Coronavirus Act 2020 (Expiry of Mental Health Provisions) (England and Wales) Regulations 2020
(4 years ago)
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Lord Bethell
That the Grand Committee do consider the Coronavirus Act 2020 (Expiry of Mental Health Provisions) (England and Wales) Regulations 2020.
Relevant document: 33rd Report from the Secondary Legislation Scrutiny Committee
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I am pleased to speak in support of the regulations, which were considered and agreed to in another place on 18 November. During the debate on the six-month review of the Coronavirus Act held in September in the other place, my right honourable friend the Secretary of State for Health and Social Care announced the Government’s decision to sunset the emergency provisions to allow for temporary easements of the Mental Health Act 1983 in England, as they are no longer necessary. These provisions may be found in Schedule 8 to the Coronavirus Act. The regulations therefore seek to enact this decision and so expire provisions in Schedule 8 to the Coronavirus Act 2020.
The emergency provisions, which these regulations seek to remove, were introduced to protect the safety of patients by ensuring that mental health services could continue to provide vital care and treatment if there were extreme staffing shortages during the pandemic. The need for them has been kept under continual review, particularly as the Government are extremely conscious that the provisions, had they been commenced, would have had serious consequence for individuals involved.
We are pleased that, due to the resilience and resourcefulness of the NHS in England and its staff, the provisions have not been commenced as they have not been needed. It is huge testament to the dedication and dynamism of NHS staff that mental health services continue to be able to provide support to people detained under the Mental Health Act, while under the extensive pressures resulting from the pandemic.
The Government, NHS England and NHS Improvement have taken a huge range of steps to support mental health services so that, despite ongoing workforce pressures resulting from the Covid-19 pandemic, they can continue to deliver vital care and treatment to individuals. The department and NHS England and NHS Improvement issued Legal Guidance for Mental Health, Disability and Autism, and Specialised Commissioning Services Supporting People of All Ages during the Coronavirus Pandemic. That guidance set out how the Act’s code of practice may be interpreted during this period. For example, it allows for the delivery of statutory forms electronically to allow mental health staff to work more flexibly and reduce risk of Covid infection. It also set out how video technology can be used for medical assessments to be carried out remotely under the Act, to make it easier for two doctors to examine a patient during the pandemic period.
The department has also supported the Care Quality Commission in bringing in a modified second opinion appointed doctor—SOAD—service, which allowed this service to work remotely. This enabled procedures around assessing and approving the medical treatment of patients detained under the Act to continue as normal, rather than enacting powers that would lessen this important safeguard. These measures, coupled with the resilience and innovation of mental health staff, have been effective in mitigating pressures on mental health services, avoiding the need to commence the emergency powers.
In reaching their decision to remove the provisions, the Government have listened to stakeholders and to Parliament. Three parliamentary committees have recommended that we take this step. The Joint Committee on Human Rights report on the Government’s response to Covid argued that the need to maintain robust safeguards for patients detained under the Mental Health Act was heightened, and cautioned that if we enacted the provisions they would weaken the protections available. The Women and Equalities Committee noted concern that the provisions went against the direction of travel towards reform of the Mental Health Act, to
“a more balanced system with more safeguards, more choice and less restriction”,
as set out in the independent review of the Mental Health Act 1983. Further, the Public Administration and Constitutional Affairs Committee report on the Government’s response to Covid and the Coronavirus Act noted the concerns of the mental health charity Mind and its call for the removal of these temporary powers.
The decision to expire these provisions has been positively received by a wide range of stakeholders—including the Law Society and Rethink Mental Illness, which said that the decision came as a relief to many people living with mental illness and their loved ones—and by the House of Commons.
The Secretary of State was not persuaded, even during the initial Covid peak, that switching these powers on was necessary because our mental health services have shown incredible strength and ingenuity, for which I express immense gratitude to NHS staff. These powers are no longer required, and these regulations seek to expire them.
I will take a moment to briefly remind noble Lords about the contents of the provisions that these regulations seek to expire. The provisions would have enabled an approved mental health professional to apply to detain an individual under the Mental Health Act following the advice of one registered medical practitioner, where securing two recommendations was considered impractical or would have led to undesirable delay. The provisions would also have allowed for an extension of the time that hospital in-patients could be temporarily detained, pending an application for longer detention under the Mental Health Act.
