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When many normal members of the public think about people who suffer from mental health problems, they often think about those who go around killing or assaulting people or self-harming, but they are a small minority. The majority of people with mental health problems, as my hon. Friend the Member for North Durham (Mr Jones) said earlier, look very normal; it could be any one of us, or people who look similar to us. Mental health issues do not often result in people self-harming, but there can be problems with depression or with how to relate to families and friends or to the community at large.
Of course, sometimes those health issues are difficult to identify and assess, and as a result it is sometimes hard to prescribe the right treatment. However, I believe that if enough time and effort is taken to try to identify the problem and support the person fully, it is probably easier to find out what is going on and what the right treatment is.
Members have already touched on how people can be reluctant to talk about their mental health issues because there is still an element of stigma and shame. Although it is great that people are talking about it, we know that it is still not being talked about enough and that there is still stigma. Mental health issues can also affect employment and housing and can lead to rejection by family and friends.
Different communities and groups of people have been mentioned. My hon. Friend the Member for Bridgend (Mrs Moon) quite properly touched on mental health issues in the armed forces, and other hon. Members touched on mental health issues in black and minority ethnic communities. I will mention that as well because, in addition to a number of barriers, such as jobs, stigma and rejection by family and friends, they also face the barrier of accessing appropriate care and treatment that is also culturally sensitive.
Although it is accepted that there is nothing genetically that makes people from black and minority ethnic groups more vulnerable to mental health issues, often those issues are not diagnosed properly. Psychiatry in the United Kingdom, understandably, is based on the western understanding of mental illness and often medical models are used to treat it, but in fact mental health means different things to different people from different cultures and different communities, and they can be affected by many different issues, such as spiritual, religious and background issues. Those might relate, for example, to the countries they have come from. Therefore, a purely medical approach is not necessarily the right one for many people. A more holistic approach that looks at a person’s overall health should be considered.
Contrary to what was said earlier, there are of course problems with resources. We know that mental health issues can be very expensive to deal with, because often it is hard to identify what is happening and the treatment might take months or years and require one-to-one assessment. It is much easier when somebody has a damaged arm or a faulty kidney; such conditions can be expensive to treat, but at least they can be identified and treated. Once the treatment is done, the person recovers. But mental health is unique in that respect, because that does not happen.
We know that drug and alcohol addiction is often linked with mental health issues. In fact, units that deal with addiction are very expensive, so there are funding problems. I know that from my own practical knowledge
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and experience, having been a criminal law practitioner for 20 years before becoming a Member of Parliament. When clients were charged with various criminal offences, they often had psychiatric problems or problems with drug or alcohol addiction. When they were being sentenced, the pre-sentence report would often require us to look into drug or alcohol rehabilitation units. The first question we used to ask was whether the local authority or social services responsible for the person had the necessary funding. Weeks used to go by while everybody searched around to find the funding so that the person could go into the unit. That is why I raised funding for mental health issues earlier and questioned whether it is sufficient and appropriately applied to the whole country. In parts of the country, there are very good practices and systems, but in many others that is not the case. It is a question of ensuring that the same treatment, facilities and services are available across the whole country.
More treatment centres should be available in the criminal justice system. There should also be more psychologists and psychiatrists. The problem we had in criminal cases was that the person in question often needed to be assessed by a medical expert or psychologist, and it used to take weeks and weeks before that could be done, which then used to take time away from treatment. Six months can elapse between somebody being charged and getting treatment. That is if they even get the treatment, because sometimes the funding authority will not fund it, so they end up in the prison system, which does not help them. That is partly why a large number of people, in comparison with the rest of the population, commit suicide in prison.
Everybody here, including Ministers, I am sure, wants to deal with mental health on a humanitarian level, but there is also an economic and financial case for ensuring that the system is working properly. If we are able to help a person to recover from their mental health problems, it will be better for our country and for society generally. For example, if an adult who cares for children suffers mental health problems and is not treated properly, those children will often be taken away and put into care homes or with foster families. That is an incredibly expensive process. If we are able to support and help the parent, the thousands of pounds that it would cost to deal with the problem will be saved. Everyone talks about the humanitarian case, and we all agree with that, but it makes economic sense as well.
I pay tribute to hon. Members who have mentioned their mental health experiences; it is great that that has happened. I hope there is a debate about this issue in the rest of the country and it is appreciated that many people can experience mental health problems of differing natures. If we recognise that, then medical and social services professionals, and others, can intervene to help. I congratulate the hon. Member for Broxbourne (Mr Walker) and my hon. Friend the Member for North Durham on talking about their experiences. It takes a lot of courage for a public person to mention these issues, and I thank them for what they have said.
2.12 pm
John Pugh (Southport) (LD):
I apologise to the House for not having been here at the start of the debate. I was in the Finance Bill Committee, and unfortunately I
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cannot be in two places at the same time. I also apologise for missing the introductory speech by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow). I pay tribute to everything he has done to put mental health on Parliament’s agenda.
It is unquestionably the case that Parliament has got its act into gear on this. I refer to Parliament rather than the Government or the Opposition because this is genuinely an all-party matter. Last night I went to a very encouraging event, which other hon. Members attended, run by the Alzheimer’s Society. The Minister was there, as was the shadow Secretary of State, a Conservative Minister, and my right hon. Friend the Member for Sutton and Cheam, and they spoke with their customary eloquence. In fact, to be fair, there were not very many Members there. I think that other people were detained with matters that had something to do with Europe. However, all of us who were there would have to acknowledge that no matter how eloquently the Minister or the shadow Minister spoke, the most impressive speech was by a very feisty medical lady who had Alzheimer’s and discussed the importance of talking about her condition and people talking to her about it.
That emphasises the fact that there is a blurred division between people who have mental problems, allegedly, and those who appear not to have them. There genuinely is not a clear distinction, other than at the extremes. If we were asked who here has perfect mental health, we would not necessarily all volunteer with alacrity, any more than we would if someone asked who has perfect physical health. It is rather like the Bible saying that the person who is without sin has to step forward. We would not say that because we acknowledge that we all have our own peculiarities and weaknesses and are not as mentally robust as we would always wish to be.
I was made aware of that the other day when I went to an event organised by Liverpool Personal Service Society, which is a well-established charity. The event was a memory day for elderly people in which it invited me to participate. The old ladies and old men were passing round objects that came from their youth, and music was being played in the background that also came from their youth. The environment was made to look almost like a 1950s drawing room. I was very struck by what it did for them. It was like the events organised by football clubs such as Everton and my own local football club in Southport, which bring old men together to talk about teams long since vanished and the glories of the past.
I picked up on two important features of that occasion. First, it was undoubtedly beneficial to the people concerned, who have dementia. Secondly, it is not in any way onerous for anybody else to participate in it. It is incredible fun. It is really enjoyable to hear these people talking about things that are now obsolete, like cigarette cases, nylons of the kind that people had in the war, or EPs—things that we no longer have and that our children do not even understand. That brings it home to us that memory is very relative. There is no magic cut-off point between a memory lapse that may afflict us at any time—
Mr Kevan Jones: Nick Clegg knows all about that.
John Pugh: We are presumably talking about unintentional memory lapses—senior moments that may afflict any of us.
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There is no absolute cut-off point between mildly obsessive behaviour and obsessive compulsive disorder, between mood swings and genuine bipolar conditions, or even between irrational fears of which everybody is sometimes a victim and some of the conditions we would call paranoia. There is a continuum; it is, to some extent, a matter of degree. It is even possible, apparently, to have hallucinations without having schizophrenia. Delusions are not unique to asylums; there are many victims in this place. There is nothing especially rational about clever, civilised people gathering here every Wednesday at 12 o’clock just to shout at one another.
There are two aspects to addressing the stigma of mental health. One of those is to persuade people that this can happen to anyone, including MPs. That is very important. The other job is to persuade the public that mental health is not an either/or, black/white distinction. I recognise that there are conditions such as serious neurological malfunctions, deterioration of the brain, and so on. Affective disorders can be evident in people classified as being well and also in people classified as being unwell with mental health issues. What determines the classification is not only the severity of the condition—the extent to which the person is down one continuum or another—but the capacity of society to deal with the condition and the ability of the person to cope within society with the condition. The cultural comparison made by the hon. Member for Bolton South East (Yasmin Qureshi) is useful in this context. The mental health of a society and the mental health of individuals are intertwined, and one is the index of the other. I wonder whether, when we talk in this place about producing a prosperous society or economic growth, or doing something about social mobility or social inequality, we ask ourselves sufficiently whether we are doing enough to make society a happy place for us all to live in.
