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The White Paper should have been published before this move was made so that my Committee, and the House in general, could consider the issue in the round and make an informed judgment. Inevitably, when the
Committee meets, it will do so when the funding and tuition fees issue has already been decided. We will have to examine the consequences and potential unintended consequences.
I refused to sign the fees pledge. I did so knowing that higher education would need more funding and that we would have to examine the funding system in the context of a difficult financial situation, which could result in difficult decisions. There is a legitimate debate to be had about the balance of interests between individual contributions, the benefit that someone gets from higher education and the public benefit that comes from that individual's education, which the public should invest in. Unfortunately, the procedure adopted has precluded that debate from being held.
Steve Rotheram (Liverpool, Walton) (Lab): On 10 November in Prime Minister's questions, the Deputy Prime Minister admitted to breaking the pledge he signed on tuition fees. However, on 21 November on the "Politics Show", the Business Secretary denied breaking the tuition fees pledge. Which end of the Lib Dem pushmi-pullyu is right?
Mr Bailey: I do not want to be diverted by the grief and contortions of the Lib Dem party because there are some other very serious issues that need to be addressed.
Any package that is put forward must meet two criteria. The first is that it must provide the extra funding necessary to provide the flow of graduates into our industries and public services that will sustain the economy.
Bill Esterson: The University and College Union estimates that students currently graduate with around £23,500 of debt and that these proposals would increase that to £40,000. Does my hon. Friend agree that such high levels of personal debt are one of the main failings of the proposals?
Mr Bailey: I will come to that issue in a moment.
Let me just finish what I was saying. I have questioned Ministers both at the Select Committee and in the Chamber on whether these proposals will bring in any net increase in funding for universities. I have yet to receive any assurances that they will. In context of the world situation, we must remember that these proposals have been introduced at a time when the most advanced western countries, including European countries with similar financial problems as us, are investing in higher education because they know the economic dividend that accrues as a result will get them out of recession. Despite such a profound change to our funding system and all the potential consequences, this country could lose out on the vital issue of growing itself out of recession.
My second point is about social mobility and accessibility. My hon. Friend the Member for Sefton Central (Bill Esterson) mentioned the potential £40,000 debt that is incurred. My constituency is a case in point, as a traditional industrial area with traditionally low aspiration and educational attainment. Over the past five or six years, that has been transformed by the money that has been put into education, the education maintenance allowance and the Aimhigher project.
Dr Stella Creasy (Walthamstow) (Lab/Co-op) rose -
Mr Bailey: I cannot give way any more-I apologise.
Unfortunately, the rungs that were going to sustain that improvement are being removed. Above all, that £40,000 debt will play on the minds of would-be graduates in my constituency. To potential graduates from low-income households, such a sum appears to be disproportionately more than to those who come from higher-income households. The measures that the Minister said would be put forward to replace Aimhigher appear to be reinventing the wheel, and privatising the wheel, because in effect they will ensure that low-income graduates will pay £9,000 to go to universities that will recycle that money to encourage more low-income graduates to go to university and incur the same debt.
A system that has been effective in improving social mobility and supporting people from low-income households into university is being replaced with one that will be essentially self-funding. It will not work, and the potential consequences for social mobility are most profound. I believe that these proposals are hasty and ill considered, and that they will be ineffective.
Mr Gareth Thomas (Harrow West) (Lab/Co-op): This has been a genuinely passionate and robust debate. We have heard interesting contributions from across the whole House, including from my right hon. Friend the Member for Sheffield, Brightside and Hillsborough (Mr Blunkett), from the hon. Members for Bexleyheath and Crayford (Mr Evennett), for Leeds North West (Greg Mulholland), for Ipswich (Ben Gummer) and for Belfast South (Dr McDonnell), and from my hon. Friend the Member for Huddersfield (Mr Sheerman).
There were interesting contributions from the hon. Members for Brigg and Goole (Andrew Percy) and for East Surrey (Mr Gyimah). The contribution by my right hon. Friend the Member for Tottenham (Mr Lammy) was particularly interesting, given his experience. There was an interesting contribution on Aimhigher from the hon. Member for Winchester (Mr Brine), and another from the hon. Member for Manchester, Withington (Mr Leech). There were particularly interesting contributions on the question of access from my hon. Friends the Member for Washington and Sunderland West (Mrs Hodgson) and for Makerfield (Yvonne Fovargue).
There were contributions from the hon. Members for Reading West (Alok Sharma), for Belfast East (Naomi Long), for Gillingham and Rainham (Rehman Chishti), for East Antrim (Sammy Wilson), for Broxtowe (Anna Soubry) and for Chippenham (Duncan Hames), and from my hon. Friends the Members for Islington North (Jeremy Corbyn) and for Islington South and Finsbury (Emily Thornberry). We heard a particularly interesting contribution from the hon. Member for New Forest East (Dr Lewis).
