Sojan Joseph
MP for Ashford · Labour · United Kingdom
“I agree with the hon. Member that people with power, especially those with political platforms, have used it to spread misinformation about vaccination. Some medical professionals working in our hospitals and the NHS—doctors and nurses—are also against vaccines. Can the hon. Member explain how we can tackle that issue?”
“This morning, I visited the Churchill school in Hawkinge and had a good interaction with the young children. Most of their questions were about protecting nature, and they repeatedly asked how we can support them to plant more trees.”
“As the chair of the APPG on adult social care, I pay tribute to unpaid carers for the enormous contribution they make to their families, their communities and wider society. I often have meetings with them, and as part of my job before I became an MP—I worked in the NHS—I had a lot of contact with carers.”
“I would appreciate it if the Minister would respond to that point, and if the Government would consider something to support carers, while not putting any more administrative burden on the NHS, where we are focusing on providing more support on the frontline.”
“It is good to see you in the Chair, Ms Lewell. I strongly believe that public health is very important to our health system because it focuses on prevention, so that people do not end up in A&E or in hospital beds. Unfortunately, over the last 10 or 15 years we have seen the opposite.”
“I worked as a nurse on the frontline in mental health services, and what we saw was money being diverted to create more senior leadership, more groups, more meetings and more management, while we were missing the people who actually did the work on the frontline.”
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“As most of them have young families, their children have joined and become settled in local schools. They left Hong Kong due to the suppression of freedoms, and came to the UK to rebuild their lives. In their letter to me, my constituents spoke about the current uncertainty in their lives, especially for those with school-age children. They hope that the Minister’s response to this debate might go some way towards giving them clarity about their status. I look forward to the Minister’s response to the points that I and others have made.”
“However, the certainty they had about their lives in the UK has been thrown into doubt, and now they cannot plan for the future. I am grateful to the 168 constituents who signed the e-petition calling for Hong Kong British national overseas visa holders to be exempted from any change to the indefinite leave to remain. I am particularly grateful to one constituent who came to a recent surgery with a letter signed by 80 Hong Kong BNO visa holders living in Ashford, Hawkinge and the villages. Those who live in my constituency are making a positive contribution to our community. Many of them have joined the workforce, finding employment in healthcare, education and trade, with some opening their own businesses. They have enriched local towns and villages by volunteering and becoming actively involved with local groups.”
“While I support efforts to end the long-term reliance on recruiting internationally to fill such roles, it is important to acknowledge the invaluable role that skilled overseas workers play in our health and social care sector. As the co-chair of the all-party parliamentary group on adult social care, and as someone who came to this House from working in the NHS, I understand how important it is that we do not lose the skills of those who are already working in our health and social care sector. My constituents who work in the NHS have made the point that the cost of recruiting and training an overseas nurse is anywhere between £50,000 and £60,000, and roughly £250,000 for a doctor. They argue that this country has made that investment so that people can train, learn and work in our healthcare sector.”
“It is a pleasure to serve under your chairship, Mr Pritchard. I congratulate my hon. Friend the Member for South Norfolk (Ben Goldsborough) on his excellent speech introducing this petition. I am grateful to the 292 constituents of mine who signed the petition urging that any changes to indefinite leave to remain should not apply to those already in the UK or on a skilled worker visa. As we all know, the NHS is reliant on overseas workers. As of September 2023, around 20% of NHS England roles were filled by non-UK nationals. That includes one in three doctors and three in 10 nurses. In both the NHS and the social care sector, recruitment of overseas staff increased after the pandemic, with campaigns run in places such as Kerala in India. In 2022, 73,000 skilled worker visa applicants were sponsored in the health and care sector.”
“One of the hotels that houses asylum seekers in Kent is the Holiday Inn in Ashford. The decision to house them there was taken by the Conservatives when they were in power. Many people living there are going through an appeal process, so I welcome the decision to speed up the appeals process. Will my right hon. Friend reassure me and my constituents that this Government will end the use of the Holiday Inn as an asylum hotel as soon as possible?”
