Mental Health In-patient Services: Improving Safety

Debate between Rosena Allin-Khan and Steve Barclay

Wednesday 28th June 2023 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

I thank the Secretary of State for advance sight of the statement. However, it beggars belief that it has taken the Government so long to address the House on this matter. It seems that every month there are new scandals regarding needless loss of life and dehumanising behaviour in in-patient mental health settings. That must be stamped out now—these are people’s lives.

That brings me to the subject of Essex Partnership University NHS Foundation Trust. I welcome the announcement today that the inquiry will be given vital statutory powers, because for several years families who have lost loved ones at the trust have been calling for the inquiry to be given those powers. The grieving families I have spoken to have told me about the pain and anguish they have felt during their fight for answers, and that has only been compounded by an inquiry that lacked the necessary powers to seek the truth.

I must pay tribute to those families for their tireless campaigning and effort. In particular, I thank Melanie Leahy, who has fought for too long to achieve the announcement that has finally come today. I hope that Melanie, and every other family, will now start learning the truth.

Dr Strathdee has been a powerful advocate for the Essex inquiry, and we want to express our thanks to her for the work that she has already put in. The next inquiry chair must continue her work, and hold the confidence of the families who have been impacted in Essex.

I have repeatedly called on the Secretary of State to give the Essex inquiry statutory powers, and I am pleased to see that he has finally listened to our calls, but why were families left in the lurch for so long? Following months of scandals in in-patient mental health hospitals, public confidence is falling. More than one in three people say that they do not have faith that a loved one would be safe if they needed hospital mental health care, but every patient must be treated with dignity. I have repeatedly asked Ministers whether they have visited failing trusts. The Minister refused to answer, so will the Secretary of State commit himself to greater transparency? The Secretary of State has announced that urgent mental health support will be made available through 111, but 1.6 million people have been left languishing on waiting lists for mental health treatment, their condition deteriorating and reaching crisis point.

It is welcome that we will finally see the publication of the rapid review today—better late than never—but Labour has been calling for in-patient mental health settings to be reviewed in the light of these serious failings, and any rapid review should have had patient voices at its centre rather than being simply the data exercise that the Government commissioned. When we look at the planned national investigation into in-patient services that they will conduct alongside the Health Services Safety Investigations Body, we see that, yet again, there is no mention of working with patients and their families. Where is the learning? Where is the focus on what staff need in these settings? Are the Government looking at additional training needs, given that mental health care relies on staff and not simply on shiny equipment?

Let me turn briefly to the planned consultants’ strike, about which the Health Secretary has said absolutely nothing. Yet again he has been missing in action. For my consultant colleagues to have voted to strike is extraordinary, and the risk to patients of seven days of strike action is intolerable. Next week marks the 75th anniversary of the NHS, and it has never been in a worse state. The country is clear about who is to blame. It is not nurses, it is not junior doctors, it is not consultants, and it is not paramedics; it is this Conservative Government. They have lost control of the NHS, they have lost the confidence of NHS staff, and they have lost the support of the British people. The only ballot that we need now is a general election.

[Steve Barclay]

It is a shame that the hon. Lady chose to conclude her remarks in such a way. Let me address that head-on. It is bizarre to accuse a Minister who is literally at the Dispatch Box of being missing, particularly when the shadow Health Secretary, having managed to turn up for Prime Minister’s Question Time, has failed to turn up for this statement. It is even more bizarre that, although we are constantly told that the Labour party sees parity between mental health and physical health as a key priority, when it actually comes to debating the issue, the contrary is clearly on show.

This debate is not about the issues normally raised during Prime Minister’s questions about the politics of the day; it is about the families who have tragically lost loved ones, about how we can learn the lessons from that, and about how we can ensure that we get the data right, get the support for staff right, and get the procedures right so that other families do not suffer loss. We have responded to the excellent points made by Dr Strathdee through her rapid review about data. There are two elements to that: there is data that is collected that does not add value, is often duplicative and takes staff away from giving care—that is somewhere that we can free up staff—but there is other data that is needed to better identify issues early, and we need to look at how we improve that data. Specific issues arose in respect of engagement by staff, and we have actively listened and responded to the concerns raised by families and by many Members of the House, particularly about the Essex inquiry. I will come on to those as I go through the wider issues.

The shadow Minister mentioned speed. Of course, there is a balance to be struck between the completeness of a statutory inquiry and the greater speed that is often offered by other independent inquiries. Indeed, the Paterson inquiry was a non-statutory inquiry commissioned through the Department, and that is another vehicle that is often successfully used. There are also inquiries commissioned through NHS England, such as the Donna Ockenden review. There is often a balance to be struck between those inquiries, given the speed at which they can proceed, and a statutory inquiry, which has wider powers but often takes longer.