We heard from my right hon. Friend the Member for Wolverhampton South East (Mr McFadden), the hon. Member for Aberconwy (Guto Bebb), and my hon. Friend the Member for North West Durham (Pat Glass), who gave another interesting speech. We also heard from the hon. Members for Carmarthen East and Dinefwr (Jonathan Edwards) and for East Hampshire (Damian
Hinds). Finally, we heard from the Chairman of the Business, Innovation and Skills Committee, my hon. Friend the Member for West Bromwich West (Mr Bailey).
Clive Efford (Eltham) (Lab): My hon. Friend has read out an extensive list, but has he noted how many Members were rising to speak when the Speaker called the Front Benchers to sum up? I wonder whether he can remember a debate of this importance, with a four-minute speaking limit, that has left so many people unable to get in. Does not that underline the fact that the guillotine that was imposed was unjustified and that it has denied Back Benchers the right to speak?
Mr Thomas: My hon. Friend makes a crucial point. We tried to get the Government to take the time out to publish a White Paper and to allow the House to have proper consultation and a proper debate. We never tried to curtail debate when we were in government-we allowed extensive time for Second Readings and for Committee proceedings.
Stephen Williams: Has the hon. Gentleman gone on such an enormous geographical tour and then spent time talking about time simply to waste time because he does not have a policy of his own to tell us about?
Mr Thomas: I thought that the hon. Gentleman could do better than that.
This has been a particularly interesting debate because of the cross-party opposition to the Government's proposals. It is a pity that the coalition Government could not be bothered to listen properly to the concerns of their Members of Parliament. The Secretary of State walked out as the hon. Member for Leeds North West got to his feet, and those on the Government Front Bench chuntered away as the hon. Member for Brigg and Goole spoke.
I agree with the Deputy Prime Minister on one thing: in the heat of the debate about the Government's plans, some unhelpful myths have circulated. He should know, because it is he and the Prime Minister who have been peddling those myths. The pair of them are about to become Britain's premier loan sharks: targeting those who are not well off, never letting people pay off their loans, always increasing the interest rates, and allowing no escape from the ever higher debts.
Mr Jim Cunningham: Did my hon. Friend note that the Secretary of State refused repeatedly to give way to Labour Members during his speech and did not allow them to express their views?
Mr Thomas: I cannot criticise the Secretary of State for not giving way to those on the Front Bench. However, if we had had more time, as Labour Members sought from the Government last night, far more Members from all parts of the House could have intervened in the debate.
George Freeman (Mid Norfolk) (Con): Does the hon. Gentleman agree that the points about debt that he and his hon. Friends have made would carry a little more weight if they had not left every man, woman and child in this country with a debt of £22,000?
Mr Thomas: I am grateful to the hon. Gentleman for that question, because I was about to say that the first myth that Government Members have peddled is that the Government have no choice in this matter because of the economic situation. As my right hon. Friend the Member for Southampton, Itchen (Mr Denham) pointed out in his speech, even within the terms of their reckless approach to reducing the deficit, the Government could have proposed a fee increase of hundreds of pounds, not thousands of pounds.
Mr Thomas: Let me just make this point. Even Ireland-which we are all watching closely, because the Chancellor of the Exchequer tells us that there is an economic miracle going on that we should emulate-is not cutting its university teaching budgets by 80%, nor is it increasing student fees threefold. The proposals before the House tonight are what happens when Conservative Chancellors of the Exchequer are allowed to run the Treasury unchecked.
Dr Creasy: Does my hon. Friend agree that it is impossible to explain to students in Walthamstow, where there has been an 87% increase in people who go to university, that the proposals are fair, when the Government are rowing back on the bankers' levy? Does that not show what their priorities are for this country?
Mr Thomas: My hon. Friend makes a very good point about the stark contrast between what the Government said they would do when in opposition, and what they are doing in government.
The second myth that Government Members have peddled is that the responsible position was to change the balance in funding between graduates and the Government. That might have been a reasonable line if a slight shift was involved, but the Government have thrown away the scales and are loading the whole cost -not a bigger part, but the whole cost-of a university education on to the graduate, particularly for art, social science and humanities courses.
The Deputy Prime Minister tells us that social mobility will not suffer. The money for widening participation, for championing the brightest and best from low-income backgrounds, and for helping mature students to do part-time courses is being axed. As the hon. Member for Winchester said, Aimhigher, the premier programme for widening participation, has been abolished. As Labour Members have said, the educational maintenance allowance, which helps low income students, will stop in January. The widening participation premium that is paid to universities to help them recruit and retain those from disadvantaged backgrounds is expected to be cut.