“One of my first visits after being elected last year was to the A&E department at the William Harvey hospital in my constituency, where 19 patients were being treated in the corridors and others faced long waits for treatment. I therefore welcome the progress that has been made so far on reducing A&E waiting times. However, too many people end up at A&Es like the one at the William Harvey because they have no other option. What are the Government doing to increase care options in local communities, including the use of virtual wards to ensure that more people are treated closer to home and that patients in A&E are those in an emergency?”
“I welcome the fact that the Government are committing additional resources to fix this problem; they are providing £500 million in extra funding for highway maintenance across the country this year, and Kent county council will receive up to an additional £16 million. If those problems are to be fixed, there will of course need to be roadworks, but I plead on behalf of my constituents for much better co-ordination to ensure that any disruption is kept to a minimum. I conclude by thanking you, Madam Deputy Speaker, as well as Mr Speaker, all my colleagues and the staff of this House.”
“We should, of course, encourage people to take public transport wherever we can, and I recognise that the charges are in place to manage traffic numbers. However, many of my constituents will have no option but to pay the increased charge, as they have only one route to work available to them. Potholes are a blight on the roads in my constituency, just as they are in the constituencies of most Members. It is wrong that, as a result of under-investment by the Conservatives, our constituents have been expected to deal with the repercussions of poor roads and the maintenance backlog that has built up.”
“In my year in the House, the other transport issue I have raised just as regularly as the return of international rail to Ashford is the deployment of Operation Brock on the M20. I am sorry that it was necessary to present a petition to the House on the subject last week, on behalf of my constituents. It is hugely disappointing that Kent county council and the Kent and Medway resilience forum have introduced Operation Brock once again, and that it will remain in force until at least 4 August. The recent announcement that the Dart charge will increase from September has disappointed many of my constituents. If we take that together with the tolls now in place for the Blackwall and Silvertown tunnels, the result is that all those routes will now cost more.”
“I pay tribute to Sir David Amess. I wish to speak about a number of transport issues relating to my constituency. Earlier this month, I had the pleasure of welcoming the Rail Minister to Ashford, where we attended the opening of a new career and skills hub for Southeastern. After the opening, I took the Minister on a tour of Ashford International station, and the part of the station left abandoned since Eurostar decided in 2020 that international rail services would no longer stop at either Ashford or Ebbsfleet. Those parts of the station stand ready for international passengers to use once again. It was great to have the noble Lord Hendy reiterate his and the Government’s support for our campaign to have international rail services return to Kent.”
“The petitioners therefore request that the House of Commons urge the Transport Select Committee to launch an inquiry into the decisions taken by Kent County Council and the Kent and Medway Resilience Forum to regularly deploy Operation Brock, and into what work is being undertaken to find a long-term alternative. And the petitioners remain, etc.] [P003095]”
“And the petitioners remain, etc.” Following is the full text of the petition: [The petition of residents of the constituency of Ashford in Kent, Declares that the deployment of Operation Brock by Kent County Council and the Kent and Medway Resilience Forum to queue freight lorries on the M20 causes severe disruption for residents and local businesses; further that although reassurances had been given that Operation Brock would only be deployed in emergencies, it has been used regularly as a precautionary measure; and further that a better, long-term solution needs to be found.”
“The petition states: “The petitioners therefore request that the House of Commons urge the Transport Select Committee to launch an inquiry into the decisions taken by Kent County Council and the Kent and Medway Resilience Forum to regularly deploy Operation Brock, and into what work is being undertaken to find a long-term alternative.”
“I rise to present a petition on behalf of my constituents, who are deeply frustrated by the regular deployment of Operation Brock. The decision by Kent county council and the Kent and Medway resilience forum to queue freight lorries on the M20 during the school holidays causes severe disruption for local residents and businesses, and is hugely expensive. My constituents do not object to Brock being deployed in emergencies, and reassurances were given that that would happen. However, it is still being regularly deployed as a precautionary measure, and it will come into force once again later this week.”
