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Assaults (Mental Health Wards)

Volume 449: debated on Tuesday 18 July 2006

8. What recent estimate she has made of the number of assaults on patients and health care staff within in-patient mental health wards. (85846)

10. How many sexual assaults took place in in-patient mental health wards in 2005-06; and if she will make a statement. (85848)

Data from the counter-fraud security management service show 43,097 incidents of physical assault against staff working in mental health and learning disability settings in 2004-05. A report published today by the National Patient Safety Agency—a copy has been placed in the Library and I have asked for further copies to be distributed to Opposition Members—shows 558 reports of physical abuse of patients, including 122 reports of incidents relating to sexual safety between November 2003 and September 2005.

I thank the Minister for her response and for providing me with a copy of the report a few hours ago, but it is remarkable that that was prompted by Health questions, rather than previous freedom of information requests from Mind, the charity. The NPSA report is detailed, and it deserves close examination, as it recognises the important work of health professionals. However, many people are concerned about the safety of patients and the need to protect them against assault in mental health units. The report shows that there were 562 cases of patient abuse by a third party in a mental health setting, and from my reading of the graph, there were a number of cases of severe harm and, indeed, death. Can the Minister confirm that, and say what steps are being taken to minimise the risk of people in need of urgent medical treatment suffering even more trauma as a result of the actions of third parties while they are in the care of the national health service?

I certainly share the hon. Gentleman’s concern about some of the issues raised in the report. We should bear in mind the fact that about 1 million people are treated in specialist mental health services every year, but of course we take many of those allegations very seriously. In the report, in collaboration with NPSA, the Department has looked at examples of best practice which implement the guidance set out by the Department to ensure high levels of patient safety. These matters are ongoing and we will continue to examine the issues raised by the report, so that if anything else needs to be done to ensure patient safety, we will do it.

My concern is for those who are facing mental health challenges, who are perhaps the most vulnerable members of our society. In 1996 the Prime Minister made a clear commitment to the ending of mixed-sex wards. Ten years later, people have a right to know why patients are still suffering abuse at the hands of the Government—people who come to the national health service in their hour of need are found to have been abused. My question to the Minister is simple and can be answered yes or no. Will she now make the commitment to ending the use of mixed wards for mental health in-patients, and will she do it today?

Let us be clear: 99 per cent. of mental in-patient wards meet the requirements that have been laid down by the Department. Those requirements are that there should be separate sleeping accommodation and separate toilets and bathrooms. We also recommend that trusts could consider whether it is appropriate for wards to be completely male-only or female-only. Those issues are often debated, and the hon. Gentleman should recognise that. In some circumstances it is right that there are areas where males and females can go. That, in a sense, makes it a normal setting. There are also those who prefer that in some instances there should be completely separate wards. We have told trusts that where it is appropriate, they should consider such matters. As I said, there is 99 per cent. compliance in mental in-patient wards. We are working with the remaining 1 per cent. to ensure 100 per cent. compliance.

I share the concerns about the delay in the publication of the report, which I understand was available last November, but I commend the Government for collecting the information. We already knew from a report from the Healthcare Commission last May about the high levels of violence in mental health and learning disability units, which it attributed to the high level of staff vacancies, the lack of experienced staff in in-patient units, the overcrowding and the lack of a therapeutic and structured care system in wards. That was last May. Have things got better since then, and if not, why not? Will the Minister take urgent action to address these very difficult issues?

We are continually seeing improvements in mental health services, particularly with some of the community teams that have been set up so that there is less need for the in-patient care scenario. We have seen the development of those teams over the past five years, accompanied by massively increased investment—about £1.7 billion extra has gone into mental health services. I recently announced £140 million in capital investment to improve in-patient services for people with mental health problems.

Taken together, all these things mean that services are improving. That is not to say that we do not take reports such as this extremely seriously, or that we are not doing everything that we can to ensure that the existing guidance accords patient safety the highest priority.

Will my hon. Friend confirm the percentage of female patients subjected to such assaults, if that is known? Does she think that we have been rather more robust in ensuring the safety of our hospital accident and emergency ward employees—we have taken up the cudgels in that regard—and could we not show the same verve and enthusiasm in respect of our patients?

We have been very clear about the importance of patient safety, and particularly about making sure that there is proper protection for women. We have a follow-up strategy for some of the allegations made in the report, which is to look in more detail at some of the incidents that have taken place and to ensure that proper local investigations have been undertaken. We can then look at some of the details that my hon. Friend talks about.

On accident and emergency departments, my hon. Friend the Member for Don Valley (Caroline Flint), the Minister with responsibility for public health, issued a consultation recently that was particularly concerned with visitors to accident and emergency departments. However, it was decided not to issue the same kind of consultation regarding mental health patients, for obvious reasons.

Having had a Bill on this subject talked out by the Government as long ago as December 1997, may I ask the Minister what level of compensation—if any—the Government typically pay to a woman mental health in-patient after she has been raped in an in-patient unit as a result of the Government’s broken promises to eliminate mixed-sex wards?

Let me be absolutely clear: the rapes referred to in this report are allegations of rape, and we have been making sure that they are investigated at local level. If rapes had taken place and there was a police investigation, that course would obviously be followed.

Does the Minister share my concern that mental health services are more at risk of reductions in expenditure, where they have to be made, than some other areas of health provision? As she is aware from figures that I gave her yesterday, the strategic health authority in my local area budgeted for a deficit, and it is making my local mental health services pay for that deficit to a degree that has led a local authority officer to suggest that those services are not safe. What action is my hon. Friend taking to ensure—

Order. I must say to the hon. Lady that her question is far too long. Can the Minister try to answer?

We have made it absolutely clear that mental health services should not be asked to pay more than any other trust in a given area; disproportionate sums should not be taken from mental health services. If my hon. Friend has any evidence of more demands being made on mental health than on other areas, I would be more than happy to look into that.

No one who has visited a mental health hospital remotely believes the Minister’s assertion that 99 per cent. of them offer only single-sex wards: a flimsy curtain across a ward does not constitute a single-sex ward. In 2004, the Mind “wardwatch” campaign estimated that in reality, a quarter of mental health wards were still mixed, and we know that the situation has got worse, as many have had to revert to mixed-sex wards owing to deficit pressures. Only after a freedom of information request by Mind was today’s National Patient Safety Agency report published, revealing those 122 reports. There are allegations that those were only the cases that were reported. There was no mention of the cases that went completely unreported.

Is it not a disgrace that the Government sought to suppress the report eight months ago? Why did they do so? How many people have suffered subsequently because of the Government’s complacency and delay? What urgent action are they taking to improve conditions for vulnerable mentally ill patients in future?

Can I be—[Hon. Members: “Absolutely clear?”] Yes, I want to be absolutely clear about what happened to the report. It came to the Department on 16 January. Between that date and 23 May officials worked on the report with the National Patient Safety Agency, examining specific issues, including, for example, whether the allegations of rape had been the subject of a local investigation. It was important that we did not publish information without—particularly with allegations of rape—considering whether there had been a local investigation. That would have put some vulnerable people in an extremely awkward position. We did not want to do that.

We wanted to work on some of the other data analysis to ensure that that material was accurate and that the NHS could learn lessons from it. At the end of May the report came to Ministers, who signed it off on 5 June. Between then and now we have been examining a follow-up strategy, which has now been agreed. This is the response to the question that the hon. Gentleman asked. What are we intending to do with the information—