House of Commons
Tuesday 30 October 2012
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Business before Questions
City of London (Various Powers) Bill [Lords] (By Order)
Second Reading opposed and deferred until Tuesday 6 November (Standing Order No. 20).
Oral Answers to Questions
Foreign and Commonwealth Office
The Secretary of State was asked—
1. What recent assessment he has made of the situation in Sudan and South Sudan. 
I welcome the agreements reached in September between Sudan and South Sudan, following months of intensive negotiations on borders, security and economic issues. We are working with the African Union to ensure that these are fully implemented and that remaining differences are settled.
I warmly welcome the Minister to his new and important responsibilities. Is it not outrageous that, as the Sudanese Government protest at the bombing of an arms factory in Khartoum, they continue to bomb their own people in South Kordofan and Blue Nile, causing untold suffering for hundred of thousands, including the largely forgotten people living in the caves in the Nuba mountains? Will he and the Foreign Secretary continue to put pressure on the international community to ensure that, in turn, it puts pressure on the Sudanese Government to allow safe access so that humanitarian assistance can get into those areas as a matter of urgency?
I am grateful to the right hon. Gentleman for his welcoming remarks, and I certainly look forward to doing this job to the best of my ability. He is absolutely right to raise the recent incident, but it is a matter for the Government of Sudan. He will be aware that they have written to the President of the UN Security Council, who will be investigating the matter, and we, along with all Governments, await the results of those investigations. His points about the ongoing conflict in South Kordofan and Blue Nile are right, and I can assure him that the UK Government, along with regional players, including the African Union and the Arab League, are doing all we can to ensure that humanitarian aid and access are given to those particularly challenging areas as soon and as fast as possible.
Although the new agreement signed between north and south is welcome, is the Minister aware that the arms factory just alluded to is supplying arms into Sinai and possibly Gaza, and is Iranian-owned? Does he agree that he should be telling the Sudanese Government that such activity simply has to stop?
I am grateful to my hon. Friend for his comments. As he will be aware and as I stated earlier, the Sudanese Government made a request to the UN, and an investigation is now ongoing. We will be watching the thoroughness of that investigation extremely carefully, and will decide what to do once we have received the results.
Does the Minister agree that the Government of North Sudan must allow the safe, unhindered access of international aid to areas that so far have been inaccessible in order to ensure full accessibility for everybody and an end to bloodshed?
I am grateful to the hon. Lady for raising this issue. To reduce and negate the suffering in Blue Nile and South Kordofan, it is essential that we enable humanitarian access to get to these areas as fast as possible, but it is extremely challenging. She might be aware that an agreement was reached in August between the tripartite—the UN, the AU and the Arab League—and signed by the North Sudanese Government and the Sudan People’s Liberation Movement-North to allow humanitarian access. We need to ensure that that agreement is implemented as fast as possible to alleviate the suffering.
I congratulate my hon. Friend on his new position. The issue of the arms factory that my hon. Friend the Member for Croydon South (Richard Ottaway), the Chairman of the Foreign Affairs Committee, mentioned was accompanied by visits by Iranian warships to Khartoum. Will the Minister do all he can to reduce tensions in the region? This is a very unwanted development.
I agree with my hon. Friend. We have consistently and strongly encouraged the Government of Sudan to set themselves on a path to becoming a stable, prosperous nation playing a positive role in the region. In that regard, we do not consider such political and military engagement with Iran to be helpful.
2. What recent assessment he has made of the political situation in Swaziland. 
The Government remain deeply concerned about the continuing decline in good governance and human rights in Swaziland, and the lack of progress towards democracy. The UK has called on the Government of Swaziland to abide by the 2005 constitution, which guarantees the rights of all Swazi citizens to freedom of assembly and freedom of expression.
I thank the Minister for that reply, but what more can he do for people such as Mario Masuku of PUDEMO—the People’s United Democratic Movement, the leading opposition party in Swaziland—with whom I worked in Barclays Bank in Swaziland? What more can the Minister do to encourage King Mswati to be a little more sympathetic and tolerant of the existence of political parties?
I know that my hon. Friend has a particular interest and knowledge of Swaziland, and I can confirm to him that the UK continues to urge the Government there to ensure that all political parties are able to operate freely and participate in the elections scheduled for September 2013. We believe that the people of Swaziland want political parties and we call on the Government there to respect their wishes. I can also confirm that our high commissioner will be visiting Swaziland in November to participate in discussions and will use the opportunity to underline the UK’s concerns about the current political and economic environment and press for reform.
3. What assessment his Department has made of the fairness of the trial of the former President of the Maldives, Mohamed Nasheed; and what representations he has made to ensure that the trial is fair. 
We have sought and received assurances from President Waheed of the Maldives that any trial of former President Nasheed will be fair and free from political influence. No trial date has been set. The next court hearing is on 4 November and we expect international observers to be present.
What effect does my hon. Friend think the trial of Mohamed Nasheed will have on a sustainable political outcome in the Maldives?
The trial process is, of course, a matter for the Maldives, but there is international concern that if it results in the former President being prevented from leading his party into the elections next year, it will be seen as though the process was designed for exactly that object. We urge political stability under all circumstances in the Maldives, and that will no doubt be enhanced if the former President is allowed to lead his party and take part in those elections.
4. What recent reports he has received on progress in uniting Syrian opposition forces around a credible transition plan for a post-Assad Syria. 
6. What recent reports he has received on progress in uniting Syrian opposition forces around a credible transition plan for a post-Assad Syria. 
11. What recent reports he has received on progress in uniting Syrian opposition forces around a credible transition plan for a post-Assad Syria. 
We judge that co-operation between opposition groups is increasing, but there is much more to do. They need to unite and to appeal to all Syrians, regardless of religion and ethnicity. Our special representative is in constant contact with opposition groups and there will be a further meeting with them in Doha next month—next week, in fact—to work on that more united position.
In light of the failure of the recent ceasefire, what recent discussions has the Foreign Secretary had with the United Nations about reinstating a monitoring mission in Syria?
That is of course a difficult thing to do because of the situation in Syria. The Arab League had a monitoring mission; then there was a United Nations monitoring mission. All of them found it impossible to do their job because the regime did not keep its word and fighting continued, so that is not on the table at the moment in Mr Brahimi’s proposals. I will discuss with Mr Brahimi this afternoon what his next proposals will be. We continue to work for a diplomatic solution and to advocate the creation of a transitional Government in Syria, but so far our efforts to do so have been blocked or not carried forward by Russia and China.
Given that we cannot fully track where UK donations are going, may I press the Foreign Secretary to explain how we are ensuring that they are not ending up in the hands of jihadist forces?
The first thing to say is that our assistance is non-lethal. We are providing to the opposition equipment such as generators, communications equipment, water purification kits and things of that kind. We make every effort to track such equipment and ensure that we know where it is going, but as I have explained to the House before, the risks that we take in this area are outweighed by the risk of not giving any assistance to such groups and to civilian populations in Syria, who are in a dire situation. The balance of risk suggests that we should give assistance to them.
Can the Secretary of State say what progress he is making with the Governments of Russia and China on their position, which is clearly proving a stumbling block to action by the UN Security Council?
We continue to try to make such progress. I and all the EU’s Foreign Ministers met the Russian Foreign Minister two weeks ago for a further discussion about this in Luxembourg. There is no change in the position of Russia as things stand, which is a tragedy for Syrians and the world. In fact, since the last attempt to pass a chapter VII resolution was vetoed by Russia and China, more than 13,000 people are thought to have died. This is a major block on our diplomatic progress. In the absence of that, we are giving non-lethal support to the opposition, we are the second largest bilateral donor of humanitarian aid, we work with other nations to prepare for the day after Assad and we continue to assist the opposition in coming together as a more coherent force.
Does my right hon. Friend agree that, as I suggested at the time, it was really a mistake for the west to encourage a civilian rebellion against the dictatorship in Syria? That rebellion has been joined by the Muslim Brotherhood, Hamas, the jihadists and al-Qaeda, among others, while the Alawite regime is being supported by the Christians, the Kurds, the Druze and Russia. As I predicted, this has become a secular civil war and it is already threatening the stability of Lebanon, Jordan and Turkey. Given that the United Nations route has failed, that even Governor Romney has ruled out military intervention, and that the Russians are seriously concerned to prevent the conflict from spreading to the Caucasus, surely the time has come for my right hon. Friend to make further bilateral suggestions to Russia to find a joint approach that will end the bloodshed.
I can assure my right hon. Friend that there has been no shortage of bilateral and multilateral suggestions being made by us to Russia. I will pick him up on something that he said at the beginning of his question, when he implied that we in the west had encouraged a rebellion in Syria. That rebellion did not require any encouragement from western nations. That was the people of Syria rising up against an oppressive regime, and they did so without any incitement from western leaders of any kind. There is the sectarian tension and conflict to which my right hon. Friend refers, as well as a genuine desire to get rid of an oppressive and tyrannical regime.
But is it not the sad truth that Syria is bleeding to death because of a military stalemate in which the insurgency is incapable of bringing down the Assad regime and the Assad regime is incapable of putting down the insurgency? May I suggest that the only way to break down that military stalemate is to break down the political stalemate at the United Nations? Do not recent events in Lebanon serve to underline the fact that the risk to regional stability is now very considerable? Is it not in the interests of Russia and others to seek to bring an end to the political stalemate?
My right hon. and learned Friend is absolutely right. I hope that if any good can come of the events in Lebanon, they will serve as a fresh wake-up call to the world about the dangers of the Syrian conflict. This is not a containable crisis. A regime is waging war against its own people, and the longer it goes on, the more extreme will be the forces that are drawn into it, which is the very thing that Russia says it is worried about. We warned about all those dangers when we called on the United Nations Security Council to act, and those predictions have so far been proven to be true. Of course we will continue to work on this at the United Nations and to support Mr Brahimi, as I have said, while in the meantime doing all that we can to alleviate suffering inside Syria and on its borders.
What assessment has my right hon. Friend made of the political programme coming from the Syrian resistance movement?
There is a variety of political programmes from a variety of opposition groups. I pay tribute to the people I have met, some of whom have come out of Syria to tell us about their experience, for the extraordinary courage and determination that they have shown in the face of overwhelming odds in trying to fight and work for a better society in Syria. However, they do need a more coherent programme for transition, and it is important for them to make every effort to win over the middle ground of Syrian opinion. That includes minorities, Christians and the business community, who need to know that there can be a change to something better than the Assad regime.
I have listened with care to the answer that the Foreign Secretary has just offered, but it is worth bearing in mind that it is now more than 18 months since the beginning of the popular uprising and that neither unity nor a credible opposition plan has yet emerged from the Syrian opposition movement. The right hon. Gentleman referred in a previous answer to the Doha meeting as the next significant step, but would he accept that that meeting has already been postponed? Will he set out what practical steps can be taken with partners in the regions to try to effect the unity that has so far proved elusive?
Yes, it is true that that meeting has been postponed, and there have been many meetings with Syrian opposition groups. It is, of course, not possible or desirable for people in other countries, including our country, to try to impose on them any particular programme. The whole point is that Syria’s future should be for Syrians to decide, so they have to take the decisive steps to come together with a coherent platform. Our special representative works with them on a daily, usually an hourly, basis, and our pressure on them for the forthcoming meeting is co-ordinated with the United States, France, Turkey and leading Arab nations. It is very clear that the Syrians know that the world is looking to them to come together in a more effective way.
Does the Foreign Secretary accept that there is a relationship between whether such a transition plan emerges and the capacity of the international community to break the diplomatic logjam that we have heard about already in the course of our questions? If there are to be further discussions with the Russians and the Chinese in particular, which I sincerely hope there will be, the emergence of a credible transition plan is going to be one of the bases on which the optics of that conversation can be changed from the last 18-month stalemate.
Yes, that is quite right. I would not want the right hon. Gentleman or the House to think that it would necessarily bring about an end to that diplomatic stalemate, but it is one of the necessary ingredients, and it is one of the arguments of Russian leaders that the opposition is divided and that there is no single interlocutor with which to deal. It would indeed be very advantageous to remove that argument in trying to bring peace and stability to Syria. I think we are all very conscious of that, and will be very conscious of it over the coming months, and that, indeed, this has gone on for 19 months in total and more than 30,000 people have died. We will continue our work for a peaceful, sustainable transition in Syria.
Given that over 30,000 people have died in this struggle, does my right hon. Friend share my view that the most important thing is for the opposition groups to come together and offer the Syrian people what they really want—the hope of a better future?
Yes, absolutely. Again, I want to pay tribute to many people who risk their lives to support the opposition and to many who have worked in the Syrian National Council, for instance, to set out a clear intention to create a better future for their country, but it is now important that they come together in a more effective way. I have often explained to them that in the history of this country when we have faced an existential threat, all parties have come together on a common programme. Syria now faces an existential threat to any peaceful or stable future; it has to do the same.
If, in the right hon. Gentleman’s answers to questions, I have detected a change of tone from the previous insistence on regime change above all else, may I welcome that? Will he explain his own view that what we are faced with is a civil war—a civil war not just at the present time, with around a third of the people backing the barbarity of Assad out of fear of something worse from Sunni domination, but the continuation of a civil war following a simple collapse of the regime? What we therefore need is his insistence on a transitional Government.
Since I agree with the right hon. Gentleman about the need for a transitional Government, I do not want to disappoint him too much in respect of the start of his question. It is not that the western world has set out on regime change in Syria, but it is certainly our analysis, and it has been for a long time, that peace cannot be brought to Syria without the departure of President Assad. There is no viable peace; there is no peace that the people of Syria would accept without that. I am not changing tone or policy on that. The right hon. Gentleman is quite right about the need for a transitional Government. We agreed in Geneva at the end of June—with Russia, China and all other leading nations—about the need for that. What we do not have is the active participation of Russia in bringing about such a transitional Government.
Does the Secretary of State have any reports about the growing anti-west resentment and feeling by the Syrian people in the opposition as a result of the west not doing enough to protect them?
As my hon. Friend will know, there is a great variety of views. I find that there is enormous gratitude for what we have done and what we try to do diplomatically, and for the huge amount of humanitarian assistance that is provided, but yes, there are also members of Syrian opposition groups who would like us to do something different, and who would like a military intervention from outside. As I have explained to the House before, we do not rule out any options. We do not know how the situation will develop. However, for reasons that I have given the House many times before, it is very different from the situation in Libya last year.
5. What his policy is on proposals to give Palestine enhanced status at the UN. 
No application for enhanced status is currently before the United Nations. The whole House supports the right of the Palestinian people to have a state of their own: that state cannot come soon enough for them, and for the peace and stability of the region. We support a sovereign Palestinian state on 1967 borders with agreed land swaps, Jerusalem as the shared capital and a just settlement for refugees, and we will judge any proposal at the UN on whether it advances that goal.
Following the announcement from President Abbas that the Palestinian authorities will be seeking observer status at the United Nations, can the Foreign Secretary give the House any kind of assurance that the Government intend to support such a bid?
: The hon. Gentleman is right: President Abbas has stated that intention. However, no proposal is currently before the UN. In our view, the priority is for the United States—after the election, obviously, and whoever is successful—to lead a major push to restart negotiations and arrive at a two-state solution. The opportunity to do that is slipping away, and may have slipped away completely within another year or two. For the present US Administration it is absolutely crucial, and we have already said that to President Obama and to Governor Romney. Any decision on votes at the UN must be made on the basis of actual proposals.
I think the hon. Gentleman will infer from what I am saying that we believe that actual negotiations would be infinitely preferable to divisive symbolic gestures, and we are advising President Abbas not to go down the path of tabling such a resolution at the moment.
Order. We need to speed up a bit. We have a lot to get through.
We all want to see significant progress towards a two-state solution, but does the Foreign Secretary agree that any attempt by the Palestinians to declare unilateral statehood might provide an obstacle to the opening up of real negotiations, without preconditions, with the Israelis?
We will only arrive at a two-state solution through successful negotiations. It is therefore very important that the Israelis and Palestinians are prepared to enter into those negotiations, and, as I have said, that the United States is ready to put its full weight behind them in 2013, after the presidential election. That is the way forward. I think that if the Israelis and Palestinians or the United States fail to do that, we shall enter into a new and even more dangerous situation.
18. If President Abbas did present proposals to the UN within the next month for Palestine to be accorded observer status, and if the UN General Assembly approved them, would that not constitute an important statement by the international community of the primacy of a two-state solution, and would it not have the potential to break the diplomatic impasse? 
That is a hypothetical question. Of course it could be argued that it would be a very important statement. As I have said, I think that Members on both sides of the House believe in the importance of bringing about a Palestinian state, but if that cut across the ability of a re-elected or new US Administration to put its full weight behind this, and if it made Israelis less likely to enter into constructive negotiations in the coming months, it would take us further away from our goal rather than nearer to it.
But what other options are available to the Palestinian people as they see a programme of settlement building increasingly closing the door on the physical possibility of a Palestinian state?
That is an understandable question. As my hon. Friend knows, we have condemned the expansion of settlements. The settlements are what is bringing about the urgency of the issue, because they are making a two-state solution in the coming years less feasible. However, I reiterate that the best hope of achieving a solution is a major push by the United States in the coming months and over the coming year. Everything else is second best to that.
But what progress has the Foreign Secretary made by failing to adopt a position on this matter?
I do not think we are short of positions on this matter, and I have just explained the Government’s position on it. It is one of the great foreign policy frustrations for this country and for people across the world, but as we know, and as all previous Administrations have known, there is not a magic or overnight solution to it. The solution is negotiations on a two-state solution, and we now have an opportunity to make a major push for that. If that does not happen, we will be in a new and more dangerous situation, and that will require many nations to reconsider their approach.
Can my right hon. Friend confirm that the Government policy is as set out by the Prime Minister in his excellent recent United Jewish Israel Appeal speech, when he made it clear that there is no substitute for face-to-face negotiations without preconditions and that the United Kingdom Government would not support a premature move to statehood at the United Nations?
As I have explained, we believe it is very important to return to those negotiations—and my hon. Friend can be assured that Government policy is always as it is set out by the Prime Minister.
Occupied Palestinian Territories
7. What legal advice he has received on the banning of all imports from illegal Israeli settlements in the Occupied Palestinian Territories. 
