Mental Health Units (Use of Force) Bill (Second sitting)
Steve Reed ExcerptsWednesday 18th April 2018
(6 years ago)
Public Bill CommitteesRead Full debate Mental Health Units (Use of Force) Act 2018 View all Mental Health Units (Use of Force) Act 2018 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 18 April 2018 - (18 Apr 2018)
The Chair
Before we begin, can everybody have their electronic devices switched to silent, please?
As the Committee cannot consider the remaining clauses of the Bill until the House has agreed to a money resolution, I call Steve Reed, as the Member in charge of the Bill, to move that further consideration of the Bill be adjourned.
Mr Steve Reed (Croydon North) (Lab/Co-op)
It is a pleasure to serve under your chairmanship this morning, Ms Buck, however briefly. I thank Members for coming—I wish we were going to spend more time together, but it seems we are not.
I will just make a few points before I formally move the Adjournment. This is the fifth successive week the Committee has been unable to complete its work, and that is excluding the two weeks of recess. The reason is that the Government have not yet laid a money resolution, so we are not allowed to consider the remaining clauses. I have raised this directly with the Opposition Whips, who have raised it with the Government Whips. I have raised it in a direct question to the Leader of the House in business questions, and I pursued it in a letter to the Leader of the House, from whom I had a very charming reply that does not shed any further light on why the delays may be happening.
After five weeks, I am starting to feel that this is a little disrespectful to members of the Committee and to the Bill’s many supporters outside this House. I do not doubt for a moment the support of the Minister, or indeed the Government, who have consistently reiterated their support for the reform we are trying to get through, but it would be nice if the Government were able to let the Bill Committee get on with its work. With great respect, I would ask the Minister whether she has had any conversations with the Government Whips or Government business managers, what they may have said and when we might expect to have the money resolution.
The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
I share the hon. Gentleman’s impatience with the current state of affairs, not least because I really do believe that this is a very important reform, and the sooner we get it on the statute book, the better. However, as he alluded to, such matters are for the Government business managers. I am pleased that he has kept the pressure up at his end and raised this with the Leader of the House, and I know that those discussions are continuing.
I would remind the Committee that we have just had two weeks of recess and a very intense few days in terms of other business, which has perhaps dominated the business managers’ thinking this week. However, I hear the hon. Gentleman’s message completely, and I completely understand where he is coming from. Following this meeting, I will resume my conversations with the Government business managers so that we can make very fast progress.
Ordered, That further consideration be now adjourned.— (Mr Reed.)
Mental Health Units (Use of Force) Bill (First sitting)
Steve Reed ExcerptsWednesday 28th March 2018
(6 years, 1 month ago)
Public Bill CommitteesRead Full debate Mental Health Units (Use of Force) Act 2018 View all Mental Health Units (Use of Force) Act 2018 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 28 March 2018 - (28 Mar 2018)
The Chair
On the basis of the motion just agreed, and given that the required notice period in Public Bill Committees is three working days, amendments should be tabled by 3 pm on Fridays for consideration on Wednesdays. I encourage Members to submit amendments earlier, if they can. I advise Members that, as a general rule, I do not intend to call starred amendments, which have not been tabled with adequate notice.
Mr Steve Reed (Croydon North) (Lab/Co-op)
I beg to move,
That the Bill be considered in the following order, namely, Clauses 1 to 6, Clauses 9 to 11, Clauses 7 and 8, Clauses 12 to 20, new Clauses, new Schedules, remaining proceedings on the Bill.
It is a pleasure to serve under your chairmanship, Ms Buck. We have finally got the Bill to Committee, and I am delighted that we are all here. The Committee has been delayed for four weeks in a row, because of the Government’s failure to lay a money resolution, which would allow us to consider the Bill in its entirety and all the amendments. Even this morning we will not be able to consider several amendments because a money resolution has still not been laid, despite the fact that the Bill enjoys the support of the Government and received the unanimous support of the House on Second Reading. When I asked the Government why the money resolution had not been laid, they said it was not possible because of the heavy schedule of business going through the Chamber, but both yesterday and last Tuesday the Adjournment was early because of insufficient business going through the House.
I want to register my disappointment that the money resolution has not been laid at this stage, and I urge Government and other Members to use their influence with the Whips to encourage the Government to do so as soon as possible. The Bill contains an important reform that will dramatically improve safety for many highly vulnerable people using mental health services, and I see no reason for it to continue to be delayed in such a fashion.
The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
It is a pleasure to serve under your chairmanship this morning, Ms Buck. I thank the hon. Gentleman for the points he has made. He is absolutely right to say that the Government support the measure. We support it very much because of the co-operative discussions that we have had, to get it to a place where everyone can agree. I fully endorse his point that the Bill is an important social reform; it is an important ingredient in our broader agenda to improve the treatment of people with mental health problems and illness.
The hon. Gentleman made his point about the need for a money resolution robustly. I will relay his representations to the House business managers, so that we can proceed without delay, as we all want such an important reforming measure to be on the statute book as soon as possible.
Question put and agreed to.
Clause 1
Key definitions
Mr Reed
I beg to move amendment 2, in clause 1, page 1, line 5, leave out subsection (3) and insert—
‘(3) “Mental health unit” means—
(a) a health service hospital, or part of a health service hospital, in England, the purpose of which is to provide treatment to in-patients for mental disorder, or
(b) an independent hospital, or part of an independent hospital, in England—
(i) the purpose of which is to provide treatment to in-patients for mental disorder, and
(ii) where at least some of that treatment is provided, or is intended to be provided, for the purposes of the NHS.’
This amendment replaces the definition of “mental health unit” with a new definition which clarifies that a unit may form part of a hospital. The amendment also removes care homes and registered establishments from the definition, and includes mental health units in an independent hospital within the definition only where the unit provides NHS treatment.
The Chair
With this it will be convenient to discuss the following:
Amendment 3, in clause 1, page 1, line 8, leave out subsection (4) and insert—
‘( ) In subsection (3) the reference to treatment provided for the purposes of the NHS is to be read as a service provided for those purposes in accordance with the National Health Service Act 2006.’
This amendment ensures that “treatment for the purposes of the NHS” is read in accordance with the National Health Service Act 2006. It also makes a change which is consequential on the removal of care homes from the definition of “mental health unit” (see Amendment 2).
Amendment 4, in clause 1, page 1, line 12, leave out subsection (5) and insert—
‘( ) “Patient” means a person who is in a mental health unit for the purpose of treatment for mental disorder or assessment.’
This amendment provides a new definition of “patient”. This definition makes clear that a patient includes a person who is in a mental health unit in order to be treated for mental disorder or to be assessed in the unit.
Amendment 6, in clause 1, page 2, line 1, leave out subsections (7) and (8) and insert—
‘(7) References to “use of force” are to—
(a) the use of physical, mechanical or chemical restraint on a patient, or
(b) the isolation of a patient.
(7A) In subsection (7)—
“physical restraint” means the use of physical contact which is intended to prevent, restrict or subdue movement of any part of the patient’s body;
“mechanical restraint” means the use of a device which—
(a) is intended to prevent, restrict or subdue movement of any part of the patient’s body, and
(b) is for the primary purpose of behavioural control;
“chemical restraint” means the use of medication which is intended to prevent, restrict or subdue movement of any part of the patient’s body;
“isolation” means any seclusion or segregation that is imposed on a patient.’
This amendment provides a revised definition of “use of force” which uses simpler language. It also removes threats from the definition and includes the isolation of a patient in the definition.
New clause 7—Interpretation—
‘In this Act—
“health service hospital” has the same meaning as in section 275(1) of the National Health Service Act 2006;
“independent hospital” has the same meaning as in section 145(1) of the Mental Health Act 1983;
“the NHS” has the same meaning as in section 64(4) of the Health and Social Care Act 2012;
“responsible person” has the meaning given by section 2(1);
“relevant health organisation” means—
(a) an NHS trust;
(b) an NHS foundation trust;
(c) any person who provides health care services for the purposes of the NHS within the meaning of Part 3 of the Health and Social Care Act 2012;
“staff” means any person who works for a relevant health organisation that operates a mental health unit (whether as an employee or a contractor) who—
(a) may be authorised to use force on a patient in the unit,
(b) may authorise the use of force on a particular patient in the unit, or
(c) has the function of providing general authority for the use of force in the unit.’
This new clause compiles various definitions for terms that are used throughout the Bill.
Mr Reed
I thank the Minister for her earlier comments. It has been a great pleasure to work with her and her team in such a constructive manner. I said in the Chamber that we would pursue the Bill in a constructive, co-operative and cross-party manner, and that is what all Members have tried to do so far. I suspect that we will not detain the Committee for too long this morning, such is the level of consensus on the amendments, so perhaps I should get on with it without any further ado.
Clause 1 sets out some of the important terms used throughout the Bill. The amendments are minor and aim to ensure that those terms are clearly defined. Amendment 2 strengthens the definition of “mental health unit” to make clear that any such unit may form part of a hospital. Amendment 3 ensures that “treatment provided” is read in accordance with the National Health Service Act 2006. Amendment 4 defines what the Bill means by “patient”, which is someone in a mental health unit who is there to be treated or assessed for mental ill health. Amendment 6 clarifies the definition of “use of force”, using more straightforward language, and it includes “isolation” as part of that definition. New clause 7 compiles and explains various other definitions used throughout the Bill.
Jackie Doyle-Price
I confirm that the Government entirely support these amendments, which make the language in the Bill consistent with the 2015 code of practice under the Mental Health Act 1983, and with broader guidance. That makes for a much tidier way of achieving the objectives of the Bill.
Amendment 2 agreed to.
Amendments made: 3, in clause 1, page 1, line 8, leave out subsection (4) and insert—
‘( ) In subsection (3) the reference to treatment provided for the purposes of the NHS is to be read as a service provided for those purposes in accordance with the National Health Service Act 2006.’
This amendment ensures that “treatment for the purposes of the NHS” is read in accordance with the National Health Service Act 2006. It also makes a change which is consequential on the removal of care homes from the definition of “mental health unit” (see Amendment 2).
Amendment 4, in clause 1, page 1, line 12, leave out subsection (5) and insert—
‘( ) “Patient” means a person who is in a mental health unit for the purpose of treatment for mental disorder or assessment.’—(Mr Reed.)
This amendment provides a new definition of “patient”. This definition makes clear that a patient includes a person who is in a mental health unit in order to be treated for mental disorder or to be assessed in the unit.
The Chair
With this it will be convenient to discuss the following:
Amendment 7, in clause 2, page 2, line 26, leave out subsections (1) to (3) and insert—
‘( ) A relevant health organisation that operates a mental health unit must appoint a responsible person for that unit for the purposes of this Act.
( ) The responsible person must be—
(a) employed by the relevant health organisation, and
(b) of an appropriate level of seniority.
( ) Where a relevant health organisation operates more than one mental health unit that organisation must appoint a single responsible person in relation to all of the mental health units operated by that organisation.’
This amendment replaces the requirement for mental health units to have a “registered manager” with a requirement to appoint a “responsible person”. That person must be employed by a relevant health organisation and be of an appropriate level of seniority. If an organisation operates multiple units, only one responsible person needs to be appointed in relation to those units.
Amendment 11, in clause 3, page 2, line 38, leave out “registered manager” and insert “responsible person”
This amendment is consequential on Amendment 7.
Amendment 60, in clause 7, page 4, line 38, leave out “registered manager” and insert “responsible person”
This amendment is consequential on Amendment 7.
Mr Reed
The clause establishes a named accountable individual in a mental health unit who will be responsible for a reduction in the use of force. It seeks to create established, clearer lines of accountability for the existence of appropriate policy, and for when things go wrong, so that it will be possible to find somebody who can explain exactly what circumstances might have led to any problems or failings with the use of force.