For those in contact with the criminal justice system who have a mental illness, the provisions in the Act would have extended the amount of time a person can be remanded to hospital, allowed an accused or convicted person to be sent to hospital on the recommendation of just one registered medical practitioner rather than two, and extended the procedural time limits for transferring a prisoner to hospital.
Since the Coronavirus Act was enacted, the Government have remained committed to keeping all its aspects under close review and have stated that any provisions no longer necessary will be sunsetted. The Act will expire in its entirety two years after the date it was passed, but also contains a power allowing for the expiry of some provisions to be brought forward ahead of that time. It should be noted that these regulations will not expire the transitional provisions within Schedule 8 to the Act; however, those will have no legal or practical effect.
The Mental Health Act 1983 applies to both England and Wales. The application of the regulations differs for each country. I will therefore seek to clarify their effect on Wales. First, those easements which relate to health services in Wales will remain available to Wales. Health is a matter devolved to the Welsh Government. But, secondly, those easements concerning the operation of justice under the Act—that is, for patients under sentence or subject to criminal proceedings—will be removed for both England and Wales. These remain matters reserved to Her Majesty’s Government. With the exception of provisions relating to the Welsh mental health review tribunal, none of these provisions has been commenced. Should it ever be deemed necessary to return to these provisions, the Government will seek to introduce new legislation.
I thank the staff of NHS mental health services, who have coped without the need to turn on these emergency powers through their hard work, supported by the department and NHS England and NHS Improvement and through innovative approaches. I beg to move.
Lord Blunkett (Lab)
My Lords, I unequivocally endorse the Minister’s words of appreciation of the work of everyone, at every level, who has maintained a degree of service that has avoided the use of the powers under Schedule 8. It is an unalloyed pleasure not to be giving the Minister a hard time, given that, as far as I can see and looking back in history, no other Minister in the Lords has taken more flak for the Government as a whole for so little reward. It is therefore a pleasure to be able to say that this is a very welcome move.
Noble Lords will remember, because they were either in the Chamber or, more likely, watching, the powerful speech made by the noble Baroness, Lady Grey-Thompson, back on 25 March, when the Minister was putting the Bill through this House. On both disability and mental health, she understandably warned of the danger to the rights of so many people from the measures that were felt at the time to be needed to ensure that functioning services could continue, albeit without the safeguards that all of us would wish. This afternoon we acknowledge that those safeguards are being put back in place—their erosion has not been needed—and, as the Minister said, that is due to so much hard work and ingenuity by so many people. I am sorry that the Welsh Administration feel that they still need the measures as a backstop. I hope that they will not, after their two-week lockdown, feel that they still need to be used.
I just ask the Minister in a friendly way whether he can identify—if not this afternoon, perhaps he can write to me—any service level agreement from the Treasury in relation to the £3 billion announced by the Chancellor of the Exchequer in respect of mental health services? While the withdrawal of the powers under Schedule 8 is entirely welcome, the capacity within the system before the Covid pandemic was under enormous strain, and that has obviously been made worse by the number of people who have experienced mental health and stress issues over the past nine months. Many more will experience these over the winter until we have the vaccine onstream and can get back to some sort of normality.
Capacity will remain a major question for all of us, and I hope that the Minister will be able to confirm that a proportion of the additional resource being allocated to getting the health service back onstream and undertaking the diagnostic and treatment requirements that have so often been delayed will also apply to the capacity of the mental health services. With that, I welcome the regulations very strongly.
Baroness Tyler of Enfield (LD) [V]
My Lords, removal of the mental health provisions from the Coronavirus Act, which represented a significant reduction in protection and safeguards for people subject to the Mental Health Act is, as the noble Lord, Lord Blunkett, said, very welcome. Serious concerns have been raised about whether it would ever be human rights-compliant to enact the provisions. Even before the Covid-19 crisis hit, mental health services were severely stretched, with waiting times and barriers to access which would be considered unacceptable in any other area of medicine.
Turning to the scale of need, psychiatrists have reported an increase in patients needing urgent and emergency care during the crisis, and the latest NHS Digital figures show the highest recorded figures for mental health contact. According to the Centre for Mental Health, there are approximately 10 million extra people with mental health needs due to the pandemic. A survey conducted in late spring by the charity Rethink showed that almost 80% of people with pre-existing mental illnesses reported that their mental health had got worse or much worse as a result of the pandemic, and the ONS found that almost one in five adults in Britain experienced depressive symptoms in June 2020—roughly twice the number before the pandemic. Against this backdrop, it is crucial to the nation's Covid-19 recovery that existing mental health funding commitments in the NHS long-term plan are delivered in full and that services are resourced to support those who had new or worsening mental health difficulties because of the crisis. It is not either/or, it is both/and.