I have neither sought nor received any legal advice on this issue, because the policy of successive UK Governments has been not to ban the import of settlement produce, but to support the policy of voluntary labelling to ensure consumers are fully informed.
Has the Minister seen today’s report from 22 Churches and charities, showing that we in Europe import 15 times more from the Israeli settlements than from the Palestinians? Is he also aware of the growing body of international legal opinion that all trade with the illegal settlements is itself unlawful? Will he therefore now seek that legal advice, so we in this House can be confident that Britain is following its obligations?
I have seen the report and I note that one of its main recommendations is to commend the United Kingdom on its policy of voluntary labelling and to encourage other European Union countries to do the same. There is active consideration in the EU about doing just that, and we are taking part in that. So far, however, I have not seen anything that would lead us to change our policy in relation to boycotts, but I will, of course, look at all the recommendations in the report.
Will the Minister give the House his opinion of the apparent legal inequality between children who live in settlements in the west bank and Palestinian children, who do not?
As my hon. Friend and other Members will be aware, there has for some time been concern about the legal rights of Palestinian children in particular. The UK Government part-sponsored a recent independent report looking into these issues. We remain concerned about the inequalities, and I have drawn these issues to the attention of Israeli Ministers when I have had the opportunity to do so.
Does the Minister agree that one-sided boycotts and sanctions will not resolve this complex and tragic issue, and does he applaud the fact that life-saving Israeli pharmaceuticals will now be made more generally available across Europe?
Yes, I do broadly agree with the hon. Lady. Successive Governments have not followed a boycotts policy because that would put at risk the relationship we wish to retain with Israel. A recent change in EU pharmaceuticals legislation will help the products she mentions to be made available, but as my right hon. Friend the Foreign Secretary has just said, such things are also caught up in the need for an overall solution to the problems between the Palestinian Authority and Israel. All the issues raised will not be settled until that happens. That is why we must urgently address the search for a solution in the way the Foreign Secretary has just outlined. These issues will only be resolved then.
Does my hon. Friend agree that the way to solve the settlement problem is to have direct, final status negotiations between the Palestinians and the Israelis, and that any academic, cultural or trade boycott will simply prove counter-productive and will damage this country’s ability to move the peace process forward?
Yes, and I hope I conveyed exactly that in my previous remarks.
Oil and Gas (Cyprus)
8. What assessment he has made of the political consequences in the middle east of the exploration for oil and gas off the coast of Cyprus. 
The discovery of oil and gas resources has the potential to bring greater prosperity and energy security to the region. We hope that all countries in the region will work to overcome their differences to develop those resources in a mutually beneficial way.
I thank the Minister for that response. He will be aware that Cyprus has moved on from olive oil to crude oil, and there are genuine concerns among all Cypriot people that the illegal occupying forces in the north may wish to assist the exploration of that oil against the best wishes of the Cypriot people. If that were to happen, what options would be open to the UK Government, given that we are a governing power and we do have a significant military presence on the island?
We have repeatedly stated publicly our acceptance that the Republic of Cyprus has sovereign rights to exploit its mineral reserves within its exclusive economic zone. We think that the prospect of the greater prosperity that would flow from the successful exploitation of hydrocarbon resources in the eastern Mediterranean is one of many reasons why it is in the interests of Cyprus—all communities in Cyprus—of Turkey and of Greece to reach a settlement to the maritime disputes in that region and a final settlement to the Cyprus question, too.
Given the stalling of the political search for a solution to the Cyprus problem, does not this exciting prospect of the exploration of hydrocarbon reserves highlight both that Britain has an important role as a guarantor power in ensuring that these are resources for the whole island of Cyprus, and that reunification of the island is an economic necessity for Cyprus and the greater region?
It is certainly important that these resources are seen as being developed for the benefit of all communities in Cyprus, not just for one section of the population there. Any settlement that endures in Cyprus has to have the wholehearted consent of both the Greek and Turkish Cypriot communities. That is why, although we want to support the work towards a settlement, it is right that that process towards—we hope—a final settlement has to be Cypriot-led.
9. What recent representations he has made on behalf of Shaker Aamer; and if he will make a statement. 
I have raised Mr Aamer’s case numerous times with Secretary Clinton and, in June, my right hon. Friend the Defence Secretary and I made representations to Secretary Panetta. Any decision regarding Mr Aamer’s release remains in the hands of the United States Government.
I thank the Foreign Secretary for that reply and for the work that he and Ministers have undertaken on behalf of Mr Aamer’s family in Battersea. Obviously, the next months offer a window of opportunity, as there will be a change of personnel, even if there is not a change of Administration. Can the Foreign Secretary assure me that he will continue to seek waivers, particularly to the National Defence Authorisation Act, with counterparts on the other side of the Atlantic?
Yes, and I pay tribute to my hon. Friend’s work on this issue. Senior US officials have confirmed that the National Defence Authorisation Act 2012 has the potential to make Mr Aamer’s release more likely than the Act of the previous year, but no releases have yet taken place under that Act and the criteria for the national security waiver remain unclear. We will certainly be pursuing this with the re-elected or incoming US Administration.
10. What steps his Department is taking to ensure the continuing education of girls in Afghanistan following the military draw-down. 
14. What steps his Department is taking to ensure the continuing education of girls in Afghanistan following the military draw-down. 
The United Kingdom can be proud of the role it is playing in ensuring that more than 2 million girls are now in school in Afghanistan. At the Tokyo conference in July, the Afghan Government reconfirmed their commitment to the rights of women and children. My right hon. Friend Baroness Warsi made the point again during her visit to Afghanistan in the past couple of weeks and got a further assurance from the Afghan Government.
I thank the Minister for his answer. Last week’s International Development Committee report said that the status of women and girls in Afghanistan would be the “litmus test” of whether we have succeeded in improving the lives of ordinary Afghans. What is his assessment of the Afghan High Peace Council’s commitment to include women in Afghanistan’s political process?
There are already a number of women in the Afghan Parliament; some 31% of Afghan Members of Parliament are women, and there is a clear commitment in the declared aims of the Government, which they reaffirmed to the United Kingdom as part of our enhanced strategic partnership on the rights of women. The truth is of course that the cultural issues are extremely difficult, and we will continue to press them and to work with the elements in Afghanistan who wish to see continuous progress. I do not think any of us can disguise the fact that it is not easy, but there are elements in Afghanistan who clearly want to see progress.
While mainstreaming women’s rights and status is important, what specific projects have the Foreign and Commonwealth Office, or colleagues in the Department for International Development, funded?
We fund a variety of projects through our conflict pool to encourage the participation of women in the political process, through elections and education and through supporting particular women’s rights advocacy groups, and to assist in their work in the media. The Foreign and Commonwealth Office and DFID do that work collectively, and we do it multilaterally with other international agencies.
Did the Minister see the important article in The Sunday Times this weekend, which made it clear that after 2014 the Taliban will be targeting all the progressive steps that have been taken, and will he therefore seek to open the Government’s mind a little more to the prospect of trying to preserve those gains by supporting the concept of a strategic base in the area after 2014 for international security assistance forces?
How the use of forces will be made after 2014 is still to be considered. My hon. Friend has made this plea before. I would say in response to his point about the Taliban that one of the most significant events in recent weeks has been the public response to the Taliban in Pakistan, in support of the young girl Malala and her right to education. Bearing in mind the links between the Taliban in Pakistan and in Afghanistan, that assertion by the people of Pakistan of the importance of women’s rights and women’s education may be the best response we have yet seen to the demands of the Taliban, and a consideration that they may not be accepted by the people themselves, which would be the best guarantor of women’s rights in the future.
The education of girls is of course very laudable, but does the Minister agree that the main reason we are in Afghanistan is to deny that country being used as a base by international terrorists?
Yes. The reason we are in Afghanistan is for both our national security and theirs, and to ensure that the use that was made of Afghanistan’s territory in the past is not made in the future. That is why we have been there; our forces have done a remarkable job and so have the development workers. They will continue their work post-2014 to ensure as best they can the future stability of that country for its own security and for the security of the rest of us.
As the Minister rightly identified, since the fall of the Taliban in 2001 the number of girls going to school has risen from fewer than 5,000 to 2.2 million. That is an achievement Britain can be proud of. Maintaining that progress is crucial, both to the development and the future security of Afghanistan, so what initiatives is he taking with the Government of Afghanistan and, equally importantly, with neighbouring powers to ensure that progress continues after the draw-down of ISAF?
I thank the right hon. Gentleman for what he said about the progress that has been made. There are two things in response. The first is the Tokyo international agreement in July; the United Kingdom has been asked by Afghanistan to co-chair the first review of it in 2014. It is a series of commitments made by the Afghanistan Government in relation to a variety of matters, such as social and economic development, including the rights of women. In addition, the enhanced strategic partnership that the Prime Minister signed with President Karzai in January this year also includes commitments on women’s rights, and we will be looking to ensure that those rights are confirmed in the future as our development support continues.
12. What progress his Department has made in its efforts to support UK exports. 
My Department is supporting UK growth and helping to realise our ambition to double UK exports to £1 trillion by 2020. We have a good story to tell. We are transforming the level of commercial awareness in the Department through secondments and training. We are supporting small and medium-sized enterprises exporting to emerging markets, including helping them to manage the risks involved, through our overseas business risk service.
My thanks to the Minister. I am very pleased that the Foreign Office is taking such a leading role in our trade efforts and that UK Trade and Investment held a successful event in my constituency. What other steps are we taking to expand missions in our embassies and the appreciation of trade on the ground?
My hon. Friend raises a very important point, which is getting hon. Members to understand that the facility is available. The more people who do, the better we can export. We have UKTI, and small and medium-sized enterprises will take part in its export week from 12 to 16 November, when more than 100 events will be organised across the UK. We have the overseas business risk service, and members of my Department spoke to members of the Kent international trade office on 18 October about the help that the Foreign Office can offer. I am glad that it is working with her, but I urge right hon. and hon. Members across the House to make use of the facilities for their local small and medium-sized enterprises. We can help—we are here to help—and if Members have any problems and encounter difficulties, my office door is always open.
22. Despite what the Minister said, exports of goods in the second quarter continued to fall, and the £10.2 billion trade deficit in June was the worst since 1997. UK exporters tell me that the increasingly isolationist rhetoric by members of the Government has done little to develop the notion that Britain is open for business, and suggests that the Government just want to be alone. 
I do not know how to respond to that. It may have escaped the hon. Gentleman’s notice that there has been a bit of economic turbulence in the eurozone, which is an important market for us. The network shift over which the Foreign Office is presiding involves more people in more places, particularly in emerging and re-emerging markets. We are opening up 11 new embassies, and eight new British consulates and trade offices. We are redeploying 300 extra staff in more than 20 countries in Asia, Latin America and Africa. If that is his definition of isolationism, it is not mine.
13. What discussions he has had with his international counterparts on sectarian violence in Rakhine state in Burma. 
Yesterday, I called the Burmese chargé d’affaires into the Foreign and Commonwealth Office to discuss our serious concerns about the violence in Rakhine state. This follows the meeting of my right hon. Friend the Foreign Secretary with Burma’s Foreign Minister in New York in September, and my own meetings during the UN General Assembly. There is an urgent need for an end to the violence, for the Burmese authorities to ensure security in the region, and for humanitarian access.
I am grateful to the Minister for that answer. Given the levels of sectarian violence that have unfolded in recent days, particularly against the Rohingya community, but also against all communities, with thousands of homes destroyed and thousands of people displaced, and people being killed, do we not need the clearest possible assurances from the Burmese Government that they will end the violence, ensure an end to impunity and work with the UN to address the underlying causes of the tension in that region?
I congratulate the hon. Gentleman on securing a Westminster Hall debate on the Rohingya community a few weeks ago. It is worth pointing out that any suggestion that the violence has been orchestrated by the Burmese Government is erroneous. We look forward to hearing from their independent investigation commission, which will shortly report on what has caused the violence. In early October, the British ambassador led the first independent diplomatic mission to Rakhine state to meet key leaders and visit camps sheltering internally displaced people from both communities. I am pleased to say that we are doing a lot on aid, but we need this to be settled, as it is extremely worrying to everyone who is following these events.
Burma’s failure to address the welfare of the Rohingya people and, indeed, Bangladesh’s failure to recognise them at all, means that they are virtually stateless. Will the Minister ensure that he takes a bilateral approach to the problem, so that we can secure the safety of people in Rakhine state?
The hon. Gentleman makes an extremely good point. The British high commission in Dhaka, along with our EU partners, has had regular conversations on the matter. It is important to talk to Bangladesh, and my right hon. Friend the Foreign Secretary has spoken to Sheikh Hasina, as has the Prime Minister. It is important on two counts: first, to ensure that those people receive humanitarian aid on the Bangladeshi border and, secondly, that people are allowed free movement across the border, because there is a serious humanitarian problem there.
With reports by Human Rights Watch of major human rights violations, along with the displacement and the killing of 78 people, what action has the Foreign Secretary taken to secure international pressure on the Burmese Government, because previous representations have clearly not worked, and we need urgent action?
I do not think that that is particularly fair on the Burmese Government. My right hon. Friend the Foreign Secretary and I discussed these matters extensively in New York. We await the report from the Burmese Government, and our ambassador has been to the area. We think that the Burmese Government are doing what they can with their army and police. Inter-communal violence has gone on for a number of years in that part of the world, as the hon. Lady will be aware. The matter needs to be resolved, not least the issue of citizenship for the Rohingya people.
I welcome the Foreign Secretary’s recent support for a review of the 1982 Citizenship Act which, as we have already heard, is one of the underlying factors rendering the Rohingya stateless. It is also important that Bangladesh is brought into discussions about citizenships. Will the Minister tell the House what efforts are being made to bring those parties to the table?
The hon. Lady is right. I alluded to that in my earlier remarks. We think citizenship is important. We have been pressing for many years for the Burmese Government to recognise this. The Foreign Secretary raised the matter with his opposite number back in September. On Bangladesh, yes, again the hon. Lady is right. Bangladesh does have a role to play. The first thing is to solve and to stop the violence that flared up again as recently as a few days ago. That must come to an end. We must make sure that there is proper humanitarian access and that aid gets in to those people who are displaced and homeless, and then we must see the report that comes out from the Burmese Government. Certainly, any long-term solution needs to address the long-standing issue that has too often been ignored about the right of those people to have a state. That needs to be resolved in the round. I wholly concur with the hon. Lady’s remarks.
T1. If he will make a statement on his departmental responsibilities. 
Tomorrow we will welcome the President of Indonesia on a state visit. We are intensifying our diplomatic and economic links across south-east Asia. As well as having one of the world’s most thriving economies, Indonesia is in the vanguard of the political change shaping Asia, and this visit will be an opportunity for us to build on the strong partnership established over the past decade.
For nearly a decade I have been a supporter and patron of the Bereaved Families Forum Parents Circle, a grass-roots organisation which brings reconciliation and tolerance in Israel and the Palestinian territories. May I ask the Secretary of State or his Minister to pay tribute to this organisation and, at his earliest convenience on their next visit to the UK, to meet me and members of the group to discuss their work and how they can be further supported?
Yes, I can indeed commend the hon. Gentleman for his work with that group, which we know and think very well of. Its members do a difficult job trying to bring together people from both sides of the divide through their grief. I would be very happy to meet the hon. Gentleman and members of the group when it is convenient for both of us.
T3. Like many others in the House, I welcome the Government’s efforts to keep the EU budget in check. Will my right hon. Friend be taking any lessons on that from the past example or present policy of the Labour party? 
That would be a strange thing to take any lessons from, because when the shadow Foreign Secretary was Minister for Europe, the Labour Government signed away £7 billion of the British rebate with nothing in return. It is notable that last year Labour MEPs voted against a budget freeze in Europe because they wanted an increase instead. It is also notable that in the time that the shadow Chancellor was a Treasury adviser and in the Cabinet, the annual EU budget increased by no less than 47%.
Let me return to the subject of Europe, but its relationship with Iran. I associate myself with the latest round of sanctions that have been imposed. Given the imminence of the elections in the United States, what does the Foreign Secretary regard as being the next steps in the diplomatic engagement on the nuclear issue with Iran? In particular, following a rather well-sourced, I understand, piece in The New York Times last week, how does he judge the prospects for bilateral discussions between the United States and Iran on this issue?
The United States and Iran have both denied the prospects, let alone the existence, of such bilateral talks. The next step is for the E3 plus 3 nations, of which we are one, to consider what we can do in any further negotiations with Iran. Our experts are meeting on this. Of course, it is necessary for the US elections to be completed before any further round of negotiations can take place. We are open to those negotiations. We are considering whether to amend our approach in any way, but it remains the case that for them to be successful, Iran would have to engage with those negotiations in a much more meaningful way than before. In the absence of that, we have agreed intensified sanctions on Iran in the European Union, and I want Iran to know that as long as these negotiations are not successful, we will go on intensifying the sanctions pressure upon it.
T4. For over a decade the United Kingdom has supported Sierra Leone, both financially and through military involvement. Will my hon. Friend assure the House that he will do all he can to ensure that next month’s elections in Sierra Leone are free and fair? 
I am grateful to my hon. Friend for raising that important matter and can assure him that we are monitoring events carefully. For the edification of the House, the elections in Sierra Leone are on 17 November. All parties have completed their nomination procedures, political supporters have been active, there has been no serious trouble so far, thankfully, and the electoral institutions are making progress, but I acknowledge that there is more to do. The Department for International Development has a programme for the electoral cycle, from 2010 to 2014, and the high commission is engaged with the political leaders and, on election day, will provide a team of observers to ensure that the elections are free and fair.
T2. In the earlier discussion on Syria we did not talk about the refugees, but of course hundreds of thousands of people, both internally and in neighbouring countries, are now homeless and face a desperate situation. What are we and the international community doing to assist them? 
The hon. Gentleman is quite right to draw attention to that. There are now up to 350,000 refugees in neighbouring countries, about 1.2 million people are thought to be internally displaced in Syria and about 2.5 million need humanitarian assistance. It is a rapidly escalating humanitarian crisis that will only get worse in the coming months. The United Kingdom is the second largest bilateral donor to the relief effort. We have so far given £39.5 million and consideration is being given to what further assistance we can give. We are also helping directly as well as through UN agencies, particularly in Jordan, so we are doing everything we can to alleviate the suffering in the crisis.