Amendment 7 replaces the phrase “registered manager” with “responsible person”. The change in language avoids confusion with existing Care Quality Commission regulations that use the phrase “registered manager”, but the intention remains the same. By introducing the legal concept of a responsible person for mental health units, the Bill increases accountability and leadership. Ultimately, the responsible person will be accountable for the requirement that the Bill places on mental health units, so it is important properly to define them as a senior officer in the organisation. They will set the organisation-wide direction for a reduction in the use of force. The responsible person will be at board level, with more detail about who is appropriate set out in guidance by the Secretary of State under clause 6. Amendments 5, 11 and 60 are consequential on changes of the phrase “registered manager” to “responsible person”.
Jackie Doyle-Price
The Government support the amendments. Perhaps one of the most important aspects of the Bill is that it enshrines accountability for ensuring that any institution fulfils its responsibilities. The buck needs to stop somewhere, and it is important that happens with someone at board level. The amendments are important for improving leadership, governance and accountability for the use of force. The amendments were drafted in line with the existing positive and proactive care guidance. It is also worth emphasising that this will not incur any additional burden on healthcare organisations; it will simply strengthen and enshrine accountability. On that basis, the Government are happy to approve the amendments.
Amendment 5 agreed to.
Amendment made: 6, in clause 1, page 2, line 1, leave out subsections (7) and (8) and insert—
‘(7) References to “use of force” are to—
(a) the use of physical, mechanical or chemical restraint on a patient, or
(b) the isolation of a patient.
(7A) In subsection (7)—
“physical restraint” means the use of physical contact which is intended to prevent, restrict or subdue movement of any part of the patient’s body;
“mechanical restraint” means the use of a device which—
(a) is intended to prevent, restrict or subdue movement of any part of the patient’s body, and
(b) is for the primary purpose of behavioural control;
“chemical restraint” means the use of medication which is intended to prevent, restrict or subdue movement of any part of the patient’s body;
“isolation” means any seclusion or segregation that is imposed on a patient.’—(Mr Reed.)
This amendment provides a revised definition of “use of force” which uses simpler language. It also removes threats from the definition and includes the isolation of a patient in the definition.
Clause 1, as amended, ordered to stand part of the Bill.
Clause 2
Mental health units to have a registered manager
Amendment made: 7, in clause 2, page 2, line 26, leave out subsections (1) to (3) and insert—
“( ) A relevant health organisation that operates a mental health unit must appoint a responsible person for that unit for the purposes of this Act.
( ) The responsible person must be—
(a) employed by the relevant health organisation, and
(b) of an appropriate level of seniority.
( ) Where a relevant health organisation operates more than one mental health unit that organisation must appoint a single responsible person in relation to all of the mental health units operated by that organisation.”.—(Mr Reed.)
This amendment replaces the requirement for mental health units to have a “registered manager” with a requirement to appoint a “responsible person”. That person must be employed by a relevant health organisation and be of an appropriate level of seniority. If an organisation operates multiple units, only one responsible person needs to be appointed in relation to those units.
Clause 2, as amended, ordered to stand part of the Bill.
Clause 3
Policy on use of force
Mr Reed
I beg to move amendment 8, in clause 3, page 2, line 36, leave out subsection (1) and insert—
‘(1) The responsible person for each mental health unit must publish a policy regarding the use of force by staff who work in that unit.’.
This amendment replaces Clause 3(1) and provides a clearer duty for the responsible person to publish a policy regarding the use of force in mental health units.
The Chair
With this it will be convenient to discuss the following:
Amendment 9, in clause 3, page 2, line 37, at end insert—
‘( ) Where a responsible person is appointed in relation to all of the mental health units operated by a relevant health organisation, the responsible person must publish a single policy under subsection (1) in relation to those units.’.
This amendment provides that if there is a single responsible person for all of the mental health units operated by a relevant health organisation, the person needs to provide a single policy for those units.
Amendment 10, in clause 3, page 2, line 37, at end insert—
‘( ) Before publishing a policy under subsection (1), the responsible person must consult any persons that the responsible person considers appropriate.’.
This amendment requires the responsible person to consult before publishing the policy under Clause 3.
Amendment 12, in clause 3, page 2, line 38, leave out second “the” and insert “any”.
This amendment is consequential on Amendment 13.
Amendment 13, in clause 3, page 2, line 40, leave out subsections (3) and (4) and insert—
‘( ) The responsible person may from time to time revise any policy published under this section and, if this is done, must publish the policy as revised.
( ) If the responsible person considers that any revisions would amount to a substantial change in the policy, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised policy.’.
This amendment requires a further consultation under Clause 3 if the responsible person intends to make substantial changes to the policy published under that clause. Amendment 12 is consequential on this amendment.
Amendment 14, in clause 3, page 3, line 2, leave out “minimise and”.
This amendment removes the requirement that the policy under Clause 3 must minimise the use of force. Instead it will require the policy to reduce the use of force.
Amendment 15, in clause 3, page 3, line 2, leave out
‘at the mental health unit’
and insert
‘in the mental health unit by staff who work in that unit’.
This amendment ensures consistency with Clause 3(1) as amended by Amendment 8.
Amendment 16, in clause 3, page 3, line 3, leave out subsection (6).
This amendment removes the requirement for the registered manager to take all reasonable steps to ensure compliance with the policy published under Clause 3.
Amendment 17, in clause 3, page 3, line 6, leave out subsection (7).
This amendment removes a consultation requirement that is superseded by the changes made by Amendment 10.
Mr Reed
This is a very important clause, because it establishes the requirement for mental health units to have in place a policy regarding the use of force in that unit. That requirement does not currently exist, so there is wide divergence and variation between procedures, practice and means for controlling and managing the use of force in different health units, which can be detrimental to the safety of patients.
A written policy will effectively govern the use of force within the units, and there is a real opportunity for NHS trusts to work with service users and their families to formalise and replicate the best of what many are already doing to reduce the use of force. The use of force varies enormously across NHS trusts. Some already have robust policies in place to minimise the use of force but others do not. The amendment will put an end to the regional disparity between trusts. Based on currently available figures, the variation can be as wide as between 5% and 50% of patients being subject to the use of force while attending mental health units for treatment.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
I congratulate my hon. Friend on bringing forward the Bill, which is a fantastic achievement. The fact that he has used his private Member’s Bill slot for this Bill is to be highly commended. My local mental health trust, Mersey Care, adopts the “no force first” approach, which is very important. I just wanted to shine a spotlight on the fact that some trusts adopt that approach. I welcome the fact that the Bill seeks to eradicate the differences in approach across the country.
Mr Reed
I thank my hon. Friend for her intervention. Mersey Care is well known to me and to many others in the room as a fine example of the best practice that we wish to replicate everywhere across the country, so that patients, wherever they are, can enjoy the very best levels of service, to which they ought to be entitled.
I will go through the amendments in the grouping. Collectively, they are intended to add greater clarity and consistency to the policies. Amendment 9 provides that, for relevant organisations that operate a number of health units, the responsible person needs to publish only one policy to cover all staff in all those units. Amendments 10 and 13 ensure that the policy is consulted on when it is first published and when changes are made. It is important that the responsible person considers and consults the views of current and previous service users to ensure that their experiences form part of improving policy and guidance into the future.
Amendment 14 requires the policy to include reducing the use of force, which is a key purpose of the Bill, and a key commitment that the use of force should only ever be used as a genuine last resort, as indeed it is in Mersey Care and other mental health trusts. We should be clear that this is only a start—we would like the use of force to be minimised and not just reduced—but this puts into legislation the Government’s intention to reduce the use of force, and we will be holding them to that.
Amendment 16 places into statutory guidance a requirement on the responsible person to take all reasonable steps to ensure compliance with the policy, and makes a failure to have regard for the guidance a breach of the statutory duty.
Jackie Doyle-Price
The Government entirely support the need for every institution to which the Act will apply to make a policy on the use of force. Central to that is the concept of accountability; having a named person, as we have already discussed, plus a policy for an organisation to be held to account to, is clearly important to achieve that. The Government support these amendments and see them as important ingredients in reducing the use of force overall in mental health units. We will ensure that any guidance produced under this clause gives further detail about what policies should include. We expect that to look like what is already set out in positive and proactive care guidance. We expect it to say that responsible persons will have a duty to have regard to this guidance in the development of their organisation’s policy, which will help ensure that each policy meets the same basic criteria as well as allowing for local flexibility.
I associate myself with the comments of the hon. Members for Liverpool, Wavertree and for Croydon North on Mersey Care, which offers a good example. The culture of transparency in itself generates sensible use of force, and only when appropriate. It is a truism for everybody in this room that we want to see minimal use of force. There are occasions when, for the safety of both patient and staff, it sometimes needs to be used, but the way to be sure that it is only used appropriately is to have that culture of accountability. Many organisations could learn from Mersey Care in that regard. We support these amendments.
Amendment 8 agreed to.
Amendments made: 9, in clause 3, page 2, line 37, at end insert—
‘( ) Where a responsible person is appointed in relation to all of the mental health units operated by a relevant health organisation, the responsible person must publish a single policy under subsection (1) in relation to those units.’.
This amendment provides that if there is a single responsible person for all of the mental health units operated by a relevant health organisation, the person needs to provide a single policy for those units.
Amendment 10, in clause 3, page 2, line 37, at end insert—
‘( ) Before publishing a policy under subsection (1), the responsible person must consult any persons that the responsible person considers appropriate.’
This amendment requires the responsible person to consult before publishing the policy under Clause 3.
Amendment 11, in clause 3, page 2, line 38, leave out “registered manager” and insert “responsible person”.
This amendment is consequential on Amendment 7.
Amendment 12, in clause 3, page 2, line 38, leave out second “the” and insert “any”.
This amendment is consequential on Amendment 13.
Amendment 13, in clause 3, page 2, line 40, leave out subsections (3) and (4) and insert—
‘( ) The responsible person may from time to time revise any policy published under this section and, if this is done, must publish the policy as revised.
( ) If the responsible person considers that any revisions would amount to a substantial change in the policy, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised policy.’
This amendment requires a further consultation under Clause 3 if the responsible person intends to make substantial changes to the policy published under that clause. Amendment 12 is consequential on this amendment.
Amendment 14, in clause 3, page 3, line 2, leave out “minimise and”.
This amendment removes the requirement that the policy under Clause 3 must minimise the use of force. Instead it will require the policy to reduce the use of force.
Amendment 15, in clause 3, page 3, line 2, leave out
“at the mental health unit”
and insert
“in the mental health unit by staff who work in that unit”.
This amendment ensures consistency with Clause 3(1) as amended by Amendment 8.
Amendment 16, in clause 3, page 3, line 3, leave out subsection (6).
This amendment removes the requirement for the registered manager to take all reasonable steps to ensure compliance with the policy published under Clause 3.
Amendment 17, in clause 3, page 3, line 6, leave out subsection (7).—(Mr Reed.)
This amendment removes a consultation requirement that is superseded by the changes made by Amendment 10.
Clause 3, as amended, ordered to stand part of the Bill.
Clause 4
Information about use of force
Mr Reed
I beg to move amendment 84, in clause 4, page 3, line 12, leave out subsections (1) to (3) and insert—
‘(1) The responsible person for each mental health unit must publish information for patients about the rights of patients in relation to the use of force by staff who work in that unit.
(1A) Before publishing the information under subsection (1), the responsible person must consult any persons that the responsible person considers appropriate.
(1B) The responsible person must provide any information published under this section—
(a) to each patient, and
(b) to any other person who is in the unit and to whom the responsible person considers it appropriate to provide the information in connection with the patient.
(1C) The information must be provided to the patient—
(a) if the patient is in the mental health unit at the time when this section comes into force, as soon as reasonably practicable after that time;
(b) in any other case, as soon as reasonably practicable after the patient is admitted to the mental health unit.’
This amendment replaces Clause 4(1) to (2) with a duty to publish information about the rights of patients in relation to the use of force in a mental health unit. Before publishing the information, a consultation must be carried out. The published information must be given to patients in the mental health unit and to new patients admitted to the unit, and to any other person considered appropriate if in the unit.
The Chair
With this it will be convenient to discuss the following:
Amendment 19, in clause 4, page 3, line 24, leave out from “provided” to “in” in line 27.
This amendment removes the requirement that the Secretary of State must prescribe the form that information under Clause 4 must be provided.