It is of course welcome that eventually an extra £500 million was promised in the mental health winter plan, published on Monday, to help with discharge to community care, workforce issues and addressing waiting times. This is a good start, but unlikely to be sufficient and, crucially, does not come onstream until the next operational year, leaving a gaping hole in the tough winter period ahead. What commitments can the Minister give that some of this new money will be spent on preventive work and early intervention to stop mental health issues escalating to crisis point and putting additional pressures on expensive police, A&E and in-patient services?
In the long term, it is not just a case of mental health services surviving the pandemic; they will need drastically to expand and improve to deal with the long-term impact of social isolation, mass unemployment and pandemic-induced anxiety.
The powers we are debating weakened an Act that was already in need of major reform. The independent review of the Mental Health Act put forward proposals to improve the system and increase patient rights. Can the Minister update the Committee on when the Government will provide a full response to the independent review and publish their proposals to take forward reform of the Mental Health Act, with a clear implementation timescale? The two-year anniversary of the publication of the Mental Health Act review will be 6 December 2020. I strongly hope that the Government’s response will not be delayed beyond that point.
Lord Bilimoria (CB) [V]
My Lords, the coronavirus and the isolation of lockdown are impacting not just our physical health but our mental health, as people deal with loneliness, stress and anxiety. Whether we are working from home, furloughed or travelling to our workplaces, the drastic changes to our workday can take a toll. Employers must play a vital role in supporting the mental health of their workforce by prioritising and promoting a positive well-being culture.
The CBI, of which I am president, has been working with firms of every size and sector to help tackle the challenge of mental health in a pandemic. The Law Society, a member of the CBI, supports these regulations, which will expire provisions in Schedule 8 to the Coronavirus Act 2020 which would weaken Mental Health Act 1983 protections if brought into force. The Law Society states that it recognises that, at the onset of the pandemic, these exceptional emergency provisions were considered potentially necessary to support healthcare professionals in responding to the immediate crisis, but that, as they have not been used in England to date, as the Minister said, they should be expired so as to restore the full certainty of important statutory protections for vulnerable people.
The Law Society also recommends that the Government consider expiring the provisions under Schedule 12 to the Coronavirus Act alongside the expiration of those under Schedule 8 being implemented by these regulations. However, if Schedule 12 remains in force, the Law Society recommends that the Government publish improved guidance clarifying how to conduct the required process under these easements and provide detailed guidance to assist local authorities in making human rights assessments. Do the Government intend to expire the provisions under Schedule 12 to the Coronavirus Act, which weaken statutory protections for vulnerable people under the Care Act 2014 and the Social Services and Well-being (Wales) Act 2014, alongside the expiration of those under Schedule 8? Will the Minister commit to providing improved guidance on the easements under Schedule 12, clarifying how local authorities should conduct relevant processes and make human rights assessments?
Lord Davies of Brixton (Lab) (Maiden Speech)
My Lords, I thank everyone whose kindness has made taking on my new role so straightforward. I thank the doorkeepers and attendants who have guided me more than once along different corridors. I thank the parliamentary staff who have supported my induction, and my party colleagues and the Front Bench team who have guided me through the rules and practices of this House. I must also thank my noble friends Lady Blower and Lady Osamor for supporting me at my introduction. Finally, I owe particular thanks to John McDonnell MP, who encouraged me to take up this new challenge, and my family, who have given me their support despite the disruption in their lives.
I aim to be an asset to this House, contributing my particular skills and knowledge. There is my lifetime of activity in the trade union movement, where I am glad to join a number of old colleagues. More notable is that I am an actuary, the first in this House for more than 70 years. The only other was the first Baron May of Weybridge. He was a prominent public figure and a formidable character, so it is odd that during his 11 years in the House he never made a speech. That means, I am proud to say on behalf of myself and my profession, that this is the first time an actuary has ever spoken in Parliament. I can certainly say that it will not be the last.
One thing that Lord May did was to play a significant role in bringing down a Government. Unfortunately, it was the 1931 Labour Government. I may not be able to go that far, but I shall use to my time to hold the Government to account.