Elizabeth Truss: Is it not the case that under the previous Government, only 19% of the lowest-income households contained students who went on to university? That is the record of the previous Government.
Mr Thomas: With all due respect to the hon. Lady, she should look at the figures. There was a 30% increase in people from low-income households going to university.
In the last week or two, even the Government have begun to recognise that high fees will put off students. As the hon. Member for East Antrim said, by proposing a national scholarship scheme for children who are entitled to free school meals, the Government are at last admitting that high fees will put off students from low-income families. It would have been nice to have had a little more detail from the Secretary of State on how that would work, but he could not offer us any.
There are people watching the Liberal Democrat contortions who think that we have been watching the first pantomime of the season, with the Secretary of State for Business as the Widow Twankey of the Government, and the Deputy Prime Minister as the servant boy Buttons, frantically rushing around trying to please his new master. I am not going to go down that path, however, because there are only two certainties for the Liberal Democrats. The truth is that they are all playing the back end of the horse, and no-no one is behind them!
I recognise that, for Liberal Democrat Ministers, the question of student finance is very finely judged. For those tortured souls, the Under-Secretary of State for Transport, the hon. Member for Lewes (Norman Baker), the Minister of State, Department for Education, the hon. Member for Brent Central (Sarah Teather) and the Minister for Equalities, the hon. Member for Hornsey and Wood Green (Lynne Featherstone), the nub of the principle that they are grappling with tonight is a tough one: "If I keep my ministerial Mondeo, will I lose my seat?"
When no G8 or OECD country other than Romania is cutting higher education back, it is clear that Opposition Members have to speak for all those people across the nation who recognise the damage that these proposals will do to our universities and the impact that they will have on the economic, social and cultural future of our country. More than 75% of students will end up paying more under these proposals than is currently the case, and graduates earning middle incomes at the age of 25 will pay the most, including those who want to be teachers, engineers and police officers: ordinary working people and families wanting a better future for their children, and young people dreaming great hopes-the very people the Secretary of State now turns his back on. Is it not clear tonight that those families and young people, whether they are on low incomes now or whether they will be on low or middle incomes when they graduate, are being let down by the parties in the coalition?
Tonight, Opposition Members speak for ordinary working people. We speak for Britain's middle class. We will speak for those on low incomes in every constituency, and for all those who are outraged by this attack on the ambitions and aspirations of the brightest and best of Britain's next generation. An abstention tonight is not enough. I urge the House to reject these proposals.
The Minister for Universities and Science (Mr David Willetts):
We have indeed had a passionate and robust debate, and I am sorry that there will not be time for me to respond to all the points that have been made. The reason for the passion is that all of us care about the future of our universities, and about how we discharge
our obligations to the younger generation. It has to be said that all three parties, when in government and confronted by the challenge of how to finance higher education in our country, have reached the same conclusion. All have concluded that the way forward is fees, paid for by loans from the taxpayer and repaid by graduates.
Mr Bone: My problem in deciding how to vote tonight is related to my constituents, and to whether this measure will put them off going to university. My right hon. Friend the Minister has already indicated that there will be an annual review of the measure. Will the £150 million be used to help all low-income families, rather than just those on benefit?
Mr Willetts: I can assure my hon. Friend, as I chair the group planning the use of that extremely valuable £150 million, that we will consider a range of options for who could be assisted by the scholarship programme.
I was explaining to the House how all three parties have reached the same conclusion, albeit by a rather circuitous route. When we were in opposition, my party voted against the fee increases in 2004, and we remember that decision because we were afraid that the effect of fees would be to put poor people off applying to university. We have now seen the evidence, however, and it shows that, since fees came in-and because there were loans as well-the proportion of people going to university from the poorest backgrounds in England has actually gone up. It has not gone down. Indeed, by contrast, in Scotland, the proportion of people from the poorest backgrounds attending university has fallen while it has gone up in England. That is why my party has concluded that fees supported by loans do not deter poor students from going to university.
The Liberal Democrat party and my right hon. Friend the Secretary of State for Business, Innovation and Skills, when confronted with the challenge of how to deliver progressive policies in a time of austerity, have rightly concluded that this is what we have to do.
The Labour party, now so irresponsibly retreating to the comforts of Opposition, was explaining such policies six years ago. I see the shadow Chancellor laughing. Six years ago, he was in the position that I occupy today, and he explained only the other day, as well as anyone could, the logic of our proposals, in his famous note to the leader of the Labour party:
"Oh, and for goodness' sake, don't pursue a graduate tax. We should be proud of our brave and correct decision to introduce tuition fees. Students don't pay them, graduates do, when they're earning more than £15,000 a year, at very low rates, stopped from their pay just like a graduate tax, but with the money going where it belongs: to universities rather than the Treasury."