Amendment 20, in clause 4, page 3, line 27, leave out “with regard to” and insert “having regard to”.
This amendment is a drafting change to Clause 4(4)(b).
Amendment 21, in clause 4, page 3, leave out line 28.
This amendment removes a paragraph that deals with providing information under Clause 4 that has regard to the patient’s communication needs because that paragraph is unnecessary.
Amendment 22, in clause 4, page 3, line 29, leave out “capacity” and insert “ability”.
This amendment is a drafting change to avoid confusion with the terminology of the Mental Capacity Act 2005.
Amendment 23, in clause 4, page 3, line 30, leave out subsection (5).
This amendment is a drafting change linked to Amendment 22.
Amendment 24, in clause 4, page 3, line 31, at end insert—
‘( ) The responsible person must keep under review any information published under this section.
( ) The responsible person may from time to time revise any information published under this section and, if this is done, must publish the information as revised.
( ) If the responsible person considers that any revisions would amount to a substantial change in the information, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised information.’
This amendment requires the responsible person to keep information published under Clause 4 under review. If the responsible person intends to make substantial changes to the information published under that clause, then a consultation must be conducted.
Amendment 85, in clause 4, page 3, line 31, at end insert—
‘( ) The duty to provide information to a patient under subsection (1B) does not apply if—
(a) the patient refuses to accept the information, or
(b) the responsible person considers that the provision of the information to the patient would cause the patient distress.
( ) The duty to provide information to another person under subsection (1B) does not apply if—
(a) the patient requests that the information is not provided to the person, or
(b) the responsible person considers that the provision of the information to the person would cause the patient distress.’
This amendment provides exceptions to the duties to provide information under Clause 4. It provides that a patient can refuse to accept the information or request that it is not provided to another person, and the information does not need to be provided if it would cause distress to the patient.
Mr Reed
The amendment deals with the requirement to provide patients with information about their rights. Many patients entering a mental health unit will be in a state of considerable distress. Many of them will be unaware of their rights regarding the use of force. Currently it is not universal practice that those patients are informed about what those rights are so that they can ensure that those rights are not infringed.
It is important that any patient entering a mental health unit is aware of what may or may not be done to them regarding the use of force, so that if people in the unit seek to do things to them that go beyond their rights, they are able to call it out and stop it. This applies not just to the individual concerned, but to their carers, family members or close relatives who might be there with them, who are often unfamiliar with mental health units and have equally high levels of concern. It is important that they, too, are aware of what their loved one’s rights are.
Jackie Doyle-Price
I said at the beginning of today’s proceedings that I view the measures enshrined in the Bill as an important social reform. These amendments and this clause go to the heart of that, in the sense that it is all about empowering patients and enshrining their rights. That is very much the spirit in which we are embarking on the review of the Mental Health Act, so we completely support the clause and the amendments.
The amendments ensure that other appropriate people, such as patients’ carers and relatives, will normally receive information about use of force, which is key for patients who do not always understand the information that is given to them, as the hon. Gentleman suggested. It is also important to understand that sometimes too much information can cause patients further distress at a difficult time. In those circumstances, a good relationship with relatives and carers is extremely important. That can be as much about empowering the patients as furnishing the individual with such information.
On the specific concern that amendment 85 might cause a loophole, I must emphasise that the exception is not about letting any unit off, but about recognising when it might be appropriate so that information will not cause further unintended distress and ensuring that patients’ interests are protected. Different patients will require different approaches, and a one-size-fits-all approach does not count.
When the measure is set alongside the other provisions in the Bill, we are satisfied that we have the right balance between protecting the rights of patients and empowering them—and empowering their carers and relatives to look after them—while having appropriate safeguards to prevent further distress. I support the amendments.
Amendment 84 agreed to.
Amendments made: 19, in clause 4, page 3, line 24, leave out from “provided” to “in” in line 27.
This amendment removes the requirement that the Secretary of State must prescribe the form that information under Clause 4 must be provided.
Amendment 20, in clause 4, page 3, line 27, leave out “with regard to” and insert “having regard to”.
This amendment is a drafting change to Clause 4(4)(b).
Amendment 21, in clause 4, page 3, leave out line 28.
This amendment removes a paragraph that deals with providing information under Clause 4 that has regard to the patient’s communication needs because that paragraph is unnecessary.
Amendment 22, in clause 4, page 3, line 29, leave out “capacity” and insert “ability”.
This amendment is a drafting change to avoid confusion with the terminology of the Mental Capacity Act 2005.
Amendment 23, in clause 4, page 3, line 30, leave out subsection (5).
This amendment is a drafting change linked to Amendment 22.
Amendment 24, in clause 4, page 3, line 31, at end insert—
“( ) The responsible person must keep under review any information published under this section.
( ) The responsible person may from time to time revise any information published under this section and, if this is done, must publish the information as revised.
( ) If the responsible person considers that any revisions would amount to a substantial change in the information, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised information.”.
This amendment requires the responsible person to keep information published under Clause 4 under review. If the responsible person intends to make substantial changes to the information published under that clause, then a consultation must be conducted.
Amendment 85, in clause 4, page 3, line 31, at end insert—
‘( ) The duty to provide information to a patient under subsection (1B) does not apply if—
(a) the patient refuses to accept the information, or
(b) the responsible person considers that the provision of the information to the patient would cause the patient distress.
( ) The duty to provide information to another person under subsection (1B) does not apply if—
(a) the patient requests that the information is not provided to the person, or
(b) the responsible person considers that the provision of the information to the person would cause the patient distress.’—(Mr Reed.)
This amendment provides exceptions to the duties to provide information under Clause 4. It provides that a patient can refuse to accept the information or request that it is not provided to another person, and the information does not need to be provided if it would cause distress to the patient.
Clause 4, as amended, ordered to stand part of the Bill.
Clause 5
Training in appropriate use of force
Mr Reed
I beg to move amendment 86, in clause 5, page 3, line 33, leave out subsection (1) and insert—
‘(1) The responsible person for each mental health unit must provide training for staff that relates to the use of force by staff who work in that unit.
(1A) The training provided under subsection (1) must include training on the following topics—
(a) how to involve patients in the planning, development and delivery of care and treatment in the mental health unit,
(b) showing respect for patients’ past and present wishes and feelings,
(c) showing respect for diversity generally,
(d) avoiding unlawful discrimination, harassment and victimisation,
(e) the use of techniques for avoiding or reducing the use of force,
(f) the risks associated with the use of force,
(g) the impact of trauma (whether historic or otherwise) on a patient’s mental and physical health,
(h) the impact of any use of force on a patient’s mental and physical health,
(i) the impact of any use of force on a patient’s development,
(j) how to ensure the safety of patients and the public, and
(k) the principal legal or ethical issues associated with the use of force.’.
This amendment replaces Clause 5(1) with a revised duty on the responsible person to ensure that training is provided for staff that covers a wide range of topics relating to the use of force in mental health units.
The Chair
With this it will be convenient to discuss amendment 87, in clause 5, page 3, line 39, leave out subsection (2) and insert—
‘(2) Subject to subsection (2A), training must be provided—
(a) in the case of a person who is a member of staff when this section comes into force, as soon as reasonably practicable after this section comes into force, or
(b) in the case of a person who becomes a member of staff after this section comes into force, as soon as reasonably practicable after they become a member of staff.
(2A) Subsection (2) does not apply if the responsible person considers that any training provided to the person before this section came into force or before the person became a member of staff—
(a) was given sufficiently recently, and
(b) meets the standards of the training provided under this section.
(2B) Refresher training must be provided at regular intervals whilst a person is a member of staff.
(2C) In subsection (2B) “refresher training” means training that updates or supplements the training provided under subsection (1).’.
The amendment sets out when training under Clause 5 should be given to staff. A definition of “staff” is given in NC7.
Mr Reed
These amendments are to the clause relating to improving training for staff working in mental health units before they are able to use force of any description against patients. It is clearly better for patient safety that any staff administering force should be properly trained, but it is worth noting that it is also important for staff safety that they are properly trained before they engage in administering force to patients.
Helen Hayes (Dulwich and West Norwood) (Lab)
I commend my hon. Friend for introducing the Bill. On the need for training, I want to flag my experience of young patients with autism being held in secure psychiatric units. In my experience, there is a lack of expertise and training across the board for staff treating young people with autism, so they fail to understand that much challenging behaviour arises from the intense levels of anxiety experienced by young people with autism. In such circumstances, the use of force further compounds that anxiety, and indeed traumatises those young people. I ask the Minister whether, when laying down guidance to accompany the Bill, specific regard will be given to the lack of training and understanding of autism within our mental health services?
Mr Reed
I am grateful to my hon. Friend for making that important point and I look forward to hearing the Minister’s comment. That point has been made to me by many service users and advocacy groups, including Rethink Mental Illness, YoungMinds and others.
Many of the approaches outlined in the Bill ought to be applied more widely for people who experience mental ill health in many other circumstances. I hope that the Government’s ongoing review into mental health will do that. I hope that some of the principles in the Bill will take us forward and allow that review, when it reports back, to make a bigger impact than it perhaps might have made otherwise.
Moving back to the principles of training in general, the Bill includes provisions on training to recognise the Equality Act 2010 and de-escalation techniques that reduce the need for force to be used in any circumstances. The amendment will also strengthen the requirement for trauma-informed care. It is important to include in the Bill that staff are trained in the impact of further traumatising patients, whose mental ill health may have already been exacerbated by forms of trauma.
I am informed by Agenda that more than 50% of female patients in mental health units have experienced physical or sexual abuse by men, which in most cases contributes significantly to their mental ill health. After those experiences, being forcibly restrained—generally by groups of men—can further traumatise those women and make their mental health conditions even worse, so it is very important that staff are fully aware and trained in the risks of re-traumatising patients who have already been traumatised.
It is also important that training takes full account of the risks of unlawful discrimination regarding race. Dame Elish Angiolini’s report last year into deaths and serious incidents in police custody found that:
“The stereotyping of young Black men as ‘dangerous, violent and volatile’ is a longstanding trope that is ingrained in the minds of many in our society.”
We only have to look at pictures of the faces of people who have died in state custody, including in mental health custody, to see how severe the risk of unconscious bias in the system is. A much higher proportion of those faces will be of young black men than the proportion present in the population as a whole. In order to ensure that staff will not be acting out of prejudice against people who enter a publicly funded health service for treatment on equal terms with everyone else, it is important that staff are trained to be fully aware of the risks of unconscious bias and racism in that service.
Putting anti-discrimination training into legislation is a move towards ending such unlawful discrimination, as is the overall aim of the Bill, and towards exposing the use of force to much closer scrutiny by standardising data recording across the whole country, so that it is possible to compare performance in mental health units on the same basis in different parts of the country. That is not currently possible, and it is a loophole that was pointed to by Dame Elish Angiolini in her report. I am pleased that the Bill will close the loophole.
Crucially, staff must also be trained in the use of techniques to avoid or reduce the use of force—essentially de-escalation. That makes the situation safer for everyone involved. It is critical that anything that might trigger behaviours in a patient that could lead to their being restrained should be avoided, if at all possible, so that the use of force can be minimised.
Amendment 86 sets out a revised duty on the responsible person to ensure that training is provided for staff in mental health units. Amendment 87 sets out when training should be provided to staff. It should be provided as soon as the provision comes into force, and there should be refresher training at regular intervals. That will build the institutional knowledge needed to ensure that force will only ever be used as a genuine last resort.
Luciana Berger
My hon. Friend, and many other Members, will probably have seen the “Dispatches” programme last month, in which a temporary member of staff went to work in a privately owned but NHS-funded mental health unit. That undercover report revealed scenes that were difficult to watch. Part of the challenge was that the individual was not given any appropriate training when she was asked to care for some very unwell people in secure parts of the accommodation. I want to reinforce what my hon. Friend has been saying: the issue is critical for existing and new staff, and often there are too many temporary staff working in such units.
Mr Reed
My hon. Friend makes an important point, clearly and eloquently. There are no circumstances in which an untrained member of staff, whether full-time or not, should be able to use force—effectively violence—on a patient. If they have not been properly trained, that should be an absolute no.