It was because of our desire to move at pace to get answers to families that we initially commissioned a non-statutory inquiry, in common with Bill Kirkup’s inquiry into Morecambe Bay and inquiries into many other instances in the NHS. However, we have listened to families and to right hon. and hon. Members who have raised concerns about the process and, in particular, the engagement by staff, and decided to make it a statutory inquiry.

The shadow Minister asked about our commitment to transparency. The very reason that we set up the rapid review in January was to bring greater transparency to the data. That is why I will be placing in the Libraries of both Houses the outcome of the rapid review. That speaks to the importance of transparency as we learn the lessons of what went wrong in Essex and in other mental health in-patient facilities.

The shadow Minister made a fair point about waiting times. We are committed to cutting waiting times, including in mental health. That is why we are spending £2.3 billion more on mental health this year than four years ago, we have commissioned 100 mental health ambulances, we have 160 different schemes looking at things such as crisis cafés to support people in A&E, and we have schemes such as the review through 111 and the funding the Chancellor announced in the Budget for mental health digital apps to give people early support. Of course, that sits alongside other mental health interventions, such as our programme to train more people to give mental health support in schools.

The shadow Minister made an important point about working with families. I agree with her about that. HSIB will be meeting families—indeed, Ministers have been doing likewise—and we are keen that that should feed into the terms of reference, both for the statutory inquiry and for the HSIB review.

We have touched on consultants, but let me make a final point on that. As far as I am aware, the Opposition do not support a 35% pay rise, whether for junior doctors or for consultants, but if that is their position, perhaps they will tell us whether this is yet another area that the stretchable non-dom contribution will reach to. Exactly how will it be funded?

This is a serious issue. The measures that we are taking address the concerns of families who have suffered the most tragic loss. It is important that we learn the lessons, both in Essex and more widely. We have actively listened to the points raised by Dr Strathdee, who has done a fantastic job. It is right that the work moves on to a statutory footing, but it is also right that we look more widely at the lessons from other mental health in-patient facilities. That is exactly what we intend to do.

Oral Answers to Questions

Debate between Rosena Allin-Khan and Steve Barclay

Tuesday 6th June 2023 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

A 14-year old climbing out of hospital windows; a child absconding to a local railway station; a teenager with complex needs brought to A&E, requiring four police officers to spend an entire shift watching them, only for them to abscond the next day. There is a pattern here. At almost every step of the way, children needing mental health services face a perfect storm of delay and treatment in inappropriate settings, fuelled by an under-resourced service with over-stretched staff. In light of the Met’s announcement that they will stop attending emergency mental health calls, is it not time for the Government to get their act together, or simply do the right thing and step aside?

[Steve Barclay]

One can see the way the Government are responding constructively to these issues by looking at the pilots we have been rolling out in Humberside, where police are released within one hour in 80% of section 136 detentions. We intend to roll out that pilot nationally.

The hon. Lady is right on the first part of her challenge, as demand for mental health services is increasing. In fact, there was a 41% increase in new referrals to mental health services in 2021 compared to the previous year. Where she is wrong is on the resourcing. She missed my previous answer that set out how we are committing an extra £2.3 billion of investment into mental health services, compared to four years ago.

Oral Answers

Debate between Rosena Allin-Khan and Steve Barclay

Tuesday 25th April 2023 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

This may surprise you, Mr Speaker, but I have found evidence that the Health Secretary has got something right. He recently hailed the power of local news outlets, and he was spot on. I have here a story from his local paper, exposing the shocking length of waits in A&E for those in a mental health crisis: 5.4 million hours across England in just one year. He is very welcome to have a look if he would like to. Given his admiration for local journalism, does he feel embarrassed for his Government’s failings and will he apologise to all the people across the country who are stuck waiting in A&E?

[Steve Barclay]

There are two separate issues there: what we are doing for mental health in-patients and the point we just touched on about A&E. On mental health, it is good of the hon. Lady to give me the opportunity to remind the House of the significant increase in funding we are making to mental health. In the long-term plan, the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), made a major strategic choice to invest more in mental health—an extra £2.3 billion per year. The hon. Lady is right to highlight the need for more capacity for mental health in-patients—[Interruption.] She asked a question on what we are doing on mental health. I am able to tell her that we are spending far more and investing far more in it, but it seems that she does not want to hear that answer.