T5. In the past three months our exports to the EU fell by 7.3% while our exports to the rest of the world rose by 13.2%. Does the Foreign Secretary agree that Britain’s future relies on strong trading relationships with the emerging economies that were largely neglected by the Labour party? 
My hon. Friend is absolutely right. That is why we are opening the 19 embassies and consulates to which the Minister of State, Foreign and Commonwealth Office, my right hon. Friend the Member for East Devon (Mr Swire), just referred. We are determined to expand Britain’s market share in the fastest-growing economies. In the past two years, from August 2010 to August 2012, we have seen an increase in our exports to China of 46%, to South Korea of 69% and to Thailand, which I will visit next week, of 118%.
The civil war in Syria and the estimated 100,000 refugees are having a seriously debilitating impact on Lebanon and remind us of the horrors that took place in that country between 1975 and 1990. What steps are the Government taking, through the international community, to try to return some stability to that country?
Again, that is an absolutely crucial issue. It is not a containable crisis, as I said earlier, and the impact on Lebanon is the starkest and most worrying example of that. We are working closely with the authorities in Lebanon. After the recent bomb outrage, the Prime Minister spoke immediately to the Prime Minister of Lebanon to urge stability, and our ambassador there is very active. We have increased the assistance we give directly to the Lebanese armed forces and, of course, much of the humanitarian assistance we are giving is going to Lebanon.
Will the Foreign Secretary confirm that the EU annual budget and multi-annual framework increased at least a dozen times while Labour was in power but that to accuse that Government of being responsible for all those complex and EU-wide budget increases would be as simplistic and opportunistic as the attack made by the right hon. Member for Morley and Outwood (Ed Balls) on this Government yesterday?
I think that we have to judge the previous Government on the basis of what they actually did while in office. The fact remains that they took decisions that conceded the loss of a quarter of the United Kingdom’s hard-won rebate and left us with a current financial framework for the EU that was £13 billion over what they said in office would be the maximum they would accept. They let our country down, and they let it down badly.
What contact has the Foreign Secretary had with the Government of Turkey concerning the ongoing hunger strikes of Kurdish political prisoners and the demand for the release of Ocalan so that there can be negotiations on a future for the Kurdish people in Turkey whereby their language and their culture will be fully recognised in accordance with the recommendations of the Council of Europe?
We always try to make it clear in our conversations with the Turkish Government at both ministerial and official level that it is important that Turkey continues to make progress towards political reform and full implementation of the rule of law measures that we all want to see. I hope that the discussions between the Turkish political parties on a new constitution take us several steps forward. I would be happy to talk to the hon. Gentleman further about the particular case that he has described.
Will my right hon. Friend update the House on developments in Somalia?
Yes, absolutely. We welcome the election of a new President of Somalia, to whom I spoke directly after his election. The new Under-Secretary, my hon. Friend the Member for Boston and Skegness (Mark Simmonds), has already visited Somalia with the International Development Secretary. Important progress has been made since the London conference on Somalia, with a reduction in piracy, al-Shabaab in military retreat, and now a new and legitimate President. The United Kingdom will continue its strong support for these developments and the international leadership that we have given in relation to them. We will place just as much emphasis on Somalia in the coming year as we have in the past year.
What assessment has been made of the monitoring report by the Organisation for Security and Co-operation in Europe on the outcome of the Ukrainian parliamentary elections?
We have had a preliminary report from the observers that indicates a number of shortcomings. We hope that in the remaining stages of the electoral process, in any appeals that follow, and, crucially, in how the Ukrainian Government conduct themselves after the elections, we will not see the wholesale democratic backsliding that we fear and that would set back Ukraine’s relationship with Europe.
Many emerging economies such as China are showing significant interest in investing in energy projects off the East Anglian coast. Will the Minister outline his plans, working with other Departments, to maximise these trade opportunities to create jobs?
Indeed we can do that. We are in a good position with China at the moment, not least following our acceptance of the very important investment of companies such as Huawei, which places us very well to take in further investment. We have been talking about exports, but it is worth pointing out that the flipside of the coin for this country is inward investment, with some £250 billion-worth of opportunities in our infrastructure between now and 2020. We do need Chinese investment. We need investment from around the world, and we welcome that. If my hon. Friend has good examples in his constituency, that is all to the good.
I call Mr Kelvin Hopkins. [Interruption.] I thought that the hon. Gentleman wanted to ask a question. Well, it will have to wait for another time; fair enough. I call Mr David Winnick.
I hope that the nation will appreciate that, Mr Speaker.
Is it not of interest that both United States presidential candidates have emphasised in the debates that took place between them their support for sanctions rather than any military strike against the Iranian regime? Does not that very largely express the mood in the United States, let alone here, that warmongering, which unfortunately some people are involved in—certainly not the Foreign Secretary—would be wrong and counter-productive?
Both candidates in the presidential debates have, yes, been talking about the policy that I have been talking about in this House. I am sure that the two candidates for President of the United States are the experts on the mood in the United States more than any of us can possibly be here. Our approach, and that of the United States, is based on sanctions and negotiations. The United States is part of the E3 plus 3 nations that I have been talking about, and its sanctions are as strict as anyone’s, so it clearly believes in this approach.
Is there not a democratic imbalance—I know that the Foreign Secretary will agree with this question and so give a good answer—in allowing every 16-year-old in Scotland to vote on whether to remain in the Union while ensuring that no one in this country under the age of 55 has ever had a chance to vote on whether we should stay in the European Union?
Since my hon. Friend seems to know that I will agree with him, I am not sure why I am bothering to answer to question, but the rules of the House require me to do so.
Tell that to the Prime Minister.
Order. Mr Bryant, calm yourself. I am worried about you—you are supposed to be a statesman.
That does not mean that I am going to give a very full or enlightening answer. My hon. Friend is comparing apples with oranges when he talks about the voting age in one referendum and the time elapsed since another referendum. I am sure that he appreciates that.
In Azerbaijan there is continuing arbitrary detention, torture and trumped-up charges against human rights defenders, journalists and now even YouTube uploaders. What active interest is the Government taking in relation to a number of recent and current cases in the courts?
We raise both general concerns and individual cases in the regular conversations between our ambassador and the Azeri authorities. I also do so myself when I have what are quite frequent conversations with the Azeri Foreign Minister.
Several hon. Members
Order. I am sorry to disappoint colleagues, but as I have said before this is a box office occasion and I hope that colleagues disappointed this time will not be disappointed next time.
(Urgent Question): To ask the Secretary of State for Health to make a statement on the steps the Government have taken to ensure the safeguarding of former Winterbourne View residents.
The review into the abuse at Winterbourne View hospital, established by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), set out 14 actions to transform care and support. Central to the review is ensuring the safety and well-being of these very vulnerable people. I shall publish the final report before the end of November.
When Winterbourne View closed, NHS commissioners put in place independent clinical and managerial supervision and commissioned an independent assessment of every patient. The Care Quality Commission worked with commissioners to relocate Winterbourne View patients to suitable alternative placements.
In March, the Department of Health review team commissioned NHS South of England to follow up the 48 patients who had been in Winterbourne View, and there was a further review in September. The first review in March revealed that 19 former patients were the subject of safeguarding alerts. In response to this, officials asked commissioners to take appropriate action and confirmed that a follow-up would take place in six months’ time. I was extremely concerned to be informed that this follow-up had revealed that there are current safeguarding alerts for six former patients. I am assured that these are all being followed up to ensure the safety and well-being of the individuals concerned. That is extremely important. Furthermore, the September follow-up exercise revealed that 32 Winterbourne patients were now living in the community in their own family homes, in supported living or in a residential care home, with 16 still living in hospital settings.
The priority is to improve commissioning to develop the good local services that will prevent people from being sent to hospital inappropriately. We are working closely with the NHS Commissioning Board, the Local Government Association and directors of social services on what support local services need. Although a small number of people will need hospital treatment, we expect to see—and, indeed, must see—a substantial reduction in the number of in-patients.
We intend to strengthen safeguarding arrangements to prevent and reduce the risk of abuse and neglect of adults in vulnerable situations. Where there are safeguarding concerns, the local safeguarding adults boards need to be closely involved. The boards will be placed on a statutory footing for the first time, ensuring a co-ordinated approach to local adult safeguarding work.
The Government will put in place the necessary legislation for safeguarding adults boards, and local councils should bring clarity to their roles and responsibilities, but it is the responsibility of the care provider—we must remember this—to ensure a culture of safety, dignity and respect for those in their care, including stopping abuse before it happens. Those providers must be held to account for the care that they provide.
I thank the Minister for his statement, but there remain serious concerns about whether the Government have taken all necessary steps to ensure that the former patients of Winterbourne View are now receiving safe and effective care. Last night’s “Panorama” programme revealed that 19 patients have been subject to safeguarding alerts since leaving Winterbourne View. Not all those alerts mean that someone has been harmed, but “Panorama” said that one was due to an incident of assault and another had resulted in a criminal investigation. Is that an accurate reflection of the picture?
Have the families of all patients with a safeguarding alert been given the full details? What specific action has been taken as a result of the alerts, and can the Minister guarantee that the patients in question are all no longer at risk? Can he also guarantee that all local commissioners responsible for all the former Winterbourne View residents now have a proper plan in place to ensure that they receive good-quality care?
Has the Care Quality Commission recently inspected all the providers that former Winterbourne View patients were moved to, and are the Government confident of the CQC’s findings? Last night’s programme raised particular concerns about Postern House, which the CQC inspected in January this year following the Winterbourne View scandal. The CQC said that it met all the essential standards of quality and safety, and that suitable arrangements were in place to ensure that people were safeguarded against the risk of abuse, yet “Panorama” revealed a number of problems at Postern House over several years and the fact that a former Winterbourne View patient had a safeguarding incident there in June this year. Is the Minister confident that all patients currently in Postern House are safe from the risk of abuse?
The Minister rightly said that responsibility for the care of people with learning disabilities lies with providers, commissioners and the CQC, but it is Ministers who set policy and have responsibility for ensuring that it is implemented. The Government have a particular responsibility to ensure that former Winterbourne View patients never have to suffer from such appalling abuse again. Organisations such as Mencap are also very concerned that the Government are not moving quickly or strongly enough to end the practice of sending patients with learning disabilities to long-stay institutions far away from their family and friends.
The Minister must answer our questions about whether former Winterbourne View residents are all now guaranteed safe care, and he must urgently bring forward proposals to reform learning disability services properly for the future.
I thank the shadow Minister for asking the urgent question. The view is shared on both sides of the House that what “Panorama” exposed is utterly intolerable and has to come to an end. I am absolutely determined that when I make the Government’s final response by the end of November, it will be robust and clear so that everybody understands what has to happen.
When I came into my job, I heard briefings about the whole saga and how long it has gone on. For years and years, public money has been spent on putting people into inappropriate settings, often putting them at risk of abuse. That is a national scandal, and it has to end. I will be very clear about ensuring that we take robust and effective action.
The hon. Lady is absolutely right that Ministers are here to set policy, and that is what I intend to do. Since my appointment, I have been working to ensure that we set the right policy to protect vulnerable individuals. She is right that they must never suffer from abuse. Of course, there is always the risk of rogue individuals who behave very badly, and they must be dealt with through the criminal law, as has been seen with Winterbourne View staff. I have also made the point that the corporate owners of such organisations must be held to account for things that go on in their homes if those homes have been neglected. I want to meet the parents of those who were at Winterbourne View to hear from them directly, and I will seek to make arrangements for that.
The hon. Lady mentioned the 19 safeguarding alerts. In fact, that intolerable figure was in March but by September, the number was down to six. She is right, of course, that not every safeguarding alert means that something awful is happening. It means that concerns have been raised, and it is important that people raise their concerns. I assure her that I will do everything I can to end this scandal and ensure that we have proper safeguarding arrangements in place.
Will my hon. Friend assure the House that the alerts are being actioned and dealt with? We know that on previous occasions, South Gloucestershire council and Avon and Somerset police received countless alerts, but if it had not been for the BBC and “Panorama”, we would never have found out about this issue. When I saw the programme last night, I was appalled that patients can be moved hundreds of miles without their families—and their parents in particular—being told. I thought that was an outrage.
My hon. Friend raises extremely important points. First, we must ensure that the alerting system works effectively. We are putting safeguarding boards on a statutory basis. That is important and means that all key players will have a part in ensuring that adults in vulnerable situations are kept safe. We must ensure that alerts always work effectively in the future.
My hon. Friend’s point about individuals being placed a long distance away from home is of absolute concern. It strikes me that if someone is placed far away from their community, in what is effectively a closed setting, conditions are created for potential abuse to take place. That has to stop.
Does the Minister agree that there can be no excuse for abuse in any setting at any time? Is there not a profound problem that many of our most vulnerable citizens up and down the country are looked after by people who are poorly trained, poorly qualified and paid the minimum wage for 12-hour shifts? Is that the underlying root of this problem?
First, it is important to make it clear that many highly dedicated care workers provide fantastic quality care for elderly people and other adults in vulnerable situations. However, the hon. Gentleman is right to address the fact that we need to raise standards across the board. We are working with Skills for Care to ensure there is a code of practice to implement proper standards, and that minimum training standards apply across the sector. We must also ensure that we keep people in good health and well-being in their own homes as much as possible, reducing the number of people who go into care and nursing homes. That will make it possible to spend more on those people who do need to go into a home, and ensure that standards are maintained at the right level.
As we learnt from Winterbourne View, the absence of safeguarding alerts is not necessarily a sign that everything is okay. Winterbourne View was receiving £3,500 a week for some of its residents, yet it was delivering very poor care and allowing its staff to abuse. In future, can we ensure that the contracts let by social service departments and the NHS are written not by the provider, but by those who are buying the service in the first place to get the right quality of care?
I pay tribute to my right hon. Friend for his work in this area. He draws attention to the fact that there is a serious issue about the quality of commissioning and the work done by primary care trusts and, in some cases, local authorities. Too often, people seem to be placed in those settings and then to all intents are purposes forgotten about, which is not acceptable. Standards of commissioning and ensuring that contracts contain the right terms are extremely important.
Does the Minister agree that this whole dreadful saga—which he rightly describes as a national scandal—underlines the importance of self-advocacy for vulnerable people? In his legislation and any guidance that may follow from it, will he take steps to ensure that the voices of these most vulnerable people will be heard directly wherever possible?
The right hon. Gentleman makes an extremely valuable point, and I would be happy to discuss that with him further. Too often in the past there has been a paternalist approach in which others have decided what is best for individuals. Hearing the voice of people with learning disabilities is absolutely central to getting this matter right.
People who watched “Panorama” will know that a tall, flame-haired young man named Simon Tovey was one of the patients who suffered horrific abuse. His mother, Ann Earley, is my constituent, as is Simon, who has now returned to a lovely community care home in West Lavington. Mrs Earley believes that the views of parents in particular were not heard under the system—they knew for years the problems pertaining to Simon’s care. What reassurance can the Minister give to Mrs Earley, and the House, that the views of parents and other responsible adults will be included when seeking to avoid these tragedies in the future?
It struck me when I listened to the story of that family that I would like to meet them if they are interested in having that discussion. Just as it is essential that people with learning disabilities have their say, it is critical that the family is involved in the discussions before the commissioning takes place, so that they are partners in the decisions that are taken in respect of those individuals.
Can the Minister reassure the House that there are sufficient inspectors to go around those establishments during the day, during the evening and at night to ensure that standards are maintained?
Inspections are essential to ensure that we identify where problems exist. The role of the Care Quality Commission is critical in that respect. We need to do more to open up those establishments to public view. One role that the new local HealthWatch can take is to go into care homes, nursing homes and so on to see for itself. The more there is a culture of openness, the less likely it is that abuse will take place.
I commend to my hon. Friend the work of organisations such as the Swindon Advocacy Movement, which does so much work not only to advocate for service users, but to train volunteers, so that more adults with learning difficulties can stay in the communities in which they live, work and thrive. In that way, the nightmare scenario of Winterbourne View can be avoided in future.
I absolutely commend the work of the organisation to which the hon. Gentleman refers and would be interested to hear more about it. The scandal is that so many people over so many years have been put into institutions and ended up there for years when their care would be much more appropriate for their needs if it took place in their communities through supported living or in a care home. As my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) mentioned, the extraordinary thing is that we were spending public money—on average, £3,500 per patient in Winterbourne View—to put people at risk of abuse. Often, an appropriate care package costs less than that, and gives the individual the care they need in their own community.
I have raised with the Minister and his predecessor the problem that, often, the responsible authority does not know where people are placed. Families might have died since the placement, and yet there is no national audit of placements of people with learning disabilities, who are often placed a long way from their home. When the Minister returns to the House in November, will he ensure that there is an audit of where people are placed so that we can track them properly?
I shall certainly consider the hon. Lady’s point and am happy to discuss it further with her. At the end of the day, we must ensure that people in highly vulnerable situations are adequately protected. I want to ensure that all the steps we take are aimed at that goal.
The Minister has mentioned raising the standard and quality of care providers. Will he consider the introduction of a starred grading system for care providers, so that we have absolute transparency on how well they are performing, and so that we know the most excellent care providers and the worst?
My hon. Friend raises an important point. One thing we are doing on the NHS Choices website is having quality indicators for every care home, nursing home and so on. That means that any individual looking for a care home for a loved one will be able to find out much more about the quality of the care that an organisation provides. In due course, the website will include user reviews, so that people who have experienced care in those homes will have their voices heard. That openness of information could have a transformational effect in driving up standards.
It beggars belief that some of the vulnerable adults who were subjected to the most appalling and horrific abuse at Winterbourne View were moved to other providers where they were either abused—according to the “Panorama” allegations—or at risk of further abuse. Will the Minister reassure me that all local commissioners responsible for each of the former Winterbourne View residents have a proper plan in place to guarantee that they are now receiving safe and effective care?
I share the hon. Lady’s view on what has happened. We must make absolutely certain that every commissioner is held to account. My understanding is that proper arrangements are in place for all those individuals, but I will continue to monitor the situation to ensure that that remains the case. We must be alert to the interests of the 48 residents who were in Winterbourne View, but we must also focus our minds on the 1,500 people who are in settings of that sort—assessment to treatment centres—often for years. The interests of all those individuals are important.