Jackie Doyle-Price
The clause relates to ensuring that all members of staff are appropriately trained on when it is appropriate to use force. It is worth emphasising that it will make any institution or organisation safer for patients, but also for staff. It is important to prioritise and enhance training in de-escalation techniques. That will make for a safer environment for everyone, with less harm to patients, and will probably help to some extent with their continuing care and recovery. I totally endorse the clause, and the amendments, which will make it more effective. Clearly these measures are important for a Government whose approach to leadership in health involves prioritising patient safety.
We see the provisions as an opportunity to build on the positive and proactive care guidance. The amended clause will now go much further to address the points made by the hon. Members for Croydon North and for Liverpool, Wavertree. Only people working in a professional capacity would be able to use force on patients; any volunteers would not be able to do so. In that sense, it is a much stronger measure, because we are giving a clear view that the use of force is not something that volunteers should be involved in.
The Chair
With this it will be convenient to discuss the following:
Amendment 29, in clause 6, page 4, line 3, leave out “registered managers” and insert
“responsible persons and relevant health organisations”.
This amendment is consequential on Amendment 7 as well as including relevant health organisations as subjects of the guidance published under Clause 6.
Amendment 30, in clause 6, page 4, line 3, at end insert—
‘(1A) In exercising functions under this Act, responsible persons and relevant health organisations must have regard to guidance published under this section.’
This amendment places a duty on responsible persons and relevant health organisations to have regard to the guidance published under Clause 6.
Amendment 31, in clause 6, page 4, line 3, at end insert—
‘(1B) The Secretary of State must keep under review any guidance published under this section.’
This amendment places a duty on the Secretary of State to review any guidance published under Clause 6.
Amendment 32, in clause 6, page 4, line 3, at end insert—
‘(1C) Before publishing guidance under this section, the Secretary of State must consult such persons as the Secretary of State considers appropriate.’
This amendment imposes a duty onto the Secretary of State to consult before publishing guidance under Clause 6.
Amendment 33, in clause 6, page 4, line 4, leave out subsection (2).
This amendment removes Clause 6(2) which is legally unnecessary.
Amendment 34, in clause 6, page 4, line 10, leave out subsection (3) and insert—
‘(3A) The Secretary of State may from time to time revise the guidance published under this section and, if this is done, must publish the guidance as revised.
(3B) If the Secretary of State considers that any revisions would amount to a substantial change in the guidance, the Secretary of State must consult such persons as the Secretary of State considers appropriate before publishing any revised guidance.’
This amendment places a duty onto the Secretary of State to consult before publishing revised guidance under Clause 6 where the revisions to the guidance are substantial.
New clause 3—Delegation of responsible person’s functions—
‘(1) The responsible person for each mental health unit may delegate any functions exercisable by the responsible person under this Act to a relevant person only in accordance with this section.
(2) The responsible person may only delegate a function to a relevant person if the relevant person is of an appropriate level of seniority.
(3) The delegation of a function does not affect the responsibility of the responsible person for the exercise of the responsible person’s functions under this Act.
(4) The delegation of a function does not prevent the responsible person from exercising the function.
(5) In this section “relevant person” means a person employed by the relevant health organisation that operates the mental health unit.’
This new clause gives a power to the responsible person to delegate functions under the Bill subject to the limitation that the person to whom functions are delegated is of an appropriate level of seniority. The obligations associated with the functions remain with the responsible person despite any delegation.
Mr Reed
Rather than including too much prescriptive guidance in the Bill, we have decided that it is best dealt with through statutory guidance, so that it can always be kept up to date with the latest best practice or other information and can be changed more quickly than legislation. Clause 6 sets out the requirements for guidance to be issued to set out compliance with the various requirements of the Bill. Amendment 28 places a duty on the Secretary of State to produce that guidance. That is a more appropriate level at which to produce the guidance than the CQC, although the CQC will have an important role to play in monitoring and regulating compliance with the Bill. The guidance will be statutory, so a failure to have regard to it will be a breach of a statutory duty. The amendments provide me with the assurance that operators of mental health units will be fully aware of their duties and the requirements under the Act.
New clause 3 gives the responsible person the power to delegate their functions under the Bill to another employee of appropriate seniority, but it does not mean that the responsible person will no longer be accountable for that function. It is important that in every unit there is always a named individual who is responsible for compliance with the provisions of the Bill and accountable, should there be any failure to comply with the provisions.
Jackie Doyle-Price
I agree that it is more appropriate for the Secretary of State to produce the guidance under the clause. The guidance will provide mental health units and the healthcare organisations that operate them with a detailed explanation of the requirements of the Bill. That will help to ensure that they understand the obligations they are under and, in turn, help them reduce the use of force so that it is only ever used as a last resort and carried out appropriately.
I want to clarify something I said earlier, in case I gave a slightly wrong impression when I referred to volunteers. We do not expect volunteers to use force and, accordingly, we do not expect them to be given training. There will not be an outright ban, but clearly the emphasis in the Bill means that only appropriately trained professional staff will be involved.
The duty to consult will ensure that there is input from a wide range of partners and stakeholders, so that the guidance is well received within the health service. On that basis, the Government are content to support the amendments. We are also content to support the new clause, which will allow a responsible person to delegate some of their functions to the right person within the organisation, but still retain overall accountability for compliance with the requirements of the Bill.
Amendment 28 agreed to.
Amendments made: 29, in clause 6, page 4, line 3, leave out “registered managers” and insert
“responsible persons and relevant health organisations”
This amendment is consequential on Amendment 7 as well as including relevant health organisations as subjects of the guidance published under Clause 6.
Amendment 30, in clause 6, page 4, line 3, at end insert—
‘(1A) In exercising functions under this Act, responsible persons and relevant health organisations must have regard to guidance published under this section.’
This amendment places a duty on responsible persons and relevant health organisations to have regard to the guidance published under Clause 6.
Amendment 31, in clause 6, page 4, line 3, at end insert—
‘(1B) The Secretary of State must keep under review any guidance published under this section.’
This amendment places a duty on the Secretary of State to review any guidance published under Clause 6.
Amendment 32, in clause 6, page 4, line 3, at end insert—
‘(1C) Before publishing guidance under this section, the Secretary of State must consult such persons as the Secretary of State considers appropriate.’
This amendment imposes a duty onto the Secretary of State to consult before publishing guidance under Clause 6.
Amendment 33, in clause 6, page 4, line 4, leave out subsection (2)
This amendment removes Clause 6(2) which is legally unnecessary.
Amendment 34, in clause 6, page 4, line 10, leave out subsection (3) and insert—
‘(3A) The Secretary of State may from time to time revise the guidance published under this section and, if this is done, must publish the guidance as revised.
(3B) If the Secretary of State considers that any revisions would amount to a substantial change in the guidance, the Secretary of State must consult such persons as the Secretary of State considers appropriate before publishing any revised guidance.’
This amendment places a duty onto the Secretary of State to consult before publishing revised guidance under Clause 6 where the revisions to the guidance are substantial.—(Mr Reed.)
Clause 6, as amended, ordered to stand part of the Bill.
Clause 9
Annual report by the Secretary of State
Mr Reed
I beg to move amendment 70, in clause 9, page 5, line 39, leave out subsections (1) to (4) and insert—
‘(1) As soon as reasonably practicable after the end of each calendar year, the Secretary of State—
(a) must conduct a review of any reports made under paragraph 7 of Schedule 5 to the Coroners and Justice Act 2009 that were published during that year relating to the death of a patient as a result of the use of force in a mental health unit by staff who work in that unit, and
(b) may conduct a review of any other findings made during that year relating to the death of a patient as a result of the use of force in a mental health unit by staff who work in that unit.
(1A) Having conducted a review under subsection (1), the Secretary of State must publish a report that includes the Secretary of State’s conclusions arising from that review.
(1B) The Secretary of State may delegate the conduct of a review under subsection (1) and the publication of a report under subsection (1A).
(1C) For the purposes of subsection (1)(b) “other findings” include, in relation to the death of a patient as a result of the use of force in a mental health unit, any finding or determination that is made—
(a) by the Care Quality Commission as the result of any review or investigation conducted by the Commission, or
(b) by a relevant health organisation as the result of any investigation into a serious incident.’
This amendment replaces the provisions of Clause 9 with a duty imposed on the Secretary of State to review reports each year made by coroners under the Coroners and Justice Act 2008 (often referred to as “regulation 28 reports”). The Secretary of State can also review other findings. After the review, a report must be published that includes the Secretary of State’s conclusions arising from the review.
This clause is very important. When there has been a fatality in a mental health unit, a coroner investigates the circumstances and the causes of that death and produces a report. I sat in for part of the coroner’s hearing following the death of Olaseni Lewis in Croydon. The coroner’s findings in that case were very damning of failures that had occurred leading up to that young man’s death, which were certainly avoidable, had lessons from previous coroners’ inquiries been properly learned and applied.
The purpose of the amendment and the clause is to ensure that all findings from coroners’ reports over a year are collated by the Secretary of State and published in an annual report, with the Secretary of State’s conclusions on how the state is learning from any incidents that occurred during that year.
That is an important step towards transparency and a culture in which lessons are learned quickly and effectively. A striking element of the findings in coroners’ reports over the years is how frequently the same recommendations are made again and again. If there was learning in the system and those lessons were being applied, that repetition would be far less likely to occur.
The proposal is to ensure that when those findings are made, they do not vanish into the ether; they must to properly understood and incorporated into the future development of best practice, to keep mental health patients safe. Amendment 70 would make the necessary provisions for the Secretary of State to carry out the publication of the reports.
Jackie Doyle-Price
Transparency is such an important ingredient in ensuring that we strengthen the rights of patients in mental health settings, and ensuring the accountability of organisations that are discharging their responsibilities at the behest of the state. That is why transparency is at the heart of the measures in the Bill.
Having read more than my fair share of coroners’ reports since taking this job, I fully endorse the provisions in the clause and the amendment. It is important that the broader system learns lessons when things go wrong. If we learn lessons when things go wrong, the chances that they will not happen again are much stronger. It is very important that the healthcare system is able to learn lessons from any death of a patient in a mental health unit that results from the use of force.
Drawing together the lessons learnt from a variety of sources into one report will allow greater transparency and shine a light on the issues that need to be tackled by organisations, and it will ensure that the learning from these tragic events is not lost. For that reason, the Government support the amendment.
Amendment 70 agreed to.
Clause 9, as amended, ordered to stand part of the Bill.
Clause 10
Requiring information regarding the use of force
Question proposed, That the clause stand part of the Bill.
Mr Reed
This will be brief. I am asking the Committee to vote against clause 10, because the provisions that were originally included in it have now been placed in clause 7, where they have also been strengthened, so the clause is no longer required.
Question put and negatived.
Clause 10 accordingly disagreed to.
Clause 11
Duty to notify Secretary of State of deaths
Question proposed, That the clause stand part of the Bill.
Mr Reed
Similarly, I am asking the Committee to vote against clause 11, because it duplicates existing duties in regulations 16 and 17 of the Care Quality Commission (Registration) Regulations 2009, so it is no longer required.
Question put and negatived.
Clause 11 accordingly disagreed to.
The Chair
We have made very good progress this morning, but we can go no further with the line-by-line consideration until the House has passed a money resolution for the Bill. I invite Steve Reed to move the Adjournment motion.
Ordered, That further consideration be now adjourned. —(Mr Reed.)
Oral Answers to Questions
Steve Reed Excerpts(6 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Speaker
Order. I want to take one last grouping. We are out of time, but I want to accommodate the Questions on mental health services—brief questions, brief answers.
Mr Steve Reed (Croydon North) (Lab/Co-op)
Trudy Harrison (Copeland) (Con)
Mr Reed
Many young people with mental ill health report that crisis care is not good enough. Of course, the pressures on them can get even worse over Christmas, so will the Government back the call by the charity YoungMinds to set up a crisis hotline for children and young people that would be available through the existing 111 service?