Oral Answers to Questions

Debate between Rosena Allin-Khan and Steve Barclay

Tuesday 7th March 2023 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

There is a mental health staffing crisis of the Government’s own making. Figures out last week show that there are more than 28,000 mental health vacancies in our NHS, which is up on the year before and the year before that. Are we seeing a pattern here? The number of mental health nurses is down 5% since 2010, but do not worry, Mr Speaker: just so the Secretary of State is aware, Labour has a plan to recruit and retain more mental health staff and to get waiting times down. Can he put a word in with the Chancellor in case he wants to nick that too?

[Steve Barclay]

It is always good to find a plan that the hon. Lady actually agrees with the shadow Health Secretary on. As we know from her questions, that is not always the case, not least on the use of the independent sector. What we do know is that she has a habit of writing her questions before she hears the previous answer. I just reminded the House of the 7,400 more staff in mental health in September 2022 compared with September 2021. Obviously she had written her question before that point.

Oral Answers to Questions

Debate between Rosena Allin-Khan and Steve Barclay

Tuesday 24th January 2023 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

In mental health we rely on staff, not shiny machinery, so why is the Secretary of State rehashing old announcements and scrapping plans? It is because the Government have run out of ideas. Labour has a plan. We will recruit 8,500 more mental health professionals, ensuring a million more patients get treated every year. We will double the number of medical school places. We will train 10,000 extra nurses and midwives every year, and we will focus on retaining the fantastic staff we already have. Where is the Government’s plan? We have had our plan for two years, but they are binning theirs.

[Steve Barclay]

It is slightly odd for the hon. Lady to talk about a plan when she does not agree with the plan of the shadow Health Secretary, the hon. Member for Ilford North (Wes Streeting). He plans to use the private sector, which he describes as “effective and popular,” whereas the hon. Lady said:

“In my own brief in mental health we have use of the private sector, which ultimately often lets patients down.”

First, the hon. Lady does not agree with the shadow Secretary of State. [Interruption.] The hon. Lady chunters, but she asked about a plan when she does not agree with her own Secretary of State.

Secondly, the hon. Lady talked about shiny new equipment. I am delighted that she allows me to draw the House’s attention to yesterday’s announcement of a fleet of 100 new mental health ambulances, which will relieve pressure on A&E. I am delighted that she gave me an open door to highlight that investment, which is part of our £2.3 billion investment in mental health.

Ambulance Pressures

Debate between Rosena Allin-Khan and Steve Barclay

Monday 18th July 2022 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

I thank the Secretary of State for advance sight of the statement and welcome him to his new role. It would have been helpful if, ahead of the current temperatures, he had responded to our urgent question last week, but I am glad that he is here now.

The Secretary of State claims that everything is in hand, but I know from my own experience and that of colleagues across the country that that is far from the truth. We have already seen ambulance wait times soar and pressure on staff spiral, all while the NHS struggles to find the essential staff needed to deliver patient care. I am sure that everyone across the House will agree that our frontline workers are truly amazing. But if nurses and doctors are so overworked and do not have the time and resources to take care of themselves in this heat, the care that they can give patients will be impacted. The Government must step up and show the urgency that this crisis demands.

The Secretary of State talks of creating additional space for new patients in hospitals. How will that happen—with what money, what resources and what staff? Will the Government try to call those new hospitals, too? Is not the reality that creating capacity elsewhere in hospital really means patients being left in corridors on trolleys or in car parks? Can he assure us today that that will not be the case?

Under the Conservatives, the NHS is simply struggling to cope. A record 6.6 million people are waiting for NHS treatment—and they are waiting longer than ever before, often in pain and discomfort. The people in our thoughts this afternoon are those waiting in queues outside hospitals in ambulances, with soaring temperatures and no air conditioning. If it were dogs or cattle, it would be against the law, but these are people in tropical heat unable to enter hospitals. People with conditions triggered by excessive heat are unable to get an ambulance, because ambulances are logjammed outside A&E. Will the Secretary of State apologise to them and their families?

This situation is impacting mental health, too. People attending A&E experiencing a mental health crisis cannot get a bed in a psychiatric hospital, so they wait in A&E, some of them for more than three days. Why? Because the Government have spent the past decade cutting a quarter of mental health beds.

I worked in A&E over this weekend and saw the amazing work being done by staff to prepare for the record heat. The heatwave and surge in covid cases are putting additional pressures on the NHS. I am glad that the Secretary of State recognised that in his statement. Without doubt, 12 years of Conservative mismanagement and underfunding have left our health service unable to cope, which not only has an impact on patients but hurts staff. Staff morale is at rock bottom. Is it any wonder that 5.7 million days were lost to mental ill health in the NHS last year?