To put it bluntly, after all this, is the Minister still confident in the CQC and does he believe that it is fit for purpose?
I tend to the view that we have had too many changes of regulator over a number of years, and that continuity would be a good thing. An assessment of the CQC earlier this year indicated that it was on the right track. I have met the new chief executive and am reassured by the plans he has in place. It is seductive to believe always that it is an attractive proposition to abolish an organisation and set up a new one, but is there any more chance that a new organisation will be better? Let us therefore make the CQC work properly.
I welcome the Minister’s response—he is sincere in his desire to address these issues. Does he recognise the important role of whistleblowers? Does he have any information on concerns raised by whistleblowers in respect of the alternative provision before Winterbourne View patients were transferred?
The role of whistleblowers is central. Importantly, the Government have funded a whistleblowing helpline, which is available to any worker in the care sector—it covers all care homes. It is important that any worker at any stage feels they can raise their concerns with the relevant authorities so that they are properly investigated. What happened with the whistleblower at Winterbourne View was not acceptable, because their concerns were not taken up effectively.
I welcome the Minister’s statement. On inspection, can he clarify what provision exists for inspectors to speak to patients? How will that be further enhanced?
I am sure that inspectors can speak to patients, and that they routinely do so, but I will check on the important point the hon. Gentleman makes. We mentioned earlier the views of those with learning disabilities and their families, but it is essential that the regulator hears directly from them of their potential concerns.
I am not sure that the Minister has made his position clear. Is it his intention to end the appalling practice whereby vulnerable people can be transported to establishments hundreds of miles away from their home town at the whim of the authorities and without the knowledge and consent of their families?
I have tried to be clear on my views on what has been happening—it has been going on for years. As I have said, the fact that someone is sent 200 miles away from home creates the conditions in which abuse is more likely than if they are in their own community. I want that to end—I want to be as clear as I can that that is a national scandal that needs to be brought to an end.
I thank the Minister for his comments. I also watched the “Panorama” programme last night and was horrified. According to the local council and the Minister, changes have been made. Will he confirm that the lessons learned will be conveyed to the devolved Administrations in Scotland, Wales and Northern Ireland to ensure that this terrible abuse never happens again anywhere in the UK?
The hon. Gentleman makes an essential point. Wherever people are, they must be protected from potential abuse and benefit from high standards of care. I will give him my absolute assurance that we will work closely with the devolved Administrations to ensure that people receive that benefit, wherever they are in the UK.
I heard the Minister’s earlier answer on the importance of whistleblowing, but will he set out what further steps he will take to encourage staff to whistleblow and to ensure that, when they come forward with concerns, they do not suffer retribution as a result?
The legal framework is satisfactorily in place to protect whistleblowers who raise their concerns with the relevant authorities, but this is about culture. We must do everything we can to ensure that providers encourage their staff to raise concerns—internally first, if possible, but with other authorities, if necessary—whenever they see abuse or neglect taking place. We must also encourage individuals to feel safe about raising concerns. The framework of protection is there for individuals to do that.
There are two problems. First, the “out of sight, out of mind” mentality has meant that thugs have been able to get away with terrible behaviour in care homes. Secondly, despite the enormous advances in ischaemic heart disease, cancer and diabetes, for example, the amount of money invested every year to find solutions and treatments for mental health conditions remains very poor.
On the first point, I agree with the hon. Gentleman that these closed settings and institutions too often create the conditions for abuse to take place. It is all the more important, then, to get the regulation right for the sake of those individuals who have to be in such institutions—a minority have to be there for their own safety or that of the public. On the second point, he raised the general issue that for a long time—probably, it has always been the case—mental health has been a poor relation to physical health in terms of the amount of money spent on research and how the money flows within the NHS. I seek to address that.
In Bristol, we face the closure of care homes, while south Gloucestershire is outsourcing the in-house home care teams. Following the case of Winterbourne View, which is just outside my constituency, there is a lack of confidence in the area in the private sector. What can the Minister do to reassure people that it is safe to place vulnerable relatives in private sector care homes?
First, abuse is unacceptable and horrifying wherever it takes place, whether in the public sector or the private sector. The review that followed Winterbourne View being exposed revealed poor standards of care in too many places in both the public and private sectors. We need to be clear on that. Secondly, I have questioned whether there is adequate corporate accountability and whether adequate rules and regulations are in place to ensure that accountability. If people are making a profit out of providing care, they have to be held to account for the standards of that care.
May I raise with the Minister my concerns about the relaxation of checks on people who work with vulnerable adults and children, as set out in the Protection of Freedoms Act 2012? As a new Minister, will he undertake to look at the specific provisions in that Act and see whether he is satisfied that our most vulnerable people are protected?
I am happy to discuss the matter further with the hon. Lady. It is clear, though, that when a care home provider seeks to recruit a member of staff to work with people in a care home setting, they have to—[Interruption.] They are obliged in law to carry out criminal records checks on people who work within that setting. I repeat, however, that I am happy to discuss the matter with the hon. Lady and to look again at the issues.
As the Minister has made clear—his commitment is coming through—the care provider is key. As he moves forward, will he look at whether there is any disparity between private and public sector provision? In cases that I am aware of, there has been a qualitative difference: vulnerable individuals are not being looked after as well as they ought to be by some private sector providers.
We probably all know from our constituencies of fantastic private sector care providers that provide a fantastic quality of care to older or younger adults with disabilities and so on, so we must be careful not to condemn the whole sector. My clear view is that wherever there are low standards of care it is unacceptable. But let us remember Mid Staffordshire hospital, where hundreds of people lost their lives unnecessarily owing to poor standards of care. It can happen in both public and private sectors. We must find it intolerable in both.
Points of Order
On a point of order, Mr Speaker. During yesterday’s urgent question on ash dieback, we discussed the Government’s reductions to forest research, and I inadvertently misled the House. I said that they had cut it from £12 million to £7 million, but in fact the figure is £10 million. I hope that the House will accept my apology and that the record can be put straight.
I am sure that the House is extremely grateful to the hon. Lady. What she said is now on the record.
On a point of order, Mr Speaker. In response to a written question from my hon. Friend the Member for Barnsley Central (Dan Jarvis) on the burial of what we hope turns out to be Richard III, the Under-Secretary of State for Justice, the hon. Member for Maidstone and The Weald (Mrs Grant), wrote on Friday that
“the current plan is for them to be reinterred in Leicester Cathedral.”—[Official Report, 25 October 2012; Vol. 551, c. 997W.]
That answer was welcomed and seen as very exciting in the city of Leicester. Last night, however, the Department appeared to backtrack. When asked, it refused to repeat her words and simply said:
“We will await the results before any burial arrangements are made.”
No one would want to accuse the Government of now U-turning on Richard III. Will you advise us, Mr Speaker, on whether the Under-Secretary has given notice of her intention to come to the House to clear up the confusion?
I am grateful to the hon. Gentleman for his point of order. In response, I make two points.
A hearse, a hearse, my kingdom for a hearse.
We are always obliged to the hon. Gentleman for chuntering from a sedentary position about hearses. I hope he will be good enough to allow me to intervene on him and respond to the point of order from the hon. Member for Leicester South (Jonathan Ashworth). First, I think that his late majesty has been dead for long enough to evade our normal rules on references to monarchs. Secondly, the hon. Gentleman has put the matter on the record and attempted to obtain clarification, which will have been heard on the Treasury Bench, but beyond that I am afraid that it is not a matter for the Chair.
Further to a point of order that I raised in the House yesterday evening, Mr Speaker. Have you received any notification from the Minister of State, Department for Environment, Food and Rural Affairs, the hon. Member for Somerton and Frome (Mr Heath), that he intends to apologise to the House, or at least clarify the comments that he made yesterday in the First Delegated Legislation Committee about wild animals in circuses? He inadvertently—I am sure—misled the Committee by claiming that a full ban on wild animals in circuses had been part of Her Majesty’s Gracious Speech to this Parliament. That is not the case. Since the approval of that order is on today’s Order Paper and will have to be dealt with by the House, surely it would be appropriate for him to come to the House to apologise or clarify his comments.
The short answer to the first question in the hon. Gentleman’s attempted point of order is no. I have received no indication of the Minister’s intention to make a statement. The hon. Gentleman is a wily and experienced hand who has made his own point in his own way, but I know also that he would not seek to embroil me in his controversy with the Minister, for that would be unworthy conduct of which I feel sure he would never be guilty.
On a point of order, Mr Speaker. You will be aware that the Government, uniquely, withdrew a statutory instrument on cuts to injuries compensation from a Committee and said that they would listen to the concerns on both sides of the House about the cuts. Are you aware that the statutory instrument is being brought back unchanged to a Committee this Thursday? Have you had any request from the Government for a Minister to make a statement to explain their abject failure to listen to Members and the public at large on this important issue?
I am grateful to the right hon. Gentleman for his point of order. Again, let me seek to engage with him directly. The answer is no, I was not aware that the statutory instrument was being brought back, as he puts it, unamended this Thursday. I am sorry if he feels that I have been inattentive in not being aware of that salient fact, but the truth is that I was not. More importantly, however, whatever he thinks about the matter, there is nothing disorderly about it. The matter can be debated in that Committee, and I have a hunch that it probably will be.
The right hon. Gentleman assures me from a sedentary position that it will be. We are grateful to him.
Mental Health (Approval Functions)
Presentation and First Reading (Standing Order No. 57)
Mr Secretary Hunt, supported by the Prime Minister, the Deputy Prime Minister, Mr Secretary Hague, Mrs Secretary May, Secretary Chris Grayling and Norman Lamb, presented a Bill to authorise things done before the day on which this Act is passed in the purported exercise of functions relating to the approval of registered medical practitioners and clinicians under the Mental Health Act 1983.
Bill read the First time; to be read a Second time today, and to be printed (Bill 83) with explanatory notes (Bill 83-EN).
Protection of Workers
Motion for leave to bring in a Bill (Standing Order No. 23)
We come now to the ten-minute rule motion. I call Mr Graeme Morrice.
Not that “Graeme Morrice”. We have heard several times from the hon. Gentleman today and are enriched by the experience, but on this occasion I have Mr Graeme Morrice from Livingston in mind.
I beg to move,
That leave be given to bring in a Bill to create a specific offence relating to assault on those whose work brings them into face-to-face contact with members of the public; and for connected purposes.
Anyone who assaults or abuses someone who is going about their work should face the full force of the law. I am pretty sure that there would be absolute unanimity on that point in the House, and I want to thank colleagues, including Government Members, who have supported early-day motion 574 on my Bill. However, far too often, assaults on workers, which most research indicates are increasing, still go unpunished. This Bill addresses the real day-to-day experience of verbal and physical assault, which is all too common to many thousands of public-facing workers across the UK. The Bill would build on the good work done on this issue in recent years, supporting victims and ensuring that those who break the law are held fully accountable for their actions.
Currently, the Emergency Workers (Obstruction) Act 2006 and the Emergency Workers (Scotland) Act 2005 give emergency services staff extra protection under the law. I understand and support the case that was made for giving extra protection to police officers, paramedics, firefighters and others in the emergency services, and I pay tribute to the trade unions and professional bodies that fought for that legislation. However, I believe there is a strong case for all public-facing workers to receive the same additional protection. Why should, for example, teachers, shop workers, health visitors, posties or bus drivers—all groups of staff who face high levels of verbal and physical abuse at work—not have the right to extra protection under the law? All these people and many more provide important services to the public, but are often in fear of being attacked or assaulted while at work. That is totally unacceptable and something that we should be constantly reviewing to ensure that everything possible is being done to reduce the potential for workers to come to harm simply for doing their job. The Bill will address the current differences in legal protection and give added penalties under the law to those convicted of assaulting a public-facing worker.
I believe that the Bill is necessary because of the increase in physical and verbal assaults on front-line public-facing workers in the UK. Research published by the British Retail Consortium in January this year highlighted the fact that in the past 12 months incidents of violence and verbal assault against retail staff had increased by 83% compared with the previous year. The survey highlighted the fact that 26 offences are committed per 1,000 employees. The charity Retail Trust has also published research, which indicated that 60% of those working in retail reported being treated aggressively at work. It also found that 56% of those affected had been the target of aggressive behaviour on more than three occasions in one year.
I am sure that each Member will be aware of examples of this type of crime from their own constituencies. One example recently brought to my attention that highlights the often premeditated nature of the violence perpetrated against staff is that of a shop worker in a busy city centre store who was working at the checkout. She had to tell off a customer for trying to push in at the front of the queue. The individual concerned was verbally abusive to the shop worker and other customers, but did leave the store. However, he then returned to the store in the evening, when it was much quieter, and assaulted the member of staff, hitting her over the head.
I am pleased that there is some emerging evidence to show that assaults on emergency service workers have declined since the introduction of emergency worker legislation across the UK. I hope and believe that the introduction of the Bill would have a similar impact on assaults against other groups of public-facing workers. The Bill would seek to create a specific offence relating to assault on people whose work brings them into face-to-face contact with members of the public. The Bill would provide for a new offence, with prosecution under summary procedure and a maximum sentence of 12 months and a £10,000 fine. The purpose of the new law is to provide additional protection to workers whose employment requires them to have at least some face-to-face contact with the public.
I believe that the proposed new law would be used in the following circumstances: when a worker has been assaulted in the course of his or her employment and the offender either knew or ought to have known that the worker was acting in the course of their employment—for example, a shop worker requiring proof of age to sell alcohol. The new law would also be used when a worker was assaulted by reason of his or her employment and the assault was at least partly motivated by malice towards the worker by reason of his or her employment—for example, someone spitting on a shop worker because they believe that they have been asked to wait too long before being served. The sentences would be the same as those for common-law assault, but there is an expectation that sentences handed out for the new statutory offence would exceed those imposed for common-law assault. The Bill would cover assaults on public-facing workers, including shop workers, public transport workers, local government staff, Royal Mail and Post Office counter staff, non-emergency health workers and so on. That is not an exhaustive list, and I would be keen to hear the opinions of others on the exact definition of the categories of staff that would be covered.
I would also like to note that my Labour colleague in the Scottish Parliament, Hugh Henry MSP, introduced a similar Bill at Holyrood in 2010. Unfortunately, the Scottish National party Government failed to support the progress of the Bill and voted it down at its first stage, leading the general secretary of the Union of Shop, Distributive and Allied Workers to comment that:
“Scotland’s shopworkers have been very badly let down by the SNP.”
The SNP Government have also stopped recording this type of offence in the annual Scottish crime survey, which is another lamentable decision. I hope that the SNP Members of this House have had time to think about that decision and will support this measure to increase protection for workers.
Before drawing to a conclusion, I would like to commend the shop workers union USDAW for its tremendous work on the issue of violence against workers and, specifically, on promoting the Bill. The union’s “Freedom from fear” campaign, which it has been running for the last 10 years, has been a huge success and has played an important part in raising awareness of the issue. We welcome the fact that progress has been made, but USDAW is the first to acknowledge that the same issues still persist. That is why the union has been instrumental in campaigning for this legislation. USDAW and the other unions that represent public-facing workers will be important partners in taking the Bill forward, but I shall also seek to work with employer and business organisations and those representing the retail sector, as well as with major retailers and large charities with front-line staff, to progress the Bill.
The Bill would impact on the lives of the hundreds of thousands of public-facing workers who face verbal and physical assault at work each year. It would help to ensure that the public looked at those groups of workers differently and that those who failed to treat them with the appropriate respect were properly punished. I very much hope to have the opportunity to progress the Bill, and I look forward to the whole House supporting it.
Question put and agreed to.
That Graeme Morrice, Michael Connarty, Mr David Hamilton, Grahame M. Morris, Ian Lavery, Ian Mearns, Mr David Crausby, Jim Sheridan, Mr Michael McCann, Alex Cunningham, Steve Rotheram and Lindsay Roy present the Bill.
Graeme Morrice accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 1 February 2013, and to be printed (Bill 84).
On a point of order, Mr Speaker. I do not want to try your patience, but I wonder whether you could offer me some advice on the circumstances in which a Minister has made not only a contentious statement but a statement that can be proved absolutely untrue. Taking a random example plucked from the air, a Minister might have said that the Queen’s Speech contained a specific measure, yet it turned out that that measure did not exist. Can you confirm that it would be entirely up to the Minister concerned to take responsibility for correcting the public record?
It is up to the Minister concerned to take responsibility for correcting the record. I hope that that is helpful to the hon. Gentleman.
Mental Health (Approval Functions) Bill (Allocation of Time)
That the following provisions shall apply to the proceedings on the Mental Health (Approval Functions) Bill:
1. (1) Proceedings on Second Reading, in Committee, on Consideration and on Third Reading shall be completed at this day’s sitting.
(2) Proceedings on Second Reading (so far as not previously concluded) shall be brought to a conclusion four hours after the commencement of proceedings on this Motion.
(3) Proceedings in Committee, on Consideration and on Third Reading shall be brought to a conclusion (so far as not previously concluded) at the moment of interruption.
Timing of proceedings and Questions to be put
2. (1) Notices of Amendments, new Clauses and new Schedules to be moved in Committee may be accepted by the Clerks at the Table before the Bill has been read a second time.
(2) As soon as the proceedings on this Motion have been concluded, the Order for the Second Reading of the Bill shall be read.
(3) When the Bill has been read a second time—
(a) notwithstanding Standing Order No. 63 (Committal of Bills not subject to a programme order) it shall stand committed to a Committee of the whole House without any Question being put; and
(b) the Speaker shall leave the Chair whether or not notice of an Instruction has been given.
3. (1) On the conclusion of proceedings in Committee, the Chairman shall report the Bill to the House without putting any Question.
(2) If the Bill is reported with amendments, the House shall proceed to consider the Bill as amended without any Question being put.
4. For the purpose of bringing any proceedings to a conclusion in accordance with paragraph 1, the Chairman or Speaker shall forthwith put the following Questions (but no others) in the same order as they would fall to be put if this Order did not apply—
(a) any Question already proposed from the Chair;
(b) any Question necessary to bring to a decision a Question so proposed;
(c) the Question on any amendment moved or Motion made by a Minister of the Crown;
(d) any other Question necessary for the disposal of the business to be concluded.