Let me add one other point with which I think you, Madam Deputy Speaker, will be au fait. Community treatment orders were a bone of contention throughout the passage of the Mental Capacity Act 2005, when I served on the Bill Committee. We have to review that issue, and the Minister needs to make a response. I think that we made the right decision, but that depends on whether the Act is understood and implemented properly. There is a genuine case, particularly given some of the variations, for trying to see whether we have got it right.
Mr Charles Walker: On that point, it is very important to ensure that advocacy requirements are being met.
John Pugh: Absolutely, and I hope the Minister will take that into account when he responds.
2.19 pm
Jane Ellison (Battersea) (Con): Thank you, Madam Deputy Speaker, for allowing me to speak in this debate. I had not planned to do so, but I realised earlier today that I wanted to address an aspect of female genital mutilation, which I have discussed often in the House. When I listened to the opening speeches, I realised that I have never talked about an issue that many of the campaigners I work with discuss a lot, namely the mental health aspects of both acute and, in particular, chronic FGM.
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I just want to put the issue on the record for the Minister to think about; I do not expect any instant answers. As many Members have said, it is hard enough to talk about mental health, but raising the issue of the mental health problems of the victims of a secret, taboo and illegal practice that we have never successfully prosecuted adds several layers of difficulty to an already difficult situation. We know enough, however, for the matter to be put on the record so that somebody at the Department of Health can at least think about it. We should be worried about it.
Female genital mutilation is practised in many countries around the world, but it is predominantly an African practice. In this country, it is practised predominantly by communities from east and sub-Saharan Africa. Most professionals in the field think that the largest diaspora groups in which FGM remains prevalent are probably from Kenya and Somalia; it is certainly heavily practised in those countries.
In the absence of a more up-to-date study, people work on the numbers given in a 2007 study by FORWARD—the Foundation for Women’s Health, Research and Development—which was itself based on the 2001 census. The study established that there are at least 66,000 women with FGM living in England and Wales and that about 21,000 more girls are at risk of becoming victims. Of course, given the substantial migratory trends of people from practising countries to the UK in recent years, the real figure is likely to be higher.
In 2004, the British Medical Association recorded that it believed that there were 9,032 births to women who had had FGM. It should be noted that not all hospitals are required or able to record FGM at birth, and I know that one of the Minister’s ministerial colleagues is looking at trying to get that right. Recent freedom of information requests by the press also show that hundreds of similar women are giving birth every year in hospitals in Leeds, London and elsewhere. We know that this is a problem and that the practice is not being abandoned at anywhere near our desired rate.
During visits to schools in my constituency in recent months, I have asked questions about the issue—other Members may also have done so—but I have not received any satisfactory answers. Most recently, a headmistress who knew about the practice, which is unusual, had been told by a school community worker, “Don’t go there. Let’s not talk about that topic.” This is a problem; do not let anyone believe that it is a myth and that we do not have a problem in the UK.
A study cited by the World Health Organisation in the mid-2000s examined the effects of FGM on the mental health of women. The researchers concluded that FGM is
“likely to cause various emotional disturbances, forging the way to psychiatric disorders,”
especially post-traumatic stress disorder, possible memory dysfunction and other problems associated with trauma.
This issue was brought home to me by a Radio 5 programme I took part in recently after a two-part story on “Casualty”—they were two very powerful episodes—featured the acute health aspects of FGM. The story centred on an older sister who was trying to stop her younger sister being taken abroad to be mutilated, and on the impact of birth on the mother of the family, who had been infibulated.
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One of the other guests on the Radio 5 discussion the following morning was a marvellous GP called Dr Abe from Slough, who told me that she sees two or three women a week who have chronic illnesses, some of which are mental-health related, associated with FGM. She asked me—the BMA stresses this and I will cite its guidance in a moment—to imagine the trauma experienced by a small girl who is being held down by people who are usually relatives or people she knows while a brutal procedure is carried out on her without anaesthetic. It is not difficult to imagine that such children will be troubled.
In case anyone thinks that such things do not really happen, let me point out that Dr Abe said that she regularly deals with children and young women whose bodies are contorted with pain and whose limbs are bruised, broken, battered and dislocated as a result of being held down by relatives. Few people who have that done to them by those who purport to be their loved ones will then go on to live with them as a family. I think we can all imagine the special and difficult mental health problem associated with that, and we are only beginning to understand it.
The BMA’s 2011 guidance acknowledged that little is documented about the psycho-sexual and psychological effects of FGM, but it does say:
“Long term consequences might also include behavioural disturbances as a result of the childhood trauma and possible loss of trust and confidence in carers who have permitted, or been involved in, a painful and distressing procedure”
“women may have feelings of incompleteness, anxiety and depression, and suffer chronic irritability, frigidity, marital conflicts, or even psychosis.”
Many of the professionals and campaigners I work with stress the growing problem of anger, particularly among young women who suffered FGM before coming to this country. They are in a conflicted state, because the mentality of those who put them through FGM could not be more different from the mentality that they see around them in Britain. It is considered entirely normal in a sexualised society for magazines to invite young women to express their sexuality and have a fulfilled sex life. If someone has had a procedure carried out on them, the entire aim of which is to stop them wanting to have sex and to be a sexual person, and to restrict them and preserve their virginity—and everything else associated with the centuries-old tradition of FGM—that leads to conflict.
Both Efua Dorkenoo, who wrote the WHO guidelines, and campaigners such as Nimco Ali of Daughters of Eve talk about a growing pool of angry young women who are caught between those two very different worlds. It is also difficult for them to talk about it, because the subject is already taboo. Some Members may have read a recent article in The Sunday Times, which reported that Nimco Ali, who has been very bold in speaking out, has been threatened by people telling her that she should stop speaking out.
Mark Hendrick (Preston) (Lab/Co-op): Is the hon. Lady saying that FGM is taking place in this country, or are parents taking their children abroad to have it done before coming back?
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Jane Ellison: That does not relate strictly to the debate topic, but I will answer. We do not strictly know, but a growing body of evidence suggests that FGM does happen here. The girls I meet through some of the groups I work with will say off the record that it is happening here, but it is more difficult to get people to say so on the record and to point the police in the right direction. For example, women are re-presenting having being re-infibulated in hospital, which is also illegal. I think there is enough evidence now to suggest that FGM is happening here, but I think that the predominant view, and that of the police and the Crown Prosecution Service, is that girls being taken overseas is still the biggest problem. Since 2004, when a private Member’s Bill closed a loophole in the Prohibition of Female Circumcision Act 1985, such girls have also been covered by British law. The extraterritorial aspect of the law means that it is against the law to take a British resident or citizen abroad to perform FGM on them. Either way, that is covered. I think it is happening here, but we do not know.
Mark Hendrick: Have there been any prosecutions?
Jane Ellison: No; to the eternal shame of this country, in 25 years of this being an illegal act, there have been no prosecutions.
In recent times—I will return to the mental health aspects in a moment, Mr Deputy Speaker—we have had encouragement because Keir Starmer, the Director of Public Prosecutions, has been really good on this issue. He has a new action plan for the Crown Prosecution Service. It has reopened several old cases and is going through them with the police to see whether a prosecution is possible. It is also looking more imaginatively at prosecuting the aiders and the abetters, such as the people who set up the travel and those who supply the strong pain killers. If we wait for a seven-year-old girl to walk into a police station and report her parents, we will have a long wait. That is one reason why there have been no prosecutions. However, I am more optimistic now than ever that the police and the CPS are taking the matter seriously.
To return to the mental health aspects, a recent survey by the National Society for the Prevention of Cruelty to Children showed that 83% of teachers either do not know about FGM or have had no training on it. From memory, 16% of teachers thought that condemning FGM was culturally insensitive. That is extremely disturbing, given that it is an illegal act.
Mr Charles Walker: It is child abuse. There is no ambiguity. It is child abuse and it must be stopped.
Jane Ellison: I could not agree more.
My worry is about the 83% of teachers who just do not know about FGM or have not had the training. There are good guidelines, but they are not statutory. Not enough is filtering down. In my constituency, I have encountered people who say, “Don’t go there. It’s too difficult.” There is a role for Members of Parliament in pushing this matter at a constituency level. If teachers have no idea what FGM is or what the behavioural and psychological consequences might be, they will fail to understand why a young girl who has come back from being mutilated abroad is exhibiting naughty, disturbed
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or bad behaviour. It is therefore important to get more knowledge out there about the physical and psychological aspects of FGM so that we can understand and help children who present with signs of being disturbed.
In UK culture, women have an expectation that their sex life will be enjoyable and that they can have a normal expression of female sexuality. That is very much at odds with the mentality that leads to somebody being mutilated. Many of the women who are suffering the physical and mental complications of FGM do not speak English and live in socially isolated communities in which they are not encouraged to speak about it because it is entirely taboo. That is added to the taboo of speaking about mental health.