“Many constituents have raised concerns about the new Reform administration’s plans in my constituency. It is even thinking about cutting transport for vulnerable young people who cannot get to school. Does my hon. Friend agree that it is very concerning that the council, without a proper plan, has brought in an external agency to look at how to save money, and that it is unacceptable to cut the transport budget for those vulnerable children?”
“My constituents in Ashford constantly contact me about strengthening animal welfare legislation. One of the issues they are particularly concerned about is the use of snares, which are imperfect and indiscriminate traps that regularly cause unnecessary suffering and harm to animals. Not only do they hurt the animals they are set to catch; other animals and pets are caught, injured and sometimes killed by them. Can the Leader of the House find time for us to debate bringing an end to the use of these cruel and unnecessary traps?”
“The Secretary of State will know how important improving mental health support is to me. I hope that what the 10-year plan says about access to mental health provision will help to address the long waiting times for mental health services that the Government inherited. I particularly welcome what he said about using the NHS app for patients to self-refer for various treatments. I hope that that will cover talking therapies as well. Does he share my belief that opening up access to talking therapies in that way will enable more people to get that effective treatment at the right time, so that they can better manage their condition?”
“As a clinician, I hope that the hon. Gentleman will understand what I am trying to say. There are many mental health patients who do not have any insight into their illness and often refuse to take medications. It is important that, as the clause says, “‘qualifying person’ means a person who has capacity or competence to make the statement,” so that people do not make inappropriate decisions in their advance choice documents. It is important to keep the clause as it is, whereby a qualifying person is someone who can make a competence decision.”
“Does the hon. Member agree that section 136 is used when the police are alerted to a disturbance in a public place? If I saw a disturbance outside the Palace of Westminster, I would call the police, not a mental health professional. If the police arrive and think that the person is suffering from a mental illness, they will use the power under section 136. How can we give powers to health professionals to attend a public disturbance?”
“By introducing an additional professional check on whether the patient really needs the support of a community treatment order, and by requiring more evidence that the patient needs the support of the community treatment order to get better, clause 22 will adopt two of the four principles of treatment proposed in Sir Simon Wessely’s independent review, namely the principle of least restriction and the principle of therapeutic benefit.”
“They also help patients to live in a home environment: without such provision, some patients would have to stay in hospitals for longer, which can be more restrictive than being in the community. The Committee needs to understand the kinds of patient who are often considered for community treatment orders. These patients are already well known to mental health services. They may have a long-term serious mental illness and may have to take medication continuously. More often, they are on regular injections of what is called depot medication; mental health professionals administer such medication either once a month or once every three months. Community treatment orders enable clinicians to make sure that patients receive the medication they need, so that they do not relapse and so they can have a good quality of life.”
“It is a pleasure to serve under your chairmanship, Sir Desmond. I welcome the changes proposed in clauses 22 and 23. Clause 22 seeks to amend the Mental Health Act to require the community clinician responsible for overseeing the patient’s care as a community patient to be involved in decisions regarding the use and operation of community treatment orders. While I was practising as a mental health professional, I was personally involved in many community treatment orders and in recalling patients to hospital. Although I acknowledge the concerns raised by various charities and members of the Committee about the overuse of community treatment orders and restrictions on patients, such orders have many benefits. As the Minister has highlighted, they help to release the pressure on in-patient settings.”
“Some conditions put on patients can be seen as restrictive: for example, if a condition states that patient cannot use alcohol or illicit drugs, the clinicians will be looking at whether the patient’s use of alcohol or illicit drugs has an impact on their mental state or on their non-compliance with treatment. That is very important. I welcome the changes in clause 23.”