5. On a Motion so made for a new Clause or a new Schedule, the Chairman or Speaker shall put only the Question that the Clause or Schedule be added to the Bill.
Sitting on Wednesday 31 October
6. At the sitting on Wednesday 31 October, the House shall not adjourn until—
(a) any Message from the Lords has been received and any Committee to draw up Reasons which has been appointed at that sitting has reported, and
(b) the Speaker has reported the Royal Assent to any Act agreed upon by both Houses.
Consideration of Lords Amendments
7. (1) Any Lords Amendments to the Bill shall be considered forthwith without any Question being put; and any proceedings interrupted for that purpose shall be suspended accordingly.
(2) Proceedings on consideration of Lords Amendments (so far as not previously concluded) shall be brought to a conclusion one hour after their commencement; and any proceedings suspended under paragraph 7(1) shall thereupon be resumed.
8. (1) This paragraph applies for the purpose of bringing any proceedings to a conclusion in accordance with paragraph 7.
(2) The Speaker shall first put forthwith any Question already proposed from the Chair and not yet decided.
(3) If that Question is for the amendment of a Lords Amendment the Speaker shall then put forthwith—
(a) a single Question on any further Amendments to the Lords Amendment moved by a Minister of the Crown, and
(b) the Question on any Motion made by a Minister of the crown that this House agrees or disagrees to the Lords Amendment or (as the case may be) to the Lords Amendment as amended.
(4) The Speaker shall then put forthwith—
(a) a single Question on any Amendments moved by a Minister of the Crown to a Lords Amendment, and
(b) the Question on any Motion made by a Minister of the Crown that this House agrees or disagrees to the Lords Amendment or (as the case may be) to the Lords Amendment as amended.
(5) The Speaker shall then put forthwith the Question on any Motion made by a Minister of the Crown that this House disagrees to a Lords Amendment.
(6) The Speaker shall then put forthwith the Question that this House agrees to all the remaining Lords Amendments.
(7) As soon as the House has—
(a) agreed or disagreed to a Lords Amendment; or
(b) disposed of an Amendment relevant to a Lords Amendment which has been disagreed to, the Speaker shall put forthwith a single Question on any Amendments moved by a Minister of the Crown and relevant to the Lords Amendment.
9. (1) Any further Message from the Lords on the Bill shall be considered forthwith without any Question being put; and any proceedings interrupted for that purpose shall be suspended accordingly.
(2) Proceedings on any further Message from the Lords (so far as not previously concluded) shall be brought to a conclusion one hour after their commencement; and any proceedings suspended under paragraph 9(1) shall thereupon be resumed.
10. (1) This paragraph applies for the purpose of bringing any proceedings to a conclusion in accordance with paragraph 9.
(2) The Speaker shall first put forthwith any Question which has been proposed from the Chair and not yet decided.
(3) The Speaker shall then put forthwith the Question on any Motion made by a Minister of the Crown which is related to the Question already proposed from the Chair.
(4) The Speaker shall then put forthwith the Question on any Motion made by a Minister of the Crown on or relevant to any of the remaining items in the Lords Message.
(5) The Speaker shall then put forthwith the Question that this House agrees with the Lords in all the remaining Lords Proposals.
11. (1) The Speaker shall put forthwith the Question on any Motion made by a Minister of the Crown for the appointment, nomination and quorum of a Committee to draw up Reasons and the appointment of its Chair.
(2) A Committee appointed to draw up Reasons shall report before the conclusion of the sitting at which it is appointed.
(3) Proceedings in the Committee shall (so far as not previously concluded) be brought to a conclusion 30 minutes after their commencement.
(4) For the purpose of bringing any proceedings to a conclusion in accordance with paragraph 11(3), the Chair shall—
(a) first put forthwith any Question which has been proposed from the Chair but not yet decided, and
(b) then put forthwith successively Questions on motions which may be made by a Minister of the Crown for assigning a Reason for disagreeing with the Lords in any of their Amendments.
(5) The proceedings of the Committee shall be reported without any further Question being put.
12. Standing Order No. 15(1) (Exempted business) shall apply so far as necessary for the purposes of this Order.
13. (1) The proceedings on any Motion made by a Minister of the Crown for varying or supplementing the provisions of this Order shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement.
(2) Standing Order No. 15(1) (Exempted business) shall apply to those proceedings.
14. Standing Order No. 82 (Business Committee) shall not apply in relation to any proceedings to which this Order applies.
15. (1) No Motion shall be made, except by a Minister of the Crown, to alter the order in which any proceedings on the Bill are taken or to re-commit the Bill.
(2) The Question on any such Motion shall be put forthwith.
16. (1) No dilatory Motion shall be made in relation to proceedings to which this Order applies except by a Minister of the Crown.
(2) The Question on any such Motion shall be put forthwith.
17. (1) This paragraph applies if—
(a) a Motion for the Adjournment of the House under Standing Order No. 24 (Emergency debates) has been stood over to 7.00 pm, 4.00 pm or 3.00 pm (as the case may be), but
(b) proceedings to which this Order applies have begun before then.
(2) Proceedings on that Motion shall stand postponed until the conclusion of those proceedings.
18. (1) This paragraph applies if the House is adjourned, or the sitting is suspended, before the conclusion of any proceedings to which this Order applies.
(2) No notice shall be required of a Motion made at the next sitting by a Minister of the Crown for varying or supplementing the provisions of this Order.
19. Proceedings to which this Order applies shall not be interrupted under any Standing Order relating to the sittings of the House.—(Norman Lamb.)
Mental Health (Approval Functions) Bill
I beg to move, That the Bill be now read a Second time.
The purpose of the Bill is simple, but urgent. The Secretary of State described to the House yesterday how the need for it arose and came to light, and I hope that hon. Members will bear with me if some of what I say today repeats what he said then. May I begin by reiterating my gratitude to Opposition Members for the highly constructive approach that they are taking to the issue, without which we would not be able to respond with the necessary speed?
Detaining a mentally ill person in hospital and treating them against their will is clearly a matter of the utmost seriousness, and it is treated as such by the law and by health and social care practitioners. The statutory framework is contained in the Mental Health Act 1983, which sets out that, for assessments and decisions under certain sections of the Act, including detention decisions under sections 2 and 3, three professionals are required to be involved: two doctors and an approved mental health professional, usually a social worker. One of the two doctors must be approved under section 12 of the Act. When strategic health authorities came into being in 2002, the Secretary of State at the time quite properly and lawfully delegated to them his function under the 1983 Act of approving the doctors able to be involved in making these decisions.
Early last week, the Department of Health learned that, in four out of the 10 SHAs—North East, Yorkshire and the Humber, West Midlands and East Midlands—the authorisation of doctors’ approval was further delegated by the SHAs to NHS mental health trusts over a period extending, in some cases, from 2002 to the present day. The issue was identified as a result of a single doctor querying an approval panel’s processes. I was informed later in the week, as soon as the extent of the issue became clear, and since then, the Secretary of State and I have been kept informed of, and involved in, the action being taken.
This is an issue of great concern. Can the Minister reassure the House that the four areas that he has identified are the only areas in which this has happened, and that it has not taken place in other regions?
I can assure the hon. Lady on that point. All SHAs have undertaken an assessment of the position, and the position has been regularised for future cases in those four SHAs. Of course, individual patients may be moved to different parts of the country, but the problem relates to those four SHA areas.
Rampton and Ashworth are involved, and patients from Wales travel to those hospitals. Have there been any discussions between the Minister’s Department and the Wales Office or the Welsh Government on the implications of this for patients from Wales?
Yes, I can confirm that that is the case. The Secretary of State spoke to the relevant Health Ministers this morning. I hope that that gives the hon. Gentleman reassurance.
Following on from what the hon. Member for Arfon (Hywel Williams) has asked, may I ask the Minister, in relation to Northern Ireland, what investigations have taken place to ensure that no one was detained illegally, and whether there are likely to be challenges from people who have been sectioned? I am afraid that they might have reason to claim against the Government for that purpose, given that no legislation was in place. Please excuse the condition of my voice, by the way.
I am grateful to the hon. Gentleman for that intervention, but I am afraid that I struggled slightly to hear all the points that he was making. Perhaps the best way of dealing with all this is to ensure that I respond in writing to all his questions. I can also assure him that the Secretary of State spoke to the Northern Irish Minister yesterday and briefed them fully on the situation. There is good liaison there.
Our current assessment is that about 2,000 doctors were not approved properly in line with the provisions of the 1983 Act, and that those doctors have participated in the detention of between 4,000 and 5,000 of the patients currently detained in NHS or independent sector hospitals. There are two important points that I would like to make clear now. First, the decision to detain a patient under the Mental Health Act is primarily a clinical one. There is no suggestion, and no reason to believe, that the irregularity of the approval process for these doctors has resulted in any clinically inappropriate decision being made, whether the decision was to detain or not to detain. Nor is there any suggestion that the doctors approved by mental health trusts are anything other than entirely properly qualified to make these recommendations.
All the proper clinical processes were gone through when these patients were detained. There is no reason why the irregular approval process should have led to anyone being in hospital who should not be—or vice versa—and no patients have suffered because of this. The doctors had no reason to think that they had not been properly approved; they acted in total good faith and in the interests of the patients throughout this period. As of Friday last week, the SHAs concerned had corrected their procedures and all the doctors involved had been properly approved. I hope that that addresses the question raised by the hon. Member for Wolverhampton North East (Emma Reynolds).
This may be a naïve question, but will the Minister tell us whether doctors approved in one SHA area are then approved automatically for other parts of England or possibly parts of Wales, or is the approval confined to the particular SHA area?
My understanding is that people are approved for the SHA in which they work, but it is an important question and I will happily confirm the position to the hon. Gentleman in writing.
In the light of our legal advice, we do not believe that any decisions made about patients’ care and detention require review because of this irregularity. Doctors should continue to treat patients who are currently detained under the Mental Health Act in the usual way.
My second point is that we have been advised by First Treasury Counsel that there are good arguments to show that the detentions involving these particular approval processes were, and are, lawful. Given the seriousness of the issues, counsel also argues the need for absolute legal clarity and advises that this is most safely resolved through emergency retrospective legislation. We are taking that advice. As soon as the irregularity was identified, the Department moved swiftly to identify the best course of action and to put the necessary preparatory work in place. Officials immediately sought initial legal and clinical advice, and then swiftly analysed the options, including the reassessment of all the potentially affected patients, working with the health leads in the regions involved and clinical experts from the Royal College of Psychiatrists.
When I was briefed on the situation, I asked for detailed information on the time it would take—the Secretary of State has also sought and obtained this advice—and the clinical risks involved in reassessing all potentially affected patients. Last Friday, the Secretary of State asked for an emergency Bill to be drafted over the weekend as a matter of contingency, and he briefed the Prime Minister personally the following day. Following further discussions and analysis over the weekend, the decision to introduce emergency legislation was taken on Sunday.
At all times, the Secretary of State’s priority—and, indeed, mine too—has been to resolve this in a way that follows clinical advice. That is the most important thing. In the interests of a group of highly vulnerable individuals, it is important to do this in the most sensitive way. It would not have been feasible quickly to reassess all the patients and it may well have caused great distress to them and their families.
We have worked to remedy the problem as it relates to current and future detentions. The accountable officers for the four SHAs in question have written to Sir David Nicholson, chief executive of the NHS, to confirm that they have made the necessary changes to their governance arrangements. Furthermore, the accountable officers in the other six SHA areas have written to Sir David to confirm, in the light of this issue, that they have reviewed their own arrangements and are in full compliance with the Mental Health Act. That directly addresses the question asked by the hon. Member for Wolverhampton North East. I can confirm, incidentally, that approval in one SHA applies elsewhere in England. The Bill will put right those doctors’ approvals wherever they are now practising. That again gives complete clarity to that particular point.
Although we believe that there are good arguments that past detentions under the Mental Health Act were and are lawful, it is vital that doctors, other mental health professionals and, most importantly, patients and their families have absolute confidence in the decisions made. That is why, in relation to past detentions, we have decided that the irregularity should be corrected by the Bill.
On this serious matter, will the Minister give a fuller explanation of why, given that the proper procedure was not followed, making it irregular, it is none the less his advice that it remained lawful?
I cannot provide full detail, but I can repeat that the legal advice received by the Department was that there are good reasons to believe that the detentions are, and remain, lawful. Absolute certainty is essential in the interests of the patients concerned, whose care is paramount, and indeed of their families. That is why it is so important to proceed straight away with this retrospective legislation.
Although we are only aware of the problem in the four areas going back to 2002, the Bill applies in principle to the approval of all doctors under the Mental Health Act since its introduction in 1983. It retrospectively validates the approval of clinicians by those organisations to which responsibility was delegated, up to the point when all the relevant doctors were fully re-approved and their status put beyond doubt. The Bill will not deprive anyone—this is a really important point—of any of their normal rights of redress if they have been detained for any reason other than the narrow issue of the delegation of authority to approve by the SHAs. All the other rights remain exactly as they are. The provision addresses only the narrow issue of the nature of the authorisation. Nor will it affect any future detentions or legitimise any similar failures in the future—again, an incredibly important issue.
Necessary as it is to address the issue in that way, it is also important that we get to the bottom of how this happened. The Secretary of State has asked Dr Geoffrey Harris, chair of NHS South and former chair of the Buckinghamshire mental health trust, to undertake an independent review to look at how the responsibility was delegated by the four SHAs and, more broadly, the governance and assurance processes that all SHAs use for delegating any responsibilities. The Secretary of State will ask him to look at that in the context of the new NHS structures that come into force from next April to see whether any lessons need to be learned.
It is imperative that that review is swift. The Secretary of State has asked Dr Harris to report to him by the end of the year with recommendations to ensure that every part of the system employs the highest standards of assurance and oversight in the delegation of any functions.
In conclusion, I stress that both the Secretary of State and I have reviewed thoroughly with lawyers, clinicians and NHS managers all possible alternatives to introducing this retrospective legislation. The Secretary of State has been advised that all alternatives would be highly disruptive to the welfare of many of the most vulnerable patients in the mental health system, and would also deprive many other patients—another critical point—of the care they need while any action is undertaken. That is why, in such exceptional circumstances, we are proposing this retrospective legislation.
Detaining people under the Mental Health Act raises fundamental questions of individual liberty and public safety, requiring the most careful consideration. I am sure that there is general agreement across the House that the circumstances in which we find ourselves today are far from ideal. Members on all sides will want to use the time we have to satisfy themselves that the measures that the Government are asking the House to approve today are justified.
Emergency legislation tends to be forward looking in its scope, so the retrospective nature of the Bill before us is unusual and potentially troubling for Members. As I said yesterday, we will need to be sure that this is the only real course of action available and that it is not setting a precedent whereby emergency legislation can be used as a convenient means of correcting administrative failings, which could in itself breed a culture of complacency in public administration.
In asking those legitimate questions, however, we must have at the forefront of our minds the simple fact that the uncertainty which has arisen in the past week affects thousands of highly vulnerable people and their families, as well as having serious implications for patients and public safety. If we leave that uncertainty hanging, it will have the potential to cause real harm to the individuals concerned, and to damage public trust in our systems of individual and public protection.
The Secretary of State was right to act quickly, and to come to the House yesterday to make his exceptional and urgent request for legislation. I am surprised that he did not make the case for that legislation to the House in person today, but the Opposition have nevertheless concluded that, on balance, the public interest is best served by our supporting the Government in the swift action that they propose, and we will ensure as far as possible that that pragmatic approach is reflected in the other place.
In reaching our judgment, I think we can take some comfort from the fact that the main mental health organisations, as well as the Royal College of Psychiatrists, are, for now, supporting the Government’s course. However, concerns and questions have already been raised today—not least by my right hon. Friend the Member for Oxford East (Mr Smith)—which have not been fully answered. I must say to the Government that it is vital for the fullest possible answers to be given to the House today before any approval is given to this exceptional retrospective measure. I shall be seeking answers not just to the questions that I am about to ask, but to questions that the Secretary of State did not answer yesterday. There are matters of detail here, but matters of principle also arise, and I want to cover both in my speech.
May I clarify something? I had intended to make the Second Reading speech earlier, but I will be winding up the debate, and during that speech I shall seek to address any points raised by the right hon. Gentleman—and, indeed, any outstanding points raised by other Members.
I thank the Secretary of State for his intervention. We understand that these are urgent matters, and I am sure that he is receiving briefings from the Department, but I think that there is a sense among Opposition Members that that is not good enough, and that he should have been here to answer the questions that were asked. We appreciate that he will be winding up the debate, but I hope he will take careful note of all the questions that are asked, and will give every Member present the fullest possible answer.
First things first: let us begin with the detail. I think it would help the House to know more about the extent of the checks that have been carried out on the 4,000 to 5,000 cases involved. The very fact that the number remains vague suggests that there has not yet been a thorough case-by-case review. Does the Minister—or, indeed, the Secretary of State—agree that it is essential to conduct such a review, and to put a precise number on the extent of the problem? I asked yesterday whether the Department could tell us how many of the people concerned were in high-security hospitals. I think that that is an important aspect of the issue, and I should be grateful if the information could be given to us at some point this afternoon. Without detailed case-by-case checks, how can we be sure that this procedural defect was the only technical irregularity in the process that was operating in the four SHAs concerned? We need to be reassured that there are no further problems that will need to be corrected at a later date.
That brings me to another question that was not answered yesterday. Families of the people involved will have heard yesterday’s news, and will no doubt have been unsettled by it. Does the Secretary of State agree that it is important for the Government to make arrangements, urgently, for direct communication to take place with the families who have been directly affected so that the issue can be explained to them more fully, and in isolation from some media coverage that may not give them the reassurance and support that they seek? Have such arrangements been made, and has any facility been provided enabling questions to be answered so that people can be given that reassurance and support?
That, in turn, brings me to another important point. If the Government were to leave a vacuum in terms of advice and communication, it could of course be filled by less scrupulous elements of the legal profession seeking to initiate compensation claims. We have already read warnings today that efforts may be made to encourage patients to sue for £500 or £600 a day, the amount that a prisoner would receive in compensation for unlawful detention. I am sure the Secretary of State agrees that any such activities would be highly unsettling, and would amount to the potential exploitation of vulnerable people. I hope he will join me in sending the clearest of messages to the legal profession that that would not be at all welcome. On the other hand, we would not want to see any curtailment of individuals’ legitimate right to challenge the decisions made affecting their liberty as a result of the Bill.