Jackie Doyle-Price
We are approaching Christmas, and the hon. Gentleman is quite right to highlight the fact that it can often be the moment of greatest crisis for people with mental health issues. I was with the Samaritans yesterday to commend it for all its work—it is obviously a good pathway to help—but, absolutely, we will speak with YoungMinds.
Mental Health Units (Use of Force) Bill
Steve Reed ExcerptsFriday 3rd November 2017
(6 years, 6 months ago)
Commons ChamberRead Full debate Mental Health Units (Use of Force) Act 2018 View all Mental Health Units (Use of Force) Act 2018 Debates Read Hansard Text Read Debate Ministerial Extracts
Mr Steve Reed (Croydon North) (Lab/Co-op)
I beg to move, That the Bill be now read a Second time.
Seni Lewis was a young graduate embarking on his life, aged 23, and living with his parents in Thornton Heath, when he suffered his first ever mental health episode. His parents recognised what was happening and took him to their local hospital. Seni ended up in the Bethlem Royal mental health hospital in Croydon. His parents stayed with him all day, but had to leave at 8 o’clock in the evening. Seni became very agitated when he realised they had gone, and he tried to leave, too. According to the coroner, the staff lacked the training to deal with him, and although there are no allegations that he attacked anyone, they called the police. Eleven police officers took Seni into a seclusion room and, using pain compliance techniques—the kind used against violent criminals—they took it in turns to hold him face down on the floor for 30 minutes in total. His hands were cuffed behind his back, and his legs were in restraints. They held him like that until he could no longer breathe, and he suffered a heart attack. He went into a coma, and four days later Seni was dead.
The coroner criticised Seni’s treatment as “disproportionate and unreasonable”. No patient entering a hospital for care should suffer and die in the way that Seni did. But the family’s agony did not end there. It took seven years of struggle by Seni’s grieving parents until an inquest was finally opened only this year. The coroner found severe failings by the police and the mental health services, and she gave the stark warning that
“there is a risk that future deaths will occur unless action is taken.”
That action is this Bill. What happened to Seni Lewis is not an isolated incident. According to the Independent Advisory Panel on Deaths in Custody, 46 mental health patients died following restraint between 2000 and 2014.
Nick Thomas-Symonds (Torfaen) (Lab)
I am grateful to my hon. Friend for bringing forward this very important Bill. Many families in my constituency have contacted me, including some affected by autism, and they are very concerned about the kind of face-down restraint that he has described so movingly in talking about this case. Does he agree that it is very important to have boundaries on the use of this restraint, and that families have some certainty about what can and cannot happen in such facilities?
Mr Reed
I completely agree, and I am delighted that the National Autism Society fully supports the Bill and its provisions.
I was talking about the number of patients who have died following the use of restraint, and the many more who have been seriously injured. Government guidelines say that face-down restraint is so dangerous it should not be used at all, but it was used over 9,000 times in the last year alone, including 2,500 times against children as young as seven. People who have been restrained talk about the experience with horror. They say that it is frightening, painful and humiliating, and they feel stripped of their dignity. In the words of one woman:
“It made me feel like a criminal, like I had done something wrong, not that I was ill and needed to get better.”
Statistics from the campaign group Agenda show that women are more likely to be restrained face down on the floor than men. Up to half of all women in mental health hospitals have been physically or sexually abused by men. Subjecting these women to face-down restraint by groups of men adds to the trauma that in many cases led to their mental illness in the first place.
It is difficult to understand clearly from the existing data what exactly is going on. There is no standardised way of recording why, when or how restraint is used. However, from their own data, there appear to be wide discrepancies between mental health providers. Some restrain as few as 5% of patients, while others restrain over 50%. There is no good reason for that variation.
Wera Hobhouse (Bath) (LD)
Does the hon. Gentleman agree that it is now time for each provider to publish, correctly and robustly, the data available, and should not the Minister make a commitment to the publication of the data?
Mr Reed
I agree, and I very much hope that the Minister will make such a commitment today.
There are fears about unconscious bias in the mental health services. The Angiolini review, a very important review published earlier this week, notes how a disproportionate number of people from black, Asian and minority ethnic communities have died after the use of force in custody more generally. Black people are four times more likely to be sectioned than white people. If we look at the faces of the people who have died after severe restraint in a mental health hospital, we see many more young black faces than in the population as a whole. We need to understand the extent to which assumptions based on stereotypes are causing that, but to do so we need standardised data recording.
What the Bill proposes is simple, but it will make a big difference. It will standardise the way in which the data on every instance of the use of force are recorded, so that we can better understand where force is being used unnecessarily, and the extent of any bias and disproportionality in the system. It will improve arrangements between the police and mental health services, and require the police to wear body cameras when carrying out restraint, unless there are good operational reasons not to do so.
David Hanson (Delyn) (Lab)
I support my hon. Friend’s Bill, particularly clause 13 on police body cameras. Is he aware that that provision applies to England only? Police body cameras are a slight anomaly in that they cannot be used by units in Wales because that matter is devolved to the Welsh Assembly. Once the Bill has been given a Second Reading, will he look at that and discuss it with the Welsh Assembly?
Dr David Drew (Stroud) (Lab/Co-op)
I congratulate my hon. Friend on the Bill. I declare a non-pecuniary interest in that my son is a community psychiatric nurse, although not a practising one. Does my hon. Friend agree that we need to look at the wider process of how people are taken into care? The sectioning process under the Mental Health Act 1983 does not allow any accountability to the victim. Does he agree that while the Bill is important, it needs to be seen in the wider context of how we deal with someone—at their most vulnerable—when they have been sectioned?
Mr Reed
I very much agree with my hon. Friend. The Government are commissioning a much wider review of mental health services. I hope it will encompass the points he raises, but that would be for the Minister to clarify.
The Bill will make sure that every mental health provider has a policy in place governing the use of force, including a clear deliverable plan for reducing its use, and ensuring that staff are properly trained in equalities and the de-escalation techniques needed to avoid the use of force. It will speed up justice and allow learning to take place by making sure that any non-natural death in a mental health unit automatically triggers an independent investigation, and making sure that recommendations from investigations and inquests are taken into account when improving mental health services in ways that currently do not happen.
The Bill is a significant step forward for our mental health services, moving them from the containment of patients to the care of patients. It will make sure that people with mental ill health are treated with compassion, not cruelty. There is overwhelming support for the Bill across the mental health sector. I am grateful for the practical support I have received from INQUEST, in particular its director Deborah Coles, and from Raju Bhatt, the widely respected solicitor who has represented so many bereaved families following deaths in custody. I am grateful to YoungMinds UK, Mind, Rethink Mental Illness, Agenda, the Labour Campaign for Mental Health, my hardworking staff and the Croydon North Ethnic Communities Forum. Also, 38 Degrees hosted an online petition that has been signed by over 60,000 people to demand this change.
Mr Jim Cunningham (Coventry South) (Lab)
More broadly, having watched documentaries on this issue, does my hon. Friend agree that there is an argument for providing the police with better training, so that they understand the difficulties facing people with mental health issues?
Philip Davies (Shipley) (Con)
I am grateful to the hon. Gentleman for the time he gave me to discuss the Bill a few weeks ago. He talks about mental health professionals supporting the Bill. I have spoken to my local care trust in Bradford, which, while it supports much of what is in the Bill, has concerns about some aspects. I therefore wonder how receptive the hon. Gentleman would be to amendments, either in Committee or on Report, that try to address those concerns, or is he determined that the Bill must end up in its current form?
Mr Reed
I thank the hon. Gentleman for his very helpful intervention. The only way to go forward with the Bill is through consensus. I have made it absolutely clear to both Ministers sitting on the Government Front Bench that I want to work with them constructively in Committee, as they have worked with me so far, so that we can secure an outcome that is supported by both sides of the House and right across the profession.
This week, the chief executives of 29 mental health organisations published a letter urging Parliament to back the Bill. It is supported by the Royal College of Nursing, the Royal College of Psychiatrists, the Care Quality Commission, NHS England and trade unions representing staff who do such an incredible job working in the mental health services. I must add my thanks to the Minister, the Under-Secretary of State for Health, the hon. Member for Thurrock (Jackie Doyle-Price), for working with me so constructively; as well as my right hon. Friend the Member for Islington North (Jeremy Corbyn), who supported the campaign long before he became the Leader of the Opposition.
Ruth George (High Peak) (Lab)
I congratulate my hon. Friend on bringing forward the Bill. Seni Lewis was a young man who grew up in my constituency of High Peak. His cousin was telling me yesterday what a lovely young man he was, that he was never in trouble with the law, and what a loss to society he is. Does my hon. Friend agree that his family should not have had to fight for six years to get an inquest? Will he pay tribute to them for all they have done to make sure that this never happens to another family?
Mr Reed
I absolutely agree. There is an old line that justice delayed is justice denied. No family who have lost their child in these circumstances should then have to fight the state to find out what went wrong, or to secure a modicum of justice for what happened.
Before I continue, I want to put on record my thanks also to the Prime Minister, who has met the Lewis family on more than one occasion and who I know supports the objectives of the Bill.
I have come to know Seni Lewis’s parents, Aji and Conrad, very well over the past few years. They are two of the most dignified and inspirational people I have ever met, but they have suffered pain and anguish that no parent should ever have to face. When I asked Aji and Conrad what they hoped for after all they have been through, they told me that they do not want Seni’s death to be in vain. They do not want any other family to suffer as they have suffered. I say to this House now, and to his parents, that Seni Lewis did not die in vain. We can honour his memory by making sure that no one else suffers the way he did, and by making our mental health services equal and safe for everyone. I dedicate this Bill to Seni Lewis. This is Seni’s Law. I commend it to the House.
Several hon. Members rose—
James Heappey
I accept that there are situations that require immediate intervention. As a former soldier who was used to working on immediate notice to move at times, I suggest that the solution is that there must always be somebody in a custody suite or a mental health ward who is wearing the right kit and is on immediate notice to move. It should be a requirement, and it should be a simple drill for those managing the facilities. That is not to say that everybody needs to be sat around at all times, wearing their stab vest and their camera. But one person in a custody suite should be required to be wearing the appropriate kit at all times. Perhaps that is something to include in the Bill. The cameras are a great addition to what police officers wear. In fact, they are a de-escalatory measure in themselves. Away from cases of people suffering with mental health issues, I have been told by the local police commander for my part of Somerset that the simple act of turning them on has such an effect. People on the high street who have had a few too many drinks see themselves on the screen and know that their behaviour is being recorded; things immediately start to calm down and responsibility returns.
Mr Reed
I am grateful to the hon. Gentleman for raising this important point and I agree with the point made by the hon. Member for South East Cornwall (Mrs Murray). The hon. Gentleman will be interested to know that there is a weight of published academic evidence showing that the mere presence of police wearing body cameras reduces the likelihood of force being used in these circumstances by nearly 50%. That alone is reason enough to require police to wear body cameras.
James Heappey
The hon. Gentleman is absolutely right. It is great on days like today when the House is in such violent agreement. The cameras really are a great addition for our police forces. They give transparency for those who want to complain about perceived unfair treatment. But they also give a protection as important as the stab vest, by reassuring police officers that they will have a video record of what they did.
James Cleverly
I only really have detailed experience of medical and policing practices from my time on the Metropolitan Policy Authority in London and now, as the representative of Braintree, from the Essex Police and my local mental health trust, so I cannot talk about the universality of the situation. However, without a shadow of a doubt, the message that I am picking up is that there is huge variation across and within constabularies and trusts.
The group of clauses relating to accountability is one of the most significant parts of the Bill, and my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) touched on this. I am one of those gruff and grumpy old Tories—[Interruption.] At this point, Members are supposed to join in a chorus of “You’re not that old.”—[Hon. Members: “You’re not that old!”] I thank hon. Members, although no one cried, “You’re not that grumpy.” Clause 7 is incredibly important. I am a gruff and grumpy old Tory, and my instinct is to take away as much red tape and administrative burden as possible but, as my hon. Friend the Member for Faversham and Mid Kent highlighted, this modest additional administrative burden is welcomed by the profession.