The lack of knowledge about FGM among teachers and medical professionals will increasingly be a problem as diaspora communities become scattered to places in the country where professionals do not see it as much. It is easier for a specialist in central London to know what they are looking for. Even if we stopped all FGM happening to young girls tomorrow—would that we could—we would still have to deal with the large number of women who are suffering the long-term consequences of it.
There is documentary evidence that some parents have second thoughts about having done this to their children. Some parents express regret. The Home Office had a good initiative last year, which we adopted from the Dutch, in which it provided girls and parents with a health passport to carry abroad with them to remind members of their extended family that the practice is illegal in the UK and that they must not do it, but must respect the rights of the child.
Mrs Moon: The hon. Lady is making some very interesting points, but the focus of this debate is mental health. Perhaps she could conclude by pointing out the mental health messages—
Mr Deputy Speaker (Mr Lindsay Hoyle): Order. It is for the Chair to decide what is in order and what the debate is about. I need no help from the Back Benches, although it was very kind of the hon. Lady to intervene.
Jane Ellison: I have clearly outstayed my welcome, so I will conclude. I realise that time is short.
The point that I want to make is that there is a significant mental health aspect to FGM, but that it is not well documented. Not many of our front-line professionals have it at the front of their minds when trying to explain other problems. I just want to put that on the record so that the Minister and the Department of Health can reflect on it and so that it starts to become a normal thing for mental health professionals to talk about and think about, particularly when they see people from communities that practise FGM and who might have suffered it.
Many of the young girls and women who talk about FGM speak of a silent scream for help. All I wanted to do today was to give that scream a voice in the House of Commons.
2.36 pm
Mike Freer (Finchley and Golders Green) (Con):
One of the first mental health cases that I came across was that of a wife and mother who had been subjected
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to repeated rape by an invading force. She was a refugee in this country. It was a tragic case. Although the physical manifestations of the ordeal had healed, the mental manifestations continued a decade on. She could not function either as a woman or as a mother and wife. That case drove home to me that many of the mental health issues that we face in this country are ignored simply because we cannot see them. That is reflected in the funding priorities in the NHS.
Two issues have come to my attention recently through my casework: the speed of treatment and the consistency of care. One of my constituents had to wait for many weeks to be referred to a psychiatrist. She was able to cope with that, but every time she went to see the psychiatrist for an appointment, she saw a new psychiatrist and had to repeat her case history. Although the notes may have been there, the new psychiatrist either had not bothered to read them or wanted the patient to repeat the details. That was disruptive to the treatment.
My second constituent was a young teenager who grew up being treated for an eating disorder in a residential unit. I see that my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) has returned to her place; I heard her powerful comments. When my constituent turned 18 or 19, she was no longer suitable for the facility that she was in. She had to fight for a new facility, with the help of her parents. When she eventually got into a new facility, it was not in the same place or with the same clinicians. That disruption of care and change in setting set her and her family back a huge amount.
No matter what I did, I could not make the mental health trust realise that sometimes the rules are there to be broken, or at least bent, if the mental health of the patient would benefit from continuity. Continuing my constituent’s care when she was 19 or 20 might not fit the rules, but it fitted the patient. I gently ask the Minister whether there might be some service-level agreements on allowing flexibility in provision.
The NHS website on improving access to psychological therapies does not mention service standards, consistency of clinical care or speed of referrals. The website of the Barnet, Enfield and Haringey Mental NHS Trust mentions a named care co-ordinator, who I assume is an administrator, but there is no mention of clinical standards or continuity and speed of care.
I realise that this is a complex issue and that there are no easy solutions, but I gently ask the Minister whether the Department of Health will consider publishing guidance on speed and continuity of care because it would benefit my constituents greatly.
2.39 pm
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): I apologise to the House for not being present for the debate’s opening speeches, which was due to circumstances beyond my control. I certainly meant no lack of respect for this debate; I think these Backbench Business Committee debates have been one of the more important and successful innovations of this Parliament, and mental health is a particularly important subject.
I congratulate the right hon. Member for Sutton and Cheam (Paul Burstow) on leading the debate in a detailed and informative fashion, and my hon. Friend the Member for Bridgend (Mrs Moon), who raised a
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number of important points, including alcohol abuse and its impact on mental health—those two issues are inextricably linked. I follow the hon. Member for Totnes (Dr Wollaston) in saying that if we are concerned about addressing alcohol abuse, one issue—although not the only issue—must be to do something about the flood of cheap alcohol that is overwhelming some of our communities, and put in place a minimum price for alcohol. I am glad to say that that is the Labour party’s policy.
I congratulate the hon. Member for Broxbourne (Mr Walker) on his speech. I remember a similar debate last year in which he made a moving speech about his experience, which resonated country-wide. Since then, he has shown great leadership in the mental health all-party group. He made a number of important points, including the fact that although the NHS can be good at managing symptoms, it is not necessarily so good at addressing their underlying causes. I will return to that issue when I mention Atos later in my remarks.
I am sorry to have missed the remarks of my hon. Friend the Member for North Durham (Mr Jones). He is always well worth listening to, and he too received country-wide respect for his contribution to last year’s debate on mental health when he spoke about his personal circumstances for the first time on the Floor of the House. He made a number of important points, including that mental illness and depression are equal opportunity conditions. They do not discriminate; they affect all social classes and backgrounds.
The hon. Member for Romsey and Southampton North (Caroline Nokes) spoke about a number of issues, including borderline personality disorders and the way that eating disorders affect women and girls. She made the important point that, although we sometimes associate mental disorders with socially marginalised communities and persons, eating disorders can affect the most high-achieving, educationally focused girls. That issue should not be trivialised because it is harming the life chances, health and well-being of many young women up and down the country.
My good Friend the hon. Member for Islington North (Jeremy Corbyn) made an important speech about mentally ill people in prison. When getting caught up with the “prison works” narrative, it is worth remembering how many people in prison are either illiterate or simply mentally ill, and if we want to contain the number of people in the prison estate, we must address the mentally ill. My hon. Friend also mentioned black and minority ethnic communities and mental health, and I will return to that point later.
The hon. Member for Totnes made an important speech and mentioned social exclusion and BME mental health. My hon. Friend the Member for Croydon North (Mr Reed) made an important speech about Olaseni Lewis and the issue of black and minority ethnic persons detained under the Mental Health Act 1983. I am glad that the Minister has agreed to meet my hon. Friend and engage with him and the family on that issue. The hon. Member for Harrogate and Knaresborough (Andrew Jones) also made an important speech.
My hon. Friend the Member for Bolton South East (Yasmin Qureshi) made a speech about—among other things—the importance of a holistic treatment for mental
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health issues and taking account of people’s different cultural backgrounds, which I thought was important. There was, as always, an interesting and provocative speech from the hon. Member for Southport (John Pugh), and I was interested to listen to the hon. Member for Battersea (Jane Ellison) who spoke about mental health and female genital mutilation—if it had been my choice, her speech could have gone on longer. I thought she raised important issues, and the House should respect the lead that she has shown in addressing the issue, which is difficult for people outside the affected communities to address. If in future some young girls are not subjected to that child abuse because of her work, she will deserve the congratulations of this House. The hon. Member for Finchley and Golders Green (Mike Freer) also made an important contribution.
We have heard figures for the incidence and prevalence of mental health problems, and because it is a Cinderella service and a Cinderella issue it is always worth reminding people that one in six people in Britain is affected by mental illness at any one time. In other words, almost every family will have experience of mental health. It is not something that happens to other people, but something that happens in our own families. One in four of us will suffer from mental illness at some point, and by 2030 depression will be the leading cause of disease around the world, costing the NHS a further £10 billion a year. The criminal justice system will also pick up the bill because 70% of those in our prisons have a mental illness. Mental health problems cost British business almost £26 billion a year.
The subject has been addressed by my right hon. Friend the Member for Doncaster North (Edward Miliband) who made an important speech to the Royal College of Psychiatrists in October last year. The key points he made are worth reporting and concern the importance of breaking down stigma—something that the House dwelt on at length in last year’s debate—and the importance of parity of esteem for mental health within the NHS. My mother was a mental health nurse in Huddersfield, and her hospital was a former Victorian workhouse on the fringes of Huddersfield. Having an old workhouse outside the city for mental health issues, and mainstream health services in the centre, illustrates the lack of parity of esteem for mental health in relation to the services we offer, and also to practitioners at every level within mental health services.