Quite right. It was true then and it is true now.
Ben Gummer: Back in June, when the Leader of the Opposition was offering solutions, he said that instead of up-front fees, graduates under Labour's scheme would be asked to contribute a small percentage of their salaries to a fund over a fixed period of time. The percentage would vary according to income. I struggle to understand the difference between his proposal and that of Government Front Benchers.
Mr Willetts: My hon. Friend is right. We have improved on the policies that we inherited from the previous Government. They had a threshold of £15,000 and we are increasing that to £21,000, which is why the poorest quarter of graduates will be better off under our proposals than on the scheme we inherited.
Dan Byles: Does my right hon. Friend agree with the former Labour Education Minister, Lord Adonis, who said that trying to introduce a graduate tax would be so complex that it would be a "catastrophe"?
Mr Willetts: Absolutely right. Lord Browne produced an excellent report. There is a group, "Blairites for Browne", but of course they fell for that trick once before, so they are a bit wary this time.
The House should recognise that our proposals improve on the inheritance from the Labour Government. We have not only raised the threshold but increased the maintenance support available to students. Indeed, 500,000 students will receive more grant than they currently do.
Pete Wishart: I am very grateful to the Minister for giving way, but there are more than three parties in the House. Does he recognise that one party has consistently opposed tuition fees, is in government in Scotland and will have nothing whatsoever to do with tuition fees?
Mr Willetts: Perhaps the hon. Gentleman will explain how, under the English system, more Scottish students study at English universities than English students study at Scottish universities. We know how to invest in high quality universities for the future, in the best interests of English students and the nation.
We have increased the repayment threshold and the value of the maintenance grant and, of course, we have offered a far better deal for part-time students than is currently available to them. In future, part-time students will be eligible for fee loans, which they do not currently receive.
Geraint Davies: On a point of order, Mr Speaker.
Mr Speaker: I hope that it is genuine point of order.
Geraint Davies: I think that Members of all parties are worried that there may be civil unrest as a result of the way in which this is being railroaded-
Mr Speaker: Order. The hon. Gentleman will resume his seat. I call the Minister.
Mr Willetts: If I may say so, that was a disgraceful intervention.
The Government are committed to explaining how our proposals are progressive, how they will improve social mobility and how they will give our universities secure financial backing for the future. Members on both sides of the House have asked about the speed with which we are implementing our proposals. In fact, that was the Opposition's main point-they want more time for a review and a Green Paper. I should explain to the House that the proposals emerge from Lord Browne's review, which was set up by the Labour Government more than a year ago. The inquiry took evidence in
public and received evidence from Members of all parties. We believe that we are implementing proposals- [ Interruption. ]
Mr Speaker: Order. Whatever people's feelings, the Minister must be heard.
Mr Willetts: I was explaining how we have not rushed our proposals. They were based on a report that was introduced and commissioned by Labour a year ago. The changes will not come into force for the first generation of students until September 2012. It is necessary to take the financing decisions now so that universities can plan for them. If we do not take those decisions now, students and universities will find that universities have less grant, and that they are unable to replace it with income from students, which is what we are introducing-that is the key feature of our proposals.
We often hear Opposition Members talk about the loss of teaching grant, but they do not talk about the other side of the proposal-the extra money that can come to universities through the choices of students. We trust students. Taxpayers will provide students with the money to pay the fees. That will ensure that universities can continue to enjoy the levels of income that they enjoy at the moment. That money will not be handed out from Whitehall; it will come from the choices of students.
We believe that those students will continue to choose arts and humanities. There is no bias against arts and humanities- [ Interruption. ] Our proposals are equitable, and we believe that they will ensure that students can choose the courses that they wish.
Mr Willetts: Because our proposals-[Hon. Members: "Give way!"] I am not going to give way because I have three minutes remaining in which to report to the House that in the past few days 53 university leaders from across England have made it clear that they support the coalition shift towards a more progressive graduate contribution scheme as the way to provide a more sustainable higher education system.
Of course the Government care about participation in universities. That is why I can assure Members on both sides of the House that unlike the system we inherited from the previous Government, we expect universities to review access and report on how they are doing on broadening it under our proposals not every five years, but every year.
There will be no loss of income for universities. We believe that students will continue to apply. They will not have to pay up-front, and they will be enabled by funds from the taxpayer to choose the university courses that they wish.