I am glad that the right hon. Gentleman has made that second point. The fact that some people are litigious, possibly as a result of their condition—of which that is a notorious aspect—should not detract from their right to pursue a case if they wish to do so.
That is a good point. So many cases are involved that challenges may have already been in progress before this technical problem arose. There may have been complaints about the nature of the decision-making process, the number of professionals involved, or any matter relating to the process by which the decision was made.
I hope that it will reassure the hon. Gentleman to learn that I have been given access to Government lawyers—the Secretary of State promised that yesterday, and I am grateful to him for arranging it—and I have been assured that the Bill will not wipe away an individual’s right to issue a legal challenge on a different point of process. That is a fundamentally important point, and I am glad that the hon. Gentleman has given me an opportunity to put it on the record. We would certainly not support the Bill if it were intended to wipe away an individual’s rights retrospectively, and I am sure that the hon. Gentleman would not either. We are grateful for that reassurance from the Government.
Along with the urgent steps that are being taken to correct the legal position, we need a review of how this came about in the first place. If it had happened in a single SHA, the explanation might have been easier to ascertain and understand, but the fact that it happened in four SHAs points to a more widespread issue of concern. It raises the question whether the problem arose from historical practice among clinicians and NHS bodies in the four regions concerned, or whether a piece of Department of Health guidance that was circulated in the past may have been responsible. I hope that the Minister or the Secretary of State will be able to enlighten the House further.
We want the Harris review—which I support—to cover all the technical issues surrounding mental health, so that the House and the public can be absolutely certain that no other technical failures or breaches of regulation have been identified. Let me make two appeals to the Secretary of State. First, I ask him to consider widening the remit of the review, and ensuring that in future it can take the broadest possible view of arrangements for sections under the Mental Health Act 1983. Secondly, I ask for the review to be conducted as swiftly as possible, so that it can inform the current reorganisation of the NHS.
It seems to me that the crux of the issue is the interrelationship between the 1983 Act and the potential for reorganisations of the NHS to disturb important existing arrangements and procedures for the carrying out of these essential public functions. That is the crux of the matter. I accept that a problem may have arisen as a result of the introduction of SHAs and PCTs in 2003, and we will have to wait and see whether that was the case. Regardless of the answer to that, however, the Government still have to face a relevant and current issue: they have to be absolutely sure that the changes they are proposing—and which the Opposition continue to believe are unnecessary and highly disruptive to an NHS that is functioning well for the vast majority of people—will not run the risk of causing further confusion.
We have not had anywhere near enough clarity from the Secretary of State—or his predecessor, the right hon. Member for South Cambridgeshire (Mr Lansley), who has just left the Chamber—on how some of the essential functions of NHS bodies to do with safeguarding and public protection are to be handled in the new NHS structure. Many months have passed since the publication of the Government’s first White Paper, yet there are still doubts in the minds of clinicians and others practitioners on the ground. That is an indictment, and shows the confusion the reorganisation has created. We are seeing the emergence of myriad new bodies in the NHS whose functions are not yet fully understood or specified by the Government. This crowded landscape has the potential to cause for further uncertainty. I therefore today ask for more clarity on this matter.
As things currently stand, what will the NHS arrangements be for sectioning people under the mental health provisions to be introduced from April 2013? I do not yet know with confidence what those arrangements are, and if I do not know there is a good chance that the wider public and many people working in the NHS have no idea. The Government need to answer these questions.
There is a further specific question the Department needs to answer, and it goes to the heart of the issues under discussion. I am sure I heard the Secretary of State say yesterday that the secondary approval function that SHAs are meant to carry out will come back to the Department of Health following the Government’s current reorganisation of the NHS.
The Secretary of State is nodding from a sedentary position, so I assume that is correct. Surely, therefore, a concern arises that the SHA part of the process is no more than a rubber-stamping exercise. The Department will be entirely remote from the local situation on the ground relating to the individuals involved and the clinicians and institutions making the judgments. If this process is taken up to the national level, will that not give rise to more concerns that mistakes might be made in the future, because of the distance between the process of approval and the individual cases on the ground? Has the Secretary of State had discussions with mental health organisations about whether they believe those arrangements are acceptable? I must say that I have serious concerns about them.
That is a very important point. Following the logic of my right hon. Friend’s argument, does he agree that the Government would be well advised to ensure there is independent professional involvement in auditing and overseeing that process?
That is a tremendously important point. Over the years, in terms of crucial public functions such as those we are discussing—and, indeed, in wider considerations such as assessments of new treatments with the National Institute for Health and Clinical Excellence—there has been a trend towards independent decision making, so that people can feel that there is no political, or departmental, interference, such as through changing local resource decisions.
The taking of these powers, and the rubber-stamping of approvals to section people, up to the national level will give rise to concerns about whether the process is sufficiently independent and people’s rights are being properly considered. I hope Ministers have listened to the important point my right hon. Friend the Member for Oxford East has just made.
I will end by addressing a point of wider principle about mental health policy and the place of mental health within our society. I believe it is possible that this whole unfortunate episode is symptomatic of a wider cultural problem: that mental health simply does not get sufficient focus and resources in the NHS at both the local PCT level and the regional SHA level—and, indeed, within the Department of Health. Beyond that, I do not believe that mental health gets the consideration it needs in Government or in this place. We do not give sufficient consideration to the hugely important issues relating to mental health.
When I was Health Secretary, hundreds of submissions would come across my desk in the course of an average week, and it was unusual if just one of them related to mental health. It is very much seen as a fringe consideration, pushed to the edges of the system—a peripheral concern in PCTs and SHAs, and all the way up to the Department of Health. That situation must not be allowed to continue.
The culture of separateness in the way we consider mental health, as opposed to other NHS issues, has deep roots in our society. Mental health services have often been provided in buildings that are out of sight, out of mind and on the fringes of the mainstream health care system.
That has to change. In the 21st century, we demand it. In our lives, we are all now dealing with much greater levels of stress, change and upheaval, and sometimes we are all left reeling by the sheer pace of modern life. We are discussing today between 4,000 and 5,000 very vulnerable people as though they are somehow apart from the rest of us. They are not. Any family can suffer the terrible consequences of serious mental health issues. In such circumstances, we would all want to be assured that those affected are not forgotten and pushed to the fringes where proper procedures are not carried out because there is a somewhat out-of-sight, out-of-mind approach. These issues are central concerns because they go to the heart of 21st century living.
Mental health must no longer be left at the edges of our national debate about health and care policy. It has to come to the very centre of our health care system. The Health and Social Care Act 2012 includes one good measure at least: to create parity of esteem between physical and mental health. I must say that it was a Labour amendment in another place that introduced that improvement into the Act, but, to be fair to the Government, I should add that I am pleased that they accepted it.
Will the Secretary of State explain what parity of esteem means in practice? What action has the Department thus far taken to put parity of esteem into effect in the national health service, and what plans does it have for the future? We have learnt in recent days that the budget for mental health has been cut in the last financial year, which suggests to me that the NHS is reverting to its default position in tough times.
Does my right hon. Friend agree that role models in society could do a lot more to help to improve cultural attitudes to mental health issues?
My hon. Friend makes a very important point, and we have the seen the beginning of the kind of campaign he advocates with the work of the Time to Change group. There has also been incredible bravery from individuals such as the cricketer Marcus Trescothick, who spoke out very publicly about the difficulties he had faced, and just a few weeks ago in this House we witnessed some incredibly powerful contributions from Members on both sides of the Chamber: for the first time Members spoke personally and publicly about the difficulties they faced.
I think a change is under way, therefore. People who have been suffering alone will take great heart and encouragement from these developments. We are beginning to challenge the last taboo—the last form of acceptable discrimination in our society—but that does not come a moment too soon. My feeling is that Parliament is finally waking up to the full scale of the mental health challenge we face. A Bill before us at the moment will outlaw the discrimination that exists whereby somebody who has suffered a serious mental breakdown is unable to be a Member of Parliament, a company director, a juror or a school governor. It is so important to remove that discrimination from the statute book because it sends a message that recovery is not possible, and that if someone has a serious mental breakdown there is no possibility of their coming back and playing a full part in our society. The further problem with that legislation is that it prevents those people from being in leadership positions in those organisations—in schools, in Parliament and in companies—where they could develop a better understanding of mental health and what policies need to be put in place to support people who may experience those problems.
Does the right hon. Gentleman share my concern, and that of organisations such as Mind, that the rate of compulsory detention seems to be growing, as does the rate of detention in police cells?
We need to look carefully at those trends. I remember the moment when my thinking about mental health changed. It came when I was Secretary of State for Health and I received the Bradley report on mental ill health in the criminal justice system. I recall the moment when I read the statistic that seven out of 10 young people in the system have some form of undiagnosed or untreated mental health problem. My jaw dropped and at that moment I realised that we were seriously failing many thousands of people by failing to give them the support they needed when they needed it, and so they went into detention and down a path of failing to fulfil their potential. That is a terrible indictment of our life today. In addition, the level of prescribing of anti-depressants has almost doubled over the past decade. We are issuing almost 40 million prescriptions for anti-depressants, which suggests to me that insufficient alternatives to medication are available in our communities and people are being given very old-fashioned, outdated interventions by the authorities which are not meeting their needs. That is why we cannot allow this complacency any more and why we need a modern approach to good mental health care.
My right hon. Friend is absolutely right when he says that mental health has been the poor relation of the health service, but does he agree that, within that mental health service, children’s mental health services have often been the poor relation again? Does he hope that the Government will address specific services for children who need mental health services?
Order. As important as the debate is, the wider considerations of mental health and its treatment are not actually the subject for today—that is the Bill before us. So in rising to answer his hon. Friend’s problem, I am sure that the shadow Secretary of State will come back to the specifics of the Bill.
I will indeed, Madam Deputy Speaker. This is a Second Reading debate, so I was just taking a moment to speak more widely. However, I believe that this comes back to the central point I made: the reason why this situation has arisen and why it was undetected for so long—10 years—in the Department was because of this culture of failing to put sufficient focus on and give attention to mental health. The issue is still on the fringes of our system. My hon. Friend makes an incredibly important point. We hear that not only is the budget for adult mental health being cut, but the budget for children’s mental health is being cut even further. That brings me back to another point I was making: in tough times the NHS reverts to its default position, which is to focus on the mainstream and to ignore mental health. That is a worrying sign, so we press the Government to say what parity of esteem means in practice. What actions are the Government taking to change this culture to ensure that the resources and the focus are in place?
In conclusion, although the Opposition will give the Government the co-operation they need to get this measure through the House today, I say again that we need to have full answers to all the concerns I have outlined. That is the least the Government owe Opposition Members. One of the good things that we hope may come from this unfortunate episode is that it may jolt us out of our complacency on mental health, and that Parliament will begin truly to work for more parity of esteem between physical and mental health and ensure that finally mental health gets the resources and the focus it desperately needs.
Yesterday I expressed bewilderment about how we have ended up in this situation, given the high profile given in this place to the issue of legal detention, particularly during the passage of the Mental Health Act 2007, on whose Bill Committee I served. Yesterday, the hon. Member for Broxbourne (Mr Walker) said that this issue has not been taken seriously during the past decade, but it has been in the House of Commons—it has been taken very seriously and has been debated at extraordinary length. I now see the Government’s problems over the issue and recognise the gravity of the situation. I understand the need for a rapid solution and the absence of any real viable alternative. However, I am not yet convinced that this retrospective legislation offers an unproblematic or wholly sufficient solution.
Let me explain why that is and underline my concerns. Let us suppose this were not an issue of mental health, and somebody was judicially processed and forcibly detained via a flawed process. Let us suppose that they were arrested by an officer who was competent but not properly authorised to arrest or that such a person were sentenced by a judge who was skilled but not properly appointed. Irrespective of the person’s actual guilt or the reasonableness of the evidence, they would be released, after an application had been made, on a technicality. That is how the law would work for those who do not have mental health issues to address. If we apply different principles for those who have mental health issues, we discriminate, and it could be argued that we might be doing so unfairly. Ironically, this week, we are beginning the Committee stage of a Bill to outlaw unfair discrimination.
If we add to that the fact that the job of determining who assesses cases was delegated to organisations such as care trusts, which are also providers of patient care and are paid for providing it, we see a legal challenge under human rights law starting to take shape. Mersey Care NHS Trust owns and runs Ashworth, and although I do not think it is one of the offending trusts in this case, it would have been a relevant example here. A consoling thought—the consoling thought—is that we believe that no one has been improperly detained or is being improperly detained, and nothing would have changed if authorisation had been done differently. However, it is not possible to be sure about that.
These cases are often genuinely difficult. I have met psychopaths who appear, on the surface of it and when encountered, to be very normal. Equally, when anyone is incarcerated it can be difficult to prove their normality. A classic pseudo-patient experiment was carried out by David Rosenhan in 1973, when mentally well researchers were admitted to an institution under false diagnoses in order to observe life and treatment there, and to conduct research. At the end of each day they wrote down their observations, and the nurses retired to their rooms and wrote down in their case notes, “Patients exhibit strange writing behaviour”. If this place was assumed to be an asylum, I often wonder what exactly would disabuse people of that perception.
Closer to home, I conducted an evening class many years ago at Park Lane hospital, which was the predecessor institution of Ashworth hospital. I encountered there a very articulate and seemingly responsible young man who appeared ready for discharge. Years later, I saw the same individual on a TV programme about Park Lane hospital applying for a discharge, arguing on camera with his psychiatrist for release and asserting his sanity. His willingness to argue and his insistence was taken by the psychiatrist as an indication of his lack of insight. Until he agreed with his psychiatrist that he was still sick he would get no joy—that is a kind of inverse Catch-22. There are those with less cause who genuinely think that they should not be detained, and they have lawyers and access to the courts. They will contest this legislation and we cannot be entirely sure what the result will be, especially as we are forced in this case to act in haste.
We have to go ahead with the measure, but it may not be sufficient for our purposes. We may have to consider judicially reviewing all flawed cases to ensure that there is a sustainable basis for continued detention. I would genuinely prefer to believe that in this case I am wrong.
Like the hon. Member for Southport (John Pugh) and my right hon. Friend the Member for Leigh (Andy Burnham), I see no alternative but to proceed with the Bill, but I too have concerns.
Clause 1(1) states:
“Any person who before the day on which this Act is passed has done anything in the purported exercise of an approval function is to be treated for all purposes as having had the power to do so.”
The clause then defines the approved function in relation to the Mental Health Act 1983, but will the Secretary of State tell us why the concept of “any person” needs to be so broad for the Bill? It could be taken to legitimise approval by anybody. Should it not have been limited to the four trusts in question, if that is the problem the House is addressing—as it is—rather than being so sweeping?
My next question relates to my intervention earlier, when we were assured that there were good legal reasons to suppose that while the procedures that had been followed were irregular and not in conformity with the legislation, they were none the less lawful. The Secretary of State owes it to the House to spell out why they were regarded as lawful even though we are having to act in such a precipitate fashion to put things right.
I see that the Secretary of State has certified the Bill as being in compliance with the European convention on human rights, but as the previous speaker pointed out, the use of such retrospective legislation, which impacts on something so fundamental as the citizen’s right to liberty, may raise questions under the charter of human rights, so I should be grateful if the Secretary of State reassured us that the most careful attention has been given to that most precious of issues.
I state an interest as a member of the all-party group on social work. Before I was elected, I was for a short time an approved social worker under the Mental Health Act 1983. I was also a member of the Joint Committee that looked at mental health legislation before the passage of the National Health Service Act 2006. As far as I remember, the issue was not addressed that winter when we looked at the legislation in considerable detail.
First, to state the obvious, compulsory detention is a serious matter, as hon. Members and right hon. Members have said. The deprivation of liberty without the legal processes of the courts has always been subject to great safeguards. I accept that this is an emergency, but it is undesirable in the extreme that the subject is dealt with in such a manner. Emergency legislation should always be used as sparingly as possible, in particular in mental health.
The House will be interested to learn that the expert group examining mental health legislation in the winter before the 2006 Act was looking at legislation from the previous century. As I said at the time, they had been looking at it for years and years, not just overnight.
As I have said, I acted as an approved social worker for some time, and I was briefly a mental welfare officer under the Mental Health Act 1959. That measure was extremely unsatisfactory and, to contextualise the subject we are discussing, there was particular concern about section 29 of the Act, under which people could be taken into hospital compulsorily as an emergency for up to 72 hours, on the basis of one medical recommendation. Recourse to that provision was particularly high in rural areas such as mine where one could not get hold of a second approved doctor. That was one of the reasons why the 1983 Act tightened things up as much as it did.
The 1983 Act brought in safeguards and followed a long campaign by Mind, among other organisations, led by Larry Gostin. The burden of the Act is that better human rights safeguards must be in place, and I welcomed it at the time. One of its provisions was that two properly approved doctors should look at any application. That is the context for the worrying statement made by the Secretary of State yesterday.
I was glad to hear the Secretary of State’s assurances that the measure is a technical matter and that no one was wrongly detained, that proper clinical processes were carried out and doctors were properly qualified for the roles they undertook—apart from this technicality. I agree that the position should be regularised as soon as possible.
However, I take the points made by the hon. Member for Southport (John Pugh) and the right hon. Member for Oxford East (Mr Smith): there are rightful worries about compulsory detention and there could be further cases. We must get to the bottom of how the situation arose and find out why it has taken so long—more than 10 years—to come before the House. Did it not come up in any of the Department’s visits in its inspectorial role? I worked briefly as a freelance for the inspectorial arm of the then Welsh Office, so I know how much detailed care went into that role at the time. Why has the issue not come to the fore until now?
I have some questions that I will ask now, even though it is a Second Reading debate. Perhaps the Secretary of State could answer them when he winds up. As background to the Bill, I read that there are between 4,000 and 5,000 current patients. Can the Secretary of State confirm that they really are current patients? If so, are there many thousands of former patients who might have been sectioned who also have an interest in the matter? Is the figure current or a cumulative total? Does it include only in-patients? What about patients in the community on compulsory treatment orders? There could be many thousands of them. We need clarity about the size of that population.