Finally, my right hon. Friend the Member for Doncaster North mentioned the importance of mental health in our society, and argued that good mental health does not start in hospitals but in workplaces, schools and communities. He took the opportunity last October to announce the formation of a taskforce on mental health in society, which will look in particular at employers and the role they play.
Jeremy Corbyn: Perhaps my hon. Friend can help me. I hope that the taskforce will also look at issues surrounding the voluntary sector and its excellent work within the mental health service, as well as the dangerous tendency of franchising out mental health services to the private sector by some mental health trusts that do it for profit rather than care.
Ms Abbott: My hon. Friend’s points are well made.
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Let me consider the future for mental health and set out for the House how important the role of local authorities can be in addressing the social determinants of mental ill health. Public health has become the responsibility of local authorities. They have a ring-fenced public health budget, and despite all their pressures and difficulties—which I do not seek to minimise—there is an opportunity for local authorities to do important and interesting work, bringing together education and housing with health care to address mental health problems and intervene in them early.
I was shocked to hear of a social housing project near King’s Cross that, presumably to make its tenants more manageable, did not want to give tenancies either to people who had a history of rent arrears or to people who had a history of mental health problems. Such things need to be highlighted and addressed. Sitting responsibility for public health with local authorities could address mental health, particularly in respect of early intervention and preventive work with children in schools.
I gave a speech this morning on the crisis in masculinity. We need to focus on the mental health challenges that face men. Whether it is because they are unwilling to come forward or because of stress in society, we know that, during a recession or economic downturn, suicide rates among men increase. Suicide is currently the biggest cause of death among under 35s. In planning services nationally and locally, we need to pay particular attention to that issue among others.
The hon. Member for Totnes made an important point. She said that, in our desire to reduce health tourism—a desire supported by the Opposition—there is a notion that people will need their passport when they turn up to see their GP. That runs the risk of making it harder for the socially excluded to access health care—many simply do not have a passport or such documentation.
I will not speak at this point about the merits or otherwise of the welfare reforms, but there is a lot of anecdotal evidence that they are having an effect on the mental health of some who are caught up in the system. There is a lot of anecdotal evidence that Atos, as it is currently configured and as it currently operates, does not meet the needs or seem to understand the problems of people with mental health challenges.
Mark Hendrick: I am sure that my hon. Friend, like many other hon. Members, has come across many constituents attending surgeries who are developing serious mental health problems purely and simply because of the pressures caused by the reforms to the benefits system. I am finding that people who are mentally ill and do not know it are getting worse—they are under pressure from the benefit changes that have been made and those that will take place in future.
Ms Abbott: I am afraid that there is increasing evidence that worry about the changes and about the threat of the changes is causing a lot of stress for people with mental health issues. Social services and health authorities must be mindful of that.
Mr Charles Walker:
I apologise to the hon. Lady because I am about to leave the Chamber—I am chairing a debate in Westminster Hall in a moment. I agree
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entirely that Atos should not be a blunt instrument used to beat those who have mental illness. We need a system that empowers people with mental illness to re-enter the labour market, and not one that terrifies them.
I endorse the hon. Lady’s views on young men. Young men need to feel part of something and they need to feel wanted by their community. They need to have a job and a role. If they do not have those things, they join gangs. Her point about young men was beautifully and perfectly made.
Ms Abbott: I entirely agree with hon. Gentleman. Changes in society and economic changes such as the collapse of manufacturing and of de-industrialisation have left many young men unclear about their role, which puts tremendous pressure on their health and well-being.
Before concluding, I want to say a few words on black and minority ethnic persons and mental health. It has been known for at least 25 years that BME persons are disproportionately present in the mental health system. We are more likely to be diagnosed as schizophrenic, less likely to be offered talking therapy, and more likely to be offered drugs and electro-convulsive treatment—the hon. Member for Totnes touched on that important point. There is therefore a great deal of fear and anxiety about approaching the mental health system on the part of some of our BME communities. Very often, mothers will be trapped at home with sons who have serious mental challenges. I have dealt with cases in which they are assaulted in their own homes, but are so frightened of the system that they will stay trapped rather than take their sons for treatment. That is a real problem. We must monitor what is happening and use the voluntary sector. We need to ensure that minority groups do not hold back from presenting with mental health problems. The later people present, the more severe the problems.
Mental health is the biggest financial burden on the health service. It will affect the families of all hon. Members in the Chamber in our lifetimes. There is much to be concerned about in mental health trends. For instance, there is a rise in mental health issues among young people. Fully half of lesbian, gay, bisexual and transgender youngsters are self-harming.
As I have said, there is a relationship between an economic downturn and a rise in suicides of men under the age of 35. None the less, there is the possibility of progress. I believe that there is now less stigma about mental health than there was a generation ago, and the debate we had last year on the Floor of the House played its part in helping to lessen it. I think there is more understanding about some of the contributory issues than there was a generation ago, and I believe that public health going to local authorities opens up the possibility of innovation in mental health, working together with the voluntary sector.
I am grateful to the right hon. Member for Sutton and Cheam for securing the debate. I hope that it is part of a process of parity of esteem that will improve the outcomes for so many of our men, women, family members and communities.
2.55 pm
The Minister of State, Department of Health (Norman Lamb):
I thank the shadow Minister for her contribution.
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I feel that this subject brings out the best in this place—we have had a well-informed, civilised and rational debate. There has been no political point scoring, just thoughtful concentration on an important subject, and I am grateful to all hon. Members.
Before I come on to the contribution of my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), I will say that I completely agree with the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that the arrival of public health in local authorities presents us with an opportunity. The establishment of Public Health England brings its expertise to bear on its relationships with local practitioners in public health, working alongside other services. The potential for public mental health, which has been largely disregarded or ignored in too many places in the past, is real. At the conference for the directors of children and adult services in Eastbourne last October, I attended a presentation by an academic from the London School of Economics on the economic case for interventions in public mental health. There is a powerful return on investment, which means that people are benefiting from it. We have a great opportunity, and I am grateful for the hon. Lady’s comments.
The hon. Lady made important comments about black and minority ethnic communities and the mental health system, and I will come back to that. I appreciated the comments made by the hon. Member for Croydon North (Mr Reed), and I will refer to them later.
The hon. Lady raised the issue of suicide and young people. There are too many cases in too many hospitals where people who have self-harmed turn up and do not get a psycho-social assessment. We know that having that assessment, with the therapy that can follow, massively reduces the risk of suicide, yet only about 50% of A and E departments ensure that that happens. That has to change, because lives are literally at stake. We have to take this issue very seriously.
I am tremendously grateful to the Backbench Business Committee for giving us another chance to talk about mental health. I again pay tribute to my right hon. Friend the Member for Sutton and Cheam for leading the debate and for the great work he did in office to lay the foundations for the progress we are now tangibly making. The previous Government invested heavily in mental health, as well as the rest of the health service, and it is right to acknowledge that progress was made in that period. The focus on parity of esteem, and making it a reality, is potentially exciting. I was struck by an interview with Angela McNab, the chief executive of the Kent and Medway mental health trust, which is one of the larger mental health trusts. She said that the Government were
“prioritising mental health like never before, making sure that it fits on a par with physical health”—
and that this had come as a welcome step change to mental health professionals. That is an encouraging view from the front line.
My right hon. Friend raised several important points, including about recovery colleges. I am very interested in the whole recovery model and the role of recovery colleges. He also talked about the importance of the inspiring Time to Change campaign, which is part- funded by the Government. I mentioned earlier that I am encouraging all Departments to sign up to that
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campaign, so that we can lead from the front. We cannot expect private sector and other public sector employers to act properly if the Government do not lead, so it is important to demonstrate parity of esteem in the way that the Government treat employees.
My right hon. Friend also referred to the adult psychiatric morbidity survey. I can confirm that discussions are taking place between the Department and the Health and Social Care Information Centre and that it should take place in 2014. He also referred to the intelligence network. NHS England and Public Health England are developing plans and using the cancer intelligence network as a model, not necessarily to replicate, but to learn from. I am grateful to him for raising those issues.
The impassioned words that we have heard today show that within these walls lies the ambition, across all parties, to make the necessary changes, and I thank all hon. Members who have spoken about their experiences, views and, yes, even their criticisms. This sort of open debate can help to challenge stigma, scrutinise services and scrutinise commissioning decisions, which are critical in terms of how much money is allocated to mental health as against physical health and to ensuring that mental health remains a core priority not just for the Government, the House and the NHS and care system, but for the whole of society.
We have heard many good contributions. I shall write to hon. Members to respond to the substantive challenges and questions they have raised, but let me touch now on several quick points made today. The hon. Member for Bridgend (Mrs Moon) mentioned the importance of recognising the link between alcohol abuse and mental health. She talked about people who have left the armed forces with problems of post-traumatic stress disorder, which has become prevalent with the conflicts in Iraq, Afghanistan and so forth. Simon Wessely and his colleagues are doing some fantastic work on that.