“It will amend section 17B of the Mental Health Act so that conditions can be imposed only if they are “necessary”. This is a simple and welcome update from the current wording, “necessary or appropriate”. Clause 23’s second modernisation is to give the tribunal a new power to “recommend that the responsible clinician reconsider whether a condition…in the community treatment order is necessary”. This would apply when the tribunal has decided not to discharge a patient completely from a community treatment order, but has come to the conclusion that not all its conditions are required. Once again, this is a welcome reform and is in line with the principle of therapeutic benefit.”
“Subsection (6) will require a community clinician to make a statement in writing, if they are not the responsible clinician, in support of the renewal of a patient’s community treatment order, if that is the conclusion of the responsible clinician. Getting written confirmation from the community clinician who is intimately involved in the patient’s care that a renewal of the community treatment order is both necessary and appropriate and is the correct thing to do. Once again, it is about ensuring that a further professional opinion is considered; it is also about checking whether the patient still needs the support of a community treatment order. Clause 23 will make changes in relation to the conditions that a person subject to a community treatment order may be required to follow.”
“That will mean that if the community clinician is not the responsible clinician, the community clinician will still need to be consulted before a patient can be recalled under the community treatment order, unless such a consultation would lead to an unreasonable delay. That seems an entirely welcome and sensible reform. In some cases, an unreasonable delay may not be helpful, because some patients need to have their medication at regular intervals. For example, a patient on clozapine who misses their medication for three or four days in a row may have to restart their whole treatment regime, which will mean an even longer in-patient admission process.”
“For example, subsection (2) will amend section 17A(4) of the Mental Health Act to require that where the responsible clinician is not the clinician who will have care for the patient in the community after their discharge, that community clinician must also agree in writing that the community treatment order criteria are met. That will ensure continuity of care of the patient from the hospital into the community, and it will have the added benefit of additional professional oversight in respect of the need for a community treatment order. That is to be warmly welcomed. I also highlight subsection (4), on the power to recall a community patient to hospital.”
“A community treatment order helps them to have at least minimum contact when they have to go and see a patient to administer medication. I support that conflict—sometimes it can be very healthy—but I also acknowledge that we need more capacity in the community. Clause 22 makes a new distinction between a patient’s responsible clinician with overall responsibility for them, including in hospital, and a community clinician with the responsibility for the patient in the community. It will impose specific duties on the community clinician where they are not the responsible clinician.”
“I thank the hon. Member for that important intervention. Healthy conflicts between professionals can be useful and can be used as a reassurance to people who are concerned about the overuse of CTOs. However, capacity can sometimes be an issue, especially in community settings, an issue that new clause 4 addresses. It is also important to understand that mental health services have changed over the years. The consultant who treats the patient in hospital may not know much about them or how they are in the community. In the past, all those patients were followed by a care co-ordinator—not necessarily a mental health psychiatrist, but a mental health nurse or social worker who followed the patient throughout their journey and kept an eye on them. We do not have enough capacity these days, so nobody is following the patient.”
“The hon. Member is making a very valid point that all patients need help with their finance and accommodation to keep them in the community and make discharge more appropriate. However, those provisions are already in place as part of the patient’s care plan. Different hospitals have different settings, such as a discharge or enablement team, or even the nurses on the ward itself can help and look into those provisions. Does the hon. Member think that that is the role for independent mental health advocates, who prioritise detention and the Mental Health Act, rather than the finance and accommodation issues, which need to be resolved by a different team?”
“Patients must receive the information when they are first detained in the hospital, and again whenever they are conditionally discharged. As with clause 42, the hospital manager must ensure that the patient has received such information both orally and in writing, and that practical steps have been taken to ensure that the patient understands the information. A copy of the information must also be given to the nominated person within a reasonable timeframe, unless the patient has requested otherwise. I support the clauses, as the changes made by it will strengthen the Act.”