We believe that the proposals are the right way forward for our universities. All the Opposition can offer is delay. They did not even dare propose their graduate tax today, because we know that although the leader of the Labour party wants it, his own shadow Chancellor does not agree. They have not even proposed a graduate tax.
Labour left a mess in the public finances, and the Government must tackle it. If we do not tackle it in the way we propose, and if we go for the delay that the
Opposition advocate, it will simply mean less funding for universities or more Government borrowing. Who pays the Government debt? It is the younger generation whom the Opposition claim to care about.
That is why the Government commend the motions to the House. We believe that we have tackled the challenge-in a time of austerity-of proposing a policy that is fair and progressive, and one that puts power in the hands of students and universities on a solid financial footing for the future.
That, for the purpose of section 24 of the Higher Education Act 2004, the higher amount should be increased to £9,000, and to £4,500 in the cases described in regulation 5 of the draft regulations in Command Paper Cm 7986, and that the increase should take effect from 1 September 2012.
The Speaker then put the Question necessary for the disposal of the business to be concluded at that time (Order, 8 December ).
Motion made, and Question put,
That the draft Higher Education (Basic Amount) (England) Regulations 2010, which were laid before this House on 29 November, be approved.- (James Duddridge.)
That, in respect of the Loans to Ireland Bill, 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.- (Sir George Young.)
That, at the sitting on Tuesday 21 December, the Speaker shall not adjourn the House until he has notified the Royal Assent to Acts agreed upon by both Houses.- (Sir George Young.)
Valerie Vaz (Walsall South) (Lab) rose-[Interruption.]
Mr Speaker: Order. Before the hon. Lady presents her petition, as usual in these circumstances I appeal to hon. and right hon. Members who are leaving the Chamber to do so quickly and quietly, affording the same courtesy to the hon. Lady that they would wish to be extended to themselves in her situation.
Valerie Vaz: Thank you, Mr Speaker.
The petition is from the users of bus service 639, Walsall to Wednesbury. The petitioners are concerned about the way the 639 bus has been taken out of service from the Kings Hill area, Walsall. They believe that this action was taken without consulting the people who live in the Kings Hill area. They have noted that the reason given was lack of use. The petitioners believe that this was not the case, and that it was due to the failings of West Midlands Travel (Walsall), as the bus often did not turn up and was mostly late when it did. They are concerned that there is now not a service to the Manor hospital. They therefore request that the House of Commons urge the Government to call on National Express West Midlands and Centro to take all possible steps to put this problem right and ensure that the 639 bus service is reinstated. There are 119 signatories.
The Petition of users of Bus Service 639, Walsall to Wednesbury,
Declares that the Petitioners are concerned at the way the 639 bus has been taken out of service from the Kings Hill area; notes that the Petitioners believe that this action was taken without consultation of the people who live in the Kings Hill area; notes that the reason given was lack of use, but that the Petitioners believe this was not the case and that it was lack and incompetence of West Midlands Travel (Walsall), as the bus often did not turn up and was mostly late when it did; further notes that there is not now a service to the Manor Hospital.
The Petitioners therefore request that the House of Commons urges the Government to call on National Express West Midlands and Centro to take all possible steps to put this problem right and ensure that the 639 bus service is reinstated.
And the Petitioners remain, etc.
Motion made, and Question proposed, That this House do now adjourn. -( James Duddridge.)
Dr Julian Lewis (New Forest East) (Con): I am delighted to have secured this debate. This is the second time I have addressed the House today and I hope that the consensus that was lacking in the earlier debate will be restored for this one, because hon. Members in all parties have the welfare of the mentally ill very much at heart. We are all constituency Members and we all have to deal with sad cases. Sometimes, we can do something to help people and sometimes it is too late to do anything to help those whom we have lost, but we can still try to achieve something in their memory to help other sufferers in future.
By way of background, I want to make it clear that I have no expertise or practical qualifications in mental health and that my doctorate is not a medical degree. I do, however, have a certain amount of experience stemming from when I first set foot in the House, in 1997, and came second in the private Member's Bill ballot. The individual who came first in the ballot promoted a Bill to ban hunting and the Chamber was packed on that Friday. I am sorry to say that when we came to debate my private Member's Bill, which was on improving conditions for people who suffer catastrophic breakdowns and need in-patient treatment, the House was back to its normal sparse attendance. Nevertheless, despite that somewhat cockeyed sense of priorities, the issue of mental health is an enduring one that requires great sensitivity.