The hon. Lady also mentioned the role of the police, particularly the Metropolitan police, and made the valid point that they are not trained well enough or systematically enough. Lord Adebowale, whom I met this week to talk about his report, makes the point that the police will always have to deal with mental health. It is not a question of it being wrong that they are dealing with it; the critical point is that there should be close working between the police and mental health services so that there is an immediate referral, not an inappropriate placing of someone in a police cell. Just imagine suffering from a mental health crisis and ending up in a police cell. It is the worst possible thing that could happen. Even children sometimes end up in police stations. It is totally inappropriate and avoidable—that is the important point.
The hon. Members for Broxbourne (Mr Walker) and for North Durham (Mr Jones), who have done so much to challenge stigma, have performed a valuable service in speaking out about their own experiences of mental illness. They have demonstrated, very visibly, that someone can be successful and make an enormous contribution to society, yet also have mental health problems. That is an incredibly important point. The hon. Member for Broxbourne talked about the role of employers and mentioned some really good employers, such as BT. This is about enlightened self-interest, not just about being kind to people. It is in companies’ and employers’ interests, including the Government’s, to treat mental
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health issues seriously. The cost to employers when those suffering from mental health problems lose their jobs—the loss of all the training and experience or just the sickness absence—is enormous, but it can be significantly reduced with a smarter approach. The hon. Member for North Durham talked about a number of individuals who have had mental health issues, but also been very successful. He talked a lot about the importance of tackling stigma.
The hon. Member for Croydon North (Mr Reed) made an important contribution about the treatment of black people by mental health services—the shadow Minister talked about that as well. There is something wrong that has to be challenged. The hon. Gentleman raised the case of Seni Lewis, which I am happy to talk to him about—I have surgeries on Monday night and we can discuss this. I have agreed to attend the Black Mental Health conference on police and mental health in June, because I felt it was important that I should engage in this whole issue and take it as seriously as it deserves to be.
The hon. Member for Totnes (Dr Wollaston)—I apologise for missing her contribution and a number of others—raised a number of issues. I will ensure that she receives proper responses to them. She talked about liaison psychiatry. While we are talking about emergency services, one thing that has become more and more apparent to me is the complete disparity between what happens to people with mental health problems and what happens to those with physical health problems. I was utterly shocked—but sadly not surprised—by a letter that a Member of Parliament in the south-west wrote on behalf of a constituent. The constituent had rung the crisis number for mental health services in his area and had not got a reply. No one was answering the crisis helpline. On another occasion they rang and were asked to ring back in half an hour. In the meantime that person could have committed suicide.
Then we come to what happens in A and E and the fact that in too many hospitals there is no mental health specialism available. Last Saturday I met a constituent who had found her son at home with ligature marks round his neck. She took him to A and E, where there was a half-hour conversation with a junior doctor before he was discharged home. The next day she found him hanging in her home. She is determined to pursue the complete failure of the system when something so dreadful can happen.
Whether we are talking about what happens when someone is picked up in the middle of a mental health crisis by the police and taken to a police station inappropriately, what happens when someone tries to get in touch with crisis services or what happens at A and E, we have to have an effective emergency mental health response system in place. This is a matter of real urgency, so I have asked all the relevant organisations—the Home Office, the Association of Chief Police Officers, the Department of Health, the Royal College of Psychiatrists and so on—to come together and draw up an agreed plan to tackle the most stark differences between the treatment received by people with physical health needs and that received by those with mental health needs.
Paul Burstow:
That is a welcome announcement from the Minister about achieving parity of esteem in emergency and crisis care. However, in the wake of the Francis
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inquiry, which rightly drew our attention to serious patient safety and dignity issues in our physical health care system, I suspect that we will need to ensure that we are not distracted or led into not addressing the same issues—which clearly exist—in our mental health systems.
Norman Lamb: My right hon. Friend makes a very good point and I completely agree.
The hon. Member for Romsey and Southampton North (Caroline Nokes) spoke again about eating disorders—I took part in a debate that she secured in Westminster Hall. She talked about the role of parents, the nightmare of a child—I will call them a child—over the age of 16 deciding to refuse treatment and the horror that parents sometimes go through when they are not listened to sufficiently by clinicians dealing with their loved one’s condition. She also mentioned type 1 diabetes sufferers, and I would be interested to hear more about that.
My hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones) is no longer here. Oh, yes he is! He has moved to a different place, just to confuse me. He talked about the low diagnosis rate for Alzheimer’s and dementia in his area. He also stressed the importance of the recognition of mental health by the Government, which I think he welcomed.
The hon. Member for Bolton South East (Yasmin Qureshi) talked about the importance of accessing appropriate and culturally sensitive care and treatment. That is incredibly important, as is getting the approach right for each individual and giving them the power to determine their priorities. She made those points well. She also stressed that the picture round the country was very variable. That is more the case in mental health than in physical health. Some areas have great services, some of which I have witnessed, but in others they are simply not good enough.
Ms Abbott: On the question of culturally appropriate care, does the Minister agree that it can extend to quite mundane matters? There are mental health wards in this country with large numbers of BME people in them. Those people sometimes do not have the right hair care or the right music, or they might not have their culinary needs addressed. Those things can be really disturbing for someone who is already in a mentally fragile condition.
Norman Lamb: Yes, I completely agree. This is about treating people as individuals, and with dignity and respect. Those things are important to people and they should be treated as such.
Jeremy Corbyn: My hon. Friend the Member for North Durham (Mr Jones) and I raised the question of the work capability interviews being undertaken by the Department for Work and Pensions with people with mental health conditions. I do not think that the Minister was in the Chamber at the time, but we suggested that it would be better for the DWP to have access to those people’s medical reports rather than conducting rather bald interviews. Would the Minister be prepared to undertake discussions with the DWP about the treatment during those interviews of people who suffer from mental health conditions?
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Norman Lamb: I am grateful to the hon. Gentleman for his intervention. I was going to mention his contribution, even though I was not present to hear it, for which I apologise. As a Member of Parliament, concerns have been raised with me about the suitability of those tests for people with mental health problems, and I was going to suggest that I should talk to the appropriate Minister at the DWP. I am of course happy to do that. Someone else made the point that this is not a question of not addressing the need to help people get back into work. Work is particularly important in relation to people suffering from mental ill health, and the idea that we should simply leave them undisturbed and out of work for the rest of their lives is totally wrong. The way in which we handle this is incredibly important, however, and if we have more to learn in that regard, we should be prepared to learn the lessons.
Mr Kevan Jones: I made the point in my speech that work was good for people with mental illness. The problem is that the present system is inefficient and costly, and that it is creating absolute agony for many people. I know that the Minister has a great understanding of, and a deep passion for, the subject of mental health, and I urge him to put pressure on the DWP to change the system. We are not asking that people should be excluded completely from work capability tests; we are just asking for the system to be changed.
Norman Lamb: I am grateful to the hon. Gentleman for reminding me that he, too, had made that point. I knew that someone else had talked about it, but I could not remember who it was. I take his point; I have heard it.
My hon. Friend the Member for Southport (John Pugh) made a thoughtful speech in which he talked about reminiscences. Oh! He has gone! Even though it pains me, as a Norwich City supporter, to talk about Everton, it appears that Everton and even Southport have done some very good work in these areas. My hon. Friend talked about a continuum of mental health. That was a good point, well made. He also mentioned community treatment orders and the need to look at how they are working. I will certainly reflect on that.
My hon. Friend the Member for Battersea (Jane Ellison) made a powerful contribution about the mental health aspects of female genital mutilation, a most horrific experience suffered by so many young girls. I really pay tribute to her for the work that she has done on that issue. The fact that there are 66,000 females in this country who have suffered this assault was an extremely striking point.
The hon. Member for Finchley and Golders Green (Mike Freer) talked about waiting times for access to treatment. He asked if he could gently challenge the Minister—I appreciated that approach. On the mandate for the NHS Commissioning Board, NHS England has been very clear that we expect it to assess the scale of the problem of access, including for IAPT. Other Members have raised the question of whether we are meeting the IAPT programme’s four-week target. We want the NHS Commissioning Board to assess the scale of the problem with a view to setting access standards.
One of the big problems relating to what I regard as the institutional bias against mental health is that on one side of the equation we have the 18-week maximum waiting time for physical health, which is a very powerful
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political driver of where the money goes, yet we have nothing equivalent for mental health on the other side. That, to me, is a lack of parity of esteem. For people with mental health problems, early access is particularly important to ensure that their condition can be halted, if possible, and the deterioration stopped. The hon. Member for Finchley and Golders Green made a good point there, and he also rightly talked about the importance of consistency and continuity of care.