There is an old saying in management consultancy, “If you want to change something, measure it”—[Interruption.] I can see my hon. Friend the Member for Faversham and Mid Kent nodding. It is important to register the use of force whenever it is applied, because that will do two things. It will prompt a small pause for reflection if someone knows that they will have to justify the use of force, and it is inevitably a good thing if they recognise in that moment of pause that the use of force is not appropriate. Perhaps more importantly, if the decision is made that force is the appropriate action, clause 7 will mean that there is a record of all the times that force has been used, including the times when that force does not lead to injury or, in the most tragic cases, death. That will enable us to get an accurate understanding of how many times the use of force unfortunately leads to injury or fatality, which is important because it will remind us of the difficulty faced by many professionals.
Mr Reed
I am grateful for the hon. Gentleman’s generous comments earlier. I should make it clear that it is not my intention that the Bill should impose any additional administrative burden. Institutions already collect data on the use of force, but they do not collect it in the same way, so it cannot be compared. The Bill will simply standardise what currently happens to allow greater scrutiny, rather than imposing a new burden.
James Cleverly
That is a fair and balanced intervention. In my next sentence—honestly, this is true—I was going to list some things that, if they are not already collected, really should be collected. It is not a bad thing if the Bill creates a standardisation so that we can see the differentials between forces and trusts.
One of the most difficult and contentious points—this goes to the heart of my opening remarks about the impact the Bill could have on British society—is that, without a shadow of a doubt, we know that examples of huge community friction, of civil disorder and of further injury and loss of life have been caused when families, friends of families and wider communities feel that the use of force has led to an unnecessary death. I will be as cautious as I can with my words because of the sensitivities, but it is particularly acute in Britain’s black communities.
There is huge disproportionality between the black community in Britain and the rest of the communities in Britain—and it cannot possibly just be chance—in the rate of death and injury in custody of people suffering mental health episodes. That has to be addressed. No single Bill can solve the situation, as it has been long in the making and will take a very long time to resolve, but this Bill could be a big step in the right direction.
If, as I suspect it will, the Bill reduces the incidence of serious injury or fatality among people suffering mental health episodes, that will in itself have a knock-on effect in reducing some of the community friction and disorder that we have seen in the past. Unfortunately, I suspect there will be further cases where a black man is detained and dies after contact with the police, but if it can be evidenced that in all instances force is applied modestly, minimally and only when absolutely necessary, that might help to defuse some of the tensions that have in the past led to further difficulties.
In conclusion, I thank the hon. Member for Croydon North, and the other hon. Members who have supported this Bill, for introducing to this place a Bill that makes it easy for those of us who want to see genuine improvement both in mental health and community cohesion to support it. I commend it to the House.
Oral Answers to Questions
Steve Reed Excerpts(6 years, 10 months ago)
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Jackie Doyle-Price
I will be delighted to meet my hon. Friend, who is a committed and passionate campaigner in this area. I am keen to explore anything that improves care and choice for all patients at the end of their life.
Mr Steve Reed (Croydon North) (Lab/Co-op)
22. Croydon’s NHS, including end-of-life care, has been funded below the London average every year since the Conservatives first came into government. That is leading to the closure of services in Croydon that are available elsewhere, and to longer waiting times for GPs or the A&E in Croydon. When will Croydon’s funding be brought up to the London average?
Jackie Doyle-Price
The amount of resource that is dedicated locally is a matter for clinical commissioning groups, and we continue to make sure that funding is fair. I suggest the hon. Gentleman takes that up with his CCG.
Cities and Local Government Devolution Bill [Lords]
Steve Reed Excerpts(8 years, 5 months ago)
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Graham Stuart
My hon. Friend has had a fair crack and I am going to sit down.
Mr Steve Reed (Croydon North) (Lab)
This group includes a number of new clauses and amendments, so I want to focus primarily on those in my name and those of my hon. Friends, although I will also touch on some of the others as I go along. I do not want to detain the House for too long and there is quite a lot of ground to cover, so I shall try to romp through it at a reasonable pace.
New clause 10 proposes votes at 16. The Government seem to be a little confused on this issue: the Secretary of State has said that there is a debate to be had; the Minister for the northern powerhouse says there is not; and the Prime Minister is against it altogether. Yet we know that the Government are considering it for the European Union referendum and that they supported it for the Scottish referendum.
There are more than 1.5 million 16 and 17-year-olds in the UK. They can get a job or an apprenticeship, get married, pay taxes and join the armed forces, but apparently they are not responsible enough to be able to vote for their local councillor to take decisions about the local services in the area where they may well have bought a home and live with their family. The Bill is the ideal place to bring about change. Incremental change is how the British constitution develops, and allowing votes for 16 and 17-year-olds in local elections seems to me to be a good place to start.
The Electoral Reform Society argues that lowering the voting age will improve registration rates. Nearly 90% of eligible 16 and 17-year-olds registered for the Scottish independence referendum, and a high proportion of them took part in it. Research in other countries suggests that the turnout rate for 16 and 17-year-olds is higher than that for 18 to 34-year-olds. Establishing the habit of getting involved and voting in elections at an early age makes a lot of sense if we want people to continue voting throughout the rest of their adult lives. The Scottish referendum set the precedent. It is unreasonable to extend the vote in one part of the Union and not in another. Local elections suffer from low turnout, so that is a good place to start, but if the Minister thinks that this is not the time to introduce the change, perhaps he can answer the question: if not now, when?
On new clause 11, the Government have been very unclear about plans to devolve fire and rescue to mayors or police and crime commissioners, but we know that the Home Office is pushing for it and it is included in the Greater Manchester devolution deal. Our new clause calls on the Secretary of State to publish a review of how the Bill affects fire and rescue services. As we have seen over the weekend, and as we heard in the flooding statement earlier, the fire and rescue service is doing an incredible job, despite extremely severe cuts that have limited its capacity and reduced the number of jobs by almost a third. The cross-party Local Government Association believes there is “no pressing need” for police and fire services to merge. Any changes of the kind being considered will heighten public concerns about safety. The new clause would simply add a level of scrutiny and oversight to the provisions, so I hope that the Secretary of State and, indeed, the Minister will welcome and support the proposal.
Since 2010, local government has faced cuts of 40%, and last month’s spending review imposed a further 56% reduction in central support to councils. We know there will be changes to business rates once they are localised, and we were promised details in the autumn statement about how an equalisation mechanism would work, but no such details were given. Councils have simply been left to plan their future budgets in the dark, despite cuts on a scale that they have never been asked to deal with before. The LGA has warned that local authorities are struggling, and that is even before the spending review hits them. Lord Porter, the Conservative chair of the LGA, says:
“We know we’ve got probably 12 or 14 councils that are very close to the edge now.”
They need to know what is going to happen to them in future if they are going to be able to avoid falling off the edge of that particular financial cliff.
The funding settlement is deeply unfair. The 10 most deprived communities have suffered cuts that are 18 times higher than those made to the least deprived communities. Councils with the highest rates of children in care have suffered cuts that are three times higher than those made to councils with the lowest number of children in care. Although Labour councils are disproportionately hit by the cuts, they are also the ones that are protecting front-line services. Tory councils have shut half their youth services since 2010.
The unfair funding settlements are made worse by England’s local government finance arrangements, which are among the most centralised anywhere in the industrialised world. Councils lack the freedom to innovate so that they can spend on local priorities. Even London, which currently is more devolved than anywhere else in the country, is reliant on central Government funding for three quarters of its revenue. That is far higher than 30% in New York and just 25% in Berlin. London is the world’s greatest city, and yet this Government insist on keeping it on far too tight a financial leash. The Communities and Local Government Committee concluded that local authorities in England
“have limited control over local taxation and, as a consequence, rely…disproportionately on central Government funding.”
Our new clause 13 does not prescribe a particular settlement, but calls on the Secretary of State to publish plans for a package of fiscal and financial devolution that addresses three areas. First, on business rate retention, councils need an equalisation mechanism to ensure that those communities with the least capacity for economic growth are not left to sink. Labour supports the localisation of business rates, but it has to be done in a way that incentivises areas to grow, without penalising areas that have less capacity to do so at the time or in the future.
Ministers promised at the Dispatch Box that details of the equalisation mechanism would be made available during the autumn statement, but that did not happen. It still has not happened and we have not been given a date by when it will happen. We simply cannot allow rich communities to get even richer while everywhere else struggles to provide basic services. The new clause calls on the Secretary of State to introduce an equalisation mechanism to ensure that the least well-off are not hammered by the change.
Graham Stuart
The hon. Gentleman, as an expert in this area, will be aware that people in rural areas are on average poorer than people in urban areas. He will also be aware that his Government—the Government of his predecessors—left a system in which there was 50% more support per resident in urban areas, which are wealthier than rural areas, than in rural areas, and that it is more expensive to deliver services in rural areas. It is no surprise that we are not seeing the same reductions in services in rural areas as in cities, because such services do not exist in the first place. His party left it that way. Are Labour Members now committed to a fairer system?
Mr Reed
The hon. Gentleman seems to support my case for a fair equalisation mechanism, which I am pleased to hear.
Secondly, on greater local control over tax rates and discounts, England has one of the most centralised funding arrangements anywhere in the world. Whitehall takes the key decisions on council tax, which means that it is barely local at all. The previous Secretary of State capped rises, while the Chancellor is now encouraging councils to push up council tax to make up for his cuts. Labour wants the Government to publish plans to introduce greater local freedom over tax rates, banding, valuation and discounts.
Thirdly, on multi-year finance settlements, every successful organisation needs to be able to plan for the future, and local authorities cannot plan complex services without knowing what level of funding is available to pay for them. As powers are devolved from Westminster, local authorities need to know that they have the resources to exercise those powers properly. Local enterprise partnerships could operate more effectively if they had longer-term funding streams. Indeed, the regional development agencies, which LEPs replaced, could make single, three-year funding agreements, while LEPs have access to a smaller budget, with too many small funding pots and with constraints on their use. We want to make sure that combined authorities do not suffer from the same problem. Our new clause 13 calls on the Secretary of State to publish plans to allow for multi-year funding agreements, which would give combined authorities the resources and time to ensure financial stability, and allow them to make better long-term decisions about local services.
On new clause 14, we welcomed in Committee the proposal that new sub-national transport bodies must consult adjoining authorities before taking decisions. On transport, the Government have recognised that the devolution of powers to combined authorities concerns neighbouring authorities that do not wish to, or cannot, join a combined authority. That is an important principle, but it extends to areas beyond transport, and the Minister’s response to our amendment in Committee was disappointing. The Minister said it was not “necessary or appropriate”, so perhaps he will reconsider and support this new clause. For example, local authorities on the periphery of the Greater Manchester combined authority have concerns about health service decisions that will affect them, but which they are unable to influence. We want to give them the right simply to be consulted. If the Government are prepared to concede that such authorities should be consulted on transport, then why not on health or other key services?
Whatever the Government say, they are imposing mayors by making them a non-negotiable condition of devolution for metropolitan areas. We believe that the spirit of devolution demands that local areas should choose their own model of governance instead of having it imposed from the centre. If areas want a mayor, that is fine, but it should also be fine if they do not want a mayor. Government amendment 7 and related amendments are disappointing. They will allow the Secretary of State to impose a mayor on a combined authority even if one or more constituent councils do not want one. It is no surprise that the Local Government Chronicle wrote about amendment 7 under the headline, “Boost to government powers to impose elected mayors”. The Government are acting in opposition to their own claims to support local decision making in that respect.
If the powers are agreed to this evening, they must be used with extreme caution. Where a potential combined authority is divided on the details of a deal, which it may well be, local co-operation must be the preferred way forward. I would welcome a statement by the Minister or the Secretary of State to that effect. Our amendment 58 would reintroduce the change made in the Lords, stipulating that devolution deals cannot be made dependent on having a mayor. That view has support from Members on both sides of the House, as we have heard again this evening.
