce dramatically suicides in health settings and in the community. At the beginning of the year, we also laid before Parliament the revised Mental Health Act 1983 code of practice, which comes into effect from April and strengthens our commitment to safeguarding the rights of people detained under the Act. The revised code of practice gives greater prominence to the need for better and more rigorous risk assessments, and for care planning that is centred around the patient and involves their carers and relatives wherever possible. That picks up on the well-made point from my hon. Friend about the need to involve families and to ensure that patients are treated in safe environments.
Let me turn to the recommendations in INQUEST’s report. The first concerned the system for investigating deaths and the matter of independence. Coroners’ inquests provide independent investigation, and we must consider the evidence carefully to inform how we improve the quality and independence of investigations in mental health settings. It is right that we focus on improving the way deaths in such settings are investigated. Clear guidance should be given to the NHS to improve the integrity and quality of investigations.
NHS England is reviewing the NHS serious incident framework, which describes how serious incidents, including deaths, should be reported, investigated and learned from to prevent them happening again. I understand that NHS England is finalising the guidance and have been advised that it is being reviewed by the chief nursing officer. This is an opportunity to re-emphasise the responsibilities of providers and commissioners by holding providers to account for how they respond to serious incidents, and holding commissioners to account for overseeing the response to ensure that it is objective, proportionate and timely.
Secondly, the report recommends the proper and meaningful involvement of families in the investigation of deaths, so that it is on a par with the way in which deaths in other custody settings are investigated. NHS England’s guidance on managing investigations in the NHS will set out the commissioner’s responsibility for ensuring that all those affected by an incident are involved, and that the investigation is conducted in an open and honest manner. The commissioner will also have the opportunity to inform the terms of reference of the investigation, and can consider and will be consulted on the investigation’s findings. The efforts to engage those affected by the incident should also be recorded in the response to the investigation. It is therefore essential that people should be able to not just liaise with the family, but demonstrate how they have done so, and record how they did it.
Thirdly, the report recommends the better collation and publication of statistics on deaths in mental health settings, including further details on the circumstances and characteristics of the death. I was struck by what my hon. Friend said about some of the uncertainties in this regard, and about the need for people to be transparent about something so important. I am aware that the Care Quality Commission is piloting ways to improve how it collects and analyses data, in partnership with NHS England. That can help to improve the way the CQC monitors the Mental Health Act.
I understand that the Care Quality Commission is looking at how it might link data from hospital episode statistics and from the mental health and learning disabilities data set to enable better cross-referencing of the information it receives through notifications of deaths, which should help it to improve the availability of data at a national level so that it supports policy responses to deaths in detention. That important work is ongoing.
Fourthly, the report recommended that coroners’ inquests be more robust. I have shared the report with the Ministry of Justice, and I am sure that the Chief Coroner will read it with interest. The fact that my right hon. Friend the Policing Minister is here on the Front Bench demonstrates that—
Jane Ellison
Yes, he is wearing both hats today. He has confirmed that he will take this matter forward in the Ministry of Justice, and I am grateful to him for that. The fact that, in the last Adjournment debate of the parliamentary week, the two Departments most closely involved in responding adequately to these matters are represented by Ministers shows how important they are.
My hon. Friend the Member for Broxbourne might wish to raise his concerns about the robustness of inquests directly with the Office of the Chief Coroner. However, let me tell the House about another way in which the better use of data is helping in this situation. I understand that the Care Quality Commission is undertaking analysis of the information available from coroners’ investigations and inquests, along with other information it already receives on expected and unexpected deaths, which should help it to target requests from coroners better.
The Care Quality Commission is also working with the Coroners Society of England and Wales and the Office of the Chief Coroner to establish a memorandum of understanding, with the aim of achieving better working relationships and sharing of information. I am sure that my hon. Friend, having had the chance to highlight the importance of this issue today, will want regularly to ask questions, presumably in the next Parliament, about how this work is progressing and what the timetable is. Indeed, the Minister for Policing, Criminal Justice and Victims has heard his request for vigour and energy behind that work.
In conclusion, it is absolutely right that we should seriously consider how to improve the investigation of deaths in mental health settings.