Since those days, I have from time to time raised issues that affect my constituency. Most recently, I have been concerned about the closure of the psychiatric intensive care unit at Woodhaven hospital, which was constructed on the site of a former mental institution. I was delighted when that great facility was opened in my constituency a few years ago, and I worry about its future now that it has lost the intensive care unit. I recently set up a small group of people from different parts of the spectrum of mental health concern in the New Forest area. I asked members of that group, which is called "Support our Mental Health Services", to drop me a note about why they had joined it. One lady, Mary Stephenson, is particularly concerned about the loss of the PICU at Woodhaven, even though we are left with an acute ward. She wrote:
"On any acute psychiatric ward, there should be an opportunity to remove very disturbed, noisy and possibly violent patients, to have private peace and 'cooling-off' facilities."
That is also for the benefit of other people on the acute ward who do not require intensive psychiatric care. Unfortunately, that facility has now been lost.
We are also concerned about the future of Crowlin House, which is a sort of halfway house. People have joined our group because they are concerned that if that residential facility were to close, those currently housed there might find themselves put into care homes for the elderly or for those with dementia. That would not be suitable for people who are, in a sense, halfway between being in-patients and being in the community.
Other people have joined us from Solent Mind, which supplies various important services. It has drawn to my attention the fact that the community mental health
team is coming under pressure, as it faces losing 20% of its budget because of the introduction of improving access to psychological therapies-IAPT. In itself, IAPT is a good idea, but it is fairly low level and not a specialist service. It was supposed to be in addition to the services available to my constituents. As I have said before in this House, the danger can be seen in what happened to the specialist student service in Southampton-I cite that example in view of today's earlier debate. That service is no more because its functions were supposedly moved in the direction of IAPT, but in fact IAPT was not able to take them up. In addition, one of the beneficiaries of a scheme called supported permitted work, David Hayward, has written to me expressing his worry that that is under threat, and I understand that there are concerns about the position of the vocational advice service-my constituent, Lorraine Miller, has written to me about that.
I have painted a general picture about the state of mental health services, which is mixed. We have lost some good services, but we retain quite a lot of valuable assets, although we are worried that they might go. That is why we are setting up a campaign group to try to ensure their future.
My specific concern tonight is the problem that arises when somebody is mentally ill and the people treating that person feel unable to share information about that person's treatment with their carers or their next of kin. For once, I can say that some excellent work has been done on the theory, but I am a little worried about the practice.
I have with me a briefing paper prepared under the imprint of the Department of Health, King's college London, the Institute of Psychiatry at the Maudsley, Rethink and the NHS service delivery and organisation research and development programme. The paper goes right to the heart of the issue. It is entitled "Sharing mental health information with carers: pointers to good practice for service providers", and it seeks to tread a delicate line between preserving patient confidentiality and letting people who care about these patients have vital information about them when they are not in their right mind.
Esther McVey (Wirral West) (Con): I congratulate my hon. Friend on securing this debate and beating me to it. I wish to raise the issues faced by a constituent who looked after her husband 24/7 until he passed away in 2006. He suffered from hallucinations, paranoia and depression. He also had falls, lost consciousness and regularly became violent towards her, all of which put a lot of pressure on their relationship and left her upset. Her health deteriorated and she felt that she could not look after him properly. It was not until he passed away that she learned that he had dementia. I have a question for the Minister: should the safety of the carer be put ahead of the patient's right to confidentiality? Should we consider the severity of the patient's mental health problem in determining whether they are fit to keep their condition a secret?
Dr Lewis: I am so grateful to my hon. Friend for staying after this somewhat trying and long day to make that important contribution, because it shows that I am not talking about some quirky, one-off situation. It is a very real dilemma, which requires great thoughtfulness and sensitivity.
I do not have time to go into the contents of that briefing paper in great detail, but I shall select just a couple of quotations that show how good it is. It says:
"Carers play an important role in many service users' lives. Their knowledge and expertise represent an enormous resource for statutory and voluntary mental health services. These are reasons why it is so important to include them through sharing information. Providing carers with information to support them in their role can improve outcomes for both service users and carers...Carers fear being denied access to important information to help them in their role. They are also concerned that their own confidences may be broken."
I came to the topic through the case of Mr and Mrs Edgell-my constituents David and Kay-whose lovely daughter Larissa, aged 34, hanged herself in 2006. They have obviously done everything that they can to come to terms with that, but I have a detailed file, which I have shared, because I knew they would want me to, with the Department and the Minister. I shall not go into the detail, because I do not have the time to do so, but it shows that from the earliest stages, back in about 2000, they warned of their fears that Larissa, or Lara as she was known, was seriously at risk.
Subsequently, in about 2004, Lara made a serious suicide attempt, but between then and 2006, when sadly-tragically-she succeeded, her parents were unable to know what was going on between her, the people who advised her in the NHS and, indeed, the people whom she saw privately, the private therapists.