A key skill that you must learn as an actuary is to explain what you do. The application of higher maths to finance sounds too technical, yet the assessment of mortality sounds too gloomy. As an actuary who specialises in pensions, my role has been to provide advice for trade unions when seeking to improve or, increasingly, to defend the pensions provided for their members. I am sorry to have missed the debates on the Pension Schemes Bill, but I have followed them and know that there are many pensions experts in the House. I look forward to joining them, particularly when we consider the further pensions Bill that the Pensions Minister has promised for this Parliament.
Turning to the statutory instrument before us today, I must state my keen and continuing interest in mental health. We know that these extraordinary powers were not required during lockdown, which is testament to the hard work of our mental health staff. They have coped without recourse to such drastic emergency measures and it is clearly right that they should now be expired. Mental health difficulties need to be discussed during this pandemic. We should understand the importance of social and financial stability in the face of the virus. We now realise that resilience lies not within an individual but within our community. Given the dire economic effects of both Brexit and the pandemic, it is vital to consider the NHS response to the increase in mental health difficulties. The proposed investment in mental health services is welcome, but it is still inadequate and barely makes up for the loss of support over the past 10 years. We need more investment. We also need to modernise the Mental Health Act. Public attitudes have improved markedly in the past 10 years, but the law has failed to keep pace. Of course, the pandemic has slowed progress, but we need the promised White Paper. Can the Minister promise to bring it forward as a matter of urgency?
Lord Hunt of Kings Heath (Lab) [V]
My Lords, it is a great pleasure to follow my noble friend and I congratulate him on a fine maiden speech. As he said, he brings to your Lordships’ House a wide range of experience in the trade union movement, service on the GLC and as chair of ILEA, where he was a forceful champion of comprehensive education. However, I rather think that his being the first actuary to enter the Lords for more than 50 years will cause the most challenge to your Lordships. He will discover that we float figures around the House like confetti to justify whatever position we happen to take. Happily, this usually goes unchallenged, yet with my noble friend in place I suspect that we will need to be on our mettle and to expect robust scrutiny in the future.
As my noble friend said, it has not been necessary to use the powers in the regulations and their removal is warmly welcomed. Although the regulations are concerned with the requirements under the Mental Health Act 1983, this debate inevitably raises wider issues in relation to mental health provision during the pandemic and beyond.
We know that the pandemic has had a significant impact on the country’s mental health and well-being. What is the Minister’s assessment of this and what measures are being taken to restore services and deal quickly with the backlog of patients? Does he agree with the assessment of Scientists for Labour that there has been a stark decline in the availability of services? Research by Mind from May 2020 reported that the restrictions on seeing people, being able to go outside and worries about the health of family and friends are the key factors driving poor mental health. The Centre for Mental Health predicts that at least half a million more people may experience a mental health problem as a result of the pandemic. Does the Minister agree?
As part of the lockdown in March, dramatic changes were made by NHS mental health services, including discharging patients from in-patient community services and moving to online provision. Has the impact of that been measured? Does he accept that eye contact often plays an important role in cognitive behaviour therapy? We need to reflect on that before assuming that services can always be online in the future. Will the Minister agree to publish a comprehensive plan to restore levels of service, including a thorough assessment of what changes in demand for services are arising from the pandemic?
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
My Lords, the noble Baroness, Lady Warsi, has withdrawn from the debate and so I call the next speaker, the noble Baroness, Lady Fox of Buckley.
Baroness Fox of Buckley (Non-Afl)
I warmly welcome the noble Lord, Lord Davies of Brixton. I know that he is well respected by trade unionists outside this place and he will bring to us a refreshing brand of politics. We will not always agree, but I like someone who gives us a feisty challenge. He cannot possibly have got lost here as often as I have done as a new girl in the past few weeks, so if I find the noble Lord, I will try to put him on the right track, although that will probably get him even more lost.
For once, I want to congratulate the Government on rolling back a piece of legislation. Indeed, I hope that we will see a lot more of this because it seems that so much of the Coronavirus Act 2020 is draconian, disproportionate and frighteningly illiberal. Even the assurance that it is temporary or for an emergency is of little consolation. I would personally expire the whole Act, but perhaps the Minister could start by looking again, as has already mentioned, at the provisions in Schedule 12 that also severely weaken the statutory protection for the vulnerable.