On amendment 59, we discussed the general power of competence earlier. The Localism Act 2011 introduced the general power of competence, which was intended to give local authorities more power and freedom to innovate. That is a good idea, but LGA research shows that the power is
“limited by significant constraints set by central government”,
and that local government needs far more independence from interference by central Government. The constraints the LGA identifies are financial, structural and regulatory. Our amendment encourages the Secretary of State simply to review the power of general competence to learn how to make it more effective and to encourage greater take-up than the disappointing level so far.
World Prematurity Day
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Mr Steve Reed (Croydon North) (Lab)
I offer warm congratulations to the hon. Member for Daventry (Chris Heaton-Harris) on securing the debate. This is a very important issue, but, as he made clear, it does not get the attention that it deserves. It is right and proper that it is being raised in Westminster Hall today, so close to World Prematurity Day.
I want to refer to a campaign that is based in Croydon North, the constituency that I represent, and that is calling for better support for the parents of premature babies. Called The Smallest Things, it was set up in 2014 by Catriona Ogilvy after her two gorgeous little boys, Samuel and Jack Smith, were born prematurely. She and her husband, Mike, were delighted to be parents. They were excited and full of joy as one would expect, but their lives were turned upside down because of the needs of their children and the fact that they did not feel that they were adequately prepared or supported to provide the care and love that their children needed.
The babies were cared for at the special care baby unit at Croydon university hospital. I had the opportunity to visit that unit with representatives from Bliss, about which the hon. Gentleman spoke. It is a fantastic unit, and I think that it is typical of many across the country. The quality of the care that is given at those special units is fantastic, but when someone walks into one even as a visitor, let alone as a parent, they are overwhelmed by an incredibly emotional feeling, because what they see is wires, tubes, boxes with portholes and bleeping machines and then those tiny little babies, vulnerable and needy, with all that paraphernalia around them. When we talk to the parents there, they are so delighted and relieved to have that support, but also so terrified and traumatised by what their little newborn baby is having to go through. At a time when they are desperate to hold that child and give them the physical love that they need, they cannot touch the child because of the intensity of the care that is being provided. That is incredibly difficult for parents, but we should pay tribute to all the staff who work in those extraordinary and wonderful live-saving units.
However, although the medical care is fantastic, the support for parents is, frankly, inadequate. The Smallest Things campaign is calling for maternity leave to be extended for mothers of premature babies. That is the primary purpose of the campaign and the point to which I hope the Minister will respond. The campaign organised an online petition that secured 10,000 signatures. Many comments that were made, but I will read out just one, which was put on the petition by a mother talking about her experience. She said:
“We had a baby born 11 weeks early and it crippled us. I lost my job because of the time I had taken off. We racked up huge debts on credit cards and 9 months on”
are
“still struggling immensely to keep a roof over our heads.”
No parent should be put in that position when they have the stress of a little baby struggling for their life at the same time. As a society, we owe better care to parents in that situation.
There are five reasons why The Smallest Things campaign is calling for maternity leave to be extended and they are as follows: financial; bonding with the child; the child’s development; the mother’s mental health; and employment. I will quickly run through each of those issues. On average, the parents of a premature baby spend an additional £2,255 in the course of the hospital stay, but very little financial support is available to parents in those circumstances. They cannot, for instance, apply for disability living allowance, and there is little flexibility to take additional paid leave from work. Therefore, many parents of premature babies, particularly if they are not earning a great deal of money in any case, are pushed into very difficult financial circumstances and even into debt, which is not a problem that parents in that situation should be forced to live with.
The second reason is about bonding between parent and child. A child can spend months in a neonatal unit and, in those circumstances, it can be near impossible for the parent to spend as much time with the child as they would if they were able to take the child home, but the physical bonding between mother and child is critical to the future healthy development of that child and can continue having impacts even in later life. Extended maternity leave would allow mothers to make up for the loss of that very important physical bonding once the child is no longer enclosed in the way that is necessary in a neonatal unit.
The third point is about development. Premature babies have different development patterns from babies born on their due date, so parents returning to work, perhaps after six months’ maternity leave, may well know that their child has reached the development stage only of a three-month-old. They go back to work worrying that their child has not had the support that they needed to reach the stage of development that they should have reached. Often, that can slow down the child’s development for years afterwards. Added to that is the fact that the child’s physical development is often slowed down. That can lead to much more frequent and regular visits to hospital during the first few years of a child’s life. All of that places further demands on the parents and, if they are working, on the employers to give the parents time off. Where employers refuse to do that, we need more flexibility to be permitted under law. The Government need to make that change, as some employers will not or are not able to do that themselves.
The fourth point is about maternal mental health. There is a huge risk of depression for mothers of premature babies. That arises from the anxiety and stress that they experience in having a child who has to struggle for their life for such a long period in their very early and very formative years. The additional financial pressures to which I have referred can add to that stress. Many mothers, struggling in incredibly difficult circumstances to cope, experience mental ill health, but they may not have been alerted to the signs of that and therefore do not seek treatment early enough. That is damaging not only to the mother but to the whole family, and can be damaging to the child.
The fifth point to which the campaign refers is employment. A planned return to employment can be disrupted by a premature birth. Often, a mother who originally planned to return after six months cannot, which can put people in extremely difficult financial circumstances. We need greater flexibility around periods of paid maternity leave for parents of babies who are born too soon.
The name of the campaign, The Smallest Things, comes from a quote from “Winnie-the-Pooh” by A. A. Milne:
“‘Sometimes,’ said Pooh, ‘the smallest things take up the most room in your heart.’”
It is time for these smallest things to take up more room in the Government’s heart as well. Maternity and paternity support for parents of babies born too soon is currently inadequate. I hope that the Minister will address the need for greater financial support for parents in those circumstances, better provision for paid parental leave and better support for the mental health issues that arise among parents whose babies come into the world too soon.
Cities and Local Government Devolution [Lords] Bill
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Victoria Borwick (Kensington) (Con)
Turning to another aspect of devolution, I would like to talk about the importance of health devolution. I obviously welcome the Government’s devolution revolution, which the Bill will help to deliver. In London, the Mayor has been campaigning for greater fiscal devolution and I know he applauds the recent announcement on business rate reform, as this will benefit our capital.
The devolution revolution that the Bill champions will ensure that Greater Manchester becomes the first English region to have full control of its health spending. However, as the Minister will be aware, London government has also been exploring how a similar model could work in the capital. As we all know, health is no respecter of ward or council boundaries. People live in one area and work in another, and may receive treatment for complex conditions in more than one area. That is why it is so important, in cities such as London and others that have been instanced today, that it should be viewed as a whole.
For a patient receiving many different treatments, it is far more effective for their care to be under one authority. As the previous deputy Mayor of London watching over this brief, I chaired many cross-London forums where councils and health authorities have come together to share resources and work together for better outcomes instead of being able to afford a smaller service in their locality. I would therefore argue that London, like Manchester, should explore ways to reform health and care provision, including a rebalancing towards prevention, early intervention, and proactive personal care and support. The aim should be to reduce hospitalisation, invest more in primary care, and integrate planning and decision-making for both the health and care services. Inevitably, there needs to be a review of NHS properties, including underused facilities, so that new integrated care centres can be opened and we have a more efficient use of the health estate.
There is agreement among London partners that the scale and complexity of health and care issues in London means that a model of reform should include actions at local, sub-regional and pan-London level. As part of their submission to the comprehensive spending review, London government made the case for greater devolution over health and social care. In the interests of brevity as we are short of time, I shall reduce the list substantially and just mention public health powers, including regulatory and fiscal interventions; multi-year allocations of NHS and local authority funding on a borough footprint; and London’s share of national NHS transformation funding.
As the Minister will know, representatives from the Greater London Authority, London Councils, NHS England, the London office of clinical commissioning groups and Public Health England are developing a memorandum of understanding to progress this work and to look at the powers that could and should be devolved to London. The recent London Health Commission report also advocated a London health commissioner, who could focus on the particular concerns of our growing city with its transient population. In London, we see diseases that many of us thought had died out, such as tuberculosis and rickets. They are often seen in people who were born or have grown up elsewhere, bringing pressures to the health system in London.
I am asking the Minister to welcome the approach being taken by London and support the aspiration for the greatest possible speed of reform to improve the health of Londoners.
Mr Steve Reed (Croydon North) (Lab)
I start by putting on record my condolences to the family and the many friends of Michael Meacher on the very sad news we have heard this afternoon. I am sure that we will have the opportunity to pay our respects to him properly and recognise the huge contribution he made to politics, Oldham and the life of this country and this House.
Turning to the Bill, this is a very exciting and long-overdue agenda. The UK, and England in particular, is deeply over-centralised. This holds back our regions, cities and communities. We welcome the Bill. It is a positive step forward. It is broadly, as the Minister said, of a consensual nature and I welcome his readiness, as he expressed it earlier, to listen to this debate before coming back with his final proposals. That does not mean, however, that there are no areas where the Bill could not go further or be improved. We have heard, across the Chamber this afternoon, plenty of examples of such areas.
Listening to the Minister, it struck me that he was on his weakest ground on the issue of mayors. A number of MPs from all sides spoke very eloquently about imposed mayors. It is right that areas that want mayors should have mayors. The Greater Manchester combined authority made it absolutely clear that it supports its mayoral model and we absolutely back it on that. When that applies to other areas, that is absolutely fine: if that is the model they want, that is the model they should have. However, the Secretary of State should not be able to force mayors on areas that do not want them. He has not been at all clear on how a metropolitan area that wants to proceed with devolution but without a mayor, is able to do so. He has made the one conditional on the other.
Clause 3, as it stands, is an important clause. It ensures that mayors cannot be made a condition of devolution and we believe the Government are wrong to seek to remove this important safeguard. We will wish to test the opinion of the Committee on that.
Ian Mearns
I entirely concur with the arguments my hon. Friend is putting forward. Unfortunately, in the north-east of England, where there are seven local authorities involved in the North Eastern local enterprise partnership area, many councillors from different authorities have said to me and to colleagues, “We’ve been told it’s the only game in town” and that only with an elected mayor will the financial incentives for the LEP area be forthcoming. That is totally unfair and undemocratic.
Mr Reed
Absolutely. I thank my hon. Friend for that intervention. Those constraints are being imposed by the Government on that region. It should be up to the region to choose the most appropriate model of governance as we proceed, rightly, with devolving powers down to that area.
Our new clause 21 seeks to ensure that the community is involved in any decision about the model of governance. Open engagement needs to go much further than that. Devolution deals that are shaped with the local community are more likely to have the support of the local community. Just as important, they are more likely to be better deals. The Government should not close the door on meaningful engagement that is open and transparent. The deals the Minister is making may not feel obscure to him, because he is the one inside the closed door. The people on the other side of the closed door—those on the outside—need to know what is going on and to be able to influence and shape it. If the Government really believe in devolution, why will they not devolve decisions over the appropriate form of governance so that local areas can decide for themselves? I wonder what they are afraid would happen.
Peter Dowd
My hon. Friend is spot on in in identifying some of the mechanisms that can be used to help local economies. For example, low carbon investment accounts for 1,400 businesses in our area and is a major growth sector. Among the organisations that invest in our area is Copenhagen city council. Why cannot we as a city council or a local authority invest in our area in that way? Devolution will eventually enable us to do that. The low carbon industry is one of our priorities and brings a huge amount of money into the local economy. We want to grow that area, and we could do that best ourselves.
There are other reasons why my city region will benefit from devolution. We want more manufacturing. The Government have said that they want to move into manufacturing because that helps with exports. In our area advanced manufacturing is worth £3.2 billion and accounts for 50,000 jobs and 3,000 businesses. Again, we need to grow that as part of our strategy, which may well fit in with the Government’s agenda. It may not, but that is a matter for us. We are working closely with businesses through the LEP and outside the LEP to continue to develop that sector.
The creative and digital sector is important. Merseyside had a long history of creativity. I am not saying that other places do not have that, but for decades we have had the benefit of the creativity that we have brought on, and we want to continue to bring it on. Why not? That will be best done from within Merseyside. The sector is worth £878 million, and accounts for 3,500 businesses and almost 19,000 jobs. We are best placed to grow that. The life sciences and health sector is huge and worth £1.7 billion, with the potential to grow even more.