I made it clear to Mr and Mrs Edgell that I felt that little could be done to improve on the excellent briefing document that I have only briefly quoted. It is an admirable piece of work and-unlike so much jargon produced in-house and, dare I say it, within the NHS-admirably clear. It is a first-class piece of work, and I would not alter a dot or comma in it.
When Mr and Mrs Edgell first came to see me in 2007, I wrote to the then Under-Secretary at the Department of Health-the hon. Member whose constituency I should have looked up. Is somebody going to tell me Ivan Lewis's constituency? I am not the only who is stumped. That is the first time I have known Mr Speaker's encyclopaedic memory to let him down. Sorry about that, Mr Speaker.
Anyway, I wrote to the hon. Gentleman and said that my main reason for doing so was to focus on two main issues relating to what had happened- [ Interruption. ] A voice off tells me that he is the hon. Member for Bury South (Mr Lewis). I am glad that we have sorted that out.
I said that I was writing on two main issues:
"The first is the frequent invocation by doctors who were seeing Larissa of the concept of 'patient confidentiality' when her desperate parents were trying to look after her interests at a time when she was too unwell to be the best judge of them herself."
I went on to say that, after Larissa took her own life, Mr and Mrs Edgell investigated that matter and discovered that the Department of Health had an extremely good policy, set out in the paper that I have described, which it issued in January 2006. The paper seemed to show, as I said in my letter,
"a clear understanding of the importance of sharing vital information with those nearest to the mentally ill person",
"the best policy in the world is worthless if the doctors concerned fail to apply it either out of ignorance or obstinacy."
Mr and Mrs Edgell discovered only when it was too late how many times-it said how many in the notes of their daughter's various visits to medical professionals-she had had suicidal thoughts.
The response from the hon. Member for Bury South was rather disappointing. I see that I did write the name of his constituency on the reply, so I apologise for having embarrassed Mr Speaker for no good purpose.
In the reply, the then Minister states:
"As you state in your letter, the Department of Health had issued excellent guidance regarding confidentiality and people with mental illnesses. However, as you may be aware, the Government's task is to set the national agenda, to put in place national standards and provide overall health service funding. The responsibility for deciding how the national agenda is delivered locally and determining how best to allocate these resources to meet the needs to their local populations rests with local health communities."
I did not think that that was an adequate response. What is the point of producing excellent guidelines on highly sensitive, critically important, life and death matters, in that way and then relying on individual trusts to bestir themselves to the extent that they decide to apply or not to apply them? For once, it was the Conservative Opposition Member who was asking for a bit more central direction because, in this case, central direction was necessary.
The second main concern of Mr and Mrs Edgell was the lack of regulation of the private therapists whom Larissa had been seeing. Larissa was 34 when she died, and was well and truly an adult. However, it is a matter of concern that, even after her death, the people treating her outside the NHS have refused to give up any notes or information about what they were doing during the period she was desperately in need of help. Again, the reply basically said that Mr and Mrs Edgell might wish to contact the British Association for Counselling and Psychotherapy, which is a voluntary professional organisation that currently helps the psychotherapy and counselling profession to self-regulate. Frankly, that is no proper method of ensuring compliance when private therapists have been taking part in the treatment of someone who has ended their life under these circumstances.
My time is pretty much exhausted, so I will confine myself to saying that I hope I have done justice to my constituents and to the memory of their daughter. They have not failed to understand the delicacy of the issues involved and they hope that their daughter's death will mean that, in the future, people recognise that the next of kin and/or the carer must be taken into confidence when people talk about doing away with themselves, even if those people are adults.
Adults do not have quite the same rights when they are not operating within their normal mental framework. We talk about people being "out of their mind," which is perhaps an old way of saying something unpleasant about someone, but there is a literal truth in that phrase. I do not come from a Christian background, but I feel a particular sense of sadness when I hear people singing the famous hymn, "Dear Lord and Father of Mankind." The third line states:
"Re-clothe us in our rightful mind".
When people are not in their rightful mind, they need professional help. The professionals need to talk to each other and the mentally ill need the help of the people who have their interests most closely at heart. Those
people are the next of kin and the carers. I would be most grateful if the Minister could give some reassurance for the future.
The Minister of State, Department of Health (Paul Burstow): I congratulate my hon. Friend the Member for New Forest East (Dr Lewis) on securing this debate. Having had the opportunity to deal with two Adjournment debates this week, I reflect on the fact that this was an entirely fitting and appropriate way to raise very serious matters, which was not entirely the case in the debate that I replied to yesterday.