The need to protect the vulnerable against an overweening and arbitrary state power is exactly why Schedule 8 was always such an egregious and frightening position. For good reason, sectioning people is made difficult. The power to deprive individuals of their liberty under the aegis of mental health and for their own good has a sinister history: think of the lunatic asylums of the past, the Soviet use of psychiatric hospitals, and so on. We are right not to section people lightly, but perhaps the Minister could reflect on a number of unresolved ironies.
Lockdowns themselves are an example of the state depriving the whole citizenry of their liberty under the veil of public health. Locked up and locked down is a thin line in my view. Can the Minister assure us that when the lockdown ends on 2 December, it will not happen again? One worry about Schedule 8 has been the extension of the length of time that the mentally ill can be incarcerated on the say of one doctor. My worry is the endless and never-ending extension of the length of time that society is incarcerated on the say of one—dare I say?—Matt Hancock.
Will the Minister comment on the devastating impact that we have heard about so eloquently from fellow noble Lords that lockdown measures have caused a lot of damage to mental health in the community. Many, both young and old, are consumed with anxiety, deprived of their autonomy, subject to a form of solitary confinement and feel lonely and isolated. There is also fear not only of the virus but about the cataclysmic effect of lockdown on jobs and livelihoods.
Sufferers of dementia in care homes are locked away from families and stimulation, leading to a deterioration in their mental capacity, and in some instances, tragically, to premature death. In other words, lockdown and its ugly sister, tiering, are bad for the mental health of the well, let alone the mentally ill.
I have a final question. I note with horror that the Welsh Government are not expiring Schedule 8. Will the Minister do what he can to cajole or persuade his counterparts in the Senedd as soon as possible? I declare an interest as I am from north Wales, but I find it rather shameful that the mentally ill in Wales seem to need safeguarding from their own Parliament.
Lord Walney (Non-Afl)
My Lords, I add my praise to the noble Lord, Lord Davies of Brixton, on making an accomplished maiden speech and I welcome him to the House. He notes that he is the first actuary ever to speak in the House of Lords. I guess that it is something of a coincidence that at least two former Ministers in the Department for Work and Pensions will have had a great deal of contact over the years with actuaries: the noble Lords, Lord Blunkett and Lord Hunt of Kings Heath. I served as a special adviser with the noble Lord, Lord Hunt, and we had a number of conversations with actuaries over the years. I hope that this does not damn him with faint praise, but the speech of the noble Lord, Lord Davies, was the most engaged and enlivening to be given by an actuary that I have yet had the privilege of listening to. I know that he will enlighten the House in many ways in the years ahead, and I welcome him.
Let me praise the Minister and his colleagues in the Department of Health and Social Care for taking this early step to remove these provisions. It is an unusual and commendable act to take swift action on a measure that was due to expire anyway, and it sends a welcome message about the Government’s attitude to mental health issues in that they have clearly heard and understood the grave concerns of many advocacy groups and individuals about the draconian level of these powers. It will help vulnerable individuals at an incredibly difficult time in their lives because of the trauma of lockdown restrictions to know that these provisions are no longer hanging over them. Let me give credit where it is due.
I will echo a number of previous speakers in raising concerns about the overall system. It is a symbol of the way that public services tend to act in that they have a bare level of functionality at the crisis end but remain desperately lacking at the preventive and therapeutic end of mental health provision, which remains a yawning gap. As many speakers have said, including the NHS Confederation, the peak has probably not yet come, and I hope that in the months ahead we will hear far more from the Government and the Minister about what action can be taken on that front.
Baroness Barker (LD)
My Lords, I warmly welcome the noble Lord, Lord Davies of Brixton, to your Lordships’ House and congratulate him on his speech. I was unaware of his professional background, but his explanation has led me to understand why there is such a sense of excitement among those Members of your Lordships’ House who are mere accountants. I look forward to the noble Lord joining the long-standing gang of Members who take a considerable interest in mental health and who often act as a bulwark against Members of the House of Commons who feel unable to take action on mental health legislation because of the grief they get from the popular press.
I declare an interest as a member of a special advisory panel for Rethink Mental Illness; I am indebted to it and to Mind for their briefings. When the Coronavirus Act went through, the mental health provisions were among the most controversial and the most feared, not only by lobby groups and patient groups—there was also a considerable amount of discomfort on the part of mental health professionals about what was being done. Under the Mental Health Act 2007, there is already a lack of patient involvement in decision-making, specifically in mental health. That is a fundamental flaw.