I asked in an intervention whether only particular strategic health authorities were involved. Rampton was certainly involved; it takes patients from Wales and elsewhere. I was not sure whether Ashworth was included. The hon. Member for Southport seemed to indicate that Ashworth—Park Lane, as it was—had not been drawn in. Could the Secretary of State provide some confirmation?
There are questions about informing patients and their families about the problem that has arisen. Those people may be very vulnerable, given their condition. Some patients are likely to be anxious as part of their illness, and this situation could exacerbate their condition. We need to make sure that these events do not exacerbate existing conditions, so I should like some assurance from the Secretary of State about how patients, former patients and their families will be contacted. Will independent advocacy services be involved? I am not talking about lawyers or ambulance chasers, but about the many services properly set up in the community to support people.
Communication must be appropriate. The code of practice for the 1983 Act specifies that communication with patients must be made appropriately on the basis of age, gender, race and language. One of the reasons I am speaking in the debate is that some Welsh-speaking patients might have been involved, so I want to be sure that they will be contacted and communicated with appropriately. Because of this incident, the process might be upsetting for people who have been sectioned in the past, so I should be grateful for reassurance that long-term support will be available if that is a disturbing factor in their condition.
The briefing notes, which I read with interest, refer to compensation, which should be the last thing on anyone’s mind at a time like this. I was reassured, however, to learn that people can bring cases. Some individuals can be litigious. Sometimes, as part of their condition, they are notoriously litigious, as I said earlier, but that does not detract from their right to bring cases unless the court rules otherwise.
I have some concerns about doctors. I asked earlier whether approval by a strategic health authority automatically enabled people to act elsewhere. The Minister initially said that it was just within the strategic health authority area, but then he said it was throughout England. I should like that matter to be cleared up and, as a Welsh Member, I should like it to be cleared up in relation to Wales and possibly Northern Ireland and Scotland. I am worried that doctors may slip through the net because they have acted outside the four areas that have been identified.
What discussions has the Secretary of State or the Minister of State had with doctors’ representatives? I appreciate that time has been short, but I hope that doctors have been fully involved. Are there any implications—I cannot think of any—for the second doctor involved in sectioning? I should be grateful for reassurance on that point. Equally, are there any implications for the social worker, as it is usually a social worker who is involved?
Finally, has the Wales Office been involved in any way? I am glad that Wales, Scotland and Northern Ireland have been informed. It is more of an issue for Wales, given that we share many clinical services and people from Wales are often treated in England: special hospitals are an obvious example. I hope that there has been the closest co-operation possible between the Wales Office and the Welsh Government in Cardiff. I am glad that an independent review under Dr Geoffrey Harris has been announced. I hope that the Wales Office and the Welsh Government will be involved to the degree that they should be.
I wish to make only a couple of points about this emergency legislation, which I support. The Government still have a number of questions to answer. First, further to the point made by my right hon. Friend the Member for Oxford East (Mr Smith), I should like to press the Secretary of State on legality. In the explanatory notes, the Government say:
“Although we believe that there are good arguments that detentions under the Mental Health Act were and are lawful, it is important that there should be no doubt about this.”
If legislation does not permit the authorisation and delegation of power to doctors under that measure, does that accord with the law? I am not lawyer. Many right hon. and hon. Members on both sides of the House served in that profession before first coming to Parliament, but I am not one of them. However, if the previous measure did not permit such a delegation of power, doctors acting without that permission were not proceeding according to the law. I should therefore welcome clarity on that point.
Secondly, with regard to what happens from now on—the Bill is retrospective in effect—the Government propose to abolish strategic health authorities. As far as I understand it, SHAs were named in the original legislation. What will effectively take their place when they are abolished and will further amendments need to be tabled by the Government?
The Opposition do not oppose the Bill. We are aware that much of this activity took place under a Labour Government, and we are anxious to work in the most co-operative way possible to resolve the situation. However, I would do the House a disservice if I did not set out the in-principle objections to retrospective legislation of this kind.
I should like to quote someone whom Government Members may take more seriously than some of us. In the “The Road to Serfdom”, Hayek said of the rule of law:
“Stripped of all technicalities [the rule of law] means the government in all its actions is bound by rules fixed and announced beforehand—rules which make it possible to foresee with fair certainty how the authority will use its coercive powers in given circumstances, and to plan one’s affairs on the basis of this knowledge.”
I shall set out objections to retrospective legislation, because despite the urgency of the situation and the problems that might arise if it were not introduced, we should recognise that it is a very serious matter to introduce retrospective legislation of this kind. The Opposition, as my right hon. Friend the Member for Leigh (Andy Burnham) said, were a little surprised that the Secretary of State for Health did not open the debate.
If retrospective legislation is undesirable in principle, it is particularly undesirable when it concerns the liberty of the subject. There is no precedent for retrospective legislation on such matters. We are dealing with the mentally ill and the sectioning of people under the Mental Health Act 1983. Due process is even more important in relation to issues under that Act than in relation to other matters of criminal justice, as we are dealing with vulnerable people who are not in a position to advocate for themselves. Due process is not less important in relation to Mental Health Act matters; it is more important.
I urge the House to pause for a second and see the situation from the point of view of the mentally ill, their families and their supporters. For people engaged with mental health legislation, the process may appear Kafkaesque and labyrinthine. They now know that 5,000 people—perhaps more—were sectioned, strictly speaking, illegally, which can only cause unhappiness and uncertainty. As hon. Members have said, it may even affect the condition of those people.
I do not disagree with anything that the hon. Lady has said, but I should like to clarify something. Is she basically saying that she supports what the Government have done, but is putting on record the fact that the measure must not be seen in any way as a precedent? This is an exceptional and unique set of circumstances. Is that effectively what she is saying?
I have been a Member for 25 years. I have never seen retrospective legislation of this kind. Although we support what the Government are doing, we do not want it to be seen in any way as a precedent; nor do we want it to be thought that, because the measure relates to the Mental Health Act, it is less significant than if it were a broad criminal justice concern. That is the point that I want to put on the record.
As I have said, for patients and their families, the mental health system may appear labyrinthine and Kafkaesque at the best of times. Now they find that for a long period—some of it under a Labour Government—people were being sectioned without proper due process. Ministers have said, both today and yesterday, that this is a technicality, but due process means that people should abide by the technicalities. Only in that way can we defend the liberty of the subject, and only in that way can the subject have any recourse. If we do not abide by the technicalities and if the rule of law does not apply, where do our constituents and other ordinary people turn if things go wrong?
Ministers have made a series of assertions. They have said that no patient has been wrongly detained or received care that was not clinically appropriate. They have said that no doctor was unqualified to make the decisions, and they say that urgent action is being taken to correct the situation. But I would be interested to hear from Ministers whether there has been an individual case review of these cases. How can they assert that no patient has been wrongly detained or received inappropriate care if the Government have not reviewed each case individually? How can Ministers assert that no doctor was unqualified to make the decisions if they have not reviewed each case individually?
I am not raising these issues to stop what I understand is an urgent process, but it would not be right for the House to railroad the legislation through without paying attention to the individuals and the individual cases involved. If there has been no individual case review, the question raised by other hon. Members whether the Bill will stand up to judicial review comes to the fore. Is the Minister in possession of robust, irrefutable evidence to show that none of the more than 5,000 patients detained by the approximately 2,000 not properly approved doctors was subject to clinically inappropriate detention or hospitalisation?
Will the families and carers of those individuals be advised of the situation and given an opportunity to raise any concerns that they may have? When a relative is detained under the Mental Health Act, the question whether that is appropriate can be one of the most difficult and traumatic questions that a family has to face, and to dismiss the lack of due process as a mere technicality, as Ministers have come dangerously close to doing, is not fair to those individuals and their families—our constituents.
Although I accept that the doctors concerned have acted in good faith, I hope the Minister will agree that we are dealing with a highly vulnerable group of individuals—the patients and their families—and they need to have absolute confidence in the Government’s response. We understand that introducing urgent legislation is part of offering such reassurance. It will protect vulnerable patients from a potentially exploitative situation in relation to what are commonly called ambulance-chasing lawyers, but when their relative is taken away from them, people also want to know that this is not a mere rubber-stamping process. I have heard nothing so far that would reassure me, if I were the mother or a relative of one of the people detained under a defective process, that Ministers do not regard this as a mere rubber-stamping process and that all the Bill does is alter in some technical way the nature of the rubber stamp.
My right hon. Friend the Member for Leigh made the point that we need to move forward with a very different attitude to mental health. We need to look for parity of esteem between mental health and physical health, but in this matter, in relation to the liberty of the subject, we also need to look to parity of esteem when someone’s liberty is taken away under the Mental Health Act and under broader criminal justice legislation. If people had been held in prison and there had not been due process, it would not be good enough to railroad through retrospective legislation in an afternoon in the House of Commons. There would be much more uproar.
We want to impress upon Ministers that we must take seriously the liberty of people detained under the Mental Health Act and demonstrate that we are doing so. A number of questions have been raised by hon. Members on Second Reading, and we hope that the Minister will be able to answer them. I thank right hon. and hon. Members who have taken part in the debate. As I said earlier, I hope the Government will try to involve the family and carers of those affected more closely in the process of bringing clarity. I hope that the Government will seek to remove any uncertainty and will explain to them what they can do to seek redress.
Like my right hon. Friend the Member for Leigh, I commend Ministers for their attempt to move quickly on a very difficult issue. We want to offer the Secretary of State any assistance that we can as he seeks to answer questions from patients, families, carers and the wider public, but we say to him that retrospective legislation is very serious. It cannot be dismissed as a technicality. The liberty of the subject is, so to speak, the ground zero of parliamentary democracy in this country. It cannot be dismissed as a mere technicality. Sadly, I do not believe that the debate this afternoon will be the last that we hear on the matter. It is extremely important that those of us who are in the House this afternoon tease out the answers to the questions that have been put.
I start by apologising to any Members who had hoped to intervene on me at the start of the debate, but I hope that I will now be able to give a fuller answer not just to any interventions, but to speeches made by right hon. and hon. Members. I thank the Opposition and the whole House for the very responsible attitude that they have taken towards this extremely sensitive and difficult issue. I intend to respond fully to all the points made by right hon. and hon. Members about the need to act so fast and retrospectively. Those are important issues that deserve the fullest attention.
It is important to record our appreciation at this stage for the invaluable help and advice that we received from partners outside the House, such as Mind, Rethink and the Royal College of Psychiatrists. Their primary concern is naturally those whom they represent so ably, but we are genuinely grateful for the mature and calm way in which they have responded. Everyone in the House has shared the same ultimate objective—to do what is best for the patients directly affected by a technical error.
Let me go through the points raised in the debate. I shall try to respond as fully as I can. With respect to the devolved Administrations, I have spoken to Health Ministers in Wales and Northern Ireland today, and I spoke to the Advocate-General for Scotland yesterday. They have been extremely supportive of the position that the Government and the whole House have taken, and they understand the need for speed. In Wales it is a sensitive matter because the Welsh Assembly is in recess, but I managed to speak to the Health Minister and go through the issues involved.
A number of Members asked about the extent to which we will be communicating with patients. We are working closely with the Royal College of Psychiatrists as to the best way to do this. That also extends to the families and carers of patients. Sir David Nicholson, the chief executive of the NHS, is writing to all strategic health authorities, stressing the need to communicate broadly across all mental health organisations, including patients and their families, and including, as has been mentioned, not just the patients who are directly affected, but potentially other patients who have been detained under the Mental Health Act, who may also have concerns. We have not been able to complete that communication exercise at this stage, because of the speed necessary to pass the Bill, but we will need to make sure that it proceeds as a matter of urgency.
We welcome the exercise being carried out by the NHS chief executive, but it is not the same as a personal communication to the individuals directly affected, so will the Secretary of State address the specific point of whether or not they will receive explanatory information from him or the Department?
Yes. What Sir David Nicholson is doing is ensuring that all SHAs have a proper communication process in place, but we want to follow clinical advice on the appropriateness of individual communications with individual patients. Where we are advised that is clinically sensible, we must ensure that it happens, but we want to listen to the advice carefully because of the vulnerability of some of the patients involved. The right hon. Gentleman makes an extremely important point. We must do this properly but, as I know he will agree, we must proceed with extreme care and caution.
I will start with some of the issues that the right hon. Gentleman raised, particularly the role of the review being conducted by Dr Geoff Harris. He is absolutely right that it needs to be done speedily because of the changes being introduced by the Health and Social Care Act 2012. I want to reassure him that Dr Harris’s review will not be simply a retrospective review; he will not just be asking, “Why did this happen?” He will also be stepping back and asking, “Where might this happen again and are our governance procedures sufficient to ensure that it does not?” In particular, he will look at the new structures that will be put in place over the next few months to give us good and independent advice on whether we have the safeguards in place to prevent this from happening again. That is an important point.
With regard to how many people are affected, the figure is up to 5,000. We think that the number includes all the patients at Rampton and 57 patients at Ashworth, but we are still verifying the exact numbers. I will keep the right hon. Gentleman informed as more information becomes available.
The right hon. Gentleman’s other point was about the new arrangements that are being put in place. He wondered, legitimately, whether, as the powers are returning to the Department of Health following the abolition of the SHAs—he was correct to pick that up from my comments yesterday—there is a danger that the process could be more remote for local areas. We will keep him informed of our plans in that regard, but we do not intend to have a single national panel doing this. We intend to have a structure that draws on local and regional expertise to help us to make the right decision on the suitability of doctors for the role. That is also something we hope Dr Harris will advise us on when he conducts his review.
I will move on to some of the comments made by the right hon. Member for Oxford East (Mr Smith). Independent oversight is also something we will ask Dr Harris to look at. He is independent and he is looking at it. We will also ask him to look at the general issue of independent oversight and whether it has been missing in the structures we have had to date and, therefore, whether it contributed to the concerns that we are now addressing.
The right hon. Gentleman and the hon. Member for Wolverhampton North East (Emma Reynolds) raised another issue: the wording we have been using, the fact that we believe there are good arguments for saying that the detentions that happened as a result of approvals made by the doctors in the four SHAs were and are legal and, therefore, why we feel the need for emergency retrospective legislation. It is a reasonable question. The answer is that we believe that there is legal precedent for why, in so sensitive a situation, a court, in deciding whether a detention was lawful or unlawful, would consider what the will of Parliament was when it passed the original law. Therefore, we believe that we have a good argument for why a court should rule that these detentions were and are lawful.
However, because of the technical irregularity in the process of approving some of the doctors who made the decisions in the four SHAs, that argument could be challenged. That is also an important part of the advice we have received. It is because it is so important to put the decisions beyond doubt, with respect to this narrow and technical issue, that the Bill is so incredibly important. However—this might help to address some of the concerns raised during the Opposition winding-up speech—this piece of retrospective legislation refers only to that narrow and technical issue. If people question the grounds for their sectioning under the Mental Health Act on clinical grounds and claim that the wrong clinical judgment had been reached, for example, or if they do not agree with what the panels have said, the Bill will not affect their right to challenge the decision and, if the court upholds the challenge, to get compensation if they have been detained. The Bill relates only to the very narrow issue of the technicality.
I am grateful to the Secretary of State for giving way and for his response to one of my earlier points. As he is adopting a belt-and-braces approach to this—a sort of “We think it was lawful, but let’s make absolutely sure” approach—would it not also be wise to arrange, if not in the Bill then as an executive action, for the doctors in question to be re-approved by the correct process?
The right hon. Gentleman makes an extremely important point. I am pleased to reassure him that that has happened. That was one of the first things that happened, and it was completed yesterday, so all the doctors who are currently making these approvals in the four SHAs were approved using the correct process. We are confident that the problem will not arise in future, but we still have the issue of the decisions they took when the technical process had not been followed.
We have taken a number of actions to deliver parity of esteem for mental health services. I wholeheartedly agree with the concerns that have been raised about mental health issues having been for too long the poor relative in a number of areas. The right hon. Member for Leigh (Andy Burnham) will know that in July we published the implementation framework for our mental health strategy, “No health without mental health”. We have legislated, with his party’s support, for parity of esteem. The operating framework for the NHS expands access to psychological therapies, which is one of the key things we can do. The number of people accessing psychological therapies has increased to 528,000 people this year, which is more than double the figure for last year, and the amount of money going into it has increased from £364 million to £386 million. Those therapies have a very good success rate of about 45%, and we think that we can get it up to 50%. I want to reassure right hon. and hon. Members that we note the general view of the House that more emphasis needs to be put on mental health services.
But overall there has been a significant real-terms reduction in spending on mental health, as the figures given by the right hon. Gentleman’s colleague in the House of Lords a few weeks ago indicate, which suggests that the NHS is making disproportionately more redundancies in the field of mental health than in other areas and that it is reverting to that default position. Therefore, although I appreciate the Secretary of State’s words at the Dispatch Box today, the reality on the ground suggests that, as ever, mental health is bearing the brunt of some of the reductions and redundancies taking place and that the capacity of people to deal with these kinds of issues will perhaps be reduced. What will he say about safeguarding against that?
The right hon. Gentleman makes an important point. I believe that in actual terms the spending on mental health has increased slightly, but when we take inflation into account it might have gone down slightly in real terms. I do not think that it is a significant drop, but overall, as he knows, the NHS budget has been protected. I would be extremely disappointed if, as we go through a process of finding important efficiency savings in order to meet the increased demand on the NHS, the picture that he paints were to be the case, but I will be watching the situation very carefully. I will expect him to hold me to account for my commitment to ensuring that mental health services are properly addressed.
Crucially, it is not just about what we say but about what we deliver, particularly as regards the progress that we make towards improving access to mental health services, which were never included in the waiting times targets that were introduced by the previous Government. There are obviously financial implications in doing that, but we are working on it. Parity of esteem needs to include access to mental health services and not just the availability of those services.
Does not parity of esteem also, crucially, need to apply to research funding—a point that was made earlier during the urgent question on Winterbourne?
Order. We are again going very wide of the Bill and the points that are supposed to be made in relation to it. The right hon. Gentleman’s question does touch on that, but I would be grateful if the Secretary of State, in responding, returns to the Bill by focusing on the items that we will be voting on today.