My hon. Friend is absolutely right to raise these issues and to bring a distressing case to the House's attention. It is the most appalling human tragedy when a young person with so much to live for ends their own life. For the friends and family, the tragedy is all the greater when there is a sense that more could have been done to prevent the person from taking that action. I know that the parents of the young lady in this case continue to grieve for the desperate loss of their daughter. I can absolutely understand their need for answers and explanations, and for assurances from the relevant authorities that out of these tragic circumstances, some good may come. That is what I hope to be able to offer in my response.
I am afraid that I have to start my remarks by saying that this case has some painful similarities to that raised in another debate to which I responded a couple of months ago. In both cases, the clear and consistent flaw was that families and carers were not properly listened to or involved. Indeed, evidence from the National Confidential Inquiry into Suicide and Homicide points to this being a flaw in too many cases. Where things go wrong in mental health services, it is so often due to communication breakdown between agencies and families. While there has been progress in mental health services in recent years, there is more to be done. In some parts of the country, the system is too secretive and defensive, and not sufficiently joined up to secure the best results for the patient.
My hon. Friend will know that we set out in our coalition programme a commitment for hospitals to be open, and always to admit if something has gone wrong. That is why we plan to give effect to a duty of candour in which health professionals and managers would be expected to inform patients and families about actions which have resulted in harm. Mistakes happen-to err is to be human-but the key thing is that the NHS learns and improves practices so that the same errors are not repeated. I know that that is what the Edgell family are looking for. I expect all parts of the NHS to engage constructively with families like them to understand and learn from their concerns. That is also why we are determined to strengthen the arrangements for whistleblowing so that where standards slip or practice is poor, staff can raise their concerns in the knowledge that they will be treated seriously.
Patient confidentiality emerges as a consistent theme in the correspondence that I have seen between the family and the local NHS; I am grateful to my hon. Friend for passing it to me. He recognises, I think, that the judgments that mental health professionals make are often finely poised. They can be damned if they do and damned if they don't. There is a balance to be
struck between respecting the patient's wishes, on the one hand, while also acknowledging how friends and family can contribute significantly to the person's safety, ongoing treatment and recovery.
All NHS organisations have clear legal and ethical obligations to ensure that patient information remains confidential. To resile from this principle, particularly in an areas as sensitive as one's mental health, would undermine the trust and confidence on which effective treatment is based, increasing the risk of the patient distrusting and disengaging from clinical care. It is very important to stress, however, that, as guidance provided by the Department of Health and the General Medical Council makes clear, patient confidentiality can and should be overridden to prevent significant harm either to themselves or to others. That very much goes to the point raised by the hon. Member for Wirral West (Esther McVey) in her intervention.
As my hon. Friend rightly said, patient confidentiality should not be a barrier to having conversations with families and carers. Those closest to the individual can play a crucial role in helping clinical teams to understand a patient's illness, and in providing an early warning if their condition changes or deteriorates. I am deeply concerned that not all trusts are applying this principle in practice. We need some basic common sense and compassion in how health professionals deal with concerned families. Having read the paperwork that my hon. Friend shared with me, I cannot help but feel a sense that some medical teams were ticking the boxes but missing the point.
I cannot stand here at the Dispatch Box and enunciate lots of new principles. My hon. Friend is absolutely right that there is already very good practice guidance, as well as clear guidelines from the Department of Health, the GMC and others. However, what we need to do to achieve real change in practice is to ensure that it is clear where professional leadership comes from to drive the practice into everyday action on the ground. One of the actions that I will be taking as a result of this debate is to meet the relevant royal colleges to discuss how we can change and challenge attitudes within general practice-where this all began-and mental health services to ensure that the voice of families and carers is never ignored. Improving mental health is a clear priority for this Government.
There is no health without mental health. Next year, as a result of our commitment to prioritise mental health, we will publish a new mental health strategy, which will set out how the Government will invest in early interventions and the extension of talking therapies, to which my hon. Friend referred, for children and older people. Those things are not all that we must do, but they will make an important contribution to tackling the burden of mental health at an earlier stage, thus promoting recovery and reducing the burden on individuals and society in the long run.
In addition, we will publish a new suicide prevention strategy to set out the steps that the NHS and others need to take to further reduce suicide. I will ensure that the points that have been made in this debate are taken into account as we finalise that strategy.
There is no adequate answer that I can give tonight to my hon. Friend's constituents to make up for their loss. However, I hope that my remarks and the fact that we have looked very carefully at what my hon. Friend said
in his correspondence, assure him and his constituents that the Government are determined to do everything they can to ensure that the lessons from this case, and a number of other tragic cases, are translated into better practice in the future and that the good practice that is out there is not the exception, but the consistent norm.
Official Report, 8 December 2010: In Division 148, column 478, Bob Blackman voted with the Ayes.