It was, on that basis, wrong to take away the safeguards that are the subject of these statutory instruments, and I am very glad that they have not had to be used. They have not had to be used because of the extraordinary efforts of both staff and indeed patients in the early part of this year. Both Mind and Rethink have done a considerable amount of work talking to people who were in acute services in particular. The surprising finding was the extent to which patients were deeply grateful to staff for continuing to look after them when the staff might well have been putting themselves in danger.
The extent to which patients were comfortable with incarceration during Covid was directly related to two factors: first, their ability to contact friends and family remotely and, secondly—because they are people just like the rest of us—the extent to which they were enabled to get out into the grounds and get fresh air. It is worth noting at this point that, in the recently announced hospital-building programme, only one of the new hospitals will be a mental health hospital. Given that we are likely for some considerable time to be going in and out of periods of physical restrictions because of the virus, we should do well to look at the physical estate of mental health services.
I agree with others that the £3 billion announced is very welcome, but there is a grave danger that it will be stretched way too thinly. A lot of it was earmarked before we entered the current situation. As others have said, and as the studies done by Mind and Rethink have shown, it is evident now that people are coming into community services with a greater degree of severity of mental distress and agitation. This is a clear signal that we will, in the coming months, see a much greater level of more severe illness if we do not put money now into rapidly accessible community services—patients are telling us that they cannot access those services. What efforts will be made to ensure that input of both staff and resources into a greater degree of community services?
In all the Government’s lockdown announcements, I have never seen anything acknowledging that those areas of the country that have been under severe lockdown for several months might have a greater need of mental health services than those that have not. Is that part of the analysis that the Minister’s department is undertaking? This is part of the question that I really wish to put to him. We are sitting waiting for the Government’s response to Sir Simon Wessely’s review. To what extent will the things that been learned during these last six months go into that review? For example, what have we learned about disproportionate levels of mental illness and lack of services among black and minority-ethnic communities, and what are we doing about children and young people? Can he tell us to what extent we have learned the lessons of the last six months and whether they will be in that new legislation?
Baroness Thornton (Lab) [V]
I am very pleased to agree with the Minister on this statutory instrument, but I first welcome my noble friend Lord Davies of Brixton and congratulate him on his maiden speech today. He and I have known each other for many years, but have not really seen each other for probably the best part of 30 years. We hark back to the days when I was the chair of that venerable Labour institution the Greater London Labour Party, and my noble friend was a leading member of the GLC and the Inner London Education Authority. A couple of abolitions, many general elections and a Labour Government later, here we are in the House of Lords, and in probably its strangest state in its whole history. I welcome my noble friend; he is one of the very smartest people, and an actuary, as he says—the first here—and will, I am very sure, bring great value to our deliberations. And he should not worry: there will definitely be another pensions Bill along very soon.
When we were putting this emergency Covid legislation on the statute book in March, the easements that are the subject of this statutory instrument were the cause of much concern, because they concerned people’s liberty and human rights, which should not be put aside lightly, if at all. That is what we were saying at the time. They would have increased the amount of time that someone could be detained, decreased the number of qualified people required in the detainment procedure and weakened the Mental Health Act 1983 protections, if brought into force. I am grateful, like other noble Lords, for the excellent brief by the Law Society and its support for these regulations.
We recognise that, at the onset of the pandemic, these exceptional emergency provisions were considered potentially necessary to support healthcare professionals in responding to the immediate crisis. As they have not been used in England to date, they should indeed be expired—so I congratulate the Minister—and thus restore the full certainty of important statutory protections for vulnerable people. I add my thanks and gratitude to the mental health staff who have made things work so successfully under the most difficult conditions that we are able to put aside this part of the Coronavirus Act.
Are the Government considering expiring the provisions under Schedule 12 to the Coronavirus Act alongside the expiration of the provisions under Schedule 8 to the Act implemented by these regulations? As noble Lords will know, Schedule 12 makes modifications to provisions under the Care Act 2014 and Social Services and Well-being (Wales) Act 2014, allowing local authorities to suspend their statutory duties to assess, develop and review individuals’ care plans, carry out financial assessments, and meet care and support needs. Local authorities must still carry out the above where a failure to do so would breach obligations under the European Convention on Human Rights but, for the majority of vulnerable people in the care of local authorities, this high bar provides little to no protection.
Six months on, it is deeply worrying that the Government still envisage the need to enact this watering down of conditions. Can the Minister provide an update on the number of times that these provisions have been used, why they were enacted and what impact they have had on residents? Can he provide assurances that provisions within this Act for care homes are not currently being enacted and describe the conditions under which they might be used?