Last week, the Minister of State claimed that the Government had procured a £30 million contract for an auxiliary ambulance service, but, moments later, it was revealed that it was yet to be awarded. Can the Health Secretary confirm whether the Minister of State has issued a correction yet?

On Wednesday, ambulance trusts were placed on their highest possible alert level. A national emergency was declared on Friday and, over the weekend, hospitals were scrambling to increase capacity. Why then has it taken until today for the Health Secretary to step up and show leadership? Can he tell us who he met over the weekend? I do not mean at Chequers; I mean from the NHS. Can he also tell us why the Prime Minister did not think it necessary to chair Cobra today? Just when we thought irony had reached a peak, the Prime Minister spent the weekend partying when he should have been dealing with a health emergency. Has the Secretary of State spoken to the Prime Minister today? The Health Secretary has been too slow. The Prime Minister has not even bothered to turn up and the Government have gone AWOL.

If the Government will not step up now, then Labour will. As temperatures reach a record high, all we are getting from the Government is more hot air. This is a crisis. The country has one message for Ministers: stop squabbling and plotting, do your jobs and get a grip.

[Steve Barclay]

Let me start with the area on which the hon. Lady was correct, which is that I recognise the increased pressure on ambulances and hospitals. That is why we put in place the long-established contingency plans. Since the heatwave in Paris in 2003, it is the case that each year in May, we put in place our heatwave plans. That is what has been activated. Those plans were refreshed as recently as two months ago and sit alongside the work that has been done on urgent and emergency care, including the 10-point action plan that was set out last September.

The hon. Lady is right: the House as a whole will recognise the significant pressure on the system, which is why we are taking the steps from our contingency plans. It is also why we have put in specific funding, such as: the additional £150 million of support targeted at the ambulance service; an additional £50 million for 111 calls to build capacity; and as she said, an additional £30 million for auxiliary ambulances, which is what the Minister of State, my hon. Friend the Member for Lewes (Maria Caulfield), was referring to in the House last week.

The Met Office and the UK Health Security Agency went to level 4 on Friday. As you will know, Madam Deputy Speaker, I updated the House on the first available sitting day after that. The irony will not be lost on the House that this issue is seen as so important that the shadow Secretary of State for Health and Social Care has failed to turn up to this statement in the middle of a heatwave. [Interruption.] Well, he is not here, which speaks for itself.

The hon. Lady also suggested that these challenges, which are being faced across Europe as a whole, were in some way due to the overall investment in the NHS. I remind the House that, to take the resource departmental expenditure limit alone, RDEL in 2010 was just under £99 billion and last year it was £150 billion. That is a good indication of the significant funding. We could also come on to capital investment, not least with the 40 hospitals programme, part of a £22 billion package to 2030, which underscores this Government’s commitment to investing in our NHS—an investment that, most recently, the Labour party voted against when we brought it to the House.

The hon. Lady asks about an apology for operational levels of performance. I do not know whether she is asking for that apology from the Welsh Government or just from the English Government. She may want to clarify that, given the performance of the Welsh ambulance service under the Welsh Government.

On the hon. Lady’s point about auxiliary, the Minister of State, Department for Health and Social Care, my hon. Friend the Member for Lewes, said in her statement that we had seen improvements in May. I referred to that as context, but on auxiliary in particular I can clarify for the House that a contract is being procured for auxiliary ambulance services and is expected to be concluded shortly.

Finally, the hon. Lady asked what meetings I have held over the less than two weeks that I have been in post. I am happy to share with the House that I have been on visits to four different hospitals, in Whipps Cross, Hillingdon, King’s Lynn and Bedford; I have been out on two different ambulance shifts, been to three different ambulance centres, been out to see GPs to look at boosting access to their services and been to look at life sciences. I have been engaging, and that sits alongside, for example, the meeting with chief execs of ambulance trusts on Saturday, Cobra on Saturday and other such meetings that I have had in the course of my duties.

Finally, the hon. Lady asked about the Prime Minister’s engagement. Just as the Chancellor of the Duchy of Lancaster set out that he was engaging with the Prime Minister in his role chairing Cobra as Minister for the Cabinet Office, I am happy to confirm to the House that I also engaged with the Prime Minister over the weekend, updating him on the health plans we have put in place. He has been closely engaged on the contingency we have put in place.