The answer to the right hon. Gentleman is yes. I will now return to the specific questions asked about the Bill.
The hon. Member for Southport (John Pugh) talked about the important issue of discrimination—that is, whether we are behaving differently because these patients have a mental illness. Removing discrimination does not mean treating everyone exactly the same. In fact, we will remove discrimination in the mental health field by better understanding the vulnerabilities and needs of people who have serious mental health problems, and that might mean treating them differently to account for that. The hon. Gentleman is absolutely right to say, as was the hon. Member for Hackney North and Stoke Newington (Ms Abbott), that important human rights issues need to be considered. I want to reassure him that, even in the four SHAs where the technical irregularity in the approval of doctors arose, the criteria were as rigorous as those used to make the clinical assessment that it was necessary to detain someone under the Mental Health Act. The same quality of expert advice was drawn on in order to make those decisions.
The right hon. Member for Oxford East asked why we are not limiting the legislation to the four SHAs where we have identified this technical irregularity. That is because we do not know at this stage whether the problem may have predated the establishment of SHAs—we should remember that these powers go back to the Mental Health Act 1983—and therefore, to make sure that we deal with the problem in its entirety, it is better to include the whole country in the legislation lest we find at a later date that the problem had existed in other parts of the country, perhaps prior to the foundation of SHAs.
On human rights, I have signed a piece of paper saying that I believe that the Bill is compliant with the European convention on human rights. I did that on the advice of Government lawyers and of the Attorney-General. The Attorney-General believes that, were a case to be brought now, people would be entitled only to nominal compensation because this is a technical, not a substantive, irregularity, and it is therefore not, on this occasion, a breach of people’s human rights to pass a law retrospectively.
The hon. Member for Arfon (Hywel Williams) asked why this has taken so long—why, for example, the Mental Health Commission did not identify the problem in its years of existence. That is a very important question. I cannot pretend that I have the answer now, but I want Dr Harris to look into that issue in enormous detail because I want to know whether there is a risk that other errors, similar or related, might exist in other parts of the system. The House needs to understand much better whether we should be concerned about that and whether the right governance procedures are in place.
The hon. Gentleman mentioned advocacy. As he will know, all patients have a right to an independent mental health advocate, but that process has not always worked as well as it should. I want to use the opportunity of the transfer of those responsibilities from primary care trusts to local authorities to make sure that we have proper procedures in place so that people really do get the advocacy support that they need.
Let me confirm to the hon. Gentleman—we received this piece of information as my hon. Friend the Minister was speaking—that someone approved in one SHA is able to practise in other SHAs. That is partly why the legislation needs to be UK-wide. We have had a lot of discussions about this with doctors’ representatives, particularly the Royal College of Psychiatrists. I do not believe that there are any implications for the second doctor or the social worker, but if I receive advice to the contrary I will write to him to let him know.
I think that I have covered most of the points raised by the hon. Member for Wolverhampton North East. She asked what is going to happen when the SHAs are abolished. We will be asking Dr Harris to address that when he carries out his independent review.
Finally, I turn to the hon. Member for Hackney North and Stoke Newington and her important comments about the seriousness with which we must treat any retrospective legislation. She referred to what Hayek said about that, with which I wholeheartedly agree. I did not think that we would be agreeing across the Dispatch Box about Hayek, but there it is. She made the important point that due process is about respecting technicalities, so we cannot brush it aside. That is why this legislation is necessary. A failure of due process—a failure to observe technicalities—puts us in an extremely difficult situation where ordinarily we would want to say that due process should be observed in all circumstances and that we should not pass retrospective legislation on that. In this particular case, however, it would have been against the clinical interests of 5,000 highly vulnerable people were we simply to consider that single legal perspective; the broader clinical perspective needs to be recognised.
The advice that I received from Professor Sir Bruce Keogh, the medical director of the NHS, was very important in persuading me that we needed to take the route of emergency retrospective legislation. He said that the alternative, which was to go through all 5,000 people and redo the entire sectioning process now that all the doctors have been properly validated, presented serious clinical risks to those individuals. It is a very difficult matter. As the hon. Lady and I are trading political thinkers, perhaps I could refer her to Isaiah Berlin and say that sometimes important moral principles are not totally consistent with each other. This is one of those occasions, and we have to weigh her very important points about the need to avoid retrospective legislation, even on technicalities, against the clinical interests of a highly vulnerable group of people.
In a previous life, I sat on the board of a Mental Health Act scrutiny committee in a west midlands mental health trust. Does my right hon. Friend agree that this retrospective change does not in any way undermine the fact that every single one of the patients he has mentioned has been through a very robust system of checks and balances throughout the sectioning process in order to be sectioned, and then while they are sectioned, and has access to a very robust appeals mechanism that the Bill in no way undermines?
My hon. Friend is absolutely right. The key point is that those patients are free to challenge any element of the clinical decisions made as part of that very thorough process. This proposed law is about the technical irregularity only, and it is precisely because of the legal risks associated with that irregularity that we think it is necessary, in the interests of those 5,000 people, to enact this Bill.
I totally accept the point that the clinical need trumps the patient’s right to due process, but if the clinical need is questioned by the patient themselves it becomes more arguable, does it not?
If the patient wishes to challenge their clinical assessment, they are free to do so and the Bill will not affect that in any way. It is important that that point is understood. In fact, the Bill is very narrowly defined for that precise reason, and I think that is why the Attorney-General felt comfortable saying that it complied with the ECHR.
In conclusion, we have had a constructive debate on this very important and sensitive issue, but there are broader lessons to be learned about the importance, more generally, of mental health issues, and I and my colleagues in the ministerial team will take those very seriously as we progress. I am grateful to all hon. and right hon. Members present for their contributions to this debate.
Question put and agreed to.
Bill accordingly read a Second time; to stand committed to a Committee of the whole House (Order, this day).
Mental Health (Approval Functions) Bill
Considered in Committee (Order, this day)
[Dawn Primarolo in the Chair]
Authorisation of approvals given before this Act
Question proposed, That the clause stand part of the Bill.
I want to raise two specific points. Opposition Members are concerned that the concept of “Any person” in clause 1 is too broad, because it appears to legalise approvals by anybody. Why does the clause not refer specifically to North-East, Yorkshire and the Humber, West Midlands and East Midlands?
Secondly, where is the provision for the doctors who have been approved by a trust according to what we now understand was a defective process to be re-approved by the correct process? As the clause stands, it seems—I am happy to be put right on this—that doctors approved previously by the trust will be able to continue to section patients without re-approval under the correct process.
I will first set out what the clause seeks to do and then respond to the shadow Minister’s questions.
The clause directly addresses the issue that the Bill intends to resolve. Between 2002 and 2012, four strategic health authorities delegated to mental health trusts the function of approving doctors with responsibilities under the Mental Health Act 1983. The legal advice that we have obtained is that there are good arguments, as we have already discussed, that decisions to detain made by doctors who were approved in that irregular way are nevertheless lawful. The clause removes any doubt—that is its purpose. It clearly spells out that when mental health trusts gave approval in the past they are to be treated as having had the power to do so.
The clause has the effect of eliminating any irregularity from decisions made in complete good faith, and in the best interests of the patient, by doctors fully qualified to make them. It does so in a way that is fully consistent with the legal and clinical advice that we have received on the issue, and means that patients and their families do not have to undergo the process of assessment for detention under the Act again solely for the purpose of correcting a technical error made by a strategic health authority.
The hon. Lady asked why the clause was so broad as to refer to “Any person”. I understand her concern, but the point is that we do not yet know whether there were other issues before the establishment of the SHAs. Obviously, that is part of the work that the review will undertake, but to ensure that we resolve the problem absolutely and that all those patients have clarity the decision was made for the clause to refer to “Any person” in order to avoid any risk of our uncovering another problem that might need a separate resolution. This deals with the whole problem of the approval process for the doctors who made those decisions.
The hon. Lady then asked, correctly, whether decisions will be taken properly as we progress. I can confirm that all the doctors have already been re-approved according to a proper process, so every decision that is taken from hereon in cannot be challenged. As we have said, any patient who wants to question the clinical judgement can do so and their rights remain the same as they have always been. This simply addresses the technical issue that we have been debating today.
The clause refers not only to “Any person” but one who
“has done anything in the purported exercise of an approval function”.
On both counts, it is incredibly widely drawn and could take us into the territory of other elements of the approval process that may have been defective. Will the Minister assure the Committee that the clause is as narrow as it needs to be? It seems to be uncomfortably wide and may well restrict somebody’s ability to challenge an element of their section other than the fact that the doctor was not approved by the SHA. It is very loose in its current form.
I am grateful to the shadow Secretary of State for that intervention. We have gone through a very careful process and have followed legal advice on what is necessary to regularise the position. This relates specifically to the approval function, which is defined in clause 1(2). As I have said, the legal advice is that this is the best way to regularise the issue that has been uncovered.
Before the Minister responded to the intervention by my right hon. Friend the Member for Leigh (Andy Burnham), he told my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) that if mistakes had been made before the establishment of the SHAs, some of the doctors who had not been properly approved previously may not have been approved by the executive action that the Secretary of Sate referred to earlier. Will the Minister assure the Committee that, should such instances come to light, those doctors will also be subject to a re-approval process?
The first thing I want to clarify, again, is that the clause ensures that if any previous authorisations were not done in accordance with the statutory provisions, the clause regularises that process, full stop. Of course, if we go back a long way, that may apply to people who have long since been discharged from their section. This regularises the situation for all. It also ensures that the detention of anyone who continues to be sectioned is regularised, because the original authorisation is deemed to be acceptable under the Bill and in accordance with parliamentary intent, as the Secretary of State said earlier.
I am grateful to the Minister, but he has not fully answered my question. The Secretary of State has now properly given approval to those who were previously improperly approved. The Minister is right that many of the people in question may have retired or left, but some may still be practising. If further instances come to light, will they too be subject to a new scrutiny process?
I absolutely take the right hon. Gentleman’s point, and I am grateful to him. We must be absolutely certain that everybody is now properly authorised to make decisions. We know that everybody outside the four affected SHAs has been properly authorised—that has been checked and confirmed by SHAs, which have undertaken a proper check of their procedures. We also know that the four affected SHAs have already regularised the position of all their authorised practising doctors. We therefore know that across the whole system, doctors who undertake sectioning from now onwards will be properly authorised in accordance with the Mental Health Act 1983. The Bill addresses the previous problems with the authorisation process, and we have addressed the problem for the future by ensuring that everybody is properly authorised. I hope that deals with that point.
It does not entirely seem to deal with it, so I give way to the shadow Secretary of State.
I am grateful. It is important to get clarity before we leave this clause.
I know that the Government have not yet undertaken a full case-by-case review of the up to 5,000 cases involved. That prompts the question how the Government can be sure that the whole team involved in each case was qualified to a suitable level, and that there were not some instances of under-qualified people making decisions. That gives rise to concern that we may be retrospectively approving processes that were defective.
I do not think there is any suggestion that any of the people who undertook sectioning were not medically qualified to do so. The issue is simply with the body that undertook the authorisation and the fact that SHAs delegated that responsibility to mental health trusts, which was not in accordance with the law. The Bill is intended to regularise the position of every clinician who was not properly authorised because of that flaw.
I do not want to detain the Committee unnecessarily, but because the clause is drawn so widely it will possibly take away some people’s right to challenge whether there was a deficiency in the process or whether someone involved in the sectioning decision was under-qualified. Given that the Government have not undertaken a case-by-case review, I wonder how we can have absolute confidence that the power in the Bill is not too widely drawn.
I am told that we have dealt, doctor by doctor, with all the doctors in question who are currently practising. The problem relates to the doctor, not the patient, because it is about their authorisation to undertake the duties in the 1983 Act. The only people who undertake the actions referred to in the clause are doctors, who were authorised but unfortunately by the wrong body. That is what we are seeking to regularise.
We must have absolute clarity about this. In that case, why does the Bill mention “Any person” rather than “any doctor”? Our understanding is that a broader team of people can be involved in a sectioning decision, such as a social worker. If it is only doctors, the Bill should just say “any doctor”, but it does not.
We are talking about the approval function. Subsection (2) mentions
“practitioners approved to give medical recommendations”,
so it clearly deals with practitioners who have already been authorised, but by the wrong body.
I am genuinely trying to understand this point and ensure that the Bill is as foolproof as possible. As I understand the Government’s case, the clinical need of people with mental health problems—the Bill clearly would not apply to people who did not have mental health problems—is trumping the absence of proper process, so the Bill is not an abuse of human rights.
The difficulty that I have with that argument—perhaps I ought not to have it, and maybe I am being particularly thick—is that the clinical need in question was established through a process that is acknowledged as formerly having been flawed. The clinical need is apparent only when a case has been heard and processed. The concept of clinical need here is certainly—
Order. May I say to the hon. Gentleman that this is an intervention, and interventions are supposed to be brief? I know that this is a complex point, but interventions are becoming speeches within the Minister’s speech. If the hon. Gentleman could make his point succinctly now, it would help all of us.
My point is that the definition of clinical need ought to be good enough for a psychiatrist, but I am not convinced that in this context it is good enough for a lawyer.
All that is being regularised is the power to approve a doctor, not whether a doctor is clinically sound. Any patient who challenges a judgment to section them either now or in the past will retain all their rights in law. We have acted on the advice of both lawyers and clinicians to ensure that we deal with the problem that has emerged in a way that respects patients’ clinical interests and considers them with the utmost seriousness. To go through a full reauthorisation process in every case could be incredibly damaging to individuals in potentially vulnerable situations. The Bill is based on the best clinical and legal advice that we have received on how to deal with the problem.
The Opposition have listened with great care to what the Minister has said. He has made a point of saying that his advice suggests that the Bill is the best way to deal with the situation. We argue that it is perhaps the most convenient way, but we know that the parliamentary draftsman has been under huge pressure to produce the Bill, and this would not be the first time that parliamentary draftsmen have come up with a form of words that is in some way defective. I repeat our concern about the broad nature of the clause, which states that “any person” who “has done anything” is to be “treated for all purposes”.
Perhaps I can assist in this matter. I do not believe that there is a drafting error, but the hon. Lady is absolutely right to scrutinise every word of the Bill carefully and ask questions.
Clause 1 does not mention “any doctor” because it is about the power for an SHA to delegate the authority in question, not about a doctor’s decision or clinical ability. It refers to the person who approves that power of delegation. I hope that that clarifies the matter.
We have listened to what the Secretary of State and the Minister have said. We remain concerned about the broad nature of the clause, but we rest our case.
Question put and agreed to.
Clause 1 accordingly ordered to stand part of the Bill.
Clause 2 ordered to stand part of the Bill.
The Deputy Speaker resumed the Chair.
Bill reported, without amendment.
I beg to move that the Bill be now read the Third time.
This has been a distinctly unusual process for the House, and one that is unprecedented for recent Members. Only after hard—if very rapid—consideration over the weekend did I decide that emergency legislation was the only safe course, and recommend that to the Prime Minister.
Retrospective legislation affecting an individual’s right to liberty is a major step, and it would be intolerable to have any doubt about such an important part of the law. Such a situation would be unacceptable for patients, their families, and doctors and nursing staff in NHS and independent hospitals. I have been insistent throughout that the clinical needs of patients should take priority within the law, and that legislation should be as tight as possible to ensure that patients’ legal rights are protected.
I thank Opposition Members for the way they have responded and for making it possible to legislate in such short order. I also thank hon. Members generally for their constructive challenge and scrutiny. Although there is need for urgency, it is essential that the Bill is properly tested, which hon. Members have done.
The House has acted wisely and swiftly in the interests of up to 5,000 highly vulnerable people. It has recognised the important human rights issues involved, and balanced that with clinical advice about the best interests of those people. I commend the Bill to the House.
The Opposition thank the Secretary of State and the Minister for attempting to answer all the questions that colleagues have raised. We appreciate that they have acted in good faith in bringing this legislation before the House with such speed, but, as my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) rightly said, this takes us into unprecedented territory. We are legislating retrospectively on matters of fundamental importance concerning people’s basic rights and public safety, and it is therefore right for the House to pause for thought and consider those issues before giving its assent to the legislation.
We had an important exchange on the precise drafting of the legislation, and a concern arose during the course of that debate. Clause 1 essentially states that “any person” who has undertaken any activity
“had the power to do so”.
If I heard the Minister and the Secretary of State correctly, that is not carte blanche to justify anything—including something inappropriate—that may have happened over the course of a decision, but simply means that the person who made the decision had the power to do so. I hope that people outside this House will hear those words clearly and understand that that is the only permission the House is giving this afternoon on this exceptional basis. In doing so, we return to the point about balancing our concerns about the exceptional nature of this legislation with the fact that this issue affects thousands of the most vulnerable people in our society and their families. We do not want any further distress caused to those people, or for them to suffer any unsettling effect, and that is why the Opposition believe that the legislation is justified.
It is crucial that no legal doubt hangs over arrangements that are made for patients and public safety. This Bill removes that doubt, but we do not want to remove any of the rights held by the individuals concerned, and in particular the 5,000—or more—people who may currently be challenging their detention. Having made that point as clearly as I can, the Opposition give the Government their support. We will seek to ensure that co-operation is continued in another place so that the Bill can be put on the statute book, and any uncertainty removed.
Question put and agreed to.
Bill accordingly read the Third time and passed.
Business without Debate
Motion made, and Question put forthwith (Standing Order) No. 118(6)),
That the draft Welfare of Wild Animals in Travelling Circuses (England) Regulations 2012, which were laid before this House on 12 July, be approved.—(Mark Lancaster.)
30 October 2012
The House divided:
Question accordingly agreed to.View Details
Motion made, and Question put forthwith (Standing Order No. 118(6)),
Town and Country Planning
That the draft Town and Country Planning (Fees for Applications, Deemed Applications, Requests and Site Visits) (England) Regulations 2012, which were laid before this House on 17 July, be approved.— (Mr Syms.)
Question agreed to.
Motion made, and Question put forthwith (Standing Order No. 118(6)),
That the draft Police and Crime Commissioner Elections (Welsh Forms) Order 2012, which was laid before this House on 15 October, be approved.—(Mr Syms.)
Question agreed to.
Resolved, That this House do now adjourn.— (Mr Syms.)