We are of course still finding out the mental health cost of Covid, and it is disturbing that the Chancellor and Secretary of State for Health refer to the additional funding that the NHS needs to catch up on the cost to patients and treatment of Covid, but do not make the same commitments for social care or mental health. That is of great concern and is very short-sighted, as my noble friend Lord Hunt said. When will we see the results of the Mental Health Act review and promised reform, as the noble Baroness, Lady Barker, mentioned? We need to give more attention and resources to mental health.
A study from researchers at Oxford University found that nearly one in five people who has had Covid-19 was diagnosed with a psychiatric disorder—such as anxiety, depression or insomnia—within three months of testing positive for the virus. Not only do we have immediate issues, there are many coming down the track.
Lord Bethell (Con)
My Lords, I thank noble Lords for a thoughtful and at times very generous debate, for which I am enormously grateful. I thank the noble Lord, Lord Davies of Brixton, for a remarkable maiden speech and offer him a sincere welcome. He laid out his stall very clearly, first as a man of numbers—as many have noted, the debates of the House of Lords benefit from those who are numerate and articulate with numbers as well as words—secondly, as a supporter of the trade union movement, and I look forward to his interventions as a trade unionist; and thirdly, as a man of compassion. He spoke movingly about mental health and the provisions in these regulations, and has marked himself out as someone who I hope will make an important contribution to our health debates—he will be extremely welcome indeed.
We are aware that many people are facing unprecedented strains due to the pandemic and the measures to contain it. The mental health of everyone is absolutely critical in these unprecedented times. We know that some people will experience exacerbated mental health problems as a result of the pandemic, as has been noted by the noble Baroness, Lady Barker. Moreover, people with existing mental health conditions and front-line workers are particularly susceptible.
The noble Baroness, Lady Tyler, noted that self-reporting has gone up. Public Health England’s Covid-19 mental health and well-being report concluded that the UK population’s self-reported mental health and well-being worsened during the pandemic. The largest decline was in April 2020.
Average levels of mental distress have been reported as going up, as the noble Baroness, Lady Fox, noted, although by 8.1% measured by GHQ 12, not the high levels that some noble Lords have referred to, indicating an increase in the severity of mental health problems overall. A robust follow-up survey from July 2020 of children and young people aged five to 16 who were interviewed for the national mental health prevalence survey in 2017 suggests that rates of probable mental health disorder have increased from one in nine in 2017 to one in six in July 2020—a very regrettable development.
We understand that there is increasing evidence of significant mental health consequences for people who have contracted Covid and evidence that Covid itself impacts the central nervous system, which can affect mental health and well-being. Survivors of Covid appear to be at increased risk of psychiatric disorder. For patients with no previous psychiatric history, a diagnosis of Covid was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days, compared with six other healthcare events.
I reassure all noble Lords who have spoken that mental health continues to be a priority for this Government. We are doing our utmost to ensure that our mental health services are there for everyone who needs them during the pandemic. I reassure the noble Lord, Lord Blunkett, that that is why in today’s spending review the Government have announced £500 million more for mental health support for new specialist services for children and young people, plus extra assistance for people with severe mental health illnesses and faster help for those afflicted by depression and anxiety.
The well-being and mental health support plan for Covid-19 published this week is a demonstration of the Government’s firm commitment to support the mental health of everyone throughout this winter and beyond. It outlines the support available to people over the coming winter. This is just one element of our work to deliver a modern mental health service and meet the demands created by the pandemic. We have announced two new commitments to support individuals: first, a winter discharge support package backed by £50 million, which will boost capacity and support good-quality discharge from mental health in-patient settings to help reduce pressures on in-patient beds and keep patients safe over the winter. Secondly, we are taking action to support the physical health of individuals with serious mental illnesses this winter, including support for systems to deliver local, system-level tailored engagement with patients and to develop national thought leadership on outreach.
We are absolutely committed to continuing our investment in expanding and transforming mental health services in England. This will amount to an additional £2.3 billion of extra funding a year on mental health services by 2023 to 2024. I reassure the noble Lord, Lord Hunt, that we are taking a range of steps to support mental health services to be able to manage pressure over the winter period.