“As a result of the clause’s changes, there will be a statutory duty on hospital managers to supply information about the complaints procedure, as set out in clause 42, to community patients and the nominated person. That will mean that the patient must be provided with complaints information as soon as practicable after they are placed under a community treatment order, and each time that community treatment order is renewed. Clause 44 deals with information about complaints for conditionally discharged patients and inserts proposed new section 132B, which requires hospital managers to give complaints information to conditionally discharged restricted patients. The proposed new section states that such information must be provided before the patient leaves hospital, or as soon as possible when the patient is conditionally discharged.”
“That means that the duty will be triggered each time the section under which the patient is detained changes, and when the authority to detain under that section is renewed. In respect of part III of the 1983 Act, which concerns restricted patients to whom automatic renewals do not apply, the duty will be triggered every 12 months from the start date of detention. As I mentioned earlier, much of that process is already expected to take place, but ensuring it takes place in future by making it a statutory duty is a sensible and welcome strengthening of that safeguard. That is also the case for clause 43, which relates to information about complaints for community patients and seeks to amend section 132A of the 1983 Act.”
“The clause would amend section 132 of the Act by placing that statutory duty on hospital managers, supplying detained patients and the nominated person with the necessary information about complaints, and taking practicable steps to ensure that the information has been understood. Proposed new subsection (2A) deals with the types of complaints covered by that duty. They include complaints about carrying out of functions under the Act and about medical treatment. Proposed new subsection (2A)(c) ensures that the statutory duty covers information about the patient’s right to complain to the Parliamentary and Health Service Ombudsman about the maladministration of such complaints. Proposed new subsection (2B) sets out that the duty is triggered “as soon as practicable after the commencement of the patient’s detention”.”
“I welcome the strengthening of section 132 of the Mental Health Act in respect of information about complaints, as proposed in clauses 42 to 44. Clause 42 deals with information about complaints for detained patients. Currently, through the code of practice, there is a requirement that hospital managers will pass on that information. They should do so both orally and in writing, ensuring that the information is accessible, including in easy-read format for people with learning disabilities. Hospital managers should also ensure that the information has been understood.”
“I was a clinician and I practised on wards; patient records are electronic for staff. When staff complete the explanation of section 132 rights, they record that on the electronic patient records. Does the hon. Member agree that that would be a good place to get the data?”
“I extend my heartfelt sympathies to all those, including the many British and Indian families, who have lost loved ones. The UK and India are closely connected, and many people in both our countries are grieving after this dreadful crash. I take this opportunity to pay tribute to the Foreign Office staff working in the UK and India to support the families and loved ones of all those affected. I understand that around 120 victims have been formally identified using DNA samples. What assistance is the UK providing to the Indian authorities to ensure that the remaining victims can be formally identified as quickly as possible?”
“Does the hon. Member agree that, since detentions under sections 2, 3 and 5(4) of the Act often happen in clinical settings, are completed by consultants, psychiatrists and social workers, and do not involve police, we do not actually need police presence on these occasions?”
“If we did not make the Government amendments, we would give more power to the police to get involved under those sections of the Mental Health Act and put more pressure on police services.”
“However, they would grant the police greater powers; as an unintended consequence, they would also apply to detentions under sections 2, 3 and 5 of the Mental Health Act, where the police currently do not have power to intervene. A section 2 application is completed by two doctors and a social worker, and the patient may already be in a clinical setting. Section 3 relates to somebody who is already receiving treatment or already has a known diagnosis in a clinical setting. Doctors’ powers extend to that section; the police currently do not have any role in completing a section 3 application. Section 5(4) provides nurses with a holding power for a patient who is already in the clinical setting, where the nurse believes that the patient is at immediate risk; again, the police have no role.”
“I rise to support the Government amendments, which will simply remove the words “by a constable or other organised person”. On Second Reading, I highlighted my concern about the amendments made to the Bill in the other place that sought to extend police powers of detention under sections 135 and 136 of the Mental Health Act to other organised persons, including medical practitioners, approved mental health professionals, mental health nurses or doctors and further healthcare and social care professionals. I know that the noble Lords who introduced the amendments intended to remove the need for the police to be present at mental health incidents in the absence of any risk.”