I want to mention four of the most important things that this Government are doing to create the environment and incentives for improving mental health across the system as a whole. The first is the Health and Social Care Act 2012, which creates a “parity of esteem” so that mental and physical health share the same importance, as we have discussed this afternoon. Changing the law is just the start, but it sends a clear signal—that mental health is important, and that the health and care system can and must play a leading role in changing attitudes across society as a whole.
Secondly, there is the mandate the Secretary of State has issued to NHS England. It shows the importance we have ascribed to mental health and makes it clear where improvements are needed. The mandate makes clear our overarching goal—that mental health must have equal priority with physical health across all aspects of NHS work. In particular, we have highlighted the need to close the gap in outcomes between people with mental illness and the population as a whole, as well as the absolute imperative to ensure that people can access the services they need when they need them. Neither of these facets of good mental health treatment is entirely up to scratch at the moment. I think we all recognise that.
Mr Andrew Smith (Oxford East) (Lab): The Minister is generous in giving way, and he is making some very important points. Would he include within this the importance of access to family therapy both to repair broken relationships and to aid recovery—an issue that Oxford Mind raised with me?
Norman Lamb: Yes, absolutely; I understand the importance of that. Incidentally, I visited children and adolescent services in Oxford and I was very impressed by the work under way there. I am getting a message that I am under some pressure from Mr Deputy Speaker to make some progress—
Mr Deputy Speaker (Mr Lindsay Hoyle): I may be able to help the Minister there. It is not a question of pressure from me; it is a question of the Backbench Business Committee suggesting that Front-Bench contributions should be up to 15 minutes. If he looked at the clock, he would recognise that he has spoken for more than 20 minutes. He should not suggest that the Chair is interfering; it is the Backbench Business Committee.
Norman Lamb: I am sorry for putting the blame in the wrong place; I take full responsibility; I have tried to be responsive to Members as I have proceeded.
We are working with NHS England to decide how best to measure progress in these areas. Because, as we all know, words are not enough, we have to be certain that the objectives we have set out on paper actually translate into better, more accessible care for those who need it.
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Thirdly, I mention the three outcome frameworks: for the NHS, adult social care, and public health. These frameworks will enable us to hold the health and care system to account for achieving what matters most—good outcomes for the people who use services and for the population as a whole. In the NHS outcomes framework, there are four measures that relate specifically to mental health and many others that include mental health just as much as physical health. The other outcomes frameworks contain other measures designed to ensure that we improve well-being and tackle the wider determinants of mental health, and that we provide the best possible care and support to those people with mental health problems who need it.
Finally, I want to mention our continuing commitment to the IAPT programme. Since the programme began, it has treated more than 1 million people with depression and anxiety, and as a result nearly 75,000 people have moved from benefits into work. Nevertheless, we need to do more. We are currently involved in a joint programme with the Department for Work and Pensions, which involves commissioning work to find a way of providing much speedier access to psychological therapies for people with mental health problems who are out of work. It seems crazy that we are spending money on benefits when giving those people access to therapy might help them to recover and return to work.
George Freeman (Mid Norfolk) (Con): Will the Minister give way?
George Freeman: I am sorry that I was not able to be present earlier. I pay tribute to the Government for the work they are doing, and to the Backbench Business Committee for raising this issue. Does the Minister agree that, on the role of mental health in mainstream health, there is important evidence concerning outcomes and compliance with mainstream medicine? Important work carried out in America by the United States Veterans Association and the American dementia and mental health societies has shown the importance of positive psychology in helping people to recover and play an active role in society.
Norman Lamb: The hon. Gentleman has made some extremely good points.
The Government are implementing a diversion service to ensure that, as far as possible, people are diverted from the criminal justice system and from prison if that is not where they should be. If they are suffering from mental health problems, they should ideally be given treatment rather than being locked up inappropriately in prison.
Personal health budgets are a really good innovation, started by the last Government and continued by this one. Giving people—particularly those with mental health problems—power to determine their own priorities, and giving them some control over the resources available for their treatment, is an incredibly important development, for which I shall continue to proselytise at every opportunity.
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In order to avoid any further trouble from the Backbench Business Committee—rather than from your good self, Mr Deputy Speaker—I shall draw my remarks to a close.
Today’s debate allows us to explore what more we can do to improve services for people with mental health problems, but as I said earlier it also allows us to encourage others to follow suit. We all have the same ultimate ambition—to provide excellent services and support for all who need it, when they need it—but if we are to achieve that ambition, all groups need to do their bit. We will not be able to do this alone. However, we can lay the groundwork to ensure that local leaders and local people can develop the excellent mental health care and treatment that can turn our common ambitions into reality.
I thank all Members who have spoken today. I also thank the Backbench Business Committee for allowing me to speak beyond my “guideline” time, and to explain what the Government are trying to do to improve access to, and the quality of, mental health treatment. Again, I congratulate my right hon. Friend the Member for Sutton and Cheam on securing the debate.
I am pleased to be able to count on my parliamentary colleagues to maintain the momentum of discussion of mental health in public forums, and I pay tribute to all who have spoken for their incredibly valuable contributions. I look forward to our third convention.
3.23 pm
Paul Burstow: I thank the Backbench Business Committee again for enabling us to have the debate. I also thank those on both Front Benches, my hon. Friend the Member for Broxbourne (Mr Walker) and the hon. Member for Bridgend (Mrs Moon), and every other Member who has either intervened in the debate or contributed directly.
Today’s debate on mental health, like last year’s, has created and elevated a sense of hope. It has made it clear that there is a real commitment across parties in the House to do better and to do more: to enable people to gain access to the right care, at the right time, in the right place. That means starting early. It means starting in our schools. It means ensuring that when there is a crisis, we have an emergency service that is as good as our physical emergency services. I welcome what the Minister has said about that today.
A number of Members have suggested that this should become an annual debate. Clearly Parliament needs to hold the Government and the NHS Commissioning Board to account on these issues, and it would be good if we could find time every year to see just how much progress has been made.
It has been very interesting for those of us who follow Twitter to see just how many people have been tweeting about the debate. It has already extended well beyond the confines of this place, and that is to the good. I am pleased that so many Members have taken part, and I am very grateful to them. I hope we will eventually reach a place where there is no health without good mental health.
That this House has considered the matter of mental health.
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Road Traffic Offences (Sentencing)
Motion made, and Question proposed, That this House do now adjourn.—(Anne Milton.)
3.24 pm
Mr Mark Spencer (Sherwood) (Con): First, let me say that it is not my intention to take up the full two hours that are available to us for this debate, but I do want to raise an issue that is very important, in particular to my Sherwood constituency. One of the issues on which I stood for election was resolving the terrible road safety record in Sherwood, particularly around the A614, a stretch of road with which all in the east midlands will be familiar. There have been a lot of fatal accidents on it, with people killed at some of the terrible junctions. That was affecting the local community.
There was one tragic accident in which six people were killed, which resonated particularly strongly with the local community, and it became one of my ambitions to get elected as a Member of Parliament and resolve some of the problems facing the people living around the A614. I have campaigned long and hard to introduce measures to improve junctions. We have been able to improve the Ollerton roundabout and make traffic flows much smoother. We have also been able to put in new traffic lights at the Rose Cottage junction and improve the flows in and out of Edwinstowe.
We have also introduced average speed cameras, which have reduced traffic speeds along the A614 and—I hesitate to say this—stopped the fatal accidents; there has not been another one since they were introduced. Those cameras are not universally welcomed. Some of my constituents do not like them; they complain they delay their journey, so it takes them longer to get from A to B. I recognise the frustration of some drivers travelling up and down our busy roads, but my priority is making sure people are not killed on the roads.
It is important to draw a distinction between a conviction for speeding, for which someone might get a £60 fine and three points on their licence, and more serious incidents for which the perpetrator might be convicted of dangerous or careless driving. There is a conception among the public that it is easy to secure a conviction for speeding, such as driving at 34 mph in a 30 mph zone, but that there is less enthusiasm among the police and in the Crown Prosecution Service to go after the more challenging conviction of dangerous driving, as the burden of evidence is much greater.
I was contacted by a constituent of mine, Louise Stanbrook, who had been to a concert at the Nottingham arena and was crossing the road to walk home when she was knocked over by a driver and quite seriously injured. She suffered a broken collar bone and was knocked unconscious. She also suffered damage to her teeth and spectacles and to her possessions. It was a very serious incident. The perpetrator had a number of previous driving convictions, and was also due to be sentenced for another crime unconnected to this driving offence. The CPS and the police decided it was not in the public interest to pursue the individual for the driving offences he had committed on this occasion, as he was serving an offence unconnected to driving.