I gave those examples of our priorities—the visitor economy, advanced manufacturing and so on—because many of those have been pushed from within our area. We want the structure, the capability, and the devolution of powers and resources to enable us to push them further.
This may be a radical proposal and it may be slightly party political. The Conservatives have made major cuts in our local government budget in Merseyside and other areas, and that will continue. If that happens, so be it, although I do not agree with it. But I would rather have devolved budgets and resources even at a lesser amount if we can determine how to use them, because our priorities may not be the priorities of the Government. One of the good things that the Government did was to lift much of the ring-fencing which had become endemic over the past 10 or 15 years.
If, with devolution, comes the resource—appropriately equitable, possibly over a transition period—all the better. Colleagues in my neck of the woods and I welcome devolution. We want to be able to push the agenda on for our area and we think we are best placed to do that. Importantly, we would be accountable for that at a local level, and that is the key.
Mr Steve Reed
This group of amendments deals with the functions of combined authorities and their funding. I shall try to cover the whole range and also speak to our amendment.
The Minister said that he and the Government are listening to these debates and making changes as a result. It is disappointing, therefore, that they have not brought any significant changes to the Committee in relation to this group, after the debates and decisions that were taken in the Lords, and the debate on Second Reading, on introducing stronger financial powers. Areas are being given new powers, which is absolutely welcome, but the truth is that they will lack the resources they need to use them fully.
Local government has proven itself to be more efficient than national Government, as hon. Members have testified, but Whitehall still will not let go. That is why I tabled amendment 58, which would introduce multi-year financial settlements. That would offer city regions financial stability and allow them to have long-term planning, which currently is not on offer under the financial settlement or the funding of local enterprise partnerships. Without long-term funding arrangements, they cannot plan sensibly for the long term.
The Government must commit to providing devolved regions with the resources they need so that they are not being set up to fail. The regional development agencies, which LEPs replaced, were able to make single three-year funding arrangements. LEPs are in many respects better, but they have access to a smaller budget, and there are far too many small ring-fenced grants, which constrains their ability to take the big, long-term, strategic decisions in the way they need to. We must ensure that combined authorities do not suffer the same problems.
Amendment 58 would therefore make provision for multi-year funding agreements, which would give combined authorities the resources and time they need to build financial stability and allow them to best protect themselves against unfair funding settlements of the kind we have seen central Government deliver since 2010, which I fear we are going to see again when the Chancellor makes his pre-Budget statement to the House in a few weeks’ time. This is an important issue, and I believe that the success or otherwise of devolution depends on it, so we will seek to push that amendment to a vote.
A number of other amendments are aimed at increasing financial stability. We are particularly interested in the Government’s view of those. I urge the Minister, in the Secretary of State’s absence, to respond to them so that we do not have to bring them back on Report. In particular, amendment 60, tabled by my hon. Friend the Member for Sheffield South East (Mr Betts), seeks further powers to allow mayors to borrow. New clause 14, tabled by my hon. Friend the Member for Nottingham North (Mr Allen), would allow local areas more discretion over the setting of council tax bands.
New clauses 10 and 11, tabled by my hon. Friend the Member for Harrow West (Mr Thomas), seek further devolution to London. I think he is quite right to point out that the devolution journey in London has not ended, because the capital is seeking further powers. His points about devolving housing to London are certainly worth further exploration. However, it is worrying that the Housing and Planning Bill contains more than 30 centralising measures, taking powers away from the localities and putting them in the hands of Ministers here in Whitehall, which runs completely contrary to everything we have heard from Ministers this afternoon about their devolution intentions.
My hon. Friend the Member for Harrow West also referred to fiscal devolution. We certainly need to see that, but it must sit alongside a fair equalisation mechanism, with incentives for areas so that they can benefit by expanding their economic potential, including the ability to invest in housing, infrastructure and those things that will increase the opportunity for jobs and prosperity.
The Government have tabled a number of minor amendments relating to the functions of police and crime commissioners, particularly amendments 23, 24 and 25 to schedule 2. There have been a number of media reports about devolving fire service functions to PCCs, but the Bill gives those functions to mayors. Can the Minister assure the House that fire services will not be politicised in the hands of mayors, a move that the Local Government Association says there is “no pressing need for” at this stage?
We support the principle of subsidiarity—an ugly word for a beautiful concept, as my hon. Friend the Member for Nottingham North reminded us in relation to his new clause 2—which states that decisions should be taken as close to citizens as possible. That is a very important principle that central Government repeatedly fail to understand.
On my hon. Friend’s points about a constitutional convention, he has been constrained to keep within the scope of this Bill by talking about a local convention. However, we believe that we do need a model for engaging civic society in the whole country—citizens, not just politicians—in seeking a new constitutional settlement that will shift powers not just from Whitehall to town hall but to communities, neighbourhoods, service users and all citizens to get power out of this place and into the hands of people who can really make a difference once they have access to it.
James Wharton
We have had an interesting and wide-ranging discussion. I recognise the comments made by hon. Members across the Committee and the range of amendments that have been tabled.
New clauses 2, 4, 5, 6, 7 and 16, and amendment 2, tabled by the hon. Member for Nottingham North (Mr Allen), are about the constitutional position of local government and putting in place arrangements for a constitutional convention to review this and implement any constitutional reforms considered necessary. I recognise his consistency in pursuing this issue; indeed, he also has a private Member’s Bill related to it. No one would deny the importance of constitutional matters. The traditions of this country are that we approach these matters in a pragmatic, evolutionary way. Our constitution has evolved over the centuries and continues to do so to meet the real needs of our people across the United Kingdom and to reflect the changes that are taking place in the wider world. I absolutely recognise the hon. Gentleman’s intentions and interest in this area, but I feel that this approach has served us well and I am confident that it will continue to do so.
The thrust of the hon. Gentleman’s amendments is that, for the first time in our history, we would put our constitution on a more rigid basis, seeking to codify issues and, in a sense, to set them in stone. Although they recognise the importance of constitutional issues and strongly support the passing of power down to the lowest practical level that this Bill will enable—the essence of devolution—the amendments are unnecessary and would be out of step with our traditions. They are also somewhat outwith the scope and intention of this particular Bill. However, I recognise his desire to put these matters on the agenda and his belief that they need to be addressed. I am sure it is not the last time that they will be discussed across the Floor of the House.
A and E (Major Incidents)
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Mr Hunt
I take huge interest in individual examples of where things have gone wrong, and that has informed a lot of my approach to the job. Just like A and E departments, when ambulance services get calls, they have to triage them and deal with the highest-priority calls quickest. The calls they get can sometimes be dealt with after a period of hours, but other calls are much more urgent. The important thing for ambulance services is to know that we are backing them with more paramedics, more investment and more ambulances, and that is what we are doing.
Mr Steve Reed (Croydon North) (Lab)
One of my constituents, an 80-year-old woman, collapsed at home over the weekend. She had to wait an hour for an ambulance to arrive, and she then waited 10 hours in A and E before being treated by medical staff. For most of that time she was on a trolley in a corridor. Will the Secretary of State apologise to my constituent? Does he not regret wasting billions of pounds on a top-down reorganisation of the health service, instead of using the money to fund the additional doctors and nurses who could have treated my constituent and thousands of others like her across the country more quickly?
Mr Hunt
Management costs in the NHS doubled under the hon. Gentleman’s Government; under this Government, they have been cut by £1 billion a year, which is paying for 9,000 more doctors and 3,000 more nurses. That is the reality of the NHS under this Government—1 million more people are getting operations every year—and if he really believed in the NHS, he would support and welcome that, rather than criticise it.
Children and Families Bill
Steve Reed Excerpts(10 years, 3 months ago)
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Mrs Main
No, I will not give way because many colleagues who have been here from the very beginning wish to speak. I am sorry if my hon. Friend is one of them.
I cannot think that this proposal will be enforceable. We all want to protect children. In that case, perhaps we should get out the fat callipers when we see very lardy children walking down our high streets because their parents feed them junk of an evening. Perhaps we should ban fattening foods because there are more than a million people with type 2 diabetes, as has been said in the media today. Where will it stop? We need to educate people. We need to ensure that parents do what is best for their children because they believe in doing what is best for them. We cannot legislate every single risk and danger out of existence.
Mr Steve Reed (Croydon North) (Lab)
I met the school council at Broadmead primary school in Croydon last Friday and I took part in a school assembly at Norbury Manor primary school this morning. I asked the children what they thought of the proposal to ban smoking in cars that are carrying children like them. Every single child supported the ban. When I asked how many of them had been inside a car when an adult was smoking, nearly half the children put their hands up. I asked one little girl what she did when she was in a car and an adult was smoking. She held her nose and told me that she tried not to breathe.
Although those children hated the experience of being forced to breathe in cigarette smoke, they did not understand the damage that it does to their health. The Royal College of Paediatrics and Child Health and other professionals estimate that up to 160,000 children a year develop lung diseases, including asthma and bronchitis, as a result of breathing in second-hand cigarette smoke. Developing lungs are far more susceptible to smoke-related disease than those of adults. That raises the question of why we protect adults in the workplace, on public transport and in pubs from the dangers of second-hand smoke, but subject children to it in cars.
I have listened carefully to the arguments against this proposal, but I find very little merit in them. The idea that this measure is an example of the illiberal nanny state is misguided. Law making is often about striking a balance between competing rights. On what balance of rights does the right of a smoker to smoke outweigh the right of a child to grow up healthy? I do not accept that an adult should have the right to harm a child who is powerless to protect him or herself. An adult who is in a car with a smoker can get out if they want to. Often, a child cannot.
To those who say that the measure is unenforceable, I say that we heard exactly the same about the seat belt law. Education in this case has clearly not worked well enough. We need to change behaviour. That requires a strong education campaign but, crucially, that needs to be backed up by law to show how seriously the country takes the issue and to create a sufficiently powerful deterrent.
We have taken many steps to protect people from passive smoking. Without this further measure, too many children will be left struggling to avoid breathing in smoke in the back of cars and, far worse, could find themselves struggling with lung disease in later life. It is our duty today to act to protect them.
Tim Loughton
I am a veteran of many children’s Bills. Yet again, such a Bill has been hijacked at the 11th hour by a subject that was not part of the original Bill. Usually, the subject is smacking; today, it is smoking.
I hate, loathe and detest smoking. I do not want any of my children or anybody else’s children to smoke. However, I also hate, loathe and detest the nanny state and its increasingly frenetic and insidious tentacles, which are creeping into individuals’ private lives and spaces.
I support many other measures that will suppress smoking and reduce the prevalence of smoking. I am for in-your-face, horrific graphics that show people the ghastly things that smoking does to their insides. I am in favour of higher tax. I am in favour of pariah status for people who smoke. I have no problem with the Lords amendments on packaging and on discouraging people from buying tobacco for under-age people.
However, I am against a measure that yet again undermines the parenting role of parents in favour of the state. The state makes for a poor parent. This measure will criminalise good parents, as my hon. Friend the Member for Broxbourne (Mr Walker) said. People should not smoke in front of their children, whether they are in a car, outside a car, in a house or wherever else, not because the state threatens them with a fine or a criminal record, but because it is a stupid thing to do. I will not quite use the language of the hon. Member for North Antrim (Ian Paisley), but it is stupid on so many levels. We should have much more empathy towards the health and welfare of our children, but we should support parents, not seek to supplant them, as the state has an increasing tendency to do and is trying to do yet again with this amendment.
If we are serious about this measure, we should have the courage of our convictions and ban smoking altogether. There is only one way that this legislation can go, and the natural conclusion is that there will be a ban on smoking in private homes. As I said earlier—not entirely facetiously—we must face the logic that pregnant women who can do untold damage to their unborn children through smoking and through foetal alcohol syndrome, which affects one in 100 children with very serious consequences, should be criminalised for doing the same thing in principle that this amendment tries to criminalise. Then there are the implications of not feeding our children healthy food. The amendment is unenforceable. It is bad law and is about supplanting, not supporting, the parent, and I cannot support it.