Above all, it is essential that the message is heard loud and clear across the country that NHS mental health services remain open for business and will be available throughout the winter. The earlier people receive support on their mental health, the more likely they are to benefit. However, in April this year, only 57,000 referrals were made, compared to 133,000 in April 2019. While figures for more recent months show that referral rates are recovering, they are significantly below last year’s. To help address this, last week we launched a new phase of our NHS Help Us, Help You campaign to encourage anyone suffering from anxiety, depression or other issues.
We will continue to make sure that mental health services, including hospitals providing in-patient treatment get equal access to PPE. All health and social care staff can access priority testing when they show symptoms, including those providing mental health services in hospitals. NHS staff without symptoms can also be tested at the discretion of their NHS trust. Hospitals can test patients, including those admitted with mental health conditions, even if there is a higher prevalence of Covid-19 in their area.
GP surgeries have been requested by NHS England to make improvements to ensure that the physical health of those living with severe mental illness is protected this winter. This includes asking practices to identify people with severe mental illnesses who are clinically vulnerable and offering those people comprehensive physical health checks and follow-up interventions, free flu vaccines to those eligible and a care plan review as appropriate.
The NHS has worked hard to keep mental health services going during the first peak, using technology where needed, but also face-to-face appointments where appropriate. All mental health trusts have established 24/7 urgent mental health helplines, where people experiencing a mental health crisis can access support and advice. In addition, we have provided £10.2 million of extra funding to support mental health charities, including the Samaritans and the Campaign Against Living Miserably.
Talking therapies will continue to be made available remotely, so that people can access help safely from home. The NHS will work to ensure that the option of face-to-face support, quite rightly alluded to by the noble Baroness, Lady Barker, and the noble Lord, Lord Walney, is provided to people with serious mental health illnesses where it is clinically safe to do so.
Public Health England has published its surveillance tracker to monitor the impact of Covid-19 on the population’s mental health. This is a proactive step which will help to ensure that our response to the effects of Covid-19 on mental health and well-being is shaped by emerging data.
The Government have committed more than £400 million over the next four years to refurbish mental health facilities, getting rid of dormitories in mental health locations and benefiting the patients of 40 trusts across the country. We are committed to supporting our staff and investing in the workforce. NHS England and NHS Improvement are also investing £15 million to ensure that all staff get rapid access to expanded mental health services. Staff who are referred will be assessed rapidly, will be treated by local mental health specialists and, where appropriate, will be referred to specialist centres of excellence.
A number of noble Lords, including the noble Lord, Lord Davies, and the noble Baroness, Lady Tyler, asked about Sir Simon Wessely’s independent review of the Mental Health Act. I reassure noble Lords that work is well under way to respond to the review, and we will publish our White Paper in due course. This will pave the way for far-reaching reforms to the legislation and practice, strengthening the rights of patients and upholding the principles of dignity, autonomy and choice, which were enshrined in the review’s recommendations.
Since the Coronavirus Act was introduced, the Government have remained committed to keeping all elements of it under close review and to sunset any provisions that are no longer needed. As I set out earlier, the emergency modifications to the Mental Health Act made by the Coronavirus Act were designed to protect patients by supporting services to be able to continue if unprecedented constraints in the mental health sector put patients’ safety at risk during the pandemic. These provisions were only ever to be used as a backstop, as I told the Committee earlier.
The noble Lord, Lord Blunkett, referred to the very moving speech of the noble Baroness, Lady Grey-Thompson. I remember her words extremely well. Decisions, over which we have no control whatever, about our uselessness will be taken by someone else in the next few months. I am very pleased that the provisions have not been switched on. I reassure noble Lords that at all times the Government have remained conscious of the need to balance those provisions against the rights of individuals detained under the Mental Health Act.
Those provisions have not needed to be switched on due to the adaptations that have been made because of the resilience and commitment of NHS staff. As a result, we believe that now is the right time to remove them so that it is clear to patients, carers, staff and stakeholders that they will not be used. The approval of these regulations by this House to remove these emergency provisions is an important milestone on the journey towards much-needed reforms to the Mental Health Act. These reforms—
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
The Division Bell is ringing. I wonder whether the Minister is coming to the end of his remarks.
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
If the Minister would like to finish, I will then adjourn the Committee and there will be plenty of time for noble Lords to vote.
Lord Bethell (Con)
These reforms, which will see that patients have greater autonomy and control over their care and treatment, will be set out in the Government’s forthcoming White Paper on this subject.
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
The Grand Committee stands adjourned until 5 pm. I remind noble Lords to sanitise their desks before they leave the Room, and to vote, should they wish to do so.