It strikes me that the justice system is there for two reasons, the first of which is to make sure that those who commit crimes are rehabilitated and are able to
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come back into society, having paid their debt. However, the justice system is also there for the victims to see that justice has been done and that when they have been violated in any way the perpetrators of the crime against them make recompense and have to pay a debt to society. That might involve a fine, a custodial sentence or a driving ban, which is another point I wish to deal with a little later.
Louise would say that it is a perception—it is her perception—that people who commit a minor speeding offence, which is still an offence, are prosecuted on a regular basis, as we can agree is only right and fair, but people who commit a much more serious offence such as dangerous driving or careless driving do not suffer the same enthusiasm from the Crown Prosecution Service; there is a reluctance to pursue convictions for such offences because of the amount of evidence that has to be gathered in order to pursue them. That sends the wrong message to society, and the House needs to overcome that and ensure that we turn that tide, so that not only is justice being done, but it is being seen to be done by our constituents and they can have confidence in it. We have to put our hands up and say that many people get caught speeding, but people need to feel that those who commit serious offences are being pursued by the legal system with the same vigour and enthusiasm.
That is very important and it leads me to my second point, which relates to where the justice system is letting us down. It seems wrong that where someone is convicted of a very serious driving offence and is sent to jail, and part of the sentence is a driving ban, they can serve that ban while they are in prison. Given that they cannot drive then anyway because they are being held at Her Majesty’s convenience, it would seem only appropriate that any driving ban that is part of the sentence should be served when they come out of prison and back into society. I would ask the Minister to pass my comments on to the Justice Secretary; he should examine that issue closely on his return, as it is a fundamental part of this debate.
There is another perception that people get enormously frustrated about—my constituents certainly do. Most people work hard, they purchase a car, which can be very expensive, they pay their tax by buying their tax disc and they pay for insurance to drive that car. They also pay for an MOT to make sure it is roadworthy and if they are caught committing a driving offence, they of course pay their fine. However, a section of society does not take out insurance, does not pass a driving test and does not obey the laws. When such people are caught committing a driving misdemeanour, they are often taken to court, prosecuted and then given points on their licence—which they do not possess—and banned from driving, even though they did not possess a driving licence in the first place. Members of the public find it enormously frustrating when they see all the hoops they have to jump through to be a law-abiding citizen and to drive appropriately, yet they perceive that those people who—I hope hon. Members will forgive my Sherwood language—stick two fingers up at the law and ignore it seem to get away with it. That really does need addressing.
Susan Elan Jones (Clwyd South) (Lab):
Does the hon. Gentleman agree that one idea worth considering is giving greater flexibility for juries on the upper sentences allowed at the moment? It seems to me that there are certain cases where juries ought to be able to give a
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higher sentence based on the situation in the case, because, as he rightly says, it is ludicrous how low some sentences are.
Mr Spencer: I am grateful for that intervention. I was just coming to that point.
I suppose the challenge is that the law is in chunks—careless driving, death by careless driving, dangerous driving, death by dangerous driving—and there are very tight boundaries. There is no sliding scale of punishment. I believe that lack of flexibility is what drives the CPS sometimes not to go for the more serious chunk, but to satisfy itself with a conviction lower down the scale because it can be sure of obtaining one. That needs addressing, and the only way to do that is to have a review of what laws are in place and whether those tools need adapting. Within the current law the tools are available to make those serious prosecutions, but at the moment the CPS is not minded to go for those serious convictions, whether that is because of the chunking of the convictions or the lack of a sliding scale. That is what needs addressing.
As a point of interest, the Nottingham Post reported that in Nottinghamshire, 58,373 speeding tickets were issued in 2011-12. That shows that our police force is out there, robustly enforcing speeding offences.
Jake Berry (Rossendale and Darwen) (Con): Does my hon. Friend agree that speed cameras have a bit of a bad reputation? They are almost regarded as a cash machine only to be used by the police. Would he, like me, be encouraged by the increased use of speed awareness courses, which are a restorative way of combating speeding rather than simply going straight for the points and fines, and would he hope that that would be extended across the UK?
Mr Spencer: I would agree with that. We must remember that the purpose of speed cameras is not to catch people; it is not to get cash out of drivers. It is to prevent them from being killed or seriously injured. I get many letters from constituents asking for the police to go into their village—I hesitate to use the words “speed trap” because it gives the wrong impression, but that is what they often ask for. They want the police to enforce speed limits to ensure that people driving through their villages and towns do not break the speed limit, particularly outside primary schools and other local schools. That gives me confidence that we are on the right side of the argument—that our constituents want enforcement of speed limits and want the law to be obeyed. However, they want a balance between serious and minor offences. The perception is that there is not that balance at the moment.
If I may summarise, my No. 1 request is to remove the anomaly of driving bans coinciding with prison sentences. If a person is convicted of an offence, serves time in jail and receives a driving ban, the start of the driving ban should be postponed until their release from prison, so that there is that extra removal from our roads for those who have been convicted of a driving offence. Secondly, I want to encourage the CPS and the police to use all the tools at their disposal. I am sure the Department would be more than happy to receive representations from the CPS or the police if they have reservations about some of those tools. I would encourage the CPS and the police to be more diligent and look at going for more serious convictions if they feel they can
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gather the evidence to get those convictions. They should not simply lay the burden of keeping up the number of convictions on the minor offences.
There have been some terrible accidents in which people have been injured, and some fairly high-profile ones which reached the media. Bradley Wiggins, our Olympic and Tour de France-winning cyclist, was a victim of a cycling accident in which he was knocked off not far from your constituency, Mr Deputy Speaker. We do not want to be knocking off our potential Olympians, to say the least. That case drives home the fact that people out there, pedestrians and cyclists especially, are at risk of serious injury, and when that tragedy happens, we look to the law to recompense us for that injury and to give us the justice that we deserve.
3.39 pm
The Lord Commissioner of Her Majesty's Treasury (Mr David Evennett): I begin by congratulating my hon. Friend the Member for Sherwood (Mr Spencer) on obtaining this afternoon’s debate on the sentencing of people convicted of road traffic offences. I commend him on his thoughtful and considered speech, which I listened to with great interest. I know that he is an assiduous and hard-working Member, serving his constituency and his constituents and raising issues of concern to them.
May I express the apologies of the Under-Secretary of State for Justice, my hon. Friend the Member for Kenilworth and Southam (Jeremy Wright), for not being here to respond in person to the debate on behalf of the Government? He is at a conference in Birmingham and asked me to respond on his behalf. I am delighted to be able to do so.
As my hon. Friend the Member for Sherwood made clear, driving offences are a very important issue, with potentially very grave consequences when they result in accidents and innocent victims are harmed, injured or killed. I was extremely sorry to learn of the case of his constituent, Louise Stanbrook, a pedestrian who was injured by a dangerous driver.
I should like to highlight the interesting and valuable contributions made by the hon. Member for Clwyd South (Susan Elan Jones) and my hon. Friend the Member for Rossendale and Darwen (Jake Berry). My hon. Friend the Member for Ilford North (Mr Scott) is in his place and I know that he, too, is concerned about the issues of sentencing and road traffic offences. My late father, Norman Evennett, said to me many years ago when I started to learn to drive, “Remember, a car driven dangerously or badly can be a lethal weapon”—very wise words indeed.
Sentences in individual cases are a matter for the courts to decide, subject to the maximum limits and sentencing guidelines. When deciding what the appropriate sentence within the range should be, the court will consider the seriousness of the offence. This includes both the culpability of the offender and the harm that the offence has caused. The court will also consider any other aggravating or mitigating factors. The law therefore seeks to punish those who cause death or injury on the road in a way that is appropriate to the degree of blame that can be attributed to the driver.
Our framework of driving offences and penalties is kept constantly under review, and the Government have striven to ensure that the framework remains balanced
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and proportionately addresses the range of unacceptable behaviours which occur on our roads. We will consider what my hon. Friend the Member for Sherwood said today and we continue to monitor these issues as a matter of course. Our current law provides a framework of offences to deal with bad driving and dangerous practices that impact on driving at every level. Every offence is extremely serious, irrespective of the consequences.
Jake Berry: On the topic of very serious offences, my hon. Friend will appreciate that the most serious of all driving offences is one in which someone loses their life. He will be aware of the reduced mortality rate when people are travelling at 20 mph rather than 30 mph. Will he join me in congratulating Lancashire county council, which recently made the speed limit on all side streets 20 mph, which is fast enough wherever we live, and will he join me in encouraging Blackburn with Darwen council to take a similar initiative to help save the lives of young people in Darwen?