“They would have the effect of lessening clinicians’ ability to treat patients, and I fear that patients would be less likely to attend an appointment if they thought they might be forcibly detained by the clinician.”
“As Dr Lade Smith, the president of the Royal College of Psychiatrists, said: “It is well known that at times, people experiencing a mental health crisis cannot be safely reached and cared for without the assistance of the police. Delegating police powers without proper consultation or planning is likely to disproportionately affect those from minoritised backgrounds and would increase risk to patients and compromise the safety of others. It sets a dangerous precedent.” I am also concerned that the amendments passed in the other place granting police powers to authorised persons risk damaging their therapeutic relationships with patients.”
“However, where the police may be required to make a detention, I know from my experience working in mental health that the presence of officers can often ensure that an otherwise risky situation remains contained and everyone remains safe. Entering someone’s home without permission is fraught with huge risk and currently is done only with the assistance of police intelligence. Under section 135, health professionals ask the court for an order to remove somebody forcefully from their residence and the police use that order to do so; sometimes, they have to break in. That is the power that the hon. Member for Hinckley and Bosworth spoke to earlier. Without it, health and social care professionals would be expected to enter homes without police help, and without crucial intelligence that could ensure their safety.”
“The Royal College of Psychiatrists, the Royal College of Nursing and the British Medical Association are among the health and social care organisations that have warned against such an extension, saying that it is “a radical proposal with a number of serious and potentially dangerous consequences”. Those organisations also point out that the proposed extension has not been properly tested with relevant health and social care professionals and has been given minimal serious consideration during the eight years in which reform of the Mental Health Act has been under discussion. The majority of assessment under the Mental Health Act already happens without police involvement.”
“What the hon. Member read is absolutely right. I was talking about sections 135 and 136. I am talking here about sections 2, 3 and 5. I absolutely stand by what I said about sections 135 and 136, and I am happy to come to that. As a former mental health nurse, I certainly would not support giving the police greater powers under sections 2, 3 and 5 of the Mental Health Act. I am also opposed to the amendments passed in the other place because I believe that the extension of legal powers held by the police to other healthcare professionals would represent a major shift in the roles and responsibilities of healthcare and care professionals, placing significant additional pressure on the NHS and social care providers.”
“Does the hon. Gentleman agree that CTOs help to keep people out of hospital so that rather than having long-term admissions, they can live in the community and in their own house, and that clinicians can recall patients to hospital if they are not complying with the agreed treatment?”
“The purpose of this part of the legislation is for ICBs to keep a register of anyone who is diagnosed with autism or a learning disability. Patients who are already under a clinical team already have a risk assessment, which covers all the areas that the hon. Gentleman is specifying. As a result of the amendment, would we not be duplicating information about risks that already exists for most patients with their clinical teams?”
“Anyone who is under the care of a clinical team for their mental health has a risk assessment. That is basic paperwork, which is completed by the clinicians. That risk assessment covers everything that is specified in the amendment. The purpose of this part of the legislation is for ICBs to have a register. However, ICBs will not be providing direct care; that will be provided by the clinicians. Those patients who are under any clinical team have a risk assessment that covers all the points in the amendment. My point is that the amendment would duplicate some of that paperwork.”
“In my own experience practising in a mental health ward, many patients with a learning disability and autism were detained and, as the hon. Member said, kept in hospitals because we could not find a suitable place for them to be discharged to—it was not that they needed the hospital. I think we are all talking about the same thing, but we need to find a solution. That is why the new NHS 10-year plan and its focus on moving care from the hospitals to the community is important. Again, can the Minister clarify how we will do that? The Government have already started the work, and the new commission, led by Baroness Casey, should also be looking into where we will find the social care support for carers and the community provision for people with learning disability, rather than just creating more crisis accommodations.”