Mr Evennett: I welcome any measure that helps to save lives. The issue that my hon. Friend raises is a matter for the Department for Transport, not for the Ministry of Justice, but I take on board what he said and congratulate any council that reduces the speed limit, which has a positive result, saving lives and preventing injury.
Fatality, of course, holds a special place in these affairs, which is why particularly robust penalties are available where death is caused by bad driving. Where drivers cause death either by dangerous driving or by careless driving while under the influence of alcohol or drugs, judges can sentence them to a maximum of 14 years in jail. Other measures include an unlimited fine and a minimum two-year driving disqualification. Where death is caused and there is sufficient evidence of gross negligence, drivers can be charged with the offence of manslaughter, which carries a maximum penalty of life imprisonment.
Summary road traffic offences include careless driving, speeding, driving with excess alcohol, driving while disqualified and using a mobile phone while driving, as well as other offences relating to the condition of the vehicle, safety measures such as seat belts and offences relating to non-compliance with, for example, driving direction and traffic lights. Those offences are punishable in some cases by short custodial sentences. Some carry mandatory disqualification. All carry the potential for robust fines and points on an individual’s licence.
Following the 2005 review of road traffic offences, two new offences were created and, since 2008, have been available to prosecutors: causing death by careless driving, and causing death where a driver is unlicensed, disqualified or uninsured. The maximum penalties for those offences are five years and two years respectively. They attract a minimum disqualification period of one year and can be punished by an unlimited fine. In December 2012 the Government introduced a new offence of causing serious injury by dangerous driving in order to fill the gap where bad driving causes very serious injury but sentences were previously limited to two years because only the plain offence of dangerous driving could be charged. The new offence has a maximum penalty of five years.
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Therefore, it is apparent that the offences and penalties are kept constantly under review to keep the framework appropriate to changing behaviour on our roads. However, our courts sentence independently, having full regard to the features of each individual case and to guidelines.
Mr Spencer: My hon. Friend is doing a fine job of outlining for the House the current tools available in the tool box. Ministry of Justice figures show that, tragically, the number of motoring deaths remained static between 2002 and 2012. Meanwhile, the number of convictions for dangerous and aggravated offences has come down and the number of convictions for careless driving has gone up, which suggests that those deciding what to prosecute are choosing the lesser option of careless driving. Would he care to comment on those statistics?
Mr Evennett: We are of course aware of those statistics and look at them carefully. We are determined, in the guidelines, to encourage prosecution of the more serious offences, and we are endeavouring to do that. However, I must highlight that it is very difficult for the Ministry of Justice, because it is not our responsibility to do that. On the other hand, we are setting the guidelines and giving the courts the independence and freedom, and we want to ensure that they use the powers they have.
The Sentencing Council sets out guidelines, which the courts must have regard to, advising in greater detail what courts should do in particular types of cases. We give the guidelines and encourage, within the statutory limits Parliament has set, of course. We encourage, but the courts have to make the decisions. The Sentencing Council has issued two relevant sets of guidelines: those on driving offences where death is caused, which were issued in 2008; and the magistrates court sentencing guidelines, including guidelines on summary driving offences, which were updated in 2012. Obviously we constantly look at updating those.
With regard to the relevant treatment of speeding and drink-impaired driving, speeding is punishable by a fine of up to £1,000, or £2,500 when committed on a motorway. The court may disqualify the offender and must impose penalty points. Driving under the influence of alcohol is punishable by a fine of up to £5,000 or up to six months’ imprisonment. The court must disqualify the offender for at least 12 months. Those convicted of serious driving offences face the prospect of lengthy custodial sentences. In 2011, the average custodial sentence length for those convicted of causing death by dangerous driving was over four years. Accident statistics from the Department for Transport suggest that speeding and drink or drug-driving are fairly equally unacceptable in terms of harm caused. In 2011, an estimated 9,990 reported casualties—5% of all road casualties—occurred while the driver was over the legal alcohol limit. The provisional number estimated to have been killed in drink-drive accidents was 280. Exceeding the speed limit was reported as a contributory factor in 5% of all accidents, but these accidents involved 14% of fatalities. Drug impairment was reported as a contributory factor in 644 road casualties.
Generally, Great Britain has a very good road safety record, but we cannot afford to be, and will not be, complacent. Deaths and serious injuries on the roads are a terrible tragedy for those affected, as highlighted in the case mentioned by my hon. Friend the Member
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for Sherwood. It must of course be welcome that the general trend is for road fatalities and casualties to fall, but every such case is one too many for the victims and their families.
Compared with the period 2005-09, the number killed in 2011 was 32% lower, the number reported killed or seriously injured was 17% lower, and the number of children killed or seriously injured was 19% lower. However, the Government will not be complacent. We will monitor those numbers and do what we can to push them down and to make sure that convictions of those who offend are implemented.
The Government’s vision for road safety remains one in which Britain is a world leader; where local authorities are empowered to take informed decisions about road safety in their area, as my hon. Friend the Member for Rossendale and Darwen (Jake Berry) described in his area; where driver and rider training gives learners the skills they need to be safe on our roads, which is vital; and where tough measures are taken against the minority of offenders who deliberately choose to drive dangerously. They are the ones we need to get to, because they are the ones who are causing such distress, danger and injury.
In 2011, colleagues in the Department for Transport published a new strategic framework for road safety that focused on supporting road users who have weak driving skills, or who have displayed a lapse of judgment, to improve their driving through a greater range of educational courses to help deliver safer skills and attitudes, while focusing enforcement resources against those who deliberately decide to undertake antisocial and dangerous driving behaviours that cover all careless and dangerous driving offences. This is the Government’s twin approach to improving road safety. I hope that my hon. Friend the Member for Sherwood will be reassured by that. We are determined to make sure that those who drive dangerously are dealt with appropriately.
Jake Berry: I must admit that I have some experience of the speed awareness course. One of the incentives to get people to go on that course is that by not taking the penalty points, they will not increase the cost of their insurance premium. However, Admiral Insurance has recently asked people to disclose whether they have been on a speed awareness course, and that will potentially increase their premium. Does my hon. Friend share my fear that we will lose this vital driver re-education tool if people start to lose the insurance benefits?
Mr Evennett: I note what my hon. Friend says. I am looking at this in the context of educating people; the insurance situation is beyond my remit. However we manage to deal with it, the whole point is to educate more people to be considerate and better drivers. We should look at every aspect to improve the standard of driving so that we cut down on the incidence of injury and death on the roads.
Mr Spencer:
Will the Minister talk to his colleagues in the Home Office to see whether people who are convicted
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of a driving offence while on holiday could conduct their road awareness training back in their own county to save them driving back to the location of the offence?
Mr Evennett: I will, of course, pass on that suggestion. We work closely with the Home Office and the Department for Transport; one of the many great things about this Government is that the Departments are working closely together. Our Department is working closely with colleagues in other Departments to make sure that the quality of life is improved for all our citizens, and this is one such example.
Since the publication of the strategic framework, the Government have continued to focus on empowering local decision makers, improving driver training and taking a more targeted approach to enforcement. Recent developments include the introduction of legislation on drug-driving to improve enforcement; the launch of a new speed limit circular to improve the flexibility of local authorities in setting the speed limits; and work with the insurance industry to develop policy opportunities to reduce risk in young drivers. That will, of course, include looking at insurance premiums and whether they can come down if people are good drivers and seeking to improve their driving skills. We are concerned to make sure that young drivers in particular have the skills and knowledge to be safe and good drivers. We are also creating a £15 million fund to improve safety for cyclists outside London by tackling dangerous junctions, alongside a £15 million fund for the same purpose in London.
Provisional figures show that Great Britain and the UK remain the leading performers in Europe on road safety. However, as I have said, every road accident that results in injury or fatality is a tragedy for the people concerned and the communities they live in. Our strategy will build on our solid foundations in order to improve our road safety performance even further and to ensure that sentences are appropriate to the offence, which is the issue that my hon. Friend the Member for Sherwood has highlighted. The sentence has to be appropriate for the road offence committed, and the Department is focused on doing our best to achieve just that.
I thank my hon. Friend for giving us this opportunity to debate sentencing for people convicted of road traffic offences, which is a very important subject for all our constituencies. I hope that I have set out the action being taken by the Government and I will pass on my hon. Friend’s comments and concerns to the Secretary of State and the relevant Minister. The Department will continue to monitor how to improve things for the benefit of every road user, whether they be a pedestrian, a cyclist or a driver, so that we can cut down on tragic fatalities and injuries and make sure that those who drive dangerously are punished accordingly.